HomeMy WebLinkAbout04-0363PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Social Security No. 26,~- q2 ~ 8i~)eceased'
Register of Wills for the
County of
Commonwealth of Pennsylvania
in the
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executon~/t0.f~o cica r tea ) named
in the last will of the above decedent, dated
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C'orrlher']a~d County, Pennsylvania, with
his last family or principal residence at 6g' l~o,~F;a I~t-;ve ; 5hi?,t~onx~t~ ~ PA
(list street, number and muncipality)
D~e~cend, e_nt.,, then '73 years of age, died
at~ac~o .ql~'~ff~ojq C~rOuQH.-u~ Ho~pi~l ;
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: ~-~: L~ixe
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
WHEREFORE, petitioner(s) respectfully r, eque, st(s) the probate of the last will ~d codicil(s)
presented herewith and the grant of letters ~ ,5~/,ote .~r~ ! y~
theron. (testamentary; adn~nistration c.t.a.; administra$/.on d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~x.~,-c,~ .~.,~
The petitioner(s) above-named swear(s) or affirm(s) that thc statements in thc foregoing petition arc
truc and correct to thc best of thc knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of thc above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
bef~e,.rne [his J ~ day of
REGISTER OF WIL~$'-OI~---~ COUNTY
OATH OF SUBSCRIBI~
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat. ~ , sign~ signed as a witness at the
reqUest of testat, in h presence and
~ ~presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of (Name)
19
~ (Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF ~"~lec//q
OATH OF N~.ON-SUBSCRIBING WlTN~S
(~h) a subscriber hereto, (each) being duly qualified according to law, d~Ose_(s) ~ say(si'that
f5 familiar with the signature of
testat ~t~ of (one of the subscribing witnesses to) the presented herewith and
that /4%::'
to the best of ~ t.~
codicil
believes the signature on the will is in the handwriting of
knowledge and belief.
(Name)
(Name)
Sworn to or affirmed and subscribed before
me this I ~ day of
(Address)
hereby certify that the foregoing is a true and correct copy of an original record that is 6n
file in Hackettstown~ NJ Dated at Washington Borough: 3-15-04
Signed:
Linda L, Hendershot, RMC/CMC, Registrar Barbara E. Van Why, Deputy Registrar
c
'C
STATE FILE NUMBER
kEG-lB NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES
AUG 03 CERTIFICATE OF DEATH
:s 1~ la. Legal Name of Decedent (First. Middle, Last)
~ Joseph F. Doerwang
~ lb. Also Known As (AKA}, If Any (First, Middle, Last) 2. Sex 3. Social Security Number
~' ~ ~ M .262-42-8159
'6 ~t~ 4a. Age-LastBidhday 4b. UnderlYear 4c. UnderlDay 5. Dateo~Birth(M~Dy/Yr) 6. Birthplace (City & State/Foreign Country)
~ '~ 73 Years Months Days Hours Mi..te~ 09--10--1930 The Bronx, NY
~ 7a. Residence-State 7b. County
7c. Mu, ,;...;:.,.;ity/City
PA Cumberland Shippensburq
'~ 7d. Street and Number 7e. Apt. No. 7f. Zip Code 7g. Inside City Limits?
~. 65 Rustic Drive N/A 17257 ~Yes DEe
~. aa. Ever in US Armed Forces? ~i~Yes E]No I-IUnk 9. Marital Status at Time of Death ' 10. Surviving Spouse Name
r~ ~ b, lfyes, NameofWar: Korean War []NeverMarrled ~Divorced (Ifwife, name pdor to first mardage)
~ []Married I-Iw d°Wed N/A '
'6 ~ O~ c. War Service Dates (From/To): 1950-1954 E]Marded but Separated DUnk.own
~ ~j ~. Father's Name (First, Middle, Last) 12. Mother's Name Prior 1o First Marriage (First, Middle. Last)
~ Edward Doerwang Catherine Adler
~ 13a. Name of Informant 13b. Relationship to Decedent
~ Michael Doerwang Son
13c. Mailing Address (Street and Number, City. State, Zip Code)
z 15 East Church Street, Washington, NJ 07882
--~14. Method of Disposigo~ 15, Place of Disposition (Name of cemetery, cremato/% other place)
" ~"~Buda~ I-IDonation St Ann Catholic Cemetery
>- OCremafion [] Entombment
rn [] Removal from State 16. Location-City, Town and State
0 []Other(Specify): Hampton, NJ 08827
~ '~ ~ 17. Name and Complete Address of Funeral Facility
~. )eVoe Funeral Service,Inc.136W.Washington Ave,Washington,NJ 0788
~ 18. Signature of F.Ji,~,5~ ~D t~tor//
~.~ ,~ ~' ¢, ~_~,j~/ 19. NJ Li ..... I~ber0 4 5
'5 20. Dec, Cabal I=duca[io.- 21. Decedent of H spanic Odgin? 22. Decedent Race - Check one or more boxes to indicate what race
~>. 14JHighest degree or level of school Check one or more boxes that the decedent considered himself/herself to be.
~_ j~ f~ completed at time of death, best describe if decedent i$ [~W hire
~>' .~ ~O []Grade 8 or less Spanish/Hispanic/Latino.[]Black or Afdcan American
OGrade 9-12; no diploma Check "No" box if decedent is
not Spanish/Hispanic/l_atino. []American Indian or Alaska Native
~ []High school graduate or GED~No. Not Spanish/Hispanic/ (Enrofledorpdncipaltribe)
o [~Some college credit, no degree
Latino []Asian indian []Filipino i--IKorean
~ ~ r-lAssociate degree (AA, AS) EYes, Mexican, Mexican •Chinese E]Japanese []Vietnamese
~ ,C~ []Bachelor's degree (BA, AB, BS) American, Chicano
'~ []Olher Asian (Specify)
~ .~ I []Master's degree (MA, MS, MEd, []Yes, Puedo Rican []Native Hawaiian []Guamanian or Chamorro
MSW) []Yes, Cuban []Samoan
~ ~ E]Ooctorale (PhD, EdD) or []Yes. Other Spanish/Hispanic/
~ Professional degree (MD, DDS, JD) Lafino (Specify): []O~her Pacific Islander (Specify)
~ E]Other (Specify)
~E 23. Occupation of Decedonl (Type of work done most of life, even if retired) 24. Kind of Business/Industry
z Lab Technician Chemical
25. Name and Address of Last Employer
Englehard Corporation, Edison, NJ 08820
FOR STATE ITEMS 26-3g MUST BE COMPLETED BY PERSON 26. Date P. ronou.nced Dead (Mc/Day/Yr) 27. Time Pronounced Dead
USE ONLY WHO PRONOUNCES OR CERTIFIES DEATH ~J 1 ~ /(~ Y ~ J~'~ ~M [~PM
Place of 28. SignatureofPer~Pron~jngD~eath(IfotherthanCertifier) 29. L, ..... Number 30. D{t'Signed(Mo/Day/Yr)
Accident
Cross Class If D~.ath Occurred in a Hospital: ', if Death Occun-ed Somewhere Other Than a HospRaL
1~ patient []Emergency Room
or Outpatienl I I-IDecedenrs Home []Other (Specify): ,.
USE OF DEATH Immediate Cause ' (Enter chain °f eventS (diseases injuries, or complications) that directly caused death ~'nterval Between
36a. PART I
-- final di .......... diti ....
I--.... Ring in death. Sub- ~'~ ~'/~$ ~ '
n,' sequent¥listconditi .... ' (.~"~-'~kv"~ ~c~7'~- ~,~,lO.
LIJ if any, leading to lhe
--1 Enter the UNDERLYING
Received ,~ CAUSE (di ....... inury c. ~_.1~1~ i ~
forLimb O hat nitiated the events Dueto(orasa~onse(~uenceoD:
Only ~ .... Iting in death) LAST. d. ~_~J.~ (.~O'%-~,v'~> l ~... ~--~ ~______~c. ~.~{~.~.."~
] ~ 36b. PART II - Enter other significant conditions contributing to death but not resulting in 137. Was an Autopsy 38. Were Aulopsy Findings
>' underlying cause given in PART I.
rn Performed? [ Available to Complete Cause
~Yes fqNo of Death?
~ { DYes ~l~
39. Date of I~ury (Mo/Day/Yr) 40, Time of Injury I-lAM 41. Place of Injury (e.g., home, construction site, restaurant) 42. njury at Work?
U.I
--I [~PM []Yes []No
D. 43a. Location of injury (Number and Street, Zip Code) 43b. Municipality
~ 43c. County 43d. State
o
¢.~44. Describe How injury Occurred
[4J 45. If Transporfatio, Injury:
Contains O I-]Passenger J-~Other (specify):
Amendment I--46. Manner of Death 47. Did Decedent 48. Did Tobacco Use 49. If Female:
~tatural []Pending Have Diabetes?Contribute to Death? f-INot pregnant within past year
[]Suicide [-ICould not be ~NNos I-lYes j~robably []Pregnant at time of death
[]Unknown if p~e~i,~.,i within the past year
50. Certifier (Check onfy one):
~1. Name, Address and Zip Code of Certifier . / ~ ~
H5119 55. S. ignalu~e~f Loc~'~egi~rar 56 Dis dc No 57 Date R ?ttecai-FiiWNumber
INSTRUCTIONS
Distribution:
JOSEPH F. DOERWANG
~ JOSEPH F. DOERWANG, residing at 26 Beethoven Avenue, in the
Borough of Washington, County of Warren and State of New Jersey, being
of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this to be my Last Will and Testament, hereby revoking
any and all other Wills or Codicils heretofore made by me:
FIRST: I order and direct that all of my just debts and
funeral expenses be paid as soon after my death as can conveniently be
done.
SECOND: I give, devise and bequeath a~l the rest, residue
and remainder of my estate, both real and personal, to my children, PAUL
JUDE DOERWANG and MICHAEL THADDEUS DOERWANG, to be theirs absolutely and
forever, share and share alike. If either of my aforesaid ch~dren should
predecease me leaving issue, then I direct that the share of my deceased
child go to said issue. If either of my aforesaid children should predecease
me leaving no issue, then I d~ect that the share of my deceased child go
to my surviving son.
THIRD: If my said Grandchildren are minors when this clause
of my will becomes effective, and if my said grandchildren should not be
21 years of age at the time of my decease, I appoint my surviving Son as
Trustee of the property of my said Grandchildren, he to serve without bond
or other security in any jurisdiction, and to have f~ power and authority
to expend both the corpus and the income of the property which he shall hold
as such guardian and trustee for the maintenance, welfare and education o~
my said grandchildren.
FOURTH: I hereby constitute and appoint my Sons, PAUL JUDE
DOERWANG and MICHAEL THADDEUS DOERWANG Co-Fiduciaries of this my Will. If
either of my Sons should die before I do, or if either of my Sons and I should
die in a common catastrophe or as a result of same, and if either of my Sons
having s~rvived me shall for any reason fa~ to qualify or having qualified
shall fail to act as Fiduciary, I then d~ect that my s~viving Son act as
sole Fiduciary. No bond or other security sha~l be required of either of said
persons in any jurisdiction for the faithful performance of the~ duties. I
empower my said Fiduciaries to se~ any real estate or any part thereof or
interest therein of which I may die seized, either at public or private
sale, at such t~me and upon such terms and for such purpose as to said
Fiduciaries shall seem proper and to execute and deliver proper conveyances
for the same in law.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~day of NOVEMBER, in the Year of O~ Lord, One Thousand Nine Hundred
and Eighty -eight.
~ ~OSEPH F. Do~R~~
SIGNED, SEALED, PUBLISHED & DECLARED by the Testator, JOSEPH F.
DOERWANG, to be his Last Will and Testament, in om presence and in the presence
of each of us, we being present at the same t~me and we at his request, and in
~ presence and in the presence of each o~her, have h~reunto signed our names
Residing i~~
CERTIFICATION OF NOTICE UNDER RULES 5.6(a)
Name of Decedent:
Date of Death:
Will No:
Joseph F. Doerwant
March 14, 2004
21-04-0363
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Col~rt Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on April t/~ , 2004:
Paul J. Doerwang
76 South Lincoln Avenue
Washington, NJ 07882
Michael T. Doerwang
15 East Church Street
Washington, NJ 07882
'"ID
Notice has now been given to all person~ept: No exceptions.
Date: April ~_, 2004
J //Yaylor'P. Andrews, Esquire
~ 78 West Pomfret Street
Carlisle, PA 17013
Phone: 717-243-0123
Capacity: Counsel for personal representatives
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE DEPT.
280601 HARRISBURG, PA 17128-0601
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21
-04
COUNTY CODE
YEAR
-0363
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Doerwan , Jose h F.
DATE OF DEATH (MM-DD-VY) DATE OF BIRTH (MM-DD-YY)
03-14-2004 09-10-1930
(IF APPLICABLE) SURVIVING SPOUSE'S NAME
N/A
SOCIAL SECURITY NUMBER
262-42-8159
THIS MUST BE FILED IN DUPLICATE
WITH THE REGISTER OF WILLS
SOCIAL SECURITY NUMBER
,.".,
'-'..,....
$0.00
$0.00
$0.00
$0.00
$0.00
1. Original Return 0 2. Supplemental Return
4. Limited Estate 0 4a. Future interest Compromise
6. Decedent Died Testate 0 7. Decedent had Living Trust
o 3. Remainder Return
o 5. Fed. Est. Tax Return Req'd
8. Total number of SOB's
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COMPLETE MAILING ADDRESS:
NAME:
Taylor P. Andrews, Esquire
FIRM NAME:
Andrews & Johnson
TELEPHONE NUMBER
717243-0123
Taylor P. Andrews, Esq.
Andrews & Johnson
78 W. Pomfret St.
Carlisle, P A 17013
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(1 )
(2)
(3)
(4)
(5)
(6)
$0.00
$2,263.80
OFF~CIAL USE O. Y
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3.Closely Held Corporation, Partnership or Sole-Prop.
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Propate Prop.
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administration Costs (Sch H)
10. Debts of Decedent, Mortgage liabilities, & Liens
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 (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amnt of Line 14 taxable at the spousal 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 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
$0.00
$35,771.32
$4,855.54
(7)
(9)
(10)
(8) $42,890.66
$12,678.67
$33,314.29
(11) $45,992.96
(12) ($3,102.31)
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x.045
x.12
x.15
(15)
(16)
(17)
(18)
(19)
$0
$0
$0
Decedent's Complete Address:
STREET ADDRESS
65 Rustic Dr.
CITY STATE ZIP
Shippensburg PA 17257
.
Tax Payments and Credits:
1. Tax Due
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discounts
Total Credits (A+B+C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
TotallnterestlPentalty (D+E)
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
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(1 )
(2)
(3)
(4)
(5)
(5A)
(5B)
$0.00
$0.00
$0.00
$0.00
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 transerred or its income:
c. retain a reversionary interest: or
d. retain the promise for life of either payments 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 disignation?
D
D
D
D
D
D
D
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~
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare that I have examined this r m, i uding accompanying schedules and statements, and to the best of my knowledge and belief, it is tru&, correct and
complete.
., Washington, NJ 07882
DATE ;;J. - ~f-o~
DATE 2 - '2lr -cf) >
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% [72P.S. Sec.
9116(a)(1.1)(I)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value oftransfersto or for the use of the surviving spouse is 0% [72 P.S. Sec. 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 deseased 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. Sec. 9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.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. Sec.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.
Mellon Investor Services
P.O. Box 3333
South Hackensack, NJ 07606
January 31,2005
~ Mellon
JOSEPH F DOERW ANG
ATTN TAYLOR P ANDREWS
78 W POMFRET ST
CARLISLE PA 17013
1~=';;~__i~T_L~, ~~. - H
i Account Key 'jDOERW ANG-
: :JOSEFOOOO
I 't
IInvestor m..#_."~.Q?}~?3.7~Q~0
Control 1[200501310002931
I Number i
I .._ ." " __ ..... . ......._
Dear Sir or Madam:
Thank you for contacting Mellon Investor Services regarding the above referenced MetLife, Inc.
common stock account.
Please be advised that as 03/14/04 was not a business day we are unable to provide you with the closing
price as of that date. We are enclosing the closing price of the stock as of the nearest working days:
DATE
2004-03-12
2004-03-15
2004-03-16
CLOSING PRICE
$ 34.3000
$ 34.0100
$ 34.1600
As per your request we have also sent in the legal transfer instructions and the instruction for sale of
stock which you will receive under a seperate cover.
If you have any additional questions or concerns, please call our Customer Service Center at 1-800-649-
3593. You may also access your MetLife, Inc. common stock account on the Internet at
https://vault.melloninvestor.com/isd.
Sincerely,
Mellon Investor Services .
SCHEDULE B
STOCKS AND BONDS
ESTATE OF
FILE NUMBER
Doerwang, Joseph F.
21-04-0363
ITEM
NUMBER
All property jointly-owned with Right of Survivorship must be disclosed on Schedule F
DESCRIPTION VALUE AT DATE
OF DEATH
66 shares Metlife @ $34.3 per share
$2,263.80
TOTAL (also on line 2, Recapitulation)
$2,263.80
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Joseph F. Doerwang
Include the proceeds of litigation and the date the proceeds were received by the estate
All property jointly-owned with Right of Survivorship must be disclosed on Schedule F
DESCRIPTION VALUE AT DATE
OF DEATH
21-04-0363
ITEM
NUMBER
Manufactured double-wide home at 65 Rustic Dr., Southampton Township,
Shippensburg Post Office, P A 17259
as per agreement of sale in arms length transaction to unrelated party.
$32,900.00
2
1995 GMC pick-up truck - high mileage [175,000] - sale price to unrelated buyer
$300.00
3
Miscellaneous furnishings - proceeds of sale Kenny's Auction House
$2,444.00
4
M&C (Menlo Park) FCU account 250-RG
$127.32
TOTAL (also on line 5, Recapitulation)
$35,771.32
A.
"onn Approved
OMB NO U.(t.UOl
B. TYPE or LOAN
I. 0 rmHA a. 0 CONV. UNINS.
i. 0 CONV. INS.
I", ~1Ul NUIIlDe,,:
i
8. MONace IDaldD~e Cue Num.ber:
SETTLEMENT STATEMENT
U. S. DEPARTMENT or HOUSING AND URBAN DEVELOPMENT
1.0 rHA
'.0 VA
.. ... ~WIlbe...:
C. NOTE: Thu form U furlli.hed 10 sive you a '1Glemenl of aclual ,el/lemenl co.'" Amounl. paid 10 and by Ihe .eltlemenl agenl ore
.hown. lIe"" /fIMked "(p.o.c.)" were paid o,,,"ide Ihe clo.ing; Ihey are .hown here for informalional p..rpo.e. and ore nol
included in Ibe 101GI..
D. NAME OF BORROWER:
JOHN G. CRIDER AND
BARBARA N. CRIDER
E. NAME or SELLER:
JOSEPH DOERWANG ESTATE
F. NAME OF LENDER:
G. PROPERTY LOCATI0N:
H. SETTLEMENT AGENT:
65 RUSTIC DRIVE
SHIPPENSBURG, PA 17257
HALE REAL ESTATE
I. SETTLEMENT DATE:
PLACE or SETTLtIlENT:
14 WEST KING STREET
SHIPPENSBURG, PA 17257
.. SUMMARY or BORROWER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORR0 Jl'ER:
101. Cootr.....I.. prl.. 32 .900.00
102. PertonaJ property
103. Settlement ~bUle. to borrower (line 14(0)
104.
10&.
.4/iilJllmenl.l (or ileml paid by WIer in adwnce
to
to
236. 71
to
213.
21'.
21&.
216.
217.
218.
219.
220. TOTAL PAID BY/FOR
BORROWER 500.00
300. CASH A T SETTLEMENT FROM/TO BORROWER
301. GIoao........II. due from bo......./Iine 120) JJ, 1JlI. 11
301. Lea _OWl" paid lIT/lor bono_ /line 220) ( 5UU. UU)
303. CASH ( EI FROM) (( I TO) BORROWER
32,638.71
:;;Z";~
$~ '-j ~~
JANUARY 6, 2005
K. SUMMARY 01' SELLER'S TRANSACTION
400. GROSS AMOUNT DUE TO SELLER:
401. Contract ....e. priee ~., ann nn
402. 'enoDal property
403.
404.
40i.
AdilJllmenl.l (or ileml mid by oeUer in advance
406. CitYltown lase. '0
401. Coun.y.....Ol/07/05 to 12/11~ 7'lR 71
408. A...umentl . to
409.
410.
411.
412.
420. GROSS AMOUNT DUE
TO SELLER 33, 13B. 71
500. REDIICTIONS TN AMnllNT DltE TO SELLER:
&01. Esee.. cteftoalt (let imtructiOl'UJ
i02. SdU.mant .b'. e. to oelle1r mne 14001 1 974.00
&03. E_f_I--loan I taken suhled to
&0'" ..-ft.1f of flni mori8:..e lout 28,067.82
&06. .....off 0' -.......ct mo.....e 10."
&08
&01.
808.
i09.
AmlJltmenl.l (or ite"" IJIIIlIJid bv IelIer
510. ctb'/toWll &uel to
ill. Coulltytue. 01/01/04 to 12/31/04 1l1.Q7
&12. ~....eDtl to
i13. SCHOOL 07/01/04 - 07/30-05 477.44
i14.
i1i.
i18..
&11'.
i18.
il'.
520. TOTAL REDUCTION AMOUNT
DUE SELLER 30,631.23
600. CASH A T SETTLEMENT TO/FROM SELLER
801. GIO. _OWl' due to -. /line 420) 33,138.71
801. Lea6 nduetiou III _OWl' duo .0.. (line 520) IllO,631.23 I
603. CASH ( It! TO) (0 FROM) SELLER 2,507.48
~~ HUD-I (5-76)
It;~
;.
~~~
-2-
L. SETTLEMENT CHARGES
700. TOTAl. SALES/BROKER '5 COMMTSSION ba..cd on price '32,900 @6 % 1 ,~/4.( UPAlD FROM PAlD FROM
/Jivi.ion of Commillion lUne 700) a. follow$: BORROWER'S SELLER'S
TOt. . '0 HALE REAL ESTATE FUNDS AT FUNDS AT'
to SETTLEMENT SETTLEMENT
T02. .
703. Commission paid at Settlement 1,~/4.UU
704.
800. ITEMS PA Y ABLE IN CONNECTION WTTH LOAN
801. Loan OriDnatioD Fee ,.
802. Loan Discount ,.
803. A......raisal Fee '0
804. Credit ReDort '0
805. Lender's Inspection Fee
806. Mort.....e Insurance Application Fee to
8',.. Assumntion ".ee
808.
809.
810.
811.
900. l1'EMS RfXlU1RED BY LEJliDER TO BE PAID IN ADVANCE
901. Interest trom '0 .. /day
~02. Morta.lIle Insurance Premium for months to
903. Hazard Insurance Premium for . years to
904. years to
905.
/000. RESERVES DEPOSITED WITH LENDl':R
1001. Hazard insurance month. . . per month
1001. Mortcaae insurance months" . per month
1003. City property taxes months" . per month
1004. County property taxes months. . per month
1005. An~ual useuments months. . per month
1006. month. . . per month
lOOT. months. . per month
1008. months. . per month
1100. TTTLE CHARGES
110t. Settlement or claDnC fee '0
1102. Ahstraet or tiUe search '0
1103. Title examination '0
1104. Tttle insurance binder '0
1100. Document preparation '0
1106. Notary fees to
1107. Attorney's fees to
(inducIe. above ileml number., )
1108. Title insurance to '-
(includes abofle item. numbe",
1109. Lender'. cover..e .
1110. Owner'. coverqe .
1111.
1112. I
1113. I I
/200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Reeol.UnR fees: Deed' ; Mortp&e . ; Rele... .
1202. City Icount)- tax/stamp.: Deed' ; Monaace .
1293. State tax/st Imps: Deed' ; Monpae .
120-4.
120&.
1300. A1JlJlTIONAL SETTLEMENT CHARGES
1301. SUl'Vey to
1302. Pest in.pect ion '0
1303.
1304.
]305.
1400. TOTAL SJ<;TnEMJ<;NT CHARGES (enler onlin.. 103 Section J and 502 Section KJ 1,974.00
HUD-l (5-76)
NOTICE:
SEE REVERSE SIDE FOR IMPORTANT INFORMATION
M & C (Menlo Park) FCU
C/O Engelhard Corporation
101 Wood Avenue South
Iselin NJ 08830
732-205-5199
~250
100023
Social Security No.
Please report address corrections using
the form on the other side of this
statement. Send ADDRESS CHANGES ONLY
to: M&C (Menlo Park) Fed. Credit Union
PO Box 12
Iselin, NJ 08830
JOSEPH F DOERWANG
65 RUST! C DRIVE
SHIPPENSBURG PA 17257
626
Please report account discrepencies to
Lori Joyner, Supervisory Committee Chair
at 732-205-5002. Thank you!
1'11111...1..1.1.1.1.1...11.1...1..1.11.....11.11...1.1.1,1.11
Statement Period
Transaction T t I Account Payments I FINANCE: Account
ransac Ion . .
Date Acllvlty Advances CHARGE I Balance
Page:
1
-.......- 010104 .. 033104
10104 Beginning Balance
10104 DIVIDEND 0.32
A dividend of $0.32 will be posted on 4/01/04
APYE for Dividend Period 1/01/04 Through 3/31/04 is 1.01%
127.00
127.32
-------------------------------------------------------_._-----------------------
The FINANCE CHARGE is
computed by multiplying the unpaid
balance(s) by the (daily) periodic rate (at
the equivalent ANNUAL PERCENT-
. ~E) applied to the unpaid loan SH - RG
."-.../,ance(s) at the time of the loan pay-
ment for the period that balance(s) was
outstanding; balance(s) change each time
new amounts are advanced or payments
lUA mRdA or crAdit!': nivAn.
New DIvidends I Year-To-Date ANNUAL Periodic
IdentificatIOn Balance Credited FINANCE PERCENTAGE I rate %
This Year CHARGE RATE (Daily)
127.32
0.32
Kenny's
Auction
4401 PHILADELPHIA AVENUE . CHAMBERSBURG. PA 17201 . (717) 264-6578
Consignment Check-In
(\/\ " ._ i . ^
Name:~Jej. LJoe-rtl!o- (\i
Address: /_5 1:: \ L I /1 U t~-^Si-- ;
'.3 I I. J . 1 j > .-
Wi1Sn IIlJ{171 IJ" e {S4.(j () 7 2~ J..
Phone: q 08 - (p fq - 'I ol7,~
Lot Number: .
t.fb1
Taken In By: }.J T ()
--
Description of Items Consigned:
t . - ~~~~
("(", s. 0 to "( Ct:L .S,C<.) I b t2.d r() [i)",,, 'S e--L 2. f) I k. s .t-c-<:.~ ~
I
Bon .~ 'SJ~t' tL.;e S ;;L l i '?l h ~ s
. . ,) .
I(l/n (\IQ~s '~ii) Cot-fer' !-c::;,ble t<oU -tv,) d.e::>K IC..k.C.l~-
I I r 'Yl /1lcA ~ <,hrp I n r'\ -f-c,," bLe tc oed c.-,k~~ l
\~ \J-.e. l L..:. * L;~. c' In., ~. s t='o \ d Q~a t; bed.
') , -'. / ..,
J lC()~!l rkl.."" c~L.r: A"'?(
I commission you to auction the items above to the highes1 bidder by public
auction. I certify that I am the owner of the above listed goods and have
good title and the right to sell. I' understand that I will receive a check in the mail
once my items have been sold only if the total sale exceeds the $75 minimum
pick up/commission fee (if my items total less than $75, I will receive no payment "
and be billed for the diff~rence) I also understand that I will be charged for <l. \ ~ ,.::0 Sc\. \ ..-
disposal of any items that fail to sell. . f- h..L. b"Oi.-J's a.00lA.:.-\::...\ ~~<:..
Special Instructions: ~\ \ I)'^"~ ~t I~ [n. lh:'7"I--\r-es S I 0, n "soJ.Q
\ I I
'1 ~.-.... , ., f.) C I
Commission Fee: .J.....). Ofii? '". Date: ,o( I v D I () LL.
.,. \ -,' m,' ·
. \ ,- /; f';'
, i. /
Seller's SigRature: it...>'.
/'
,:J....
--)
\--.,r-
Thank you for using Kenny's Aucti services. We are proud to be
serving this community for over 20 years! Please keep this receipt. Should
you have any questions, please call us at 717-264-6578.
?, '2-0
'-" --
d({!/2
= $ 7t1tJ.-
1.(3/
. /# ,4 wdf' &1
~7
~bl!i!ilJ _@ = $ 35" .-
'/
-@
9
BUYER
ITEM
11 ... 13/
BUYER -r
ITEM ~/n;~~. .h1...!'"~/
~
~ _@ = $ 6,{'.-
13
BUYER
1..(5/
.:2 - {;n('/ Zd~
~
~ 2, @ Jt7tJO = $ -/0 .
ITEM
.s9'
15
BUYER
ITEM d. - ~tf
~ /
)~ 2-@ 5't)() = $ /0.
HEET # .3 ' t),l)7> SHEET TOTAL $ ,;"lJ..c;y. DQ
I
3
,~
_@ = $ I (l . -
IUYER
~~4f' ~JV
= $0100.-
RUNNING TOTAL $
2 ~~:ER~7;FiM
LOT #
'/)
1{; '( @
;2/ LI '\
if -c4o-u r
$ _?25:-
4
BUYER
77
{~L~t..(->C
ITEM
LOT #
h lfl1
@ = $ 7.50 ,,'-
.
6 BUYER ,;20 Z _
ITEM /.h;-v~~ ~
~
)bl!fJL1j _@ = $ 3S · -
8
BUYER
/,.57
J-kTYJ ,13~4L z;.j~
= $ 6'5'. -
ITEM
LOT #
'1.6 '1
@
10
BUYER
ITEM Od
~
~-@
1,;(3
~cu/7
= $
iI.--
12
BUYER
~eck~
tlJj'
ITEM
LOT #
b Lt6 7
@ = $ 9(1.--
/61
14
BUYER
ITEM
= $
5'.-
16
BUYER
= $
~GC} .
. -' ..- ..
0'*
210-+
8,80 .. +
1'3540+
2 , 4' L~ 4 . *
2,44<'.':<
35'%
855'4
1,580-6:;;
_ o.,;c
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
Doerwamz. Joseoh F. 21-04-0363
if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G
Surviving Joint Tenant (s):
NAME
ADDRESS
RELATIONSHIP TO
DECEDENT
A Michael T. Doerwang
B
C
18 E. Church St., Washington, NJ 07882
Son
Jointlv-owned property:
LETTER FOR DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF TOTAL V AWE OF DECD'S % INT. DOLLAR VALUE OF DECEDENTS
ITEM NUMBER
JOINT TENANT INSTITUTION AND BANK ACCOUNT NUMBER OR ASSET INTEREST
SIMILAR IDENTIFYING NUMBER. ATTACH DEED
FOR JOINTLY-HELD REAL ESTATE
1 A 11-Jun-96 Orrstown Bank - checking $6,332.37 50% $3,166.19
account #689661
2A 26-Jun-96 Orrstown Bank - checking $3,378.70 50% $1,689.35
account #34445
TOTAL (also on line 6, Recapitulation)
$4,855.54
~~
ORRSTOWN BANK
TO: Andrew & Johnson
Attorneys at law
78 West Pomfret Street
Carlisle, PA 17013
FROM: ORRSTOWN BANK
P.O. BOX 250
SHIPPENSBURG PA 17257-0250
RE: ESTATE OF Joseph F Doerwang
DATE OF DEATH: March 14, 2004
DECEASED
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE
FOllOWING ACCOUNTS WITH ORRSTOWN BANK:
(3)
CHECKING ACCOUNTS
DATE OF DEATH
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST
689661 Joseph F Doerwang 6/11/96 6,332.30 .07
Michael T Doerwang
SAVINGS ACCOUNT
DATE OF DEATH
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST
34445 Joseph F Doerwang 6/26/96 3,378.70 2.40
Michael T Doerwang
CERTIFICATES OF DEPOSIT
DATE OF DEATH
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST
(1 )
5/4/ 04 By Timothea Customer Service Operator
P.O. BOX 250
.
SHIPPENSBURG. PA 17257
TEL. (717) 532-6114
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
FILE NUMBER
ESTATE OF
21-04-0363
Doerwang, Joseph F.
ITEM
NUMBER
A.
1
2
3
B.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
Funeral Expenses:
DeVoe Funeral Home, Washington, NJ
Primrose Path Florists
St. Ann's Catholic Church, Hampton, NJ - for burial costs
Administrative Costs:
Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
$4,000.00
$146.10
$1,550.00
Zip:
City: State:
Year(s) commissions paid:
Attorney fees to Andrews & Johnson
Family Exemption
Claimant
Street:
City: State & Zip
Relationship of Claimant to Decedent:
Probate Fees to Register of Wills
Accountant Fees to Patricia Rosendale, CPA
Tax Return Preparer's Fees
Lot rent for decedent's empty home
Electricity for decedent's empty home
Gas for decedent's empty home
Water for decedent's empty home
Insurance for decedent's empty home
Repairs of water leak at decedent's empty home
Bank charges - estate account
Kenny's Auction - commission on sale of personalty
Real estate taxes
$2,000.00
$129.00
$200.00
$2,100.00
$159.75
$131.53
$493.87
$297.60
$103.99
$18.99
$855.40
$492.44
TOTAL (also on line 9, Recapitulation)
$12,678.67
SCHEDULE I
DEBTS OF DECEDENT
MORTGAGE LIABILITIES AND LIENS
ESTATE OF
FILE NUMBER
Doerwang, Joseph F. 21-04-0363
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
Medical bills
$934.64
2
JR's Auto service - auto repairs due at death
$122.96
3
Sprint
$57.08
4
AT&T - cell phone
$13.71
5
Capital One - account 4305722346204228
$1,331.91
6
Bank One - account 5466759990063338
$1,619.53
7
Purchase money installment loan [secured by mobile home]
due to Waypoint bank
$29,234.46
TOTAL (also on line 10, Recapitulation)
$33,314.29
t'lWayl=tqiflJ
January 3,2005
Andrews & Johnson
Attorneys at Law
78 West Pomfret Street
Carlisle P A 17013
Re: Estate of Joseph F Doerwang
Dear Mr. Andrews
Weare writing in response to your faxed request for information regarding that above
customer account. The account is a mobile home installment loan and was held solely by
the deceased. The principal balance as of the date of death was $29,234.46, with the
interest balance being $121.75 for a total of$29,356.21 as of March 14,2004. Please note
that this figure is not a payoff as of the date of death.
We hope that this satisfies your needs, however should you have other questions, please
feel free to contact the Loan Servicing Department at (800) 554-5472, extension 2100.
Respectfully,
I" .
~hOY\'i-~ch
Shannon L Deatrich
Loan Servicing Team Leader
WaypointBank
P.O. Box 1711. HARRISBURG. PENNSYlVANIA 17105-1711
Toll Free 1-866-WAVPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
D
J
hF
21 040363
oerwan, oseot - -
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributioos, and transfers W1der Sec. 9 I 16(aXl.2)]
1 Paul Jude Doerwang, 76 S. Lincoln Ave., Son 1/2
Washington, NJ 07882
2 Michael Thaddeus Doerwang Son 1/2
15 E. Church St., Washington, NJ 07882
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
None
B. Charitable and Governmental Bequests:
TOT AL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation)
$0
~.
.q
~
s:
~
a
lad. aua
ol
(~nmeuf
JOSEPH F. VOERWANG
..
~:i ,
"J ' :the
JOSEPH F. VOERWANG, ~e6iding at 26 Beethoven Avenue, ~n
Bo~oug h 06 Wa..6 hing-to n, . Coun-ty 06 WaJVte.n a.nd s-tate. 06 New J eJL.6 ey, being
06 .6ound a.nd cU..6po.6ing mind, me.mo~y a.nd undVl..6.ta.nding, do h~eby ma.ke.,
b!:l !l.evofU-ng
publi-6h a.nd de.c1.aJc.e. -th.Lo -to be. my La..6-t W-ill a.nd Te6.ta.ment, h~e
a.ny a.nd a.U o-theJt WLU.6 OIL CocUUL6 heJtetonolLe. ma.de. by me.:
.:t6 a.nd
FIRST: I olLdeJt a.nd cLiJc.e.c;t -that a.U 06 my ju.6:t deb
, rz;tl!:l be
6unvz.a..t e.xpen6e6 be. pdid a..6 .6oon a.6.teJt my death a..6 c.a.n c.onve.~e
done..
. !l.eJ>idue
SECONV: I give., de.vi.6 e. a.nd be.que.ath a.U .the !l.eAt,
,J"en PAUL
a.nd lLe.mdindeJt 06 my e6-tate., bo.th ~eai. a.nd pVl..6onai., .to my c.hilwLo ,
fJ;.:telY a.nd
JUVE VOERWANG a.nd MICHAEL THAVVEUS VOERWANG,to be. .the>>cA a.b.60
.. , d!!.en .6 hou1.d
6 olLe.veJt, .6ha.tte. a.nd .6ha.tte. ilike.. 16 e..U:heJt 06 my a.nolLe6a..i.d c.hll
. dec.eM ed
plLe.de.c.e.a..6 e. me. te.a.ving i.6.6 ue., .the.n I cLiJc.e.c;t .that .the. .6 ~e 06 my
u.ed p!l.e.de.c.e.a..6 e.
c.hil.d go .to .6did i.6.6ue.. In e..U:heJt 06 my a.601Le6did c.hil.dJLe.n .6 ho
d c.hild go
me. te.a.ving no i.6.6ue., .the.n I cLiJc.e.c;t :that :the. .6 ha.tte. 06 my de.c.eM e
-to my .6U1Lviving .6on.
tfI),h c..e.a.u.6 e.
THIRV: 16 my .6did GILa.ndc.hil.dlLe.n aJte. minoM whe.n
u.ed not be
06 my w.i.i1. be.c.ome6 e.66e.c.tive., a.nd i6 my .6did glLa.ndc.hil.dJr.en .6ho
, ing So n M
21 ye.a.JL6 06 a.ge. at :the. time. 06 my de.c.e.a..6e., I a.ppoin.:t my .6uJLV~v
without bond
TILu..6.te.e. 06 .the. plLopeJt:ty 06 my .6did GILa.ndc.hildILe.n, he..to .6~ve . .
:th .... :.,.' ,. J: ~ .,. : d:t ha. [.. 0 0 ow~ a.nd a.uthoM:ty
OIL 0 eJt .6e.C.WlAA,.y ~n a.ny jU/l.,{,6u-l.l:AA..on, a.n 0 ve. nlUA- P d
, he.6 ha.U hot
.toe.xpe.nd bo.th .the. C.OlLpu..6 a.nd .the. inc.ome. 06 .the. plLopeJdy whic.h [
duC.a;UO}t 0 u
a..6 .6uc.h gu.aJr..cUa.n a.l'I.d btu..6:te.e. 60~ -the. mdin-te.na.nc.e., we..tnaJLe a.nd e
my .6a.id gMndc.hil.dlLe.n.
FOURTH: I h~e.by C.OM.tli.u.te. and appoin-t my SOM, PAUL JUVE
VOERWANG and MICHAEL THAVDEUS VOERWANG Co-Fidu~e.6 06 -th..Lo my Will. 16
e);th~ 06 my SOM .6hou.td die. be.6o~e. I do, o~ i6 U:th~ 06 my SOn6 and I .6hou.td
die. in a c.ommon c.ata.6:tJtophe. o~ a.6 a ~e.6uR..:t 06 .6a.me., and i6 e);th~ 06 my SOM
having .6Mvive.d me. .6ha.ll .oO~ any ~e.Mon .om to quili6Y o~ having quili'Me.d
.6ha.U 6a-U :to ad M Fiduu~y, I :then cLiJc.e.d :that my .6Mviving Son ad M
.60.te. Fiduc.iaJr.y. No bond o~ o-th~ .6e.c.MUy .6ha11. be. ~e.qtWte.d 06 eA..:th~ 06 .6a.id
pVl..60M in any juJU.6dic;t[on 60~ -the. 6aLth6lLi p~60~anc.e. 06 -thw ciu;t{.u. I
e.mpow~ my .6a.id FiduuaJU..u to .6e.U any ~e.a..e. u-tate. o~ any paJL:t :th~e.06 o~
in.:t~ut :th~un 06 whic.h I may die. .6uze.d, U:th~ at pubLic. o~ p~vate.
.6ai.e., at .6uc.h time. and upon .6uc.h -t~ and 60~ .6uc.h pMpO.6e. M -to .6a.id
Fiduu~e.6 .6ha11. .6e.e.m p~op~ and :to e.xe.c.ute. and de.Uv~ pJr.op~ c.onve.yanc.u
ioJr. :the. .6a.me. in .taw.
IN WITNESS WHEREOF, I have. h~e.un.:to .6e.:t. my hand and .6e.ai. -th..Lo
:l#da.y 06 NOVEMBER, in -the. Ye.~ 06 OM LOJr.d, One. Thou.6and N.i.ne. Hun~e.d
and Ug h:t.y - ug h:t..
),t1PH~: b~
~
SIGNEV, SEALED, PUBLISHEV & VECLAREV by :the. Tu-tato~, JOSEPH F.
VOERWANG, :to be. h..Lo La.6:t W-ill and Tu-ta.me.n.:t, in OM pJr.e.6e.nc.e. and in -the. p~Ue.}tc.e.
06 e.ac.h 06 u.6, we. bung pJr.e.6e.n.:t at the. .6a.me. time. and we. at h..Lo Jr.e.quu-t, and in
h..Lo pJr.e.6e.nc.e. and in :the. pJr.uenc.e. 06 e.ac.h oth~, have hVLe.un.:tO .6igned OWL na.me.6
~?
..------~ ~
i
-----.\
Re.oidirtJg at .:.: ,;/~ M T
~ '/ '~j
Re6~Mn9 ~~~ vO
("
WELTMAN, WEINBERG & REIS CO., L.P.A.
A TTORNEYS AT LAW
175 South Third Street, Suite 900
Columbus, Ohio 43215
800.325.9965
614.801.2710
www.weltman.com
BURLINGTON, NJ
609.914.0437
CHlCAGO,IL
847.940.9812
CINCINNA n, OH
513.723.2200
CLEVELAND,OH
216.685.1000
DETROIT, MI
248.362.6100
PHILADELPHIA, PA
215.599.1500
PITTSBURGH, PA
412.434.7955
March 10,2005
Cumberland, Register Of Wills
One Courthouse Square
Carlisle, PA 017013
f".)
Re:
Estate of Joseph F Doerwang
Case No. 21-2004-363
Our Client: Mobile Consultants, Inc.
Account No. 31829
Balance Due: $27,988.26
Our File No. 4051422
i~)
rv
,)
Dear Clerk of Courts:
This law firm represents Mobile Consultants, Inc. in connection with ils claim which we wish to file on our client's behalf into
Ihe eslate of Joseph F Doerwang, deceased. Enclosed is our check in the amount of $1 0.00 which we undersland is the filing
fee for this claim.
Our client's claim is based upon its account number 31829 in the amount of $27,988.26. As oflhe date of this letter, this is the
amount due. Included with this letter is the claim form which we wish to present to this court and which we are forwarding to
the attorney and/or fiduciary of this estate.
It would be appreciated if all correspondence and disbursements with respect to this matter be forwarded to our office and to
the attention of the undersigned. Additionally, it would be appreciated if any notices of any hearings also be forwarded to the
undersigned. Thank you for'your cooperation in this matter.
Sincerely Yours,
~~u
STEPHANIE SLAUGHTER
Aulhorized agent for the claimant
SSL:sek
Enclosures
cc: Paul Jude Doerwang
Taylor P Andrews
WWR#405l422
CLAIM FORM FOR COMPANY OR ORGANIZATION
STATE OF NEW JERSEY
COUNTY OF CUMBERLAND, REGISTER OF WILLS
CASE NO. 21-2004-363
)
The undersigned, _STEPHANIE SLAUGHTER Authorized agent for Claimant, herewith
presents and files their claim against the Estate of
Joseph F Doerwanq I deceased, for and on account of
the following described indebtedness owing by said Estate of Claimant, viz:
For a an installment loan with Mobile Consultants, Inc., Account No. 31829
Balance Due: $27,988.26(As of the date of this claim, this is the amount due.)
STATE OF OHIO
COUNTY OF FRANKLIN
Before me, the undersigned authority in and for said County in said State,
personally appeared STEPHANIE SLAUGHTER Authorized agent for the claimant, who being
first duly sworn, says that (s)he is Authorized Aqent for Mobile
Consultants, Inc., the claimant, and that (s)he has full and complete
knowledge of the correctness of the above claim against the Estate of Joseph
F Doerwanq , deceased, and the amount claimed is justly due (or to become
due), and after allowing all proper credits.
~.~ ~~tv
Authorized Agent for the Claimant
175 South Third Street, Suite 900
Columbus, Ohio 43215
20cb .
Subscribed and sworn to
",'," c, CO"~ I o+!, '" ~y( !A
~~ ?t., _
Notary Public
\""" I I
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,,-;, ~~,.I..e.!J ~',
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SEBRINA l. KEHOE
Notary Public, State of Ohio
My Commission Expires
01-17-07
WWR # 4051422
STATEMENT OF ACCOUNTS
FOR:
Mobile Consultants, Inc.
DECEDENT'S NAME: Joseph F Doerwang
ADDRESS: 76 S. Lincoln Ave
CSZ: Washin~ton, NT 07682
SSN: 262-42-8159
DOD: 03/14/04
ACCOUNT #: 31829
BALANCE DUE: _$27,988.26
EXHIBIT A
)1#
~
\'1'\\2: 4\
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
Or BUREAU OF INDIVIDUiiiTAXSS.
, CnUn!iJIERITANCE TAX DIVISION' .; ..
'v n ox Z80601 ,;
} r-'("\ H., ISBURG PA 171Z8-0601
7nnr 'Ii' '{ ')0 ,",'J ,,,. L I
."oJ (,," '- 1-11 <.' ...
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
c: EPi: (iF
ORDI '^ \J' JQ' 0r;t ,;-.,..
I Mnl v \.)~}'J ri !
TAYLOR jiUi\RDREWS<ESgi
ANDREWS & JOHNSON
78 W POMFRET ST
CARLISLE PA 17013
05-23-2005
DOERWANG
03-14-2004
21 04-0363
CUMBERLAND
101
*'
REV-1547 EX AFP (03-05)
JOSEPH
F
hount Re.ittecl
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 ~
1t~V-~Il,."ft.l'Wm~'tI!1.mtm.W'.!MfI!RW4M!'t.m.~'II\fJt~mMMT~.'lrC[!lV4M!'t.r.rr.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DOERWANG JOSEPH F FILE NO. 21 04-0363 ACN 101 DATE 05-23-2005
TAX RETURN WAS: I X I ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R8.1 Estate (Schedul. A)
2. stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property ISchedule F)
7. Transfers (Schedule S)
8. Total Assets
(1)
(2)
131
(4)
IS)
161
171
.00
2.263.80
.00
.00
35.771. 32
4.855.54
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral ExPenses/Ad.. Costs/Misc. Expenses [Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. N.t Value of Tax Return
13. Ch.ritabl./Gov.r~ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
191
(10)
12,678.67
33.314.29
1111
1121
1131
1141
NOTE: To insure proper
credit to your account,
sub.i t the upper port ion
of this form with your
tax pay_nt.
42,890.66
41;.99:> 96
3,102.31-
.00
3,102.31-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: I~ an assessment was issued previously, lines
re~lect ~1gures that include the total o~ ALL
ASSESSMENT OF TAX:
15. ~ount of Line 14 at Spousal rate (15)
16. ~t of Line 14 taxable .t Lineal/Class A rat. (16)
17. Amount of Lin. 14 at Sibling rat. (17)
18. Amount of Line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
TAX CRE S:
rAY" '.J AMOUNT PAID
DATE NUHBER INTEREST/PEN PAID 1-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
~
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
1191=
.00
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YDU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/06/2006
DOERWANG PAUL JUDE
76 SOUTH LINCOLN AVE
WASHINGTON, NJ 07882
RE: Estate of DOERWANG JOSEPH F
File Number: 2004-00363
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:
4/14/2006
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
Counsel
f1
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/06/2006
DOERWANG MICHAEL THADDEUS
15 EAST CHURCH ST
WASHINGTON, NJ 07882
RE: Estate of DOERWANG JOSEPH F
File Number: 2004-00363
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:
4/14/2006
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,
G~~~
Clerk of the Orphans' Court
cc: File
Counsel
V"Y
cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/06/2006
MCNEW MICHAEL A
1042 WILLOWBROOK DRIVE
CHAMBERS BURG , PA 17201
RE: Estate of RIGGINS MARGARET R
File Number: 2004-00358
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:
4/04/2006
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
Counsel
VY
IN RE:
ESTATE OF JOSEPH F. DOERWANG
DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-04-0363
FIRST AND FINAL ACCOUNT OF PAUL J. DOERWANG AND MICHAEL T. DOERWANG
EXECUTORS OF THE ESTATE OF JOSEPH F. DOERWANG
LATE OF SOUTHHAMPTON TOWNSHIP,CUMBERLAND COUNTY, PENNSYLVANIA
Date of death:
letters Granted:
Advertisement of letters:
The News Chronicle:
Cumbo Law Journal:
ACCOUNT STATED AS FINAL
March 14, 2004
April 15, 2004
March 29. April 5, 12, 2005
April 1, 8, 15, 2005
Purpose of Account: Paul J. Doerwang and Michael T. Doerwang offer this account to inform interested
parties of the transactions that have occured during this administration. It is important that the Account be
carefully examined. Requests for additional information or questions or objections can be discussed
with: Ta lor P. Andrews, Es .78 W. Pomfret St., Carlisle, Pa. 17013. Phone 717-243-0123
PRINCIPAL
Receipts
Less Disbursements
Balance Before Distributions
Distributions to Beneficiaries
Principal Balance Remaining
SUMMARY & INDEX
Paae No.
2
3
3
$37,907.80
$44,166.13
($6,258.33)
$0.00
($6,258.33)
INCOME
Receipts
Less Disbursements
Balance Before Distributions
Distributions to Beneficiaries
Income Balance Remaining
4
4
$0.00
$0.00
$0.00
$0.00
4
$0.00
COMBI~ED BALANCE REMAINING
($6.258.33)
. I \ 1
8 \ 'U '" .-.
Page 1
PRINCIPAL RECEIPTS
(Value as of Date of Receipt unless otherwise indicated)
66 shares Metlife @ $34.3 per share
Manufactured double-wide home at 65 Rustic Dr., Southampton Township,
Shippensburg Post Office, P A 17259
as per agreement of sale in arms length transaction to unrelated party.
1995 GMC pick-up truck - high mileage [175,000J - sale price to unrelated buyer
Miscellaneous furnishings - proceeds of sale Kenny's Auction House
Total Receipts of Principal
Page 2
Amount
$2,263.80
$32,900.00
$300.00
$2,444.00
$37,907.80
PRINCIPAL DISBURSEMENTS
Purchase money installment loan [secured by mobile home]
due to Waypoint bank:
Funeral Expenses:
De V oe Funeral Home, Washington, NJ
Primrose Path Florists
St. Ann's Catholic Church, Hampton, NJ - for burial costs
Administration Expenses:
Attorney fees to Andrews & Johnson
Hale Real Estate - broker's fee for selling double-wide
Lot rent for decedent's empty home
Electricity for decedent's empty home
Gas for decedent's empty home
Water for decedent's empty home
Insurance for decedent's empty home
Repairs of water leak at decedent's empty home
Bank charges - estate account
Kenny's Auction - commission on sale of personalty
Real estate taxes
Patricia Rosendale, CPA - tax preperation
Register of Wills - filing fees
The News-Chronicle -legal advertising
Cumberland Law Journal - legal advertising
Unpaid Claims [general creditors] =
Capital One account - $1,331.91
Bank One account - $1,658.81
TOTAL DISBURSEMENTS OF PRINCIPAL
DISTRIBUTIONS TO BENEFICIARIES
None
TOTAL DISTRIBUTION OF PRINCIPAL TO BENEFICIARIES
Page 3
I
$29,234.46
$4,000.00
$146.10
$1,550.00
$2,000.00
$1,974.00
$2,100.00
$159.75
$131.53
$493.87
$297.60
$103.99
$18.99
$855.40
$492.44
$175.00
$257.00
$101.00
$75.00
$44,166.13
$0.00
INCOME RECEIPTS
None
Total Receipts of Income
None
INCOME DISBURSEMENTS
Total Disbursements of Income to Beneficiaries
Page 4
$0.00
$0.00
$0.00
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
Paul J. Doerwang ,being duly sworn according to law, deposes and says that
the Account as stated is true and correct, and that the Grant of Letters and the first complete
advertisement thereof occurred more than four (4) months before the filing of the Account.
~~o~
ul J. Doerw?l:' j .....--
Sworn and subscribed to before me
this i.3 day of ~"). d DO<.o
SUSAN FUM~}\kzq
QAWr PIIJUC Of NEW J~V
~~ J2I2a/200;
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
Michael T. Doerwang ,being duly sworn according to law, deposes and says that
the Account as stated is true and correct, and that the Grant of Letters and the first complete
advertisement thereof occurred an four (4) months before the filing of the Account.
Michael T. Doerwang
Sworn and subscribed to before me.
this J~ day of ~0 d{)tJ/P
~'Y) ~~~
SUSAN FLEMING
NOr~~ PUSUc OF NEW J&SIV
Com~n ~ B2/afJJ'm
-
IN RE:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
JOSEPH F. DOERWANG
DECEASED
ORPHANS' COURT DIVISION
NO. 21-04-0363
NOTICE OF FILING ACCOUNT
NOTICE IS HEREBY GWEN that Paul J. Doerwang and Michael T. Doerwang,
Executors of the Last Will and Testament of Joseph F. Doerwang, Deceased, has this date filed
the First and Final Account in the above-captioned Estate in the Office ofthe Register of Wills in
and for Cumberland County, Pennsylvania, where the same are filed as public records and may
be inspected. There is no schedule of proposed distribution because the estate is insolvant.
YOU ARE FURTHER NOTIFIED that any exceptions or objections to said Account
must be filed in writing at the Office of the Register of Wills aforesaid prior to the confirmation
of said Account, scheduled as set forth below.
UNLESS written exceptions or objections are filed prior thereto, said Account will be
presented to the above-captioned Court in Courtroom No. I of the Cumberland County
Courthouse, Carlisle, Pennsylvania, at 9:30 o'clock A.M. prevailing time, on Tuesday, June 20,
2006, at which time said Account will be confirmed.
ANDREWS & JOHNSON
Date of Notice: Y. -(8 ,. d~
By:
ax r P. Andrews, Esq.
tomeys for the Estate of
Joseph F. Doerwang
TO: Weltman, Winberg & Reis Co., L.P.A.
Attn: Allen J. Reis, Esquire
175 South Third Street
Suite 900
Columbus, OH 43215
Estate Information Services, Inc.
ATTN: NATASHA McDANIEL
5330 East Main Street, Suite 2001
Davis Professional Building
Columbus,OH 43213
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Register of Wills of Cumberland County
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
:S<:;5.e.p~ F' !1e1vJa",,;
:3 - I V: - ZLJO 1
J-( -OC{- -()~')
Date of Death:
Estate No.:
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 0 No ~
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete: g - (- O~
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
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 0 No 0
Date:
Telephone No.
"7....
(.;_:~ t
Capacity: 0 Personal Representative
~ Counsel for personal representative
{l)
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
1
'J .;!, e p h ,C'. i::J 0 t" r W Cl '" .5
Date of Death:
3- J'i - Ci.f
2 1- o'i - 0:'\4 ;
Estate No.:
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 ofthe estate is complete:
Yes 0 No Ul
2. lfthe answer is No, state when the personal representative reasonably believes that
the administration will be complete: U 1"1 {' ~ yo- l' c, \ v1
)( lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
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 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed wi t Clerk of the Orphans' Court and may be
attached to this report.
Date: l.\ .,13- u ~
M l C l-'\ Co ~ \ T. D 'C ~ r W " .., j
Name
15. E. Chl..ll--ch st.
Address VV c'.5 J, ; (l 5 r Q (l I ,oJ ]'" 0 1 ~~ :l
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Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/20/2007
ANDREWS TAYLOR P
78 W POMFRET STREET
CARLISLE, PA 17013
RE: Estate of DOERWANG JOSEPH F
File Number: 2004-00363
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:
3/14/2007
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)
rrl
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle! PA 17013
Phone: (717) 240-6345
Date: 2/20/2007
DOERWANG PAUL JUDE
76 SOUTH LINCOLN AVE
WASHINGTONt NJ 07882
RE: Estate of DOERWANG JOSEPH F
File Number: 2004-00363
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 RULESt NO. 103
SUPREME COURT RULES DOCKET NO. 1t for decedents dying on or after
July 1t 1992t the personal representative or his counsel! within two
(2) years of the decedent's deatht shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
3/14/2007
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
~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/20/2007
DOERWANG MICHAEL THADDEUS
15 EAST CHURCH ST
WASHINGTON, NJ 07882
RE: Estate of DOERWANG JOSEPH F
File Number: 2004-00363
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:
3/14/2007
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,
~~~
~ f'
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
o
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF ev (.tA.~ 1Lr I o.~
COUNTY, PENNSYLVANIA
Name of Decedent:
5~s~pL, F. (1u~9
r
Date of Death:
:5 -I <f - or-
File Number:
'Joe 'f - 00 ~3
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: . . . . . '. . . . . . . . . . . . . . . J!fl...Yes 0 No
2. lfthe answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . .. ~Yes DNo
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. DYes DNo
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this report.
Date
3 .... Co ~o"
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Capacity: DPersonal Representative }VCounsel
-ro.{(c, Po. A-AJr~;; ( t.:s i.
Nameof:;iFiIi~:FormR, -.. fref 5,f-
Address G(" {,51 -( P 4- 17~ / ~
,
'1/7 ;;ziJ>-e>(Z~
Telephone
Form RW-JO rev. JO.J3.06
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