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HomeMy WebLinkAbout03-0667Estate of also known as Register of Wills of~ County, PETITION FOR GRANT OF , Deceased Pennsylvania LETTERS Social Security No. lq, 8 - ~-g~'79 Petidot~eHst. who islme 18 years ol age or oldm, apply(les) for: (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 r~ev~t circumstances, e.g.. renunciation, deaLh 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 incompetent: B. Grant of Letters of Administration Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional., heets if necessary. Decedent was domiciled at death in residence at i Od CEAY'zI,.- OP_-., Decedent, then ~ years of age, died County, Pennsylvania, with his/her last family or principal Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ............................... $ (tf not domiciled in PA) Personal property in Pennsylvania ...................... $ (if not domiciled in PA) Personal property in County .......................... $ Value of real estate in Pennsylvania ............................................... S Total .............................................................. $ Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and (he grant of letters in the appropriate form to the undersigned: Typed or printed name and residence ,3 ~.~ ,,", 12-,,, 4. c. C~O Prell, Or~ l-lOtl RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as~onal representative(s) of the Petitioner!s) .will well and truly administer the estate according~/ Decedent, Swor. n to~a~m~ff,, J~r'medxand subscribed ' befere'me thi~- ~L[~ ~- day of 20(~ I DECREE OF REGISTER Estate of EDWARD RUDA JR Deceased No. o~1- 03'~ ~l~.7 also known as Social Security No: 198-44-8~79 Date of Death: 7-30-2003 AND NOW, ~~ I.?_ , 20(~L~ , in consideration of the Petition .on the reverse side here~, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary [] of Administration are hereby granted to JASON RUDA in the above estate and that the instrument(s), if any, dated described in the Petition be admi~ed to probate and filed of recor~a~ th~st ~tlq~f Decedent. ~,.:~. . ~, ......~ · FEES Short Certificate(s) .......... Renunciation .................. Affidavit ( ) ................. Extra Pages ( ) ............ Codicil .......................... JCP Fee ........................ Inventory & Tax Forms... Other ............................ Attorney: I.D. No: Address: R~-7a TOTAL ................ Telephone: DATE FILED: '-EF FO',:~ HL~ CERT. NO. WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH T 548058 7 August 5, 2003 Date of Issue of This Certification Name of Decedent Edward d. Ruda Jr. FitFI Middle Sex Male Social Security No. 198-44-8879 Date of Birth Aug. 21, 1954 Birthplace Harrisburg, Place of Death Rural Road Cumberland PA Last Date of Death 7 - 30 - 2003 Middlesex Twp. Pennsylvania Facility Name Race. White Occupation Laborer Decedent's Marital Status Divorced Mailing Address Informant Almeda R. Rude Name and Address of Funeral Establishment Part h Immediate Cause (a) (b) (c) (d) Part Ih Other Significant Conditions Davi'd Myers Multiple Traumatic 100 Pearl City Borough or Township Armed Forces? (Yes or No) Drive Carlisle Numbel Stlee[ City or Town Funeral Director Sally A. Myers Funeral Ho_me'~ Newport, PA 17074 Injuries No PA 17013 State Interval Between Onset and Death Manner of Death Natural ~ Homicide [] Accident ~X Pending Investigation [] Suicide fl_~ Could not be Determined [] Describe how injury occurred: Pedestrian struck by truck Name and Title of Certfier Michael L. Norris Coroner Address (M.D., D.C., Coroner, M.E.) 6375 Basehore Road, Suite #1, Mechanicsburg, PA 17050 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent f iling~~~ ~ '~~-~ ~./ 50-455 August 3, 2003 01 New Bloomfield, PA 17068 D~t,? Re~ elved by Lo[.a~ Registrar Street Address City Borough, Township PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTYE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Edward Ruda, 3r. Date of Death: July 3o, 9oo3 Estate No. PA File No. 21-o3-o667 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-referenced estate: State whether administration of the estate is complete: Yes No X If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Pending Litigation Date: If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No. 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 No D. Copies of receipts, releases, joinders and approvals of formal or informal may be accounts may be filed with the Clerk of the Of!~hans' Court and attached to this report. //fl !. .... Signature ~/'~ (MAH:rmt/AM3) R.W.-58 Capacity Bruce D. Foreman, Esquire Foreman & Foreman, PC 44o9 N. Front Street Harrisburg, PA Wno-wo9 (717) ~36-9391 X Personal Representative Counsel for Personal Representative rule5-6.not CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Date of Death: PA File No. EDWARD RUDA, JR. July 30, 2003 21-03-0667 To the Register: I certify that notice of beneficial interest 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 October 28, 2003. Name Address Jason Ruda 42 Stephen Road, Apartment 4F, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule,~except: No exception. ~ Dated: October 28, 2003 Signature ~_~-,_~ l~ruce D~ FoYen~a~, Esq. 4409 North Front Street Harrisburg, PA 17110 Capacity: __ Personal Representative X Counsel for Personal Representative Name (s), address (es), and telephone number (s) of all counsel Name Address Telephone Bruce D. Foreman 4409 North Front Street (717) 236-9391 Harrisburg, PA 17110 Additional information may be obtained from the undersigned. ~ Dated: October 28, 2003 Signature ~ _ ~ D. F-~or Capacity: ~Personal Representative 3207 North Front Street Harrisburg, PA 17110 X Counsel for Personal Representative CUMBERLAND COUNTY REGISTER OF WILLS AND CLERK OF THE OPHANS' COURT FACSIMILE TRANSMITTAL SHEET TO: FROM: KIRK S SOHONAGE JACKIE AUST, DEPUTY COMPANY: DA] E: Saidis, Shuff, Flower & Lindsay 2./20/04 FAX NUMBER: (717) 7~9~3~72~4a_ PHONE NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: SENDER'S REFERENCE NUMBER: RE: YOUR REFERENCE NUMBER: ESTATE OF EDWARD RUDAJR 21-03-667 [] URGENT g~ FOR REVIEW [] PLEASE COMMENT [] PLEASE REPLY [] PLEASE RECYCLE NOTES/COMMENTS: ENCLOSED IN THIS FAX IS AN ESTATE THAT HAS ALREADY BEEN PROBATED BY THE SON OF EDWARD RUDA JR, THEREFORE LETFERS HAVE ALREADY BEEN ISSUED TO MR. RUDA'S SON. LOOK THEM OVER PLEASE AND GET BACK TO US TO LET GLENDA AND I KNOW WHAT OUR NEXT STEP IS. THANK YOU JACKIE I COURTHOUSE SQUARE CARLISLE PA 17013 PHONE: 717-240-6345 FAX: 717-240-7797 :'~"~_ ~~ '~ DEPT. 280601 ~ HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFiCiAL USE ONLY FILE NUMBER COUNTY CODE YEAR N-U M 8 ER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) RUDA, Edward Jr. DATE OF DEATH (MM-DD-YEAR) DATE Of BIRTH (MM-DD-YEAR1 07-30-2003 08'-21-1954 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 1 98 - 44 - 8879 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 0 ~1. Onginal Return ~._~4. Limited Estate F-'~ 6. Decedent Died Testate (Attach E~]9. Utigation Proceeds Received E~2. Supplemental Return ~'-~ 4a. Future Interest Compromise (date of death after 12-12-82) E~7. Decedent Maintained a Living Trust (Attach c~py of Trust) E~ 10. Spousal Poverb/Credit (date of death between 12-31-91 and 1-1-95) F--J3. Remainder Retum (data ef dearn prior to 12-13-82) E~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes E~11. Election to tax under Sec. 9113(A) (^~ch sch o) NAME Bruce D. Foreman, Esquire FI,[~Vl NAME, .... ~'oreman & Foreman, PC TELEPHONE (717) 236.9391 1. Real Estate (Schedule A) (1) 2. Si:ocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) []Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) COMPL~EMAILINGADDRESS 4409 N.' Front Street Harrisburg, pA 17110-1709 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not. been made (Schedule J) 14. Net Value Suhiect to Tax (Line 12 minus Line 13) 7,323,89 6t455.76 (8) 7,323.89 (11} (12) (13} (14) 6,455,76 868.13 868.13 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE PATES 15. Amount of Line 14 taxable at the sDousal tax rate, or transfers under Sec. 9116 (a!(1.2) 16. Amount of Line 14 taxable at lineal rate 8 6 8. 1 3 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 1,t Iaxauie a~ collaterai rate x .o .. ¢5) × .o 45 (16) x .12 {17) x .15 (18) 39.07 39.07 19. Tax Due 1191 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF EDWARD RUDA, JR. File Number Item # 1. Description Amount Personal Injury Settlement approved by the Court of Common Pleas to 04-1031 by Order of March 22, 2004 by the Honorable Judge Edgar B. Bayley $5,323.89 Approved Attorney fees for Foreman & Foreman, PC under Court Order of March 22, 2004 to 04-1031 by the Honorable Edgar B. Bayley $2,000.00 Total $7,323.89 MAR 1 5 2.004 JASON RUDA, individually and as the Administrator of the ESTATE of EDWARD RUDA, JR., Petitioner PROGRESSIVE INSURANCE COMPANY, Respondent · IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA · NO. ~ --'/~1 .. · CIVIL ACTION - LAW ORDER OF COURT I of the foregoing Petition, ,2004, upon consideration IT IS HEREBY ORDERED that: 1. The above parties may compromise the action set forth in the Petition to Approve Settlement of Wrongful Death and Survival Actions for the principal sum of $88,000.00. 2. Jason Ruda, Administrator of the Estate of Edward Ruda, Jr., Deceased, is authorized to distribute the monies in this action as follows: Authorize the payment of counsel fees in the amount of $29,333.33 and costs in the amount of $436.54 to Handler, Henning & Rosenberg, LLP, from the funds due; Authorize the payment of said lien against Decedent's Estate in the amount of $3,000.00 to CNA Claim Plus; Authorize the payment of said Estate Attorneys fee in the amount of $2,000.00 to Foreman & Foreman, P.C.; and Direct distribution of the remaining net proceeds of the settlement as follows: To the Petitioner, Jason Ruda, son, for'the wrongful death action, the amount of $47,908.89; and ii. To the Estate of Edward Ruda, Jr., for the survival action, the amount of $5,323.89. Approve the allocation of 10% to the Survival Action and 90% to the Wrongful Death allocation as approved by the Commonwealth of Pennsylvania, Department of Revenue. BY THE COURT: TRUE COPY FROM RECORD In Testimony whereof, ! here unto set my hand Estate of EDWARD RUDA, JR. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS File Number: A. FUNERAL EXPENSES: Bo David M. Myers Funeral Home (less work comp payment) James R. Gingrich Memorials Clarion Convention Center and Hotel (reception) ADMINISTRATIVE COSTS: Personal Representative's Commissions: Name of Personal Representative(s): Jason Ruda Social Security Number(s) of Personal Representative(s): Address: 42 Stephen Road, Apt. 4F, Camp Hill, PA x7o~ Year(s) Commission Paid: Attorney Fees: FOREMAN & FOREMAN,PC Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant: Carol Balser-Blackwell Address: Relationship of Claimant to Decedent: Probate Fees: Filed 8/~2/2oo3 Advertising Fees - Cumberland Law Journal Advertising Fees - The Sentinel $2,952.78 $607.00 $695.63 $2,000.00 $37.00 $75.00 $88.43 TOTAL $6,455.76 March 9, 2004 Attorney David Rosenberg 1300 Linglestown Road Harrisburg, Pennsylvania 17110 Dear Atty. Rosenberg, Per our conversation, I am sending this correspondence regarding the funeral expenses that I incurred while burying my son, Edward J. Ruda Jr. The funeral expenses I incurred are the following: David M. Myers Funeral Home Second And Walnut Streets Newport, Pennsylvania (These expenses included the funeral, burial vault grave casket, grave opening, etc.) $2,952.70 James R. Gingrich Memorials 5243 Simpson Ferry Rd. Mechanicsburg, Pennsylvania (Grave marker, border and foundation) $ 607.00 Clarion Convention Center And Hotel 1700 Harrisburg Pike, Carlisle, Pennsylvania (Reception after services for family and friends, many out of town) TOTAL $ 695.63 $4,255.33 This represents the expenses I incurred burying my son. If you have any questions, please feel free to contact me at 717-243-3161. I look forward to heating from you concerning these expenses. Sincerely, Aimeda M. Ruda 100 Pearl Drive Carlisle, Pennsylvania 17013 RECEIPT FOR PAYMENT Cumberland Counyy - Register Of Wills Hanover and Hiqh Street Carlisle, PA I7013 Receipt Date Receipt Time Receipt No. 8/12/2003 15:29:09 1033717 RUDA EDWARD JR File Number Remarks 2003-00667 FOREMAN & FOREMAN JA ........................ Distribution Of Receipt ........................ Transaction Description Payment Amount Payee Name LETTERS ADM ISSUED 18.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 9.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D Check# 2350 ~337.00 Total Received ......... 7 00 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 SEPTEMBER 12, 2003 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Matthew T. Kelly, ESQUIRE RE: Edward Ruda, Jr. ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: AUGUST 29, SEPTEMBER 5, 12, 2003 Advertising Cost Proof of Publication Second Proof Request Payment Received Total Amount Due Payment received AUGUST 26, 2003 by Becky H. Morgenthal/Executive Director $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : SS. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Joumal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: AUGUST 29, SEPTEMBER 5, 12, 2003 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Ruda, Edward, Jr., dec'd. Late of Cumberland County. Executor: Jason Ruda, 42 Ste- phen Road, Apt. 4F, Camp Hill, PA 17011. Attorneys: Matthew T. Kelly, Es- quire, Foreman & Foreman, P.C., 4409 North Front Street, Har- risburg, PA 17110-1709. (//Lt'sfi l~arie Coyn~ Editor SWORN TO AND SUBSCRIBED before me this 12 day of SEPTEMBER, 2003 Notary ~ /// ': NOTARIAL SEAL ..i LOIS E. SNYDER, Nota~7 Publicr, Cadisle Boro, Cumberland C°unty.,,i,~ My Commission Expires March 5, 2005, PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. Lori Saylor, Classified Advertising Manager of THE SENTINEL, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following dates, viz Copy of Notice of Publication NOTICE LETTERS TESTAMEN- TARY on the Estate of EDWARD RUDA, JR., late of Cumberland County, Pennsylvania, having been granted to the undersign~ed, all per- sorts indebted to the s~ld Estate ara required , te make immediate payment and tho~e hav- ing claim~will present :them for settlement~o: Jason Rude ApL 4F Camp Hill, PA 17011 Or~o: ~ Me,hew T. Kelly, F.~quiro FOreman & Foreman, PC 4409 North Front Street Herrleburg, PA 17100-1709 August 20 & 27 & September 3, 2003 Affiant further deposes that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. September 3, 2003 Sworn to and subscribed before me this 3rd day of September ,2003. Notary Public My commission expires: NOTARIAL SEAL ELLEN B. RUNDLE, Notary Public Mechanicsburg, Cumberland County REMITTANCE ADDRESS BILL TO THE SENTINEL - LEGAL FOREMAN & FOREMAN P.O. BOX 130, CARLISLE, PA 17013 ,AD NUMBER I CLASS SALESPERSOi% BILLING DATE LINES 249896I 10 PUBLIC NOTICES c31 09/03/03 24 AD DESCRIPTION START DATE STOP DATE NOTICE LETTERS TESTAMEN- TARY ON TH 08/20/03 09/03/03 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 82.08 TOTAL AD CHARGE 82 . 08 3 PROOF OF PUBLICATION 01PRF 6.35 DAYS RUN PURC.ASEO.DER PAY THIS AMOUNT 88 43 106 12. Edward Ruda, Jr ' ' * AFTER 10/03/03 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Lori Saylor 243-2611 ext. 201 Fax your legals to 243-3754, attention Lori Saylor You can also EMAIL your legal to Classified ads: ads@cumberlink.com. Please send a cover letter including your name and address as an attachment DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL - LEGAL P.O. BOX 130, CARLISLE PA 17013 Edward Ruda, Jr AD NUMBER CLASS0 START DATE STOP DATE 249896 PUBLIC NOTICES 08/20/03 09/03/03 AD DESCRIPTION BILLING DATE TELEPHONE NUMBER NOTICE LETTERS TESTAMEN- TAR¥ ON TH 09/03/03 717-236-9391 GROSS AMOUNT OF 106.12 DUE AFTER 10/O3/O3 FOREMAN & FOREMAN 4409 N. FRONT STREET HARRISBURG, PA 17110-1709 20200000002498960000000000000001061200000088433 TOTAL AMOUNT DUE 88.43 ENTER AMOUNT ENCLOSED Estate of Also known as Register of Wills of Dauphin County, Pennsylvania INVENTORY EDWARD RUDA, JR. ,Deceased. No. Date of Death: 07/30/03 Social Security No. 198-44-8879 Personal Representative(s) of the above-Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. 1/We understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Address: Telephone: Bruce D. Foreman, Esquire 21193 4409 North Front Street Harrisburg, PA 17110-1709 (717) 236-9391 Personal Representative: Jason Ruda 42 Stephens Road, Apt 4F Camp Hill, PA 17011 Date: Description Value Settlement on Personal Injury Claim approved by the Court on March 22, 2004 by the Honorable Judge Edgar B. Bayley to No. 04-1031. $7,323.89 (Attach Additional Sheets if necessary) Total $7,323.89 the value of each item, but such figures should not be extended into the total of the Inventory. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003861 FOREMAN & FOREMAN 4409 N FRONT STREET HARRISBURG, PA 17110 ........ fold ESTATE INFORMATION: SSN' 198-44-8879 FILE NUMBER: 21 03-0667 DECEDENT NAME: RUDA EDWARD JR DATE OF PAYMENT: 04/23/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $39.07 REMARKS' FOREMAN & FORMAN TOTAL AMOUNT PAID: $39.07 SEAL CHECK# 5598 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ES'ITE IS NOT COMPLETED, FILE A 6.xa FORM ~Y UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: EDWARD RUDA, JR. Date of Death: JULY3o, 2oo3 Estate No. aoo3-oo667 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-referenced estate: State whether administration of the estate is complete: Yes X No If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Date: 3. If the answer to No. ~ is yes, state the following: A. Did the personal representative file a final account with the court? Yes No B. The separate Orphans' Court No. (if any) for the personal representative's account is: (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 formal or informal accounts may be filed with the Clerk of the Or_phans'~Court and may be attached to this report. /~/~_~~ Signature (MAH :rmt/AM3) R.W.-58 Capacity Bruce D. Foreman, Esquire Foreman & Foreman, PC 44o9 N. Front Street Harrisburg, PA ~7~oq7o9 (7~7) a36-939;t Personal Representative Counsel for Personal Representative X rule5-6.not CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Date of Death: Will No. To the Register: EDWARD RUDA, JR. JULY 30, 2003 I certify that notice of beneficial interest 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 June 2, 2004. Name Address Jason Ruda Almeda Ruda 42 Stephen Road, Apt. 4F, Camp Hill, PA 17011 100 Pearl Street, Carlisle, PA 17013 Notice has now been given to exception. Dated: June'S., 2004 all persons entitled thereto under/~Rule 5.6 except: No Signature t3 mc~e D. ~or~an, Es~iuire~ ~-"~ 4409 North Front Street Harrisburg, PA 17110 Capacity: __ Personal Representative X Counsel for Personal Representative Name (s), address (es), and telephone number (s) of all counsel Name Address Bruce D. Foreman 4409 North Front Street Harrisburg, PA 17110 Telephone (717) 236-9391 Additional information may be obtained from the undersigned. Dated: June~2004 Signature /~ ~ ~~x~ l~ruce D. F~rre~squire 4409 North Front Street Harrisburg, PA 17110 Capacity: __ Personal Representative X Counsel for Personal Repregentative GENERAL RELEASE KNOW ALL MEN BY THESE PRESENTS: THAT AI,MEDA M. RUDA, in consideration of the receipt of Four Thousand Two Hundred Fifty Five and 33/loo ($4,255.33) Dollar and other good and valuable consideration does hereby remise, release and forever discharge the Estate of Edward Ruda, Jr. and Jason Ruda, Administrator of the Estate of Edward Ruda, in his capacity as Administrator and individually, and Foreman & Foreman, PC, a Pennsylvania, Corporation, and their respective heirs, executors, administrators, successors or assigns of an from all and any manner of actions, causes of actions, suits, debts, dues, accounts, contractual agreements, judgments, claims and demands whatsoever in law or in equity, especially from any obligations, liabilities, claims or payments required particularly arising from administration of the Estate of Edward Ruda, Jr. or any debts or obligations owed from Edward Ruda to Almeda M. Ruda or expenses paid by Almeda M. Ruda for the Estate of Edward Ruda, Jr., or any other claims which she ever had, now has or which her heirs, executors, administrators, successors or assigns, or any of them, hereafter can, shall or may have, for, or by reason of any cause, matter or thing whatsoever to the date of these presents. IN WITNESS WHEREOF, the said ALMEDA RUDA has hereunto set her hand and seal the [ ~ ~ day of [~ ~ C', I ,2004. WITNESS: ALMEDA M. RUDA GENERAL RELEASE KNOW ALL MEN BY THESE PRESENTS: THAT JASON RUDA, in consideration of the receipt of One Thousand Fourteen Dollars and 49/~oo ($1,o~4.49) Dollar and other good and valuable consideration does hereby remise, release and forever discharge the Estate of Edward Ruda, Jr. and Jason Ruda, Administrator of the Estate of Edward Ruda, in his capacity as Administrator and individually, and Foreman & Foreman, PC, a Pennsylvania, Corporation, and their respective heirs, executors, administrators, successors or assigns of an from all and any manner of actions, causes of actions, suits, debts, dues, accounts, contractual agreements, judgments, claims and demands whatsoever in law or in equity, especially from any obligations, liabilities, claims or payments required particularly arising from administration of the Estate of Edward Ruda, Jr. or any debts or obligations owed from Edward Ruda to Jason Ruda or expenses paid by Jason Ruda for the Estate of Edward Ruda, Jr., or any other claims which he ever had, now has or which his heirs, executors, administrators, successors or assigns, or any of them, hereafter can, shall or may have, for, or by reason of any cause, matter or thing whatsoever to the date of these presents. IN WITNESS WHEREOF~ th/~/aid JASON RUDA has hereunto set his hand and seal the z/rg'~ day of _ . _fi__. , 2004. WITNESS: ¢ NOTARIAL SEAL MICHELE A. RENEKER, Notary Public City of Harrisburg, Dauphin County ._..~Commission Expires March 17, 2007 BUREAU OF ZNDTVZDUAL TAXES TNHERTTANCE TAX DTyTSTON DEPT. 18060! HARRTSBURG) PA 17128-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT) ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-1547 EX AFP (01-55) BRUCE D FOREHAN ESQ FOREHAN & FORENAN 4409 N FRONT ST HBG PA 17110 DATE 06-14-2004 ESTATE OF RUDA DATE OF DEATH 07-$0-Z005 FILE NUHBER 11 0:5-0667 COUNTY CUHBERLAND ACN 101 Amount Ram/fred EDWARD J HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LINE t~~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF RUDA EDWARD J FILE NO. 21 0:5-0667 ACN 101 DATE 06-14-2004 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Rmal Estate (Schedule A) (1). 2. Stocks and Bonds (Schedule B) (2) $. Closely Hmld Stock/PartnmrshAp Zntmrast (Schedule C) ($) ~. Hortgagas/Notms RmcaAveble (Schedule D) (~) E. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expenses/Adm. Costs/flAsc. Expenses (Schedule H) (9) 10. Debts/Hortgage LAabAIAtAas/LAens (Schedule Z) (10) 11. Total Deduct/ohs 12. Net Value of Tax Return 1~. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate Subject to Tax O0 O0 O0 O0 7,,:523.89 O0 0O (8) 6,455.76 .00 NOTE: To Ansurm proper credit to your account, submAt the upper port/on of thAs form with your tax payment. NOTE: 7,:52:3.89 (11) 6.45~. 76 (lZ) 868.1:5 ('ts) .00 (1~) 868.15 If an assessment Nas issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amount of LAne 1~ at Spousal rate 16. Amount of L/ne 1~ taxable at LAneal/Class A rate 17. Amount of LAne 1~ at SAblAng rate 18. Amount of LAne 1~ taxable at Collateral/Class B rate 19. PrAnci~al Tax Due '. ~'.~. TAX CREDITS · PAYI~ENT RECEZPT DISCOUNT (+J DATE NUNBER INTEREST/PEN PA/D (-) 04-2:5-2004 . O0 CD005861 18 and 19 will IF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/TZONAL /NTEREST. (15) .00 x O0 = .00 (16) 868.1:5 x 045 = :59.07 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= :59.07 ANOUNT PAZD :59.07 TOTAL TAX CREDIT :59.07 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( 1F TOTAL DUE 1S LESS THAN $1, NO PAYHENT 1S REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE I~ . A REFUND. SEE REVERSE S/DE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of tho decedent after tho expiration of any estate for life or for years, the Commonwealth hereby expressZy reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 6 (collateral) rate on any such future interest. PURPOSE OF NOT[CE: PAYNENT: REFUND (CR): 06JECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z1~0 of the Inheritance and Estate Tax Act, Act 15 of ZOO0. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, which mas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance end Estate Tax" (REV-IS15). Applications are available at the Office of the Register of Hills, any of the Z$ Revenue District Offices, or by calling the special Z0`-hour answering service for forms ordering: 1-800-381-2050; services for taxpayers with specie! hearing and / or speaking needs: 1-800-0`0`7-3010 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dapt. 161021, Harrisburg, PA 17116-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in mriting to: PA Department of Revenue, 6ureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 160601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. [f any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the lute1 of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the tho same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent par annum calculated et a daily rate of .000160`. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 196Z through ZOO0` are: Interest DaiIy Interest Daily Interest Year Rate Factor Year Rate Factor 196Z 207. .00050`8 ~'8-1991 117. .000301 1983 161 .0000`~6 1992 97. · 00020,7 1980` 117. .000301 1993-1990` 72 .00019Z 1965 137. .000356 1995-1998 97. .00020`7 1966 107. .000270` 1999 77. .000192 1987 10Z .000270` ZOO0 72 .000191 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Dmily Year Rate Factor 2001 9Z .000247 ZOOZ 61 .000160` Z003 51 .000137 2000` 0`2 .OOOllO X NU)~BER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bm calculated.