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Home My WebLink About02-0286Estate of KEVIN M. DALTON also known as PETITION FOR GRANT OF LETTERS No.~I I "O ~__- GARY L. DALTON Petitioner(s), who is/are 18 years of age or older, apply)les) for: , Deceased Social Security No. 174-58-0329 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ~ [] Decedent, dated and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence GARY L. DALTON JUDITH A. DALTON I FATH E R MOTHER 343 OAK DRIVE NEW CUMBERLAND~ PA 17070 6040 EDWARD DRIVE MECHANICSBURG~ PA 17050 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 6040 EDWARD DRIVE~ MECHANICSBURG, HAMPDEN TOWNSHIP (list street, number and municipality) Decedent, then 38 years of age, died MARCH 2 ,2002 , at HOLY SPIRIT HOSPITAL~ CAMP HILL~ PA Decedent at death owned property with estimated values as follows: (Location) (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 ........................................................................................ $ Total Real Estate situated as follows: NONE 50~000.00 50~000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence Signature GARY L. DALTON 343 OAK DRIVE NEW CUMBERLAND~ PA 17070 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and afffirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this 19th dayof .~ ~v~z~RCH 2002 DECREE OF REGISTER Estate of KEVIN M. DALTON also known as Deceased Social Security No: 174-58-0329 Date of Death- 3~2~02 AND NOW, MARCH 19~ 2002 , 2002 , in consideration ofthe Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters O Testamentary ~ of Administration ((c.ta., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) are hereby granted to GARY L. DALTON in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ 1 15.00 Short Certificates(s) ............... $ 12.00 Renunciation .......................... $ 5_ 00 Extra Pages ( ) ...............$ I.T.R ....................................... $ JCP Fee ................................. $ ~. nn Inventory ................................ $ Other ...................................... $ TOTAL ............................. $ 137.00 called attny on 3-19-02 Signature Attorney: MURREL R. WALTERS~ III I.D. No: 24849 Address: 54 EAST MAIN STREET MECHANICSBURG PA 17055 Telephone: 717-697-4650 DATE FILED: MARCH 19. 21302 Estate of KEVlN M. DALTON also known as , Deceased RENUNCIATION The undersigned,JUDITH A. DALTON~ mother (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters of Administration be issued to Gar*/L. Dalton Witness my hand this 8th da,, of March 2002 6~h~aEdWard Drive (Sig,~ture) nicsbur~l (Address) PA 17050 of (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this °~ ~/'/' day of Notary Public i Notarial Sea~ My Commission Expires: I Diane M. Smith, Notary Public I Mechanicsburg Boro, Cumberland County I My CommissIon Expires June 22, 2004 (.Signature and sea! of Notary or other off~ci~ qualified to administer oaths. Show date o1' expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 IN THE COURT OF CO~ON PLEAS, CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF KEVIN DALTON ) ) Register's # 2002~0286 Deceased ) CLAIM To the Clerk of the Orphans' Court Division: Index and make proper entry in your official records of the claim of CI~BANK(SOUTHDAKOTA)NA in the amount of $564.30 against the estate of the above-named decedent. This claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S. ss. 3532 (b) (2). The said decedent, whose last known residence was at EDWARD DR MECHANICSBURG PA 170506818 6040 Written notice of this claim was given to GARY DAL TON, Executor, 343 OAK DI~ NEW CUMBERLAND, PA 170700000 on May 8, 2002. ( C 1Aiwa nt ) KRISTEN WELLS, Manager of Citicorp Credit Services, Inc.,USA under limited power of attorney for CITIBANK SOUTH DAKOTA) NA 930 NW 110 Street, Kansas City, MO 64153 (Claimant' s Address) 05/06/2002-58 Acct. #4128003508992834 04/03/02 ~ $40.00 KEVIN DALTON 6040 EDWARD DR MECHANICSBURG 17050-6818000 SITE:KC PA CITI CARDS P.O. BOX 8109 S HACKENSACK, 07606-8109 NJ TM:6350 ACID: 04/24/02 ~193 22:10:43: Citi® Card Account Number 41;78 0035 0899 2834 Payment must he received by 1:00 pa local time on 04/03/2002 Statement/Closing Date Total Credit Line Available Credit Line 03/14/2002 $2400 $1805 Amount Over Credit Line $0. 00 + Sale Date Post Date Reference Number Activity Since Last Statement For Customer Service, call or write 1-800-950-5114 To report btlllnq erro~o write BOX 6500 to~,,~;¢mllm~wl, SIOUX FALLS, SD not preserve your rlQhts. 57117 Cash Advance Limit Available Cash Limit $2400- $1805 Purch/Adv Past Due Minimum Due Minimum Amount Due $20.00 + $20.00 = $40.O0 Amount 3/14 3/14 LATE FEE - FEB PAYMENT PAST DUE 66 0000 0 PURCHASES*FINANCE CHARGE*PERIODIC RATE 84 0000 0 ;?5.00 70000000000 5.70 70000000000 The Annual Percentage Rate on your account may increase due to one of the following reasons stated in your Card Aqreement with us: if you fail to make a payment to us or any other creditor when due, you exceed your credit line pr you make a payment to us that is not honored Dy your bank. FREE ONLINE SERVICES FOR CITI CARDMEMBERS! View your card activity, check your balance, get ~' -'~ free account alerts, communicate securely with customer service and more. Visit Account Online at www.citicards.com today. J ....... Internet Access, Video E-Mail AND One Month Free,/// ~i~n ~_f~ AT&T Worl~Net(R) Service by 3/31/02:'/ ~'~ I- un/y )lboVb a month, call 1-888-375-1028, ext. 70[55 or visit http://download.att.net/citimsg1695 Terms and conditions apply. AccounE Summary Previous (+) Purchases (-) Payments (+) FINANCE (=) New Balance & Advances & Credits CHARGE Balance PURCHASES ADVANCES TOTAL Rate Summary PURCHASES $564.30 $25.00 $0.00 $5.70 $595.00 $0.00 $0.00 $0.00 $0.00 $0.00 $564.30 ' $25.00 $0.00 $5.70 $595.00 Days This BIIIIn~ Period: 29 Balance Subject to Periodic Nominal ANNUAL Finance Charge Rate APR PERCENTAGE RATE Standard Purch $567.05 0.03466%(D) 1;?.650% 12.650% ADVANCES $0.00 0.05477%(D) 19.990% 19.990% PLEASE REFER TO THE REVERSE SIDE OF THE ORIGINAL STATEMENT FOR PAYMENT INFORMATION. MakecheckormoneyorderpayablelnU.S. dollarsona U.S. banktoCitiCards, lnclude ~countnumberoncheckor money order. No cashpiease. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: KEV]2q M. DALTON Date of Death: March 2, 2002 Will No. Admin. No. 21-02-0286 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 April 3, 2002. Name Address Gary L. Dalton Judith A. Dalton 343 Oak Drive New Cumberland, PA 17070 Notice has now been given to all persons entT~ Date: July 15, 2002 7~( 6040 Edward Drive Mechanicsburg, PA 17050 to er RUl .6(a) except: none Murrel R. Walters, III, Esquire 54 East Main Street Mechanicsburg, PA 17055 (717) 697-4650 Capacity: Personal Representative X Counsel for personal representative PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 ~ ~ ~ Name of Decedent: KEVIN M. DALTON Date of Death: 3/2/02 Estate No.: 21-02-0286 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: State whether administration of the estate is complete: Yes No X o o If the answer is No, state when the personal representative reasonably believes that the administration will be complete ct ^ La o ~,q (date) If the answer to No. 1 is yes, state the following: A. Did the personal representative fil9 a final account with the court? Yes No Date: Bo Co Do March 30, 2004 The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Did the personal representative state an account informally to the parties in interest: Yes X' No Copies of receipts, releases, joinders and approvals ~o,f formal or inf~al accounts may be fried with the Clerk of the Orphans ~urt andj6ay be attached to this report. /f MURREL R. WAI?i'ERS, ~I~, ESQUIRE 54 East Main Street Mechanicsburg, PA 17055 --' 717-697-4650 Capacity: Personal Represent~ttive Counsel for Personal Representative PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION ~ ~ ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: KEVIN M. DALTON Date of Death: 3/2/02 Estate No.: 21-02-0286 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: State whether administration of the estate is complete: Yes No o If the answer is No, state when the personal representative reasonably believes that the administration will be complete Ct r~ ]ca o.o ,-~ (date) If the answer to No. 1 is yes, state the following: A. Did the personal representative f.fl,e a final account with the court? Yes No Bo The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Date: March 30, 2004 Do Did the personal representative state an account informally to the parties in · interest: Yes ~ No Copies of receipts, releases, j oinders and approvals of formal or inf, f,~al accounts may be filed with the Clerk of the Orphans' ~urt and, fflay be attached to this report. // /~////~/ // MUlL R. WA~TERS, ~, ESQ~ 54 East Main Streef ~ Mechanicsburg, PA 17055 ~ 717-697-4650 CapaciW: Personal R~Presen~ve __ X__ Counsel for Personal Representative JRD/June 30, 1992/17858 Date: February 03, 2005 ORPHANS' COURT DIVISION Murrel Walters, III, Esquire 54 East Main Street Mechanicsburg, PA 17055 RE: Estate of Kevin M. Dalton File Number: 21-02-0286 Dear SirlMadam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 03/02/2005 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, ~~,~ GLENDAFARNERSTRASBAUGH REGISTER OF WILLS cc: File Judge vA PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: KEVIN M. DALTON Date of Death: 3/2/02 Estate No.: 21-02-0286 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 No_X_ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete Unknown (date) 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No_X_ B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest: Yes_X_ No D. Copies of receipts, releases, joinders and approvals of form lor informal accounts may be filed with the Clerk of the Orphans' Co t and may be attached to this report. .- . 'Date: Fe1:>fuary 14, 2005 MURREL R. W ALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, PA 17055 717-697-4650 Capacity: Personal Representative _X_ Counsel for Personal Representative -- \.-0' C^ . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~.I<-\I'lrv M. UAc.lof'l Date of Death: 0..1 oz.1 '2.00:2 Estate No.: Q \ - 0 J- - 0 "J..'X ~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: I. State whether adll1inj8tration of the estate is complete: . Yes 0 No g 2. If the answer is No, state when the personal representative reasonably bel!=ves that L fi 0 N the administration will be complete: Th~ .e s11'1 Ie. IS vr€.seAl t'f 110 \T'~A \ tJ\f\ t:..i'ti'rC t; e...-e. < Es-n>.\L.- \"A..v'le?-s. DB"e~ -e -\'1'\-/\"( "\"n.~ l", 'V),'\ 0 N If the answer to No. lIs Yes, state the folfowmg: \ '\ \. " \ 1 '" ~ C00 "() \ ~ I-E:. l\f\O-\-nt f ad-. \'f\ 0 (\'\ a. Did the personal representative file a final account with the Court? Yes 0 No 0 \Y\~'CI\L, 3. 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 with the Clerk of the Orphans' Court and may be attached to this report. Date: ;).. / 'Lz..f toe>!:: 01 (,~:'j SignatUre~ /...Uk;t 01J,LY ])/lL/OI1 , Name 343 0'/1/<. JJ)illlt NecU t!.1J/)1~.etA/lJ I), Address ' P.4- n070 Capacity: 7/7- 77'1-c16 '76 Telephone No. ~ersonal Representative o Counsel for personal representative Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2006 WALTERS MURREL RIll 54 E MAIN STREET MECHANICSBURG, PA 17055 RE: Estate of DALTON KEVIN M File Number: 2002-00286 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 3/02/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, '~c.~.~ GLENDA FAm~ER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/21/2006 DALTON GARY L 343 OAK DR NEW CUMBERLAND, PA 17070 RE: Estate of DALTON KEVIN M File Number: 2002-00286 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: 3/02/2006 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, k ... ,. ~~, ! I~Jk~J. ~ v1'.ID'=-"~ ~O'" Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel \W PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: KEVIN M. DALTON 3/2/02 Estate No.: 21-02-0286 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 No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete Unknown (date) 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest: Yes X No D. /' /' Copies of receipts, releases, joinders and approvals of formaC,ef informal :~t~~:~ t~~~j~~e~~~.Wjth the C7i~h71and may be Date: February 1, 2006 MURREL R. WALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, P A 17055 717-697-4650 Capaci ty: Personal Representative _X_Counsel for Personal Representative ~{; Lt- \,'" ). Register of ~ ills of Cumberland County STATUS REPORT UNDER RULE 6.12 Nan1e of Decedent: K E V J A.J M b A L',o III Date of Death: Estate No.: ;), 0 CJ ~,- 00 ;( ? & 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 ad~tration of the estate is complete: Yes 0 No ~ 2. If the an.s",:er is. No, ~tate when the perso~al ~e~r~se~tativ_e r~,on~ly beli:ves th~t._ _' _ t'\ the admlnlstratlon wIll be complete: ~} tJ l;e r l rv' f \:" .DA \ t:..~ S~E: A vr t\(.,t\, ~'} L\f-'1l~t2- 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 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be li . ~ I a~Ched to this report. Date:" I U 'ZoO (~') G,4T/JJh Signature .... . _ G It .Li '0 If- LI 01.; Name ^. .' ,... ,~Y.3 {0/j /( ~tl V c A/;:-w ("Jo1\6,;.ll.lfJJ) P 4 /7t' '7c) I Address ~7' 1 -71'-f- 207'. C._ Capacity: Telephone No. ~~ersonal Representative o Counsel for personal representative .. "; I \. ",-' '., ." /~ .~ F El.. 0 MAN · 5 IH E P HER 0 -- ", ...... '. f W~O H L GEL ERN T E R ,~T A'. , N-E R · W E INS Toe K 25TH FLOOR. 1845 WALNUT STREET PHILADELPHIA, PENNSYLVANIA 19103 TEL 215.567.8300 FAX. 215.567.8:333 ()f Ui CAROL NELSON SHEPHERD .ALAN M. FELDMAN t~ EZRA WOHLGELERNTER .MARK W. TANNER r D:~N'EL S. WEINSTOCK ROBERTA D. PICHINI +t JOHN M. DODIG t EILEEN RILEY SUTTON t THOMAS MORE MARRONE H DANIEL J. MANN PETER M. NEWMAN t JASON A. DARIA t EDWARD S. GOLDIS t CAROLYN M. CHOPKO TRIAL LAWYERS E-Mail Address. cshephcrdr {j)feldmanshcpherd. com OF COUNSEL SARAH M. THOMPSON January 13, 2006 Mr. Gary Dalton 343 Oak Drive New Cumberland, PAl 7070 Ms. 1 udy Dalton 6040 Edrnund Drive Mechanicsburg, PAl 7050 -CERTIFIED ClVIL TRIAL ADVOCATE. NATIONAL BOARD OF TRIAL ADVOCACY + LL.M. IN TRIAL ADVOCACY t ALSO MEMBER N.J BAR * ALSO MEMBER TX BAR Ii ALSO MEMBER NY BAR Re: Dalton v. Hasson" M.D." et al Dear Mr. and Mrs. Dalton: ..~lthough we have completed the discovery phase of the litigation we have pending on your behalf, and have turned over our experts' reports to defense counsel, we are encountering some considerable difficulty with getting the case listed for trial. Because there are several defense counsel in the case with other trial commitments, each time we endeavor to get the case listed for trial, there are conflicts. Although we will continue to list the case for each of the upcoming trial terms in Cumberland County, and will request a scheduling conference \\lith the Court, we anticipate that this will continue to be a problem as the Court is generally unwilling to grant a special listing for a date on which all counsel is available. Accordingly, we are giving some thought to whether we should consider an alternative mechanism fOf resolution of the claim such as mediation before a neutral attorney or retired judge. In this fashion, I would be more optimistic that we could arrive at some resolution of the claim at least in this calendar year. 1 have Hoated the idea with dei"ense counsel and I'IU looking forward to their response. Assuming that they are agreeable to proceeding with mediation, or pursuing some settlement discussions, I will further be in touch with you. It is, of course, ultimately your decision with regard to settlenlent and I will certainly consult further with you at that time. Sincerely, CA\ Carol Nelson Shepherd CNS/pmc WWW.FELDMANSHEPHERD.COM PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: KEVIN M. DALTON 3/2/02 Estate No.: 21-02-0286 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 No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete Unknown (date) 3. Ifthe answer to No. I is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest: Yes X No D. Copies of receipts, releases, joinders and approvals of f011l).al or informal accounts may be filed with the Clerk of the..Orphans' ~ and may be attached to this report. ~ Date: March 23,2007 1..0 M co MURREL R. WALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, P A 17055 717-697-4650 "":.'r- --- o.tJ:: ro N 0-"': Capacity: Personal Representative -....,... ....;,r-- ..;;."-- cc" O_u. ~ U _X_Counsel for Personal Representative r-- = c~ "'.-.....,1 \ 9: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DALTON GARY L 343 OAK DR NEW CUMBERLAND, PA 17070 -------- fold ESTATE INFORMATION: SSN: 174-58.0329 FILE NUMBER: 2102-0286 DECEDENT NAME: DAL TON KEVIN M DATE OF PAYMENT: 09/18/2007 POSTMARK DATE: 09/18/2007 COUNTY: CUMBERLAND DATE OF DEATH: 03/02/2002 REMARKS: RECEIPT TO A TTY CHECK#102 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: CJ RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 008698 AMOUNT $6,113.07 $6,113.07 GLENDA FARNER STRASBAUGH REGISTER OF WILLS REV-1500 EX + (e-o,ol '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1712~01 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) .- z w c w (,) w c DALTON KEVIN M. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 03/0212002 03/17/1983 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ lIl::~1I) C,)lIClIl:: W ILC,) :00 C,)lIC...I tlD C [R] 1. Original Retum o 4. Limited Estate o 6. Decedent Died Testate (AlIach copy ofWll) ~ 9. Litigation Proceeds Received o 2, Supplemental Retum o 4a. Future Interest Compromise (dalllofdealh aIler 12-12-82) o 7. Decedent Maintained a Living Trust (AlIach copy of Trust) o 10. Spousal Poverty Credit (daleofdealh ~ 12-31-91 and 1-1-95) OFFICiAl USE ONLY FILE NUMBER 21 -0 2 0 2 8 6 "'COiiNTY"'COOE -YEAR- - - 'NuiiliER- - SOCIAL SECURITY NUMBER 174-58-0329 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (daleofdealhpriorlD 12-13-82) o 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under See. 9113(A) (AlIach Sch 0) I- Z W C Z o IL II) W lIC lIC o C,) COMPLETE MAILING ADDRESS NAME MURREL R. WALTERS III ESQUIRE FIRM NAME (If Applicable) 54 EAST MAIN STREET TELEPHONE NUMBER 717-697-4650 MECHANICSBURG X _(15) 135,846.07 X ~(16) X .12 (17) X .15 (18) (19) z o ~ ::) .- a: c( (,) W 0:: 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation. Partnership or SoIe-ProprietOlship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposils & Miscellaneous PefSOnal Property (5) (Schedule E) 6. JoinUy OWned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= ~ ::) D. ::E o (,) ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTIt\JG {l REFUND OF AN OVERPAYMENT PA 17055 :0 -':~}l~ Z~.~~I ~) (/) rr1 -'0 co ,-.-; 153,748.37 co W -J i'-~~ ~'-n ~:: (8) 153,748.37 7 ,625.00 10,277.30 (11) (12) (13) 17 ,902.30 135,846.07 (14) 135,846.07 6,113.07 6,113.07 .. Decedent's CamPI ete ress: STREET ADDRESS 6040 EDWARD DRIVE CITY I STATE I ZIP MECHANICSBURG PA 17050 Add Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 8,113.07 Total Credits (A + 8 +C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 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; ........................................................................... 0 !XI b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 !XI c. retain a reversionary interest; or ...................................................................................................... 0 !XI d. receive the promise for life of either payments, benefits or care? ............................................................. 0 !XI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 !XI 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 !XI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 !XI 0.00 8,113.07 8,113.07 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS MURREL W TERS III, ESQUIRE 54 EAST MAIN STREET, MECHANICSBURG PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 ~+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 02 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. ESTATE OF DALTON KEVIN M. 0286 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. VALUE AT DATE OF DEATH 69,045.44 DESCRIPTION DALTON V. HASSON, MD SURVIVAL CLAIM S~TTL~MENT (PLEASE ABATE INT~REST) FIRST INSTALLM~NT . ANTICIPATED 9/28/07 DALTON V. HASSON, MD. SURVIVAL CLAIM SETTLEMENT (PLEASE ABATE INTEREST) SECOND INSTALLM~NT. ANTICIPATED 12/31/07 M~MBERS 1ST F~DERAL CREDIT UNION CH~CKING ACCOUNT 37,500.00 798.76 M~MBERS 1ST FEDERAL CREDIT UNION CHRISTMAS CLUB 115.83 PION~ER MUTUAL FUND 7,964.72 PRIMERICA MUTUAL FUNDS 4,793.03 LEGG MASON MUTUAL FUND 1,508.80 STATE FARM REIMBURSMENT CAR INSURANCE 60.36 TWIN ARCHES PROFIT SHARING . BENEFICIARY. JUDITH A DALTON 31,357.13 INT~RNAL REVENUE SERVICES INCOME TAX REFUND 318.00 BEST SUNOCO . FINAL PAY CHECK 251.50 EKG ASSOCIATES MEDICAL 35.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheels of the same size) 153.748.37 REV-1511 8(-+ (12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DALTON KEVIN M SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. 21 02 0286 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 4,615.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) GARY DALTON Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 343 OAK DRIVE City NEW CUMBERLAND State PA Zip 17070 Year(s) Commission Paid: 2. Attomey Fees MURREL R. WALTERS III, ESQUIRE 2,700.00 3. Family Exemption: (If decedents address is not the same as claimants. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS. CUMBERLAND COUNTY 310.00 5. Accountants Fees 6. Tax Retum Prepare~s Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 7.625.00 (If more space is needed. insert additional sheets of the same size) RElf-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS . FILE NUMBER 21 02 0286 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DALTON KEVIN M. Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. CAPITAL AREA SURGICAL ASSOCIATES MEDICAL 3,050.00 2. MOFFIT HEART AND VASCULAR GROUP MEDICAL 200.00 3. PCCMA MEDICAL 1,770.00 4. WEST SHORE PATHOLOGY MEDICAL 290.00 5. WEST SHORE ANESTHESIA MEDICAL 2,210.00 6. ROBERT D. MCINROY MEDICAL 385.00 7. CITICORP CREDIT SERVICES, INC. CREDIT CARD 564.30 8. QUANTUM IMAGING & THERAPEUTIC MEDICAL 1,808.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10.277.30 "";"" '" "* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER nAI TON KFVIN M ?1 O? 0286 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude OU~ht s~usal distributions, and transfers under Sec. 9116(a (1. )] 1. GARY L. DALTON FATHER 50% 343 OAK DRIVE NEW CUMBERLAND, PA 17070 2. .JUDITH A. DALTON MOTHER 50% 6040 EDWARD DRIVE MECHANICSBURG, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX .. APPRAISE;HEIH, ALLOWANCE OR DISALLOWANCE OF' DEDUCTIONS AND ASSESSMENT OF TAX DATE 01-21-2008 ESTATE OF DAL TON KEVIN M DATE OF DEATH 03-02-2002 FILE NUMBER 21 02- 0286 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 03-21-2008 ( See reverse side under Objections) Amount Remittedl I 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 ~ ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DALTON KEVIN M FILE NO. 21 02-0286 ACN 101 DATE 01-21-2008 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRIS8URG PA 17128-0601 f':i ',.~_; r- ~ l "j .. c: ') '~....' ...- MURREL R WALTERS 54 E MAIN ST MECHANICSBURG I I;L. ',ESQ PA 17055 REV-1547 EX AFP (06-05) TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets .00 .00 .00 . DO 153,748.37 .00 .00 (8) 153,748.37 (1) (2) (3) (4) (5) (6) (7) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. 12. 13. 14. Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax (13) (14) If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate NOTE: (9) (10) 7,625.00 10,277. 3D (11) (12) 17.9n7 3n 135,846.07 .00 135,846.07 (15) (16) . DO X DO . DO 135,846.07 X 045 = 6,113.07 .00 X 12 .00 .00 X 15 .00 (19)= 6,113.07 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-18-2007 CD008698 .00 6,113.07 09-18-2007 WRITEOFF .00 1,664.37 01-14-2008 SBADJUST .00 .01 TOTAL TAX CREDIT 6,113.07 BALANCE OF TAX DUE . DO INTEREST AND PEN. .00 TOTAL DUE .00 \ * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $I, NO PAYMENT IS REQUIRED. " " FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)