HomeMy WebLinkAboutOC1971-1113 - ESTATE OF NIXTestate Form
PETITION SUR AUDIT
IN THE ORPHANS'COURT OF WASHINGTON COUNTY
Estate of NlL.RE.R'I Ji~NlX.,..J.,.~t~9J _.._.
....F-a-ll..ow£ie.ld..To.wnship.,W.as.b.ing:t.QJ)..._.
....C.o.Un.tY-.,....P.~D.l}~y.~y~mJ~_ .
Deceased
No Q.3.::1J.::.lJ:J.~__A. A.
Fiduciary Ele.anar J.e_an..Nix.,.
.Admini.s.tr.a.t.rix.,C.•.T.•A,..
~~cl ~~cl
Decedent's death AP..gP..~J~f~.,J.~JJ._Grant of Letters N.Q.y.~.mQ.~1:s..,..J..9.Z.1 .
This is the Eir.s.L.and...EinaL account filed in this estate
If there have been former accounts filed in this estate,list file number or number and term N.Q.l}~.
Election to take
Under or Against will.(cross out one)
Date Election Place of;
Filed Record _ .
Name of surviving spouse El.e.an.ar J.e.an...N.ix._.___._.._ _.._ _.._ .
List issue,where material:
Did decedent marry after execution of will?(indicate))t~.No.Any children born after execution of will?(indicate)
'6ex.No.If answer yes,name them ___ _ _ _..
Leg.atees Relationship Interest Fiduciary,if deceased or not sui juris
Eleanor Jean Nix Wife Sole Beneficiary
•
List,if exceptions to above:
Not applicable
If partial intestacy,give facts:
Not applicable
Adeemed:Revoked:Lapsed: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.t'koc
If any exception give cause:.
Fi Ie copy of Notice
and date of mailing D.~~.~mb.er ~~..l9.7.2 ,,,..
Is estate subject to the filing of a Federal Estate Tax Return?y.e.s H •••••••••••_••••••••••••••••••••••_."
Actual payment made on Pennsylvania Transfer Inheritance Tax.Amount $2.,.62.8.•.QO _ .
If the Will makes any portion of estate subject to a life-estate,give name and birth date of life tenant .
...N.Q.t ~p..P..J:J.~~.~J:.'?_ .
Give Names and addresses of all unpaid creditors who are legally entitled to notice,together with the amounts
of such claims;state whether they are admitted to be correct;and whether the claim is denied.
Not applicable
"
•
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
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:
$NQne._ .
$4.4.~~J.1.!.:I.J).
".".
Washington County Personal Property
Department.. . . . . . . . ...$172.18
Russell Marino,Agent-Pa.Inh.
Tax . . . . . . . . . . ...2,628.00
Total additional credits (Subtract)$...2.,.8.0.0 l~L .
Balance for distribution $41.,.5.10.•.92..
If balance for distribution is not in cash,list eath item held in kind,giving appraised Value (or distribution Value);
100 shares Common Stock,Bausch &Lomb,Inc.
375 shares Common Stock,Coventry Care,Inc.
350 shares Common Stock,Exolon Company
$15,500.00
1,500.00
3,281.25
...
If F 'I E 'I'd b P 't',I f R d'Not annlicableamiyxemptloncalmeyetilon,give pace 0 ecor ..-----...--.-----.------.----.,1;"-----------.....--.----------------------------..-
If Family Exemption is claimed at audit,give name,relationship and basis for Claim:N_Q_t ~np-lic..a..b.l.e---------..
List any advancement or distribution on account that has been made,and nature and amount of same:
Not applicable
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:
I
Eleanor Jean Nix -Sole Beneficiary
Personal Property held in kind:
100 Shares Common Stock,Bausch &Lomb,Inc.
375 Shares Common Stock,Coventry Care,Inc.
350 Shares Common Stock,Exolon Company
COUNTY OF WASHINGTON,S5:
COMMONWEALTH OF PENNSYLVANIA.
The above named Fiduciary or representative thereof,
$15,500.00
1,500.00
3,281.25
being duly Sl-iOI_n .doth depose and say
that the facts set forth in the foregoing petition are true
to the best oL her knowledge and belief,
___.SW.QXD.....to and subscribed before
me thiS..Lg_~.day oL__De.c:emb.e.I:19 7..Z.
Signature of Officer .riL!:-&~_~..rIJ.~
Title of Officer.-N-Qt~J;~~~LJ?~~~~ie .
,Notary Pub:ic,Ch2rleroi,Weshington County
Office expl res 1Ifi'tOmmtsslorl"~prr~s.AlIgUsH;T975'............•
And your petitioner will ever pray,etc,
6~~..............................~.~.............•.........•.......Eleanor Jeana{-i~--------:····
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No..Q.-3..".7.l."'.1.1.l3 A.A.
Estate of W.lLB.ERT..H .NlX .
Deceased
Fiduciary .E.l~.anQr J.e.an...N.i:x.,.
...................Adminis.tr.at.r.ix."'I...C_.T_A~.
PETITION SUR AUDIT
FROM WHERE DECEDENT LEFT A WILL
-..,\,t,'-I It '.t,I ~.'.\..
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G.
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.or an attest copy of Will.
6.Copy of inventory and appraisement.
7.Proof of advertisement of grant of letters
if not filed with account.
8.Certificate of liens in case any of the
funds for distribution are from judicial
sale of real estate.
9.Signed and itemized elections if any
distribution in kind.
10.Copy of Federal Estate Tax return if es-
tate is subject thereto.
)JJ..J..JL:tL;;;9?t~
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HORMELL,TEMPEST,SIMMONS,BIGI &MELENYZER
OLIVER N.HORMELL
CLYDE G.TEMPEST
PAUL A.SIMMONS
HERMAN J.BIGI
D.KEITH MELENYZER
JOHN W.MCiLVAINE
ATTORNEYS AT LAW
411 WASHINGTON AVENUE
CHARLEROI.PA.15022
AREA CODE 412
489.9523
483.8515
February 17,1973
OTHER OFFICES:
CALIFORNIA
MONONGAHELA
WASHINGTON
Mr.John Hana
Orphan's Court
Court House
Washington,Pennsylvania 15301
IN RE:Estate of Wilbert H.Nix
No.63-71-1113
Dear Mr.Hana:
This letter is to explain the attorney's fees,which were
charged in regard to the above estate which amounted to
$5,500.00.The estate fee was calculated upon the following
basis.There was an estate filed in Washington County of
$52,000.00,which based upon a five percent fee would amount
to $2,600.00.In addition,I was required to collect all of
the assets and take care of all of the payments,distributions,
etc.out of the estate;thereby entitling me to charge an
additional $600.00 as an estate fee.The balance of the fee
consisted of work,which I had done in regard to handling the
federal estate tax return,which was in the gross amount of
$333,892.00,which upon our minimum fee schedule would be
7/10 of one percent permitted as a fee or $2,337.00 ..The
combined total of all of those allowable fees would be
$5,567.00.But,in addition to the work hereinabove enumerated
it was also necessary for me to take certain preliminary action
regarding a law suit,which was filed by the Estate of William
Lee Britt who was killed in an automobile accident as a result
of the within decedent having been on the wrong side of the
highway.Included,of course,were some expenditures for
pictures,etc..
The foregoing is a brief summary of the work done in
regard to the above referenced estate;and if any further or
additional information is necessary,please do not hesitate
to contact me.
Very truly yours,
J/)L~/ljf/)J~~/l~d21,lty)~W/-Euv /'0-I
D.Keith Melenyzer
DKM:bk
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LAW OFFICES,
HORMELL.TEMPEST,SIMMONS,BIGI &MELENYZER
OLIVER N.HORMELL
CLYDE G.TEMPEST
PAUL A.SIMMONS
HERMAN J.BIGI
D.KEITH MELENYZER
December 1,1972
NOTICE OF FILING OF AN ACCOUNT
(As required by the Rules of Practice of the Orphans'
Court of Washington County,Pennsylvania),
Mrs.Eleanor Jean Nix
R.D.12
Charleroi,Pennsylvania 15022
In Re:Estate of WILBERT H.NIX
Place of Audit:Third Floor,Court House,Washington,Pennsylvania
Date of Audit:December 20,1972 .
Time of Audit:10:00 a.m.,B.S.T.
Dear Mrs.Nix:
I am sending you this letter in order to comply with the rules of the Orphans'
Court of Washington County,Pennsylvania.
The account on the above captioned estate has been filed in the Office of the
Register of Wills of Washington County,Pennsylvania~On the above date and time,
there will be presented to the Orphans'Court of Washington County,Pennsylvania,
a petition to audit this account,An heir of the estate,as well as any creditor,is
entitled to notice of the filing of this petition and audit,and,should you so desire,
you may appear there at that time.
You are not compelled to appear at the audit,but you may have some questions
on this estate.If you have any questions,please do not hesitate to write or call me.
I shall be happy to give you any information I can,and will do everything I possibly
can to answer any questions you may have.
Very truly yours,
D.Keith Melenyzer
File No.M-71-238
CE RTIFIED MAIL
RETURN RECEIPT REQUESTED.
J
IIns~iugtnu Q!nuUtYf SS:
I,.B_l::u?~_E?_ll ~lg_rJnQ_...__...Register for the Probate
of Wills and granting Letters of Administration,in and for the County of
Washington and Commonwealth of Pennsylvania:
To .~l_~_gn_9..r.""'.!I.~g_n N.j.JL -....._._...:....._.c.l.~•.t1..
AdministratriYof all and singular,the goods and chattels,rights and credits
~xg;.R~xixtui!1J"which were af-W.:tl_R_f;l_r_t H_Q 'N1.~. _
. .._!~_~~_~~.!.!._~}9_.__~9_~~!?:~_~~_E late of the said County,
deceased;with a copy of deceased's will annexed,GREETING:
TVhereas,the said .~~J._~_~_;t;~~~_!~!_~..._.. . .
"His l"f'd His I'W'll d T .'~o.-m .__._~etzme,mae ....ast 1 an estament 11t dJntl1lg)
",I d h 5th.d'f November A D [)71/'I'l t Hewhzchwasduyproveont e ......__._ay a ._.__...__. .__._____0 0'L.v.._-WVl1lg,W II S .-----.-..----
lived,and at the time ofJiJ_fkleceasc,divers goods and chattels,rights and credits,'U.!ithin the said County,by
means 7.uhereof the full disposition and po'wer of gr,mting letters of administration thereof,is manifest,ly
kl107i.'n to belong to me,.Therefore desiring that the goods and chattels,rights and credits which 7.r.:ere of
the said deceased,a:JtctR];/ridz"XJ!mrtilt1UXllXfktmM~may bc well and truly administered,converted and
disposed of according to the tenor and effect of the said deceased's will and according to law,I do hereby
gral1~1111to you the said__.._._J~1e..g_D.9.r ~:~_~n_}TJ~.".---A..dm1ni.s_t.rg,t.r.J.~__.s!_9__._1_i'---.~_!. _
____c.••• •••._.(in whose fidelity in this behalf I very IIluch confide,)fllll
p07.(·er by the tenor of these presents,to administer the goods,chattels,rights and credits )f'KJ7J.a:ixiJJ:g.
)Il~'zvhich were of the said deceased,within the said County,as also to ask,collect levy,re-
cover and receive the credits whatsoever of the said deceased,'which at the time of-f.~~_~death 7.t'ere owing,
or did in any way belong to!i~!!1'.__.and to pay the debts in which the said deccased stood obli[)cd,so fur
forth as the said goods and chattels,rights and credits will extend,according to their rate and order of la,(';
especially of well and truly administering the goods and chattels,rights and creditSXJ)lJrmizm.z.rJ-~~x
JW!,which were of the said deceased,according to the tenor and effect of said deceased's 'will,and according
to law;and making a true and perfect inventory and conscionable appraisement thereof,and exhibiting
the same into the Register's Office,at Washington,all or before the .day 01---.-----.--------.. _
llext,ensuing,and also a true and just account,calculation,and reclwning of your ad1l1inistratio1l,upon
your solemn_.._.Q_~_th.._....to render at the expiration of six months,or wizen legally thereunto re-
quired;and I do by these presents ordain,constitute and depute you,the said_.__. .._..._..__
Eleanor Jean Nix·-----·-··----·-·-----···---C·;··-'T:;---A":;---···---------..----.----.----.---.------.-..---.--.----.-----------..--.---..--.---------------.----.--.---------------------------.
adnlinistratr:ixof all and singular the goods and chattels,rights and credits,~t'tu.~iXt~~~~~
:>ami.which,were of the said deceased,'With acopy of said deceased's Will an~e~-ed,within the limits afore-
said;sQ7Jing harm?ess and forever indemnifying me and all other officers against all persons by reason of
your administration aforesaid,and saving all others their rights,&c.
3Ju W'r.atinutuy IIqrrrnf,I have hereunto set my hand and affixed the seal of said offic~at
Washington,the__..2_~Q~.....__.__day of····---.··-..~.<?~.~_!l2.1?..!:_~_._.. . .-.---.in the year of oilr Lord
one ,ho..sand ..ine h....dred and __~~_V.~_"!_tx __Orc_~:-:~_-_:~~~_
Register.
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That I.WILBERT H.NIX ,of Fallowfield Township
in the County oj Hashington and State ofPennsylvania,being ofsound
mind,memory dnd imdcrstanding,and considering the uncertainty of life,do hereby mahe,publish
and declare this my last llUHll and ucstament,hereby revoking and mahing void any and all
former TVills by me at any time heretofore made.
FIRST:I direct that all my just debts and funeral eX/Jenses be paid by my Executor
hereinafter named,asIsoon after my decease as may be convenient.
SECOND:I give,devise and bequeath the entire remainder of my estate both:i
real and personal,of any nature whatsoever,to my wife,ELEANOR
JEAN NIX,absolutely and in fee simple,including the business nml1
being conduded at 129 Lincoln Avenue,Charleroi,Pennsylvania.
THIRD:In the event that my wife Eleanor Jean Nix shall pre-
decease me,or in the event that we should hecome the victims of a ~
common accident in 'i3hich we should both lose our lives,then I give,::
devise and bequeath my entire estate to my children,JAHES CHARLES I:
NIX,DEBORAH LYllf.."JE NIX.,and JEFFREY LEE NIX,absolutely and in fee I:
simple.. .!
I
,
FOURTH:In the event that my wife shall predecease me,I hereby'
name and appoint my brother PAUL NIX,of Pittsburgh,Pennsylvania to I:
serve as testamentary guardian of both the estate and person of my l
thr.ee children un til they shall attain the.age of twenty-one,at Ii
which time the entire proceeds of this estate shall be turned over to
them,.less the reasonable amounts expended by their guardian for Ii
their maintenance and care.I
FIFTH:I hereby direct that my executor shall have full power ,
and right to sell and dispose of any and all of my property to
effectuate the purposes of this will.
No bond is required to be given by the executor in
tration of my estate,and that if notwithstanding this
bond is required by any law,statute or rule of Court,
required therefore.
the adminis-
request,any I
. b
llnosuret~es e
I~
If
AND LASTLy',-I do make,constitute and a/)point my brother PAUL NIX
to be Executor of this my last Will and Testament.
-----lin mrlitnes5 lll11hercof.I have hereunto subscribed my na'me,and affixed my seal,tlie
b''!h day oj Oc tober in the year onc thousand nine
hundred and fifty-nine (1959)'
Signed,sealed,published and declared by
•
'.-....---------~-
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,!:::...-~2~.L.tfq.F;:lJ.jj ..2l({!~)
Wilbert H.Nixjl..·..0
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l-JILBERT H.NIX•.•......................................................................................................-...
the testalor above named,as andfor
his last Will and Testament,in the
prcscnce of us,who have (71 his n~qu('sl,
subscribed uur rJrlJlU'S ill hisjJrcscJ!(/',(/J/(!;'
in Lhe resence of cach other,as witJlrsscs
hcr5#/;;,f~r7?/'
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Affibuuit (@f iExrrutnr (@r i\~miui!itrutnr J
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t;tatr of 'rnnaylnania,t ss:
mounty of Baalfington \
Personally before me,the undersigned authority,a N.Ql~r.Y.:P.~JJ?l.i.~..in and for said
County and .State,appeared.........El.e..a..nsu:....J.~.an...N.i~........·....·:A:dmtn·ts·iii·m$~h<>r ~iJl~duly
sworn accordmg'to law,deposes and says that S he IS the ~:mt mx of the estate of
.......W.il.b.e.r.t .H N.i.x deceased,that the foregoing schedules constitute a
~,complete inventory and appraisement of the real and personal estate of....N.ilb.e.r.t H N.ix ,
.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.,b~sed upon a.just appraisement of each
item made by the above named :UM~XX~ft AdmInIstratrIx C.T.A..
daY;~.~_~Ub~:~~:~;";Jj~~':.:!..?.._:..)c:.:~~~..._
Nt·ca:~~t"":~~=)A inistratrix C.T.A.oary ..,.,.,'''.0 ,!.ng or._7.·Afu'~,.ADDITIONAL INSTRUCTIONSt.~.G.:rA:~inv~ni~ii'k~~~~e~ll~~within three months after appointment of personal representative.
2.A suppleme!l;i:aJ 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 Copies 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
3Juututnrg nub ""pprnispmtut of the goods and chattels,rights and credits which
were of lv.ilb.e.r.:t H N.ix Jate of Gh~.r.l.~r..Q.i ..
Washington County,Pa.,taken and made in conformity with the above affidavit.
DOLLARS CENTS
15,500.00
a Penna.
at
PERSONAL PROPERTY:
1.100 Shares Cornmon Stock,Bausch &Lomb Inc.
2.375 shares Common Stock,Coventry Care,Inc.
Corp.having its principal place of business
1277 Country Club Road,Monongahela,Penna.
3.350 shares Cornmon Stock,The Exolon Company
4.Investors Syndicate of America,Inc.,a systematic
savings plan,a Minnesota Corp.,8th &Marquette
Streets,Minneapolis,Minnesota
5.Civil Air Patrol Bond
1,500.00
3,281.25
31,327.05
561.00
$5,180.00
death:3,116.46
($2,063.54)
REAL ESTATE OUTSIDE OF THE COMMONWEALTH:
1.Unimproved real estate being Tract No.82, 83,98,
and 99 of Section 35 of Township 27S,Range 33E,
Oscela County,Florida.This property being
purchased under Articles of Agreement.
Total Value:
Less balance owed at date of
2.Improved real estate,situate in Town of North
Harmony (Hadley Bay area),Chautauqua,State of
New York,and having erected thereon a one story
frame cottage,including a bl~ck building for
storage.Recorded.in Deed 1198,Page 228,
Chatautauga County,New York.
Total Value:($17,500.00)
TOTAL 52,169 30
I
430 /'l
..I '
Inventory and Appraisement
IN THE ESTATE OF
FILE D~
!72 ocr I?PH 12 I0
• • 1 ::
.......:.:.,J(.l~.~p..R:r.H.!!NIX ..
/.".\.(."11 \.'
Filed ,19 .
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\
;Vd "00 N01':JN1HSVtA
SlllM 30 H3J.SI~3l;i
HORMELL,TEMPES~~1~1MMaNS~SnH
BIGI,&MELENYZER
By:D.Keith Melen~zer_
411 Washingtor{))\vabtid II 130 2L
Charleroi,PA 15022=====~(Qd=.-;tj l,i .~
~9 •,\
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RUSSELL MARINO
REGISTER OF WillS
WASHINGTON CO.,PA.
IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNSYLVANIA
ESTATE OF WILBERT H.NIX
FIRST AND FINAL ACCOUNT
SUMMARY
No.63-71-1113
SCHEDULE A
PRINCIPAL -PERSONALty
Receipts
Disbursements
Page 1
Page 2
$SZtl.69-.30
~,409 ..75
Balance
SCHEDULE B
INCOME ..,PERSONALTY
$43,7S9.5S~
Receipts ·Page 1
SCHEDULE C
PR1NCIPAL -REALTY
None
SCHEDULE D
INCOME -REALTY
None
$
$
$
551.55
00.00
00.00
Net :Balance $44,311.10
ESTATE OF WILBERT H.NIX
SCHEDULE A
PRINCIPAL -PERSONALTY
Receipts
As per Inventory filed
Additional Assets
Dividends:
1971
1972
$62,169.30
None
SCHEbULE B
INCOME ..PERSONALTY
Receipts
$446.90'
304.65
Total Divideftds $
SCHEDULE C
PRiNCIPAL ..REALTY
Non~
SCHEDULE D
INCOME ..REALTY
None
551.55
=(-
ESTATE OF WILBERT H.NIX
DISBURSEMENTS
Administrative Exp~nses:
Russell Marino
Valley Independ~nt
Washington County
Legal Journal
Hormell,T~mpest,
Simmons.Bigi &.
Melenyzer
Administrative Expenses
Estate Notice
Estate Notice
Attorneys Fees
$29.00
12.75
16.00
5,500.00
Bond
Preferred Debts:
Slezak Funeral Home Funeral Expenses
Al Landrenl Flowers
Sacred He-art Cemetery Services
Kurtz Monument Co.'Headstone
Stump Ambulance Service Ambulance Service
Buckley InsuranCe
Agency
Total
$1,757.00
120.00
600.00
265.00
50.00
60.00
$8,409.75
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF WASHINGTON
58:
The above named Accountant being dUly sworn according to
1 aw deposes ,and says tha,t Letters Testamentary were gratlted to
Eleanor Jean.Nix and advetti~ed more than Six 'months prior to the
filing hereof;that -th~disbursements shown in the aceount have
been made to the parties entit1ed thereto and that the account as
stated is tTue andcbrr·ect as she verily believes •
.',;1
Sworn tQ and subscribe4 before me this~d day of
~,1912.
CORA EANE APESSOS.oorAR'{PUBLIC
};lONONGAHELA,WASHINGTCN COUNTY
MY COMMISSION EXPIRES JUL'i 21,1975
REQUEST FOR DIStRIBUTION
Accountant requests that distri1)ution be determined by
the Court in accordance with the Petitio~for Distribution to be
offered in evidence at the aUdit.of this Account~
'h '.''I-tl
-.
Washington County Reports:
Washington#Pennsylvania
(PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION)
PROOF OF PUBLICATION
In compliance with the Newspaper Advertising Act of May 16,1929,
P.L.1784 Sec.S,paragraphs (S)and (25).
COUNTY OF WASHINGTON}SS.
STATE OF PENNSYLVANIA
Personally appeared before me,a Notary Public in and for said County
and Commonwealth,CHARLES C.KELLER,who,being duly sworn,deposes
and says:that he is the Editor of the WASHINGTON COUNTY REPORTS,
the 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 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 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:
August 17,24,31,1972
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.
•• •• ••• ••••• ••• • •
\
NIX,WILBERT H-:Dec'd.
Late of Township of Fallowfield,
Washington County,Penna.
\
Administratrix C.T.A.:Eleanor .Tean INix,Box 442A.R.D.2,Charleroi,
Pennsylvania 15022Attorney:D.Keith Melenyzer,Hor-I
mell "Tempest.Simmons,Bigl &Melenyzer,411 Washington Avenue,
,-_C_h_a_rl_e_ro_i,_p_e_n_n_SY_lV_a_n_ia~:5~0_22_.---,
that the affiant or the corporation in behalf of whioh he is acting is not
interested in the subject matter of said notice or advertising and that all of the
allegations of this affidavit as to the ti ,p ce and characte@rf,hepu,bl,ic,ation
are true.~~0,-,dfJ,/
"~:..,,:;Z:~b~
Sworn to and subscribed before G ------~~~-::.
.......;?.!.~.t..day of ~Y.K!:!.~.!,19.Z?.~<L/~-~~__
JOSEPHiNE T.SCIAMANNA
Notary Pubiic.Washington,Washin2ton Co.
My Commi::;sion Expires July 1.1974 (n -'II ?/t
Under Act No.S87,Apprcved May 16,1929,P.L.1784,
aS,amended by Act Mo.51 of April 24,1931,P.L.67
State of Pennsylvania }
is'County of.Westmoreland •
Personally appeared before me William H.Pore,General Manager of The Volley Independent,who being
duly sworn,deposes and says that The Valley Independent is a daily newspaper of general circulation in
Fayette,Washington and Westmoreland counties,Pennsylvania,and elsewhere,published in !he City
of Monessen,Westmoreland County,Pennsylvania,that it was established June 28,1902,since which
dote The Volley Independent has been regularly issued in said county,and that a copy of the printed
notice or publication is attached hereto exactly as the some was printed and published in the regular
editions and issues of The Valley Independent on tha following dotes,November 10I 1971
November 17 and 24,1971
Affiant further deposes and says that he is General Manager of The Valley Independent,a doily
newspaper of general circulation,and as such is authorized to verify the foregoing statement under
oath,and Affiant is not interested in the subject matter of the aforesaid notice or advertisement,and
that all allegations in the foregoing statements as to time,place and character of publication are true.
Public:',,\llic
"il..ell,_'~.r..'~.~.:._..-/My comrrissbn ex,'ires.'~.;;,-'-------_?_'-v~·-----" • j."J It..
SrA'rEMEtn OF ADVfRTISiNG 'COSTS:
Hormell,Tempe~~L Simmons,Bigi and
Melenyzer,Att~rney~s__a_t__L_aw _
4JJ Wash1n~tQn Avenue;CharJeroi,Pap 15022
TO THE VALLEY INDEPENDENT,DR.
For publiShing tl'!e not:ce or Qd\'Clii~,ment attached hereto in The
Valley lndepcmdpnt on above !tatll1d dates . . . . . ...$12.00
Nota",'$'".75
COPY of NOTICE
Lttter5 of tdmi~lst,~':on 0".the estaleIIIWflberlH.Nix leI.01 To,·,...."ip 01Faliowfi~,Ill.Wash,pglo"CQlJnlv.e~ceas-I
ed.havln<t be...,q'anted by 1M R<,isler i
of Washington CtLunty..",eflce '''l ~1reby I:
givtn to ,11 -peMo~1nd~10 "'d e5-lalt 10 mat~Imm.dla"Il",vm<nl;andtolhos."'V;~<l claim,hgain'l the ,ametopr."nt then'!wltl>out \lelev '0 Ellea-nor Jean ,Nj~,£emi11'i~,..,trlY..c:,r.a.,
Box 412 A•.•;{0:2.Ch"rl~rai'.P.rrwl-
vania lS0Z2.HqM:t'lefr,T.cmp~~"Sim·
mons,Bjgi &N..ej:e~~el""a~.orn:"f1._atl~w,0.Keith ~j.,('!eriYl'":r....11 wi,t"nq.ton Aven~..Cl>~"t(QI;Pe~l1$ylwnjaU022.,11;10,17,2•
.......----
Total ..~."............ .......... .. .............. ................... ....$12.75
IIl!CilPT 'OR ADVERTISING COSTS
The Valley.Independent,a daily "ew~aper of general circulation,hereby acknowledges receipt ofth~aforesaid advertising and publication ..:osts and certifies that the same have been duly paid..
THE VALLEY INDEPENDENT
B/~_
STATE OF PENNSYLVANIA,
WASHINGTON COUNTY,~ss:
The within named Accountant being duly sworn qccorqing to law,depose Sand sayS that the above account
~\:i .~-
as stated is true and correct as _..she verily believe,
Sworn and subscribed before me this.~~~.__
day of Qc_tob.er.~-- -19_..1.2 .
~gRA.l3ANE Jl.PESSOS,NOTARY PUBLIC
.NONGAHELA,WASHINGTON COUNTY
MY COMMISSION 8{PIRES JULY 21,1'975
Warshington County,ss;I do certify that I have given legal notice 'to all persons
concerned of the filing of the within account in the manner
prescribed by Sta'tute and Rule of Court,as evidenced by proofs
thereof filed to No....~..q.:::.2~.~.2.?-Z-
...o
Witness my hand and official 'Seal this....~..7 _.
day of !Y.f?.v.~~k.~_.._ _19_.??-
~
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Eo<~RU ~i v C>-.I..".,.\1,1 0<:)U'l C'di WILLS <:)ri1 ~(I):REGISTER OF cd
~~\CO.•PA.:::l
WASHINGTON ...,;§I'i
H H 0.~.~:.3~0.cdr.a s:::0 OJ S...,.l:I ....~C'di ~...,q:i.4 (I),0 :::l
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The Court is respectfu Ily requested to determine
proper distribution in this estate.
;IJ,lft:t£~~r r __.•L.A ..__L .L ~
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In the matter of the Audit of Account in
Estate of WILBERT H.NIX
TO THE AUDITING JUDGE:
No.63-71-1113
Enter our appearance for Eleanor Jean Nix,Adminis tratrix,C.T.A.
of the Estate of WILBERT H.NIX,Deceased
HORMELL,TEMPEST,SIMMONS,BIGI,
N.B.-Counsel shall,by separ!lJte paper,present a concise statement of each
claim,with supporting calculation of any interest claimed.Objections
to an account as filed,shall be concisely stated in a separate paper.
Council suggesting proper distribution shall file a separate concise state-
ment in that regard.
\.
No.·63-71 -1113
In ra Audit of Account in Estate of
WILBERT H.NIX,Deceased
AUDIT
Jrarripr fnr !\ppraraurr
FOR
Eleanor Jean Nix
Administratrix,C.T.A.of
t.h~~tate of WILBERT .H.
NIX,Deceased
HORMELL,TEMPEST,SIW~ONS,
BIGI,&MELENYZER
By
JJ I l!edi \;If:~
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ATTORNEYS AT LAW
411 WASHINGTON AVENUE
CHARLEROI.PENNSYLVANIA
ETITION SUR AUDIT
ciary:
nor Jean Nix,
nistratrix,C.T.A.
TE OF WILBERT H.NIX
RMELL.TEMPEST,SIMMONS,
BIGI &MELENYZER
1-1113
~~--
63-7
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IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNA
ORPHANS I COURT DIVISION
HEARING ON AUDIi'
The Ho~orable ALEXANDER R.CURRAN,J.,
Sp,ecially·Pr~siding '.
INRE:
Estate of
WILBERT H.NIX,
Deceased.
«
z«>~>-III
Z
ZIIIII.
~BEFORE:l-e>z
J:III«~
(
)
(.
)
(
)
(
No.1113 of 1971
~~APPEARANCES:
I-IIIo
~~u
o::l..,~TIME:
l"-N
HORMELL,TEMPEST,SWMONS,BIGI &MELENYZER,
Esqs.,of Washington,Pa.,representing the Accour ant.
Wednesday,December 20,1972,at 10:00 o'clock A.M.,
EST
-,
lfi0:IIII-0:oII.III
0:THE COURT:Number 1113 of 1971,the estate of Wilbert H.Nix.I-0:::lou Mr.Melenyzer?
~
<{
u
ii:MR.MELENYZER:If the Court please,I have the final papers inlI.o
~a,rd to this estate,and there are no complications.
THE COURT:Is there anybody else in Court interested in the estat
of \\J ilbert H.Nix?
(NO RESPONSE)
THE COURT:The Court will consider the audit closed.
(A UDIT CLOSED)
The foregoing record or the proceedinga upon the bearing of the
••<
0(I hereby certify that the proceedings and evidence are contatnedz0(>~fUlly and acc'urate1y in the notes taken by me on the hearing of the aboveo.
ZZ~cauue.and that this copy is a correct transcript of the same.
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x..~above ('ause is herely approved and dtrected to be filed.
.,
aill:
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By the Court,
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'tuusylnttuitt,~rp4ttua'<l!nurt minislnu
ESTATE OF
Wilbert H.Nix,
deceased.
NO._----Jo64J3-~7.#-111.!!!-!.I..]).I..I]~)~-------
In the matter of the First and Final
Account of Eleanor Jean Nix
Administratrix C T A
ADJUDICATION AND DECREE
And now :March 5 ,19-13...,this matter came on for hearingl
audit and distribution at this session and testimony taken;and thereupon,upon due consideration
thereof of the balance for distribution in the hands of the Accountant is determined to be
$Ll,SlO.92 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 wi.ththe
schedule of disribution hereto attached and madE!'part herepf,unless exceptions he 9~filed
sec.,ego or on appeal be token herelmm sec.Il!-J."..~--'-"-~:'::-:'~~~-~i--~-JI----:,!...f£.!j~",.L:---==-
SCHEDULE OF DISTRIBUTION
Balance per account ~_~_
Additional credit asked at audit
$44,311.10
Balance'_
Deduct Clerk/s Costs &Receipts _
Attorney ..±Ho~rm!!!/e!liiColl__.AT.Ji<eMl'!mpe~s;utL.Ws....imrnllllW.o.u.nu:SL.w.Bi.,L.jgi!&L__..I:lI&~M~A]~!~n~p~e~r-
-.
,.~~o,1-'t1jW-'<119J3RussellMarino,Agent,transfer inheritance tax,#47.75 I 'r?-:.~../1/1 ~",'ifi:
Interest from .5-22-72 to 3-16-73 ;1:-..5.--1-7..5 2.34 ,0.09 V<-l-4~L.441~.:.et:4·~12.83 ~~
..f"-1-'f?,.:3!1 111 .,/--~'-)+~
Eleanor Jean Nix,widow,residue,including cash and
100 shares conunon stock of Bausch &Lomb,Inc.;375 share ~
Common stock of Coventry Care,Inc.,J and 350 shares
common stock of ExoloD CompBn1"J held in kind and
distributed as such at the appraised value,4+412•83
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Form RCC-33
RESIDENT DECEDENT
to
hJ-7/-///0
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF
---------------,
j
WASHINGTON....................................................................................
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.)
IN THE MATTER OF THE ESTATE OF }:AFFIDAVIT OFWILBERTH.NIX_·_..····i's~t~..·f~ii..;;;,:;;;~..·~f·d~~~~t·)···..1lmll«
Late of :WASHINGTQN..................County DD1HUa5~
State of PENNSYLVANIA }ss:
County of W.ASHINGTON .
Administratrix C.T.A.
Administratrix C.T.A....El.e.ano.r J.e.a.n N.ix.......1Ii::Ji:!ll~
~lltJJliK of the estate of the above-named decedent being duly sworn,depose S and sayS
Decedent dJed ......Aug.ust ....
(Month)
"'i~~.i ..'19(~=~)..,{;;~~eaVing a last will,copy of which is hereto attached.}
D.J<eithMelenyZel'...Name and address of attorney or}
other authorized representative to
whom all correspondence should be 411Wc;lsbingtQnAve.,Chc;lxl.el:'9:i",PA.
mailed.Administratrix C.T.A.
That as such U«X«tDrI:IS deponent is familiar with the affairs of said estate and the property con:-----.I
(1·:XN~lItor·Adminj8trator)
Rtituting the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name,or jointly
with,or as agent or deputy of another,or in decedent's individual name,with right of access by another as agent
or deputy,with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
l\Tnno
".
That the contents of said safe deposit box or boxes are itemized under Schedules of this
return,with the exception of the following,for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fullv and in detail all the
real property in the 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 individual,l.y;.or in trust for
any other person or persons giving also separately the accrued inte~est thereon,if a~y,down to the last
interest day prior to decedent's death in the case of savings banks,and to the date·o~decedent's death
in all other cases;all bonds,postal savings,treasury certificates or notes and othe\eVid~n~e of in-
debtedness of the United States to the decedent;all obligations,whether by statute 'or agreement·they
are designated as tax free,of the United States,or any state,or political sUbdiv~sion 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 bydecedent,together with the fairly estimated
market value thereof;all bonds and mortg6!tes 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.
c:~~~..
.~..d d..d::...
~treet llumb~
tJ.->/SO.)..2--...............................................'/..
(City or Town and State)
..,
In the case of securities of close or family corporations,the values reported.are as far as
possible substantiated by financial statements of the corporations,showing the assets and liabilities
thereof as of the date of death.The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business,and in support of the value of such interest there is annexed to
said schedule,financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement,(if oral,a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business,its location,and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted.It should also set forth in itemized form,together with the fair market value
thereof,any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers ofproperty,real or personal,within two years of decedent's
death,in contemplation of decedent's death,or intended to take effect in possession or enjoyment at or
after death,said schedule sets forth the nature and value of such property,to whom transferred,the
r~lat~onship of the transferees to the decedent,the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers.In the case of transfers intended to
take effect in possession or enjoyment at or after death,there is also attached to the schedule a co~y
of the deed,trust agreement or other instrument creating the trust.Ther,~is also set forth in said
schedule a list of all property,real and personal,with its value,which passes at decedent's death by
virtue of the exercise by decedent,either individually,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 forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death,the nature of their res-
pective interests,their relationship,if any,to the decedent,together with the ages at the time of
decedent's death of all minors,annuitants and beneficiaries for life under decedent's Will.It also
contains a statement showing which of the beneficiaries named in the decedent's Will,if any,died prior
to decedent,the dates of their death,their issue,andthe relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets forth all property,real and per-
sonal,owned by the decedent jointly with another or others,including intangible,standing in the name
of the decedent and others,plus the date and place of record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty,plus the name,address and relationship,if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate,including funeral expenses paid;
family exemption,where applicable;costs of administration of this estate;counsel fees and fudiciary's
commissions paid or to be paid;cost expended for burial trusts,tombstones or gravemarkers,and reli-
gious services,in consequence of the death of the decedent;debts and claims owing and unpaid at time of
death;taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act);together with a statement of collateral pledged for obliga-
tions,if any.It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest,that if the amount actually paid in settlement of any fee,commission or debt is less than the
estimated amount claiming and allowed,that the same will be reported to the Register of Wills,and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A","B","C","E",and "F"as directed therein,
have been carried forward and properly registered in the Summary.
d
Subscribed.and-sworn to before me this :il....z..~······id~;O~.19.2'.~~;:(~~.
Notary p[.~,,""l":litigfct',,..'~hi1gtOri Cii.<
My C.:r~rl::'i .E....."~(''l1ber 1 197·<1'J ••~...~I,.,','"
NOTE:Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None",and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business,that the
data and statements reqUired under the paragraph above relating to Schedule "B"are attached.Also make
certain that column #1 in the "Summary"has been properly completed as above-directed.
RCC-~4 (1~64)
COMMONWEA;LTH OF PENNSYLVANIA
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 held by
the decedent as tenant in common with another or others,should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
The real property located In the Commonwealth of Pennsylvania should be (1)(2)(3)
described by lot and block number,street and street number,together with DEPARTMENTageneraldescriptionoftheproperty,with a reference to the record of the ASSESSED VALUE VALUATIONconveyancebywhichthedecedenttooktitle;If a farm state number of a.FOR YEAR OF ESTIMA TED 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 this space)to be listed on Schedule "FlO and must not be d"ducted from this schedule.
None
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 OF 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 property,such as bonds,treasury certificates,cash on hand and in bank,
stocks,mortgages,notes,together with accrued interest or ~ivldends,salaries or wages,insurance pay-
able to the estate or fiduciary in said capacity,partnership :i.nterests,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 fully
UNIT
VALUE
ESTIMATED
MARKEl'VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.100 Shares Common Stock,Bausch &
Lomb Inc.
~v
155.00 15,500.0 17::1 !15;SfJo.~
31,327.05
561.00
-4~(Jr44.0~1,500.00 lTV
!f -Yr:."...6LI,.r/_____~3,281.25;V~3;zf/,~6
L
350 shares Common Stock,The Exolon
Company
375 shares Common Stock,Coventry Care,
Inc.a Penna.Corp.having its principal
place of business at 1277 Country Club
Road,Monongahela,Penna.
Investors Syndicate of America,Inc.,
a systematic savings plan,a Minnesota
Corp.,8th &Marquette Streets,
Minneapolis,Minnesota
Civil Air Patrol Bond
2.
5.
3.
_____e.-------
'C;--~P5?-)If,'J.30
Insert this total opposite "Personal Property",Schedule "B"in
the "As Reported"column on the last page of this return.
x X 52,169.30
,.RCC-::%
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "c"
TR-~NSFEn.S
(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)No
(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)No
(3)If the answer to (1)or (2)above is in the affirmative state:
(a)Age of decedent at time of transfer NtA
(b)State of decedent's health at time of making the transfer.(Note 1).
(c)Cause of decedent's d~ath.(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)No
(a)Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition?(Answer yes or no)~N~o~_
(b)What was the transferee's age at time of decedent's death?NtA
(5)Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a)The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no)No
(b)The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom?(Answer yes or no)~N~Ou-__
(6)If the answer to (5)(b)above is in the affirmative,state whether the right was reserved in decedent
alone or 0t hers ..LNLj!r-.cAL-_
(7)Did decedent in his lifetime make a transfer,the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor?(Answer yes or no)~N~o~__
(8)Did decedent,at any time,transfer property,the beneficial enjoyment of which was subject to change,
because of a reserved power to alter,amend,or revoke,or which c01lld revert to decedent under terms
of transfer or by operation of law?(Answer yes or no)__~N~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)N/A
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
Not Applicable
DESCRIPTION MARKET VALUE
(Estimated)DEPT.VALUATION
(Dept.Only)
Insert this total opposite "Transfers",Schedule "C"in the
"As Reported"column on the last page of this return.
COMMONWEALTH OF PENNSYLVANIA
TnAN~}"""'ER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRFCTIONS:This schedule must disclose all property,real and personal,owned by the decedent jointly
wi th 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 percentage Estate
Address and Relationship of Co-Owners,and Place I Value Share Valuation
of Record of Instrument,where Rea!~state.l
REAL ESTATE HELD BY ENTIRETIES:
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
1.Unimproved real estate situate in
Fallowfield Township,Washington
County,Pennsylvania,and contain-
ing 0.4820 acres See Deeds
dated May 8,1962,and May 19,1962
in Deed Book Vol.1103,Page 323
and in Deed Book Vol.1130,Page
262.Held as Tenancy by the
Entirety with Eleanor Jean Nix,
surviving widow.,;
Value $1,000.00 'I7(fY
2.Improved real estate located in
the Borough of Charleroi and along
Lincoln Avenue Extension,
Washington County,Pennsylvania,
containing 0.2412 acres and having
erected thereon an office building
and apartment building,including
an optical business and equipment
in said office building.See
Deed dated June 16,1960,and
recorded in Deed Book Vol.1078,
Page 118.Held as Tenancy by the
Entirety with Eleanor Jean Nix,
surviving widow.~;I
Value $285,500.00 rtr;n
~3.Improved real estate being Lot No.
6 of the Sub-Division of Lots Numbe
8,9,10 and 11 of the Smithdale
Plan of Lots si~uate in Fallowfield
Township,Washington County,
Pennsylvania,having erected there-
on a family dwelling.See
Deed dated February 8,1960,and
recorded in Deed Book Vol.1068,
Page 431.Held as Tenancy by the
Entirety with Eleanor Jean Ni~,
surviving widow.~/~
Value $15,000.00 -/\/rv
PERSONAL PROPERTY HELD BY ENTIRETIES:
Checking Account No.341-7039
Mellon National Bank and Trust Co.
Charleroi Office .!
Value $3,200 .00 r;{(f'J
~
CJ
Insert this total opposite "Jointly Owned Property",Schedule"E"
in the "As Reported"column on the last page of this return.
I •,.....,.....'".,.
RCC':3?-.(12-63)
COMMONWEALTil OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
(
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OFstatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARY
ave an interest,vested.contingent or other-are involved,set STATE YES IN ESTATE
wise,in estate)forth this fact.)OR NO BIRTH
'Pl .Jean Nix Wife Yes Residuarv Beneficiar
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
Will {
Administration ~No.Year .....
P.-I THE
~IATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
Lv I k BE }(TJ-t ..NIX
Deceased
-'"II """0t~,~~t '~
"72 get rl Pt1 fZ t Z
ttHI'e!e..--.1 II <t'.,'~"¥I't:'tin\,\;'~~7i ~.t::,~l!.....:'1 r.~·;~d:rf,~·
~EGil'S-r"'t'""',..P'/I'lL"cl'.[';\\'1 •.l't:l/'"\j r;~v,··~~
l'fiI'I:i!!:W'\"l'("TO'''1 '\01 ('l;A'1I'llH.Jn I',,;1',!'i'G '..•.1'1-\','
(Executor-Administrator
must complete "As
Reported"column #1.)
0 .....,'"0 ::0...,...,Cll Cll0III...,e:..til ::l til
til til 0.....,ct ::l '"0...,e....,
III til 0:><'"0 "dIIICll0-......co 0 ~"d
~Cll...
til ..........'<III.....Cll
Late of FA ~l t?~f.I~L.D.,..~Lv f"
County ofWR&11 I N<;<:[q!'!.
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
enc:~
~>::0-..-..-..~en en en(')(')(')
?"?"?"n tx5 ~::::::::.....................
-00-00-00-00-00-00
-00-00-00-00-00-00
>:r.
CIIt~2"tv...,.......2,
::lr.c...
'"
H,T,S,Pr ""'i Jtt /.
DI )tl~/Th lVIr=l.EN).JcEJe.
'-lll W \4 sH I N6TO/f lit/£.,
Ch R R 1-.E ~0 '/))OA I Ie;;0;<::>-
:V(:~\U\
~:~:
~:,..,.
~J:t>:
~.-;:
:\''J \;___:;-.:Cll.-. . .'0 .......
:~.~.~:.......:.....
v~.
\Y
.,-
AND AGENT OF THE COMMONWEALTH
Form RCC·lO
OFfiCE OF"THE
REGISTER OF WI'LLS
OF Washington COUNTY
~'J.7/~///3
"STATEMENT OF DEBTS
AND DEDUCTIONS
0'0'''''"'mow,""J
THE SUM OF ....•.......$!~~~;?..c;.<.:,
~~I Register 01 Will.,Age.t
ESTATE OF _W=..:...:i:.:l:.:b::..:e::.:r=-t=-~H:..:."--=N:.:..1=·x~LATE OF Washington County,Pennsylvania
DATE OF FILING APPRAISEMENT DAT&:OF DEATH August 22,1971
DATE NO.OF NAME OF PAYEE REMARKS AMOUNT
VOUCH,""
Slezak Funeral Home Services 1.757 00
Al Landren Flowers 120 .illL
Sacred Hearts Cemetarv Services 600 QL
Kurtz Monument Comoanv Headstone 265.00
Stump Ambulance Service Ambulance 50 00
Hormell,Tempest,~1mmons
Attorney'sBigi&Melenyzer Fees 5.500 00
Russell M:=Irino Clerk Administrative Exnenses 11 1)0
Buckley Insurance Agency Administrix Bond 60 00
Vallev Independent Advertising 12 75
Wash1ngton county
16 00T.eQ":=Il .TournaI Advertisin2:
Russell Marino.Clerk Administrative Expenses 25 00
~W~/177/-,1/9~1 !s-l "j 7.
VQ}A 11M:7::-I Lf~tL(),-.......=
-
-
~U J lO
COMMONWEALTH OF PENNSYLVANIA 8,417.2
COUNTY OF Washington
I,EJ aaDar Jean Nix HEREBY CERTIFY.THAT.TO THE BEaT OF
MY KNOWLEDGE AND BELIEF,THE FOREGOING IS A JUfAND T,UE STAffENT OF DEBTS,FUNERAL EXPENSES AND EXPENSES OF
ADMINISTRATION SUBMITTED TO THE EST"TE OF W lbel"H.X DECEASED,AS DEDUCTIONlii POR
INHERITANCE TA~PURPOSES.J_c;f~~(Jd1 A
L
~,~
27th 11-~'-7 ~(L.5.1
SWORN AfolD SUBSCRIBED r;lSFORE ME THiS .'.DAY OF //&~~el".--.--R [/~~_~~~'8
•
.."-.l
:!:I"J";0 :::0
\
l>rn t:::::)r(f)G?C c-,:x:-en --<rn-en (0:z -l rnt1',rn I f'V 0-l :.:0 I0 '"Z 0 ..,..-C...".:*":::::r:0 :~...-;;:;n0--r-v--r z""llI r <0):0-(f)
,.
'.1..
."..
'..
RCC-81 (6-7!)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
NOTICE OF FILING OF APPRAISEMENT
ElEANOR JEAN NIX
(Executor or Administrator)
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
)
In Re:Estate of WI__T,_RER_T_H_._N_IX _
WASHINGTON County -File No._6_3_-_7_1_-1_1_1_3 _
Dear MRS.NIX:
Y h b
'f'd h h ORIGINALouareereynotlletatte------.y::TT'!'..,......=rrr---r-lr--......,..,---------
appraisement in the estate of 'WILBERT H.NIX
has been filed in the office of the Re9.ister of Wills of WASHINGTON
County on NOV.9.,19E,Said appraisement reflects the following
valuations:
Real Estate ~-------
PersonaI P ropertY ...1:.5.=2:L'=1.::..69!....:.:..:o3:.,.:O:.-_
Transfers _
J 0 inti y Owned ---::~~-=--=-----
Total ....:::.5_2~,_1_69:......:.:..::.3_0 _
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 an appraisement may appeal therefrom
as provided by law.
...-:=\
Date~d ~,/0/7 v---t:/
.DATE OF DEATH:AUGUST 22',1971
Note:This is not a bill.
..
RCC-39 (!r6~
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
~RESIDENT DECEDENT\
Estate of WILBERT H.NIX
(Last Name)(First Name)
SUMMARY
DA TE OF DEATH 8-22-71
(lni tial)
FILE No.63-71-1113,
REPORT OF INHERITANCE TAX APPRAISER
I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of_~;?-L!!:.:e...:::-E:k.~-=::£I.cLb:::::!-..L__
Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the
the values set forth opposite each item in the last column to the right in Schedules '·~A","B", "C",and "E".
Dated:fk-J,f,If?V'FRED T08I
INHERITANCE TAX APPRAISER
REPORT OF THE REG~R OF WILLS
I,the undersigned duly elected Register of Wills inand f~/-~'-~~'L County,Pennsylvania,do respect-
fully report that I have allowed deductions in the amounts claimea"oy depone~*eptas to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F",~greateror lesser amount represents the Sum
allowed as a deduction.
Dated:_
REGISTER OF WILLS
VALUE AS REPORTED VALUE AS APPRAISED
$$----::=-~-:c-l-=~52,169.30 52.169.JO
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint -Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
52.169.3)
none
52,169.30
none
52,169.30
VALUE AS REAPPRAISED
$r
.00 T
.00 T
.oOT
Valuation of life estates or 5 Zl 693 ()
521 16930 S
SZ16930 T
I
FOR USE OF REGISTER ONLY
Tax on $----------f--2%
Tax on $(§J
Tax on $5%
Tax on $10%
Tax on $15%
Exemptions *
Total Estate -I-__
TOTAL TAX
COMPUTATION OF TAX
$--------+-.--
$-------+---$-------..,.j....--
$-------4---
$------....-/---
$------_-L...,_-
(*)As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5%of tax if paid within
3 months after death :::::::::==t==
BALANCE OF INHERITANCE TAX DUE $$---.JC..Add interest at rate of 6%from_____to _
AMOUNT OF ESTATE TAX ASSESSED $-------IL-
Estate tax paid $.-JL-$-....J1 ..
BALANCE DUE L-
Add interest at rate of 6%from
------tt'o-----$--------'t=...TOTAL TAX BALANCE $------1.PAID $--1
FOR USE OF REGISTER ONLY .ADJUSTMENTS
NOTE:Where subsequent adjustments are made t~the above computation of tax by the Register of Wills,for proper reason,
same should be noted below,with short explanation.
,
Will t...No.AdmInIstration
IN THE
Year .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
WILBERT H.NIX.
Deceased
Late of FALLOWFIELD TWP.
County of WASHING.TON
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
'.
\..
}o"unn :1CC-2
1 •DEPARTME~~T OF REVENUE
BUREAb OF COUNTY COLLECTIONS
HARRISBURG.PENNA.17127
, , I
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE NQY.~~,J.??~.
COUNTy~A.~~.~g~9..~.
FILE NO (>3.:::71~lll3..
Whereas..~~.~~~..~~.;I!,late of ~~.~~~.~.~':r.I'J!.~..
in the County of WASHINGTON Commonwealth of Pennsylvania.having died on
the .?~9:day of AYgY.~.~197.~seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore.I•..........................X~?!.?.?..~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.
DescrIption of Asset
PERSONAL
SEE "SCHEDULE B"OF APPRAISEMENT
;'.'
Unit
Values
$
Appraisement
Made for Inheritance
Tax Purposes
52,169.30
WASHINGTON County
r>
I ,
STTl!~,\;l~:H31.-:;L:j 3'J
.C\tt.L~~~·~I ,~~~-4:~'~1..:;J r3 ,~:,nIl
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
..........y..T+.L:E3I!::R'J:'J:i•..NIX...... .
Deceased.
Late of
FAI.J..OWFIELD TWP.
Datc of Dcath,AUGU.S.T ~Z.,.19.71 .
Appraisemcilt Docket Vol.,J?::.
Page,2.?Q~+'.....No 9.J..~7J,::mJ..
Filed ill Register's Office,..!'J.9Y~9.L .197.2:..
Amount of tax due,$.
DEPARTMENT OF REVENUE
Received,
Examined and Approved,.
Wrote abo.ut Appra.isement,
''ttl"'0:)l~);'i!HS'VN~
Appeal j"om Appraisement,..
Entered and charged,,..
,...,."..".1 "'.., ..,j'J r'l\ll.,..h·\i ,..'}",..r··'.~u..'JU .-;",.~.,J .I.LM t,,._1
.triPi ':r ....;;;1 A
'......::...~!~f1 J..J ~....,,,~
i•
RCC-72 (9-68)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
j
DATE January 23,1973
,on August 22,1971
(Date of death)
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 Associalion located in Pennsylvania:
(a)~o rrhares(b)Coventry Care,Inc.(c)common stock
(NOT:n 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 April 16,1970,and having a TOTAL MARKET VAILUE OF $-,1...........,2~OJ-loO.......-\lOL.VO------
(Date)
as of the date of death of the decedent,Wilbert H.Nix
(Name of Decedent)
who was late of Box 443A,R.D.12,Charleroi,
(Street and Number)(Post Office)
Washington,
(County)
Pennsylvania
(State)
The secu ri ti es are reg istered as fo II ows:----'Wp-i4-14-bu.e!\ii40-r....t--l..lH'-e-.--UNl-.Ili.4lX ------------~---
(Name or names in which certificates are registered)
ADMINISTRATRIX
«Wl~~~Eleanor Jean Nix
Ui«.ll1iIRXXXl)(Name)
Box 443A.R.D.12 ,.Charleroi.PA
(Address)
NAME OF APPLICANT Eleanor Jean Nix
15022
COUNTY FILE NUMBER 63-71-1113 ADDRESS OF APPLICANT 'Box 443A,R.D.'2,Charleroi,
VA 15022
BUREAU FILE NUMBER 63-71-1113 SIGNATURE OF APPLICANT_._
NOTICE:IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION,IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATEJanuary 23,1973
I hereby 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 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.
(Signature)
Register of Wills Washington
(Title)(County)
r--,.!
<-----.......--..
lJu tl1r OOrpQuu.6~O!ourt of lIusQiugtou <11ouuty
IN THE MATTER OF THE AUDIT OF ACCOUNT
J
I
1-
In re Estate oL...Ni.x~Wilb.er.t..H•...............................No 6-3:":'.7-1."!".I+I3-4th..~~1ifl.?.,AA
...............El.eanor.*...Je.an..Ni.x.,...A.dm.:r.~.•........E.Q.:r.m.~.:lJ.I-...T~mp-.~.~.t.I-...~~mm..Q.n~.,...J?~gj,...~..J1~J.~D'y'~er
Attorneys.
-A#PeIe't"it-
Date of death August 22".19.7.1.Date of filing Inventory Appraisement Qct.ab.e.r 19.,...l9.7-2 __
Asse56l'l'lel'M'
TO THE AUDITING JUDGE:
Enter my appearance for _Personal Property Tax Due Washington County,viz:
IT E M Valuation
•
1972
350 sh Exo]on Company @9.625 3368.75
1971
~~o ~h li!v"1 m'l ('!1""--~--(@p.P.7~~1Oh ::>~
I
1970
350 sh Exolon Company --ID5.75 551::>.50
_.
lq6q
350 sb Exo1on Company @17 1::>~5993.75
1968
350 sh Exo1on Company @2'3.71J 8312.50
1967
350 sh Exolon Company @19.75 6q12 .~o
-I Inventory Assessment 12%Assessment Tax at 10%CollectionYearAppraisementReturnedValuationPenalty4MillsPenalty 6%Interest Total Claim
19 72 3365 None 3365 1 <l,t:.!~JS ---~Il.L.81_.._-
19 71 3105 None 3105 12.l.L2 1.24 .90 14.56-----
19 70 5515 None 5515 22a()h 2 21 2.97 27.24_...._-
19 69 5905 None 5905 23.98 ::>l,()I,t:.P.31.06-----
19 68 8315 None 8315 -----33.26 3.33 8.67 45.26
19 67 6915 None 6915 27.66 2.77 t\8.82/39.25-----
-,.
N"AL ~M 172.18
.~~1Theforegoingisastatementofallitemstaxableastheyappeainh v ory ~aJ~-~
davit or Assessment filed for the purpose of determining the Personal P~~T on said Est .
..........4:t!.h day of ~P.~.c.~mp.~.~..........19 7.2 .A.V.CAPANO,Solicitor
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6 Qtr.No 3.~.7l~lJ.13.4-ttu.Q~,19.__.7.2_,_,AA
In re Audit of Account in Estate of
...........Ni.x~Wi.lb.e.r.t._H _ .
AU'OIT
Jrarripr for i\ppraranrr
FOR
WASHINGTON COUNTY
PERSONAL PROPERTY TAX
,A.V.CAPANO,.
Solicitor
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In the matter of :the Audit of Account filed in the Estate of
IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNA.
)
Date of death ..:!!!..~_-_L_Z_-_7_1__
\No._1_1_1_3_0_f_1_9_7_1 ,Term,19 ,A.A.
__NIX_-:..,_W_il_b_er_t_H_.-=-_--,----)(Docket ~ft -t 7.,(::J_-.:..-/__
Deceased
TO THE AUDITING JUDGE:
Enter my ,appearaiIlce for the Commonwealth of Pennsyl~illia,claiming tl'ansfer inheritance tax in the above estate,as follows:
DR.
To appl'aised Vialue of Estate:Realty-------------------------------------------$----:;::--__
~'-~/6l'Q#Personalty-------------------------------------$__~_=_____.:__=___
Additional Assets per Account,Subject 'to Tax -----------------------------------$_
Addrtionllil Assets per Audit,Subject to 'Dax -------------------------------------------------------------------------$_
GROSS VALUE -----------------------------------------$_
CR.
Debts rand Expenses per Account;see Note
Additional Debts and Expenses per Audit
I
)
$-------
$------
$-------
$-------
$------$-------------
$-----------
TOTAL DEDUCTIONS.$_
CALCULATION
Gross V,llI1ue _
NOTE:The following credits claimed in the Account are
held not deductible 'lliS against the tax:..
~-LI'~f>}O
Less Deductions ------------------2"f.-1)"..-'-V _
Clear Value ----------------------'4-~'1:-"'---_
7"-~--1-"L
....
)----------------
L~/~,8'"
$----
~--------~~-
)--
Trax-
able
at
15%
'f$--------
TAX PAID 0;A,O~),rl'Total Tax_______________$_~I z,.,.~~___
---$~~~1.9~....":!1 ammm'p""iou"",paid_______"""M____$_2.-_'H.\',"_L
$~S\;~Balance ------------------------------------------------$__~7J.~--
$Interest__yrs.Lmos-~dayS@~%$l".,.}r.
$TOTAL TAX AN;~REST DUE -----Z:/;Xc;:;;-;--$$-<J I.~!_
~~0::;..r-rJ.~S-
'-1)'1,0 3"~~().4!-5 ~
~·o??;/17J ~~-
z
0 r03:113::0
0 »z m(J)4 ::E 00-l 0-m 11..::...-l »m t.'".l
t""
rc::.....0 -l ."~:;....C...J:."0-..~~~l_0 0 :0-•-::>.......":0 »l::'11 11~-~,~m 11 ~~.
.....1 .'.Z m ~z »L!.1.._1 l-X (p :0 ~tn U)0(»
U)r Z0(J)~0 ...:::::J m '"c:::uJ <!Z Ir:.:::~,..:;i:>-
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RCC-47 (5-69)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
J
PETER McHALE ,Director
Bureau of County Collections
Department of Revenue
Finance Building
Harrisburg,Pennsylvania
Dear Sir:
Re:Estate of vlILBERT H.NIX
Date of Death_8_-_2_2_-_'_1 _
County of WASHINGTON
State File No.63-71-1113
Pursuant to the memorandum of April 7,1969,concel'ning valuation of closely
held business interests,I herewith request your advice concerning the value of the following:
A.Corporations BUREAU USE ONLY
TYPE OF NO.OF INVENTORIED VALUE SUGGESTED VALUE
2
3
NAME OF CORPORATION SHARES SHARES UNIT TOTAL UNIT TOT1
/"
~~COVENTRY CARE,INC.COMMON 375 4.00 $1500.///~
.//
.
B.Non-Corporate Interest
2.
3.
NAME OF BUSINESS ORGANIZATION
Remarks:
TYPE OF BOOK
BUS.ORG.VALUE INVENTORIES VALUE SUGGESTED VALUE
Enclosed is the available financial data for all requests under "B"above and I
await your advice before appraising any of the above described assets.
APPROVED By -~///
FOR ~~~PETER)~.McHALE
DIRECTOR Inheritance Tax Appraiser
County of WASHINGTON
(FILE IN DUPLICATE)
~-
::4
-14 1 4
4 1 4 2 _'.'I'
1 7 ~7 o 0-'
1 2 0 o 0
6 0 0 o 0
2 6 5 o 0
5 0 o 0
5 5 0 0 o 0
1 1 5 0
6 0 0 0
1 2 7 5
1 6 0 0
2 5 0 0
1 5 7 3 7
4 8 0 0
8 6 2 2 6
2 :::
RECEIPT FOR CERTIFIED MAll-30¢
POSTMARK
DR DATEJeanNix
P.O.,STATE,AND ZIP CODE
STREET AND NO.
SENT TO
Q
Z
1.Stick postage stamps to your article to pay:
BASIC CHARGES OPTIONAL SERVICES
Certified fee-30¢Return receipt (10~or 35~)
Postage (first-class or airmail)Deliver to addreaaee only-50~
.Special delivery
2.If you want this receipt poatmarked.stick the gummed stub on the left portion of the
)addreaa side of the article,leaoin,the receipt attached.and present the article at a post office
service window or hand it to your rural carrier.(no exira charge)
3.If you do not want this receipt postmarked.stick the gummed stub on the left portion of
.the addre..side of the article,detach and retain the receipt.and mail the article.4.'l If you want a return receipt.write the certified-mail number and your name and addre..on
a return receipt card.Form 3811.and attachit tothe backofthearticle by means of the gummed
ends.Endorse front of article RETURN RECEIPT REQUESTED.(Fees-IO~or 35~.)
5.If you want the article delivered only to the addressee.endorse it on the front DELIVER TO
ADDRESSEE ONLY.(Fee-50¢).Place the same endorsement in line 2of the retw'n receipt
card.
6.Save this receipt and present it if you make inquiry.*GPO:19660-216-700
(Only if requested,and include ZIP Code)
e sure fo follow insfructions on ofher side
RECEIPTReceivedthenumberedarticle described .be/ow
SIGNATUREOR NAME OF ADDRESSEE (Must always be fil!ed in)
1f'l~JM!~RNISH SERVICE(S)i~DICATED BY CHECKED BLOCK(S)
(Additional charg~s.required for these services)
Show to whom,date and address D Deliver ONLY
where delivered to addressee
9587
DATE DELIVERED
CERTIFI ED NO.
INSURED NO.
NIX
\~EGISTERED NO.
SENDER INSTRUCTIONS
Print in the space below your name,address,including ZIP Code.
•Ifspecial services are desired,check block(s)on other side.
•Moisten gummed ends and attach to back of article.
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U.S.POSTAL S~...
OFFICIAL BUSINESS~i''::''--
...~~..
Postmark of Dllliverin'i Offite--
HORMELL,TEMPEST,SIMMONS,
BIGI &MELENYZER
Attorneys at Law
411 Washington Ave.
Charleroi,Pa.15022
-----~-~l
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-~<!r~I....,~~,~~~~...1"_.,...,(~""~;"'t !"~UJ,.~~:'."~'.':,"'.£>\'.UUH,:~li U.
&tu1L'111'pl'lHtt:!!lu41llia.(!\~;:
•(finuntn 411'Ut.ld!iuglun \
Per~onaJly bdore me,the 11ridersignecl authority,a N9..t..0X.Y..EghJ.i.~_..in and for said
County and·State,appean.:d :·,:.D.i~D.Q.r.J.\;.;:'(;LJ:J.ix ,..y.t ",..--f>o 1·._~wh(h.behJg duly
.., •1'..I',".t 'r ~t t-..~L.:.>!:;"i·t '.~".\...-L.1\.'•sw(.rn :II.·.cordlnf';to Jaw,del'(I:·)..-i ~!ncl says tnat She 'IS the ~·~··.\:<:utQGJ1A::ncb.1HiliL.L~itvKofthe estate of
t·TiJl,.,,~P ~'Tix d 1 tl t·tl f '.h d 1 t't........'.1.•.,J.!.;<'..;.k L~;.,eceasec,la 1e oregomg sc e u es cons 1 ute a
I '.l'1 f '·r 'lb .ttl ~'.COl11p ete Ill\'cntory :111(appraisement of t le real and PGrsonal estate 0 .':1.1 ,.Col k I:,.lX ,
c!rceasl'd,c\:ccpt ri·:Jl c:sl:I(('nil(~;idc thl.~Comnlonwc:d;h or Pt;ll11sylv:lllia;tklt thc figures opposite t:ach itcm
of rC:J1 and personal estate in the foregoing schedlil:.:s are determincd and stated by the undersigned to
?~the ~air \·a.llIc,o,f ~aid it:n:s as..?~.~.he;,(1.~~~..0!;,:!~~_~I~~e~1.~~1t's R;f~~~'.b~s:~u~on n.~st apPt'tise~ent of eachItem111.1cle In thl..ILo\e n.lIlled 1..,."..,:.",.•.".~.,...:'v t.".,.,..,."....J .....'J.,t1-,~rutr 1 C.• •
-7 4:':.
S7:'Ol?1 (I'''~subscribed before me this...~.2.........l c:/-."------"l/-
da.!LJ".o£,\./.~C~:(·:~~.~.:.t:...?.~:.19.:.:.-?:.f G.._.t{~.·:-;.:.!:~..'::.:~~?/~·.J:~.:.~~-::::~..~;:/...~..~:y/
../•/'.;f_d.'Vl~",-,'''''-··......-.1.:v;-.r~r."~'.''-..(:.;..~/~/:>,:,'j.'/1/'2.(:'-cyc:.u AJI'..lt~~Wl:~nWU.~IoL:~I.-'/._."_.",M _);;;•.J _~........................................Adninistratrix C.T.A.
I •;/.:,;.....ADDITIONAL I~STRUCTIONS
1."Anin\',i;tnry :11'..1st bi~filed <':ithin three months ~Ift(;r appointment of personal representati\·e.
2.A ';i.:?plt·r,i'::lhl im'entory must be filed within thjrty days of disco\'ery of additional assets,
3.1 Oris'iilal :md 2 Copies and 2 HCHI-J4,Under $10,000;1 Original arid 2 Copies and 2 RCRI-33,
O\'t:1'$10,000,including Copy of vVill;1 Original and 3 Copies and 2 RCRI-33,Over $50,000 in-
cluding C.opy of 'Vill and copy of Federal Estate Tax Return.'
REFtnEKCE FOR ADDITIO);'AL COPY
Act of 194·7 P.L.513 Sec.5.2,72 P.·S.4S't4.2
--_.._.__..-._----,~._...._--_.__._._..__....----_._...._.__.._-.-::..__._-_.--:------_.._-----_...__.__.._--....-..~:-:------_·_----.------I
"-.._----------.."---....:,.~,~_._..._.-....,.._..___._-_._._-_-.-_.--_.--.---.-_._.-_.._,-_._----,,-
1JuurutDl'n UUll AppruhiPlllPul of the goods and chattels,rights and credits which
were of ..lH.1h.~.T..t u..!Ni~1ate of ~~~.~.!..!.~!.9..!..
Wa~hington County,Pa.,taken and made in conformity with the ab01'e affidavit,
DOLLARS CENTS
!1,500.00
3,281.25
,.q
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[i52,169.130
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'31,327.05
Ii 561.00q
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$5,180.00
owed at date of death:3,116.46
($2,063.54)
TOTAL
Improved real estate,situate in Town of North
Harmony (Hadley Bay area),Chautauqua,State of
New York,and having erected thereon a one story
frame cottage,including a block building for .
storage.Recorded in Deed 1198,Page 228,
Chatautauga County,New Yo~k.
Total Value:($17,500.00)
2.
REAL ESTATE OUTSIDE OF THE COHHONWEALTH:
1.Unimproved real estate being Tract No.82, 83,98,
a'nd 99 of Section 35 of TO\·mship 27S,Range 33E,
Oscela County,Florida.This property being
purchased under Articles of Agreement.
Total Value:
Less balance
PERSO;;AL PROPERTY:
1.100 Shares Common Stock,Bausch &Loriib Inc.
2.375 shares Cor::;,':on Stock,Coventry Care,Inc.
Corp.h~ving its.principal place of business
1277 Country Club Road,r·1ononzahela,Penn=t.
3.350 shares Corn..'TIon Stock,The Exolon Company
4.Investors Syndicate of A~erica,Inc.,a systematic
savings plan,a Minnesota Corp.,8th &Marquette
Streets,~·Iinneapolis,Hinnesota
5.Civil Air Patrol Bond
..
•1