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HomeMy WebLinkAboutOC1969-1009 - ESTATE OF SUTHERLAND..----------;.--------- j In t4t <nnurt of <nommon Jtlrns of Ihls4iugmn <nouuty. Jruusylunnin.(@rpqans·<noun fHittisiou ESTATE OF Louetta Sutherland,a/k/a T'011et.+.a S.Brown, Q8eSaS8Q. No.63-69-1009 In the matter of the__F_i_rs_t_an_d_F_i_n_a_1__ Account of Jennie Tricb, Execut.rix ADJUDICATION AND DECREE And now Februa.cr ~19.-71-,this matter came on for hearing, audit and distribution at this session and testimony aken;'and thereupon,upon due consideration thereof the balance for distribution in :the hands of the Accountant is determined to be $10,110.00 .and the account is accordingly confirmed;and it is ordered, adjudged and decreed that the said balance be paid out by the Accountant in accordance with .the schedule of distribution hereto attached and made a part hereof,unless exceptions hereto be flied sec.reg.or an appeal be taken herefrom sec.leg. SCHEDULE OF DISTRIBUTION Balance per account _ Balance:_ Deduct Clerk's Costs &Receipts _ At'tomey W.:.:..o:::.:odw=~a.rd=.....:&==_=B:iiiaiWs~s=i _ Russell Marino,Clerk O.C.,costs in certifying real estate to recorder, John Mazza,Recorder,costs recording certification of real estate, Russell Marino,Agent,tr~fer inheritance tax, including tax due on individual liabitity, personalty and life estate in real estate,$99.69 Interest from 12-1-70 to 2-U~-71 1.22 Carol Lee Sutherland,granddaughter;KatherynPatricia Sutherland,granddaughter;Robert Stanley Sutherland, grandson,bequest in kind of jewelry-,held in kind and distributed as such at the appraised value,in equal shares,credit to be taken by the accountant for items advanced prior to distribution b.1 the Court, Floyd Brown,husband,bequest in kind of 1958 DeSoto Sedan automobile,held in kind and distributed as such at the appraised value, Contribution to maintain real estate in kind for distribution, 4.00- 10.00 100.00 l37.1~ $10,110.00 $10,085.00 l..ekl'3-7 I I"_'.,e?..r.?-I :~.fJ~-;?A~ ~qf~e $10,081.00 Ifji/7!2-Y-/fJI9n- $10,073.50 1..Ad-I'y-7/ PCt.-{frY~t>p .?/~~~ $9,972.59 te~ $9,862.59 $10,000.00 •J, -'.~'...."''''--...,,:.,,'1..~.............. .~.....,'...I,:\ \ t ...\, 0 ~..... ~ :J Z 's -+~::rc:(\) (\):J 3 0 -+ 0 0.....-fJ... 0-·t. -+::r(\) t . ,- :','/"(~..I Floyd Br~"husband,life estate in real estate as hereinbelow described,with remainder over at the death of the life tenant"under the tenns of the will,held in kind and distributed as such at the appraised value,10000.00 No balance REAL ESTATE TO BE.CERTIFIED TO THE RECORDER OF WASHIN TON COUNTY BY THE CLERK OF THE ORPHANS'CO DIVISI N Louetta Sutherland a/k/a Louetta S..BrOwn;devisor,to Fl yd Brown"devisee of a ,!.• live es"tate 'with the remainder interest,in subject real state,ov r under the • ,•~c • terms of the will,with interest represented being all th right"t tle and interest of the devisor in and to parcel of mproved real estate de cribed as,VIZ: " " (26) described ered asofWashington,State of Pennsylvania,.being known and... in the SPEERS FARM NO.1"as recorded in the Recorder's Washington County in Plan Book Vol.3,page 32,and being bounded AtL THAT CERTAIN La1'OR PIECE of grolpld.situate.in the Bo ough of Seers,County., as follows:BEGINNING on the'Sduthwesterly side of Lewis Avenue,a the dividing line between lots NOSe 2,and 26 in said plan,ich point is distant one hundred sixty.five (16,)feet North ,1 degrees 2,'West,distance of Forty (40) feet to the dividing line between Lots NOSe 26 and 27 in aid plan;thence along said last mentioned dividing line,South 38 degrees 35'Wst"a dis ance of one (100)hundred feet to "B"Alley;thence along said Alley,South 51 egrees 25' .East,a distance of forty (40)feet to the dividing line etween Lq Nos 2,and 26 aforesaid;thence along said last mentioned dividing 1 35'East,a distance of one hundred (100) beginning. North place of CERTIFIED TO RECORDER:FEBRUA Y 18,1 71 ,'''1' '0;.> ('~----,'-..No.F 1 1 r:n :i:..;!~..._.........',~ In the ~atterofth:71 FEB 4 PH 2~49"p ., v • ..' ACCOUhtof ~. of Estate of l_' ,/ : -U"C:Ell 'f'n1ItOK:;>v ..._,'.........'\II'f REG 1ST ER 0r"vll LLS ViAS HINGTO NO 0.,PA. -r '-' ....v '. .. 71 .' ". , \ :.' " 1\b~~rutinti uub 1Btirtt " u '- '-' '" •I ,., "" ,~\'~a <i}\~ '-' .., '"~ .- '. '-' '-l '" QIommouUtealt4 of ,eUU5YIUaUia,}ss.JllhUl~ingtnn monntg. KNOW ALL MEN BY THESE PRESENTS:Whereas,at Washington,in the County aforesaid I on the 11th.day of September A.D.19 69,before me, Russell Marino ,Register for the Probate of Wills and Granting Letters of Administration in and for the County of Washington,in the Commonwealth of Pennsylvania, the last Will and Testament of Louetta Sutherland,A/K/A Louetta S.Brown late of Borough of Speer8 in the County aforesaid,deceased, (a true copy whereof is to these presents annexed),was duly admitted to probate;and Jennie Trich rix the ExecutCX 111 said Will and Testament named,having appeared before me and taken and subscribed the oath of office prescribed by law; NOW,THEREFORE,I,RUBsell Marino ,Register as aforesaid,do grant these LETTERS TESTAMENTARY,unto the said' Jennie Trich committing unto Her the administration of all and singU'lar the goods and chattels,rights and credits,which were of said deceased,and requiring Her to exhibit a true and perfect inventory thereof into the _Register's Office,at Washington,within ninety days from the date hereof,and to render a just and true account of said administration at the expiration of six months from the date hereof,and to regard and comply with the provisions of the laws of this Commonwealth relating to inheritance taxes. IN TESTIMONY WHEREOF,I have hereunto set my hand and the seal of said Office at Washington,this 11th. day of September III the year of our Lord one thousand nine hundred and Sixty Nine -/J e :977~r;';r,_____________I....~~.:':::1..;(..._. Register '-~'~-----------oolIIIIl_"'"_.....----------~---...-..,21 ~ .. i~ i"-..:l"!~t:"i ~ 0 ..., :~c ..... 10 ()........, .1:C't ~!<t C't tnjC't III I'Tl t ieT (JJ GllIDtil-II:)-..., Itil C't -I tn N i·i'I'Tl ..... 0 ~Ie.;'1 "TI a:'1 .... ·0 III ..., !=e ~::::~p,.....~~sa j}• I,LOUETTA SUTHERLAND,of Speers Borough,Washington County,Pennsylvania,being of sound and disposing mind,memory and understanding,do make,publish and declare this to be my Last Will and Testament,hereby revoking and making void any and all other Wills by me at any time heretofore made Q 10 I direct my Executrix hereinatter named to pay' and discharge all my just debts and funeral expenses as soon as may be after my aecease e 2 0 I give and bequeath all jewelry of which I may be possessed at the time of my death to my grand-children,viz: Carol Lee Sutherland,Katheryn Patricia Sutherland and Robert Stanley Sutherland,to be divided among them equallyo 3.I give,devise and bequeath the·house and lot I now own located on Lewis Avenue,in Speers Borough,Washington County,Pennsylvania,to Floyd Brown,Box 63,Allenport,Pennsyl- vania,to have,hold,use and enjoy for and during the full term of his natural life o At and immediately after the death of the s~id Floyd Brown,I give,devise and bequeath said house and lot to my son,William E.Sutherland,his heirs and assigns. 40 All the rest,residue and remainder of my estate, real,personal and mixed,I give,devise and bequeath to my son, William E.Sutherland,his heirs and assigns. 5.I hereby appoint Mrs.Jennie 'frieh,of Speers Street,Bellevernon,Per~sylvania,to be the Executrix hereof. Witness my hand and seal this~day of ~ ,1950. j \1 j 1It 1 l.fI :,,,:;. ·7:'r.'c -_._~_. Signed,sealed,published and declared by the above name Testatrix as and for her Last Will and Testament in the presence of us,vmo,at her request and in her presence and in the presence of e8ch other have hereunto subscribed our names as " h, •!: wi tnesses. i t It t ..... rrTr~c-":'~.j.l~•...J.!-I Borough of Speers, r/.~;,~.f' l.j .L JUDO 2D,1950,60 hereby .:-'T·''1'.ow...L ........:...and -rrn~::1r,'r•..I...L J....;..!.ll •-- ~ltle and ~o8ses3ion of 6ny autaI~obi18 to ~h~ch I a~rightfully IT~~'1:-ana ~SSt~~8~t i~s0far as a~y r~rt thereof is re~cl:8d or ~atlfled by th:s Codicil. (l(l~,J~",'\----...,,-,,U/9 ~s &~d each of ~sJ an~at ~:hy her to us to be 3 Coiicil to h8r Lost ~ill ~nd Testament dated in her p~esenca and in the presence c~each other,have horeunto I:, ~subscr~bed our na~e3 as ~itnesS6S this day ond year aforesaid. iI, ._-...~~~::tr".",?,........-..-....~,.... J i\ffi~uuit (@f 1txrrutnr OOr i\bmiuiatratnr ~tatt of JtttttaYIUa.ttia } Cltnuttty of ltaa4ittgtntt.aa: P II b f th d · d th't Notary Public . d f 'dersonay e ore me,e un erslgne au orl y,a __.._In an or sal County and State,appeared J~p.D..t.~_..'J):t.~h..__. . .__..who,being duly sworn according to law,deposes and says that he is the executor or administrator of the es- tate of L.QUett_a_..Su.th.er.land_,....a1.kladeceased,that the foregoing schedules constitute aLouettaS.Bro~!UcompleteInventoryanaappraIsement of the real and personal estate of _._.. .....__.__.., deceased,except real estate outside the Commonwealth of Pennsylvania;that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death,based upon ajustappraisementofeachitemmadebytheabovenamedExecutor~.Jtx Sworn and subscribed before me this ..J.~.t." }H'1':.IJ. d~.. October (/()})O ..."..'""""""..".".V~."".".." "..ay :...~..~.._.'Executor-1bimiot~ "'~"',."'..d'J...",~JCHAR..................'''.u ·re".."........~Tl..·~~..· IRtUMMlSSJ'1 .~aUNrY ADDITIONAL INSTRUCTIONS ' 1.An u~n~~~t~;y:~~~tl~i filed within three months after appointment of personal representative. 2.A supplemental inventory must be filed within thirty days of discovery of additional assets.3.1 Original arid 2 Copies and 2 RCRI-34,Under $10,000;1 Original and 2 Oopies and 2 RCRI-33,Over $10,000,including Copy of Will;1 Original and 3 Copies and 2 RCRI-33,Over $50,000,in- cluding Copy of Will and copy of Federal Estate Tax Return. .REFERENCE FOR ADDITIONAL COpy ,Act of 1947 P.L.513 Sec.5.2,72 P.S.4844.2 3JnUttttnry anb .AppraistUltnt of the goods and chattels,rights and credits which Louetta Sutherland,a/k/a Borough of Speerswereof··Louet"t·a···S·~·..·B"t.owt'i·············..···············late of . Washington County,Pa.,taken and made in conformity with the above affidavit. I DOLLARS CENTS I PERSONALTY 1.Two (2)Christmas Club Accounts at Charleroi Federal Savings and Loan Association 2.Costume jewelry 3.Chip diamond ring 4.1958 DeSoto Sedan REALTY ALL that certain lot or piece of ground situate in the Borough of Speers,County of Washington and State of Pennsylvania,being knwon and numbered as Lot Number Twenty-six (26)in the SPEERS FARM PLAN NO.1,as recorded in the Recorder's Office of said Washington County in Plan Book Vol.3,page 32,and being bounded and described as follows,to wit: BEGINNING on the Southwesterly side of Lewis Avenue,at the dividing line between lots Nos.25 and 26 in said plan, which point is distant one hundred sixty-five (165)feet North 51°25'West from the northerly line of State Street; thence along said Lewis Avenue,North 51°25'West,a distance of forty (40)feet to the dividing line between Lots Nos.26 and 27 in said plan;thence along said last mentioned dividing line,South 38°35'West,a distance of one hundred (100)feet to liB"Alley;thence along said Alley,South 51°25'East,a distance of forty (40)feet to the dividing line between Lots Nos.25 and 26 aforesaid; thence along said last mentioned dividing line North 38° 35'East,a distance of one hundred (100)feet to Lewis Avenue,at the place of beginning. ~80.00 No value 10.00 100.00 $ I 190.00 I 10,000.00 I TOTAL INVENTORY AND APPRA ISEMENT $10,190.00 Jb'f'f ~j -(D 9-/"00 c; Inventory and Appraisement IN THE ESTATE OF LOUETTA SUTHERLAND,ajkla LOUETTA S.BROWN................................................................................. Filed Q~!.9.1?~J",19...7.0 . ...'-or-' ::;:::;:;:J --.l •1 c::::> >m;;':; (J)G)c::.c::::J 11-'"- ::c -(I) ,....,! _(J')'-,-~ Z ---4 ~.r'"ryt G~rn ,..~'-'---{:::a Jr--_'=o .0 :;c::$:::-0 ... o _v-:';>:::l: o ..c :D--I -:--~-0 ~-l>~o LoJ -4=" ~y'//~..j'g'.2J Woodward and Bassi .....-5 ~l~J !' ~'\.\' STATE OF PENNSYLVANIA, WASHINGTON COUNTY,~55: 'it'• The within named Accountant being duly sworn according to law,deposes and say S that the above,account as stated is true and correct as..~.b.~.:verily believe, WANI1A CARRINGTO CHARLEROI BORO '"N,NOTARY PUBliC MY COMMISSION ;;~R;S'lAS;:t:iGTON COUNTY AUGUST 19,ISJ2 Sworn and subscribed before me this ls.t . day of .·9.~~.~~~.~19..?Q . ~:. Wa1shington County,ss: ~TC~----_·_-----------_· I do certify that I have given legal notice 'to all persons concerned of the filing of the within account in the manner prescribed by Sta'tute and Rule of Court,as evidenced by proofs thereof filed to No..b.3~.7Q:.7Y...O . Witness my hand and official 'seal thiS SQ:!.-:__m ...... dayOf ~191.0.'~~----,_.. Register of Wills ,. ~v ;........,0 ....r:cl ;::l...., \0.:\t'Co)-!"':;::l0 ~Q)-..!<.J .d<.J ~:....,~:~"~i -..:.r-!!.;~...,0,".....L f'\...., Q!"':1-1:i C 'J 't;l~:t,,Q)...;j!...., 1:1~i "0:U!Pq Q)~D"'~28 '"c:(I):fu Ii i -'r 34 Q)0 ",tlil ...."':c ~:0.(:ri1 .-1:~~!....,0-...:Eo<I-li 0 .:~;::lEo<(I):1-1 ...0'-3\w."c!i=Cl ...cl nU2,:::;~-1 ,<.J:i,;~f-\RfN0 <.Jri1~:U:~..~"~~..oj,!;j:.r-!i Dr:('IC'''-CIl OF WILLS .: 'Y)!OOj 00 1-1:'\1-"....J I L I.~E-l:Wf\(~HI'~GT()'10:"':'"\.;.;i \."r\'CO.,p1\..~ l ~:~(I)!Q) ~:~.r-!:.d~....,(I);(I)c!0 0;j:;j c!1:1 C'+0'0 (I):'t;l ~c:i ...:11 ...:I lJi .:c=>Z ~M ,I 4 -~_ ...., 1:1oj....,.:;::l0 "6""<.J<.J~~....0•r-!.... tI.l i:»ICI.l Q)~'".....~0i=Cl ....,...., ~"0C '""0 ~1-1 '"~"00 ~0 ;3; ~ r;;w ,.... :1 ,~ ,.,J ......., '\. • The Court is respectfu II y requested to determine proper distribU'mk- .Counsel for Accountant . ,,,i;,p. THE FIRST AND FINAL ACCOUNT OF JENNIE TRICH,EXECUTRIX OF THE lAST WILL AND TESTAMENT OF LOUETTA SUTHERlAND..l. .....:~ A1KIA LOUETTA S.BROWN ,DECEASED ,lATE OF THE BOROUGH OF SPEERS ,WASHINGTON COUNTY ,PENNSYLVANIA Principal Personalty $190.00 Income Personalty 357.38 Principal Realty 10,000.00 Income Realty None Total Assets of Estate $10,547.38 Cash contributed by Executrix to maintain real estate and'personal 3,52-'5.45 (I I items in kind Total $14,07.2.83 .... Less Credits claimed .3,962.83 fI\:._I' ... Net Balance for Distribution $10,11'0.00 C I I I I I I - PRINCIPAL PERSONALTY The Accountant charges herself with Principal Personalty received out of said estate as follows: Per Inventory ~nd Appraisement INCOME PERSONALTY $190.00 The Accountant charges herself with Income Personalty as follows: ,$107.38Refundonincometaxreturn Social security death benefit 250.00 $357.38 The Accountant credits herself with the following out of the assets of said estate: Russell Marino,Register 2 short certificates Brun.o's Plumbing &Electric Balance due on paint 1969 Sept.4 8 10 15 29 30 Easton's Pharmacy Russell Marino,Register GUy Rogers Mon-Va11ey Newspapers Washington County Reports J.C.,Penney Balance due on prescriptions Probate of will Witness trip on will Legal advertisement Legal advertisement Balance due $7.58 19.00 15.00 10.00 14.00 2.00 7.95 10.00 Oct.2 6 Flower shop Dr.A.C.Dent Harold R.Toner Flowers Medical expense Funeral expenses 22.50 181.00 1,353.00 4 1970 Oct.22 Belle Vernon-Post Office Jennie Trich Woodward and Bassi Floyd Brown (Husband) Notary Public Russell Marino,Register Postage Executrix commission Attorneys'fee Family exemption Notarizations Filing inventory,first and final account,etc. 4.80 509.50 509.50 1,000.00 10.00 22.00 ~:,.-. '0 I June 3 David P.Scholl Marker PRINCIPAL REALTY 265.00 Total $3,962.83 a- The Accountant charges herself with Principal Realty received out of said Estate as follows: Per Inventory and Appraisement INCOME REALTY $10,000.00 The Accountant charges herself with Income Realty as follows: None Washington County Reports Washington,Pennsylvania (PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION) PROOF OF PUBLICATION In compliance with the Newspaper Advertising Act of May 16,1929, P.L.1784 Sec.S,paragraphs (S)and (25). COUNTY OF WASHINGTON}SS STATE OF PENNSYLVANIA.. Personally appeared before me,a Notary Public in and for said County and Commonwealth,CHARLES C.KELLER,who,being duly sworn,deposes and says:that he is the Editor of the WASHINGTON COUNTY REPORTS, the officiail legal periodical for said Washington County,published weekly hav,ing its place of business at Washington,Washington County,Pennsylvania, and is acting as its agent in this behalf;that the said WASHINGTON COUNTY REPORTS was established on March SI,1920,and was designated as the official legal publication for Washington County,Pennsylvania,by order of the several courts of said County,dated November 11,1920;that the printed notice or advertisement attached hereto is a copy of a notice or advertisement, exactly as printed or published,which appeared in the said legal periodical in its regular issues on the following dates: .......,sept.e.heJ:l8..,U ,.1969 . .......9.G.t..ber.a 19..69.. that the affiant or the corporation in behalf of which he is acting is not interested in the subject matter of said notice or advertising and that all of the ~g=~of [7'~'-1f}~d ohM'ct~of th,pulili,,~on L,.I:.d :.~.--.-...Editor Sworn to and bscribed before me this ......~2nd.day of..:O.c.t.beJ:,19..69 .,cZ· .....................................................................:f.•.. .otary Public KATHERINE C.YARIl,N,wry ~c Wishin!t,n,Washlnltlln Co.,Pa. My C,mmissilln Expires Novemher 1,1969 Estate Notices The Register of WiHs has granted letters,testamentary or of administration, in the following estates.Notice is hereby given to all persons indebted thereto to make payment without delay and to those having claims or demands to present them for settlement to the Executors or Administrators or their Attorneys. • • ••• • • ••• •• ••••• SUTHERLAND,LOUETTA.a/k/aLOUETTAS.BROWN,Dec'd. Late of Borough of~Sp'e~rs:Wa~hlng­ton County,Penna.Executrix:Jennie Trlch,441 Speers .St.,Belle Vernon.Pa..; Attorneys:Woodward &:Bassij,·701McKeanAve..Charleroi,Penna., Proof of Publication of Notice,in The Valley Independent Under Act No.587,Approved May 16,1929,P.L.1784, as amended by Act.No.51 of April 24,1931,P.L.67 State of Pennsylvania }5S'County of Westmoreland . Assistant Personally appeared before me William H.Pore,Secretary ofMon Valley Newspapers,Inc.,a Penn- sylvania corporation,publisher of The Valley Independent,who,being duly sworn,deposes and says that The Valley Independent is a daily newspaper of general circulation in Fayette,Washington and Westmo'reland counties,Pennsylvania,and elsewhere,published in the City of Monessen,Westmoreland County,Pennsylvania,that it was established June 28,1902,since which date The Valley Independent has been regularly issued 'in said county,and that a copy of the printed notice or publication is attached hereto exactly as the same was printed and published in the regular editions and issues of The Valley Independent on the following dates,September 18,1969 September 25 and October 2,1969 Affiant further deposes and says that he is General Manager of The Valley Independent,a dolly newspaper of general circulation,and as such is authorized to verify the foregoing statement under OQth,and Affiant is not interested in the subject matter of 'the aforesaid notice or advertise· ment,and that all allegations in the foregoing statements as to time,place and character of publica- tion are true.d=Y:~~)~(~ COpy of NOTICE Sworn to and subscribed before me this _ 'My commission expires _ .") ) day of ---,19 _ Notary Public STATEMENT OF ADVERTISING COSTS: Woodward and Bassi,Attorneys at Law 701 McKean Avenue Charleroi,Pa.15022 TO MON VALLEY NEWSPAPERS,INC.,DR. For publishing the notice or advertisement attached hereto in The Valley Independent on above stated dates $10,00 //Notary ,$ _ Total $10.00 PUBLISHER'S RECEIPT FOR ADVERTISING COSTS Mon Valley Newspapers,Inc.,publisher'of The Valley Independent,a daily newspaper of general circulation,hereby acknowledges receipt of the aforesaid advertising and publication costs and certi- fies that the same have been duly paid. .1, MON VALLEY NEWSPAPERS,INC. 3Ju tile (@rpQuua~aInurt of lJual1iugtuu (!tuuuty In the matter of the Audit of Account in j Estate 01I,.(-=L~o-=u:..::e:..:t:..:t:.:a.:.....:S:..u::.t::.h:..:.e~r-=l_a.;;.;rt:.:d~''--1 a/k/a Louetta S.Brown' TO THE AUDITING JUDGE: 1969 -1009No.,'-',19__,_.A.A. our Jennie Trich.ExecutrixEnter,appearance for·_-'---=:.-;,...:..:....:..:-..:...-...::...;:;".;::,~.;..;~r.-=-....;...,;;"........;..._ 19 70'- N,B.-Counsel shall,by separate paper,present a concise statement of each claim,with supporting calculation of any interest claimed.Objections to an account as filed,shall be concisely stated in a separate paper. Council suggesting proper distribution shall file a separate concise state' ment in that regard. .....,..I II"'""·r't..i I'"'.!I ...-.~.."J) '71 FED 4 Pl1 2 50 RUSSELL ht4HlNO I1EGISTEH OF WILLS WASHINC,TON CO.•PA. Testate Form J PETITION SU R AU DIT IN THE ORPHANS'COURT OF WASHINGTON COUNTY LOUETTA SUTHERLAND a/k/aEstateof,..t ••••••••••••••••••••••.•• LOUETTA S.BRm~N Deceased 1969 -1009No . Fiduciary J.~~ni-.?..:r.~J.~h.#E.~~.c.JJ:tt.iK ..... Date of .S b 1 1969 Date of Decedent's death ~.p.~.~.~~E .L Grant of Leitters ~~.P.~.~.~J??~..J.L J9..9.9.. This is the ~~E~.~~.~~~.~.~~.~account filed in this estate If there have been former accounts filed in this estate,list file number or number and term ~~~:. Election to take Under CX~~1ttwill.(cross out one) Date Election Place of; Filed Record ). Name of surviving spouse fJ9.Y.9 ~J;.9.WXL . List issue,where material: William E.Sutherland Did decedent marry after execution of will?(indicate)~.No.Any children born after execution of will?(indicate) ~No.If answer yes,name them . ..........__.._-----_-__--_-_---____----_._---_.._----------_---_-----_.._------_.._--.._..--.._._.._-------__-----_.._-_._---__:..-__---------- Leg.atees Relationship Interest Fiduciary,if deceased or not sui juris Granddaughter Granddaughter Grandson Husband Son Remainderman interest in real estate Carol Lee Sutherland Mesp1e KatheFyn Pat~icia Sutherland Bates Ro~~rt Stanley Sutherland Floyd Brown William E..Sutherland (die~January 3,1970) Wife Helen Sutherland Children Carol Lee Sutherland Mesp1e Katheryn Patricia Sutherland Robert Stanley Sutherland Bates Specific Specific .Specific Specific;lifeestateinreal Sui juris Sui juris Sui juris Sui juris estate List,if exceptions to above: None If partial intestacy,give facts: None Adeemed:Revoked:Lapsed:Abated:Give Cause: Notice to interested parties.Have all parties,having either vested or contingent interests and all crediors entitled to notice (Court Rule No.9 paragraph C:Section 6:Subdivision c)received written notice of the filing of the account and of call of audit?Yes.X*x If any exception give cause:~~!_::.~. File copy of Noti~~November 30,1970anddateofmailing ;.. Is estate subject to the filing of a Federal Estate Tax Return?~.~. Actual payment made on Pennsylvania Transfer Inheritance Tax.Amount $~~~~. If the Will makes any portion of estate subject to a life-estate,give name and birth date of life tenant . Floyd Brown,born April 15 1896 ..................................................................,. Give Names and addresses of all unpaid creditors who a re legally entitled to notice,together with the amounts of such claims;state whether they are admitted to be correct;and whether the claim is denied. None Give reference to such parts of the will as require interpretation by the Court;a reference to all questions re- quiring adjudication,and a statement of any other facts deemed necessary for the preparation of the adjudication: Paragraph Third -William E.Sutherland died on January 3,1970 (Death certificate is attached)•.Surviving him are his wife,Helen Sutherland, and three (3)children,Carol Lee Sutherland Mesp1e,Katheryn Patricia Sutherland Bates and Robert Stanley Sutherland,all of whom are sui juris. Balance for distribution per account, Itemize any additional debits not shown by account Total additional debits (Add) Itemize any additional credits not shown by account: Total additional credits (Subtract) Balance for distribution $~~~~. $~9~~. $!.9..t.~!g.~.g.9.. \. $J9.~JJQ.!.Q.Q . If balance for distribution is not in cash,list each item held in kind,giving appraised Value (or distribution Value); ~'- Real estate Costume jewelry Chip diamond ring 1958 DeSoto Sedan $10,000.00 No value $10.00 100.00 ".".'.' .. If Family Exemption claimed by Petition,give place of Record:~Q~~. If F "E t"I'd t d't 'I'h'db'f CI'Flovd Brown husband.ami y xemp Ion IS c alme a au I,give name,re atlons Ip an aSls or Qlm:./L . List any advancement or distribution on account that has been made,and nature and amount of same: Floyd Brown Carol Lee Mesple nee Sutherland Robert Stanley Sutherland Katheryn Patricia Bates nee Sutherland Automobile Chip diamond ring Costume jewelry Costume jewelry Costume jewelry $100.00 10.00 No value No value No value Suggested distribution of balance shown,both as to principal and income,attaching signed and itemized elections to take in kind if balance is not in cosh:residuary shares being stated in proportions: Carol Lee Sutherland Mesple Katheryn Patricia Sutherland Bates Robert Stanley Sutherland Floyd Brown William E.Sutherland (died Costume jewelry Chip diamond ring Costume jewelry Costume jewelry Automobile;life estate in real estate Remainderman interest in real estate;residue No value $10.00 No value No value $100.00 COUNTY OF WASHINGTON,55: COMMONWEALTH OF PENNSYLVANIA. The above named Fiduciary or'representative thereof, being duy sw.orn._doth depose and say that the facts set forth in the foregoing petition are true to the best oL h~_~_knowledge and belief, Sworn ,····to and subscribed before.. me this J~t day of Q.c;.tf>.1?~.;:l IQ . Signature of Offic~.~ Title of Officer ~.?~.~~Y.~~~.~~~. Office expi res tlfA~~~~~.•~~e8INSJ.(JN.•Hf1i'ltqr1i .....•........•• EROI BOROYGH,~}:,,":....UHUe MY COMMISSiON E",'>c...,,"iI,:C~!iNTY "PIRES AUGUST 19,1912 And your petitioner will ever pray,etc, ····~Tr~····. ......................................................................,. r '. I .''t No.1969 -1009 Estate of...~9.~~.~~.~...~.~:t:.~~E~~.~~.,....<;J:I.~/a .~~~~:t:.~~~.~~.~9~_._.. Deceased Fiduciary...J.~~~!~...:r~~.c;.h.2 ...g.~~.c;.~.~.~:t.~ PETITION SUR AUDIT FROM WHERE DECEDENT LEFT A WILL Counsel of Fiduciary will submit herewith the following,in conformity with Court Rules adopted effective December 3,1951,being rule No.9:pa rag raph b-c;and divisions thereof:shown on pages 23-24. 1.Written praecipes of all Counsel in the case. 2.Copy of order appointing Guardian ad Iitem,if pertinent.. 3.Copy of Order appointing .Trustee ad litem,if pertinent. 4.Proof of service of above. 5.Letters Testamentary or Administration C.T.A.or on attest copy of Will. 6.Copy of inventory and appraisement. 7.Proof of advertisement of grant of letters if not filed with account. 8.Certificate of liens in case any of the funds for distribution are from judicial sale of real estate. 9.Signed and itemized elections if any distribution in kind. 10.Copy of Federal Estate Tax return if es- tate is subject thereto. Woodward and Bassi Attorney ",,~2 J''<>I '''''-''),-'I !...·L [."L, '1/FEB 4 Nt Z 49 fi ile's,:· 1\.),)L.:L..L i4,,~RIN0 flECIStEII OF WILLS WASHINGTON CO.,PA. .. IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY~'PENNA. ORPHANS'COURT DIVISION IN RE: ESTATE OF LOUETTA SUTHERLAND.a/k/a LOUETTA S.BROWN. ,. Deceased. ) ) ) ) ) ) ) ) ) No.1009 of 1969 BEFORE: APPEARANCES: TIME;: THE COURT:; HEARING ON-AUDIT THE HONORABbE P,.VINCENT MARINO.Judge of the said Court. WOODWARD &BASSI•.ESQS .•of Charleroi.Pa. representing the Accountant. Mon.day;,Decembe'r 14,19 :70,at 1:30 olcl ock P.M.,·,.EST. 'Number ;1009 of 1969,the estate·of Louetta Suther- ~' land,deceased.The Executrix is Jennie Trich and the attorneys ar'e Woodward &Bass"L Mr.Bass i? MR.BASSI:If Your Honor please,this estate is somewhat co~- plicated.in that the decedent died leaving certain items of jewelry to named persons,all of which I have represented by a signed acknowledgement of receipt when distributio'n was made."These parties all live in California with the ~xception of 'the Executrix. The other and only item that was in the estate was real estate loca ed ---------------,-----------. 2 .---r:-----fr------------------------~--~ -.. in ,the Borough of Speers.And that was devised to Floyd Brown, who is the husband of the decedent,for 'his life.And the balance then to William E.Sutherland who was the decedent's son by a previous marriage.That party died on January 3,1970. •THE COURT: MR.BASSI: That is the life tenant? No,that is the residuary lega tee.The decedent, <z~of c~:)Urse,died on Sept~mber 1,1969.No Letters have been raised >-OlZ~on the estate of William E ..Sutherland,who was the residuary lega ee. Q, iel.'lzi Ol; And he died a resident of the State of California,leaving as survivi g his wife,Helen Sutherland,and three children,all of whom are of Patricia Sutherland Bates and Robert Stanley Sutherland. majority.They are Carol Lee Sutherland Mesple,Katheryntii:I-!!! Q .I<§ Q THE COURT:::l., :I:5 MR.BASSI: What is your suggestion as to distribution? I think that·the distribution has to occur to the iiilI:IIIl-ll:oQ, IIIlI: l-ll:::loU ~oii:II.o .named decedent in the Will or:the named ~egatee in the Will,subje<t ,-'to the life.estate in Floyd Brown.I don't know any other way the Court can do it,11JiIiliess the Court can award the real estate in residue directly to the widow of the decedent,William E.Sutherlar d, and the children in two thirds shares.I am not sure tha t that would be a very good way of doing it. THE COURT:Well,we will give that consideration.Are the re any outstanding claims at all ? MR.BASSI:An of the claims have been paid,Your Honor, by resort of the Executrix to af.$pint bank account that she had with ,-----------------,-,-----------------------------------------_..._------------,,-----------, 3 .~_:__------i!r_---------------------------1-- the decedent.But she does not choose to make any claim against thE estate for any payment that might have overlapped. THE COURT:Was the tax on the joint estate paid? ..MR.BASSI:No,not yet,Your H"nor.It is included in the assets here.One thing I would not like to do is to impose any liability on the Executrix in the event that the amount in that accoun individual liability imposed on her by law. •Brown or the (Sutherland heirs and request contribution. is insufticient in view of th'e Inheritance Tax. ~"~·"r.-l -- And I;will simply have to go to Mr. Well"we will'try to work it out,but that is an We will try fo work it out.Is there anyone els e Right.I know it's ticklish.I am sure that what if I can probably 90,if it does happen that way,lit happens there is .nothing we can do about it. :!z~-'>-UI~'THE COURT:III".,' D. ig I!l··z i AUIMR.B SSI:~ § ll:I-UI Q -'c(§ Q :J., :t ',5 THE'COURT: , in Court interested in this decedent's estate? Court.; oill:~ll:oD.IIIll: l-ll::Jo THE COURT:u -'c(u~o (NO RESPONSE) The audit of this account is ordered closed by the ( AUDIT CLOSED) -~--------------------.----------. ..,·'-------1I-----------------------...:.----------lI--- ~z~.J>-enzz IIIII. 1 bereby ~ertify that the proceedtnp and evidencet are contained The fo:regolng record of the PrOCeedings upon the heartSld of the •to=uii:t-IIIQ .J«§ c::l... :I:/:; N vi0:IIIt-o:oII.III0:~atiove cause 1&hereby apPrOved and dir§cted to b~tUed.::l •..~ ou ~Uii:II.o -.. J./ ....-. +•. t ~_' -~-..... '0 .., / '., ,.....·tf .. .~.••>- "I. ., .. •< ~."",t.."'... ~X;-........:uJ:>.m(.l)0 c::::r::'-ef)Vi {0Z-1 r ~rn r--i ...-~t-.......0 Z .....~..', ('")'-1'- 0 ~:£i :;v r---...",IJ I":-0>(/) " r,,:-;.. -". .. ". RECEIPT RECEIVBD of JENNIE C.TRICH,Executrix under ITEM 5 of Last Will and Testament of LOUETTA SUTHERLAND, also known as LOUETTA BROWN,deceased,Miscellaneous Items of JEWELRY.Bequeathed to under Item 2 of her Will. BY:~,,!~'\yQ ~-J.0·9Qr.~KATHERY~PATRICIA BATES (Nee:)KATHERYN PATRICIA SUTHERLAND DATED:----.:.\-",-Q.::--~\-----,\"",-3...L-_1969\ ~"-.,~...'......-. KATHERYN PATRICIA BATES (Nee:)KATHERYN PATRICIA SUTHERLAND MISCELLANEOUS ITEMS OF JEW~LRY 1.Set Silver Bracelet,Neclace &Earrings 1.Set of Earrings &Neclace 5.Sets Pins &Earrings 4.Neclaces 2.Neclaces &Bracelets 2.Bracelets &Earring Sets 3.Rings 5.Pins 5.Bracelets 6.Pairs of Earrings 1.Watch 0, r11 ... ~~,~ri ---.l 'H, (,/)(,Q, ~..,....i r~$ (")..J1T!.•"'"',:-4 ~)t- 0 0 _"._Z -r~-..:~~ a -'4l:~!:~o 0<0:.;'rJ rz V J-0 ~(J) $;:0 ~1:'1:1, (fJG):c RECEIPT RECEIVED of JENNIE C.TRICH,Executrix under ITEM 5 of Last Will and Testament of LOUETTA SUTHERLAND, also known as LOUETTA BROWN,deceased,Miscellaneous Items of JEWELRY.Bequeathed to you under Item 2 of her Will. CAROL LEE ~lliSPLE (Nee:)CAROL LEE SUTHERLAND DATED:~\lo j 1969 / CAROL LEE MESPLE (Nee:)CAROL LEE SUTHERLAND MISCELLANEOUS ITEMS OF JEWELRY 1.Set Pearl Neclace,Bracelet &Earrings. 1.Set Crystal Neclace,Bracelet &Earrings 1.Set Neclace &Earrings 5.Sets of Pins &Earrings 4.Neclaces 6.Bracelets 2.Bracelet &Earrings Sets 3.Pins6.Pairs of Earrings 1.Watch 1.Chip Dia~mond Ring. ..-n 0--.J -""i rn o RECEIPT RECEIVED of JENNIE C.TRICH,Executrix under ITEM 5 of Last Will and Testament of LOUETTA SUTHERLAND, also known as LOUETTA BROWN,deceased,Miscellaneous Items of JEWELRY.Bequeathed to you under Item 2 of her Will. ! By: ROBERT STANLEY SUTHERLAND DATED:_.....;..I_(!)_·_-_1_3__1969 ",,'..I","'0'..'1 ROBERT STANLEY SUTHERLAND MISCELLANEOUS ITEMS OF JEWELRY t.Gold Bracelet,Neclace &Earrings 1.Neclace &Earrings 5.Sets of Pins &Earrings ly•Neclaces 1.Bracelet &Earring Sets 1.Neclace &Bracelet Set 5.Bracelets 6.Pins 6.Pair Earrings 2.Rings 1.Watch ~~J...........-! r~q o f'"~•i"'~i'''b;".,,~..~~~ J l-"o"....;::; • .....;\,'/I FEB it PrJ?If9 IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNA. ORPHANS'COURT DIVISION NO.1969 -1009 F:US ,'~f:'-'...F;IiIO nEGISTf.f:OF '/fILLS VIASH It;C-lON GO.•PA. IN RE:ESTATE <F LOUETTA SUTHERlAND,a/k/a LOUETTA S.BROWN,deceased ....., t ~j ELECTION TO TAKE IN KIND ..\ i1~"j,~",d ..r ,.;;.,~.... ~~!l&~ ~d~' 7tl/~~~ :C~9~/§tJpp '- -) ·,.'7 ., IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA ORPHANS'COURT DIVISION IN RE:ESTATE OF LOUETTA SUTHERIAND,A/KIA LOUETTA S.BROWN,deceased NO.1969-1009 ELECTION TO TAKE IN KIND KNOW ALL MEN BY THESE PRESENTS,that I,the undersigned, hereby elect to take the following assets of the Estate of Louetta Sutherland,~/k/a Louetta S.Brown,deceased,in kind: 1958 DeSoto Sedan $100.00 Life estate in and to:ALL that $10,000.00 certain lot or piece of ground situate in the Borough of Speers,County of Washington and State of Pennsylvania,being known and numbered as Lot Number Twenty-six (26)in the SPEERS FARM NO.1,as recorded in the Recorder's Office'of said Washington County in Plan Book Vol.3,page 32,and being bounded and described as follows:BEGINNING on the Southwesterly side of Lewis Avenue, at the dividing line between lots Nos.25 and 26 in said plan,which point is distant one hundred sixty-five (165)feet North 51&25' West,a distance of forty (40)feet to 'the dividing line between Lots Nos.26 and 27 in said plan;thence along said last mentioned dividing line,South 38°35'West,a distance of one hundred (100)feet to "B"Alley;thence along said Alley,South 51°25'East,a distance ·of forty (40)feet to the dividing line between Lots Nos.25 and 26 aforesaid; thence along said last mentioned dtviding line North 38°35'East,a distance of one hundred (100)feet to Lewis Avenue,at the place of beginning. .. WITNESS'~Y ha~d and seal this 22nd day of October, 1970. WITNESS: ~~, --- - - -----------, ", ForlI RCC-33 RESIDENT DECEDENT COMMONWEALTH OF PENNSYlVAN IA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF ) ~..............WA.$.l:IJNG.TQN . IMPORTANT:This return must be completed in detail and filed in dupl.icate,with will attached,with the' Register of Wills of the County where decedent 'resided;Return is due within one year after date of death,unless an extension is'granted by.the Secretary of Revenue.(Section 703 of .._t heJng~ri tllnce_.l1n!l.E.~tllte J'.ax A.c tor 1~91.) , .IN THE MATTER OF THE'ESTATE OF '}'. LOUETTA SUTHERlAND,a/k/a LOUETTA·s.AFFiDAVIT OF .......................................................................................................................".............................................................................EXECUTOR .'BROWN (State full name of decedent) Late of J~~.~.ht..~K:t:.q~;County ADMINISTRATOR ::,:.:-::~~::~~::::~:~~_:_-_-_}os, Jennie T·rich ........Exeeutor of the estate of the above-named decedent being duly sworn,deposeS and say S Decedent'cUed ...........s.~pt...e.ml.:>.e.x 1 (Month) ..........,19....:.6..9...,r testate ~eaving a last will,copy of which is hereto attached.,} (Day)(Year)L~M» Name and address of attorney or} other authorized representative to whom all correspondence should be . mailed. Woodward and13l:l§~J~.A:t:.:t:.Q:I:..P:.~.Y~l:lt:Ll:lW ... 7QI ..McKean ..Avenue,CharieroL,Pennsylva.nia .. That as such ~~~.~.~~.~.!.~deponent is familiar with the affairs of said estate and the property con- (!<:x",,,,lor·AdminiBlrawr)• stituting the assets thereof and their fair market value.. . That at the time of death there was no safe deposit box registered in decedent's individual name,or jointly with,or as agent or deputy of another,or in decedent's individual.name,with right of access by another as agent or deputy,with the exception of the following;- .'..."NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT RENTED A SAFE PEPOSIT BOX None THIS SAFE DEPOSIT BOX RENTEDINNAMEORNAMESOF RELATIONSHIP OF JOINT HOLDERS TO_DEC~DENT That the contents of said safe deposit box or boxes are itemized under Schedules of this return,with the exception of the following,for the reasons hereinafter set forth: That Schedule A attached hereto and made part hereof sets forth fullv and in"detail all the~ real property in the Commonwell,J.th o·f Pennsylvania of which decedent .died having an interest therein.It also sets forth the mortgage encumbrances upon each parcel of real property at the date of death,giving the amount still due at death,name of mortgagee,date,rate of interest,and book and page or record thereof.It also sets forth in the columns provided therefore the assessed valuation of each or said parcels,the estimated market value thereof as of date of death of decedent. That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property wheresover situated owned by the decedent at the time of death;all moneys lert by the decedent at the time of death,whether in decedent's immediate possession,standing to decedent's credit in banks of deposit,savings banks,tr~st companies,or other institQtions,whether individually,or in trust for any other person or persons giving also separately the accrued interest thereon,if any,down to the last interest day prior to decedent's death in the case of savings banks,and to the date of decedent'.s death in all other cases;all bonds,postal savings,treasury certificates or notes and other evidence of in- debtedness of the United States to the decedent;all obligations,whether by statute or agreement they are designated as tax free,of the United States,or any state,or political sUbdivisio~thereor,or of any foreign country,which are owned at the time of death;all wearing apparel,Jewelry,silverware,pic- tures,books,works of art,household furniture,horses,carriages,automobiles,boats,and any and all other personal chattels of Whatsoever kind or nature,left bydecedent,together with the fairly estimated market value thereof;all bonds and mortgal!;es held by decedent and of all claims due and owing decedent at the time of death,and all promissory notes or other instruments in writing for the payment or money of which decedent died possessed,of whatsoever nature,·with interest thereon,if any,giving the race value and estimated fair market value ·thereof,and if such estimated fair market value be less than the face value,it sets forth briefly the reasons for such depreciation·as to each item;all moneys payable to the estate from life insurance polici-es carried by decedent;all annuity and endowment contracts the proceeds of which were payable upon the death of the decedent;and all the corporate stocks and dividends due thereon and unpaid as of the date of death,bonds and a'ccrued interest thereon to the date of dece- dent's death and other investment securities owned by the decedent ~t the time of death,with the market value thereof at such time. "Il , In the case of securities of close or family corporations,the values reported are as far as possible substantiated by financial statements of the corporations,Showing the assets and liabilities thereof as of the'date of death.The schedule also sets forth the interest of decedent at the time of death in any co-partnership or business,and in support of the value of such interest there is annexed to said schedule,financial statements showing the assets and liabilities of said co-partnership or business. A copy of the co-partnership agreement,(if oral,a statement setting forth the nature of the agreement) together with a statement setting forth the character of the business,its location,and such other facts pertaining to the business as maybe pertinent to a fair and just appraisal of the decedent's interest therein must be submitted.,It should also set forth in itemized form,together with the fair market value thereof,any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contained therein and in the case of transfers ofproperty,real or personal,within two years of decedent's death,in contemplation of decedent's death,or intended to take effect in possession or enjoyment at or after death,said schedule sets forth the nature and value of such property,to whom transferred,the relationship of the transferees to the decedent,the proportionate share received by each transferee and all other facts of a pertinent nature regarding said transfers.In the case of transfers intended to take effect in possession or enjoyment at or after death,there is also attached ~o the schedule a co~y of the deed,trust agreement or other instrument creating the trust.Therl~is also set forth in said schedule a list of all property,real and personal,with its value,which passes at decedent's death by virtue of the exercise by decedent,either individually,orjointly with another,or any power of appoint- ment vested in decedent,either individually or jointly,by the Will,deed,or other instrument of another, with a copy of the instrument creating such power attached to the schedule. That Schedule D attached hereto and made part hereof sets forth the names and addresses of all persons beneficially interested in this estate at the time of decedent's death,the nature of their res- pective interests,their relationship,if any,to the decedent,together with the ages at the time of decedent's death of all minors,annuitants and beneficiaries for life under decedent's Will.It also contains a statement showing which of the beneficiaries named in the decedent's Will,if any,died prior to decedent,the dates of their death,their issue,and the relationship of such issue to the beneficiary. That Schedule E attached hereto and made a part hereof sets forth all property,real and per- sonal,owned by the decedent jointly with another or others,including intangible,standing in the name of the decedent and others,plus the date and place of record of instruments effecting the vestiture of real estate and the date of acquisition of personalty,plus the name,address and relationship,if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deductions claimed for and on behalf of this decedent's estate,including funeral expenses paid; family exemption,where applicable;costs of administration of this estate;counsel fees and fudiciary's commissions paid or to be paid;cost expended for burial trusts,tombstones or gravemarkers,and reli- gious services,in consequence of the death of the decedent;debts and claims owing and unpaid at time of..., death;taxes accrued charge.able for period prior to decedent's death (except.those allowed under Section 651 of the Inheritance and Estate Tax Act);together With a statement of collateral pledged for obliga- tions,if any.It is agreed that the fiduciary will present proof of said claimed obligations upon re- quest,that if the amount actually paid in settlement of any fee,commission or debt is less than the estimated amount claiming and allowed,that the same will be reported to the Register of Wills,and that the amount of tax assessed can be reassessed in accordance therewith. That the totals of the appropriate columns in Schedules "A","B", "C","E",and "F"as directed therein" have been carried forward and properly registered in the Summary. Subscribed and sworn to before me this ."""".""""" """"..""~~.~.~""""day of """.""9..~..~.?,~~E"""""",,..19 7..9.. ""~,..WAND.~~~~"·~·G..rN,NDTAR uOlle CHARt:.'·'..\Si:INGTON COUNTY ~CDi~i..-.;,.<..,....,~S AUGUST 19,1912 ....,f.!...~.,::~.".~..:."~.~.~,,J~_,..rf~~r-~fm~ ....~.~.~."..~.P.~,~E.~..""$..~.!?~.~..t..-',,....~.~.1.1~....'y'.~;r.P.:Qp., Pa .(Street Number) (City or Town and State) NOTE:Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None",and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business,that the data and statements required under the paragraph above relating to Schedule "B"are attached..Also make certain that column #1 in the "Summary"has been properly completed as above-directed. RCC-34,(1-64) ~OMMqNYlEALTHOF P,ENNSYLVANIA ,'DEPARTMENT OF REVENUE ..BUREAU OF CbUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY Real property in Pennsylvania,with statement of mortgage encumbrances upon each parcel at death of dece- dent.Where property held as joint tenant or tenancy by entireties,report on Schedule "E".Property held by the decedent as tenant in common with another or others,should be identified as to quantum of interest and the estimated value should be that of the decedent's interest only. The real property located In the Commonwealth of Pennsylvania should be described by lot and block number,street and street number,together wi th a general description of the property,with a reference to the record of the conveyance by which the decedent took title;If a farm state number of a· cres;also statement of mortgage encumbrances upon each parcel at death of decedent.Taxes,assessments,accrued Interest on mortgages,etc.,are to be listed on Schedule "F"and must not be deducted from this schedule. (1) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH (2) ESTIMATED MARKET VALUE (3) DEPARTMENT VALUATION CAUTION (Do not write In this space) ALL that certain lot or piece of ground situ in the Borough of Speers,County of Washingt n and State of Pennsylvania,being known and numbered as Lot Number Twenty-six (26)in th SPEERS FARM NO.1,as recorded in the Recorder's Office of said Washington County in Plan Book Vol.3,page 32,and being bounded and described as fcllows: BEGINNING on the Southwesterly side of Lewis Avenue,at the dividing line between lots Nos.25 and 26 in said plan,which point is distant one hundred sixty-five (165)feet North 51°25'West from the northerly line of State Street;thence along said Lewis Avenue,North 51°25'West,a distance of forty (40)feet to the dividing line between Lots Nos.26 and 27 in said plan;thence along said last mentioned dividing line, South 38°35'West,a distance of one hundred (100)feet to "B"Alley;thence along said Alley,South 51°25'East,a distance of forty (40)feet to the dividing line between Lots Nos.25 and 26 aforesaid; thence along said last mentioned dividing line North 38°35'East,a distance of one hundred (100)feet to Lewis Avenue,at the place of beginning. Insert this total opposite "real property",Schedule "A"in the X X X X X "As Reported"column on the last page of this return. $10,000.00 10,000.00 RCC-35 ,COMMONWEALTH OF PENNSYLVANIA T~SFER4INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY INSTRUCTIONS:This Schedule must disclose all tangible and intangible personal property owned individually by the decedent,at the time of his death.Property owned by the decedent jointly with another or others must be listed under Schedule "E".Intangible personal property,titled in the name of the decedent,but payable at death to another or others,including but not limited to P.O.D.U.S.Savings Bonds and tenta- tive trust accounts,must be listed,despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g.jewelry,wearing apparel,household goods,and furnishings,books,paintings,automobiles,boats,etc.),,; Intangible personal property,such as bonds,treasury certificates,cash on hand and in bank, stocks,mortgages,notes,together with accrued interest or dividends,salaries or wages,insurance pay- able to the estate or fiduciary in said capacity,partnership interests,interest in anyundistributed estate of or income from any property held in trust under the will or agreement of another,even though located outside of the State,at the time of death,should be listed in this schedule. Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION No.List and describe fully VALUE MARKET VALUE (Do not write in this space) ~'ffit'1.Two (2)Christmas Club Accounts at $80.00 ,/t5.0 0 Charleroi Federal Savings and Loan Association 1at2.Costume jewelry No value" 3.Chip diamond ring 10.00 r .004.1958 DeSoto Sedan 100.0Q •" " Insert this total opposite "Personal Property",Schedule "B"in X X the "As Reported"column on the last page of this return.$190.00 /90.66 RCC-36 GO~f1If'o~lI'EALTH OF PENNSYLVANIA .TIUNSl;1ER INHERITANCE TAX'. ~~SIDENT DECEDENT SCHEDULE "c" TRANSFEIlS (1)Did decedent,within two years ofdeath,make any transfer of any material part of his estate,without receiving a valuable and adequate consideration therefor?(Answer yes or no)No (2)Did decedent,within two years of death,transfer property from hi~~elf to himself and another or others (including a spouse)in joint ownership?(Answer yes or no)1.'10 (3)If the answer to (1)or (2)above is in the affirmative state: (a)Age of decedent at time of transfer _ (b)State of decedent's health at time of making the transfer.(Note 1). (c)Cause of decedent's death.(Note 1). (4)Did decedent,in his lifetime,make any transfer of property without receiving a valuable or adequate considerati0.n therefor which was to take effect in possession or enjoyment at or after his death? (Answer yes or no)__~N~O~__ (a)Was there any possibility that the property transferred might return to transferer or his estate or be subject to his power of disposition?(Answer yes or no)_ (b)What was the transferee's age at time of decedent's death?__ (5)Did decedent in "his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: (a)The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no)No (b)The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?(Answer yes or no)N_O _ (6)If the answer to (5)(b)above is in the affirmative,state whether the right was reserved in decedent alone or 0thers _ (7)Did decedent in his lifetime make a transfer,the consideration for which was transferee's promise to pay income to or for the benefit of care of transferor?(Answer yes or no)__~N~o~__ (8)Did decedent,at any time,transfer property,the beneficial enjoyment of which was sUbject to change, because of a reserved power to alter,amend,or revoke,orNwhich could revert to decedent under terms of transfer or by operation of law?(Answer yes or no)O _ (9)If the answer to (8)above is in the affirmative,was the power to alter,amend,or revoke the inter- est of the beneficiary reserved in the decedent alone or the decedent and others? (Answer yes or no)_ NOTE 1:The answers to these questions should be supported by affidavit by the attending physician as well as a copy of the death certificate. NOTE 2:If answer to any of the above questions is yes,set forth below a description of the property transferred,it's fair market value at date of death,dates of transfers and to whom transferred,with relationship of transferees to decedent,if any.Submit copy of any trust deed or instrument,if trans- fers are claimed to be non-taxable,also submit detailed statement of facts on which said claim is based. NOTE 3:List applicable property below in manner in which provided in Schedules A,B,or E. ITEM DESCRIPTION None MARKET VALUE (Estimated) None DEPT.VALUATION (Dept.Only) Insert this total opposite "Transfers",Schedule "C"in the "As Reported"column on the last page of this return.None ... .. •.C<lMMONWEttLTH OF PENNSYLVANIA TRKNSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY INSTRUCTIONS:This schedule must disclose all property,real and personal,owned by the decedent jointly with another or others,including intangibles,standing in the name of the decedent and others.List real estate first,as entireties,or joint tenants,giving brief description,as indicated under Schedule "A",plus the date and place of record of instrument effecting vestiture,but do not include entireties or out of state real estate value in estate valuation column.Personal property should be listed as in Schedule "B",plus date of acquisition,and the name,address and relationship (if any)of co-owners to the decedent. Description of Property,Date of Acquisition,Namel unit percentage Estate Address and Relationship of Co-Owners,and Place Value Share Valuation of Record of Instrument,where Real Estate.I DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's l. Savings Account #7643 at Charleroi Federal Savings and Loan Association established May 27,1957 -$1,167.88 in names of Louetta S,Brown or Jennie Trich 2. Checking account #294-4582 at Mellon National Bank and Trust Company, Charleroi office,in names of Louetta S.Brown or Jennie Trich $105.26 3. Savings account #64-17914 at Mellon National Bank and Trust Company, Charleroi office,in names of Louetta S.Brown or Jennie Trich -$230.05 Property Interest ~583.94~ ,.. 115.02//-5.0:; Insert this total opposite "Jointly Owned Property",Schedule "E"f7~/.~(.J in the "As Reported"column on the last page of this return.$751 59~=;o·'"-/'~_~_..;.·7....-.J ,.... 'RCC~37 :(1;2:-,63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES ( h BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step·children or DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARY ave an interest,vested,contingent or other-are,involved,set STATE YES IN ESTATE wise,in estate)forth this fact.)OR NO BIRTH - Carol Lee Sutherland MesplE Grandchild Yes Sui juris Specific ~f~v~~gn~:1~¥~~~fa. Kathem:Sutherland Bates Grandchild Yes .Suiiuris Sneci£ic -h~f,~.lalerR1i -FnrniA. Robert Stanley Sutherland Grandchild Yes Sui juris Specific !!-'VV l~.~:if1i OR.,~pecl.1:tc;11.1:e estateFlovdBrownHusbandYesSuiiurisit,.~a ~Rtatehe9.r~Wl.s A~enue '7~pe~fs,!!t..........."'.;IiPA'"A William E.11 "Sui iuris ~esl.du~i femal.~yermanSuthed.and Son Yes ;'n rAsa AClt-sa (now deceased -wife is ~~l.~~~ut:nerlana;11,.Ii IrAn sarA rRrn T.AA Sutherllnd Mesple,~.........."':TU ....~u... Bates and RobertStanleySutherland) o-,vv l'4UL \..11 l'l.rs (; Fresno California Deponent further says that all the above-named beneficiaries are living at this time except below: te NAME William E.Sutherland DATE OF DEATH RESIDENCE 8300 North First Street °fornia OF THE ESTATE OF ~IATIER OF THE APPRAISEMENT .,..;j '"d =:c...Cl>Cl>Il:l ...Il:l::s '"...-'"0.....::s ""dCl>Il:l .........-0 '""tj'"d Cl>.......g ~ ~ Lotot-a.::srt )--I "<: I::::r '(I):t-aP. "0H:0':CS:(1):1'1:rt ~ .,..;j ~~~ C1a'"'" (Executor·Administrator must complete "As Reported"column #1.) ~'"S"1b ......... Deceased IN THE t No../4J?7 Year 4.7 . LOUETTA SUTHERLAND,a/k/a LOUETTA S.BROWN . Will Administration Late of....130.J:()1:1gl:l.'?f:...S.peers... enc:~ ~>=:c en en ><n n?"?" ~>;:;: ..-::(1)::0 v;::::r (.) :.-?" :C%i n:-:.--- :t-I- :0>~en :......2:t-I:O ~ .:VI 0 \O:O.@-;:::: ':t-I ::s 0:0 0 --.:.(De:•.., :VI 0:0 (b -:\0 OO~:VI : :\0 : :t-I:0 :.. :\0:,p. :t-I . ~~-0~~~ :- ~'J W~.sh~~g~Ol1 .. :'::::v _---::-;........,Commonwealt~-o~~P~~sylva~i!}=:~t ;~~{~ t",-~.,.__.~,.·--I ",'~ REPti~+~'AND APPRAI~AL 'J-0 •;.--..""'-·'"1 -,---,............ C)"~~."=;"'" o ::~:...; =-0:=::;: 1><11 0 County of ~~-0~""'~ '-.'\~ ~~":. ~ \)q ~ .~ "'-0 -->.::..0 cr-.•tl '"Qo ct~~(b~~()...--:...2. :(}::I.C).~ O'Qc.. • DEDUCTIONS ALLOWED IN v'" THE SUM OF .2CZ99r?3 ,...:4.~2.:7 (APP({~DATE (;~1 ...·l9-1(jo7 STATEMENT OF DEBTS AND DEDUCTIONS .-"'... ESTATE OF Louetta Sutherland,LATE OF Borough of Speers a/k/a Louetta s.Brown O t b 28 1970 September 1,1969DATEOFFILINGAPPRAISEMENTcoer,OAT&:OF DEATH -=--:.-_ OFFICE OF TME REGISTER OF WILLS ... • AND AGENT OF TM&:COMMONWEALTH OF __W..:..:..;;:a~s~h;.::i:..::n::s;g;z,.;t=..;o=..;n=--COUNTY Form RCC-IO DATE 1969 Sept 4 NO.OF VOUCH~1Il NAM&:OF PAYEE Easton's Pharmacy REMARKS Balance due on prescription~$ AMOUNT 7 58 8 Russell Marino,R~gister Probate of will 19 00 10 Guy Rogers Witness trip on will 15 00 15 Mon-Va1ley Newspapers Legal advertisement 10 00 Washington County Reports Legal advertisement 14 00 29 Russell Marino,Register 2 short certificates 2 00 30 Bruno's Plumbing &Electric Balance due on paint 7 95 J.C.Penney Balance due 10 00 Flower shop Flowers 22 50 Oct.2 Dr.A.C.Dent Medical expense 181 00 6 Harold R.Toner Funeral expenses 1,353 00 4 1970Oct 22 Belle Vernon Post Office Jennie Trich Postage Executrix commission 4 80 509 50 Woodward and Bassi Attorneys'fee 509 50 Floyd Brown (Husband)Family exemption 1,000 00 Notary Public Russell Marino,Register Notarizations 14'1..(,t.ng 1.nventory,-t 1.rstandf1.na1 accoun~etc. 10 00 22 00 June 3 David P.Scholl Marker 265 00 \.I "..~v v TOTAL ($3,962 83) COMMONWEALTH OF PENNSYLVANIA COUNTY OF Washington J,,Jennie Trich -- --------'------------------------------- .....\ i...-'. 0..,.;0::;:: r -V :-1>(f) """""'-, .-'1\-". • RCC-B\(2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT Jennie Trich (Executor~ IN YOUR REPLY PLEA.E REFER TO 38-4-5 ..J In Re:Est a te of__L_o_u~e_t_t_a....,.S:.....u_t.:..:h.:..:e~r..;::la:......:....n...;.d_a:...!./....;k~/~a=--_ ____.....:.W~a::.::s:=.:h:.:::in~gt~o~n:._County - F He No.63-69-1009 De ar Mrs.Trich You are hereby notified that the.~Q~r.jgeJ~·n~a~l~--------------- appraisement in the estate of Louetta 3&Sutherland has been filed in the office of the Register of Wills qf Washington County on November 9 ,191.Q.Said appraisement reflects the following valuations: Re alEstate __---'--=l::.;O~,~0'F_100~.:...;;OO;,;....-------- Personal property ~1~9~O~.-O~O~------- ~._J::..:t::..:.._:H:.:::d:..!.._.."......"..~7~51::::.!.~5~9--- Total -=1::.;:0:..:l.:..;:9.::s:4=.lLo.5"-'9'----- As to such tax that is paid within three months from date of death,a five (5%)percent discount is allowable.As to any tax that remains unpaid after one year from date of death,interest at the rate of six (5%)percent per annum is charged. Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. Dat e ..::..N-=o..::..v..::.:em:::.b=-e:..:r:......2:e'.Lj=l~97!....O=------ DATE OF DEP.TH:September lL,1969 Note:This is not a bill. Signed Titie tv/eLy ,h,fi. W.,ll.Chaney,Chief _Appraiser .~"'j l "CC-39 (5-S8) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY C:state of Sutherland (Last Name) Louetta (First Name) a/k/a (Initial) E 9-1-69DATEOFDATH_-'--_-'--_FILE NO,63-69-1009 REPORT OF INHERITANCE TAX APPRAISER WashingtonI,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of _ Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at the values set forth opposite each itern in the last column to the right in Schedules "A","B","e",and "E". November 9,1970Dated:---"----=..::..--'.---.:.-<'----'-'---- REPORT OF THE REGISTER OF WILLS I,the undersigned duly elected Register of Wills in and for County,Pennsylvania,do respect- fully report that I have allowed deductions in the amounts claimed by deponent,except as to those items where a greater or lesser amount is set forth in the last column to the right in Schedule "F'"which greater or lesser amount represents the sum allowed as a deduction. Dated:_ REGISTER OF WILLS VALUE AS REAPPRAISED $-------+-- 10,941 59 $10,000 00 190 00 'T51 ')'j 10,941 59 VALUE AS REPORTED VALUE AS APPRAISED $10,00~100 190'00 INVENTORY Real Property (Schedule A) Personal Property (Schedule B) Transfers (Schedule C) Joint-Held Property (Schedule E) TOTAL GROSS ASSETS Less Debts and Deductions (SCHEDULE Fl CLEAR VALUE OF ESTATE Valuation of life estates or FOR USE OF REGISTER ONLY Taxon $~2% Taxon $~@Y Taxon $~5%Tax on $10% Tax on $15% Exemptions * Total Estate .....J, TOTAL TAX COMPUTATION OF TAX $-------+--- $-------4-- $-------+-- $-------+-- $--------1-- $l....-_ (*)As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. Less tax previously paid BALANCE Less 5%of tax if paid within 3 months after death :::::::::t==== BALANCE OF INHERITANCE TAX DUE $t= Add interest at rate of 6%from _____to $------ AMOUNT OF ESTATE TAX ASSESSED $------IL- Estate tax paid $--JL- BALANCE DUE $--------~~ Add interest at rate of 6%from t= ------tto-----$-------1 TOTAL TAX BALANCE $-----~PAID $....J FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason, same should be noted below,with short explanation. 1f' Will Administration !No . IN THE Year . , .... MATIER OF THE APPRAISEMENT OF THE ESTATE OF LOUETTA SUTHERLAND a/k/a Deceased Late of .....B.ELLE::.VERNON.. County of WA3HlliGTON.........-. Commonwealth of Pennsylvania REPORT AND APPRAISAL ~... Fonn RCC-2 .. '-UPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG,PENNA.J7 J27 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ..N.Qy.f?mp~r..9,..'.+:979).~. COUNTY !v.9.:.~.~.~P:&~.~.~.. FILE NO...??:~.?=~.??.:._ . Louetta Sutherland a/k/a Belle v'ernonWhereas,late of . in the County of ~~.~.~!.1~~.~~Commonwealth of Pennsylvania,having died on the rt.:r..~~day of $..~pt..~mb..~r.19 6.9..,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,~.~~.~.9..~~~y.,an appraIser duly appointed according to law, having been designated to make a fair and conscionable appraisement of the said estate,and to assess and fix the cash value of all annuities and life estates growing out of said estate,hereby file the following appraisement: I In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration of any estate for life or for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest. Description of Asset REALTY: ...... PERSONAL PROPERTY: Unit Values $ Appraisement Made for Inheritance Tax Purpoles 10,000 00 See Sl"her'l1l1 P."Hili JOINTLY HELD: ..;]+.1"1 190 00 See schedule liE"attached to appraisement '.TOTAL 751 59 --------------------------------------I-----H-------I----' I===============================H:::=======' Having been duly sworn according to law,I do hereby certify that the above appraisement is made in con- formity with law on this ~day of ~.~......~~...2(). ........W If?.~. ppraiser .WA$HJ.NGtI'ON.....County ...' RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ...I.py}!;'J;''l'A ~P.'l'f.l~I.:J.it.~~/~/?:. Deceased. Late of ....BELLE VER.NON.·. Date of Death,9~+.~.9.9 .. Appraisemei!t Docket Vol...J?,. Page,.4~5.No 9.?.~.9.2::~.9.9..9... ....Nov.9 70FzledtnRegzster's Office,19 . Amount of tax due,$.. DEPARIMENT OF REVENUE Received, Examined and Approved,. Wrote abo.llt Appra.isement, Appeal f,.om Appraisement,. Entered and charged,. "\ Petroleum \.,·\'Dn.~'.,I "0029 'LOCA~Tj"i5jrDISTRICT AilDrF.RTIFIcAtE t;Uh1BER ZA.DATE OF DEAfH-'-MONTH DAI 'EA~129 HOHR,\ January :J:20 A,M 7.AGE ,LA>','-,.,-',,"-,,-,-T"'-----'---T--''------'''-- ,~. DECEDENT PERSONAl. DATA i'f,,>~"\;';i:~J ~!>'''f;f,~i(;\;:'~lk'i' I~;,'_;','.,~(", CIITI"eA1.0'DEATH ," -:iTATE ITirNilMmf---------'STATi ll'CALlFORNIA-OEPARTMEI'fY OF PUBLIC HEALTH----'-'----,lrlA---=r·/AMECi'FDrcEAsEO--FlRST NAME lIb "!DOLE NAME Ie.LAST NAMEU' '"I SUTHElUAND:'~-Sf.~ILLI~C~O'O''AC':'g.:~~:"~:~,,~.DATI OF .11'" N~J~Wh 1te Penns 1vania Sept.26,1917 52_,='EA=RS.J..----1 8 NAMF ANU BIRrHPLACE OF FATHER ,,'",,'9.MAIDEN NAME AND BIRTHPLACE OF MOTHER I Sherman S.Sutherland .'.Penn.Louetta Stevena -Pennf!y1vanla~u:ciTiL[r,~OF WHAT COUNTRY 11 SOCIAL SECURITY NUMBER 12.IIARRIED.NEVER IIARRIED.WIDOWED 13.NAME OF SLJRV"--'V-IN-G:-7S-PO"--U-S-E-'-'F-w-"-E-,-EN-TE-R-M-"-DE-~-,,-.!t-;- DIVORCED (SPECIFYI ..__JJSA 1 -01.08'11 .Married Helen Herzer 14 LAST oc:.:'c=,U::;P::.A-T-IO-.N-----<f-1S:=:..~.u~.;.."".':::o,::::..::::_;,;.,,~·;;.,.:;'6-,LNA.=."",....O-'-LA--!~T-E-M-PL..:O:..:Y~IN;:..G;:'C":0;"M":PA;"N;:'Y-O-R-FI-RM------ifC"7"::',-cK"',"--N""D-cO=-=F INDUSTRY OR '=B:C'US""!.,--N""ES7S::----'------' THIS ~PAftO_~or ilBL¥i~fIO so runl Warehou eman 18 ·'1 Standard Oil Com an 'APPRO.'I MillE It;TERVAL SETWH', ONSET ANDDI'ATH 20 INFORMAt\T .' 20 'resno -.1 j'·.it ~;··~iT' CONDITIO/'S I>\NY WtllCH \DUE TO.OR AS A CONSEOUENtE OF G'M r'Sf TO IHE :"'MFOI CBI Arteriosolerosis~T!C~'iSE 'AI STAliNG ,------==:...:::.:.=-=::.:::-=.;:.;:=.:=.:=..:.;=~----....;.;------..,___~---------+_'--'-__I THE UN'DI"RL YING CAUSE IDUE TO.OR AS A CONSE~UENCE OF LAST \'-'7 Ie) 29 PART I.DEATH WAS CAUSED 6Y:ENTER ONLY ONE CAUSE PER LINE FOR A.:~~[D1m CAUSEReourrent Ce'rebral Hemorrhage {2A,SP'W,IIII""1 ENTOMO..[NI 221 DATE ()R CRrMI\TlqN Bur1_8::..::1::""-.0--..-+--=1::.--&--.J-O~--+:,.~~~~r.::::-i~~~~~::L-..+~r,.tJ.A,.­ 25.NAME OF PJNF..RAl DIRECTon t9R P£R:;ON ACTING~18UCHI 26.r"~o~[\\~T:i~~~~%o=o:l-~ Bo1oe Funeral Home,C1ov1a '''''''..1100:,I 18,PLACE OF DEATH--'NAME OF HOSPITAL OR OTHE/lIN,PATlENT FACILITY 18a.STREET ADDRESS-ISTREET AND NUMBER.on I.DCAm,,,,Iik ,',-,n"IT'"\I)PORATF.l'OIl,;,'.•:,14sPt:\It r YlS 1.'.'f1't","L!~O\~~;~o~~Ol)V-a_1_e_aQ-~.==n:..:t:....:H:::..O=B:&.:1=-·t=.;a::;.::l;.o',_.......;"""I8.=.~:=~~ol::,UN..,;:;:.T~.\Bara tow :~~,~_~",,,.,,,,.""",-,',-,"-,;;'-;-!iii~_.l~.~.-;~;T.:"'-' : 1 I CAUSE .OFt DEAT~, 'PLACE OFOEATi~,.• FUNERAL OlRECTdR,ANOJ .a ou ')oj , ~LOCAL C.REGISTRARI .r fJ)PHysiCIANS-.,pH CORONER'S <U:ERTIFICATIONCo USUAL'19.USUAL RESIOENCE---STREET ADDRESS '!!TRU;.,AIIO _mO~LOCAnQN;190,INSIDE em CORPORATE LIMITS •RESIDENCE '1 8 "'.ISPECIFY YES O~NOI~F m;,o('rU~.fO ,.__~OO N?.-.--!'1r ~y~treetQQ"l.)-"1,/,np -'HINsnTllnON '~T<R ,,19_CITY llR TOWN :19D COUNTY ..:19E.STATE ~RESI~ENCF.eriCA'I 'I I C 11r '11.4 AnN''''''Ni Pre ano I Freano ,a·orn ~-71-...I