The URL can be used to link to this page

Home My WebLink About04-0602Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Daniel L. Burkholder also known as , Deceased Social Security No. 166-48-9454 Petitioner(s), who is/are 18 years of age or older, apply(les) (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 Except as follows, Decedent did not many, 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 incompetent: B. Grant of Letters of Administration (c.t.a,, d.b.n.c.t.a.: penclente lite; durante absen0a; durante minodtate) Petitioner(s) after a proper search has/hove ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: J Name Relationship Residence ] Lloyd K. Burkholder Father 3725 Scotland Main St.; Chambersburg, PA 17201 **NOTE: Decedent was not survived by spouse or issue. In addition, his mother, Betty Elsie Blair Bu~h..ol};ler, died January 7, 1980. (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/he~ last family or p~n¢ipal residence at 1071 Rid.qe Road, Shippensbur.ql Hopewell Township, (list met, number and municipality) Decedent, then 43 years of age, died June 16 _, 20 04 , at Chambersburq Hospital, Chambersbur,q, Pennsylvania {Location) Decedent at death owned propeK¥ with estimated values as follows: (If domidled in PA) All personal property $ 1,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 25,000.00 Total $ 26,000.00 Real Estate situated as follows: ..1071 Ridge Road, Shippensburg Post Office, Hopewell Township, Cumberland County, Pennsylvania 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 Typed or pdnted name and residence J /~~' Lloyd K. Burkholder; 3725 Scotland Main St.; Chambersburg, PA17201 Signature Fom~ RW-1 Page 1 of 2 (Dauphin County- Rev. 9/92) 307583-1 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and afffirm(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 according to law. Sworn to and affirmed and subscribed before me this ~:~ day of '~,~,,~ ,20 04 DECREE OF REGISTER Estate of also known as Daniel L. Burkholder , Deceased Social Security No: 166-48-9454 Date of Death: June 16, 2004 AND NOW,_~_3.Q~,. ,:~ ' ,20 04 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters__ Testamentary X of Administration' (c,t.a.; d.b.n.c.t,; pendente lite; durante abseff. Ja; durante minofitate) are hereby granted to Lloyd K. Burkholder in the above estate and that the instrument(s), if any, dated N/A 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 ............................ $ Attomey: Jered L. Hock, Esquire I.D. No: 19211 TOTAL ................ $ ~5, P/h Address: 3211 North Front Street PO Box 5300; Harrisburq, PA 17110-0300 Telephone: (717) 238-8187 DATE FILED: Form RW-I Page 2 of 2 (Dauph~ County. Rev. 9/92) 307583-1 105 805 REV g/86 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. ,,., o 3 ?'. o .? , No. ~ ~ Date H105.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA ° DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT (First, Middle, Last) SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Month. Day. Year) ~KT 1. Daniel L. Burkholder 2. Male a. 166 --48 -- 9~4 {4..June 16, 2004 AGE (Last Eillhday) I UNDER 1 YEAR UNDER 1 DAY I DATE OF BIRTH BIRTHPLACE City and =LACE OF DEATH (Check only one - see inst~ction$ oll otbeY-(l~9 Mo~ths Days H~Jrs Minutes (Mo~th, Day, Year) State ~r Fore~ Count~) ,n,~nl [] E~UO~a~n, [] ~Oa [] [] ""~"~ []~[Sp~} [] S. 43 Yrs. S. 3--14--61 ?.Ch~, PA COUNTY OF DEATH CITY. BORO, TWP OF DEATH FACILITY NAME (E nol ms~tu~on, g~e street and number) I No Yes Cuban, (Sbec~y} ~b. Franklin ~. Chambersburg ~d. Chambersburg Hospital I~e~ca~'Puea°~ican'atc' It0. White DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS / INDUSTRY AS DECEDENT EVER IN I MARITAL STATUB - Ma~ied, SURVIVING SPOUSE ACTUAL Did 17c. [] Yes, decedent~vnd~ Hopewell Township ~p, 1071 Ridge Road RESIDENCE decedent la. Shippensburg, PA 17257 o~o~h~d*) 17b. County Cumberland township? ¶?d.• No, flecedentllved ~. ~.J-oyd K. Burkholder 1,. Betty E. Blair INFORMANT'S NAME (Type/Print) INEOJ~A.~PS MAILING ADDR~SS~Slr~et, City, own, State. Zip 20~. T.1oyd K. Burkholder 20~..~/~ ScOtlanD maJ. n ~treet, Chambersburg~ P~ 17201 Donation[] Burial [~] Cremation [~ ..... Iflom State [] ( .......... ) orOtherPlece 21.. Oth~r(Sp~Ory) [] 21b. 6--21--04 21o. Spr.5-ng Hill CemeteryIred' Shippensburg~ PA 17257 s,GNA o .E S EL, E.SEEORPERSONACT,.GASSUC. I.CE.SENUM0129}~4_~ER I.~E^NDADO.ESSOF~AC,~,TY persm~ who pronounces death. I ' ( O ~ I t C~-~ ~ ' --~-,,-x ~'1 -- Yes IT~ No 'MMEDtATE CAUSE (Final ~')S' ' Z ~7 ~__ ' : onset and death ~ cause, if anY' leading t° immedistel Enter UNDERLYING .... O( ................ ): / ..... ~.' ~ i COMPLETION OF CAUSE Natural [~ Homicide [] OF DEATH? Accident [] Pending Invest~gatlen [] Yes [] No [] Yes [] No [~ Yes [] No ~ Suede [] Cou d nol be d .... ed [] 30a. ~b. M 30c. 30d. ...... It:R (Check only one) , ' : SIGNAT. IJ~ AND TITLE OF CERT FI_~/.~ 'C~E.RJIF~Y~ IN.G.PHYS. IClA.N(~hysi.cta.n. certilyingcause o~'deethwhen another physiaanhaspronounceddeath and completed i~em 23) r--l: / /~,-'~, //._r~: ........ y ,nowl.g ..... tn occun-ed due to the causes(i) Ind manner aa sla~ed. ............................................................... I I 31b[ f f,.~:)/'~.~*~- PERMANEHT BLACK INK C uJ September 14, 2004 SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Certified Mail, Return Receipt Requested Ms. Glenda F. Strausbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re.' Estate of Daniel L. Burkholder No. 2004-00602 Dear Ms. Strausbaugh: Dc-. Other Offices Colonial Park Lancaster 717-652-7020 717-431-0131 Mechanicsburg Millersburg 717-691-5577 717-692-5810 Shippensburg York 717-530-7515 717-843-0502 Enclosed is a check in the amount of $625 for early payment on inheritance tax. Please send the receipt for this check to me, using the envelope provided. Thank you. Very truly yours, METZGER, WlCKERSHAM, KNAUSS & ERB, P.C. Jered L. Hock JLH/amm Enclosures cc: Lloyd K. Burkholder 311867-1 James E Carl Edward E. Knauss, IV* Jered L. Hock Steven E Miner Clark DeVere Francis J. Lafferty, IV David H. Martineau Andrew W. Norfleet Andrew C. Spears Young-Sub Koo * Board Certified in civil trial law and advocacy by the National Board of Trial Advocacy COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 28O601 HARRISBURG, PA 17126 O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004394 HOCK JERED L ESQ P O BOX 53OO 3211 NORTH FRONT STREET HARRISBURG, PA 17110 ........ fold ESTATE INFORMATION: SSN: 166-48-9454 FILE NUMBER: 2104-0602 DECEDENT NAME: BURKHOLDER DANIEL L DATE OF PAYMENT: 09/16/2004 POSTMARK DATE: 09/1 6/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/16/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $625.00 TOTAL AMOUNT PAID: $625.00 REMARKS: ~SEAL CHECK# 28400 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Jered L. Hock, Esquire 3211 North Front S~reet P.O. Box 5300 Harrisburg, PA 17110~0300 7003 3110 0002 9922 5446 Return Receipt Requested Ms. Glenda F. Strausbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Daniel L, Burkholder Date of Death: 06/16/2004 Will No. Admin. No. 2004-00602 To the Register: I certify that notice of (beneficial interest) estate administration 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 06/25/2004 : Name Address Lloyd K, Burkholder (sole heir and notified as such) 3725 Scotland Main Street Chambersburo PA 17201 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: Capacity: Signature Name: Jered L. Hock. Esauire Address: 3211 N. Front St., PO Box 5300 Harrisbum PA 17110-0300 Telephone(717) 238- 8187 Personal Representative X Counsel for Personal Representative Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 HOCK JERED L ESQ P 0 BOX 5300 3211 NORTH FRONT STREET HARRISBURG, PA 17110 RE: Estate of BURKHOLDER DANIEL L File Number: 2004-00602 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 10/05/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge Sincerely, GLENDA FARNER ~ Clerk of the Orphans' Court Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 BURKHOLDER LLOYD K 3725 SCOTLAND MAIN STREET CHAMBERSBURG, PA 17201 RE: Estate of BURKHOLDER DANIEL L File Number: 2004-00602 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 10/05/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge GLENDA FARNER STR3tSBAUGH Clerk of the Orphans' Court Glenda Farner Strasbaugh Register of Wilis 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 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 251 3/14/2005 DANIEL 1. BURKHOLDER 21-2004-0602 JERED 1. HOCK, ESQ. 3211 NORTHFRONTST P.O. BOX 5300 HARRISBURG, PA 171100300 JA Qty 1 Fee Description Additional Probate Fee Total 55.00 $55.00 Total: $55.00 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. l ~. -.-.---.,,.-, it. 'i'i _'t.;):.,;?:)l ~ ,ti ("~ j ~ C' ~ '" Lr~ '" "- ,<',~-- C' en ,- =' '._~-~ '" ,.Il, L'; ~ uJ i'I)''!" --;J =< ~I>:j.;..,\\,\ :r: "",,--,.:1 ~'!l' <;:",_""'IW'!'l""""_""""'" f<.1 12; !} 1 ...I - <C o .,; "' ~ 8 ~ ~ ~ ~ z "- :.: ..... .:....;!<""~~.~,,~ _"~,~'=~"m"_"~'i""""""""'''''''''''''''''''' I- en JX ~ H ,.,~,~"...,,>..,...,>. --,. ''',~'''~-~'' ,"'" -""'~ March 10, 2005 SINCE 1888 3211 North Front Street PO. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Ms. Glenda F. Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Other Offices Colonial Park Lancaster 717-652-7020 717-431-0131 Mechanicsburg Millersburg 717-691-5577 717-692-5810 Shippensburg York 717-530-7515 717-843-0502 Re: Daniel L. Burkholder No. 2004-00602 Dear Ms. Strasbaugh: Enclosed for filing are original and one copy of Inheritance Tax Return. Also enclosed are checks in the amounts of $17.60 for inheritance tax due and $15 for the filing fee. So that I may be sure this mailing has been received and the filing completed, please stamp the extra copy of the summary page with your clock-in stamp and return it to me in the pre-posted envelope provided. Thank you. Very truly yours, METZGER, WICKERSHAM, KNAUSS & ERB, P.C. G:---- Jered L. Hock JLH/amm Enclosures cc: Lloyd K. Burkholder ~~,..; James E Carl Edward E. Knauss, IV* Jered L. Hock Steven P. Miner Clark DeVere Francis J. Lafferty, IV David H Martineau Andrew W. Norfleet Andrew C. Spears 323109-1 Young-Suh Koo * Board Certified in civil triallawflndadvomcv hy/heNaliolln! Board of Tria/ Ad"uocacll '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT.2B0601 HARRISBURG, PA 1712B.()601 v;,;~- i:\ Si[~'\) M ,'p, u Ss db I)r!. U()REV-1500# J..r;l INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1~EX+(6-00) W I- ,,$11> 0"''' W..O ",00 ufiil .. < v DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C W U W C BURKHOLDER DANIEL L. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 06/16/2004 03/14/1961 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) [X] 1. Original Return D 4. Limited Estate o 6. Decedent Died Testate (AIlach copy of Win) o 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dateofdealhaIter12.12.a2) o 7. Decedent Maintained a living Trust (Attach copy of Trust} D 10. Spousal Poverty Credit {dateofdealh between 12.31.91 and 1.1-95) OFFICIAL USE QNl Y FILE NUMBER 21-040602 ""'COUNTY"'Cci6E -Y"EAR- - - NUMBER-- SOCIAL SECURITY NUMBER 1 66- 4 8 - 9 4 5 4 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (date ofdeath priorto 12-13-82) o 5. Federal Estate Tax Retum Required .!.. B. Total NumberofSafe Deposit Boxes D 11. Election to tax under Sec. 9113(A) {A"'" So" 0) 0.00 X _(15) 0.00 15,010.78 X .045 (16) 675.49 0.00 X .12 (17) 0.00 0.00 X .15 (IB) 0.00 (19) 675.49 I- Z W C Z o .. II> W '" '" o o 'tHISSIlCl!ON,.USTr NAME Jered L. Hock Es uire FIRM NAME {If Applicable) Metz er Wickersham Knauss & Erb P.C. TELEPHONE NUMBER 717 238-8187 Harrisbur P.O. Box 5300 z o 5 ::l l- ii: <C u w II:: 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Joinly Owned Property (Schedule F) (6) o Separate Billing Requested 7.lnterNivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) B. 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 (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= <C I- ::l D. :!!: o U ~ I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a){1.2) 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 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SORE TO ANSWER ALL QUESTIONS ON REvERSE7SIEJE AND RECHECK MATH < < 49,900.00 pA 17110"0300 OFFICIAL USE ONLY 326.95 (B) 50,226.95 12,855.28 22,360.89 (11) (12) (13) 35,216.17 15,010.78 (14) 15,010.78 Decedent's Comolete Address: STREET ADDRESS 1071 Ridae Road Cumberland Countv CITY I STATE I ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 675.49 625.00 32.89 Total Credits (A + 8 + C) (2) 657.89 3. InteresUPenalty if applicable D. Interest E. Penalty 4. T otallnteresUPenalty ( D + E ) If Line 2 is 9reater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (3) 0,00 (4) (5) (5A) (58) to: REGISTER OF WILLS, AGENT 0,00 17.60 5, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. A Enter the interest on the tax due, 8, Enter the total of Line 5 + 5A This is the BALANCE DUE. Make Check 17,60 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a, retain the use or income of the property transferred; ........................................................................... D ~ b, retain the right to designate who shall use the property transferred or its income; ,....................................... D ~ c. retain a reversionary interest; or ...................................................................................................... 0 [Xl d. receive the promise for life of either payments, benefits or care? ............................................................. D ~ 2, If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?"""",.."""..,... ......,'..""".."",.. .........."",........"""""""",'.."" D ~ 3, Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................, D ~ 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... D lKl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE SIGN 3725 Scotland Main Street Chambersbur EPARER OTHER THAN REPRE ENTATIVE t:JOS" ::..5' c.:::P PA 17201 DAT "3 ADDR 1 orth Front Street, PO Box 5300 HarrisburQ 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 PS, 99116 (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, 99116 (a) (1.1) (ii)), The statute does not exemot a transfer 10 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 Juiy 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 naturai parent, an adoptive parent, or a stepparent of the child is 0% [72 P,S, 99116(a)(I.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. 99116(1.2) [72 P,S, 99116(a)(I)], 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, 99116(a)(1,3)1, 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. REV-1S02 EX + (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BURKHOLDER DANIEL L 21 04 0602 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real Drooertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION Lot located at 1071 Ridge Road, Shippensburg Post Office, Hopewell Township, Cumberland County, PA; Property Tax 10 11-10-0610-01 B; consisting of tract 150 fl. x 145 fl. x 150 fl. x 145 ft. and containing 1970 vintage mobile home; sold since 000 to Lewis B. Nolt for $49,900. Please see HUD Statement attached. VALUE AT DATE OF DEATH 49,900.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 49 900.00 A. Settlement Statement U.S. Department of Housing and Urban Development ~ 1r ~ OMB No. 1502-0265 (Page II 8. Type of Loan 1. C FHA 2. 0 FmHA 4. C V A 5. t8J Conv. Ins. 3. 0 Cony. Unins. 16. File Number 3151~S 7. wan Number 42081003 18. MortgagelnsW'anceCaseNumber C.:Sote: Tblll form II l'umlsl>od 1<1 tw. you ~.tI~m.mGr"IUaI..Ul...enl""U. AIIIOIIIIU paid 10 ond by du: '.ll~.III.gc"'.... ,110"0. he... ...rked "Ip.....l"werc paid oul.ide lhe dQ.lID~; llicy a.. .hown lie.. for lomnn.lIo...lpurpoHSlUldon....'III.llHl.dtllll.roI.OIL "E Name, Address, and Taxpayer identitication # of Seller Daniel L. Burkholder Estate Lloyd K. Burkholder, Administrator 1071 Ridge Road Shippensburg, PA 17257 'F Name anJ Addres.s of Lender AgChoice Farm Credit 109 Fann Credit Drive Chambersburg, PA 17201 D. Name and Address of BOiTOwer Lewis B. Nolt 992 Ridge Road Shippensburg, PA [7257 H. Settlement Agent Name, Address and Tal\payeT Identification Number HamiltonC.Oavis P.O. Box 40 Shippensburg, PA 17257 25-1530888 G. Property Location 1071 Ridge Road, Shippensburg, Pennsylvania Hopewell Township, Cumberland County Tax Parcel No. 11-1O-061O.018B Place of Settlement 20 E. Burd Street, Shippensburg, PA 17257 K, Summary of Seller's Transaction 400, Gross Amount Due To Seller ;1. SettlemenlDate i 9f812004 J. Summary of Borrower's Transactions 100. Gross Amount Due From Borrower 101. Contract sales price 49,900.00 401. Contract sales price I 49,900.00 102. Personal Property 402. Personal Property 103. Settlement charges to borrower (line 14(0) 2,150.75 403. , 104. 404. I 105. 405. I Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106. City/town taxes to 406. City/town taxes to I 107. Countytax.es 09/08/04 to 12/31104 12.35 407. Countytax.es 09/08/04 to J 2131104 I 12.35 108. Assessments to 408. Assessmems to I too. School Tax. 09/08/04 to 06/30/05 160.44 409. School Tax 09/08/04 to 06/30105 I 160.44 110. 410. , 111. 411. 112. - 412. 120. Gross Amount Due From Borrower 52,223.54 420. Gross Amount Due To Seller 50,072.79 2:00. Amounts Paid By Or in Behalf Of Borrower 500. Reductions io Amount Due To Seller 201. Deposits or earnest money I 500.00 501. Excess deposit (see instructions) 202. Principal amount of new 100n(s) I 55,000.00 502. Settlement charges to seller (line 1400) 4,448.79 203. Existing loan(s) taken subject to I 503. Existing Joan(s) taken subject to 204. 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206. 506. Payoff to: M&T Acct #10900190413000001 4,158.39 207. 507. Payolfto: M&T Acct #10900190199000001 5,287.18 208. I 508. Payoff to: Credit One Acct #06444752 7,470.72 209. I 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210. City/towntaxes to 510. City/towntaxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. School Tax. to 513. School Tax. to 2]4. 514. 215. 515. 216. 516. I 217. I 517. I 2l8. 518. 219. I 519. I 220, Total Paid By/For Borrower i 55,500.00 520. Total Reduction Amount One Seller i 21,365.08 I 300. Cash At Settlement FromITo Borrower 600. Cash At Settlement To/From Seller 301. Gross Amount due from borrower (line 120) 52,223.54 601. Gross Amount due to seller (line 420) , 50,072.79 302. Less amounts paid by/for borrower (line 220) I( 55,500.00 602. Less reductions in am!. due seller (line 520) I( 21,365.08) 303. Cash DFrom [Xl To Borrower $3,276.46 603. Cash 'Xl To DFromSeller $ 28,707.71 I bavecarefully re,vi<:wed the HUD-l Settlemenr Stalememand to till> I:>est of my knowledge and OOhe~~ ~.curatena~~~~~rece;?helltsm~~ account or by me mrhiliuansacuon.1 furthercernfythat I have """,iveda completed copy of pages I and 2 of "7;: L),"' ::;;"A"': '+1/.II'J<:. . JJ.liN --d fJZ.-Ir Borrower Lewis 8. Nolt 7"" i ~d K. Burkholder, Administrator Seller Seller's Tupayer Jdeollficatlon Number Solicitation and Ceniflcatlon you..... "'.<luircd by low to pro,'ide the Senle",",,' A~.." named .bove wit~ "OU' 00....01 to'poy... idc.otiticollnn numbe,. lfyon,d9 00' pro~'de tlle Settlement A~ent wub tin' C.ml:ct '"-'pOX" td.""~c.<ion numb..- YO" IDa> ~~o~~J~,~.c:~~,;,li'':~ =;\'~';:~~:~de~riA~~i;o:~:m~.'I".. ofp"'Jury. I .:.nill; that the numb., HUD_ i 3/9] Selkr'sSilmlltw"e Dale RESPA,HB4305,2 p// 1:: Settlement Charges 700. Total Sales/Broker's Commission based on $ Division or Commission (line 700) as follows: $ m $ m '%= PllidFmm Borrower's Funds at Settlement Page 2 Paid From Seller's Fundsal Senlement @ 701. 702, 703. Commission paid at Settlement 704 ~OO. Item_s Payable in Connection With Loan 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804, Credit Report 805. Lender's Inspe'lion Fee 806, Mortgage Insurance Application Fee to AgChoice Farm Credit 807. Lenders Stock Participation to: AgChoice Farm Credit 808. 809. 8]0. 811. 900. 901. 902, 903. 904. 905. 1000. ]OOl. 1002. ]003. 1004, 1005. 1006. 1007, 1008. 1100. 110l. 1102_ 1103. 1104. 1105, ]106. 1107. I % % 10: AgChoice Farm Credit 200,00 to to ]8.00 : 500.00 i lIems Required B}' Lender To Be Paid In Advance Interest from to @$ Mongage Insurance Premium for Hazard Insurance Premium for Iday montns to years to Reserves Deposited With Lender Hazard Insurance Mongage Insurance Ciry property taxes County propeny taxes Annual assessments School Taxes months@$ months@$ months@$ months @ $ months@$ months@$ months@$ per month per month per month per month per month per month per month 1108. Aggregate Reserve Adjustment Title Charges Settlement or closing fee Abstract or title search Title examination Title insurance binder Document preparation Notary's fees Attorney's fees (inc1ude~ above items numbers; Title insurance (includes above items numbers: Lender's coverage Owner's coverage 49,900.00 to to I ~ to to to to to Jered Hock, Esquire I ) 1,200.00 to Hamilton C. Davis, Agent (for CTrC) 558.75 1109. 1110. 1111. 1]12. 1113. noo. 1201. 1202. 1203 1204. 1205. 1300. 1301 1302. 1303. j304 1305. 1306 1307. 11!l8 1309 1400. Total Settlement Char2C! (enter on lines 103, Section J and 502. Section K) 2,150.75 4,448.79 Inhial Escrow Accounl Slatemenl Required b)' Section 10 (c) (1) oftbe Real Estlle Setllement Procedures Act (RESPA) If cha:ked, [J the lenns of your loan require you 10 have an escrow account to assure that the certain obligations relating to the mortgaged properly, such as taxes, insurance premiums and other charges are paid. The amounl specified below will be collected, along with your mortgage principal and interest payments, during the first 12 months after your account is opened to pay these anticipated expoenses: EIicn:Jw Aa:ount $ $ Government Recording and Transfer Charges Recording fees: Deed $ 50.00; Mortgage $ 75.00; Releases $ City/county tax/stamps: Deed $ 499.00 ; Mortgage $ State tax/stamps: Deed $ 499.00 ; Mortgage $ Additional Settlement Cbarllcs 2UU4/05 School Tax to: HarryE. Killian, Tax Collector E:tpenses to: Metz~er Wickersham Knauss & Erb PC Escrow for Pa. Inheritance Taxes to: Metzllcr Wickersham Knauss & Erb PC Additional Attomey Fee to Hamilton C. Davis, ESQuire Beginning Date: Your e~crow acconnt payment will be S Purpose Antlelplted Due Date p" Pa~'ee EstlmaledAmount HUD-13!9J RESP A, HB 4305.2 --- ~(Q)~W THIS DEED c) y~ Made this ~ day of September, in the year Two Thousand Four (2004). Between LLOYD K. BURKHOLDER, Administrator of the Estate of DANIEL L. BURKHOLDER, deceased, late of Hopewell Township, Cumberland County, Pennsylvania, party of the first part, GRANTOR and LEWIS B. NOLT, of992 Ridge Road, Shippensburg, Pennsylvania, party of the second part, GRANTEE Whereas, the said Daniel L. Burkholder became in his lifetime seised, in fee, of and in a certain lot or piece of ground, together with the buildings and improvements thereon erected, situate in Hopewell Township, County of Cumberland, State of Pennsylvania, known as 1071 Ridge Road, Shippensburg, Pennsylvania, and more particularly described hereinafter; and being so thereof seised, departed this life on June 16,2004, not having made a Last Will and Testament, of whose estate, Admin No. 2004-00602, the said Lloyd K. Burkholder was appointed Administrator and to whom Letters of Administration were duly issued by the Register of Wills of Cumberland County, Pennsylvania, on June 25, 2004, as in and by the records of said Register of Wills, recourse thereunto being had, appears. Now this Indenture witnesseth, that said Grantor, for and in consideration ofthe sum of Forty- Nine Thousand Nine Hundred Dollars ($49,900) to said Administrator in hand paid by the said Grantee at or before the sealing and delivery thereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released, and confirmed, and by these presents does grant, bargain, sell, alien, release, and confirm unto the said Grantee, his heirs and assigns, the following: All that certain tract of land situate in Hopewell Township, Cumberland County, Pennsylvania, more fully bounded and described as follows: Beginning at a nail and washer in the center line of Legislative Route 21046 and corner of other land now or formerly to be conveyed to the Ridge Church of the Brethren; thence along said land of the Ridge Church of the Brethren, North 29 degrees 37 minutes West 150 feet to an iron pin and other land now or formerly ofJohn E. Fogelsanger and Velva H. Fogelsanger, his wife; thence by the said land now or formerly of Fogel sanger, North 59 degrees 49 minutes East 145 feet to an iron pin; thence by the same, South 29 degrees 37 minutes East 150 feet to a spike in the center line of the said Legislative Route; thence along the center line of the said Legislative Route, South 59 degrees 49 minutes West 145 feet to a nail and washer, the place of beginning. 31!299-1 '!It. Containing 0.5 acres, more or less, pursuant to a survey of John Howard McClellan, R.S., made May 27, 1966. Being the same premises which DanielL. Burkholder and Pamela K. Burkholder, husband and wife, by deed dated January 10, 2002, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book 253, Page 3497, granted and conveyed unto DanielL. Burkholder, the said DanielL. Burkholder being the decedent of whose estate Lloyd K. Burkholder is Administrator and Grantor herein. Together with all and singular ways, waters, water--course, rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in any wise appertaining, and the reversions and remainders, rents, issues and profits thereof; and also all the estate, right title, interest, use, trust, property, possession, claim and demand whatsoever, in law, equity, or otherwise howsoever, of, in, to, or out of the same: To have and to hold the said hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said Grantee, his heirs and assigns, to and for the only proper use and behoof of the said Grantee, his heirs and assigns, forever. And the said Grantor does promise and agree, to and with the said Grantee, his heirs and assigns, that he, the said Grantor, has not done, committed, or knowingly or willingly suffered to be done or committed, any act matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached charged or encumbered, in title, charge, estate, or otherwise howsoever. In witness whereof, the said Grantor has hereunto set his hand and seal the day and year first above written. Signed, sealed, and delivered ~~',"f GRANTOR: .~ ~ 10 . Burkholder, Administrator of the Estate of Daniel 1. Burkholder, deceased 3//299-1 / .7i COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF : dti On this, the ~ day of September, 2004, before me the undersigned officer, personally appeared LLOYD K. BURKHOLDER, Administrator of the Estate of DANIEL L. BURKHOLDER, deceased, known to me (or satisfactorily proven) to be the person described in the foregoing instrument, and acknowledged that he executed the same in the capacity therein stated and for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand Notarial Seal Haminon C. Davis. Notary Public ShiPll8/l8l)Urg Bora, Cumberland Count, My Commission Expires Seplca7,-2llQ4. =~C=..~.- c:;.,. i ) (SEAL) Member. ~..... :,^~.'.A'.,'1......... M....~ri.o~ COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND Recorded in the Office for Recording of Deeds in and for Cumberland County in Record Book , Page , Etc. WITNESS my hand and seal of Office this _ day of , Anno Domini 2004. , Recorder 311299-j REV;1508 EX + (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 04 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ESTATE OF BURKHOLDER DANIEL L ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 0602 DESCRIPTION County real estate tax rebate, as per HUD Setllement Sheet VALUE AT DATE OF DEATH 12.35 School real estate tax rebate, as per HUD Setllement Sheet 160.44 Patriot Federal Credit Union 5.10 Progressive Casualty Insurance Company - insurance refund 110.54 Gas company - credit for unused propane 38.52 1991 ChevrolelTruck, Model S10, VIN 1 GCCT1928M2137533, worthless and hauled away by Hostetler's Salvage Yard, Shippensburg, PA 0.00 1987 Subaru Station Wagon, VIN JF1AN4388HC459030, worthless and hauled away by Hostetler's Salvage Yard, Shippensburg, PA 0.00 1970 Fleetwood Mobile Home, Iitlle value, left on real estate and included in the real estate sale price set forth in Schedule A 0.00 Miscellaneous old and used furniture, left in mobile home when house was sold, as part of sale deal with purchaser, no separate value 0.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 326.95 REV~1511 EX + (12-99) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF BURKHOLDER DANIEL L FILE NUMBER 21 04 0602 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Spring Hill Cemetery 425.00 2. Fogelsanger Bricker Funeral Home 6,657.50 3. Gordon's Memorials - grave marker 640.00 4. Shirley Morris - organist for funeral 50.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Metzger, Wickersham, Knauss & Erb, P.C. (estimated) 3,000.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 85.00 5. Accountanfs Fees 6. Tax Return Prepare(s Fees Metzger, Wickersham, Knauss & Erb, P.C. (estimated) 450.00 7. Cumberland County Register of Wills - Short Certificates 18.00 8. Harry E. Killian - real estate taxes paid to preserve real estate 39.55 9. Staples - faxing charges 3.12 10. Darrell's Lawn Mowing - necessary property upkeep and maintenance to make 123.60 property attractive for sale 11. Commonwealth of PA - title for 1991 Chevrolet, required for salvage of same 22.50 12. Commonwealth of PA - title for Fleetwood Mobile Home 22.50 TOTAL (Also enter on line 9, Recapitulation) $ 12 855.28 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent BURKHOLDER, DANIEL L. Decedenfs Name Page 1 21 04 0602 File Number Schedule H - Funeral Expenses & Administrative Costs - 87. ITEM NUMBER OESCRIPTION AMOUNT 13. Hamilton Davis Law Office - settlement expenses 200.00 14. Cumberland County Recorder of Deeds - realty transfer tax 499.00 15. Harry E. Killian - school tax 198.51 16. AAA - vehicle title transfer fees 21.50 17. Cumberland Law Journal - fee for publication of Estate Notice 75.00 18. News Chronicle Co. - fee for publication of Estate Notice 84.50 19. Metzger Wickersham - reserve for further photocopy, fax, and telephone tolls 40.00 20. Reserve for filing Account 150.00 21. Reserve for closing 50.00 SUBTOTAL SCHEDULE H.B7 1,318.51 REV-1512 EX + (6-98) * SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BURKHOLDER DANIEL L. FILE NUMBER 21 04 0602 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Tax Claim Bureau - real estate tax debt of decedent VALUE AT DATE OF DEATH 532.29 2. Patriot Federal Credit Union - debt of decedent 1,684.81 3. Penelec - debt of decedent 31.00 4. Cumberland Valley EMS - debt of decedent 83.82 5. Cumberland Valley Medical Services - debt of decedent 17.72 6. Household Credit Service - debt of decedent ($635.07 - settled for $400) 400.00 7. Hockersmith Auto - debt of decedent 217.84 8. Trill's Plumbing & Heating - debt of decedent 274.16 9. Timmons - debt of decedent 68.48 10. Sprint - debt of decedent 366.68 11. CRA Security Systems I Sheetz - debt of decedent 74.21 12. CRA Security Systems I Rite-Aid - debt of decedent 69.36 13. Hershey Medical Center - debt of decedent 68.50 14. M&T Mortgage. Acct #10900190413000001 - debt of decedent 4.158.39 15. M&T Mortgage, Acct #10900190199000001 - debt of decedent 5,287.18 TOTAL (Also enter on line 10. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 22,360.89 Continuation of REV-1500 Inheritance Tax Return Resident Decedent BURKHOLDER, DANIEL L. Decedent's Name Page 2 21 04 0602 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. Credit One, Acct #06444752 - debt of decedent 7,470.72 17. Metzger Wickersham - outstanding debt of decedent 821.90 18. George W. Barer, M.D. - debt of decedent 157.83 19. Chambersburg ALS - West Shore - debt of decedent 576.00 SUBTOTAL SCHEDULE I 9,026.45 GRAND TOTAL SCHEDULE I $ 22,360.89 . REV.f513EX><* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER DI I m::o nANIFL L 71 0"- nfm7 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE L TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfe" under Sec. 9116 la) (1.2)] 1. Lloyd K. Burkholder Lineal 15,010.78 3725 Scotland Main Street Chambersburg, PA 17201 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET IL 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 OF PART II - 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) CDMMONWEALTH OF PENNSYLVANIA OEP;.;"'r\tMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11.96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HOCK JERED L ESQ POBOX 5300 3211 NORTH FRONT STREET HARRISBURG, PA 17110 nnUn fold ESTATE INFORMATION: SSN: 166-48-9454 FILE NUMBER: 2104-0602 DECEDENT NAME: BURKHOLDER DANIEL L DATE OF PAYMENT: 03/11/2005 POSTMARK DATE: 03/1 0/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/16/2004 NO. CD 005049 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $17.60 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 30195 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $17.60 GLENDA FARNER STRASBAUGH REGISTER OF WILLS lVW METZGER WICKERSHAM March 10, 2006 SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Ms. Glenda F. Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Other Offices Colonial Park Lancaster 717-652-7020 717-431-0138 Mechanicsburg Millersburg 717-691-5577 717-692-5810 Shippensburg York 717-530-7515 717-843-0502 Re: Daniel L. Burkholder No. 2004-00602 Dear Ms. Strasbaugh: Enclosed for filing is Status Report Under Rule 6.12. So that I may be sure this mailing has been received and the filing completed, please stamp the extra copy ofthe Report with your clock-in stamp and return it to me in the pre-posted envelope provided. Thank you. Very truly yours, METZGER, WICKERSHAM, KNAUSS & ERB, P.C. (~ J ered L. Hock JLH/amm Enclosures cc: Lloyd K. Burkholder (w/enc.) O~:I U~ 01 I ...(; G James F. Carl Edward E. Knauss, IV* Jered L. Hock Steven P. Miner Clark DeVere Francis J. Lafferty, IV Andrew W. Norfleet Karen W. Miller Mark E. Clouser * Board Certified ill civil trial law and advocacy b!!!i1f Natiol1al Board 349094-1 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Daniel L. Burkholder Date of Death: 6/16/2004 Will No. Admin. No. 2004-00602 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 X 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. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans' Court No. (if any) for the personal representative I 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 informal accounts may be filed with the Clerk of the Orphans I Court and may be attached to this report. Date: ~~ lliJ 0(.., ~-tL Signature Jered L. Hock. Esauire Name (Please type or print) 3211 North Front Street, PO Box 5300 Harrisbura PA 17110-0300 Address (717 ) 238- 8187 Tel. No . Vel Jf) Capacity : Personal Representative X Counsel for personal representative Of} : J , f/d (' I I'L' v ,..,[;../,.. {)