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HomeMy WebLinkAbout02-0025 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of J~l'C./qa ~/ 7f-}//O.~I~ No. also known as To: Deceased. Social Security No. d 7,y '--/~ '- '7 7 / ./4-- 21-02-25 Register of Wills for the County of ~9~b~°,'Z./~ f/.o~ in'.the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who i~are 18 years of age or older, apply for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in ~[J/~,, ~cz?g~/~f/L;.~ County, ,Pennsylvania, wi~h h t' ~ last family or principal residence at C'O~ 8~ '~ _CO~ ~)~[~ /'~ ~"f ~ l ~r i/~ /~1 ~d / ~0 I ~ (m/OOJ~ street, number and municipality) Decendent~ then ~7 ye~s of age, died /~ ~, ~ ~~ ~ ,~ Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ ~--() -- (If not domiciled in Pa.) Personal property in Pennsylvania $ '~0 -- (If not'~l~0~m.i_ciled in Pa.) Personal property in County $ ;---0 -- Value of real estate in Pennsy!vania $ - ~') situated as follows: Petitioner.__ after a proper search ha.5 the following spouse (if any) and heirs: . ,~_4~)~ame , Relationship /7~ ,~c.h ~ i~,///~ ~ ~ ~) t"/'O.L~ h/-~e'~ ascertained that decedent left no will and was survived by Residence f q, 91 At,/ir~o' THEREFORE, petitioner(s) respectfully request(s) the grant of letters o{~ administration in the appropriate form to the undersigned. /%?/-/7,//,. ,,.,os / ~-~'oc~ aZ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF .PENNSYLVANIA ~ ss COUNTY OF ~ ' CUMBERLAND 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 before me this ::.'~. vep ~ __ day of · ElwT~ca,ccz_. .... .v ~- -__ Estate. of No. 21-02-'25 MICHAEL POLLAK ,.Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW JANUARY 10 I~2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED 'that MICHEL~E.~ .... "ANN RENEE is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to MICHEL_E...'~- ANN RENEE in the estate of -' ......... MICHAEL POLLAK FEES Letters of Administration $/~, "" Short CertificatesCT,,) .......... $ ?- ~ - Renunciation ' $ ~ .. $ ~FoTAL $ ~.. C~, . . Cra,~ A.D. Filed .LJ-~/q ...:..,~.. : 'i~ .- : ATTORNEY 'ct. No.) ADDRESS · ~:~o'k~:,Rimgf?fft. The'.orm,n~ cemficate w, lLbe fo~arded ~to th~:~State.,Vlt~'. Records,Omee far perm~ent fihng , % "-~ g;?~5 -~,' , "vs,~ WARNING: It4s illeflalto'dbplicate-.thi~,coPy:bY photostat~r phbt~fira~h.~ ~ . .: '~ Fee for this. certificate, $2~00 .. .. . ~, . . '" ..... 21'02-25 . H105144 Rev. l~l =',' - % :;.,7 ,,. COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VlTAL RECORDS -c.. . .,. ~ ~,~ "~- , ~ CERTIFICATE OF DEATH . ~, ' ........ .... ' ' ~ .'' -I,'M~, .... , February 8, 2000 'Dau hln ..... I Lower Paxton Twp;[ Interstate-~ soutQDo · M,~,o~c -- . ,,.1252 Hbg.' Pike, Carltsle,'PAl~°m~ '%?~.~,' , . ~ ' g~l~ ~,,~t~' ' .' ~ ' ~ '~ ' - - ,~. 2747 Stonewood'Dr., Bethlehem, PA 18017 M~ltiple traumatic ~nJurtes : ~~ I .:,~.. , :.. .. .. ~ _ .. ....... ,._~. ~..~. .~.~ ~ vehicle vs. two tracto ~m~'-' : ' - '.:' .' ( ' Graham S. Hetrick, Coroner: ...... .,, ..... ........ :... . . ..¢.,...,.T ..... ,. ~ '...~: - - --/. ~ . ' . . .-. :.",'- . ;' , r~ Name of Decedent: Date of Death: Will No. CERTIFICATION OF NOTICE UNDER RULE 5.6{a) ~ ] Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' ~ourt Rules was served'on or mailed to the following beneficiaries of the above-captioned estate on ¢/ ~'] 6/ ~ · Name Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ca /. '/, I , c o b Signature Capacity: ~ Personal Representative ' ~Counsel for personal representative STATUS R~I~ORT UNDER RULE 6.12 Name of Decedent: Michael Pollak Date of Death: February 8, 2000 Will No. None Admin No.' 2002-00025 (PANo.21-02-0025) 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 the administration of the estate is complete: Yes No X 2: If the answer is No, state when the personal representative reasonably believes that the administration will be complete: The estate was opened for purposes of litigation only.. The parties are currently trying to resolve the civil case. If resolution is not possible, the parties will proceed with litigation. The administration will be completed shortly after completion of the civil action, which is expected in approximately one year. 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties of interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court' and may be attached to this report. bgte: Capacity: X SignatUre Michele Ann Renee Name (Please type or print) 1975 Brookside Drive, Bethlehem, PA Address (610) 861-93'06 18018 Telephone Number Personal Representative Counsel for personal representative ~88-8~-83 88:1~ TRI TECHS15-868-1768 BETHLEHeM, P" S'rATUS REPORT, UNDER RUL~. 6.1~, Name of Decedent: ' .,Michae~l Pol!ak Will No. None _Admin No. 2002-00025 (PANo.21-02-0025) Pursuant to Rule 6.12 of the Supreme Court Orphnns' Court RuI~, I report the following with respect to completion of the administration of the above-captioned estate: ' 1. State whether the administration of thc estate is complete: Yes No X 2. ff the answer is No, state when the personal representative reasonably believes that the administration will be complete: The state was o ed for oses of liti 'on onl . e ' nti t ' to re lye ecivil ase. Ifresol 'on isn t i 'es will roceed wi h liti ation. The 'nj ' ' I ted sh I after eom ietion of the civil ' whi' is · ro' atlo . ~ ffthe answer to No. 1 is Yes, state ~e-e-efollowmg: -'-- -'" a. Did the personal representative, file a final account with tho court? Yes No .... b. The selmmte Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an' account informally 'to parties of interest7 Yes No d. Copies of receipts, releases, join~ers and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Capacity: X OX' Signature Michele Aim Rqnee Name (Please type or print) !9_75 Bmokside Drive, Bethlehem, P~, t801P Address ~610_~ 861-9306 Telephone Number Personal Representative ~ Counsel for personal representative UNITED ~TATES POSTAL SERVICE IIII First-Class'Mail Postage & Fees Paid USPS Permit No. G-10 ' Se,~,v~_/,) ~ .v/, ~./~::~ ~Ple'ase .print ~y°dr name, add re~. and ZIP+4 in this box ° · Complete. items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverSe so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to:_ o~'3 C. Signature ~~ ~~ I-'1 Agent X _~__ . [] Addressee D. Is delivery address different from item 17 ,~ Yes If YES, enter delivery address below: No IE~'-Certified Mail [] Registered [] Insured Mail [] Express Mail [] Return Receipt.fp.r...Me_mhandise [] C.O.D. 4, Restricted Delivery? (Extra Fee) [] Yes 2. Article Number (Transferfromservicelabel) ~_~./~ ?~. _ :~/~_ PS Form 3811, March 2001 Domestic Return Receipt 102595-01-M-1424' Certified Mail Provides: ~, .- [] A mailing receipt ~ [] A unique id. entifier for your mailpiece ~ ~ , [] A signature upon delivery ., ;[] A record of delivery kept by the Postal Service for two years Important Reminders: ~ Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. [] Certified Mail is not available for any clas.,s of international mail. : [] NO iNSURANCE COVERAGE IS PROVIDED with.Certified Mail. Fo~ri valuables, please consider Insured or Registered Mail. [] For an additional fee, a Return Receipt may be requested toprovide proof,of delivery. To obtain Return Receipt service, please complete and attach a Return, Receipt (PS Form 3811) to the article and add applicable postage to cover the fee Endorse mailpiece "Return Receipt Requested". To receive a fee waiver f6r a ~'upJicate return receipt, a USPS postmark on your Certified Mail receipt is required. , E3 For an additional fee delivery may be restricted to the addressee or ~ addressee's authorized'agent A-dy se the clerk or mark the mallpiece with the' ~ endorsem, ent "Restricted Delivery". ~ , , . '_~ t~"a ~ostmark'~ the Certified Mail rec~'tpt is ~deb~d. please present,the' ar~i-' re'at t~e [~ost' office for ~oStma~kino. If a po§ti~ark'bn the'Certified Mail .... il ' ' ~eipt is not needed detach.and affix label w~tl~ postage and ~a . -- ,', . .,-, , . .~,...'~ , ,~' ,. ~, '.~: '~,TANT: Save th S r.ece pt and pre?ent ~t-when m.al~mo?n'mqu,ry. '~00, May 2000 (Reverse) ~ , ~, ' - '~ , ~ '1~2~9'5-9~rxM-2087 JRD/June 30, 1992/17858 In Re: Estate of Michael Pollak Late of Middlesex Township Estate No.: 21-2002-0025 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2002-0025 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Michele Ann Renee Counsel for Personal Representative: .Date of Decedent's Death: 02-08-2000 Date of Delinquency Notice: 01-08-2002 The undersigned, Mary C. Lewis, 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 01-08, 2002, 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: 03-21-2002 ~/~//~/C ~/2z/~/~_/..,o ~~. M~y ~//Lewi~,/15,egister of W~lls Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ~' at in Cou~room No. 3~}~3e~ta~s Report is filed prior to the he~ing date, the hemng will automatically be ' '~41 # 1/I George~ Ho r, ,J STATUS REPORT UNDER RULE 6.12 Name of Decedent: Michael Pollak Date of Death: February 8, 2000 Will No. None. Admin. No. 21-2002-00025 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No X If the answer is No, state when the personal representative reasonably believes that the administration wilY' be complete: The Estate was opened for purposes of litigation only. A lawsuit was commenced and docketed at Dauphin County No.: 488-00-2002-CV. On September 3, 2002 one of the Defendants in the civil action, Consolidated Freightways, filed for bankruptcy in the United States Bankruptcy Court, Central District of California (Case No.: 02-23284). Therefore, in accordance with Bankruptcy Code § 362, all actions against Consolidated Freightways are stayed pending disposition of the Bankruptcy proceedings. Administration of the Estate will be completed shortly after completion of the civil action. o If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: ,-- 'Capacity: Signature Name (Please type or print) ( 5to) '2&/ - 9 30 & ' Tel. No. Personal Representative Counsel for personal representative STATUS REPORT UNDER RULE 6,12 Name of Decedent: Michael Poilak Date of Death: February 8, 2000 Will No. None. Admin. No. 21-2002-00025 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration-of the above-captioned estate: State whether administration of the estate is complete: Yes No X If the answer is No, state when the personal representative reasonably believes ~at the administration will be complete: The Estate was opened for purposes of litigation only. A lawsuit was commenced and docketed at Dauphin County No.: 488-00-2002-CV. On September 3, 2002 one of the Defendants in the civil action, Consolidated Freightways, filed for bankruptcy in the United States Bankruptcy Court, Central District of California (Case No.: 02-23284). Therefore, in accordance with Bankruptcy Code § 362, all actions against Consolidated Freightways are stayed pending disposition of the Bankruptcy proceedings. Administration of the Estate will be completed shortly after completion of the ~ivil action. o Date: If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes · No b. The separate Orphans' Court No. (if any) for the personal representative's account is:' c. Did the personal representative state an account infoi'mally to the parties in interest? Yes No d. Copies of receipts, releases, joinders hnd ai~P/-0vals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may b~ attached to this report. Capacity: Address Tel. No. --Signature .Name'(Please type 0rprint) ,O g ¢-h le_h Z' Personal Representative Counsel' for personal .representative JRD/June 30, 1992/17858 Date: January 10, 2005 RENEE MICHAEL ANN ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA RE: Estate of POLLAK MICHAEL File Number: 2002-0025 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 will become delinquent on: 02/08/2005 Your prompt attention to this matter will be appreciated. CC: Thank you. File Personal Representative Judge Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Will No. None. Michael Pollak February 8. 2000 Admin. No. 21-2002.025 Name of Decedent: Date of Death: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: The Estate was opened for purposes of litigation only. A lawsuit was commenced and docketed at Dauphin County No.: 488-00-2002-CY. On September 3. 2002 one of the Defendants in the civil action. Consolidated Freightways. filed for bankruptcy in the United States Bankruptcy Court. Central District of California (Case No.: 02-23284). Therefore. in accordance with Bankruptcy Code & 362. all actions against Consolidated Freightways are stayed pending disposition of the Bankruptcy proceedings. By Order dated November 22. 2004. the U. S. Bankruptcy Court for the Central District of California confirmed the Consolidated Plan of Liquidation dated July 1.2004. We are currently awaiting further directive from the U.S. Bankruptcy Court. 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: //3//()f I . CZrJfu I}JI...{,(' .kLM . '1U/ Signature AI1 /7 f)), ( /Jeje) I? {J f7 e {! Name (Please type or print) OJ Capacity: IGj 7<) /J ro{/kSi 'de Orrvv Address fNtl1/e /1 t'nV/ rJUI ,?O/g (i8#J ) No n of' Tel. No. V Personal Representative Counsel for personal representative J ,-j Cumberland County - Register Of Wills On~ Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/05/2006 RENEE MICHELE ANN 1975 BROOKSIDE DRIVE BETHLEHEM, PA 18018 RE: Estate of POLLAK MICHAEL File Number: 2002-00025 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: 2/08/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~. rA ~~. , .. I ,'.' " ~,-' y {J~CE:/U ,! GLENDA FARNER STRASBAU ..' REGISTER OF WILLS cc: File Counsel Judge If V ST A TUS REPORT UNDER RULE 6.12 Date of Death: Will No. None. Michael Pollak February 8, 2000 Admin. No. Name of Decedent: 21- 2002-00025 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: The Estate was opened for purposes of litigation only. A lawsuit was commenced and docketed at Dauphin County No.: 488-00-2002-CV. On September 3, 2002 one of the Defendants in the civil action, Consolidated Freightways, filed for bankruptcy in the United States Bankruptcy Court, Central District of California (Case No.: 02-23284). Therefore, in accordance with Bankruptcy Code ~ 362, all actions against Consolidated Freightways are stayed pending disposition of the Bankruptcy proceedings. By Order dated November 22, 2004, the U. S. Bankruptcy Court for the Central District of California confirmed the Consolidated Plan of Liquidation dated July L 2004. We are currently awaiting further directive from the U.S. Bankruptcy Court. 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties III interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: ~ .1 ! Ufo illL-U it ~ h U/Yl/}( / I2vJUU!_ Signature ') f}/t( he/~) .j /1 il I? ~IJfl.p Name (Please type ~; print) Capacity: / C; 7 j-' (JrlJ(~ KS'td E) Jr; Address ( ) Tel./No. X . , jJ (j)} e n .,., . ~/ .f J / / -C' J) it ;PiJ-//c:-',/c/',/ v;V IcPO if Personal Representative Counsel for personal representati ve \\L' Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/25/2007 RENEE MICHELE ANN 1975 BROOKSIDE DRIVE BETHLEHEM, PA 18018 RE: Estate of POLLAK MICHAEL File Number: 2002-00025 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 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: 2 / 0 8 / 20 0 7 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, 0~ #: ~ ~4. .. !" ..1.:4-..1 /l \v'dA"4M.<AU.... '<f/AAi-,./ ~// /l1 U r.;.c.c ."""-,......~~...~-v /I' Glenda Farner Strasbabgh Clerk of the Orphans' Court cc: File Counsel STATUS REPORT UNDER RULE 6.12 Date of Death: Will No. None. Michael Pollak February 8. 2000 Admin. No. 21- 2002-00025 Name of Decedent: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: The Estate was opened for purposes of litigation only. A lawsuit was commenced and docketed at Dauphin County No.: 488-00-2002-CV. On September 3. 2002 one of the Defendants in the civil action. Consolidated Freightways. filed for bankruptcy in the United States Bankruptcy Court. Central District of California (Case No.: 02-23284). Therefore. in accordance with Bankruptcy Code ~ 362. all actions against Consolidated Freightways are stayed pending disposition of the Bankruptcy proceedings. By Order dated November 22. 2004. the U. S. Bankruptcy Court for the Central District of California confirmed the Consolidated Plan of Liquidation dated July 1. 2004. We are currently awaiting further directive from the U.S. Bankruptcy Court. 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: ,?PV c:l?f7 :200 I \~JJ\~ ~~ Ignature /r;(J~.v j~eIJfI~ Name (Please type or print) /0, 7:i.lJrooJ' Ylci~~r/ v_~ ,lie f-/J Ie he flU, (~ /?u J t' Address ( ---) /1 () /1 (2J Tel. No. i/ Personal Representative Counsel for personal representati ve 8' S r "i,., <;~pacity: : Hd 62 dilj luuc ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/15/2008 RENEE MICHELE ANN ; \.-::J ~:I -r'J c:".:> (- 1975 BROOKSIDE DRIVE BETHLEHEM, PA 18018 en -,., w N RE: Estate of POLLAK MICHAEL File Number: 2002-00025 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, 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: 2/08/2008 please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, t! lf~/l . . ~i~lI. ~ ...j? /{<~~/,z~..e... il?'A~1tLj ~f-~" Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel STATUS REPORT UNDER RULE 6.12 Date of Death: Will No. None. Michael Pollak February 8, 2000 Admin. No. 2 I -2002-00025 Name of Decedent: Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: The Estate was opened for purposes of litigation only. A lawsuit was commenced and docketed at Dauphin County No.: 488-00-2002-CV. On September 3, 2002 one of the Defendants in the civil action, Consolidated Freightways, filed for bankruptcy in the United States Bankruptcy Court, Central District of California (Case No.: 02-23284). Therefore, in accordance with Bankruptcy Code ~ 362, all actions against Consolidated Freightways are stayed pending disposition of the Bankruptcy proceedings. By Order dated November 22, 2004, the U. S. Bankruptcy Court for the Central District of California confirmed the Consolidated Plan of Liquidation dated July 1,2004. We are currently awaiting further directive from the U.S. Bankruptcy Court. 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties m interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: ;2/L(/O:? ~f})A,~hffi t7(0A1l1~ Signature m I 'c --A ~ (~) 12 {! 11 e if! Name (Please type or print) ~._;;~;ilJ(18 ~~\'!\{J~~~c:dO J I......) I ) Address ( ) Tel. [;7 '" I) "'1 i f I .::J ./. "".'.j '-' .'" 6 t~r~.:Z Personal Representative Counsel for personal representative d Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 -~, C7 ~`~ ::.~ f p ^ l~ ~-r~ G--- . ~ c-7 Date: 1/14/2009 -!~; ~ - J ~-. c~ ~; RENEE MICHELE ANN - ~,. -- 1975 BROOKSIDE DRIVE = - - ~ ~ ,~ BETHLEHEM, PA 18018 ~ -~` w RE: Estate of POLLAK MICHAEL File Number: 2002-00025 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per t~-~ AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPRENT~' JRT RULES DOCKET N0, 1, for decedents dying on or after July .192, the personal representative or his counsel, within two (2) 1~~~rs of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted admini.st.ration. This filing is due by: 2/08/2009 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~..._._~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel STATUS REPORT UNDER RULE 6.12 Name of Decedent: Michael Pollack Date of Death: February 8, 2000 Will No. None. File No. 21-2002-00025 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captior~ed estate: State whether administration of the estate is complete: Yes No X 2. [f the answer is No, state when the personal representative reasonably believes that the administration will be complete: The Estate was opened for purposes of litigation only A lawsuit was commenced and docketed at Da~hin Coun No • 488-00-2002-CV. On September 3 2002 on of the Defendants in the civil action Consolidated F'reivhtwa's tiled for Bankru tc in the United States Bankru tc Court Central District of California Case No.: 02-23284 . Therefore in accordance with Bankru tc Code 362 all actions a ainst Consolidated Frei htwa s were sta ed endin dis osition of the Bankru tc proceedings. By Order dated November 22 2004 the U S Bankruptcy Court for the Central District of Cahforn~a confirmed the Consolidated Plan of L- u~dat~on dated Jul 1 2004. Consolidated Frei htwa s is now out of bankruptcy and we are currentl seeking settlement with the adiustin~ service for that company 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Y No The separate Orphans' Court No. (if any) for the personal representative's account is: Did the personal representative state an account informally to the parties in interest? Ye No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be tiled with the Clerk of Orphans' Court and may be attached to this report. Date: !~(~d~ S,h~~~ldt~0 gZ ~ ~ ~ ~~ ~- ~~~ ~~~Z Capacity: Signature ~'J.~' ~1 ~.~P? ,~--~, ri ~~ii~ ~' Name (Please type or print) 1~75~ ~~~ SiC~`'~o; f-~r~Ur~ Address ~? f~ ~ ~ ~? ~ < yam', ~~~..~- l ~ G ~~ ( ) ,~ ~~~ Tel. No. ---~T- V Personal Representative i i~^, ~ ~ ' ~ - Counsel for Personal Representative ~~:>> Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 1/18/2011 RENEE MICHELE ANN 1975 BROOKSIDE DRIVE BETHLEHEM, PA 18018 RE: Estate of POLLAK MICHAEL File Number: 2002-00025 Dear Sir/Madam: Rf.C~~~~n'~~~`~~ D~ ~,..- C µ~~ti 1 .~a 18 Phi 12~ 2 CI.~~K QF QRP'HA1~!'S uO~f~~` ~}~,t~`~~I.~ ;,n t.,n , PA This notice is to serve as a reminder that the Status Repot by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 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: 2/08/2011 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, t~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ir.ECISTr 0;'ti~i:T LS Gr CGt':vTY, P;~~+3YL~~'~•t~~1 iti3nie GfBeCedan D~~e o. !~eath:_ ~1// U ~'~d GUU FII~ i`rul?:b::: i~u: ~~i3iit iv Pic. ri~.C. ~:::.°. ~.ii, I .•`...~.i t :e {;~~11.Yizn r.J ti: itil r=C;lat_t t.1 r.rTT:..,~!ir.l t?f t]~a a a• ~?t r file above-captiulied estate: 1. .State W(?C(l1Cr adlll:l!Siiat!021 Of tii~ ~Staiv 15 Cc::lplste: ............. .... ~~~eS 2. if the an5~'reC1S i~1~0, State'Nllen tl?e personal repl'esentatlVe reasona~ly L-elie-res ti at the adlrinistratio?i «'ill be complete: 3. If the a;?saver to No. l is YES, stag L;le fcllo~z•irj: • a. Bid tl:e personal represe:ltatve le a f:•nal~accotlnt will the Coup? ....... Yes b. •I,ile separate O:phalls' Court Ise. cif any) for tl?e peISOI?al . ,e;;resentativ~'s account is: c. Bid the personal rtpresentatlye stste an acco!?11t . in`omial:y to the parties in it?ter~st? .:.................:........... ~ (~ ;'e3 d. Copes Ci reC@7r i5, TC]2. SCS,~0I1:4.°.I'S 211d i D~*OV31S Of fC!TI121 Or 1nfOnT12] aCCO!!ntS ?h :;red with the Clerlc of tLe Org':?aas' Court and 1T?3 j% be at:ach~d to this report. Y Dnrc~~~lL_ ^a.. ~ G> ~ ,~ C~ ::_~ ~ ~ ~ - ~ ~ ~0! IVY,/ V Q ~O. ~~ o~? cr ~~~ C;7 CCaux>,`~ ~ No vo ie S~nriart of 2tr;Dn t:;lirj ri~i! F'prm C2}iS:.iIV: C:'SO::Z] ~CJ!•:Sth!3llYC ~COUyISr•] {-~';~~ tire. P~Q~~ ~~' lri (f; ~~~G ' ° ~ U.` `Pi~ l ~..> = f r- ~' ~.Z I ~ 6- <~ ~ ~ ~ ~ : ~° ~"- t~ ~ d ~ 3~ 1;~ V ,; r ~:~i~~li lJ~~`u'V~~~ ir!=C:t~Tct: l: F \~i;r,LS Gi~ ' 1_~ D_Da C~I'UYU_/~~_JY~•~ ~_ .~,:~n,.l.:'t GJ rU;On f:iir:~ lNii ~~Or'A7 Czpacity: ~o:?z1 Repr~sen:afire ^Cou:acl D l rv. ~ ,Q-i'1 vi ~~~'~I c~~... 1~izn;e Gf D~ce~e.at:_ ~~~=~(~(; ~ ~ (i~U l jG ~C, _____--- _. D'te o; D_zt',i:_____ ~I ~ ~"I rd CI~U _ File i`~u:~be~- ~' l1 ~ a '-"-__~~~5~ O•.•• ..,....,, D rl r C.,?= r: t~ S. -..,.t t~,~ {;~1;.Jluir,s a:irn -?~ - , [l2. i t~~2':,tti.'..rit?v]'. Ci i ~.:~uaut w • c:. v.~,. a~..... v..., ..'.v v.. .. _.. .' ._~ ~~:_` In rQ?'7_ _'IQ_l 1_ i file above-captiul2ed estate: Jta.., w1 t.2er ae.7.,a_~~~at.ou Vi ~,.::, c:. ct.. iS C:v::i~:..:e. . ~. if the 2^$~'ve1"15 ~0, State'.Vllerl tle FzrSGIi31 ;evl'eSeT1t2t1Ve reasonably L-elleves ti at the 2d','!"iliilSti3t:012 «':li 1?e COP.i~?l:.i~: 3. ?f the z:1s~~~er to ?~'o. l is ?'ES, stare tie follo«•ir.~• d~ t. .a ,~~~~~~ i~3~ii1~ ~1~~'. ~1~ ~~~ r ~ ; l E ..e~? ~ ~. 1 ~'U h`~ r~r.o~= ~ `. _ ~, r yy,,,1 a. Dd tl~e perserzl represe:itatve rile a f 1131 2000Llrlt Wll1 the Court? ....... []Yes ~ No 0. l l?° 5epa1'1ie O:ph:ins' CoLlrt :\0. ;If ari;/~ iJi tl:e pc;IS0111 re~resel7tative's zccourt is: c. Did tl:e personal representative s~at~ an account infolr.,aliy to the parties in ilaer~at? ............................... (Yes (~ vo d. Copizs of *e:zijs, reka;es, joi~2~er:: ad 2.n~rova}s of film=1 or informal accoants may be :2~ VJIIi'1 ti2e C12:1C OL i~?8 Olrl2:1:?S"' t..~il:~ 2110 1%3',~i be at:acl2ed tC? tl?1S 1'er01't. L l C '.. '' ! ~-`~ = t~i =, . ` wf ' -~ f-.. ' ;= .: . -- ~ ~ . ~ .. C3 C~ r ; -` aft eY! ~ ~ " ~•.~ t~, ~~ ~ ~~. ,~ W ~¢; a ~ ~~ :~ .- ~ ~: ~-- ., ~, G~ c ~? t ~~,,- _ ~ iti, ; d.:, YD: Rt c~C~.~ CJ~ ~C' c~ Cca~t . ~J ~vt cQ r `/) ~' P rho ~~ ----- 8"U ~ ~ Cumberland County - Register Of Wills One Courthouse Square .- ~ ~'`~~= .. ~.. Carlisle, PA 17013 r ;~~ Phone:(717) 240-6345 `~ ~ ;` ~ „ ~ ._ ;mil ~. , ~ ,LE'--~,., , , ~ 1'~i;na ,~, ^,r CR{ _ ~;, Date: 1/17/2012 RENEE MICHELE ANN 1975 BROOKSIDE DRIVE BETHLEHEM, PA 18018 RE: Estate of POLLAK MICHAEL File Number: 2002-00025 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 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: 2/08/2012 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda Farner Strasbaugh ~' Clerk of the Orphans' Court cc: File Counsel Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF ~UY~ ~~~~a ~~OUNTY, PENNSYLVANIA Name of Decedent:~~ ~ ~ Q ~ ~~ ~ Ch Cp-L°/~ Date of Death: ~~~ ~ ~,~~ ()U ~ File Number: ~r%1~~ -Q~~~ S Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... I~r es ^ No 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: /1///~ ~ ~~~ E$ P [:~~ S D~J c r~ F~' ,~J!' /t 'f ~ ct Q_.~-tarl ~U r~~ S ~'S Qr7 l y. a. Did the personal representative file a final account with the Court? ....... ^Yes ^No ;~ b,~The separate Orphans' Court No. (if any) for the personal ~ representative's account is: Did the personal representative state an account informally to the parties in interest? ............................... ^Yes ^No d~/Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk of the Crphuns' Court ar~d :ray be attached to this report. Date ~ ~`) ~l! Z t ~~'~i ~' C// C/N~C~rv ' `~ Signature of Person Filing this Form tt~~ Capacity: ~rsonal Representative ^ Counsel ~.7 U7 `~ 4 t - wL t~ Q ~ ; Name of Person Filing this Form =; ~ - --_ LLB Z _ Ad eQSS,~ / ,,,,, 1 /~ ,~ ` p- ~~ ,';' ~ C~ ~ u_ ~.:.: ~ ~ rl rl c~ J Telephone Form RW-l 0 rev. t 0.13.06 1505610101 REV-1500 Ex `°'-'°' L~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY oEP.w.MEN,oFaE~E~~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX z8o6o1 ~ / ~ ,~ ~ ~ ~ ~, Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth pMMDDYYYY Decedent's La/st Name Suffix Decedent's First Name MI (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 O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) ~ 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number First line of address q 7s ~~'~~K~i p~ ~R1 V ~- Second line of address City or Post Office Correspondent's a-mail address: PLEASE USE ORIGINAL FORM ONLY ~~~ ___. Side 1 1505610101 1505610101 State ~~ REGISTE WILLS USE~LY r~ C... -~ ~ r •• ~z ~ v:~ cn CJ~-,, - < C'~C~' '~ QC _~. :~ ~ _3~~~ FILED ZIP Code L- 1 ~ a ~ ~` Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSO RESPONSIBLE FOR FILING RETURN ~ v DATE A DRESS IGNATURE OF PREPARER OTHER THAN REPRE NTATIVE DATE ADDRESS ~~ ~"~+'t :~ -r/ _:_~ '~ i r~ 1505610105 REV-1500 EX ecurity Number Decedent's Social S ' ~Ji ~ ~ ~ V ~ ~ / ~ ~ E Decedent s Name: ~ - RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. /~y V • 2. Stocks and Bonds (Schedule B) ..................................... .. 2. C ~ • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. / ~ (~' • 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. ~ • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ~ • 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ..... .. 6. Ca • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property " (Schedule G) p Separate Billing Requested...... .. 7. ~ 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ~~ 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. ~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. / 1 l~' • 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. (;' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which l J 13 C! • ) ..................... e an election to tax has not been made (Schedu ... . 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. Ct • TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 _ • 16. • 17. Amount of Line 14 taxable at sibling rate X .12 + 17. • 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • © 19. TAX DUE ...................................................... ...19. • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 File Number r~/~~ r~ -~~~r~V~ J Decedent's Complete Address: DECEDENT'S NAME ----- STREETADDRESS ~S~ ,tfR:~~iS_~ vie ~ ,P/~F C`o~sT ~ Co,~-s_~` /~c-T~y- ----__ J_ _ __ ~I SL.~ STATE ~ ZIP /~ / Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) ~' Total Credits (A + B) (2) (s) C? (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes 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 Dec. 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. ., .... .. ;. , .. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed 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 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 21 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 percent [72 P.S. §9116(a)(1.2}]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX t (i-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8r ~VIISC. INHRESIDENTDECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Fle~lC-~f~ T Gt~A~S ~' cT~f', ' f,.tl ~O~~-~U~ D ~f~"T~f TOTAL (Also enter on line 5, Recapitulation) I $ ~(~~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) ~:~ ~.~ SCI~IEDIJLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under 1. Sec. 9116 (a) (1.2)] ~ ~ CI-f,E~-~ ~'N/~ oe~~l~~ ~,~id trJ~7~~ ~.i~N ~~ ~UL- 19~~ ~~~~~s~~~ ~~v~ ~~~ JP ~T~fL %/~~~ ~'~ /~~' /'~ ~ ~~~ ~ ~' ~nr ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 11 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -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) IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA CIVIL DIVISION MICHELE ANN RENEE, Administratrix of the ESTATE OF MICHAEL POLLAK, Deceased Plaintiff, vs. ARTHUR D. CALVERT and CONSOLIDATED FREIGHTWAYS CORP. Total Settlement: Attorney Fees: TOTAL Reimbursement of Costs: Defendants SETTLEMENT SHEET $25,000.00 $7,507.50 162.63 $7,670.13 $0 TO MICHELE ANN RENEE TO TALLMAN, HUDDERS & SORRENTINO: TOTAL No. 488-CV-2002-CV $17329.87 $7,507.50 Michele Aru1 Renee Date-~ ~., ~~~ ~:: ~~ ~. ~ ~:.'~' a ~~ N ~O ^, ~ W ~ Y~~ /~ GN O ~Q ~ ~! ' ~ V p ~ i zi -a ~ ~' ;"'o~ o~ ~~~~v% N ~ G cd ~ ~~C~ /. ~: ~. ^/ c~ '=. O i :S' ~ ~~, '3 f, e, ~ • .~.{ > ~ Tj '~ ti 4 tJ (~ T ~ "~ -: r •~ r F^d ~ ~ !-' BUREAU OF INDIVIDUAL INHERITANCE TAX DIVIg10N ~~{~~,~I{, TAXES 1 PO BOX 280601 HARRISBURG pq ~{' ALL INHERITANCE TAX 1 7128-0601 ~~~~'%v""!'~,,~ OWANC ~~'L~ONS AND ASSESS ENT LOLOWgNCE peens/.~~J// Z~IZ SEP 24 p F TAx DEPgRTMENr~~REb ~• ~~ R~-1547 EX AFP (12-1a DA rE ~:~t '`+~.:i ,..:;~ ESTATE OF 09'24-2012 MICHELE ~yOi~~pP~Hq~'S (;OUFiT DATE OF DEATH 2LLAK 1975 BROOK IDENDRvu'v~pCR~[~ C~, ~ FILE 08-2000 MICHAEL NUMBER 21 02_0025 BETHLEHEM COUNTY Pq 180 ACN CUMBERLAND 18-4501 101 (S QPEAL DArE; everse side under 1 - 23 - 2 012 Amount Remitted ~bfeCtions~ MAKE CHECK p CUT R COU TER OFB WILa SD REMIT PAYMENT REy=ALONG_THIS LINE 1 RTHOUSE T0; 1547 EX AFP C12-11~ y RETAIN LOWER P CARLISLE pq SQ~UR3 ESTATE OF; D SgLLO OF INHERITgN~~RTION_pOR YOUR LAK E OF AX App""'- RDS POL WAN( DEDUCT T RAIS___RECO____ f. MICHAEL FILE IONS AND ASSESSNT' ALLOWANCE APPRAISED N0.:21 MENT OF TAX OR _-- VALUE OF TAX RETURN WAS: CX) ACCEPTED 02_0025 1 • Real RETURN BASED ON: 0 ACN' 101 Estate (Schedule q) AS FILED DATE: 2• stocks RIGINgL RETURN [ )CHANGED 09"24-2012 and Bonds (Schedule B) 3• Closel y Held Sto 4. Mort ck/part C1) 5• Cas gages/Notes Receivabership Interest CSche C2) •00 6• Jointlank Deposits/Mist, lperSchedule D) dine C) C3) •00 coeditTt ensure Proper T• Transfers WCS he rope GJ [Schedule p) roPerty (Schedule E) C5) 00 of bthis tfo muP'Per Portion 8 dine Total Ass 0 tax payment, ith your APPROVED ets C6) 0 DEDUCT [~) • 00 9• Funeral Expenses/ •00 ONS a ND EXEMPTIONS : 10. Debts/Mor Costs/ tgage Liab Misc. Expenses 11. 1lities/ CSche C8) Total Deduct Liens CSche dine H) •00 12. ions dine I) C9) Net Value °f Tax Return 13. Char' C10) stable/~oyernmental B •00 14. Net Value of Estate e4uests; ,TE• ref an assessmentu w ect to Tax Non-elected 9113 Trusts [Schedule J) C12) • 00 8S 1SSUed prey • C13) • 00 ~ESSMENT OFct f18ures TAX; that include 1OUSly, lines 14, C14) •00 15. Amount of Line 14 th a total 15 and/or 16, 17, •00 16. Amount of Line 14 at Spousal rate of A ~~ retur 17. Amount of taxable ns assesse 1B and 19 will Line l4 et Linea d to date, 18. at Sibli 1/Class A rate C15) 19 Amount of Line 14 n9 rate Pri taxable C16) • 00 X 00 nciPal Tax Due at Collateral/Class C17j X 06 •00 CREDITS; _ AYMENT B rate C18) )C 00 = • 00 DATE RECEIPT • 00 X 15 = • 00 NUMBER DISCOUNT C19)= •00 INTEREST/PEW pglD C_) •00 AMOUNT pA1D TOTAL TAX PAYMENT BALANCE OF TAX DUE D aFrE • 00 R DATE INDICATED, SEE INTEREST AND PEN. • 00 LCULgTION OF ADDITIONAL RSE REVE INTEREST. IF TOTAL DUE IS TOTAL DUE .00 A REFUND, REFLECTED qS •00 SEE REVERSE SIDE OFq CREDIT~~ THIS CCR), FORM FOR INS ORUCT ONS • DUE