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PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of P\rc\Cf',u...J L. Cjn..,ke No. ~/-O~- /OCJ
also known as A~i CJo..("k~ To:
Register of ellS for the <
Deceased. County of 'uMhe(\nf"tr\ in the
Social Security No. d \0 <- lr, 4 - <6 \ lnlo Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appI i ed for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the aoove decedent.
Decendent was domiciled at death in CLL(Y'\b..e('a.,,~ County~Pennsylvania, with
h '1 ~j last family or principal residence at d[~ L\ (' j) \, ~'2- \\-1 \\ Kncic\ ) F h() \n. \ "fJ '* \loas
(list s eet, number and muruclpahty)
D~cendent, then ~ years of ~g~, died ma.~ ,':J.} ~ , . ~CXJ?>,
at L\.m t\n {L -\-.j ?\\~)t""'\
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ 50ll.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
TIn <:'51-oJ.t:. )~( -The.- -t>U\~l>'Se.. oSf \;-\-\~o..-\-\bn (")n\u.
~
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
--hi ~~ \~d.S
t l\ \-:=Jo ~ 5
CL It" '<1-03-5
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF (\) '(Y) b~\ Io..n)
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law. '"
Sworn to or affirmed and subscribed I ~j .~ ~
dme tills II day of ' ?' .r
::~;;, ~~ Leslie S. 6,,,,,,,..~,,, )j
7"n &:J~i I . , ~
~ ,/)U/~egister l. ::=-:; ~
~
No.~/-O...y<./~ -,
Estate of ~J(E'I') L ~J ARke.. , Deceised
GRANT OF LETTERS OF ADMINISTRATION
AND NOW _t=e..b RU P R. l( ,;) ~ ~ in consideration of the petition on
the reverse side hereof, sa 'sfactory proof having been presented before me,
IT IS DECREED that m
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to LES lie: S '""-:GJn>rnE. Y'fflTlYf
in the estate of ~RO\I) 1 UIARI<l=
~. ~~=..u~~. ~ .//a~l;7"h
~ ~i3ter of Wi S fl, .J
/~/ /(j!.e.-/~~~
FEES
Letters of Administration ..... $ I g c;CJ
Short Certificates( ).......... $ . q.1'Jn ATTORNEY (Sup. Ct. LD. No.)
~nunciation ................ $ l<~
$ /('),00
TOTAL _ $ ADDRESS
Filed ~:-.~............. A.D. .....~r
PHONE
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RENUNCIATION ~/-O~-/CJC)
In Re Estate of A(\A<ew L, t \0.< 'K e- deceased.
To the Register of Wills of C \.1 N\ bex \o..C"'\c\ County, Pennsylvania.
The undersigned ~\~ ~; C \O-.( 'K e.- of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
be issued to -L.e.. s \~E' c' ~~",e, ('::~rnsLyll~~r~
~.
WITNESS JAV
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Y-. ~.~ ~~,ef
f
(Signature)
;X ~ 8"11" 1MJ:f,,~ '"
(Address) /'10 Sr
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(Address)
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(Signature)
(Address)
J I\O).XIl'i RFV l)!X()
This is to certifY that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00 ",lIlItf"""ffJ"J"" /2 ~ ~,""
/~ (./. ...",
\\\,'f'~~\.\" OF PEi:----_. 'AA' At ~.. (, "r2~0.-~._(.."'pr, ~
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l~"'" Local Registrar (;
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"a.., /~~ MAY o 5 Z003
P 9095871 \.~ . /-$>,/
""-", 'f-?'M ---{'t-\: "",
--..-__, ENT \) /"""
No. JJJJN,,,,,/lJJ' Date
s 144 Rev. 1191 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
STATE FILE NUMBER
SEX SOCIAL SECURITY NUMBER
2. Male 3.210 .. 64 - 8166 iil 02003
UNDER 1 DAY BIRTHPLACE (City and PLACE OF DEATH (Check only one - see instructions 00 other side)
Hour. Minutes State or Foreign Counlry) HOSPITAl: Ot"",/l1SON
Harrisburg, PA Inpa'iontO ERlOutpalienl 0 OOAD (Sped'y) J8'
7. a..
FACILITY NAME (II nol instilution. gIve slrael and numbel') RACE - Amer~an Indfan, Black, White, elc.
(Specdy)
Cambria Twp. Cambria County Prison White
Ie. Id. 10.
DECEDENT'S USUAL OCCUPMION KINO OF BUSINESs/INDUSTRY MARITAL STATUS. Married SURVIVING SPOUSE
(Give IOnd 01 work done durin2 most Never MarrJed, Widowed, (It wife, give maiden name)
S'~tti'f~'h~'" use ,e "ed I Nev~rC~~'hed
1 11b. ".
DECEDENT'S MAILING ADDRESS (Slreet. CityfTown, Stale, lip Code) DECEDENT'S 17c.Kl Yea, decedent hved in East Pennsboro
204 College Hill Road ACTUAL twp
RESIDENCE
Enola, PA 17025 (See instructions Cumberland
on other side) 11d.O =h:~=:i~::OI
11. 17b. Cou citylboro
FATHER'S NAME (First. Middle. last) MOTHER'S NAME (First. Middle. Maiden Surname)
11. Roy B, Clarke a Leslie S. Venet
INFORMANT'S NAME (TypelPrinl) INFOR2ANT'S MAlLI~lDRESS (Street, GilvfTown, State. Zip Code) Enola,
Leslie S. Zimmerman o. 04 Co ege Hlll Road, PA 17025
METHOD OF DISPOSITION PlACE OF DlSPOSITION. Name 01 Cemetery, Crematory LOCATION. Citytrown, Stale, Zip Code
Buriol~ Cremation 0 Removal hom Slate 0 or Other Place /'
Other (Specfty\ 2003 BlueRidgeMemorial Garde s Harrisburg,PA 17112
21c. 21d.
LICENSE NUMBER NAME AND ADDRESS OF FACILITY 1 d 0 P R
22b. FO 012342-L ;!:one&MurrayFH408 3rd St New Cumberlan ,
of my knowfedge, death occurred at the time, dale and place slared. LICENSE NUMBER DME SIGNED
ig IUfeandTitle) (Month, Day, Year)
2,.. 23<.
DATE PRONOUNCED DEAD (Month. Day. Year) ....S CASE REFERRED 10 MEDICAL EXAMINER/CORONER?
I/:S0 P. M. mA'( .;I. ;;1.003 Y"~ NoD
24. 25. 21.
27. PART I: Enter the diseuea,lnturies or complications which caused the death. Do nol enter the mode of dying, such as cardiac or respiralory arrest, shock or heart failure. IAppfo~mate PART II: Other lignlficant conc:Ntions contributing to death. but
L1sl only one cause on each line. : interval between nol resulting in the underlying cause given In PART I.
I onset and death
. i
e.
,
b. !
DUE 10 (OR AS A CONSEOUENCE OF), I
I
C. ,
DUE 10 (OR AS A CONSEOUENCE OF), :
,
d.
WERE AUTOPSY FINOtNGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJUAY AT WORK? DESCAIBE HOW INJURY OCCURRED.
AVAILABLE PRIOR 10 (Monlh. Day, Year)
COMPLETION OF CAUSE D Ye. 0 NO~ R~N.'~CS
OF DENH? Natural Homicide .;lOO~
Yos[jl NoD Accktenl D Pending Investigation
Sulclde IX Could nol be determined
2a.. 2... 29.
CEATtFlEA (Check only one)
-CERTIFYING PHYSK:JAH (Physician certilyUlg cause of death when another phy&ictan has pronounced dealh and compleled Ilem 23)
To lhe bMl of my knowtedge, .eth occurred due to the UUH(s) and manne,.. ataNd. .,..,.........,. ......."..,...,.,...,... .,....,... 31b.
LICENSE NUMBER
-PRONOUNCING AND CERTIFYING PHYSICIAN (PhySician both pt"ooouncing death and cerlilying 10 cause at death) D
To the bMI of my knowledge, .ath occurred at the ttme, de.., endplace,endduetothe ceUH(s)and manne,es statad..,......,.."........",.
'MEDICAL EXAMINER/CORONER Jeffrey Lees, Deputy Coroner
On the baala of axamlnatlon .nd/or 'nyeatlvatlon.ln my opinion. de.th occurred .. the time, date, and place. and due to the cauH(a) and ~ .no Franklin Street, Suite 500
mann.ru.t.Ied.....,..............,.........................,.......................................,.....,.." ,
31.. 32. ,
AEGISTRAR'~NATURE AND NUMBER bsl,/J<O"l"',....," I DATE FILED (Month, Day, Year)
'- /:r)t.~ ~ &>0 ~
33. l......-h:~.'r./ ( ,. '.-(...;..,!1-ot' 3..
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: I\()drew ~ c"\od<..e.
Date of Death: (Y\QU ~ I ~D?:>
,
2 I - 04 - I QD .
Will No. Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the o~ans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~pte ro P.( ;)'Do?1 :
Name Address
'Roy ~. t\a('k€.- ~.~. ~{)'f. \1.0 N\ \ \-~ \, {\\-nu::> (\ I ~A- )1-059
-W'\\\OY'Y\ '-.liVY\M~CTYlfl<\ d..oL\ Co \ \ f'L1 e.. \A) l \ 'R.ti . t, f\Dk1.l ~A \'TO~E:
6
~c1el A ;t. .\ ffi me r ffia lC'\ d.oy r>> \\eje.. \\1\\ ~ . ((\D\a, ~A \1'W~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except (!.'\Je.. (' ~ 0 (\ of? ~QS ~
f\o-h-hed
Date: 5~Io-o4
~
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('" Address
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_Counsel for personal representative
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
August 31,2004 DC'": 717-787-6677
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c)"e' c'i
FRANK LAFFERTY r'-,
(/)
3211 N. FRONT ST. rr1
\:J
HARRISBURG, PA. 17101 ,
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Re: Estate o!ANDR~ L. ctARKE
File Number 21 0+l01 00
Dear MR. LAFFERTY:
The Department has been advised that the above-referenced estate is
presently involved in litigation. The Department will suspend further activity on this estate until
AUGUST 31,2005. You are required to notify the Department when the status changes or the
extension date expires.
If you have any questions, please contact me at (717-787-6677).
Sincerely,
~---- ~
EMERSON LUCIANO
Inheritance Tax Division
FAX 717-772-0412
5~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 4/07/2005
ZIMMERMAN LESLIE S
204 COLLEGE HILL ROAD
ENOLA, PA 17025
RE: Estate of CLARKE ANDREW L
File Number: 2004-00100
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
Jul y 1, 1992, the personal representative or his counsel, within two
(2 ) years of the decedent IS death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 5/02/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
vA
Estate of CLARKE ANDREW L : ORPHANS' COURT DIVISION
Late of EAST PENNSBORO TOWNSHIP : COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY
Estate No, : 21-04-00100 : PENNSYLVANIA
:
Date: 6/10/2005 : NO. : 21-04-00100
ZIMMERMAN LESLIE S
204 COLLEGE HILL ROAD
ENOLA PA 17025
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: ZIMMERMAN LESLIE S
Personal Representative Counsel: ** NO INFORMATION FOUND **
Date of Decedent's Death: 5/02/2003
Date of Delinquency Notice: 5/02/2005
The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans'
Court, in accordance with rule 6.12, Supreme Court Orphans' Court
Rules, hereby notifies the Orphans' Court Division, Court of Common
Pleas of Cumberland County, that neither the above named personal
representative nor their counsel, have filed with the Register of
Wills or Clerk of Orphans' Court, his/her Status Report required by
Rule 6,12, Supreme Court Orphans' Court Rule, and that the
requisite notice, pursuant to Rule 6,12, Supreme Court Orhans'
Court Rules, was given by the Clerk of Orphans' Court on 4/07/2005
and that the ten (10 ) day notice to file the status report has
expired. Accordingly, in accordance with Rule 6.12 the Court is
hereby notified of such delinquency and the undersigned requests
that a Court conduct a hearing to determine whether sanctions
should be imposed upon the delinquent personal representative or
their counsel,
cc: File ~~~
Personal Representative Glenda Farner Strasbaugh
Counsel Clerk of Orhans' Court
A hearing is scheduled for July 08, 2005 at 9:30 AM in
Courtroom No, 03, If the Status Report is filed prior to the
hearing date, the hearing will automatically be cancelled.
Geor
u%
Register of Wills of Cumberland County
STA TIJS REPORT UNDER RULE 6.12
Name ofDecedent: t\0()(ew \-.ee... C.\Q.(\(eJ
Date OfDeath:\f\al.t,Q ,dDD?J
EstateNo.:J.\- D'-\ -OO\OD
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration Df the estate is complete:
Yes ~ No 0
2; If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
If the answer to No.1 is Yes,state the following:
ND \O-W~ a. Did the perso~resentative file a final account with the Court?
\.UQS \\\e~,~lV Yes 0 No
~O\.SL ~\lL ..uu b. The separate Orphans' Court No. (if an~ th~SOnal repl;sentative'S ~
.') account is: 6 i~-1\'Q l\Jm'oe( \Ie. ~ O\\-0L\<:OW
(10 e5~ ", .
''lN2- o~~ c. Did the personal representative sta!e an acc~t informally to the ptl ~ -\h ~ l 'rack \c,
I o:.ut. interest? Yes $: No 129~d:Lo. (\C' \ -\-NL Q.D\X\-.... ." 1\ ;
~ ~... cD . Ml~~~SW1s ~~g)g-~"'U\\
~\)\ CJL 36,. c. Coples ofre 1 , eas Joinders an app 0 0 or infornia1
~... ~ accounts may be filed with the Clerk of the Orp0' Court and may be
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e;>~, D.",t.\\OIDS .. ..__
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Address
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Telephone No.
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Counsel for personal representative cYf
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISIDN
PO BOX 280601
HARRISBURG PA 17128-0601
C~E~~ ~'"
a~P~~~~s co;~~~
FRANK LAFFERTY CtJ~'1~'~~~ "•;`IJ ~'.~., PA.
3211 N FRONT ST
HBG PA 17101
NOTICE OF INHERITANCE TAX
14'~pRA_I-$~,N~EN!~, ALLOWANCE OR DISALLOWANCE
-;F ~ OF ,°D~13UC~TIONS AND ASSESSMENT OF TAX
j~~.~w C;; 4~ _.__
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1547 EX AFP (10-09)
DATE 12-14-2009
ESTATE OF CLARKE ANDREW L
DATE OF DEATH 05-02-2003
FILE NUMBER 21 04-0100
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 02-12-2010
(See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND RffMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
2009 DEC ~ ~ AID ~ ~ ~ 36
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
-------------------------------------------------------------------------------------------
REV-1547 EX AFP C10-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: CLARKE ANDREW LFILE N0.:21 04-0100 ACN: 101 DATE: 12-14-2009
TAX RETURN WAS: C ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) C2) ,QO credit to your account,
00 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) . of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets C8) .00
APPROV ED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (g) .00
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .00
11. Total Deductions C11) .00
12. Net Value of Tax Return (12) .00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) .00
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) .00 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .DO X 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)° .00
TAX CREDITS:
P DATE T I RNUMBER I INTEREST/PEN PAID (-) I AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* 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.
~, ':
REV-747 EX (6~~
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Andrew L. Ciarke 2104-0100
REVIEWED BY
Eunice Baker ACN
101
ITEM
SCHEDULE NO, EXPLANATION OF CHANGES
Efforts to file an Inheritance Tax return have been exhausted in the above referenced
estate. Therefore, the filing requirements have been waived. The Department however,
reserves the right to assess any assets that may be recovered at a future time.
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