HomeMy WebLinkAbout03-1020PETITION FOR PROBATE & GRANT OF LETTERS
Estate of Helen L. Killin.qer
also known as
, deceased.
Social Security No. 179-12-3460
No. 21-03-
To: Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
The Petition of the undersigne~d~ respectfully represents that:
Your Petitioner, who is 18 years of age or older and the Executor named in the Last Will of the above
decedent dated Auqust 21, 1976 , and codicils dated none . The Executor
named none died . Renunciations for Paul L. Killinqer Jr, Paul Barry Killinqer, John
R. Killinqer and Terry L. Killinqer are attached hereto.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal
residence at 303 Dwellinq Court, Shippensbur.q Borough
Decedent, then 81 years of age, died September 16 , 2003, at 5400 Block
Philadelphia Avenue, Chambersburq, Greene Township, Franklin County, Pennsylvania
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:
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in PA
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania, situated as follows:
$500.00
~$
WHEREFORE, Petitioners respectfullY requests the probate of the Last Will and Codicil(s) presented
herewith and the grant of letters testamentary thereon.
Signature(s) and Residence(s) of Petitioner(s):
Richard A. Killin~er
704 Charles Street
Shippensburq, PA 17257
717-532-2355
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
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 of Petitioner(s) and that as personal representative 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 \b~-~ day of
December ,2003.
Richard A. Killinqer /r --
No. 21-03-
Estate of HELEN L. KILLINGER , deceased.
DECREE OF PROBATE & GRANT OF LETTERS
AND NOW, December ~1 ,2003, in consideration of the Petition on the
reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s)
dated AuRust 21, 1976 described therein be admitted to probate and filed of record as
the Last Will of Helen L. Killinqer ; and Letters Testamentary are hereby granted to
Richard A. Killin.qer
FEES
Probate, Letters, Etc ........ $18.00
Short Certificates(-1- ) .... $ 3.00
Renunciation(s) ........... $ 5.00
JCP .................... $10.00
Other .... $ 36.00
TOTAL: .... $.~
Filed. ),~: .Il :~. .c.p. .~ ...............
.,q IRWIN & McK~NIGHT
Roqer I~c'[r~n, Esquire (06282)
ATTO~EY~Sup. Ct. I.D. No.)
60 West Pomfret St., Carlisle, PA 17013
ADDRESS
717-249-2353
PHONE
In regard to the Estate of
To the Register of Wills of
RENUNCIATION
Helen L. Killinger ,deceased.
Cumberland
County, Pennsylvania.
The undersigned spouse & children of the above decedent
renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testametary be issued to Richard A. Killinger
hereby
WITNESS our hands this 28th
day of November ,2003.
SIGNATURE
ADDRESS~ - t
ADDRESS
0"/"/ol
SIGNATURE /
REGISTER OF WILLS OF ~-~ COUNTY
OATH OF SUBSCRIBING WITNESS
Roger B. Irwin
(~m~) a subscribing witness to the will presented herewith, (~11l~9 being duly qualified according to
law, depose(s) and say(s) that he was present and saw
Helen L. Killinger
the testatrix , sign the same and that he signed as a witness at the
request of testat rix in ker presence and (in the presence of each other) (~X~t~~
Sworn to or affirmed and subscribed before
me this [{~4;h day of
December , .. ~ 2003
60 W.
(Name)
t.~ Carlisle, PA
17013
(Address)
(Name)
(Address)
REGISTER OF WILLS OF c,no~RT.^nn COUNTY
OATH OF NON-SUBSCRIBING WITNESS
Richard A. Killinger
~Igya subscriber hereto, (~ being duly qualified according to law, depose(s) and say(s) that
he is familiar with the signature of Helen L. Killinger
c~iiSi~l
testatrix of /$ammx~Xh~txmtm~hin~xm6mmmexx~) the will presented herewith and
d~i~x
that he believes the signature on the will is in the handwriting of
Helen L. Killinger
to the best of
his knowledge and belief.
Sworn to or affirmed and subscribed before
me this l~'ti~ day of
c', _December - 19 2003
, ~ O l egister
(Name)
704 Charles St., Shippensburg, PA
17257
(Address)
(Name)
(Address)
I, HELEN L. KILLINGER, of the Borough of Shippensburg,
Cumberland County, Pennsylvania, declare this instrument to be my
Last Will and Testament, hereby expressly revoking all Wills and
Codicils heretofore made by me.
1. I authorize and empower my executor to sell any realty owned
by me at my death, at either public or private sale, and to give good
and sufficient deeds therefor, in fee simple, as I could do if living.
My executor is authorized and empowered to continue to engage in any
business in which I may be engaged at my death, for such a period as
seems expedient to said executor.
2. I devise and bequeath all of my estate of every nature and
wherever situate to my husband Paul L. Killinger, Jr.; providing he
shall survive me by sixty days.
3. Should the gift in Paragraph No. 2 not take effect, I devise
and bequeath all of my estate of every nature and wherever situate
to my children, share and share alike, the child or children of any
deceased child taking the share their parent would have taken if
living.
4. I nominate and apPoint Paul L. Killinger, Jr., to be 'the
executor of this my Last Will and Testament, he is to serve as such
without bond. Should he die before my death, renounce or refuse to
serve for any reason, or die leaving any of my estate unadministered,
I nominate and appoint Paul Barry Killinger, John R. Killinger,
Richard A. Killinger and Terry L. Killinger as substitute executors,
also to serve as such without bond, with the same powers as are
given herein to my executor.
5. I hereby suggest that my personal representative retain the
services of Irwin, Irwin & Irwin as attorneys in the settlement of
my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of August, 1976.
~[ELEN L. KILLINGER ~
Signed, sealed, published and declared by Helen L. Killinger,
the testatrix above named, as and for her Last Will and Testament,
in the presence of us, who at her request, in her presence and in the
presence of each other have subscribed our names as witnesses hereto.
5 ill
HELEN L. KILLINGER
LAW OFFICES
IRWIN, IRWIN & IRWIN
44 SOUTH HANOVER S:'~REET
CARLISLE, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
HELEN L. KILLINGER
Name of Decedent:
Date of Death:
Estate No.:
SEPTEMBER 16, 2003
21-03-1020
To the Register:
I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's
Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate
on January 15, 2004 .
NalBe
Paul L. Killinger Jr.
Address
303 Dwelling Court, Shippensburg, PA 17257
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except __
Date:
none .
01/15/04 {I '
Signature
R I
Name Roger B. Irwin, Esquire
Address60 West Pomfret Street
Carlisle, PA 170~13
Telephone (717) 249-2353
Capacity:
X
__ Personal Representative
__ Counsel for Personal Representative
REw- 1500 EX + (6-00)
D
E
C
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. ~:80601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
DECEDENT
RESIDENT
OFFICIAL USE ONLY
FILE NUMBER
21-03-1020
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
179-12-3460
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
DECEDENT'S NAME(LAST, FIRST, ANi MIDDLE iNITIAL)
Killinger Helen L
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DO-YEAR)
09/16/2003 10/08/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AN D MIDDLE iNITIAL)
N
1. Original Return 2. Supplemental Return
CA P R ~ 4. Limited Estate · Future lnterest Compromise (date of death after 1Z-17-8Z)
HpRL
E P I O ~J 6. Decedent Died Testate . Decedent Maintaineda Living Trust
AC
~C nR T K (Attach copy of Will) (Attach copy of Trust)
"-- S S [] 9. Litigation Proceeds Received ["~ 10. Spousal Poverty Credit
SC~r'I~.I ~[~t"llRITY NUMBER
3. Remainder Return ~[6i tb ~
12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
C
O
R
R
E
S
NAME
Marcus A. McKni~ht Esq.
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717/249- 2353
1. Real Estate (Schedule A)
Stocks and Bonds (Schedule B)
Closely Held Corporation, Partnership or
Sole-Proprietorship
(date of death between 12-31-91 and 1 - 1-95)
(Attach Sch O)
COMPLETE MAILING ADDRESS
60 West Pomfret' Sl~reet
West Pomfret Professional Bldg.
Carlisle, PA 17b0]?
(1)
(2)
(3)
~ne
NOne
None
None
10,000.00
None
None
8,604.10
None
OFFICIA~ L USE ONI:Y
Mortgages & Notes Receivable (Schedule D) (4)
Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
Jointly Owned Property/Schedule F) (6)
~ Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) {'10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11 )
Charitable and Governmental 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)
(8) 10,000.00
(11) 8,604.10
(12) 1,395.90
(13).
(14) 1,395.90
R 5.
E
C
A 6.
P
I
T
U 7.
L
A
T 8.
I
O 9.
N 10.
11.
12.
13.
14.
C
O
M
T
I
O
N
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)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibiin§ rate
18. Amount of Line 14 taxable at collateral rate
1,395.90 X .0 Q. (15) 0.00
0.00 x .0 45 (16) 0.00
0.00 x .12 (17) 0.00
0.00 X .lS (18). 0.00
19. Tax Due (19) 0. O0
,~',~ Copyright (c) 2000 form software only The Lackner Group, Inc..._ ~ ' Form REV- 1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
303 Dwelling Ct.
CITY
Shippensbur~
STATE
PA
ZIP
17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(~) 0.00
Total Credits ( A + B + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3) 0.00
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) 0.00
5. If Line I + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (SA) 0.00
B. Enter the total of Line 5 * 5A. This is the BALANCE DUE. (SB) 0.00
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; ......................... ~ ~
b. retain the right to designate who shall use the property transferred or its income; ...........
c. retain a reversionary interest; or ....................................
d. receive the promise for life of either payments, benefits or care? ...................
2. If death occurrec~ after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................ [~] ~,.:;~ [--'1
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? .............................................. [---1 r-'-]
4. Did decedent own an Individual Retirement Account, annuity,~or other non-probate property
which contains a beneficiary designation? .......... '. ..................... [--'1 I-'-1
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 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.
S~..~T..URE OF PERSON RESPONSIBLE FOR FILING RETURN Paul L_ Killinger, Jr. DATE /
/_
/
S'aNATUREO~~*~NTP~ES~T~T'VE IRWIN & Mc~IG~ OA~
~ ///~ /_ // / , ~ 60 West Pomfret Street .//
For dates of death on or after July~ a~ be~re 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. 9~6(~(. ~jl)_(O~ ~
For dates of death on or after Janu~ 1995~ 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~ot exempt a transfer to a surviving spouse from tax, and the statuto~ requirements for disclosure of asse~
and filing a tax return are still applicable even if the surviving spouse is the only beneficial.
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(aXl)].
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-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Helen L Killinger SS~/ 179-12-3460 09/16/2003 21-03-1020
Include the proceeds of liti§ation and the date the proceeds were received by the estate. Ali property joiNtly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM VALUEATDATE
NUMBER DESCRIPTION OFDEATH
1 Proceeds of Settlement Survival Action Portion - Order of Court - 10,000.00
Copy Attached
TOTAL (Also enter on line 5, Recapitulation) $
10,000.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
· REV-1511'EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen L Killin~er SS#
179-12-3460
Debts of decedent must be reported on Schedule I.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
09/16/2003
FILENUMBER
21-03-1020
ITEM
NUMBER
DESCRIPTION
FUNERAL EXPENSES:
Fogelsanger-Bricker Funeral Home
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 Zip
Year(s) Commission Paid:
Attorney's Fees IRWIN & McKNIG[-Tr
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
.Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Prorated Costs
State Zip
AMOUNT
6,100.50
2,500.00
0.00
3.60
TOTAL (Also enter on line 9, Recapitulation) 8,604.10
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form RE¥- 1511 EX (Rev, 1-97)
· REV-1513 EX +(9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen L Killin~er SSf/ 179-12-3460
SCHEDULE J
BENEFICIARIES
09/16/2003
FILENUMBER
21-03-1020
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER
II,
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1
Paul L. Killinger, Jr.
303 Dwelling Ct.
Shippensburg, PA 17257
Do Not List Trustee(s)
Husband
OF ESTATE
100% of
residue
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 $ 0. O0
(If more space is needed, insert additional sheets of the same size)
Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00/
NAR 1 7 2004
RICHARD A. KILLINGER,
Executor of the Estate of
HELEN L. KILLINGER,
Plaintiff/Petitioner
PAUL L. KILLINGER, JR.,
Defendant/Respondent
IN TIlE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2004. CIVIL TERM
CIVIL ACTION - LAW
ORDER OF COURT
AND NOW, this/~ day of./¥}0.['~h. , 2004, upon consideration of the attached
Petition of the Plaintiff/Petitioner, it is hereby ORDERED that the approval of the settlement of
Plaintiff's claims are granted as follows:
The Executor, Richard A. Killinger, shall settle for the amount of $i00,000.00 on behalf
of the Estate of Helen L. Killinger.
· The settlement proceeds shall be allocated as follows:
Ao
Wrongful Death ........................................................ $90,000.00
Survival Action ........................... , ................ . ............. $10,000.00
The legal fees and expenses to Irwin & McKnight are aPproved as follows:
Less Legal Fees to Irwin & McKnight:
(25% of Settlement) .................................................. $25,000.00
The distribution of the Survival Action proceeds shall be as follows:
Survival Action .................................................... $I0,000.00
(100% of proceeds distributed to surviving spouse)
Less prorated costs ........................................................ -3.60
Less prorated legal lees to IMH ............................. -2.500.00
Distribution to Paul L. Killinger, Jr.
(Surviving Spouse) ............................................... $7,496.40
o
The distribution of the Wrongful Death proceeds shall be as follows:
Total Wrongful Death proceeds .................................... $90,000.00
Less cost .................................................................................. - 12.40
Less legal lees to I&M ..................................................... -22,500.00
Balance for Distribution .............. ' ................................. $67,467.60
o
The final distribution of the settlement proceeds shall be as follows:
1. Paul L. Killinger, Jr. (Surviving Spouse) ......... $30,000.00
2. Paul L. Killinger, Jr. (Surviving Spouse) ........... 12,500.00
Paul B. Kiilinger ..................................................... 4,993.52
Richard A. Kiilinger ....... : ........................... i .......... 4,993.52
Terry L. Killinger ................................................... 4,993.52
John R. Killingei- .... j ............................... ' ......... : ...... ,4,993.52
Total Settlement Distribution ........................... $67,467.60
By the Court:
TRUE COPY FROM RECORD
In Testimony whereof, I h~e unto set ,my hand
RICHARD A. KILLINGER,
Executor of the Estate of
HELEN L. KILLINGER,
Plaintiff/Petitioner
PAUL L. KILLINGER, JR.,
Defendant/Respondent
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
: NO. 2004- CIVIL TERM
:
: CIVIL ACTION - LAW
PETITION FOR APPROVAI J
OF SETTLEMENT
AND NOW this 16th day of March 2004, come the Petitioner, Richard
Executor of the Estate of Helen L. Killinger, by his attorneys, Irwin & McKnight, hnd'makes the ':
following Petition for Approval of the Settlement of the civil claims of Paul L. Killi~gerl
The petitioner is Richard A. Killinger, Executor of the Estate of Helen L. Killinger, an
adult individual residing at 704 Charles Street, Shippensburg, Pennyslvania 17257. He was
granted Letters Testamentary on December 11, '2003 at PA .21-03-1020.
The Respondent is Paul L. Killinger, Jr., an adult individual residing at 303 Dwelling
Court, Shippensburg, Cumberland County, Pennsylvania 17257.
o
The Petitioner seeks approval of a settlement of $100,000.00 from Nationwide Insurance
Company and allocates it in the following amounts:
mo
Wrongful Death ........................................................ $90,000.00
Survival Action ......................................................... $10,000.00
A copy of the Release is attached hereto and marked as Exhibit "A" and is made a part of
this Petition.
3
This allocation between the Survival Action and the Wrongful Death is based upon the
immediate death of the spouse in the traffic accident. She was a passenger in an automobile
driven by her husband, Paul L. Killinger, Jr. when he was involved in a one car accident on
September 16, 2003. His liability carrier has offered the limits of its policy. A copy of the Police
Report is attached hereto and marked as Exhibit "B" and is made a part of this Petition. The
Death Certificate of Helen L. Killinger is hereto attached and marked as Exhibit "C" and is made
a part of this Petition.
o
The Petitioner als0 seeks approval of the legal fees and expenses to the firm of Irwin &
McKnight as follows:
A. Legal Fees (25% of Settlement) ................................ $25,000.00
6.
The Petitioner also seeks approval of the Survival Action proceeds as follows:
Survival Action .................................................... $10,000.00
(100% of proceeds distributed to surviving spouse)
Less prorated costs ........................................................ -3.60
Less prorated legal fees to I&H .............................. -2,500.00
Distribution to Paul L. Killinger, Jr.
Estate of Helen L.Killinger .................................. $7,496.40
7.
The Petitioner seeks approval of the Wrongful Death proceeds as follows:
Total Wrongful Death proceeds ........................... $90,000.00
Less cost ...................................................................... - 12.40
Less legal fees to I&M ......................................... -22,500.00
Balance for Distribution .................................... $67,467.60
The Petitioner seeks the final distribution of the settlement proceeds as follows:
1. Paul L. Killinger, Jr. (Surviving Spouse) ......... $30,000.00
2. Paul L. Killinger, Jr. (Surviving Spouse) ........... 12,500.00
3. Paul B. Killinger ..................................................... 4,993.52
Richard A. Killinger .............................................. 4,993.52
Richard A. Killinger, Jr ......................................... 4,993.52
Terry L. Killinger ................................................... 4,993.52
John R. Killinger .................................................... .4~993.52
Total Settlement Distribution ........................... $67,467.60
9.
The Pennsylvania Department of Revenue has reviewed this Petition and approved it in a
letter dated February 27, 2004, by J. Paul Dibert, Inheritance Tax Division of the Pennsylvania
Department of Revenue. A copy of this approval is attached hereto and marked as Exhibit "D"
and is made a part of this Petition.
WHEREFORE, the Petitioner respectfully request 'the approval of said Petition with the
distribution as set forth above.
Date: March 16, 2004
By:
Respectfully submitted,
IRWIN & McKNIGHT
Marcu~ A. McKnight, I][I, ~;sq. "X
60 West Pomfret Street tx. x~
Carlisle, Pennsylvania 17013-~
717-249-2353Supreme Ct D# 25476
5
VERIFICATION
The foregoing document is based upon information which has been gathered by
counsel and myself in the preparation of this action. I have read the statements made in this
document and they are true and correct to the best of my knowledge, information and belief. I
understand that false statements herein made are subject to the penalties of 18 Pa. C.S.A. Section
4904, relating to unsworn falsification to authorities.
RD A. KILLINgS;ER
Executor of the Estate of
HELEN L. KILLINGER
Date: March 1.6, 2004
EXHIBIT A
RELEASE OF ALL CLAIMS
CLAIM NO. 1554713i39B30
This Inden,~ure Witness=~'
~_n that, in consideration of the sum of One Hundred Thousand Dollars
($100,000.00), receipt whereof is hereby acknowledged, for myself and for my heirs, personal representatives and assigns, I
do hereby release and forever discharge Paul L Killinger Jr. and any other person, firm or corporation charged or chargeable
with responsibility or liability, their heirs, representatives and assigns, from any and all claims, demands, damages, costs,
expenses, loss of services, actions and causes of action, arising from any act or occurrence up to the present time and
particularly on account of all personal injury, disability, property damages, loss or damages of any kind already sustained or
that I may hereafter sustain in consequence of an accident that occurred on or about this 16th day of September, 2003, at or
near Greene Twp, Franklin Cry, Pa.
To procure payment of the said sum, I hereby declare: that I am more than 18 years of age; that no representation about the
nature and extent of said injuries, disabilities or damages made by a physician, attorney or agent of any party hereby
released, nor any representation regarding the nature and extent of legal liability or financial responsibility of any of the
parties hereby released, have induced me to make this settlement; that in determining said sum there has been taken into
consideration not only the ascertained injuries, disabilities and damages, but also the possibility that the injuries sustained
may be permanent and progressive and recovery therefrom uncedain and indefinite, so that consequences not now
anticipated may result from the said accident.
I hereby agree that, as a further consideration and inducement for this compromise settlement, this settlement shall apply to
all unknown and unanticipated injuries and damages resulting from said accident, casualty or event, as well as to those now
disclosed.
I understand that the parties hereby released admit no liability of any sort by reason of said accident and that said payment
and settlement in compromise is made to terminate further controversy respecting all claims for damages that I have
heretofore asserted or that I or my personal representative might hereafter assert because of the said accident.
I further understand that such liability as t may or shall have incurred, directly or indirectly, in connection with or for damages
arising out of the accident to each person or organization released and discharged of liability herein, and to any other person
or organization, is expressly reserved to each of them, such liability not being waived, agreed upon, discharged not settled
by this release. ·
Signed .and sealed this
Witnessed bv~ _ ~ I
dayof ~,'A. cLk.,1 '
(CAUTION - RE/~I BEFORE SIGNING)
(SEAL)
(SEAL)
STATE OF PENNSYLVANIA
COUNTY OF CUMBERL~_DSS
On this 19 th day of JANUARY
Appeared RICPalRD A. KILLINGER
2004 , before me personally
executed the foregoing instrument, and acknowledged that
My commission expires
COMMONWEALTH OF PENNSYLVANIA
rv~Y~Ex,t~s Sept 18,2007 .
Member, Pennsylvania Association Of Notaries
, to me kr)ew~ to be the person who
C53-9 Release ct' All Claim,a
re;-' :08,' l 6/01
EXHIBIT B
COMWiOt'.iWE,~.Li"H OF PENNb f LYAN,,-,
" ' Ca~e Closed Reportable Crash Page
~.,m 300 ] 0 e. 0 i t I
Incident Number
:llhil ill , : ~ ; Crash Number
P0a,_7
Police Agency Patrol Zone
t'i-/'l o j3
Agency Name
Dispatch Time ..?:,;. Arrival Time :m...': Investigator
fit o! l 1/Ia I lv'l
Reviewer
Precinct
Investigation Date
Badge Number
Badge Number Approval Date
['l'
County County Name Municipality Municipality Name Day of Week
Crash Time (re~t) No of Units People Injured Killed* *If > O0
olol311z Iol lql complete ~Tue OSat
FormF 0 Wed 0 Unk
W°rkz°ne (If Yes' C°m~'ete ] I
Form /V( Se~t/on 29~ 0 Yes ~ No School Bus School Zone Notify PENNDOT~ Yes ~'No
Related 0 Yes ~ No Related 0 Yes ~ No Maintenance
Int~ection. Type 0 4 V~..ay' ~ ...... ....'-'e,.,un¢~;~ 0 "Y" Intersection 0 IntersectTonMUlti-Leq 00[f Ramp 0 Railroad Crossing *S¢ec_i~J
Traffic Circle/ Location
~ Midblock 0 "T" Intersection 0 Round About 0 On Ramp 0 Crossover 0 Other
Route Number
1..o ol / /1
Street Name
Segment (Optional) Travel Lanes Speed Limit
C2~ North
· ~ O South
Street Ending 0 East
~ O '¢/e~t
0 Unknown
R~our. e
Signing C) Interstate Turnpike Turnpike State CoUnty
(Not Turnpike) O (Easf/VVest) O Spur ~ O
Highway Road
~, Rou~e Number Segment (Optional) Travel Lanes Speed Limit
* See Overla,
House Number (if applicable)
For Mid-btoc~. crashes 3niy. Use
postal House Number and make sure
Princfpal Roadway Street Name is
fil!ed in' if using ~his option
Local Road Private Other,/
or Street O Road O Unknown
0 North
~ 0 South
O' East
0 West I
0 Unknown
Street Name Street'Ending
Rout~
5ic~nino ¢'~ Interstate Turnpike Turnpike''~ ~-~ St.ate. County
- "-" (Not Turnpike) 0 (Cast,Jest) 0 Spur '--' ~Righway 0 Road
O Local Road Private Other/ '
Or'Stre~ . O O
~, Road Unknown
Please
Enter
Information
for BOTH
Landmarks
if Using
Intersecting Rt Num Or Mile Post Or Segment Marker
olel'el ll I I.r-ll .I III I I II
Or Intersecting Street Name St Ending
Intersecting Rt Num Or Mile Post Or Segment Marker
I I I I [" I I 1 !.i_llL,/ /! -.! !
J -~ Or Intersecting Street Name
,I
Degrees ...'-u _s ~,nds
I0 Nortl-
0 Sour,~
O East
_~ ~ ~:~.,~ Distance From Crash
~ ~ ~ ~OLitRl
Ending ~lm , i ~or Crash bet;veen
~ ~ cas[ I Landmark land
t
__ Degrees Minutes Seconds
atltude: ~ . .L_on gi{u de: .. .
Control. Device O Y[¢I,'._~ ~qign O ~'~'l~a[ah'¢ Q ¢=r n'ffi-- _r TCD F~n~ioning_ ._ '
Flashing Traffic ~ ~. Controls . . _~ . ~ No Cont;'ols 0 Device Functionh~g
~,bt,~;.~ic~bt~ O Traffic Signal 0 Active RR Crossh~g 0 otb'or-Two TOD Improperly
5ianai ~ _.top ~gn ~ Passn, e RR ,~ De'vice Not Device Functioning
Functioning Properly
. ~ C,os~ing Con,roSs ~ .~.n~,nown O
Feet
l zl l: l¢l I
Or Miles
·
Emergencv
C~) Preemptiv~
Signal
L.._J Unknown
L~sc__C./os_q~__d {?f "NotApph'cable" skip rest of the Lane Closure section) Lane Closur¢ 0 North 0 East (~ North and South 0 All
C) Riot Apoiicahle 0 Pacioli,/ ~ Fully 0 Unknown O~Jq~ 0 South 0 West 0 Edit ~r:d West (a.S F,W)
~ Yes ~ No 0 E~L ~
~et~.ured Unknown~ ClOsed 0 < 30 Min. 0 30-60 Min. 0 1-3 hrs. ~ 3-6 hfs 0 6-9 hr; 0 > ~a hoLns 0 Unknown
Driver Restrictions O Restrictions r--q Not a Pennsylvania
Comoliance Complied With ~ Driver
Restrictions Not Unknown
~. No Restrictions/ CD CDmptied V, Jith O Compliance
Not Applicable
Compliance
0 Unknown
Driver Endorsement C~
Compliance
CD
C~' None Required
Driver License O Not Required for
,C..gmpiiance Vehicle Class
C~) No Valid License
for Class
O Not Licensed
C~ Valid License for
Class
Required - Not a Pennsylvania
Complied With C~) Driver
Required - Non Unknown
Compliance ~/ Compliance
Required -
Compliance Unknown
C~Unk if CDL or
CDL Required
C~ Not a Pennsylvania
Driver
Unknown
OrucI Test Tyoe. ~ Blood CD Other
C~r' None I~ Urine L~l Unknown if Test
Given
Drug Test Results - (Up to Four Results)
0 = NO Test Given 65 Amphetamines
1 = No Drug Reported = PCP
2 = Marijuana ~t ~ Other
3 = Cocaine - Unknown Test
4 = Opiates Results
Unit No
Driver Restrictions C~) Restrictions
.Compliance Complied With
Restrict]ohs Not
No Restrictions/ ~ Complied With
C) Not Applicable
Compliance
~ Unknown
C~) Not a Pennsylvania
Driver
Unknown
Compliance
Driver Endorsement ~ Required. Not a Pennsyb'ania
'_Compliance_ Complied 'With 0 Driver
CD Required - Non 0 Unknown
L'~ None Required Lornpfiance
Compliance
C~) Required-
Compliance Unkno~vn
Driver License (~ Not Required for
'Coml~lianc~ Vehicle Cias~ ~ Unk if CDL or
- CDL Required
(~ for Class
(~) Not a Pennsylvania
Driver
0 Not Licensed ~ Valid License for
~ Class C~ Unknown
~ruq Test Type 0 Blood ~ Other
Unknown if Test
(~t None CD Urine C) Given
D~rug Test Results - (Up to Four Results)
0 = NO Test Given S: Amphetamines
1 = No Druq Reported 6 PCP b
2 = Marijuana 8 = Other
3 Cocaine 9 = Unknown Test ~ L_~
4 = Opiates Results
j Principle Impact Point
~ Non-Collision
L_~ Undercarriage
~ Towed Unit
o o7
g UDkDOWn
Avoidance Maneuver
No Avoidance
(~ Maneuver
Braking - Skid
0 Marks Evident
Braking - No Skid
C~) Marks, Driver
Stated
Under Ride Indica tot
No Underride or
Override
Braking - Other
~ Evidence
C~) Steering - Evidence
or Driver Stated.
~ Other Avoidance
~ Maneuver
C~) Inconclusive
Steering and Braking O' Unknown
Evidence or Stated
Underride, No
Compartment ._ C~) Override, Other
Intrusion ., -- Vehicle
Underride, Underride, Unknown if
0 Compartment 0 Compartment 0 Underride or
Intrusion Intrusion Unknown Override
Emerqency Use
Not in Emergency
Use
Prindple Impact Point
0 Non-Collision
0 Top
C~) Undercarriage
C~) Towed Unit
~ Unknown
Avoidance Maneuver
L~ No Avoidance
Maneuver 0
Braking - Skid
(~ Marks Evident ~
--I.: . S~,ltl
B~.~,ng - No "'-'
CD Marks, Driver ~
Stated
Under Ride Indicator
Lights Flashing 0 Both Lights and
Siren
Siren.:~_ou.nding" C~) Unknown
CZ) i~oz CZ3
0 09 ' ~03 0
CD 0a
CD
Braking - Other
Evidence -
Steering - Evidence
or Driver Stated
00mer Avoidance
Maneuver
t___,~ Inconclusive
Steering and Braking 0 Unknown
Evidence or Stated
Underride, No
C~' No Underride or ~ Compartment (-'/Ovel'ride, Other
Override Intrusion ~' Vehicie
Underride. Underride, Unknown if
C~ Compartment (~) Compartment C~ Underride or
Intrusion Intrusion Unknown Override
Emer.gency Use
Not in Emergency
Use
L ghts Flashing ~ Both Lights and
Siren
Siren Sounding 0 Unknown
.~.< 500 2
CRASH REPOF, Th'~G FORM
Page:
,
Commercial Vehicle
I'/f Yes, Comple:e Form
Unit No
Last Name
Address / City I State
First Name MI Date of Birth
Driver License Number State Class
Telephone Number
Zip
Alcohol/Drugs Suspected
~ No 0 illegal Drugs
0 Alcohol 0 Alcohol and Drugs
Alcohol Test Type
(~ Test Not Given O Breath
L~ Blood (~ Urine
Alcohol Test Results
Medication
Unknown
0 Other
O Unknown if
Test G~ven
Driver or Pedestrian Physical Condition
O ,Apparently Illegal Drug
Normal O Use O Fatigue O Medicatlon
0 Had Been 0 Sick 0 Asleep (~) Unknown
Drinking -
Primary Vehicle Code Violation
Test Refused
Test Given,
Contaminated Results
Unknown
0 Results
Charged?
Ve~ ~ No
Driver Presence 1 =Driver Operated ?=Driver Fled Scene
E~ Vehicle 4=F~i~ and Run !
2=No Driver 9=Unknown
Owner/Driver 00=Not Applicable
01 =Private Vehicle Owned/
Leased by Driver
02=Private '7ehide Not
Owned/Leased by Driver
03=Rented Vehicle
04=State Police Vehicle
05=PENNDOT Vehicle
06=Other State Goo Veh
07=Municipal Po/ice ',,'eh
08=Other biunicipal
Government Vehicle
09=Federal Goo Veh
9B=Other
99=Unknown
Same as Owner First Name
Driver
Address / City / State / Zip
i
VIN
License Plate
Insurance
"/es 0 t'4o
Owner Last Na~e. or Business Name (If Pedestrian, skip this Section)
Vehicle Make *Make Cod,
Insurance Company
U F~ -
0 kno,,,.~
-- Model Year :: Vehicle Model
Reg. State Est. Speed Vehicle Towed Towed By
~ Yes O NO ,, ',.~ /'/ ~,_~v~/tZ ....
~oli¢~ ~o
(see overlay)
Unit
No of
Trailing
Units:
~vpe l=Towmg Pz,';;. '.,'eh 4=Mcbde:'?JoduSr
Uni___[ F-~ 2=To,nin:g Truck 5=Camper
3=Towing Utility Trailer 5=Full Trailer
Tra vel
7=Semi-Traiie'
S=Other
9=Unknown
Vehicle Color
O6=Yellow
U/=bllver
08=Goid
0~=91ue O9=Brown
C2=Red t O=Orange
03=?/hite 11 =Purple
O4=Green 12=Other
OS=Black 99=Unknown
*Movement ~ *See
Overlay
Vehicle Tv~e 05=Large Truck 20=Unicycle, Bicycle,
01=Automobile 06=SUV Tricycle
02=Motorcycle 07=Van 21 =Oti~er Pedaicyde
03=Bus 10=Snowmobile 22=Horse & Buggy
04=Small Truck I 1 =Farm Equip 23=Horse & Rider
(if "02'; Comp/ere Form 12=Construction Fquip 2,~=Train
M, Section 25) ' 13=APo' 25=Troltey
(If "20" or "21 ", Complete l$=Other Type Spec Veh 98=Other
Form M, Sect/on 2,7) 19=Unk. Type Spec Veh 99=Unknown
14=Undercarriage 0=None 2=Functional
1S=Towed Unit !=Minor 3=Disabling l=Le,.,el
9=Unknown ] 2=Upt~ill
99=Unknown
!nit/al Impact Point
O0=Non-Cotlision
01-12=Clock Fonts
13=Top
Tag No
Tag Year Tag St
Special Usaqe
Passenger
00=Not Applicable Carrier
O~ =Fire Veh 13=Taxi
02=Ambulance £ 1=Tractor Trailer
03=Po!ice 22=Twin Trailer
08=Orr, er Eflhei,~eF'c,/ 23=Triple Tram
Vehicle 3 'I =Modified Veh
1 l=?upil Transport 99=Unknov,,n
3=Downhill
4=Bottom of
5=Top of Hill
9=Unknow, n
Road Aliqnment
1 =Straight
2=Curved
9=Un known
POLICE CRASH REPORThNG FORM
Page:
Crash
Type
Unit
Commercial Vehicle
(If ;'ex, Comp/ere Form 0
Unit No First Name
Last Name
Address / City / State
MI
Date of Birth :r.,~t,4-~,D- r"[ '~''
Telephone Number
Zip
Driver License Number
I I I t
State Class
Alcohol/Druqs Suspected
(~) ~o
~ Alcohoi
Alcohol Test Type
~ Test Blot Given
C) BiDed
Alcohol Test Results
Iliegal Drugs
Alcohol and Drugs
O Breath
O Urine
, ~s~ Refused
Test Given.
C~) Contaminated Results
Medication
Unknown
O Other
0 Unknown f
Test Given
U r~ k R OW n
O Resurts
Driver or Pedestrian Physical Condition
C~ Apparently Illegal Drug
Normal 0 Use 0 Fatigue
0 Had Been - 0 Sick 0 Asleep
Drinking
0 Medication
C~ Unknown
Pr/man/ Vehicle Code Violation Charged?
Driver Presence 1=Driver Operated 3=Ddver Fled Scene
~I1 Vei~ic!e 4=Hit and Run
2=No Driver g=Unknown
Owner/Driver 00=Not Applicable .'* , ~
0,_.=PrlVat~ Vehicle Not 04=State Police Vehicle 07:MuniOpal Police ',/eh 0g=Federai Gev ',/eh
01 =P'rivate Vehicle Owned/ Owned/Leased by Driver 05=PENIqDOT Vehicle 08=Other Municipal 98=Other
Leased by Driver 03=Rented 'Vehicle 06=Other State Gev Vel~ Government Vehicle 99=Unknown
Same as Owner First Name ' Owner Last Na~eOr Business Name (If Pedestrian, skip this Section)
Address / City / State / Zip
- Vehicle Make *Make Code
VIN
License Plate
Insurance Insurance Company
ON0 o .t ....I' -- -,'
- Model Year Vehicle Model
,,iiq 9 51 I SC 4T
Reg. State Est. Speed Vehicle Towed Towed By
Policy No
l=Towmg Pass. Veh 4=Mobile,,'MoClutar Home
2=Towing Truck 5=Camper
~-To,.vmg-~- ' i./tilitv, Trailer 6=Full Trailer
7=Senti-Trailer
8=Other
9=Unknown
Tag No .
Tag Year Tag St
*Vehicle Position
,~,,.,I, e,,,en ~
Overlay
Vehicle Type 05=Large T~uck 20=Unicycle, Bio?cie,
0 ! =Automob te 06=SUV Tricycle
u~=~,~,tu, ~yc,~ 07=Van 21 =Other Pedalcyc!e
03=Bus _ 10=Snowmobile 22=Horse & Buggy
04=Sra.,al! T~,JBk- 11=Farm Equip 23=Ftorse & Rider
('if '02', Compiete Form 12=Construction Equp 24=T;-ain
M, Section 26) 13=ATV 25=Trolley
(If "20" or "21 ", Complete l$=Other Type Spec Veh 98=Other
Form M. Section 27) 19=Unk. Type Spec Veh 99=Unknown
Soecial &'sage
00=Not Applicable
0] =Fi~e Veh
02=AmbulanLe
03=Police
2=Commercal
Passenger.
Comer
3=Taxi
] =Tractor Trailer
2 2=T',vin Tra,,ler
08=Other Emergency 23=Triple Trailer
Vehicle 3 l=Modified Veh
'11 =Pupil Transpo~ 99=Unknown
14=Undercarriage
15=Towed URit
99=Unknown
Damage Indicator.
[0=hlor~e 2=Functional
1 =Minor 3=Disabling
9=Unknown
Gradient 3=Downhill
F'~ 4=Bottorn of Hi!t
1 =Le',/e! 5=Top of
2=Uphill 9=Unknown
Road Alignment
I =Straight
2=Curved
9=Unknown
~L,C~ CR,-,SH REPORTING FORM
50O 3 i
Page
:Iii IililJ
P05P7 _
C.'a:h N~mber
c~=Fer' a,e
=Male
In/ury LTe~ e
C 0=Not plured
]=Kdles
2=bla!or mtur
~=Moderate
Iniury
4=Minor n~ur/
8=h]jury, UnK
Seventy
9=Unknown
mjury
_e:t ;ide
C'5=Ti'ir~ %~,~ O~, '-:r:~,...-- ~:~ -
~gn[ S4e
t=tn Other Enclo:ed
Pa:senger Or Car3o ~.rea
?2=In Ocen Area
(Back Of Pickup.
'3=Tra:img
14=R~ding On Vehicle :xfer:or
5=Bus Passenger
9S=Other
99=lJn k' owr
~'eT ~':?' ,"O"-.:,~ 7 '~,' e
}=3afet. ~eit u:es rr:)rt, er,v
'~=C:'Id Safe:, Sea[ ~sec mcrt.:,er.v
12=He,me: .Seal mDrcDenv
9~=Re~[ramt Jsec T/pe JNKPO'/vq
Safety Eou/oment T.,vo.
00=F one Jsed ' FIst'Ao3 ICaD'e
01=Frcn[ A~r Bag Deployea =or This Seat)
02=~xde ~<r Bag Deployed For This Sear)
0]=Other T/pe A~r Bag Oeo,oreo
04=MuE~ple &~r Bags Deployea
05=Mo~orc) :ie Eve Protection
O~=Bicychs~ Wea~-ing Eibow/Knee/Pads
~ 3=A r Ba9 Not Deployed· Switcf On
1 l=Atr Bag Not DeDloyed. Switch Off
12=A r Bag Not Deployed
UnK Switch Sex ng
~3=AIr Bag Removed ~nor To Crash.
19=Unknown If Air Bag Deployed
99=UnKnown
G
H
i=-Srouqn S~Se Door Coentng
2:~"OtJO:-~ ~lde VV~ndo,,v
4=T"'OUCr Back Door
5=Throucn Back Docr Tall~a~e Opening
6=Througr Roof Osenir g (Sunroof/
Conve-tlbie Tc D ~own,
7=?rough Roof Ose~,ng (Con'/ertibie
lop
9=U~KNOWn
~XTr/C9 tlon :
0=N st &Doticable
1 =Not Extricated
2=Extn :ated By Mechamcat Means
S=Freed By N~n - Mechamca~ Means
8=Other
9=UnKnown
EMS Agency:
Unit No Person NO Date of Birth fl'J.M-DD-YYYY! A B C D E F G H I
r-7~ ~ Delete? '
° I
· Name I Address / Phone
~]Sameas [ t EMSTransp°rt
Operator ~ Yes CD No
Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F O H I
Name / Address / Phone
I IEMS Transp°rt
F~ Same as ~' . ,-
Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H
~[T~Delete?
Name / Address / Phone
Same as [ I EMS Transport
~ Operator / (~ Yes C) No
Unit No Person No Date of !3i.rth (MM-DD-Y'¥"¥'Y)
Name / Address / Phone
~ Same as I
~ Operator
[
.~ B C D E F G H F
EMS Transport
0 Yes 0 No
Unit No Person N.__o Date of Birth (tvlM-OD-Y'¢YY) A B C D E F G H ~
° _ i i II-Ir-tr-II-l-l
Name / Address / Phone
I-~Sameas I t EMSTra?'sp°rt
Operator O Yes O NO
Unit No Person No Date of Birth (MM*DD-YYYY) A B C D E F G H !
~T-~ ~Delete? .....
Name / Address / Phone
I EMS Transport
~ Same as [ i O Yes O NO
- Operator '
_~ _ ~_F..~_H RF_PGRT=~!',~G FOR?Fi Pag~
,,, , i [.gi, ?05777
.-..~, 500 4 ! I I -
Crash Description ~ G=r.i:,~-C:l;Fsfcn 2=Head Or, a=Angle ;~---ScJes..~'~e &=Hit medes?~an
/=moor End ~=~ear to P~r 5=S;desw~se ~O~Dos~e D~recficm
~Backin~ ~Same Direction) T=H~i Fixed Object '~=Cthe?Urkqo',v~
~~i !=C.F, Tra'/ei Lanes 3=Medi~,n 5=Outside Trafficv, av. 7=Gore ~n=,~ p .......... =r ..... ~ o,,
Relation to R~ad,~av ~ ~ 2=Sncui~er 4=Roads;de 6=in Parkmg Lane 9=Unknovm
~=Dayfigh~ 3=Dark ~ =~* 5=Davm 8=Other
illumination
~ 2=D~rk - No Lights ~=Dark - Unknown
~ ~~ Street I~ghts 4=Dusk Road',va'/ Lighting
~ ~ 1=No Adverse 3=Sleet (Hail) 5=Fog 7=Sleet & Fog 9=Unknown
~ Weather Conditions Conditions
~I I I 2=~ain 4=Snow 6=Rain & Fog 8=Other
- Road SuVaco Conditions ~ 0=Dp/ 2=Sand, Mud, Di~, 4=Slush 6=Ice Patches 8=Other
Oil 7=Water- Standing
IUl
1=Wet 3=Snow Covered 5=Ice or Moving
Harm Event L/R Most? Utility Pole Number ~ Harmful Events (~arm Event) 30=H~t Fence Or vVai[
1 ~ 02=Hit Unit 2 32=Hit Cuk, ert
Unit No 03=H~t Unit 3 33=H~t Bridge Pier Or Abutment
2 O 05=Hit Unk 5 35=Hit Bridge Rail
06=Hit Other Traffic Umt 35=Hit Boulder Or Obstacle
Event~ in 3 ~ OS=Hit Other Ammal 37=Hit Impact Attenuator
. . 09=Col~[sion With Other Non ' 38=Hit Rre Hydrant
Sequential Fixed Object 39=HE Roadway Equipment
= Order ~ ~ ~ 11=StruckByUn~t1 40=HitMailBox
4 O !2=Struck By Unit 2 41=Hit Traffic island
13=5[ruck By Umt 3 42=Hit 5noYv ~anK
~ ~ .... By 43=Hit Temporanz Ccnstruct~on
Harm Event L/R Most? Utility Pole Number IS=Struck ~y Unit 5 Barrier
16=~truck B'/Other T;'affic Unit 48=Hit ~' g 'Object
1 ~ . 21=Hit Tree Or ~hrubberj- 49=H$t Unknown [ixed
Unit No 22=Hit Ernbankmen'f- 50=Ove~urn/Ro!i Over
2 O 24=Hit Traffic Sign .._ Obje~
25=Hit Guard RaH .... 52=Pot Holes Or Other
26=Hit Guard' Rail End Pavement irregutarities
:PleasePut~~[ven~ in 3 O I I I I I I I I~7=Hit curb- 53=Jacknife
2$=Hit Concrete Or 54=FEte In Vehicle
Sequential Longitudinal Barrier 58=Other Non-Collision
First Unit No Harm Event Most Unit No Harm Event Driver Actioa' (D) 17=Careless Or illegal
~ ~ 01 =Driver Was Distracted 1S=Dr[vina On The Wrong
~h ~h OO=DrMng Using Hand HeId Phone Side ~f Road
Do not repeat rh 2 mtorma IQn ,)n mulboie ~aaes Ca=Drivmg Using Hands Free Phone 19=Making [mproper
' 04=Making Illegal U-Turn Entrance To Highway
Environmental / Roadway ~ ~ ~ OS=lmproper/Carele~s Turning 20=Making [mpro~er Exi~
Potential Factor~ (E/R) 1 Z 3 . 06=Turning From Wronq Lane From H~g~way
07=Proceeding VV,'O - 2 l=Careie~; Parkin~,"Unparkin~
00=None ~ l=Sliapeni Road Conditions (ice/Snow) Clearance After Stop =~=O/_nUn
01=Windy Conditions 12=Substance On Roadway 08=Running S~op ~ign Compensation At O Jr,lo
02=Sudden Weather Conditions 13=Potholes 09=Runninq RedLight 23=Speeding
.... C.~.._ Pavement 10=Failure To Respond To
03-O*h=~ Weather Conditions 14=Broken Or r=~b=d 2~=Driving Too Fast For Conditions
04=P~=r In ~eadw~,, 15:T-~ ~ .st ..... J Omer Traffic Control Device 25=Failure To Maintain Proper
05=Cbstade On Roadv, a.z. ! ~=Sof~'- ' S,vu~d=r'-- ~ ~....r Shoulder Dreo. '~'~'ff ~ iz=~uauenl ~=Ta[[qatin~)~uw~r~,z,~opurnq 25=Driver Fleefnq Police (Pot Chase)
06=O[her Animal in Roadway 28=Other RoadYv~y FdcLu~ ~ ~ ' "' ' '~' ' 27=Driver inexperienced
07=Giare 2~=Other E,?,.ironme;.tal Fac;:ol ~3=[lle,:al['.t .... ~ ~ '
]4=Careies: Pa~:[ng Cr La~e 9Z=Affected 8y Physical Condition
08=vVork Zone Re~a~ed 99=Unkncwn I Fhanqe -
~ - qS=Other improoer Drivmg Act~ons
Possible Vehicle failures (W ~2=Wipers 15=Passir~g In No Passing Zone - .
00=Nane 06=Exhaust 1S=Dri,,er Se.ating/Cm:tro'r !6=Driving The Wrong Way On 99=Unkno,,.vn
01=Tires 07=Headligh~ !4=Body, Doors, Hood, Etc 1-Way Street
...... K~ . OS=Sianai Uqhrs ....... Unit
03=Steering System 09=Otq~er Li~i~ts 16=Wheeis 1 2 ] 4
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Indicated Prime Factor Unit No Factor Code 02=Walkinq, Running, Jogging, 07=Standing
- 98=Other
0 ~ ~ 0 If EIR is [he Prime Factor
Type, leave Unit No blank
'ROE. ICE C~A.SH RE?ORTING FORM Page
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i- :' POLICE C~ASH REPORTING FORM
AA 500 t",~ ~':~
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Narrative and additicnal witnesses:
Page '~ New
?, ~'-t Change/
, "--'~ Continuation
COI~,~JV¶IOI~IWEALTH OF PENNSYLVAN!A
POLICE CRASH REPORTII~iG
Narrative and additional wftnesses:
Page
J ! ' ' ~, Continuation
22
22
CO,MMONWEA.LTH OF PENNSYLVANIA
POLICE CRASH REPORTING FORM
NarratF~e and additicnat witnesses:
'. /
CO~.N1ONWIEALTH OF PENNSYLVANIA
CRASH R[PORTING FOR~I
221
Narrative and additional-witnesses:
PENNSYLVANIA STATE POLICF__.
PUBLIC INFORMATION RELEASE REPORT.
PUBLIC INFORMATION RELEASE REPORT
'"" NATURE OF h"iCiC~Z,'TT
4. DATa. ME OF
7. INCIDENT DETAILS
~J
EXHIBIT C
OPY
Paul L. Killinger, Jr.
..... [] o~h.,<sr~:,*y, [] 2,~. 9/22/03
~,lo~ ,44 ~.v ug, COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
,,, H~_LC~O Lou~s~- KIL-C/IOG,E/Z... ~ F~'~A~ ~ ~7cl-tL.-3z/40 . , ?~lCfz~o
F~DkCl~ J ~ T~. 5400 Block Philadelphia Ave.
/~ t~. Chambersburq PA .
Homemaker I'" /': l': ,o,,, 12 I ........ i,..~R~(~p J,~aul L. Killinger,Jr.
30] D~L&I~_~ C~ ,7, s .... Pennsylvania
~.E~ s~.~[Harry~,~, ~.oo,. L~,~ ,~ Beulah E. Fry
. 303 Dwelling Court, Shippensburg~ PA 17257
'~S~ng H~ll Cemetery 2,~h~~ County, PA
~er-~i~ F.H.,Inc. ,P.O. ~x 3~, ~. ,PA ~7257
,:L.r/,~/2~ ~o~ :-1 - - I z ~,~,~, ~.~.
~ :~ ..................... ~,~ ~l,tl.~ j
EXHIBIT D
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
2/27/2004
Marcus A McKnight, III, Esquire
Irwin & McKnight
West Pornfret Professional Building
60 West Pomfert Street
Carlisle, PA 17103-3222
RC:¸
71%78%0972
717-783-3467 (fax)
l &bert(5'!state.pa.us
Estate ofHclcn L Ki!linger
File Numbez 2 [03-1020
Dear Mr. McKnight:
The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on
behalf of the above-referenced Estate in regard to a wrongfid death and survival action. It has been tbrwarded to
this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions.
Pursuant to the Petition, the 82 -year-old-decedent died as a result ora motor vehicle accident. Decedent is
survived by the decedent's spouse and 5 adult issue.
Please be advised that, 'based upon these facts and for inheritance tax purposes only, this Department has no
objection to the proposed allocation of the net proceeds of this action, $ 64,467.60 to the wrongful death claim and
$ 7,46.40 to the survival claim. Proceeds ora survival action ate an asset included in the decedent's estate and are
subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302; 72 P.S. §§9106, 9107. Costs and
tees must be deducted in the same percentages as the proceeds are allocated. In re' Estate of Merryman, 669 A.2d
1059 (:Pa. Cmwlth. 1995).
I trust that this letter is a sufficient representation of the Department's position on this matter. As the
Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending any
hearing regarding it. Please contact me if you or the Court has an,/questions or requires anything additional from
this Bureau. Finally, the approval of this allocation is limited to ti,is estate and does not reflect the position that the
Department may take in any other proposed distribution of proceeds ora wrongful death / survival action.
S~incere, ly, ( .................
,.:.:- ../"
~ ",-'1 /,t
J Paul D'ib~i-t -
Business & Trust Valuation Manager
Inheritance Tax Division
Bureau of Individual Taxes
RICHARD A. KILLINGER,
Executor of the Estate of
HELEN L. KILLINGER,
Plaintiff/Peritioner
PAUL L. KILLINGER, JR.,
Defendant/Respondent
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
: NO. 2004. CIVIL TERM
:
: CIVIL ACTION - LAW
CERTIFICATE OF SERVICE
I, Marcus A. McKnight, III, Esquire, hereby certify that a copy of attached Petition for
Approval of Settlement was served upon the following by depositing a true and correct copy of
the same in the United States mail, First Class, postage prepaid in Carlisle, Pennsylvania, on the
date referenced below and addressed as follows:
Paul L. Killinger, Jr.
303 Dwelling Court
Shippensburg, PA 17257
Michael Smoluk, Claims Adjuster
Allstate Insurance Company
Market Claim Office
6345 Flank Drive, Ste. 1000
Harrisburg, PA 17112
By:
IRWIN & McKNIGHT
Ma r cus ~l,~McKll~g~tII, ~'XS'q~i re
60 We~'Pomfret Street
Carh~.le, PA 17013
(717) ~'49-.2~53
Supreme C o ui:t~. D~. No~_25~7 6 __
Date: March 16, 2004
G:,'MMcKNIG[IT/ESTATES/KILL[NGERIKILLINGER PETITION SE'I-rLEMENT APPROVAL
Inventory of the real and pers.o, nal estate of
HELEN L. KILLINGER
deceased
1. Proceeds of Settlement Survival Action Portion - Order of Court .......
TOTAL ..................
10,000
10,000
O0
O0
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Paul L. Killinger, Jr.
being duly sworn according fo law, deposes and says fhaf he is the Executor
of fha Estate of Helen L. Killinger
late of the Borough of_Shippens~burg __ _, Cumberland County, Pa., deceased and fhaf fha
w;fhin is an invenfory made by Paul L. Killinger, Jr. .., fhe said Executor
of +he enf;re esfa+e of said decedenf, consisf~ng of all +he personal properly and real esfafe, excepf real esfefe ours;de
fhe Commonwee~fh of PennsyJven~e, end fhef ~he figures oppos~fe each J+em of +he lnven+ory represen+ Jf's feJr value
~s of +he defe of decedenf's deafh.
Sworn and subscribed before me,
this ;;lgY6day of 2004
' !- ' ~uMJI,~ONWEA~H'OF FIENNSYLVANiA
I l
L "'; .... nautXI I[:X~l'e~ ~ 18, ~007/
Member, Pennsylvania Association Of Notarie~s
Date of Death 16
303 Dwelling Court
Shippensburg, PA 17257
Address
09 2003
Day Month Year
INSTRUCTIONS
I. An inventory must be filed wifhin three months after appointment of personal repre~_ pfaf,ve~:~
2. A supplement inventory must be filed within thirty days of discovery of additional
3. Additional sheets may be aHached as fo personalty or realty
4. See Arficle IV, Fiduciaries Act of 1949.
-o
UJ
0
0
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRTSSURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOT[CE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
MARCUS A MCKNIGHT ESQ
IRWIN & MCKNIGHT
60 W POMFRET ST
CARLISLE PA 1701:5
DATE 06-28-2004
ESTATE OF KILLINGER
DATE OF DEATH 09-16-200:5
FILE NUMBER 21 0:5-1020
COUNTY CUMBERLAND
ACN 101
Amount Remitted
HELEN L
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -.~
~': [ ~- ' E~- -g~'-~i~-~3' ~ET~-~ ~ ~-~ - ~ E~-f ~-g - T-g~ - ~-~ ~-~ E~ ~- -g£t~-; ~-~£~ - ~- .................
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KILLINGER HELEN L FILE NO. 21 0:5-1020 ACH 101 DATE 06-28-2004
TAX RETURN NAS: C X) ACCEPTED AS FILED C ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) C1)
2. Stocks and Bonds CSchedule B)
$. Close[y Held Stock/Partnership Interest CSchedule C)
6. Mortgages/Notes Receivable CSchedule D) C6) .0~
5. Cash/Bank Deposits/Misc. Personal Property (Schedule
6. Jointly Owned Property (Schedule F) C6) .0~
7. Transfers (Schedule G)
8. Total Assets (8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/M/sc. Expenses CSchedule H) C9)
10. Debts/Mortgage Liabilities/Liens CSchedule I) ClO) .00
11. Total Deductions
12. Net Value of Tax Return (12)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form w/th your
tax payment.
10,000.00
8,604.10
1,595.90
15.
16.
NOTE:
reflect figures that include the total of ALL returns assessed to date.
Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J) (15)
Net Value of Estate Sub~ect to Tax C16)
If an assessment was issued previously, lines 14, 15 and/or 16, 17,
ASSESSMENT OF TAX=
15. Amount of L/ne 16 at Spousa! rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 16 at Sibling rate
18. Amount of L/ne 16 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-)
.00
1,:595.90
18 and 19 w111
1,:595.90 x O0 = .fl0
.00 x 045 = .00
.Oe-~-:12.. , = .00
.00_ x 15 :-::~ .00
AMOUNT PAID
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
¢19)=
c
.00
TOTAL TAX CREDIT ;1' .00
I
BALANCE OF TAX DUEI .OO
I
INTEREST AND PEN. il .00
c IF TOTAL DUE IS LESS THAH $1, NO PAYMENT IS REGUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUB~-~;-~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND CCR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B {collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
Section 9140}.
Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF MILLS) AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are avaiiable at the Office
of the Register of Mills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with spec/al hearing and / or
speaking needs= 1-800-447-3020 CTT
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax Cincluding d/scount or interest) as shown on this Notice must object within sixty C&O) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone {717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" CREV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three C3} calendar months after the decedent's death, a five percent CSX) discount of
the tax paid is allowed.
The 15~ tax amnesty non-participation penalty is computed on the iota! of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tile period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquenc~, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6X} percent per annum calculated at a daily rate of .000164. Ail taxes which became delinquent on and after
January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1982 2Or. .000548 1988-1991 ll~ .000501
1983 I&Y. .000438 1992 9Y. .000247
1984 1 lY. .000301 1993-1994 7Y. .000192
1985 13Y. .00035& 1995-1998 9Y. .000247
1986 IOY. .000274 1999 7Y. .000192
1987 IOY. .000274 2000 7Y. .000192
--Interest is calculated as follows:
INTERES? = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT
Interest Oailv
Year Rate Factor
~ 9X .000247
2002 6Y. .000164
2003 5X .000137
2004 4~ .000110
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
Not/ce, additional interest must be calcu[ated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
HELEN L. KILLINGER
Date of Death:
SEPTEMBER 16, 2003
No. 21-03-01020
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? X Yes No
Date:
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the C k ;;J[f Orph 's Court and may be
attached to this repott. I /7
09/06/2005 C . ~
r.'
C
0,
c
IRWIN & McKNIGHT
Marcus A. McKnight, III, Esquire
Name (please type or print)
60 West Pomfret Street
Address
Carlisle, P A 17013
City, State, Zip
(717) 249-2353
Telephone Number
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Capacity:
Personal Representative
X Counsel for Personal Representative
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Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 8/30/2005
IRWIN ROGER B ESQ
60 W POMFRET ST
CARLISLE, PA 17013
RE: Estate of KILLINGER HELEN L
File Number: 2003-01020
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:
9/16/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~.'~R~J~
,/
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
~~