HomeMy WebLinkAbout04-0012PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of WAYNE R. CONRAD, JR. No
also known as WAYNE R. CONRAD To
Soctal Securtty No 164-42-6321
Register of Wills for the
Deceased County of Cumberland in the
Commonwealth of Pennsylvania
The peUUon of the undersigned respectfully represents that.
Your petitioner(s), who is/are 18 years of age or older, appl J_es for letters of administration
N/A on the estate of
(d b n, pendente hte, durame absentm, durante mmontate)
the above decedent
Decendent was domiciled at death in Cumberland County, Pennsylvania, w~th
hzs - last family or principal residence at 175 Woods Drive, Silver SprJ_ng ,TownshJ_p
(hst street, number and munf~pahty) j
Decendent, then 55 years of age, dled December 12
at 919 West Trxndle Road, Mechanxcsburq, PA
Decendent at death owned property with estimated values as folllows
(If domiciled in Pa ) All personal property $ 20,000.00
(lf not domiciled m Pa ) Personal property ~n Pennsylvama $
(If not do~mtclled ~n Pa ) Personal property m County $
Value of real estate in Pennsylvama $
situated as follows none
Petitioner
the following spouse 0f any) and heirs
Name
after a proper search ha s ascertmned that decedent left no will and was survived by
Residence
See attached Information St
Relationship
atement
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate for.m to the undersigned
L. ~totler
130 Center Street
Carlisle, PA 17013
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF CUMEERLAND
The pettttoner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petmon are true and correct to the best
of the knowledge and belief of peUUoner(s) and that as personal
representattve(s) of the above decedent petmoner(s) wdl well and
truly, ad_mlm.ster the estate according to law
Sworn~to or-afflAme, d and subscribed c
b~f. qre me this - ,~1 day of
Samantlla L. Stotler
No.
Estate of
WAYNE R. CONRAD, JR.
a/k/a WAYNE R. CONRAD
,Deceased
GRANT OF LETTERS OF ADMINISTRATION
ANDNOW ~l'knax~s. ~ ! ~C~ l~x , tn consMeratlon of the petlUon on
the reverse sMe he~eof, satlsfa0tory proof hawng been presented before me,
IT IS DECREED that SAMANTHA L. STOTLER
~s/are entitled to Letters of Administration, and tn accord wtth such findtng, Letters of AdrmmstraUon
are hereby granted to 832q~NTHA L. STOTLER
~n the estate of WAYNE R. CONRADr JR.~ a/k/a WAYNE R. CONRAD -' ~_~ ._o
Register of ~W,llsC40~ ¢00~/X~ ~
$._-,~l~-- Marlxn R. McCaleb, Esq. (#06353)
$ q (DO ATTORNEY (Sup Ct 1 D No )
$ ~O,~(~ 219 East Main Street, P.O. Box 230
$ ~0,0~-~ Mechanlcsbur~, PA 17055
ADDP~SS
FEES
Letters of Adm~mstraUon
Short Cemficates( )
Renunciation
TOTAL __
$ '-la etd
Flied 1~~Oc} AD. 19__
(717) 691-7770
PHONE
RENUNCIATION
In Re Estate of WAYNE R. CONRAD, JR., a/k/a WAYNE R. CONRAD
deceased.
To the Regtster of Wdls of
Cumberland
County, Pennsylvania
The unders~gned Bryan Wayne Cnnrac] of
the above decedent, hereby renounce(s) the right to adm~mster the estate and respectfully ask(s) that Letters
of Administration
be issued to Samantha L. Stotler
WITNESS ~y hand this
day of ~eXl~2 0 0 3
Bryan W~ne ~onrad
ED3815-0
P. O. Box 200
Camp Hill. PA 17001
(Addr~.~)
(Signature)
(Address)
(S~gnature)
(Address)
RENUNCIATION
InReEstateof WAYNE R. CONRAD, JR., a/k/a WAYNE R. CONRAD
deceased
To the Register of Wills of
Cumberland
-County, Pennsylvania
The undersigned KelllTo K. Wert of
the above decedent, hereby renounce(s) the right to adm~mster the estate and respectfully ask(s) that Letters
of Admlnzstratzon
be issued to
WITNESS
Samantha L. Sto~l~r
my
211-A Chestnut Street
Mt. Holly Springs, PA 17065
(Address)
/- -/j
(Address)
(Signature)
(Address)
I05 805 REV 9/86
This is to certify that the ~nformauon here gtven ~s correctly copmd from an original ceruficate of death duly filed w~th me as
Local Registrar The original cemficate wdl be forwarded to the State V~tal Records Office for permanent ~hng
WARNING: It is dlegal to duplicate th~s copy by photostat or photograph.
Fee for this ceruficate, $2 00
P 9641583
No
Local Registrar
Date
COMMONWEALTH O1: PENNSYLVANIA * DEPARTMENT OF HEALTH 'VtTAL RECORDS
CERTIFICATE OF DEATH
, Wayne R Conrad, Jr Male , 164 42-- 6321 · December 12, 2003
Cumberland Sdver Spnng Tw 919 West TRndle Road ~.~ ~.~wc~.. ,s~,,, White
Wayne R Conrad Sr
Samantha L Stotler
Dec16,2003
Hazel Myers
130 Center Street Carhsle, Pa 17013
TRndle SpRng
Mechanlcsburg, Pa 17055
37 East Main Slreet MechanlCSbulS Pa 17055
LAW OFFICES
MARLIN R. McCALEB
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Wayne R. Conrad, Jr., a/k/a Wayne R. Conrad
Date of Death: December 12, 2003
Will No. 21-04-0012
To the Register:
I certify that notice of beneficial interest and estate
administration required by Rule 5.6(a) of the Orphans' Court
Rules was personally served on the following beneficiaries of
the above-captioned estate on April 2, 2004.
Name
Samantha L. Stotler
Brandon W. Conrad
Bryan Wayne Conrad
Jennifer N. Wells
Kellijo K. Wert
Address
130 Center Street
Carlisle, PA 17013
612 Hilda Court
Mechanicsburg, PA 17055
ED 3815-0
P.O. Box 200
Camp Hill, PA 17011
19 East Harrisburg Street
Dillsburg, PA 17019
211-A Chestnut Street
Mt. Holly Springs, PA 17065
Notice has now been given to a~.l persons entitled thereto under
Rule 5.6(a) ./~~/~
Date: April 2, 2602' I ":~ '~
arfin R. McCaleb
Attorney I.D. No. 06353
f~[ [~ L- ~dV2~7~.East Main Street
P.O. Box 230
Mechanicsburg, PA 17055
[ ~7) 691-7770
i~ ~'~ (717) 691-7772
Counsel for Personal Representative
REV- 1500 EX + (6-00}
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AN D MIDDLE INITIAL)
Conrad Jr. Wayne R.
DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-DO-YEAR)
12/12/2003 09/02/1948
(IF APPL[CABLE) SURVIVING SPOUSE'S NAME (LAST, F RST, AND M DOLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
21-04-0012
COUNTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
164-42-6321
THIS RETURN MUST BE RLED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ ~ 4~ ~ (date of death
1. Original Return 2. Supplemental Return 3. Remainder Return pdo to 12-13-8Z
4, LrmltedEstste . Futurel~erestCompromtse(dateofdeathafter12-1Z-S2) 6. FederalEstateTaxReturnRequlred
6, Decedent Died Testate Decedent Marntalned a LIvl.g Trust 0 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
--~ 9. Lrtigat,onProceedsReceived r~10. SpousaIPovertyCredlt [~ 11.Eiectlontot~xunderSec. 9113(A)
(date of death between 1Z-31-91 and 1-1-95) (Attach $ch O)
NAME ~OMPLETE MAiLING ADDRESS
~arlin R. McCaleb Esq. 219 East Main Street
FIRMNAME{IfAppI~cable) P.O. Box 230
Law Offices-Marlin R. McCaleb Mechanicsburg, PA 17055
None
None
None
None
186,021.80
None
30,837.22
17,123.02
(8) 186,021.80
(11) 47~960.24
(12) 138,061.56
(13l
TELEPHONE NUMBER
717/691- 7700
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4}
6. Cash, Bank Deposits & Miscellaneous Personal Property (6)
(Schedule E)
6. Jointly Owned Property (Schedule F) {6)
] Separate Billing Requested
7. 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
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
an election to tax has not been
(14) 138,061.56
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
16. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2) X .0 0 (15) 0.00
16. Amount of Line 14 taxable at lineal rate 138,061.56 X .0 45 (16) 6,212.77
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 (18). 0.00
19. Tax Due (19) 6,212.77
Copyright (c) Z000 form software only T he Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
175 Woods Drive
CITY
Mechanicsbur~
STATE
ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C ) (2)
3. Interest/Penalty it applicable
D. Interest 60.83
E. Penalty
Total InterestJPenatty ( D + E ) (3)
4. 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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING GIUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. 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; ...........
c. 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 GUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
6,212.77
0.00
60.83
0.00
6,273.60
0.00
6,273.60
Und~ ~naltles of Nd u~, I declare that [ have ~amlned t his return, Including a~ompa~lng schedules a~ s~tements, and to the best of my knowledge a~ ~llef, It Is true,
n of pre~rer other than the pemonal repr~en~tlve Is based on ali Information of which pre~r h~ aT knowledge.
Samantha L. Stotler D~E
PA 17013 ' ~
Law Offices-Marlin R. McCaleb DATE
219 East Main Street
PA 17055
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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for discJosure of assets
and filing a tax return are still applicable even if the surviving spouse is the onJy beneficiary.
For dates of death on or after Jul)' 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 lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S, 9116(aX1)].
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(aX1.3)]. 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.
Copyright (c) 20~0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
REV-1508 EX + (1-97)
COMMONWEALTHOFPENNSYLVANIA
INHERITANCETAXRETURN
RE$1DENTDECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Wayne R. Conrad Jr. SS~/ 164-42-6321 12/12/2003 21-04-0012
Include the.proceeds of litigation and the date the proceeds were received by the estate. All I~reperty Jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OFDEATH
5,727.30
4
Commerce Bank, - Checking Acct. #0536308760, principal balance as
of D.O.D.: $5,726.91; interest accrued to D.O.D.: $0.39.
1985 Chevrolet truck, - (in damaged condition from tree limb
falling on it).
Distributive share of Estate of Wayne R. Conrad, Sr., -
(Decedent's Father, who died 11/18/2003 (Cumberland County File
No. 21-04-0118) and Father's Living Trust dated January 11,2000)
estimated amount.
Personal property, - tools, equipment and vehicles sold at publi
aution on 04/10/2004 (value based on proceeds of sale).
275.00
175,000.00
5,019.50
TOTAL (Also enter on line 5, Recapitulation) 186,021.80
(If more space is needed, insert additional sheets of the same size)
Copyrlg ht (c) 1996 form sof~ware only CPSystems, [nc. Form REV- 1 $08 EX (Rev. 1-97)
rCommerce
Bank.
February 24, 2004
Marlin R McCaleb
Frankeberger Place
219 E Main St
P O Box 230
Mechanicsburg, PA
17055
RE:
Estate of: Wayne R Conrad
Social Security #: 164-42-6321
Date of Death: December 12, 2003
Dear Sir/Madam:
In reference to the letter regarding the above mentioned
Estate, we would like to inform you of the information that
we have researched and found.
Type: Checking
Account #: 536308760
Date Opened: 6/23/03
Primary Owner: Wayne R Conrad Jr
Date of Death Balance: $5,727.30
Accrued Interest: $.39
If there are any questions or additional information that
is needed, please feel free to contact me at (717) 795-7118
ext. 3151.
Sincerely,
Wanda J. Morris
CIF Team Leader
CommemeBank/Haffisburg, N.A.
RO. Box 8599
100 Senate Avenue
Camp Hill, Pennsylvania 17001-8599
Date: 04-20-2004
Elmer Hurry Auctions, inc.
23 North Water Street
Lititz, PA 17543
717 626-2636 Fax 717 627-6757
Settlement Wayne R Conrad Jr. Estate Page: 2
Seller: 2
Item Description Price ~ty Total
AIRHOSES ~
~ I 17.00
WIREBASKETS/NUTS/BOLTS I 10.00
- AIRNOSSEL I 4.00
- WATERHOSE 1 3.00
- 4ROLLSELECTRICCOIL 1 17.~0
- REDDYHEATER 1 30.00
- REDDYHEATER 1 38.00
- REISTAT 1 2.00
- LAMP I 1.00
- GENEATOR I 15.00
- SHOVEL I 1.00
- CHOPSAW I 5.00
- TOOLBOX I 4.00
- PALLETJACK 1 b5.00
- SHORTBLUCK/VALVECOVERS i 10.00
- STAND I 32.50
- SHORTBLOCK I 10.00~
- HOOK 1 1.00
ENGINESTAND ! 36.00
TRANEYS I 1.00
VALVEHEADS 1 2.00
MANIFOLDS I 1.00
TIRES I 4.00
PICKUP TRAILER ! 5.00
CAR 1 10.00.
TRAILER/TIRES 1 200.00
- TRAILER i 140.00
- 1963CHEVY TRUCK 1 370.00
- 1976STAKETRUCK I 400.00
Items: 71 Amount:
Commission at 10.000X 501.9~
Advertising (15.5% of 904.50) 140.20
5,019.50
Less adjustments:
Net due to seller:
-~42.15
4,377.35
THANK YOU FOR EMPLOYING ~LMER MURRY AUCTIONS FOR YOUR AUCTION NE~DS !
Date: 04-20-2004
Elmer Murry Auctions, Inc.
23 North Water Street
hitita, PA 17543
717 626-2636 Fmx 717 627-6757
Settlement Wayne R Conrad Jr. Estate Page:
Seller: 2
Farm
Item Description Price Qty Total
SNOWPLOW-19BSTRUCK 1 600.00
BAKERFORKLIFT 1 150.00
2SCRAPPILES i 100.00
MOWER 1 2.00
- TRAILER I 7.50
- RACK i 25.00
- RACK 1 24.00
- UNREPAIREDSKIDS I 5.00
- REPAIREDSLATS 1 15.00
- SKIDWRUNNER$ 1 27. b0
- NOTCHRUNNERS 1 2.00
- REPAIREDSKIDS PERSTACK 5.00 4 20.00
- REPAIREDSKIDS 1 2.00
- REPAIREDSKIDFS/ALL I 10.00
- DISASSEMBLER 1 1,900.00
- DIS/BLADE 1 20.00
- TABLE ! 45.00
- 4CHAIRS 1 7.50
- W~EELS/CAST 1 6.00
- PLASTIC WRAP/BOWLINSBALL I 3.00
- FRAMES 1 2.00
CARRAMP/WATERSEAL 1 1.00
iWIREBASKETLOT i 1.00
.~WINDSHIELD-TAILLIGRTS 1 3.00
HUBCAPS i 4.00
MUFFLER 1 2.00
WIREBASKET. LOT i 1.00
STSARTERS i 5.00
WRENCH/OIL 1 12.00
- 2TRAILERRECEIVERS 1 25.00
- S~OCKS/TRAILERBALLS 1 1.00
- TOOLNAILER 1 45.00
- TOOLNAILER 50.00 2 100.00
- SKILLSAW I 16.00
- SKILLSAW 22.00 2 44.00
- GAGES 1 17.50
- WIERBASKETSLOTNAILS 1 9.00
- EN~LOWCOMPRESSER 1 225.00
- WIREBASKETLOT-STRAP$ I 45.00
- EXTENSION CORDS 1 22.00
- 2CYTTERS i 10.00
BASKETLOT/CLAMPS 1 32.50
EV-1511 EX ,(1-97) SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEOENT
ESTATE OF
Wayne R. Conrad Jr. SS~/ 164-42-6321 12/12/2003
FILE NUMBER
21- 04 - 0012
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
7.
1
2
3
5
6
FUNERAL EXPENSES:
Gtngrich Memorials, - gravemarker.
Myers Funeral Home, - funeral service.
Trindle Springs Cemetery Association, - cemetery lot.
ADMINISTRATIVE COSTS;
Personal Representative's Commissions
Name of Personal Representative(s) Samantha L. Stotler
Social Security Number(s) / LIN Number of Personal Representative(s)
Street Address 130 Center Street
City Carlisle State PA
197-60-9457
zip 17013
Year(s) Commission Paid:
Attorney's Fees Law Offices-Marlin R. McCaleb
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Pmbate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal, - advertising Letters.
Register of Wills, - Short Certificates.
Register of Wills, - Short Certificate.
Register of Wills, - short certificates.
Register of Wills, - filing Inventory and Appraisement.
Register of Wills, - reserve for filing Account, Releases, etc.
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
1,776.00
9,925.62
300.00
8,440.00
9,000.00
264.00
75.00
6.00
3.00
15.00
25.00
250.00
757.60
30,837.22
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form R NV-1511 EX {Rev. 1-97)
Estate of: Wayne R. Conrad Jr.
Soc Sec #: 164-42-6321
Date of Death: 12/12/2003
Continuation of Schedule H-B7
(Other Achninistrattve Costs)
Item Description
Amount
?
8
Richard P. Murry, Auctioneer, - commission and expenses for
public auction.
The Patriot-News, - advertising Letters.
642.15
115.45
757.60
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES[DENT DECEDENT
ESTATE OF
Wayne R. Conrad ,)'r.
SCHEDULE I i
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SS# 164-42-6321 12/12/2003
FILE NUMBER
21-04-0012
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Andrews & Patel Associates, ~ account payable, medical.
Case Credit Co., - account payable (purchase of mower).
Dr. Robert J. Kantor, - account payable, medical.
Holy Spirit Hospital, - account payable, medical.
Moffttt Heart & Vascular Group, - account payable, medical.
Orthopedic Institute of PA, - account payable, medical.
PA Department of Revenue, - account payable, 2003 state income
tax return.
Palmer's Auto Service, - account payable.
Pathology Associates of Central PA, - account payable, medical.
Plastic Surgery Center, Ltd., - account payable, medical.
U. S. Treasury, - account payable, 2003 federal income tax.
W W Pallet,
W W Pallet,
W W Pallet,
West Shore Tax Bureau,
- account payable (Inv. #1290).
account payable (Inv. #2338).
- account payable (Inv. #1299)
- account payable, 2003 local income tax.
TOTAL (Also enter on line 10, Recapitulation) i
122.00
31.77
62.51
1,033.00
1,339.00
684.00
891.00
118.01
487.00
271.00
7,122.56
1,500.00
1,500.00
1,500.00
461.17
17,123.02
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, [nc. Form REV-lSlZ EX (Rev. 1-97)
REV- 1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES[DENT DECEDENT
ESTATE OF
Wayne
NUMBER
1
2
3
4
5
II.
SCHEDULE J
BENEFICIARIES
R. Conrad Jr. SS~/ 164-42-6321 12/12/2003
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DiSTRIBUTiONS [l~ludeoutrlghts~u~ldlstrlb~lo~,and
transfem under S~. 91 l~aXl.~
Samantha L. Stotler
130 Center Street
Carlisle, PA 17013
Brandon W. Conrad
612 Hilda Court
Mechanicsburg, PA 17055
Bryan W. Conrad
22-1/2 McBride Ave.
Carlisle, PA 17013
Jennifer N. Wells
19 E. Harrisburg Street
Dillsburg, PA 17019
Kellijo K. Weft
211-A Chestnut Street
Mt. Holly Springs, PA 17065
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Son
Son
Daughter
Daughter
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
FILE NUMBER
21-04-0012
AMOUNT OR SHARE
OF ESTATE
One-Fifth (1/5)
One-Fifth (1/5)
One-Fifth (1/5)
One-Fifth (1/5)
One-Fifth (1/5)
1500 COVER SHEET
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LiNE 13 OF REV 1500 COVER SHEET 0.00
{If more space is needed, insert additional sheets of the same size)
Copyrlg ht (c) ZOO0 form software oIMy The Lackner Group, Irtc. Form REV-1 $13 EX (Rev. 9-00)
Register of Wills of
CUMBERLAND
INVENTORY
County, Pennsylvania
Estateof Wayne R. Conrad, Jr.
also known as Wa.yne R. Conrad
No. 21-04-0012
Date of Death 12/12/2003
, Deceased Social Security No. 164-42-6321
Samantha L. Stotler,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Narr~ of
Attorney:
LO. No.:
Marlin R. McCaleb Esq.
06353
Address: 219 East Main Street
Mechanicsburs, PA 17055
Telephone: 717/691- 7700
Personal Representable -- /
Samantha L. Stotler
Signature:
Address: 130 Center Street
Carlisle, PA 17013
Telephone: 717/245- 0511
Dated: /2
Description
(See continuation page(s) attached)
(Attach additionar sheets if necessary)
Value
Total: 186,021,80
NOTE: The Memorandum of real estate outside the Coi,,i,~.wealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Estate of:
Date of Death:
County:
INVENTORY
Wayne R. Conrad, Jr.
12/12/2003
CASH:
Commerce Bank, - Checking
Acct. #0536308760, principal
balance as of D.O.D.:
$5,726.91; interest accrued
to D.O.D.: $0.39.
PERSONAL PROPERTY:
1985 Chevrolet truck, - (in
damaged condition from tree
limb falling on it).
Distributive share of Estate
of Wayne R. Conrad, Sr., -
(Decedent's Father, who died
11/18/2003 (Cumberland
County File No. 21-04-0118)
and Father's Living Trust
dated January 11,2000),
estimated amount.
Personal property, - tools,
equipment and vehicles sold
at public autlon on
04/10/2004 (value based on
proceeds of sale).
5,727.30
275.00
175,000.00
5,019.50
5,727.30
180,294.50
TOTAL RECEIPTS OF PRINCIPAL ...............
186,021.80
-1-
INFORMATION STATEMENT
Decedent was not married but was survived by five {5)
next-of-kin and heirs at law
Brandon W Conrad
612 Hilda Court
Mechanlcsburg, PA
17055
Samantha L Stotler
130 Center Street
Carlisle, PA 17013
Son
Daughter
Bryan Wayne Conrad
ED 3815-0
P O Box 200
Camp Hill, PA
17011
Jennifer N Wells
19 East Harrisburg Street
Dillsburg, PA 17019
Kelll~o K. Wert
211-A Chestnut Street
Mt. Holly Springs, PA 17065
Son
Daughter
Daughter
children as
Brandon W. Conrad (D O B.: 1/8/91) and Jennmfer N. Wells
(D O.B.- 5/25/87) have not yet attained the age of eighteen (18)
years and are therefore not eligible for Letters of
Adminmstratlon Bryan Wayne Conrad and Kelli]o K Wert have
renounced in favor of Petitioner.
COMMONWEALTH OF pENNSYLVANiA
DEPARTMENT OF REVENUE
BUREAU OF ~NDIV~DUAL TAXES
O~PT 280601
HARRISBURG, PA ~ 7128 O601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1102 EX(11 96)
NO. CD 004721
MCCALEB MARLIN R
219 E MAIN STREET
MECHANICSBURG, PA
17055
...... fold
ESTATE INFORMATION: SSN: 164-42-6321
:ILE NUMBER: 2104-001 2
)ECEDENT NAME: CONRAD WAYNE R JR ~-
DATE OF PAYMENT: 12/10/2004
~OSTMARK DATE: 12/10/2004
:OUNTY: CUMBERLAND
DATE OF DEATH: 12/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,273.60
TOTAL AMOUNT PAID:
~6,273.60
REMARKS: GFS
SEAL
CHECK# 1819
INITIALS: GFS
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDU~~()'~~E_~:U
INHERITAHCE TAX DIVISIOtl-,--
PO BOX Z80601
HARRISBURG PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REY-1547 EX AFP 112-041
~i'")
C3
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-21-2005
CONRAD JR
12-12-2003
21 04-0012
CUMBERLAND
101
WAYNE
R
MARLIN gi ~CCAtEBESQ;
M R MCCALEB LAW OFCS
PO BOX 230
MECHANICSBURG PA 17055
Allount Re..itted
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 ~
lEV :rA'li""Ex..AFp.CI~r:6!')..NoiTcE.oF.i'N'IiER.ifANct.TAi.API1IA.fSEi...rN'~.ALtOWAN'CE-olC----.------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CONRAD JR WAYNE R FILE NO. 21 04-0012 ACN 101 DATE 02-21-2005
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
186.021.80
.00
.00
(8)
NOTE: To insure proper
credit to your account~
subllit the upper portion
of this forll with your
tax payment.
186~021.80
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. 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
14. Net Value of Estate Subject to Tax
(9)
(10)
30~837.22
17.123.02
(II)
(12)
(13)
(14)
47.960 24
138.061. 56
.00
138,061.56
(Schedule J)
I~ an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. AlIOunt of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
D TS.
NOTE:
.00
138~061.56
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
(19)=
.00
6,212.77
.00
.00
6~212.77
DATE
12-10-2004
NUMBER
CD004721
+
INTEREST/PEN PAID (-)
60.82-
AMOUNT PAID
6~273.60
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
6~212.78
.01CR
.00
.01CR
. IF PAID AFTER DATE INDICATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $l~ 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.)
\\B~D
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV- 1500 EX + (6-00)
CAPB
HpRL
EplO
CRAC
KOTK
ES
FILE NUMBER
OFFICIAL USE ONLY
21-04-0012
o
E
C
E
o
E
N
T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA '7128~0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Conrad Jr. Wa ne R.
DATE OF DEATH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
164-42-6321
THIS RETURN MUST BE RLED IN DUPL!CATEWlTH THE
NUMBER
DATE OF BIRTH (MM~DD-YEAR)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
Marlin R. McCaleb Es .
FIRM NAME (If Applicable)
Law Offices-Marlin R. McCaleb
TELEPHONE NUMBER
R
E
C
A
P
I
T
U
L
A
T
I
o
N
69 - 00
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. 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/See 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)
12/12/2003 09/02/1948
IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, FIRST, AND MIDDLE INITIAL
1. OrfglnaJReturn
4. LimIted Estate
6. Decedent Died Testate
X 2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach copy of Trust)
o
3 date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
C P
o 0
R N
R 0
E E
S N
T
C
o
M
P
T U
A T
X A
T
I
o
N
(Attach copy of WIJI)
D 9. Litigation Proceeds Received
010.
o
COMPLETE MAILING ADDRESS
219 East Main Street
P. O. Box 230
Mechanicsburg, PA 17055
Copyright (c) 2000 form software only The Lackner Group, Inc.
(1)
(2)
(3)
None
None
None
(4)
(5)
None
35,150.41
OFFICIALIJ E ONLY
. -:'
-.':'."
r',,'
c)
(8) 35,150.41
(11) 50.00
(12) 35,100.41
(13)
(14) 35,100.41
(15)
(16)
(17)
(18)
(19)
0.00
1,579.52
0.00
0.00
1,579.52
(6)
None
None
50.00
None
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. X
35,100.41
x
X
X
X
o 0
.0 45
.12
.15
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
175 Woods Drive
CITY I STATE I ZIP
Mechanicsbur~ PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1,579.52
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D.lnterest
E. Penalty
40.31
Totallnterest/Penalty ( D + E) (3)
4. 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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax dUe. (SA)
B. Enter the total of Line S + SA. This is the 8ALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
p~~;~~;~~~:~~i;~~E ~igit~i~::i~~;;;~~~~f~6~~;;i~~i;~tl~iii~~::~~;':::!~]!iH;~";~:~'~:'I~~:~;~~!~i;~~~ ;:~~~!~~";;";;
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred: ~ ~~x
b. retain the right to designate who shall use the property transferred or its income; .
c. 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.
40.31
0.00
1,619.83
0.00
1,619.83
D
D
D
~
~
~
Under penalties of perjury, I declare that 1 have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It Is true,
correct nd complete. DeclaratIon of preparer other than the personal representative Is based on aJllnformatlon of which preparer has any knowledge.
SIG REOFPERSONRESPONSIBLEFORrU GJEjRN Samantha L. Stotler DA~f
~ L U. tur---2i~r~~i~:"r&1O"j}6i3--------------------------- '1- Jq-()S
SIGNA7:;' PREPARE);HERTHAN RE~.;S~TATIVE _ _ _~~;_ ~::~_~;;_~_~~~~.~;~;_'_ _ ~~_~~~e_~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ DATE
CL~ :r~ Mechanicsbur PA 17055
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.$. 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
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 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 lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2)
[72 PS 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 individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
REV-1S08 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Wayne R. Conrad Jr. SS# 164-42-6321 12/12/2003 21-04-0012
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
1
DESCRIPTION
Distributive share of Estate of Wayne R. Conrad, Sr., -
(estimated on original Inheritance Tax Return filed 12/10/04 in
the amount of $175,000.00; initial principal distribution on
09/27/2004: $18,239.95; final principal distribution on
04/21/2005: $191,910.46; total actual distributive share:
$210,150.41).
VALUE AT DATE
OF DEATH
35,150.41
TOTAL (Also enter on line 5, Recapitulation) $ 35,150.41
(If more space is needed, Insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
REV-1511 EX +(1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETI'X RETURN
RESiDENT DECEDENT
ESTATE OF
Wayne R. Conrad Jr.
SStl 164-42-6321
12/12/2003
FILE NUMBER
21-04-0012
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES,
B. ADMINISTRATIVE COSTS,
1- Personal Representative's Commissions
Name of Personal Representative(s}
Social Security Number(s) / EIN Number of Personal Representative(s}
Street Address
City State Zip
-
Year(s} Commission Paid:
2. Attorney's Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
-
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Register of Wills, - filing Supplemental Inheritance Tax Return. 15.00
2 Register of Wills, - additional probate fee. 35.00
TOTAL (Also enter on line 9, Recapitulation) $ 50.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1511 EX (Rev. 1-97)
REV-1S13 EX +(9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETIiX RETURN
RESIDENT DECEDENT
ESTATE OF
Wavne R. Conrad Jr.
SSII 164-42-6321
12/12/2003
NUMBER NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS {Include outright spousal distributIons, and
transfers under Sec. 9116(a)(1.2)]
1 Samantha L. Stotler
130 Center Street
Carlisle, PA 17013
2 Brandon W. Conrad
612 Hilda Court
Mechanicsburg, PA 17055
3 Bryan W. Conrad
22-1/2 McBride Ave.
Carlisle, PA 17013
4 Jennifer N. Wells
19 E. Harrisburg Street
Di11sburg, PA 17019
5 Ke11ijo K. Wert
211-A Chestnut Street
Mt. Holly Springs, PA 17065
FILE NUMBER
21-04-0012
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Daughter One-Fifth (1/5)
Son One-Fifth (1/5)
Son One-Fifth (1/5)
Daughter One-Fifth (1/5)
Daughter One-Fifth (1/5)
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN..15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 SHEET $
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
0.00
Form REV-1513 EX (Rev. 9-00)
COMMONWEALTH OF PE:NNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT, 280601
HARRISBURG, PA 17 1 2B-060,
REV"1162 EX(11-96j
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MCCALEB MARLIN R
219 E MAIN STREET
MECHANICSBURG, PA 17055
----,--- fold
ESTATE INFORMATION: SSN: 164-42-6321
FILE NUMBER: 2104-0012
DECEDENT NAME: CONRAD WAYNE R JR
DATE OF PAYMENT: 05/02/2005
POSTMARK DATE: 05/02/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/12/2003
NO. CD 005278
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,619.83
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$1,619.83
REMARKS:
CHECK# 1861
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
08-01-2005
CONRAD JR
12-12-2003
21 04-0012
CUMBERLAND
501
APPEAL DATE: 09-30-2005
( See reverse side under Objections)
AmDunt Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS -
REY:is4;-EX-AFP-ioi:osi-NOTicE-OF-iNHERiTANCE-TAX-APPRAiSEMENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
WAYNE R FILE NO. 21 04-0012 ACN 501
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BDX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DC0,~.~jI'~r,~~Ijl;"ITANCE TAX
APJ!RATlsHIIt ""AUJl\I4!l:E OR DISALLOWANCE
qF:~JIiI~''I!IID(:ASSESSI1ENT OF TAX
"".';'.>'.." ".,. ";',.n'.;
n05 AUG - I
P!iI2: ~~~:TE OF
DATE OF DEATH
FILE NUMBER
COUNTY
.. ,"'ACN
MARLIN R MCCALEB ESQ
219 EAST MAIN STREET
PO BOX 230
MECHANICSBURG
CLERI\
OC-" ". I""
....c,...'.
I,ll'" j',
(:1 ,.
....J'.,1
PA 17 055
ESTATE OF
CONRAD JR
'*
REV-1547 EX AFP (06-05)
WAYNE
R
TAX RETURN WAS: I X I ACCEPTED AS FILED
I CHAIIIlED
DATE 08-01-2005
I~ an asses..ent was issued previDusly. lines 14. 15 and/Dr 16. 17. 18 and 19 will
re~lect ~igures that include the total ~ abb returns assessed tD date.
ASSESSMENT OF TAX:
15. Anount of line 14 at Spousal rat. (IS)
16. A~t of Line 14 taxable at Lineal/Class A rate (16)
17. ~ount of Line 14 at Sibling rat. (17)
18. ~unt of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
X C
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. R..l Est.t. ISc~dul. Al III
2. Stocks ...d Bonds ISch.dul. BI 121
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. "ortgages/Notes Receivable (Schedule D) (4)
S. Cesh/Bank Deposits/"isc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Tot.l Assets
.00
.00
.00
.00
35.150.41
.00
.00
181
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/"isc. Expenses (Schedule H) (9)
10. DebtslHortgage Liebillties/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
13. Charitab1e/60ve~enta1 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
50.00
.00
1111
1121
1131
1141
NOTE:
.00 X
35,100.41 X
.00 X
.00 X
+
INTEREST/PEN PAID I-I
40.30-
AIIllUNT PAID
1.619.83
DATE
05-02-2005
_BER
CD005278
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insu.... proper
credl t to your account I
sub.it the upper portion
of this fora with your
tax pay.ent.
35,150.41
liD nn
35,100.41
.00
35,100.41
00 =
045 =
12 =
15 =
.00
1.579.52
.00
.00
1,579.52
1191=
1,579.53
.01CR
.00
.01CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
IN RE:
ESTATE OF WAYNE R.
CONRAD, JR., DECEASED,
LATE OF THE TOWNSHIP
OF SILVER SPRING,
CUMBERLAND COUNTY,
PENNSYLVANIA
:IN THE COURT OF COMMON PLEAS OF
:CUMBERLAND COUNTY, PENNSYLVANIA
:ORPHANS COURT DIVISION
:ESTATE NO. 21-04-00012
PETITION TO AUTHORIZE DISTRIBUTION OF
MINOR'S ASSETS INTO A RESTRICTED ACCOUNT
TO THE HONORABLE, THE JUDGES OF SAID COURT:
The Petition of Samantha L. Stotler, Administratrix of the
Estate of Wayne R. Conrad, Jr., Deceased, by and through her
attorney, Marlin R. McCaleb, Esquire, respectfully represents
as follows:
1. The Decedent herein was Wayne R. Conrad, Jr., who died
on December 12, 2003, unmarried, intestate, a resident of the
Township of Silver Spring, Cumberland County, Pennsylvania.
2. The Decedent was survived by his children, namely:
Samantha L. Stotler, Bryan Wayne Conrad, Jennifer N. Wells,
and heirs-at-law.
Kellijo K. Wert and Brandon R. Conrad, as his onlynext-of~kin
( 1 '\
- ..-") J
,,-,
- ,
. ,
i---J
3. Letters of Administration were issued by the Reg~h~er
of Wills of Cumberland County, Pennsylvania, on Januaryi 5,:.. .
, ..
. ..
2004, to Samantha L. Stotler, the Petitioner herein, which.....
.'
c.,
Letters remain in full force and effect.
4. All of the Decedent's children identified in Paragraph
2, above, are adult individuals except for Brandon R. Conrad,
born January 8, 1991, who is presently 14 years 7 months of
LA\V OfFICFS
MARLIN R. McCALEB
age.
cjR
5. The said Brandon R. Conrad, minor child presently
lives and resides with his mother, Donna Miller, at 612 Hilda
Court (Upper Allen Township) Mechanicsburg, Cumberland County,
Pennsylvania 17055.
6. The Decedent and the said Donna Miller were previously
husband and wife, having been married on July 28, 1989, and
divorced by Decree of your Honorable Court dated September 16,
1998, and entered in the Office of the Prothonotary of
Cumberland County, Pennsylvania, to No. 98-866 Civil Term.
7. Petitioner has stated an informal Account of her
administration of the Decedent's Estate to all persons
interested in the Estate, reporting gross assets in the amount
of $228,186.68, and debts, funeral expenses, liabilities,
administration expenses and taxes in the amount of $57,273.65,
resulting in a net balance for distribution to the Decedent's
heirs-at-Iaw in the amount of $171,943.93.
8. The distributive share of the Decedent's Estate for
the said Brandon R. Conrad, minor child, is $34,388.78.
9. Petitioner proposes to conclude her administration of
the Decedent's Estate by way of a Family Settlement Agreement,
Receipt and Release to be executed by or on behalf of all
distributees.
10. Petitioner believes and therefore avers that no
guardian has heretofore been appointed by any Court for the
Estate of the said Brandon R. Conrad, minor child.
LAW OFFICES
MARLIN R. McCALEB
-2-
11. Petitioner believes and therefore avers that the Slze
of the said minor child's distributive share does not merit the
expense of the appointment of a guardian and entry of security
and Petitioner further believes and therefore avers that it is
in the best interests of said minor child to deposit his
distributive share into a restricted account for his benefit,
until his 18th birthday.
12. Brandon R. Conrad, minor child, and Donna Miller, his
mother and natural guardian, have consented to this Petition
and the relief herein requested, which Consents are attached
hereto and made a part hereof by reference thereto.
WHEREFORE, Petitioner respectfully requests that pursuant
to Section 5103 of the Probate, Estates and Fiduciaries Code
(20 Pa.C.S. 5103), your Honorable Court authorize deposit of
the distributive share of Brandon R. Conrad, minor child, In
the amount of $34,388.78 from the Estate of Wayne R. Conrad,
Deceased, without appointment of a guardian or entry of
security, into an interest-bearing, restricted account at PNC
Bank, N.A., in the name of said minor child, said account to be
marked "Not to be withdrawn before January 8, 2009, except for
the payment of state and federal income taxes on the interest
earned by the account, or upon further Order of Court"; and
that Donna Miller, mother and natural guardian of the said
Brandon R. Conrad, minor child, be authorized and directed to
execute the Family Settlement Agreement, Receipt and Release on
LAVV OFI-'ICES
MARLIN R_ McCALEB
-3-
his behalf.
Date: September
LAVV OFFICES
MARLIN R. McCALEB
.6
, 2005
-4-
Marlin R. McCaleb
Attorney I.D. No. 06353
219 East Main Street
P.O. Box 230
Mechanicsburg, Pennsylvania 17055
(717) 691-7770
FAX: (717) 691-7772
Attorney for Petitioner
~
IN RE:
ESTATE OF WAYNE R.
CONRAD, JR., DECEASED,
LATE OF THE TOWNSHIP
OF SILVER SPRING,
CUMBERLAND COUNTY,
PENNSYLVANIA
:IN THE COURT OF COMMON PLEAS OF
:CUMBERLAND COUNTY, PENNSYLVANIA
:ORPHANS COURT DIVISION
:ESTATE NO. 21-04-00012
CONSENTS
We accept notice of the foregoing Petition to Authorize
Distribution of Minor's Assets into a Restricted Account and we
hereby consent to said Petition and the relief therein
requested.
Date: September G:, , 2005
.t~()I1 R. C~4(
Brandon R. Conrad
Minor Child
~ fi&-WJ-
. Donna Miller
Mother and Natural Guardian of
Brandon R. Conrad,
Minor Child
LA\V OFFICES
MARLIN R. McCALEB
VERIFICATION
SAMANTHA L. STOTLER hereby certifies and states as
follows:
that I am the Administratrix of the Estate of Wayne
R. Conrad, Jr., and Petitioner of foregoing petition to
Authorize Distribution of Minor's Assets into a Restricted
Account; that the facts set forth in the foregoing Petition are
true and correct to the best of my knowledge, information and
belief; and I understand that all statements herein are made
subject to the penalties of 18 Pa.C.S. Section 4904 relating to
unsworn falsification to authorities.
Date:
August 5-
, 2005
~LJIrf&
Samantha L. Stotler
LA\V OFFICES
MARLIN R. McCALEB
I
LAW OFFICES
MARLIN R. McCALEB
.nECEIVU ~j u 7 200
'Y
IN RE:
ESTATE OF WAYNE R.
CONRAD, JR., DECEASED,
LATE OF THE TOWNSHIP
OF SILVER SPRING,
CUMBERLAND COUNTY,
PENNSYLVANIA
:IN THE COURT OF COMMON PLEAS OF
:CUMBERLAND COUNTY, PENNSYLVANIA
:ORPHANS COURT DIVISION
:ESTATE NO. 21-04-00012
DECREE AUTHORIZING DISTRIBUTION OF
MINOR'S ASSETS INTO A RESTRICTED ACCOUNT
AND NOW, this
1 ~L day of
';e f'r
2005, upon petition of Samantha L. Stotler, Administratrix of
the Estate of Wayne R. Conrad, Jr., Deceased, and upon motion
of Marlin R. McCaleb, Esquire, attorney for said Estate, it is
ORDERED, ADJUDGED and DECREED that Petitioner be, and she
/
hereby is, authorized and directed to deposit the distributive
share of said Estate for Brandon R. Conrad, minor child, in the
amount of $34,388.78, into an interest-bearing, restricted
account at PNC Bank, N.A., in the name of said Brandon R.
Conrad, without appointment of a guardian or entry of security,
said account to be marked "Not to be withdrawn before January
8, 2009, except for the payment of state and federal income
taxes on the interest earned by the account or upon further
order of the Court."
PNC Bank, N.A., may pay over the balance of said account
to Brandon R. Conrad on or after January 8, 2009, when he
attains majority, upon the order of Brandon R. Conrad, without
further order of this Court.
Donna Miller, mother and natural guardian of Brandon R.
Conrad, minor child, is hereby authorized and directed to
LAW OFFICES
MARLIN R. McCALEB
on his behalf.
execute the Family Settlement Agreement, Receipt and Release,
glg/D5-
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BY
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Glenda Farner Slrasbaugh
Register of WillS
and
Clerk of Orphans' Court
Marjorie A Wevodau First
Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
MARllN R MOCALEB LAW FIRM
219 EAST MAIN ST
PO BOX 230
MErnANICiBURG, PA 17055
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
532
9/8/2005
WAYNE R ffiNRAD TR
21-2004-0012
"
Qty
1
Fee Description
CERTIFIED ffiPY
Fee Total
5.00 $5.00
Total:
$5.00
d1ecks should be made payable to the Register of Wills. Tenns: Net 30.
Please return one copy of this invoice with your payment. Thank you.
FAMILY SETTLEMENT AGREEMENT,
RECEIPT AND RELEASE
WHEREAS, WAYNE R. CONRAD, JR., also known as WAYNE R.
CONRAD, late of Silver Spring Township, Cumberland County,
Pennsylvania, died intestate on December 12, 2003, and Letters
of Administration issued by the Register of Wills of Cumberland
County, Pennsylvania to SAMANTHA L. STOTLER; and
WHEREAS, SAMANTHA L. STOTLER, BRANDON R. CONRAD, BRYAN
WAYNE CONRAD, JENNIFER N. WELLS and KELLIJO K. WERT, are heirs
and next of kin of the said decedent and the only persons
interested in his Estate;
NOW KNOW ALL MEN BY THESE PRESENTS, that we, SAMANTHA L.
STOTLER, DONNA MILLER, mother and natural guardian of BRANDON
R. CONRAD, BRYAN WAYNE CONRAD, JENNIFER N. WELLS and KELLIJO K.
WERT, being the beneficiaries sharing in the distribution of
the Estate of said decedent, do hereby declare and say tha.t~ we
"
have examined the Account and Statement of Proposed ~
, i:=?
Distribution of SAMANTHA L. STOTLER, Administratrix as~;
( .,,)
f;<f~
>~.
I',)
I,., ; t~':
, '::.
. ~:.
aforesaid, for the period ending July 28, 2005, and fitip t~e
same to be accurate and according to law, and we, SAMANTHA-:7L. ~,
. I,
{ /1
C">
STOTLER, DONNA MILLER, mother and natural guardian of BRANDON
R. CONRAD, BRYAN WAYNE CONRAD, JENNIFER N. WELLS and KELLIJO K.
WERT, beneficiaries as aforesaid, do hereby acknowledge that we
this day have, had and received of and from SAMANTHA L.
STOTLER, Administratrix of the Estate of WAYNE R. CONRAD, JR.,
LA\N OFFICES
MARLIN R, McCALEB
also known as WAYNE R. CONRAD, the cash or property set
&
opposite our names in the above stated Statement of Proposed
Distribution, in full satisfaction, payment and discharge of
all claims we, or any of us, have or may have against each
other or against the Estate of WAYNE R. CONRAD, JR., also known
as WAYNE R. CONRAD, and all interest accrued thereon.
NOW, THEREFORE, we, the same SAMANTHA L. STOTLER, DONNA
MILLER, mother and natural guardian of BRANDON R. CONRAD, BRYAN
WAYNE CONRAD, JENNIFER N. WELLS and KELLIJO K. WERT,
beneficiaries as aforesaid, do by these presents, remise,
release, quit-claim and forever discharge each other and the
said SAMANTHA L. STOTLER, Administratrix, her heirs, executors
and administrators, of and from our distributive shares of the
Estate as set forth in the Statement of Proposed Distribution
aforesaid, and of and from all actions, suits, payments,
accounts, reckonings, claims and demands whatsoever, for or by
reason thereof, or by contract, or under the intestate law of
the Commonwealth of Pennsylvania, or by reason of any other
act, matter, cause or thing whatsoever, from the beginning of
the world to the day and date of these presents, except for any
obligations arising under this Family Settlement Agreement,
Receipt and Release or under the Statement of Proposed
Distribution.
AND desiring to avoid the delay and expense of the
settlement of said Estate by filing the foregoing Account of
said administration in the Office of the Register of Wills of
LAW OFFICES
MARLIN R. McCALEB
-2-
said County and by having the balance in the hands of the
Administratrix, as shown by said Account, distributed by the
Court of Common Pleas of Cumberland County - Orphans' Court
Division, we do hereby agree that the within Family Settlement
Agreement, Receipt and Release concerning the matter of
settlement may be recorded with the same effect upon us as if
the same had been reported upon by said Court, and a decree of
distribution made on such report by the said Court of Common
Pleas - Orphans' Court Division.
AND in consideration of the aforesaid settlement being
made without the aid of such Court of Common Pleas - Orphans'
Court Division, that we, SAMANTHA L. STOTLER, DONNA MILLER,
mother and natural guardian of BRANDON R. CONRAD, BRYAN WAYNE
CONRAD, JENNIFER N. WELLS and KELLIJO K. WERT, beneficiaries as
aforesaid, do hereby agree that if any debts or demands other
than those included in the aforesaid Account of the said
SAMANTHA L. STOTLER, Administratrix of the Estate of WAYNE R.
CONRAD, JR., also known as WAYNE R. CONRAD, as hereinbefore set
forth, shall be hereafter recovered against the Estate of said
decedent and be legally payable out of the same, that we will
return to the said Administratrix such amount thereof as may be
necessary to pay such debts or demands.
The signature page or pages may be executed by the parties
hereto in several counterparts (one by each signatory hereto) ,
each of which is an original and all of which taken together
L:\V\/ OFfiCES
MARLIN R. McCALEB
-3-
shall be deemed and considered as part of the original document
herein.
IN WITNESS WHEREOF, we have hereunto set our hands and
seals this 5 day of Rll} US+ , 2005, intending
thereby to be legally bound. (1mw~L J~+kEALJ
Samantha L. Stotler
(SEAL)
Donna Miller
Mother and natural Guardian of
Brandon W. Conrad
(SEAL)
Bryan Wayne Conrad
Jennifer N. Wells
(SEAL)
Kellijo K. Wert
(SEAL)
LA\V OFFICES
MARLIN R. McCALEB
-4 -
shall be deemed and considered as part of the original document
herein.
IN WITNESS WHEREOF, we have hereunto set our hands and
seals this ~ day of ~~+J
thereby to be legally bound.
, 2005, intending
(SEAL)
(:Jantha L. Stotler
Don~tl~L- (SEAL)
Mother and natural Guardian of
Brandon R. Conrad
(SEAL)
Bryan Wayne Conrad
(SEAL)
Jennifer N. Wells
(SEAL)
Kellijo K. Wert
LAvV OFFICES
MARLIN R. McCALEB
-4-
shall be deemed and considered as part of the original document
herein.
IN WITNESS WHEREOF, we have hereunto set our hands and
seals this ~ day of t2ttJu.si
thereby to be legally bound.
, 2005, intending
(SEAL)
Samantha L. Stotler
(SEAL)
Donna Miller
Mother and natural Guardian of
Brandon W. Conrad
~~~~ (SEAL)
(SEAL)
Jennifer N. Wells
(SEAL)
Kellijo K. Wert
LAW OFFICES
MARLIN R. McCALEB
-4 -
shall be deemed and considered as part of the original document
herein.
IN WITNESS WHEREOF, we have hereunto set our hands and
seals this ~day of ~, 2005, intending
thereby to be legally bound.
(SEAL)
Samantha L. Stotler
(SEAL)
Donna Miller
Mother and natural Guardian of
Brandon W. Conrad
(SEAL)
Wayne Conrad
(SEAL)
(SEAL)
Kellijo K. Wert
LA\V OFFICES
MARLIN R. McCALEB
-4-
shall be deemed and considered as part of the original document
herein.
IN WITNESS WHEREOF, we have hereunto set our hands and
seals this ~ day of ~, 2005, intending
thereby to be legally bound.
(SEAL)
Samantha L. Stotler
(SEAL)
Donna Miller
Mother and natural Guardian of
Brandon W. Conrad
(SEAL)
Bryan Wayne Conrad
(SEAL)
N. Wells
( EAL)
lA\lV OFFICES
MARLIN R. McCALEB
-4-
STATE OF PENNSYLVANIA)
SS
COUNTY OF CUMBERLAND)
#. 4u'1U~f
On this, the S- day of , 2005,
before me, a Notary Public in and for said State and County,
the undersigned officer, personally appeared SAMANTHA L.
STOTLER, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument and
acknowledged that she executed the same for the purposes
therein contained.
IN WITNESS WHEREOF,
I hereunto set my hand and official
seal.
~~~~
My commission expires:
(SEAL)
Notarial Seal
Mar1in R. McCaleb, Notary Public
Mechanicsburg Bora, Cumber1and County
My Commission Expires Dec. 14,2006
--
Memt:J€[, Pennsylvania Association Of Notaries
LA\V OFFICES
MARLIN R. McCALEB
-5-
STATE
OF
PENNSYLVANIA)
SS
COUNTY
OF
CUMBERL1\ND
On this, the
6th day of
September
, 2005,
before me, a Notary Public in and for said State and County,
the undersigned officer, personally appeared DONNA MILLER,
mother and natural guardian of BRANDON R. CONRAD, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
~~~
Notary Public
My commission expires:
( SEAL)
r',1a-'1I:" ~.~
eal
\!8tary Public
p,land County
,,~ :.1. 2006
Mecn" c,; ;-
My CG; >" n,:, ,
r Notarial Seal
Marlin R. McCaleb. Notary Public
. Mechanj~lQ Bora, Cumberland County
~4v~~.?mmlsslOl1 Expires Dec. 14.2006
'-''''lr,svfvania Association Of Notaries
LAVV OFflCFS
MARLIN R. McCALEB
-6-
STATE
OF
PENNSYLVANIA)
(1mh.~ )
SS
COUNTY OF
On this, the ~Yl
day of ~US.J-
, 2005,
before me, a Notary Public in and for said State and County,
the undersigned officer, personally appeared BRYAN WAYNE
CONRAD, known to me (or satisfactorily proven) to be the person
whose name 1S subscribed to the within instrument and
acknowledged that he executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
...
cJ4J~
My commission expires:
( SEAL)
COMMONWEALTH OF ~eNN8YLVANIA
I NOTARIAL SEAL
i DARCIE A. NEIL Notary Public
r Boro of Carlisle, Cumber1and County
t My Commission ExpIres Nov. 24 2006
. I
LAW OFFICES
MARLIN R. McCALEB
-7-
STATE OF PENNSYLVANIA)
&QU( ; SS
COUNTY OF
On this, the 1:y7:11 day of ~~ , 2005,
before me, a Notary Public in and for said State and County,
the undersigned officer, personally appeared JENNIFER N. WELLS,
known to me (or satisfactorily proven) to be the person whose
name is subscribed to the within instrument and acknowledged
that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
~~ 1l.1J.t-
Notary Public I /
My commission expires: 7 7 1J7
(SEAL)
COMMONWEAi:rH Of PENNSYLVANIA
Nolarial Seal
Theresa A. Ott, NOfaIy Public
Waningtoll Twp., YOIIe County
My COllUmsslOfl Expire. July 7. 2007
Member. Pennsylvllnlll Adlloeletlon of Notaries
LAVV OFrlCES
MARLIN R. McCALEB
-8-
1> .
STATE
OF
PENNSYLVANIA)
Wrv1twtMJ1' ) SS
day of ~u..J
, 2005,
COUNTY OF
On this, the q
before me, a Notary Public in and for said State and County,
the undersigned officer, personally appeared KELLIJO K. WERT,
known to me (or satisfactorily proven) to be the person whose
name is subscribed to the within instrument and acknowledged
that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I her
to set my hand and official
seal.
(
(SEAL)
~OMM Notary Public
Ml QNW~ OF~~N~.s.; .
NOT ;)TLvAN/t\
; DAW "ARIAL SEAL -,
I 8oro N M. SHUGHART. Nc't I
, of C 'I~ ,.... , aty Public
, My Comm Orlllle. \....U~berland COunfy
-- . ~ Nov. 28, 2006
-------..--
lA\V Of-'"FICFS
MARLIN R. McCALEB
-9-
LIt
C:c
C;:-
L._
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Register ofWiIls of Cumberland County
STATIJS REPORT UNDER RULE 6.12
Name of Decedent:
Wayne R. Conrad, Jr.
Date of Death:
December 12, 2003
Estate No.:
21-04-0012
_ 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 .129. 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 Com?
Yes 0 No rn
b. The separate Orphans' Com 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 1Kl No 0
c. Copies of receipts, releases,joinders and approval offormal or informal
accounts may be filed with the Clerk -of the Orphans' Court and may be
attacbedro~repmt 104~
Signature
Date: 10/20/05
0J
Marlin R. McCaleb
"J
L~"..
Name
219 East Main Street
Mechanicsburg, PA 17055
Address
717/691-7770
Telephone No.
\._-",'
c
Capacity: 0 Personal Representative
J!1 Counsel for personal representative
\It