HomeMy WebLinkAbout04-0050 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as To:
Register of W~lls for the
Deceased. County of /.-'~.,~ .b ~../,~ ~ d in the
Social Security No. ~ ¢ 9 - ~/~ - 7Z,~-' Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl / ~ for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in ~//~7~ m £ st /ro~-d__. County, Pennsylvania, with
h /-~ last family or principal residence at -~ c~. ~ ~.~ dv~n.,~ _5 i, ~-~,~/,t ~-~ ~,s~,.~.~, /~
(list street, number and municipality)
Decendent, then ~'ff '~ years of age, died ~JJ9 ,, / ~, o ~ o <./ , ~ .,
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ ~/~''~ o., ~-~ r
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Petitioner after a proper search ha $ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
~ame Relationship Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONV~AE~['I ~ OF PENNSYLVANIA ~ ss
COUNTY OF Ct~nberland
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
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this 16~-h day of |
.~..~, January_, 1:~_2004
Glen~a Farner Strasba~gh ~ /% . --~
No. 21-2004-50
Estate of m~s~ L. VARNER , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW Jann~ry Pf~-h PgX 200~lin consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Carol 1. Rohrbaugh
ig/are entitled to Letters of Admi~stration, and in accord with such finding, Letters of Administration
are hereby grated to C~ol L. R0~bauqh
in the estate of ~,~ty L. V~er
' - Register of Wills
Glenda F~er Strasbaugh
FEES
Letters of Administration ..... $ 18.00
Short Certificates(3 ) $ 9.00 A~OaN~Y (Sup. Ct. nD. No.)
R~~ .............. $
JCP Fee $ 10.00
TOTAL __ $. 37.00 ADDRESS
Filed J~u~ 20th A.D. ~ 200~
~i~ %e~e~ ~o ~is~uix PHONE
on 1/20/04
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.
No. ~
H105.144 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH "VITAL RECORDS
CERTIFICATE OF DEATH
TYPE/PRINT (Coroner)
tN
PERMANENT # 2 9 - 18 3 STart F,~
m SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Monlh, Day. Yen)
BLACKINK ~AMEOFDECEDENT(Fi,~.MIOd~e. La~) L Varner g. Male {3. 209-48-7565 IOanuary 10, 2004
Rusty
M~,lhs Days Nours Minules (Month. Day. Yeal) Stale or Foreign C~mry) HOSPITAL: OTHER:
5. ~3 Yrs. CITY BORO/'~OE~DEATHFAC LIITY~ .... . ...... ion ~*ve .... r~l~ur~lber WAS~ECEOENTOF HISP[ANIC ORIGIN? RACE .......
I OOUN'rY OF DEATH ' ~ { NO [] ~rl~, [] If y~s. SpeClly Cuban. I~pec~Iy)
Cumberland South Newton 512 West Main Street Mexicmn. PuerloR~n. etc. 10
~ ~' r~,=~I:P~:I~rI"SUSUALOGCUPATION IIc KiNDOFBUSNESS/INDUSTRYIBd WASLn:t,laC, IaNTEVERIN ~I:G~O~IT'SEDUCATON19 MARFrALSTATUS-M&~C~ I SURVI¥1NI:~S?OUSE
(=~,~'l~x Inc Ye~ L~ No L-J 1 2(°'12) (t-40'5+) Divorced ..
N DECEDENT'SMAILINGADDRESS(StreeLOiIy/Tovm. Stme. ZipCode) U~:~IabENT'S PA l?Q.r~ ~r~s. decedentllvedin South Newton Township
ACTUAL ITa. 5tate Did twp
3 West Main Street, Apt.. ~2 RESIDENCE d~:edenl
Walnut Bottom, PA 17266 (~,~* ~"
~B. David W. Varner ~g. Carol L. Hancock
~N~O,M~NT'SN~E~i~,);~ Carol L. Rohrbaugh I~ 2444 Lindsay Lot Rd. P.O. Box 521, Shippensburg, PA 17257
Do~aiion[] Other(Spec~yl ~]21b 1--12--04 2~cSmithsburg Crematorium ='~d Smithsburg, MD 21783
~ ·
M },GNAT RE UNERALS ICELI NSEEORPERSONACTINGASSUCH
~,. 12:25 AM. ,,. January i0, 2004 ..
d~ ~' cond~ion Head Injuries
Motor Vehicle Crash
..... BL~RR,OR~ I I~,.~.~0 I Unbelted operator,
IOFDCr. ATH? ]Nmural U Homic~ U I T=~ lfl 9f~lqA I · ~ . I ~" ~ -or-~ I crossed road, struck tree
~m ("em=7)TyPeorPrinMichael L. Norris, Coroner
'"-'"~"°""'~ ................................................................................................ '-~ 3z Mechanicsburg, Pa. 17050
Z REOISTFIAR'S SIG ....... DNtl .... ~ C ~,~{ /~/ ~ DATE IFILED [M ......)
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ~s~ ~.
Date of Death: %d/~ad. /O/ O-o~ ~/
Will No. t~O,/I/~" Admin. No.c~-. [ - (.~q -~(~)
To the Register:
I certify that notice of (beneficial interest) estate admini.~tration 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 :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
'~' : Name
C,,S Address ./~-~ ~cr~
Telephone
Capacity: /~ Personal Representative
Counsel for personal representative
OFFiCiAL USE ONLY
REV-1500
PENNSYLVANIA
OEPARTMENT OF REVENUE INHERITANCE TAX RETURN :,LE
oEPT. 28oeo I - 0 _0_ __0 .50
HARRISBURG, PA17128-0601 RESIDENT DECEDENT o- -oooE
DECEDENTS NAME (LAST, FIRST, AND MIDDLE iNITiAL)
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
.'~- .20 - 70 REGISTER OF WILLS
/ - /g) - O ~ SOCIAL SECURITY NUMBER
(~F APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) _ _
1. Original Return [~ 2. Supplemental Return [~ 3. Remainder Return (date of death prier to 12-13-82)
Estate Tax Return Required
[~ 4a. Future interest Compromise (date of death after 12-12-82) E~ 5. Federal
~ 4. Limited Estate
E~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) -- 8. Total Number of Safe Deposit Boxes
E~ 6. Decedent Died Testate (Attach copy of Will)
~ 9. Litigation Proceeds Received ~ 10. Spousal Pove~y Credit (date of death between 12-31-91 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A)(Attach Sch O)
NAME /'~ , ~ ~ / COMPLETE MAILING ADDRESS
TELEPHONE NUMBER
~FFICIAL ~ ONLY
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~)
4. Mortgages & Notes Receivable (Schedule D) (4) (2 ("~O
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) O
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) 0 ~ O
E~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L) "~
(6) O
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)
11. Total Deductions (total Lines 9 & 10)
(12) dP
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J) (14) _
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE iNSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax x .0 __ (15)
~.. rate, or transfers under Sec. 9116 (a)(1.2)
x .0 (16)
) 16. Amount of Line 14 taxable at ~ineal rate
x .12 (17)
17. Amount of Line 14 taxable at sibling rate
~O x .15 (16)
~ 18. Amount of Line 14 taxable at collateral rate
(19)
19. Tax Due
20. ~
Decedent's Complete Address:
RESS
Tax Payments and Credits: (1)
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty Total Interest/Penalty ( D + E ) (S)
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) ('~
(5A)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
1. Did decedent make a transfer and:
a. retain the use or ncome of the property transferred; .......................................................................................... [] []
b retan the right to designate who shall use the property transferred or its income; ............................................ [] []
C reta n a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ......................................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death [] []
· out receivina adequate consideration? .............................................................................................................. [] []
w~th " , .......... ~., ...... death bank account or secur ty at his or her death? ..............
3. D d decedent own an in trus~ TOr' uf p~y~u,=
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which []
contains a beneficiary designation? ........................................................................................................................
IF THE ANSWER TO ANY OF TIlE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE
SIGNATUP, Fc;~OF PERSON RESPOJ~ljBL~FOR FILING RETURN ,,~ .,,) 7 ,=,,7 d~
ADDRESS" ~ ~'
'/LJd .,~-.,~ ..~,.z_/ ~ f '~- / 7.~ 3-'7 DATE
~ ---'--'-' THER THAN~EPRESENT~'CWE
SIGNATURE OF PREPARER O
ADDRESS
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 ~ a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a 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 ar
individual who has at least one parent in common with the decedent, whether by blood or adoption.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
*'
REV-1547 EX AFP (03-05)
CAROL ROHRBAUGH
PO BOX 521
SHIPPENSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-28-2005
VARNEK
01-10-2004
21 04-0050
CUMBERLAND
101
RUSTY
L
Allount Rellitted
PA 17257
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 ~
I1f~W~"Yf.m.m!'8!'.1-mtYt!t.W.!wtAW4M!!.m.lmlTftMMr~.YCtW4M!!'.8Tt.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VARNEK RUSTY L FILE NO. 21 04-0050 ACN 101 DATE 03-28-2005
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. HortgageslNotes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
.00
.00
(8)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
.00
.00
(11)
(12)
(13)
(14)
DO
.00
.00
.00
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX R IT
NOTE:
.00 X
.00 X
.00 X
.00 X
00 =
045 =
(i~)=
15-.)=
U9:l Q
i""",..)
"'-'-'--,
"')
C.,/'I
.00
.00
.OQ
.no
.ob
"'-,-., ..~
.......~.,
:J
J
DATE
NUHBER
+
INTEREST/PEN PAID (-)
AHOUNT PAID
(,.)
(j"[
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE. DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.~~~
, . , ~
RegistoBi' ofV;iHs of Cliiiibedand County
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
R ~ So t ') L t \Ir.l er1 t IC,
~,4tV. /0 OJ DO 4
Date of Death:
Estate No.:
100LI- OO(;).so
.
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 ,l81: No 0
2. lfthe answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. Ifthe answer to No.1 is Yes, state Lne tOlhJYliillg.
a. Did the personal representative file a fma1 account with the Court?
Yes J8L No 0 .sE-~ A+tAC h..t d PPrpz-R..
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. /"l
Date:/..2-(O-o~- ~ X ~~~L
~-"
Signature
(!/fRO! /- - f}jKjl/~ '--
Name
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Address
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Telephone No.
Capacity: MPersonal Representative
o Counsel for personal representative
~1;
~ . 04-0050
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Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 11013
Phone: (717) 240-6345
Date: 12/06/2005
ROHRBAUGH CAROL L
POBOX 521
SHI PPENSBURG , PA 17257
RE: Estate of VARNER RUSTY L
File Number: 2004-00050
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:
1/10/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
,@ V
.i fi"
. Ah:.': '.?'''''
. J-;'~,_._........ __"
.~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
~~