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PETITION }'OR PROBATE and GRANT OF LETTERS
o:t't-,n
Estate of Otto P("C!1aneY_L~___ No, -~:!lJ./-J/1
also knowll as . _ To:
-------- Register of Wills for the
'>~ Deceased, County of Cumberland In the
Social Secllrlly No, 245 - J 0 - 6 181 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents Ihut:
Your petltloner(s), who Is/ure 18 yeurs of IIgc or older IIn the exeeut r i X
In the last will of the above deeedellt, dated _.JW.Y_elllb.ar 17
and codlcll(s) dated __._______.__
named
,19~
(slate relevant drclIImtullccs, c,g. renlllwlnllolll dculh of CltCC1IIOf, CIC,)
Decendent was domiciled at dellth 111___ Cumb~E} a nd _ County, Pennsylvania, with
his lust family or -pripclpal residence al....l115 S ,. rR I'f orcLD,.-; "" ,
Carlisl~~_~J_ _
(Ihl meet, Ilumher (llld mlllldpllllty)
Dec~Jld~nl,then 62 yearsofulle, died____.!1ece~lh.~r 16 ,1993
at Un1versi ty HasPl tal, Hershel' Nedical Cen1er .
Except as follows, decedent did not marry, WIIS 1I0t divorced und did not have a child born or adopted
after execution of the will offered for probate; was uollhe victim of a killing and was never adjudicated
Incompetent: __
Decendent at death owned property with estlmmed values as follows:
(If domiciled In I'u,) All personlll properlY
(If not domiciled In PII,) Personal property In Pennsylvania
(If not domiciled In I'a,) Personal property la County
Value of teal estate in Pennsylvania
situated as follows:
sunder
$
$--
$
$5.000.00
WHEREFORE, petltioner(ij respectfully
presented herewith and the grant of lellers.
theron,
requcst(s) the probate of the last will and eodlcll(s)
testamentary
(IC~lllI11Cnlltry: admlnlmalioll c.l.n.; admInistration d,b,n,c,l.a,)
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--
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAI,TH 0.. PENNSYI,VANIA } Ill!
COUNTY 0.. CUMBERI ANn
The petltloner(s) aboveonllmed swear(s) or afflrl11(s) Ihut the statements In the foregoing petition are
true and corrcct Wthe bcsl of the knowledge und bcllef of PClltloner(s) and that as personal rcpresen.
tatlve(s) of the ahovc decedcnt petltloncr(s) will wcll IInd truly administer the estale according to law.
Sworn 10, or nffltn_I'l _A~,1(1 SUbscribe(~1 -. J~~d I (~Q {Ii U>Q~ ~
bcforc me this 7-------- dllY of _____ __ ~
- -ff1-::~L!..IL____ ,{\~~I!it.:. ~\ --- - S
l.fL(J.a.w.l:'~f-A"I~ 1.::::!.7lI1.-.. ~
MAfttj LEWIS ReRM('r, _ _______. ~
Iii -/ f'JI-~ /..(
N 21 . 94 . 49
O.
. Estate of .
OTTO P CH^NEY JR
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW January ?~ 19~,lnconslderatlonofthepetlllonon
the reverse side hereof. satisfactory proof having been presented before me,
IT IS DECREED that the Instrument(s) dated November 17, 1982
described therein be admitted to probate and flied of record as the last will of
Otto P. Chaney, Jr.
and Lellers Testamentary
are hereby srantedto Bridilet Nary Chaney
FEES
25.00
Probate, Letters, Etc. "" , , . " $__
Sh(\rt Certlficates( 3)"""..., S 9.00
RenuDclutlQn ,..."""".... $.
x-paGb . $ 12.00
JCP TOTAL _ $--51:Rt
Flied "'" ~.~~Y~~,X, ?~'" .1 ?~,~ , .. ,,'.' , .
Patricia R. Brown, 27474
ATTORNEY (Sup, CI, 1.0. No.)
50 E. High St., Carlisle
ADDRESS
(717\ ~43.7922
PHONE
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Called attorney on 1-25-94.
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This Is III rerllfy Ihlll chis is II Inle ('/)I'y lIf Ihe rl'wcd which Is Oil fll,' Illthc' Pellnsylvllllla Dlvlslllllllf Vilnllll'wnls III n(Cordance
whh Act 66, 1'.1.. ~l)<j, approved by Ihe Uelleral Assemhly, .I III Il' :>9, 19yt
WARNING: Ills Illegal to duplicate thll copy by photostat or photograph.
l't'C for this ccrtlfk@
No,
~)/~
Clmles Harde,aer
SlaW ReRistrar
2927487
DEe ,%91993
Dille
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COM"ONWU~TH 01' P!NNIVlW,NIA . 01,,-,,.1MINT all HULlH I VITAL 'UICOrlDII
CERTIPICATE OP OEATH
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~~ "C\lIIII'''.lIwtlill
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. llecember 16.1993
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LAST WILL AND TESTAMENT
OF
OTTO PRESTON CHANEY, JR.
I, OTTO PRESTON CHANEY. JR., a legal resident of the
State of Florida, now in the active military service of the
United States and tr.mporarily residing in Cumberland County,
Commonwealth of Pennsylvania, being of sound and disposing
,mind and memory, do hereby make, publ ish and declare this
instrument to be my LAST WILL AND TESTAMENT.
I hereby
revoke any and all wills and codicils by me heretofore made.
I
IDENTIFICATIONS AND DEFINITIONS
A. I am married to BRIDGET MARY CHANEY, hereinafter
referred to as "my Spouse." We have two (2) children, DAVID
PRESTON CHANEY and MELISSA CATHERINE CHANEY, hereinafter
referred to as "my Children."
B. The following definitions obtain in any use of the
terms in this Will:
1. "Descendants" means the immediate and remote
lawful, lineal descendants of the person
referred to, and it means those descendants in
being at the time they must be ascertained in
order to give effect to the reference to them,
whether they are born before or after my death
or of any other person. The persons who take
under this 1011 as Descendants shall take by
right of representation, in accordance with the
rule of per stirpes distribution and not in
accordance wi th the rule of per capita
distribution. Persons legally adoptod when
under the age of fourteen years shall not be
differentiated from blood descendants for any
purpose.
2. "Survive me" is to be construed to mean that the
person referred to must survi ve me by thi rty
days. If the person referred to dies within
thi rty days of my death, the reference to him
shall be construed as if he had failed to
survive me.
3. As used in this WI II, the words "Executor,"
"he," "him," "his," and the like shall be taken
as generic and applIcable to a natural person of
ei ther sex or a corporate person or other Ie al
, .
C. I ha ve served in the Armed Forces of the Uni ted
States. Therefore, I di rect my Execlltor to consult the
legal assistance office at the nearest military Installation
to ascertain if there are any benefits to which my
dependents are entitled by virtue of my military affiliation
at the time of my death. Regardless of my mi 1 i tary status
at t.he time of my death, I di rect my Executor to consult
wi th the nearest Veterans Admlni stratlon and Social Securi ty
Administration office to ascertain if there arc any benefits
to which my dependents may be entitled.
I I
PAYMENT OF DEBTS AND TAXES
I di rect my Executor to pay the following as soon after
my death as may be practicable:
1. All of my just debts and the expenses of my last
111ness, funeral and of the administration of my
estate; but my Executor need not accelerate and
pay those unmatured obligations which, in his
opinion, it might be proper and more
advantageous to retain or renew and pay as they
become due and payable.
Z. All inheritance, transfer, estate and similar
taxes (including interest and penalties)
assessed or payable by reason of my death, on
any property or interest in my estate for the
purpose of computing taxes. My Executor shall
not require any beneficiary under this will to
reimburse my estate for taxes paid on property
passing under the terms of this Will.
I I 1
RES IDUAR Y ESTATE
A. I def i ne "my Residuary Estate" as all of my property
after the payment of debts and taxes under Article II,
including real and personal property, whenever acquired by
me, property a5 to which effective disposition is not
otherwise made in this Wi 11, and property as to which I have
an option to purchase or a reversionary interest.
B. I gi ve my Residuary Estate to my Spouse if she
survives me.
C. If my Spouse does not survive me, I direct my
Executor to divide my Residuary Estate into equal shares and
to distribute those shares as follows:
1. one share to each of my Children who survive me;
Z. if any of my Children fail to survive me, then
hi s 01' her share shall be distributed among his
or her descendants who survi ve me;
3. if any of my Children fail to survive me and
leave no descendants who s\lrvive me, then his or
her share shall be divided equally among such of
my Children who survi ve me, or thei l' descendants
who survive me, as set forth in subparagraphs 1
and Z above.
Pago Z of 4 Pages
, ,
D. If my Spouse does not survive me and none of my
Children nor their descendants survive me, I direct my
Executor to divide my Residuary Estate Into two (2) equal
shares and to distribute the shares as follows:
1. one share to my Spouse's mother KATIILEEN M.
GILLESPIE, or hor descendants.
2. one share to my sister CATHERINE C. BERNADUCCI,
or her descendants.
IV
GUARDIAN
If my Spouse does not survl ve me and it I s necessary to
appoint a Guardian for anyone or more of my Children, I
nominate RUTH JUNKER MITCHELL of Spartanburg, S.C., as
Guardian of the person and property of each of my Children
who requi res a Guardian. If RUTH JUNKER MITCHELL of
Spartanburg, S.C., is unable or unwilling to serve as
Guardian, I nominate HENRY MITCIIELL of Spartanburg, S.C., to
serve instead. I request that no sureties be required on
the bond of a Guardian appointed under this article.
V
APPOINTMENT AND POWERS OF EXECUTOR
I nominate and appoint my Spouse, BRIDGET MARY CHANEY,
as Executor of this my LAST WILL AND TESTAMENT. If BRIDGET
MARY CIIANEY is unable or unwilling to serve In this
capacity, I appoint CATHERINE C, BERNARDUCCI of Rego Park,
New York, to serve instead. I request that my Executor be
perml tted to serve wi thout bond or surety thereon. I
authorize my Executor to do any and all things which in his
opinion are necessary to complete the administration and
settlement of my estate, including full right, power and
authori ty, wi thout the order of any court and upon such
terms and under such conditions as my Executor shall deem
best for the proper settloment of my estate i to bargain,
sell at public or private sale, convey, transfer, deed,
mortgage, lease, exchange, pledge, manage and deal with any
and all property belonging to m}' estate; to compromise,
settle, adjust, release and discharge any and all
obligations or claims in favor of or against my estate; and
to borrow money for the payment of inheri tance and estate
taxes or for any other purpose. Without in any way limiting
the scope of the powers enumerated herein of my Executor, I
hereby specifically give to him full power to retain any and
all securities or property owned by me at the time of my
decease whenever, in his absolute and uncontrolled
discretion, such a course shall seem to him to be best,
without liability for depreciation or loss, and free from
investment restrictions incident to executorship, whether
imposed by common law or statute. In the execution of his
duties and powers as Executor he shall have tho power to
comply with all legal requirements as to the execution and
delivery of doeds and all other writings, documents or
formal i tlos without the order of any court; and he shall
furnish a statement of receipts and disbursemonts at least
annually to each porson thon entitled to receive income or
property from my estate.
Page 3 of 4 Pages
"I'
"
101,
.' ,
, ,
,
.,".
,
"
'", ,
IN WITNESS WHEREOP, I have at CarHsle ,Barracks,
Pennsylvania, this 17~ay of ~lI"tlllkr , 1982, set my hand
and, seal to thIs my LAST WILL AND TESTAMENT consisting of
four (4) typewritten pages.
~}~~AL)
Testator
Signed, sealed, published and declared by the Testator,
OTTO PRESTON CHANEY, JR., as and for his LAST WILL AND
TESTAMENT, in the presence of liS, who, at his request, in'
his presence and in the presence of each other, have
hereunto subscribed our names as witnesses.
NAME
- r( /'-,
~u..'~ I' ~ C.l~"'--
~a~
- .."
~L_,)kd-J
ADDRESS
" I) t/
IN 7 ~~"7 ;t.;;~~J<.4, AI
, O1'"',i.rj ~/~ 1~~rJ4
1')) u~ 'BO)( .3o(lA (1'1, ~/., B'-
Page 4, of 4 Pages
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Acknowledgment
COMMONWEALTH OF PENNSYLVANIA)ss'
COUNTY OF CUMBERLAND ).
I, OTTO PRESTON CHANEY, JR., 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 therel n expressed.
Sworn or affirmed to and acknowledged before me, by OTTO
PRESTON CHANEY, JR., the Testator, this ('L.J.tday of~,
1982.
~~~
Testator
(SEAL)
/J ~ (/
Nft~ry Publl c
IlOSA A, ORIIl, MOIARY rUQllC
CARlISLE OORO, CUMor,RLAH~ COU"'Y
Af f i d a v I t MY COIolMISSION ~XPIRES OCI, II, 19B~
"'ombll, pcnnsylvanla Allctlallcn 01 "olarl"
COMMONWEALTH OF PENNSYLVANIA)ss'
COUNTY OF CUMBERLAND ).
We, CHdM(:.-'V ,(, /(""'/0$ ,aiM',?) ,4. (},qbl./el(' ,
and MANV 1I,u"'E .J,""r" " 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 OTTO PRESTON CHANEY, JR., signed willingly and
that he executed it as his free and voluntary act for the
purposes therein expressed; that each of us in the hearing and
sight of the Testator signed the will as witnessesi and that to
the best of our knowledge the Testator was at that time 18 or
more years of age, of sound mind and under no constraint or
undue influence.
Sworn or aEfI rmed to and subscr bed to before me by (11.t:'''"-t~/tI
/!.., 1\&1 u,.{d 5 ,GIu('IA 11. ,q.htJct'?, and ~,4!z;
4110, J," dJ} , wi tnesses, t s n tI_, ay of7z.. <-I .~, 1982.
19 (2 I')
. a/).r,'l4'....- ;:, /, ( a .....,,~
W NESS
t{I:~
Wfli~~ .oJ ,.i.,,:;l
(SEAL)
(.-1
otary u lie
ROSA A, ORIII, HOlm PUBLIC
CARLISlE Bono, C1J1l~ERI^1I0 COUNTY
MY COMMISSION lXPlRES OCI. 21. 1915
IAlmbcr, PIMlylvlnl, AII.tlallon 01 Not",ln
r.o.
0) - 1(" -q 4
~
~ERTrFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedentl Ot.to P. Chaney
Date of Death I 12-16-93
W1l1 No.
Admin. No.
21-94-49
To the Registerl
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Hules was served on or mailed to
tlt3~?Jlowing benef;Ciari8S of the above-captioned estate on
Name
Bridget M. Chaney
Address
1115 Stratford Drive
Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) ex~ept
Dat.e I 2-10-94
\~'--'-'~ , ~~ /~....., < ,,, /
Signature
Name Patricia R. Brown
Address 4 Liberty Avenue
Carlisle, PA 17013
Telephone ( 717) 243-7922
Capacity I
Personal Representative
x
Counsel for personal
representative
REV,!SOO EK. IJ '."1}
,
I I..!- I ~"./ - (/
G
ffi Chaney, Otto P.
._.1_ __ _ s6~;~I:;_~-~~u~~1 ____JDAf!~O;~~;~~~E;; ~R/31
~ m 1. Original Relurn r] 2, Supplemenlal Rllurn
l'i~~
lll- [J 4, Llmll.d E.lole [140, Fuluro Inlm.1 Compromllt
02... Ifor dolll of dlolh all.. 12.12,92)
~Ol ['XI 6, Dectdenl Dlld T..loJI IJ 7, DtCldl~1 Malnlalnld a Living Tru'l 9,
____.~____ (Allorh copy of Will) __ IAllach copy 01 Tru'll -
ALL CORRIlPONDINCI AND COt<lPlDINTIAL TAX INPOIlMATlON SHOULD I' DlllCt1D TO. '
I N M MPUl! MA'IING ADDRm
~! _Patricia R. Brown, Esquire 4 Liberty Avenue
~ z fElElHONEtlUMIfA ____0____ Carlisle, PA 17013
u2
1. R.al E'lal.(Schedule AI ( 11
2, Slack. and Bond. ISchedul. B) 1 2)
3, CIOItly H.ld Stack/Parlne"hlp Inl....1 (Sch.dul. C) (3)
4, Mortgoo.. and Not.. Rectlvoble ISchedul1 01 1 4)
5, Ca.h. 8ank D.po.III & Mllctllaneou. PI"onal Properlyl 5)
IS,hldul. E)
6, Jointly Owned Prop..ly (Sch.dule F) 1 6)
7, Tran.fe" (Schedule GI (Schldul. L) 1 7)
8, Talal Grall Auell (toJollln" \,7)
9, Funeral E'pen..., Admlnl.lra"" Co. I., MI.ctllaneou. I 9) 9, 319 .49
E'p.ns..(Sch.dule H)
10, D.bJ., Mortgage Llablll"", Llen'ISchedulell 110)81,929.50 ___
11, Talal Dedudlan. (Iolalllnll 9 & 10)
12, N.t Valu. of E.tate (line g mlnu.lln. 111
13, Chorllabl. and Governm.nlol B.qu..J. ISch.dul. I)
____.__ 14, N.J Valu. Subject 10 To. IlIne 12 mln~.lIn. 131
15, Amounl of line 14 Ja.abl. oj 6% role
Ilnclude valu.. from Sfh.dul. K or Schedule M,)
16, Amounl a' line 14 la.able 01 15% roJ.
Ilnclude valulI from Schedule K or Schedule M,I
17, Prlnclpolla, due (Add to, from line 15 and from line 16,)
18, Crodill Spou.ol POVOlJy Cr.dll Prior Paym.nll DilCount I~t""t
_____________~__o + _u____._.____,_ +____ - ___
19, IIl1n. 181. grealer thnn line 17, .nl.. Jh. dlffmnce on Iinl 19, Thl.I.lhl OVERPAYMENT,
aiD
20, IIlin. 17 II groater Jhan IIn. IB, en I.. Jhe dlffmnce on Iin. 20, Thl'l.lhl TAX DUE,
A, Enter Iho InJer..t on Ihl balance due on line 20A,
B, Ent.. Ih. 10101 of IInl 20 and 20A on line 20B, Thl' 1.lh. BALANCE DUE,
Makl Ch"k Pay!'bll t., Rlg~.ttr of Will., Aglnt
--:---.-- ... I.IUR. TO ANSWIR ALL QUmION. ON RMRSIIIDI AND TO MCNICK MAne... "
IT;J;;p;n~;; ('If perlury, I dedare thai I have IJtcml"ed thlt rllurn, Including accompa"ylng .ch,dul.. and II all minh, and 10 the bill of my knowledge Dnd bllllf,
It II truD, correcl and complell, I declare lhat all renl 111010 hat been r'ported at trUIt market value, Oeclaratlon of preparlr olh.r Ihon the plrlonal rlpre.enlallvl II
ball" on nil Information of which preper., hal any knnwledge,
!iON";fu", 0' pf'so'nrlP6NliliTRiA"ffiiNoA"n1iiNm----..;Mmr--------- DAlE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
(11l'(~ h.'I(' if vou (lit. IItCl"f'\lIl1tJ CI lI.fund (II yUlll oVI'lpuynwlll
~~q*~
COMMONweALTH m PHIN~YlV"NI"
D!\l,~R'MENT Of REV!NUE
Of.Pl,le0601
.~~."~~!5IURO.'~ 17128.:~601
I, AND MIDDLE ,fuiiAtr
.171 Z-.12~_~-7922_
z
o
3
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S
.01 DATU 0' OIAIH Anl.U/aU" CHICK Hili
I' A IPOUIAL
POYlln CUDIT II CLAIMID 0
PILI NUM..I
21-94-49
COUNlY CODE
YEAR
NUMB~R
1115 Stratford Drive
Corlisle, PA 17013
c'""L-Cumbcrlancl
o 3, Rlmalr,d.. Rllur~
(for dolt. 01 d.alh prior to 12.13,92)
o 5, Fld..al E,lal. To.
Rllurn Rlqulred
Tolol Numb" a' Safl Dlpo.11 BaXl.
, ,
o
o
o
o
4,136.03
o
o
I 9)
4,136.03
115)
(11) 91,248.99
(12) -87,112.96
(131 0
1141 0
M,Oh 0
o
(16)
M ,15.
o
(17}
(191 -
(191
o
o
1201
(20AI
12091
o
o
o
llON"Iu,t-o,-p, E PAHiofH1!A"fii.\N"R!fRTIfNiAlIW-------- - --"ool!W--------
_~~____Lf.~I~-~~.&J~.u, P4L-
~
..3- LL0_L
.
ItIY,UO, 11I.111'1
~~~
SCHEDULE E L '
CASH, BANK DEPOSITS AND
MISCELLANEOUS
_ ____ PER~~N_AL ~~OPE~TY Pleale Print ar Type
FILE NUMBER
, 21-94-49
COMMONW!AlTH 0' P!NNSYWANIA.
INHIIIIANCI1AX mUIN
III,DINl alCIDINl
. -
ESTATE OF
Chaney, Otto P.
IAII p,oPtltv'loln~v.own~d' wll"-.!!'.'...Rlght o.!.!.u!;i;orohiP,mu" b. dll;jo~d on S.h;dul. P)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
4_-< _____~,._____._....
1.
First Charter National Bank (N.C.)
Volvo Sedan (1977)
Nissan Sedan (1987)
USAA (~ubscriber's account)
914.12
300.00
1500.00
1421. 91
2.
3.
4.
, ,
,
, "
,I'
"
,
,
" '
"
"
, ,
, '
, ,i
01'
or,.
,
TOTAL l~lla enter on line 5, Recapitulation S 4, 136.03
IAUQ(n addlllonal ell" )( II" ,h.11I1l ~ore 'pac. h ntldld,l
I'V.III1I" (1,",
UTATI 0'
;4 ,-
^~'l.,.n'"
.:'1t-Y.J....
COMMONWfAI'H O' ,eN~5VIVANIA
INHIIU1ANCf TAlC _nU_N
_UIO!Nl D!C~D!Nl
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
........L MISCELLANEOUS EXPENSES
'1.01. ',Inl o'.!!'I"
I 'Ill NUM".
21-94-49
-
Chaney, Ot to P.
ITEM
NUMBER
A. funarol bp.nlt"
B.
4,
C.
1.
2,
, 3,
4,
5,
II,
7,
8,
DESCRIPTION
AMOUNT
,
t
1.
1.
Pro fe s s ional Services
Hearse to Arlington
Casket
Death Certificates (50)
Clergy & family car
flowers
Dress (Daughter)
Admlnlllroll~1 Colli I
Plllonal Rlpr..lnloli.. Commllllon.
Social Security Numblr 01 Pellonal Rep""~lollvt:
Vlar Commllllon. paid _
6,073.49
2195.00
150.00
3320.00
100.00
100.00
123./19
85.00
2,
Allornoy Fee. Kayer & Brolvn
1,000.00
3,
Family Exemplion
Claimant Bridget M. ChaneYRllalion.hlp wife
Addre" of Claim ani at deeedlnl'. doath
Slroet Addroll 1115 Stratford Drive
City Carlisle Stote PA
2 ,ooa . 00
Zip Cod. 17013
Probot. F...
Petition, short certs.
Advertising - Cumbo Law
Sentinel
14fl ,00
100 , 00
, I
I
,
51.00
40.00
55.00
"
I
MIIClllan.oul bplnllll
Misc. Filing Costs
"
TOTAL IAllo Inllr on IInl 9, Rlcopltulalion)
(II malt IpaCI II n"dld, Inlllt addlllanal Ih".. ., lam. 1111.)
S 9 319,49
REV.15U ~X+ (7<83)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
NUMBER
2.
3.
SCHEDULE "I"
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
Chaney, Otto P.
OEseR IPTlON
1.
Loan against Life
Loan against Life
Loan against Life
Insurance Policy (Prudential)
Insurance Policy (Acacia)
Insurance Policy 1176871-0
759.59
804.96
+ 20.29
1,584.84
Gasoline Charge Cards
CITGO
Shell
Mobil
FILE NUMBER
21-94-49
AMOUNT
13.70
188.38
38.65
240.73
4,831.11
Car loan - Dauphin Deposit (1/2 of 9662.21)
4. Utilities
.5 .
6.
7.
PP&L
Telephone
water/sewer
Cable TV
Taxes (Personal Occupation)
reassessment
265.00
188.84
39.35
24.10
517.29
81. 00
Miscellaneous Debts
Myers (interior painting) 780.00
Stine, Inc. (bathroom repair) 50.00
Cline s (repair oven) 191.33
Walnut Bottom Home &
Garden Center (tree trim 590.00
& brush remova 1)
Tuition (college for 9,590.00
daughter)
~Iortgage on Property at 1115 Stratford Drive,
Carlisle, PA - 50% of $95,239.14
8. Charge Cards
USAA
VISA (AFBA)
VISA <fad
Penn Bank)
VISA (Dafcu)
Ci tibank
VISA
VISA (AFBA)
11,201. 33
47,619.57
326.81
3,406.54
1,596.33
50% of 4801.34 .. 2400.67
4,122.75
50% of 2886.36 '" 1443.18
50% of 3706.70 .. 1853.35
15,1119.63
(CONTINUED - Page 1 0 f 2)
TOTAL {Also ontor on IIno 10, Recapltulatlonl $
REV.1B12 E.X+ 17.831
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE "I"
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
Chaney, Otto P.
ILE R
21-94-49
-
-
ITEM
, NUMBER
DESCRIPTION
AMOUNT
9.
Medica 1
Champus Deductible
on insurance
Psychological Testing
(Hershey) ,
University Physicians
Tax Preparer
150.00
60. dO
244.00
454,00
250.00
10.
,
"
" '
"
, .
,"
"
(Page 2 of 2)
,-..~_...._._,-_..-....---_._----- --
TOTAL (AIIII fln\Br on IIno 10, ROlIBI1I\lilatlonl . 01 , \)29,50
. -'--"~'-'1'.~'~-~ .---,'..-...-.----
. IIi, IJUI~' 1"'1
~'Jit.,~
...,'fi1uf
(()A.I"ONwl_lIM 01 ""'I4~lIV."',_
IH""IIAHClI'" UIUIH
IItIOII.l DfClDI~1
SCHEDULE J
BENEFICIARIES
--
J
ISTATI O.
FIll NUM81R
Chaney, Otto p,
21..94-49
ITIM
NUMIIR
NAME AND ADDRESS O' BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARI O' ISTATI
A, Ta.abl. hqu""1
1.
Bridget Mary Chaney
1115 Stratford Drive
Carlisle, PA 17013
Wife
100%
ITIM
NUM8ER
NAME AND ADDRm 01 BINIIICIARY
AMOUNT OR
SHARI 01 ISTATI
8, Cha,lIabl. and Ga.ornm.nlOl hqutlll:
1.
lOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS IAI,a .nlor on Iin. 13, Rocapllulatlonl $
III m... 'p." 10 ."d.d, I...~ .ddIU..al,h.... ., lam. II..)
, .
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" .
",<,... '
, ~. i
"
'..... ..' II
" ;\
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,
,
~AST WILL AND 1'IiSTAMENT
OF
OTTO PRESTON CHANEY, JR.
.1,OTTO PRESTON CIIANEY, JIL, a legal r,esident of the
State of Florida, now in the active mili taryse !'Vice of the
United States and temporarily residing in Cumberland County,
Commonwealth of Pennsylvania, being of sound and disposing
mind and memory, do hereby make, publish and declare this
instrument to be my I.AST WILL AND TESTAMliNT.
I hereby
revoke any and all wills and codicils by me heretofore made.
I
IDENTIFICATIONS AND DEFINITIONS
A. I am married to URIDGIiT MARY CIIANEY, hereinafter
referred to as "my Spouse." We have two (2) children, DAVID
PRESTON CHANEY and MELISSA CATHER INE CIIANEY, hereinafter
refer rod to as "my Children."
B. Tho following definitions obtain in any use of the
term sin t his Will : '
I .
"Descendants" means the immediate and remote
lawful, Ii neal descendants of the person
referred to, and it mllans those descendants in
being at the time they must be ascertained in
order to gl ve effect to the reference to them,
whether they arc born hofore or aftor my death
or of any 0 ther person. Tho per~ons who take
under thi s Will as Descendants shall take by
'right of representation, in accordance with the
rule of per stirpes distribution and not in
accordance with tho rule of per capita
distribution. Persons legally adopted when
under the ago of fourtoen years shall not be
,differentiated from blood descendants for any
purpose.
"
"Survive me" is to bo construed to mean that the
person referred to must survive me by thirty
days. IE the perclon referred to dies within
thirty days of my death, the reference to him
shall be construed as if ho had fai led to
survi ve me.
3, As used In this Will, the words "Ilxecutor,"
"he," "him," "his," and the like shall be taken
as generic and applicahlo to a natural person of
01 ther sex or a corporato person or other legal
entity.
, 2. ,
"
"
.
.
.
"
.
"
C. I have served In the Armed Porces of the Unl ted
States. Thereforo, I dlroct my Executor to consult the
legnl assistance office at tho noarest military Installation
te as<:ertnln if thoro uro any heneflts to which my
dependl'nts artl ontltllld by vlrtUll of my military affiliation
at thll time of my doath. Rellur<lless of lilY military stntus
at tlw timo of my doath, I dire\:! my Executor to censult
with the nearest Votorllns Allmlnlstratlon and Social Secul'ity
Admlnlstrntlon office to ascertain If thore lire any henoflts
to which my dopendents may he ontltled.
11
PAYMENT 011 lllillTS AND TAXES
I d I roct my Executor to pay tho following n!! soon after
my denth ns may he prnct Irnble:
I. All of my just debts and the expenses of my last
Illness, funeral and of the administration of my
estntej but my Executor noeu not accolerate and
pay those unmatured obi igatlons which. In hi s
opinion, It mlllht be proper and more
advantalleeus to retal n or renew and pay as they
hecome due arlit payable.
2. All InlHlrltance. trunsfer, ostate and similar
taxes (Including Interost and penalties)
assessed or puyab1e by reason of my death, on
any property or Interest In my estate for the
purpose oC computing taxes. My Executor shall
not require any benoflciary under this wiJl to
reimburse my estate for taxes paid on property
passing under the terms of this NIl1.
III
RESIDUARY liSTATli
,A. I define "my Residuary listate" as all of my property
after the payment ef debts and taxes under Article I I.
inCluding real and personal property, whenever acquired by
me, proporty as to which eHective disposition is not
otherwise made in this Will, and property as to \~hlch I have
an option to purchase or a reversionary Interost.
B. I give my Roslduary I1state to my Spouso If she
survives me.
C. If my Spouse docs not survive me, I
Executor to dlvldll my Residuary Estate IlIto equal
to distribute those shares as follows:
I. one share to each of my Children who survl ve me i
direct my
shares and
2. If any oC my Children fall to survive me, then
his or her share shall be dlstrlbutod among his
or her descendants who survive mej
3. I f any of my Children fall to survl ve me IInd
leAve no doscendants who survive me, then his or
her share shall be divided equally among such of
my Children who survive mo, or their descendants
who survlvo mo, as set forth In subparagraphs 1
and 2 above.
I'agll 2 of 4 Pages
.'
~
~
.
"
,
n. If my Spouse does not survi ve me and none of my
Childrel\ nor their descendants survive 010, I direct my
lixecutor to divide my Residuary Estato into two (2) equal
shares and to distribute the sharos as follows:
1. one share to my Spouse 's mothe r KATIILEEN M.
GILLESPIU, or hor doscendants.
2. one fihare to my sister CATIIIJRINU C. llERNADUCCI,
or her descendants.
IV
GUARDIAN
If '"I Spouse dof.'s net survi vo me and It is necessary to
aPlloint a Guardian for anyone or more of my Children, I
nominate RUTII JUNKER ~IITCIIIJLI. of Spartanburg, S.C., as
Guardian of tho person and property of each of my Children
who roquires a Guardian. If RUTII ,JUNKER ~lITCIIELL of
SpartanhurR, S.C., is unahle or unwilling to serve as
Guardian, 1 nominate HENRY ~llTCIIELI. of Spartanhurg, S.C., to
sorve instoad. I request that no sureties be roquired on
the bond of a Guardian appointed under this article.
V
APPOINTMENT ANll POWERS OF EXECUTOR
I nominate and appoint my Spouse, IIIUDGIiT MARY CIIANEY,
as Executor of this my LAST WILl. ANll TUSTM1IJNT. If nRIllGIlT
MARY CIIANEY h unahle or ullld Illng to serve In this
capacity, I appoint CATIIERINE C. IIERNARllllCCI of RellO Park,
New Yllrk, to serve Instead. I roquest that my lixecutor he
perml tled to serve wi thout hond or surety thereon. I
authorize my EXflcutor to do any and all things which In his
opinion aro necessary to complete the administration and
settlement of my estate, Including full right, power and
authorl ty, wi thout the order of any court and upon such
terms and under such condlt.lons as my Executor shall deem
best for the proper settlement of my estate; to bargain,
solI at public or private sale, convey, transfer, deed,
mortgalle, lease, exchange, pledge, manage and deal with allY
and all property belonging to my estate; to compromise,
settle, adjust, release and dlschargo llny and all
obllRotions or claims In favor of or uRainst my estate; and
to borrow monoy for the payment of Inheritance and estate
taxes or for any othor purpose. Without In any way limiting
tho scopo of tho powors onumorated herein of my Executor, I
hereby specifically Rive to him full power to rotaln any and
all securlt.les or property owned by me at the time of my
decnaso whonover, In his absolute and uncontrollod
discretion, such a course shall seem to him to be best,
without llahlllty for depreciation or loss, and free from
Invostmont restrictions Incldont to executorship, whether
Imposed by common law or statuto. In the execution of his
duties and powers as Executor he shall have tho power to
comllly with all leRal requlremonts as to the execution and
delivery of deeds and aU other writings, documents or
formalities without the order of any court; and he shall
furnish a statement of receipts llnd dlshursemonts at loast
annually to each person then ontl tIed to receive income or
property from my ostate.
Page 3 of 4 Pages
,
.
"
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.
IN WITNIlSS WIWREOJl,
Pennsylvania, this 17~RY
. '
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of ty'" Vtm kr
C~r1i~1eDarracks,
, 1982, sot my hand
and soal to this my I.MT WILl, ANIl TESTAMIiNT consisting of
four (4) typowritton pages.
~(SIlAI.)
01 0 I :S 'ON C , JR.
Testator
"
Signod, soaled, published and declared by the Testator,
OTTO PRIlSTON r.IIANIlY, JR., as and for his LAST WILL AND
TIiSTMIliNT, In thr. presr.nce of us, who, at his request, In
his presence anll In the presence of each othor, hllve
horeunto subscrlhed our narnos as witnesses.
NMlB
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Lr;.... (l,. 1.'-.1.......- > ' C (", "....................
~~ a ~j..uJ
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11iu'1 ;,'._. I .An.d-l
AnDRESS
--.. .1) C'
t! 'I 7 j.u '7):/' ::t-- vc.. o.J.e.<-; i? I
,;;:,j,;-o} ~,.t ,(-K.(./ 1i4..{ I~U&t;;~ 14
,
l' t> H,y 7J~ If 30M (Ill, l....t.. AL.
Page 4 of 4 Pages
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Acknowl edgmen t '
COMMONWBAI,TIl OF PBNNSYLVAN IA) ~s'
COUNTY OF CUMDIiRLAND ).
I, OTTO PR BSTON CIli\NIlY, JR., Te sta tor, whose name Is signed
to tho attached or forogolng Instrument, having beon duly
qualified accordlnp, to law, do hareby acknowledge thllt I slgnad
and executed tho Instrumont as my Last Will; that I slglled It
willingly; and that I signed It liS my freo and voluntllry act
for the purposes therein expressod.
Sworn or affirmed to and acknowledged bofore me, by OTTO
PRBSTON CIlANBY, JR., the Testator, thls/1..,l(,day of~.
1982.
~~~
m " 0 N eFt I .
Testa tOI'
(S BAL)
/
.' t.l;t~ (J.
otary 'u Ilc
ROIl A, OR1Il, kOlARl rUBlIC
Af f I d a v I t ~ARll\11 BORO, CUllmtAN~ COUNl'
M' COMMISSIOH [XPlRIS OCl, II. 1m
IlIlmbll, r.n",ylvl"'llllotl!\I.~ 01 NoUlln
COMMONWEALTH OF PHNNSYLVANIA)ss'
COUNTY OP CUMBBRl.AND ).
We, r,II<'f../t,,!II i?, Rrll'IOS ,(JIM,,(J 11. (}~/)I./cl(' ,
and /I'-1"11/<),,-'E),""I-N , the witnesses whoso names are
slllnnd to tho attached or foregoing Instrument, being duly
qualifIed according to law, do deposo and say that we were
present and saw Testator sign and execute the Instrument as his
Last Will; that OTTO PRIiSTON CHANEY, JR., signed wllllr,gly and
that he oxecuted It as his free and voluntllry act for tho
purposes therein exprossed i that each of liS III the hearing and
sight of tho Tostator slgllod the will as wltllesses; and that to
tho hest of our knowlodgo the Testator was at that time 18 or
more yoars of age, of sound mind lInd under no constraint or
undue Influence.
Swprn or affirmed to,and sub!lcqbod to before me by (1/.c'Mt:"/';
!:., 1\ d ,I (d 5 ,Glatf'/A,4, (J(j/llolb\ ' and .AllIe!!/.
/)IW, J,ndJJ _, witnesses, this IIlkdllY of7ltJ,d....LI-, 1982.
LC:a,z.,.w,,~ ,'2 /(~ ",."--
illNESS
Jt;;f t~ }k;..<VJ
wt;~'b~S") j~~~l
9 4
A t14.A .
!t;tary I'ubl c
R051 A, ORIII, NOlm PUBLIC
mum Bono, C,"10[RIANO COUNlY
III COMMIS!,ION IXPlRII OC1. II, 191\
, IlImblf. P,nnlll"nll Allndltlon 01 HoWl1I
(S BA L)
~ RIY.lS47 IX AFP 110.93_
COIIlOH"Ul TN OF PEHHSVlYANU
O€PARIHEHT OF REYOU NOTICE OF INHERITANCE TAM
BUREAU Of INO!YIIlIJAl TAMES APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OEPT,1I0601 ~~" I 0 '
HARRill..... PA 111za-0001 ,..J~F DEDUCTIONS, AND ASSESSHENT OF TAX
ESTAT!~F CHANEY P - FILl NO.
DAn OF DEATH 12-16-93 COUNTY CUMBERLAND
HOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBHIT THE UPPER PORTION OF TNIS FDRH WITH YOUR TAX
PAYHENT TO THE REOISTER OF WILL~, HAKE CHECK PAYABLE TO "REOISTER OF IIILLS, AOENT"
REMIT PAYMENT TO:
PATRICIA R BROWN ESQ
4 LI BERTY AVE
CARLISLE PA 17013
ACN
DATB
07-05-94
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLf, PA 17013
L
AMount Ro.lttld
,
101
J
~
i
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ....
Ri:V: isiij' iif"Ai:ii -j iii: 93"1" - NOTieni F-YNliiii if ANCE- "fAX - 'A-PPRXi siifEiiT ~- - ALUiwANCE -iili - - ----.... -......
DISALLOWANCE OF DE~UCTIONS AND ASSESSMENT OF TAX
ESTAT! OF CHANEY OTTO P FILE NO. 2.1 94-0049 ACN 101 DATE 07-05-94
TAM RETURN liAS. I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSB
APPRAISED VALUE OF RETURN BAsaD ON: ORIGINAL RETURN
1. Roo1 Elteto ISohodull, AI
2, stook I Ind Bondi I5chod\f1l B I
3. Clololy Hold Stook/Portnl"hlp Intlrut (Sohldulo Cl
4, Hortaoau/Not.. Rloli.obll (Sohodull D)
5, Cuh/Bri Dopolih/Hho. Plrlonol Proplrty (Sohodulo EI
6, Jointly Ownod Proporty (Sohldulo FI
7, Tron.1orl (Sohodulo 01
a. Totol huh
I I CHAHOED
UI
(21
(31
141
l&l
(61
(7)
.00
.00
,00
,00
4.136.03
,00
,00
(al
APPROVED DEDUCnONS AND EXEHPTIONS:
9. Yunorol Exponl../Ad.lnhtrlt!.o COital
H1IoollIMouI Explnlol (Sohldulo HI
10. Dobh/Hortaoao LllbUlt1II/Ulno (Sohldulo II
11, Totol Dlduotlonl
12. Net V.luo of Tox Roturn
13, Chorlhbll/OoYlrn.onhl Slquuh <Sohodull Jl
14, Not VolUI of Elhto Subjlot to Tox
9.319.49
81,929,50
III I
(2)
(13)
1141
(9)
UOI_
IISI
U61
RECEIPT
NUHBER
DISCOUNT I + I
INTEREST 1-)
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
4,136.03
91, 248.99
87,112.96-
,00
.00
,00
,00
X.06 .
X,15 .
1171
.00
.00
.00
.00
.00
.00
,00
. IF PAID AFTER DATE INDICATEU, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU HAV BE DUB
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
Non! If an a..e..m.nt WI' illued pr.vioully, lin.. 14, 15 and/or 16 and 17 will
refl.ct figur.. that includ. the total of ALL r.turn. all.....d to dat..
ASSESSMENT OF TAX I
15, Anount of Lino 14 h"blo .t 6% roto
16, AMount of Lino 14 to"blo ot 15% rite
17. Prlnolpol Tox Duo
TAX CREDITS!
PAVHENT
DATE
RfstltYATtOMI Eltat.. of dec'"*tt. dytng on or beforl Otc'lber 12, 1912 ..~ If any 'utur. Inter..t In thll ..t.t. Is tran.farrld
in po....'lon or InJOYMnt to tin. . (coU.t.r.1) btnIflollr I.. 0' the cJtcldtnt .fhr thl nplrlUon of MY utlt, for
IHI or far y..rl, the C~lth htIrlOY IXpr,..ly r.."y.. thl right to IfIPr.I.. Ind ...... trlnlf.r Inherltancl TIK"
It thl 1...,ul CI... . (oollltlnU rite on any luoh 'utur. Intlrult.
PURPOSE ~
NOTlCEI To fulfill the r.qulr,""t. of SIOUon n~lI 0' the InlMrltanel Md Eltetl TalC Aot, Aot Z2 0' 1991, 7! P.S.
leatlon 214D,
PAM",I o.tlCh the top porUon of thlt NotlcQ Met slblllt with your ply""t to thl RtOlltlr of Willi prlntld on the rlVlrll ,Ide.
. -Ibko ohock or oonoy oruor pm"ll to, REDISTER OF HILLS, ADENT
All PlY""h rlollvlld Ihlll first be appUld to .ny Intlr"t 'Ihlch ..y b, dul ..lth MY r...lndlr Ippllld to the tlM.
REfLICD (CIUI A rafund 0' . t.1C credit, which.... not r......tNl 0f1 tM TIIC Rlturn, .IY bt rlqu..tld by oo.,lIUng an "Appllcltlon
for R,f1M 0' PlMlylvlnlllnhlrltanol ar.d Eltetl fllC" (REY"UISI, AppllcIUon. .ra IVllhbl..t thl Offlol
of the Rqltter of '11111, any of the i?1 Rlvlnut Ohtrlot Dfflc.., or by clUing thl IPNJlt 2~.hour
."",rl"l .arvle. nuMllr. 'or for.. ordering I In Pennsylvanl. 1~aoO~562"2050, outside P"",sYlvlfll. II'ld
within 100.1 Harrisburg Ir.. (711) 1I1~81194, TOO. (717) 712"2l52 (Hurlng lapllrld Only),
GaJECTlDNSI Any perty In Interllt nat SlUsflld with thl Ippr.hlHnt, all0'llnCI or dlllUowanol 0' deduction., or ........"t
of tllC (lnoludl~ dlleo\M1t or Intullt) II shown on this Hotlu IUlt obJlct within IlMty (60) d.ys of rlo.lpt of
thit NoUn bYl
"wrltter. prot..t to the PA Otp.rtMnt 0' AIVInUI, lOlrd of ApP.llI, DEPT. lal021, Hlrrlsburg, PA 17128"lGZl, OR
ueltotlon to h.vI thl ..Ulr atlr.Jn" It IUdIt 0' thl aocount of the Ptrlonll r.prllentltlvl, DR
uapptll to thl Orphanl- Court,
AIlIIIH
IITRATlYI!
CCIRR(CTlDHlI hotual IrrOrl dllcov.r" on thh .........,t .hould bl addrl"ld In writing tOI PA OIpartMnt of AIVsnull,
BurllU of Indlvldu.1 TllC'I, AnHI po.t A....a..nt Alvll.. Unit, DEPT, 280601, Herrllburg, PA 1112a~0601
PhoM (717) 787.6505, S.. psg. S of thl bookllt "Inltruotlan. for Inhlrlt3nC1 TIIC Alturn for I A..ldtnt
DMldlnt" (REV.lSOlJ for an IKPllnltJon 0' IdlIlnhtrltlv.ly oorrletlbl, errcrs,
DISCCUfTI If any talC due II p.ld within thrll (3) (l.I'~r ItOnthl aftar thl dtudent's dtlth, . flv. Ptrelnt UX) dltclUit of
tN tlM p.ld II l11oNed.
INTEREST I Int.r..t it oharglel bltgll'W'll~ with flrlt dlY of dlUnqulnov, or nlnl (9) lonthl and ana (1) dlY frol thl chili of
de.th, to the d.tl of PIlYllOOt. Tax.. "htch ble... delinquent blfor. Jll1Uery I, 1982 bur Inter..t It the r.tt of
IlK C'X) percent per ~ caltulltld at . dllh rats 0' ,OOC16~. AU talC" lIIhleh bee... dllInqu,lnt on MdIUtr
J~ry 1, 1'8Z will b..r Intlrllt at a rltl which will vllry frOl e.1lnctar Yllr to o.ltndtr Yllr with that rlt.
announced bv thl PA Dlplrtlent of A.vanutI. Ttlt If'PlIctbll Interllt rat.. for 1912 through 199~ Inl
'!!!! Intarllt RltI O.lly Inter..t Factor !!!r Intlr..t R... OIUy tnterllt.!!!!2!:
1911 ZU , ODDl~' 19.6 lOX ,DDDm
19'5 16X ,0000' 1917 9X ,DDDm
1984 IIX ,D00101 19"'19'1 llX .DonOI
1'85 IlX ,0001S6 I99Z 'I ,DDDm
1991-1994 11 ,OODm
....Inter..t I, c.lcvl,tld .1 followl1
INTSREST . BALANCE OF TAX UNPAID X NU"IER OF DAYS DELINQUENT X DAILY INTEREST fACTOR
"'Any Hotloe luuld Iftlr the tllC bleOMI delinquent '1111 r,fIlet ." Intlr.st clleulatlon to flItHn (11) dlY'
beyond the dltl of thl ......Mnt. If pavNnt It _1Id1 aftar thl Intlr..t CUlPUtltlon dltl .howI an tM
Nc:rUel, Mkfltlonel lnter..t IUlt be c.leul.ttd.
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IN THE COURT OP COIDION PLUS OP ctlKBBRLAND COUNTY
In Rei Estate of
Otto P. Chaney. Jr.,
Deceased
Orphan's Court Division
No. 21-94-0049
PBTITION FOR SBTTLBMENT OP SMALL ESTATB
To the Honorable Harold E. Sheely, the Judge of said Court:
The petition of Bridget M. Chaney, executrix of the estate
of Otto P. Chaney, Jr., respectfully represents:
Your petitioner is Bridget H. Chaney I who is the executrix
of the estate of Otto P. Chaney, Jr..
The above-named decedent died testate, having first made a
last will and testament dated November 17, 1982, which will has
been duly probated and letters testamentary on the estate of the
decedent were duly issued by the Register of Wills to your
petitioner on January 25, 1994.
The names and addresses, and relationships of all persons
having an interest in the estate of the decedent as heirs or next
of kin are as follows:
Bridget M. Chaney 1115 Stratford Drive, Carlisle, PA. Wife
The total value of the decedent's personal estate is less than
$10,000.00 and consists of personal effects only.
The expenses of the decedent's last illness and funeral have
been paid and there are no unpaid creditors of the decedent.
A Pennsylvania Inheritance Tax Return has been filed and the
amount of tax due upon the decedent's estate has been paid. A copy
of the inheritance tax official receipt and a copy of the statement
RIV.1S~7 IX AFP (10.93*
C_AlIH Of I'[HHjYlYAHIA
DEPARIHlNI Of REI'EIU!
IUREAU Of INDIYIDUAL IAXEI
DEPI. 211'01
HAlUUlIl.llO. PA 17121-0'01
ACN 101
NOTICE OF INHERITANCE TAM
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSES5HENT OF TAM
DATI 07-05-94
FILl NO.
DATI! OF DIATH 12-16-93 COUNTY CUHBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCDUNT, SUBHIT THE UPPER FORTI ON OF THIS FORH WITH YOUR TAM
PAYHENT TO THE REGISTER OF WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TOI
PATRICIA R BROWN ESQ
4 LI BERTV AVE
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
F
AMount Ro.Utod
-
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
il'kV: Uej".EX"AfP"r ilj: 9~i""NilTi ar"OF" Y NHEii'ii AifcE"T"A'x"iipjiiiiii ii EHENi'";' AL'LoWANC E "cjri"" -- -". ""-- - - - -"-
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF CHANEV OTTO P FILE NO. 21 94-0049 ACN 101 DATE 07-05-94
If an a..e..ment was issued previously, lines 1~, 15 and/or 16 and 17 will
refllct figurll that include the total of ~ returnl a..lI.ld to data.
ASSEllSMENT OF TAX I
15. AlIOUnt of Line 14 to.ob1. .t 6% roto
16. AlIOunt of Line 14 to.ob1. et 1&% ret.
17. Fr Inolpo1 T.. Duo
TAX CREDITS I
FAYNENT
DATE
TAK RETURN WAS I I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL~TURN
1. ke.l Elllto (Soheclulo A)
2. stook. ond Bondo (S.h.du1. B)
S. C10.01y Hold Stook/P.rtn.r.hlp Int.ro.t ISoh.dul. C)
4. Harte'eo./Not.. Ro..hobl. I Soh.clul. D)
S. C.oII/Benk Dopolih/Hh.. P.rlonol Froporly ISohodulo E)
6. Jointly o.nod Prop.rty (Sohoclulo Fl
7. Tr....foro I Sohodulo 0 I
8. Tot.l A..ot.
APPROVED DIDUCTIONS AND EXEMPTIONS I
9. F"""re1 txpon.../AdolnhtroUvo Co.h/
Hl.oollonoou. E.pen... ISohadul. H)
10. Dobt./HartQl9O LJobllltl.o/Llon. ISch.clulo I)
11. Totol DoduoUon.
12. Not V.lllO of T.. R.turn
15. Chorltoblo/Oovorllll.nto1 Boqullto (S.hodu1. J)
14.'- Not-Vtlllo of'c.tot. SlJbj.c, .toT..
NOTEI
RECEIPT
NUNBER
DISCOUNT (+1
INTEREST (-1
. IF PAID AFTER DATE INDICATED, SEE REUERSE
FOR CALCULATION OF ADDITIDNAL INTEREST,
I I CHANDED
(1)
(2)
(5)
(4)
1&)
161
(7)
,00
,no
,00.
,00
4.136.03
,00
.00
181
4,136,03
(9)
(10)
9,319,49
91,929.50
(11)
(2)
US)
Uq,'
91,248.99
87,112.96-
.00
.. ---....... .,... .,.QO-.-
US)
(6)
,00 M.06 .
,O~ M.1& .
U71
,00
,00
,O~
AMOUNT PAIO
TOTAL TAX CREDn
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
,00
,00
,00
.00
IF TOTAL DUE IS LESS THAN H, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YDU HAY BE DUE
A REFUND. SEE REUERSE SIDE OF THIS FORti FOR INSTRUCTIONS.)
, .
, ..
RESeRVATION I EI'I'I. of dtc""'t d~l", on or blfor. Ot<IMber U, 1981 u If any future Int.r..t In thl .u.t. h "lnlf.rred
In po.....lon ar enJoYMnt to Cl... I (aoUlterlO benefiolarlll 0' thl dMedent Ift,r thl ..plr.Uon of IIlV IIta" for
llf. or 'or Vtlr., tht C~.1th hlrtbv ,)Cprl.ttv r...rVII thl rllht to epflr.h. end ...... trlnlf.,lrNrItMOCI ,....
It thl IlNfu. el... I (oolll'.r.U rlt. on MV Iuoh future Int.'lIt.
PIJIlt>OItDl'
NOTlCt:1 To fulfill thl nqvlrlMtlt. of "otton Z1~O 0' "'I tnhlrHenol Met Elt"t leliC AGt, Aot U of l,.L 72 P,I.
IIollon 11I0.
PAMMTI DltlOh thl tOf! portion of thil MoUat tnd ,ubIIlt with yOur PIVMht to thl Aqhtlr of NUh printed on tlM! rlv.r.. tide,
0011II<0 _k .r .....W ordor p......1o tOl REGISTER OF NILLS, AGENT
All ,Ivanh rMllvH IhIll firl' be 1PP1l1d to InV Int.rllt ~Ich "V be due .Uh any ru.lnd.r .,..Utd to the till,
Rlfl*O teA), . r,'\RI of " '1M Orl,dlt, Mhlch .... not requested 01\ ttw Till Alturn, "V tMI r....ted bit COIIpllUng .., "."lIaaUon
for R,fLnd of PennlVlv",l, InherltltlC. Ihd E.t.t. Tex" CREIJ~1S1S)' AppllcaUonl .re 1",lbble It thlOffllll
0' thl R..lltlr of Wl1h, "''1 of thl13 RI"1f1U4I Dhtrlat Offlllll, or b~ oll1lng thl ,pHIII 2~~hour
,"1"'rAnt IIr\llol nlabIrI 'or 'onlorderlngl In PIN'l'vlv.,,11 1~.OO."2.Z050, ouhlr1e PIMI~lv,"l. Ind
..!thin locll Hlrrhbur, I,.e (117) 717~1O'~, TOOl (717) 77Z~UU (Hurlne 1.llrld Onh),
OIJlCnOHlh Anv Plrtv In Int"lIt not ..thtied MUh thl "prlhMlnt, l110MItlCI or dl..Uowlftce of dtduGUonl, or IUlIlatnt
0' tlM ClnolucUne dlleOWlt or lntlr..U '1 .hown on thlt Notte. MIlt obJtot ..ithln Ihctv (60) dl'" 0' rIGI'ttt of
thh Holl.. bw.
-~lCrIU," protest to tht PA o.plrtHnt of Rlvenl.M, 10lrd 0' Appe.II, DEPT. 211021, Hlrrhbu!'l, PA 171U"lOtl, OR:
....leoUon to haY, the IIU" deter.lnteI .t IUdIt of thl IOCCM.I1t of thl perlonel repr..lntlUvl, O.
........1 to the Orphenll Court.
AlllnM
IIIUTlI/l
CIllltll!CTIllll1.
IMlERlIT.
FMtU.1 .rrorl cU.o~.,td on thl. ......."'t should be Iddrl...d In MdUng tOI PA OeplrtHnt of A.".....,
lun.. of tncllvldulll Tell", ATTN, POlt A........,t R.vl... Unit, DEPT, za0601, Harrl.burl, PA 17UI-0601
Phone (717) 711-6101t. I.. Pili 3 of thl boOkI.t "In.truotlonl for inheritlnGl I.IC N.turn ~or I A~IlI,,*lt
DIe.,.,t" (RE\I~"Ol) for." IlCpl.,.Uon of IdlIlnhtreUvllv corrlGtMil1 .,rors.
U InV tllC duI II p.ld within thrill (I) allender IIOnthl Iftlt thl dectdln,l, elMth, I fl"l parcent (lXI dllCount of
tho t.. ,.Id 10 011_.
tn,or..t It chlrlld bqlml,. "lth Utlt dav of dellnql.MnCv, or nlM (9) ~thl ItId OM (I) dev frOll thl d.tl of
delth, to thl dltl af P.~t. TlIlII which bee... dtllnqyent blfor. Janulr)' I, 19U b..r Int.ru' I' 'hi nt. of
,1M ('Xl parclnt per It'INII clleuhtld It I aUV tit. of .0001641. All tlMu which b.o... dtllnquent on end I".r
JInuIrv I, 19U wUI bNr In'.r..' It . rlt. wh1ch will v.rv Irew. C,llhd,r year to clltndlr vllr with thlt r.tl
, emounoM bV the PA Depltt""' af R'''InIM. Th4I Wllclbl. Intlt..t "t.. for ltlZ thrOUlh 1994 Itl.
DIICOUNT.
'!!!t tnllrll' RI" e,IIY Intertlt Fie tar !!!! Int.,..t RI" Dilly lntltllt ,.!!.!.!!
1"1 iii ,000141 1916 lOX ,000110
"'1 l6X .0004H 1917 n ,0001'7
"" m .OOOJOI 1910'1"1 m ,000501
1101 m ,IOU" 1"1 n ,000147
I"Sol994 7X ,ooom
utnt.rll' It c.lcull'ld II foll,*l.
JNTElaT . BALANCE OF TAll UNPAID X NUHIER OF DAVI DELINqUENT X DAlLV INTEREST FACTOR
-"AnV MoUcI 1tM*t'lftlt thl 'I. bMOIlII HUnquent will reUlat In Int.r..' ollcullUon to flftHn CUI tlV'
"WoM thl d.t. of thl ........"" 11 .,IWlMN"lt II ... .ft" thl Int.rut QIHIP\lt.Uon dlt. Ihown on thl
HaUoe, IckUUonel Intlrllt .,.t be e.lculeted.
. .
"
LAST W ILL AND TESTAMENT
OF
OTTO PRESTON CHANEY, JR.
I, OTTO PRESTON CIIANEY, JR., a legal resident of the
State or Florida, now in the active military service of the
United States and temporarily residing in Cumberland County,
Commonwealth of Pennsylvania, being of sound and disposing
mind and memory, do hereby make, publish and declare this
instrument to be my J.AST WILL AND TESTAMENT.
I hereby
revoke any and all wills and codicils by me heretofore made.
I
IDENTIFICATIONS AND DEFINITIONS
A. I am married to BRIDGET MARY CHANEY, hereinafter
r(lferred to as "my Spouse." We have two (2) children, DAVID
PRESTON CHANEY and MELISSA CATHERINE CHANEY, hereinafter
referred to as "my Children."
B. The following definitions obtain in any use of the
terms in this Will:
1. "Descendants" means the immediate and remote
lawful, 'j ineal descendants of the person
referred to, and it means those descendants in
being at the time they must be ascertained in
order to gi ve effect to the reference to them,
whether they are born before or after my death
or of any other person. The persons who take
under thi 5 Will as Descendants shall take by
right of representation, in accordance wi th the
rule of p(lr stirpes distribution and not In
accordance wi th the rule of per capi ta
distribution. Persons legally adopted when
under the age of. fourteen years shall not be
differentiated from blood descendants for any
purpose.
2. "Survi ve me" is to be construed to mean that the
person referred to must survive me by thirty
days. If the person referred to dies wi thin
thirty days of my d(lath, the reference to him
shall be construed as if he had failed to
survive me.
3. As used in this Will, the words "Executor,"
"he," "him," "his," and the like shall be taken
as generic and appl icable to a natural person of
ei ther sex or a corporate person or other legal
entlty.
Page I 0 f 4 Pages
--:"'~41', .. '
-,
.. "', i,j,
C. I have served in the' Armed Forces of the United '
States. Therefore, I dl rect my Executor to consul t the
legal assistance office at the nearest military installation
to ascertain If there lire any benofits to which my
dependents arc ontitled by virtue of my military affiliation
'at the time of my death. Regardless of my military statu5
at the time of my death, I direct my Executor to consult
with the nearest Veterans Administration and Social Security
Administration office' to ascertain If there are any benefits
to which my dependents may be entitled.
.', ' . M_'
-.
I I
PAYMENT OF DEBTS AND TAXES
I di rect my Executor to pay the following as soon after
my death as may be practicable:
1. All of my just debts and the expenses of my last
illness, funeral and of the administration of my
estate j but my Executor need not accelerate and
pay those unmatured obligations which, in his
opinion, it might be proper and more
advantageous to retain or renew and pay as they
become due and payable.
2. All Inherl tance, transfer, estate and similar
taxes (including interest and penalties)
assessed or payable by reason of my death, on
any property or interest in my estate for the
purpose of computing taxes. My Executor shall
not requi re any beneficiary under this will to
reimburse my estate for taxes paid on property
passing under the terms of this Will.
III
RESIDUARY ESTATE
A. I define "my Residuary Estate" as all of my property
after the payment of debts and taxes under Article II,
including real and personal property, whenever acquired by
me, property as to which effective disposition is not
otherwise made in this Will, and property as to which I have
ao option to purchase or a reversionary interest.
B. I give my Residuary Estate to my Spouse if she
survives me,
c. If my Spouse does not survi ve me, I
Executor to divide my Residuary Estate into equal
to distribute those shares as follows:
1. one share to each of my Chil~ren who survive me;
d i rec t my
shares and
2. if any of my Chi Idren fai 1 to survi ve me, then
his or her share shall be distributed among his
or her descendants who survive me;
3. If any of my Children fai 1 to survive me and
leave no descendants who survive me, then his or
her share shall be divided equally among such of
my Children who survi ve me, or thei r descendants
who survi ve me, as set forth in subparagraphs 1
and 2 above.
Page 2 of 4 Pages
. .
"'&~'_
"~I,(~..~,o(.~ "'. .
" ,,!I.',~ '
~ ., '"., \."
D. If my Spouse does not sllrvi ve me and none of my
Children nor their descendants survive me, I direct my
Executor to divide my Residuary Estate Into two (2) equal
.shares and to distribute the shares as follows:
I. one share to my Spouse's mother KATHLEEN M.
GILLESPIE, or her descendants.
2. one share to my sister CATHERINE C. BERNADUCCI,
or her descendants.
IV
'GUARDIAN
If my Spouse does not survl ve me and I tis necessary to
appoint a Guardian for anyone or more of my Children, I
nominate RUTH JUNKER MITCHELL of Spartanburg, S.C" as
Guardian of the person and property of each of my Children
who require s a Gua I'd I an. If RUTH JUNKER MI TCHELL of
Spartanbllrg, S.C., Is unable or unwilling to serve as
Guardian, I nominate HENRY MITCHELL of Spartanburg, S.C., to
serve instead. I request that no sureties be required on
the bond of a Guardian appointed under this articla.
V
APPOINTMENT AND POWERS OF EXECUTOR
I nominate and appoint my Spouse, BRIDGET MARY CHANEY,
as Executor of this my LAST WILL AND TESTAMENT. If BRIDGET
MARY CHANEY is unable or unwilling to serve in this
capaci ty, 1 appoint CATHERINE C. BERNARDUCCI of Rego Park,
New York, to serve instead. I request that my Executor be
perml t ted to serve wi thout bond or surety thereon. I
authorize my Executor to do any and all things which in his
opinion are necessary to complete the administration and
settlement of my estate, inCluding full right, power and
authori ty, wi thout the order of any court and upon such
terms and under such condi tlons as my Executor shall deem
best for the proper settlement of my estate i to bargain,
sell at public or private sale, convey, transfer, deed,
mortgage, lease, exchange, pledge, manage and deal wi th any
and all property belonging to my estatej to compromise,
settle, adjust I release and discharge any and all
obligations or claims in favor of or against my estate; and
to borrow money for the payment of i nheri tance and estate
taxes or for any other purpose. Without in any way limi ting
the scope of the powers enumerated herein of my Executor, I
hereby specifically give to him full power to retain any and
all securities 01' property owned by me at the time of my
decease whenever, In hi s absolute and uncontrolled
discretion, such a course shall seem to him to be best,
without liability for deprecl.atlon or loss, and free from
investment restrictions incident to executorship, whether
imposed by common law or statute. In the execution of his
duties and powers as Executor he shall have the power to
comply with all legal requi rements as to the execution and
delivery of deeds and all other writings, documents or
formalities without the order of any courti and he shall
furnish a statement of receipts and disbursements at least
annually te each person then entitled to receive income or
property from my estate.
Page 3 of 4 Page s
.J...."-"..."~.'"
" "'10""1,'
IN WITNESS WHEREOF, I havo at Carlisle' Barracks,
Pennsylvania. this 17H...aay of ~Illkr , 1982, set my han~
and seal to this my LAST' WILl, AND TESTAMENT consisting of
four (4) typewritten pages.
~(SEAL)
o E , JR.
Testa tor
Signed, sealed, published and declared by the Testator,
OTTO PRESTON CHANEY, JR., as and for his LAST WILL AND
TESTAMENT, in the presence of liS, who, at his request, in
his presence and in the presence of each other, have
hereunto subscribed our nRmes as witnesses.
NAME
~ev~..- -, r;? (Z~
~a~
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f?t"1 L_.J kd.-1
ADDRESS
11'17 4~7 ~ ~~;J4-
~,rt) ~~~~
1b~"" '230'" .300A t'f1Lt....l. ~
Page 4 of 4 Pages
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Acknowledgment
COMMONWEALTH OF PENNSYLVANIA)ss:
COUNTY OF CUMBERLAND )
I, OTTO PRESTON CHANEY, JR., Testator, whose name is signed
to the attached or foregoing instrument, havingbeon dUly
qual Hied according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will i that I signed it
willingly; ancl that I signed it as my free and voluntary act
for the purposes therei n expressed.
Sworn or affirmed
PRESTON CHANEY, JR.,
1982.
to and acknowledged before me, by OTTO
the Testator, this 11..k.day of~,
(SEAL)
~~~~
Testator
?~p b (j,
Notary u lie
Affidavi t
ROSA A, ORTIZ. ~o'ARY PUBlIO
CARLISLE BORO, CUMDF,RLAHO COUN1Y
MY COMMISIION EXPIRES OC1.II, 19&5
Mombll, Pennlylmla AlI1lelallen 01 Notarial
COMMONWEALTH OF PENNSYLVANIA)ss:
COUNTY OF CUMBERLAND )
We, CHd/l,flnV '/7. 1("l'7o:i-....' alM',1J ,4. ~,qblJe1( ,
and. MAII~ /'IAJ"". ~""(f{" , the wi tnesscs whose names are
signed to the attac ed or foregoing instrument, being duly
qualified according to la\" do depose and say that we were
present and saw Testator sign and execute the instrument as his
Last Wi 11 i that OTTO PRESTON CHANEY, JR., signed willingly and
that he execut.ed it as his free and voluntary act for the
purposes therei n expressed; that each of us in the hoaring and
sight of the Testator signed the will as wi tnesses; and that to
the best of our knowledge the Testator was at that time 18 or
more years of age, of sound mind and under no constraint or
undue i nf luence.
Sw..,orn or afti rmed to and subscr bed to before me by (!:1I.e.....It!~:w '
1<.. 1\ rl ,,0 s ,~/o 114 A, ~htJel?, an~
~( Snolrh' , w tnesses, t s n~(.... ay of _, 1982.
L.~ O~
tl/l/...w......... '/(, ~
W NESS
~a~N
WI
~ll~r) L;;''/
, (SEAL)
otary u I c
ROSA A, ORTIl, N01ARY PUBLIC
CARLlSlt BOnO, CUMBERLAND COUNTY
MY COMMISSION lXPlRU 001, 28, IllS
Mlmblr. Pannlylvanla Anoelallon 01 Nolarlll
, ..
JRDIJUDO 30, 1992/17858
REGISTER OF WILLS '
Cumberland County Courthouse
, One Courthouse Square
Carlisle, PA 17013
NOTICE PURSUANT TO RULE 6.12
PENNSYLVANIA SUPREME COURT ORPHANS' COURT RULFS
To:Porsonal Reprosentatlve
Counsel: PATRICIA R. AROWN, R!'lQ, ,
RE: Estate of OTTO P CHANEY JR ,Deceased, Late of
CARLISLE BOROUGH
Estate No.: 21.94.049
Date of Decedent's Death: DECEMBER 16, 1993
Pursuant to Rulo6,I2, the above named personal representative or the above named attorney, if
applicable, within two (2) years of the decedent's death, and annually thereafter until administration Is
completed, is required to file with the Register of Wills a Status Report as required by Rule 6.12, in
substantially the prescribed form, showing the date by which the personal representative, or attorney, as
applicable, reasonably believes administration will be completed, The purpose of this Notice is to advise
you that unless the requisite Status Report is filed with the Register of WlIIs or Clerk of the Orphans'
Court, as appropriate, within ten (10) calendar days after the date of this Notice that the Register of Wills
Is required to nollfy the Orphans' Court Division, Court of Common Pleas of such delinquency and to
request that said Court conduct a hearing to determine whether sanctions should be Imposed upon the
delinquent personal representative and the delinquent personal rejlresentatlve's counsel, If any.
Accordingly, if the requisite Status Report Is not flied by J AN. 29 . 19~~ you are hereby
advised that a request will be submitted to the Court in accordance with Rule 6.12.
Date: JAN. 17, 1996 . nln'\.l/(I\./~(U(/.J'-N.('~ V)) 10bA./UtJ '
Deputy R~glster of Wills . 10.(~,Uhlr
Distribution to Estate File
"
STATUS REPORT UNDER RULE 6.12
Name of Decedent I
"'1
._' T"MJ
p
('/ -,
',,"..,.,\ " A.b '- \ ,(.1
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Date of DeathIDcc."wnIN.-
. '1 'I
Will No. )../- ~.. 0 '14-
Pursuant to Rule
Court Rules, I report the
the administration of the
d.
,
Admin. No.
6.12 of the Supreme Court
following with respect to
above-captioned estate I
Orphans'
completion of
1.
State whether administration of the estate is complete I
Yes X No
2. If the answer Is No, state when the personal
representative reasonably believes that the administration will be
completel
3. If the answer to No. 1 is Yes, state the following I
J:e,r~~ b 'OS '~'h~ "~er~~~.~'t r~p~~s'~~~'~i~-:..t1ie a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account iSI
c. Did the personal representative state an
account informally to the parties in interost? Yes_____ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Cour.t and may be attached to this report.
Datel I )Il, / <J Go
, f
'-1-2T1.'~J v<? ~I-h., .-",j
Signature
-a "
, :{\7(~ 1<.,,, ,,f 1~)<<t>UN
Name (Please type or print)
-/ 6- LI13~/i! 1 Y l1i.....(J -"
Adclress
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Tel. No.
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Personal Representative
CapacitYl
x
,
Counsel for personal
representative
(MAH I rmflAM3)