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Home My WebLink AboutOC1970-0918 - ESTATE OF GYSEGEMOC7 J !n t4t Q!.um nf Q!.nmmnu 'has nf lIaaqiuglnu Q!.nuuty, Jtuuayluauia ®rpquua'QIl1urt lIitth;inu ESTATE OF No.63-70-0918 _________~A~L~B~E~R~T GYSEGEM,In the matter of the FIRST AND FINAL Account of JOHN E.GYSEGE~ DECEASED ____________--=E~X'_=ECUTOR ~E COURT,·SAMUE~~--- SCHEDULE OF DISTRIBUTION ADJUDICATION AND DECREE And now December Jj',19~,this matter having came on for hearing,audit and distributtion and testimony taken;upon due consideration thereof,the bal- ance for distribution in the hands of the Accountant is determined to be $11,072.24 and the account is accordingly confirmed;and it is ordered,adjudge,d and decreed that the said bal- ance be paid out by the Accountant in accordance with the schedule of distribution hereto (]ttached and made a part hereof,unless exceptions hereto,be filed sec.reg.or an appeal taken herefrom sec. leg. Balance per account 1 Credits per Audit Petition Advancements per Audit Petition $18,091.24 19.0C 18,072.24 7000.0C Ba lance Attorney _-----~_.......----~--------------I JANE G.CROSBY 3690.75 7,381.49 ALBERT GYSEGEM,JR.3690.7:3690.74 JOHN E.GYSEGEM 3690.71,NO BALANCE .\-i ,••~,,c ('-..~.1 ,- ~ 0.....~m :r z V>..... () i 0 0 .....9 .....c :::r ~ CD :J CD '" ;::t 0 .....3 w $ .....0 0 I = ............... ~ CD.., I\) 0 ~ =: ..........:r-CD =& ~.,~H; fo"t:: ,- • ---------"------~"-~~-."----------~~-~-..l J C!!llUtUtlluUt:eult4 llf J:euunyluuulu.f nn:lIun4iugtllu C!!lluuty. KNOW ALL MEN BY THESE PRESENTS:Whereas,at Washington,in the County aforesaid on the 18th.day of September Russell Marino A.D.1970 ,before me, ,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 Albert Gysegem late of The Borough of Charleroi in the County aforesaid,deceased, (a true copy whereof is to these presents annexed),was duly admitted to probate;and John E.Gysegem the Executor in said Will and Testament named,having appeared before me and taken and subscribed the oath of office pr,escribed by law; NOW,THEREFORE,I,Russell Marino ,Register as aforesaid,do grant these LETTERS TESTAMENTARY,unto the said John E.Gysegem committing unto Him the administration of all and singular the goods and chattels,rights and credits,which were of said deceased,and requiring Him to exhibit a true and perfect inventory thereof into the Register's Office,at Washington,within ninety days from the date hereof,and to r,ender 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 18th. day of September in the year of our Lord one thousand nine hundred and Seventy ~,.................................................................................:...,~.... Register ...\.. ~----~-'-...., ~~ !~::: :1-'~ 10'~ :(1)~!~ITl GtC/l~c:1"-It~Q »~-I tni~ITl .....iCD 0 ~":(1)"T1 alOQ :(1)~ IS :=.....~~~ ........ I)ALBERT GYSE GEM,of the Borough of Charleroi, -Washington County,Pennsylvania,'being of sound mind and memory do hereby make,publ~sh and 'declare this to be my Last Will and Testament,hereby revoking and making void any and all Wills by me at any time heretofore made. FIRST:I direct that all of my just debts and the expense of my funeral be,paid. I direct that all inheritance, succession and estate taxes assessed because of my ,death, whether the property or funds to which such taxes are attribut- able pass under this my will or not,be borne by the principal of my rr-osiduary estate and that my Executrix payor provide ......" fol.'t,·..,..i·~ayment,of such taxes dt s'u~h time or times and in such manner as she deems to be convenient. SECOND:I give,devise,and bequeath to my wl.fe,Eleanor Gysegem,one-half (1/2)of all of my bank accounts of 'every nature and kind which I hold in my name on the date of my death. THIRD:I give and bequeath the,sum of . Five Hundred and no/IOO ($500.00)Dollars to eachof'my following three grandchildren,Donna Panzo,Ernest Lee Gysegem, Charmel Gysegem,per stirpesi of my estate,real,personal or mixed,of whatsoever nature FOURTH:All the rest,residue and remainder I,, or wheresoever situate at the time of my death,I give,devise _____________________________...:...........J and bequeath in equal shares to my three children,Jane G. ., Crosby,.Albert Gysegem,~r.~and John E.Gysegem,share and share.a.like,per st.irpes.F~rther,I direct that my Executor collect all of my assets of my estate,both realty .and personalty,and sell the same at the best available price and distribute the proceeds as hereinabove set forth.With reference to my sou,Ernest Gysegem,I have already financially assisted him during my lifetime. FIFTH:I hereby nominate,constitute and appoint my son John E.Gysegem as Executor of this my Last Will and Testament.Should my said son,John E.,Gysegem, predecease me or for any reason whatsoever be unable to serve, then I nominate,constitute.and appoint my son,Ernest L. Gysegem,to serve as Executor in his stead.The personal representative above named or his substitute or suc,cessors shall not be required to enter bond or security in any jurisdiction in which he may serve. IN WITNESS WHEREOF,I have hereunto set my hand and seal to this my Last Will .and Testament,consisting of two :...\.I ~(2)typewritten pages,this . ;..&day of _··..;..,fr.~'.,;;,.;;/.'....;.:-_,-_',1968. ..,t_'.........'1:-"_"~:-.:.:...,._L_'__~t:_"<_,,_,_:~_,,,:_,?_-:(./_~,_<_,/_:,.I_·j._!(SEAL)~'-1../-,I-,:.'"-_--::-{/~....~ Albert 'Gysegem r-._-..;......-..............-.................tE2LL2A ......~.____.L_.....................-.__"'"'-_ -. I'';',' I ,I... Will and Testament,in the presence of us,who at his request,in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses: ., I I j(-,~ I, I \..d !I IJ I /00/1- IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA ORPHANS'COURT DIVISION ESTATE OF:) ) ALBERT GYSEGEM )NO. ) ) D.Keith Me1enyzer 63-70-918 January 6th.1971 TO LEGATEES,DEVISEES AND CREDITORS OF THE ABOVE ESTATE: , TO REGISTER OF WILLS AND CLERK OF THE ORPHANS'COURT OF WASHINGTON COUNTY: PRAECIPE FOR APPEARANCE TO:RUSSELL MARINO,Clerk of Orphan's Court I Enter my appearance for Eleanor Gysegem,the survivingIwidowoftheabovenameddecedent. 'I I ELECTION TO TAKE AGAINST WILL TO JOHN E.GYSEGEM,EXECUTOR OF LAST WILL AND TESTAMENT OF THE DECEDENT: 'I 'I;1 I!IIII YOU WILL PLEASE TAKE NOTICE that I,Eleanor Gysegem, I,widow of the said Albert Gysegem,deceased,do hereby elect to take against the will of the said decedent dated 20th day of November ,1968,as provided in Section 8 of the Wills Act of 1947,as amended,and request you to record and file this notice in accordance with the Act of Assembly in such case made and provided. ,I,I WITNESS my hand and seal this I I j I 11,I ilp II I' II III~ \,, ~l 'II .. )j day of December,1970 II I !, 1I I ii il r,I F,I !III,I :! -, 'I tI, I: 1,1 'j ,i i' !It, , " ,/ COMMONWEALTH OF PENNSYLVANIA ) )SS.:COUNTY OF WASHINGTON On this ~3~day of December,1970,before me,the subscriber,a Notary Public in and for the Commonwealth of Pennsylvania,and residing in Charleroi,Washington County, personally appeared the above named Eleanor Gysegem,widow of Albert Gysegem,deceased,and in due form of law acknowledged the said notice of her election to be her act and deed for the purposes therein mentioned,and desired that the same might be recorded as such. WITNESS my hand and notarial seal the day and year aforesaid. Notary Public [;~ms E.HAUl 'Notary Public.Ch,:lerai.V"ashington County My Commission Expires A e ~21 1~12. t~--,r IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENN- SYLVANIA Ie-("ATTDT ( ESTATE OF: ALBERT GYSEGEM CHARLEROI,PA.15022 ....-t~~ .~~ "1 ~ W~ .;.\?':~ r ~~V)Jc:i 0 :c:::0 ..r-1 ....9 I r-I?'.E QIu \J <U ~•0\-...~,tA3 ~0 ~:i4~.I ~"'QIQQI• /~-:E'"(~~!~~O'H liag--ctS f ~Ql~g{ i C1('"•,~h.~~l( f q,;J -.<AA 0 ~.l. (' ,~•-0 ~'Vi•~"'"It,~.:"~~\~~~~~l""~··"'·~1uC1I>-:.\" eo£:~£:'".....c:-C:'...) v 0 ....',c:ll.J1.;r.....~~'-~-c~~_.I :•.t~~1 ]~§.c ,...,-,..~ "~V)-+>,~1:3 ~c:r-Ic::st j ~r-1 QJ '-.Q..-~(.J J 1 -_I r;l :; -:I --..J fl s- ....., /)/i ...},("tor-I'.,,_/"r\..;,,....-~/."'J t...j ;I',)/"::....c. l.A..I I~ ~~l:>-:::z;V><---f7l:::-~-.::::#"*':1 c-)C)('J I'\J-I:.::)a5=:=0.....~t-:;t..J ..........-.,('")f7"',.....-v ..Q;J :::::J!D-0 -J:;,.-..,c::;- -,~ ') ATTORNEY AT LAW - • t l"")._~ L>._ ...r·-__ -0 1--C ..>-0) 411 WASHINGTON AVENUE .KEITH MELENYZER -:;;"'4-/ ELECTION TO TAKE AGAINST WILL :1 N '7 frf\ do' ~--...~ ~~~J:= ~1t~ \ <--.. I.,3-1 D -1/g l\ffibuntt (@f tExrrutnr ®r i\bmtutatrutnt ~tatt nf 'tuusyluauia } (Ltnuuty nf lIas4iugtnu ss: Personally before me,the undersigned authoritY",a N.otaI:¥Public in and for said County and State,appeared .IO.HN E..GYSEGEr-.1.who,being duly sworn according to law,deposes and says that he is the e~ecutor or administrator of the es- tate of ALBERI..__GYSE_GEM deceased,that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of ALBERl'__J~YSE_G~M., 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 a just appraise~ent ~f each item m~de by ~~~bove named Executor Administrator. Sworn and mbscrtbed before me thn ..../7.~....}~4J .fU~daY~f.Se te~mber.1 70 t/-J!?~........Executor-Ad istll r .................~. ADDITIONAL INSTRUCTIONS 1.An inventory must be filed within three months after appointment of personal ~epresentative. 2.A supplemental inventory must be filed within thirty days of discovery of additional assets. 3.1 Original and 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 :1fuututnry a.w l\ppraistuttutof the goods and chattels,rights and credits which were of ALBERT•.GySEGEM .late of t.b.e B9.;J;9.JJg.h-...Q.!.G.h-~;J;.l~~.9.j...s . Washington County,Pa.,taken and made in conformity with the.above affidavit. J Niagara Mohawk Power,300 shares @ $14.25 per share Allegheny Power,100 shares @ $20.375 Per share DOLLARS $4,27S 00 2,03,50 CENTS Equitab~e Gas Company,130 shares @ $29.00 per share Conso_~ida1lil!1Natural Gas,224 shares at $29.25 per share Standard Oil of New Jersey,30 shares at $66.25 per share Income Foundation,70 shares @ $6.66 per share Nuclear Corporation of America,200 shares @ $2.625 per share United Park City Mines,200 shares @ $2.375 per share Great Basins Petroleum,200 shares @ $3.175 per share Continental MaterialS Corporation,300 shares @ $1.875 per shc~e Electric Musical Industries,300 shares @ $4.25 per share 1957 Backard Coupe,"400"series 3,770 00 6,552 00 1,98,50 46<:20 52S 00 47S 00 62!00 56~50 1,27£00 (OO\:)~.:> 6)r,,'!l11l l.U 1iil ci ,DO DL ~' \)J I \--, ~~co CY~ \ ~"- ~ ~----- IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNSYLVANIA IN RE:THE ESTATE OF ALBERT GYSEGEM THE FIRST AND FINAL ACCOUNT OF JOHN E.GYSEGEM,EXECUTOR JOHN E.COSTELLO,Esquire Attorney at Law 418 Washington Avenue Charleroi,Pennsylvania 15022 -,p ., TIlE ACCOUNTANT IS CHARGED AS FOLLOWS: PRINCIPAL,REALTY INCOME,REALTY PRINCIPAL,PERSONALTY Consolidated Natural Gas Co. Niagara Mohawk Power Co. Equitable Gas Co. N~clear Corp.of America Allegheny Power Co. Standard Oil or New Jersey united Park City Mines Great Basins Petroleum Electrical Musical Industries Continental Materials Corp. Boston Foundation Fund 1957 Packard Coupe TOTAL None None $6299.88 4270.41 4091.62 522.23 1931.45 1942.76 473.74 691.98 ::1259;.95 565.10 692.30 1000.00 $23741.40· INCCME,PERSONALTY Dividend,Allegheny Power Co.$33.00 "Consolidated Ntl.Gas 105.28 "Standard Oil of N.J.216.00 II Boston Foundation Fund 11.20 II Niagara Mohawk 82.50 II Equitable Gas Company 71.50 TOTAL $519.48 THE ACCOUNTANT IS CHARGED: PRINCIPAL INCOME ... TOTAL .... $23,741.40 519.48 $24,260.88 12.75 3.00 5.00 :'1145.00 1145.00 THE ACCOUNTANT IS CREDITED AS FOLLOWS: Administrative Expenses Russell Marino,Register o£Wills, Probate &:Letters ••••••••$ Guy Rogers,deputy Register o£Wills, Probate Services ••••••••• Washington County Reports, Advertising Letters •••••• Daily Republican Advertising Letters •••••• Register o£Wills,Filing Inventoryo ••••• Karen Kuhn,Notary Fees •••••••••••_•••••• John E.Gysegem,Accountatns Commission•• John E.Costello,Attorney £ees •••••••••• Register o£Wills,additional Short Certi£icates. TOTAL $ PREFERRED DEBTS Eleanor Gysegem,Reimbursement £or Funeral expenses •••••••$ Eleanor Gysegem,Reimbursement £or Medical expenses •••••••$ TOTAL $ ORDINARY DEBTS Barbara Joyce Shoppes,£ood at £uneral ••$ RECAPITULATION ~CREDITS 31.50 20.00 14.00 2.00 2378.25 ./ 1625.00 125.00 1750.00 1060 05 Administration Expenses Pre£erred Debts Ordinary Debts TOTAL RECAPITULATION Charges Credits Net Less Inheritance Tax Net a£ter Inheritance Tax $2378.25 $1750.00 $106.05 $4234.30 $24,260.88 4,234.30 $20,026.58 $,1,935.34 $18,091,24 ·~ COMMONWEALni OF PENNSYLVANIA S5: COUNTY OF WASHINGTON Before me,the undersigned authority,appeared John E. Gysegem,Executor of the Last Will and Testament of Albert Gysegem,deceased who,being duly sworn,deposes and says that the fact set forth in the First and Final Account of John E. Gysegem are true and correct. Sworn and subscribed /lITh.before me,the ~day of,J!).u~1971. ~{Uryn/v2Ju~ .NOTARY PUBLIC CAROLE ANN REHULA,Not.sry Public Charleroi,Washington Co.,Pa. My Commission ExpirltS October 27,1975 ·.. .~ THE DAILV REPUBLICAN MONONGAHELA,PA. PROOF OF PUBLICATION In compliance with the Newspaper Advertising Act of May 16,1929 P.L.1784,Sec.3. paragraphs (3)and (25)' County of Washington I ss: State of Pennsylvania ( Personally appeared before me,a Notary Public in and for said county and state, J1r.~....A.E_..P~~;taJ:1j:.j.$.rho,being duly sworn,deposes and says:thaL__S..h~.is the Q.Q.Q~K~.~.p.~.r of The Monongahela Publishing Co.,a Pennsylvania corpora· tion,and its agent in this behalf:that the said company is the publisher of The Daily Republican,published daily except Saturday and Sunday,having its place of business at Monongahela,Washington County,Pennsylvania;that the said Daily Republican was established in the year of 1846;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 newspaper in its regular issues on.the following dates: ----LEG~L N~CE '-1 Letters te,t"mel"."on thl!eS' 1tateofALBEttT(iYSEGE~,,1 lateofChareroi.Wa"hmgtol'County.'deceased.havinr be,m gra:Jted by the Register of WadunJ'(ton County. notice is ht'r"by gIven to all per· 50ns indebt"1 to said estate to makeimmediatepayment,and to thosehavingclaimsagainstthesameto ~Jpresentthemwithoutdelayto: JOHN E.GYSEGEMExecutor3831BruceDr.,S.E., Warren,Ohio 44484 f JOHN E.COSTELLO,Esquire i Attorney t418WashingtonAve.,Charleroi,Pa 1.5022 SEPT.22,29 _.OCT.6L L",9.;.,70,--_==. .§.~p..t~m}Q.~:r.__.g.g.,.z:9.__.9-.mt.QQj~.QQ.~.!§.~~9.ZQ .........__....... __.__ES.TATE NO.TTGR:....__.Es.t.at.8 o.L...Alhe.r.t__..G;¥:S.8.g.em............ C.REID DOUGHERTY,Notary PullllG MONONGAHELA,WASHINGTON CO.,/lA, t My Commission expires July 29,1972 / that the affiant or the corporation in behalf of which ..she.--...----is acting is not inter· ested in the subject matter of said notice or advertising and that all of the allegations of this affidavit as to ~:~:4 ..~~~~~------..------. ilito ~:d ,:"""h~ c:~...~~ Washington County Reports· WashingtOD,Pennsylvania (PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION) PROOF OF PUBLICATION In compliance with the Newspaper Advertising Act of May 16,1929,P.L. 178~Sec.3,paragraphs (3)and (25). COUNTY OF WASHINGTON) STATE OF PENNSYLVANIA (SS. 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 official legal periodical for said Washington County,publis'hed weekly having its place of business at Washington,Washington County,Pennsylvania,and is act- ing as its agent in this behalf;that the said WASHINGTON COUNTY REPORTS was established on March 31,1920,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 adver- tisement 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: ..._s.~.p.t.~.m~.~r Z.4..J J.91Q . Estate Notices The Register of Wi1Is 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 hav- ing claims or demands to present t'hem for settlement to the Executors or Admin- istrators or their Attorneys. • •••••• • • ••••• • • • I(~YSEGE-M:ALBERT,D~~;.1.- Late of Charleroi,Washington Coun- ~~e~~ro~~'John E.Gysegem,3831 I Bruee Dr.,S.E.,Warren O.44484Attorney:John E.Costello,418 Wash-L••ington Ave.,Charleroi,Pa.15022 .........O.c.t.obe.I:'l.,8·,····.1.970 . that the affiant or the corporation in behalf of which he is acting is not interested in the subject matter of said noti.ce or advertising and thaI!?"f tl;)ea'leg~~'onofthisaffidavitastothetime,plary~haracte51f the pu 'ca ion a _pUe. f:::TLOJr.£tJ ..'t-/ Sw="..d ,ob"db'"bef""~'----'~ ......~~.~day of..Octoh7{,19¢.~O.~!frt",,";"'",cL.._~"';;;i:::;;::~ JOSEPHINE T.SCIAMA~NA Notary Public,Washington,Wiishin,ton Co. My Cemmission·Expilles July 1,1974 .". ;::--<'t;;3 -/0 -7/'t IN THE COURT OF COvtMON PLEAS OF WASHINGTON COUNTY,PENNA. ORPHANS'COURT DIVISION l IN RE:THE ESTATE OF ALBERT GYSEGEM .-.~'....~ ~: ~ <t :~':~~~~~;~"-'......-~.:::s.-",'.~ct\s..,-~'t!:~?O.....::::-S-.a Oll ""i::l.i>.,'.,."'"(~~'......~"'-.:.:t- C,>S ~j .._,\"'I:c ~F"..;;'."_~<.~rt?:'::: <0::;:>'~.~~.:'i~g-~~~~~:"~:-'":~::.:;.,. :::.w ~?i:?;~;:: :;~)c'~~~.~~'-.,)._,,,IiIll -.'J __~~~~.~::.~):~:~. (~L........::J,.3 ~...._~-:'10:}__.:::._~~.~."~;;;} ~~.-i; PHONE 463-5961 {£,--;642./~.t/~ .J COUNSELLOR AT L....w 416 WASHINGTON AVENUE CHARL.EROI,PA. THE FIRST AND FINAL ACCOUNT OF JOHN E.GYSEGEM EXECUTOR .~fl"~_l\1..~tl!,,,)~(W...._~b 9:1:J..tne ilJlinln(Itcfn,urfr ~[oa to rna OCelliu,t,,··JOnfirmatlf",.~~~ ..JOHN E.'fm'W'ff~L't!I -- , 0-«-l z;( ~~«~ ~u.J>o ~ ~, ~ I ~~ ~ ~ 'DKt:JS7-~_~3 b ~~'.._ '/ IN THE COURT OF COMMON PLEAS OF WASHINGTON COONTY,PENNSYLVANIA ORPHANS'COURT DIVISION ESTATE OF: No.63-70-918 ALBERT GYSEGEM DeceaSed WITHDRAWAL OF ELECTION 10 TAKE AGAINST THE WILL AND NOW,this ;l.~day o:f -?th~\-,1971,comes Eleanor ~segem,widow o:f Albert ~segem,deceased,and do hereby withdraw my election to take against the will which election was :filed under date o:f September 13,1970.Further I direct that my Attorney D.Keith Melenyzer withdraw his appearance :for me and his authority to act is revoked. I have been :fully appraised o:f my rights and the signi:f~ icance o:f my withdrawal and it is my intention to withdraw. INTENDING to be legally bound hereby,I have hereunto set my hand and seal this ;;r~day O:f2~,1971. ~~'SEALlELEANORE STATE OF OHIO ) COUNTY OF TRUMBULL)ss: Before me a nota'ry-publ'ic in and for said couhty,personally appeared the above named Eleanor Gysegem who;acknowledged that she did sign the foregoing instrument and that the same is her free act and deed. In Testimony whereof,I have hereunto affixed my name and official seal at Warren,Ohio,this 2nd day of November,1971 ~,~~BARBARA VWIN Notary Public,Trumbull County,Ohio My Commission Expires Sept.21,1974 STATE OF OHIO COUNTY OF ...., ··:55: •· Personally appeared before me,Eleanor Gysegem,who being duly sworn according to law deposes and says that the foregoing is her act and deed. WITNESS my hand and official seal this _________,1971. ____day of NOTARY PUBLIC ~ ,\ z<l'IX«~ IXLU>o, 0.«-' , IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNAo ORPHANS'COURT DIVISION ESTATE OF.:. ALBERT GYSEGEM, Deceased NOo 63-70-918 WITHDRAWAL OF ELECTION 1'0 ~KE AGAINST THE WILL .JOHN E.COSTELLO COUNSELLOR AT LAW 418 WASHINGTON AVENUE CHARLEROI.PA. PHONE 483-5961 .~ ., ~lt):tq.r O!nurt nf O!nmmnu l~f1.run nf lIunqiugtnu (@rpquun ~O!uurt minintnu O!nuuty i,\. i Es,ta;t~of--i'---1~L..:.:....l/~=--.L---"'"'----f\---7I':::;::'~--~-(No.---------------- Enter_----'-_--L__-f\-appearance for -+~..;c.---.::=--------=---~~=-...i~~:::::===::-- N.B.-Counsel shall,by separate pa ,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. ~r::J 1-+:= '"~~~~~~I-~-0 ll::0:J $.t r;:.«~ ~~'C~~~ ~~ .6 PETITION SU R AU DIT IN THE ORPHANS'COURT OF WASHINGTON COUNTY Testate Form J Estate of ~~~~;'.~~Y..~.~~.~~_.._._-.----.-. _.Deceased No _.__..'·~~_~~~.-_.._..:_·_..~~._~_... .,John E.GysegemFlduclary_. Date of Date of Decedent's deatK :.A~g.~~~~.-?i ~9.7Q _Grant of Letters ~~P.~~~~~.~..J..~.L ..~.9.?9.. This is the r.~~.~~~.4 ~~~.~account filed in this estate If there have been former accounts filed':in this estate,list file number or number and term . None Election to take Under or~ixIxtwill.(cross out one) Date Election Place of; Filed Record ..........•.........._ _ . Name of surviving spouse N~.~~~.~._.GY..~~g.~~_.__~;--.-.__..____ . List issue,where material: Note that.by paper dated January 6,1971,an Election to take against the.'Wi~l wa.s filed;,bU~was withdrawn by~paper dated November 2,1971. Did decedent marry after execution of will?(indicate)'M.No.Any children born after execution of will?{indicate} Yes.No.If answer yes,name them ~~.~.:____.__._.. --__-----_.._--__--..---------.._------------.---------------_----_.-------_----___--__-------__---------_._---_-------_-_-_.._.-""--------------_--- Legatees Relationship Interest Fiduciary,if deceased or not sui juris Donna Panzo Ernest Lee Gysegem Jane G.Crosby Albert Gysegem,Jr. John Gysegem granddaughter grandson daughter son son $500.00 500.00 1/3/residue 1/3 residue 1/3 residue 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.bUt If any exception give cause.:. Fi Ie copy of Notice and date of mailing . No .).Is estate subject to the filing of a Federal Estate Tax Return?. Actual payment made on Pennsylvania Transfer Inheritance Tax.Amount $.}.~.~~.~.~.?~. If the Wi.lLmakesany.portion of estate subject to a life-estate,give name and birth date of life tenant . \..'. ....~~.~~p.p.~~.C?.~~~~. Give Names and addresses of all unpaid creditors who a re legally entitled to notice,tog-ether 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: None ~ °'1 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: Regist~~~:~:f Wills '.:filing account. C~role ~.Rehula,Notary :fee Total additional credits (Subtract) Balance for.-distribution -' $.~.~,.Q?.~.~.~~. None $.-.~.~'-~?~.~.?~. $18.00 1.;00 19.00$. $18 072.24......,. If balance for distribution is not in cash,list each item held in kind,giving appraised Value (or distribution Value); All cash '- i!"77JiJ"IlIIIi\1..-W":.~~''''''~8I'''''·P_!''li'''.."",_",_""_"".",,__..__...g;I"'~F""""''''''''''T'"'''''''''''''''''''''''-'''''·7~'''~''''Gr-'''~'''''''''''''_ii .._e_... , If F "E 'I'·d b P ,.,I f R d'Not claimed "','ami y xemptlon c alme y etltlon,give pace 0 ecor , "",.,.,..""",..,..,.~,..",'.'"""""",'.'" If F "E t"I'd t d't 'I'h'db'f CI'Not claimedamiyxempIonIScalmeaauI ,give name,re atlons Ip an aSls or aim:.""""" . List any advancement or distribution on account that has been made,and nature and amount of same: $500.00 to Donna Panzo $500.00 to Ernest Lee Gysegem $2,000.00 to Jane G.Crosby $2,000.00 to Albert Gysegem,Jr. $2,000.00 to John E.Gysegem 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: Balance equally divided among Jane G.Crosby,Albert Gysegem,Jr.and John E.Gysegem COUNTY OF WASHINGTON,SS: COMMONWEALTH OF PENNSYLVANIA. The above named Fiduciary or representative thereof, being duly,,,,,~~~~~........,,,,,,,,,,,,,.doth depose and say that the facts set forth in the foregoing petition are true to the best of..."..~,~~.."".."",,__..knowledge and belief, "..."~~~~~"...""""........,,,,,to and subscribed before me this.__"V'~day of,.,+jt-;~~Y-'-~ Signatu·re of Officer,......'f'<.'IT'T"-"""'- Title of Officer CA O'J.E.ANN..~J;Ij~~!.!':l~~~~Y..~~..!~. Charleroi.Washington Co.,Pa, Office expires ~y..~~~!~~i.~~.~~~!~?~..?~!~~~~.~~:.~?~~. And your petitioner will ever pray,etc. ~ No .f/£.4J~../..1..1.[) Estate of._._.~~~!::~.~._-~¥._~~~~~..._._._.._.... -,,. Deceased Fiduciary....:!.~_~~..~.!...~:?~9.~~._._..._._._._.__ 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:paragraph 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 litem,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.<?r an attest copy of Will. 6.Copy of i'nventory 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. John E.Cos~ello............-- --..--_-.._----..--..-.-_---_. Attorney ~2 \' J- \' »• Febxuarv 29"1972 Y«o;Albol"~Gyoeg<;ttn 31~_v.all~f!o!d Avenue Chn%1ezooi o FonDs,lvan:1a D30S'~~so Q100£3LlS ~~ 1bic t'1ill advise you th~~~~n8t Cout of \'1.aOhiDet.on C¢7.an'ty \7111 conduc~tile!udi~1n the estate of your late bueband,Albe.:t Gysegoo,on the 20th ooy of r·1n8cb, 1972 at 1:30 o'clock P.M.YOU'ha~-ptevicualy boen tw:niohed t'Jltb a copy of the ncccunt by ,son,JOhn Gyaegea,tbo 81tecutos og tho estate,Gnd hav·the matter rev1ot1ed £cz you tboX'oughlyo . t'Jil1O~n you axe not xequuoo to ~proGent at tho Qudit c you ma,do 00 ODd oppeaz U Ycn\cbOOOGo You ~y ap~08'poroc1UI11y Oll:bV CCU!Wolo Wo thank you tor ).lour:conoiderat1on and attoQ~iQ1Ao John Eo COO~ol10 JEC:car ""' ) IN THE COURT OF COMMON PLEAS OF WASIDNGTON COUNTY,PENNP. ORPHANS'COURT DNISION J \I INRE: Estate of ALBERT GYSEGEM, Deceased. ( ) ( ) ( ) ( No.918 of 1970 :!z«>oJ>-UI ZZIIIII. ~BEFORE: I-CIziUI~APPEARANCES:~iiiI-UI Q oJ«§ Q;TIME: :I:I::l'I HEARING ON AUDIT The Honorable P.VINCENT MARINO,Judge of the said Court. JOHN E.COSTELiDO,Esq.,of Charleroi,Pa., representing the Accountant. Monday,March 20,1972,at 1:30 P.M.,EST vi~THE COURT:Number 918 of 1970,the estate of Albert ~o~Gysegem,deceased.The Executor is John E.Gysegem and the l-ll:5 attorney is John E.Costello.Mr.Costello?u oJ«u MJ:{.COSTELLO:If Your Honor please,this is the estate of ii:...o Albert Gysegem.We know of no debts which have not been paid. There had been an election filed by the widow to take against the Will.However,if Your Honor please,this has been withdrawn ane I have the acknowledged withdrawal executed by the widow which we pres ent at this time with the closing papers. THE COURT:Do you have all the relevant papers? , MR.COSTELLO:I have all the relevant papers prepared,Your 2 HOrD r,and ready to be submitted herewith. THE COURT: decedent's estate? THE COURT: Is there anyone els e in Court interested in this (NO RESPONSE) The audit of this account is ordered closed by :!:z0(>...I>-UlZ ZIIID.. ZoI-elZ iUl0( ~ the Court. ( AUDIT CLOSED) , i ~u iI-UI Q ...I0( ~Q:I., X.."III vi lI:IIIl-ll:o~t::.'::'con~~i~,~t:lt l-ll: :10 01 :",$-~".'4r C''u ,U ..J...w ......,......,J,..........-.;~ ...I0( Uk:II.o c '~_..,.r...J...._~........_-_'3f_,""-~-~." ·"...-•~,." IN THE COURT OF COMMON PLEAS ORPHAN'S COURT -AUDIT DIVISION WASHINGTON COUNTY,PENNSYLVANIA J RE:ESTATE OF ALBERT GYSEGEM No.63-70-0918 Now comes all surviving heirs of the above decedent pursuant to this Court's inquiry of August 19,1988,and states as follows: 1.Eleanor Gysegem,decedent's surviving spouse who died September 8, 1981,withdrew her election to take against decedent's will on November 2, 1971,said election having been filed January 6,1971; 2.We as surviving heirs understand that we must consent to this withdraw to legally effectuate the same insofaras it had been filed after a six month period of Eleanor Gysegem's initial decision to take against Albert Gysegem's will; 3.We as surviving heirs do hereby voluntarily give our consent to Eleanor Gysegem's petition to withdraw her election to take against decedent's will: 4.We as surviving heirs give said consent knowing that it is our free will to do so and knowing that by doing so our shares in decedent's estate could be reduced; 5.Albert Gysegem's estate was distributed to us according to the terms of his last will and testament; 6.The civil litigation to which the Court speaks involved the actions of Ernest Gysegem,our now deceased brother.This civil action was withdrawn prior to October,1973 when Ernest Gysegem died. ... / DATE DATE //-/5-?J~ d«~~-a,v~_r:!~~;fANE ELEANOR GYSEG~R y -; This document was completed by Attorney Thomas P.Gysegem of Harren,Ohio who is a duly registered Attorney in the State of Ohio,grandson of decedent, and who affirms to this Court that to the best of his knowledge the facts contained herein are true and signatures affixed heron are genuine. Z::~~~v Attorney-at-Law 160 High Street,N.W. Warren,Ohio 44481 (216)841-0426 ~--------------------------- £5Jr;lc cJc/1M-&-y..:qulJt /2/~?OLJIJIV~/lb.t:Y-7t:J -tJt;/r Chrmc;./&yJej'':-!JL JY4.7 my UV.5/~"d;tyI~ oC &:nCff-&/5~c::ua!y'{z?/Ja0~/-h--oC /~,L,{ar/JJc/~rcaf;.coud my ;Jr4/1L-6~k J~y-,/~5;Jr//2fr or /90?5~G /rC/5 h/U /~ (/t7r /970 0/2-o~aec/~/Jr /~LCl/O//~'p /~4ft-///' ~/oC r,1a/-YO?/,~r rceo~c/C5'7fT/fyi70 si:J?/ki I/Jdcak--//d P/?CC.5¥./J~ca<d '~k ;/esrcJ~--/k;r /#~~dyrr/M~. -»/)~ ~~ ;PRESENT RECEIPT WHEN LIFTING INSTRUMENT 11 025 Washington,Pa.,./.-::::.U.::-...7/.19 . REC:I;EDf}:·····;t:·:d~~~~d:~i;;~~,~7~~~···················P.P.7;d;],!,.,.h~d.4p:,L,J1~o.....,.../{J(!ll....to 1><_,dod in the Recorder's Office of Washington County,Pe a.Parties named below.£.'\ Fees .....•.••$.P...~/l...zi :al/._1.--<4!-7/~-:~~. State Tax $1"::~;:t'-4:/..~:VL.4;~::f.(k/((;(.~~ Certificate and Seal $........................../J Registration Fee •.$_. Satisfaction ••••••$•..••.. Total • . • • •••$••::::~••4 7 .- JOHN D.WOODWARD Recorder Of Deeds State Realty Tax•.$.~:::::.. -~------~~-~~~----........-.._-_......_-----....._--.I 9911 Washington,pa.~_,-+f..,.,I,,....._--I,1911 OFFIC;r=o CLERK OF ORPHANS'COURT DIVISION of Orphans'Court Division For·_~-=-_-=--_~_,,--__---:~,_..,.,......_~9fl(W~ Clerk of Orphans'Court per__~4Jn.-State,etc.•.•$====== Total ••,__•$~I .5 0 County ••••••;{,50 I',;;~e::...::---.;=--__~--,=-_=--~Do"ars ~~2L.~~_._~.~~_~~__ NO.63-70-918 IN BE: ESTATE OF ALBERT GYSEGEM, DEC'D E~CTI(}J TO TA~AGAINST \-JILL BY ErE ANOB GYSEGEM,WI DOV!, PIli D--Elec •dated 12/23/70 TA:\~N :'0 ~ECO~D -.:.~,S O?F'ICr: !09 ~SCORDING:JA~UA1 11,1971 ELECTION FILED:JAN.6,1971 Atty:D.Keith Melenyzer Clk:FKH <> No.63 ·'71 N~28 / 19/ I~" December 8, ESTATE OF \Julia Lee DATE J a Duar'f ;H,l.t)'ll ATTORNEY 1.1·...",un.~...lVUl;JJi CLERK _~ ~2 .._,'..... RCC-4S (5-65) ~J-l6 -7/1 ) COMMONWEALTH OF PENNSYLVANIA Rf'CfFl'VIE'O DEPARTMENT OF REVENUE COU,~:~~~t.11iJ 'O~ HARRISBURG .·L,DL LEe ~'/O,tiS SEP 3 3 la3 !PM '10 NOTE:TO BE SUBMITTED IN TRIPLICATE Pennsylvania Department of Revenue Bureau of County Collections 26 S~4th Street Harrisburg,Pennsylvania Dear Sir: Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report:' NAME OF REPORTING FINANCIAL INSTITUTION PITTSntJFGH NATIONA!.BANK e CHflPT·Tt'PQT oFFlc;e ADDRESS CharlAroi,Pa.15022 ACCOUNT NO.OF JOINT, TRUST OR INVESTMENT DEPOSIT_(~S;.;::av.;.,;1n~gB:.!.)---=:002;.:.;:.:8:.::::33::..:7~_ NAMES ON ACCOUNTORINVESTMENT Albert Gysegem or John Gysegem DATE OF DEATH .:=::-::-,8;l..-.",,=2)il-="f.'+O~--------------_-- SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR ---:lJlC.:lohw·.u.n~Gy!.,,'t.Wae;u;:ie.s<JemUt.-_ ADDRESS __-=3~8.:::;31=--=B.=.ru=.;c:.;:e;...D:;.:r:":':.L,....:f,.:.:lar::.:.:re:::.n:.z.J....:O::::h=i.=.o---=::!h=4h::t::8:::::3~_ TITLE #':/Jf/ ISl RELATIONSHIP TO DECEDENT SonDATEDEPOSITORINVESTMEN·-=T-..;;;;...;;.:::..------------- WAS ESTABLISHED oII.l3lllo::-:.II16:w.:..6~l__""""7'"_ BALANCE,INCLUDING INTEREST I. 380.40 "2DUE,AT DATE OF DEATH $_""""'-~...;....;;..;;:~_..J::~~_-:..-.....;..;;.::...-_~/::../---~t..Secy. \,ARREN,OHIO 44483 ...:........~... OFFiCiAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SU BJ ECT TO ADMINISTRATION Date:September 16,1970 County \{ashington County File No.Jj'-/o;-.3 Bureau File No.C;3"-10 -f /'? We have received notice that,}ox1bXr~IlnKXt.XHXIUtll'}Q1XXXXXXXXXXXYXX~XXX!XXXIXXXnYXYXXXXX on August 25 19..1Q..,you came into ownership of certain property through Xii9K~HMNfI.X~1i:OC ~Y~~iiXX~~transfer from.DmX ALBEaT tYSEGE);,deceaoed. TO:JOHN GYSECEM 3831 naUCE DRIVE RCC-134 (1-69) COMMONWEAL TH OF PENNSYLVANIA ~DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable and the liability for the payment of the inheritance tax due is imposed upon you,as transferee. .The p.ro.perty on.which tax is hereby assessed consists of:Jt.Savings Account H0028337:l held in the PITTSnURGIi NATIONAL DA~1\,CHARLEROI OFFICE,CHARLEROI,PENNSYLV NIA. In the name:J or A.LBERT GYSEGE1-!or JOHN GYSEGEM.Opened,11....16...61.Balance as of date of death.$31BX $380.40. appraised by the Commonwealth,as of the date of death,at $__3_8_0_'_,,4_,0_'_ 50 %of this amount is taxable at the rate of 6 % ORIGINAL ASSESSMENT AMENDED ASSESSMENT DATE OF.ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE $190.20----==..::...;~=-- 11.41 $--------- -I D If you pay the above amount within three (3)months of the datNof dea~of the d,<tfdent,or on or before ott"....19 you may deduct a discount of 5%of the amount of tax due,or ______"lil _ D This tax became delinquent,fifteen (lS)months after the date of death and,in addition to the tax,statutory interest at the rate of 6%of the tax per annum is also due as of *_ 19__in the amount of *If the tax is not paid by the above date additional interest is due at the rate of 6%per annum until paid /O./Y ASSESSED BY:_ (Agent for the Commonwealth) TOTAL AMOUNT DU E $ APPRAISED BY:(JJ -4°C~~.-'!.,( (Inheritance Tax Apprai r) -11.41 $============ INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to: /R.ro c?l .$'/O.?y ots:/7/() To insure proper credit to your account thiS Official Notice must accompany your payment.Mail or bring it to: If you have already paid this tax to an executor,administrator",attor~ey or other personal representative of the decedent for forwarding to the Commonwealth,list below ·tlie·date paid,name and address of the person to whom you made payment,their official title and the amount.~.I Date Paid Name and Address of Payee Official Title Amount Paid ~ Under certain circumstances,if,after the date of death of the decedent,you personally paid funeral expenses or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended I by you may qualify as deductions against the gross value of the property in the computation of tax due.If any such expenditures meet all of the three following tests,it is recommended that you itemize the payments below, execute the affidavit,and return this notice.The Register of Wills will examine the debts claimed and allow those which he determines to be proper.The tax will then be recomputed and you will receive an amended assessment of tax. THE THREE TESTS WHICH MUST BE MET ARE THAT: 1 -You were personally legally responsible for these debts,and 2-You actually paid these debts out of the account or property described above and can furnish proof of such payment,if required,and 3 -These same debts are not also claimed,for tax purposes,by an executor,administrator or other personal representative of the decedent handling the administration of the general estate of the decedent or any other transferee. SCHEDULE OF DEBTS Date Paid Name of Payee Description of Obligation Amount Paid TOTAL $ (attach separate sheet if requ ired) COMMONWEALTH OF PENNSYLVANIA) COUNTY Of _ SS: I,hereby certify that the foregoing is a just and true statement of funeral expenses and other debts of the decedent,,for which I was legally responsible and which I did payout of the property herein taxed.I further certify,that to the best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance tax purposes. SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19__" REPORT OF REGISTER OF WILLS Signature of Taxpayer I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I have allowed deductions listed above in the total amount of $--------0 Date of Approval:_ Register of Wills , Fonn RCC-2 •'"' COMMONWEALTH OF PENNSYLVANIA DATE .......s..e.P..t.e.m.b..e.r........~.s...,......I ..Q7..Q .... DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX .u ••••••••W~..~.h.i..:!1.gt...Q.n............u •••••••••••••••• ~COUNTYBUREAUOFCOUNTYCOLLECTIONS.APPRAISEMENT FILE N.63-70-918HARRISBURG.PENNA.17127 o ...................................................u................u •••••••••••••••••••••••••••• Whereas,.........................A.l.:b..e..r.:t.....q.y.$..e..g~mL ....................................u ........................late of ..........u ....................C.ba..r..l.e.r.QJ......................................... in the County of ..............................Wa.s.hingt.o.n.............................................................Commonwealth of Pennsylvania,having died on the .................................Z.5.....gh..........................................day of ..............A~g1J.s.:t........................................19....7.0,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; I Therefore,I,....................W.•.R.......Chane.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 fbc the cash value of all annuities and life estates growing out of said estate,hereby file the following appraisement: 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. Unit Apprai.ementDe.crlption of A..et Value.Made for Inheritance Tax Purpo.e. $ JT.HELD:!, ! J1:.Savin~s Account #0028337 held in the , PITTSBURGH NATIONAL BANK.CHARLEROI OFFICE,CHARLERO PENNSYLVANIA.In the names of ALBERT GYSEGEM or .TOHN lTY "r •ll_lh_hl 'R~1 ~n r p :u:n f' ~ date of death.$380.40.(One-half taxable)190 20 Total 190 20 , form~;v~~hb;:::~h~Sw<>rJl~Z:~a~o~~~~~~iS:;;~~ Appr~:·····.2····=~i·••;··•••.•:•••••••••••••...·•••••••••••••••••••..••••••••••••.....;~:~..6-,.....""~I J11\Sl.fI:NQ1'QN .County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ALBERT GYSEGEH Deceased. Late of CHARLEROI Date of Death August 25,1970J••••••••••••••••••••••••••••••••••••••..••••••••••••••••••••••••••••• Appraisemel!t Docket Vol..38J••••••••••••••••••••••••••••••••••••••••••••••••••••• Page,.lQl~3.No 6.3.~.7'O.~.9.l8 . Filed in Register's Office,.5ept .2.5.,19 .70 Amount of tax due,$. DEPARTMENT OF REVENUE Received, Examined and Approved,. Wrote abo.ut Appraisement, Appeal t,.om Appraisement,. Entered and charged,. # <. ~ RCC-43 (5-65) "COMMONWEAL:TH .OP PENNSYLVA~IA B~~~~/VE0 DEPARTMENT OF REVENUE '~OUNTY COLflf H-ARRISBURG l-nONS SfP 3 3 43 PH '70 j NOTE:TO BE SUBMITTED IN TRIPLICATE Pennsylvania Department of Revenue Bureau of County Collections 26 S.4th Street Harrisburg,Pennsylvania ,) ,1J1) i.'~IV'}I Deor Sir: Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING FINANCIAL INSTITUTION PITTSBURGH NATIOUAL B.A.lJK-CHARLmOI OFFICE DATE OF DEATH _-:----~8-;;:::2"""$;:;;J..7u.;:O~------------ SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR t4rs.Jane Crosby----------------- ADDRESS __4_2_9_San_t_B_R_oS_B_R_d_._I:_A_X'_C_ad_i_a_,_0_1&_.if'_orn_ia_9_1_00_6__--- RELATIONSHIP TO DECEDENT_~--..,;;;.D,;;;;;;aug~h..:.;te;:;r----------- DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED 1l_..._1_6.._6_1 ~------- BALANCE,INCLUDING INTERESr-380 40 J .J-f/o/l.,./l DUE,AT DATE OF DEATH $•~-=7(//o<.C/ COMMONWEAL TH OF PENNSYLVANIA DEPAR'iMENT OF KEVENUE BUREAU OF COUNTY CS~LECTIONS I~HERITANCE TAX ,-'>{ISION .--,,"'...... OFFICIAL Nl f,cr'uf<INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ,ASSETS NOT SUBJECT TO ADMINISTRATION ;0 _~-'c....~~""""'~""""iioiiOiiiiii~~;;!;;;;;;;;;;iiiiiiiiiiii~~~=::::::=-;:::S::-·=-~~ Date:__S_e.....p_te_n_lb_e_r-"'1;;...;6'-'•.......-1;..;;;9~1__0 1 County __t1._a_o_h_i--,Ill;ut_o.=...n~_ c,-mty F I:.:'No ---::..3=--.Jfl::---~/_C>--.;.-Y-_-_...3_ ~3 -26'-P~ 91\JD5ARCADIA,CALiFOR~TA V.ftS.JAN):(..Q~,...;~ 429 SA~rrA RC~A j,ChJ) Bureau Fde No . ...................""v~V'~~mir ....v ....'..,~.-··XXXXXXXXXXXXXWehavereceivednoticethat,~tr~WK ~~~~.XXXXXXXXXXXXX on AuGt,nt 2S 19 ·~.:.1.0u carre into ownership of certain property through JGl;jlitM~~~~';Z~~~t.trt-.-,sf'or from t ALBERT GYSECElj,deceased. TO: Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable and the liability for tl,e payment of the Inheritance tax due is imposed upon you,as transferee. The propert~n which tax is here_by assessed consists of:Jt.Savin{.)O AccountU0028.l4lio 1Ju'iAA . in ~Jic PY'fTSBURCI1 t1A?ICtlAt BANK,CHARLEROI OFFICE,CHARlEROI ..PENNSnVMttl\n :in tho ·'~!lt.1CO or AOOERY GYSBCEM or MP.5.JArt"E CROSBY.OpooQd,11..16-61. Bo1on~c 00 01 &ato of death,8rtbbDX ~3S0.40. oppral')ed by the Commonwealth,as of the dote of death at $__3_8_0 4...;0 _ :()"~of this amount is taxable at the rate of 6 % ORIGINAL ASSESSMENT DATE or ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DE:::IS NET TAXABLE AMOUN T $190.7,0---------- AMENDED ASSESSMENT $-------- AMOUNT OF TAX DUE ['If you pay the above amount within three (3)months of the date of death of the decedent.or on or before -.l!C7.25 10 --1_"_you may deduct 0 discount of )'of the amO ..1t oj 'ax due.or .57 --~-------- L This tox became delinquenr,fifteen (1))"onth5 after the date of death and,lr 'ddltion ;,)the tax,statutory Interest at the rate of 6%of the taxperannumisalsodueasoi+_ 19 _,_in the amount of 11.41$TOTAL AMOUNT DUE $======o :t!a~,_</ASSESSED BY,_ {Inheritance Tax APP~(Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS *1£the tax is not paid by the above date additional Interest is due at the rate of 6(10 per annum until paiC: APPRAISED BY: r1 ./ ,,~'S'~/,7'"/ / ",'--./'"./-'/,.(----(~,,' ~(',.:,///"/(".//~K Make checl<:.or money orders p,,~,.J .,},To insure proper credit to your account thiS Official Notice must accompany your payment.Mai I or bring it to: '~h The.COMMONWEALTH COURT HOUSE 1'·.'lL~·r.:rJGJON,PENNA.15301 Fonn RCC-2 DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARKISBURG.PENNA.17 127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ~.~.~'??~E.§'.~.?..?..~ COUNTY ~y~.~.?.~.~&.~.~..~. FILE NO §.~..::::.7...Q.:..~.!...~. Whereas,Alb.e.r.t G.Ys..ege.m late of C.har1.e.roi . in the County of Wa.shingt..o.n Commonwealth of Pennsylvania,having died on the ~.S.t.b day of A~.g:q.~.t.19..7.0 ,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,.w..~..R.~C..ha..:n~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: 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. JT.HELD: Description of Asset Jt.Savin~s Account #0028345.held in the Pittsburgh National Bank,Charleroi Office, Charleroi,Pennsylvania.In the names of ALBERT GYSEGEM or MRS.JANE CROSBY.Ouened 11-16-61.Balance as of date of death.$380.40. (One-half taxable) Total Unit Values $ Appraisement Made for Inheritance Tax Purposes 190 20 190 20 W'ASHINGTON County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of, ALBERT GYSEGEH Deceased. Late of .CHARLEROI . Date of Death,....AMg'P,..~.t...7.:5..,.1970..................................... Appraisemei!t Docket Vol.38,. Page,1.Q4.~J No §.;3,.~7..Q.~.~1~L . Filed in Register's Office,..Oc.t.o.b.e.r...719..7'O.. Amount of tax due,$. DEPARTMENT OF REVENUE Received, Examined and Approved,. Wrote abo.!lt Appraisement,.. Appeal j1'om Appraisement,. Entered and charged,. { '" .. Form RCC-33 " RESIDENT DECEDENT \~VVI 'l-'3 .., COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF John E.Gysegem IMPORTANT:This return must be completed in detail and filed in duplicate,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 the Inheritance and Estate Tax Act of 1961.).=-=~=-..;=~-----------------::~~~::i~~~;~~::~ATE.OF~_.::}~ ::.:o:~=::~::~"::_::::-_::::}'" ............................;r.<?~~~..!~¥~.~..~.~.~. Administrator of the estate of the above-named decedent being duly sworn,depose .Eueutor and say Decedent dJed !\~g!1.§1::??. (Month) Name and address of attorney or} other authorized representative to whom all correspondence should be mailed. .........,19........7...9..,5 testate leaving a last will,copy of which is hereto attached.} (Hay)(Year)L intestate John E.Costello,Esq•....41'S"····Washing-t-·Ofi····Averi'iEi·_. ..Charleroi,"'Pennsylvania··15022····....·..·......·....··..···....··.... That as such ~~~9.~~.Q~deponent is familiar with the affairs of said estate and the property con- (ExeclJtor-Administrator) 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 deI>uty,with the exception of the following:- NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT r~a .t:)anK 6c.L'rUSl;~o.A~ber't Gysegem or lHusband and WJ.£ Charleroi Office Eleanor Gvseqem e That the contents of said safe deposi t box or boxes are itemized under Schedules None of'this return,with the exception of'the following,f'or the reasons hereinafter set forth: That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property in the Commonwealth of 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 of'record thereof.It also sets forth in the columns provided therefore the assessed valuation of each of 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 left 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,trust companies,or other institutions,whether individually,or in trust f'or 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 s~vings bank~,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'f'ree,of the United States,or any state,or political subdivision thereof,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 by decedent,together with the fairly estimated market value thereof;all bonds and mortga~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 of money of which decedent died possessed,of whatsoever nature,with interest thereon,if any,giving the face 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 accrued interest thereon to the date of dece- dent's death and other investment securities owned by the decedent at the time of'death,with the market value thereof at such time. In the case of'securities of'close or f'amily corporations,the values reported.are as f'ar as possible substantiated.by f'inancial statements of'the corporations,showing the assets and liabilities thereof'as of'the date of'death.The schedule also sets f'orth 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,f'inancial statements showing the assets and liabilities of'said co-partnership or business. A copy of the co-partnership agreement,(if oral,a statement setting f'orth the nature of'the agreement) together with a statement setting f'orth the character of the business,its location,and such other f'acts pertaining to the business as may be pertinent to a f'air and just appraisal of'the decedent's interest therein must be submitted.It should aJ so set f'orth in itemized f'orm,together with the f'air market value thereof',any other propert¥owned or bequeathed by the decedent at the time of'death. The Schedule C attached hereto and made part hereof'sets f'orth a true answer to each inquiry contained therein and in the case of'transf'ers of'property,real or personal,within two years of'decedent's death,in contemplation of decedent's death,or intended to take ef'fect in possession or enjoyment at or af'ter death,said schedule sets f'orth the nature and value of'such property,to whom transf'erred,the relationship of'the transf'erees to the decedent,the proportionate share received by each transf'eree and all other f'acts of a pertinent nature regarding said transf'ers.In the case of'transf'ers intended to take ef'f'ect in possession or enjoyment at or af'ter death,there is also attached to the schedule a co~y of'the deed,trust agreement or other instrument creating the trust.Ther,~is aiso set f'orth in said schedule a list of'all property,real and personal,with its value,which pa8ses at decedent's death by virtue of'the exercise by decedent,either individua~ly,or Jointly 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 f'orth the names and addresses of all persons benef'icially 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 benef'iciaries f'or lif'e under decedent's Will.It also contains a statement showing which of the benef'iciaries 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 benef'iciary. That Schedule E attached hereto and made a part hereof'sets f'orth all property,real and per- sonal,owned by th~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 ef'f'ecting.·the v'estiture 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 de·tail all debts and deductions claimed f'or and on behalf'of'this decedent's estate,including funeral expenses paid; f'amilyexemption,where applicable;costs of'administration of'this estate;counsel f'ees and fudiciary's commissions paid or to be paid;cost expended f'or burial trusts,tombstones or gravemarkers,and reli- gious services,in consequence of'the death of'the decedent;debts and claims owing and Irnpaid at time of' death;taxes accrued chargeable f'or 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 f'or obliga- tions,if'any.It is agreed that the f'iduciary will present proof'of'said claimed obligations upon re- quest,that if'the amount actually paid in settlement of'any f'ee,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 f'orward and properly registered in the Summary. ~:~i~~)~..:g..~..·'Gd~~ ..3.83.1 Bt'.g.c.e D..:t.i.y.e...,.g.~~. (Street Number) Warren Ohio 444~....................................................................................................................................... (City or Town and State) Subscribed and sworn to before me this /....i!...~.. September,70...........................................................day of ,19 . ••...•........•.•................~~.........................•••. ~k?~...r..~.~~'pr~'~.t~.'Ii....'~..Q~~~,-•d..J}lf ';'j< 1a;'-'.~.'. NOTE:Bef'ore signingaf'f'idavit make sure all blank spaces in the af'f'idavit and schedules annexed are f'illed in with details or the word "N~ne",and in case the assets include rare and unlisted securities, securities of close or f'amily 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) COMMONWEALTH OF PENNSYL't'ANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY 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 bid 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 Commo['lwealth of Pennsylvania should be (1 )(2)(3)/ described by lot and block number,street and street number,together wi th DEPARTMENTageneraldescriptionoftheproperty,with a reference to the record of the ASSESSED VALUE VALUATIONconveyancebywhichthedecedenttooktitle;if a farm state number of a.FOR YEAR OF ESTIMATED CAUTIONcres;also'statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not writeofdecedent.Taxes,assessments,accrued Interest on mortgages,etc.,are DEATH In th Is space)to be listed on Schedule "F"and must not be deducted from this schedule. NONE ,.' ~l]J;~.'~1"'>": •l/'<.'.•. 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. RCC'-35 COMMONWEALTH DF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "n" 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 propertJ,such as bonds,treasury certificates,cash on hand and in bank, stocks,mortgages,notes,together with Rccrued 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 No. ITEM List and describe fillly UNIT VALUE ESTIMATED MARKET VALUE DEPARTMENT VALUATION (Do not write in this space) 1. 2. 3. 4 •. 5. 6. 7. B. 9. 10. 11. 12. ~iagara Mohawk Power,300 shares $14.2~$4,275.00 ~llegheny Power,100 shares $20.3~2 $2,037.50 ~quitable Gas Company,130 shares $29.0($3,770.00 C8~~~~~Natural Gas,224 $29.2 $6,552.00 Standard Oil or New Jersey,30 shares $69~8~~5$1,9B7.50 Income Foundation,70 shares $6.66 $466.20 ~uclear Corporation or America,290 $2.65 $525.00 ~nited Park City Mines,200 shares $2.~~~$475.00 Great Basins Petroleum,200 shares $3017~$625.00 Continental Materials Corporation,300 shaJes$1.f75 $562.50 ~lectric Musical Industries,300 shares $4.25 $1,275.00 1957 Packard Coupe,"400"series $1.000.00 TOTAL $23,550.70 If,~Jj5(jo ~/°.3f)·SO ~'710.0 0 "'~i 66tJ.o 0~'qg·Q.6 0 (/of f:J~.(;J 0 ..sa$.Oo ;1 '1S·06 b;J6.i>6 Sb?...56 /:;l ?s'.00 I If 060-00 ~556·70 Insert this total opposite "Personal Property",Schedule "B"in the "As Reported"column on the last page of this return. x X ,;)3 S-SO,?t>Ol ~$-:5'-cJ.';>0f, RCC.-36 COMMONWEALTH OF PENNSYLVANIA TRANS}~~INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "c" TRA.NSFErtS (1)Did decedent,within two years of death,make any transfer of any material part of his estate,without receiving a valuable and adequate consideration therefor?(Answer yes or no)110 (2)Did decedent,within two years of death,transfer property from himself to himself and another or others (including a spouse)in joint ownership?(Answer yes or no)yes (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 heal th at time of making the transfer.(Note 1).Good (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 consideration therefor which was to take effect in possession or enjoyment at or after his death? (Answer yes or no)__~Il~O=-_ (a)Was there any possibility that the property transferred might return ~cfransferer 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)---'11"""0!:<-_ (b)The right to designate the persons who shall possess or enjoy the property transferred or income therefr.om?(Answer yes or no)110 (6)If the answer to (5)(b)above is in the affirmative,state whether the right was reserved in decedent alone or others Not applicable (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)110 (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,or which could revert to decedent under terms of transfer or by operation of law?(Answer yes or no)Il_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)~Il~O~_ 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 MARKET VALUE (Es timated)DEPT.VALUATION (Dept.Only) Note that these bal1k accounts referred to OIl Schedule E were all ill Ilame of decedellt until August 10,1970,wpell his wife's Ilame (Eleallor Gysegem)was added. Insert this total opposite "Transfers",Schedule "C"in the "As Reported"column on the last page of this return. •RCC-Sa COMMONWEALTH oy PENNSYLVANIA rRANSFER·INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY INSTRUCTIOl'iS: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,Name I unit Address and Relationship of Co-Owners,and Place I Value of Record of Instrument,where Real Estate.! percentage Estate Share Valuation DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest Charleroi Federal Savings &Loan /00 1<>Acct.#5737 ~1..15-3tAmount$4,125.36 (savings)1 -58l$~2062.68'\ 1st National Bank (Checking) Check No.~~ 0492 /oo~~}~(cy Acct.No.02-00975-7-06 Amount $1,874.69 1 ~$937.35 \ Charleroi Federal Savings &Loan 0610Account#19029 I ~$G410.611 J C;.;?tl/~~eI'Amount $6,821.24 1 Insert this total opposite "Jointly Owned Property",Schedule "E" in the "As Reported"column on the last page of this return. '. RCC-37·(12-63) COMHONWEALTH ,OF PENNSYYLANIA TRAi(SFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES BENEFICIARIES AND ADDRESS£S RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARYaveaninterest,vested,contingent or other are involved,set STATE YES IN ESTATE wise,in estate)forth this fact.)OR NO BIRTH Jane G.Crosby Dauahter ves Aug.7.192 1/3 'Doc.';,:Ino 429 Santa Rosa Road . Arcad1a,Ca11forn1a Albert Gysegem,Jr.Son yes,~une 15,19~4 1/3 Residue 409 1 Lynd Ave. ArCa01a,~a~1Iorn1a John E.Gysegem Son yea ~an.31,193(1/3 Residue ;;Sts;;S~Bruce Dr.S.E,• Warren,Ohio ·." Eleanor Gvseaem Widow UA~A pri}.16.189-R.o:l1"l1<- 314 Fallowfield~iAve.Adeemed·,,....... Charleroi,Pa. Donna Panzo pranddaughter yes Feb.11,19 2$500.00 K.1).R'J. .Charleroi.Pa. Ernest Le~..Qy$egem Grandson ves ~ay 30,194 )~I:iOO ()() R.D.#1 •-(.\ Charleroi,Pa. _.......· '.. ·.I"' ( h Deponent further says that all the above-named beneficiaries are liVing at this time except below: NAME DATE OF DEATH RESIDENCE NO EXCEPT\OONS OF THE ESTATE OF ~IATIER OF THE APPRAISEMENT I'Will Administration !No. P."THE Year .. (Executor-Administrator must complete "As Reported"column #1.) C1 "'"'3 "'t:l ::0 "1 "1 ('l)('l) 0 ~"1 e:..'":::l '"'"'"0 "'"'3 .....:::l "'t:l('l)e:.."1 ~"1 0XIi>'t:l~"'t:l ('l)cr-"1 "1 ~0 ~'t:l tr1 ('l)"1 '"........'<:~....('l) Albert Gysegem Deceased Late of Charleroi . COllnn'of .Washington... Commonwealth of Pennsylvania REPORT AND APPRAISAL enc:::~ :::->::0Wenen-< ?"?-?-n ~>:::: "'ltd "00 f.:OJ.~liIHS'tj\ S111/.t,:10 \/'=1 I i:;!f)':' Jollb;~r~:C?~te,~~~~Esq. Attorney for"E'state . \418 Washington Ave.fbha~il~';'oi~!Pa"'!l 1~022. .i.JU Ur.~ -Ee-Ee-{n-Ee~-Ee :>;r. tJ~~C1:t-V..."-'2. ::l('::c.. , 'z---0>::s'"10::0('l)---"'::l .....0''-'...(;c... "-' -Ee -Ee -Ee:N' ~~I'"...~~UI (.)-1 1I1:00 :.. :Q\i...t:U1 0 -Ee -Ee -{n:(\):. :\0 : :'-. :\0 : :~: :~::.:'~L .' ~,..~.' ~.; t r''.-.I _,1\"-I ~, Form RC C·lO OFFICE OF THE REGISTER OF WILLS WashingtonOF..:....COUNTY AND AGENT OF THE COMMONWIiiALTH .:~',(~.'f6.T~TEMENT OF DEBTS i :\,.•,';AND DEDUCTIONS DEDUCTIONS ALLOWED IN THE SUM OF ..,.''$JI~CZZOQ. DAT~OVED La.:t27~7.() v~M7/t~ Register of Wills,Age.1 j ESTATE OF _A_l_b_e_r_t__G.::c.y_s_e....;g:;..e_m LATE OF _-:B=.:::o.::r..::o:..:u:::.igL:h=-..::o=f:..-=Ch=a=.:r=1~e:.:r::...::o:::.:1=-·_ October 1970 August 25,1970DATEOFFILINGAPPRAISEMENT---"::.-DATIi OF DEATH __.;;...:.~_---'=:....:....L-.....:...:...:....:.._ DATE NO.OF NAME OF PAYEE REMARKS AMOUNTVOUCH""..... I 1.:tvElmvzer Funeral Home funeral service 1625 00 2.Dr.U~A.DeRienzo.M.D.medical care.last illness 125 00 3.Barbara Joyce Shoppe food service,funeral dinre.:'"106 bo 4.Washington County Reports advertising letters testa-14 bo advertising letters J.I£I::U '-"'J.) 505.The Daily Republican testa-12 .....'C,u ""'J.y ~O6.Register of Wills,Washingt n probate &short certificat es 31. 7.Guv Rodaers Washinaton Co.Drobate services ?O bo 8.John E.Gysegem accountants commission 1177.[so ,9.John E.Costello,Esq.attorney's fees 1177 50 10.Reqister of Wills filinq inventory .~100 11.Karen Kuhn Notary fees 5.pO I i, I TOTAL ~4297 bo COMMONWEALTH OF PENNSYLVANIA } COUNTY OF Washington sa: I,John E.GYsegem,Executor HEREBY CERTIFY,THAT.TO THE BeaT OF MY KNOWLI!;DGE AND BELIEF,THI!;FOREGOING IS A JUST AND TRU E STATEMENT OF DEBTS.FUNERAL EXPENSES AND EXPENSES 01"' ADMINISTRATION SUBMITTED TO THE ESTATE OF Albert;;Gys~egem ljECEASED'AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES.3.~ 11.-u-~_(L.S.) SWORN ANQ SUBSCRIBED BEFORE ME THIS DAY 0fI'Octooer 70~~- "~,p'.MI l\l""'l1lton ~ .~.......~&."\ClI'.11.1,,.,,'.~l\ RCC-81 (2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT .John E.Gysegem (Executor~) IN YOUR REPLY PLEAD&: REFER TO 38-104-3 J In Re:Est a te of A...:;l;:.;.b~e...:;r:....:t~G..J!y:....:s:....:e....sg2...e;.::m=---_ _____....:.V;.;;la;.:;s..:..;h:;:;;in~giol.t:...;o;.:;n~County -File No.63-70-918 Dear Mr.C-ysegem: You are hereby notified that the~o_r_i~g~in_a_1 __ appraisement in the estate of A~l~b_e~r~t~G~y_s_e~g~e=m~__ has been filed in the office of the Register of Wills qf Washjngton County on October 27 ,19 70.Said appraisement reflects the following valuations: Real Estate _ Personal Property ~2~3~,~5~5~0~.~7~0~__ TEOO6.~",""",J~t.........:H.::.e""'1....d__....1o!:;'2-#-18~2::...110.0.~2:...t.9 _ Total --3!.:::6:..t.,..L37..L.:1:!::.'.L<9'"""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 (8%)percent per annum is charged. Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. Dat e 0.:.....c:-t:....:o:..;b....:.e..::,r.--:2...:..7"....:.1:;;.9~7.:....0~_ DATE OF DEi,TH:August 25,:.L~ Note:This is not a bill. Signed h R.~+ Title W.R.Chaney,Chidf Appraiser ··CC-39 (!;;l6Bl :> CO#-.MONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY estate of Gysegem (Last Name) Albert (First Name) DATE OF DEATH 8-25-70 (Initial) FILE NO.63-70-918 REPORT OF INHERITANCE TAX APPRAISER INHERITANCE T Dated:October 27,1970 I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of W_a_s_h_J.n_"_g:::::...-w_n _ 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 item in the last column to the right in Schedules "A","B","C",and "E". REPORT OF THE REGISTER OF WILLS I,the undersigned duly elected Register of Wills in and for Washington 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 er lesser amount represents the sum allowed as a deduction. Dated:_0_c_t_o_b_e_r_27..;,..;,::.-1_9-..7_0._ 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 F) CLEAR VALUE OF ESTATE VALUE AS REPORTED VALUE AS APPRAISED $23,550 ~$23~55~ VALUE AS REAPPRAISED $-------+-- Valuation of life estates or FOR USE OF REGISTER ONLY Tax on $------...........--.....,.,.-r-+............- Tax on $-----.--..--:..--~4--~ Tax on $---------+--- Tax on $---------4--- Tax on $---------4--- Exemptions=========t=== Total Estate ---4__ TOTAL TAX 10% 15% * COMPUTATION OF TAX $ $---:1::.;.•1.-<.9,-==;2:::1:LlJ.+~C)10:::......- $--------+-- $--------+-- $--------1--- $1.-_ (*)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 $~ Add interest a\~ate of 6%from $-----JL AMOUNT OF ESTATE TAX ASSESSED $------IL- Estate tax paid $-----Jl- BALANCE DUE $----IL- Add interest at rate of 6%from t= -------I.to-----$---------<, TOTAL TAX BALANCE $-----~ PAID $.....1 FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason, same should be noted below,with short explanation. ,.,.....': Will !.,.No.Administration IN THE Year . MATTER OF THE APPRAISEMENT OF THE ESTATE OF ....~m ..Gts~-!.. Deceased "' ,. Late of . County of CHA.~Ql.. ..'1ASH:'WCro:;. Commonwealth of Pennsylvania REPORT AND APPRAISAL Fonn RCC-2 DEI!ART~~T OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG.PENNA.17 127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ,QG.t.obep 27.,1.970.. COUNTY via.$.hingt.on . FILE NO 9..J.::::.7.Q.=9..~?. Whereas..Alhert .Gys.egem :~..=~late of Char-leroi . in the County of 1;f.~l3..htngt..Qn Commonwealth of Pennsylvania.having died on the ?.5.:t:-.D day of A:wnJP..t.197.0.seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore.I W•.R Chan@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 sh val e f 11 an T d l"f t te t f .d t t h r b fil th f II wi g a e t·ca u 0 a nUl les an I e es a s growmg ou 0 sal es a e.e e y e e 0 0 n ppralsem n 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 transferinheritancetaxesatthelawfulcollateralrateonanysuchfutureinterest. Unit AppraisementDescriptionofAlletValuesMadeforInharitanceTaxPurpo.es $ - Personal Propert:y: See schedule "B"attached to appraisement 23,550 70 Jt.Held: S<><>. 1 <>lIRlI ..,~.j....,.,"'""r1 +n 12,821 29 TOTAT 36,371 99 . Having been duly sworn according to law.I do hereby certify that the above appraisement is made in con-I formity with law on this ...............;{..7.~...dayOf ........~..................................~~...W.o.....~.. :Appraiser ..........................................................................................................-..................................................... 4J~r and Street) ...........................,Penna............................................................. (Post Olllee) ,~--._--_..-~ .J"J\$H:r:~rm.J County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ALBERT GYSEGEH Deceased. Late of ......GHARLEROI . Date of Death,··8-25-70······..· ·.. Appraisemel!t Docket Vol.,.3..$. Page,l.Q4.~':.J No 6.3:~~7.~91$.. Filed in Register's Office,O'c.t.!t 27.J9 7.Q Amount of tax due,$. DEPARTMENT OF REVENUE Received, Examined and Approved,.. Wrote abo.ut Appra.isement, Appeal f1'om Appraisement,. Entered and charged,. ,.. ! " COMMONWEAL Tti OF FfNl'lSYU At~iA DEPARTMENT OF I\EVENUE BUREAU OF COUNTY CalL E'CTIONS• ,."I l.I\,...i-'I lur,j-'.I~ANU LUN:>tN r TO TRANSF ~R SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT J DATE 9-22-70----APPLlCATlf~:MUST BE FILED n,J TR!PlICATE) TO THE PENNSYl VAr~IA DEPMH MEN;OF REVENUE: Applic:Jliof!i<;hereby rnad?>f"f COllS(~':t to the transfer of the followinq securities of a Pennsylvania Corporation or a t~cti(jil(Jl DO'1klng /\ssoci(l1ion located in Pennsylvania: (at~~_~~~res __(h \_Stan~ar~Oil_o~N~w_.,=,~rs~y (c)_C_Q_!9I_M_O_n _ (NOTE:In dt:~criblfllJ secuniies enter in (0),ab CNe,either the number of shores of stock or the face amount of registered bonds,in (~j,ihc narpc aT th;;issuing company and in (c)the closs of stock or the stated interest rate and maturity datE',)f re'jislered bonds.) ISSUED m~_,and hovlny (l TOTAL MARKET VALUE OF Ll,_9_8_7--'e_S__0 _ (Do~e ) as of the date of death ,)f the dpcedent,__~_:l~~~~G.Y~~_~M ,on Aug.25,1910 (N"me of Decedent)(Date of death) (Pnsr Oifice) The securi ties ure regi stereo as follows:__~J.~~t_~~e_ge~_ (County)(State) (Nome or na",es in which certificates are registered) xjoU(iti(ixR1a)tltiLJQ~n~,,_GYS~g.e.~u__;38,3!BJ.".\1CtL~_J--.S.E.Warrel4-0bjo 444M EXECUTOR)(N,,:ne)(Address) NAME OF APPLICANT .Jgbn &._--.eoatollo AttOgRov.~or 8stnto COUNTY FILE NUMBER __~~.:70-9_~~__ADDf?ESS OF APPLlCAN~18 ~J'1gtOl'l A~Claaxl0goi,l 1" BUREAU FILE NUMBER Same SIGNATURE OF APPllCANT_~~;~L~~~·/--'/'-- NOTICE:IF YOU FAIL TO PROPERL Y FIL.L IN ANY PORTION OF THIS APPLKATION,IT WILL NOT BE CONSIDERED COM"L£:TE AND WILL BE RETURNED TO YO,l1 FOR'COMPLETION. ------',:::":,,-'---~-----:--=.::---=-.:...-.::.-.::...::-:--=:::.:.:--=-====== .COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF REVENUE .I, ~O~SE.~_!_.TO rRAN:?f~_R__S_E_C~~~TIE~DAT~__'di;f70 I hereby consent I;)the transfer 0:the abovf'securities now registered in the name of the aforesaid Decedent and woive the f~ling oi 0 certifir.ote cerldying to the paym....nt of the transfer inheritance tax to which the property of said Decedent is mode subject pursuant to the pravisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961 f P.L.373,os amended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This Consent to Transfer the herein described property operates only in reference to the estate of the above-named Decedent. e ecretary of Re~a:-~ By _ (Signature) Register of Wills Wa shington -----(TitleT-------(C~nty)----------- L-_ I am the attorney of record fOT the ~s tate or the transferee shown on the front of this form.I no hereby person- ally guarantee the payment.within the time prescribed by law,of eny ~o,nnsyl vania inheritance t8Y.:vir-j ('h mEW be dUG on the tranf;,fer of t}1?sC'e1J1"'i+.ipp li ~teri hereon for which to transfer is.~~~~~~:....~ (Date)ature)I ---------------------- COMMONWEALTH OF PENNSYLVANIA'JAPPLICATION FOR AND CONSENT DEPARTMENT OF REVENUE TO TRANSFER SECURITIES BUR,EAU OF COUNTY COll ECTIONS REGISTERED IN THE NAME OF A RESIDENT DECEDENT -------- DATE 9-22-70APPLICATION(MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made for Calsent to the transfer of the following securities of a Pennsylvania Corporation or a Notional Banking Associalion located in Pennsylvania: (0)300 Sh__r~~b)~~~_~_!~ent--_~~teri~ls Corp~~~~(c~ozmO~D=--_ (NOTE:In describing securities enter in (0),ab Ole,either the number of shores of stock or the face amount of registered bonds,in (b),the name of the issuing company and in (c)the closs of stock or the stated interest rate and maturity dote of regi stered bonds.) ISSUED ON ___,and having a TOTAL MARKET VAilUE OF $_5_6_2-'e=-5_0 _ (Dote) as of the date of death of the decedent,A~be;rt Gy~~~m ,on Aug.25,1970 (Nome of Decedent)(Dote of death) who was late of 314 Fa~~~t'ield Avenue,Ch__rleroi,Wasb_iDgtoD,Penasylvania (Street and Number)(Post Office)(County)(State) The securities are registered as follows:_A!-}.)-=~t ~~~_g~_ (Name or names in which certificates are registered) ~John E e_~~!~_e~_~~~l Bruce Dre,S.E e ,W__rren,Obio 44484 EXECUTOR)(Name)~O(A~'O'O..... NAME OF APPLICANT 0 oov COUNTY FILE NUMBER 63-70-918 ADDRESS OF APPLlCA~~ BUREAU FILE NUMBER~me__~__SIGNATURE OF APPLICANT '~~ NOTICE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS A'pP~~ATION,IT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.---------._----------------------- COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF REVENUE~ C0!iSENT JO TRANS~ER SECURITIES OAT _UP' I hereby consent to the transfer of the above securities now registered in the nome of the a oresaid Decedent and waive the filing of a certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is made subject pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,as amended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This ConS'ent to Transfer the herein described property operates only in reference to the estate of the above-named Decedent. (Signoture) Signed f e Secretory of Revenue By __~.~~_ R~gis~_er of _~~ll_~Was_r:.:~_E~~On (Title)(C:Junty) (Date) .......... I am the attorney of record for the es- t'ate or the transferee shown on the front of this form.I do hereby person- ally guarantee the payment.within the time prescribed by law.of any Pennsyl- vania inheritance tax whi ('h may be due on the transfer of the 88curit:i.es listed hereon for which a consent to transfer is granted . ~-----_. \. . COMMONWEALTH OF PENNSYLVANIA 'DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS APPLICA TION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT DATE9-22-10 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made for consent to the transfer of the following securities of a Pennsylvania Corporation or a National Banking Association located in Pennsylvania: (0)200 Shares (b)Great ~sin!_Petro~eum (c)~_omm__on _ (NOTE:In describing securities enter in (0),ab Ole,either the number of shores of stock or the face amount of registered bonds,in (b),the nome of the issuing company and in (c)the closs of stock or the stated interest rate and maturity dote of registered bonds.) ISSUED ON . ,and having a TOTAL MARKET VAtUE OF $625.00 .(Date) as of the date of death of the decedent,A1Qert Gysegem (Nome of Decedent) _____,on Aug_25,1910 (Date of death) who was late f 3i4 Fa11a::tie1d Avenue,Charleroi,Washington,Pennsylvanino..... _ (Street and Number)(Post Office)(County)(State) The securities are registered as follows:~l:..~~r~~s~~~_ (No'me or names in which certificates are registered) ~John E.Gysegem,3831 Bruce Drive,S.E••Warren,Ohio EXECUTOR )---.--::-\-(N~",,,)-----(Address) NAME OF APPLICANT~n.C40toUo~-:--A~~J'1/Oii-aotOoo COUNTY fiLE NUMBER~_~_:J_~~_VADDRESSOF APPLlCAN~18 'Avo BUREAU FILE NUMBER~l ~'''~~SIGNATURE OF APPLICANT~~~~~~~~~ NOTicE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS AP-CATION,IT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FO COMPLETION. ----------==--~-=--~==--==--::...::.::==-----==-------:==------==~-:.=-=-----~-:-:=--~-=_._------::-========= .I) COMMONWEAL TH OF PENNSYLVANIA -DEPARTMENT OF REVENUE 1970 CONSENT TO TRANSFER SECURITIES-------------DATESept.24th.19 I hereby consent to the transfer of the obove securities now registered in the nome of the aforesaid Decedent and waive the fi ling of a certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is made subject pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,as amended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This Consent to Transfer the herein described property operates only in reference to the estate of the above-named Decedent. la Signed for t By .. Regis~~;at~f'Wi]Is Washington (Title)(County) I am the attorney ()f r(~eord for the es- tate or t.he tY'ans feY'8e GllOwn on the front of ~~ip f0Y'~.T ~o hereby person- ally P'1}f'Y'!:U't"'8 th'"T.lf:i.""W""t.wi thin the time urep~rihp~hv lAW.of Any Penn8yl~ vania i:rh81";~-Q"0ph7 "/hi ~r :nay be due Ion the tran'f~?-~L~0 8Rrurities listed !hereon fo:r whi ('};"C J'sent to transfer is granted. (Date) '* APPLICATION FC1-\AND CONSENTl TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT __-L-__...____ COMMONWEALT,H OF PENNSYLVANIA .DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS DATE 9-22-10 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made for consent to the transfer of the following securities of a Pennsylvania Corporation or a National Banking Association located in Pennsylvania: (a~30 Shares (b)_J~_9.Y.itable ~~_<;;;~ny (c)Common (NOTE:In describing securities enter in (a),ab Ole,either the number of shares of stock or the face amount of registered bonds,in (b),the name of the issuing company and in (c)the class of stock or the stated interest rate and maturity date of registered bonds,) . ,on~~25,1970 (Date of death) ISSUED ON_'. ,and having a TOTAL MARKET VA'LUE OF $ (Date) as of the date of death of the decedent,Albert GYsegem (Name of Decedent) 3,170.00 who was late of 314 Falla::field,cahrleroi,Washington,Penn=sL.y.::::l:..::v.=a:.::D=i=.=a==-----_ (Street and Number)(Past Office)(County)(State) The securities are registered as follows:_~~er.:t~~n-=--_ (Name or names in which certificates are registered) ~_Joh~~._Gysegem 3831 Bruce Dr ••S.E.,Warren,Ohio 44484EXECUTOR)(Name)....--.JAdd~.!.~ NAME OF APPLICANT ~00 ~oot1\eA~~nooooo COUNTY FILE NUMBER_63-70-9l8 ADDRESS OF APPLICANT ~P.O ~~ACOo~ BUREAU FILE NUMBER __~me __SIGNATURE OF APPLICANT_~2~ HOTICE:4F YOU,FAIL TO PROPERLY FILL IH ANY PORTION OF THIS APP-(ICATlON,IT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.-------------------_._--_..------.._-_.'----------_..----_.-._-------------_._---============--------_.~-------------.--._.-----_"_._..-------_.-._---_.._.--'--- COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF REVENUE ~ .~QNSE~T__I.9 :TR~tl_~£ER ~~_~_URITIES OAT._.;;1;;fl7d I hereby consent to the transfer of the above securities now registered in the name of the aforesaid Decedent and waive the fi ling of a certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is made subject pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,as amended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This Consent to Transfer the herein described property operates only in reference to the estate of the above-named Decedent. Signed tz:0recretory of Revenue U-2h IBy__. _~ (Signoture1 Register of Wills Washington (Title)(County) I am the att0rY\C~Y ('If rpc.orn for the es- tate or the t~8n~fere8 shown on the front of +l'i",f"rp'.T rJ 0 hereby person- ally R'l1f1 1"8ntee :,};n paVr'1n nt.within the time preserjOpr1."bv l8w.of "nv Pennsyl- 'vania jnheritl'1nC.E;t~lX VI},i rn 'Clay be due I on the tram-fE'r nf thp ,,"curiti.es li'sted hereon for which a co sent to transfer is granted. (Date) COMMO!'lWEAL T H OF p=~m:',(LVllNIA o E P"RTM[NTO;:k Cv f.h U r: BUREAU 0 r·'':('1 UNT Y CO,--'•.EC 1iONS f\r I L.i\..~J1""i :Vl·"i"\i"4l1 ,-\)T~..JL/~. TO TR,ANsr ,::R SECURITIES lREGISTEREDINTHENAME Of'A RESI?~~_T_DE~~?EN~. . DA TE_9_-_2_2_-_7_0 _M:ELlCAnON (MUST BE FilED IN TRIPLICATE) TO niE PENNSYLVANIA DEPARTMENT OF REVEt~UE: ApplicGtlol'is hereby made for C OClsent tu the transfer of the following securitie~of a Pennsylvania Corporation or a Not,(jl)o!Bonking Association :Jcared in Pennsylvania: (aL~_24 _?h~r.e~Jb)~o_nsum~r ~a~u;.!l~~~.(c)_C.:::...o=.:DlDl==on=-=-_ (NOTE:In describing securities enter in (a),ab Ole,either the number of shores of stock or the face amount of registered bonds,in (b),the name of the issuing company and in (c)the class of stock or the stated interest rate and maturity dote of registered bonds.) ____,on Aug.25,1970 (Date of death) ISSUED ON .__. ,I)nd having a TOTAL MARKET VAtUE OF $ (DOle) as of the date of death of the decedent,A1_l:?ert Gysegem (Nome of Decedent) 6,552.00 who was late of __3~~_~~!-~!~~~~__~yenue_!__~.,~!!~r~iJ __Washington.l_.J>ennsylva~n_1;.::..·a'-'--_ (Street etnd Number)(Post Office)(County)(State) Th~securities are registered as follows:~lbert Gysegeo (Name or names in which certificates ore registered) ~)John E.Gysegem 3831 _~ruC?~_J!r_!...L-S.E.,Warren,Ohio 44484EXECUTOR)--------(N;;~·---·-_.-(Address) NAME OF APPLICANT_.JohD E.Costello Attorney £or Estate COUNTY FILE NUMBER_~-7_~:91~ADDRESS OF APPLlCAN~!_8 Washington Ave,Cbarlexoi,I7' BUREAU FILE NUMBER __~a.m~_..._SIGNATURE OF APPLICANT _~,..~~/ NOTICE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS AP.PL~-WILL NOT BE CONSIDIiRED COMPLETE AND WILL BE RETURNED TO YOU Ft'6R COMPLETION..--------- --._----------_..,._-,---_._~----_._._-_._._--------================---------_._---------------..-_._---_._----_._-------------- COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF REVENUEC0!iSEN~..T0_!_~ANSFER SECURITIES OAT ..../lJI ./.:;~/P7d I hereby consent to the transfer of the above securities now registered in the name a~aid Decedent and waive the fi ling of a certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended'and the Act of June 15,1961,P.L.373,as amended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This Consent to Transfer the herein de5~ribed property operates only in reference to the estate of the above-named Deceden t. Si.gnf:'d f~Secretory of RevenueBy._-I-~~~ (Signature) .__R!_~~~~~!:_~~__Wil~_s Was?in~~on (Title)(County) I am the attorney of record for the eb- tate or the transferee shown on the front of this form.I do hereby Derson- ally Quarantee the pa~n8nt.within the time prescribed by law.of qny Pennsyl- vania inheritance tax Vlh}er rr:a~r be due on the transfer of the pp('uritie8 listed hereon for which a c.onsent to transfer is granted. .......... (Date) DATE 9-22-70 --.TO TRANSFER SECURITIES II REGISTERED IN THE NAME OF A RESIDENT DECEDENT-1_.._.~.__...__. APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby mode for consent to the transfer of the following securities of a Pennsylvania Corporation or a National Banking Associal ion located in Pennsylvania::) (~f>?Shares (b~~:e~~ark_:_~~y_~~~e_~_____________(c)_common __ (NOTE:In describing securities enter in (0),ab Ole,either the number of shores of stock or the face amount of registered bonds,in (b),the name of the issuing company and in (c)the closs of stock or the stated interest rate and maturity date of registered bonds.) DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS ISSUED ON __ ,and having 0 TOTAL MARKET VAtUE OF $_47hOO __ (Dote) as of the date of death of the decedent,A1ber't Gysegem ,on Aug.25,1970 (Nome of Decedent)(Dote of death) (Street and Number)(Post Office)(County)(State) The securities are registered as follows:Alber't Gysegem----~~._._-------------------_.----------- (Nome or names in which certificates are registered) -_.._-_.._---- 444843831BruceDr.,S.E.,Warren Ohio~John E.Gysegem EXECUTOR r---------(N~-r~~J-------------------------------------------(Address) NAME OF APPLICANT __Joba 8._Cots1:ello_ Attoraey Loz 8stnte COUNTY FILE NUMBER_~~_~70_...918 ADDRESS OF APPLICANT418 t'JatJh1J'9ton Aw...Ole.Rloroi,Pi ,~-~ BUREAU FILE NUMBER~_Same __~~_.__SIGNATURE OF APPLICANT_(M--~ NOTICE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS AP~UCA ION,IT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU F~MPLETION . .===-~-=----=:::.-_:-=.=-:_------.-----._-:-=~=-:':=~--==-":':=-:=-=---=---'---------=---=~=-===-------:"'------============== COMMONWEALTH OF PENNSYL VANIA -DEPARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES-----.-------..------------------DA r@ept.24th.1970 I hereby consent to the transfer of the above securities now registered in the name of the aforesaid Decedent o'nd waive the filIng of a certificate certifyir-g to the payment of the transfer inheritance tax to which the property of said Decedent is mode subject pursuont to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,os amended.This is also in accordance with the provisions of the Act-of April 9,1929,P.L.343. This Consent to Trandf!r the fIt-rein described property operates only in reference to the estate of the above-named Decedent. Sigi'ed fo~Secretary of Revenue By ._~4'~~ Regls~~rat'o¥Wills Washington (Tit!e)(County) .-' I am the ~'tt~'~n~y ~f record for the es-J t,ate or the transferee shown on the front of this form.I do hen?by persoh-I ally guarantee the payment,within the \i time prescribed by law,of any Pennsyl- vania inheritance tax whi.0h may be dUB on the transfer of the 2~ruriti88 listed hereon for which a consent to·transfer is granted . .......... (Date) RCC-12 (9-68) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BURE;AU OF COUNTY COLLECTIONS APPLICATION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED L~THE NAME OF A RESIDENT DECEDENT DAT!:9-22-70 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made for CQ1sent to the transfer of the following securities of a Pennsylvania Corporation or a Notional Bonking Associalion located in Pennsylvania: (0)70 Shares (b).__.IncoES Fo~ndation._.__.(c)C_O_JDJD_O_D _ (NOTE:In describing securities enter in (0),ab Ole,,"ither the number of shares of stock or the face amount of registered bonds,in (b),the name of the issuing compc·ny and in (c)the closs of stock or the stated interest rate and maturity date of registered bonds.) 466.20 ____,on AUSh 25.1970 (Dote of death) GYsegeo le of Decedent) Alber (I' ISSUED ON __.,and having a TO AL MARKET VA<LUE OF $ (Dole) as of the date of death of the decedent, who was late of_3_~~_~al1a;1field Avenue,Charleroi,Washington,Pennsylvania (Slreel and Number)'osIOffice)(Counly)(Stole) The securities are registered as follows:Albe)Gysegen f .me r names in which certificales are registered) ~John E.Gysegem 3831 EXECUTOR )..----(1'1;,;.,-)-----.. Nt..G COUNTY F~LE NUMBER63-70-~18 JRF.:' BUREAU FILE NUMBER_~~~_SIGNA T NOTICE:.IF YOU FAIL TO PROPERLY i iLL IN AN) CONSIDERED COMPLETE MlD WILL 8E R .r\i:e or.,S.E.,Warren,Ohio 444~ -~_.._- (Address) Af 'UCANT _~6 0 C;:;:')\1Q~Ao A~~~•tI€:J 000000 j 01 APPLlCAN~lO~eoo ~~o ~ ~E )F APPLICANT 7~~. ' '0."'ON OF THIS ~~YCATION,IT WILL NOT BE rui~ED TO YOU fOR COMPLETION. ----=.=-==.:==-~~--.----~--.-.--=--=-=---=-============1 COMMONWfAl..TH OF PENNSYLVMIA -DEPARTMENT OF REVENUE CONSENT TO ;~?ANSFER SECURITIES OAT I hereby consent to ·i e !IJnsfer of the above '.ecurities now registered in the name 0 the aforesaid Decedent and waive the til:,:':)of a certificate certifying to the payment af the transfer inheritance tax to which the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,as amended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This Consent to Transfer the herein described property operates only in reference to the estate of the above-named Decedent. Washingtpn (County) e Secretory of Revenue ~~By (Signature) Register of Wills -------_._---_.. (Title) r r---------.--------..-.I am the attorney of record for the es- tate or the transfer88 r.hovrn on the front o~+hio fo~m.I AO herAby person- al1:v f!.'l1RY'Rntp.8 the,na~r:;vmt,wi thin the I ti~e Drp~~ribpd }v law.of nny Pennsyl- .vania i.n1o.-:>y-i +prv'('trY.:··/).-i r,l--~ay be due 0n th.8 t:an.f:fql~~...~t.l~~.s~(>l1r:i ties listed hereon for whicr a consent to transfer is granted. (Date) I j j j j j j j j j I I I j j j j j j j j j j j j j j At"t'UCA i IUN t"U~ANV '-lJl'UI:.N I TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT DATE~9-22-70 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made for coosent to the transfer of the following securities of a Pennsylvania Corporation or a National Banking Association located in Pennsylvania: (a)380 ShareS(b)__El~c~ic Musical Industrios (c)...=C:...::o:=lDIl=o.=n=--_ (NOTE:III describing securities enter in (a),ab Ole,either the number of shares of stock or the face amount of registered bonds,in (b),the name of the issuing company and in (c)the class of stock or the stated interest rate and maturity date of registered bonds.) ISSUED ON _,and having a TOTAL MARKET VAILUE OF $~14,cAl2r...L7.....5~.~0'-3l!O:.------_ (Dote) as of the d'gte of death of the decedent,Albert _Gy~_s_e..J1ll9'__'eo:..c::-_ (Nome of Decedent) ,on Aug.25.1970 (Date of deoth) who was late of ~14 FallG?~ield Avenue,Cha~1eroi,Wash;i.ngton,Pennsy1vanic. .,,1 (St,eet and Number)(Post Office)(County)(State) The securities are registered as follows:Albert Gy:~s_e~g...:.eo_=__ (Nome or names in which certificates ore registered) ~John E.Gysegem,3831 Bruce Dr.J .S.E.,Warxel\Ohio ~4484 EXECUTOR)(Nome)(Address) NAME OF APPLICANT John R.CostelloAt'toxne,.--roc--=x:;--,g....s=t-=a-::i:t:-=e:-------- COUNTY FILE NUMBER 63-70,,:.~1~ADDRESS OF APPLICANT418 ~ashin9ton Ave., BUREAU FILE NUMBER_Same_.SIGNATURE OF APPLICANT.':::C:::::;:l.-~&,<::U~~~~_ HOTICE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS~APB /'ATIOH,IT WILL HOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU F OMPLETION.=============.,--'".-.~=-~-"----=---_:==:...::.:--_.~---~-~--_...================ COMMONWEALTH OF PENNSYLVANIA ,-DEPARTMENT OF REVENUE ~_ON~ENT_"IQ..!~~NSFER SECURITIES DAT~~~t?l~ir.f{?a I hereby co~sent to the transfer of the above securities now registered in the name 0 e a oresaid Decedent and waive the fi ling of 0 certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,'JS amended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This Consent to Transfer'the herein de~t:ribed property operates only in reference to the estate ofthe above-named Decedent. e Secretary of Revenue ~~~~~ (Signature) Register of Wills Washington "'-(Titi;-)-.(County) I arr t},p.p,+t,r,1.':·'c::"(!f Y'<::eorCi for the es- tat8 or the +,-'PT:..f'';lOPf.'::1,-.,'1',"Y1.on the froY't of'Hoi"f'r,o•..,_T ri r }>"''''''hv person- all:-'R'1'8 Y·",,,1-,r.'f'L,1-",,01""--.-+",,,i i~h·i.n the time '9~'e8<;rihC-rl "h::1''''',,-,f'"'0:1 pp,nnsyl- vania i.nhp-r;+,0'-'-''''"-""..,-~'n ',"''''v be due on the tr8r,-r""'or'"'r'',r'llloit:i,es li8ted hereon for v'hi,....:'""('It,:'81:'t to transfer- is granted. (Date)...... DATE _9_-2._2_-_7_0 _ I TO TRANSFER SECURITIES l REGISTERED IN THE NAME OF A RESIDENT DECEDENT ---.-----._------'--- APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby mode for consent to the transfer of the following securities of a Pennsylvania Corporation or a Notional Banking Associalion located in Pennsylvania: .._-----_.._-- (,;OMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS (0)300 Shar_e~(b)..__...~~2~.~..~~~~!~?OV!e~__._._.._...(c)~omm~o~n!...-_ (NOTE:In describing securities enter in (0),ab Ole,either the number of shores of stock or the face amount of registered bonds,in (b),the nome of the issuing COfTlpony and in (c)the closs of stock or the stated interest rate and maturity dote of registered bonds.) ISSUED ON _.____._._.__.__,and having (l TOTAL MARKET VAtUE OF ~~,_2_7_5_._00_._ (Dote) as of the dote of death of the decedent,~!~(i!.J;.~..~~~.ge~.__,on_~ug.25,1970 (Nome of Decedent)(Dote of death) who was late of __~!~_.~~~_l_CJWfi~l~_~~e~u~_.__S:_~~rler~iJ_~~shington~Pennsylvani.a (Street ond Numberl (Post Office)(County)(State) The securities are registered as follows:..~:l:~~rt._.~s,!2.~~..._..._. (Nome or names in which certificates are registered) ~)John E.Gysegem _?8:3_1..J~r_~~e_Dr!..._§..!._~!...LWarren,Ohio 44484EXECUTo.R r--·--··--'---(Na-;-~;)--..(Address) NAME 0 F APPLICAN T .J::z!!o 80 C::::>\1OAAs-~}JO~\5 COUNTY FILE NUMBER_!?~~2~~'918 .ADDRESS OF APPLlCAN~~_~eoo ~o J;,1 BUREAU FILE NUMBER __~ame._SiGNATURE OF APPLICANT ~.£~~7 NOTICE:IF YOU FAIL TO PROPERLY FIl.l IN ANY PORTION OF THIS,AP~t1CATION,IT WILL NOT BE CONSIDERED COMPLETE AND ·v{!L L flf RETURNED TO YOt/FOR'COMPLETION. .. COMMONWEAL TH OF PENt'ISYLVANIA -DEPARTMENT OF REVENUE k CQ~?~~~1'.TO !R~NS£.~R __SE~L!~.IJ!_~~TE ~I'/'f7c1DA ..lJ..!.__ I hereby C0n5€'n~h~he transfer of the t'tJOve seclorities now registered in the name af the aforesaid Decedent and W(li",Ie the iilin;;;(01 r rf'rtificctc '·ertdying to the payment of the transfer inheritance tax to which the property of soid Decedent IS ,'"udt>subJer.~~'~Jf5UOr..to the provisions of the Act of June 20,1919,P.L.521, as amended one ,he Act of June h,1'1/,],P,~..373,G"urnended.This is olso in accordance with the provisions of the Act of April '7,1929,P.L..3:13. This Cons~nt te llan~,de,.the (,.)rein described property operctes cr:ly in reference to the estate of the above-named Dec,~der.t. Signed ~~Secretory of Revenue f~:f3J .By ~...~ (Signature) R~g ~st ~r ..gf__~.t!.L~.._.Wl!.~.h!!1.B.~_Qn (Titlei (County) ,-------------.-------I am the attorney of record for the es- tate or the tY'anfiferee shown on the front of thi s form.I 0.0 hereby })er80n- ally gliarantAe t~c;rs.;nr l't..'l6thin the time prescribed h:\T law,of 0nY'PAnn8yl- vania inherj't-;::,,:ce t'H wn;r"+I"',y bre 01)'" on the transfpr nf thn 2~nv~ittp~l;~+Ad hereon for which a cOL is granted. (Date) DATE 9-22-70 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby mode for Calsent to the transfer of the following securities of a Pennsylvania Corporation or 0 Notional Bonking Association located in Pennsylvania: COMMONWE-\LTH OF PENNSYLVM~IA DVARTMENT OF REVENUE BURE'AU OF COUNTY COLLECTIONS APPLICATION FOR AND CONSENT TO TRANSFER SECURITIES 'I'REGISTERED IN THE NAME OF A RESIDENT DECEDENT____________.__...l _ (a)200_~~~~~L N~'?_l:~~J;_~~r~o!.at;_~_,!:f ~eri_ca __(c)_C~==o...c:n,----_ (NOTE:In describing securities enter in (0),ab Ole,either the number of shares of stock or the face amount of registered bonds,in (b),the nome of the issuing company and in (c)the closs of stock or the stated interest rate and maturity dote of registered bonds.) (Name of Decedent) ISSUED ONL-.-,and having 0 TOTAL MARKET VALUE OF $~_?OO ._ (Dote) as of the date of death of the decedent,__~~b~~1:.__~Y§Le~,on Aug.25,1970 (Date of death) who was late of 314 Fallo;Ui.e.ld_Avenue,.Charler..oi....-WaShington,PenDsylvaoia (Street and Number)(POS!Office)(County)(Stote) The securities are registered as follows:Albert Gysegem (Nome or names in which certificates are registered) ~John E.Gysegem.,3831 Bruce Dr.,S.E.,Warren,Ohio 44484EXECUTORr-----(Nom~)---..--'----.----------------·---------CAddress)--------~--.------- NAME OF APPLlCANTJ~_~.L..costello___.______, Attorney :for Estate COUNTY FILE NUMBER 63-70-9~~__ADDRESS OF APPl.ICANT~_!.~Washingt~~~ve •...1..Chaitleroi,Pa BUREAU FILE NLJMBER~~_~!SIGNATURE OF APPLICANT__~.-.~ NOTICE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLlCj('TION,IT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU Y6~.....CdMPLETION.---------._----"~---_.-._._--.-_.---.----"---.._---'~_._._"-----,~._._--"---_.----------.-_.._------.__.--------------------~_._----------_._-------------_.------_._-~------~-----------------~---------- COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES---------------DATE~~t.24th.1970 I her.eby consent to the transfer of the above securities now registered in the name of the aforesaid Decedent and waive the filing of a certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is mode sub;ect pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,us omended.This is also in accordance with the provisions of the Act of April 9,1929,P.L.343. This Consent to Transfer the herein described property operates only in reference to the estate of the above-named Decedent. Sign.dfO~.'~~ By I-_~. . Regis:b~¥gn&'freWi11s Washington (Ti,le)(County) I am the attorney of record for the es- tate or the transferee shown on the front of this form.I do herpby person- ally guarantpe the payment,within the time prescribed by l~w,of any Pennsyl- vania inheritance tax whi<,h may be clue on the transfer of the securities liste~ hereon £or which a CO~ is granted.-". .......................... (Date)ature) ~-~OM:~=::~~~::~:~:~:~~~~~N~~V~EA~N~I~A~~~~TT~O~T~R~A~N~SrFrE~'R~S~E"CVU~R~I~TnIE~S~~~~~~~~~~~~~~~~~- BUREAU OF COUNTY COLLECTIONS REGISTERED IN THE NAME,..... OF A RESIDENT DECEDENT ~~~_._~__~~~~_~.._..._~_-.J..~_ DATE 9-22-70 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made for coosent to the transfer of the following securities of a Pennsylvania Corporation or a Notional Banking Association located in Pennsylvania: (0)100 Shares (b)Allegheny Poaer (c)_C_o_mlD_o_n _ (NOTE:In describing securities enter in (0),ab Ole,either the number of shores of stock or the face amount of registered bonds,in (b),the nome of the issuing company and in (c)the closs of stock or the stated interest rate and maturity dote of registered bonds.) ISSUED ON .,and having a TOTAL MARKET VAtUE OF $.....:2::...z-,O=-=3::...:7:......:.=--=5::...:0"---_ (Dote). as of the date of death of the decedent Albert Gysegem ,on_A_U-::9_._2__5_,:...-_l_9_7_0 _,------~----------- (Nelme of Decedent)(Dote of death) who was la'te of 314 Fallowfield Avenue,Gharleroi,Washington,Pennsylvania (Street and Number)(Post Office)(County)(State) The securities are registered as follows:Albert Gysegem.-------- (Nome or names in which certificates are registered) ~JOhD EXECUTOR ) < E.ftys~~~83l:-BJ;uc::_~_Dr~,S.E.,War~e~.t.-9hio 44484 (Nome)(Ad4ress) NAME OF APPLICANT .1a!m a.~'toll0A'~cwto'iZOB BO'eritO COUNTY FILE NUMBER 63-70-~1~__ADDRESS OF APPLICANT~18 ~obimetG:)A~o,~ BUREAU FILE NUMBER Same SIGNATURE OF APPLICANT-~',/>.>~..~' NOTICE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS ~p ICATION,IT WILL NOT BE /.. CONSIDERED COMPLETE AND WILL BE RETURNED TO YOLY.FOR COMPLETION, COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF REVENU~ CONSENT TO TRANSFER SECURITIES //a -..DATE d..~L!2I I hereby consent to the transfer of the above securities now registered in the name of e a oresaid Decedent and waive the fi ling of 0 certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20,1919,P.L.521, as amended and the Act of June 15,1961,P.L.373,us amended.This is also in occordance with the provisions of the Act of April.9,1929,P.L.343. This COllsent to Transfer the herein described property operates only in reference to the estate of the abov~.named Decedent. Washington (County) ecretary of Revenue 7~~ (Title) By ._ (Signature)Register of Wills c r I am the attnrmw of r'ecoro for the es- tate or the transferp,p,shown on the front of -t-,hi.8 f0r"'.T ill"'!herebY-person- ally Q1.lp~·8.ntp.e t 1,,,nn'T~Y'~,r.-t-..'V)thin the time prBscrihp~by law.~r ·~v Pennsyl- vania inher;t":lr,('P trY'll,;(".""Ply be due on the trarF'f·:"·'",f'1;1"..""lri.ties listed hereon for which 8 ('ON:ent to transfer is granted . .......... (Date) .' 1--J IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNA. In the matter of :the Audit of Account filed in the Estate of Gysegem,Albert Deceased )Date of death ---.f..fT_-.....:d.:.....-.)_-_·-_1_0 _ \No.918~1970,Term,19~,A.A. )ll<>cket 38-104-3 TO THE AUDITING JUDGE: Enter my 'appearance for the Commonwealth of PennsylVlaIlia,claiming transfer inheritalnce tax in the above estate,as follows: Additioll!al Assets per Account,Subject 'to Tax_______________________________________________$_ Additionall Assets per Audit,Subject to Trax __$_ GROSS VALUE ..$__--.3 t/~7 Ie f 7 CR. Debts and Expenses per Account;see Note $----------------- Add~tional Debts and Expenses per Audit $-------- $------- $-------- $------- $--------$ TOTAL DEDUCTIONS,$ $----------------.ye/?7.._Q_c:)_ $-------- (----- Clear Value __ CALCULATION Gross v:aJ!ue _ Less Deductions ._ Tox·! able at 2%) !flo ~~?------- at )'15% -------- NOTE:The following credits claimed in the Account are held not deductible .:liS against the tax:~~I,Zo'-II.1{1 'l~.5')~'.....ctAJ\,I 0,.'4 $---_._---- .f?tf:AX PAI:ON;;:N:--..0 0 Tot,j T"'_..._.._...$_ -f;~.$~9co)y:S 0 1:s/~~~t~reviOUsly paid mm m m__ _$I r --- $------ $-------- $------- Balance $_ Interest__yrs.__mos.__days @ __%$ TOTAL TAX AND INTEREST DUE .$_ (')r0s:"s::IJ 0 >Z III:E (') III "t:<.l>III ~r~'11t:r '11 0 0 0 :IJ '11 :IJ > 0"""%J jIII"Z III'" Z >III :IJ0(>...r z CO<(') I >IIIZ ~> ('l)>III~;.. ------------------------.. RCC-4 (8-68)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NO.A125127 OFFICIAL RECEIPT 0 PENNSYLVANIA INHERITANCE AND ESTATE TAX RECEIVED TEN and 84/100 -----------------------------------------------_dollars Mrs.Jan Crosby -Paying On Ind.Liab.representing Pennsylvania Inheritance or From:ATTY.JOHN COSTELLO Estate Tax due from the following estate: Address 418 lvASHINGTON AVENUE 2%Tax on $$----------u CHARLEROI,PENNSYLVANIA 15022 6%Tax on $190.20 $11.41--------'----~~~--111 File No.63-70-918 Date of Death 8-25-70 15%Tax on $_$---------[':lJ $--------1I'l Date of Payment __0_c_t_o_b_e_r__2....L-....:c1::...c9'-7'-0-'-------i Name of Decedent --=A:.=.:L=.:B=.:E=R~T----=G:..:Y:..::S:..:E~G::.::E~M~___1 %Tax on $$~ Estate Tax,Act of May 7,1927 County W_A_S_H_I_N_G_T_O_N -I Remarks: Replacing Rec.#A125106, which was voided. TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest ot the rate of __%from _ to _ $,-=1=1::..;:.-=4=1__tI $..........5-L7__11iI1 $----------1111 $====1~O~.~8~4~=I~1TOTALAMOUNTPAIDSEAL 38-104-3NOTE:To be delivered to taxpoyer Received by-....,~~~~I.&lW!5..~._f:.'L..::~~~~~------til NOTE:In accepting the transfer inheritance tax on future estates,prior to the death of the Ii tenant or tenant for years,as evidenced by this receipt,it is understood that the Commonwealth sh II not be precluded or prevented from hereafter assessing additional inheritance tax at the death of t ~...g~"¥..u..s..l!!..!S..-L~1r.-....I.<!!"Q.~~~:....-----11 life tenant or tenant for years whenever it appears that such additional tax may be legally due an collectible for any reason whatsoever. RCC-4 (8-68} NO.A124431 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OFFICIAL RECEIPT 0 PENNSYLVANIA INHERITANCE AND ESTATE TAX RECEIVED ONE XHOUSAND NINE HUNDRED T\YENTY-FOUR and 50/100 --------------dollars Jolin E.Gysegem -Excr.representing Pennsylvania Inheritance or From:ATTY.JOHN E.COSTELLO Estate Tax due from the following estate: 2%Tax on $$----------G1Address418\"ASHINGTON AVENUE CHARLEROI,PENNSYLVANIA 15022 6%Taxon $32,074.99 $__1=....z....;,9:......c2_4'-'-•....::..5....::..0__~1 File No.63-70-918 Date of Death__8_-_2_5_-_7_0_--i 15%Tax on $$---------c $-------- Date of Payment _.::...N:.::o:....:v:....:e:;:m::.:b=..e.::...r=--.=1:...:0..J-:....:1=-9=...7.:.-.;:..0 --l ALBERT GYSEGEM Name of Decedent ----------------1 %Tax on $---------$----------1lll1 Estate Tax,Act of May 7,1927 Cou nty W_A_S_H_I_N_G_T_O_N ---i Remarks: TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest at the rate of __%from _ to _ $1-'-,_9_2_4_.5_0__ $---------H1 $---------1111 1,924.50$=======:I~ITOTALAMOUNTPAIDSEAL 38-104-3NOTE:To be delivered to taxpoyer Received by ~~~~L&~......T!:..L-~~~~l.L.------tJ] NOTE:In accepting the transfer inheritance tax on future estates,prior to the death of the e tenant or tenant for years,as evidenced by this receipt,it is understood that the Commonwealth all not be precluded or prevented from hereafter assessing additional inheritance tax at the death of ::s-e....L~~~...u"-!j;...L~ft-:-.,.-L.6J.:6....I~...Q,..L------11I life tenant or tenant for years whenever it appears that such additional tax may be legally due and collectiblefor any reason whatsoever. '"~.. 0:7- COpy O~INVENTORY 76 -C;/~ -r (j r3Y-/oJj~~ ."I \ ~torv Public JOHN B.GYSBGE1 ALBBRT GYSSGm4 3}unrutnrg aub Appraisrmrnt of the goods and chattels,rights and credits which were of ~~~9.!§~late of.~~9.~~.~~~~~~.~.?::~.~.!. Washington County,Pa.,taken and made in conformity with 'the above affidavit. DOLLARS Nio.gczo ~hnt11t PoQOS',ton obo%oo @ $1~.3S P03'ohoro $45,275 00 AlleghenV Pooo:r.100 ohol'co @ $.20.S'1S PO:r ohoro 2,031 sn Equitablo Goo o:>apc.nV,130 oharco G $.29.00 POl:'ohozoo $..no 00 Consb.:l:±datErl No'turol Gooo 2~obo%oo at $29.25 poX"oho1ro 6.552 00 Stodnrd 011 'of r~co JOrroov,SO ohOzCO at $66.25 po!"obo%o 1,987 SO Incooo Fol!!lt12ot!on,10 ohn1:co G $6.66 poE'OboJro .MG SO Nv.clOO2'o:>ttz;oxotloD o~root'!co,Soo oharroD a $3.633 pOZ o~o sa!)ott unitc4 Ptu:dt Citv r.1!aoo,aoo 0120%00 (J $2.375 poJ:'ohatta <G7S on G%rot Baoino Pot1101C".:!!:lo 200 ohon'co @ $j).175 peg'olnrro 625 00 CENTS 1.211)00 ., L3-70-9/f I)ALBERT GYSEGEM)of the Borough of Charleroi, Washington County;pennsylvania ,'bej,~ng of ~Ol.ind mind and memory do herebymakej publish and declare ~his.~o be.my Last Will and Testament,hereby revoking and making void any and all Wills by me at any time heretofore made. FIRST:I direct that all of my just debts and the expense of my funeral be paid. I direct that all inheritance, succession and estate taxes assessed because of my death, whether the property or funds to which such taxes are attribut- able pass under this my Will pr not,be borne by the principal of my residuary estate and that my Executrix payor provide for the payment of such taxes at such·time'or times and in such manner as she deems to be convenient. SECOND:I give,devise,and bequeath to my wife,Eleanor Gysegem,one-half (1/2)of all of my bank accounts of every nature and kind which I hold in my name on the date of my death. THIRD:I give and bequeath the sum of Five Hundred and no/100 ($500.00)Dollars to each of my following three grandchildren,Donna Panzo,ErneSt Lee Gy~egem, Charmel Gysegem,per stirpes.. FOURTH:All the rest,residue and remainder of my estate,real,personal or mixed,of whatsoever nature or wheresoever situate at the time of my death,I give,devise _____--.l...............:---...l.l.-At_m_7-...._..........:._~___._.....__ '.. "{. ).;.." and bequeath in equal shares to my three children,Jane G. Crosby,Albert Gysegem,Jr.,and John E~Gysegem,share-and share alike,per stirpes.Further,I clirect that my Executor -, I ..collect all of my assets of my estate,both realty and personalty,and sell the same at'the best available'pr1ce and distribute the proceeds as hereinabove set forth.With reference to my son,Ernest Gysegem,I have already financially assisted him during my lifetime. FIFTH:I hereby nominate,constitute and appoint my son John E.Gysegem as Executor of this my Last Will and Testament.Should my said son,John E.,Gysegem, predecease me or for any reason whatsoever be unable to serve, then I nominate,constitute and appoint my son,Ernest L. Gysegem,to serve as Executor in his stead.The personal representative above named or his substitute or successors shall not be,required to enter bond or security in any jurisdiction in which he may serve. IIt seal to this my Last Will and Testament,consisting of two IN WITNESS WHEREOF,I have hereunto set my hand and .~../":(2)typewritten pages,this .)_I,'day of ___.:...J.I?....~'v~·:>_·.:·_-~,1968•, I!II II f! Albert "Gysegem I f~ .. SIGNED'~SEALED,PUBLISHED and DECLARED by the .above.named Testator,ALBERT :GYSEGEN •as and for his Last .. Will and Testament,in the presence 'of us,who at his request,in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses: ., I , J .-:,I (A o irrt:........rt