HomeMy WebLinkAbout04-0392 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of JOHN D. HORSTICK, JR. No. t~l - ~)q - ~
also known as : To:
Register of Wills for the
, Deceased. County of CUMBERLAND in the
Social Security No. 20t-t8-$334 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executor . named
in the last will of the above decedent, dated 7/13/83
and codicil(s) dated NONE
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with
h is last family or principal residence at 305 HIGH STREET~ SUMMERDALE
EAST PENNSBORO TOWNSHIP~ PENNSYLVANIA
(list street, number and municipality)
Decedent, then 77' years of age, died 415104
at HOLY SPIRIT HOSpITAL~ CAMP HILL~ EAST PENNSBORO~ PENNSYLANIA '
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 ajudicated
incompetent:
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 60~000.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ 77~000.00
situated as follows:
305 HIGH STREET~ SUMMERDALE~ EAST PENNSBORO TOWNSHIP PENNSYLVANIA
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters TESTAMEHTARY
thereon. (testamentary; administration c.t.a.; administr, at~oIkd.b.n.c.t.a.)
4845 OAKMONT GREEN ~ "'
~ MECHANICSBURG /':~' 'PA I 50
~ DENNIS GENE HORSTICK ,i!~' ::~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
ss
COUNTY OF cm~naEm. AND
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the ab0veldecedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affi~r~l~d a.~d subscribed t"/'~ ~,,~..~ ~)~,~,o _ ]~/-r~ ~.
bef~e me this b/,~_ _~s day of / ~
No.
Estate of JOHN D. HORSTICK, JR. ~ Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~(~3~x~t_· ~q~ ~-~ C~q , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated ?113183
described therein be admitted to probate and filed of record as the last will of JOHN D. HORSTICK, JR.
and Letters TESTAMENTARY
are hereby granted to '~
DENNIS GENE HORSTICK
Register ofWills~O..~ (~ .~-~
V~x~ ?o~ FEES q .O~ MURRELR. WALTERSlII, ESQ.
Probate, LeRers, Etc ......... $~- ~ 24849
Short Ce~ificates ( ) ...... $ ~ A~0~EY (Sup. Ct. ~.D. No.)
Renunciation ............ $ ~, ~ 54 EAST MAIN STREET
~ $ lo-oo MECHAN~CSBUR6 PA ~7055
ADD.SS
TOTAL_ $
717.6974650
Filed ........................ PHONE
RENUNCIATION
In Re Estate of JOHN D. HORSTICK, JR.,deceased.
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned, Alan Lee Horstick, son of the above decedent, hereby renounces
his right to administer the estate and respectfully asks that Letters of Administration be
issued to Dennis Gene Horstick.
WITNESS my hand this -I t f r~ay of ,{ f g t c 2004.
(Address)
COMMONWEALTH OF PE~S~VANIA · ~5 ,
SS: .7: ~ '
CO~TY OF Q &' J( flF2X ,,~ m ~ · : ~
~D NOW, ~is '~ /7~ay of ~ ~ t C ,2004, ~ore me, ~the
undersigned officer, personally appeared Alan Lee Horstick, ~own tO:me (o~atish~tofily
proven) to be ~e person whose name is subscribed to the instrument, and a~owledged
that he executed same for the pu¢oses therein contained.
~ WI~ESS ~E~OF, I hereunto set my hand and official seal.
otary Public
$olm 11. C~mp.~e~, Notary Public
Lower Align Twp.. Cumberlanc} County
· My Commissien Expire~ Mar. 1, 2006
Member, Permsylvar~.~/',~o(?,.', -~.ior~ of N~rtes
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
,,,,~ ocal Registrar (/
'"*' APR i 3 2004
No. ~ Date
H105.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
~,T CERTIFICATE OF DEATH
NAME OF DECEDENT (Fimt Mid,lo. Lalt) I SEX I SOCIAL SECURITY NUMBER DATE OF DEATH (Monl~. Day. Yea0
,. John D..orstiek Jr. [,Male 1, 20~_ la_ S334 ,. Ap,",t 8.9_00'4
AGE (Last ~uL~ly) DATE OF BIRTH I B,RTHPL~CE (City and IP[.ACE OF DEATH (Ct'~ onl, one - see instructions on other
(Month, Day, Year) I State m' Foreign Co~nbT) I HOSmTAL: I OTHER:
COUNTY OF DEATH CITY, BORO, ~ OF DEATH[ FACILITY NAME (If not Institution, give street and number) [WAS DECEDENT OF HISPANIC ORIGIN? [RACE - American Indian, Black, White, ell
~bCumberland. ._~ast: Forms•crc L ..o. 7~ tw ~ ~"'}'l ~'~o' r>~t'c~l
DE(.buI-NT'S USUAL OCCUPATION KIND OF BUSINESS I INDUSTRY IWAS DECEDENT EVER IN I DECEDENT'S EDUCATION I MARITAL STATUS - Man')ed I! SURVIVING SPOUSE
I U.S. ARMED FORCES? I (Specify on~ I~heat Fade ~p~ted} I Never M~qi~d YVK:~ed ' I (If w~le, give rm~idefl name)
tt~. -A-UtO ~echarlic r ...... / -~,a ~ I (042) o-4ms+) ! ~idox4ed I
DECEDENT'S 17a. StateP.~ East Penl-tsboro
305 ~"~igh St ACTUAL Did 17c. [] Yes. decadarltlive<tln .hvp.
· RESIDENCE ~cadent
live in a No. decedenl lived
Su~erda].e, PA ] 7093 o,(S*"m'~'~°~'om~,~,) ~7~. cou~y Cumberland tmvnship? 17d. l-1 within actuat limit$ of cilyroom
~ FATHER'S NAME (First. Middle. Last.) I MOTHER'S NAME (First. Middle. Malden Surname)
I~*. John D. Horst].ck Sr. {,p Carrie Shouter
I INFORMANT'S NAME (Type/Print) '
A20a. Dennis G. Horst:ick {INEOR. M.~I~JT'.~M&IU~GADDRESS£Street. Cily/Town. Stata. Zi~Co~j)
i,~~+~ Oa. Kmont Green [V[echanlcsburg, PA 17055
I~1~,,o."~ ~ETHOD O.D,S~OS,T,O.[] ~.. [] C.... ~emovlt,~ Stata [] ,I DATEOF DISPO~,T,O.i~. ~.,.-, [:g%~SPOS,T,ON-Nomo.~.me~. C~.me,o~ ]LOCAT,O.-C,ty.o~n. St.ta.Z,,Oedo 17 ~ ~ 2
[-gl~a. om~<,s~:~) []1'~' Aprll 12, 2004 12~c Blue ridge Hem. Gardens I,~d Lower Paxton Twp. PA
I SIGNATURE OF~UNE~L ~VICE HCENSEE OR PERSON ACTING AS St,~CH I LICENSE NUMBER I NAME AND ADDRESS OF FACILITY
'""~~'-J<~'~ .... //- I"~.FD~012774-L I;zc Richardson F.H.29 S. gnola Dr Enola,PA ]7025
~ Compibta items 23a-c o~y whorl ca~ifying o the belt Of m ' ea '
:'~-~"y"~lie~oflWltl'ealf. of.lhto ~'---t~ffi~.~ ~c~t'~dalttle~le'dataandptacaltated' IUCENSENUMBER ,DATESt~NED
' : tam$24-20mult~- -:~: by TIME / .
· ~ - --'T-:;'- OF DEATH I OATcPl~df~31:D DEAD{Month Day Year) I WASCASE REFERREDTOA MEDICAL EXAMINER /CORONER?
r.~parsonwnolxonouncasaeam. / -'="~ I -'1 ~ -- . -- ' ' -- ·
, marvel be~ear not resulting in the un(ta~lying cause given in PART I
IMMEDIATE CAUSE (Final ', onset and death
)~ST ~PO
WAS AN AUTOPSY ~ W~RE AUTOPSY FINDiNGS ~ MANNER OF DEATH DATE OF INJURY ~ T ME OF N JURY tN JURY AT WORK'~ ~ DESCR SE HOW INJURY OCCURRED
PERFORMED? ~ AVAILABLE PRIOR TO ! ~' ! CM~lh. D~¥, You) I I '
ICO~PLET~O. OF DAUSE I N~,nd I~ H~Ode F-II I I
OF DEATH?
~ ~ I ~ I ~ At home, tarn, street, tacto~y, o~ca I LOCATION (Street O~/Town, State)
' ERTIFYING PH IClAN Ph ~ctan cert' i cause of death when anoUler , . ,S G
'P_RO.N~ O.UNClNG AND CERTIFYING PHYSICIAN (Physician both pronouncing death and cedlifytng to cause of death) LICEI~SE ~ SIGNED (M_on~, .Day, Year) V
· MEDICAL EXAMINER/CORONER NAME AND ADDRESS OF PERSON V~ COMPLETED CAUSE OF DEATH
(Item 27) Type or Pdnt ~5 ~/:)~tor-
On "`e blsll of examination and/or InveltlgaUon, In my opinion, dea~ occurred It the time, date, end place, and due to the caueea(a) end [] 32,
LAST WILL AND TESTAMENT
OF
JOHN D. HORSTICK, JR.
I, JOHN D. HORSTICK, JR., having my legal res~A~e~nce at
305 High Street, Summerdale Cumberland County Co~nwe~th
of Pennsylvania, do hereby declare this to be my L~st Wi~
and Testament, revoking all other Wills and Codici~is ~
heretofore made by me. ~
ITEM ONE: I direct that all my just ~-~
debts and the expenses of my last illness and funeral be
paid from my estate as soon as practicable after my death.
ITEM TWO: I devise and bequeath all of
the remainder of my estate and property, of whatsoever
nature and wheresoever situate, to my wife, BEVERLY J.
HORSTICK, if she survives thirty (30) calendar days after my
death. I intentionally make no devise to my children should
my wife survive my death by thirty (30) calendar days for
the reason that I am confident that she will
provide
adequately for any children now living or hereafter born to
us or adopted by us.
ITEM THREE: If my wife, BEVERLY J.
HORSTICK, does not survive thirty (30) calendar days after
my death,then I devise and bequeath all of the remainder of
my estate and property, of whatsoever nature and wheresoever
situate, to my issue, per stirpes, who so survive.
ITEM FOUR: I appoint my sons, DENNIS GENE
HORSTICK and ALAN LEE HORSTICK, or the survivor of them, to
serve as the guardian(s) of the property for any
beneficiaries hereunder who by reason of age or mental or
physical condition are incompetent to receive any funds to
which they are entitled hereunder. In addition to the
powers given by law, I authorize such guardians of property:
(a) To use such amounts of both income and
principal as they, or the survivor of them, in their
sole discretion, deem proper for the support, education
and welfare of such beneficiaries without leave of any
court.
(b) To receive and distribute assets in cash or
in kind, or partly in cash and partly in kind.
ITEM FIVE: All estate, inheritance,
succession and other death taxes, imposed or payable by
reason of my death, and interest and penalties thereon, with
respect to all property comprising my gross estate for death
tax purposes, whether or not such property passes under this
Will, shall be paid out of the principal of my general
estate, as if such taxes were administration expenses,
without apportionment or right of reimbursement. I
authorize my legal representative to pay all such taxes at
such time or times as may be deemed advisable.
ITEM SIX: I appoint my wife, BEVERLY J.
HORSTICK, Executrix of this Will and direct that she be
permitted to serve without bond and without any intervention
of any court except as required by law. I authorize my
Executrix to sell, encumber, mortgage, invest, distribute in
kind, or retain any items of property of my estate in such
manner as she shall deem proper, limited only by her own
discretion. If for any reason my Executrix appointed under
this Will should fail to serve in that capacity, I appoint
my sons, DENNIS GENE HORSTICK and ALAN LEE HORSTICK, or the
survivor of them, as my Executors with the same powers and
privileges set forth above.
IN WITNESS WHEREOF, I have at Hershey, Pennsylvania,
this \~-day-- of ~%-~ , 1983, set my hand and
seal to this, my Last Will and Testament consisting of
~ pages.
~ ~, (SEAL)
~ [ ......'---: '
JJOHN D. HORSTICK, UR.
SIGNED, sealed, published and declared by JOHN D.
HORSTICK, JR., the above named Testator as and for his Last
Will and Testament, in the presence of us, who, at his
request, in his presence and in the presence of each other,
have hereunto subscribed our names as witnesses.
~ Residence
Residence ~~~ ~.
ACKNOWLEDGEMENT
We, John D. Horstick, Jr., ~_~~ ,
and ~,~ ~.~,~/ , the testator and the witnesses
respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the testator
signed and executed the instrument as his last will and that
he had signed willingly (or willingly directed another to
sign for him), and that he executed it as his free and
voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the
testator, signed the will as witness and that to the best of
their knowledge the testator was at that time eighteen years
of age or older, of sound mind and under no constraint or
undue influence.
TOR '
Subscribed, sworn to and acknowledged before me by
John D. Horstick, Jr., the testator, .and subscribed and
sworn to before me by ~~ ~ ~~~ ,
and ~~.~,~~ ~ witnesses, this~ day of
~/~_~'~ _//..---~ , 1983.
Hershey, Dauphin Count, Pa.
My Commi~ion ~pires Nov. 21, 1983
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: JOHN D. HORSTICK, JR.
Date of Death: April 8, 2004
Will No. 2004-000392 Admin. No. 21-04-0392
To the Register:
I certify that notice of (beneficial interest) estate administration required by Role 5.6(a) of the
Orphans' Court Roles was served on or mailed to the following beneficiaries of the above-captioned
estate on April 23, 2004
Name Address
Brenda M. Stinson 167 Diamond Way, Courdand, OH 44410
Dennis Gene Horstick 4845 Oakmont Green, Mechanicsburg, PA 17050
Alan L. Horstick ~ 70 Palm City Park, Annville, PA 17003
James E. Horstick 307 High Street, Summerdale, PA 17093
Notice has now been given to all persons entitled thereto/(mder Role 5.6(~)d~xcept: NONE
Date: April 23, 2004
Murrel R. Walters, III, Esquire
54 East Main Street
Mechanicsburg, PA 17055
(717) 697-4650
Capacity: ~ Personal Representative
, .~., ," X Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA REV-11 62 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-O601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004051
HORSTICK DENNIS GENE
4845 OAKMONT GREEN
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..................
101 $4,500.00
ESTATE INFORMATION: SSN: 201-18-5334
FILE NUMBER: 2104-0392
DECEDENT NAME: HORSTICK JOHN D JR
DATE OF PAYMENT: 06/16/2004
POSTMARK DATE: 06/16/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 04/08/2004
TOTAL AMOUNT PAID: $4,500.00
REMARKS: DG HORSTICK
CHECK//1001
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA
DEPA.TME.TO REVENUE INHERITANCE TAX RETURN
DEPT. 2~601
RESIDENT DECEDENT . -o o
DECEDENPS ~ME {~ST, FIRST, ~D MIDDLE INITI~ S~I~ SECURI~ NUMBER
HORSTICK~JOHND. J~ 2 0 t - t 8 - 5 3 3 4
DATE ~ D~ (~Year) DA~ OF BIRTH (MM-D~Y~r) ~15 R~URN MUST BE FI~D IN DUPLICATE ~E ~E
0~0812004 0t/071~927 REGISTER OF WILLS
(IF APPUC~L~ SURVIVING SPOUSE'~ NAME (~ST, FIRST, ~0 MIDDLE INITI~) S~IAL SECU~ NUMBER
~ t. ~ina[ Ream ~ 2. Sup~e~n~l Ream ~ 3. Remainder Ream (d. dd.~ ~ m 12-1~)
~ 4. Lim~ Es~ ~ 4a. Fu~m In.mst ~mpmmi~ (~ d~m ~ 12-12~2) ~ 5, F~eml Es~ T~ Ream R~ui~
~ 6. ~nt D~ Tes~
. ~ 7. D~ent Main~i~ a Uving Trust (A~ ~ ~ m~) ~ 8, To~I Numar of Sa~ ~t Boxes
~~~0 9.~a~nP~sR~ ~ lO.S~usalPo.~C~it(da.d~2~-9,~,.1.~ ~ 11.El~n~under~.911~A)~o)
THIS SECTION MUST BE COMPLETEB~ALL CORRESPONDENCE AND CONFIDENTIAL T~ INFORMATION SHOULD BE DIRECTED,TO:
NAME COMPLETE ~ILING ADDRE~
MURREL ~ WALTER8
FIRM NAME (~)
~ ~ST MAIN ST~
TELEPH~E NUMBER
7~7-697~650 , MECHANICSBUR~ PA ~7055
1. Re~ Es~ (~u~ A) (1) 9~1900.00 OFFIC~L USE ONLY
2. ~s a~ ~s (~u~ S)~ (2) 3~SA.~ S
3. Cb~HeU~n, Pa~ipor~Pmp~e~hip (3) _~ ~L~ ~,:~ f.
4. ~es & No~s R~iva~e (~ule D) (4) ~ ~ ~ ~,~
5. Ca~, Bank ~ & Mi~llan~us Pe~n~ Pm~ (5) 6~06.28
(~u~ E)
6. Join~y ~ Pm~ (~U~ ~ (6) '
7. In~-~s T~ & M~ Non~mba~ P~ (~ ~;' : ~
(~h~ule G or L)
8. To~l Gm~ ~ (~ U~s 1-7) (8) ~ 58~5~.46
9. Fu~l ~ & ~n~ ~ (~u~ H) (9) ~ 6~350.00
10. ~b~ d ~n~ ~e ~a~ll~, & ~ns (~u~ i) (10) 670.20
1t. To~l D~u~ons (~ Lin~ ~& 10) (11) ~ 7~020.20
12. N~ Value M Es~ (Une 8 minus U~ 11 ) (~ 2) ~ 4~ ~.26
13. C~fi~ ~ ~n~l ~ 9113 T~ ~ ~ an e~ ~ ~ h~ n~ ~ (13)
~e (~u~ J)
14. N~ Value SuH~ T~ (D~12 ~nus Li~ 13) (14) ~41~5~.26
SEE INSTRU~ONS ON,~RSE BIDE FOR ~PLIC~LE ~TES
~, ~ ~ns~m u~er ~. 91~6 (a)(~.2) X ~ (15)
16. A~nt of D~ 14 ~b at lineal r~ ~4~ ~5~.26 X .04S (16) 61369.49
17. A~u~ of U~ 14 ~abb at sibl~ ~ X .12 (17)
18. A~t of ~ 14 ~ at ~ m~ X .15 (18)
19. T~ Due (19) 6~369.49
> > BE SURE TO ANSWER ARE QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
I STREE ' ADOREas
305 141GH STREET
CITY I STATE
t;UMMERDALE PA 19093
Tax Payments and Credits:
1. Ta ( Due (Page I Line 19) (1) 6~369.49
2. Cr.~dits/Payments
A. Spousal Poverty Credit
B Pdor Payments 4~500.00
C. Discount 225.00
Total Credits ( A + B + C ) · (2) 4~725.00
3. Iht ~mstJPenalty if applicable
D. interest
E. Penalty
Total Inferest/Penaity ( D * E ) (3)
4. if Iine 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Pa[.e I Line 20 to request a refund (4)
5. if Iine 1 + Une 3 is greater than Uoe 2, enter the d~erence. This is the TAX DUE. (5) 1r644.49
A. Enter the interest on the lax due. (5A)
B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B) '1~644.49
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 incorne of the property transferred; ........................................................................... [] []
b. retain the dght to dosignata who shall use the properly transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. if death occurred after Deoember 12, 1982, did denedent transfer pmparty within ene yesr of death
without receiving adequate consideration?. .............................................................................................. [] []
3. Did decedent own an '!n trust for' or payable upon death bank account or sesurity at his or her death? ................. [] []
4. Did desedent ow~ an I;adividual Retirement Account, annuity, or other non-probate pmparty which
contains a beneficiary designafion? ....................................................................................................... [] · []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~ ~ .1~ of peru,, I d~l~ ttlat I have exan~ed this tatum, indudii~ ~ying schedul~ and ~, ad ~ ~e ~t ~ my k~e a~ ~., ~ ~e, ~ ~d ~. ol pm~em' el~a' man ,le pe~,onal repmseat~ is based on ali mfom~ of which prepare, has a~y k~e.
ADDRE~ S /
DENN'S/~NE ~R~/~T~CKI ~50AKMONT GREENI MECHANICSBURG PA 17055
MURREL R. WALTERS IIII ESQ. 54 EAST MAIN STREETI MECHANICSBURG PA 17055
For dat(s of death on or after July 1, 1994. and before January 1, 1995, the tax rote imposed on the net value of transfem to or for the use of the su~ving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dat~ s of death on or alter January 1, ~..995, 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 stat Jte does not exem~)t a transfer to a surviving spouse from tax, and the statutory reduiraments for disclosure of assets and filing a tax ratum are efill applicable even if
the surv viag spouse is the only beneficiarY/,
For dat~ s of death on or after July 1,2000;
The tax ~ate imposed on the net value of t~ansfera 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 stel,parent 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 ~ate imposed on the net va~ue of transfers to or for the use of the desedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individu~l who has at least one parent in common with the decedent, whether by blood or adoption.
~'~=~ '~ ~ SCHEDULE A
:o,~.~w~ o~,~,,s~w~ ~. REAL ESTATE
ESTAT~ OF FILE NUMBER
HORSTICK. JOHN D. J~, [ 21 04 0392
AIl mai ~ e~ mole~ or ~ a ~nmnt in common must ~ mpo~d at fair manet valua. Fair ma~e[ value is defin~ ~ ~e pdce at ~ pmpe~ ~u~ ~ exchang~
~en ~ ~lling ~yer ~ a ~i~ ~r, ne~er ~ing ~m~lled ~ buy ~ ~1, ~ having reachable knoW.ge of ~e relevant ~. Real pmpe~ ~ich is JoinUy~ ~ffi right of
su~ivor ~hlp muat be dlsclos~ on Sch~ule F.
ITE ~ VALUE AT DATE
NUM~;ER DESCRIPTION OF
1. HOUSE SITAUTE AT 305 HIGH STRE~ SUMMERDALE, CUMBER~ND COUN~ 94~900.00
PENNSYLVANIA
SALE PRICE
TOTAL (Also enter on line 1, Recapitulation $ 9419QO._nn
(if more space is needed, insert additional sheets of the same size)
~ SCHEDULE B
~O~O~L~ OFp~..SV,V~.~~ STOCKS & BONDS
ESTAT=~ OF FILE NUMBER
HORSTiCK. JOHN D. JR. 21 04 0392
1,11 pmper~y Jointly-owned with right of Sun'lvorshlp mu~t be disclosed on Schedule F.
ITE ~ VALUE AT DATE
NUME ER DESCRIPTION OF DEATH
1. UGI STOCK 1~398.90
45 SHARES
NET SALE PRICE
2. MET LIFE STOCK 2~059.28
58 SHARES
NET SALE PRICE
TOTAL (Also enter on line 2, Recapitulation) $ 3~458.t 8
(if more space is needed, insert additional sheets of the same size)
, SCHEDULE E
CO~O~-T. O~PENNSYLV~.~A' CASH, BANK DEPOSITS, & MISC.
I..ERIT*.C~T*XRE~UR. PERSONAL PROPERTY .
RESIDENT DECEDENT ~
ESTAT5 OF FILE NUMBER
HORSTICK. JOHN D. JR. 21 04 0392
Im lude the proceeds of lifiga~on and the date ~e proceeds were received by the estate. All propen'y Jointly.owned with the right of sunqvorshlp must be disclosed on Schedule F.
ITE~I ~ VALUE AT DATE
NUMI½ER DESCRIPTION OF DEATH
1. PNC BANK ~ 20~015.57
CD ~
2. PNC BANK t 8~054.09
CD
3. PNC BANK 7,867.10
CHECKING
4. PNC BANK 12~264.92
CHECKING
5. MET LIFE 1~042.35
INSURANCE POLICY ON LIFE OF BEVERLY J. HORBTICK WITH
DECEDENT AS BENEFICIARY
6. COMCAST 19.73
REFUND
7. ALLSTATE 3.40
AUTOMOBILE~INSURANCE REFUND
8. CHUCK BRICKER AUCTIONEER 255.00
NET BALE OF HOUSEHOLD CONTENTS
9. LIBERTY MUTU,~L 51.00
HOME INSUR~,NCE REFUND
10. UNITED STATE~ TREASURY 309.00
2003 INCOME TAX REFUND
tl. 1987 FORD PICKUP TRUCK 200.00
NET SALE PRICE
12 REAL ESTATE TM(, SEWER~ REFUSE 124.12
REIMBUSEME!~IT AT SALE OF HOUSE
TOTAL (Also enter on line 5, Recapitulation) $ 60;206.28
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H
COM~.W~T. o~ H~N.S~.VAN~A FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
"ESIDENT DECEDENT
ESTATE OF FILE NUMBER
HORSTICK. JOHN D..JR, 21 04 0392
i)ebts of decedent must be reported on Schedule I.
ITL Vi
NUMI~ER i, DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. RICHARDEON FUNERAL HOME ENOLA 4~917.00
BLUE RIDGE MEMORIAL CEMETARY GRAVE OPENING 900.00
B. ADMINISTRATIVE COSTS:
1 Personal Representative's Commissions
Name of Personal Repn~s~ntative (s) RENOUNCED
~ Secudty Numbers) /EIN Number of Pemanal Representative(s)
Sf~et Address
City State Zip
Year(s) Cdmn,.ission Paid:
2. AttomeyFaee MI~RREL I~ WALTERS III, ESG, 3,000.00
3. Family Exemption; (If decedant'$ address is not the same as cis~'nant%, attach explana~on)
Claimant
S~eet Address
C~ State ~p
RalalJonship of Claimant to Decedent
4. Pmbato Fees REGISTER OF WILLS 3t0.00
CDMBERLAND COUNTY
5. Accountan[% Fees AL WHITCOMB, P.A. 495.00
6. Tax Return Prepamr'$ Fees
7. SETTLEMEN~ CHARGES SALE OF 305 HIGH ST, EUMMERDALE 6,648.00
TOTAL (Also enter on line 9, Recapitulation) $
(If mom space is needed, insert additional sheets of the same size)
~v.,.,.E: .,,~ ~ SCHEDULE I
~oM.o.w~.~. OFPE..S~.V~.IA DEBTS OF DECEDENT,
~..E.,T~"CET~X~*~U.. ~ MORTGAGE LIABILITIES & LIENS
RES[DENT DECEDENT ~
ESTATE OF FILE NUMBER
HORGTICK. JOHN D..JR, ~ Zl 04 0392
I~clude unreimbursed medical expenses·
ITEr, 1
NUME~ER DESCRIPTION AMOUNT
1. PULMONARY AND CRITICAL CARE 14.23
MEDICAL
2. TIMOTHY CLARK, M.D. 6.80
MEDICAL
3. PPL 50,58
ELECTRIC
4. FA AMERICAN WATER 65.55
WATER
6. VERIZON ~ 20.50
TELEPHONE
6. AMERIGAS 146.54
PROPANE HEATING FUEL
7. UGI UTILITIES ~ 25.00
MEDICAL INSURANCE PREMIUM
8 DENNIS HORSTI~K 266.00
ELECTRICAL AND PLUMBING REPAIRS
305 HIGH STREET~ SUMMERDALE
9 HOLY SPIRIT HOSPITAL 50.00
MEDICAL
t0 BIBLE BAPTIST ~ 25.00
CONTRIBUTION
TOTAL (Nso enter on line 1 O, Recapitulation) $ 670.20
(If mo~'e space is ne~:ied, insert additional sheets of the same size)
SCHEDULE J
CO~IMONWEALTH OF PENNSYLVANIA BENEFICIARIES
ESTA1 E OF FILE NUMBER
HOR:~TI( :K, JOHN D, JR, 21 04 0392
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBFR NAME AND ABDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
[. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and ~nsfem under
Sec. 9116 (a) (1.2)]
1 SRENDA M. STINSON DAUGHTER 25%
167 DIAMOND WAY
COURTLAND, OH 44410
2. DENNIS GENE HORSTICK SON 25%
4845 OAKMONT GREEN
MECHANICSRURGI PA 17055
3. ALAN L. HORSTICK SON 25%
70 PALM CITY PARK
ANNVILLE~ PA 17003
4. JAMES E. HORSTICK SON 25%
307 HIGH STREET
SUMMERDALE, PA; 17093
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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same sb:e)
COMMONWEALTH OF PENNSYLVANIA REV 1162 EX{ 11-96)
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004401
WALTERS MURREL R III
54 E MAIN STREET
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..........
101 $1,644.49
ESTATE INFORMATION: SSN: 201-18-5334
FILE NUMBER: 2104-0392
DECEDENT NAME: HORSTICK JOHN D JR
DATE OF PAYMENT: 09/17/2004
POSTMARK DATE: 09/17/2004
COUNTY: CUM BERLAN D
DATE OF DEATH: 04/08/2004
TOTAL AMOUNT PAID: $1,644.49
REMARKS:
CHECK# 1008
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
' REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVAN/A ~k._
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION NOT/CE OF /NHER/TANCE TAX
PO BOX 180601 APPRAZSEMENT, ALLOHANCE OR DZSALLONANCE
HARRISBURG, PA 17118-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX REV-IS4? EX AFP (09-04)
DATE 11-15-200q
ESTATE OF HORSTICK dR dOHN D
DATE OF DEATH Oq-08-ZO0~
FILE NUMBER 21 0~-0592
COUNTY CUMBERLAND
MURREL R WALTERS III ESQ ACN 101
5q E MAIN ST Amount Remitted
MECHANICSBURG PA 1705S
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HORSTICK dR dOHN D FILE NO. 21 0q-0592 ACN 101 DATE 11-15-200q
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 9q/900.00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 3~58.18 credit to your account,
$. Closely Held Stock/Partnership Interest (Schedule C) ($) . O0 submit the upper portion
q. Mortgages/Notes Receivable (Schedule D) (q) .00 of this form with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (6) 60 ~ 206.28 tax payment.
6. Jointly Owned Property (Schedule F) (6) . O0
7. Transfers (Schedule G) (7) .00
G. Total Assets (a) 158,56q.q6
APPROVED DEDUCTIONS AND EXEMPTZONS: 16,350. O0
9. Funeral Expanses/Adm. Costs/M/sc. Expenses (Schedule H) (9)
lO. Dabts/Hortgaga Liabilities/Liens (Schedule Z) (10) 670.20
11. Total Deductions (11) 17. 020.
la. Nat Value of Tax Return (1~) 1ql,Sqq.26
15. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0
lq. Nat Value of Estate Subject to Tax (lq) lq1,5qq.26
NOTE: If an assessment was lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that lnclude the totaZ of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line Ir+ at Spousal rata (15) .00 X O0 = . O0
16. Amount of Line lq taxable at Lineal/Class A rate (16) 1ql,5qq.26 X 0q5 = 6,369.q9
17. Amount of Line lq at Sibling rata (17) . O0 X 12 = .00
18. Amount of Line lq taxable at.;o~i~qtaral/Class B rata (18) . O0 X 15 = . O0
19. Principal Tax Due :~',. ';.. (19)= 6,369.q9
TAX CREDITS:
PAYMENT RECETPT DISCOUNT
AMOUNT pATD
DATE NUMBER TNTEREST/PEN PATD (-)
06-16-200q ,-.COOke05! ~,~ ~0, 236.8q q,500.00
09-17-200q 9~DOiYqq~][ ': .00 1,6~q.q9
~ TOTAL TAX CREDZT ] 6,381.33
BALANCE OF TAX DUEl 11.8qCR
INTEREST AND PEN. .00
TOTAL DUE 11.8qCR
IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE ZS LESS THAN $1~ NO PAYMENT ZS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 11, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section ZIqO of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S.
Section 9140).
PAYNENT: Detach the top portion of this Notice and submit mith your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #ILLS, AgBNT
REFUND (CR): A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1511). Applications are available
online at www.revenue.state.ca.us, any Register of Rills or Revenue District Office, or from the Department's
Z~-hour answering service for forms orders: 1-800-t61-Z050; services for taxpayers with special hearing and/or
speaking needs: 1-SOO-q~7-tOZO (TI only).
OBJECTIONS: Any party in interest not satisfied with the appraisaent, aJlowanca or disallowance of deductions or assessment of tax
(including discount or interest) as shown on this Notice may object aithin 60 days of the date of receipt of this notice
by filing one of the following=
A) Protest to the PA Department of Revenue, Board of Appeals. You may abject by filing a protest online at
www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for
an electronic protest to be valid, you must receive a confirmation number and processed date from the
Board of Appeals websita. You may also send a written protest to PA Department of Revenue, Board of Appeals
P.O. Box 2BIOZ1, Harrisburg, PA 17liS-lOll. Petitions may not be foxed.
B)Election to have the matter determined at the audit of the account of the personal representative.
ADMIN- C) Appeal to the Orphans' Court.
ISTRATZVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box ZB06Ol, Harrisburg, PA 171ZS-060!
Phone ¢717) 787-6S05. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is pald within three (2) calendar months after the decedant's death, a five percent [SI) discount of
the tax paid is allowed.
PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal tho tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, ar nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. A11 taxes which became delinquent on and after
January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by tho PA Department of Revenue. Tho applicable interest rates for 198Z through ZOOq ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20Z .O00Sq8 1'q~-a-1991 nx .oo050l ~'~ 9x .000zq?
1982 162 .OOOqtB 1992 92 .O00Zq7 2002 6Z .00016~
198~ llZ .000301 199t-199q 72 .O0019Z 2005 5Z .0001t7
1985 152 .000t56 1995-1998 9X .0001~7 ZOOq ~Z .000110
1986 lOX .00027q 1999 71 .000191
1987 IOZ .O00Z7q ZOO0 72 .000191
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAZEY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (iS) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must ba calculated.
Glenda Farner Strasbaugh Marjorie A. Wevodau First
Register of Wills Deputy
and
Clerk of Orphans' Court ~~.'i~_~!i~. Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To: InvoiceNo: 169
Murrel R. Walters III Esq. Invoice Date: 01-14-05
Estate of: lohn D Horstick lr
54 East Main Street Estate No: 21-2004-00392
Mechanicsburg, PA 17055 vz
Q~ Fee Description Fee Total
1 Short Certificates 4.00 $4.00
Total: $4.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
BUREAU OF INDIVIDllA~rW\~"
INHERITANCE TAX DIVIS!brt,j,_}:-"':. ~._-i)
PO BOX Z8060l ~I!-~("'"
HARRISBURG, PA 171Z8-06I11i '_'~
:':\T\CE OF
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-16D7 EX AFP (D9-0~l
CLt!:,::( C~
r.PGl-1 ~~\!'::'\
.)il' 1<." ,,-,
MURREL R:)!~nERS rIIEsiji
54 E MAIN ST
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-13-2004
HORSTICK JR
04-08-2004
21 04-0392
CUMBERLAND
101
JOHN
D
Znnr- p,'~ !t, p~,~ 1-1.0
JJd,) ..),::'j' ,. ,I,"" "'j-
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this for.. with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~~:r&~,r.~5r.A~~..rGl~.~!'........;..:rA~!~~lr"fA5r.~'A"f!~.O".A~1:~O~...;;......................
ESTATE OF HORSTICK JR JOHN D FILE NO. 21 04-0392 ACN 101 DATE 12-13-2004
TNIS STATEMENT IS PROVIDED TO ADVISE OF TNE CURRENT STATUS OF TNE STATED ACN IN TNE NAMED ESTATE. SNOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-15-2004
PRINCIPAL TAX DUE:.
M,.,.,.'''''.'M'M'.'.'.''n,.,.,.,''''~'M'M'M'.''''.''n'n'.'.'..M'M"''''''.
6,369.49
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-16-2004 CD004051 236.84 4,500.00
09-17-2004 CD004401 .00 .~ 1,644.49
11-29-2004 REFUND .00 11 . 84-
TOTAL TAX CREDIT 6,369.49
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, see REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
.......",\<..
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/06/2006
HORSTICK DENNIS GENE
4845 OAKMONT GREEN
MECHANICSBURG, PA 17050
RE: Estate of HORSTICK JOHN D JR
File Number: 2004-00392
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:
4/08/2006
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
~}
Cumberland County - Register Of wills
One Courthouse Square
Carlisler PA 17013
Phone: (717) 240-6345
Date: 3/06/2006
WALTERS MURREL RIll
54 E MAIN STREET
MECHANICSBURGr PA 17055
RE: Estate of HORSTICK JOHN D JR
File Number: 2004-00392
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 RULESr NO. 103
SUPREME COURT RULES DOCKET NO. lr for decedents dying on or after
July lr 1992r the personal representative or his counselr 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:
4/08/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Reportr please disregard
this notice.
SincerelYr
.~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
V}
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:
John D. Horstick, Jr.
April 8, 2004
Estate No.:
21-04-0392
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_X_ No
2. 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.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.
in interest:
Did the personal representative state an account informally to the parties
Yes___X_ No
D.
Copies of receipts, releases, joinders and approvals of formal or inf<;>rmal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: Marc;.~8, 2006
C)
/ I/~L
/
f
L,
!
a
i_
MURREL R. W ALTERS, III, ESQUIRE
54 East Main Street
Mechanicsburg, P A 17055
717-697-4650
Capacity:
Personal Representative
___X___ Counsel for Personal Representative
~Y