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HomeMy WebLinkAbout00-0883 Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF c.. u.. m hr~ d COUNTY, PENNSYLVANIA -- ----~~ ,...--;---._~ Name of Decedent: -/ /Jt/ert//I- Date of Death: (l)J 8, :2.IJt)t) / ~~ File Number: ,ltJt9P"-- oogg.3 Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. 0 Yes ~No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: ,. ~ ~ CL. t""Y}fb ~ -#.. OS L 0.. -j 6- rY\ a-)(. \ ryll ) fY'. 3. If the answer to No.1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . .. 0 Yes 0 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? ............................... DYes DNa d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court ~che to this report. / /, ./ ~/ . c, \ \ I f3 I () 7 ~"I """ Fm"g 'hi, F",. Dale -.,r C5~ Capacity: ~rsonal Representative 0 COlillsel C~I("' Ip~ L. rnClr- + :L Name of Persall Filing this Form 30B n. dSf.-;.5f. A~ ~ ~ "",p LL /~ } 70 l ~ 7 I, - 5 7 I - 6 S g; Y Telephone t....._": ',--) ! J -I 15[]56[]41147 REV.1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes ~ PO BOX.280601 ~ Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File.Number ~~:3 gOB3 INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 0 Date of Birth 10082000 MARTZ TAUENTA MI B Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name MARTZ CHARLES MI L Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW l~ 1. Original Return D [J 4. Limited Estate D 6. Decedent Died Testate D (Attach Copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7 Decedent Maintained a Living Trust . (Attach Copy of Trust) 8. Total Number of Safe Deposit.Boxes 10 Spousal Poverty Credit (date of death . between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) ~ORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number CHARLES L MARTZ 7175715558 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY 308 N. 25TH STREET o ~==~ ,!::C) r-,.., c_:._~ C-;;';' ;> o..j -n r...i CD I -.I First line of address Second line of address CAMP HILL ZIP Code 17011 u5 ;~ _ ';? C) DA~~ l=ILED -:' City or Post Office State PA > ::r: , , ::::{ f'':; Correspondent's e-mail address: harles L Martz 308 N. 25th Street, Camp Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS Side 1 L 15056041147 15056041147 --.J ~~ -..J 15056042148 REV-1500 EX Decedent's Name: Tauenta B Martz Decedent's Social Security Number RECAPITULA TION 1. Real Estate (Schedule A).......................................................................................... 1. 2. Stocks and Bonds (Schedule B)............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D).......................................................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5. 6. Jointly Owned Property (Schedule F) D Separate Billing Requested............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested............. 7. 8. Total Gross Assets (total Lines 1-7)....................................................................... 8. 349.83 9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 9. 349.83 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)................................ 10. 11. Total Deductions (total Lines 9 & 10)......................................................................11. 12. Net Value of Estate (Line 8 minus Line 11).............................................................12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J)................................................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X ~ 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 349.83 15. 0.00 16. 0.00 17. 0.00 18. 19. Tax Due............................... ............ ...... ....................................... ........ ......... ..... ....J.g. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 15056042148 0.00 349.83 349.83 0.00 0.00 0.00 0.00 0.00 D -..J ~ . . REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-00-0083 DECEDENT'S NAME Tauenta B Martz STREET ADDRESS 308 N. 25th Street Camp Hill CITY I STATE IZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) 0.00 (5A) (5B) 0 . 00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.................................................................................0 b. retain the right to designate who shall use the property transferred or its income;....................................D c. retain a reversionary interest; or............................................................................................................... 0 d. receive the promise for life of either payments, benefits or care?............................................................O 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................................................................................................................ ....0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.................................................................................................................. 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. No ~ ~ ~ ~ ~ ~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P .S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemoa transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116 1.2) [72 P.S. ~9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1508 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMON~L TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Martz, Tauenta B FILE NUMBER 21-00-0083 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Harris Savings Bank - Account No. 2300014664 VALUE AT DATE OF DEATH 349.83 TOTAL (Also enter on Line 5, Recapitulation) 349.83 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV.1513 EX+ (9-00) . SCHEDULE .. BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Martz, Tauenta B NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal C1istributions,l and transfers under Sec. ~116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21-00-0083 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) ESTATE OF I. 1 Charles L Martz 308 N. 25th Street Camp Hill, PA 17011 Husband Residue Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) 11/13/2007 TUE 11:28 FAX ..... . . @ 003/004 TAUENTA MARTZ ESTATE 308 N 25TH 5T CAMP HILL PA 17011-3612 5T A TEMENT OA TE 11/03/00 PAGE ACCOUNT NUMBER TYPE OF ACCOUNT: I NTEREST PAID YEAR TO DATE ANNUAL PERCENTAGE YIELD EARNED (APYE) DAYS IN CYCLE AVER.AGE BALANCE 2300014664 TOTALLY FREE 13 .00 --------------------------------------------------------------------------------------------------------------------------- PREVIOUS BALANCE DEPOSITS WITHDRAWALS CHARGES INTEREST ENDING BALANCE 349.83 .00 349.83 .00 .00 .00 DATE ACTIVITY DESCRIPTION DEPOSITS WITHDRAWALS BALANCE 10/04/00 CHECK #106 56.55 293.28 10/23/00 CLOSING DEBIT 293.28 .00 CHECK SUMMARY * indicates skip in check numbers DATE CHECK NO. AMOUNT DATE CHECK NO. AMOUNT DATE CHECK NO. AMOUNT 10/04/00 106 56.55 --------------------------Need-cash?--App1y-for-a-Harrls-1oan-Monday-through-Frlday-before--------------------------------- 2:00 p.m. and we guarantee you a crfrdit answer that same day or we'll pay you SlOO.OO in cash) Apply today! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ,,~~I{,:-~r~\P~\ r'r~'~:t~~:=OF INHERITANCE TAX ( '. '\jIAP~41'SE~Fn!f ALLOWANCE OR DISALLOWANCE HtG~!Tc.ff \J'lED,u~:rJONS AND ASSESSMENT OF TAX *' DATE 04-21-2008 ESTATE OF MARTZ TAVENTA B DATE OF DEATH 10-08-2000 FILE NUMBER 21 00-0883 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 06-20-2008 ( See reverse side under Objections) A.ount Remittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS 4-- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MARTZ TAVENTA B FILE NO. 21 00-0883 ACN 101 DATE 04-21-2008 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 2008 APR 28 PH \: 06 CHARLES L MARTZ 308 N 25TH ST CAMP HILL r:LERK OF ORP~tl\T\!JS COURT ,,,,,,,'-r,J ,""iI." nr"', P^, ell" /,1.,,:,. ., '.; ,t'\ .1\;:L.'., :-_.~( " --;L. .', PA 17011 REV-1547 EX AFP (06-05) TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 349.83 .00 .00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 349.83 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax .00 .00 (11) (12) (13) (14) (9) (10) nn 349.83 .00 349.83 NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Tax Due * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ -L (-) (15) 349.83 X 00 .00 (16) .00 X 045 = .00 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19) = .00 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/11/2008 CHARLES L MARTZ 308 N 25TH STREET CAMP HILL, PA 17011 RE: Estate of MARTZ TAUENTA B File Number: 2000-00883 Dear Sir/Madam: ~; r~ c:°a : .4 ~ ~- ,., , ~ `~ ~~~ cn L ~ ~ ~.ri - ~ _ -'~-~ ,t~ _. --, ,- , ~ , _ _ _ . ,.,, ~- , , ~__ -- .._, . ._ , , , {~ . , _.__ This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after ~Tuly 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. 'This filing is due by: 10/08/2008 Please feel free to contact this office with any questions you may have. If you have-already filed your Status Report;-please disregard this notice. Sincerely, ~~~~~~~ Glenda Farner Strasbau Clerk of the Orphans' Court cc: File Counsel ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF In Re: Estate of CUMBERLAND COUNTY MARTZ TAUENTA B : PENNSYLI'ANIA NO. 2000-00883 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: CHARLES L MARTZ Counsel for Personal Representative: Date of Decedent's Death: 10/8/2000 The Orphans' Court r:,cord indicates that neither the above named personal representative nog the above namr:d counsel for the personal representative have filed with the Register of Wills or Clerk of the Orpi;ans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 11/5/2008 ~~~~ Glenda Earner Strasbaugh ~~ Clerk of the Orphans' Court _~ rrr n '--gym Distribution: Personal Representative ~'~, Counsel for Personal Representative `=' c`~ ~; Estate File ~~~~ ~~ c~ C t cn _.. _. f~ ..o tv , . ~s„ ~: C Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk S. Sohonage, Esquire Solicitor 1 Courthouse Square, Room 102 Carlisle, PA 17013 OFFICES OF Marjorie A. Wevodau First Deputy Wanda S. Zeigler Second Deputy (717}240-6345 FAX (717) 240-7797 1-888-697-0371 x 6345 ~egt~ter of tY~~ ~~b ~~er~ ~~ t~je 4~r~~ja~~' ~Cou~~ County of (r> rrtherll>tD 2/13/2009 ~~ --, ~, ~ , -.-, -_. ~__~3 ~ , s~7 - ~~ ' r -- CHARLES L MARTZ r,`-' _ ,- ~ r - ~ _- . ` , ~c_~y~' - _~ ~~ ~~ IN RE: MARTZ TAUENTA B , c ,~ ' 2000-00883 Dear Sir/Madam It has come to my attention as solicitor for the Office of the Register of Wills and Clerk of the Orphans' Court in and for Cumberland County, Pennsylvania, that the above estate has failed to file a report of the status of administration as required by Pennsylvania Orphans' Court Rule 6.12. Subsection (f) of Rule 6.12 requires that the Register of Wills notify the Court in the event the personal representative or counsel fails to file this notice after (10) days written notice thereof. You have already received written notice of this delinquency by the Register. Kindly accept this letter as written notification that unless the required 6.12 Status Report is filed with the Register of Wills Office within ten (10) days of your receipt of this correspondence, Iwill be compelled to file a Motion for Sanctions for Failure to Comply with Orphans' Court Rule 6.12. If required to do so, I will request that the Court grant counsel fees and court costs to be assessed against the offending party. Sincerely, ~~ ,1~ • .~25~/-1J~ Ki S. Sohonage ~ ~~ Solicitor cC: f .~ m ~ , ..- .. .~. o- ut N 0 ~ Postage $ ['~ Certified Fee f1J Postmark ~ Return Receipt Fee Here ~ (Endorsement Required) O Restricted Delivery Fee ~ (Endorsement Requred) ..D 5j 1.c-Ec Y ~ Total Postage & Fees ~ ~$ 3 ~ t2_ ~ -~ o Sent To / .' I~.r le S L '(~~.t~-- ----------------------------------------- - --------------- ----------------------- ~ ~ Street, Apt. No.; ~ ~~ ~ ^~~ or PO Box No. QQ \Y -------- U-----------------°-------------------•- _--__-_-__. ----------° -° c;ry,;ayaie, ztP+a ~ 1 L --~ ~ ~ ~0 l 1 ( ~n w.~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF C-~,t ~h ~~ r1~ u~ cl COUNTY, PENNSYLVANIA Name of Decedent: ~ f3U c~y i r4 ~ ~ l~} ~T~ Date of Death: ~ U ~~ 8 ~ :~ o U y File Number: c~- / ' O U -- d ©$ ~.3 Pursuant to Pa. O.C. Rule 6.12, 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 2. If the answer is No, state wren 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 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 Clerk of the Orphans' Court and e a , ~to this report r-~ ,~,,, Date ~ _ ~ ~ Cam' nature o fling this F m ~ Q Q- N ~ ~ . ~ ,~_ o ~: „ _ `-+- 4 _ `_ ,, ~,_. m v~ o r_~ r;~ ~ rte.: Form RGV-10 rev. 10.13.06 Capacity: ersonal Representative ^ Counsel c.~ /~/9 ~ L C S L ~ /~'I ~4 r~ i ~ Name of Person Filing this Form _3og nl. ~5~s~ 5T Address Telepha:e UNITED STATES POSTAL SERVICE First-Class Maii Postage ~ Fees Paid USPS Permit Ivo, G-1Q • Sender; Please print your name, address, and ZIP+4 in this box Cz, ~3 .~Y1 Glenda Farner c;.~:_~.ti;?,au,~]Z Register of Wills and Clerk of Orphans' Court Counr~~ of CLU11Lcand LiiC Courthouse Square Carlisle, PA 17013 f1,~Iil„~Ili~~~„~}i~~il,~,li"~II<<,i~i~~l,l„1~I1~~,i1~1„t ^ Complete items 1, 2, and 3. Also complete ~"°' item 4 if Restricted Delivery is desired. X ^ Print your name and address on the reverse so that we can return the card to you. ^ Attach this card to the back of the mailpiece, or on the front if space permits. p 1. Article Addressed to: If CHARLES L MART 308 N 2~TH STREET Date of _ d~rffer~from it~, Yes .~ ' ~ ~, ~t elivery ad~gss belovat '.; ~^ No / ~ ~~ ~ rn t f .~ Ji Ci;,/IP HILL PA .7011 3. Servic`eC~l ^ Certlfied~all ^ f~jfress f1~a'i1- ' ~ ^ Rred ^ Ism Reb9i~t fo7 Merchandise ^ Insured Mail ^ Q,~iD. -_ 4. Restricted Delivery? (Extra Fee) ^ Yes 2. Art1cleNumber 7pp6 2760 0002 7407 5973 (transfer from service label) ---------------- - -- - -- -- ' -- Domestic Return Receipt ~ 102595-02-M-1540 PS Form 3811, February 2004