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Home My WebLink About04-0466PETITION FOR PROBATE and GRANT OF LETTERS also known as-.~"~/l,/~.~t~./'~,, ',~'~q'7~ ~' ~ ~ TO: Deceased. Social Security No. /q ~ -/~-~~ The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ~ in the last wilt of the a~ decedent, dated and codicil(s) dated ~/~'[~ Register of ~W. ills for the / County of C~t~t4~t~'//gJ.~' in the Commonwealth of Pennsylvania named ,19 (state relevant circnmstances, e.g. renunciation,yth of executor, etc.) Decendent was domiciled at death in 0t,4 t, t4 ~,~/~/~,-- County,.P~nsylvanj~'with h O_o0, last family or principal residence at P/qA//I/O/q (-~q~ ~ -- ~/q~/'./'/t'//; /'~,,4t , (list street, number and muncipality) Decenclent, then ~ ~ ye~a,cs~of.age, died at ~e/eC/' 5J~ci ~l /'t(r(,~_. -~[~/,,.i ~9,'/[,',J- E~cept as follows, decedent did not marry[wdn°~ d]v~rc~d'and~lid not have a child born or adopted after execution of th ,e ~i.ll offered for probate; was not the victim ora 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: WHEREFORE, petitioner(s) respectfully requ,est(s), the probate of the last will and codicil(s) presented herewith and the grant of letters ~ 7~'~'~..~d_/44'~',n'/'~/qt< 0e' (testamentary; administratior~c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well a/~y administer the estate according to law. Sworn to or affirmed and subscribed ~- )~ r~/~.~_~~_~.._~.~..~_ ~' before me this ~ ~ day of [ ~ ~~ ~ Estate Of No. , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW l~Y3~t J t7 ~ ~, 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 -~-6. f',. ~_Q. [~ 7~ described therein be admitted to probate and filed of record as the last will of and Letters ~GT~ ~v ,~ a u ~e hereby granted to ~t~[~ L A~ ~)<~ ~ -~L)~E~ FEES Probate, Letters, Etc. .. Short Certificates( ) .......... ciation ................ TOTAL Filed . f.'.'.'.'.'.'.'.'.~q../.~.... ~ ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ~egi~ter of ~iIt~ of (Eumberlan~ t~untp ~enn~pl~ania OATH OF NON-SUBSCRIBING WITNESS Estateof "-~.~2.,~3~/ /97 / Also know as ,Deceased No. (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that (I am/we are) familiar with the signature of 6 I~'~-1- lhB~"-~-Fr ~¢__~ , testat/~/x of (one ofthe wimesses to) the will/codicil presented herewith and that~ believe~kthe signature on the subscribing will/codicil is in the handwriting of ~. 1 h,~-- ~'~ \ i~ CFr Ft~-~ to the best oC-~e knowledge and belief. Sworn to or affirmed and subscribed before me this ~ ~'/-" day of ./);,~,/ ,2WZ'7' For the Register Sworn to or affirmed and subscribed before me this __ day of ,20 For the Register (Signature) (Signature) L-~,V.,! t20. 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. Fee for this certificate, $2.00 No. /L;cal Registrar 4'/ L~.' CO~L~ ~ P~NBYLV~ · D~T ~ H~L~ · ~AL RE~ CERTIFICATE OF DEATH 17gg I~latl~t ~. PA I?0t~ LAST WILL AND TESTAMENT OF JANET B. RUTTER I~ JANET B. RUTTER~ a resident of Upper Paxton Town- ship~ Dauphin County~ Pennsylvan~ being of sound and disposing mind~ memory and understanding, do hereby make, publish and. declare this instrument to be my Last Will and Testament~ hereby revoking any and all wills by me at any time heretofore made. ITEM I: I direct my hereinafter named. Co-Executors to pay all my just d. ebts~ funeral expenses~ administration expenses and inheritance~ estate~ succession or excise taxes~ which I owe or may become due on account of my d. eath~ as soon as may be convenient after my decease. ITEM II: I give~ devise and bequeath all the rest~ residue and. remainder of my estate~ be it real~ personal or mixed~ of whatever nature and. wheresoever situate which I may own or have the right to dispose of at the time of my decease to be divided, equally among my three children as follows: 1. Gregory D. Rutter of 117 Terrence Place~ New Cumberland~ Pa. 17074 2. Douglas L. Rutter of 713 Lentz Avenue~ Mounted. ROute~ Millersburg~ Pa. 17061 3. Karen L. Rutter of 713 Lentz Avenue, Mounted. Route~ Millersburg, Pa. 17061 ITEM III: I hereby nominate~ constitute and appoint . my three c.bildren~ Gregord D. Rutter~ Douglas L. Rutter~ Karen L. Rutter~ Co-Executors of this my Last Will and. Testament~ with full power in their discretion to do any and all things necessary for the complete administration of my estate, with full power to sell at public or private sale and without order and to compound~ compromise or otherwise settle or adjust any and all claims~ charges~ debts and demands whatsoever against or in favor of my estate as fully as I could if living. IN WITNESS WHEREOF~ I have hereu~ set my hand and Last Will and Testament this~~day of se&l to this my Signed~ seated~ published and declared by the above- named Janet B. Rutter~ 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~ we believing her to be of sound and disposing mind~ memory and understanding~ have hereunto subscribed our names as~wit~esses this~~ day o f~~~/.~ ~ A.D. ~75. - ~' RENUNCIATION In Re Estate of-- ~e n~ve d~t, h~bY t~un~s) thc ~t to ~mi~st~ the ~tatc and ~NIly ~k(s) that Lett~ be i.uea to. /ET' WITNESS - ~' ~matuge) (A~ldre-~)/ (Address) (Sisnamre) (Addr~) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: DATE OF DEATH: WILL NO.: Janet B. Rutter a/k/a Janet M. Rutter April 22, 2004 2004-00466 ADMIN. NO.: TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 3, 2004: Douglas L. Rutter, 30 Shermanata Drive, Duncannon, PA 17020 Gregory D. Rutter, 700 Allen Street, New Cumberland, PA 17070 Karen L. Himmelreich (Rutter), 1018 Golf Course Road, Birdsboro, PA 19508 Notice has been given to all persons entitled thereto under Rule 5.6(a) except NONE Date: June 3, 2004 Signature Name Earl Richard Etzweiler, Esquire Address 105 N. Front Street Harrisburg, PA 17101 Telephone (717) 234-5600 X Counsel for Personal Representative b~. R f~evenue ETZWEILER AND ASSOCIATES ATTORNEYS-AT-LAW 105 NORTH FRONT STREET HARRISBURG, PA 17101-1436 Office hours: Mon.-Fri. 8:00 a.m.-$:OO p. m. (717) 234-5600 Earl Richard Etzweiler, Esquire ..... Christian S. Daghir, Esquire HALIFAX LINE (717) 896-3737 225 Market Street Fax Line: (717) 234-5610 Millersburg, PA 17061 Emall Address: retzweiler(&xomcast.net (717) 692-2519 Office hours: Tues. and Fri. 4:00 p. m.-8:OO p. na Sat. 10:00 a.m.-12:00 noon 2 West Main Street Elizabethville, PA 17023 (717) 362-8395 Office hours: Thurs. 7:00 p. m.-9:OO p. m. July 16, 2004 Register of Wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17013 RE: ESTATE OF JANET B. RUTTER A/K/A JANET M. RUTTER File No. 2004-00466 Dear Sir or Madam: Please find enclosed a check in the amount of $3,250.00, which represents an estimated payment of inheritance tax to be applied within the three-month discount period. Kindly return the receipt for payment of the inheritance tax in the self-addressed, envelope provided. Thank you for your assistance in this regard. ERE:hal Sincerely, Earl Richard Etzweiler r Enclosure Etzweilcr and Associates 105 North Front Street Harrisburg, PA 17101 Register of Wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVtDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004177 RUTTER DOUGLAS L 30 SHERMANATA DRIVE DUNCANNON, PA 17020 ........ fold ESTATE INFORMATION: SSN: 192-14-6364 FILE NUMBER: 2104-0466 DECEDENT NAME: RUTTER JANET B DATE OF PAYMENT: 07/19/2004 POSTMARK DATE: 07/1 7/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/22/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,250.00 TOTAL AMOUNT PAID: $3,250.00 REMARKS: SEAL CHECK# 238800 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMHONREALTR OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIYZDUAL TAXES NOTZCE INFORMATION AND TAXPAYER RESPONSE '~¢ '~ S.S. NO. Z~-Z~-9878 ~S~,~IOF EVELYN S ~ELLEHAN DATE 0F DEATH 05-02-200q h~5 ~U~ :09 CUHBERLAND BEVERLY A EISENACHER $9q HIVNER RD HBG PA 17111 FILE NO. 210~-Oqq6 ACN 0q150119 DATE 08-05-200q TYPE OF ACCOUNT [] SAV'rNGS [] CHECKINg [] TRUST [] CERTIF. REMIT PAYMENT ANn FORMS TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 VARTAN NATIONAL BANK has provided the Department Nith the In;or. etlon listed helD. which has been used Jm COMPLETE PART ~ BELON # # # SEE REVERSE SSDE FOR F~L~NG AND PAYMENT INSTRUCTIONS O,*, I2-11-Z00:~ EstabLished Accoun~ BaLance 100, ~:~ q. 7 ~, Percen~ Taxable X 100. O0 Amoun~ Sub~ec~ ~o Tax 100, ~. 7~ Tax Ra~m X , Oq5 Potential Tax Due q,519.56 Accoun~ No. 151-519-6 PART TAXPAYER RESPONSE A, ~The above tn;ormation and tax due is correct. ~. Y~ amy c~ose to remit payment to the Register e~ NJ~s ~]th t~o cop~es o~ this notice to obtain a d~soount or avoid interest, or you amy check box 'A' and retu~ th~s not,ce to the Register o~ You must complete PART ~ and/or PART ~ below. PART Zf you indicate a different ~ax rata, please s*a~e your TAX RETURN -COMPUTATZON OF 2. Accoun~ Balance $. Perce~ Taxable q, Amoun~ Subjec~ ~o Tax $. Debts and Deduc~/ons 6. A~oun~ TaxabXe 6 7. Tax Ra~e 8. Tax Du~ PART [] DATE PAID TAX ON JOINT/TRUST ACCOUNTS 7 X PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID I ,' h e c- /o/.? I TOTAL (Enter on Line · of Tax Computation] $ ¥/~ ~ ff.~[' co.le*. ~:o *ha bps* o, ay knowledge and belief. HOME (7/7 T TELEPHONE NUMBER DATE 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. CD OO4300 EISENACHER BEVERLY A 394 HIVNER RD HARRISBURG, PA 17111 ........ fold ESTATE INFORMATION: SSN: 144-16-9878 FILE NUMBER: 21 04-0446 DECEDENT NAME: BELLEMAN EVELYN S DATE OF PAYMENT: 08/23/2004 POSTMARK DATE: 08/23/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/02/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT )4130119 $4,519.56 TOTAL AMOUNT PAID: $4,519.56 REMARKS: SEAL CHECK# 1020 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS N.kP j) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV.1500 EX + (6-00) '. w ~ ~~ u~ w~ IO u~ ~ ~ ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280801 HARRISBURG, PA 17128-0601 .... Z W " W () W " 1 DECEDENTS NAME (LAST, FIRST,-ANDMioDLE INITIAL) I' i Rutter, Janet B. : DATE OF DEATH (MM-DD-YEAR) ~----~E OF BIRTH (MM-DD-YEA~--~ 04-22-2004 I 02-16-1922 I (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST AND MIDDLE INITIAL) I , OFFICIAL USE ONLY FILE NUMBER II 04 0466 NUMBE~~ COUNTY CODE YEAR SOCIAL SECURITY NUMBER ~. 192-14-6364 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1. Original Return D 2. Supplemental Return C 4 Limited Estate D 4a. Future Interest Compromise (date of death , . after 12-12-82) ~ 6. Decedent Died Testate (Attach D 7. Decedent Maintained a living Trust (Attach copy 01 Will) copy of Trust) D 9. Litigation Proceeds Received D 10 Spousal Pover:t'i Credit (date of death between . 12.31-91 and 1-1-95) i~~!@mNwmtijl1*~it$QM4!:iQijiijj~ffiNij!I@~Miic_iiiii#iii$i;\ji~!JallSHQij~!ij$!iIIl{C!il1otiji NAME COMPLETE MAILING ADDRESS Earl Richard Etzweiler ~ z w o z o ~ o w ~ ~ o u FIRM NAME (II applicable) Etzweiler and Associates TELEPHONE NUMBER (717) 234-5600 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o i= '" ...I ::> .... e: '" () w '" 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) D Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11 Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) D D 3. Remainder Return (date 01 dealh prior to 12.13.82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes U 11.Eleclion to tax under Sec. 9113(A) (Attach Sch 0) 105 North Front Street Harrisburg, PA 17101 (1) None (2) 23,532.05 (3) None (4) None (5) 66,414.98 (6) None (7) None (9) 12,454.68 (10) 1,856.06 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 Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES , OFFICIACiJSE ONLY , I I (8) 89,947.03 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 X .00 (15) or transfers under Sec. 9116{a)(1.2) z 0 i= 16. Amount of Line 14 taxable at lineal rate 75,636.29 x .045 (16) '" .... ::> "- 17. Amount of Line 14 taxable at sibling rate 0.00 .12 (17) :; x 0 () 18 Amount of Line 14 taxable at collateral rate 0.00 .15 (18) X X .. .... 19. Tax Due (19) (11) 14,310.74 75,636.29 0.00 (12) (13) (14) 75,636.29 0.00 3,403.63 0.00 0.00 3,403.63 20.0 . ... ...............................i...$ll~llPl!~.#i~il,"AAAlI$t~PKml~ll!~J;Afjltil,~qRMMII#......... CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Copyright 2002 form software only The Lackner Group, Inc. > "-~,:o",,_,,.. Form REV-1500 EX (Rev. 6-00 Decedent's Complete Address: STREET ADDRESS 1700 Market Street IZIP 17011 ""~ CITY Camp Hill STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3,403.63 3,250.00 170.18 Total Credits (A + B + C) (2) 3,420.18 3 Interest/Penalty if applicable D. Interest E. Penalty Totallnterest/Penalty (0 + 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 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. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) (4) 16.55 (5) (SA) (5B) Make Check Payable /0." REGISTER OF WILLS, AGENT mrJljr.lmrfillr%i@l:~;~:Y:';Y//.~;::lMWiMmWiWiftMFrdi;Pifk1JiMtWiffiWIWIiTJ>>/WfftiiZlE'YAMtiir:>>':JliC7fJW.&:..t1tHMMJ@ 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;.. D [!J b. retain the right to designate who shall use the property transferred or its income;.. D [!] c. retain a reversionary interest; or .................. D 0 d. receive the promise for life of either payments, benefits or care?.. D 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.. n ~ [!j 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.. [!J 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 ather than the personal representative is based on all information of which preparer has any knowledge 30 Shermanata Drive Duncannon,PA 17020 DATE al;l~/(js SIGNATUR ERSON RESPONSIBLE FOR FILING RETURN Dou as . Rutter ADDRESS ADDRESS DATE 700 Allen Street New Cumberland, PA 17070 -~DRESS---' OJ-/')')'/dS DATE 105 North Front Street Harrisburg, PA 17101 ~/,);)I(j:; 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 is3% [72 P.S. ~9116 (a) (1.1) (i)] For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P .S. 39116 (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 ,So 39116 (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 PS ~9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .S. 39116 (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 LAST WILL AND TESTAMENT OF JANET B, RUTTER I, JANET B. RUTTER, a resident of Upper Paxton Town- ship, Dauphin County, Pennsylvana, being of sound and disposing mind, memory and understanding, do hereby make, publish mld declare this instrument to be my Last Will and Testament, hereby revoking any and all wills by me at any time heretofore made. ITEM I: I direct my hereinafter named Co-Executors to pay all my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after my decease. ITEM II: I give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal or mixed, of whatever nature and wheresoever situate which I may own or have the right to dispose of at the time of my decease to be divided equally among my three children as follows: 1. Gregory D. Rutter of 117 Terrence Place, New Cumberland, Fa. 17074 C" 2. Douglas L. Rutter of 713 Lentz Avenue, Mounted Route, Millersburg, Pa. 17061 i~- i 3. Karen L. Rutter of 713 Lentz Avenue, Mounted Route, MilleI'sburg, Pa. 17061 ITEM III: I hereby nominate, constitute and appoint my th~ee cnildren, GregoI'd D. Rutter, Douglas L. Rutter, Karen !._l ,c: L. Rutter; Co-Executors of this my Last Will and Testament, with full power in their discretion to do any and all things necessary for the complete administration of my estate, with full power to sell at public or private sale and without order of court any real or personal property belonging to my estate, /1 dr3n" (1;" ,-(; /,) . J (SEAL) , I y i/ and to compound, compromise or otherwise settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could if living. IN WITNESS WHEREOF, I have hereunD set my hand and seal to this my Last ~~~ ,A.D. 1975. Will and Testament this J-O# day of ~ /7~ ,0 ~(SEAL) Signed, sealed, published and declared by the above- named Janet B. Rutter, 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, we believing her to be of sound and disposing mind, memory and understanding, have hereunto subscribed our names~as wit~esses this~Jr~ day of ._~~. ' A.D. . 5. C7 ~cA:~~_ i/J flj (!I JJ lV III "7 (1 Y\Ot/ j 1(; / V , Rev-1503EX+ (6-9Bl . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN . RESIDENT DECEDENT ESTATE OF Rutter, Janet B. FILE NUMBER 21-04-0466 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 3:24:02 PM ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 37 shares of MetLife stock @ $34.40 per share = 1,272.80 $1,272.80 2 Waddell & Reed -Investment Account No. 20346177 I 20,853.25 $3.57 per share multiplied by 5,834.837 shares = $20,853.25. 3 $1,000.00 Series EE U.S. Savings Bond 1,406.00 - TOTAL (Also enter on Line 2, Recapitulation) 23,532.05 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) ETZWEILER AND ASSOCIATES ATTORNEYS-AT-LAW 105 NORTH FRONT STREET HARRISBURG, PA 17101-1436 Office hours: Mon.-Fri. 8:00 a.m.-5:00 p.m. (717) 234-5600 Earl Richard Etzweiler, Esquire Christian S. Daghir, Esquire HALIFAX LINE (717) 896-3737 Fax Line: (717) 234-5610 Email Address:retzweilertiVcomcast.net 2 West Main Street Elizabethville, P A 17023 (717) 362-8395 Office hours: Thurs. 7:00 p.m.-9:00 p.m. 225 Market Street MilIersburg, P A 17061 (717) 692-2519 Office hours: Tues. and Fri. 4:00 p.m..8:00 p.m. SaL 10:00 a.m.-ll:OO noan October 13, 2004 Walter C. Wilhelm, Jr. Waddell & Reed, Inc. 4755 Linglestown Road, Suite 402 Harrisburg, PA 17112 This office represents the Estate of Janet B. Rutter who died on April 22, 2004, a resident of the Camp Hill Borough, Dauphin County, Pennsylvania, and whose Social Security Number is 192-14-6364. Would you please complete the bottom portion ofthis letter for all accounts in which the decedent had an interest in as of the date of death showing the balance in said account(s) at date of death and have the same signed by the appropriate officer or employee of your financial institution. ERE:hf Sincerely yours.. . /r~' Earl Richard Etzweiler RECEIVED &l BEFORE 3:00 P,M. d- 0 3'-1 (c.1~'"7 Type of Account mMt"'" I F"".J) Date Opened . . ;Z-')-";<.'"1 Ol~c:;ln........k Accrued li.l....... posfedcalendar i> year up to date of death Z U 3. 33 P.;ud"aJ. Balance as of Decedent's Death Accrued Interest not disbursed as of Decedent's Death Account Ownership Name of Joint Owner Date Joint Ownership was Established Or.T 2 2 7004 WADDELL & REED SERVICES. INC. Account Number(s) $Z(!I 'i5SS. Z.S NIA ':J =z::;.'V~l.iJ: L---. tJ FA . . ~)I A , If a joint account is dated within one year of the date of death of decedent, could that account be traced to a prior joint account in existence over one year prior to the death of decedent. NIA. ~;>C~cC'r: \S.;-~ I Q-ZS- Cf+- ~ncia. visor..... ') f'.\WP\DOC'\H,"'F\2(Xl~\0cIobcJ\III-13..(I~.lt ~ '""" o p.. ~ >-. 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E x Co .....02,000 .,G t"')......-o .~('lJ~ll.l 'OJ f/) >.g =0;\) roc.. --gUJ-gECl o Q:l(3 -c.!: .a >c: c Q) ::I: ......- roD I 0 -g 0 .~ C(J)ro~"S ('a._I'- ~.o ,S!-g~ ~-d 0"- ro c -g.o>-~o Ol,t\'l(l].D ctJ.l:a:~:r: ~ZCii(jj:r: u . .:t=.t= c: "'"'"' WOOD ~ -g.!:,~:; 3.o-c-o~ -o.cwQ)t:: CI:3;:::1 ro oI!& ~~ ..c .-.- 0 ,Cthl/lX, ><: co (IJ row ~o33..... .-uiu.fo ~wwE .0 '- '- -0 C~OOO) -0 g>; -; {i ~ ~ .~ .~ (3 lJ)uQ}\1) rox({)(/)~ ~roro3 ~ 0 .!!! .~ -0 5" -0"'0 C "'0 -0 C c..8 ceoa oro.o.o .0-0' 0 , Q) V"1 * - 'so.. Uro. ~ ~ o ~ CD Q) ro a.. o a +J '" m a CD 0> H<FT CD +J <:: H o o o o W'" tJ<FT ..< H '" .!!! 11l o f- .!!l ." c: o -" ~ -0 ~ "" c: => 0"' -'0 c<::~ OJ 0 iO'" z ::E . Rev_1508 EX+(6-98} *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENTOECEOENT ESTATE OF Rutter, Janet B. FILE NUMBER 21-04-0466 Il'lcludethe proceeds of litigatlol'l al'ld the date the proceedswer ereceivedbytheestate All property jointly-owned with the right of survivorship must be disclosed on schedUle F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Mid Penn Bank - checking account no. 790089 65,009.46 2 Miscellaneous Deposit 1,405.52 TOTAL (Also enter on Line 5, Recapitulation) 66,414.98 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule E (Rev. 6-98) Main Office: MID~BANK www.midpennbank.com 349 Union Street MiIlersburg PA 17061 Dauphin County (717) 692-2133 (717) 896-3140 Mortgage Center: (717)692-2133 Trust Division: June 10,2004 (717) 692-2133 Etzweiler and Associates 105 North Front Street Harrisburg, PA 17101-1436 Re: Estate of Janet B. Rutter Date of Death: April 22, 2004 SSN: 192-14-6364 Dear Mr. Etzweiler: r.:anital RElQitm DfficAA' 4098 DeffY Street Harrisburg PA 17111 (717) 558-2144 In response to your recent letter requesting information on the accounts of Janet B. Rutter, we have researched our files and enclosed is the necessary data: 2615 N. Front Street Harrisburg PA 17110 (717) 233-7380 Account #: 790089 - Checking Account Date Opened: November 14, 1969 Account Name: Janet B. Rutter Balance DOD: $65,005.42 Balance Accrued Interest DOD: $4.04 Total DOD Balance: $65,009.46 Joint Ownership Name: N/A Interest Earned During Calendar Year Up to Date of Death: $29.13 4622 Carlisle Pike Mechanicsburg PA 17050 (717) 761-2480 1001 Peters Min. Road Dauphin PA17018 (717) 921-8899 Other Offices' School Road, PO Box 205 Dalmatia PA 17017 (570) 758-2721 If you have any questions, please call me at 717-692-2133. Halifax Shopping Plaza 3763 Peters Mtn Road Halifax PA 17032 (717) 896-8258 Sincerely, f~S~ Beverly S. Hand 2 E Main Street Elizabethville PA 17023 (717) 362.8147 550 Main Street LyKens PA 17048 (717)453-7185 545 E Grand Avenue Tower City PA 17980 (717)647-2157 7-9 E Main Street Tremont PA 17981 (570) 695-3358 Member FDIC Since 1868 REV.1151 EX+ (12.99) ~ ~ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF. Rutter, Janet B. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-04-0466 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: Hoover Funeral Home - funeral service 7,365.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / E1N Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid - 2. Attorney's Fees Etzweiler and Associates - legal services 4,497.35 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 248.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 343.83 See continuation schedule(s) attached TOTAL (Also enter on line 9. Recapitulation) 12,454.68 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule H (Rev. 6-98) Rev.1502 EX+{6-98) *' SCHEDULE H-87 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Rutter, Janet B. FILE NUMBER 21-04-0466 ESTATE OF ITEM NUMBER DESCRIPTION 1 Cumberland Law Journal - advertise Letters Testamentary AMO U NT 75.00 2 Etzweiler and Associates - notary fee, postage and photocopies 30.00 3 Register of Wills - two short certificates 8.00 4 San Diego, California - Vital Records (co owner of US Savings Bond I predeceased) 13.00 5 The Sentinel - advertise Letters Testamentary 156.83 6 Vital Records - duplicate Death Certificates 61.00 Subtotal 343.83 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+(S-98} *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETlJRN RESIDENT DECEDENT ESTATE OF Rutter, Janet B. FILE NUMBER 21-04-0466 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Community Life Team - medical services 80.00 2 East Pennsboro Ambulance Service, Inc. (check cleared after death) 50.00 3 EKG Associates - medical services 35.00 4 EKG Associates - medical services 35.00 5 Healthsouth Rehab - balance due on account (check cleared after death) 1,314.00 6 Manorcare - balance due on account 272.00 7 Quantum Imaging & Therapeutic - medical services 36.06 8 Quantum Imaging & Therapeutic - medical services 34.00 TOTAL (Also enter on Line 10, Recapitulation) 1,856.06 (If more space IS needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule I (Rev. 6~98) ,/ 1\ \ '. , ...........-.....- .;. ~ \a\ 00 0 ... ~ i1 ~ ~~. d\as ,.. ~~~ ~ ~ ~ 0 or' ~ i ~\ \ ~ .0 I .. - i\ ::-: \ ~ ~ - t-) 0 0 \3) ~ ! .D 0\ " Gl 0 0\ .cI) ~ \a\\ .... - ~ ? * ~ ~ . ";. 0 0 0 0 O' 0 ... ~ en .. r Q) , 0 \~ 0 ~o m '"" , Fl:EV-1513 EX+(9-O *' SCHEDULE .J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rutter, Janet B. 21-04-0466 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT NUMBER PERSON(S) RECEIVING PROPERTY Do Not List Trusteefsl (Words) ($$$) I. TAXABLE DISTRIBUTIONS [include outright Sfrousal distnbutions, and ransfers under Sec. 9116(a)(1 .2)] 1 Karen L. Himmelreich (Rutter Son 1/3 residue 1018 Golf Course Road Birdsboro, PA 19508 2 Douglas L. Rutter Son 1/3 residue 30 Shermanata Drive Duncannon,PA 17020 3 Gregory D. Rutter Son 1/3 residue 700 Allen Street New Cumberland, PA 17070 Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: - A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 01 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Register of Wills of Cumberland County, Pennsylvania INVENTORY No. Date of Death 2004-00466 04/22/2004 Estate of Janet B. Rutter also known as Janet M. Rutter 1 Deceased Social Security No. 192-14-6364 Douglas L. Rutter Gregory D. Rutter ____._._u.,.'._. The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. I.D No.: 06398 Signature: Personal Representative Attorney: Earl Richard Etzweiler Signature: Signature: Firm: Etzweiler and Associates Address: 105 North Front Street Harrisburg, PA 17101 Telephone: (717) 234-5600 Address: 30 Shermanata Drive Duncannon,PA 17020 ",) , Telephone: Dated: ;2-d-d --05 Personal ProDertv Cash.................................................................................................... Miscellaneo us Property.... .............. ...... ................. ........... ............... Stoc ks/Listed................................ .......... ............. .............................. Stocks/Closely Held ............. ..................... ........... ...................... ...... Bo n ds................ ............ .................... ................ .............. ................... Partnerships and Sole Proprietorships ........................................ Mortgages and Notes Receivable.................................................. 66,414.98 (j", 22,126.05 1 ,406.00 Total Personal Property........................................... 89,947.03 Total Real Property................................................... Total Personal and Real Property........................... 89,947.03 I Total Out-of-State Real Property............................ 0- Register of Wills of Cumberland County, Pennsylvania INVENTORY also kn own as Date of Death 2004-00466 4/22/2004 192-14-6364 Estate of Janet B. Rutter Janet M. Rutter No. , Deceased Social Security No. Cash Mid Penn Bank - checking account no. 790089 65,009.46 Miscellaneous Deposit 1,405.52 Total Cash 66,414.98 Stock I Listed share 37 shares of MetLife stock @ $34.40 per share = $1,272.80 1,272.80 Waddell & Reed -Investment Account No. 20346177 I $3.57 per share multiplied by 5,834.837 shares = $20,853.25. 20,853.25 22,126.05 Total Stock I Listed Bond $1,000.00 Series EE U.S. Savings Bond 1,406.00 1,406.00 Total Bond (Attach additional sheets if necessary) Total Personal Property and Real Estate 89,947.03 ~-. ,_. ~~ ""'-" ,', ~~ ,- ,"'. BUREAU OF INDIVlDUACMUSL ... INHERITANCE TAX DIVISION PO BOX Z806Dl HARRJ~ PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . NOTICE OF INHERITANCE TAX 'A'APPRAISEHENT, ALLOIIANCE OR DISALLOIIANCE OF DEDUCTIONS AND ASSESSHENT OF TAX 2ilD5rlAY 16 PI' 2: 43 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CLERK OF ORPf-V,N'S com EARL RIcQMi!'rel~~t): PA ETZWEILER a ASSoCS 105 N FRONT ST HBG PA 7101 05-09-2005 RUTTER 04-22-2004 21 04-0466 CUMBERLAND 101 A.......t Re..itted '*' REV-iS47 EX AFP (03-05) JANET B MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS ~ ~l!"'-"M4"Yf.m.m~'tm'.'Im .!lI!'.!MMI'l"t'lM.'t.m.l'III'IUTftMM1'~.YCtWlM.'t.IlTt.............. ... DIS LLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RUTTER JANET B FILE NO. 21 04-0466 ACN 101 DATE 05-09-2005 TAX RETURH liAS: I X I ACCEPTED AS FILED I I CHANGED RESERVATION CONCERNING FUT RE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN ASED ON: ORIGINAL RETURN 1. Real Estat. (Schedule A) 2, Stocks end Bonds ISchlld 3. Closely Held Stock/Part 4. HortgageslNotes Receiv 5. Cash/Bank. Deposi tslHi$C. 6, Jointly Owned Property 7. Transfers (Schadule G) 8. Total Assets III (2) (31 1'1) IS) (6) (7) e B) rship Interest (Schedule C) e (Schedule D) Personal Property (Schedule E) chedule FJ APPROVED DEDUCTIONS AND E EMPTIONS: 9. Funeral Expenses/AdM. C stslMisc. ExPenses (Schedule H) 10. Debts/Hortgege Liebilit es/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax R.t rn 13. Charit8ble/GoYe~ al Bequests; Non-elected 9113 Trusts 14. Net Value of Estate biect to Tax (91 1101 .00 23.532.05 .00 .00 66.414.98 .00 .00 IB) 12,454.68 1.856.06 1111 1121 (13) 11'11 ISchedule .}) I~ an assessment as issued previDusly. lines 14. 15 and/Dr 16. 17. 18 and 19 will r~le~ ~igures t at include the tDtal ~ Abb returns assessed tD date. ASSESSMENT OF TAX: IS. Aaount of Line 14 at usal rat. (IS) 16. ABOUnt of Line 1~ taxa 1_ at Lineal/Class A rat. (16) 17. A.OUlt of Line 1~ at S ling rate (17) 18. Anount of Line 1~ taxe le at Colleteral/Cless B rete (18) 19. Principel Tax Du. S' NOTE: NUMBER CD00417 REFUND INTEREST/PEN PAID 1-) 170.18 .00 DATE 07-17-2004 05-02-2005 .00 X 75,636.29 X .00 X .00 X AllDUNT PAID 3,250.00 16,55- , TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 00 = 045 = 12 = 15 = (19)= NOTE; To insure proper credit to your account, subalt the upper portion of this for. with your tex P8Y118ftt. 89,947.03 14 .310 74 75,636.29 .00 75,636.29 .00 3,403.63 .00 ,00 3,403.63 3,403.63 .00 .00 .00 . IF PAID AFTER DATE INDICATE , SEE REVERSE FOR CALCULATION OF ADDITI L INTEREST. I IF TDTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) BUReAU OF INDIVIDUAL ,rA)le$,'-' INfERITANCE TAX DI\'ISIDN ,. . PO BDX 280601 HARRISBURG PA l1lZ8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN l "-' 10 !.::J CLE,~;( EARL RICH~tiZ\Ji~llEf{m ETZWEILER'-'t("ASSOCS 105 N FRONT ST HBG PA 17101 *' REV-1607 EX AFP (03-05) 05-16-2005 RUTTER 04-22-2004 21 04-0466 CUMBERLAND 101 Anaunt R..IUed JANET B MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your 8ccount, submit the upper portion of this fo~ with your tax pay.~t. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... .......................................~.......................................................................1 REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF RUTTER JANET B FILE NO.21 04-0466 ACN 101 DATE 05-16-2005 THIS STATeHeHr IS PROVIDeD ro ADVIse DF THe CURReHT STATUS OF THe STATeD ACH IH THe HAMeD eSTATe. SHOWH BeLOW IS A SUHHARY OF THe PRINCIPAL TAX Due, APPLICATION OF ALL PAYHENTS, THe CURReHr BALANCe, AND, IF APPLICABLe, A PRouecreD IHreReST FIGURe. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-02-2005 PRINCIPAL TAX DUE: 3,403.63 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-17-2004 CD00417~ 170.18 3,250.00 05-02-2005 REFUND .00 16.55- TOTAL TAX CREDIT 3,403.63 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFrER rHIS DAre, SEe ReveRSE SIDe FDR CALCULATION OF ADDITIONAL INTeReST. ( IF TOTAL DUe IS Less rHAN $1, ND PAYHeNT IS REQUIReD. IF TOrAL DUe IS REFLeCl'eD AS A "CReDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERse SIDe OF THIS FDRH FOR INSTRUCTIONS. I Q...SV-- ETZWEILER AND ASSOCIATES A TTORNEYS-A T -LAW 105 NORTH FRONT STREET HARRISBURG, PA 17101-1436 Office hours: Mon.-Fri. 8:00 a.m.-5:00 p.m. (717) 234-5600 Earl Richard Etzwei1er. Esquire Christian S. Daghir. Esquire HALIFAX LINE (717) 896-3737 Fax Line: (717) 234-5610 Email Address:retzweiler(a;.comcast.net 2 West Main Street Elizabethville. P A 17023 (717) 362-8395 Office hours: Thurs. 7:00 p.m.-9:00 p.m. 225 Market Street Millersburg, P A 17061 (717) 692-2519 Office hours: Tues. and Fri. 4:00 p.m.-8:00 p.m. Sat. /0:00 a.m.-12:00 noon January 13,2006 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 RE: ESTATE OF JANET B. RUTTER FILE NO. 2004-00466 Dear Sir or Madam: Please find enclosed for filing the original Status Report Under Rule 6.12. Sincerely yours, , I'A) ../ / "'//-C c' Earl Richard Etzweiler ERE:haf Enclosure ~,",m be <\Cc~ c.o...m j STATUS REPORT UNDER RULE 6.12 Name of Decedent: =s- o,x...,e..-~ e 'R~ \\-e\ Date of Death: L\ - d-. d- - oq Will No. ::2 DOY - (){'),-\l:,(o Admin. No. Pursuantto 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 No. ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~No. d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Dated: January 13.2006 (~ ~ (./) ~!'~- ,:/2~-Vc> Ic. L........ ~5~-.Q ./ Signature Earl Richard Etzweiler, Esquire 105 North Front Street Harrisburg, PAl 71 0 1 (717) 234-5600 Capacity: _ Personal Representative X Counsel for personal representative V1. \ \\-G