HomeMy WebLinkAbout04-0008PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of .~ ~ ! 7/'J .~ el-. ~n/O~_ No
also known as To
Deceased
Soctal Securtty No /~/-',-~'~1- x/C~'o~,?
Register of Wills for the
County of ~ m the
Commonwealth of Pennsylvama
The petttion of the undersigned respectfully represents that
Your petlt~oner(s), who is/are 18 years of age or older, appt I ~'~ for letters of admlmstration
/ZA~£1~ J., E/.F.o,o£/~ /~£~oou,~c~ ..r',~ F,4-VO,'Z. OF: R. gI~T a C,¢,C~rtm the estate of
(d b n , pendente htr, durante absenaa, durante mxnontate)
the above decedent
Decendent was domiciled at death m ~_~L//O? L<~ ?.~ A./4A_9/0 ~'C~u~ty, Pennsylvama, w~th
last famdy or pnnc~pal residence ai' q¥'O
(hst street, n~umb~ and mumcq~alliy)
Decendent, then ~ years_.of age, died
Decendent at death owned property with estimated values as folllows
(If dommded in Pa ) All personal property $ ~00
(If not domiciled in Pa ) Personal property ~n Pennsylvama $
(If not do~m~clled in Pa ) Personal property ~n County $.
Value of real estate in Pennsylvama $
situated as follows
Petmoner after a proper search ha5
the following spouse (if any) and hmrs
Name
DoRo 7,,,, ~
_ ascertmned that decedent left no will and was survived by
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of adm~mstrat~on in the
appropriate form to the unde?signed
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
The pem~oner(s) above-named swear(s) or affirm(s) that the
SS
statements in the foregoing petition are true and correct to the best
of the knowledge and behef of petitioner(s) and that as personal
representat~ve(s).of.~the above decedent petitioner(s) wdl well and
truly admmmter the_ e§tate~ according to law
Sworn to o[-aff?med,/and subscribed
before me th~s ' /,~) ~.f,./v,~. day of I
,Deceased
GRANT OF LETTERS OF ADMINISTRATION
Letters of Administration
Short Certtficates()
~.~atlon
J TOTAL __
Fried J -,~
AND NOW -"~/"z~ t ~,... ~.,. ,~F/ ~t~O~, m cons,deratmn of the et,t,on
the reverse s~de her~ s~t~qa~proof ~v~ b~en presented before me, P on
1T IS DEC~ED that
ts/~e enmled to Letters of A~mstrat~on, and ~n accord w~th such finding, Letters of Adm~mstratmn
are h~eby grated to ~ ~ ~~
~n the estate of ~J
FEES
$ ~ ATTORNEY~Sup $ ID No)
$~ ADDRESS
A.D
PHONE
RENUNCIATION
In Re Estate of
To the Register of Wdls of
The undersigned
d~e~
County, Pennsylvania
the above decedent, hereby renounce(s) the right to adnumster the estate and respectfully a~k(s) that Letters
belssuedto /~],~T ~ , CA~]oP~/~
WITNESS
hand flus //0 b~, day of ~) C 7'. , l~ ~E~
(Ad~s)
($~gnature)
(Address)
(Signature)
(Address)
I05 805 ]KEV
This ~s to cernfy'that the ~nformanon here giv~en l~ cor'rectl~'cop~ed frown'aff'"ong~'al'~ certificate' '' of death~'~"
Local Registrar Th,e original ceruficate wdl be forwar~led to the State V~tal Recbrds Office for p,ermane,~nt
WARNING' It IS Illegal to d,u,pllcate this copy by photo?a? or phot, ograph.
Fee for th~s cernficate, $2 00
P 83 9800
No
Local ~eglstrar
JUN '" 4 2002
Date
59
CERTIFICATE OF DEA?H
Kexth S, Cleppe~ Male 161 34 --'4827 , June 1,~
- 0~2
Carlxsle, ~--~ ,~~~ o~ ~ ~-~ ~U
Artist . -
Carlisle,Pennsylvania
James D. Clepper
Karen L. Clepper
Painter
Cumberland ~ ,,,,0 ~,,~,.'~*'~' ~'
June 4,2002~ =c~'~East Harrisburg
Cre
.rrisburg,Pennsylvanla
2,40 June 1,2002
.,,[]
~00=~
STATUS REPORT UNDER RULE 6.12
A& in. No.: I - o_ oo V
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:
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: ~' - I -' 0 5/
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal repr,~entative 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 r~resentative state an account informally to the parties
in interest? Yes F__.[ No [--]
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
~/~and may be attached to thisf~/~f.~, ff._/"'~~.~ _
Capacity:
Address
Telephone No.
~ersonal Representative
[-'] Counsel for personal representative
i 70
h,,llh,,lth,,,,,ih,lh,,hlhi,,,,ht,,I,ili,,,,,l,h,,lli
Decedent's Complete Address:
STREETADDRESS
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
3~
5o
O
O
Interest/Penalty if applicable
D. Interest
E Penalty
ISTATE p/~.
I z~. /76/J
(1) O
Total Credits (A + B + C ) (2)
Total Interesl/Penalty ( D + E ) (3)
O
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page '1 Line 20 to request a refund
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.
(4) 0
(5) 0
(SA) 0
(5B) ~)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
i. Did decedent 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; ............................................ [] []
~. retain a reversionary interest; or .......................................................................................................................... [] ~-].
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
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. Did 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.
Under penalties of pe, l~r'/, I/eclara thai I have e~lmined~duding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration_of p~epf,e~lo~,r than the personal r~]D'rese,~ativ~base~ on all information of whicil preparer has any knowledge. .
SlGNAT~P[rRSON RESP~LN,~II~.E~FOP/F)t. IN(~ RETURN ' DATE
ADDRES,t5~'/ } . '~ ~ /' / - / / .' .
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~ DATE
ADDRESS
II
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 3% --
[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 0% [72 P.S. {}9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 0% [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 tineal beneficiaries is 4.5%, 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 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
inrlivirhml whn h~t¢ ~f I,aaef nn~ n~r~nf in r'nmmnn wifh fh~ d,ar,~danf ~uhath,c,r hu hlnnd nr ~d~,nfinn
REV-1§O0 ~X I$-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
OFFICIAL USE ONLY
I-'
Z
Z
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
-,27 -5"727
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(iF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
- -
[~1. Odginal Return E] 2. Supplemental Return E~ 3. Remainder Return (date of death pda'to 12-13-82)
E~ 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) E~ 5, Federal Estate Tax Return Required
E~6. Decedent Died Testate (Attach cop./of W~) r'-] 7. Decedent Maintained a Living Trust (Attac~ cop~ of Trust) 8, Total Number of Safe Deposit Boxes
[] 9. Litigation Proceeds Received [ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (Attec~ sch o)
FIRM NAME (IfApplicable)
COMPLETE MAILING ADDRESS
TELEPHONE NUMBER
bi?-- 7o-1 70
1. Real Estate (ScheduleA) (1) {~)
2. Stocks and Bonds (Schedule B) (2)
3. (3)
4. (4)
5. (5)
m
Closely Held Corporation, Partnership or Sole-Proprietorship
Mortgages & Notes Receivable (Schedule D)
Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
Jointly Owned Property (Schedule F) (6)
]-]Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
r
OFFICIAL USE ONLY
(8) 0
(11)
(12)
(13) ('~
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax (~ x .0 (15)
rate, or transfers under Sec, 9116 (a)(1.2) --
16. Amount of Line 14 taxable at lineal rate ~) x .0 (16)
17. Amount of Line 14 taxable at sibling rate O x .12 (17)
18. Amount of Line 14 taxable at collateral rate (~) x .15 (18)
19. Tax Due (19) ~'~
Karen L. Clepper
300 Summer St. #53/54
Boston, MA 02210
617-670-1670
May 24, 2004
Commonwealth of Pennsylvania
Department of Revenue
Dept. 280601
Harrisburg, PA 17128-0601
Re.-
Keith S. Clepper, Deceased
Social Security No. 161-34-4827
To Whom It May Concern:
Enclosed is a completed Form REV-1500 Inheritance Tax Return Resident
Decedent.
My brother Keith had no assets at the time of his death. The reason that his file was
opened was due to the fact that I received notification from the Social Security
Administration that there was an underpayment due to his estate. The proper paper
work was completed (Form SSA-1724) and submitted to them on March 23, 2004.
As of this date no payment has been received. Upon receipt a Supplemental Return
will be filed.
enclosure
Name of Decedent: ~
Date of Death: & //' /t~ ~
~ /
Will No.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
7' t4 ~, C(_~co ce_
Admin. No.-,~.1 Oq ~Z
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
Sallle
~eT, //~
?
Address
~o~T6 ~v , M ,q,
/
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Name
Address
Teleph°ne'{]/~] c,~'-'~;~ 3 c:'~-~ (
Capacity: ~ Personal Representative
Counsel for personal representative
~, - ~ ~
BUREAU OF TNDTVTDUAL TAXES
ZNHERTTANCE TAX DXVXSXON
DEPT. 280601
HARRTSBURg, PA 17128-0601
KAREN L CLEPPER
$00 SUMMER ST 55 5q
BOSTON MA 02210
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
~eCOrO~.i-i~'l~ 08-02-200fi
~e~i:,~'~' ~ ~,E~TE OF CLEPPER
DATE OF DEATH 06-01-2002
FILE NUMBER 21 0q-0008
JUL 30 ¢~Ja3'¥ CUMBERLAND
ACN 101
Aeoun* Reei~ed
REV-i$~i? EX AFP CD1-03)
KEITH S
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LZNE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-15&7 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CLEPPER KEITH S FILE NO. 21 Oq-O008 ACN 101 DATE 08-02-200q
TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATION CONCERNING FUTURE ~NTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es*a~e [Schedule A) (1)
2. S*ocks and Bonds (Schedule B) (2)
S. Closely Held S~ock/Par~nership In*eros* (Schedule C) ($).
q. Mor~geges/No~es Receivable (Schedule D)
$. Cash/Bank Deposits~MAsc. Personal Proper~y (Schedule E) (S)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ado. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule 1) (10)
11,
12.
13.
lq.
NOTE:
O0
O0
00
O0
O0
O0
O0
.00
(8)
NOTE: To insure proper
credA~ ~o your accoun*,
subei~ ~he upper portion
of ~hAs fore wASh your
~ax payeen~.
.0O
.00
To,al Deductions (11)
Ne~ Value of Tax Re~urn (12) .00
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13)
Net Value of Es~a~e Subjec~ ~o Tax (1~)
If an assessment ~as lssued previously, 11nos 1~, 15 and/or 16, 17, 18 and
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Aeoun~ of LAne lq a~ Spousal ra~e
16. Aeoun'l: of Line lq ~axeble a~ Lineal/Class A ra*e
17. Aeoun* of Line lq a~ Sibling re~e
18. Aeoun'l: of LAne lq ~axabla at Collateral~Class B ra~e
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DTSCOUNT
DATE NUMBER TNTEREST/PEN pAID (-)
ZF PA/D AFTER DATE ZNDZCATED~ SEE REVERSE
FOR CALCULATION OF ADDZT[ONAL INTEREST.
.00
.00
(1~) .00 x O0 = .00
(16) .00 x Oq5= .00
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= .00
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 11, 1981 -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Common#ealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the 1aclu1 Class B (cotlataral) rate on any such future interest.
To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S.
Section 91~0).
Detach the top portion of this Notice and submit eith your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NZLLS, AGENT
A refund of a tax credit, ehich was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office
of the Register of Hills, any of the 15 Revenue District Offices, or by calling the special Z4-hour
ansHaring service for forms ordering: 1-800-SSZ-ZOSO~ services for taxpayers eith special hearing and / or
speaking needs: 1-800-4~7-50Z0 (TT only).
Any party in interest not satisfied eith the appraisement, allowance, ar disalloaance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--mritten protest to the PA Deportment of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 17128-1011, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in orating to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviee Unit, Dept. 180601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. See page 5 of tho booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (51) discount of
the tax paid is allowed.
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appea! the tax and interest
that has been assessed as indicated on this notice.
lnterest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the data of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 w111 bear interest at a rate ahich alii vary from calendar year to calendar year eith that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 are:
Interest Daily Interest Daily Interest
Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~'~ ZOZ .000548 ~'8-1991 llX ,000301 ~ 91 .0002~7
1985 16Z .000458 1992 91 .0002~7 ZOOZ 61 .000164
1984 112 .000501 1995-199~ 7X .000192 2005 51 .000157
1985 15Z .000556 1995-1998 92 .000247 2004 ~Z .00OllO
1986 lOZ .000274 1999 71 .000191
1987 101 .000274 ZOO0 7Z .000191
--Interest is calculated as folloes:
ZNTEREST= BALANCE OF TAX UNPAZD X NUMBER OF DAYS DELTN~IUENT X DATLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (X5) days
beyond the date of the assessment, If payaent is aada after the interest coaputation date shown on the
Notice, additional interest must be calculated.
Cumberland County - Register of Wills
One Courthouse Square
Carlisle, P A 17013
Phone: (717) 240-6345
Date: 05/03/2005
CLEPPER KENT B
2 WEST PENN STREET
CARLISLE, P A 17013
RE: Estate of CLEPPER KEITH S
File Number: 21-04-0008
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' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after 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 is due by: 06/01/2005
Your prompt attention to this matter will be appreciated.
Thank you.
Sincerely,
~.~aV~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Judge
rfl
Register of Wills of Cumberland Connty
STATUS REPORT UNDER RULE 6.12
Name of Decedent: k E /7 H ~. C L.l fJfJ E J:<
Date of Death: (0/0/ / 0 :L
/ '
Estate No.: ;; / -fJ<j -L:t?oS
Pur5uant to Rule 6.12 oftr'1e Supreme Court Orphans' Court Ruies, I report the following
with respect to completion oithe administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes m No 0
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 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? Yes JZ1 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report. /~ . ~
Date: ~/~3/1'JS- ,/, 4- & ~~
Slgnatur /
en
,"")
('c,J
k 2. AJ T f1 CJ..1-fJP ER.
Name ,;) WE.s..r pz).;)AJ .s.r. #//6
CA~J.../~g PA-. } 7()/..3
I
Address
~~;';:.J.:
7/7-~5g -3.;(3 /
Telephone No.
Capacity: ~ Personal Representative
o Counsel for personal representative
cI