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Home My WebLink About02-0094PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as To: Register of W/lis for the Deceased. County of ~UMBERT,AND in the Social Security No. [~ -~ - 5 ~- ~O~ ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appllkg (d.b.n.; pendente lite; durante absentia; durante minoritate) for letters of administration on the estate of the above decedent. Decendent was domiciled at death in ~trl~l-[Cct, ~ , County. Pennsylvania. with hi5 lastfamilyorprincipalresidenceat ~ ~ 0~ qctle ~Oo/etq. Lip_._ Uanct7 /'f,ll- ' ~[list street, number and municip~lit~i ' Dece~dent, then_ 3 7 years of age, died ~ ~" at ¢ · . ~_, t~ ~C0).2., Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ ~) .o~ (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: _/Xl6tle.~ $- -- Petitioner after a proper search ha% the following spouse (if any) and heirs: Name ascertained that decedent left no will and was survived by Rel e(- ~ce THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA y ss COUNTY OF CUMBERLAND 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' ~__~~_. _~/~? and subscribed I day of Sworn to or affirmed before me this 2 ~t h JANI]ARY MARY c T,F, WT,~ Estate of HANSARICK JAMES A Register L ~ FF ~l~ NO. 2 1 - n '~ - 9 4 ::/ ~ i~!! i:,,, ~ ~ De.seal~ '~ GRANT OF LETTERS OF ADMINISTRATION AND NOW ~NUARY ?~qTH 3[~[2 0 0 2., in consideration of the petition on the reverse side he~eof, satisfactory proof having been presented before me, IT IS DECREED that jOS.~H=~E=HA~AR~CK is/are entitled to Letters of Administration, and in a6cord with such finding, Letters of Administration are hereby granted to JOSEPH E HANSARICK in the estate of JAMES A HANSARI K Register of Wills FEES Letters of Administration ..... $ Z 3.0 0~ Short Certificates(~ ) .......... $ 3. Renunciation ................ $~ -- -JCP TOTAL ~ $ Filed . ~ANUAR.Y.- 2.8T~. · ~vt~. kgK-2~M~2 mailed to administrator 1-28-02 ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE 105.805 REX,' 9/86 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. Local Registrar P 7 8 8 7 5 3 5 ~'~ ~-- ,,~,,,,, JAI,~ 0 ~ 2:002 No. Date ,5 144 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH (Coroner) 1. James 37 Y~,. A Hansarick Male (Mort h, Day, Year) Stale or Fo~egn Country) 18,1964 .Allentown, PA East Pennsboro Holy Spirit Hospital Asst, 2805 Yale STreet Camp Hill, PA 17011 ,Es,~c~ Joseph E. Hansarick Joseph E. Hansarick ,. Store Cumberland 1-9-02 Did Iownstllp? ER/Outpatient Divorced ~"' '~ Hill Marie L. Bobowski ,,,.Holy Savior Cemetery January 5, 2002 PA 17011 (Il wile, White Bethlehem, PA reaJJng in dmath) LAST PERFORMED? 12:48 p. · - P_endin InvestiRation DUE TO (~q~ DUETO~ January 5, 2002 dying, such as Cardiac or re%oiratory arrest, shock c D Nalural [] Homicide E Ye~ [] NO ~L ACCfd~ [:~ Pending Investigation i~l~er~b~lofbl~x.l~tb~lllOrllnd/M' nv.stJgatlon fl my oplnlon death occuflld .............. ' , =H~w.me date endpace Indduetothecaule(i)lfld .o[] v.. [] NO[] Coroner January 7,2002 Micha. ris, Coroner 6375 Basehore Road, Suite #1 Mechanicsburg, Pa. 17050 21-02-94 RENUNCIATION In Re Estate of deceased. To the Register of Wills of ~,iiTI ~ i Cctq(~ County, Pennsylvania. The undersigned f~&FiC ~Q/15ZLF/CL ~,~ } of the above d~edent, hereby renounces) the ri~t to adjuster the estate ~d res~tfully ~k(s) that Letters be issued to dO~t~ Z. ~~(~C , ~r WITNESS hand this ~_~L~ day of ~0~ ~ff~ , 1~_,~27., 0._ ' ,/ / ~ ' ' (Si~ature) c~ ~ (Address) (Signature) (Addr~s) (Signature) 9C. itL; ~ N~' ~0. (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: No. 2002-00093 Verdie E. Holland, Deceased January 18, 2002 PA No. 2102-0093 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 or about January 31, 2002: Name Address Jack Holland, Jr. 3411 North Second Street Harrisburg, PA 17011 Ronald L. Holland 36 Westfields Drive Mechanicsburg, PA 17050 Russel W. Holland 1602 North Third Street Harrisburg, PA 17102 Robert W. Holland c/o Ronald L. Holland 36 Westfields Drive Mechanicsburg, PA 17050 Verdie M. Whitekettle 830 Lincoln Street Duncannon, PA 17020 Mary E. Bla~h ' ' Sheryl A. Benton I R.D. 1, Box 490 Shermans Dale, PA 17090 6 Pine Hill Avenue Mechanicsburg, PA 17050 NC~has now be~L~ 4~ven to all persons entitle ONE. . Date: January 31;r'~2 -RicWal~C. Snelbaker, Esquire 44 West Main Street Mechanicsburg, PA 17055-0318 (717) 697-8528 Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: j0d3~0.(5 5~, ~00',','~ 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 .J 0. t~ fl (tt5 30: ~00~ o : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Name Address Personal Representative ~.Counsel for personal representative · REV4500 EX . I REV-1500 ~ PENNSYLVANIA ~¢~/~~, DEPARTMENT OF REVENUE J INHERITANCE TAX RETURN ~~~ DEPT. 280601 ~ HARRISBURG, PA 17128-0601 ~ DECEDENT'S NAME (~ST, FIRS~ AND MIDDLE INITIAL) ~ DATE OF DEATH (MM-DD-YEAR) ~ DATE OF BIRTH (MM-DD-Y~R) (IFAPPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)/ ',' ~'~1. Original Retum [] 2. Supplemental Return ~ 4. Limited Estate o [] 6. Decedent Died Testate (AUach cepy of Will) < [] 9. Litigation Proceeds Received OFFICIAL USE ONLY FILE NUMBER ---'-~-- LL- o_g COUNTY CODE YEAR -- N~ER~ SOCIAL SECURITY NUMBER ! 73 - j--& - a-o ?¢'" THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I-- Z Z O O FIRM NAME (If Applicable) []4a. Future Interest Compromise (date of death after 12-12-82) ~]7. Decedent Maintained a Living Trust (Aftach copy of Trust) []10. Spousal Poverty Credit (dale of death between 12~31-91 and 1-1-95) [~3. Remainder Return (date of death p~or to 12-13-82) ~-~5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit BOXes [~11. Election to tax under Sec. 9113(A) (A~ch Sch O) COMPLETE MAILING ADDRESS TELEPHONE NUMBER 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) 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-Pmbata 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. 14. (8) (,) /0., (12) ~ C) (13) (14) Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 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 rate, or transfers under Sec. 9116 (a)(1.2) - x .0 (15) 16. Amount of Line 14 taxable at lineal rate x .0_ (16) 17. Amount of Une 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 20. [] Decedent's Complete Address: ~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) -, Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) ,-- 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) ~..--... 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, (5B) -'" 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; ................................... [] E~ b. retain the dght to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or ........................... [] [] d. receive the promise for life of ether payments benefits or care? .................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? [] [] 4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under penalties of perjury, I declare that I have examined this return, including accompanying schedule~complete. Declaration of preparer other than the personal representative is based on all informalion of which preparer has any knowledge. SIGNATURE OF PERSON RESPON~ DATE ADDRESS SIGNATURE OF PREPARER OTHER T--"~ REPRESENTATI~/'~ ADDRESS DATE 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 exempt 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 RS. {}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-IF',5 £X * (1-§7) (I) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF ~.,~/.fg..=c.,( ,/~. FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE Of DEATH ~:~ OO000 ~oz,Ta .Z~o,/-Y- (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANI^ ~ FUNERAL EXPENSES INHERITANCE TAX RETURN / ....... ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. DESCRIPTION FUNERAL EXPENSES: AMOUNT .5-? d, oO ADMINISTRATIVE COSTS: Personal Representative s Commissions Name of Personal Representative (s) ~ ,.~'7;//)~f Social Security Number(s) / EIN Number of Personal Representative(s)/ ~;;""~--/~'f") '/~"~? 7 Street Address ~""~ ~ ~"' ~L~'~- City ~"/~"/?) ~/~/~" State jf'~.,4Z. Zip Year(s) Commission Paid: ~:~ Attorney Fees Family Exemption: (If decedent s address is not the same as claimant s, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Accountant s Fees Tax Return Preparers Fees State. Zip TOTAL (Also enter on line 9, Recapitulation $ (If more space is needed, insert additional sheets of the same size) REV-i~ EX + (1-97) (I) ~ m co..o.w~.'r. OFPE..S¥~.V~,^ / DEBTS OF DECEDENT, ESTATE OF ~ - Includ, ITEM NUMBER Z unreimbursed medical expenses. DESCRIPTION TOTAL (Also enter on line 10, Recapitulation (If more space is needed, insert additional sheets of the same size) AMOUNT ~6v. O0 S-,oo r s q~, 5-3 2EoO ' '~" / SCHEDULE J / CO~MON~V~LTH OF PENNS~LVAN A / BENEFICIARIES INHERITANCE TAX RETURNREsiDENT DECEDENT I RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE ]. TAXABLE DISTRIBUTIONS (include outright spousal distributions) II. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES NON-TAXABLE DISTRIBUTIONS: 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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 size) BUREAU OF ZNDZVZDUAL TAXES ZNHERZTANCE TAX Drv]'SZOH DEPT. Z&060/ HARRTSBURG, PA 171Z8-0601 JOSEPH E HANSARZCK 2805 YALE AVE CANP HZLL CONNONNEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX PA ~r17011 DATE ESTATE OF DATE OF DEATH FZLE NUNBER COUNTY ACN RE¥-1567 EX iFP (01-02) 08-19-2002 HANSARZCK dANES A 01-05-2002 21 02-0094 CUNBERLAND 101 = Amount Remitted HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGZSTER OF NZLLS CUNBERLAND CO COURT HOUSE CARLZSLE, PA 17015 CUT ALONG THZS LZNE ~'~ RETAZN LO ................. #ER PORTZON FOR YOUR RECORDS ~ REV- ZS&7 E~ AFV-[~i=~-~-~-~[~-~_~[.~.~p~_~[k~_~[~_~h~_~_~ ................. ESTATE OF HANSARZCK DZSALLOHANCE OF DEDUCTZONS AND ASSESSNENT OF TAX JANES AFZLE NO. 21 02-0094 ACN 101 DATE 08-19-2002 TAX RETURN NAS: (X) ACCEPTED AS FZLED ( RESERVATION CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE ~'~ RETURN BASED ~ CHANGED 1. Real Estate (Schedule A) ORZGZNAL RETURN 2. Stocks and Bonds (Schedule B) (1) (2) . O0 $. Closely Held Stock/Partnership Znterest (Schedule C) ($) O0 ~. Nortgagas/Notes Receivable (Schedule D) ' (4) .00 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) ($)_. 1/~98.65 6. Jointly O~ned Property (Schedule F) 7. Transfers (Schedule G) (6) .§0 8. Total Assets (7) .00 APPROVED DEDUCTZONS AND EXENPTZONS: 9. Funeral Expenses/Ad~. Costs/Hisc. Expenses (Schedule H} (9) 10. Debts/Nortgage Liabilltles/Liens (Schedule Z) 11. Tote1 Deductions (10)_ 8,725.00 2,142.75 NOTE: To insure proper credit to your account, submit the upper port/on of this fore ~ith your tax payment. 1,298.65 12. Net Value of Tax Return (11) . 10.R67.7~ (lz) 9,569.10- 15. Charitable/Govern.entel Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 ltl. Net Value of Estate Sub~ect to Tax 9,569.10- NOTE: Zf an assessment ~as issued previously, lines 14, 15 and/er 16, 17, 18 and 19 re~lect figures that include the total o~ ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amount of Line 1~ at Spousal rate (lS)_ .00 X O0 = .00 16. Aeount of Line lq taxable at Linaal/Class A rata (16) O0 X 045 17. Amount of L/ne 1~ at Sibling rate ' = .0~ (l?) .00 X 12 = .00 18. Amount of L/ne 1~ taxable at Collateral/Class B rate (18). O0 X 15 19. Principal Tax Dua ' = .00 TAX ~REDZTS: (19)~ .00 ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ZNTEREST/PEN PAZD (-) ANOUNT PAZD ~ TAX CREDZT I~ALANCE OF TAX DUE ~N?EREST ANi) PEN. TOTAL DUE .°°l .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REI~IZRED. ZF TOTAL DUE TS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORN FOR ZNSTRUCTZONS.) RESERVATION: Estates of decedents dy[ng on or before December II, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CoamanmaaJth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the Lawful CLass B (collateral) rate on any such future interest. Tax Act, Act Z5 of ZOO0. (7Z P.S. PURPOSE OF NOTICE: To fulfill the requirements of Section Il40 of the Inheritance and Estate 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 NXLLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may bm requested by completing an -Application for Refund of PannsyXvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-562-ZOS0~ services for taxpayers aith special hearing and ! or speaking needs: 1-800-447-5020 (TT only). oBJECTIONS: 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: OR --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZB-lOZ1, --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADNIN- to: PA DapartJent of Revenue, ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed tn writing Bureau of Individual Taxes, ATTN: post Assessment Revise Unit, Dept. ZB0601, Harrisburg, PA 171ZB-0601 Phone C717) 767-6505. See page 5 of the booklet ,.Instructions for Inheritance Tax Return for e Resident Decadent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three [5) calendar months after the dacadant's death, a five percent [SX) discount of the tax paid is allowed. PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed~ and not paid before January 18, 1996v the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed es indicated on this notice. INTEREST: Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one [1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six [6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 19az ail1 bear interest at a rate whioh will vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor -- -- .O00gq7 198Z ZOZ .000548 1992 9Z 1985 16Z .000q58 1995-1994 7Z .000192 1984 112 .000501 1995-1996 92 .O00Zq7 1985 152 .000556 1999 72 .000192 1986 lOX .000274 ZOO0 8Z .O00ZX9 1987 9Z .O00Zq7 ZOOX 9Z .O00Zq7 1988-1991 llZ .000501 ZOOZ 6X .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID )[ NUNBER OF DAYS DELINQUENT X DAILY 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 be calculated- STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No.: Admin. No.: f~ff ~ 2_/- 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 ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes _X~ No 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 [-~ No [--1 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 th.is report. '- Address 7/'7- 7 7- 17 Telephone No. Capacity: I~] Personal Representative [--] Counsel for personal representative