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HomeMy WebLinkAbout04-0067 PETITION FOR PROBATE and GRANT OF LETTERS ' '3°o,,, t.. o ,,,2 7 also known as To: Register of Wills for the , Deceased. County of Social Security No. <o \\- 'L2.- 2.\~0 ~ 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 exqcutg_ v' in the last will of the above decedent, dated ~\~ - and codicil(s) dated in the named ,19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~'~ r~X'~¢~-~ 0~ (~ County, Pennsylvania, with tx er' last family or principal residence at ~¢'D ~r,~e. ~ ~,~ (list street, number and muncipality) Decendent, then '-~ 0~ __ years of age, died %0 oz~x~ o,,, ~ \~ at_ -- /'1'9' 2o6,~ 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 adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania situated as follows: ~ <g 5'~{3 0 Q $-' WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters. theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } COUNTY OF :ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief ot~petitioner(s) and that as ersonal re - tattve(s) of the above decedent etitioner(s) wtll x¢~ll an&th,Iv adminio*o- ~- ....... ~ .. pre. sen P ' ~x~ ~JJVh ...... ,,~ ~atat~ accoralng tO law. ~orn to o.r af_fir_me$t a~nd subscribed ,-x,~ ~(J~ . oelore me th~s ~xY_..~/__-/~a~./ da-' of / ~ ~ DECREE OF PROBATE AND GRANT OF LETTERS , Deceased AND NOW ~~/~/~-'/ r"~'~/ .j~~in consideration of the petition on the reverse sid~ereof, satisfactory proof havin~een presented before me~ IT IS DEC~ED that the instrument(s) datedfi f~~ /~ '" ord as the last will of ~, ~d Letters ~...~'~ /~ ~ ~ ~e ~r~t~ ~ ~ FEES Probate, Letters, Etc .......... $~ Sho~Certificates( )-.-' ....... $~ ation ................ $ ~ . S //q,~.. TOTAL - $~ Regis. ter.qf V~.~ _/ , ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (each) a subscribing witness to the law, depose(s) and say(s) that codicil will presented herewith, (each) being duly qualified according to present and saw the testat. ., sign the same and that signed as a witness at the request of testat.~ in h.. presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19.~ (Name) (Address) (Name) (Address) Register REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber [~eto, (each) being duly qualified according to law, deposes) and say(s) that '~. ~-.a'~,~ X'~C~:~c t'~ familiar with the signature of ~t~, k._~)x~ testat that to the best of Ja;~ ;;'itncs:os ts) the will presented herewith and codicil believes the signature on the will is in the handwriting of knowledge and belief. (Name) Sworn to or affirmed and 3ubscribed before (/~~~ ~ Register/. (Address) (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (each) a subscribing witness to the law, depose(s) and say(s) that codicil will presented herewith, (each) being duly qualified according to present and saw the testat. , sign the same and that signed as a witness at the request of testat in h_ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_. (Name) (Address) (Name) (Address) Register REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, testat ~,,~ of that ,_~']~ ~ to the best of_ ]%e~ (each) being duly qualified according to. law, depose(s) and say(s) that familiar with the signature of ~_~ r) ~. --~q~So.~ , ......... sc ...... $ w,tlicssc3 to) the will presented herewith and codicil believes the signature on the will is in the handwriting of knowledge and belief. Sworn to or affirmed and subscribed before //~~_-~~Regi~ter (Name) (Address) (Name) (Address) 105.805 REX.' 9~86 This is to certi~ that the information here giveh 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. ,.,.~ . Fee for this certificate, $2.00 P 10047128 No. ~o~egistrar Date 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Joan L Ros~ ]s~, }~c,.t~c~.,.~.~. ~g~o.e---. Hechanicsburl, Pa. 17055 .~ ~ ~ ' '" ; Forres~ Curtis ~ Beulah ~cey Curtis ~ose Pa. lYllO lan, 23, 2~4 Baltlmore Natlonal C~meter' ~, ~ryl~nd FD 010628 L 2100 Lln IJAST WILL AND TESTAMENT OF JOAN L. ROSE I, JOAN L. ROSE, of Mechanicsburg, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my children, JANET E. LARSON, J. CURTIS ROSE, and JAMES G. ROSE, provided that should any of my children predecease me, I give and bequeath such child's share unto his or her issue per stirpes by representation, and if there be a failure of same, then I give and bequeath such deceased child's share to my surviving children as provided herein. SECOND: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal ~roperty and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- ~on, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. the death, resignation or inability to  hatsoever of the said J. CURTIS ROSE, 2 (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. THIRD: I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. FOURTH: I nominate and appoint J. CURTIS ROSE, Executor of this, my Last Will and Testament. In the event of serve for any reason I nominate and appoint JAMES G. ROSE, Executor of this, my Last Will and Testament. In the further event of the death, resignation or inability to serve for any reason whatsoever of the said JAMES G. ROSE, I nominate and appoint JANET E. LARSON, Executrix of this, my Last Will and Testament. I direct that my Executor or Executrix, as the case may be, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set mv hand and seal to this, my Last Will and Testament, this u~'day of , 1995. Jo . ROSE Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address 3 OF JOAN L. ROSE JAMES D. BOGAR LAW OFFICES JAMES D. BOGAR, ESQUIRE ANDREW C. SHeELY, ESQUIRE I WEST MAIN STREET SHIREMANSTOWN. PENNSYLVANIA 17011 REV 1500 EX (6-00)  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER COUNTY CODE YEAR NUMBER DECED, F~N.~S NAME (LAST, FIRST, A, ND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ILl DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LLI k_~,o- ~,.~ ~,~_ c~_.~._ ¢'~.,,~ REGISTER OF WILLS UJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER LU 0 [~. Original Return ~'~4. Limited Estate [~]6. Decedent Died Testate (A~ch copy of Will) [~9. Litigation Proceeds Received ~-]2. Supplemental Return ]4a. Future Interest Compromise (date of death after 12-12-82) ~17. Decedent Maintained a Living Trust (A~ch copy of Trust) [~10. Spousal Poverty Credit (date of death between 12-31-91 and %%95) [~ 3. Remainder Return (date of death prior to 12-13-82) ~15. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ~111. Election to tax under Sec. 9113(A) (Attach Sch O) FIRM NAME (If Applicable) TELEPHONE NUMBER %7 COMPLETE MAILING ADDRESS 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-Probate Property (7) (Schedule O or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) Total Deductions (total Lines 9 & 10) (8) (11) (12) 9. (9) 10. (10) 11. 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 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) OFFICIAL USE ONLY SEE INSTRUCTIONS ON REVERSE SlOE 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 Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) Decedent's Complete Address: CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE z~P Total Credits (A+ B +C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 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 (3) (4) (5) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 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 IF THE ANSWER Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] E~ b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] E~' d. receive the promise for life of either payments, benefits or care? ...................................................................... [] E~ If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [~ Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [~ Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] 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 schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of.~pre~arer other than the personal representative is based on all information of which preparer has any knowledge. %(~N RESPONSIBLE FOR FILING RETURN [,,~%D~[~,~,% 0~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 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 RS. §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 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 RS. §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. VICTORIA LEE ROSE 4015 GREEN STREET HARRISBURG PA 17110  PAID ~ AMOUNT NEW CUMBERLAND,PR ~ 17070 I~ ~o~r~wc~ 00054129-07 ~ h,,llh,,llh,,,,,Ih,lhh,hl ~OADVIEW MORTGAGE CD 717 SELLER'S GUIDE ADDENDUM D PENNSYLVANIA HOU~G FINANCE AGENCY SINGLE FAMILY MORTGAGE REVENUE BOND PROGRAM AFFIDAVIT OF ~etELLER [This Affidavit is NOT ~'quir~d if: (I) a n~v bom= i~ being cuns~rucmd on the borrower's In~, (2) the berrower is purcham/~ p~:)perty ~der an ¢liffibl¢ mslaUr~ ~ agt~-~lmm~, or (3) ~ s~ll~ is ~qJD) THIS AFFIDAVIT IS MADE FOR THE PURPOSE OF SATISFY]NO THE R.EQLrlRI~,/RNTS SET FOR3~'I IN TI4~ 1NTF2,NAL RE~ CODE OF 1986, AS ~ED, (thc "Code") AND THE RULES AND R]g]ULATIONS PROIvlULGATED lrO'RSUANT THERETO BY THE U.S. DEPARTMENT OF THE TRF2sSURY. RI/AD IT CAREFL~Y TO BE SURE THAT THE EqFORMATION IS TRUE AND CORRECT. MAR-17-2004 12:00 { PHFA Form 3d 3. The acquisition cost of tl~ land and m~cl~nce to be acquired by the Ben, ewer from the Seller listed above is compul~ ns ~llows: (a) Amount paid, m cash or in kind, by ~hc Borrower to or for ~e benefit of the Seller (or a relat~ party) ~ the land and Residence (excluding any l~onal (b) Amount paid, in e~sh or ia ~ by any crier t~xsun to or for the ~ of Seller (or a r~a/ed party) for the land and Re~idm~ (excl~dial~ any p~rsonal PrOl~-rty which/s n~t a £v,m~) ............................................................................... $ (~) Amount l~d f~ ~s (if ~t part of price of the l~d and Residence i~l~ded iu (a) and t~) ,bore) ................................................................................................ $ pcff-ommd by thc Borrowc~ or members of his family (which include li~c Borrcrwcr's percnla, brothe~ smd sisters (wf~her by whole or half blood), spome, ancestors and tin,al descendants) in completing or rehabilitating the residence (L~. "sv,~eat equity"). "Settlement costs" 5tcludc title and xccordino, f~es, title insurance, survey fees and other sim.ilar costs; and "Ruar~ing costs~ Lrtclud~ credit reference fees, legal ~es, aFpraisal expense, points which arc paid by the Borrows, or n~her c-o~ts of Fn~ucing the c~id~o.~o. Ii' su~ snttlement ami fimncing costm e~md the unud and mmonnble ensts wBich olh~rwise would be paid, such excess must be included in the a~qttisitien cost. '1~ acquisition cost Roes not i~cludu tim co~t o£1ami owned by th~ Borrower for two years or raore prior to the dam on which consu-aetion or,me residenc~ besim. PI-WA has information available concerumg whal consfitums a fixture or permoual property under utate law. 15 731 1061 P. 02 MAR-l?-2004 12:01 BROADUIEL~ MO~b~u~ ~ 3. cH~CI~ ONE OF TH]~ FOLLOWING A1~D COMPLETE AS ^pPL~CABLE: SELLER'S GUIDE ~imiln~ to ~ Ken~nc~. rmu=~ · ' The Re~idene~. is compile and doe~ not con. in any ~ ~ ~ ~e ~ n~ of compt~on. Ple~ ~m~ 4. No ~of~ .; i;:. . :'.. DaZe ,~eltc'r S~II~ 16 12: 01 BROADU I EW MORTGAGE CO PENNSYLVANIA HOUSING FINANCE AGENCY HOMESTEAD PROGRAM NOTICE TO SELLER .Y D=m- h°mc. ~ ~ of ~ ~ to ~e ~is p~, ~e Bwers ~c ~Hcd re ~e P~t~ Ho~ing F~ A~ (~e "A~cf) for a HO~S~AD L~. ~ is a lo~ ~om ~e A~cy ~ ~ Buy~ ~ he~ ~y ~ ~ PsY~ ~d ~ rel~ clo~g ~s ~volv~ ~ ~R p~. ~ ~ ~ ~c 1~ ~ B~ f~ gov~m~ ~y ~y be u~ ~ ~ p~ch~ ~yo~ ~, y~ ~ ~ ~o~ of ~ ~Uo~8: I. Bgca~ ~ ~s a volu~O~ ~le, hy w~gh y~ ~e ~Y ~H~g ~g rasing ~ ~ Buy~, the gov~ to ~e ~ for p~l~ ~). ~s~ ~d ~ Pm~ Acq~fion PoHc~s Act of 1970, ~ ~de& F~, ~ or~ ~o oo~[~ ~ ~ f~ re~s (49 ~.F~. P~ ~), ~ ~ ~t ~t ~ ~glosc wh~ y~ were ~ yo~ p~o~ ~ ~Fan.e at ~e ~me ~ ~nt of S~ ~ si~ ~d ~so w~ you ~v~ r~t~ ~ pm~ ~ ~yo~ s~ ~en. PI~ ~&ca~e below ~m ~ ~ or ~ve ~ ~an~ on yo~ ~: ~le~c ~k aH ~ apply) ~ or ~ ~ ~ (ch~k one) ~ occupi~ ~ ~ ~e ~ A~t af 1. Th~ prop~-Ly Sale was s/gncd. 2. The pmpc~y ~ d/ned. h~s or ~/._ h~ not (check one) bom rented since the Agmem~ of Snle was 3. ~ Th= property /z c~rnmtly being r~,ed by the Buyer. PLEASE NOTE: IF THE PROPERTY WAS TENANT OCCtPPIED (BY ANYONE OTHER THAN TIlE BUYER) WHEN THE AG , ,REEME2qT OF SALE WAS SIGNED OR SINCE THI~, THE PROPERTY IS NOT ELIGIBILE TO BE FINANCED UNDER THE HOMESTEAD PROGRAM. You should hay= received two copies of this letter. Please keep one for your records, and pleac~ sign the other ~opy on the applicable hno below and return to the lending insfimlion that is evaluating thc Buyer's loan application_ Tim Buyer can .~pply ynu with the address of the tending institution. Please fill out and return this Notice immediately, as the Buyer's loan application cannot be considered until yoa remm this Notkc. I/we have read this left,r, understand the contents, have answered thc questions rela~ed to tenants on the property, ~md wish to proceed with thc sat~ to the Buyer: x I/we hzw read this letl~r, understand the cements, b~ no longer wish to proceed wi~h ~he sale to fl~ Buyer: 717 731 8/2o02 1061 P. 04 TOTAL P.04 · Pisc~oned Rea/ty, Inc; ..: Sugt,oran,~ Om' Co,nm,m~ REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair i~arket value. Fair market value is defined as the price at which property would be ITEM exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedul, F. NUMBER DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH HARRISBURG PA 17110 L~ate ,~,, %% ,, .... O PNCBAN< PNC Bank, N.A- 040 Central PA ChoiCeplan ~ .~..~~ SOON 1,5 ils E i.~,· 1,0 ilO ,,'0000 0 :~ :t I, ii ?," '-----' .::.:..; :.:7:.': ::.': ~,:"' ". ' L:_ ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN SI' HARRISBURG, PA 17110 O PNCBA PNC ~a~k, N.A. 040 Choice central PA Plan For ~ 'Ill'Il I='1 ........... - ': ...... I) ' Iii 1021 B0-1273/313 041 Dollars ~ ~'~ ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 1005 HARRISBURG, PA 17110 Date 60-1273/313 041 PNc ~,, N.a. 04o Choice Central PA J CURTIS ROSE EXEC. 1018 4015 GREEN ST HARRISBURG, PA l?110 Date 041 REV-1503 EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ (~O,.','~ '~---. ~-O %<'- SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) $ (if more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH REV-1508 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ,~ (30~'~ ~-. ~(3 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the ITEM NUMBER )mceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorshi DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) must be disclo_~ on Schedule F. VALUE AT DATE Of DEATH CONHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRZSBURG, PA 17128-0601 REV-/~S EX AFP (09-00) ZNFORNATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. 21 04-0067 ACN 04115945 DATE 04-06-2004 JOHN C ROSE 4015 GREEN ST HBG EST. OF JOAN L ROSE S.S. NO. 511-22-2168 DATE OF DEATH 01-16-2004 COUNTY CUMBERLAND PA 17110 TYPE OF ACCOUNT [] SAVZNGS [] CHECKZNG E~ TRUST [] CERTZF REHTT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department Hith the information listed beloH Hhich has bean used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you Hera a joint oHner/benaficiary of this account, if you feel this information is incorrect, please obtain written correction from the financia! institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance Nith the Inheritance Tax LaMs of the Commonwealth of Pennsylvania. Questions may be ans~ared by calling (717) 787-8327. COMPLETE PART I BELON x # # SEE REVERSE SZDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Accoun~ No. 21001012691 Da~a 0 7- 2 2-19 9 4 To insure proper credit to your account, t.o Established (z) capias of this notice must accompany your Accoun~ Balance 12,0 ~7.9 0 payment to the Register of Hills. Hake check payabZa to: "Register of Hills, Agent". Parcan~ Taxable X 5 0.0 0 0 Amoun~ SubSec~ ~o Tax 6,018.95 NOTE: If tax payments ara made Hithin three (3) months of the dacedent's data of death, Tax Ra~a X . 045 you may deduct a SZ discount of the tax due. Any inheritance tax due ~ill become delinquent Po~an~ial Tax Due 270.85 nine (9) months after the date of death. PART TAXPAYER RESPONSE PART TAX LINE A. []The above information and tax due is correct. 1. You amy choose to remit payment to the Register of Hills with tho capias of this notice to obtain CHECK -~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of ONE Hills and an official assessment will be issued by the PA Department of Revenue. BLOCK J B. [] The above asset has been or Nil1 ba reported and tax paid Hith the Pennsylvania Inheritance Tax return ONLY to be filed by the dacedent's representative. C. lithe above information is incorrect and/or debts and deductions Hare paid by you. You must complete PART [] and/or PART [] beloN. Zf yOU indicate a diffaran~ ~ax ra~a, please s~a~a your relationship ~o d®cedan~: RETURN - COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS 1. Da~a Established 2. Accoun* Balance 2 3. Parcan~ Taxable 3 ~ ~. Amoun~ SubSac~ ~o Tax ~ S. Dab~s and Deduc*ions $ - 6. kmoun~ Taxable 6 7. Tax Ra~a 7 ~ 8. Tax Due 8 PART ' DATE PAID DEBTS AND DEDUCTZONS CLAZMEn PAYEE DESCRIPTION AMOUNT PAID TOTAL (En*ar on Line $ of Tax CompuSa*ion) $ Under penalties of perjury~ Z declare ~ha~ ~ha fac~s Z have reported above are ~rua, correc~ end complete '1:o ~he besi: of my knowledge =,nd belief. HOME ( NORK ( TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z&0601 HARRISBURG, PA 171Z&-0601 ~EV-1Sq$ EX AFP C09-Oo) ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 04-0067 ACN OqZ139qq DATE Oq-OG-ZOOq JOHN C ROSE qO15 GREEN ST HBG EST. OF JOAN L ROSE S.S. NO. 511-22-2168 DATE OF DEATH 01-16-200q COUNTY CUMBERLAND PA 17110 TYPE OF ACCOUNT [] SAVINGS [] CHECKING [] TRUST [] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 PNC BANK has provided the Department with the information listed balsa which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain Hritten correction from the financial institution, attach a copy to this form and return it to tho above address. This account is taxable in accordance Hith the Inheritance Tax Lams of the CommonHealth of Pennsylvania. Questions may be answered by calling [717} 787-85Z7. COMPLETE PART 1 BELOW M ~ # SEE REVERSE SIDE FOR FZLZNG AND PAYMENT INSTRUCTZONS Account No. 5050098072 Date 11-18-1991 Established Account Balance 1,897.92 Percent Taxable X 5 0.0 0 0 Amount Subject to Tax 9q8.96 Tax Rate X . Oq5 Potential Tax Due q2.70 To insure proper credit to your account, tho (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Hills, Agent". NOTE: If tax payments ara made within three (3) months of the dmcedant's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due Hill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of #ills with tho copies of this notice to obtain a discount or avoid interest, or you may check box -- Nills and an official assessment Hill bm issued by the PA Department of Revenue. B. [] The above asset has been or Hill be reported and tax paid Hith the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions Here paid by you. You Gust complete PART [] and/or PART [] baloH. PART Tf you indicate a different tax rate, please state your [] relatlonsh/p ~o decedent: TAX RETURN -COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS LINE 1. Date Established 2. Account Balance 2 3. Percent Taxable $ ~ q. Amount Subject to Tax q $. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DE~TS AND DEDUCTIONS CLAZMED PAYEE DESCRIPTION AMOUNT PAID TO]AL (Enter on Line S of Tax Computation) Under penalties of perjury, T declare that the facts I have reported above are true, correct end complete to the best of my knowledge and belief. HOME C ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COHHONHEALTH OF PERHSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVZDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 REV-lSd3 EX AFP ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. 21 0q-0067 ACH 0q11~751 DATE 0~-07-200~ JOHN C ROSE R015 GREEN ST HBG EST. OF JOAN L ROSE S.S. NO. 511-2Z-2168 DATE OF DEATH 01-16-200q COUNTY CUMBERLAND PA 17110 TYPE OF ACCOUNT ~--~ SAY/NaS [] CHECK/NG [] TRUST [] CERTZF. RENZT PAYHENT AND FORHS TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:3 PNC BANK has provided the Department aith the information listed belo~ ehich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you ~ere a joint oener/beneficiary of this account. Zf you feel this information is incorrect, please obtain ~ritten correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance aith the Inheritance Tax La~s of the Commonwealth of Pennsylvania. O~mstjons may be answered by calling (717) 7BT-83Z7, COMPLETE PART 1 BELOg # ~ # SEE REVERSE SZDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Account No. 5070072299 Date 11-18-1991 Establ/shed Account Balance 1,7:32.17 Percent Taxable X 50.000 Amount Subject to Tax 866.09 Tax Rate X .0~5 Potent/al Tax Due :38.97 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of gills, Agent". NOTE: If tax payments are made within three ($) months of the dacedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain CHECK a discount or avoid interest, or you amy check box "A' and return this notice to the Register of  ~ Rills and an official assessment will be issued by the PA Department of Revenue. ONE BLOCKJ B. [] The above asset has been or ~ill be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART [] and/er PART [] beloN. Zf you indica'~a a d/fferent tax rate, please state your relationship to decadent: RETURN - COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS 1. Date Established I PART TAX L/NE 2. Account Balance 2 5. Percent Taxable 3 ~ q. Amount Subject to Tax q $. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTZONS CLATME]] PAYEE DESCRZPTION AMOUNT PAID TOTAL (Enter on L/ne $ of Tax Computation) Under penalties of perjury, Z declare that the facts z have reported above are true, correct and complete to the best of my knowledge and be12ef. HOME ( NORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE Advisor Connect - Account List by Product Page 1 of 2 Account List by Product Group Account List -Active ONLINE SERVICE & TRANSACTIONS Find Next Client Loq Off I Pendin~l & InactiveAccount~ I Group Arranqements 1663 6272 3 001 JOAN L ROSE I Group ID: 0713 5124 1 001 ~ Grandfathered: Yes I [ Create New Fund J [ Create New Cert ] ITotal value of accounts shown below. [ $38,524.10I The total value of accounts does not include all products and accounts as shown on the client Consolidated Statement. The total value is not reduced by any outstanding Overdraft Protection or Card balances. Non-Qualified Accounts Cost Value as of Mutual Funds1 Basis - Sharas 0112112004 'CASH MANAGE FD-A ' JOAN L ROSE TOD 0000 0011 3713 5124 5 002 $1,061.71 1,061.710 $1,061.94 Total Contract Purchase Value as of IDS Life Annuity Date Payments 0112112004 FIXED RETIREMENT ANNUITY - VP JOAN L ROSE oooo 0930 0443 264s ~ 004 05/19/1995 $25,000.00 $27,178.82 FLEXIBLE PORTFOLIO ANNUITY JOAN L ROSE 0oo0 0930 o521 s925 3 004 04/24/1996 $9,724.17 $10,283.34 [ CHIcDL~E~ Notes: · The cost basis may not be accurate if the fund's shares were transferred to the account as a gift or inheritance. Disclosures for Clients: ~This cost may not be accurate if your shares were transferred to you as a gift or inheritance. Please read the instruction on your Consolidated Statement for further detail and consult your personal tax advisor to properly report this information on your tax return. Please rely on your Consolidated Statement for further detail. Values for some accounts summarized above may vary because of market fluctuations, account activity or outstanding loans. Some values may be subject of surrender charges, https://advisor5.aexp.com/ost/secure/AccountList yProduct/AccountList yProduct, asp 1/22/2004 Advisor Connect - Account List by Product Page 2 of 2 market value adjustments, or other fees. If you notice an error, please notify us immediately. You may direct any questions to your financial advisor, or call Client Service at 1-800-315-3460. You may write to us at: American Express Financial Advisors Inc., 70100 AXP Financial Center, Minneapolis, MN 55474. For more complete information on any product or service, including associated fees and expenses, contact your financial advisor for a prospectus. Please read it carefully before you invest or send money. The FDIC requires that we make the following disclosure to our clients. American Express Financial Advisors Inc., IDS Life Insurance Company, IDS Life Insurance Company of New York and IDS Certificate Company are not banks, and the securities they offer are not backed or guaranteed by any bank, or are they insured by the FDIC. American Express Centurion Bank deposits are insured by the Federal Deposit Insurance Corporation to the maximum of $100,000 for each depositor. IDS Life Insurance Company is not, and is not required to be, a member of the Securities Investor Protection Corporation (SIPC). Copyright © 1998-2001 American Express Company. All Rights Reserved. Users of this site agree to be bound by the terms of the American Express Web Site Rules and Regulations. View Web Site Rules and Regulations and trademarks of American Express. https://advisor5.aexp.com/ost/secure/AccountList yProduct/AccountList yProduct, asp 1/22/2004 Edward Jones 201 Progress Parkway Maryland Heights, MO 63043 Check Number 10 8 17 9 2 8 4 Account Nl~mber 851-11601-1-4 EST OF JOAN L ROSE J CURTIS ROSE EXEC 4015 GREEN STREET HARRISBURG PA 17110-1622 Account Registration EST OF JOAN L ROSE J CURTIS ROSE EXEC 4015 GREEN STREET HARRISBURG PA 17110-162 Date Description Amount 03/08/04 CASH BALANCE IN YOUR ACCOUNT FOR 03/08/04 2,738.48 TOTAL CHECK ISSUED 2:738.48 REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF % (~ (:X~~' ~._. <~ (~ % <.. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. AMOUNT 1. 5. 6. 7. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant __ Zip Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees State__Zip TOTAL (Also enter on line 9, Recapitulation (If more space is needed, insert additional sheets of the same size) January l9,2004 J. Cuais Cuais Deceased, Jesse H. Geigle Funeral Home, Inc. 2100 Linglestown Road Harrisburg, PA 17110- (717)652-7701 The Funeral Service for Joan L. Rose We sincerely appreciate the confidence you have placed in us and will continue to assist you in every ~vay we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Services of Funeral Director/Staff Embalming. Cosmetology/Dressing/Casketing Viewing prior to service Vehicle to transfer to Funeral Home Out of town transportation FUNERAL HOME SERVICE CHARGES ............ SELECTED MERCHANDISE: Reynoldsville - Frankfort ...................... $1905.00 Acknowledgement cards ...................... $10.00 Register Book - Gold Cross. .................... $36.00 Memorial folders - Prayer # 5 .................... $42.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED ............... $4468.00 Cash Advances Newspaper Notices - Baltimore Sun .................. $294.00 Newspaper Notices - Patriot-News ................... $138.96 Certified Copies of the Death Certificate ................. $40.00 Hairdresser .......................... $45.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES ........ $517.96 Total Total Cost' $1185.00 $495.00 $140.00 $125.00 $185.00 $345.00 $2475.00 $4985.96 SUB-TOTAL $4985.96 INITIAL PAYMENT / DISCOUNT / CREDITS 0.00 TOTAL AMOUNT DUE $4985.96 Joan L. Rose Page t Securii~ enhanced document. See back fo_r d?t O PNCBAKK PAY TO THE ORDER OF PNC Bank, N.A. ' 040 Central PA ESTATE OF Z~,~.'~.-~- ~A'¢ _ _ DATE .~<'S': '0~_ 68-1273/313 500~ ,i, 5 2 5 2 2," -DOLLARS ADMINISTRATOR 1 ~ERSON~I. REPRESENTATIVE ----, TRUSTEE iR ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Order of .PNCBAN< 1001 041 Dollars ~ ~ For PUC B~, N.A. 04o Choice Central PA Plan SCHEDULE I COMMONWEALTH OF PENNSYLVAN,A / DEBTS OF DECEDENT. ESTATE OF ~.~ (~ O,.w, '~-. ~'~.~ '>~- FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT \~ ~ o.O~ %~,~'o TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1512 EX * (1-9Z} ~ I COMMONWEALTH OF PENNSYLVANIA J DEBTS OF DECEDENT, FILE NUMBER Include unreimbursed medical expenses. iTEM NUMBER DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT ........ - ......~$ecurtty enhanced document. See back ]or derails. O. PNCBA'NK PNC Bank, N.A. 040 C~tr~ PA ORDER OF . Z E, O"'b q~ 0 ,<:;- i';Z, 0 DATE... 500h & 5 2 5 ~i~," EXECUTOR/ ADMINISTRATOR PERSONAL REPRESENTATIVE TRUSTEE F:,800 q,,' ,PNCBAN<. ,, IE{$ecuri~y enhancqa documenL See back tot details, l~,,~.- ................................... NO. ~ PNC Bank, N.A. 040 Ccnttil PA ........ PAY TO THE X~' ~ ~ ORDER~OF ~ -~. ~,-Q_~ 68-1273/313 DOLLARS I~1 ~=.~...  ADMINISTRATOR ~ - - _ I1~ 'PERSONAL ~ I REPRESENTATIVE ~P TRUSTEE .... NO. ~ 6~-1273/313 tOLLARS ~ =-~'~"~ EXECUTOR/T R ADMINISTP~ O. PERSONAL REPRESENTAT~E TRUSTEE PN CBANK PNC Bank, N.A. 040 C~ntral PA Secur~t~ enhanced document See back Fo? deta PAY. tO THE ORDER OE ESTATE OF FOR ~;0 0 N i, 5 2 5 2 2.' NO. 60-1273/313 DOLLARS EXECUTOR/' ADMINISTRATOR PERSONAL REPRESENTATIVE TRUSTEE ,,'DDOODDP. ? SO,,' ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC.' 4015 GREEN ST HARRISBURG, PA 17110 Order of.. Date~ I OO3 6(~1273/313 041 For. ' - ....... ~ ,"0000 2~N ~NN," ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Order of. .PNCBAN PNC Bank, N.A. 040 Central PA EOF m-'O 3 & ] & 2 ? ]P,m: Date 1 OO6 041 Dollars Choice Plan ~._ ~ SOON 1,52522,' ~,OO& ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Paytothe 9 f L 007 60-1273/313 041 O. PN CBAN ' Dollars I~ ~.~.~---~.%'~' : . PUCS~ n.~ o~ Choice For ~al PA Plan ' 0000008200 : -::" ..... ....... . .... J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Order of_, O. PNCBAN( PNC Bank, N.A_ 04O Central PA For Choice ~ ~ Plan 5OOh &525 22,' &o&q ,"0000000 ?~ ~ 5,,:~ ! ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Pay to the Order of O. PNCBAN PNC Bank, N.A. 04O C~ntral PA Date 1 O09 041 For. m:O3&31,27 Dollars Choice Plan SOO t, l, 5 2 5 2 2,' 1,00 q ,"00000 2N ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Date PNC Bank, N.A. 04O C~tral PA For Choice 1011 60-1273/313 041 __Dollars Plan ~_. ~ ............................. ~ ]- S ~ S ~ 2"" ~O I i ,"O00000P. O ? S,'" ESTA'~E OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN~T HARR..: .,~ ~.~:. ?~A 17110 Pay to-~he Order of, O. PNCBA P~C~.~.x 0~ Choice ~trai PA" Plan Date 1013 041 O.J[o~.__. Dollars SOON&S~52 ~,. &Oi:~ ,"00000 ~ r~ SO0,,' ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Date Order of_ O. PNCBA PNC Bank, N.A. 0lO Choice Central PA Plan For. 1015 60-1273/313 041 Dollars SOD t, 1, 52 S 22," ],0 ], S ,"00000 2 ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Order of O. PNCBANK Date 1016 60-1273/3 !3 041 PNC Bank, N.A. 040 Choice ESTATE OF JOAN LEE ROSE J CURTIS ROSE ~EC. 101 ~15 GREEN ST ~'L ..-'.. -.. Order of I .PNCBANK PNC Ba~k, N.A. 040 Choice Central PA Plan or..._qt l 293 m:O ~ ~ ~ ~ 2 ? Dollars SOD i, i, 5 2 5 2 2,' ~O ], ? ,"OOOOO h.°.SOP.,, · ' : "-' ': :'": 'i':'..-:' -'} ::-' -: ........................... 1 ..... ' ' '--m~ilillll" 1008 041 ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Order of .PNCBA K PNCB~k N.~ O40 Choice C~ntral PA Plan Dollars SOD&, & S 2 S 22,' &OO~ ,,'O000OOOB? S,,' ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. 4015 GREEN ST HARRISBURG, PA 17110 Pay to the ~L Order of PNCBAN< PNC Bank. N.A. 040 Choice C.~ntral PA Plan Date· 1023 60-1273/313 041 ESTATE OF JOAN LEE ROSE J CURTIS ROSE EXEC. ) 1025 4o15 GREEN ST ~'- HARRISBURG. PA 17110 Date.. 9~C~'~ 0~ 6o-,273/3,3 l:'-' "' ' '":':--' "' Order of ' - - O. PNCBANK _Dollars i~ ~---~. JOAN LEE ROSE 131 EASTERLY DR. . MECHANICSBURG PA 17~50 Pay to the ~ DX~¢.) N~. ~k~(~.& ~X. Order of 3004 60-1273/313 Date .. _ 041 Dollars PNCBAN( PNC Bank, N.A. 040 Central PA For 507D07 2 2qq,' 3ODt, Prio~ty p~u~~ JOAN LEE ROSE 131 EASTERLY DR. MECHANICSBURG, PA 17~50 Pay to the SJ'~ ~ ~ ~' Order o~ k~.% ~ ~.O'X~ PNCBAN( PNC Bank, N.A_ 04O Central PA Pl~s~ For m.'O :t I, :t I, 2 ? :iSm: 3009 Date , 041 Dollars SO 7OD 7 2 2q qll' :~ooq ,,'OOOOOO F...o. DO,,, JOAN LEE ROSE.~ 131 EASTERLY DR.' MECHANICSBURG, PA 1~50 .PNCBAN( PNC Bank, N./~ 040 Central PA For I:O3 i,~. t, SD ?DO ? 2 2q .................... q" 300 2 ,"OOOOOO 3 S ], ],,,' 3002 60-1273/3 !3 04! JOAN LEE ROSE 131 EASTERLY DR. MECHANICSBURG, PA 17050 Date. Pay to the Order of~ { .PNCBAN< PNC Bank, N.A. 040 Central PA For 3OO6 60-1273/313 041 JOAN LEE ROSE 3007 131 EASTERLY DR. ~X ~OL~'~ ~)'\ 6~-1273/313 MECHANICSBURG, PA" 17050 Date 041 Orderof I $ '~ (~ ; Dollars ~t~ P~ Plus For 2 m:Ol~l~273fim: SO?OO?22qq,' lDO? ,"O00OOOSO00,,' PNC Bank, N.A. 040 Central PA JOAN LEE ROSE 131 EASTERLY DR. MECHANICSBURG, PA 17050 Date Order of Plu~ SO?DO? 8 ~qq,' ~OOS For 3005 60-1273/313 041 Dollars JOAN LEE ROSE 131 EASTERLY DR. MECHANICSBURG, PA 17050 Order of O. PNCBAI PNC Bank, N.A. 040 Central PA For m.'O:~ &=, i. 2 ? 3~m: I$ Dollars PlusPri°rity~. ~ SO ?DO ? 28qqll' 3008 ,i'0OOOOO8 ~t,O,,' 3008 60-1273/313 041 JOAN LEE ROSE 131 EASTERLY DR. MECHANICSBURG, PA 17050 Date 3010 o41 ~ --'.."-- O. PNCBANK , PNC l~a~ N.~ 040 Priority Central PA Plus m:O :~ & ~, & 2 ? aP, m: S0 ?00 ? 22qq," qO i, 0 ,,'OOOOO t, ? ? ?-- ~," 3003 JOAN LEE ROSE ~.(~ 131 EASTERLY DR. 60-1273/313 MECHANICSBURG, PA 17050 Date . o41 Order of .PNCBAN - PNC Bank, N.A. 040 Central PA For I:O~, &~ k 2?:',P,m'. JOAN LEE ROSE 131 EASTERLY DR. MECHANICSBURG, PA ~7050 Pay to the ' ~ r O. PNCBANK PNC Baak, N.A. 044) Central'PA For ~10:1 i, ~. i, 2 ? :~1 ? Priqfity Plu~ 3000 60-1273/313 ~ $ '\\b-O~ --Dollars I~1 SO ?OD 72 2qq,' 3000 ,"OOOO0 ~. ~,OOO,,' PNCBAN( February 27, 2004 JOAN L ROSE C/O J CURTIS ROSE ~015 GREEN ST HARRISBURG, PA 17110 Important Information About Your Loan Account Number: 40-1-8109729751 Dear JOAN L ROSE: Thank you for completing payment on your PNC Bank loan. Your loan is now "paid-in-fuW and our records have been updated to reflect your excellent payment history. The mortgage or deed of trust used to secure your loan will be sent to you shortly. Because of your prompt and responsible loan repayment, we look forward to serving you whenever you need to borrow. Your next loan can be arranged very quickly -just call us at 1-888-762-2265, tell us how much you need and briefly update our credit information so we can process your request. Once your new loan is approved, we can send the necessary paperwork to your home or workplace, or you can stop at any convenient PNC Bank office to finalize your loan and pick up your check. Why not take advantage of our competitive rates and affordable monthly payment plans for * Bill Consolidation _ if you have bills from high-rate charge cards or other loans, you could save big by consolidating them into a single monthly payment; * New or Used Car Purchase - whether you're looking for a new sport utility vehicle or a used economy car, we have a variety of vehicle loans that will meet your borrowing needs; * Home Improvements. why delay that home improvement or repair any longer when the money you need is just a phone call away? In addition to our great rates and wide variety of repayment plans, we can also help you save on taxes with a home equity loan or line of credit. (Ask your tax advisor about the deductibility of interest in your particular tax situation.) Remember, the money you need is as close as your phone. Just give us a call at 1-888-762-2265, any time, day or night. We look forward to hearing from you the next time you need to borrow. Thank You, Operations Manager PNC Bank LENDER REV-1513 EX+ (9-00~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER I 1. II 1. RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS (If more space is needed, insert additional sheets of the same size) TOTAL OF PART [I- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LiNE 13 OF REV-1500 COVER SHEET STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE estate of ROSE JOAN L (mAS'Z, ~'±~S'±', m±~m~) GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 22nd day of January A.D., Two Thousand and Four, Letters TESTAMENTARY in common form were granted by the Register of said County, on the , late of SILVER SPRING TOWNSHIP in said county, deceased, to ROSE J CURTIS (~'l', ~'±~'1', and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 12th day of February A.D., Two Thousand and Four. 2004-00067 21-04-0067 1/16/2004 511-22-2168 File No. PA File No. Date of Death s.s. # NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL his 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. P 10047120 ./- No. ~ Date Fee for this certificate, $2.00 COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH · VITAL RECOROS ~ CERTIFICATE OF DEATH ---~ Joan L. Rose ,. Female 3. 511 -- 22 :~o,o~..-~.~ 79 ~. ~ : ne 21, 192 Haven, Kansas ~ E~,~ ~ D ~ ~,U Dauphin Harrisburg ~arrisburg Hosp. ~ ~.~. ~) White ,,~cupation ~erapist ,,~tate of ~ryland I,,. I,,. I 5 Widowed ,,. ~'* ~~'~'~ z"~ ~'~ PennsTlvania 131 ~sterly ~rive ~ ~ .,~ ~.~ S~lver Spring Mechanicsburg, Pa. 17055 ~ ,~.~ Cumberlond ~' ,,,.0 ~ Forrest Curtis Curtis Rose ,7'"E"'s"*uE'F'" "~*"'~'"'~"~"'""') Beulah Lacey ureen 5t. Harrisburg, Pa. 17110 23, 2004 Baltimore National Cemeter~ Catonsville, ~ryland ,~.s.~--. ~esse~ei~le Fu~er ~g?el7~5. ~ FD 010628 L 2100 Lin lesco~n ~. ~arr[sour · m ~u CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ~ (30,.X'x L.~)~ (3 Date of Death: Will No. ~}~{313'~ -¢¢3 b~(~ Admin. No. To the Register: I certify that notice of (beneficial interest) estate adnfinistration 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 Signature Address Telephone C~IA) Capacity: ~Personal Representative ~.Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT¢280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0O3865 ROSE J CURTIS 4015 GREEN STREET HARRISBURG, PA 17110 ........ fold ESTATE INFORMATION: SSN: 511-22-2168 FILE NUMBER: 2104-0067 DECEDENT NAME: ROSE JOAN L DATE OF PAYMENT: 04/26/2004 POSTMARK DATE: 04/26/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/16/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I 86,462.33 REMARKS: TOTAL AMOUNT PAID' 86,462.33 SEAL CHECK//1031 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVZSZON DEPT. 180601 HARR/SBURG, PA 17128-0601 COMHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-15¢7 EX &FP (01-05) J CURTIS ROSE fi015 GREEN ST PA 17110 DATE 08-09-ZOOq ESTATE OF ROSE DATE OF DEATH 01-16-200q FILE NUMBER 11 0~-0067 COUNTY CUMBERLAND ACH 101 Amoun* Ram/~ad JOAN L HAKE 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 ~-~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROSE JOAN L FILE NO. 21 0~-0067 ACN 101 DATE 08-09-200q TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Ram1 Es~a~a (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closaly HeZd S~ock/Partnership Znteres~ (Schedule C) ($) q. Mortgages/No,es RaceivabZa (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schadula F} (6) 7. Transfers (Schadula G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Adm. Costs/Misc. Expanses (Schadula H) (9) 10. Debts/Mortgage Liabilitias/Limns (Schmdula Z) (10) 11. TotaZ Deductions 12. Ne~ Value of Tax Rmturn 85~952 70~27~ .~8 NOTE: To insure proper O0 credit to your account, O0 submit the upper portion O0 of this form ~ith your tax payment. 00 00 (8) 5,671.96 15. NOTE: ASSESSMENT OF TAX: 15. Amoun~ of Line lq et Spousal rate (15) 16. Amount of Line lq taxable a~ Lineal/Class A rata (16) 17. Amount of Linm lq at Sibling rate (17) 18. Amount of Line lq taxabla a~ Collatmral/Class B rate (18) 6~9q7 .q8 (11) 156,226.81 19. Princi TAX CREDITS PAYMENT DATE 0q-Z6-200q ~al Tax Due RECEIPT NUMBER CD005865 ]:NTEREST/PEN PA:]:D (-} AHOUNT =~r~.Zu I TOTAL TAX CRED'rT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE .00 lq$,607.$7 18 and 19 Nill IF PAID AFTER DATE ZND/CATED, SEE REVERSE FOR CALCULATION OF ADD/TZONAL INTEREST. 6,q62.$$.00.00.00 ~'~ ( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REQUIRED. I'F TOTAL DUE TS REFLECTED AS A *'CREDIT" (CR}, YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF TH'rS FORM FOR INSTRUCTIONS. ) Chari~ablm/Govmrnmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Nat Value of Estate Sub~mct to Tax Zf an assessment was issued previously, lines lq, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. 1~$,607.$7 RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- 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 Coemoneaalth 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: PAYNENT: REFUND OBJECTIONS: ADNIN- [STRATIVE CORRECTIONS= DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act Z5 of 2000. (TZ P.S. Section 91~0), Detach the top port[on of this Not[ca and submit with your payment to the Register of #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which ams not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Off[ce of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z~-hour answering service fcc forms ordering: 1-800-56Z-Z050~ services for taxpayers with special hearing and ! or speaking needs: 1-800-~47-30Z0 (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 sheen on this Notice must object aith[n sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-lOZ1, 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 writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment RevJee Unit, Dept. 280601~ Harrisburg, PA lTIZB-0601 Phone (717) 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150i) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (SI) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 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 tiaa per[od 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 end one fl) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes ah[ch became delinquent on and after January l, 198Z mill bear interest at a rate #hich will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOOq are: Interest Dally Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ['~ 20X .000548 ~'~-X991 IIZ .OOO30l ~'~ 9Z .O00Z~7 1983 16Z .000~38 1992 92 .000247 2002 62 .O0016q 1984 Ill .000301 1993-199~ 7Z .O00lgZ 2003 5Z .000137 1985 ISZ .000356 1995-1998 9Z .0002~7 200~ CZ .000110 19B6 lOX .O0027~ 1999 72 .O0019Z 1987 X0Z .O0027~ ZOO0 7Z .00019Z --Xnterast is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELTNQUENT 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 Not[ce, additional interest must be calculated, Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA'17013 Phone: (717) 240-6345 Date: 12/16/2005 ROSE J CURTIS 4015 GREEN STREET HARRISBURG, PA 17110 RE: Estate of ROSE JOAN L File Number: 2004-00067 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. 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: 1/16/2006 Your prompt attention to this matter will be appreciated. Thank You. Sinc~rely, " . ~'. bk- L J/ .. ~A""'/A? r, """:'~#.",,::/ t?z/"1JIf} ..o/~?i', t1' ,..iJ-!-'Wr-",,~, ...",,:U,~;f,-,._.;r.::;;,~,t{'..~ OU/jt'. __. /1 GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge Vl Estate of ROSE JOAN L Late of SILVER SPRING TOWNSHIP - --':";:"l'n=D FC~) ,~ ~, ~ ,~ ORPHANS' COURT D'I-;I~~~N . ~O :, ~ ((' COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-04-00067 Date: 2/22/2006 NO.: 21-04-00067 COSE J CURTIS 4015 GREEN STREET HARRISBURG PA 17110 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: COSE J CURTIS Personal Representative Counsel: ** NO INFORMATION FOUND ** Date of Decedent's Death: 1/16/2004 Date of Delinquency Notice: 1/16/2006 The undersigned, Glenda Farner Strasbaugh, Clerk of Orphans' Court, in accordance with rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor their counsel, have filed with the Register of Wills or Clerk of Orphans' Court, his/her Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule, and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk of Orphans' Court on 1/06/2006 and that the ten (10) day notice to file the status report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or their counsel. cc: File Personal Representative Counsel .~~ Glenda Farner Strasbad Clerk of Orphans' Court A hearing is scheduled for May 01, 2006 at 11:00 AM in Courtroom No.2. If the Status Report is filed prior to the hearing date, the hearing will automatical e cancelled. , "t] t'> . . CIJ > Q )>In''t];:+() ." ~~ + ::l:O:l"~O 0 ;" g~3-;a. 3 3 C/) iD ;- ....::rs--< ""'"2- ~ > ::r....:Eg::;;9l. u:> ., z :r:: "" 0 l. eI) a-~ l. co:;!. -':OCO -'- ~ 0 0 I ::;-CI>(t)::sCD;::+ -'- 3 cr tel f--1 en , ooglll!:!l.co ~ , ~ tel tr.J ~ ;a.~::l3:l.3 ." 1Jl ::;;Q."",CD$lcn co H t {lo~~&.:-" cr enQy 2 t:J:ltel III 3-3 o..o,!'J III gco....~~1ll -< C:tr.JO I\J teltr.JC: "0 g 15 Q- ~" a 0 ...,J QZtel ~ooco-<U) 0 "'"Illln . "'" CJ 1-3 ;:+g,a.~ lii'~ CJ '"den H ~r+""'::Sa.~ Ln ~1-3 en 15 ~ ::T~' 0 tel 3ocoiilo I:-' t:I:l !!l. f= iil p..g Q:I f--1 tr.J -a < - 0 ru -J 1-3 roO ~ 9l. 0 o co 3 CJ f--1 !D CD (1) f-> !!l- CJ 0 1'i' :xl CJ la CJ co ru 3 !" !=J :xl :xl OO"~ ~ ~ (1) (1) [f" !!l- 5"$lQ "S I:-' :3. ~ ~ co ::I- Ln (1) @ ~ 3i a. a.!!l&. Ln 0 ~&.~ (1) ~ ~ ~ [f" ,," =' !!!. I:-' (1) S. ~ <D Ln 000 Q. ~ ():D~ ~ iil ola-o 3 ! " co Ol ~ !=J 3 g! :D~ ~ ll> ~= ~ 0 "So --> Q 0 c; 00 !!l- 00 I\) 0 ~ <t> '" z~ So )>)> <0 ~ (1) 'I' 0 Q.<C o C/) 0 Q.<t> 0 rJ> =s- Ol 3- I\) gJ ~ ~ ,," C/) a. <t> rJ> ;n" .::2 m Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~G ~'Y'- L... ~ 0 & R- Date of Death: \ \ \~ \ a~ d.. \-C'-\- (') 0 0 \Q' Estate No.: 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 ~h.9her administration of the estate is complete: Yes B No 0 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 t~ BP'fsonal representative file a final account with the Court? Yes L.M' No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the person~ r5Presentative state an account informally to the parties in interest? Yes hJ' No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~ ~ Date: c)\.l~ 61C _ Signa ure 'j ~ (~~\ ~~)'- Name ~\)'" ~""~"" )~ \\\} ~ ~\ \,\\~ Address 'hI . / :;, ; 6./ ""v ~~~- ~D3 Telephone No. Capacity: ~ersonal Representative o Counsel for personal representative /~