The URL can be used to link to this page

Home My WebLink About04-0094Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Karin B. Dollins-Ewertz also known as Karin B. Ewertz , Deceased Petitioner(s), who is/are 18 years of age or older, apply(les) for: No. SOcial Secu~iiy No. 425-41-7240 ! (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut Decedent, dated and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence Steven G. Dollins Ison Carolyn B. Dollins daughter (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. 136 South Enola Driver Apt. 2 Enola~ PA 17025 1172 Oyster Mill Road Camp Hill~ PA 17011 Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 813 Wertzville Road~ East Pennsboro Township (Enola, PA 17025) (list street, number and municipality) Decedent, then 41 years of age, died January 21 ,2004 , at Holy Spirit Hospital~ East Pennsboro Township Decedent at death owned property with estimated values as follows: (Location) (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 ........................................................................................ $ Total Real Estate situated as follows: 79 Hillside Circle, East Pennsboro Township (Camp Hill, PA 17011) 3~000.00 132~000.00 135~000.00 1172 Oyster Mill Road, East Pennsboro Township (Camp Hill, PA 17011 ) Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: J ~gnature Typed or printed name and residence Steven G. Dollins 136 South Enola Driver Apt. 2 Enola~ PA 17025 RW-7 ~ ~ ! 4 ~ ~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ORPHANS' COURT DIVISION ESTATE OF KARIN B. DOLLINS-EWERTZ, : DECEASED NO. 21 04-0094 ORDER OF COURT AND NOW, this ~ ? day of 2010 upon consideration of a Praecipe to Discontinue the within ' action, the Motion is granted, the Rule is dismissed and the Citation is discharged upon payment of costs by the Estate. THE COURT: Judge c7 a ~ ® -~ ~ ~ m~."7 ~ G:, !y? C/) x CO rZJ j - ~. . r ~ ~ ~ ~7 ' ~ :• ir t ~ ~ ~~~ m ~ • ORPHANS' COURT DIVISION In Re: KARIN DOLINS-EWERTZ COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 04-0094 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: non v, n JUDGE'S INITIALS: TIME STAMP DATE: IN RE: SERVICE TO: OFFICE n>r rut>rc `.,,..,,,,,._ ___ METHOD OF MAILING: ®USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: 06/18/10 SERVICE TO: METHOIS OF MAILING: ^USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ENVELOPES PROVIDED BY ® PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT ENVELOPES PROVIDED BY ^ PETITIONER ^ JUDGE ^ CLERK OF pRPHANS COURT Y IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: . ORPHANS' COURT DIVISION ESTATE OF KARIN B. DOLLINS-EWERTZ, DECEASED NO. 21 04-0094 PRAECIPE TO DISCONTINUE WITHOUT PREJUDICE To Glenda Farner Strasbaugh, Clerk of Orphans' Court and Register of Wills: The above-captioned action is a Citation for failure to file an inheritance tax return. Please mark this action discontinued upon payment of costs by the Estate as the Estate filed the inheritance tax return. DATE: June 11, 2010 Lor A. ck Attorney for Petitioner PA Department of Revenue d Office of Chief Counsel ~~ c~ ~•' ~ ~-a'. P.O. Box 281061 ; N c~ ~ ~ Harrisburg, PA 17128-1061 ~~~- ~ "'Q U Attorne I.D. No. 69436 = ~ ~ ~ C.::, ` z ~J L, : ~ ~`. . Gt^ :., ~ ~ C~`,~ c , 'y= Y- N Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate acc.&o~in~,~. Sworn to and affirmed and subscribed -~ ~ ~' - %~ Steven G. Dollins (,~r:.me this ~ ~',,¢ day of '7' DECREE OF REGISTER Estate of Karin B. Dollins-Ewertz also known as Karin B. Ewert~ Social Security No: 425-41-724Q Deceased Date of Death: 1/21/04 AND NOW,.. , 2004 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary ~ of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoritate) are hereby granted to Steven G. Dollins in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... $ ~ Short Certificate(s) ............... $ ~,,,/, ~ Renunciation .......................... $ ~ Affidavit ( ) ....................... $. Extra Pages ( ) .............. Codicil ................................. JCP Fee ................................. Inventory & Tax Forms ............. $ $ Other ...................................... $. TOTAL ............................. $ ~..~_..~. RW-7A Attorney Attorney: Kent H. Patterson I.D. No: 15307 Address: 221 Pine Street Harrisburg PA 17101 Telephone: (717_.) 238-4100 DATE FILE/~ _~//..~/ RENUNCIATION Estate of Karin B. Dollins-Ewertz also known as Karin B. Ewertz ., Deceased The undersigned,Carolyn B. Dollins~ daughter (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters of Administration be issuod to Steven G. Dollins Witness (',,x ~ hand this o~Lc/ da_y._~ _~...~,,~.~_~, 2004 v (Signature~' 1172 Oyster Mill Road Camp Hill (Address) PA 17011 (Signature) (Address) (Signature) (Address) of Sworn to or affirmed and subscribed before me this ,=~-_~ day of Notar~ Public - // My Commission Expires: COMMONWEALTH OF PENNSYLVANIA 1'Ina M, Robertson, Notary Public East Pennabom Twp,, Cumberland County My CI3117 Expires Nov. 15, 2007 Member, Penn,yiventa Association Of Notaries (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 105.805 REX,' 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as I,ocal Registrar. The' original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9961499 No. Local Registrar Date ,,1§. 144 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ~29-195 (Coroner) - ~Female [*. 425-4 1-7240 J,.Januarv 21. J~anuary Zls ZUU4 ~mberland ~'~) Cumberland ~' -- -- Georg~ eidl~ ~~A~f~} ....... .__Athersclerotic Cardiovascular Disease I ,.. . , ....... :.__ I~,.,,~-,; ....... "'~' ~- .......... '~'~"~m~'~--"""~ ...... ~ ~,~:. b~.~anua~v 22~ 2004 (item 27) Type or Print Hichael L. Norris, Coroner 6375 Basehore Road, Suite #l ~Hechanicsburs;. Pa. 17050 · V. IN RE: IN THE CIRCUIT COURT FOR Cumberland Coyunty, PA, PROBATE DIVISON ESTATE OF: Karin Dolling-Ewertz PROBATE DIVISION Deceased FILE NUMBER 21-04-94 STATE OF CLAIM The undersigned hereby presents for filing against the above estate this statement of claim and alleges: 1. The basis for the claim is Retail as evidenced by attached Retail Installment Contract 2. The tax identification number of the claimant is 132619562, and the name and address of the claimant are Chase Auto Finance, 4110 George Rd, IP-1, Tampa, FL 33634, Attn: Inez Dolatowski. 3. The amount of the claim is $7,058.62 which amount is now due, or if not due, will become due on 4. The claim is not contingent or unliquidated. If contingent or unliquidated, the nature of the uncertainty is 5. The claim is not secured. If secured, the security consists of Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true, to the best of my knowledge and belief. Executed this 15th day of June, 2004. Chase Manhattan Bank USA', N.A. Ronald E. DeSpain, Jr. Attorney-in-fact Copy mailed to Executor on: ,20 CLERK OF THE CIRCUIT COURT BY: STATE OF FLORIDA COUNTY OF HILLSBOROUGH The foregoing insmunent was acknowledged before me this /'? June _ ,2004 by Ronald E. DeSpain, Jr.,Attorney-in-fact, on beh .alfof.~t,l~ corporation. She~~ily known to me and did not take an oath. ~//~/~e~ ,~//~,~9 NOTARY PUBLIC **The Tax ID NO. is as follows: 132619562 (CAF) ,~.~,, Barbara L. Thompson 62-13-134579-23 (CMBF) _:~3"'~'~.;g'= Commission # DD315329 ~~ Expires May 22~00~8 ,o,~ REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of ~ecedent Karin B. Dollins-Ewertz Date of death January 21, 2004 Will No. n/a Admin No. 200~-0009~ To the Register= I certify that notice of beneficial interest re~uire~ by Rule 5.6(a) of the Or, hans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on July 22, 2004. Name Address Carolyn B. Dollins 1172 Oyster Mill Road, Camp Hill, PA 17011 Steven G. Dollins 79 Hillside Circle, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date= Signature Name Address Telephone X Kent H. Patterson 221 Pine Street Harrisburg, PA (717) 238-4100 17101 Personal Representative Counsel for Personal Representative MEMBERS 1~ FEDERAL CREDIT UNION R,gco ,... ;~? 3f '04 JUL 30 P12:15 O~.r~beiia ;,:~ ;~i o., CREDITOR'S NOTICE OF CLAIM ESTATE OF KARIN B. DOLLINS-EWERTS, DECEASED ESTATE FILE #2004-00094 To the Register of Wills Court Division: Index and make proper entry in your official records of the claim of Members l~t Federal Credit Union in thc principal amount of $4,039.25, account #204891-01, against the estate of the above-named decedent. This claim is filed under Section 3532(b)(2) PEF Code, 20 Pa. C.S. 3532(b)(2). The said decedent, who's last known residence, was 813 Wetlzville Road, Enola, PA 17025 SSIN 425-41-7240, died on January 21, 2004. Verbal notice of this claim was provided to Stcven G. Dollins, Administrator, on February 12, 2004. Formal written notice of this claim has been provided on July 23, 2004. M~ERS 1 s~/~ffDERAL CREDIT UNION July 23, 2004 5000 Louise Drive · I~O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www. memberslst.org 4 MEMBERS 1st '04 JUL ..30 P12:15 CREDITOR'S NOTICE OF CLAIM ESTATE OF KARIN B. DOLLINS-EWERTS, DECEASED ESTATE FILE #2004-00094 To the Register of Wills Court Division: Index and make proper entry in your official records of the claim of Members 1st Federal Credit Union in thc amount of $4,717.00, account g4155372222048918, against thc estate of thc above-named decedent. This claim is filed under Section 3532(b)(2) PEF Code, 20 Pa. C.S. 3532(b)(2). Thc said decedent, who's last known residence, was 813 Wertzvillc Road, Enola, PA, 17025, SSIN 425-41-7240, died on January 21, 2004. Verbal notice of this claim was provided to Stevcn G. Dollins, Administrator, on February 12, 2004. Formal written notice of this claim has been provided on July 23, 2004. BERS 1 ST DE L CREDIT UNION · . Wolfe, Insurjflice Services Supervisor July 23, 2004 ~ 5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www. memberslst.org JAMES A. BALOGH - MN GARY W. BECKER - DC, FL, IL, MN. WI* =CREDITOR'S RIGHTS SPECIALIST AMERICAN BOARD OF CERTIFICATION CHELSEA A. WHIII_EY - MN, WI ANGELA M. HORN - MN MICHAEL D. JOHNSON - MN MARY ELLEN WEEMAN - KS, MN. MO THERSIA O. LEE - MN CHAD J. BOUNSKE - MN STEVEN M, TOMS - MN MICHAE£ L MCCAIN - MN WILLIAM B, HOPKINS - MN, WI JOHN E. OLCHEFSKE - MN JASON R. FOSTER- MN MF~GAN M, PROBSI' - MN MICHALL J. DOUGHERTY - MN BALOGH BECKER, LTD. ATTORNEYS AT LAW SEND ALL WRITTEN REPLIES TO: 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8440 FAX 763-852-8499 TOLL-FREE 877-768-4494 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 ARIZONA OFFICE: 64 E. BROADWAY ROAD SUITE '175 TEMPE, AZ 85282 DIANA THEOS - AZ. CO SANDRA TANG - AZ, CA OF COUNSEL: LITOW LAW OFFICES, P.C. (IOWA) LUSTIG, GLASER & WILSON, P,C, (MASSACHUSE~FS) 07/14/04 Re: In the Estate of KARIN B EWERTZ ~ Cc Probate Case No. 2104-94 Social Security No: 425417240 Last known residence: 813 WERTZVILLE RD ENOLA, PA 17025 Our Client: CITIBANK USA, N.A. (SEARS ROEBUCK Account Number: 1150071230686 Amount of Debt: $ 279.66 Dear Sir or Madam: Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll free at 1- 877-768-4494 Cordially, Balogh Becker, Ltd. Attorneys at Law Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. ~ 7/~2~ ~1~2~ COMMONWEALTH OF PENNSYLVAN~'A NOTICE OF CLAII~I COURT OF COMMON PLEAS OF CUMBERLAND ,COUNTY ORPHANS' COURT DZVZSZON Zn Re: The E.tate of: Court File No: 2104-94 KARIN B EWERTZ Deceased TO: THE CLERK OF THE ORPHANS' COURT DZVZSZON: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). CITIBANK USA, N.A. (SEARS ROEBUCK & CO) 1) Claimant's name: C/O BALOGH BECKER LTD, 4150 OLSON MEMORIAL 2) Claimant's address: HWY #200 MINNEAPOLIS, MN 55422 877-768-4494 3) Creditor listed below is the owner and holder of a claim in the amount of $. 279.66 4) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 813 WERTZVILLE RD ENOLA, PA 17025 ~ C~ ::~ ~-~ 6) Date of Death: 01/21/04 ~:: 7) That the claim arose prior to the death of the decedent on OE about r~ 8) That the claim is secured by C~ On behalf of the claimant, ! do solemnly declare and affirm under the penalties of perjury that they !nformation and representations made herein are true and correct to the best of my knowledge, information and belief. Dated :~2~,Z~,, ..~'... _// / ~ / Chelsea A. Whitley/Angela M. Horn/Mary Ellen Weem"~f'~had Bolins~'l~a Lee, Attorney Written notice of claim was given to Personal Representative and/or his/her Counsel as stated below: Name Address ENOLA, TX 17025 City/S~ate/~ip, ~ / %101 Date' hotic~ mailed IN RE ESTATE OF: KARIN B EWERTZ AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of $ 279.66 evidenced by account number 1150071230686 The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not BALOGH BECKER, LTD. By: One of its attorneys: Chelsea A. Whitley __ Angela M. Horn __ Michael D. Johnson __ Mary Ellen Weeman __ Thersia O. Lee Chad J. Bolinske 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4811 Subscribed and sworn before me This ~ day of~, 2004. ESTATE OF KARIN B. EWERTZ C~AIM FORM BOSCOV ' S ORPFL~NS ' COURT DIVISION O.~ COURT OF COMMON PLEAS OF COUNTY CUMBERLAND NO. 21-04-94 Notice of claim by in the amount of $ 124.53 Fiduciaries Code Laws of 1972, Act NO. 104 effective July 1, filed pursuant to section 3384, Probate, Estates and 1972 as amended. Date 19 TO TH~ CLERK OF THE ORp~HA~S' COURT DIVISION: Enter the claim of BOSCOV'S (c~men~ and Address) 124.52 944i Lt:3J FREEWAY Lock Box 30 in the amount of $ against the above entitled Estate. The decedent who resided at 12/12/03 (Address) died on Date STEVEN G. DOLLINS c/o KENT H. PATTERSON ESQ. Written no=ice of said claim was given to (Personal Representative or Counsel) at ?71 DI~E ST.. HARRISBURG PA 17101 (Address) on (Date) The basis of aforesaid claim is as follows: (Itemize folly to enable personal representative to make proper investigation). Acct. ~207284823 Claimant's Counsel (Name) (Address) ~,41 LBJ FREEWAY O~f~s,'~ 752~ PROBATE COURT Cumberland County, State of Pennsylvania Karin B. Ewertz, Deceased Case #21-04-94 Proof of Mailinq I mailed the creditors claim to the fiduciary (and attorney, if applicable) as follows: I deposited a copy/copies of the claim with the United States Postal Service in a sealed envelope with the postage fully pre-paid. I used first-class mail. I am employed in the county where the mailing occurred. The envelope(s) was/were addressed and mailed as follows: Mr. Steven Dollins c/o Kent H. Patterson, Esq. 221 Pine St. Harrisburg, PA 17101 County of Mailing: Dallas, Texas I declare und~ p~alty of perjury that the foregoing is true and correct. // Date: ///~/~ ~/ ~r~ . Albertson, Agent for ~ Boscov' s P.O. Box 741026 Dallas, TX 75374 Page: 1 Document Name: BA_RBAKA CASSIDY ~IQ~f~' ) BOSCOV'S CREDIT DIVISION ACCOUNT INQUIRY ORGANIZATION 100 LOGO 110 ACCT 000000000020/2~4~23 SHORT NAME EWERTZ ESTATE 0 STATE PA HOME PHONE TOT CR LMT 0 EMPL CD STATUS Z CA CR LMT 0 CSH AUTH .00 CASH BAL .00 TOT DISP 0 .00 CASH AVA_L .00 CASH DSP 0 .00 O-T-B **********0 CYCLE DB 0 .00 PCT LEVEL / ID S PA1 CYCLE CR 0 .00 CURR BAL 124.52 CYCLE PMTS .00 PAGE REL 01 09/18/2004 10:11:45 BLOCK CODES NBR PLANS CARD USAGE BILLING CYCLE D DATE OPENED CA_RD FEE DATE DTE LST BILL G 1 4 3 07/28/2001 09/03/2004 Cumberland County - Register Of Wills One Courtpouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/16/2005 PATTERSON KENT H 221 PINE ST HARRISBURG, PA 17101 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 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 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~-'J~ , 'I GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~~ Cumberland County - Register Of wills One Courthouse Square Carlisle, 'PA 17013 Phone: (717) 240-6345 Date: 1/05/2006 DOLLINS STEVEN G 136 SOUTH ENOLA DRIVE ENOLA, PA 17025 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~)~LjJ ;6'~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge \7/ ~~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/16/2007 PATTERSON KENT H 221 PINE ST HARRISBURG, PA 17101 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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 decedent1s death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ./11 I Y 1-1-- I~. JJI..uzu \/fJ4JwJ QM41:x.,' J Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/16/2007 DOLLINS STEVEN G 136 SOUTH ENOLA DRIVE ENOLA, PA 17025 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Itk~ d:u.<I./J Jtw.k.tf '..) Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel In Re: Estate of DOLLINS-EWERTZ KARl ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00094 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: DOLLINS STEVEN G Counsel for Personal Representative: PATTERSON KENT H Date of Decedent's Death: 1/21/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. ~l~~ Date: 1/25/2007 Glenda Farner Strasbaugh Clerk oU\.= -- .. . .. . "" U.S. Postal ServiceTM CERTIFIED MAILM RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) Distribution: Personal Representative Counsel for Personal Representative Estate File co M ru LI1 I"'- CJ 3' I"'- Postage $ Certified Fee ru CJ Return Receipt Fee CJ (Endorsement Required) CJ Restricted Delivery Fee CJ (Endorsement Required) ...D I"'- Total PostaQe & Fees $ ru Postmark Here cJ ...D Sent To DOLLINS STEVEN G CJ CJ s~~J136 SOUTH ENOLA DRIVE I"'- ~~~ENOLA PA 17025 City,Sta . . In Re: Estate of DOLLINS-EWERTZ KARl ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00094 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: DOLLINS STEVEN G Counsel for Personal Representative: PATTERSON KENT H Date of Decedent's Death: 1/21/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to detern1ine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. ~~~ Date: 1/25/2007 Glenda Farner Strasbaugh Clerk of the C Distribution: Personal Representative Counsel for Personal Representative Estate File I"- CJ :::r I"- , -, I1.J Certified Fee CJ CJ (E Return Recei CJ ndorsement R ptFee equlred) Restricted Deliv CJ (Endorsement R ery, Fee ,JJ eqUlred) I"- I1.J Total Pastaoe & Fees $ POstmark Here ) ~ ,JJ Sent ]; CJ CJ S{reei I"- Or PO' CiiY.'s PATTERSON 221 PINE KENT H HARRI SBtJR~T PA 17101 ~ ..--.--/ " I 0"""<'"1 '" ~g;; g (ON :: \1: ..;" ~ ~I~ o~ 8 s..'''" ItlFtlL~ ",fJ CD :z ~ (~ ~ ~ ~6. ~ ~~~ ~.s- N g <i: ".ill/Nfl 0 0 :E . I"'- CJ .:r I"'- ru CJ CJ CJ CJ ..D I"'- ru ..D CJ CJ I"'- I:() M ru Lt1 - a Q ',,) '\A ::: .. ~e ;;; ~ ~ '-' r- ,.DQ.#re~~ ~~tg.":l b__:::::Jr./)r') Qil~E~o ~~~~g~ =: - ~..c <r: ~',,)'Q~": ,*",~b'8~ ~re=:lV~ J:)f;A==S::l-: ES~00 i~ - Q .... '" is> ';;' '" ~ -y b ;.t:) ,:[; n ::~ ,: "1 / I ! ; , I I , !..LJ LU' UC) i.:::: /:' 0'- z ," I- (!) "- ~~ w ;> H ~ P CJ ~lI1 Z ...:l0J !'rl 0 0 >zr- rLl W r-i E-i U):I: E-i~ en ::::)(:1.. zo HU)~ ...:l ;-J ...:lwO OMZ QrlW 'riJ '-..,'.' ; .( ..,... ItJf'1()'~i ::l0 I'- ~ 0 (l) " I ~ (\4 - 0 0 - - .... ! - - (\4 (\. - 0 U) - z (\. - u) :3 III (\4 00 0 - o:;z:!t I - W~([ 01 0 :3 "" - z....o: (\4 - WOO 0 ,",Zll.. oj( - "" - 010 = I- .... - 0 - - ZWW (\. - - O:....J (\4 - :>am (\4 ....!:([ (Jl - wwz (l) 0:....:> (l) - I- (l) - ([ "" - 0 - I'- "" - .. - u m "" (\. "" W H X H Z ('~ m ~~ I:~ f.e I'- (R (Tl I I.i\ ..,.... r'" ('.1 ..I" I.n <'I I::) r'" _..4 .J , '-' 8 8'" - :.1..; ~1 '> \:'1="8 0 '1 2007111 IN RE: ESTATE OF DOLLINS-EWERTZ KARl ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00094 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSU~NT TO RULE 6.12, SUPREME COURT ORPHANS' <<;:::OURT RULE Personal Representative: DOLLINS STEVEN G Counsel for Personal Representative: PATTERSON KENT H Date of Decedent's Death: 1/21/2004 Date of Delinquency Notice: The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 217/2007 ~~J~ {~.",~l Glenda Famer Strasbaugh Clerk of the Orphans' COUl1 Distribution: Personal Representative Counsel for Personal Representative Estate File A healing is scheduled March 12. 2007 ~ l1AM . .~~\l ,_____~ . . 111 COUl1room NO.2. lfthe Status Report IS filed pnor t.o t:JJ.e heann,gdate,.rt1le heanng WIll automatically be cancelled., '\~-:/ '. \/f,!, ~ \.4., ~-1-/C>,-'~.{~. 'io.> \J... ...". \ ~j\,_.., \ ~\ Edgar B. Bayley, J. IN RE: ESTATE OF DOLLINS-EWERTZ KARl FEe 0 '1 2007 r' ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00094 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A . HEARING PURSUANT TO RULE 6.12, SUPREME ,COURT ORPHANS' COURT RULE Personal Representative: DOLLINS STEVEN G Counsel for Personal Representative: PATTERSON KENT H Date of Decedent's Death: 1/21/2004 Date of Delinquency Notice: . ~ - .... .. ---..... - - ... . -- .. U.S. Postal ServiceTM CERTIFIED MAILM RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) lT1 U') U') U') I"'- CJ ::T I"'- ru CJ ; Return Receipt Fee g (..' dorsement Required) estricted Delive ry Fee CJ ( dorsement Required) .ll I"'- ru Total PostE .ll Sent To CJ CJ SireeCAp{i I"'- or PO Box ~ City;'Siaie,'; Postage $ u'-t-OCf1L\ "ear\n~ \ \<-. Postmark Here Certified Fee a \ \2:> \ 01 PATTERSON KENT H 221 PINE ST HARRISBURG PA 17101 PS Form 3800, AUgust 2006 Strasbaugh, Clerk of Orphans' Court, in accordance Court Rules, hereby notifies the Orphans' Comi nberland County, that neither the above named personal sel for the personal representative have filed with the ;' Court his, her or its Status Report required by Rule e and that the requisite notice, pursuant to Rule 6.12, s given on the above date and that the ten (10) day d. Accordingly, in accordance with Rule 6.12 the Court d the undersigned requests that a Comi conduct a l10uld be imposed upon the delinquent personal :nt personal representative. ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Comi Personal Representative Counsel for Personal Representative Estate File Distlibution: A healing is scheduled March 12. 2007 (ii) HAm in Courtroom NO.2. If the Status Report is filed Plior tOJ~g date, the hearing will automatically be cancelled. / /" ./~ ,,~'X ,// \ :.' \... --...;~ v' I ( ,-:;j.I--,,, Yr/;d '-\ \ Edgar B. Bayley, 1. ~ . Complete items 1, 2, and 3. Also complete Item 4 If Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? If YES, enter delivery address below: r!~_T~,ET?'?OK KENT ..-1 2 2 1 J? ~: NE S T HARRISEJRG PA 17~0i . 3ep'ce Type .~ Certified Mall [J Express Mall (] Registered [J Retum Receipt for Merchandise [J Insured Mall [J C.O.D. 4. Restricted Delivery? (Extra Fee) 2. ArtIcle Number (Transfer from service label) PS Form 3811, February 2004 7006 2760 0002 7407 5225 Domestic Return Receipt 102595-<l2-M-1540 I UNITED STATES POSTAL SERVICE 111111 First-Class Mail Postage & Fees Paid USPS Permit No. G.10 · Sender: Please print your name, address, and ZI~+4. I i~. th. is box · 0'\- Ot) '1"\ ~ Glenda Farner ~~'lsbaugh Register of Wins" and Clerk of Orphans' Court County of Cum berland One Courthouse Square Carlisle, P A 17013 J.. .111. f .111. "" f II.. H 11.11.. .11...1.1. .11.1.1..','. .1.1..1 SENDER: COMPLETE THIS SECTION . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: P\TTER';OH KE"NT H 221 pum ST 17".L'Cil HARRISBURG pi\ 2. Article Number (Transfer from servlC$ label) PS Form 3811, February 2004 COMPLETE THIS SECT/ON ON DELIVERY \ ) -."1 ( ) 3';r~~MaII D~Mall o Registered 0 Retum Receipt for Merchandise a Insured Mall a C.O.D. 4. Restricted DelIvery? (Extra Fee) o ';)_ 7006 2760 0002 7407 5553 1 02595-02-M- 1540 Domestic Return Receipt l"l"""I' ""'1\"1'1'''''' "H..'U""....,. \ II'" \ \1"'1 t lOL I V d '~Is~puJ ~uunbs dsnoqJ.InoJ ;mo puup.)qumJ JO l\lUnOJ lmoJ ,SUUII':UO JO )[ldlJ puu slI!i\\ JO .IdlS~~d~ q~nuqsens ldUlUd upudlD ~ ~bQQ-"G . xoq S!llt Ulv+dlZ pue 'ssaJppe 'aweu JnoA lUl.ld aseald :Japuas . O~-€> 'ON l!WJad SdSn Pled see:f 'i a6Blsod Ue~ sseIO-lSJI:f 111111 3::l1~3S lVJ.SOd S31V1S 031lNn ~ I 0 ~" l'- 0 ~o~ '" 0 0 0 o;t I ~:; s ..... I ""' If! ijl' 000 8 ..-~ .-l Ir....;, 0 I - - ., ~ w 0 - I" W (.) : it fA-lL ~ -) 0 "'I I'- l(~1 ~;@ 11.1 0 ] I/) W ~ c i ! I'~' ~:O~ lID 0 - - ie. lIOII I - WO([ 1JI - - ~ ~ <(~ 0 0([3 .-l - : j,..:-'" ~'" ~ ;Z n: If! - ....s> Ng <( W{;JO 0 - - O.3.lINO 0 0 (:i (11([11. \l( - - II 1"1 OWO : - I-Jt- - III - Z([W I'- : O:IIJ ~ - 1"1 :)W{ll (\\ - - l'- 1-><< 1JI : 1"1 WHZ (!) - lIJ:J (l) - W (l) a .-l - 0 - - l- I'- - W 0 ,-t - - H Z - x .. - H U Z IIi J S , ~i (Jl, 0 i J 0 ~ '", ~ ~) W ,. > l" H ~ r:r; .... D .') c.'J ~ - ,:t If) 0 ::: Z >-=l ('\) 0 WOo l" '"l >:;2;r--- ... '" WWr-J = E--l ttl ~~ (f);I; ~e E--l~ ;; ~ ~ "r- ....00 (f)~o., ~~sg~ 2;0 re~t:O"'I H(f)~ $0-0 ..- ,.,t:t (/) (") i;5~~ H H t:~~5'- H~O =g -'€~ .:) tV) 2. ... O::s Drili.j ';'~b8..!F ttS = .~ 2~g8~ E -- '"l u ~~ 0 . 1 ... ~ ~L( /~ 'l$l & ... ~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CvV\A'flJ~oD COUNTY, PENNSYLVANIA Name of Decedent: l(AR; rv ~,~ L-L) 1...1~- eLclB=nr2- Date of Death: 'S PdJV N'L~, 28 4 4- File Number: '""). ~f) 4- - q 4- Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. DYes ~o 2. If the answeris No, state when the personal representative reasonably believes that the administration will be complete: 3~u~I~f"" 3. Ifthe answer to No.1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . .. DYes DNo 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? ............................... DYes DNo 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. DOle ,),jIJ7 I~ nl{?-~ Signature oj Person Filing this Form SO :li Capacity: DPersonal Representative ftCounsel j('~1 t~. PATI82-S~A.J Name oj Person Filing this Form ?-~ l R V 'E? .( 'fl2-e:e-- f Addre~{; 131/ 12 ~ /JJ- /7/ GJI TeQ,~l) 2.~ 9- ~ 4-JO a Fo,.", RW-iO rev. JO.J3.06 crt- Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 f'*'...J Date: 12/27/2007 C) PATTERSON KENT H 2:21 PINE ST f.~: '"l -....J o f..c..... ,. , ("J N -...I ") ') c.,_h..... HARRISBURG, PA 17101 ::t:.'I~ -,~_.... -:.- C") N RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing 1S due by: 1/21/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, /I~... ~.& #.. /) ~. .'7;.LJ / Itl~~<:t~~L ,,,:Va>&:?l'.../J:(.fLJ;f.,Ii:-rL~-, ,....1 Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 240 - 6345 Wills Date: 12/27/2007 (-) 136 SOUTH ENOLA DRIVE ENOLA, PA 17025 G~;1 C"J 1'..) -.J DOLLINS STEVEN G J::'.,'JJ -"'1r'l'"' -Lo. C) N RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (:2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Since",rely, k ','," <;';21'> ",< LL., /} /i,ZI"~,6_.ti0'Ai1l"<<!,'(../ Ja2/J.'1:,("k;,;vc Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel t \\\, ~H ~'l ~~ ~ !?~ '~l\ N ~ t' ;~ ~~ ~ ~i~ ~Q NO <( :3l/N('\ 0 0 :i "..,:.' ~ 1"- ('{ 0 ~ "'^l ! "-.Ie r t-- - C'1 - I,l'll . - 1vl.' 1 - tlI - .,-I .,-I - I t ~ -2 .,-I - '''--F , . PH I =gro {II to - fIlO 0 - - 1l:Wtr. \ - CLERK r wn:1J. (fI - 00'3 .,-I :: 1:-0n: .,-I - wlJ.O 0 - fI) I.l.. 1( - I- - ozo III rill\- 0 H zUlli 01 - lr.HJ 91 - .,-I :::>I.l..fil .,-I - 1"- l-I.l..([ 0 - .,-I w:::>z (l) ([{II:) (l) z (l) - H .,-I 0 1'- - ill .,-I - H :: X H 0 1:- III -:r 'B I -:J G7 t.~ ~~& i.f.\ e LA . ,1ft rO (tt ...~ 1.\\ (....\ (.~) l .. _,--I (l) .w cO o C) ~ ~ (-I CJ1 CJ1 Z H ....:1 ....:1 o o ~ >- H ~ o l!) :3~ or- Zr-l rIl ';I::~ (-Ip.. p o ' CJ1~ ....:1 \DO r'1Z r-lrIl ... ... ;:: C> ~ '", ~ <e -&e E~~e~ ~(l.ldroM m e '"C g..~ _tJ~: ~~!1~ .~. e g "Q ~ g; ~no' ~ ~ ~ g J e:: d = U $ ~~E~~ ",-e ~ou ~W\ - C> ... '" ~ & ~ e- o o N --... e- N --... N ..-I ~ .~ In Re: Estate of DOLLINS-EWERTZ K;\RI ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYL VANIA NO. 2004-00094 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: DOLLINS STEVEN G Counsel for Personal Representative: PATTERSON KENT H Date of Decedent's Death: 1/21/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register or-Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status RepOli. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 2/4/2008 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File Court of Common Pleas of Cumberland County In Orphans' Court Division Q (?9, ~.. ~-};5? '~:']3.~ , . t:;':';' -- ...0 -'J Name of Decedent: Karen B. Dollins-Ewertz -- r:-? STATUS REPORT UNDER RULE 6.12 -' ~'" t'-' Date of Death: January 21, 2004 Will No. Admin. No. 2004-00094 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 X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: February 2009 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. Page 1 of 2 ~ ,'-" Date. ~ S~2fJO~ . I N ~ ,.....- CL en C:::J ;.'.) I- ~, Sf) ". / f:i &s. o /hf1f17~ Signature Kent H. Patterson Name (Please type or print) 221 Pine Street Harrisburq, PA 17101 Address (717) 238-4100 Tel. No. Capacity:___ Personal representative x Counsel for personal representative Page 2 of 2 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 1/05/2009 *.~ DOLLIi1S STEVEN G ~ ~ -~ c7 b 136 SOUTH ENOLA DRIVE ~ ~~ Z ENOLA, PA 17025 jt„~ ~ s` __ to .' ~- .~- RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the belou~~ listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file vaith the Register of Wills a Status Report of completed or uncompleted admirlistra_t_~_on. This filing is due by: 1/21/2009 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sinf~/eJJ~Jrely~, ~y y f/ ' 1x"yb~~~'~L~~6J fir' j^.iY ~"i~-'C'~L.°:~' i~ E~ ...._.~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 1/06/2009 PATTERSOly KENT H 221 PINE ST HARRISBURG, PA 17101 RE: Estate of DOLLINS-EWERTZ KARIN B File IvTumber: 2004-00094 Dear Sir/Madam: na C7 `.;:~ t ~ ~ r , ~ n n x~. ~ : ~ ~ ~_ rn i ~ c`7 d -~-~ 3 ' ~~ y`Q .,-a ;-.. ~ N ~~ ~ This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Will~> a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2009 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~a °" ~ ~ .=;,,ev, I~d..:d td /~~'t'`:,~~'~ai~~a ~aro.rriF-is%~o,n > ~ ~~~ Glenda Farner Strasbaugh ~`--' Clerk of the Orphans' Court cc: File Personal Representative(s) r ,~~ ~~ o ~~ ~=. ° ~- ,. ~~ y ~ ~, ~ ~ ~~ ~~~ . ~ a u v; r} O ~~_ 6 .~~t a `LA_ ~ r f _ ..~ Jl '~ ~yt.{ ! ~~~_ t'i ~~~._. s~ r~ c~ ~~r c~ ~a ~c c~ ~~ ~ ~~~ ~~~ a~ ~~~ ~a ~ ~ ~ ~~ ~" '~ ~~~ ~~ ~~~ ~ ~$~1 ~-! ii r r i .-4 °- Q i ~~ .. .! Y't ?~ x-+: ('-1 "'7 C'3 ~_ ~i_ t~ `. .- r-, `. ~.._ . is ~i .- t G m o s~® ~~ 0 'p ~ "~ Y ~ y d a y m ~ sY ~ ~d w. a- d ~ d ~sp~yo ~~ ~?v ~ r w w~ `ova (`:~ ~ 5,.:~ i..} 1„~ ~~ 1 t'~! ,~ ~ ks ~ ~'~ W i„~ ~, Q lS~ N ~1 rn ~ a o 0o W O ~ _' '~ W N x~ o ~ ~, p; ~ ~ O O ~ aU M ~ Q ~ P ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF In Re: Estate of CUMBERLAND COUNTY DOLLINS-EwERTZ KARIN B ~ PENNSYLVANI_A NO. 2004-00094 ~.~ __ _.._ ~ __ 77 f:.__ ~~ _,~ NOTICE OF FAILURE TO FILE STATUS REPORT -;~? ~ -: ~ ~ r ~J~ _ ... ..., Personal Representative: DOLLINS STEVEN G ~ ~ ==" _~, _ ;}~ --1 i Counsel for Personal Representative: PATTERSON KENT H y ~' `° co Date of Decedent's Death: 1/21/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of `Vills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. ,, ~., Date: 1/29/2009 ~ % ~~ Glenda Farner Strasbaugh --- Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File In Re: Estate of DOLLINS-E«%ERTZ KARIN B ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA PTO. 2004-00094 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: DOLLINS STEVEN G Counsel for Personal Representative: PATTERSON KENT H Date of Decedent's Death: 1/21/2004 ::_7 F"J _ s_.j 4s~ " -• '-:7 - ~ ~ t -~ c'1 . - KL , __ _ ==? r,~ _. ,- ~ ' ~ _~ .~, ~,~. i .. <, c~ , The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Stahls Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date 1/29/2009 Glenda Farner Strasbaugh Clerk of the Orphans' Court ^~ _~ ;.-~; Distribution: Personal Representative Counsel for Personal Representative Estate File PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of Karin B. Dollins-Ewertz File Number 21 04 94 also known as Karin B. EweftZ ,IattllaN 21.2004 ,Deceased Social Security Number x-41-7240 Petitioner(s), who is/are I S years of age or older, apply(ies) for: (COMPLETE A' OR 'B' BELOW:) ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are [he last Will of the Decedent dated and codicil(s) dated named inrthe ='i -u>~~ (Slate relevant circumstances, e.g.. renunclatlon, death of executor, etc.) "~ ~ C ' `~ Except as follows, Decedent did not marry, was no[ divorced, and did not have a child bom or adopted after execution p[~ iit~tmmE3ts) offe_re_ ~-~ for probate, was not the victim of a killing and was never adjudicated an incapacitated person: "O W r n Y W ^X B. Grant of Letters of Administration Carolvn6. Dollins d. b.n.c.t.a fV (lfapp/icable, enter: cra.; d. b.n.c. t.a.; pendente lire: durance absentia; durance minaritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (/f Administration, et.a. or d. b. n.e. t. a., enter date of Wil! in Section A above and complete list of heirs.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at 813 Wertzville Road Enola PA 17025 (List street address, town/city, township, county, state, cip code) Decedent, then 41' years of age, died on 1/21/2004 at HOIv SDlflt Hospital Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 3.000.00 (If not domiciled in PA) Personal property in Pennsylvania $ Qf not domiciled in PA) Personal property in Counry $ Value of real estate in Pennsylvania $ 132.000 00 79 Hillside Circle,Camp Hill, PA 17011 1172 Oyster Mill Road,Camp Hill, PA 17011 situated as follows: Wherefore, Petitioner(s) respectfully request(s) [he probate of [he last Will and Codicil(s) presented with this Petition and [he gran[ of Letters in [he appropriate form [o the undersigned: e Typed or printed name and residence /' Carolyn B. Dollins Page 1 of 2 Form RW-02 rev. 10.!3.06 (COMPLETE /N ALL CASES:) Anach additions! sheets ijneeessary. 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 aze true and cottect to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed a~n,`d'subscribed befork rpe the ~`~ day of File Number: C7 ~_ v_~' _-~ m O i i '':r~ Ci> ~r ,. - W N Signature of Personal Representative ry e7 c"7 ~ ... , Signature of Personal Representative - nrrw~ v Estate of Karin B. Dollins-Ewertz , Decked Social Securi Number: 425-41-7240 q~~~~q Date of Death: 1/21/2004 AND NOW, ~ ,~/ , in consideration of the Foregoing Petition, satisfactory proof having been presented before me, [T [S ECREED that Letters Administration are hereby granted [o and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as FEES Letters $ .OC7 Short Certificate(s) ............ $ /~, 6 U Renunciation(s) ~~~~~ ~~~~~~~~~ $ .... $ $ .. $ .. $ TOTAL ............................. $ , of /r cf Wills ~ ~`~~ L/a c ~ Attorney Signature: Attorney Name: Karl E. Rominaer. Esquire Supreme Court LD. No.: 81924 Address: Telephone: 155 South Hanover Street Carlisle PA 17013 Form Rw-na rev. 10.13.06 Page 2 of 2 in the above estate Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 12/09/2009 ROMINGER KARL ERNST ESQUIRE n N_ c _r~ 155 S HANOVER ST '~ o r-ii%--•i ~ ~n t'~ ~~'~ CARLISLE, PA 17013 U ~„~~'+ ~ i ~.~-;=r~ %~'viR lO _2~ !_7 L7~1~ ~_.~ r-} U~ l -i a = ~~ de °, ~,. ~"I iA:" ~ i 4' l RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET N0. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda F r a ner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 ~ N ~'' ~ T ~~~"i ~ f"t~ ~. ; Date: 12/09/2009 h ~ -~y~ ~ ~ c., C:-y CJ C7 CJ p Y, ~. DOLLINS CAROLYN B J~ ~ _ ~~r ~, 1172 OYSTER MILL ROAD --i pry,? b o CAMP HILL, PA 17011 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda Farner Strasbaugh~ Clerk of the Orphans' Court cc: File Counsel IN RE ESTATE OF KARIN B. DOLLINS-EWERTZ DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. TERM ~~ ~ v y_ ~~ PETITION FOR CITATION TO THE HONORABLE THE JUDGES OF SAID COURT: ~ ~.' a C o ~~ _~ z ~~ N ~~: c ~~~ ~ N b N W AND NOW, this ~ S~.h day of Sav~~o~c.~ as ~ , comes the Commonwealth of Pennsylvania, by Robert Freedenberg, Deputy Secretary for Taxation, for C. Daniel Hassell, Acting Secretary of Revenue, who avers: 1. That Kann B. Dollins-Ewertz, deceased, (hereinafter referred to as "the Decedent"), died on January 21, 2004. 2. That a Petition for Letters of Administration was made by Steven G. Dollins, Administrator (hereinafter referred to as "the Administrator"). Letters of Administration were granted to the Administrator on January 30, 2004. Attached hereto and made a part hereof is a copy of a document attesting to said date on which Letters were granted marked Exhibit "A." 3. That on August 24, 2009, a certified demand letter was sent to the Administrator, advising that the Inheritance Tax Return for the Decedent had not been filed. A receipt was signed and returned to the Department of Revenue. Attached hereto and made a part hereof is a copy of said letter and receipt marked Exhibit "B." ,. ~~ ~~_, , r,, n ,r , C"` r ', -I- f1 .~ i'TI •-r ~ 4. That as of the date of this Petition no Inheritance Tax Return has been filed by the Administrator of this estate as required by Section 1736 of the Act of December 13, 1982, P.L. 1086, No. 255, (72 P.A. C.S: § 1736). 5. That under Section 2176 of the Act of August 4, 1991, P.L. 97, No. 22, (72 P.S. § 9176), the Secretary of Revenue is authorized to request the Court to issue a Citation directed to those subject to any duty imposed by the aforesaid Act, commanding such persons to appear and show cause why the requirements of this Act should not be met. WHEREFORE, your Petitioner prays your Honorable Court to issue a Citation upon the Administrator, directing the Administrator to appear and show cause why said Inheritance Tax Return in the estate of the Decedent should not be filed as required by law; and to further direct that the costs of this action shall be borne by the Administrator. OF PENNSYLVANIA BY Deputy Sec#etary for Taxation FOR: C. Daniel Hassell Acting Secretary of Revenue COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF DAUPHIN Robert Freedenberg, Deputy Secretary for Taxation, for C. Daniel Hassell, Acting Secretary of Revenue, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Petition are true and correct to the For: ledge, information and belief. Deputy Secr~ary for Taxation C. Daniel Hassell Acting Secretary of Revenue Sworn to and Subsc'ri/b~ before me this c~~ day of ~~'~% r~OG9 ~£~~~. a CGivlMUidWic,=.LTH Gr PENNSYLVgNIH Notarial Seal Sue E. Hetrick. Notary PuN~ City Of Harrisburg, Dauphin County My Commission Expires Apr. 10, 2010 Member, Pennsylvania Association of No4aries Page 1 of 1 Bath ofi Personal R+;pr+~s~r}tativ~ Gommonvt~at~ a! Pt:rtnsyfvarua County tat Grmbaland arxi correct s©© tFte taeist W Ste knntrattd eared swear(e}end affirart(s) that the staa+6ratents In Gte foregroing Petition am true Pettlitantx(sJ wl©weB and t 9e arad beNet of Pedtbe~ta) and that, as personal reprBSentaftreps} of the Dec tuFy administer Sae estate atcor~ng tom` ~ edenf. Swnrn to end atflmaeet tiiAd sut'r3cr~r4d ~ c-"?' `~---- ,_ me ihis~ t&iy of St6aie[a G. Do~ttas DECKLE pF REGI$'CER 9_stata of also kracXr~m es Deceased 13n. Social Security A1o_.3~-9t.72it6 Dare aF C}aattt:lr'2t roa AND nfrna+, ran the re5,erse sib taarr:+ota, satiatact 1 2t1Ek , In consitieratfon of the Potiticn as3+ prrxd hawiry bsera Pwsentad before me, IT 15 DECREED that t_lat'ters j] Testatrrerttarylg ~+'Wmktistratit:rt to I a., a ~nq.4: pyrilfneae Ns; .are hereby granlcd b St6Vela_G. L?altYts a"~"a1~a"""'tt°'01~"r ai the abtlve eSt,7tB anrf th~tlha Instruttta,nt(g}, it any. dated desc:ihsd ira the Ptrt~on be adritted to Arobat$and filed tN rectyB ~ the Ia;t 4YilI of Dnce~dertt. FEES ~tterS .................... ~....._.. , Staa?t Cietti;loatE(5) ............... Ren~rncaation ............... t:xtra t'ayes ~ ,^ ....... JCP Fee __ ..............._.. tnVerlt4ry dr 73X ~far1Y .............. athar ._ .........:........................... s ~... ' ~~+~/ l~z l u J ~ ~ j 5~ 5 5 ~_ $ /CJia.. ~~~. S ratvxt Attanaey. Kent H: f dtteB¢1 t..D, r,to: rs3Q7 Adtteas: 221 Pine Street Rlsbtt RA t710T Ttataphone: 71 238-1 t pg GATE FU.E~~{~~itrdYtlt~iir .s_z~ ~"_-....---.,~.~. http://records. ccpa.net/weblink~ublic~rint/ImageDisplay. aspx?cache=yes&sessionkey=... 8/20/2009 Page 1 of 1 RefpSler of tNulls trf Cumbmianr! Cowliy, Pefirurylvanla PEr~z~~~- ~aR ~~~~rr ~f ~~rrEr~s Estaia of Karin 8. Dolpns-Earorit alas krfnltiYY aA E{arln B. ;= h10.(~,[r~~.. ~+~y/ , ihiCBasad Snosal SaCtyrltyi.Fq d25•A1--~.....~ aeMhD•a+ti~.MVnwaa tw Naais~atatbwaq~r~ w»la: FC4MpC 'A' OR "8' pE1.0iY:y © A. PmDDte and Grant tit t-attere eeN soar Iha7 t'gilicnerfs) iiu'8rg the axatar DaCDCtah1. tamed named ~ the Lear 1Nill aY Iha _ errai eaWcii(aj dared __ -~.~. ~ MavrotrnrDxa-aaencaaavlmam,weaaaidn~eeoawa'r•,w O1B1Annu~.ea..rr~._amin,yarx„w.at, ~'caa+e: was hot rho NCDIn 61 a Wiaq end was nawr ~uQraryp 4'raM Dom a ~cnr.d spar eKiDUIIDn d atie tltlGtisnprsb snared ncaDackaled; .~ 8• Cr~M of l.CHmra of Admia[atralior, ~ . _... P«.. ffiLa..e DDCt. a. P~Dwmi R4. Weak 'bp6e+(~I aROr a +~a: auraia miawe.~ f~ ~pny) seat hetrx; proper s4enYh hesthaw Ascertaintd trMD E3ecadfenl pNt no Wtlt aria 7aaa 7lINlVad tyy (~, ie9owlhp ~alJae Kamp iaetaeo„e~ 3te+ren G, i7cl~s fioetaene. {CU1tipE:grE iFF AL(, GkSESsy- kMUty add[tiunel sheets it ii6CtMSSry. (Iecedern w~ domlcGad as aeatit In Ctanbariant reslp$nt:e et 813 Weriaullte F3oad is ttst PAnns6oro T County. RAryryYi~'enia. with hiafierJaei femdy urpre~ipol Enol PA 17Up5 Decedent, Ihen:Es Wa . ,arrt.r„m . years of type. died Jmrsaafy 21 , 2L104 , at Fiety Solrr7 Hos~ial East Fenn~ioto T. 04Cadenl a9 death taN+ree ProRarfy w+th .atiayapd 4alUaa ey lofi>•ws: iLaraDS~ ?w~18~ ;if deraicaod in w,ai ~ i Ol got: domicii7y ir, pR} prxe+iiy.._._~......._..,....._..__.__,.,,. f a000.o6 [11 nct~aDapyai in Pal Par5anal raop.~a~. nt?anDayhanta..__...._._.,.,,, S Varuear rDar t'eryanet po~°nr nCotmry.....,.,....._.__»..._..... s saGSta in ~enrale+mala ____..__._.,...~._._._.....:.....,._.._..._........,...................,. s_..LL.. Teter ..,...___.. 1't~ C}OQ (?U Roul Estala ailWirasl as 47Wwa: ........._........ ....... . ..... ..... ~ .. ] 3i 4tliJ..f30 ~~I'.CieE~»t:i~aaimeh ,.?, ww,r.a..wr~mp tti$7rtp HiN, PA 7'7D11~."'r` 4Mhsrefarc, qei ~P~autty t`pgDesti~j a+a ~Atatr brmbDw ~Wasklnea P~DDme rt ll'nP Last ri'u ~n~tt:+adiF;itaj Presenlatl wiM Mss Pa4Mian one Ms . A'NYt Df aaw6 If+ t>Tod pr AMmiad nmrn Fiyt~> http://records. ccpa.net/weblinle~ublic~rint/ImageDisplay.aspx?cache=yes&sessionkey=... 8/20/2009 HARRISBURG DISTRICT OFFICB sTRAwseRRY 4TH a wAC,NUT suers HARRISBURG PA I7Ipg_OI01 STEVEN G DOLLINS 79 HILLSIDE CIRCLE CAMP HILL PA 17011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Date: Estate of EWERTZ Date of Death: File Number: 8/24/2009 KARIN B 1/21/2004 21 04-0094 (Certified Mail-Return Receipt Requested) Dear STEVEN G DOLLINS: ^ ~ ~ s 1, 2, and 3. Also ^ PriM your ame and ~~ ~ d~complete so that we can return the e ro otha averse ^ Attach this card to the back of the mailplece, or on the irorrt If space peeks i • Article Addressed to: STEVEN G DOLL4NS 79 HILLSIDE CIR CAMP HILL PA 1:701 I A Aper,t D. Is defrvery address dlfletent from It~rf 1? ^ Yes If YES, enter deQvery address below p No rove estate or that you this matter. dins unsettled :payment of -°state within nine r stains open because: FH,ED. a servlceiype _ 'te was opened for the 21 040094 DIBARTOLOMEO p ~~ MaA ~ s Mail ~e proceeding in writing ~ ~~~ ^ Insu d M ^ Return Receipt for Merdrandise re ail ^ C.O.D. ~ 2. Artlde Number °• ~ (F.rba r-ea) 0 Yes to fees of up to (7ra»sferfiom servke laberj 7 ~ ~ 9 16 8 0 !1 l101 6 9 3 7 16 2 8 'nt, may be PS Form 3811 Fetxu ;contract counsel , ary 2004 Domestic Return Receipt _ Revenue. If you fail to file the return, we ueparnrlenr may ,ucitt,,v~~requlnngeyou to appear in court to show cause for your failure to comply with the law. A finding of contempt in this matter could subject you to additional penalties and/or incarceration by the Orphans' Court of Cumberland County. RETURNS SHOULD BE FILED AND CHECKS MADE PAYABLE TO: REGISTER OF WII.LS,~AGENT Sincerely, Anastasia DiBartolomeo Direct any questions regarding this estate to: (717)787-3863 HARRISBURG DISTRICT OFFICE cc: STRAWBERRY SQ KARL E ROMINGER 4TH ~ WALNUT STS 155 S HANOVER ST HARRISBURG PA 17128-0101 CARLISLE PA 1.7013 w V LL LL V M ~. S a 'O .. . -'~ W (J J ~ ll. W N W ~ Q W ~ ~ a a '~" ~ J ?~ ,_ O ; `g~ . O ' V ~ t: `R1~ `^~ O V ~ _ Q~ j"C ,~ , n ur N ~ .~ z Zo W~ ~ ~ UUw ~n~JU OJ O O ,¢ z v i LL ~ ~ ~ ~ W }_ >a¢a W x 2 ~ m H ~ Q W ~ Z Z W Q Z ~ O D (A W LL U ~~'~'~._ a W d F W y J {L y C7 oC Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF 1~ w- Gee-/~>lCU?~ COUNTY, PENNSYLVANIA Name of Date of Death: / File Number: C7~ ~~~ ~~ 9 Pursuant to Pa. O.C. Rule 6.12, 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 :.................... Q Yes ~~o 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: lei 3/ - 2 U ~U 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. Qate J °7- Zvi Z a~~ Signohve of Perm Filing this Form O ~1 .. 3 ~ .. ~ ~__~.i ~.__~ Ll._ C.-'~ t-j A. _; ~, ~:_i - N ~ '~ ~ y. ~- ~ r.+ ~r ~ Usw ~--. , -J ...'Y' "'S ~ o t::_- o ~ v c, Form RW-IO~lfv. 10.13.06 CapJaci-ty-: ©Personal Representative ~unsel Nmne of Person Filing this Form v U /~~S ~• ~ vlov~l' ~ . A ss r l~~ ~~ ~ ~U~3 . ~l7) ~~// ~ Lc>O7d Telephone ~6 JAN 212010 IN RE ESTATE OF KARIN B. DOLLINS-EWERTZ DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. ~,t~{. ~oC~~ TERM ORDER Now, to wit this the pZ ~ day of (f jq ~~~ , upon consideration of the do/D foregoing Petition, it is ORDERED and DECREED that YOU, Steven G. Dollins, Administrator for the Estate of K~jarin B. Dollins-Ewertz, deceased, are hereby cited to be and appear at Courtroom No..~7 , on the ~~ay of~jG~L, in'the Courthouse of Cumberland County, Petmsylvania, at9;~AM., then and there show cau~,~f an~ there be, why the Inheritance Tax Rehu7i in said estate should not be Filed; and to further duect that the cost of this action be borne by the said Adnuuistrator; said citation rehu•nable at 9',~j~1vL, on the 8'~day of f~i~'L, ~oia . ~ ~,,. t_a .- N d ~c.i ' CV C . i' •_ ~ ~ ~ L.... ~. r-- ~.4,i i_,_1 . f` N Y~~ ~~ .. _.. - ~: :? z v C.:', o d N BY THE~C`OURT ~.' __ ~/ ORPHANS' COURT DIVISION J. In Re: KARIN B. DOLLINS-EWERTZ ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA N0.04-0094 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 1/27/10 JUDGE'S INITIALS: TIME STAMP DATE: 01/27/10 IN RE: ORDER SERVICE TO: PA DEPT OF REVENUE STEVEN DOLLINS CAROLYN B DOLLINS KARL ROMINGER METHOD OF MAILING: ENVELOPES PROVIDED BY: ® USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: 01/27/10 SERVICE TO: METHOD OF MAILING: ^ USPS ^~. ^ HAND DELIVERED ^ OTHER MAILED: ® PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT ENVELOPES PROVIDED BY: ^ PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT r eputy Clerk of Orphan Court Glenda Farner Strasbaugh Register of W ills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 l INVOICE ~ Bill To: InvoiceNo: 2839 Invoice Date: 1 /19/2010 DEPT OF REVENUE- BUREAU OF INDNID Estate of KARIN B. DOLLINS-EWERTZ REPORTS RECONCILIATION DIVISION Estate No• 21-04-0094 PO BOX 280603 wz HARRISBURG, PA 17128-0603 Qty Fee Description Fee Total 1 PETITION 15.00 $15.00 3 CERT COPIES 5.00 $15.00 Total: $30.00 ,~t~~G ~~- 1 VC~i" I "~lJt.t.,~.Q~ " ~duC1~iC-F Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment Thank you. IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS OF KARIN B. DOLLINS-EWERTZ, CUMBERLAND COUNTY, PENNSYLVANIA DECEASED , ORPHANS' COURT DIVISION NO. 21-04-0094 ORDER OF COURT AND NOW, this 8th day of April, 2010, counsel having relayed that the inheritance tax return is a work in progress, he is directed to file said return within 60 days. Edward E. Guido, J. Lora A. Kulick, Esquire Office of Chief Counsel Department of Revenue Strawberry Square P.O. Box 281061 Harrisburg, PA 17128-1061 Karl E. Rominger, Esquire srs o ~~ ~i~ ~a1 ~ ' ~ ~ 7 ~ ~ ~ t`n ~ 7iD ~ qz~ -, ~'~ r ~ a 7 ~ C%a ` • '? ~ j p ~ ~ ~ ~ ~ rn :: ~ ~ ~~~ In Re: KARIN B DOLLINS-EWERTZ ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 04-0094 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 04/08/10 JUDGE'S INITIALS: EEG TIME STAMP DATE: 04/09/10 ~ ~~ ORDER OF COURT SERVICE TO: LORA KULICK KARL ROMINGER METHOD OF MAILING: ENVELOPES PROVIDED BY• ® USPS ^ RRR .. ^ HAND DELIVERED ^ OTHER _ ^ PETITIONER ^ JUDGE ® CLERK OF ORPHANS COURT MAILED: 04/09 10 SERVICE TO: ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, METHOD OF MAILING: ^ USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ENVELOPES PROVIDED BY• ^ PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT REV-1162 EX111-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ROMINGER KARL ERNST ESQUIRE 155 S HANOVER ST CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: ssN: a25-ata2ao FILE NUMBER: 2104-0094 DECEDENT NAME: DOLLINS-EWERTZ KARIN B DATE OF PAYMENT: 06/10/2010 POSTMARK DATE: 06/10/2010 COUNTY: CUMBERLAND DATE OF DEATH: 01 /21 /2004 NO. CD 012886 AMOUNT 101 ~ 5700.46 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY SEAL CHECK# 2311 5700.46 INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 4 2 5 4 1 7 2 4 0 0 1 2 1 2 0 0 4 Decedent's Last Name Suffix Do I l i n s- Ewer t z (I(Appllcabk) Enter Survivlny Spouse's IrMortnatlon Below Spouse's Last Name Sutra Spouse's SoGal Security Number Date of Birth Decedent's First Name MI Kari n g Spouse's First Name MI TH13 RETURN MUBT BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRUITE OVALS BELOW ® 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death ® 4. Limited Estate ^ 4a. Future Interest Compromise (date of prior to 12-13-82) ^ 5. Federel Estate Tax Return Required ^ 8. Decedent Died Testate (Attach Copy of wilq ^ death aRer 12-12-62) 7. Decedent Maintained a Living Trust A 8. Total Number of Safe Deposit Boxes ^ 9. L'Rigation Proceeds Received ^ ( ttach Copy of Trust) 10. Spousal Poverty Credk (date of death ^ 1 t. Ebction to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Agagr Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORI~SPWIDENCE AND COIIFMENTIAL TAX NFORMATION SNOULD BE DIRECTED T0: Name Daytime Tebphone Number K a r I E. R o m i n g e r 7 1 7 2 4 1 6 0 7 0 Firm Name (If Applicable) Romi nger 8r A s s o c i a t e s RE OF trrlL SE ONLY -i-; ~,J,~~ ` First line of address C.. F-T t ~. 7 C C; ~ CJ 1 55 Sout h Ha Hover St r ee ~ t `~~~ o rzi~ Second fine of address C7 ~ ~::-' ~--> City or Post Office Car l i s l e CorroapondenYa e-mail address: 1505607121 REV-1500 Ex (06-05> oFFIC1AL USE ONLY PA DePaNnentofRevenue Bureau d Individual Taxes County Code Year File Number Po eox 260801 INHERITANCE TAX RETURN J~ I ,y~ O o p Harrisdxy, PA 17128{1601 RE8IDENT DECEDENT ~l C.l sera srar i nave examned flue rehrm, Dedaralbn ~ preparer direr than the is C~OC~Ji,~ T+' :, DATE FlL6~ ~''3 `mY has ADDRE `^ e Z'G v 155 South Hanover Street Carlisle PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE ~~ ADDRESS PLEASE 113E ORIGINAL FORM ONLY Side 1 L 1505607121 1505607121 State ZIP Code ~ PA 1 7 0 1 3 1505607221 REV-1500 EX Decedent's Socisl Security Number osoedsnr, Neme: Karin B. Dollins-EVNeft2 4 2 5 4 1 7 2 4 0 RECAPITULATION 1. Real estate (Schedub A) ........................ ........ 1. 2 0 0 0 0, 0 O 2. Stocks and Bonds (Schedub B) .......................... ........ 2. 3. Closely Hekf Corporation, Partnership or Sob-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivabb (Schedub 0) ................ ....... 4. O . O O 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedub E) ....... 5. 1 O 8 1 7 . 2 O 8. Jointly Owned Property (Schedub F) ^ Separate Billing Requested ....... 8. 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Grass Assets (total Lines 1-7) .................... ....... s. 3 0 8 1 7, 2 0 9. Funeral Expenses & Administrative Costs (Schedub H) ........ ....... 9. 8 7 6 1 , O O 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedub I) ..... ....... 10. 1 6 2 1 ~ . O 5 11. Total Dsductlons (total Lines 9 8 10) .................... ....... 11. 2 4 9 8 0. 0 5 12. Net Valw of Estate (Line 8 minus Line 11) .................. ....... 12. 5 8 3 7 , 1 5 13. Charitabb and Governmental Bequests/Sec 9113 Trusts for which an ebction to tax has not been made (Schedub J) ........... ..... 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ....... 14. 5 8 3 7 , 1 5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Lins 14 taxabb at the spousal tax refs, or transfers under Sec. 9116 18. Amount of Line 14 taxabb at lineal rate x .o_ 0. 0 0 ts. 0. 0 0 17. Amount of Line 14 taxabb at sibling rate x .t2 5 8 3 7. 1 5 17. 7 0 0. 4 6 18. Amount of Line 14 taxable at collateral rate X .15 O. O O 18 O. O O 19. Tax Dus ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505607221 1505607221 700.46 REV-1500 FJ( Page 3 File Number ueecec~ent's Complete Address: 0 0 DECEDENTS NAME Karin B. Dollins-Ewertr STREET ADDRESS clrr STATE ZIP Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C ) 3. Interest/Penaltyrfopplicable D. Interest E. Penalty Total Interest/Penaty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the differerx:e. This is the OVERPAYMENT. Fffl in oval on Papa 2, Line 20 to request a rNund. 5. ff 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. (1) 700.46 (2) 0.00 (3) 0.00 (4) 0.00 (5) 700.46 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 700.46 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. ratan a reversronary interest or .............................................................................................. .. ^ d. receive the promise for life of eitlter payments, benefits or care? ..................................................... .. ^ 2. ff death occurred after December 12, 1982, did decedent transfar property within one year of death without receiving adequate oonsiderafion? .................... 3. Did decedent own ~ "in trust for' or a able u on d th b k p y p ea an account or secudty at his a her death? ......, .. ^ 4. Did decedent awn ~ Individua Retirement Account, annuity, or other non-probate property which contans a beneficiary designation? ................................................................................................ .. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value ~ transfers to a for the use of the surviving spouse is three (3) percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on w after January 1,1995, the tax rate imposed on the net vaue of transfers ro or for the use of the surviving spouse is zero (0) percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute ~ 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 applic~le even if the surviving spouse is the only benefiaary. 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 a younger at death ro or for the use of a natural parent, an adoptive parent or a stepparent of the child is zero (0) percent (72 P.S. §9116(x)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is four and one-haf (4.5) parcent except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(x)(1)1. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(aj(1.3)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in comnron with the decedent whether by blood or adoption. REV-1502 EX + (8-98) CDAMNDNWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT tJF SCHEDULE A REAL ESTATE AN reN properly owned toUly or et a tirrtrrt M corrurarr mutt be reported at ftir mtrket value. Fak rrlaAurt value b delklad as the prke at which exchanged tleiween a wiNklg buyer and a wilNrlg seAer, neitl~er baklg compelled to buy ar seg, lath hav' reaaanable k ~'rrouW be Rul OroDMtr whldr b btntlfrowred rWlh rleht of smvive~ehin wu~ee ti. a~ ...~ .._ Q of the mlevarrt fads. M NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 1172 Oyster Mill Road, Camp Hill, PA 17011 20,000.00 Appraised on May 5, 2010 2 ryrAL (Also enter on (lf more space is needed, insert additlonal sheets of the same sae) REV-1503 EX + (8-98) SCHEDULE B COMdONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT Karin B. Dollins-Ewerfz 0 0 ~~ ProP~9 joiMlyownad wMh rlgM of aunrhrorahip must be dbeloaad on SehsduN F. ITEM NUMBER ~ DESCRIPTION I VA OFDEATHTE TOTAL (Also enter on line 2, Recapitulation) (If rtare space is needed, insert addNbnal sheets of the same slze) REV-7504 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY•HELD CORPORATION, PARTNERSHIP OR SOLE•PROPRIETORSHIP Karin B. Dollins-Ewettr 0 0 Schedule C-1 or C-2 (including all supporting infom~ation) must be att~hed for each closely-held corporatioNparNership interest of the decedent other than a sole-proprietorship. See instnutons for the supporting inEorrnatfon to be submitted forsole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 3 Recapitulation) ~ i (If more space is needed, insert addltiortal sheeb of the same size) REV-1505 EX +-(5-96) COMMONWEALTH OF PENNSYLVANIA INHERfTANCE TAX RETURN SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT t:sT~TE of FILE NUMBER Karin B. Dollins-Ewertr 0 0 1. Name of Corporation Address 2. 3. City State Zip Code State of Incorporation Date of Incorporation Toth Number of Shareholders Federal Empbyer I.D. Number Business Re porting Year Type of Business ProducbService 4. STOCK TYPE TOTAL NUMBER OF PAR VALUE NUt1BER Of SNARES VALUE OF THE V SHARES OUTSTANDING Oy~p BY THE DECEDENT DECEDENTS STOCK Common $ Pnferrod $ Provide all rights and restridions pertaining to each doss of stock. 5, Was the decedent employed by the Corporation? ....................................... ^ Yes ^ No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ....................................... ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the wrporation upon the death of the decedent? ............... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner ~ the pdicy 8. Dld the decedent sell or transfer stock in this company within one year prior to death or within two years iF the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ............ ^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ................................................. ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was fhe corporation dissdved or liquidated after the decedent's death? ....................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, induding dates and amounts received. 12. Dld the corporation have an interest in other corporations a partnerships? ...................... ^ YeS ^ I,ip If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed cak:ulations used in the valuation of the decedent's stock. B. Complete copies of finandal statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. ff the corporation owned real estate, submit a list showing the canplete addresses and estimated fair market valuels. If real est~e appraisals have been secured, attach copies. D. List of prindpal stodchdders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefds received from the corporation. F. Statement of dividends paid each year. List those dedared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same afze) REV-1508 EX + t9-00) COrrMONWEALTH OF PENNSYLVANW INHERITANCE TAX RETURN RESIDENT DECEDENT OF FILE Kahn B. Rollins-Ewertz 0 0 1. Name of Partnership Date Business Commenced Address Business Reporting Year City 2. Federal Employer I.D. Number 3. 4. 5. State Zip Code Type of Business Produd/Service Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ PARTNER-NAME PERCENT OF MICOME PERCENT OF OIIMNERSNIP BALANCE OF CAPRAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................ ^ Yes ^ No If yes, provide amount ~ indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ........ ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the pdicy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-62? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferredlsdd Transferee or Purchaser Consideration $ Date Altach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death?........ ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .................................. ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................. ^ Yes ^ No H yes, provide a breakdown of distributions received by the estate, incuding dates and amounts received. 13. Was the decedent related to any of the partrrers? ................................ ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? ................. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or G2 for each interest. A. Detailed cak:ulations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market values. If real estate appraisals have been secured, attach copies. SCHEDULE C-2 PARTNERSHIP (FORMATION REPORT D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX + (g_98) SCHEDULE D COINMONWEALTFi OF PENNSYLVANIA MORTGAGES ~ NOTES IN RES GENT DECEDENT N RECEIVABLE of FILE Karin B. Rollins-Eweltz 0 0 All property jointlyowned rrMh tlb dght of sunrivorshlp must be discbsed on SehsduM F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. TOTAL (Also enter (If more space is needed, insert addRional sheets of Uie same size) REV-7508 EX + (e-9e) ' '` SCHED!/iLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. IN RESIT ENT DECEDENT N PERSONAL PROPERTY Karin B. Dollins-Ewertz 0 0 Include the proceeds of Ntigatbn and tl1e date the prooeeds were received hY the estate. AN owned MAtlr of survhonhtp must be discbsed on £wMduN F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Sold real estate located at 79 Hillside Circle, Camp Hill, PA 9,817.20 House sold on November 18, 2009: $140,578 Mortgage paid to Chase Home Financial: $94,633.10 Closing Costs to Seller: $36,120.54 Total Received: $9,817.20 HUD 1 attached 2. Personal Property 1,000.00 "Personal property was estimated as the Excutrix replaced her deceased brother as personal representative. Excutrix is currently unaware after reasonable investigation of any other assets or liability other than stated herein. TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert addilanal sheets of the same size) REV-1509 EX + (8-98) ' ~ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN Karin B. Rollins-Ewers 0 0 K an asset vwa made joint wHhin one yar of the deesdeM'a date of death, N must be reported on ScMduk G. SURVNING JOINT TENANT(S) NAME A. C JOINTLY-OWNED PROPERTY: TO DECEDENT ITEM LIMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTfTUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S fNTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) I s (If mon3 space is needed, insert additional sheets of the same size) REV-1510 EX + (8.98) COMMONiNEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON•PROBATE PROPERTY Karin B. Dollins-Ewertr 0 0 This schedub must be completed and fibd if the answer ~ any of questions 1 thrtxgh 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY iNCLUDETNENA11E0FTHETWWSFEREE,THEIRFEUTIOlIFINpT00ECEDENTAND ~~~~Ta^"s~ ATTACNACOPYOFTHEOEEDFORRE/LESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1. TOTAL (Also enter on line 7 Recapitulation) ~ S (If more space is needed, inseR additional sheeLa of Cie same size) REV-1511 EX + (10-08) COMAAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS Karin B. Dollins-Ewertz 0 0 Debt of decedent must bs reported on ScMduts [. A. ITEM NUMBER FUNERAL EXPENSES: 1. Richardson Funeral Home-Enola, Pa B. DESCRIPTION ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Repraserdative (s) Carlovn Dollins streetaddress 1172 Ovster Mill Road city Camp Hill g~~ PA zlp 17011 Year(s) Commission Paid: 1 p, AtOomeyFees Karl E. Rominger, Esquire 3. Family Exemption: (If decedents address is not the same as claimanCs, attach explanation) Claimant Street Address City Sta@e Zip Relationship of Claimam to Decedent 4• Probate Fees Cumberland County Register of Wills One Courthouse Square, Carlisle, PA 17013 5. ArxountaM's Fees 6. ~ Taz Retum Preparer's Fees 7 AMOUNT 1, 700.00 1,000.00 6,000.00 61.00 TOTAL (Also enter on line 9, Recapitulation) ~ : (If more space L~ needed, Insert additional sheets of the same size) REV-1512 EX + (12-03) COMAAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS Karin B. Dollins-Ewertz 0 0 Repoli debts ineumd by the decederk prior to death which remained unpaid ae of the date of death, including unroimbursad medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Citi Bank-1150071230686 279.66 2 Boscovs;g207284823 124.52 3. (Members First Credit Union-#4155372222048918 4. (Members First Credit Union #22044444891-01 5. (Chase Auto Finance ti TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additlonal sheets of the same size) S 4,717.00 4,039.25 7,058.62 REV-1513 EX + (g-00) COM~AONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES FILE NUMBER Karin B. Rollins-Ewertz 0 0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustsals) OF ESTATE I TAXABLE DISTRIBUTIONS [ndude outright spousal distributions, and transfers under S 9116 ec. (a) (1. )2 ] 1. Carolyn Rollins-1172 Oyster Mill Road, Camp Hill, PA Sibling 100.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL l>F PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S to nXXe space 1s neeaea, insert aoamOnal SneetS or the same size) REV-1514 EX + 02.03) SCHEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA ~ TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT Chock Box 4 on Rev1500 Cover Sh ~er.~ .,~ Karin B. Dollins-Ewettz 0 0 This schedub is to be used for all singb life, joint or successive life estate and term certain calculatons. For dates of death prior to 5-1-89, actuarial factors for singb life calculations can be obtained from the Department of Revenue, Specialty Tax UnR. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Abph Volume for dates of death from 5-1-99 and theroafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) 0!F LlFE TENANT(S) DATE OF BIRTH NEAREST IUfE AT DATE OF DEATH Tt~ OF YEARS LFE ESTATE E PAYABLE ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Temt of Years ^ Life or ^Tenn of Years ^ Life or ^ Tenn of Years 1, Value of fund from which life estate is payabb,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,$ 2. Actuarial factor per appropriate table ............................................... . Interest table rate- ^31/2% ^6% ^10% ^VariabbRate % 3. Valus of life estate (Line 7 muWplisd by Line 2) . . . . . . . ............................... $ NA1E(810F LIFE ANNt1RANT(S) DATE OF BIRTN ~ Af3E AT DATE of DEATH TERMMt1F YEARS ANNUIT1f Ni PAYABLE ^ Life or ^ Tenn of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity ispayabb ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,$ 2. Check appropriate block below and enter corresponding (number) , , , , , , , , , , , , , , ,,, , ,,,, , Froquency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^ Semi-annualty (2) ^ Annualty (1) ^ Other ( ) 3. Amount of payout per period ...................................................... $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 , ,, , , , , , , , , , , , , , , , , , , , , , , , , , , ,, , 5. Annuity Factor (see instructions) Interest tabb rate - ^ 3 1/2°k ^ 6°k ^ 10% ^ Variable Rate % 6. AdjustmentFaGor(seeinstrudions),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 7. Value of annuity - If using 3 1/2°k, 6°~, 10%, or 'rf variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line B ...........................$ If using vartabb rate and period payout is at beginning of period, calculation is: (Line 4 z Line 6 x Line 8) + Line 3 ................................................. $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedubs A through G of this tax return. The resuRing life or annuity interost(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18 (If more space is needed, insert additional sheet of the same size) REV-1844 EX *(3-04) INHERITANCE TAX SCHEDULE L COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN REMAINDER PREPAYMENT RESIDENT DECEDENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER ~ O [. ESTATE OF Dollins-Ewertz, Karin B. (Last Name) (First Name) (Midtlle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to re ort the invasion of trust rind al. II. REMAINDER PREPAYMENT: A. Election to prepay filed wkh the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. $ 2. Stocks and Bonds ......................... $ 3. Closely Held StocWPartnership ............... $ 4. Mortgages and Notes ....................... $ 5. Cash/Misc. Personal Property ................ $ B. Totalfrom Schedule L-1 ....................................................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................... $ 2. Unpaid Bequests .......................... $ 3. Value of UninGudable Assets ................ $ 4. Total from Schedule L-2 .................................................... $ E. Total Value of trust assets (Line C-6 minus Line D-4) ................................. $ F. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . G. Taxable Remainder value (Line E x Line F) ........................................ $ (Also enter on Line 7, Recapitulation) [II. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Tenn of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed ........................................................... $ D. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . E. Taxable value of corpus consumed (Line C x Line D) ................................ S (Also enter on Line 7, Recapitulation) RED-1643 ex+13-8d1 INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- FILE NUMBER 0 O I. Estate of Dollins-Ewertz Karin B. (Last Name FirsT Name Middy InBall II. Item No. Descri ion Value A. Real Estate (please describe) Total value of real estate S include on Section 11, Line C-1 on Schedule L B. Stocks and Bonds (please list) Total value of stocks and bonds ; include on Section II, Line C-2 on Schedule L C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Fleld/Partnership S include on Section II, Line C-3 on Schedule L D. Mortgages and Notes (please list) Total value of Mortgages and Notes S include on Section II, Line C-4 on Schedule L E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property s include on Section II Line C-5 on Schedule L III. TOTAL Also enter on Section II, Line C-6 on Schedule L) S (If more space is needed, attach additional 8'/z x 11 sheets.) REV-1 B46 EX + (3-84( INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANU' REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER ~ I• Estate of Dollins-EwerlZ Karin B. (Last Norm) (First Name) (Middle Initian 11. Item No. Dsscri lion Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liobilkies = include on Section 11, Line D-1 on Schedule L B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests s include on Section II, Line D-2 on Schedule L C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under 'B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets j include on Section II, Line D-3 on Schedule L 111. TOTAL (Also enter on Section II, Line D-4 on Schedule L) s (If more space is needed, attach additional 8'/~ x 11 sheets.) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE e~lwle ur FILE NUMBER Karin B. Dollins-Ewertz 0 0 Thia Schedule is appropriate only for estates of decoders dying after December 12,1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ t)ther [. IV. Summary of Compromise Offer: 1. Amount of Future Interest .................................................. $ 2. Value of line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ...... $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0°~ ................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ...... $ 6. Value of Line 1 taxable at collateral rate (15°,6) (also include as part of total shown on Line 18 of Cover Sheet) ...... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ..................... S esenencranas NAME OF BENEFICIARY ~ RELATIONSHIP ~ DATE OF BIRTH ~ „~, ~ AGE TO w _" I 7. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, 'rf a surviving spouse exerdsed or intends to exerdse a right of withdrawal within 9 months of the decedents death, check the appropriate block and attach a copy of the document in which the surviving spouse exerdses such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal Qf more space is needed, insert additional sheets of the same size) REV. 1848 EX (11-99) ([ COMMONWEALTH OF PENNSYLVANIA SCHEDULE N SPOUSAL POVERTY CREDIT ABLE FOR DATES OF DEATH 01/01!92 to 12 This schedub must be compbted and fibd ff you checked the 1. Taxable Assets total from line 8 (cover sheet) .......................... 2. Insurance Proceeds on Life of Decedent .................................. 3. Retirement Benefds .................................................................. 4. Joint Assets with Spouse .......................................................... 5. PA Lottery Winnings ................................................................. 6a. Other Nontaxable Assets: List (Attach schedule if necessary) .. 6. SUBTOTAL (Lines 6a, b, c, d) 7. Total Gross Assets (Add lines 1 thru 6) ............... 8. Total Actual Liabiiltbs ......................................... 9. Net Value of Estate (Subtract line 8 from line 7) .. nlMa 9 is yra~sra~an .uoo,ooo - s~TOP. nre eaa~ N Income: a. Spouse ............................ b. Decedent ......................... c. Joint ................................. d. Tax Exempt Income ......... e. Other Income not listed above ..................... credit box on the cover sheet. ro 17.20 ro 30,817.20 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (tfl + (2fl + (3f) (+3) 4b. Average Joint Exemption Income ............................................................................................................... Mine fi(b) !s yraatsr Men S40,oo0 - $TOP. The estate is not elly(b/e ro Gaim the aedR. snot, continue ro Part fu. 1. Insert amount of taxabb transfers to spouse or $100,000, whichever is less 2. Multiply by credit percentage (see instructions) .................................................................................... 3. Thia is the amount of the Resident Spousal Poverty Credit. Include this figure in the caculation of total credits on line 18 of the cover sheet ............................................................. 4. For Nonresidents, enter the ratio of the decedenCs gross estate in PA to the value of the decedenCs gross estate ....................................................................................................................... 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credlt. Incude this figure in the calculation of total credits on line 18 of the cover sheet ........ REV-1849 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) Karin B. Dollins-Ewertz 0 0 Do not complete this schedule unless the estate rs making the election to tax assets under Section 9113tH) of the krheritana 3 Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital residual A B By-Doss Unified Credit etc 1 H a trust or similar amangement meets the requvements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may spedfically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or sim- ilarproperty treated ass a taxable transfer in this estate. ti less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, surviving spouse under a Section 9113 (A) trust or similar arrangement. pass to the del:edenYs Description Value Part A Total $ Part B: Enter the descri lion and value of all interests included in Part A for which the Section 91 13 A election to taxis bei made. Description Value Part B Total pr more space Is needed, insert additional sheets of the same size) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: Discount: 0.00 Inten~st Table Year Days Delinquent this time period Balance Due this year Interest this period Before 1981 1882 1983 1884 1985 1986 1887 1988 thro h 1991 1882 1993 throw h 1984 1896 throw h 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: 06-07-'10 12;18 FROM-BH AGENCY BEALTOBS 717-243-1718 T-749 P0002/0004 F-950 A. aacaalcluorn vawwrrwlra -'-' --r-•_ .. .... .. ...... ~ "IaypMs 11170/2009) and Urban DaWlopmOnt a goal 0. Fie Nuntw: 7. LOell Nwrer. A MerYele fnlwrner dM Nwnee~ t. ~ F1tA 2, n FmW1 9, O COnr. UninO, O1s.917-zY1C 9101d9e2o 10-10~Q-OBOa031' 1, VA 5. L~ Jq Caw. Ms. C. Note: This later it lumltht0 b e1W y00 0 aleameM eledull eeOlar1M10o1a. AmouMe Pak ro end by lM seltlerrNM BOOM an lhOVm. pma me4fle yp.e.el• wen Otdll eyaide 1M deeb0: mwy ate shown Irene for trforrrrtionN Ou4teeee ens Ire nel Yrc~rdld b era ball O. NMM 6lrewera d Oan'/wM: 0. Nrrw A Alaeu Bader. . Nero 1 A001M d unekC 01nk R. Callon faa dfOvNr DolMnrLlwrts Cir ~ l ~HN ylAA l7edOr11 inns sM Anbnro OioO /M/drrfakr d fleM oe1,~n Avon ~ e e c I , , 76:Ie i fmro Naw denb«prd Camp M/ll, PA 17011 NIOSw J. CeRen 1dfN HOrUm AvonYYe New CamberMrd PA 17070 G. ProperQr leMeOn: ~~ Reipaawn Dab• ilvr Group, LLC 79INII1/IN C/roN TNV: 2Y•10sM10 C1mp HNI, PA 1701 f Pboa a/aleternlnt 1.8HlbrneM OeM CumbMrne Ceuny 2172IIN2'N bbee! f 1/1 6 11 0 0 0 camp /N0, M 11091 J lumen dlorrowa/a Tronteatbn K.lumnar2 d/dMe TransaAen 700. Drop ANOUM Ow Fred 1ef10rwll 106. Alep AmaNrl Ow TO leMr 1Dt, QOMrod ealtl j110, 000.00 101. Canbed wNrt pdoe /310, Op. 06 702. Par3erW t0>.aaAle/rrer6ehenlesbbel/OWl/(OIN/100) 03,190.00 W2, Peeeaal 166. /a1. 40/. tos. ~. A W fen IMInO k1 plNr In edrNnM b /Or NemO Iaesr M advanp 106. teats b 107, Conlin INN 11/11/t009 b J000 106. A1aeilmenb 11/16/9109 b et/s0/1010 109. ilpaipip.3; 1 16 Y - 31/P00! 110. II.J ONs,p py, ee 106. Itaes ~ b 101• IY1e 11/11/1009 b la/.f3/=OOJ 166. MOIOONwOa 11/10/2I0! b p/7o/ie10 166. Matie>1y01: 10 Y00f - as JAOt 110. SIO.J9 Of16. 00 dtra. o6 111. 1rer~Elea1 lied-/e13ar Ardrt • 1171.1! 411. lrosatSeos Od-8a1,10e' lesist ~ Ig71. 111 112. 412, 116. G/wa AmOlmt Dea r-OVVfr 1111 131.61 120. GrMe ATW11t OIN To SOIIN /110, D7/.01 ]0a. 1meuMb FW 3M Or b leheM Of lOfroWlr 006, RNuONOM M AmPOnt DIN TO lMef 201. k M aNlipl K d10. M 601. iaare a Iir1IrI1a401N 202. IumeuMdn.w s d11l, 030.00 602. aet6enNM .b seMr 1 t1d,3f0.l1 209. ~ b0 Wan 11NNd b 603. YN{n Mb' b 201. Paoeaeeinj tree parpoait d11r0.00 601. e(Or11 by C'Aa/otroraoPtwer 691 671.10 20e_ 800. 'NSeeOndni bon 206. ~• 207. ~~. 206. ~. 206. 666. Ad)arabnlna for hem/ uirpld a1111r nb M/ lerat unplld aelef 210. ape b 810. IIa11 b 2tL County Nees b ett. l1NM b 212. AiaewmaMa b 612. A{ew3menli b ' 213. 617. ' 214. 6I4. zts. a16. z16. sre. 219. 617. 2te. ste. 2t 6. bte. 120. TOW Pahl NBOIrbrMr 5311,160.60 620. T00311bdaoeon AnrouMOwttrlbr dY10, 713.61 300. qsh At eleiwnmt PromRe lOweeNr e00.Opk AtiNONM1AT01ProN IMNr 701. Grose emovM Orre ham tarroenr AMe 7 111,Ot1.1/ 601. Groot OaraNrl Ow b seMr 1 1110 670, II 302. Leas emeuM pOb byNMtronOwOr 'M 111 160.00 601. ui• redlretblle al enr. OM N61r d330r7q. 61 101. Cash From TO borrower dl21.36 ~, Cath ®Te F/0n16e1N SD, 017.10 aeodon e d Yie Rest watt 61abmint Prooedvre Ad1~I e(0~iml A) 8eaisn 4t0) d f168PA mm~wbe Ual M!D darob0 snd r~saMN rM0 l~oeulO~M h1b peroona•eowewln6 mene~b finsnMBj t~M preohalePMei a msrowlbmd7 all MiiNrgesx7npeew 6poe N~b ~owNOrbm~seNv reebened reel eslell b ONN WdOrAYM IM eelwe erld OOete d Thee ero OrMt psMy IWtlMeroe eat sro des7srr0 b proviee IM ro01 s01eb alpMreere eeMtM; Eaeh kndN mustp Ors boaldM benpwr wkh In/OrIrI01i0n OvdnO ON 1MaiM11t OrOOeee k ro se e0F3eeMe from rrlroin k koslw+ N ror wfrellr~A1 propenke a er01r b M • b disppsr. w/41sn p0lbslion b bonew rrrensy 70 firwrce eee PurMSSa d Tn1 PuE6o WPOAin6 lumen fa Uris aoNedion d ~nlbmslwn is roeidl t71N gE1a: L.enesro mal wewro One dbar0elt with the M6nN~ ro evera6e ens holN Der reaplnae, inaetlhp M IiirN rot aoobN s Gees Fatdr Eslimab • d Mw tr6/rraro ooea tlN1 Ub IM{Nldiple, p31dIYi6 ee6eeiq Ma eornau, 9eNNrMg borrower b nkey ro inWr in eenneetlon with Oia aseiwrr.M. Tns/1 sNaMMee 6en~ n1eM0, sro eengbtllg end rwbwsp M d~eaMUns ero mrne.tsy. TMe e0e11eY mey nol coked bee trfOrmeOOA end yov era n01 rogan0 b e0r110k1s Md1 Ibire, until it d404ya a wwaaYp wad ONb OOr11r01 niNeMr. TM iI1r011kedOn rokvaad OMs n01 bne sNNb Mn6den0e0y. ProviOUS a6kltrb ero abe/bte Pe6e t erg MUD•111Me1 rd Nendbelk 1100.2 06-07-'10 12;19 FBOM-BH AGENCY AEALTOA9 L. set8ement anerpes • 700. TOW SaIefJ6rokeiy Commisslon based on pAw f Division d eontnvecion (dtr 7001 as toeovra: 701.1 ,500.00 to R-N ogee ~~ 717-243-1718 1.00 ® J %_ T-749 P0003/0004 F-950 PsN Frain Fele from 80110nep 9e0eli FyIS M Fyn/i at SelUlM111 e'eleeminl 7(µ TsmsecElaa iUi t0 Jb11sr Mlll3sid • I I 5125.00 001.6osn OApinaGon Fee~~ ~ % OYei rederQ seelees 902. Loan Discount % Oi•1J1 r+dOrµ 81'n+'g1 801. /lppreBN FM b Jee l~ceegoleu • 5175.00 00a. Cre00 RepoA b cOC ' f31. 00 805. Lendsls lnypecYOn Fee Jlyi Aer0y0aW • i1o0. 00 808. MO a Inwranctf J1ppliti0en Fee b ~/~ eMmral IeyieY• »eelc 007. JlssymOtioh Fie Onu Yedrrel i.7Jie7e b.rk 800. proceerlwy e w Oo1ni1 rederll da/NaOs leek • 1]]0.00 1175.00 809. deed Case 1tw w Area ti riooa mes ensrlooe • ~ 35.45 970. 971. • Oraotes Yeas ~/1pp33e0 w BeYlor Aesirt~ e7z. eta. 911. Ste. ete. 917. ete. b19. 810. 907.Int.reetNan 3 30/a0o) (e 14/0 100D e39.s6 10 IsSI.s3 902. M Ineunna PmNurn br moldfn b 909- Neterd Insyranas PromWm Ior z. 00 h b tnNll • 1177.21 9a. n b 9e5, Ira 71md3a~ 1W ee nape. of 1n u,ele.oe t001. Ma3srd ineurrYts i. s0 In0~18te 196.11 (NI mOMh ~ 1307.4/ s 1004. M e Msuana melMte per m01Alt 11105 a0/ D ally lalamc m9tdhe per memb t004.Cov P 1NUe lo.aon,ayhe i]7.Id rm0nlh 1171.70 1005, MnuN tltMMmeMe meMlr rmOnlh 1009. melldle plrmonln teo7. months f per mengl 7008. rmoe3 r...r c. ao npnlhy Sz11.17 par m0mh 1161.71 t11tl.11 1009. N1AOm Esaow NMeM ! 1Q.71J de.oo 1,01. SeMNrtlalAM IM b a~°Ee ~os0 ~'• ~, LiR 1101. Abased a 8l4 swrch b 1109. Tdla O7eminelbn b 1101. Tent MtWreeye bYdOr b 1109. Oeoumem OnpMiee b O Lroaiebel 00.00 1108. Ie01 b m(:blalsRyker), Lsr Ceeyp, E7L• Ii7yb 110.00 „b7. A~ nea ro (MdyOas eeeve 11em1 nlenMa: 1108. TbN lnwran b 1,etrylrelluo/DOe1tleFi~fjdCOrE Ter iroyl•• 11,140.OI moedp above dens nymbent Ne1wa1 - 7 am. 1709. Landsh 1 f ill J, 010.00 11,010.00 1,10.Owneh oevengle f if10,000.00 ( 5110, 000.00 1111. Olwity Oeslrtoe 1~ttr 711. eo a•~gnsa nw iii. eo 1112. >%dapmade MredJ~es iOaK°° it, ii], 01 1113. mdepea~e ° eereiae 1187. ]3 1201. Ilemrd kes: OeM f if0. s9 = 01. ao • tielaees s uo2. tewb :Deed i1,loo.eo ~ _ /201,Ht-N11tWUnlpa: Deeds ,ss,loo.oe i 11,IOO.eo 12W. ltaeo+W+e6 tee J1pp13ed is 6suer aa,s.e + i711.o0 11pg, l~laseeer tar /yeyl3ed w Ooiler Jtrrlre ' i3, 100.01 1901, BYnretr b 1301. Peel In b y101. Y!J the m mt!leFr-13r3wh ysr Qrenp, ZLC /S17.1 170.00 17W. aet0.ta[s-ryiya4 wr Oevt~, scc fesa3l ri+J • itd. o0 1305. JbeLlefr-Iykoa111e• Creup, src rr« wra +~a~J 10.00 13pp, 7eet emiseboro IbeeeAlp 817].00 1107. lltwlp Wllloea f daeroLOry, 7,fd 111, 061.N 1100_ Tool fletttement CberaM (eMeF on fines 101. 8eellen J OM 001, ieCMOtt K) 1],]60.00 1]0,140. d1 Pnvaus edi8ons aro oweYns PMe 2 d 2 krM ~~ ~J081 rrr 1111tebeo111108,2 06-07-'10 12:19 FAOCI-BH AGENCY BEALTOAS 717-243-1718 T-749 P0004/0004 F-950 Certification (contlnuad from HUD-1) . I have carefitlly reviewed the FIUD-1 Settlement 8tetemenl and to the best of my Knowbdpe and beNef, it is a true and accurate statement of atl receipts and dkbursementa made on my eooount o<by mein Ihls tronaaotion. 1 further certify that I have roceived a Dopy oithe NUD-1 Sataament 8tatwrwnt. Borrows . Dets: roK . Borrower. Oak: a l -~' SaNar or / Agent Seller or q /~ ~~ n tr Mix ~~/ m Karen Dol Ewer Data: Eerote of Karin Doll'~nc-EMiar~ The NUD-1 9etllement which 1 have propsrod is a true and aoour>sts axount of this sofion. 1 have caused or WiN ausa aye hinds b bs disbursed in aocordanoa with this statement. Daft: 5etdsment Agent Oata: «r11P'O ~ WARWINQ: It fs a aime to lerowirgy nwke false statemanW to the States on lhia or any other similar form. Penelllaa upon mnvietion can Mlohrrk a arse an impAsonmtM. For details sae: ritb 18 U.S. Coda section 1007 and 8aotion 1010. NOTICE OF INHERITANCE TAX ~_ 94PP,RA,LS,EMEI~,Z, ALLOWANCE OR DISALLOWANCE BUREAU OF INDIVIDUAL TAXES + ~. ~, .•.r- INHERITANCE TAX DIVISION L?'F• b~'DU~~~7I~d~u$ AND ASSESSMENT OF TAX PO BOX 280601 ~<'-• '., ' ~' r •, HARRISBURG PA 17128-0601 ~' `' `' fit' t~4..'t ~, ;'~' ;. ~ I ~ SEA' 10 d~ 11 ~ 4 $ C~RPCl.E~K C~ K A R L E R O M I N G E R I S' C~tJRT 155 S HANOVER ST CARLISLE PA 17013 pennsyLvania ~ ~ • DEPARTMENT OF REVENUE REV-1547 EX AFP (12-09) DATE 09-06-2010 ESTATE OF EWERTZ KARIN B DATE OF DEATH 01-21-2004 FILE NUMBER 21 04-0094 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 11-05-2010 (See reverse side under Objections Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE _ ~ R_ETA_IN LOWER POR_TION FOR YOUR RECORDS ~ _ _ REY-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE _______________ OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: EWERTZ KARIN BFILE N0.:21 04-0094 ACN: 101 DATE: 09-06-2010 TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 20, 000.00 NOTE• To ensure proper 2. Stocks and Bonds (Schedule B) (2) .0 0 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .0 0 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) •0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 10,817.20 6. Jointly Owned Property (Schedule F) (6) .0 0 7. Transfers (Schedule G) (7) .0 0 8. Total Assets (8) 30 , 817 .20 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 8.7 61.0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 16,219.05 11. Total Deductions (11) 24,980.05 12. Net Value of Tax Return (12) 5,837.15 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0 14. Net Value of Estate Subject to Tax (14) 5,837.15 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 , 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) _0 0 x 0 4 5 = .0 0 17. Amount of Line 14 at Sibling rate (17) 5,$~7. 1 ~ X 12 = 700.46 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 = .0 0 19. Principal Tax Due (19)= 700.46 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 06-10-2010 CD012886 .00 700.46 t3ALAN[:t of UNPAID INTEREST/PENALTY AS OF 06-11-2010 TOTAL TAX PAYMENT 700.46 BALANCE OF TAX DUE .00 INTEREST AND PEN. 242.23 TOTAL DUE 242.23 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~s~-~ pennsyLvania ~ BUREAU OF INDIVIDUAL TAXES ~ IVi~I~~trI ~`ANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION i ~-'~ST~T~M:~,~u~n QF ACCOUNT REV-1607 EX AFP C12-09) PO BOX 280601 HARRISBURG PA 17128-0601 ~~~ ~~~ "'B ~~ ~: ~~ DATE 11 - O1 -2010 ESTATE OF EWERTZ KARIN B C~~~~ ~~ DATE OF DEATH 01-21-2004 Q~PN~f;}'~ ~~j(~~T FILE NUMBER 21 04-0094 C~~s~~;~~r ~~~, ,~~`~ ~,~ COUNTY CUMBERLAND KARL E ROMINGER ACN 101 155 S HANOVER ST Amount Remitted CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG_ THIS LINE _~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV X1607 EX AFP~ C12 09~~~ ~~~ *** INHERITANCE TAX STATEMENT~OF ACCUUNT ~~*** ~~~~~~~~~~ ~~~~~~~~~~ ESTATE OF:EWERTZ KARIN B FILE N0.:21 04-0094 ACN: 101 DATE: 11-01-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-30-2010 PRINCIPAL TAX DUE: 700.46 PAYMENTS CTAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-10-2010 CD01288b .00 700.46 09-10-2010 CD013338 242.23- 242.23 TOTAL TAX PAYMENT ~ 700.4b BALANCE OF TAX DUEI .00 INTEREST AND PEN. ~ .00 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .00 ,_ _ - rt.._ _ __. _-- _- - , _. CumberlaOndeCCon~y ~tegister Of Wills urthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 12/13/2010 ROMINGER KARL ERNST ESQUIRE 155 S HANOVER ST CARLISLE, PA 17013 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: ~C~s~~E~ ~1~~f,E OF 2010 DEC 13 AM I I = 08 c~R>< aF QRPHAN'~ COURT CUMfiER(~lD C4 , PA This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET N0. 1, for decedents dying on'oz after July 1, 1992, the personal representative or his counsel,, within two (2) years of the decedent's death, shall file with the R~g~ster of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2011 Please feel free to contact this office with any questions'you may have. If you have already filed your Status Report, please disregard this notice. cc: File Personal Representative(s) Sincerely, ~,~x Glenda Farner Strasb h Clerk of the Orphans' Court Cumberland County - Register?Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 {~' (~~- ~~~5~c~ Gib ,r~~l~ 2010 DISC t 3 AM ~ 1: p ERK OF Date: 12/13/2010 'S COURT Ct1M Fq-_~ ~~ , pA; DOLLINS CAROLYN B 1172 OYSTER MILL ROAD CAMP HILL, PA 17011 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Re art by Personal Representative under Rule 6.12 is due on the be~ow listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RU~EIS, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on'or after July 1, 1992, the personal representative or his counsels within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2011 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, ple~s~ disregard this notice. Sincerely, `~ ', L~w~v~ilLitJJ~~ Glenda Farner Stra~'sbaug Clerk of the Orpha~n~' Court cc: File Counsel _. r ,- _.. i~.EC1STEi: hF ~w:'_LS Gr CQL~:vTi', Pi.?~?*~SYL~~'~~\?, T\~ame of Decedent:__~_~,~~ lLIY1~ =_ ~Qf~~ ~ _ Dace o`Death:~ ~ _ File i`lu:~be=° - nL:~Sa?; • ••• D ~ r C..!a ,: 17 T r~".,.'t fire :?~1.~isrinA u:ir;, •=eaa^` f1 r.rr_r.••,P.`ir7 (?f tl.'' ~ i':illl~tl'3+l01: Cf llL L'J 1 L. V•\.. 1\~., ~. V.1L, NV• ~• .~ v L. L.l.:~ . ~~ i file above-ca;~tioned estate: ', 1. State whether ad:z:inistration of t,te estate is cct:~plete: .................... ~ 'e~ ~N~a 2. if the answei•is l~'o, state when the personal representative ~ ' reasona~ly L-elieves t;lat the adrrlinistratio?i will be con,plet~: ~!, . ~ 3. If the z~sLver to No. l is YES, state t;ie fo'aowin~: I'i es', a. Did tl:e personal representative ile a f=.nal~accotrnt wi'lit the Court? ....... ©?\o b. The separate Orphans' Court No. cif any) for the person: l representative's account is: c. Did the personal representative state an account ~~ ' informal:y to the partiea in i:aerest? .:.................:........... ~~` csl ~ yo d. Copies of receipts, releases, joi;:ders and apr royals of formal or infs~nnal acco!ul s nay be filed with the Cle.lc of the Orphans' C,ou;t and tray be at:.achzd to this repo;l. ~~,~ ~ _ . Z+r7 S:gnr:ra- Oj ?u•;Dn Fff:r:y riliJ farm -- ~ ' ~+ "'~ ~ ~ vj ~ Capacly: ~PersoralI?c;~r:selliall'JC~ !! l_ ~ ~~o r ~. u~ '` ~ ~ ~ N d x~~ ~ ` ~~.r.,•:e c.'Ftrtcn iili,r; tks FOrm ~ N ` S J. CAW 1[~AfQ Y' ~ ~' ~nrG ~ r-~o i3 ' t`~ ~~L-5~~ ~. r.• IZr ~,On t Cumberland County - Register Of Wills One Courthouse Square ~' "^ r'~`""' ~`~'''~" '' Carlisle, PA 17013 ~~~~ 1~ ~` ~~i i ~r Phone: (717) 240-6345 CI.~~K ~~ o~~}~~,n~~s ca~~T Date: 2/01/2012 ROMINGER KARL ERNST ESQUIRE 155 S HANOVER ST CARLISLE, PA 17013 RE: Estate of DOLLINS-EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET N0. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2012 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, %.'~~' , 'riJ r'r, Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square ~. ,.}.~J ~V~, ~,,._„~ Carlisle, PA 17013 ~~~~~i-~'-!' <:~-r",,~ ~~ Phone: (717) 240-6345 ~!~;}'~~'•;' ;~~','y~II~ r~R~ 0~ ORPHAN`S COURT 11~~1~EF,t.w~~ CO , P;? Date: 2/01/2012 DOLLINS CAROLYN B 1172 OYSTER MILL ROAD CAMP HILL, PA 17011 RE: Estate of DOLLINS=EWERTZ KARIN B File Number: 2004-00094 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/21/2012 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ---- ;~ ~ f ~ +/ r~ Glenda Farner Strasbau~ Clerk of the Orphans' Court cc: File Counsel Pa. O.C./RJule 6.12 STATUS REPORT REGISTER OF WILLS OF C~ /~in~fac ~ rv i~ COUNTY, PENNSYLVANIA Name of Date of Death: //~//~f/~ ~ File Number: ~~~ ~ - G'cicl'1'S~- Pursuant to Pa. O.C. Rule 6.12, 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 r ~To d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and may be attached to this report. ~°~ 7~,~ c.t..t '.' ~ rJ ~~ cV 4- rQ ty` - t~ . ~ ~ -~ ~''- ~ C .._ L j ` V vY. ~~ ~' ~ L+J ~- u_, ~.. :~ U Form RW-/0 rev. /0.13.06 Signature ojPerson Filing this Form Capacity: ^Personal Representative ^ Counsel Nome ojPerson Filing this Form <` v Address Telephone \.,C1 F:�FILES\ClientsV6171 Dollins-EwertzU6171.1.praecipe.appearance.wpd IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA KARIN B. DOLLINS-EWERTZ, : ORPHANS' COURT DIVISION deceased : N0. 21-04-0094 PRAECIPE TO THE REGISTER OF WILLS OF CUMBERLAND COUNTY: Enter the appearance of Hubert X. Gilroy of Martson Law Offices on behalf of the Estate in the above matter. MARTSON LAW OFFICES By ubert ' oy, Esquire I.D. No. 29943 Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: September 29, 2015 Attorneys for the Estate of Karin B. Dollins- Ewertz , �,� `� , �-n c' `.- `� C-' G p - `:, _l� -_::} ?." ,::3 (_T7 � 3 ..- ..-, , . i.3 - �.� , �-J C�� i ; `.� � _ .J yr, _ t:,,-� ' , ' ._ E_. ,. , ��? �� . .�.� CP � � 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 ROMINGER KARL ERNST ESQUIRE 155 S HANOVER ST CARLISLE, PA 17013 fold ESTATE INFORMATION: ssrv: 425-41-7240 FILE NUMBER: 2104-0094 DECEDENT NAME: DOLLINS-EWERTZ KARIN B DATE OF PAYMENT: 09/10/2010 POSTMARK DATE: 09/10/2010 COUNTY: CUMBERLAND DATE OF DEATH: 01 /21 /2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 5242.23 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY CHECK# 2361 SEAL INITIALS: CJ RECEIVED BY: 5242.23 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162EX(11-961 NO. CD 013338 REGISTER OF WILLS /}~ W ,V ~ O~ ~~ 2 0 w i~ > ~ a LL Q N _. ~ v ¢ u+ a ~ ~ a W U K z Q a~ 3 O ~y Q J O ~a~ N Z W A W U S Z H FQ- O W H W y oe ~ a W Z =ap Z 3 Z w O Q J LL J N O Q Z W O U ~ H M .P. ~~ _..a wc~ 3 r~.:%: ~_~:y Lam.' ~ i_ C7" y w x a oa 0 ~"' Z Z ~ W ~ Z Y ~ -~ a r a o N .~ w ~ 1 I,y o ~1 Z o rl ~7 ~7 A o a~ z ' ,.., O OC w M 0 0 o Q •• y p n! .a f/1 Q o N 1 N N o J 1 1 OC ~ ~+ ~ Z Q J 2 f~ ' ~p H ~ ~7 W ~ J d '"1 o a N o a0 N N 1 w o. 3 1 ~ .-+ .a .-~ ~ o ~ ~ Q ~ ' J3 00 w Q W N d o W o N U .-~ p y ~ Q o ~ J ~ d ~.1 y O Q~ 2 W W~ {~ .~ a W H J Q GC W W d y ® ~~ a N L1 Q T W N O J o ~ vj O C C9 U ~ W W O O Z~ ` C = U~ 'r U W Q W W Z 7 ~ W H H H J~ Z ~L Q Vl Q -•1 O U Q p W p li U Q Z 1 O.. O w N 0 n cV J Z Q p o ~ ~. ~o q Vl o w ' ~ H N N [] Q r Z "'. ~ ~ o d O Q N a~xai ~wm~ d.- L1_ Q U OC~C_`~ ~ ~1. ct~ ? o ~ ~ a ~ a H N W C9 CG z w .-1 > z o ~ Z ~ Q W S J W N N H J J d' U1 CG Q ~ Q ~L .--~ U 1 1 1 ~1 I (A 1 pl ~1 OI UI WI ~ 1 1 ~1 ~1 of 1 1 ~1 OI LL I ZI OI w 1 ~1 pel OI al ~1 WI 31 OI JI 1 ZI NI Q 1 ~1 WI OC I 1' WI zl H , JI NI NI 21 ~1 ~1 ZI OI JI Q 1 F- 1 ~1 UI