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HomeMy WebLinkAbout04-0322I)IIOiIATF, and GRANT OF LETTERS No. Register of' Wills for the Cotlnly of-~~I1:::t~ in Conmlonweallh of l'ennsylvania tile /'he pclilion of lhe umle~Mgncd ~cspcclfully ~Cl. CSenls lhal: Your i~clilione~(s), uho is/a~c IR yca[s (,1' age or olde[ an {he cxcculO~ ~h~[necl i,,Ihcla~l will of lhe above dcccdcm, dalcd 0otobe~ ~3, .................... ~i'~ ~0 and codicil(s) dated (slale i('levan[ CifCtllllSfHflt'eS, e.g. lellllllci~ltiOll, deal[i of exectllor, elc.) Decendenl was domiciled a[ dealh in 0~mbe~d County, P~nnsylvania, with h er .... lasl family or principal residence al ~03 GettySburg Pik~ ~echanic sburg (Iisi Slleel, illllllllel filial muncipalilv) ' race.dent, m~. ~6 ,~sor, ~.died N~h 2 200 . ---- -~ .................... 7 5 . Excepl. .as. follows, decedem, r did. nol Inal'l'V,. was not divorced. .and did not.. have a child' born or adopted afte~ exectmon of the will of. el ed for prolmle; xvas not lhe vlclm~ of a kdhng and was never adjudicated ~ i,compelenl: I)ecendent al dealh mvned properly wid~ eslimaled values as follows: dr domiciled in Pa.) AU personal properly $ ~0,000. O0 (If nol domiciled in t'a.) Personal properly in Pennsylvania (if not domiciled m Pa ) I ersonal properly m ('onnl Value of real eslale ill [~ellllSvlVallia s,lt,a~etl as folloxvs: ~0~ and Lot ~ Orotund sittm, te at- 303 Gettysbur --WIIS~7~ORS? petit?net(s), re~?clfully requ~(:)~,X~X~aS~ or t,,~ ~t wigand ~resemea nerewim and tl~e gram m lelters ......... ,,~=-'g meron. '::" ~ ...... ~o ! Ascan~ve.; Aot. ~ ..... OATtl OF PERSONAL REPRESENTATIVE COMMONWEALTll OF PENNSYLVANIA '1 COUNTY OF CU~ff3~s~RLAND ~ ss Thc petitioner(s) abovcmamed swear(s) or affirm(s) that thc statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- lalive(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 tiffs ~ day of .~ril ,~ .,' . ~ ~O0~J III'~CIII~]I'] (IF I'IIt)IIA'I'I'; ANI) (iII/\NT ~[ ~F , Deceased LI,71"[EIIS ANI) NOW __Apri~__.~ ........................ .. _2_0_0lt..in consideration of the petition on Ibc jcvcrse side hcteot', salisl'actmy pr,)o' h;tving l,,'eu I,CSCntcd before me, 11' IS IIECIH~EI) that thc iu:;litt,ncntlsl tlesc~ibed lhereiu be admilled Io prolmte ami lilcd t~l rec.,rd as the last will of LOMA R. ~k~S also known as bO:.'5~ J. EVANS , and ~ .~ ~ ............ ~_e_~.~?P.t_~rY me he~c/,y gmn~ed ~o_~_ Timothy_ P. Evans FEES Probate, Letters, Etc .......... $~~ J. Robert Stauffer (No. 06356) ATTORNEY (Sum Ct. I.D. No.) Short.Certificates( ) .......... 5_~./, d)D_ btarket Square Bldg. ~/.-2~.¢~.s' I4echanicsburg, PA 17055 Reffuncfahon ................ $ ¢4. ~c-~  $ J_~,_~_x~-- ADDRESS TOTAL __ ~g'? O,O 717-766-9673 Filed ./AO/4..~.',,'./..'~.....c~.~.~. ......... PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 10040096 No. Date #29-229 CERTIFICATE OF DEATH (Coroner) J EVANS , Female ,. 197 '40 6700 4. March 24, 2004 76 Merrittslown, Pa. Cumberland Upper Allen 303 Gettysburg Pike Mechanicsburg. Pennsylvania G. C. Roadman Timothy P. Evans 303 Gettysburg Pike ,~O *.[].,...~c~ 1~7~'' White ;w 1 Ascan Ave Apt 55 Forrest Hills, NY 11375 · []:~,~ Apr 3, 2004 ~=. Chestnut Hill Cemete~ ~ . g, Pa. 17055 March 2004 8:00 P. . z~, . Occlusive Coronary Artery Disease [] LAST WILL AND. TESTAMENT OF · ' LOMb, R. EVANS· I,. LOMA R. EVANS, df/.Upp~r'AIlen Tov~nship, Cumberland County, Pennsylvania, declare, this to be my Last Will and Testament, hereby revoking any will previous'l~.made bM me'. I I direct-the paymen~ of ~11 my-just debts and funeral expenses out of my esnate..as soon as may be ~ra'ctical after my de~th~ II I devise and bequeath all of~my estate of what- ever nature and wherever situate unto my 'husband,· Russell C., III - Shduld:.my said husband'pred~cease me, then I devise an~-bequeath '~11 ~f .my estate o'f .whatever nature and ev~ situate unto].my, issue pey stirpesf ppo~.nt~ my,' husband,. ~Russe,ll~ :~Evans, ~Executor Of this,' my Last Will ._an.j Testament. Should my said husband fail to qualify or ,c~e~.se,,'to~.ac~t. as ~su, ch, then I appoint my son, · ~ :i,+ .-~ ~' '"~ '~,~ .W .' Timothy P, Evans toe'act ~n th~s 'c~pac~ty. Should Ti~thy P. Evans fail to qual f~/O~ cease to-act as my Executor, ~hen I .appoint my son, Jack R~ E~s~o.,ac~-~,~nhis caqacity. None .of my personal representatives ~shall be required ,to pos,t bond' in this or any jurisdiction. Page· 1 on IN WITNESS WHEREOF, Sigfie~, sealed, % have hereunto set my.~.Hand and seal' day' of ~:~i~" i" ",'~ 1980. "~''' . (SEAL) Lom~ R, Evan~,' publi~he~ and declared b~ Loma R. Evans, Testatrix ~herein named, on this and one (1) other sheet of paper as and fo~ her. Last Will and'Testament in our presence,, who, iq.her presence; ~t. her request and:in'the presence of each ot~.': have her'eun~o subsdribed our names'as'attesting witnesses. ame Address .- Pag& 2 COMMONWEALTH OF PENNSYLVANIA) COUNTY ...OF CUMBERLAND) SS. " WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authorify that the testat rix signed and executed the instrument as-h er Last Will and that ~he had signed willingly (or willingly directed another to sign for he~, and that he executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witness and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. (Testatrix) Subscribed, testatrix , and witnesses, this sworn to and acknowledged before me by the subscribed and sworn to before me by both /,~('~ day of October 1980 ~.~\~ ~ '~ ' Notary Public /~/~ ~'-i~ 'i K~th.~e~n ~,~. D~¥is, NOTARY PUI~LIC '- ~ Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) LOMA R. EVANS aka Date of Death: March 215, 200[~. Will No. 2004-00322 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Apr±'l 5, 200[4 : Name Address TIMOTh~Y_ P. ~'A}~iS, t Ascan Ave., Apt. 55, Forest Hills, New York, 11375 AL:.~XIS'~ D. ~s'~?A~sS"~', ~40 Lindenwood Ave., St. Charles, Missouri, 63301_ DAVID R. 'hm"r^*'~q~..~, 140 Lindonwood A~o. , St. Chsrtos, M~ssouri, 63301 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Nono Date: Aoril 6, 200[1. Name J. Robert Stauffer Address Market Square Bldg. 111echanicsburg, PA 17055 Telephone (717-766-9673 Capacity: __ Personal Representative X Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 ~HARRISBURG, PA 17128-0601 REV-1500 J OFFICIAL USE ONLY INHERITANCE TAX RETURN I ................ Iz z-o_ o o 2 RESIDENT DECEDENT I-- Z UJ LU UJ DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) ~VA]~$, Lo~a B. SOCIAL SECURffY NUMBER 197 - 4.0 -67OO DATE OF DE. Am (MM-OD-yEAR) DATE OF BIRTH (MM-DO-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE WITH THE F[arch 2~., 2004 A. ug. 12, 3.927 REGISTER OF WILLS (IF APPLICABLE) SURViViNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER :IA - - 1'"~ 1. Original Relum [] 2. Supplemental Retum [] 4. Limited Estate [] 4a. Future Interest Compromise (c~t* [] B. Decedent Died Testate ~ =or~ orwm) [] 7. Decedent Maintained a LMng Trust (~t~ [] 9. Lk~gatlon Proceeds Received [] 10. Spousal Poverty Credit (date d death bs{~een 12.31~r and 1-1-g5) NAME J. Robert Stauffer~ Atty. FIRM NAME .~ e.~O TELEPHONE NUMBER 1. Real Estate (Schedule A) (1) 2. Stocks and Bands (Schedule a) (2) 3. Closaly Held Cm'i;m~atJ~, partnership or Bale-Pmpdetorehlp (3) 4. Mor~ages & Notes Resaival~e (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous personal Property (5) (Schedule E) 6. Jota_~ Owned Pmpody (Schedule F) (6) [--~ ,Boparate B~lting R~uestod 7. Intm'.Vivus Transfers & Miscellaneous Non-Probate Property (7) (Sch~dulo O or L) 8. Totel Oro~e A~ete (total L[nee 1-7) g. Fumral Expenses & Ao'mlnistratlve Costs (Bahedule H) (9) 10. Debte of Decedent. Mo~gage Liabilities, & Liens (Schedule I) (10) 11. Tetel De(lue~lon~ (Iotel LInue 9 & 10) 12. Hot Value ef Estate (Ll~e 8 minus Uue 11) 13. Che~toMe and Govemmentel BeqUests/Sec 9113 Tmsta for which an election to lex has not been ma~e (Schedule J) 14. Net Velue ~u~ect to Tax (Line 12 minus UUe 13) ~5. Federal Estate Tax Retum Required ~ 8. Totel Number of Safe Depoell Boxes [] tl. Election to tax under Sec. 911S(A) i~:i~ s~ o) C~PLETEMAIUNG~pRESS Ha~cet Square Bldg. I West Main St. Mechantcsburg, PA 170~ 127 000 O0 ~ ,- 0.00 ~-. 0.00 ::-i O. O0 ~ 115,67~. 95 : 5s,462.4o 0.00 0.00 (11) ¢2) 290~78~.O2 (t3) 0,00 (14) 290,783'02 SEE INS~UCTIONS ON REVERSE EIOE FOR APPUCABLE RATES 15. Amount of Line 14 tenable at the spcuusl tax ~ ,~r~ , O OO rate, or tmusfem under Sec. 9116 (a)(1.2) "* '~ "' x .0 (t5) 290,783'02 x o (lO) 13'085'24 16. Amount of Uno 14 texabte at IIr~al rate -- . 11. Amount of Line 14 taxable at sibling rate 0 *, O0 x .12 (17) O o OO O. O0 x 15 18. Amount of Line 14 taxaMe at collateral rate __ , (18) 0. O0 19. TaxDua. .· (t~) 13,085, ~~-7~.~~ .~'~:~, ~ .................................. Decedent's Complete Address: 303 Gettysburg Pike Mechanicsburg ISTA~ PA [zrP 1705~ Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Pove~y Credit B. Prior Payments C. Discount Intaraat/Penalty if appllcebre D. Interest E. Penalty 0.00 0.00 0.00 0.O0 0.00 If Line 2 is gmafer than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page I Ltha 20 to request a refund If Line I + Erie 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the [ntarest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 13,085.24 Total Credits (A + B + C ) (2) 0.00 (3) (4) Total Interest/Penalty ( D + E ) (SA) (Sa) 0.00 O,OO 13,085.24 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b, retain the fight to designate who shall use the properly transferred or Its Income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benetits or care? ...................................................................... [] [] 2. If death occurred alter December 12, 1982, did decedent transfer pmporty within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or secufity at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other rmn.probafe proporty which contains a beneticia~ designation? ................................................................. ~ ...................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS I$ YES, YOU MUST COMPLETE SCHEDULE G AND PILE IT AS PART OF THE RETURN. SIGNATURE OF J~,E. SON RESPON$1~I-E ~ FILING RETURN DATE ~DRES8 ' ' ~ ~ - ' ~ l~scan Ave., Apt. ~, Forest Hills~ N.Y.~ 11~75 ~D~E~ ' ~ . ~arkot Squa,o~dg., Mochan~osburg, PA 170~ For da~s of ~a~ on ~ after July 1, 19~ a~ ~re Ja~ua~ 1, 1 ~5, ~e ~ rots impo~ on the net value of ~ns~m ~ or for ~e u~ of ~e su~king s~ce ts ~% F2 P.S. ~g~s (a) (1.~) F~ da~s of dea~ ~ or aEer Ja.ua~ 1, 1995, ~e ~ m~ im~ced on ~e net value of ~cefem to or ~r ~e u~ of ~e su~g ~ is 0% ~2 P.S. $9116 (a) (1.1} (it)[ ~e s~tuta does not exemot a ~ns~r to a su~lving s~use ~m ~x, a~ ~e s~b~ mq~imme.~ ~r disclosure of as~b and tiling a ~x mba am ~11 appli~kts even · e muwl~.g s~se is ~e cos becefl~a~. F~ da~s of dea~ ~ or a~r July 1, ~00: ~ ~ mfe i~ ~ fie net val~ ~ ~.s~m ~m a d~s~ ~lld ~.~e y~m of ag~ ~ ~er al dea~ ~ or ~r ~ u~ of a nakml ~mn~ ~ s~ve par~ ~ a s~ppa~t ~ ~e ~i~ is 0% ~2 P.S. $9116(a}(1.2)]. ~e ~x rots Im~ ~ ~ cet walue of ~n~em to or ~r ~e uce of ~e de~ent's lineal ~,efldaHes is 4.5%, ~pt as .o~ ~ 72 P.S. $9116(1.2) ~2 E~. $9116(a)(1)]. ~ ~x m~ imbed ~ ~ ,et value of ians~m ~ or for ~e u~ of fie d~de.t's ~bliogs is 12% ~2 P.S. $91165)(1.3)]. A ~i~ is d~ced, under ~ec~. 9102, as a, I~Mduel ~ has at least ~e ~m.t In ~m~. with the d~d~t, ~e~r ky b~ or a~p~. REV-t502 EX; (6-98) , SCHEDULE A COMUONWE^LTH OF PENNSYLVANIA REAL ESTATE ESTATE OF FILE NUMBER LOMA R. ~ANS 2004-00322 21-04-0322 All real property owned solely or as a tenant In common must be reported al fair market value. Fair market value is defined as Ihe price at which property would be exchanged between a willing buyer and a willing sefler, neither being compelled to buy or sell, both having reasonabFe knowledge o! the relevant facts. Real property which la Iolfltly-owned with right ol survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ALI, THAT CEI~TAIN Itouse and Lot of Grol~nd situate in Upper Allen, Township, Cumberland County, Pennsylvania, bounded and deseribed as follows: BEGINNING at a poinB on the southern side of Pennsylvania State Highway Traffic Route No. 1~, at other lands of C. Arthur Huntsberger and wife. said point being 302.[L feet East of the eastern side of B~blebee Hollow Road; thence along Pennsylvania State Highway Traffic Route No. l~, North 3[g degreem, l~ minutes East, 90.~ feet to a poLnt at lands now or formerly of Martin B. Bowman and Hermie R. Bo~an, his wife$ thence said last mentioned lands Sough 38 degrees O~ minutes East, 2~0.00 feet to lands now o~ fo~memly of Laban Zt~e~man; thenee along ~atd last mentioned lande, South ~ degrees l~ mtnute~ West, 63.7~ feet to other lands ow C. Arthur H~t~be~ger and wife; thence along said last ment~.oned lands, North ~3 degrees 3~ minutes Wes~ 220.~ feet to the southern side of Pennsylvania State Highway Traffic Route No. l~, the place of BEGINNING. CONTAINING 0.40 acres. I~VING thereon erected a single family dwelling pmesenbly known and numbered as 303 Gettysburg Pike. BEING the same premises which C. Arthur Hunts- begger and Leila Irene Huntsbergem, his wife, by their Deed dated August 19, 19~8 and recorded in the Cumberland County Recordem of Deeds Office in Deed Book "P", Volume 18, Page ~l, granted and conveyed unto Russell C. Evans ~d Loma R. Evans, his wife. The said Russell C. Evans died on the 26th day of March , 2000 , whereupon sole title tn said premises vested in his wife, Loma R. Evans, by right of suvtvorship. New assessed value of meal estate by Cumbemland Cowry fo~ year 2004, per reassessment progmam is ~121,490. See new assessment attached. ~ecuto~ has received an o~al offe~ to p~chase the s~e at $127,000.00. TOTAL (Also enter on line 1, Recapitulation) 12~,~00, O0 (If more space Is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I,OJ IA R. SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER 200I~-00322 ~1-o~-o322 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of sundvomhip must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 6. 7. O. PNC Bank, N. A., Checki_ng Account No. 50-7007-8746. PHC Bank, ~. A., Savings Account No. 50-3001-5265. Pennsylvania State Retirement System, final payment on retirement. I13ternal Revenue Service, refund on 19(-)3 Income Taxes The Patriot News Company, refund. MetLife, Variable Annuity, Account 1Jo. 072992600 AB. 1996 Chevrolet Sedan automobile, I. D. No. 361JC52k- j~TS87~622, Title L?o. 49601382301. ouse~old furnishings. $ ~,556.~o 27,057.31 1,137.50 351. oo 5,oQo.oo 1,257.50 TOTAL (Also enter on line 5, Recapitulation) $ 115,674.95 (If more space is needed, insert additional sheets of the same size) INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LOFt\ R. E~.~A}TS SCHEDULE F JOINTLY-OWNED PROPERTY 'FILE NUMBER 2004_00322 21-04-0322 Joint tenant(s): Aa Bo Co NAME ..IHO~.{z P. EVANS ADD, RESS 1 Ascan Ave., Apt 55 I~ore~t lr'.!l_s, ~f.Y. 11375 RELATIONSHIP TO DECEDENT Son Jointly-owned property: LETTER ITEM FOR DATE NUMBER JOINT MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF TENANT JOINT OF ASSET % INT. DECEDENT'S INTEREST 1. A. 4/18/ !~10,000.00 Series EE U. E003 ~. Savings Bond-No. X6002963~EE. 9,584.00 100% $ 9,584.00 A. 4/18/ $10,000.00 Series E]~ U. 2003 $. Savings Bond-~o. X600296~E. 9,584.00 1~ 9,584.OO A. [~/18/ $10,000.00 Series EE U. 2003 S. Savin~ Bond-No. X6002965EE. 9,584.00 10~ 9,58~. 00. A. 4/18/ $10,000.00 Merles EE U. 2003 $. ~avings Bond-No. X6002966~. 9,584.00 10~ 9,584.00 A. 4/18/ $10~000.00 Series EE U. 2003 $~ Savings Bond-No. X6002967EE. 9,584.00 10~ 9,584.00 A. 4/18 ~5,000.00 ~eries~EE U. ~. 2003 Savings Bond-No. V6189- 152EE. 4,792.00 10~ 4,792.00 A. 4/18/ $5,000.00 Series EE U. S. 2003 Savings Bond- Ho. 6189153EE. 4,792.00 10~ ~,792.00 A. 4/18/ $200.00 Series ~ U. S. 2003 Savings Bond- No. R177759227EE. 191.68 10~ 191.68 A. 4/18/ $200.00 Series ~ U. 8. 2003 Savings Bond- No. R177759~8EE. '~ 191.68 10~ 191.68 TOTAL (Also enter on line 6, R~apltulatlon) $ ~a~e~ ~0~ (If more space is needed insert additional sheets of same size) PAGE - 1 ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMeER 2004_0322 ~1-04-0322 Joint tenant(s): NAME ADORESS RELATIONSHIP TO DECEDENT A. Co ( Conb ~nue d ) 1 Ascan Ave., Apt. 55 Forest ]{ills, N. T. 1137 So~ Jointly-awned property: LETTER ITEM FOR DATE NUMBER JOINT MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'! DOLLAR VALUE OF TENANT JOINT OF ASSET % INT. DECEDENT'S INTEREST 1. A. 4/18/ ,~200.00 Series EE U. S. 2003 Savings Bond- No. R177759229EE. 191.68 100%, $ 191.68 A. 4/18/ $200.00 Series EE U. S. 2003 Savings Bond- No. R177759230EE. 191.68 100% 191.68 A. [~/18/ $200.00 Series EE U. S. 2g03 Savings Bond- No. R177759231EE. 191.68 100% 191.68 TOTAL (Also enter on llne *, Recapitulation) $ 58,462.40 (If more space is needed insert additional sheets of same size) Page 2 'REV-151t*EX~- (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LOMA R. EVANS SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-o4-o322 Debts of decedent must be reported on Schedule ITEM NUMBER 10, Il. 12. 13. 15. 16. 17. DESCRIPTION FUNERAL EXPENSES: Myers Funeral Home, 37 l?.ast Hain St., Pennsylvania. ]?uneral expenses. I[echanicsburg, ADMINISTRATIVE COSTS: Personal RepmsentatNs's Commissions Name of Personal Representative(s) Timothy P. Social Security Number(s)/EIN Number of Personal Representative(s) Street Address Evans City State __ Zip Year(s) Commission Paid: AttomeyFees J. Robert Stauffer, Esq., attorney fee. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant N/A Street Address City State Zip Relationship of Claimant to Decedent ProbateFees Register of Wills of Cumberland County Pennsylvania, Letters Testamentary. Ac~untanrs Fees ~x Return Preparer's Fees Verizon, April telephone. Waste Management, refuse collection. Holy Spirit Rospital, balance due on Bill. AAA Central Pennsylvania, balance due on Credit Card PPL Electric Utilities, April electric. Cumberland Law Journal, Estate Notice. Shipley Energy, heating fuel. Verizon, May telephone. PPL Electric Utilities, May elecSric. Verizon, June telephone. James Lutz, l~wn Care. TOTAL (Also enter on line 9, Recapitulation) AMOUNT ? 573.5o 0.00 5,~00.00 307.00 48.93 35.39 50.00 136.5© 55.oo 75.00 268.05 45.ol 55.00 37.67 350.00 $ CARRIED FORWAR] (If more space is needed, inserl additional sheets of the same size) PAGE ESTATE OF SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND' MISCELLANEOUS EXPENSES Please Print or Type FILE NUMBER ~I-04-0322 ITEM NUMBER DESCRIPTION AMOUNT 18. Northelln I, iL~ht Book Club, balance due. 19. Uaste I.~anago'.~ent, refuse oolleottou, ~rd Quarter. 20. The Sentinel, Estate Notice. 21. T[arlfn Yohn, Treasurer, 2004-2)05 School '.['axes. 22. Verizon, July telephone. ~3- James C, Inltz, lawn care, 2~1., '.;erizSt~, .&uqust telephone. 2~. Verizon, September telephone. 26. P~L Electric Util~.t~es, September electric. 27. James C. I.utz, lawn care. 28. 7erizon, October telephone. 29. Register of Wills, Filiug Pennsylvau~a Inheritance T~ Ret~n. 30. Register of Wills, Filing Accoun$. 8.98 35'.39 102.11 1,506.12 3~.18 .15 o, oo 39 .13 3U.65 21.72 300.00 39.00 25 · 00 1~3. O0 Total PAGE 2 'REV-t Sl 3'EX+ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I,OlqA ft. ~TZA~S SCHEDULE J BENEFICIARIES FILE NUMBER 21-o4-o322 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LIs! Trustee(s) OF ESTATE I 1. o Il 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9119 (a) (1.2)1 TIMOTHY P. E%'ANS i Aecan Avenue, Apartment 55 Forest IIille, ~ew Tork, 11375 140 Llnden~,~ood Avonue Si;. Charles, ~_,~ssour-[ DAVID R. EVANS 140 Lindenwood Avenue St. Charles, Missouri 6 3Ol 63301 S on Granddaughter Interest in U. S Savings Bonds i~ the a~zoun2 of $58,46a.40 and one-half of Re- siduary Estate. One-fourth share of Residuary Estate. One-fourth share of Residueary Estate. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL D~STRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert addilional sheets of the same size) Inventory of the real and personal estate of deceased (1) House aod Lot 0%' Ground s~_tuate in Upper Allen Township, Cumber .].and County, Pe~nsy]vauia, prese~tlT/ ~o~m a~d ~umbered as ~0~ Gett~sbl~rg Pike, Mechanicsburg, PA 170~. (2) PT~C Ba~k, ]~. A., Cbec~i¥~g Accol~t ~o. ~0 7007 (3) P~C Ban]c, ]]. A., Savings Accoumt ~:o. [~0 ~001 ~26~. (~) Zmterms]. t ew~ue f;erv~.ce, re1 ~ C of 1995 ][~cn:~ el~sjlvanLa ota~, ~ et~remeu5 ~Vsbem, f;.nal pa~uenb. Patriot ;' ~ eu~ Compa!~y, refl (7) ~et Life Va]?iable Annuity, Accou~t Uo. 072992600. (8) 1996 Chew, olet Sedan automobile, Title ~;o. ~9601382301. (9) Household furn[sh-~n~;s. Sold at public auction. Total ........ ~ la~. ooJ oo 2,~5~ ~o ~7, o5'i 3i ~ 4-[ 65 70,266 19 5,00( O0 1~57 5o 242,674 95 COMMONWEALTH OF PENNSYLVANIA ]~ ss: COUNTY OF CUMBERLAND being duly s~?ortl according fo law, deposes and says that he is the Executor of the Estate of Lol~a It. Evans [ate of ___ ~][~C',r A]_.]_on .~ o~ms~ , Cumberland County, Pa., deceased and that th within is an inventory made by U~ .~.]~va~ .., fha said Executor of the entire estate of said decedent, consisting of all the personal property and real estate, except real ~s~afe.oufsld, the Gommonwealfh of Pennsylvania, and that the figures opposlfe each item of fha Inventory represent tfs fatr valu~ as of fha date of decedent's death. and subscribed before me. 1 Ascan Ave., Apt. 55 ].'orest IItlls, Ir. Y. 11375 Addre,s Date of Death ?~arch 2004 Day Idonth Year INSTRUCTIONS I. An inventory must be filed w;thin three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as fo personalty or realty 4. See Article IV, Fiduciaries Act of 1949. Z COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004762 STAUFFER J ROBERT MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 ESTATE INFORMATION: SSN: 197-40-6700 FILE NUMBER: 2104-0322 DECEDENT NAME: EVANS LOMA R DATE OF PAYMENT: 12/22/2004 POSTMARK DATE: 12/22/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/24/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $13,085.24 TOTAL AMOUNT PAID: $13,085.24 REMARKS: SEAL CHECK# 1017 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1S.1 EX AFP 112-D., J ROBERT STAUFFER ATTY MARKET SQUARE BLDG 1 W MAIN ST MECHAtfICSBURG C""") DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-07-2005 EVANS 03-24-2004 21 04-0322 CUMBERLAND 101 LOMA R Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS '"'_ CUMBERLAND CO COURT HOUSE _ CARLISLE. PA 17013 CUT ALONG THIS Li~iNE . .. RETAIN LOWER PORTION FOR YOUR RECORDS ..... Ri:Y;f!7:"I;e:.AFli~T:6J'r.NO".fcE.OF.iNHERYfA;.reE.TAX.A.PPRAYsi'r€NT~..ArlowlNcE.oR'......_.........- . """ ci: :'. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ;<EVANS C>'; LOMA R FILE NO. 21 04-0322 ACN 101 ~:_-.,; '~.- . PA 17055 DATE 03-07-2005 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) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (I) (2) (3) (4) (5) (6) (7) 127.000.00 .00 .00 .00 115.674.95 58.462.40 .00 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllant. 301.137.35 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 (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 10.354.33 .00 (Ill (12) (13) (14) 10.354 33 290.783.02 .00 290.783.02 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of Abb returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. AlIOunt of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 290.783.02 X 045 = 13.085.24 .00 X 12 = .00 .00 X 15 = .00 (19)= 13.085.24 ~ TAY ~DEDITS. . ... ....... 1C1:'-1:.11" 1 (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-22-2004 CD004762 .00 13.085.24 TOTAL TAX CREDIT 13..085.24 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR).. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) In Irjfg lJOUljr.p OP ,~()""'n:o!,~ PT,EA3 OP (~UJIB:-;:I1J.,(U:D ,';ourr?y, p-;_~JnrStl;".'Al'I1\. ro. 2001\-00322. BPHI\J!~!..'__;onl1'J.'.2.lT-lSIor. FIHS:I'/\rD FIlTAL ^ccourf_~ OF l~ITIO"[,HY P. l~-7/\ns, EXE';Ur.i:'OR OP "PEE L1\SJ:l lTIT,TJ _I\HD rrEs':t\'\n~ r1? OP !.,O~lJ\ H. EVA1J8, LA~E OF' rpnE fI'()1TrSHIP OF UPPER ^LLT~F, ccn F'_L"'[ (y.:r .';U'iJ3T'I1L:\FD }\rD Srr(\r2E OF p'Q;rrS"",[T/,~AFIA, D~_~, .~I!:A~)ED. I Date 01' Death: IHarch 2l" 2001,. I Dates 01' AdvertIsement of Letters 'l'estamentary: .~ In the (;umberla cl T,m' ,Toul'nal: ITay 21, 28 and June 1t, 2004. .-, In 'rhe Sent:tnel! June 15, 22 and 2'), 2(0)\.. Debits ,~ccountant Char~\es himsel1' HLth the 1'o1101.ring receipts and assets ofldecedent1s estate, consisting of real es tate ard personalty as 1'ollo"s: 2004 ! 3/24 PIm Bank IT. A., Ghecki ng Account No. 50700787],6. !$ 3/2), pnG Bank IT. A., Savings account Ho. 5030015265. 8/1 !!etI,Ue, policy no. 09],196375. 8/1 !-letI,Ue, polic,T no. 09'-!-196375. 0/1 HetLUe, I policy no. 722 970 048 A 11/15 Diane 'Chfmpson, furniture. 12/10 Lisburn unction Auction Co., net proceeds from sale 0 balance of household contents. , I proceedsj1'rOm sale of 1996 Chevrolet "Cavalier" automopile. Proceeds from sale 01' real estate located at 303 Ge tysburg Pike, Mechanicsburg, Pennsylvania, solc~ t Grecary A. anc! Alrlelia S. '<leaveI'. Re1'und 0 prepaid GOUQty and Township Taxes from 1, 15/05 to 12/31/05. Refund 0 prepaid School Tax 1'rom 4/15/05 to 6/30/0 . I i PRInCIPALI AS~JE'rS AI]) RECEIPTS.............. ._.......$ 2005 3/10 V15 4/15 4/15 GROSS PT~Il'i;I PAI, AJ;~~OU1T'r -1- , , t',..) (:n 2,557.],8 28,608.54 801.30 801.82 1,419.07 175.00 1,267.00 5,000.00 127,000.00 212.58 315.66 168,158.45 rnr;,jIP/lT, A,;>;()U'/I' ;rodi ts Accountant as',sl ';rerl it for the :following amounts paid out 01' rrLncilpal in the settIement and adlntnistra- tion of' d8ced~ntls estate, to wit: 200!, V6 1,/13 )1/13 VI3 !,/1 3 1,/26 il!2C, 5/5 5/15 5/15 5/21 6/21 6/21 ',' IC, 7/6 7/7 7/17 7/17 7/26 8/8 9/7 9/11 9/11 10/2 10/10 10/18 11/1 11/16 12/15 12/15 12/10 12/13 12/18 2005 1/10 1/21 2/1;2 CUlllberlalnd c;ount7T Hegis ter of' \fills, Let l.ers r:l:'estam\entar:r. ;jyors FUlneral Home, balance due on funeral expensfJs. ~eriz0n'lAPril teler~lone. ""aste Tlanar:;onJent, 2nd Quartor re1'use collection. Holy Spi "it I"'osI1ital, balance due on Bill. AM Gentral Pennsyl-varlia, balance due on Credit ~ard. ! ppr I",T:l.''"lI--:'~'._,'"l IJr~-TT--'-[--;"Q _: -}~UJ.!A'I.Ll._.l '-' ,I.!. _J":" l.. J':'0, r:;umberlapd Lau .Journal, ~hi:pley F;:ergy, heating lePJ_ZOn,lllaj- telephone. PPL Elecltric Uti Ii ties, liay electric. Verizon,l June telephone. Ja;nes J,u~z, Im.Jl1 care and landscaping. I~ort1Jernl Licht Goo1( Clu.b, due on account. '.'a.ste ;ia~.Ja;;eii18nt, 3rd Quartel' refuse collection. \l11e Sentinel,. Estate ~']otlce. ; iarlin Y hn, 'l'reasurer, 200!~-2005 School ','ax. Verizon'l July telephone. James G.I I,utz, 1m-Ill care and landscaping. Verizon,lAugust telephone. , Verizon,1 Septenilier telephone. PPL Elec~ric Utilities, electric to September. James G., Lutz, lmIn care and landscapinr;. Verizon,l October telephone. 'faste :Ia~ac;ement, l.j.th Quarter re:fuse collection. PIT, IElec-ric Utilities, October electric. Verizon" ITovember telephone. PPL Elecj:;rlc utilities, 110vember electric. Vertzon,! December telephone. I'pr, EIGc~ric utilities, December electric. l1ee;tsterl at: ,;U.ls, 1'iling Inventory and Penns"fJL vania Inl1eri tance Tax Return. Ree;istel'lo1' ',:il1s, Agent, PennsylvanLa Inheritance Tax. ; James G.ILutz, lawn care and landscaping. 1 , ., , April electric. Estate I:otice. :fuel. PPL Elec~ric Utilities, January 2005 electric. Lester Wf Erb, Inc., heating 1'uel. Stale;>' lI~chanicals, Furnace lnaintenance. -2- 307.00 573.74 1.j.8.93 35.39 50.00 136.50 55.00 75.00 268.05 45.01 55.00 37.67 350.00 0.98 35.39 102.11 1,506.12 38.18 150.00 39.13 38.65 21.72 300.00 39.00 35.39 13.68 30.88 12.38 38.[)9 18.31 25.00 10,451+.44- 270.00 21.29 351.55 165.10 2005 3/1 '/12 3/28 4/1)> )-1-/15 4/15 4/15 4/18 PlUUGI PAL ACCOUH'f Crecli ts ~. "' Verizon final telephone Bill. PPL Ele tric utilities, February electric. PPL Ele tric IJti1ities, Final electric BilL Greena~l It cO Company, preparing fiduciary 'i'ax R turn. Recorde of Deeds, real estate transfer tax. Harli.n I . Yohn, ';'reesurer, T'ax Certificate. ilarlin 1. J:"011l1, ';'reasuror, County and 'i.'m-Tnsl1ip 7axes~for year 2005. Lyle Tic eever, Pump Doctor, replacinB pump. J. Robe t Stauff~r, Esq., attorney fee. Cash re,erved to preparation of final Fiduciary Tax H turn and contingencies. Hegiste, of \;ills, filing final account. , TOTAl, PHlnGIPA~ EXPEl1DlTUHES..........................$ GROSS LESS: RECAPITUIJATION , , PRIllCIPAI~ ASSE'rS AND RECEIPTS...................$ PH:INGIPA!L EXPENDITURES.................... . . . . . ! BALAllCE III HAIrr:JS OF ACCOUIl'.rAHT FOR DIS'rRIBU'rIOH.......$ I , -3- 42.31 19.74 12.58 185.00 1,270.00 5.00 297 . 29 600.00 5,900.00 500.00 260.00 24,85:3..40 168,158.45 24t853.4Q li1-3. 305.05 ~r~IIEDUI,E OF PROPOSED DISTRIBUnOIl Suggestionj is made that the balance in hands of Accountant for Distributiop, to wit, the sum of t143.30.5.0.5 be made in CASH to decedent's sion, 'l'IiIOTW[ P. ]';'lAFS and to her t~lO (2) grandchildren, , to Hit, her gra!nddau/3hter, ALEXIS D. EVAHS, presently tHenty-one (21) years of ar,e and to her grandson, DAVID R. EVAl'S, presently seventeen (17) i;rears of G.E;e, "ho are the children of JACK R. E:V AilS, deceased. Atten!tion is culled to the fact that both, HU3SELL G. K:AIrS, decedentj's husband and JAGI( R. EVAHS, her son, predeceased , I,OHA R. E'IAlIS, !the within decedent. 'i'HEREFORE,! Distribution is proposed as follows: In CASH, ~o decedent's son, TIMOTHY P. EVANS, a ! one-ha]f share of the Estate. In CASH, ~o decedent's granddaughter, ALEXIS ! $ 71,pz>2.51 D. ~vAI~, a one-fourth share of Estate. , 35,826.27 In CASH, ~o decedent's grandson, DAVID R. EVANS, , a one-~ourth share of Estate, to be placed in a loca~ banking institution, on interest, until such t~me as he attains the age of eighteen ( 18) I years, lto wit, on August .5, 2006, at which time ! the s anie shall be released to him. 35.826.27 $ -143.305.05 -4- STATE OF HE'd Y~nK COUNTY OFtVJL-f 1d--t/<-- ) )SS: ) personallf' appeared bef'ore me, the undersigned of'f'icer, a l!otary Publi , in and 1'or said State and County, TIHOTHY P. INAlTS, Executo 01' the Last Hill and 'i'estament of' LOHA R. EVANS, late 01' the T01vnship of' Upper Allen, County of' Cumberland and State of' Pennsrlvania, deceased, who being duly sworn according to law, deposeljl and states that he is the Aooountant in the annexed Aocount and that said Account is true and oorrect to the best of' his Im4wledge, inf'ormation and belie1' and that there are no unpaid credltors to be noti1'ied of' this Account and the day of' proposed decreq of' confirmation has been givento all parties who have an intore$t in the estate as bene1'iciaries. Deponent further avers that thelf'oregoing schedule of' proposed distribution 01' the not assets of ~he Estate of' LOHA R. E'iANS, deoeased, is true and correct and is !made in accordance with the provisions of said decedent' s Las~ \iill and 'i'estament and the laws of' the Connnonwealth of' Pennsylvani~, applicable thereto. ~~ f BA7tf#- Timot P. Evans Sworn and subs~ribed bef'ore me this 1-7 da~ of' fvvrI , 2005. ~ "t~ I' ANTHONY MAGRO Notary Public, State of New York 01MA4716659 Qualified in New York County Commission Expires Sept. 3D, 2006 -5- ., .... \V \... II. '; \,'\uY \\ \ . \'\\11'\ \. ) I \...\\1 l'" . \.'1\1\ ' \~ \ . !:: .." I" 1 ..... 1!~3 \ i -'-N o ~ 'j i \ \ ''''', \ ! ~ 8 ~.~ "~'\ -:::':-'<:""'~' \ 'f~ ~~ "" ~ (II :)_..,., ~ '" ~ sa 1 ~ ~ ~ .~~~, ";~ , '5 %~gi sl\~l-:-.,., 8~ 1!~... " ~ . 1\" 'l2 Sl~O '~:~ c ~ ~ II ~ '" c." Sa \ ell . ~~ l!a.l "6 .s' ~ e 1L'i . \ ~~i tl\~'\1~1':: ?- ., t ... $! .c;. re....... . \ \\\\\i\\~':~ ::~, - ~~\- \ . tl~\\l\.\ \"~.~ ~"6 J~S\ 'Sl-,) 11!\1I\~ .~. ~ \\\l\~\\\\ h\'1~\\\'I~" 1.1\' t\\h " \\\\n\\\\ ,,,::, c.:a;..1 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/17/2006 STAUFFER J ROBERT MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 RE: Estate of EVANS LOMA R File Number: 2004-00322 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 3/24/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) V~ /.~~, !:;,~fJI~ ,(,.\ !ok,iJ.l. ~ I~\::! k ,,~"'~ ~ I$I"J \ \.~ I ~ '":"'":) _ --.! _."_,_._... __.-"L~"",=:"J\T!i1lI _ _.If' 0_____:i_ __.....ii _-_...::;1 '~-~-'I~~- .Jr'"~\'C~.!L:S;Il,.tC;!( lUI.!!. ~"tj .l!..J!..!U5i OR ~IUL.l!..l:.llliJ}(;;:li.:ll.~lL!!.U v\Uii!...iL.!l..!J.tLJ . STATUS REPORT tJl\!vER RULE 6.12 Name of Decedent: LO:TA R. EV A 1:S Date of Death: ....If h 24 J'.Larc , 2004 . Estate No.: 200J..~-00'322 II 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 Q9 No 0 2. !fthe 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 accoinitwith the CoUrt? - Yes E9 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state &"1 account informally to the p2.L"iies in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Cl of the Orphans' Court and may be attached to this report. Date: r'eb.. ?3, 2006 "!'" J. Robert Staufrer Name :>Iarket Square Bldg. l-Techanicsburg, Pi\. 170::;5 Ji...ddress 717-766-9673 Telepl~011e }.To . Capacity: LJ Pets0ilal Represen:3.1:1-ve Iil Counsel for personal representative '~L'