HomeMy WebLinkAboutOC1970-1015 - ESTATE OF GERBERFORM 67
REV.1-50
REG.WILLS
Appliratinn fnr 14:cit:crn nf A~minintratinn nn tq:c
..J
Estate of §.~~.g.~~~9.g~g~.
late of gjj;y.9..f W.?.§.b.t.o.gtg.rh :w.9.§.bJng:t.9.n gQ.~.J P..9.~,Deceased.
Before the Register of Wills of Washington County
personally ap peare d .K.~P..~IIngJ.~g.~.@.~.B..:.
who,being duly sworn deposes and says that..SAMUEL...H...GERBER :..
age ;).4 ,having hi.s last family or principal residence at.....8.;).L~Qn.ard .Av.enlJ.e.,..
(Street and Number)
...................................................W.a.shing.t.Q.n ,Washington County,Pennsylvania,died intestate
(City.Borough.Township).
at ,on the 13 day of Q.ciQb.er ..
A.D.,19 7.9 ,at..7..;}9 P..M.,possessed of personal estate to the estimated value
$...l.Q.t.Q.O.Q.~.Q.Q.,and of real estate in the Commonwealth of Pennsylvania to the estimated value of
$NQ.o.e ,situate in .
The names and addresses of the decedent's surviving spouse (if any)and other heirs (including
heirs by adoption)are as follows.
R};J~ATIONsmI'UESIDENCE
~.~~9.:t:~.t..~.t..?..g~~p..~~W.U.~85 Leana:r:d Av.e.a.'.wa.shi.ngto.n,p.a.•.
~~y.D.9.~~~9..~!.P.§.~.9.ht.~.!8.5 Leo.nard Av..e.•..,Wa.shing.ton1..·.P·a .
.......................................................................................................~.
..........................................................................n .
........................................................................................................
........................................................................................................,.
..............................................................................................................................................
That deponent is over 21 years of age,resides at.....85 Leo.nar.d A:v.e ~lNa.sh.i.n.g.to.n.,.P..a.•.,..
.......................................................................................................................................................................................................................................................
is a citizen of the United States and a resident of Pennsylvania,and respectfully applies for Letters of
Administration upon the Estate of said decedent,no letters having been previously issued thereon.
Sworn and subs:ribed before me this /~~.~.:i..£~i::::~.
day of..~..Q.!(.tQQ~r ,A.D.,19 70 .
............v.~22~~.
COMMONWEALTH OF PENNSYLVANIA}SS:
WASHINGTON COUNTY,
And now Q.C.j;Qb.er /..?:~,19..7.0 ,comes K .P..a.tr.i.c.ia G.e.rber..
who being duly sworn doth depose and say that §he will well and truly administer the 'goods and
chattels,rights and credits of §.?m~.~.L..~.~q.~.~.J:?~.r ,deceased,
to the best of...h~r.......skill and judgment in striot compliance with the laws of this Commonwealth,mind-
ful of the laws relating-to inheritance ta~es.
Sworn and subscribed before me thiS.../~...~....
~~~...~~:~;::~~~~::::::::::
REGISTER
J/~pj~'
:X..S../~.
Ju 6 3 -7&-/t3/~
APPLICATION FOR
Letters of Administration
ESTATE OF
........§.h.M1!.f:.J::H.~9.g~gR.,.
Deceased
R $..
Letters......................................................i .s:0-(1
P $..
Extra Alias $............".
Certificates .?4..~.~$~~.:-
Renunciations $.
..................................................................$..
;~~:;:::~:::~:::·~~:::·::::::~::.::::::1:.:~?ii~~
_...-,
~!!I
CJ
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(=::J
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en
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--_J c=:>>m:::O
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::I:-(f)-0~r,'""~--j r'~'••J rn ---:-1 ;::;~.
'20~-n :~;:CJ __;-.~
o -'lC :::0;r=z
-orol>(f)~.....$.AN.f.QBD..:.$..~..J:J.ND.f;:.fL .c;;".
Attorney
~2
~"
i(unm 1\11 jtru iy wqesr IlrrBruts
Estate of.....§b.My.g~...H.1....~.~RIl.ER..............................................}Nfl900 ..
late of..W.£\.$.hJ.Qgi9.D."...P..eI.lI:l~y.b:ania ......,Deceased
KNOW ALL MEN BY THESE PRESENTS,
That we,K~P..AI.BJ.gJ/tS?£@.£R."P.;r.J.Q.9.Jp..g.l.~$w.d....I.B.ANS.AMERIGA..INSURJ.l.NCE CQM.P.AW.¥.,..
.....~~:.~.~.y..t .
all of Washington County,Pennsylvania,are held and firmly bound unto the Commonwealth of Pennsyl-
vania,for the use of those interested in the estate,in the sum of..I.~.N...lrn.US.ArID::".:::::".:::::'.::::::::::::::::::Dollars,to
be paid to the said Commonwealth,to which payment,well and truly to be made,we do bind ourselves,
jointly and severally,for and in the whole,our heirs,executors,administrators,successors and assigns,and
each and every of them,firmly by these presents.Sealed with our seals and dated the l.6.th day of
...........Q.g.:tg.!?g;r.A.D.,one thousand nine hundred and seMer.l:t:y..
THE CONDITION OF THIS OBLIGATION IS,That if the above bounden.......~.~...EAI.BIgIA...sfRBER
Administrator :or any of them,shall well and truly administer
the estate according to law,this obligation shall be void as to those who shall so administer the estate;but
otherwise,it shall remain in force./&-. .r-I J
Sealed and delivered in the presence of:~·~../..·~~..·~~;rf:.~:L/~~J nA ~/.).1..l±~S.O..l!1.j~:i~l..:)S...V.l~.Ce .
.~.4..:../.!:.~~:(SEAL)·~~:
---~.....................................................................~:.:,..~SEAL)]i;::,~.~'i -
~.~tatrmrnt nf ~urrty ".,~_....;f~:
I,,surety in the sum of $:on the
administration bond in the estate of...~,say that I reside at
..............................................................:,Washington County,Pennsylvania;that I am the owner of real estate,
the title to which is in my own name and duly recorded,situated in ,
Washington County,Pennsylvania,worth above all encumbrances $;and that I am worth
the amount expressed in said bond,over and above my just debts and liabilities.
,.
Street
~tatrmrttt nf §urrty
P.O.
I,,surety in the sum of $on the
administration bond in the estate of...,say that I reside at
..............................................................................,Washi~gton County,Pennsylvania;that I am the owner of real estate,
the title to which is in my own name and duly recorded,situated in ,
Washington County,Pennsylvania,worth above all encumbrances $;and that I am worth
the amount expressed in said bond,over and above my just debts and liabilities.
Street P.O.
COMMONWEALTH OF PENNSYLVANIA,}S8.
WASHINGTON COUNTY,..
And pow 19 comes .
who being duly sworn,says that he is acquainted with the financial standing of the securities to the within
bond;that the said obligors have each executed the said bond and that the sureties thereto are the owners
of real estate in their own right of value more than the penal sum ·of said bond over and above all incum-
brances and exemptions.
Sworn and subscribed before me this .
day of A.D.19 .
~3 -)7[J-/J IS-
No.821 .).;.Z'l:,,;j'....,\'.....t~.....-C".f?~~~",'....~\....)I
~,
r
A~miltiBtrtttinn 1Bnn~
IN THE ESTATE OF
SAMUEL H.GERBER,Deceased.
And now October 16 ,19--ZO-
Bond approved and Letters issued to
-.:;11
K.Patr±oia.Gerber
p rfl ;::c::>r-
(f)0 '-C">•
..,....-(fl --'!
who wii ~Qu.aJ.i.fiean
0 fT1 ,en ~
-l:;;:O,"--'"°G ...Russel~J.~:r:1no _-0
~~
r,~:~,.1 \,..''.:r'c ~"\CO'/\,,'1\,'-
-,<....
"J-"-
--"""'-~(")~~~0 __Register
rz-orOl>(f)..cc:::n
Bond Book 64 Pag,e
~2
2Q..:
&3 -7~-J()/S-
Affibuuit (@f iExerutnr(@r Abmiuistrutnr
@lttttr nf ,rltltSYlnUltiu.}.
C!!nulttn nr lIus~tn!ltnlt ss.
Personally before me,the undersigned authority,a..N.Q.t.aJ;'J(.P..1J.Q.l.i.~in and for said
County and State,appeared JS.~r..~.t.l..t~.t~L..g.~l..~.~.:F,who,being duly
sworn according to law,deposes and says that IDe is the ~XJr administrator of the estate of
...........................Samual..J:i ~.e;tb.e;t _..deceased,that the foregoing schedules constitute a
complete inventory and appraisement of the real and personal estate of....~?-m.ld~l...tl~~~.*.P..~.*-,
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 appraisement of
each item made by the above named Executor.jdministrator.
s~rna~~SUb,scribed bef~e me this...!..!...............}i tl-t "/-I j
day of :19 ...11:..~/~
ALICE J:.~""~'T-.-::".I ,!J.._____~,__.
\. W h·ln..'..r~~.•eJ..:..I.:LC:?«kU......................~dmmlstratorNotaryPubIC.as,.gLU"".,<•
My Commission ~pires Ma~ch 20,197t ADDITIONAL INSTRUCTIONS
'1.An inventory must be filed within three months after appointment of personal representative.
2.A g~lpplemental inventory must be filed within thirty days of discovery of additional assets.
3.An original and one copy must be filed.
lJuurutnry aub l\ppratnrmrut of the goods and chattels,rights and credits which
were of §R:my.~l H.!g.~;F.!?.~;F.late of W!?:.~h~D.g!:QD..,..
Washington County,Pa.,taken and made in conformity with the above affidavit.
J
PERSONALTY:
Frothy's Beer Mart--Distributor's license
REAL ESTATE:
None
TOTAL ESTATE
DOLLARS
10,000 00
I
I
110,000 100
I
II
CENTS
"
/ofS-1
Inventory and Appraisement
IN THE ESTATE OF
•"'..,.::0~~t _1 ..I""'.I.,..
'.,A'.<..'"""/('c:·:·r·;·:·:···..~·~~§~·V.·f.b H.~g.f.B.l?.{;.a..
·"tl '.~:"'.:.~,....-....,....,...
Filed ,19 M ..
.."-1~
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.........
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SANFORD S.FINDER,IEQ.?;;,
729 Washington Trust Building
Washington,Pa.153 01
STATE OF PENNSLYVANIA,}55:WASHINGTON COUNTY,
The within named Accountant being duly sworn according to law,depose and say that the above account
d 'd she 'I b I'as state IS true an correct as.._ven y e leve,
t V i~:,~~.·"';,~'~'.·0'·:~':·J'/~/~K~'FairTd:a·:"Ger15er..·····:..···..·--·----·--··----..·....
,,~:.-~·1,~..~~..."..,_
~.......
,I '0":~.".
,~"~.~.1 ;~,
S ' d 'b 'b d b f .th'J/dwornansuscne e ore me IS __,...__..•.__
~7!rdayof--·-,Z~---CJ··::;z;--..---19 __----~~--~--e{-~~./----
,))
-....~UCE CMILLER
"NOfafY.f.ijlilic.WilsbingloiJ.Washington Co.
My.Commisili0Q-:fxpires March 20,197'"
,.-
Washington County,ss:Ido certify that I have given legal notice to all persons
concerned of the filing of the within account in the manner pre-
scribed by Statute and Rule of Court,as evidenced by proofs
thereof filed to No....&-~~..:Z--':/.=.I..__.
'.Witness my hand and official seal thiS ~.."
day of"_!!1..4._!::..~~__19.2.~.
.........._..._~..~
.Register of Wills h-zL
._------'-OCJ
,....~1::...,~•0 •..-l ~b ::l cS ~0 11 0 ...,~~u ~G>::l 0 ::l0Q)00+1 :S ....0\:"0:0 0~i -0::Ul I"-0 <I I 0Q)i ';:1 t r-0,...,'C~w:w..i r~l-<co!'..-l i ,"0 Q).EE--.,.~m Q)G~Q);...,0,4 ~ai :>.f74 Q)0 0:Q)~Q),J-(;!J ,II en '0 ~0 Of .1~'I n\....Lj?Q)U>.l-<
'".•rn I l-<;;::u.l:0 <tIP,.......,
'C)!r.:l ..:1-4 .'9 ...,,Eo<0::[<U 11 <10 -0::"'-........;u.l:..Q x 0:::-0::;::>r.:l~1 Eo<ffii H 0 u:J:Q1 RUt>...'"0 0:~~[rn ~"0\;·tll } t ~"-'1 J ~0 "0r.:l u:J:~U4i\jdO ~~z:N 19!co,RE;GISTEn ~H:d cd OF WILLS .,..;~d J-L..!:E ..I:e:•..-l;·rl WASH/NGTQN .~.S Q)~!::r:r J-L..j 0 ...,...,.:CO .~.....en·rl PA.~~'So (J):
.....:If c6!0 sH.....~!'J Q)Q)b:u.l'~::;:S .:::Il:<:::>,-1-'1 co ....0:::0 ~~i wi P.i i=:0 oJHi~0 J-L..:
0 (J)!,..-l:"0 ~iJ-L..!~i=:oi ..Z -0::0,...;....(J):
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---;......:,.-..:...
r ~:,',ff•'"<J •~:."'.;'"•"<...~fbe Court 11 rta»eottul11 requ9Btea
to 4etermlD&p~oper d18trlb~t1on inUa1.est_ttl•
Couneel for Aocountant'
..,,.....
The First &Final Account of K.PATRICIA GERBER,Administratrix n.f
the Estate of SAMUEL H.GERBER,Deceased,late of the City of Washingtn.n,
Washington County,Pennsylvania.
The Accountant is charged as follows:
---~--------------------------------------------------------------------------
To amount of Inventory &Appraisement $10,000.00
TOTAL ASSETS $10,000.00
TOTAL CREDITS CLAIMED 2,594.84
BALANCE DUE ESTATE $7,405.16
.¢:
',.J.t.
..
..
".
The Accountant claims credits out of the assets of said estate,as
follows:
--~.--~----------------------------------~---------~--~-----------------------
Stewart Barnhill
Sanford S.Finder
K.Patricia Gerber
Beth Israel
Rabbi Matzner
Register of Wills
Register of Wills
Washingtnn County Repnrts
Observer-Reporter
Commonwealth of Pennsylvania
Russell Marino,Reg.
.Funeral Expense ~$1288.84..,
Attorney's fees 500.00
Fiduciary commissinn .500.00
'.
cemetery plot 150.00
Services 50.00
Letters of Admn.&
3 short certificates 15.00
3 short certi ficates 3.00
Legal advertising 15.00
Legal advertising 15.00
Transferring liquor license 42.00
Filing Accnunt 16.00
$2·594.84
'f
·-Washington County Reports
Washington,Pennsylvania
(PUBI..ISHED BY WASHINGTON COUNTY BAR ASSOCIATION)
PROOF OF PUBLICATION
In compliance with the Newspaper Advertising Act of May 16,1929,
P.L.1784 Sec.5,paragraphs (5)and (25).
COUNTY OF WASHINGTON}88.STATE OF PENNSYLVANIA
Personally appeared before me,a Notary Public in and for said County
and Commonwealth,CHARLES C.KELLER,who,being duly sworn,deposes
and says:that he is the Editor of the WASHINGTON COUNTY REPORTS,
the officiaJI.legal periodical for said Washington County,published weekly
having its place of business at Washington,Washington County,Pennsylvania,
and is acting as its agent in this behalf;that the said WASHINGTON
COUNTY REPORTSwas 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 advertisement attached hereto is a copy of a notice or advertisement,
exactly 'as printed or published,which appeared in the said legal periodical in
its regular issues on the following dates:
.............D..~~.gm.f::?e..r.:3..,..1..Q.•.....l.l..•.....l..9.7Q .
,..Estate Notices
The Register of WiHs has granted
letters,testamentary or of administration,
in the following estates.Notice is hereby
given to all persons indebted thereto to
make payment without delay and to those
having claims or demands to present
them for settlement to the Executors or
Administrators or their Attorneys.
• • •• ••••• ••• • •• ••
---------GERBER,SAMUEL,Dec'd.
Late of Washington,WashingtonCounty,Penna.
Administratrix:K.Patricia Gerber,85 Leonard Avenue,Washington,
Penna.Attorney:Sanford S.Finder,729
Washington Trust Bldg.,Washing-ton,Penna.
that the affiant or the corporation in behalf of which he is acting is not
interested in the subject matter of said notice or advertising and that all of the
.ll,g,tiom of th;,",.""it M to th'lJ phre md ""~,,",of th,publi''''M~,tru,.------?!a?J1tJ---l!d__~
Sworn to and subscribed before ~~~
....l9.1.b.day Of -j.y.o.g ,19 7...3...~.#-rLu.JiL-r-~~b~0
JOSEPHINE T.SCIAMANNA
Notary Public.Washington,Washington Co,
My Commission EX'lirrs 'ti!'!1,1.9i4
"
Commonwealth of Pennsylvania,County of Washington,SS:•••.•
Personally appeared before me,a Notary Public in and for
said.County and state,Richard S.Cowan who---------------,
being duly sworn according to law,deposes and says that
he is the Vice President of Observer
Publishing Company,a Pennsylvania Corporation,and its
agent in this behalf;that the said Company is the
for Samuel Gerber
Observer-Reporter .-_-...-----------------,publisher ,of the
that an Estate Notice
,appeared in the Observer-Reporter---------------'
Nov.27,Dec.,4,11,1970
Sworn to and Subscribed before me this
2 day of July
EDITH W.SANDERS,NOTARY PUBLIC
Washington,Washington Co.,Pa.
My Commiss:on Expires February 14,19n
1 ,f.,
, I
~lt .t~r ,I <trnurt nf <trnmmnu JUras nf lJus4iugtnu
I ®rp4aus'<trnurt ilinisinu
In the matter of the Audit of Account in
<trnu~ty
J
Estate of SAMUEL H.GERBER,Deceased
TO THE AUDITING JUDGE:
d3-70-/o/~-No,_-=-__~~_...:-~-=_
Enter__---=ffi:J.V appearance for__-=a.=c..;:c..;:o-=u:,:.n.:..t::..:a::..:n:..:.t-=--,--__
N.B.-Counsel shall,by separrute pape,r,present a concise statement of each
claim,with supporting calculation o·f 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.
F\LE.D~
'14 MiW Zi~PI1 \Sll
NO•.=
In re Audit of Account in Estrete of
RUS SELL H;\.Hi H0
REG ISIT i'(j r WILLS
WASHIN(:'C:-J GO .•PA.
I
SAMUEL H.GERBER,Deceased
AUDIT
'rartipr fnr !\ppraraUtr
FOR
K.Patricia Gerber,AdIDhistratrix of
the Estate of Samuel H.Gerber,Dec'd
SANFORD S.FINDER.ESQ.
Attorney
~2
'9
(Form where decedent died intestate)
3Ju tlIr (@rp!Jun.a'<!tnurt nf lIus!Jtngtnu <!tnun~y
j
ESTATE OF.Term,19 ,A.A.
SAMUEL H.GERBER
In the audit of the First and Final
Account of K.Patricia Gerber,Administratrix
Deceased
The petition of K~P.9.t*-.t.y.1C\§~*-p.~L .
(Name of Petitioner)
State (l)whether de-
edent was married or
unmarried;(2)if mar-
ried,whether a husband
or wife survived and
his or her name;(3)
whether or not there
was any marriage settle-
ment;(4)whether or
not family reiation was
maintained until deced-
ent's death;and (5)
whether the decedent
left children or issue of
deceased children.
respectfully represents:.
(a)The decedent died QG.tQp.~;r.U.J....l.9..7Q ,intestate and
(Date)
letters of administration on h.i.$.estate were granted .9..<?j:~p..E?!.J.§.1 J2.7.Q .
(Date)
as per record thereof appearing in Adininistration and Bond Book No .
at page .
Decedent was survived by K.Patricia Gerber,wife,and Bryna Gerber
Daughter;(the daugHer has assigned all her interest to her mother)
within(b)At the time of death,the decedent's domicile was ~bIOtNk the Com-
monwealth of Pennsylvania,to-wit,at...w..g.!?bJn.gt.O'Q.,....P..e.r.m.$.y.ly.ani.a.~....u....S...A.....
(Town or Township,State and Nation)
and residence was at..w.?§.b.~.D.g.t.9.D:.L.P.~D.n.!?.Y.~.Y~.n.t.9 ..')J.!.§.!.A!.
(Town or Township,State and Nation)
(c)The names of all persons ,having any interest as heirs or next of kin
with the names of their deceased parents,to show relationship if they take by
representation are as follows:
NAMES Relationship Interest
Of age,sui-
juris,or not,
(write yes or
no).
Name of Guardian,Trustee or Committee,if
any,or beneficiary,manp..er and place of
record of appointment and is bound suffi-
eient to cover and protect share.
K.Patricia Gerber
Bryna Gerber (note~-daughter has
assigned all her interest to her
mother)
Wife
Daughter
1/2
1/2
sui juris
sui juris
State exceptions,if any,
giving names and dates
of death and the names
of their executors or
administrators,or the
names of their issue as
the same may be mater-
ial.
Describe type of notice.
All of said parties III interest are living,except
(d)All parties having any interest have had notice of the filing
of the account by letter
(e)Balance for distribution per Account
(f)Additional debits,not shown by Account
(Itemize)
(g)Additional credits,not shown by Account
(Itemize)
$...7.,.49.~.~.lQ ..
$ .
$ .
not $.7..!.4Q2.!JQ.....
Insert word "not"where I (h)Claim for exemption has/been made,and has Dirt..been paid.
necessary.
(i)The estate is subject to the payment of inheritance tax to the
State of Pennsylvania.
If taxable state w~eth-I (j)The estate is..l no:t subj ect to the payment of the county 4 mills
er tax has been paId.
tax.
(k)The e-state is D.9.t..subject to the payment of Federal inheritance
tax.
if too many for the
space,annex a list there-
of;if no such claims,
insert the word H ncne."
If any creditor or other
claimant has not re-
ceived actual notice,that
fact must be stated.
Indicate such claims as
may be secured or en-
titled to a preference,and give detailed infor-
mation concerning such
security or preference.
Here insert a reference
to all questions requir-
ing adjudication,and a
statement of any mater-
ial facts not already
given.If none insert the
word "none."
If any share has been
assigned or attached
that fact should also be
stated here.
State kind,form and
character of property
composing the balance
for distribution,and if
any part thereof is not
cash,whether or not
there has been any elec-
tion to take such part
in kind.
(1)All creditors (and other persons who have complied with Rule II,
Sec.9),of whose claims the accountant...notice or knowledge,have
........................received actual notice of this audit;the amounts of their claims and
whether or not they are admitted to be correct are as follows:
None
(m)The daughter of the decedent,Bryna Gerber,has assigned her
interest in the estate over to her mother,K.Patricia Gerber.
(n)The balance for distribution consists of property in kind,form and
character,as follows:
Frothy's Beer Mart--Distributor's license
,Are there any advance-
ments by decedent to be
considered on distribu-
tion and has any distri-
bution on account been
made by accountant to
any distributtee?
(p)No
(q)Give .brief location of any real estate sold.None
If prior accounts have
heen iiled,list number
and term.
(r)None
Wherefore your petitioner asks that distribution of principal and income
be awarded to'the persons thereunto entitled and suggests that the balance of
principal and income should be awarded respectively as follows (shares being
stated in proportions but not in amounts):-
The balance of the estate be awarded to K.Patricia
Gerber.
County of Washington,ss.
The above named petitioner being duly
sworn doth depose and say that the
facts set forth in the foregoing petition are true
to the best of h..ex knowledge and belief.
,..-/L to a~d _su~~cri~ed before me thiso<~t:''(.,d_ay -Of..::14:1:0dM(j ,19 .7.!f......r,.h'0J~~r
......~..~~~..
ALICE t.:.MILLER
·····..····"..Notary-·Publfc;·WOfrhington;··W-a5hingt1l11..CG .
My Commission Expires March 20,197,
And your petitioner will,etc.,
L~~
(Signature of Petitioner)
t
I .,
FORM IN CASES OF INTESTACY
No _ ,Term,19 ,A.A.
IN THE
ORPHANS'COURT
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WASHINGTON COUNTY,PA.
SAM.UEL..Ha GERBER .
Deceased.
Estate of
Sur account of ..K,!..J?9tA;i.g.i.a Gerb.er.,..
.Mm.iId.s.:t.r..atr.ix _ .
PETITION SUR AUDIT
In Conformity with Court Rule III,
Sec.5 (B)
COUNSEL FOR THE ACCOUNTANT WILL
SUBMIT HEREWITH
1.The fetters of administration.
2.A copy of the inventory and appraisement.
3.Proof of advertisement of the grant of fetters,
if not filed with accountant.
4.An appearance for those represented.
5.Inheritance tax receipts,if any.
6.Certificate of liens in case any of the funds for
distribution are derived from the sale of real estate.
7.Copy of Federal Estate tax return,if estate is
subject thereto.
8.Signed elections to take in kind,if any.
..SANFORD...s.--.E.INDER-,._.~ESQ•.......................-..
Attorney for Accountant.
....9
SANFORD S.FINDER
ATTORNEY AT LA.W
Tag-TMWAflUINOTON TRUST BUILDING
WASHINGTON,PENNSYLVANIA U5301
February 25,1974
Miss Bryna Gerber
85 Leonard Avenue
Washington,Pal 15301
Re:Estate of Samuel Gerber
Dear Mrs.Gerber:
TELEPUOKE aalJ-ICl30
....u ....CODE 4151
Please be advised that the above estate will be called
for audit on Tuesday,March 19,1974,at 10:00 o'clock A.M.,in
the Orphans v Court Room,Court House,Washington,Pennsylvania,at
whi~h time you may appear and be heard,if you so desire..
Yours very truly,
SSFaam
f
/
SANFORD S.FINDER
ATTORNEY AX LAW
TaO-T34WA8UINGTON TRl:J,8T BUILDING
WASHINGTON,PENNSYLV~Al~301
February 25,1974
Mrs.K.Patricia Gerber
85 Leonard Avenue
Washington,Pa.15301
Re:Estate of Samuel Gerber
Dear Mrs.Gerber:
TELEPDGJOfE aa5-JAJ30
AREA.CODE 412
Please be advised that the above estate will be called
for audit on Tuesday,March 19,1974,at 10:00 o'clock A.M.,in
the Orphans'Court Room,Court House,Washington,Pennsylvania,at
which time you may appear and be heard,if you so desire.
Yours very truly,."
':;-...
"....
SSF:am
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rn THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PA.
ORPHANS'COURT DNISION I
•I
•
INRE:
Estate of
SAMUEL H.GERBER,
0(zDeceased.
0(>oJ~IIIZZ11/II.
iol-e>;BEFORE:xIII0(::
(
)
(
)No.63 -70 -1015
(
)
(
HEARING ON AUDIT
The Honorable PAUL A.SIMMONS,Judge of the
said Court.
Mr.Finder...;"'.t.."'f.he eS,tat'e'of Samt'!el H.Gerber.
"l r·~~
SANFORD S.FINDER,Esquire,of Washington,P .,
represen.ting the Accountant.
.'
If.,the Co:ur,t ,pleal?e;,I have all the papers in thi
.....to.t \..j,,,••.I ~.
estate.,There are no problems.We do have attached,so that whe
MR.FINDER:
aia:11/I-a:oII.11/a:
I-~THE COURT:
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a:...~APPEARANCES:
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•
the Court makes the Schedule of Distribution,an Assignment
of the daughter of all her interest to the mother.The only asset
in this es'tate was a liquor retail dis tributor .ilicens e.
THE COURT:There are no complications,no need for a hea ing?
MR.FINDER:No.
THE COURT:
MR.ZERMANI:
(Co urt Crier)
-r
Would .you anno'unce this estate,please?'
~.,4~•r....
Your .Honor~\·n received no res p0l").s e .
THE COURT:Is'an;o~e in -th~.Courtroom interested in the
.....•"p."'"I ,h
,,~.,~"estate of SamueLH.,Gerber?',-•~z~>.J>-VIZ
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THE COURT:
is ordered clos edt
(NO <RES PONSE )
Hear.il").g no,res pons e,.the audit of this estate
(AUDIT CLOSED)
.>
Ihereby certify that the proceedings and evidenoe are contained
and that this copy is a correct transcript of the same..~,
~~~~~-~~/~.....,
fi ial tenographer .-
The foregoing record of the p ceedings upon the hearing d the,
!IiII:III..II:•.
gfully and accurately in the notes taken by me onth~hearing of the above
II:..II:gcause,
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above cause is hereby approved and directed to be filed.
By the Court,
~~~~~~-Paul A.Simmons,J.
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In t4r <!tnurt uf <!tummnn JUran nf llun!1iugtnn muunty,
'rnnnylttttnitt (Orp4ttnn~<!tuurt iittininn
ESTATE OF
Samuel H.Gerber,
Deceased.
63--'70-1015No.__~~_---.:=--_
In the matter of the First and Final
Account of K.Fatricia Gerber,
Administr.!trix.
ADJUDICATION AND DECREE
An now Hay c2 I ;£t ,19-.1!±,this matter came on for hearing,
audit and distribution of this session and testimony taken;and thereupon,upon due considerationt~(~tht balance for distribution in the hands of the Accountant is determined to be
$.0 .1 and the account is accordingly confirmed;and it is ordered,
adjudged and decreed that the said balance be paid out by the Accountant in accordance with the
schedule of distribution hereto attached and made a part hereof,unless exceptions hereto,be filed
sec.reg.or an appeal be taken herefrom sec.leg..
SCHEDULE OF DISTRIBUTION
=====================;=====r=====
Balance pe.r account....,.-'_'I
'---------------------1
$740,.16
No balance
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ASSIGNMENT
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WHEREAS,Samuel H.Gerber in his life time was the owner of
a established distribution company:known as Frothy's Beer Mart which
bore license Number TD 2872;and
WHEREAS,the said Samuel H.Gerber died on October 13,1970
intestate leaving to survive him,his wife ;Kay Patricia Gerber and his
daughter,Bryna Gerber;and
WHEREAS,the said Bryna Gerber wishes to relinquish all her
said right,title,and interest to her mother.
NOW,THEREFORE,WITNESSITH,I,Bryna Gerber,for and in
consideration of the sum of One Dollar ($1.00).,and other good and
valuable consideration do hereby assign,discharge,set over,and
quit claim to my mother Kay Patricia Gerber all my right,title,and
interest in the estate of Samuel H.Gerber and hereby direct the Orphans I
Court of Washington County,Pennsylvania to distribute,the entire estate
unto my mother Kay Patricia Gerber;I Bryna Gerber hereby certify that
I was born on July 26,1952 and certify that I am fully aware of my rights
to inherit one-half (1/2)of the estate of Samuel H.Gerber,deceased.
Dated:February 3,1973 (./Bryna Gerber
,J1"-I).
I
COMMONWEALTH OF PENNSYl,VANIA ),.
)ss:
COUNTY OF WASHINGTON )
,1973,before me a
Notary Public,the undersigned officer,personally appeared
Bryna Gerber,known to me to be the persons whose name::-.is
subscribed to the within instrument,and acknowledged that they
executed the same for the purposes therein contained.
IN WITNESS WHEREOF,I hereunto set my hand and offical seal.
,.
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My Commission Expires March 20;117{'-".'•
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Notary Public,'.~
ALICE L MILLER~.."
Notary Public.Washington.Washftigtqnee.~:~My Commission expires
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.00 r
1)288.84
500.00
500.00
150.00
5 0.00
15.00
3.00
15.D 0
15.00
42.00
4578.84 T
.00 r
.eo T
10)000.00
If)JOOO.OOs
2~578.B4-
71421.16 T
Form No.RCC-62 (6-70)THIS FORM REQUIRED IN ALL ESTATES WITH GROS~ASSETS UNDER $10.000.UNDER SECTION 701 OF ACT OF JUNE 16.1961.jJ;F~~IV;E .JANUARY 1.1962.(FILE IN OUPUCATE WITH COPY oF'WILL ATTACHED)~3_7{}~/j/S
OFFICE OF THE REGISTER OF WILLS
County of ..\tYq.$l;~fl9:t.o.11 .
....!<.".):q.t:F~~~p...q~:r:q~:F 'of 8.q .I:~QI)?;rp...J\'I(~H.W?~P.i.r1g~QI),.Fa...
(Name)(Addreu)
being duly.___~W'Oh.IJ...•....._according to law,deposes and says thatSle is the Mmi-lli-s.t.r.auix....__..__.(Exec.•Adm.,Legatee.Etc.)
T.
S.
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the
ial
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of the estate of...__.§~'1l~~L.H~...g.~;:p.~;:.._____._..._.__...__whose last residence was _...e.9...t.~.O.n.9.:r..d...AY..e.•.~...Wash.ing.ton,...(No.)t~t)
..~.~~------....-.....__....._______.._..____...__deceased,and that the whole of the estate of said decedent,who died _..O.c.t.•...l3",..l9.7D.(CitY.Borough or Township)(Date
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA.WITH STATEMENT OF MORTGAGE ENCUMBRANCES UPON EACH PARCEL AT DEATH OF DECEDEN
WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES.GIVE NAMES.ADDRESSES Aim RELATIONSHIP OF OTHER OWNER
Real Estate Estimated
Value
NONE
i-,
Personal Property
Frothy's Beer Mart--Distributor's License 19,,000,,00
0
-.~,-0
n ~
.,-n ~
NOTE:You may expedite the processing of this return by filing with it,and as a part of the retu
letters from financial institutions or mortgage holders,certifying to amounts on deposit or owed by
decedent as of the date of death.Such letters must be signed by a responsible officer of the financ
institution or mortgage holder and indicate clearly amounts of principal and interest in the deceden
account at the date of death and the type of account, account number and the exact name or names
which the account is registered.
...-.-.-'.~"
Jointly Held Property Estimated
'Va~
None ,-..-
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0
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Transfers within TWO Y-EARS Prior to Death-II '-.None'I h .......
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That at the time of death there was no safe deposit box registered ih decedent's individual name,or jointly wit~,or as agent or deputy of
another,or in decedent's individual name,with right of access by another as agent or deputy,with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
-
BENEFICIARIES
,BENEFICIARIES AND ADDRESSES
RELATIONSHIP SURVIVED AGE OF LIFE ,
(If step-children or TENANTS OR INTEREST OF
;(state fu\1 n~m~s ot·a11 and their addresses who have illegitimate children DECEDENT ANNUITANTS BENEFICIARYSTATEYESaninterest,vested,contingent or otherwise,in estate.)are involved,set OR NO,AT DEATH OF IN ESTATE
:forth this fact.)DECEDENT
K.Patricia (50 Leonard Ave.Wife Su i i1l1'i c::Gerber.,Wash••Pa .•Yes nne...half85LeonardAve.Bryna Gerber,Wash...Pa.Dauqhter Yes Sui iuris one...half
(dauqhter has assiqned all her
interest to mother)
,
II
I"'R-E-S-I~"",~--O....T-·-~""E-C-E-.D-E-N-T-----~~-._....;-D-E-B-T-S-A-N-D-D...•...:...~...:'~~.....T·.,..:O....·N-S-C-L-A...I""M...E-D-----------------II!II!
N9'TE'List first five items in the spaces so provided observe notations thereon,and instructions.,
DEBT OR CLAIM NATURE OF SAME AMOUNT THIS COLUMN
iKEGISTER ONLY
Stewart Barnhill Funeral expenses paid $1288 ~4 $
Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)
Administration Expenses •
Sanfnrd S.Finder Counsel fees •500 DO
K.Patricia Gerber Fiduciary commission •500 Do
OTHER DEBTS AND CLAIMS
(• )See Note below
i
Beth Israel Cemetery Iiot 150 00
Rabbi Matzner Services 50 00
Register of Wills Letters of Admn.&3 Short Certif.15 QOc'Register of Wills 3 Short Certificates 3 00
Washington County Reports Legal advertising 15 00
Observer-Reporter Legal advertising l~00
Commonwealth of Pennsylvania Transferring liquor license 42 00
I
I
Total 2,578 84 7..5'J~~"I
~~.~J:l~n9~.ql!-',Y?~.~.q~9.~.
(City or Town and State)Notary PUblic:Washington,Washington Co.
M)B~'Iil;~ig3i3i1 E;,pi~zg rem!;:29,197 6
Note,Th...t.t.......to ad.Vise the Register..of Wm,;f tho .mount ootn.lly p.;d ;n ..t~lemenof an.y fee,comm..is.,ion 0;d.ebt is greater
or less than the estimated amount cIaim:d and aJlO~ed.->//~'~:'y~
Subscribed and sworn to before me this ...',:.. . . . . . .[J..'.j .-.~'.
_,.1 -./'\f/;;;;:tt._.-(E:zecutor"Ad1!1in~t-r:.qtor)
!I-e/(,:..197q...........';(J~':',~<.'d~Z-Z;"/"":""",??.~~.q1!i3-.:r;'9-..JW~St~~~t·N~~~~;~:"""""""'"
........·.~·~-~1.i:.Ir;Et;M1lll::R'.
ApprAiser
~aving been duly sworn~a~cording to law,I do heIT certify that the above appraisement is made in conformity with law on this
...................!.7..z;n dayOf -U~-.······R~19~tA~.
·V·~·····J.dJU1Y.L~.
In the event th~t any future interest in this estate is transfelTed in possession 01'enjoyment to collateral heirs of the decedent after the
expiration of any estate for life 01'for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer'inheri-
tance taxes at the lawful collateral rate on any such future interest.
REPORT OF T~STE .OF WIL S
I,the undersigned duly elected Register of Wills in and for.. . .....ounty,Pennsylvania,do respectfully
report that I have allowed debts and deductions in the amounts cia'deponen pt s~those i ms where a greater or lesser amount
is set fort~in the last column to the right in said s~,hedule above,which greater or Ie amoun re rese S the sum allowed as a de<4!ction.
'~ated:'~~~~}~.!~~~RUSS~.~~..~~i_~........~l.l ~~..~.___A....-Register of'Wills
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..I Form No.RCC·62 (6·70)
WillAdminisb;ation }No Year .
IN THE
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
SAMUEJ,..Ii GJ;Wlm jje~~~~~. ,........
La~of B5.Leonard.Av.e.,.Washington..
County of .~,11~9J:l~pgton....................
Commonwealth of Pennsylvania
....,"-....;
--.J 't'~;u -r
REPO~~AP~AIS'AL
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SANFORD S.FINDER,ESQ.
729 Washington Trust Building
Washington,Pa.15301
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Rcc-al ("-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
NOTICE OF FILING OF APPRAISEMENT
K'.PATRICIA GERBER
(Executor or Administrator)
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
In Re:Estate of --=S=AMUEL=·==-..:..G.:.....ERBER:..:..-_
WASHINGTON County _File No._6_~_-_7~_·_J._01_5_·_
Dear MADAM:
You are hereby notified t~.....O""'RI""mG...I.....--NAL---------------
apprai sement in the estate of •GERBER·--....==0;""""""""--------
has been filed in the office of the Re.9'ister of Wills of_W_A_S_H_I-'-N_G_T_ON _
County on JANUARY 17,,19A,Said appraisement reflects the following
valuations:
Real Estate ....,.....,........~.--..~----
PersonaI Property l_O::...,O_OO_:·00 _
Transfers,--,---_
J0 intiy Owned ---.-............._.........__----
Tota I 1_0.....:·,:.....0_00_·'_e_OO_i
_
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 nine (9)months
(fifteen months when death occurred from December 22,1965 to June 16,1971,inclusive;
and twelve months when death occurred prior to December 22,1965)from date of death,
interest at the rate of six (6%)percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961,72 P.S.2485-1001,P.~~.:.
Date JANUARY 17,1974 Signed~...R ~"
Title __AP_P_RA_I_SER__11 _
DATE OF DEATH:OCTOBER 13.1970
Note:This is not a bill.
------------
..
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RCC-39 (!loBB)j
/
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
Estate of GERBER,SAMUEL
(Last Name)(First Name)(Initial)
DATE OF DEATH 10-13-70 FILE NO.63-70-1015,
REPORT OF INHERITANCE TAX APPRAISER
th d . d d I . d I h'T A . . d f th C f WASHINGTONI,e un erslgne u y appointe n entance ax ppralser In an or e ounty 0 _
Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each itern in the last column to the right in Schedules "A","B","C",and "E".
Dated:_'J_ANU_A_R_Y_17_,_1_97_4 _
REPORT OF THE REGISTER OF WILLS
"-~~-
REGISTER OF WILLS
~~
I,the undersigned duly elected Register of Wills in and for ~ASHINGTON County,Pennsylvania,do respect-
fully report that I have allowed deductions in the amounts claimed by deponent,exc.l;pt as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F",wh~eate or lesser amount represents t.he sum
allowed as a deduction.(
d :JA~j 18 1974RUSSELL MARJNO~Date:it
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 APJ>RAISED
$$--.......---........----1-_-
2 578.84
7,421.16
VALUE AS REAPPRAISED
$------+--
Valuation of life estates or
FOR USE OF REGISTER ONLY
Tax on $-----------l--~
Tax on $-----------l--C6$J
Tax on $5%
Tax on $10%
Tax on $15%
b~ptioos *
Total Estate -+..__
TOTAL TAX
COMPUTATION OF TAX
$--------1---
$-------+--
$----------l---
$----------l---
$-------~-
$L--_
(*)As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5%of tax if paid within
3 months after death
:-----It=:
$=====L==
BALANCE OF INHERITANCE TAX DUE $t=
Add interest at rate of 6%from_____to $--.J
AMOUNT OF ESTATE TAX ASSESSED $----~I-
Estate tax paid $--Jl-
BALANCE DUE $L-
Add interest at rate of 6%from t=
------{t'o-----$--------1
TOTAL TAX BALANCE $-------lPAID$...J
FOR liSE 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.
WAdill ...~No.. ..mlmstration ~
IN THE
Year .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
SAMUEL GERBER
..............
Deceased
Late of .
County of
WASHINGTON
WASHINGTON..............
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
".<
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Fonn RCC-2 ..~1.....L ,JANUARY 17,1971t.I..;..COMMONWEALTH OF PENNSYLVANIA DATE ...................................................................··....········....···..·..·..·..····1
,DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX WASHINGTON I,
BulEAU OF COUNTY COLLECTIONS COUNTY ..................................................................................................
I
HARRISBURG.PENNA.17127 APPRAISEMENT FILE NO.63-70-1015..............................................................................................."'1,
1 Whereas,...............................~~...G.~;........................................................................late WASHINGTONof...................................................................................................................
in the County of ..................................w.~§.~.~g~.9.~...................................................................Commonwealth of Pennsylvania,having died on
.11th OCTOBEl 70 seized and possessed of estatethe............................................................::..................................day of ...............................................................................19............,an
I subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
1 DOMINIC ,R.neMARIATherefore,I,.......................................................................................................................................,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 even,t 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 llfe 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 AppraisementDescriptionofAssetValuesMadeforInheritance
Tax Purpoles
PERSONAL $
SEE COpy OF APPRAISEMENT 10,000.00,
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WASHINGTON:County
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RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
SAMUEL GERBER
Deceased.
Late of
WASHINGTON..,.
Date of Death,QG.'rQ~~J.L.j.J..,J..9.7Q ..
Appraiselnellt Docket Vol.J Y,.
Page,../I/-::..-?No §?:7.~~~Q~~.
Filed in Register's Office,.J.~~.~~7..~19 '14..
Amount of tax due,$.
DEPARTMENT OF REVENUE
Received,
Exa.mined and Approved,,.
Wrote abo.ut Appra.isement,
Appeal j1'Qm Appraisement,.
Entered and charged,..
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IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNA.
In the matter of ,the Audit of Account filed in the Estate of
38 ]11-3
1970
Docket
)Date or death October 13,
\No,63-70-1015-,Term.19 ,A.A.
I
)Deceased
___~~=.,~Rm~u=el H.Gerber
TO THE AUDITING JUDGE:
Enter my ,appearance for the Commonwea~th of PennsylVlClIlia,claiming tronsfer inheritance tax in lfue above estate,as follows:
DR.
To appraised V1alue of Estate:ReaLty $._
Personalty $--~.f--I-"().L..,"'-,tJ",-,"!lL-""Ow'Lct'l""...>(l.L._
Additiollial Assets per Account,Subjeot 'to Tax _$_
Additionall Assets per Audit,Subject to Tax _$_
GROSS VALUE $__~/L..---",().'()()cJ;(JO
CR.
Debts and Expenses per Account;see Note
Additional Debts and Expenses per Audit
$---_.._--
$------
$---------
$-------
$$..:r'_2:.....A..Q=-__
$--
TOTAL DEDUCTIONS,$
NOTE:The f()llowing credrts claimed in the Account are
held nDt deductible 'as against the tax:CALCULATION
Clear VaJue ...
Gross v:aJ1ue .,I I'l,""a..t..LJ...t1......._
Less Deductions __.~2.=.........,''---'''3'-''a~..L.,f?L--I-i _
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able
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$--_.
TAX PAID ON ACCOUNT
$------
$--_._--
$------
$---
$-------
Total Tax....._.
Less amount previously pa1id..............................................................$--If'1:(')..7
Balance .&U¥.d.f:1:!.~.".!:.4:!...£.$._._
Interest__yrs.__mos.__days @ __% _$_
TOTAL TAX AND INTEREST DUE _ :$_&<-(2(').(,t.6
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ESTATE OF -S_8_rn_u-.el_H_._G_e_rb_e_r....I_D-.e_c_ea_s_e_d_.-_
ADJUSTMEJ~TS -FILE NO.63-70-1015
DEBTS &DEDUCTIONS FORM -AMOUNT CLAI~ffiD
LESS ITEHS DISALLO\'lED:
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BALANCE
ADDITIONAL DEDUCTIONS -ACCOUNT &AUDIT
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TOTAL ALLOWABLE DEDUCTIONS..
$-----
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Date Approved RUSSELL MARINO,REGISTER OF "TILLS
By:.~
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$2.:).:7 f~~
RUSSELL MARINO,REGISTER OF WILLS
By:'Jr~
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$-----
$-----
TOTAL ALLmiABLE DEDUCTIONS
$-----
$-----
$,-----
if ...
Date Approved
BALANCE
ADDITIONAL DEDUCTIONS -ACCOUNT &AUDIT
ADJUSTMENTS -FILE NO.63-l''--J"-'l~
DEBTS &DEDUCTIONS FOID1 -AMOUNT CLAINED
LESS ITEI·IS DISALLOI'lED:
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