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HomeMy WebLinkAbout01-0535PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~ ~ ~. - S ~ ~ No. ~ l - ~, ~' S~ als known as v _• - ~. -~~~ /~O To: l~-''X~'~~ ~~ ~ ~_/-~%~ ~ Register of Wills for the / Deceased. County of ~ c,~ rv, 6 Pr 1~.~~.~/ in the Social Security No. l~f"5= -~~.~ - /_S~O~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl i~ for letters of administration on the estate of (d.b.n.; pendente liter durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in _~-t~i~~~~(~'~~~ County, Pennsylvar~}a, with h~ last family or principal residence at ~ .~ ~- ~ ~/ ,~/ /~,~, (list street, number and municipality De endent, then JT ~ years of a e, died ~(/ ~,~i/ ~ ~~~ ~- ~ v Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $_ ~~~~~ L~~7~~ (If not domiciled in Pa.) Personal property in Pennsylvania $ -~` (If not domiciled in Pa.) Personal property in County $ ---~-~ Value of real estate in Pennsylvania $ ~-~~ situated as follows: Petitioner after a proper search ham ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: game ~ ~~ ~ ~elattonship ~ Residence ~1 J ~T, J THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ci l 4r •~ ~"~ 6. GJ ~ x~ ~ o G ~~- :~ .: ~v ~a v ~. ~° m c ~~ ~~'i7y~~i OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } 5S The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~ ~'L%<'~ G~~G%~~~f''~1~~~ before me this 4TH day of o h .~~MAy /~,X~( ,2001 o'V' Y C L E W I S ~ Register NO. 21 - 01 - 535 Estate of PATRICIA A DAWSON a/k/a Deceased PATRICIA A MORAMARCO a/k/a PATRICIA A EKING GRANT OF LETTERS OF ADMINISTRATION c ~o AND NOW JUNE 6 X~~c2001 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that JOHN A MORAMAR('D is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ]OHN A MOByMARCn in the estate of _ PATRI .TA A DAWSON a/k/a PATRI('TA A MORAMARCO a/k/a PATRICIA A EKING - ,, ~- '.` / Register of Wills .. ~ ' ~~~ MARY C LEWIS '~~ FEES Letters of Administration ..... $ 50.00_ Short Certificates( 1p.......... $ 3~ . QO Renunciation ................ $ J C P _ $~~ - g(~_ ToT'AL $ R~ _ nn-- Filed ...JUNE .h,.......... A.D. >dQ ~nn1 ATTORNEY (Sup. Ct. LD. No.) ADDRESS PHONE Called Administrator on 6-6-2001 ;` .~ L'~ ..t !,. :t. ~ ~~)71<~11 .. i y i' L 1- :'7 L..~, ..~ ~ , , ., .. Et S's it ~? iCl:'IS. ~ , .4 ~..., ,, , .., , ;i ,.1. ,;~lt~i1_a,_ ~ti,l , _•e r . ,~ _)_,., 1 <_ °?' ..« ~ ~. .~. ;~LiJ d?tlir_ , ~ , ~.I; ~1A~F~9§~I4a; Et [~ i~l~~a1 ~~c~ ~€s~46cai~ ~~i~ ~c~~v ~~ ~hcato~tat o~~ p~t~i~ags~.~~~#a, `, ~~~~ i 2., i ~+! t _. 1~~ ~~ ~, I' ?i ~ ~,- E _. ..7 ~_ ~ ~ ~1~EY ~ ~ 7tJ01 ~ ~. ~~ ~ . ',: ~f ;~' P 74524.3._4_ _ ~= ~'~f~ ,; _ - _ _ _- _ __ .,~~41T 1 ~~'/ r r _._. y- i r 05.744 Rev. 1/91 ~PE/PRINT IN ~\~~ ERMANENT -J^ BLACK INK `~ O ' ~ '~ I ~'v f~ CO 1~ G Q y ~ t C: ~ Q,, QI ^ 2 W U W D O a Z COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (Coroner) NAME OF DECEDENT (Fns't. Middle. LasO SEX P STATE FILE NUMBER SOCIAL SECURITY NUMBER DATE OF DEATH (MOn1D Day, Year) I. atricia A DAWSON 2Female AGE ILasl Rrtlntla J UNDER i YEAR UNDER D 3. - 3 .. ~,SOh 4. May 25, 2001 y 1 AY DATE OF BIRTH BIRTHPLACE ICuy end PLACE OF DEAT M D H (Check only one - se instructions on other side) Olnli. Months Days Hours Mlnwe, / ny, Yeat! Stale of FOte~gn COUmry7 HOSPITAL: 55 Yrs. July 19, 195 y mpahem ^ s OTHER'. Ewompanem ~ DDA ^ Nnratng omer ^ . 7. D Be. Home Reamence ^ IsPa,:nvl ^ COUNTY OF DEATH ~ CITY, BORO. P F DEATH FACILITY NAME (II not insleution, g.ve street and numDei) WAS DECEDENT Of HISPANIC DRIGIN7 R Cumberland Esat Pennsboro Holy Spirit Hospital ACE ~ American Indian, Black, While, etc. "°~ Yea^Ily°a,waOltyaban. IsPe<~IYI Bb. 8c. gd ," Mext n, Puado Rican, etc. ~ / ~e 9. 10. / DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS/INDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MAgITAL STATUS~Marrietl (Gwen d t rk d tl U$ wo o one uring I -ARMED FORCES9 S~ecil °nl Di hest of working tile; do not use reined) SURVIVING SPOUSE ratle tom IeleU Neva M r Widowed. (II with ive m d Elementer /Seconds Yea ^ No ~ y ry Lo.121 ~ T~ $ Dl C . g ai a S en name] Colle a VO Y) (1.4 or s+) a ''n~a ne. x M eRU ~ nb. i2. 13. ' l4 R DECEDE NT S MAILINGA RE SSISv e el. GlylTown Stale. Lp CoU DECEDENT'S (J . I ,s. 1 // 11 ~~ N ,7a. Stale ` B-N NS.v III~)'A 3V S I%I,U In /R(VL ,]c.^Yes tlecadenl livedin , RE$DENCE tw tlecetlenl p (See.n truclions live In )~ N o~ A P A nnlher=,tle, 7 a lownahl Y IB. ~ ~~ no. c0°m ~ a ~ 6<•.: ~Ar+'o~ P ty~ No, decedem ayaa 17d t within acW f Cn/O~ l l it . q a im s o FATHER'S NAME IFrsl. MidUla, L.asq M ceylDOro. TH R' O E S NAME (F le. ~ M S h tti'.N ~ SR F rtsl, MiUUIe, Maitlan Surname) ~ " ,B. . INFORMANT'S NAME (TypelPnnO ' z U INFORMANT S MAIL ING ADDRESS ISIreeT CdyR wn, Stale. Zip Code) 20..E 1J oR R" lob. 31 T ~,Y.~ ~, /~}~7< ME HOD OF DISPOSITION NI~AA GATE OF DISPOSITION PLACE OF DISPOSITION-Name of Cemetery, Crematory LOCATION-CityR wn, Slate, Lp Code ^ IMClIIh, OaVYeaH Burial^ Cremati //~A Oth P H . on yU °r er amoval from Stale lace l ^ ///r7 t~ LJOnalldn^ ONB! S ( pecity 2,.. 2m. 3! v Q~ 2,°.~/1 ~ /~~0~ 7 ~7 ~c .~~edic~ ,a ~L . SIGNAT~UrRE~Of FUNERAL S€RVICE~L yENSEE OR PERSON TING AS SUCH LICENSE UMBER NAME AND ADDRESS OF FACILITY ~ ~~ ~ 22a. /1 ~ .~h~ /Cam i%.~ ,t sxb. f~ - O 3 7 -L 22 }J~l J'A'I f '~~ic Ai e 0 Complete dams 23a~c only when cenitying To meb tot my krwwledge, death attuned al the lima Gate and lace stated P . o , . ~ c '~`~` N,O ~ ~ , . physician isnol avallablealtimeoltlealh to (SignaW Band TAle) LICENSE Nl1MBER DATE SIGNED cenlly cause 01 death. (MOnlh, Day. Yeas) 23a. - Items 24-26 muss be completed by TIME OF DEATH DATE PRONOUNCED DEAD (Monm. Day. Year) person who prorniunces tlealh. 230. 23c. WAS CASE REFERRED TO MEDICAL EXAMINERICORONER7 24 12:41 P May 25, 2001 Ves~ N ^ o M 2B 26. 2T. PART 1: Enter the diseases, injuries or complications which caused the death Do not enter the mode o,Dying, such as cardiac or respiratory arrest, shock or bean lailure. ~Approxlmate PARTLI: Other si List onl nificant c one cause on each lin diti y e. g on ons <onlri0uting to death, Out rval between not resulling in the underl in i IMMEDIATE CAUSE (Final y g cause g ven in PART 1. nset and death ci,ea=ew°°"dti°" Pendin I ti i nves at on sulling in death)-~ a DUE TO (OR ASA CONSEQUENCE OF): say°ankany eat 0ondibona b i it any, leatling to immediate DUE TO (OR AS ACONSEOUENCE OF): se. Emer UNDERLYING ~ CAUSEIDisease or injury c. i that In4ialed events DUE 70 (OR AS A CONSEQUENCE OF): sulong in tlealh) LAST a WAS AN AUTOPSY PERFORMED? WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK7 DESCRIBE HOW INJURY OCCURRED ,N OF CAUSE O (MVlllh, Day, YeeH . OF DEATH7 Natural ^ Homicltle ^ Yes ^ No ^ r, ~( Yes IlJ No ^ ~ Yes ^ N Accidem ^ Pending Investigation ~ 30a. JOb. M. 311c. 3pd. o Suicide ^ Could not De tletermineC ^ PLACE OF INJURY - Al home, far tlin etc (S a l m, street, lactory, of/Ice LOCATION (91ee1. G1ylTOwn. Slate) 2Ba. 2Bb. 29. g, . ul y) P CERTIFIER (Check only one) a _ 'CERTIFYING PHYSICIAN(Physcian ce,ulying cause ul deem when another physician has V 31 prnnuunced tleatll dnd cwn lelnd lt SIGNATUREA CER FIER To the beat of my knowledge, tlealh occurred due to lhs ceuae(s)and manner ea elated ..................................... ...... .... .... . . ^ - Ty. -~ COLOner i - 'PRONOUNCING AND CERTIFYING PHYSICIAN Ph s¢mn Gulh ~ ( y Pronouncing death end ~aiulpny wcausa of deaai) LICENSE UMBER DATE SIGNEDIMOnm Day, Vear) To,he heal olm knowlrM y ge, dealhoccurredal lhell~e,dale,aMplaca, and due to lhecauaa(e)and mannarasalatad .......................... ^ 31c. 31d May 29,2001 NAME AND ADDRESS OF PERSON W HO COMPLETED CAUSE OF DEATH 'MEDICAL EXAMINER/CORONER (Item 27) Type or Print Michael L. Norris, Coroner On,ha basis a, examina,ton end/or lnves,lgation, In my oplnian, death occurred a„he,lma,data, and place, and due,o,ha causa(s)and annaTass,a,ed , 6375 Basehore ROad Suite ail ........................................................................... ........... 3,a. @ , Mechanicsburg, Pa. 17050 3z REGI RAR'S SIGN UREA . DAT FILED (MOnlh, Day. Year) ~ ~ ~ I 1 Q 0 a9 a i ,,. J!'.D/June 30, ]992/17858 I:n Re: Estate of Patricia A. Dawson Late of East Pennsboro Township Estate No.: 21-O1-535 7C~ g ~ ?0f~~' ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. :NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: John A. Moramarco (:ounsel for Personal Representative: Date of Grant of Original Letters: June 6, 2001 Date of Delinquency Notice: September 16, 2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on August 24, 2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned 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. er 2 2001 ~~ ` Date:Octob , Mary C Lewis, Register of Wills ]Distribution: Personal Representative Counsel for Personal Representative Estate File .A hearing is scheduled for ~<._~~ ~~y ~ Z' ~-'~' gat ~~ - r ~~ In Courtroom No. 3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be #'y °i cancelled. >'` ~~ ~~' George . Ho er, .J. H . ,. .. •, r .< _ ~,_,,~, ., .. r~ ~ cZ~ ~ ti ['I L 0 s ;~ ~U Q902 565't 520 Ofl90 ~DOZ .TRD/June 30, 1992/17858 In Re: Estate of Patricia A. Dawson Late of East Pennsboro Township I3state No.: 21-01-535 OCT 0 2 2i~fl~J ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE :Personal Representative: John A. Moramarco ~r~t:ns°1 f^r Personal I? e^resentat~ve: Y` Date of Grant of Original Letters: June 6, 2001 Date of Delinquency Notice: September 16, 2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on August 24, 2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned 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. ,~,. ~. ~-.,.~,.e. ~,. ~ inn: ~"/ //!A . ~ ( " : /.~l~r,n d i, _ _ ~~7~ ?~~jp.~//w- 1lGiv: l.f ~. ~.lJ ~s ..I L., ..vVl V // Mary C Lewis, Register of Wills U Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ~C~- wv iat : ~ d In Courtroom No. 3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. /~~ Geo e . Ho er, .J. 09132611212001 Cumberland County - Register Of Wills 1121/2001 ROW621 File Info 2001-00535 PA File No 2101-00535 Decede°nt DAWSON PATRICIA A Docket Entries Date Filed 6/04/2001 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION OATH OF PERSONAL REPRESENTATIVE DEATH CERTIFICATE 6/06/2001 GRANT OF LETTERS OF ADMINISTRATION ~/_3a-6> °.,.~-d ~"' J November 30, 2001 John A. Moramarco, Jr. 316 Overbrook Drive York, PA 17404 IN RE: ESTATE OF PATRICIA A. DAWSON Failure to File Certification Dear Mr. Moramarco: A hearing was set for November 30, 2001, at 9:30 a.m., in the Courthouse in Carlisle, at which you failed to appear. The certification must be filed in the office of Register of Wills. We must hear from you within twenty-four hours; please phone Donna in the Register of Wills office at 240-6409, if you have any questions. Sincerely, Sandra S. Gobrecht, Secretary Judge Holler's Chambers JRD/June 30, 1992/17858 In Re: Estate of Patricia A. Dawson Late of East Pennsboro Township Estate No.: 21-01-535 OCT 0 2 2~8p,1 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: John A. Moramarco Counsel for Personal Representative: Date of Grant of Original Letters: June 6, 2001 Date of Delinquency Notice: September 16, 2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on August 24, 2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned 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: October 2, 2001 Mary C Lewis, Register of Wills Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ~~~in ~ gat = ~ v In Courtroom No. 3. If the Certification of Notice is filed prior to the Baring date, the hearing will automatically be cancelled. Geo e o er, .J. JRD/June 30, 1992/17858 In Re: Estate of Patricia A.Dawson Late of East Pennsboro Township Estate No.: 21-2001-0535 JUN 0 ~ `t60~ ~' ~~~~ ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2001-0535 NOTICE OF FAILURE TO RULE 6.12, SUPREME COURTT ORPHANSO OURT RULE HEARING PURSUANT Personal Representative: John A. Moramarco Counsel for Personal Representative: Date of Decedent's Death: OS-25-2001 Date of Delinquency Notice: 04-09-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' 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, was given by the Register of Wills on 04-09, 2003, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned 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: 06-04-2003 / , r ~.~1~( /) ~ _ ~~' ~-; ~ . ) ~ ._. Donna M. Otto, Register of Wills ~ ~~ 1 ~ ~ ~ , ;, f '~z; ell ~ ~. ~' ~ f `-r Distribution: Personal Representative Counsel for Personal Representative Estate File 7 ~ s'-v3 ~ ~~~,~' A hearing is scheduled for at in Courtroom No. 3. If the Status Report is filed rior to the hearing date, the hearing will automatically be cance d. ~ George ff . . ,~~ ~~~ 0~ Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone:(717) 240-6345 Date 4/09/2003 MORAMARCO JOHN A 316 OVERBROOK DRIVE YORK, PA 17404 RE: Estate of DAWSON PATRICIA A File Number: 2001-00535 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURToRULoESaf~Or for decedents dying 103 SUPREME COURT RULES DOCKET NO. 1, July 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 will become delinquent on: 5/25/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~ Quo; ~~ ~~ ~~~~ DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: File Counsel Judge 14512206202003 Cumberland County - Register Of Wills 620/2003 ROW621 File No 2001-00535 PA File No 2101-00535 Decedent DAWSON PATRICIA A Docket Entries D/E Date No. Filed 001 06/04/01 OATHTOFNPERSONALNREPRESENTATIVOF ADMINISTRATION DEATH CERTIFICATE 002 06/05/01 GRANT OF LETTERS OF ADMINISTRATION 7000 Q60Q OQ25 1595 2Q68 r~\`` R M } (~ yy i \ V t 1 r- ~C}~ \ !'~ ~ ~~ ~ `P!~^ ~! ~, V L`~ A~,~ l _ _ ~~ _ _ _ \~W. L .- T y ~ t'~ `~,T - - - 4 s ° _- ~ ''y , 2Eh0 29Q5 9000 O'IS2 'CDOz JRD/June 30, 1992/17858 In Re: Estate of Patricia A.Dawson Late of East Pennsboro Township Estate No.: 21-2001-0535 JUN 0 ~ ~~0~ ~' ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO.21-2001-0535 NOTICE OF FAILURE TO FILE STATUS CREME COUR ORPHANSO OURT RULE HEARING PURSUANT TO RULE 6.12, SUP Personal Representative: John A. Moramarco Counsel for Personal Representative: Date of Decedent's Death: 05-25-2001 Date of Delinquency Notice: 04-09-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' 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, was given by the Register of Wills on 04-09, 2003, and that the ten (10) day notice to file the Status Report has expireand tthe undersigned requests th tla Court 6onduct a Court is hereby notified of such delinquency hearing to determine whether sanctionsUe ~uld bonalpepre entativee delinquent personal representative or counsel for the dehnq p ~ F, ,., Date: 06-04-2003 ~ ~ n 1 ~~"¢ 1~-~` ~ ~.- Donna M. Otto, Register of Wi=r s f~`~ , ~ ,~~~ ~ ,, ; y"~ ~; Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for at ~~ ~d in Courtroom No. 3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cance d. ,~ George ff . . ~~ ~-' ~`h ais ~' 0 o ~- ~ ~- ------ -- fLl -R-_~.~ r ~- O O 0 U y N C ~ M t L O - o- r r. L 0 Q ~ c U y r > L C T R y > N V U c c aif ~ = ti 3~= d U U .. N (~ v\ C~ r- ~, c-~ r ~~ 0 ,p-+ .. f. W o t .` ^ ~ N h W O \ y ~ W ~ Z m ~~G J ~ N Z~~~ 0 0 L L ~ O I` = O ~- r- - Q > ~ C ~ ,C O c0 O - -) M } :a... s ~~~ .~ ~ _~ . ii. ~3:t i~• 1';l.~ ~t ~q.. ~~s" ~'•! ~i ~.. ~;a ~' ~} ~i' ¢.. C'~ a Of d i . � 15�5610105 REV-1500 EX�o2_��,�F�> � enns lvania OFFICIAL USE ON�Y PA Department of Revenue P p,,,Mt Y „ , County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX Z8o6oi / Harrisburg PA 1'7128-o6oi RESIDENT DECEDENT � 1 � � ���� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05/25/2001 DecedenYs Last Name Suffix Decedent's First Name MI DAWSON PATRICIA A (If Applicable)Enter Surviving Spouse's information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Atlach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number JOHN A MORAMARCO (717) 309-4602 REGISTER OF WILLS USE ON4Y -.,� n _-� .�� fil First Line of Address - - `�, ' « -„ __ � " _:;+3 , a �_� 1 E MAIN ST '' r ==�' � ' - y Second Line of Address �� " ; APT 11 ; City or Post Office State ZIP Code DATE F,ILED -_ _,; }_.� ::, DALLASTOWN PA 17313 r�a : ,�f c.n �:;3 �.._, r--� `'� CorrespondenYs e-mail address: Under p�y�alties of pery'ury,I deciare lhat I have examined this ret�m,including accompanying schedules and statements,and to the best of my knowledge and belief, it is tru�;corr ct and complete. eclaration of preparer o[her than the personal representative is based on all information of which preparer has any knowledge. SIGNATU OF P� ONSIBLE FOR FILING RETURN D TE ,'i` ���'�--�--- 3 G /�' DRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � 1,5056101�5 150561,�105 � \ � � 15�5610205 REV-1500 EX(FI) DecedenYs Sociai Security Number oecede�t's Name: DAWSON,PATRICIA A RECAPITULATION 1. Real Estate(Schedule A). ... .. .. .. .. .. .. .. .. .. .. ... .. .. .... ...... .. .. 1. 0.00 2. Stocks and Bonds(Schedule B) . . .. .... .. .. .. .... .. ... .. .... .. .. .. .. . . 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedu�e C) .. .. . 3. 0.00 4. Mort a es and Notes Receivable Schedule D 4. 0.00 9 9 � ) .. .. ..... . . .. .. .. .... .. .... 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. ... . . 5. 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . ... .. 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. . . .. .. 7. 0.0� 8. Total Gross Assets total Lines 1 throu h 7 8. 0.00 ( 9 ).. .. .. .. .. .... .. ..... . .. .. . . . 9. Funeral Expenses and Administrative Costs(Schedule H). .. .. .. .. .. .. . . .... 9. 5,400.00 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I).. .. .. .. .. .... . 10. 0.00 11. Total Deductions(total Lines 9 and 10). . . .. .. .. .. .. ..... .. .... .. ... .. . . 11. 5,400.00 12. Net Value of Estate(Line 8 minus Line 11) .. .... .. .. .. . . ..... .... ... .. .. 12. 0.00 13. Charitabie and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ..... .. .. .. .. .. . . .. .. .. . 13. �.00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . .... . . .... . . .. .. . . ... 14. 0.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0_ 16. 0.00 17. Amount of Line 14 taxable at sibling rate X.12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X.15 1g. �.�� 19. TAX DUE ... .. .. ........... .. ...... .. .. .. .. .... ..... . .......... .. . 19. �.00 20. FIL�IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 � 1505610205 7,5�5610205 � REV-�500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DAWSON PATRICIA A STREETADDRESS PO BOX 7253 , _ CITY _ _ _ __ I STATE _ I, ZIP YORK ' PA 17404 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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 tlecedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ � c. retain a reversionary interest .............................................................................................................................. ❑ � tl. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. If tleath occurred after Dec.12,1982,did decedent transfer property within one year of tleath without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Ditl decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, For tlates of death on or after July 1, 1994,antl before Jan. 1, 1995,the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets antl 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 deceasetl child 21 years of age or younger at death to or for the use of a natural parent, an atloptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's linea�beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. . The tax rate imposed on the net value of transfers to or for the use of the tlecedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, untler Section 9102,as an indivitlual who has at least one parent in common with the decedent,whether by blood or atloption. REV-`1511 EX+ �08-13) � ��p��� SCHEDULE H � � �� pennsylvania � DEPARTMENTOFREVENUE FUNERA� EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAWSON PATRICIA A 2101-0535 Decedent's debts must be reported on Schedule i. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1� Heffner Funeral Home Of Jacobus Inc 1502 Mount Rose AveYork, PA 17403 5,400.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) .. _ __ __ __ _ Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedenYs address is not the same as claimant's, attach explanation.) Ciaimant _._ _ Street Address City --..-- -- ----- -.--- -State ZIP _— Relationship of Claimant to Decedent _ _ __. 4. Probate Fees: 5. Accountant Fees; 6. Tax Return Preparer fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 5,400.00 If more space is needed, use additional sheets of paper of the same size. NOTICE OF INHERITANCE TAX pennsyLvania BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE OF DEDUCTIONS AND ASSESSMENT OF TAX INHERITANCE TAX DIVISION __r REV-1547 EX AFP (11-14) PO BOX 280601 HARRISBURG PA 17128fgUORDED OFFICE OF REGISTER OF WILLS DATE 07-20-2015 DASO 7015 JUL 27 PM 2 09 DATEESTATE OFOF DEATH 05-W25-N 2001 PATRICIA A FILE NUMBER 21 01-0535 CLERK OF COUNTY CUMBERLAND MORAMARCOO QHtoUr�TA RPHAtJ10 ACN 101 APT 11 APPEAL DATE: 09-18-2015 , &UMBERLAND CO -, PA 1 E MA S1 (See reverse side under Objections) DALLASTOWN PA 17313-2200 Amount Remittedi MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS I COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4- --------------- REV-1547 EX AFP C11-14) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: DAWSON PATRICIA AFILE NO. :21 01-0535 ACN: 101 DATE: 07-20-2015 TAX RETURN WAS: CX) ACCEPTED AS FILED CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) Cl) .00 NOTE: To ens';r. proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) CS) •00 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) C9) 5,400.00 10. Debts/Mortgage Liabilities/Liens (Schedule 1) C10) .00 11. Total Deductions (11) 5,400.00 12. Net Value of Tax Return (12) 51400.00- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . 00 14. Net Value of Estate Subject to Tax (14) 5,400.00- NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will reflect figures that include the total of all returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at spousal rate (15) .00 X 00 = .00 16. Amount of Line 14 taxable at lineal rate (16) -Otl x 045 = .00 17. Amount of Line 14 at sibling rate (17) . 00 , x 12 = .00 18. Amount of Line 14 taxable at collateral rate (18) .00 x 15 = .00 19. Principal Tax Due (19)= 00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT AMOUNT PAID DATE NUMBER INTEREST/PEN PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT CCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.