HomeMy WebLinkAbout04-0606 PETITION FOR PROBATE and GRANT OF LETTERS
E.~tate of Helena I. Smith
To:
Register of Wills for the
Social Security No. 204-28-126'8 Deceased. County of ~C'~ard~rland
Commonwealth of Pennsylvania
The petition of the undersigned respectfully repr~ents that:
Your petitioner(s), who is/are 18 years of age or older an the executrix
in the last will of the above decedent, dated _ l~cemb~r 8
and codicil(s) dated -'
in the
_ named
., m_, s
(state relevant circ.mstancc.% c,g. renunciation, death of executor, crc.)
Decendent was domiciled at death in __Cumberland
County, Pennsylvania, with
I~er last family or principal residence at l~ket Street, LemQvne,
. __PA, 17043
(li.~t street, number and muncilxality)
Decendent, then 81 . years of age, died ~
Except as follows, decedent did not marry, wa..q not divorced and did not have a child bom or adopted
after execution of the will offered for probate: was not the victim of a killing and was never adjudicated
incompetent: N/A .. '
Deeendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 40,000.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: N/A Sm
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters~_.~,q_t,~l~n~ . .
thcron.
Donna L. Prarlk
Yeaqe~_own, PA
17099
(testamentary.: administration c.t.a.; administration d.b.n.e.t.a.)
--
OATH OF'PERSONAL REPRESENTATIVE
COMMONWEALTH O.F PENNSYLVANIA '] ss
COUNTY OF Cumber]and f
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition arc
truc and correct to the best o£ the knowledge and belief of petition~'ts~
tative(s) of the above decedent petitioner(s) will ~,, .... that as personal represen-
well and truly administgr t.~ estate aecording..to law.
bef .......... '-
ore me this ~-0c4~x`-~ ~- -
'" uayol' / ~ - ' ' -
No. ~.t - oq - {, o'%
Estate Of, Helena X. Smith
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW (~ xor~m_ tC)_q' 1~ 2004 in consideration of thc petition on
the reverse side h'~of, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated_ _Decem~....r ~,. 1998
described therein be admitted to probate and filed of record as the last will of. Helena I. Smith
and Letters __TesLamo. n~-arv ;
are hereby granted to Donna L. Frank
FliES
Probate, Letters, Ere ..........
Short Certificates( ) .......... $
.s~nam.~~._~,.~. s Q.c'~
· ,~x,~.~ TOTAL
F~a . .~q,. ~ ..........
James W. Kollas (81959)
ATTORNEY (Sup, Ct. I.D. No.)
1104 Fernwood Avenue, Suite 104
C~m~ Hill, PAAoo~S~
71 7-731-1600
PHONE
1 7011
105.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
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
No.
Hey 2/87
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
,- Helena I. Stol. th ~le I, 204 _ 28 ' '
AGE(LaMO~nr~aY) I u_U~I~_R.tY~E~Jt I U~RlO~ [--D~E~ffiRTH I ~HP~CE'C~--' -- 1268 I:~m'~;. 2004
?: ........ Marian Duszkowski ~m~..s.~,~.~. ~. ~,~ ~.~ . ~~.
~r~¢~m ~ ~ ~ Sokolowska
~ ....... Debbi R~berger 1'"'~'3~
~s~. - _ ...... ~~w u~ve~ ~*~sDurg~ PA 1~019
~AME AND ADORESS OF PERSON WHO COIdPLETEO CAU~ OF OEATH
LAST WILL AND TESTAMENT
OF
HELENA I. SMITH
I, HELENA I. SMITH, of 819 Market Street, Lemoyne, Cumberland County,
Pennsylvania 17043, do make and declare this to be my last Will and Testament, hereby revoking
all prior Wills and Codicils.
FIRST: I direct that all my debts and funeral expenses be paid as soon a/ter my death as
may be practicable. I further direct that all estate, inheritance, transfer, legacy, or succession
taxes which may be assessed to my estate, or any part of my estate, whether passing under my
will, shall be paid out of my residuary estate as an expense of administration and without
appointment.
SECOND: I make the following specific bequests:
A. I bequeath to SOFIA E. BRUMBACH of 107 Pleasant View Terrace, New
Cumberland, Pennsylvania, any and all personal effects and furnishings which she may
select from my apartment at 819 Market Street, Lemoyne, Cumberland County,
Pennsylvania.
B. I bequeath to DONNA FRANK of 124 North Main Street, Yeagertown,
Pennsylvania, any balance remaining from my insurance policy with the Life Insurance
Company of North America and the Commonwealth of Pennsylvania a/ter payment has
been made for my burial from said insurance policy.
C. I give the rest, remainder, and residue of my estate as follows:
i) Thirty percent to DEBORAH RAMBERGER of 52 Glenview Drive,
Dillsburg, Pennsylvania 17019;
· ' ii) Twenty percent to SOFIA E. BRUMBACH;
i~:~ iii) Fifbj percent to the GOOD SHEPARD CATHOLIC CHURCH of 3435
~ Trindle Road, Camp Hill, Pennsylvania, provided that said church conduct
..~: memorial services for the next Ten (10) years for my deceased son, Raymond
Smith, and for me, Helena I. Smith, on the Sunday closest to the anniversary of
our respective dates of death and our respective Birthdays, and on Christmas and
Easter.
THIRD: I hereby constitute and appoint DONNA FRANK of 124 North Main Street,
Yeagertown, Pennsylvania, Executrix of my Will. In the event DONNA FRANK does not
survive me or cannot act as my Executrix, I hereby constitute and appoint DEBORAH .
RAMBERGER of 52 Glenview Drive, Dillsburg, Pennsylvania, as my Executrix. No Executrix
acting hereby shall be required to post bond or enter surety in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~:~B day of
HELENA I. SMITH
SIGNED, PUBLISHED, and DECLARED by the above, HELENA I. SMITH, as and for her
Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the
presence of each other, have hereunto subscribed our names as witnesses:
· ' .pfc /
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
We,~'~?~' _6~ ~jfj,~]74 and 0_G tO/a,_ ~(_~ , the witnesses whose names
are signed to the attached instrument, being duly qualified according to law, do depose and say
that we were present and saw the Testatrix, HELENA I. SMITH, sign and execute the
instrument of her Last Will and Testament; that she signed it willingly and that she executed it as
her free and voluntary act for the purposes therein expressed; that each of us in the hearing and
sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the
Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn to and subscribed to before me by/'/~iq, d' [A~ajq.J-2?~/ and
cOD,. {2.O~,. , witnesses, this ~ day of ~,._~-o~ , 19~___.,.
Witness
Witness
Notary Public
i NOTARIA-£ sEAL
CHRISTA M. HOFFMAN, Notary Pubh¢/
Newberry Twp., York County
My Commission Expires Dec 22, 2001
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
I, HELENA I. SM1Tlt, Testatrix, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I have signed and
executed the instrument of my Last Will and Testament; that I signed it willingly; and that I signed
it as my fi-ce and voluntary act for the purposes therein expressed.
Sworn to and acknowledged before me by lIE. LENA I. SMIT[I the Testatrix, this c-%4~
day of~C.e.r-x_~.~2_ , 199 ~b. ~
Notary Public
NOTARIAL SEAL --
CHRISTA M. HOFFMAN, Notary Pubhc
Newberry Twp., York County
My Commission Expires Dec 22, 2001
CERTIFICATION O1* NOTICE
Name of Decedent: Helena I. Smith
Date of Death: April 25 t 2004
Will No. 2 g)c9 9'- /9 c9 ¢"c3 C
To the Register:
Adm. N0. 2/- oq-O~o~
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 following beneficiaries of the above-captioned
estate on :
Nam.e. Address
Donna Frank P.O. Box 26, Yeaqertown. pA
Sofia E. Brumbach 107 Pleasant View Terrace,
Deborah Ramberqer 52 ~lenview Drive.
Good Shepard Catholic Churcht 3435 Trindle Road:
17099
New eumberlandoPA 17070
PA 17019
Camp Hill. PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6a) except:
Date:
ture)
Name:. James W, Kollo$
Address: 11 04 Fernwood Avenue
Camp Hill. PA 17011
Telephone ~ 1 7) 7 31 - 1 6 O O
Capacity: Personal Representative
x Counsel for Personal
Representative
HELENA I. SMITH
ESTATE OF
Notice of claim by_ BOSCOV'S
CLAIM FORM
ORPHANS, COURT DIVISION 0~
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY NO. 21-04-606
in the amount of $ 24 5.8 $ filed pursuant to section 2284, Probate, Estates and
Fiduciaries Code Laws of 1972, Act No. 104 effective July 1, 1972 aa amended.
in the azaount of $
who resided a=
Date
9441 LBJ O EgVAY
Lock Box
Dallas, TX 75243
TO TH~ CLEB3( OF THE ORPJ~%NS, COURT DIVISION:
Enter the claim of BOSCOV'S
(Claimant and Address)
245.88
against =he above entitled Estate.
19
The decadent
4/25/04
(Address) died on
(Da=e)
Writ=eh no=ice of said claim was given to DONNA FRANK c/o JAME KOLLAS, ESQ.
(Personal Represen=atiwe or Counsel)
11~4 WRRNWOOD AVE. #104 CAMP HILL PA 17011
(Address) on
(Date)
The basis of aforesaid claim is as follows: (Itemize fully to enable personal representative
=o make proper investigation).
Acct. #003188396
Claimant's Counsel
(Name)
(Address)
PROBATE COURT
Cumberland County, State of Pennsylvania
Helena I. Smith, Deceased
Case #21-04-606
Proof of Mailinq
I mailed the creditors claim to the fiduciary (and attorney, if applicable as
follows:
I deposited a copy/copies of the claim with the United States Postal Service in
a sealed envelope with the postage fully pre-paid. I used first-class mail. I
am employed in the county where the mailing occurred. The envelope(s) was/were
addressed and mailed as follows:
Ms. Donna Frank
c/o Jame Kollas, Esq.
1104 Fernwood Ave. Suite 104
Camp Hill, PA 17011
Date of Mailing:
County of Mailing:
Dallas, Texas
I declare unde~Talty of perjury that the foregoing is true and correct.
Date:
~Boscov ' s
P.O. Box 741026
Dallas, TX 75374
._age: 1 Document Name:
)
ORGANIZATION 100 LOGO
SHORT NAME
TOT C9 T,MT 0
CA CR LMT 0
CASH BAL .00
CASH AVAL .00
O-T-B **********0
PCT LEVEL / iD S PA
CURR BAL 245.88
BARBARA CASSIDY
BOSCOV'S CREDIT DIVISION
ACCOUNT INQUIRY
110 ACCT 0000000000003188396
SMITH ESTATE OF STATE PA
EMPT, CD
CSH AUTH
TOT DISP 0
CASH DSP
CYCLE DB 0
CYCLE CR 0
CYCLE PMTS
HOME PHONE
STATUS Z
PAGE 01
09/18/2004
11:05:03
REL
717'7322749 BLOCK CODES
NBR PLANS
.00 CARD USAGE
.00 BILLING CYCLE
.00 DATE OPENED
.O0 CARD FEE DATE
.00 DTE LST BILL
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1
4
3
!0/01/1985
09/03/2004
;f::.,';OOEJ."'~\ .
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEOENTS NAME (LAST, FIRST, ANO MIDOLE INITIAL)
smith, Helena I.
DATE OF DEATH (MM-OD-YEAR)
04-25-2004
OFFICIAL USE ONLY
FILE NUMBER
...l...L-..Q.A.... 0 6 0 6
COOlmCOOE IDA -if:iWieR- --
SOC~SECURITYNUMBER
204 - 28
1268
THIS RETURN MUST se FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOC~ SECURITY NUMBER
(!] 1, Original Return
o 4. Limited Estate
o 6. Decedent Died Testata (Attach copy of Will)
o 9. Utigation Proceeds Received
o 2. Supp\eme!ltal Re\Urn
o 4a. Future Interest Compromise (dlIl8 01 delll1 after 12.12-62)
D 7. Decedent Maintained a Uving Trust (AttaCh alpyolTIIISt)
o 10. Spousal Poverty Credit (dale of dHlh between 12.31-91 and 1-1-95)
o 3. Remainder Relum (date ofdealh prior 10 12.13-82)
o 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
o 11. Election 10 tax under Sec. 9113(A) (AlladlSchO)
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OATE OF BIRTH (MM-OD-YEAR)
05-01-1922
(IF AFPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDOLE INIT~)
N/A
NAME
James W. Kollas
FIRM NAME 1""'_) Kollas and Kennedy
TELEPHONE NUMSER
(717) 731-1600
COMPLETE MAILING ADDRESS
Kollas and Kennedy
1104 Fernwood Ave., ste. 104
Camp Hill, FA 17011
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(1) 0.00
(2) 0.00
(3) 0.00
(4) 0.00
(5) 33.236.84
(6) 0.00
(7) 0.00
r'
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:;:;:1
r',-~
,. Real estale (SchoduIe A)
2. Slocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Noles Reoeivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing R~uested
7. InterNivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
6. Total Gress Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Oebls of De<:edenl, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (Iotal Lines 9 & 10)
12. Net Value of Estate (Une 8 minus Une 11)
13. Charitable and Governmental BequestslSet 9113 Trusta for which an elet1Ion to tax has not been
made (Schedul. J)
(9) 11 .902.62
(10) 1.958.49
14. Nel Valu. Subject to Tax (L1n.12 minus Lin.13)
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see INSTRUCTIONS ON REVERse BIDe FOR APPUCABLe RATES
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15. Amounl of Line 14 taxable al the spousal tax
rale, or transfers und... Sec. 9116 (a)(l.2)
N/A
N/A
N/A
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(B) 33.236.84
(11) 11.R61 1 1
(12) 19.375.73
(13) 9.687.86
(14) 9.687.87
x.o_ (15)
x.O_ (16)
x .12 (17)
x .15 (lS) 1 4t;~ 1R
(19) 1 , 453.18
19. Tax Oue
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
16. Amount of Una 14 taxable at lineal rate
17. Amount of Una 14 taxable at sibling rate
1S. Amount of Line 14 taxable al cotlaleral ral.
Q."R7 R7
200
Decedent's Complete Address:
"
STREET ADDRESS Market street
819
CITY Lemoyne I STATE PA I ZIP 17043
Tax Payments and Credits:
1. Tax Du. (Pag.l Lin.19) (1) 1 r 4 <; '\ 1 R
2. CreditslPaym.nts
A. Spousal Pov.rty Credit N / A
B. Prior Paym.nts
C. Discount
TolaICredits(A+B+C) (2) None
Tolallnt.resllP.nalty (D + E) (3) None
4. If Lin. 2 is gr.at.rthan Lin. 1 + Lin. 3, .nt.rth. diff.rence. This is the OVERPAVMENT.
Ch.ck box on Page 1 Lln. 20 to requ.st a refund (4) N I A
5. If Lin. 1 + Lin. 3 is great.r than Lin. 2, .nt.r the diff.rence. This is the TAX DUE. (5) 1, 4 5 3 . 1 8
3. Int.resUP.nalty if applicabl.
D. Int.r.st
E. P.nalty
A. Ent.r the int.rest on the lax due.
(5A)
Nonp-
B. Enter the tolal of Line 5 + 5A. This is the BALANCE DUE. (5B) 1, 4 5 3 , 1 8
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: Ves
a. relain the us. or income of the property transf.rred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its Income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of eith.r payments, benefits or care? ...................................................................... D
2. If d.ath occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consid.ration? .............................................................................................................. D
3. Did d.cedent own an 'in trust for" or payabl. upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Accoun~ annuity, or other non-probate property which
conlains a beneficiary designation? ........................................................................................................................ IXI
No
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IX]
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D
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 peljury, t declare thai I have examined this return, induding 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 sO infonnation of which prepam has any know1edge.
SIGNATURE OF P SON SPONSIBLE FOR FiL~RETURN
ADDRESS 124 N, Main street, Yeagertown, PA 17099
PAI3~OT~ REPRESENTATIVE
#~7'----
ADORES
1104 Fernwood Avenue, ste, 1Q4, Camp Hill, PA 17011
DATE
/
DATE
For dalas of death on or after July 1, 1994 and before January 1, 1995, th.lax rate imposed on the n.t value of transfers to or for the use of the sUlViving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)l.
For dates of death on or after January 1, 1995, th.lax 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) 01)!.
Th. slatute does not .xemot a transfer to a surviving spouse from lax, and the statutory requirem.nts for disclosure of assets and filing a lax retum are still applicabi. even if
the surviving spouse is the only b.neficiary.
For dates of d.ath on or aft.r July 1, 2000:
Th. lax rat. imposed on the net value of transfers from a d.ceased child twenty-,me y.ars of age or young.r at d.ath to or for the us. of a natural paren~ an adoptive paren~
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
The lax rate imposed on the n.t value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, .xcept as noled in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
Th. lax rate imposed on the net vaiue of transfers to or for the us. of the decedenfs 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 deceden~ wh.ther by blood or adoption.
FILE NUMBER
21-04-0606
All..., proporty owned solely or as. f8n1nt In commGI\ must be "POflod at fair m....Il..Iu.. F.lr marl<et valu. is defined ..Ill. price at which property would be excl1anged
betwten a willing buyer and a wilrll1!lseller, neilher being oomptlled III txJy or sea, bolll having reasonable knowledg. 01 Ill. relevant lacIs. Re.1 property Which is jolnUy..wned
with right of
."NIv.roh'. mull be _la.ed.n Schedule F.
ITEM
NUMBER
1.
1lf',o.~~.,I.'n
ESTATE OF
. - ....._._~. --_.~-
'*
SCHEDULE A
REAL ESTATE
VALUE AT DATE
OF DEATH
0.00
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RfTlJRN
RES
Helena I. Smith
DESCRIPTION
None.
"
TOTAL (Also enter()l\ line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
_"'D.',," '*'
COMlIONWEALlll OF PENNSYLVANIA
INHERITANCE TAX REIU!lN
I NT NT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Helena I. Smith
FILE NUMBER
21-04-0606
All property jolnUy-owned wllh rlght of lurvlvollhlp mUll be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. None.
VALUE AT DATE
OF DEATH
0.00
/'
TOTAL (Also enteron i1ne 2, Recapitulation) $ 0.00
(ff more space is needed, Insert additional sheets of the same size)
REV-1504 EX< (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY.HELD CORPORATION,
PARTNERSHIP OR
SOLE.PROPRIETORSHIP
E~A~OF Helena I. Smith
FILE NUMBER
21-04'-0606
Schedule C-1 or C.2 (Including an.uppolting Infomlation) mu.t be attached for each cIo.eIy-held corporatlonlpartne"hip Inlarast of!ha dacoden~ o!her !han a
sole-proprietorship. See instructions for tf1e supporting Infonnatlon to be submitted for sole-proprietorships.
ITEM NUMBER
NUMBER DESCRIPTION
1. None.
VALUE AT DATE
OF DEATH
0.00
/'
TOTA~ (Also enter on line 3, RecapRulation) $
(If more space is needed, Insert additional sheets of the same size)
0.00
REV-1S07 EX. (1-97) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DeceDeNT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF H 1 I
e ena .
Smith
FILE NUMBER
21-04-0606
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
,.
None.
0.00
/'
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed. insert a~djtional sheets of the same size)
0.00
REV.l508 ex_ (8-98) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RE1\JRN
RESIDENT DECEDENT
ESTATE OF
Helena I. Smith
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-04-0606
Include the proceeds of litigation and the date the proceeds were received by the estate.
All pn>Plrty Jolnlly-ownld with ~ghl of lurvlvorshlp mull bl drocrolld on Schldull F.
ITEM
NUMBER DESCRIPTION
1. Waypoint Bank
Account # 1054245719
VALUE AT DATE
OF DEATH
15,004.20
2. M&T Bank
Account # 21000001196791
14,444.59
3. Misc. Personal Property
See Attachment A
3,189.00
4. Other
Rebate Check
Retirement Check
72.00
527.05
/
TOTAL (Also enter on line 5. RecapituraUon) S
(If more space is needed. insert additional sheets of the same size)
33,236.84
....,.."'.,'..".
COIAIMlNWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESI NT NT
ESTATE OF .
Helena I. Sm~th
SCHEDULE F .
JOINTL Y.OWNED PROPERTY
FILE NUMBER
21-04-0606
K In asset was made joint within ono year of tIIo decedont's dal8 of _, ft must be IOportod on Schedule G.
SURVMNG JOINT TENANT(S) NAME
ADORESS
. RELATIONSHIP TO DECEDENT
A. None.
B.
c.
JOINTLY.QWNED PROPERTY:
LETTER DATE DESCRIPTION OF PRlYERTY ..OF CA TE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution CIld ba'lk a:count number 01' simila' identifying number. Attach DATE OF DEATH DECO'S VAlUE OF
NUMBER TENANT JOINT deeclforjoindy-heldrealestate. VAlUE OF ASSET INTEREST DECEDENrS INTEREST
1. A. None.
/'
.
TOTAL (Also enter on line 6, RecapilulatJon) S 0.00
(If more space Is needed, insert additional sheets 01 the same size)
....~c...("".
COIMlNWEAlTH Of PENNSYlVANIA
INHERlTANCI; TAX RETURN
I ce ceNT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Helena I. Smith
FILE NUMBER
21-04-0606
This schedule must be oomple1ed and filed Wthe answerlD any of questions 1 through 4 on the rave... side of the REV-l500 COVER SHEET is yes.
DESCRIPTION OF PROPERTV %OF
ITEM lNCLUDe THE NAME OF nETRNISFEREE. TlEIRRS.ATIOHSHIPTOOECEDENTANOM OATEOfTlWlSFER. DATE OF ~';,A.~H DECO'S EXCLUSION TAXABLE VALUE
NUMBER ATTA01ACOPl' Of THE DEED FOR REAL ESTATE. VALUE OF A ET INTEREST nFAPPUCAEIlE\
1. Cigna Companies 5,500.00 100% ~,500.0( 0.00
Life Insurance Company of
North America
- Account fI 5008310
- Life Insurance policy
.
,
/'
.
TOTAL (Also enteron line 7, Recapitulation) $ 0.00
(ff more space is needed, insert additional sheets of the same size)
REV-1511 EX. ('2-99).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Helena I. Smith
FILE NUMBER
21-04-0606
Debts 01 decedent must be reported on Schedule I,
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,.
a. Myers-Harner Funeral Home 7,330.00
1903 Market St., Camp_Hill, PA 17011
b. Gate of Heaven Cemete:ry 700.00
1313 S. York st. , Mechanicsburg, PA 17055
c: Mise:. Funeral and Burial Costs 70.74
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions
Name of Personal Representative(s) Donna Frank 1,661.84
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 124 N. Main Street
City Yeagertown State~Zip 17099
Year(s) Commission Paid: 2005
2. Attorney Fees 1,661.84
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant None.
Street Address
City State _Zip
Relationship of Claimant to Decedent
4. Probate Fees letter and short cert. 169; Adv. of letters25~a 20; 478.20
inven+o(~ 15; tax return 15; family settlement 2
5. Accountant's Fees 0.00
6. Tax Return Preparer's Fees 0.00
,
7.
~
.
TOTAL (Also enter on line 9, Recapitulation) $11,902.62
(If more space is needed, Insert additional sheets of the same size)
REY-1512 EX+ (lHI8)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABILmES, & UENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helena I. Smith
FILE NUMBER
21-04-0606
Incluell unrelmburs.d medlcal.xpen....
ITEM
NUMBER DESCRIPTION
1. SERS - overpayment made/reimbursement
VALUE AT DATE
OF DEATH
105.41
2. Verizon: -telephone bill
11.34
3. PP&L - electric bill
10.57
4. Boscov's - department store bill
245.88
5. Holy Spirit Hospital - final illness bill
41.34
6. Outlook pointe - assisted living services at
Dillsburg
,1,543.95
.
. .
TOTAL (Also ante, on Un. 10, Recapitulation) $ 1 , 958 . 49
(If more space is needed. Insert additional sheets of the same size)
AEv-15t3CX.tl-t7)
'*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE DE NT
ESTATE OF .
Helena 1. Sm~ th
FILE NUMBER
21-04-0606
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not Ust Trustee{s} OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (Include outright spousal distJibutions)
1. Deborah Romberger
52 Glenview Drive
Dillsburg, PA 17019
Friend 30%/5,812.72
2. Sofia E. Brumbach
107 pleasant View Terrace
New Cumberland, PA 17070
Friend 20%/3,875.15
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
None.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Good Shepard Catholic Churcli
a.k.a. Good Shepard Parish
3435 Trindle Road
Camp Hill, PA 17011
0%/9,687.86
/
.
TOTAL OF PART ll. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 130F REV 1500 COVER SHEET $ 9,687.86
(If more space Is needed, insert additional sheels of the same size)
Amount
100.00
5.00
3.00
2.00
1.00
10.00
1.00
2.00
5.00
2.00
4.00
100.00
8.00
15.00
10.00
4.00
2.00
4.00
2.00
2.00
2.00
1.00
1.00
2.00
10.00
3.00
4.00
5.00
30.00
25.00
SCHEDULE E
Attachment A
Detailed list of Miscellaneous Personal Property
KITCHEN
DescriDtion
Oak table and four chairs
Yellow knit placements
Radio
NYC poster
Salt and pepper shakers
Assorted pots and pans
Floral centerpiece
Dish and utensil drainer
Assorted knickknacks
Trivets
Tea-towels and dishcloths
Dishes, glasses and cups
Stainless steel utensils
Assorted kitchen utensils
Non-perishable food
Kitchen curtains
Throw rug
Window blinds
Wall rack
Window blind for door
Curtain for door
Umbrellas
Ceiling duster
Grocery/laundry cart
Assorted tools
Extension cords
Light bulbs
Paper products and laundry detergent
Jar of quarters
Jar of dimes
SCHEDULE E
Attachment A
Page Two
Amount
100.00
40.00
20.00
100.00
50.00
50.00
30.00
100.00
200.00
25.00
30.00
15.00
15.00
5.00
100.00
25.00
8.00
6.00
6.00
Amount
500.00
20.00
10.00
25.00
50.00
25.00
100.00
5.00
100.00
50.00
100.00
LIVING ROOM
Description
Sofa
Recliner
Magazine floor stand
Two end tables
Coffee table
Assorted 45 rpm records
Assorted 33 rpm albums/records
Stereo/record player (floor model)
Shortwave radio (large table model)
Shortwave radio (table)
Two table lamps
Large framed print
Assorted small prints
Decorative rubber tree plant
27" floor model TV with remote control
Assorted knickknacks and framed photos
Live flower (on windowsill)
Three pairs of curtains
Three window blinds
BEDROOM
Description
Double bed, dresser/vanity with mirror, chest, nightstand
Lamps
Doilies
Cordless telephone
Wooden telephone stand
Comforter and pillow shams
Mattress and box spring
Mattress and pillow covers
Large framed oil painting
Sheets, blankets, pillow and pillow cases
Clothing
SCHEDULE E
Attachment A
Page Three
Amount
50.00
125.00
425.00
20.00
4.00
4.00
Amount
100.00
20.00
5.00
1.00
10.00
10.00
7.00
Amount
5.00
7.00
1.00
15.00
5.00
2.00
2.00
15.00
10.00
5.00
BEDROOM continued
Description
Shoes, boots, purses and wallets
Jewelry
Unset diamond
Old photos
Two pair of curtains
Two window blinds
HALLWAY
Description
Cedar chest
Vacuum cleaner
Steam iron
Laundry basket
Storage cabinet
Throw rugs
Cleaning supplies
BATHROOM
Description
Dryer rack
Rug set
Commode brush set
Towels
Window and shower curtains
Window blind
Towel rack
Electric heater
Electric floor fan
Assorted lotions
SCHEDULE E
Attachment A
Page Four
Amount
15.00
5.00
1.00
10.00
25.00
3.00
1.00
3.00
1.00
2.00
STORAGE AREA IN CELLAR
Description
Four lawn chairs
Small glass table top
Small round table
Floor fan
Air conditioner
Three window screens
Porch runner
Flower pots
Watering can
Gardening tools
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT 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
FRANK DONNA
POBOX 26
YEAGERTOWN, PA 17099
____nn fol<l
ESTATE INFORMATION: SSN, 204~28~ 1268
FILE NUMBER: 2104-0606
DECEDENT NAME: SMITH HELENA I
DATE OF PAYMENT: 01/21/2005
POSTMARK DATE: 01/21/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 04/25/2004
NO. CD 004871
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,453.18
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 014
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$1,453.18
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH Of PENNSYLVANIA
COUNTY OF CUMBERLAND
}
...:
Donna Frank
being duly _~_worn , ilcc:orcl.ift9 to faw, deposes and '.Y' th.+ she i,::; thQ 'Rv':H"'nt"r; y
of th. Est"te of Helena I. Smi th
t.t. of ....-l&lIlQyne" a9~.Qjlgb__. ._ .._.._.__ . Cumb.rland County, P... d........d end th.t the
within Is .n inventory meele by Donna Frank . th. said F.xe<"ntr; x
of the entire estate of said deced.nt. con.isting of all the p.rsonal prop.rty and rul e,tate, except real .state outside
the Commonwealth of Ponnsylvania. and th"t the flguros opposite u..h Item of the Inventory represent it's fair value
as of the date of dec.dent's death.
Donna Frank
ijJ, ;f\!~a/
and subscribed before me,
ellnutvr .. AJ",inid'ltor
16 ?OO <;
124 N. Main Street
YeaQP-r~nwn, PA 170QQ
Adcf"J,
Oate of Outh __.___. 25
D.y
April
MQnth
2004
Y..r
INSTRUCTIONS
I. An inventory rnu.t be filed within thr.e months .fter appolntm.nt of porsona' r.presentativa.
2. A supplement inventory must b. filed within thirty days of discovery of .dditional usato.
3. Additional sheets may be aftached as to p.rsonalty or r..lty
4. S.. Arti"l. IV, Flelu..i.ri.s Act of 1949.
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Inventory 01 the real and personal estate 01
Helena I. Smith
deceased
1. Real Estate 0 00
None.
2. Bonds 0 00
None.
3. Stocks 0 00
None.
4. Bank Deposits, Cash, and Miscellaneous Personal Property
Waypoint Bank - 15,004.20
M&T Bank - 14,444.59
Misc. Personal Property - 3,189.00
Other - 599.05
33,236 84
,/
Total
33,236 84
() l-c~-looG
SETTLEMENT AND FINAL RELEASE
IN
ESTATE OF HELENA I. SMITH, DECEASED
r-~
...,
,
-,
-'
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KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, HELENA I. SMITH, late
-,"1
of 819 Market Street, Lemoyne, Cumberland County, Pennsylvania, deceased, died testate on -~~,
I
,
April 25, 2004, having made her last will and testament, which was duly executed on December
8, 1998;
WHEREAS, letters testamentary for the estate of the said decedent were duly issued on
June 29, 2004, by the Register of Wills of Cumberland County, Pennsylvania, to DONNA
FRANK, Executrix, hereinafter called personal representative, for the Estate of HELENA I.
SMITH, Number 2004-00606;
WHEREAS, said personal representative has gathered the assets of the estate of said
decedent and the assets consist of personal property, to a total value of$33,236.84, as set forth in
the estate tax return filed on January 21, 2005, and which is made a part hereof by reference;
WHEREAS, the debts and deductions, including the payment of inheritance tax in the
said estate, have left a balance for distribution of$21,272.81;
WHEREAS, the balance for distribution has been reduced to cash and shaH be distributed
as herein indicated in accordance with the last Will and testament of said decedent such that
twenty percent (20%) shall go to Sofia E. Brumbach, thirty percent (30%) shall go to Deborah
Ramberger, and fifty percent (50%) shall go to Good Shepard Catholic Church of Camp Hill
(a.k.a. Goo~ Shepard), or as otherwise agreed to in writing;
~
)
,1
NOW, THEREFORE, KNOW YE, that we, Sofia E. Brumbach; Deborah Ramberger; and
the Good Shepard, through its authorized agent the Reverend James M. Lyons, Diocesan
Administrator, being all of the testate heirs of said decedent, and being those persons or entities
entitled to inherit under said Will, do hereby, each, acknowledge that we have this day had and
received from the aforesaid personal representative, in full satisfaction and payment of all sum or
sums of money, the amounts due us under said Will, that is $4,254.56 to Sofia E. Brumbach,
$6,381.84 to Deborah Ramberger, and $9,536.41 to Good Shepard Catholic Church of Camp Hill
(a.k.a. Good Shepard Parish), which amounts we have received this day;
AND, each of us does hereby stipulate that in order to avoid the expense and time
involved in the filing of a formal account and schedule of distribution, we each agree that no
account is necessary and we do hereby agree that we do consent to distribution being made
without the filing of an account and schedule of distribution, the same to be with the same force
and effect as if they had been filed and confirmed by the Orphans Court Division of the Court of
Common Pleas, Cumberland County Branch.
THEREFORE, we and each of us do hereby remise, release, quitclaim and forever
discharge the said personal representatives, their heirs, executors, attorneys, and administrators
and assigns, of and from the said estate and from all actions, suits, payments, accounts,
reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use,
matter, cause or thing whatsoever touching upon the estate of said decedent, and each of us do
further hereby covenant and agree that should any liability come due to the estate of the said
decedent after the signing of this agreement, we and each of us do hereby covenant and agree
with each other and the aforesaid personal representative that we will contribute pro rata our
share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be
successfully prosecuted against the said estate or the aforesaid personal representative after the
signing, sealing and delivery of this family settlement agreement and final release.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this C, -t1-t day
of
Oc:h/u,r
, 20a!" .
WITNESS:
4~
? /% /~
(,->/~/-G----
~ bd. -----2- .
Y //~~
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JJ~LA- \-1~
Donna Frank, Executrix
(SEAL)
~~&..J~
Sofia . Brumbach
(SEAL)
Wf..t'n iAV\ --M. (~..'J ItA kur7 -er (SEAL)
Deborah amberger
~
e . James M. Lyons
uthorized agent for Go Shepard Catholic
Church of Camp Hill (a.k.a. Good Shepard)
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
tY\ C I
On this, the I -- day of ~p~ , 200 ~ before me, a Notary
Public, the undersigned officer, personally appeared Donna Frank, Executrix, known to me to be
the person whose name is subscribed to the within instrument, and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
o ARIAL
CAROLE A ROSE
Notary Public
TWSP OF LOWER AllEN
CUMBERlAND COUNTY
M CormllSIlOn E as OCt 21. 2007
CUA.D ~ (){. {2u"XC
Notary Public
My Commission Expires:<9c.f ,2-1, 2cDi
I
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
On this, the ~..."" day of ~~ , 200.!;, before me, a Notary
Public, the undersigned officer, personally appeared Sofia E. Brumbach, known to me to be the
person whose name is subscribed to the within instrument, and acknowledged that she executed
the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
NOTARIAL SEAL
CAROLE A ROSE
Notary Public
TWSP OF LOWER ALLEN
CUMBERLAND COUNTY
Commission E res Oct 21. 2007
C CLuJ LL LA - f2.,o S0-
Notary Public
My Commission Expires: OC:f-' 2-1,2...007
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
On this, the;] I s!- day of ~~ , 200S, before me, a Notary
Public, the undersigned officer, personally appeared Deborah Ramberger, known to me to be the
person whose name is subscribed to the within instrument, and acknowledged that she executed
the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
NOTARIAL SEAL
CAROlE A ROSE
Notary Public
TWSP OF LOWER AllEN
CUMBERLAND COUNTY
My Commission Expires Oct 21. 2007
rJitDG- Q. ~
Notary Public ,
My Commission Expires: (t). 21, LcD7
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF G~I.IBEIlLAml LiJ~~ SS:
On this, the cf:; d day of tCJ .d~, 2005 before me, a Notary
Public, the undersigned officer, personally appeared Rev. James M. Lyons, Authorized agent for
Good Shepard Catholic Church of Camp Hill (a.k.a. Good Shepard), known to me to be the
person whose name is subscribed to the within instrument, and acknowledged that he executed
the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
~~4MLd~
Notary Public
My Commission Expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Susan C. Hartman, Notary Public
Lower Paxton Twp.. Dauphin County
My CommiSSion Expires J(jy 25. 2008
Member, Pennsylvania Association Of Notaries
.
.-~
COMMONWIALTN Of PlMNSYLYANfA
COUNTY OF CU...IJlL&ND
}.
$I:
Donna Frank
being duly ~worn , according to r.w. deposes .nd s.y. that she is the Executrix
of the Estate of Helena I. Smi th
I.t. of -I&r:tJ.9.yne". .___._._. .- .._.._._ , CumDerlancl County, Pa., dece.sed .nd th.t the
within is an inv.ntory made by Donna F"t:ank , the I.id Executrix
of the entire estate of said decedent, consisting of .11 the personal prop..rty and reaJ .at.t.. except r..r estate outside
ths Commonwealth of Pe"nsylvani.. and that the figurt$ opposite eteh Item of the Inventory represent it's fair varue
as of the date of dec.dent's death.
.nd subscribed before me,
19
Donna Frank
~. M/ftl"id"tor
P.O. Box 26
Yeagertown, PA 17099
Address
Date of Outh __,.
25
D4Y
April
Mgnth
2004
Y.ar
INSTRUCTIONS
I. An inventory must b. filed within thr.e months after appointment of p.rsonal r.presentative. !~)
2. A supplement inventory mud be filed within thirty days of discovery of .dditional .u.t..
3. Additional sheets may be a+tached as to personalty or realty
4. S.. Artiel. IV. Fiduciui.s Act of 1949.
r--.:>
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---'1
-..I
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Inventory of the ntaI and personal estate of
Helena I. Smith
deceased
Real Estate
1. None
Bonds and Stocks
2. None
Cash, Bank Deposits, and Misc.
3. Cash
33,236 84
./
/
33,236 84
LAW OFFICES OF
KOLLAS AND KENNEDY
1104 FERNWOOD AVENUE
CAMP HILL, PENNSYLVANIA 17011
WILLIAM C. KOLLAS
JAMES W. KOlLAS
OF COUNSEL
MARY KOlLAS KENNEDY
TELEPHONE NO. (717) 731.1600
FAX NO. (717) 731.1460
December 15,2005
Glenda F. Strausbaug
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Helena I. Smith
No: 2004-00606
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Dear Ms. Strausbaug:
Enclosed please find an original and one (1) copy ofthe Status Report Under Rule 6.12 to
be filed in the above-referenced matter. Kindly, time-stamp the copy and return it in the enclosed
self-addressed, stamped envelope.
If you should have any questions, please feel free to contact my office.
Very truly yours,
KOLLAS AND KENNEDY
~~ UJ. KOLlaLb\CfW-
James W. Kollas
JWKJcar
Enclosures
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Helena I. Smith
Date of Death: April 25, 2004
~\<.
Witt No.: 2004-00606
~~. No..21-04-0606
Pursuant to Ru1e 6.12 of the Supreme Court OrphfulS' 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 QD No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No 1!1
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 0
.Date:~DS'
c. Copies of receipts, releases, joinders and approval offormaI or
informal accounts maybe :filed with the Clerk of the Orphans' Court
andmaYbeattachedlo1his~~ ~~_
gnature
James W. Kollas, Esq.
Name
1104 Fernwood AVe., Ste. 104
Camp Hill, PA 17011
t'..,
o
c....
Address
(717) 731-1600
Telephone No.
II I
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Capacity: 0 Personal Representative
1!1 Counsel for personal representative
~t