HomeMy WebLinkAbout96-00684
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PETITION FOI( PHonATE nllll c;nANT OF I.ETTEnS
Nil. ..e,L::J99Lo~ to~~u____
To:
Esrllre oj Holw,..t". !-!i'-[!t~.t,.fu:-,---_w.-
II/SO kllO\l'1I 11.\' _----------.-.... -.-
.,____ Re~bter of Wills for Ihe
Ik<'C'dlwl COllOIY of JUIllIi~LlallL.. ill the
Sodll/ SL'clIriry No. 17 7-II,-LYTiO' .. COlllllloowealth of PCllnsylvania
The pClilion of thc lInder>igncd respcClflllly rcprcsenls that:
YOllr pClilioner(s). who is/arc 18 ycars of age or oldcr alllhc e.scclIl ,.Ix
in lhe last will of the abovc dccedelll, datcd r~arch 74.
and codicil(s) datcd
named
,IY~
(!i.lllle relc\'"nt cirCllIlISlanCCS, e.g. rcnunciiUion. l1enth of ct.:ccutor, rlc.)
Deccndcnt was domicil cd at dcalh in ClImhe rI nnd
h is last famil\' or principal rcsidence at Y'j llllckthorn
(South Hidilleton Township)
(list suct't, number and rnunt'ipality)
COllnty, Pennsylvania, with
Drive, Carlisle. I'A 17013
Deccndcnl.lhcn 60 years of agc, died Fehruary 7,
al Geisinger Hedical Center. Unnville. 1'''
Exccpt as follows, dccedent did not marry, was not divorced and did not have a child born or adopted
afler execution of the will offered for probate: was not the victim of a killillg and was never adjudicated
incompetent: None
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal properlY in County
Value of real estate in Pennsylvania
situated as follows:
,19 95
S no estimate
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WHEREFORE, .pctitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presenled herewith and Ihe grant of lelters testnmentary
(lcst:lIncnHuy; administration c.I.a.; :tdminisuation d.b.n.t.t.a.)
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Z9 ~S Alydar Drive
Dillsburg, 1''' 17019
(717\412-3603
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } S5
COUNTY OF CUMBERLAi';o
The pelitioner(s) above-named swear(s) or affirm(s) that the slatements in the foregoing pelition arc
true and correct to Ihe best of Ihe knowledge and belief of petilioner(s) and that as personal represen-
tative(s) of the above decedent pClitioner(s) will well and Iruly administer the estale according to la\\'.
Sworn to or affirmed amI subscribed ~\~",.)~",.,,~. \'\.~'n \ '"
before me this 18th da., of G,ongtancc I.. ~h?tter ~, ~~.
liLY ~ < 1-,; -96 ::iY-_ 1\ \~....,,~-;"'\'''''.g. "'.!-""'J,l:~
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No. (}"I-Iqq~-w~
Estllte of
1101I1(llT ^. WMNEIl, SIC
I Deceased
DECREE OI~ PROnATE AND GRANT OF LETTERS
AUGUST 30
AND NOW 19~, in consideralion of Ihe petition on
the reverse side hereof, satlsfaclory proof having been presented before me,
IT IS DECREED Ihatthe instrumenl(s) dated ~lll rch 21,. 1911 1
described therein be ndmilled 10 probate and filed of record as the last will of Robe r t ^. \~Il rne r. Sr.
and Lellers
are hereby granted 10
TESTM1ENT^RY
CONST^NCE I.. ~IOTTER
A. ~.t\, ~tl~\\\"',. 'L '"', ~(~('{\l\
Will Book"
Page
MARY
7!lC0~l C'~~,~rwt W,m.~({L)
c. LewIS R,gister of Wills V ~
FEES
Probate, Lellers, Elc. ......... S
~h.of}a1fmpcates( 1) .......... S ~ : BB
Renunciation................ S 5.00
JCP S :>.uO
TOTAL _ S 37.00
Filed . .M/GUST. .3.Q t. .1 9.9 fi. ...........
18.00
Wm. D. Schrnc , III
AITORNEY (Sup. Ct. 1.0. No.) 15893
P. O. 8m, 110. Dil1Rbur~. P^
ADDRESS 17019-0310
PHONE
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LETTERS AND ORDER MAILED TO THE ATTORNEY.
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In addition to thl! (lowl!r>> conf<!rrl!d by law, 1 ,1uthoriz<! my gx<!cutor,
in hi>> ab>>olut<! discretion.
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i lI. to retain in the form rl!ceived, and to sell either at public or
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,\ private sale any real or personal property I
\ B. to manage real estatel
C.
to invest and reinvest in all forms of property without being con-
fined to
legal investments, and without regard to the principal of diversificat anI
to exercise any option or rights arising from ownership of investmentsl
D.
E.
to compromise claims without court approval, and without the consent
of any beneficiary.
FIFTH
II I nominate, constitute and appoint my wife, BE'M'Y J. WlIRNER, Executrix of
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\ this my Last Will and Testament. In the event my said Executrix fails to
I serve for any reason, 1 hereby appoint my daughter, CONSTlINCE L. CONRAD,
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'\ Executrix of this my Last Will and Testament. I direct that my said Executrix
not be required to post bond or other security which may be required by the
commonwealth of Pennsylvania or otherwise.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my
Last will and Testament, consisting of two (2) pages, the first one (1) of
which b~rs my signature in
ctJid day of -114r4C'/ ,
the margin for the purpose of identification, this
1981.
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ROBERT 1\. WI\RNER, SR.
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I lI. Warner, Sr., as and for his Last Will and Testament, in the presence of us,
i who, at his request, in his 9i~ht and presencp., and in the siqht and presence
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i of each other, have hereunto subscribed our names as witnesses.
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Signed, sealed, published and declared by the above named Testator, Rober
I\DDRESS / tJ 0 f
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COMMONWEALTH OF PENNSYINANIA,
,55.
COUNTY OF CUMDERLAND
We, ROBERT A. WAllNEIl, SR., 11'1"' ~ Ii. r)'1J1r"rs
and ;( ~v _ 11 ,I, 'I
the testator and the witnesses, respectively, whose names are signed to the
attached or foregoing instrument, being first duly sworn, do hereby declare to
the undersigned authority that the testator signed and executed the instrument
as his last will, and that he signed willingly, and that he executed as his
free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testator, signed the will as
witnesses, and that to the best of their knOWledge, the testator was at the
time eighteen (18) years of age or older, and of sound mind and under no
constraint or undue influence.
Sworn to and subscribed before me
this;ltfl/ day of 1n.t.L r!.A. , 1981
~l(d.. J.' C7)'J7/J ../ I' .I ./
~c,.' 'n IlARClj, NOTARY PUBliC
I " i U,op". CUIlBfRt1.IlQ COUNTY
~., ,.(!I.l~'1: ,IUN [)PIRES V[r. 31. 1m
Mpmr). '. ft:flll.~~r~'lnrit A~~OCrd:lon Of Nl.'h:,e~
J. I - I qq &- - f.t; s t..{
HENUNCIATION
In Re EMale of
IUlllH'l' A. II'AHNEll. SI!.
decellsed.
To the Regisler of Wills of
aJ\IlIllU,AND
County. I'ennsylvllnin.
The undersigned
snouse
of
lhe above decedent, hereby renounce(s) Ihc righl 10 adminislcr Ihe csl:lle and rcspeetfully ask(s) Ihal LCllcrs
TE~
bc issued 10 cn~STANCll L. i.Dl'IEH (nee Constnnce L. Conrndl ",.k'. (.\ , ~,,~,~~.,t'~
WITNESS
1yl1day of
,19-BL.
ow
h:md lhis
Julv
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95 Buckthorn Dr.. Carlisle. PA
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Warner, Sr., Deceased filed suit on behalf of the Estate and the
beneficiaries of the Robert A, Warner, Sr., as a result of a
mishandled legal case arising from Robert A. Warner, Sr.'s death.
4. A aforesaid lawsuit named William D. Schrack, III, as
Defendant as he was handling the Estate's claim for the death of
Mr. Warner.
S. Defendant has made an offer of $175,000.00 to settle the
claim being brought in the aforementioned lawsuit and he is
requesting a release of liability in that case.
6. The petitioner desires to accept the aforementioned offer
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and to provide a Release to the Defendant and as such is requesting
this Court for an Order approving the aforementioned proposed
compromise of said civil action against Defendant William D.
Schrack, I II .
The distribution and settlement proceeds will be
made pursuant to the laws of the Commonwealth of Pennsylvania.
7. The Decedent was retired from his employment as a police
officer, but intended to do part-time investigation at the time of
his death. An economic analysis indicated that he may have earned
$130,000 to $190,000, including the value of his services net of
maintenance, had he not died as a result of salmonella sepsis from
ingesting contaminated ice cream. All the medical expenses related
to treatment of Mr. Warner's illness have been paid.
2
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the amount of $4,909.86 have been incurred and they are
recoverable, in addition to the stated attorney's fees, again,
pursuant to the agreement.
13. The net proceeds from the proposed $175,000.00,
settlement, after attorney's fees and cost will be $111,756.81.
The Petitioner proposes that said proceeds be distributed as
follows:
(a) survival
action:
Seventy-five
(75%)
or
percent
$83,817.61.
(b) wrongful death action: Twenty-five percent (25%) or
$27,939.20.
14. Petitioner has requested approval of the aforementioned
distribution from the Commonwealth of Pennsylvania, Department of
Revenue. Said approval has been granted by the Commonwealth of
Pennsylvania, Department of Revenue. (See letter from Lora A.
Kulick, Assistant Counsel, Department of Revenue, Commonwealth of
Pennsylvania attached hereto marked Exhibit "B" and incorporated
herein by reference.)
15. The sole beneficiary is the Decedent's wife Betty J.
Warner, who is also a Plaintiff in the civil action, and she joins
and concurs in this petition and requests for the compromise as set
forth herein. (See attached will of Decedent, marked Exhibit "C",
incorporated herein by reference) .
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EXHIBIT "A"
PETITION FOR PRonATE nlld GHANT OF LETTERS
N(\. _~lqgl.e.~.lo&H._---.
To:
Eslalc oJ \loherl A. Warller, s.r.,.__.___
a/so known as --..--"-
negisler of Wills for Ihe
. /)('('('a.<I'II. CounlY of ..J,;umbu,L1II1l1 .. in Ihe
Socia/ Security No. I J 1-2/~Q._____. Commonwealth of Penllsylvania
The pelition of Ihe undersigned respeelflllly rel"l'sellls Ihal:
Your pelitioller(s), who islare 18 years of age or older ,mlhe cxecllI.!..U~____.._----_. named
in Ihe lasl will of the above decedelll, daled _._M.Ji,Jl_Z1. -----. 19.111-
and eodieil(s) daled
(slale rrlC\';H1I cirCllm\lanCC\. t.g. renunci:uion, dcath or execulor, cIC.)
Decendenl was domiciled at death in Cllmherland County. Pennsylvania, wilh
I' in lasl family or principal residenceal 911l1lcklhorn Drlve. Cnrlinle. I'A 17013
(South Middleton Town"hip)
(list strCCI, number and mundpality)
Deeendenl. then 60 years of age. died Fehrunry 7, .19 95
at Geisinger Medicnl Center. .Dnnv i lie. l>A
Except as follows. deeedent did 1I0t marry. was not divorced and did not have a child born or adopted
after execution of the will offered for pro bale; was not Ihe victim of a killing and was never adjudicaled
incompetent: None
Decendent at death owned property wilh estimaled values as follows:
(If domiciled in Pa.) All personal property S no estimate
(If not domiciled in Pa.) Personal property in Pennsylvania S
(If not domiciled in Pa.) Personal properlY in County S
Value of real eslate in Pennsylvania S
situated as follows:
WHEREFORE, .pelitioner(s) respectfully rcqucsl(S) the probate of lhe last will and codicil(s)
presented herewith and Ihe grant of lellers testnmentnry
(testamentary; 3dminislr3lion c.I.a.; administration d.b.n.c.I.a.)
Iheron.
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Constance L. otter
2B MS Alydar Drive
Dillnburg, PA 17019
1717\412-3603
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } 55
COUNTY OF CUMBERLAi'm
'.
The petilioner(s) above. named swear(s) or affirrn(s) thatlhe statements in the foregoing petition arc
true and correct to Ihe besl of Ih~ knowle.Jge and belief of pelitioner(s) and Ihat as personal represen-
lative(s) of the above decedelll pelilioner(,) will well and Iruly administer Ihe estate according to law.
Sworn to or affirryw allll sllbscri~ed s::.('h'\)~""~' '\'\.~., \ '"
before me this Ilth day of ~lstnnC" I.. M~ter ..,,)., ~~.
~LY r 1-11).,9,~96 q.y...._WJ,-,....~,~,~
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MY. L WIS ~ II ,iSle :s:
15-/J.3-4
No.
Estate of
RO\l~:I\T A. WARNER. SR.
I Deceused
DECltEE OF PROnATE AND GRANT 01' LETTlmS
AND NOW AUGUST 30 19~, in considcration of thc pClition on
the reverse side hcreof. satisfactory proof having been presented before mc.
IT IS DECREED that the inslrumcnt(s) datcrl March 24. \98\
described th~rcin bc admittcd to probate and filed of record as the last will of Robert A. Warner. Sr.
and Lellers
are hereby granted to
TESTAMENTARY
CONSTANCE L. MOTTER A ." ..t\ . "\;l ~\\\~~ <L, \,., t..I:l~{'-l\~
Will Book H
Page
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C. L R.gi.ter of Will. II ~
MARY
FEES
Probate, Letters. Etc. ......... S
~h,!l8a<1jm[icates( 1) .. . .. .. .., S ~ :-&8
RenuncIation ................ S 5. 00
JCP S :>.uO
TOTAL _ S 37.00
Filed. .lillGUST. .3.Q I. .1 !l.9fi. ...........
18.00
Wm. D. Schrac. III
ATIORNEY (Sup. Ct. 1.0. No.) 15893
P. O. Box 3\0. DillsburQ. PA
ADDRESS 17019-0310
PHONE
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LETTERS AND ORDER MAILED TO THE ATTORNEY.
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EXHIBIT "B"
OFFICE OF CHIEF COUNSEL
DEPT. 2810S'
H~RRlSDURO, P~ 17128.'061
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.
July 16, 1998
PliaNE: 717.787.1382
FAK: 717.772.'459
Dennis R. Sheaffer, Esq.
Hepford, swartz and Morgan
111 North Front Street
P.O. Box 889
Harrisburg, PA 1710B-0889
VIA FACSIMILE AND FIRST CLASS MAIL
Re: Estate of Robert A. Warner, Sr., deceased
Court of Common Pleas of Dauphin County
orphans' Court Division File No. 0225-1994
Dear Mr. Shaeffer:
'Please be advised that this Office is in receipt of the
proposed Petition for Approval of Compromise filed on behalf of
the above-referenced Estate in regard to a wrongful death and
survival action. Due to a misunderstanding, the Department's
July 10, 199B letter on this matter contained incorrect
information. Please therefore accept this letter as a
representation of this Office's corrected position on the issue.
'pursuant tp the Petition, the retired decedent died
February 7, 1995, as a result of multiple organ failure caused by
salmonella sepsis. The sole heir to decedent's estate is his
wife. Any payment as settlement of the survival action would
therefore be subject to a zero percent inheritance tax rate.
Please be advised that, based upon these facts and for
Inheritance Tax purposes only, this Department has no objection
to the proposed allocation of the net proceeds of this action,
$27,939.20 to the wrongful death claim and $83,817.61 to the
survival claim.
I trust that this letter is a sufficient representation of
the Department's position on this matter. As the Department has
no objections to the Petition, I will not be attending any
hearing regarding it. If you or the Court have any questions or
require anything additional from this Office, please do not
hesitate to contact me. Thank you.
Sincerely,
Oj~~
Lora A. Kulick
Assistant counsel
cc: Clerk of orphans' Court
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r.AST WILL AIID -reSTI\MEIIT OF
ROOF.RT A. WARtIER, SR.
I, RODERT A. WARlIER, SP.. or South Mlddloton Township, Cumborland county,l
Ponnsylvania, being or Bound and disposing mlnd, memory and undorstanding, do
horeby make, publish and doclaro this as and tor my LAst Will and Tostament,
hereby revoking all other willR and codicils heretoforo made by me.
FIRST
I direct the payment oC my debts nnd oxpensos of my last illness and
:1 (uner.,} from my estate as Goon after my death 49 conveniently may be done.
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there be no cemetery lot available for my interment, owned by me at the time
of my death, I authorize my personal representative to purchase such cemetery
lot with a contract for porpetual caro, using therefor funds from my estate,
in such amount as he shall consider necessary and desirablo, and 1 authorize
my personal representative to cause title to or ownership of such lot so
purchased to be vested in such person as my personal representative shall
designate.
Further, in this connection, I authorize my personal representative to
expend funds from my cstate, In such amount as my personal representative shal~
consider necessary and desirable, for the purchase, erection and inscription
of a suitable marker for my grave.
SECOND
1 give, devise and bequeath my entire estate, of whatever nature and
wherever situate, together with all insurance policies thereon, unto my wife,
BETTY J. W^~~tR. if she survives me by thirty (30) days.
THIRD
In the event my wife fnils to survive roo by thirty (30) days, I give
and bequeath my entire estate in equal shares to such of my issue 8S shall
survive me by thirty (30) days, per stirpcs.
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III
, In addition to thn pOW(!rn con(nrrod by 1I1w, I allthor1:.., my f:xf!cutor,
in his absolute d1Bcrctionl
A. to rotain in tho tonn rocoived, and to Boll Dither at public or
private sale any roal or personal propertYI
D. to manage real ostAtol
C. to invest and ro!n\'ost in all Canna of property wIthout being coo-
flnod to legal invostments, and without rogard to tho principal of divorsltlcat
D. to exorcise any option or rights arising from ownership of investments
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of any benefiCiary.
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to cOlnpromlso claims without court approval, and without the consent
FIFTH
I nominate, constituto and appoint my wife, DETTY J. WARtlER. Executrix of
ji this t:\y Last Will and Tostament. In tho event my said Executrix fails to
I
I serve for any reAson, I hereby appoint my daughter, CONSTANCE L. CONRAD,
,
Executrix of this my Last Will and Testament. I direct that my said
not be required to post bond or other security which may be required by the
Commonwealth of Pennsylvania or othorwise.
IN WITNESS WHEREOF, I have hereunto sot my hand and seal to this my
Last Will and Testament, consisting of two (2) pages, the first ono (1) of
I' which bears my signature in
;; 6"// day of ""/~I-!.~-C."/
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the margin for the purpose of identification, this
1981.
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(cu., W(t!.)d(~./( .(SEAL)
ROBERT ^. WARNER, SR.
Signed, sealed, published and declared by the abovQ named Testator, Robor
A. Warner, Sr., aR and for his Last Will and Testament, in the presence of us,
who, at his request, in his sight and preacnce, and in the niQht nnd prononce
of each other, have hereunto subscribed our names 8S witnesses.
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NOTICE OP BENEPICIAL INTEREST IN ESTATE
PENNSYLVANIA ORPHAN'S COURT RULE 5.6
BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
In reI
THE ESTATE OP ROBERT A. WARNER, SR.
DATE OP DEATH: 02/07/95
ESTATE NO. 21-96-0684
To: Betty J. Warner
95 Buckthorn Drive
Carlisle, PA 17013
Please note the death of the decedent and the grant of Letters
Testamentary to the personal representative named below. You
have a beneficial interest in your husband's estate in
accordance with his Will (a copy of which is attached).
The Will was accepted for probate by the Register of wills of
Cumberland County on August 30, 1996.
Name of the decedent:
Robert A. Warner, Sr.
Last known address:
95 Buckthorn Drive
Carlisle, PA 17013
Date of Death:
February 7, 1995
Geisinger Medical Center
Danville, PA 17822
Place of Death:
County of Grant of
original letters:
Cumberland County
Pennsylvania
Decedent died testate, and a copy of the will is attached.
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Warner Estate
January 3, 1997
Page 2
Name(s), address (es) and telephone number(s) of all personal
representatives appointed:
Constance L Motter
28 South A1ydar Drive
Dillsburg, PA 17019
Telephone
717-432-3603
Nue
Address
Name(s), address (es) and telephone number(s) of all counsel.
Nues
Address
Telephone
Wm. D. Schrack, III
124 West Harrisburg st.
P.O. Box 310
Dillsburg, PA 17019
717-432-9733
Additional information may be obtained from the undersigned.
Date:
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WH. D. SCHRACK, III, ESQUIRE
124 West Harrisburg Street
P.O. Box 310
Dillsburg, PA 17019
(717) 432-9733
Counsel for Personal
Representative
CERTIrICATION or NOTICE UNDER RULE 5.6(al
Name ot Decedent,
Date ot Death,
Batate No.
To the Register:
ROBERT A. WARNER, SR.
re~ruary 7, 1995
21-U-0684
I certify that Notice of Beneficial Interest required by Rule
5.6(a) of the Orphan's Court Rules was served on or mailed to the
following beneficiary of the above-captioned estate on
Januarv 3. 1997.
If.ilJlm
Betty J. Warner
Address
95 Buckthorn Drive
carlisle, PA 17013
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except none.
Date:
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WH. D. SCHRACK, III, ESQUIRE
124 West Harrisburg Street
P.O. Box 310
Dillsburg, PA 17019
(717) 432-9733
Counsel for Personal
Representative
-~......"",,-...-- --.".-.',,' ". '-, '_"\.~-.._..,....,~_."....~,.,~--",.,.,.,...._"--
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REV-1SCO
INHERITANCE TAX RETURN
RESIDENT DECEDENT
{If ru:IAL U~i[ otlL 1
FILE NUMOER
1',
COUNI1COOE
1//1
YEAn
I/,j/.j
tlu~u[n
COM~ONW[AL 114 OF f'ENNSYlYANIA
DEPARIMENI OF REYENUE
OEPI ZftOf,Q1
HAnnI50URG.PA 11128.Of,Q1
DECEDENI'S NAMEILA!il. fmSI. AND MIDDLE INITIAL!
\/arner Robert A.
DAIEOF OEA1HIMlr.4-00-YEAnl
~.OCIAL ....tCUml '( flUMutn
177.2/,.290ll
IItlSnl1unN lotUS1 liE .ll[UIN UUI'LlCA1tWlllltl'E
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UA1E OF Oln,.tIMM.OO.YEA"l
"
02 07 1995
\1 l 1.) U VI I
3 Id~l" 0 dlt~l
. Hemalnde' ".luln pllOl 10 \Z- \J.l!ll)
5. Fedfll.1 hl.l" ,.. R"luln Requlled
8. ToI.I Num~1 01 S.le Oeposll BOles
\/arner lIett J.
X t. Ollgl",1 Reluln
4. L1m11edEsl.le
X 6. Decedent DIed lesl.le
(A!llch copy 01 WIlli
~ 9. LIUgl1iOnPloce.dsRec'l~ed
2. SupplflrYM!'nl.IRelutn
4a. Fulul" InlPlnt complomlseld.le 01 dfl.th .Ilel 1Z.1l.l!ll)
7. Ol!cedenl M'lnl.lnt!d a Living Tlust
(AIl.eh copy ollIU$t)
010. Spou!O,),IPo'lellyCled1t
(d.le 01 de.lh btIh'wet'!n 1l.J1.']\.nd 1-1.9S1
II
CAPO
HpRL
EplO
CRAC
KOTK
ES
o
11. [1",llon 10 1.11I uodllfS~. 911J(A)
IAlI.eh SehOl
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPlE1E MAILING AOORESS
C P
o 0
R N
R 0
E E
S N
T
111 North Front St.
P.O. 110>< 889
HarrlsburB. PA 17101
James G. Mor an. Jr.
FIRM NAME (If AppliublttJ
Tucker Arensber , P.C.
TEl.EPHONE NUMBER
OFFICIAL USE ONt Y
None
None
None
R
E
C
A
P
I
T
U
L
A
T
I
o
N
1._1
1. ABaI Eslals (Schedule Al
2. Slocks and Bonds (Schedule 0)
3. Closely Held Corporation, Partnership or
Sole.Proprielofship
4. Morlgages & Nolss Rsceivable (Schedule 01
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Scheduls E)
6. Joinlly Owned Proporly (Schedule F)
o Separate Billing Requested
7. Inler-VlvOS Translers & Mlscen.lneous Non-Probate Properly (7)
(Schedute G or Ll
8. Tolal Gross Assels (tolal Llnss 1.7)
9. Funeral Ellpenses & Administrative Costs (Schedule H) (9)
10. OsblS 01 Decsdent. MOltgage Liabililles. & Liens ISchedutel) (10)
II. Total Deductions (Iolal Un.. 9 & 10)
12. Nit Value 0' Estate (Line 9 minus l1np 111
13. Charitable and Governmental Bequests/See 9113 Trusts lor which an election to tax has not beon
made (Schedule J)
14. Nal Valua Sub ect 10 Ta. (Line t2 minus Line t3)
(8) 116.756.81
(II) ll.OO
(12) 116.756.81
(13)
(141 116.756.81
(1)
(2)
(3)
(4)
(5)
None
116.756.81
(6)
None
None
None
None
C
o
M
T P
A U
X I
T
I
o
N
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
116.756.81 X o II (15)
X 0& (16)
X .12 (17)
X tS (18)
(19)
15. Amount ot Une 14 tallable .11 the spousal t.11l
rate, or transfers under Soc. 9116{aX 1 2)
16. Amount of Line 14 tallable alllnoal rate
17. Amount 01 Line 14 tallable at sibhng rato
18. Amount of line 14 tallable at eollator.11 ,ato
19. Tax Due
20. CHECK HERE IF yoU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH < <
FOlmREV-1500 EX (Al!v_ 6-00)
Copyllghl (c) 2000 10lmsollw.re only The l.clnef Group. Inc
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Decedent'lI Complete Address:
STREET ADDRESS
95 Buckthorn IJrlvo
CITY
CnrJlnlo
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Ta, Duo (Pago lLIOo 19)
2. Credits/Payments
A. Spousal Poverty Crodlt
B. Prior Payments
C. Discount
(1)
3. InteresVPenalty if applicable
D. Inleresl
E. Penally
Tolal Crodlls ( A + 8 + C) (2)
Tolal 'nls/osVPsnally ( D + E) (3)
4. "line 2 is greater than Line 1 + Line 3. enlor the difference. This is tho OVERPAYMENT.
Chock box on Plgo lLlno 20 to ,0quOIt I ,olund (4)
5. II Line 1 + Line 3 is grealer than Line 2. onler the difference. This is the TAX DUE. (5)
A. Enler the inlerest on the laIC duo. (SA)
B. Enlorlho lolal 01 Uno 5 + SA. This is Ihs 8ALANCE DUE. (58)
Mlko Chock PIYlblola: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a Irans'er and: V.I No
.. relain the us. or income of the property transferred: . . .. .......... ~ ~~x
b. retain the righllo designale who shall use the property transferred or its income: .
c. retain a reversionary interest; or . . . . . . .
d. receive the promise for hfe of either payments, benefils or care? . . . . . .
2. It death occurred aller December 12. 1982, did decedenllransfer property within one year of death
without receiving adequale consideration? . . . .. . . . . . . . . . . . . . . . . . . . . . . . 0 [RJ
3. Did decedent own an -in trust fo'- or payable upon death bank account or security at his
or hsr doalh? . . . . . . . . . . . . . . . . . . . . . 0 rn
4, Did decedent own an Individual Retitement Account. annuity, or other non-probate property
which contains a beneficiary designation? . . . . . . . . 0 [R]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Und.r plI".IUe. of perjury ,I decl.r.lhall h.v. '~'mlned this '''turn, Including .ccompanylng schedules.nd st.tements,'nd Co the best of my knowledg..nd belief ,Ills true,
correct 'ndcomplele. Decl.,.Uon of prep.rerolh" th.n the pllrsON1 represenl.llvels bf;s&d on.lllnfonMl1onof which preparllf has,",! knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR fiLING RETURN
. .
Constance L. Mottor
..?~. ~.c:~~!1..~~Y.<!~!'. .~()",.l.'!~!lF.<! ....... ............
Dll1sbur ,PA 17019
Tucker Arcnsborg, P.C.
III North Front St.
. "finrr'isbu'': ';'W.." .ijiiii........................
Iy .! 1994 and bsloro January 1. 1995. Ihota, lalo imposod on Iho nol valuo ollranslo" 10 or lor Iho us. ollha
~(a)(1.1)(i)1
For dales of,d th on or alte January 1. 1995, the tax rate imposed on Ihe net value of ttansfets 10 or ror the use of the surviving spouse Is 0-/_
172 P.S. 91 a){1. 1) (jj)). he statute does not ellemot a transfer to a sutviving spouse from lax, and the slalutory requirements for disclosure of assets
and 'i1ing a II return are still applicable even if the surViving spouse is the only beneficiary.
DATE
DATE
For dalos 01 doalh on or allo, July 1. 2000:
The lax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at dealh to or for the uo;e of a natural
parsnl. In adoplivo paronl. ora sloppa/ont ollho child is 0'1.172 P.S. 9116 (a) (12)1
The tax rale imposed on Ihe nel value of translors 10 or tor the use of the decedent's lineal beneficiaries is 4.5-/_, except as noted in 72 P.S. 91 16{1,2)
172 P.S. 9116(aX1l1
The lax ralelmposed on the nel value 01 transfors to or for the use ollhe decedent's siblings is 12-/_l72 P.S. 9116(aX1.3)}. A sibling is defined, under
Section 9102. as an individual who has alleasl one parent in COtTVnOn with tho decedent. whether by blood or adoption.
Copyrlghl (cj2000 lormloftwllreonty The L.ck".r Group, Inc. form REV-1500 EX (Rev. 6.00)
\
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0.00
0.00
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\.. BUREAU OF INDIVIDUAL TAXES
INtI[AIJAHCE lAIC DIVJSIOH
IJ(PI. 180601
IJARAISIUNC, PA 11118-06DI
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
*'
NDTICE DF INHERITANCE TAX
APPRAISEHENT, ALLDWANCE OR DISALLOWANCE
DF DEDUCTIDNS AND ASSESSHENT DF TAX
.n.lu, ..,,, IfI.tll
JAHES G MORGAN JR
TUCKER ARENS BERG
PO BOX B89
HBG PA 17101
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
ROBERT
11-24-2003
WARNER
02-07-1995
21 96-0684
CUMBERLAND
101
Allount Ralli ttad
HAKE CHECK PAYABLE AND REHIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEV:ist.-i-Eif-AFP--iiiFoiriiiiYicniF-iiiHEiiTrAiicE-YAx-jipPRiiisEifEiiT~--ALi-ciwAiicE-ciri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF WARNER ROBERT A FILE NO. 21 96-0684 ACN 101 DATE 11-24-2003
TAX RETURN WAS: I X I ACCEPTED AS FILED
I I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. RooI Estoto ISchoduIo Al
2. stocks end Bonds (Schedule 8)
3. Clos8ly Held stock/Partnership Interest (Schedule C)
q. Hartg.gas/Not.s Raceivable (Schedule OJ
5. Cash/Bank Deposits/Hlsc. Personal Property (Schedule EJ
6. JoIntly Owned Property (Schedule fJ
7. Transfers ISchedule G)
8. Tot.l Assats
III
121
131
141
151
161
171
.00
.00
.00
.00
116.756.81
.00
.00
181
NOTE: To insure proper
credit to your account I
sub.lt the upper portion
of this forll with your
tax paYllant.
116.756.81
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funere1 Expenses/Adn. Costs/Misc. Expenses (Schedule H) (9)
10. Dobts/Hortgogo Llobilitios/Li.ns ISchoduI. II 1101
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Not Voluo of Estot. Subj.ct to T..
.00
.00
1111
1121
1131
1141
nn
116,756.81
.00
116,756.81
NOTE:
If an assessment was issued previOUSly, lines 14, 1S and/or 16, 17, 18 and 19 will
reflect figures that include the total of Abh returns assessed to date.
ASSESSHENT OF TAX:
IS. A.ount of L1no 14 .t Spousol roto 115'
16. Anount of Lin. 14 taxabl. .t Lin..l/Class A rate (16)
17. A.ount of L1no 14 .t Sibling r.t. 1171
18. Anount of Lin. 14 tUKable at Collateral/Class 8 rat. (18)
19. Principal Tax Dua
116,756.81 X
.00 X
.00 X
.00 X
00 .
06 .
00 .
15 .
.00
.00
.00
.00
.00
1191'
DATE
NUH8ER
INTEREST/PEN PAID I-I
AHDUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FDR CALCULATIDN DF ADDITIDNAL INTEREST.
( IF TDTAL DUE IS LESS THAN '1, NO PAYMENT IS REQUIRED.
IF TDTAL DUE IS REFLECIED AS A "CREDIT" ICRl, YDU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FDR INSTRUCTIDNS.l
A
RESERVATIONr
E.tete. of decedent. dvlng on or before D.c..ber Il, 198Z -- If any future Int.r..t In the ..t.t. I, trln.f.rr.d
In pa.....lan or .njay.ent to C.... . (coll.t.nll b.n.flcled.. of th. d.c.dent aft.r the ..plntlan of My ..t.t. for
llf. or far y..r., the Ca..anw.alth h.r.by ..pr...ly r...rv.. the right to appr.I.. and ...... tran.f.r Inh.rltanc. T....
.t the l.wful Cl'.1 . (collet.r.ll rat. on any such future Int.r..t.
PURPOSE OF
NOTlCEI
To fulfill the r.qulr..lnt. of S.ctlan 2140 of the Inh.rltanc. and Eltat. T.. Act, Act 23 of ZOOO. (72 P,S.
S.ctlon 9140).
PAYMENT I
D.t.ch the tap portion of thl. Notlc. .nd .ub.It with your P.Y..nt to the Rlgl.t.r of Will. prlnt.d an the r.v.r.. .Id..
--Hak. ch.ck or .on.y ard.r p.y.ble tal REGISTER OF MILLS, AGENT
REFUND CCA). A r.fund of . t.. cr.dlt, which Wa. not raqu..ted an the T.. Return, ..V ba r.qua.t.d by caapl.tlng an "Appllc.tlon
far R.fund of Penn.Ylv.nl. Inh.rltanc. and E.tate ,.." IREV-IlI3I, Application. .r. Ivallabl. .t the OffiCI
of the R.gl.t.r of Willi, any of the Z3 Rlvenu. DI.trlct Offlc.., or by calling the .p.clal Z4-haur
an.w.rlng .arvlc. far fora. ard.rlngl 1-800-362-Z050J ..rvlc.. far ta.p.yer. with .p.cla. h.arlng and I or
'P.aklng n..d'l 1-800-447-30Z0 ITT anly).
OBJECTIONS I Any party In Int.r..t not ..tl.fled with the .ppr.I....nt, allawancl, or dl..llawlnc. of deduction., or .......ent
of t.. (Including dl.caunt or Int.r..t) a. shown on this Notice IU.t abJ.ct within .I.ty (60) day. of r.c.lpt of
thh Notlc. by,
ADNIN-
ISTRATlVE
CORRECTIONS.
--wrltt.n protl.t to the PA Dlpart.ant of Rav.nue, la.rd of ApP..ls, Dapt. Z810l., Harrl.burg, PA
--..ectlon to have the .atter d.t.relnld at .udlt of the account of the parsona. represent.tlvl,
--app..l to the Orphans' Court.
17128-1021,
OR
F.ctual .rrar. dl.covar.d an thl. BSS..saant should ba addrass.d In writing tal PA D.p.rt.,nt of Rav.nu.,
lur.lu of Jndlvldual T...., ATTNI POlt A.......nt Ravlaw unit, D.pt. Z80601, Harrl.burg, PA 17128-0601
Phon. (717) 787-6505. S.. page S of the booklet "In.tructlon. for Inherltanc. T.. R.turn for B R.sld.nt
Dlc.dent" (REV-ISOI) for In I.planatlon of adelnl.tr.tlvely corr.ctabll .rror..
DISCDUHT,
If eny ta. due I. paid wIthin thra. 13) calendar Bonth. .ft.r the dacadent', d.ath, . flv. p.rcent (5%) dllcount of
the tall' p.ld I, Illow.d.
PENALTY.
Thl 15% ta. .an..ty non-partlclp.tlon panalty I. coaputed an th. total of the ta. Bnd Intar..t .......d, and not
p.ld b.for. January 18, 1996, tha flrlt day aft.r the .nd of the ta. ..n..ty p.rlod. Thl. non-participation
p.nalty 1. epp.elabl. In the .... .annar and In the the .... tl.a plrlOd a. YOU would Bppe.l the tall' and Int.r..t
that has baen .......d .. Indlcet.d an this notlca,
INTEREST I
Int.rllt II ch.rg.d b.glnnlng with Urst day of dellnqu.ncy, or nln. (91 .anth. 'nd on. (11 day fro. the dllt. of
d..th, to tha date of peyeant. TeM'1 which b.CB.. d.llnqu.nt b.far. January I, 198Z b.llr Int.r.lt .t the rat. of
11M (6%1 p.rc.nt p'r annua calculat.d .t a delly rata of .00016~. All tiMe. which blca.. d.llnqulnt on .nd .ft.r
Jenuery I, 198Z will baar Int.ra.t at B rat. whIch will vary froe c.lander y.er to c.l.nd.r yaa~ with that rBtl
announc.d by the PA Depart..nt of Rlv.nua. The appllcabl, Inter..t rBta. for 198Z through ZOO] .rar
Jnt.tllt D.lly Int.rut D.lly Int.n.t
~~~~~~~
V.ar
-
Dally
rector
-
198Z 2'X .000548 1987 9X .000Z47 1999 7X .000192
1983 16X .000~38 1988-1991 I1X .000301 ZOOO OX .000219
1984 I1X .000501 1992 9X ,OO021i7 Zool 9X ,OOOZ47
1985 UX .000l56 199]-1994 7X ,OOO19Z ZOOZ OX .000164
1986 10% ,OOOZ74 1995-1998 9X .000Z47 ZOO] 5X .000137
--Int.r..t II cBlculatld .. fallow..
INTEREST = BALANCE OF TAX UNPAIO X NUNBER OF DAYS OELINQUENT X OAILY INTEREST FACTOR
--Anv Notlc. I,su.d .ft.r the tlM b.co... d.llnqu.nt will r.flect .n Int.r..t calculation to flfte.n (15) dav.
b.Yond the det. of the ........nt. If peyaant I. ..d. .ft.r the Intera.t caBput.tlon d.t. shown on the
Notlc., .ddltlon.l lnt.r..t .u.t b. calculat.d,
OR
STATUS REPORT UNDER RULE 6.12
Name of Decedent: lOIElfl' A. 1I'A1INEH. SIt.
Date of Death: FEB. 7. 1995
Will No.
Admin. No.
1996-n06R4
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: 199R
3. If the answer to No. I is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if anYl for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be 'jttached to this report.
Date: .Tnn?~ 1997 (______A~-
. Signature
-
o t.";
.'
.....
In
N
tUn n Sphl.nPK T I J 1
Name (Please type or print)
~- ~('
"1'1."':
~
~
.:'
POBox 310. nillshurg. FA 17019-0310
Address
r--
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i'Z
-,
( 717) 432-9733
Tel. No.
g ~;'
we:
a:
,~
QC
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Uu
Personal Representative
r--
P'
Capacity:
X Counsel for personal
representative
(MAH: rmfl AM3)
(CrgfPY
STATUS REPORT UNDER RULE 6.12
Name of Decedent: RlTlERT A. WARNER. SR.
Date of Death: FF.R. 7. 1995
Will No.
199R-OORR4
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No x
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: 199R
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be ~ttached to this report.
D/ll:e: T'\~?~.:',,~.,.97 I~-
o .!-2 _ Signature
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,Un n ~~hrn~k TTT
Name (Please type or print)
T> n Jlmr ~10 nl11/lhllrg-. PA 17019-0310
Address
( 717 ) 4~2-9733
Te l. No.
Capacity: Personal Representative
(MAH:rmf/AM3)
X Counsel for personal
representative
PLEASE FILE TillS REI'ORT WITIIIN TWO YEARS OF DATE 011 DEATH I{E(;AIWLESS OF
TilE STATUS OF THE ESTATE. ((I ESTATE IS NOT COMI'I.ETED, FILE II 6.12 FOI{M YEARI.Y
UNTIL COl\ll'LETlON Cl I-
(l\\
STATUS REPORT UNDER RULE 6.12
Name or Decedent: Rolli' r t ^. Wi! rlH> ['
Date of Death: 07/07 II'lq,\
Estate No.: 21-96-0684
Pursuant to Rule 6.12 of the Supremc Court Orphans' Court Rules, I rcport the following with respect
to complction of the administr:llion of the above.cuptioncd estutc:
I. Slate whether udministr:llion of Ihe est ute is complete:
Yes X No
2. If the unswer is No, statc when the personal represel1lative reasonably believes
that the administration will be complete:
(date)
3. If the answer to No. I is yes. state the following:
A. Did the personal representative tile a linal account with the court'?
Yes No X
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
C. Did the personal representative state an account infonnally to the parties in
interest'? Yes No X
D. Copies of receipts, releases, joinders and approvals of fonnal or infonnal
accounts may be tiled with the Clerk of the Orpha d may be attached
to this report.
Date:
~\...~C)
-
Signal .
Jam-' G. Morgan,
Tue r Arensberg,
Name (Please lype or prinl)
P.O. Box 889
Harrisburg, PA 17108-0889
Address
(717) 234-4121
(MAII:rmllAMJ)
Telephone No.
Capacity:
Personal Representative
X Counsel for Personal Representative
R.W.-56
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
IOlERT A. WAllNER SR.
Date of Death:
0210711995
Will No. 1996-00684
Admin. No.
pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounls may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
,C,/f; <6b'
Sure
Date: 01/06/2000
, -.I
\'lI1. D. samACK I I I. ESQUIRE
Name (Please type or print)
P. O. Box 310
Dillsburg. PA 17019-0310
Address
(717 I 432-9733
Tel. No.
_' '_0
Capacity: Personal Representative
X Counsel for personal
representative
(IotAH: rmf/ AM3)