HomeMy WebLinkAbout04-0149'R-lINKING AHEAD®
,'~.~I~ONN L. SNYI)ER
Auorney At Law
Phone: (717) 257-7552
Fa.x: (717) 257-7594
dsnyder~saul.com
BALTIMORE
Penn National Insurance Plaza · 2 North Second Street
7th Floor, Harrisburg, PA 17101 · www. saul.com
CHESTERBROOK NEW YORK PHILADELPHIA PRINCETON
A Oelaware LLP
WILMINGTON
CUMBERLAND COUNTY
REGISTER OF WILLS
AND
CLERK OF THE OPHANS' COURT
TO.p,. ~
FACSIMILE TRANSMITTAL SHEET
VROM:
COMPANY: DATE:
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
PHONE NUMBER: SENDER'S REFERENCE NLTMBER:
RE: YOUR REFERENCE ~ER:
[] URGENT [] FOR REVIEW [] PLEASE COMMENT [] PLEASE REPLY [] PLEASE RECYCLE
NOTES/COMMENTS:
The information in this message may be privileged and confidential and protected from
disclosure. If the reader of this message is neither the intended recipient, nor an employee
or agent responsible for delivering this message to the intended recipient, then you are
hereby notified that any dissemination, distribution, unauthorized use, or copying of this
communication is strictly prohibited. If you have received this communication in error, please
notify us immediately by replying to this message and deleting it from your computer. Thank
yOU.
1 COURTHOUSE SQUARE
CARLISLE PA 17013
PHONE: 717-240-6345
FAX: 717-240-7797
ESTATE OF ETHEL M. HOLLER
Deceased
BEFORE THE REGISTER OF WILLS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 21-04-149
ORDER OF REGISTER OF WILLS
AND NOW, this 24TH day of February, 2004, upon consideration of the Petition for Probate
of Lost Will, specifically including a photocopy of the proposed Will and Oaths of Subscribing
Witnesses from Bruce Foreman, Esquire, dated February 18, 2004, and Milton Bernstein,
Esquire, dated February 18, 2004, it is hereby ordered that the photocopy of the Last Will and
Testament of ETHEL M. HOLLER, dated September 17, 1977, shall be admitted to probate upon
the filing of a Petition for Letters Testamentary by the named Executor and the administration of
the Oath of Personal Representative to said Executor, and that such Letters Testamentary shall
thereupon be granted to said Executor.
In light of the above-described Petition, together with the Oaths of Subscribing Witness,
a hearing with respect to this matter is not required.
February 24, 2004
Date
· Glenda Farner Strasbaugh,'Register of ~
OATH OF SUBSCRIBING WITNESS
Estate of' ETHEL M. HOLLER, deceased
No.. 21-04-149
Bruce Foreman, Esquire,~a subscribing witness ~o the will presented herewith
being duly qualified according to law deposes and says that he was present and saw
the above Testatrix sign the same and that he signed as a witness at the request of
the Testatrix in her presence and in the presence of other subscribing witnesses.
Sworn to or Affirmed and Subscribed
before me this /~ ~ day
of ~"~_, ~, t'-O ~_.tJ~V ,2004
Bruce Foreman,)~squire
My Commission Expires:
NOTARIAL SEAL
¥11CHELE A RENEKER, Notary Public
City of Harrisburg, Dauphin County
,~,n::-': ~s!on Expires March !7, 2007
OATH OF SUBSCRIBING WITNESS
Estate of.' ETHEL M. HOLLER, Deceased
No. 21-04-149
Milton Bernstein, Esquire, a subscribing witness to the will presented herewith,
being duly qualified according to law deposes and says that he was present and saw
the above Testatrix sign the same and that he signed as a witness at the request of
the Testatrix in her presence and in the presence of other subscribing witnesses.
Sworn to or Affirmed and Subscribed
before me this /~t_ day
of_ 2004
N o~ary F~blic ' -
My Commission Expires:
Milton Bemstein, Esquire
(Address)
Notarial Seal
Angela M. Mil/er, Notary Public
City of Harrisburg, Dauphin Count
My Commission Expires Oct. 15, 2~6
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
Ethel M. Holler
Deceased
Social Security No. 204-03-7708
Kermit W. Holler
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner is the Executor named in the Last Will of the Decedent, dated
September 17, 1977.
Stale relevanl circmuslanccs, cg, renunciation, death of cxccutor, etc.
Fxccpt as l¥11ows, Dccedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the documents offered for probate; was not the
victim ora killing and was never adjudicated incompetent: NONE
B. Grant of Letters of Administration
(d b n.c.t.a.: pcndellte lite; dm-ante lbsentia; duralltc minoritat e)
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:
Name Relationship Residence
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 2925 Maple Road, Camp Hill,
Borough of Camp Hill, Cumberland County, Pennsylvania.
(list streel, illllllbl~l' alld municipality}
Decedent, then eighty-three (83) years of age, died November 22, 2003, in Harrisburg, Pennsylvania.
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ................................................................................................................................ $ 60,000.00
(If not domiciled in PA) Personal property m Pennsylvania ........................................................................................................... $ .................
(lfnot domiciled in PA) Personal property in County ..................................................................................................................... $ .................
Value of real estate in Pennsylvania .................................................................................................................................................................................... $
Total ..................................................................................................................................................................................................................... $ 60.000.0 0
Wheretbre, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of letters in the appropriate tbrm to the undersigned:
Signature Typed or printed name and residence
,.~ ~j/~ ~ J/ Kermit W. Holler, 2925 Maple Road, Camp Hill, Pennsylvania 17011
~ P; ' o~2 [Cumberland Cou,lly, - Rev 9/92
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner above-named swears and affirms that the statements in the foregoing Petition are tree and correct to the best of the
knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly admimster the estate
according to law.
Swom to and affirmed and subscribed
before me this 04tlltay of
March, 2004.
GLENDA FARNER STRASBAUGH Register of Wills
No.
Estate of Ethel M. Holler, deceased
Social Security No: 204-03-7708
Date of Death: November 22, 2003
AND NOW, March 04th2004, in consideration of the Petition on the reverse side hereon, satisfactory
proof having been presented before me,
IT IS DECREED that Letters Testamentary are hereby granted to Kermit W. Holler in the above estate and
that the instrument dated September 17, 1977 described in the Petition be admitted to probate and filed of record as
the last Will of Decedent.
FEES
Letters ........................... $115 o 00
Short Certificates..(~)~5 )$ 15.00
Renunciation ................ $
Affidavit ( ) .................$
Extra Pages (1) ............ $ 3.00
Codicil .......................... $
JCP Fee ........................ $10.00
Inventory ....................... $
Other ............................ $
TOTAL ................ $143o00
Letters are to mailed
3/10/04.
1033 ] 4 1 3/8/04
Attorney: Donn L. Snyder
I.D. No: 06858
Address: Penn National Insurance Plaza
Two North Second Street, 7~ Floor
Harrisburg, PA 17101
Telephone: (717) 257-7552
to Attorney on
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fiiing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
9G51008
No.
Local Registrar U
Date
NAME OF OECEDENT (F.sL Mid41e L~I)
AGE (las~ 8.1t~aay) ! UNDER 1 YE.A~
. 83 vt,. :
I~uDhin
DECEDENT'$ M~dLII~K~ ADORESS ~eM, C~y/Town, ~1®. Z~
2925 ~ple Ro~
~ Hill. PA 17011
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
I J I 10-13-2n I w
I ~ I~.
J C~. ~. ~p OF DE~H IFACIL~ NAME (11
I. . , I I-~ ~,~. I,~, ...............
I~[SD~q City
'
JACTU~
,.. Chester Weaver
INFOI~IANT'S NAME (Typo/Pnnl}
Kennit W. Holler
~,~--u ~.,~, ~ mi.,. 11-26-03
I,~:T.EU'S .AME,F.~. M,~.. U~ ~,~) Nellie Cle!and
2Qb ~ap±e Roao, uamp Hill, PA 17011
a,. Rolling Green Mem. Park [2,~3mp Hi I ], PA 17011
7(]11
J~-
J2ic'. [] Couk~ n(x be determined
menne~ la stated ............. ' ' , . ( ) []
PART I1: O~w I~itJcinl C(la(llioM ~ I0 die, ~
Petition to Admit to Probate a
Photocopy of Will of Ethel M. Holler
To The Register of Wills of Cumberland County:
The Petition ofKermit W. Holler states that:
1. Petition is the surviving spouse of Ethel M. Holler ("Decedent") who died
a resident of Cumberland County, Pennsylvania on November 22, 2003.
Surviving Spouse:
Children:
Decedent is survived by the following:
Kermit W. Holler
Selinda Homsey, Nedra Marshall and Oneida Beigh
3. On September 17, 1977, Decedent executed a handwritten Will prepared
by Attorney Earl J. Melman, a copy of which is attached as Exhibit "A".
4. The Will was prepared by Attorney Earl J. Melman of Melman, Gekas,
Nicholas & Lieberman and was witnessed by Milton Bernstein, Bruce D. Foreman and Earl J.
Melman, all attorneys of the firm.
5. A letter dated May 11, 1982 from Attorney Bruce D. Foremen to Mr. and
Mrs. Holler enclosing a copy of the last Wills that his office has record is attached as Exhibit
6. On November 24, 2003 a voice message was left for Attorney Bruce D.
Foreman by Attorney Donn L. Snyder's office requesting the original Will referred to in the May
11, 1982 letter. On November 26, 2003 a secretary from Mr. Foreman's office, Michele, called
Mr. Snyder's secretary, Carmen, and stated that they have no record of a Will for Mr. or Mrs.
Holler.
WHEREFORE, Petitioner respectfully requests that a citation issue directed to: Kermit
W. Holler, Surviving Spouse; Daughters: Selinda Homsey, Nedra Marshall and Oneida Beigh,
to show cause why a photocopy of the Will dated September 17, 1977 of Ethel M. Holler, should
not be admitted to probate as if it were the original.
~eermit W. Holler, Petitioner
1016211 12/9/03
Decree - Issuance of Citation - Photocopied Will
AND NOW, this ~:),/-h day of/~'~/~r/.w.r~...~ , 200~, upon consideration of the
annexed Petition of Kermit W. Holler, it is herebsVordered and decreed that a citation issue
directed to Kermit W. Holler, Selinda Homsey, Nedra Marshall and Oneida Beigh to show cause
why a photocopy of the Will dated September 17, 1977 of Ethel M. Holler, should not be
admitted to probate as if it were the original, together with the original.
Regis2~te~o f Wills
ks
101621.1 12/9/03 -2-
EXHIBIT A
: -.~ __ . .
EXHIBIT B
GEORGE W. GEKAS
STEVE C. NICHOLAS
ROBERT B. LIEBERMAN
MILTON BERNSTEIN
BRUCE D. FOREMAN
JAMES L. WALSH
CONSTANCE P. BRUNT
LAW 01~FI CE S
May 11, 1982
EARL J. MELMAN
1952-1979
3207 NORTH FRONT STREET
P. O. BOX 902
HARRISBURG, PENNSYLVANIA 1710E3
(717) 236-9391
;,-; .o: 77-809
Mr. and Mrs. Kermit Holler
2925 Maple Road
Camp Hill, Pennsylvania 17011
In re: Wills
Dear Mr. and Mrs. Holler:
As per your request, I enclose a copy of the last Wills
which we have record of in our office. These documents were written
with the assistance of Attorney Earl Melman.
After you have reviewed the Will, if you have any questions
or if you wish to make any alterations, please feel free to contact me.
BDF:bjh
You will recall these Wills were signed on a Saturday and prepared
as an emergency due to your trip. Perhaps it would be a good idea
to execute more formal and typed Wills.
RE!iq 500 EX
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21 04 149
COUNTY CODE YEAR NUMBER
I-'
Z
LU
UJ
LU
LU
=o~
Q.
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Holler, Ethel M.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
11-22-2003 I 10-13-1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Kermit W. Holler
SOCIAL SECURITY NUMBER
204-03-7708
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF VVILLS
SOCIAL SECURITY NUMBER
[] 1. Original Return
[] 4. Limited Estate
[] 6. Decedent Died Testate (Attach copy of Will)
[] 9. Litigation Proceeds Received
[] 2. Supplemental Return
] 4a. Future Interest Compromise (date of death after 12-12-82)
[] 7. Decedent Maintained a Living Trust (Aftach copy or Trust)
[] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
] 3. Remainder Return (date of death prior to 12-13-82)
[] 5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
[] 11. Election totax under Sec. 9113(A) (Attach ~ O)
THIS SECTION MUST BE COMPEETED: ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
Donn L. Snyder, Esquire
FIRM NAME (If Appli~ble)
Saul Ewing LLP
TELEPHONE NUMBER
717.257.7552
COMP~TE~ILINGADDRESS
2 North Second Street, 7th Floor
Harrisburg, PA 17101
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly'Owned Property(Schedule F)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly
(Schedule G or L)
8. Total Gross Assets (total Lines 1 - 7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Unes 9 & 10)
12. Net Valueof Estate(Line8 minus Line 11)
13.
14.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
40,942.21
7,000.00
58,060.21
(8)
17,128.00
276.00
(11)
(12)
(13)
(14)
OFFICIAL USE ONLY
121, 118.10
17,404.00
103,714.10
103,714.10
SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
103,714.10 x.0 0 (15)
0.00
16. Amount of Line 14 taxable at lineal rate
X .0__ (16)
17. Amount of Line 14 taxable at sibling rate
X .12 (17)
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
19. Tax Due
20. [] [ CHECK HERE IF yOU ~E REQUESTING A REFUND OF AN OVERPAYMENTI
(19)
0.00
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
SmF PA42021F. 1
Decede~t's Complete Address:
STREET ADDRESS
2925 Maple Road
Cl~
Camp Hill
STATE PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
IZIP17011
(1) 0. O0
0.00
0.00
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) O. O O
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................ [] []
b. retain the right to designate who shall use the property transferred or its income; ................... [] []
c. retain a reversionary interest; or ....................................................... [] []
d. receive the promise for life of either payments, benefits or care? ............................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................. [] []
3. Did decedent own an "in trust fo¢' or payable upon death bank account or security at his or her death? ..... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjurT, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which pr?parer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILINGRETURN~~/~._.~'~-~'~ ' / /C"~.~ _~ DATEjune
2004
ADDRESS ~'~'--'-.~- -- --
2925 Ma~le Road, q~p Hill, P~011
SIGNATURE~ ~REPARER)~,~'CJ'-IER ~'H/~N REPRI~6ENTATI~.~ DATE
//~1~,/'/"~' ~("~Lll .,. June~_~ 2004
ADDRESS ~ v--'-V 4 ~'[:~-~__;~ "'"'-'~" -
2 North Second Street, 7th Floor, Harrisburg, PA 17101
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a)(1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even
if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive
parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate im posed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
STF PA42021F .2
,REV-1503 EX + (1-97) (I)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ethel M. Holler 21-04 149
All property jointly-owned with the dght of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4.
U.S. Series EE Bond - #L865893533
MetLife - 29 Shares @ $31.27
American Express - #021537640555002
PNC - 145 Shares @ $50.79
89.58
906.83
32,581.25
7,364.55
TOTAL (Also enter on line 2, Recapitulation) $ 4 0, 9 4 2.2 '[
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.4
,REV-1507 E,X + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ethel M. Holler
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
21-04 149
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Jason Beigh
7,000.00
TOTAL
(Also enter on line ,'..,,[::' '";* ' *~ ~,.eca.,,u,a,,on/ '~, 7, 0 0 0.0 0
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.8
,REV-1508 EX + (1-97)(I)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ethel M. Holler 21-04 149
Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
System
2.
3.
4.
5.
6.
State Employee Retirment
PNC Bank - #5140159147
Commerce Bank Credit
MetLife
PEBTF
Commonwealth of
Pennsylvania
TOTAL (Also enter on line 5, Recapitulation
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.9
13,756.69
20.00
6.67
881.12
451.20
$ 15,115.68
,REV-1509 EX + (1~97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ethel M. Holler
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21-04 149
If an asse~ was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Kermit W. Holler Surviving Spouse
2925 Maple Road
Camp Hill, PA 17011
JOINTLY-OWNED PROPERTY:
L~- ~ ~ ~-K DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of finandal institulion and ba~ accomt number or similar identifying number. DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed for jointJy-beld real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1, ^. Personal Residence
2. 1997 Saturn
3. Bank Account - PNC
TOTAL (Also enter on line 6, Recapitulation)$
(If more space ~s needed, insert additional sheets of the same size)
STF PA42021F. 10
,REV-1510 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Ethel M. Holler 21-04 149
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the RE5/-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER. ATTACH A COPY OF TFE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF AP~IC~LE
1. MetLife Annuity - #A2067003 58,060.21 100% 58,060.2]
TOTAL (Also enter on line 7, Recapitulation) $ 5 8 f 0 6 0.2 ]
(If more space ~s needed, insert additional sheets of the same size)
STF PA42021 F.11
,REV-1511 E,,X + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ethel M. Holler 21-04 149
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1.
5.
6.
7.
8.
9.
10.
FUNERAL EXPENSES:
Myers Harner
ADMINISTRATIVE COSTS:
Personat Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees - Saul Ewing LLP
Family Exemption: (If decedent's address is not the same as c~aimant's, attach explanation)
Claimant Kermit W. Holler
Zip
Street Address 2925 Maple Road
City Camp Hi 11 State PA
Relationship of Claimant to Oecedent Surviving Spouse
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Cumberland Law Journal
Sentinal
File Petition to Admit
Saul Ewing LLP
Presentation
Zip 17011
Copy of Will
- Prepare and File Petition
to Court
to Court
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F, 12
6,394.00
6,000.00
3,000.00
143.00
75.00
16.00
1,500.00
$ 17,128.00
,REV-1512 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ethel M. Holler
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-04 149
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
Care For People
Lorie Ann Wynn - Nurses Aide
TOTAL (Also enter on line 10, Recapitulation) $
AMOUNT
36.00
240.00
276.00
(If more space is needed, insed additional sheets of the same size)
STF PA42021 F. 13
,REV-1513 E,X + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ethel M. Holler
SCHEDULE J
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I.
I1.
1.
T~ABLEDISTRIBUTIONS[includeoutdghtspousaldistdbutions, andtmns~
underS~.9116(a)(1.2)]
Kermit W. Holler
2925 Maple Road
Camp Hill, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINEI
FILE NUMBER
21-04 149
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Surviving Spouse
100% of Residue
15 THROUGH 15, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 1I - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.14
IU.S. Savings Bond Redemption Receipt
Branch ID: BP174192
Redemption Date: 03/17/2004
The Estate of
P.O. Box 1291
Harrisburg, PA
Ethel M Holler
17108
20-6153313 Transaction Number: 3095019
Teller ID: sandernm
Serial Number
Denom
Issue Interest Redemption
Date Issue Price Earned Value
IL86589353-EE EE
$50 03/1983 $25.00 $64.58 $89.58I
Total number of bonds redeemed: 1
Total Total Total
Price Interest Value
$25.00 $64.58 $89.58
Customer Signature
Customer ID: 04004988
Harrisburg,, P
HARRISBURG(CAMP HILL)
100 Senate Ave.
2004
Harrisburg,, PA 17011
717-972-2875
Page 1 Of 1
Benkovich & Associates
A financial advisoP/branch
Advanced Advisor Group
March 22, 2004
Ms. Maronetta F. Miller
Saul Ewing
2 North Second Street
7th Floor
Harrisburg, PA 17101-1604
Re: Estate of Ethel M. Holler
Jack Benkovich, CFP®, CFS
Senior Financial Advisor
CERTIRED FINANCIAL PLANNERTM
practitioner
American Express
Financial Advisors Inc.
IDS Life Insurance Company
Westwood Center
4661 Trindle Road
Camp Hill, PA 17011
Bus: 717.761.4208 Ext. 26
Fax: 717.761.6282
Toll Free: 800.962.8694
john.a.benkovich@aexp,com
Account Information
Mutual Funds
Account Number
O1153764055 6 002
02153764055 5 002
Ownership
Kermit W. Holler and Ethel M. Holler Joint Tenancy
Ethel M. Holler
Mutual Funds
Account Number Open Date Total Value
01153764055 6 002 12/29/86 $107,658.59
Scheduled monthly redemptions of $490.00
# of shares
24,084.696
Asset Value Per Share
4.470
02153764055 5 002 7/2/90 $ 32,581.25 7,288.870 4.470
The date of death values provided are for estate tax purposes and are not values to be paid. Accounts may be
subject to market fluctuation.
Beneficiary Information
We have the following beneficiaries on record for the deceased's accounts.
Account Number: 02153764055 5 002
Designation: Kermit W. Holler
Sincerely,
Laflre E. Kane
Senior Planning Assistant
HAR 2 ~
American Express Financial
Advisors Inc. Member NASD.
An AEFA associated financial
advisor franchise.
Insurance and annuities ara
issued by IDS Life Insurance
Company. an American Express
company. American Express
Company is separate Imm
American Express Financial
Advisors Inc. and is nat a
broker-dealer.
Lic: 0850227
MetLife Investors USA Insurance Company
P.o..ox 295 MILl?lt"e--"e'nves-ors
Des Moines, IA 50301-0295
KERMIT W HOLLER
2925 MAPLE ROAD
CAMP HILL, PA 17011
Date: 12-05-2003
Check No: 004057819
Partial Withdrawal
Gross Payment
Federal Withholding
Net Payment
58,060.21
806.02
57,254.19
Contract No: A2067003
Benkovich & Associates
A financial adviso~, branch
March 22, 2004
Ms. Maronetta F. Miller
Saul Ewing
2 North Second Street
7~h Floor
Harrisburg, PA 17101-1604
Re: Eslalc of EIh(,! M. llollcr
Advanced Advisor Group
Jack Benkovich, CFP®. CFS
Senior Financial Advisor
CERTIFIED FINANCIAL PLANNERTM
practitioner
American Express
Financial Adviaor~ Inc.
IDS Ufa Insurance Company
Westwood Center
4661 Trindle Road
Camp Hill, PA 17011
Bus: 717.76t4208 Ext. 26
Fax: 717.761.6282
Toll Free: 800.962.8694
john.a.benkovich@aexp.com
The PNC Financial Services Group
Computershare Trust Co., Inc.
2 North LaSalle Street
Chicago Illinois 60602
Within the US, Canada ~ Puerto Rico: 800 982 7652
Outside the US, Canada ~ Puerto Rico: 312 360 5235
Facsimile: 312 601 4335
PNC
ETHEL M HOLLER
2925 MAPLE ROAD
CAMP HILL PA 17011-2825
h,,llh,,llh,,,,,ll,,,Ih,hlh,h,,hhhh,,hhhh,lh,I
For a change of address please call the above number.
Holder Account Number
C 0000385263 IND
SSN/TIN Certified
Uncertifled accounts are subject to wlthhetding taxes
on dividend payments and sales pmcseds.
The PNC Financial Services Group, Inc.. Dividend Reinvestment Plan Statement
Dear Shareholder,
Your Holder Account Number appears above and should be used whenever you communicate with Computershare.
If you have questions regarding your account, contact Computershare shareholder services at 1-800-982-7652 or by mail al Computershare
Investor Services, Post Off'me Box 3504, Chicago, IL 60690-3504.
Dividend Information
Record Date: 10 Oct 2003 Holder Account Number:C 0000385263
Payment
Date I Class Description I Shares/Units Participating
in Dividend Rainvesment I Dividend
Rate ($) I Gross
Dividend ($) I Deduction
Amount ($) I Deduction
Type I Net
Dividend
24 Oct 2003 Co~,,,~ 143.688094 0.500000 71.84
Transaction History
From: 01 Jan 2003 To: 24 Oct 2003
71.84
Date
Transaction Description I Transaction Deduction Deduction
Amount ($) J ($)
Amount I TypeJ Net Price Per Total
Amount ($) Share/Unit ($) Shares/Units
24 Jan 2003 Dividend Reinvestmen! 66.85
24 Apr 2003 Dividend Reinvestment 67.57 66.85 44.505000 1.502078
24 Jul 2003 Dividend Reioveslmunl 68.30 67.57 44.345000 1.523734
24 Oct 2003 Dividend Reioveslment 71.84 68.30 48.755000 1.400882
71.84 50.870000 1.412227
Summa~ of Holdings Date: 24 Oct 2003
Certificated Shares/Units Direct Registration/ Dividend
Held By You Book Shams/Units I Reinveetment
Shares/Units I Total Shares/Units I Closing Price Per
Share/Unit ($) I
Value ($)
95.000000
50.100321
145.100321
7,369.65
Optional Cash Purchase
If you wish Io make an optional cash purchase at this time, please make your check
payable to Computerehare. No third party checke will be accepted.
Please write your Holder Account Number and the Company Name on your check.
This form should ONLY be used for The PNC Financial Se~ces Group, Inc.
The enclosed conlributi~ will ONLY be applied to the account referenced to the right.
Attached Is a check for iS
The plan allows for a minimum amounl of $50 with a maximum amount of $5,000 per month PNC im, ests optional
.cas.h pay~.ents_mo?thly on the 1st. I! the Invsslment dale is a non*Ired' da funds wi
O.~l.ness oay. uunn9 monlhs in which divldonds m rmid IM.~.-.-..m?. lay, _ II be invested on the next
raY. ends. a._ ~ .......... u,,~ ma oe maon concurr~lly with the investment of
Please note: NoUflcatlon of race p~ et' funds will not be mailed to you.
No Interest will be peld on Ibe funds held pendld9 purchase,
Funds received mere than ~0 day~ prior to an Inveslment Mil be returned.
Holder Name: ETHEL M HOLLER
Holder Account Number
C OO0O385263
IND
I IIIIIIllllllllllllllillllll llllllllllllllllllllllllllll
Please detach this portion and mail to:
Computershare
P.O. Box 6006
Carol Stream IL 60197-6006
ODO000000PNC SPP1 C 0000385263
Register of Wills of Cumberland County,
INVENTORY
Pennsylvania
Estate of Ethel M. ~oller
also known as
, Deceased
No. 21-04-149
Date of Death
November 22,
2003
Social Security No. 2 0 4 - 0 3 - 7 7 0 8
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said ]:nventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory, l/We verify that the statements made in this Inventory are true and correct. ]:/We understand that
false statements herein are made subject to the penalties of 18. Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Name of Dorm L. Snyder PersoJ~a~esentati.v~
Attorney:
I.D. No.: 06858
Address: 2 North Second Street, 7th Floor
17101
Telephone:
Harrisburg, PA
(717) 257-7524
REAL ESTATE
PERSONAL ESTATE
See Schedules B,
Description
(Attach Additional Sheets if necessary)
D, E and G
attached
Value
NONE
$63,057.89
Total: $63, 057.89
Note: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value
of each item, but such figures should not be extended into the total of the Inventory.
93141 1 6/22/04
~EV-1503 EX + (1.97) (I)
COMMOI~,/VEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ethel M. Holler
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21-04 149
All property jointly-owned with the right of su~ivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
2.
3.
4.
U.S. Series EE Bond - #L865893533
Metlife 29 Shares @ $31.27
American Express - #021537640555002
PNC - 145 Shares @ $50.79
TOTAL (Also enter on line 2, Recapitulation)
VALUE AT DATE
OF DEATH
89.58
906.83
32,581.25
7,364.55
40,942.21
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.4
REV-1507 "EX ~- (1-97) (I)
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMON~r_ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ethel M. Holler 21-04 149
All property jointly-owned with the right of survivocship must be disclosed o~ Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 7,000.00
Jason Beigh
TOTAL (Also enter on line 4, Recapitulation) $ '7, 000.00
(If more space is need~, insert additional sheets of the same size)
STF PA42021F.8
REV- 150~' EX' + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Ethel M. H:oller 23.-04 149
Include the proceeds of litigation and the date the proceeds were received by the estate. All properb/jointly-owned with the right of survivomhip must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
System
2.
3.
4.
5.
6.
State Employee Retirment
PNC Bank - #5140159147
Commerce Bank Credit
MetLife
PEBTF
Commonwealth of
Pennsylvania
13,756.69
20.00
6.67
881.12
451.20
TOTAL (Also enter on line 5, Recapitulation) $ 15, 115.68
If more space is needed, insert additional sheets of the same size)
STF PA42021F,9
REV.1,510 ~X..+ (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Ethel M. Holler 21-04 149
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION Of PROPERTY % OF
ITEM INCLUDE THE r~E OF TIE TRANSFEREE, TIEIR RELATIONSHIP TO DECEDENT AND THE DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER. Al'TACH A COPY OF TIE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1. MetLife Annuity - #A2067003 58,060.21 100% 58,060.2.~
IOIAL (Also enter on line 7, Recapitulation) $ 5 8 t 0 6 0.2 1
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.11
JRD/June 30, 1992/17858
In Re: Estate of ETHEL M HOLLER
Late of CAMP HILL BOROUGH
Estate No.: 21-04-149
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2004-149
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: KERMIT W HOLLER
Counsel for Personal Representative: DONN L SNYDER, ESQ
Date of Grant of Original Letters: 03-10-2004
Date of Delinquency Notice: 06-20-2004
The undersigned, Glenda Farner-Strasbaugh, Clerk of the Orphans' Court, in accordance
with Rule 5.6, 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 certification required by Rule
5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e),
Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on JUNE
20, 2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in
accordance with Rule 5.6(e) 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.
Distribution:
Date: Glenda Famer Strasb,augh ~ x,(~ ~ ~
Clerk of the Orphans Cou - (3'~ ~
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for~ at q.,~13 in Courtroom No.,3_.~,~i~aati~fN°tlce is
~eorge-F.~c ffe:, P.J. ' ' '
filed pri°r t° the hearing date' the hearing will aut°maticallT/~?~t~V~ ~
IN RE: ESATE OF
ETHEL M. HOLLER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DiVISION
No. 21-04-0149
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
ETHEL M. HOLLER
Date of Death:
NOVEMBER 22, 2003
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the beneficiary of the above-captioned estate on July 26, 2004:
Name Ad&ess
Kermit W. Holler
2925 Maple Road, Camp Hill, PA 17011
Notice has been given to all persons known to the undersigned to be entitled thereto
under Rule 5.6(a)
ire
Saul Ewing LLP
Post Office Box 1291
Harrisburg, PA 17108-1291
Attorney for Estate
621761 7/26/04
FORM 93 - O. C. DIVISION
IN THE COURT OF COMMON PLEAS
OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ESTATE }
: : No. ~- 149 6f ~3
ETHEL M HOLLER }
(Deceased)
CLAIM
To the Clerk of Orphans court Division:
Index and make proper entry in your official records of the claim of OMNIUM
WORLDWIDE, INC. for HOUSEHOLD RETAIL SERVICES (Claimant), account #
0176401104702392, in the amount of $9,579.33 against the estate of the above named
decedent.
This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended.
The said decedent, who resided at 2300 FOX FIRE CIRCLE, MECHANICSBURG,
PA 17055, died on November 22, 2003.
Written notice of this claim was given to KERMIT HOLLER, 2925 MAPLE RD,
CAMP HILL, PA 17011 (Personal representative, if any, or counsel).
July 29 , 2004
''~- ~C~nffnt)-
OMNIUM WORLDWIDE, INC.
7171 MERCY RD, SUITE 400
PO BOX 6618
OMAHA, NE 68106
800-99%3778
(Claimant's Address)
A~S-A~J~C 25
RECDSP 9:04:18 7/29/2004
CLIENT: HOUSEHOLD RETAIL SERVICES
STATUS: ACTIVE STATUS
CLI REF#: 0176401104702392
~SOM: 42-CLAIM FILED
comcT I~OmnOM] [ ~D=SS ~OmTYONI I
ADDP, ESS TYPE: PRMHOM
STREET: 2300 FOX FIRE CIRCLS
~AIL CODE: D~C~R
CONTACT TYPE: PRMCON LANGUAGE: ~GLSH
PREFIX: ~SP: P]{~REP
FIRST NLME: ETHEL
· DD~ I%%~E: M CITY: MECHANICSBURG
LAST ~: ~5[~ STATE: PA
~XT~n: ZIP CODE: 17055
SIIFFIX: SSN: 204037708 COUNTRY: US
PAWS] [
ACCOUNT: 91530099
PACI~ET:
More.,,
PMOI~ TYPE: no~P~
~ CODS: 717
PREFIX: 737
EXT~;EION: --
A~S~R CODE: --
~LL ~DE: ~L
ACCOUNT STATISTICS ]
PROMISED PAI~ENTS:
9579.33000 AD~STED BALAMCE: 0.00000
0.00000 PRHClPAL PAIg~ENTS: 0.00000
LISTINOBALANCE:
LOCAL LISTI~ BAL:
ACTIVITY:
RTNRECRETURNTORECOVERY
S42 CLAIM FILED
CLM REPRES-FILE CLAIM WI~ PROBATE:PRO~TE CLAIM FORM
9579.33000
0.00000
More...
FOLLOW UP ACTI-vlTY: REVIEW FOLLOW UP DATE: 7/30/2004 FOLLOW ~m
F2,CONTIFOESEARCH FS=EXIT Fi=PRO~T F$,ADDCONTACT FT=PREVIOUS CONTACT FS=NEXTCONTACT
Do Not ~ail Co:ditio~ E~ists For Co~mct Address
102749 07/29/2004 09:04:17
102749 07/29/2004 09:04:15
102749 07/29/2004 09:03:33
More,..
[ ACCO~ Am~E~rESl
Fg=MISTORY F2i=MORE KEYS
(DO
IN RE: ESTATE
OF
ETHEL M. HOLLER
(Deceased)
IN THE COURT OF COMMON PLEAS
OF
CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
NO. 21-04-149
SATISFACTION OF CLAIM
To the Clerk of Orphans' Court Division:
Make proper entry in your official records of the claim of Omnium Worldwide, Inc. in
the amount of$9,579.33 against the estate ofthe above named decedent has been settled and
satisfied in full.
'1:1
February ~, 2005
en
('J
r,.-....
'. J
I
!
A -
( Claiman
OMNIUM WORLDWIDE, INC.
7171 MERCY ROAD, SUITE 400
P.O. BOX 6618
OMAHA, NE 68106
800-999-3778
(Claimant's Address)
,
C,.M......'. GENEh~~,I.!;,ln~-,.'tR';...:-:~:"?t~ ':~a-'
':' :'; . ,_ ,. ,,: I : ""'~^".J ,I, :1\.".: .,....'\
;!;i' SUZANNE M. TIPPiN
-..:~ J..\,.~ .. r r, .
~; ...::;;;,7-;:.~::;,~ ly:Y jjiTl:T:. r:X::J.., t',U~ "11
c...._ -".- " . r
-,,) <--C.. .,.\,[~.NC. I '1 . 1'''' '\
\\{,
IN RE: THE EST ATE OF
IN THE COURT OF COMMON PLEAS
ETHEL M. HOLLER, DECEASED
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
FILE NO. 21-04-0149
SATISFACTION AND AWARD
The undersigned, hereby acknowledge that Kermit W. Holler, Executor of the Estate of
Ethel M. Holler, deceased, has distributed to the undersigned cash, note and securities valued at One
Hundred Three Thousand Seven Hundred Fourteen and 101100 Dollars ($103,714.10) as full
payment of all sums due pursuant to the Estate of Ethel M. Holler, directs and authorizes the Clerk
of the Orphan's Court Division to mark satisfied of record the award which may be made in his
individual favor.
I L),IN WIT~~S ~EREOF, the undersigned has caused these presents to be executed this
~dayof~2005.
~~~
<.:-~/'/
---~~//~
6C ,-
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ethel M. Holler
Date of Death: November 22, 2003
Register File No. 21-04-0149
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion ofthe administration ofthe above-captioned estate:
1. State whether administration of the estate is complete: Yes ~ No
2. If the answer to #1 is No, state when the personal
representative reasonably believes that the administration
will be complete:
3. If the answer to #1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No -.X
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 -X- No_
d. Copies of receipts, releases, joinders and
approvals of formal or information accounts may
be filed with the Clerk ofthe Orphans' Court
and may be attached to this report. (attached)
Date: Marcht!t, 2005 !J ')4 0 ()
~
SAUL EWING LLP
POST OFFICE Box 1291
Harrisburg, P A 17108-1291
717.257.7552
;:-,~-~
L- ',_'- -
54463.11 3/8/05