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HomeMy WebLinkAbout03-0227PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as To: Deceased. Social Security No. / '7.cl- ~ gS) " ~.t/ 7~. 9..I-og,- at Register of Wills for the County of Commonwealth of Pennsylvania in the The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years~f age or older, appl t I~ ~ for letters of administration o,..- M~cL I¥ 2oo ~ ''- (d.b.n.; pendente lite; ]t~rante ab~ntia; durante minoritate) on the estate of the above decedent. Decendent was domiciled at death in ~"g///a ~O-t/~ ~' County. Penns~vania, with. h ~;~t"' last family or principal residence at 7ff_..)O ~./',t/~,,,/'/3o~4.,.. ltd (list street, number and municipality) Decen~o~t}teh~ ~)7 years of age, died /.2t~d~/~./ [ . , ~,.-I< /V,,r~,~ . - e "~ ' Decendent at death owned property with estimated values as folllows: (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 PerrLnsylvania situated as follows: . %Toe Petitioner the following spouse (if any) and heirs: ~a~,,~ ;.e Name after a proper search ha $ ascertained that decedent left no will and was survived by Relationship Residence &,hd._ Dc. I ¢o~'--~ ~-,..,..; ,¢4 ?~ /7o,,I' THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ct) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ~ ~'t'~ day of No. Estate of ~e~_~ L_ ~\~,ae_. , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW ~t~O~t'CY'x ~ ~ ~©0 3 ~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted in the estate of FEES Letters of Administration ..... Short Certificates( ) .......... $ .___~_~:ID~ Renunciation ................ $ ~cA TOTAL ~ $_~_~.OO _ Filed ~y.i.q..-z..O.~ ......... A.D. 19 _ Register of Wills ATTORNEY (Sup. Ct:.,I.D. No.) ADDRESS PHONE RENUNCIATION deceased. To the Register of Wills of County, Pennsylvania. the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to T, WITNESS ~ ~ hand this day or~ff~'-~, ,'~ ~', 1~ 0 ~ . ~ (Ad~) (Signature) (Address) (Signature) (Address) RENUNCIATION deceased. To the Register of Wills of County, Pennsylvania. The undersigned ~On/~ ~ ~ C 1006a ~' , ~ot,~ ~JF°-I'' of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to ~ xa C~ ',ar-~r-x A- ~ 't ~9 ~)e.."lL21' WITNESS handthis ,,,~---/ dayof '"rf~/0, (S~gn/~re) (Signature) (Address) (Signature) (Address) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8454209 No. Date Helen L. Alwine 83] Cumberland COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ................... ,5~-T- .... s~'~ ~;^L--~;~T-a,r~ ~,~u~n ~ Female},. 179 -- 30 -- 3474 ~rc~ ~, .,¥~ ~rrl~urg, P~"~"~ ~ , I,. I, ..... Carlisle ] Forest Park Health Center I~ .... ~" .... ...~.,._ Pennsylvania ~ ,~.~ ~..~,. ,m.c~ Cumber] and ~* ,,a.~~o, Carlisle ,,.. Office Clerk 700 Walnut Bottom Road ,E~,CE ,,.Carlisle, PA 17013 ~"~) July 1, 2002 ,,. Jesse Welliver ,,. Dora Shumaker ~.. Judith A. Tippett 105 Hawk Court, Mechanicsburg, Pa. 170~0 ~ ~ C~ ~ ~M ~ ~e~ (~ ~ * ~) y 5, 2002 ~ng Green Memorial Par C~p H511, PA ~/' LICENSE NUMBER OATE ~N~q (Itlanl~ ~. ~) CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Alwine, Helen L. Date of death: July 1, 2002 Admin. No. 21-03-00227 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above captioned estate on May 14, 2003.. Name Address Wilma Gebhart 109 Linden Drive Camp Hill, PA 17011 Bonnie Clouser 2470 Valley Road Marysville, PA 17053 Notice has now been given to all persons entitled thereto under Rule 5.6 (a). Date: May 14, 2003 Michael J. Whare, Esqu~e 155 S. Hanover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Personal Representative COMMONWEALTH OF PENNSYLVANIA NOTICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION In Re: The Estate of: HELEN ALWINE Deceased Court File No: ~/- C-L:3- ~ ~ ~' TO: THE CLERK OF THE ORPHANS' COURT DIVISION 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). 1) 2) 3) Claimant's name: Claimant's address: BANK ONE cio NCO Financial Systems, Inc Probate Department,#.450 1804 Washington Boulevard Baltimore, MD 21230 (443)263-3300, ext 3304 Creditor listed below is the owner and holder of a claim in the amount of $1,500.76 4) The facts upon which this claim is based is a credit agreement between Creditor and Decedent, identified as account number which is evidenced by the attached affidavit of account stated. 5) 6) 7) Decedent's address: 1291 STRAFFORD RD., CAMP HILL, PA 17011 Date of Death: VNKNOWN That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by. On behalf of the claimant, I do solemnly declare apad~ffirm u0d~he p~.nalties of perjury that they Information and representatior~ made her~n a~e tr~ and correct to the best of my knowledge, information and Dated:April 30, 2003 .~"~/~l/l~--~' ~/~__-~' ,AGENT Claimant v55o59 Wdtten notice of claim was given to Personal Representative and/~ ..ffis/her counsel -,., as stated below: JUDITH TIPPETT Name 105 HAWK COURT Address MECHANICSBURG, PA 17050 City/State/Zip April 30, 2003 Date notice mailed COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 2B06~1 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCETAX RETURN RESIDENT DECEDENT IFILE NUMBER COU 2N~] COOE OFFICIAL USE ONLY 03 00227 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INmAL) SOCIAL SECURITY NUMBER Alwine, Helen L 179-30-3474 z DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-DO-YEAR) ua THIS RETURN MUST BE FILED IN DUPUCATE WITH THE C~ ,.o 07/01/2002 03/02/1919 REGISTER OF WILLS ¢3 F APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRSTAND MIDDLE INrrlAL) SOCIAL SECURITY NUMBER [] 1. Original Retum [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Futum loferest Compromise (date of death after 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. LitigaflonPmceedsReceived [] 10. Spousal Poverty Credit (date of death betwee~ 12-31~91 and 1-1-95) dAME Mark F Baylcy --IRM NAME (If applicable) Rominger & Bayley Law Offices [] 3. RemainderRetum(dateofdealhpnorto12-13-82) [] 5, Federal Estate Tax Return Required 8. Total Number of Sate Deposit Boxes [] 11 .Election to tax under Sec. 9113(A) (Attach Sch O) r'ELEPHONE NUMBER 717/241-6070 COMPLETE MAILING ADDRESS 155 S. Hanover St. Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprielorship (3) 4. Mortgages & No{es Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (to{al Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has no{ been mede (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rote, or transfers under Sec. 9116(a)(1.2) .00 16.Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due z 0 o x x .045 x .12 x .15 20. [] None None None None 2,662.73 None None 2,890.42 Copyright 2000 form software only The Lackner Group, Inc. OFFICIAL USE ONLY (8) 2,662.73 2,890.42 insolvent (11) (12) (13) (14) (15) (16) (17) (18) (19) Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: [ STREET ADDRESS Forest Pm-k Nursing Home 700 Walnut Bottom Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) ~0.00 4. If Line 2 is greater than Line 1 + Line 3, ~n~t~r the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 20 to request a refund 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.0O A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ..................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ......................................... [] [] c. retain a reversionary interest; or ......................................................................... d. receh~ the promise for life of either payments, benefits or cam? .................................................................. 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 for' or payable upon death bank account or security at his or her death? ............... [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] 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 o~ perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pmpam~ other than the personal representati~m is based on all information of which preparer has any kno?ledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE / Judil~Tippett . Mechanicsburg, PA 17050 TUREOF PERSON RESPONSI .~E ROR FIt. BIG RETURN ADDRESS SIGNATURE OF PREPARER OIHER ~RESENTATN'E ADDRESS DATE Mark FBaylgy . A /If ~ 155 S. Hanover St. t/x ~-~ .~-~ ......... /a/r L,,/~(~_ :~ ..................... Carlisle,~_A_ 17013 ___ [(.~/--~.. {~--'"'C.~ 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 nat 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 ex~gnot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Alwine, Helen L SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 - 03 - 00227 Inclu.de the. pmceecJ, s. of I~.(~iga.tJon and the .date. ~e_proceeds were received by the estate, All property jointly-owned with the right of survworsmp must oe ¢fi~close¢] on scneome r. ITEM NUMBER Cash DESCRIPTION TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE Of DEATH 2,662.73 2,662.73 COklMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Alwine, Helen L FILE NUMBER 21 - 03 - 00227 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: Jesse H. Geigle Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address C~ State Zip Year(s) Commission paid Attorney's Fees Rominger & Bayley Law Office Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address C~y Relationship of Claimant to Decedent Probate Fees State Zip Accountant's Fees Tax Retum Prepare~s Fees Other Administrative Costs Cumberland County Register of Wills Sentinel (Advertising) Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 1,915.73 747.00 54.00 98.69 75.00 2,890.42 Schedule H Funeral Expenses & Administrative Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ,~,1 ;,~ FILE NU~IBER ...w-.e, Helen L 2 i 03 - 00227 3 Cumberland Law Journal (Advertising) 75.00 Page 2 of Schedule H '~i\ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX J:~]}CC' :' ' .-::' DATE 05-22-2004 :~!q ,' ,',; ESTATE OF ALNINE DATE OF DEATH 07-01-2002 FILE .UNBE, 21 0.'5-0227 '04 I~ 17 ,!!i'~ :~1'} COUNTY CUNBERLAND MARK F BAYLEY ACN 101 ROMINGER & BAYLEY 155 S HANOVER ST CARLISLE PA 170~'1¥ C* HELEN L MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF NILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF ALNINE HELEN L FILE NO. 21 05-0227 ACN 101 DATE 05-22-2004 TAX RETURN NAS: (X} ACCEPTED AS FILED ( } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CSchedule A} 2. Stocks and Bonds (Schedule B} $. Closely Held Stock/Partnership Interest (Schedule C} 4. Nortgages/Notes Receivable (Schedule D} 5. Cash/Bank Deposits/His(. Personal Property (Schedule E} 6. Jointly Owned Property (Schedule F} 7. Transfers (Schedule G} 8. Total Assets APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H} 10. Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions 12. Net Value of Tax Return 1.%. 14. NOTE: ASSESSNENT OF TAX.' 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate C17} 18. Amount of Line 14 taxable at Collateral/Class B rate (18} 19. Principal Tax Due TAX CREDITS PAYNENT RECEIPT DISCOUNT DATE NUHBER INTEREST/PEN PAID 2r662.75 .00 .00 NOTE: To insure proper .00 credit to your account, · 00 submit the upper portion .00 of this form with your tax payment. ¢8} 2,662.75 2,890.42 .00 2.890 .~2 227.69- IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. reflect figures that Include the total of ALL returns assessed to date. · 00 x O0 = · O0 x 045 = · 00 x 12 = · O0 X 15 = C19>= AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J] Net Value of Estate SubSect to Tax (14} 227.69- If an assessment was issued previously, lines 14, 15 and/or 1~, 17, 18 and 19 will .00 .00 .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN ~1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} .00 .00 .00 .00 .00 STATUS REPORT UNDER RULE 6.12 Will No.: (~ 00 ~ -- 00 ~ & ~'~ Admin. No.: '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: State .whether adrnin{stration of the estate is complete: No If the answer is No, state when the personal representative reasonably believes that the adrniuigtrafion will be complete: 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' c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Signature Name Capacity: Address' Telephone No. [~1 Personal Representative [-] Counsel for personal representative STATUS REPORT UNDER RULE 6.12 Name of Decedent: _ Date of Death: J~L~ i, 'LO O 9.~ Wi/1 No.: ,4/~ t7 e~ Admin. No.: ~1-o ~ - 2z] ~s~ to k~e 6.12 of~e Supreme Co~ O~h~' Co~ Rules, I repo~ ~e . bllow~g ~ re, eot to completion of~e a~s~afion of~e above-captioned estate: 1. Smt~h~er ~s~ation of~e 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: Did the personal representative file a final account with the Court? Yes _ No J~ , b. The separate Orphans' Court No. (if any) for the ~ersonal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~ No' Copies of receipts, releases, joinders and approval of formal or infernal accounts may be fried with the Clerk of the Orphans' Court and may be attached to this report. Signature / OW Address' ~..~r'1/51¢ , P/~ /7o/_5 "'tdephone No. Capacity: [-] .Personal Representative Counsel for personal representative