HomeMy WebLinkAbout03-0259Register of Wills of CUMBERLAND County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estateof Kay Markus Freiberg
also known as
, Deceased
Petitioner(sl, who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
Social Securit7 No. 064-28-§:230
[~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut, or
the Decedent, datedj~,~a_~and codicil(s)dated . --
2o0i
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documer~
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; pendente lite; durante absentia; durante minoritata)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name
Residence ]
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in North Middlcton Township, CumbcrJand County, Pennsylvania with his/her last family
or principal residence at 4,0 Mcadowbrook Road, Carlisle, Pennsylvania
(list street, number, and municipality)
Decedent, then ,,~7 years of age, died Fcbrua~ ! 5, :2003 at Thornwald Home, Carlisle, Cumberland County, Pennsylvania
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(if not domicffed in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
(Location)
$
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant
letters in the a rD r/ate form to the undersi ned: -----.-.,--- ~ --..-....--.-.- ~ .... of
x'_ . · ~1 % ~ Thomas .Drucker
'- ~t. c-3
Whitewater, WI 53190
Prepared by the Pennsylvania Bar Association
Copyright (c) *t996 form software only CPSystems, Inc.
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
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 Decedent, Petitioner(s) will well and truly administer the estate according to Jaw.
Sworn to or affirmed and subscribed ~
before me this.... 25 day of
801 East Clay Street, Apt.
March 2003 ...... C-3
,~u.~ Iv]. uEro,±st Deputy---~Z~
No. 21-2003-259
Estate of Kay Markus Frciberg
Deceased
Social Security No: 064-28-8230 Date of Death: February 15, 2003
AND NOW, March 25 th, , 2003 , in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS OECREED that Letters ~'~ Testamentary [] Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; ducante absentia; durante minoritate)
are hereby granted to Thorna__~s Drucker
in the above estete and that the instrument(s) dated
March 22,2001
Letters ........... $
Short Certificate(s). lO..
Renunciation ........ $
Affidavits ( ) .... $
Extra Pages (' 3 ) .... $
Codicil.
JCP Fee ..........
described in the Petition be admk'ted to probate and filed of record as the last Will of Decedent.
FEES
~ Register of Wills / // / /-/~~_.2
30.00 DONNA M. OTIS, ±st 13eputv v
9.00
10.00
Attorney: Thomas E, Flower, Esquire
i.D. No: 83993
Address:
S~AIDIS~ SHUFF~ FLOWER & LINDSAY
2109 Market Street, Camp Hill, PA 17011
Telephone: 717/737-3405
Inventory ..........
Other
TOTAL ......... $ 284.00 CALL THCIVIAS E.
Prepared by the Pen~ylvanla Bar Association Copyright (c) 1996 rearm software only CPSystems, Inc.
FLOWER ESQUIRE ON 3-25-03
Form RW-1 (19911
s to certi .fy that the information here given is correctly copied from an original certificate of death duly filed with me as
Registrar. The original certificate will be forwarded to the Stare Vital Records Office fbr permanent fili.ng.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
FEB 1 9 2O03
Dare
21
Kay Freiberg
67
Cumberland
40 Meadowbrook Rd.
Carlisle, PA 17013
COMMONWEALTH OF PENNSYLVANIA ~. DEPARTMENT OF HEALTH ° VITAL RECORDS
CERTIFICATE OF DEATH
Female 06~ --
17, ~o~ []
28 -- 8230
~[]
Carlisle
Thornwald Home
Widowed
Feb. 26, 2003
013144 L
Feb. 15, 2003
White
Strauss
801 East St.,Unite C, Whitewater, WI 53190
Tikvah Cemetery Carlisle, PA
219 N. Hanover Carlisle, PA 17013
21-2003-259
LAST WILL AND TESTAMENT
I, KAY MARKUS FREIBERG, of 40 Meadowbrook Road, Carlisle, Cumberland
County, Pennsylvania, 17013, do hereby make, publish and declare this to be my last
will and testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this
Will, shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefor, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at
my death, for such period of time after my death as seems expedient to said
representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate as follows:
A. I direct that a Literary Trust be established to organize, preserve
and maintain my literary works and appoint Patricia Sunday, to be the trustee of
this trust.
B. All the rest, residue and remainder of my estate, I give, devise and
bequeath as follows:
1 .) The sum of $500.00 to Simon Wiesenthal Institute, of
California, for general purposes;
2.) The sum of $250.00 to Caroline H. Kramer;
3.) The sum of $250.00 to Bernice H. Mandel; and the
4.) Balance I give devise and bequeath as follows:
a.) 50% to fund and maintain the Literary Trust
established in paragraph 3. A. above; and
b.) 50% to Beth Tikvah Congregation, Carlisle,
Pennsylvania, for the Sam Freiberg Fund and for the perpetuation,
care and maintenance of the Beth Tikvah Cemetery on McClure's
Gap Road, Carlisle, Pennsylvania.
4. I nominate and appoint Thomas Drucker to be the personal representative
of my estate, to serve without bond. If he cannot or does not serve, then I appoint
Harold S. Irwin, Ill, to be the substitute personal representative, with the same powers
and also without bond.
5. I suggest that my personal representative retain the services of the Law
Offices of Harold S. Irwin, Ill, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 22nd day of
March, 2001.
EAL)KAY ~I'ARKOS FREIBERG' y"
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
ACKNOWLEDGMENT AND AFFIDAVIT
WE, KAY MARKUS FREIBERG, RHONDA S. IRWIN and HEATHER A.
BARBOUR, the testatrix and witnesses respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument as her last will and that
she had signed willingly, and that she executed it as her free and voluntary act for the
purpose herein expressed, and that each of the witnesses, in the presence and hearing
of the testatrix, signed the will as a witness and that to the best of their knowledge the
testatrix was, at that time, eighteen years of age or older, of sound mind and under no
constraint or undue influence.
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF CUMBERLAND
:SS:
Subscribed, sworn to and acknowledged before me by KAY MARKUS
FREIBERG, the testatrix herein, and subscribed and sworn to before me by RHONDA
S. IRWIN and HEATHER A. BARBOUR, witnesses, this 22ND day of March, 2001.
Notary Public
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Kay Markus Freiberg
Date of Death:
February 15, 2003
Will No. 21-03-0259
Admin. No. 2003-00259
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of
the Orphans' Court Rules wasr~erved on or mailed to the following beneficiaries of the above-
captioned estate on May b ., 2003.
NalTle
Simon Wiesenthal Institute
Caroline H. Kramer
Stephen Tompkins
Patricia Sunday
Bernice Mandel
Address
1399 South Roxbury Drive, Los Angeles, CA 90035
22 Harvard Road, Shoreham, NY 11786
Beth Tikvah Congregation, 1677 Quail Drive,
Carlisle, PA 17013
820 West Trindle Road, Mechanicsburg, PA 17055
11 Tulip Lane, Port Washington, NY 11050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none.
Date: ~'~' C'"C)~
Capacity:
Thomas E. F'lower, Esquire
SAIDIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Personal Representative
X Counsel for Personal
Representative
RENUNCIATION
S£p 2 9 2003
In Re: Estate of Kay Markus Freiberg, deceased. ,,~ ~o~- c~O 2...~'
To the Register of Wills of Cumberland County, Pennsylvania:
The undersigned, Patricia Sunday, appointed Trustee of a certain "Literary Trust
to be established to organize, maintain and preserve [the decedent's] literary works"
under Article 3(A) of the Last Will and Testament of the above decedent, hereby
renounces the right to administer the said literary trust and respectfully asks that
DeAnna Spurlock be appointed to serve as the said literary trustee, in accordance with
my understanding of the decedent's wishes.
WITNESS my hand this ~/..~day of_.~2~.~__~.<~ , 2003.
/
Mechanicsburg, PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
003238
SAIDIS ET AL
26 WEST HIGH STREET
CARLISLE, PA 17013
fold
ESTATE INFORMATION: SSN: 064-28-8230
FILE NUMBER: 2103-0259
DECEDENT NAME: FREIBERG KAY MARKUS
DATE OF PAYMENT: 11/1 7/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/15/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $1,585.41
TOTAL AMOUNT PAID:
$1,585.41
REMARKS' SAIDIS ET AL
SEAL
CHECK# 5001 2
INITIALS: DO
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003237
SAIDIS ETAL
26 WEST HIGH STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 064-28-8230
FILE NUMBER: 21 03-0259
DECEDENT NAME: FREIBERG KAY MARKUS
DATE OF PAYMENT: 11/17/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/15/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $5,000.00
TOTAL AMOUNT PAID:
$5,000.00
REMARKS' THOMAS L DRUCKER
C/O SAIDIS ET AL
SEAL
CHECK# 1050
INITIALS: DO
RECEIVED BY.'
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
~r ' oo EX (6-0o)
j~~ COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
Z
n~
o
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Freiberg, Kay Markus
DATE Of BIRTH (MM-DD-YEAR)
07/17~35
NOV 172003
ON ./?' '~
DATE OF DEATH (MM-DD-YEAR)
02/16~03
FILE NUMBER
21 _ 03
COUNTYCODE YEAR
O259
NUMBER
SOCIAL SECURITY NUMBER
064-28-8230
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
r~i1. Odginal Retum
[~l4. Limited Estate
1~6. Decedent Died Testate (Attach copy of Will)
I----I. Litigation Proceeds Received
NAME
Thomas E. Flower, Esquire
i~l2. Supplemental Return [] 3. Remainder Return (date of daalh pdor to 12-13-82)
[] 4a. Future Interest Compromise (date of daath a~r 12-12-82) [] 5. Federal Estate Tax Return Required
I--I. Decedent Maintained a Living Trust (A~ach copy of Trust) 8. Total Number of Safe Deposit Boxes
[] 10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (^uac~ Sch O)
COMPLETE MAILING ADDRESS
2109 Market Street
Camp Hill, PA 17011
80,000.00"
17,905.24
0.00
0.00
31,429.31
0.00
0.00
(8)
30,190.72
11,338.34
(11)
(12)
(13)
129,334.55
(14)
41,529.06
87,805.49
43,902.75
FIRM NAME (IfApplicaUe)
Saidis, Shuff, Flower & Lindsay
TELEPHONE NUMBER
(717) 737-3405
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. (4)
5. (5)
6,585.41
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Mortgages & Notes Receivable (Schedule D)
Cash, Bank Deposits & Miscellaneous Personal Property
(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 (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
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
.... X I 0 I (15)
................ x .0 _ (16)
x .12 (17)
.......... 43_902._.7_4_ x .15 (18)
(19)
20. []
Deced~nt's Complete Address:
STREET ADDRESS
40 Meadowbrook Road
CITYCarlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE PA ZIP 17013
3. Interest/Penalty if applicable D. Interest
E. Penalty
Total Interest/Penalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund
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.
(1)
6,585.41
0.00
0.00
6,585.41
0.00
6,585.41
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Total Credits ( A + B + C ) (2)
(3)
(4)
(5)
(5A)
(5B)
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 preperly transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of 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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
ADDRESS t--- ....
801 East Clay Street, Apt. C-3, Whitewater, WI 53190
,IGNAT~E~~E~.T~ DATE
Saidis, Shuff, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §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 RS. §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.
REV-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Freiberg, Kay Markus
SCHEDULE A
REAL ESTATE
FILE NUMBER
21-03-0259
All real property owned solely or aa 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 property which Is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 80,000.00
House on 0.7 acres at 40 Meadowbrook Road, North Middleton Township,
Cumberland County, Pennsylvania per contract sales price
TOTAL (Also enter on line 1, Recapitulation) $ 80,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Freiberg, Kay Markus
FILE NUMBER
21-03-0259
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
Gleason stock: GLE Stock 00016114 - 10 shares @ $23 per share
GLE Stock 00019766 - 10 shares @ $23 per share
F&M Trust:
FiServe Investment Account # 67600921 - $9,876.14
FiServe IRA Account # 67602072 - $7,569.10
VALUE AT DATE
OF DEATH
$460.00
$17,445.24
TOTAL (Also enter on line 2, Recapitulation $ 17,905.24
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98) ~
-.~'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Bretz, Mary E 21-97-0260
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
F&M checking account # 34-13217 no interest
Waypoint Bank checking account # 20087979:$17,098.71
accrued interest 1.64
Waypoint Bank checking account # 90869546:$3,116.29
accrued interest .02
Sun Trust account checking account # 0404003132683:$8,203.15
accrued interest 1.05
Blue Cross refund of overpayment
Household goods and personal effects: auction proceeds
1983 Oldsmobile, auction proceeds
TOTAL (Also enter on line 5, Recapitulation) $
$266.45
17,100.35
3,116.31
8,204.20
64.271
2,532.00
210.00
31,429.31
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Freiberg, Kay Markus 21-03-0259
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
8.
9.
10.
11.
12.
13.
FUNERAL EXPENSES:
Hoffman Roth Funeral Home:
professiona services: $3,590.00
casket: $1,050.00
concrete box: $ 995.00
grave opening: $ 425.00
obituaries: $ 444.58
death certificates $ 24.00
Congregation Beth Tikvah - grave opening fee -$425
Carlisle Memodal Service - grave marker-S1,492.00
Dickinson College - room rental fee-$210.O0
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
city
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Retum Preparer's Fees
The Patriot News - estate notice
Cumberland Law Joumal- estate notice
Farmers & Merchants - fee for date of death information
PNC Bank - checking printing charges
James & Donna Gordon - cleaning at residence
York Waste Disposal - dumpster rental
Pet Adoption Services
Penn National Insurance - homeowner's insurance premium
shipping charges
See Attached continuation
State __Zip
TOTAL (Also enter on line 9, Recapitulation)
$8,655.58
8,750.00
284.00
123.55
75.00
5.00
55.20
2,690.53
1,704.66
500.00
573.00
24.10
6750.10
30,190.72
(If more space is needed, insert additional sheets of the same size)
Freiberg, Kay Markus
No. 21-03-0259
Pennsylvania Inheritance Tax Return
Schedule H - Administrative Expenses
Continuation
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Fee for vehicle title transfer
James Morrison - lawn maintenance
Vital Statistics - death certificate for decedent's mother
North Middleton Township - septic repair permit
Craig Anderson - hedge trimming
Russ Shughart Excavation - replace drain pipe to septic tank
Recorder of Deeds - recording fee for real estate power of attorney
Russ Shughart Excavation - replace septic tank
Jerry Lindsay - hauling
Estimated settlement costs on sale of real estate
real estate transfer tax
adjustment to buyers for mowing before settlement
$10.00
1,205.00
19.00
80.00
45.00
2,724.10
17.00
1,600.00
150.00
800.00
100.00
6,750.10
REV-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
FreJberg, Kay Markus 21-03-0259
Include unreimbursed medical expenses.
ITEM
NUMBER
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12,
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
DESCRIPTION
Charlie Carothers - lawn maintenance
Orkin Exterminating - pest control at residence
PPL Electric - electric bill at residence
Craftmatic Organization - service to bed
Jewish Family Services - social services
Arizona Mail Order Service - credit card payment
Shipley Energy - heating fuel
York Waste Disposal - residential trash service
Sprint - telephone bill
Bank Card Services - credit card bill
Comcast Cable - cable bill
Robin Sollenberger - 2003 real estate taxes
Capital Self Storage - rental fee for storage unit
Carlisle Regional Medical Center- medical bill
Glenn Brubaker - personal services prior to death
Judie Gillette - personal services prior to death
PPL - electric bill
Carlisle Apothecary
Cumberland Goodwill EMS services
Bosler Library - overdue charges
Life Alert - emergency medical service
Cumberland Goodwill Fire & Rescue
Penn's Woods Physical Therapy - medical bill
Andorra Radiology - medical bill
Family Health Care Products - wheelchair - Medicare co-pay portion
VALUE AT DATE
OF DEATH
$150.00
78.27
200.85
848.00
465.00
45.75
2,257.85
214.20
272.61
106.84
277.99
2,260.65
182.24
440.60
1,000.00
192.00
314.61
30.76
364.00
47.90
400.00
30.16
12.92
95.00
1,050.14
TOTAL (Also enter on line 10, Recapitulation) $ 11,338.34
(If more space is needed, insert additional sheets of the same size)
REV-151'~ EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kay Markus Freiberg
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-03-0259
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Caroline H. Kramer
22 Harvard Road
Shoreham, NY 11786
Bernice H. Mandel
11 Tulip Lane
Port Washington, NY 11050
DeAnna Spurlock, Trustee of Literary Trust UNV
301 W. Ridge Street
Carlisle, PA 17013
first cousin
first cousin
no relation
$ 250.00
250.00
36,817.33
(1/2 of residue, net
amount after tax)
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Simon Wiesenthal Institute
1399 Roxbury Drive
Los Angeles, CA 90035
Bet Tikva Congregation
1677 Quail Drive
Carlisle, PA 17013
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
$ 500.00
43,402.75
(1/2 of pre-tax
residue)
43,902.75
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
I, KAY MARKUS FREIBERG, of 40 Meadowbrook Road, Carlisle, Cumberland
County, Pennsylvania,17013, do hereby make, publish and declare this to be my last
will and testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this
Will, shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefor, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at
my death, for such period of time after my death as seems expedient to said
representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate as follows:
A. I direct that a Literary Trust be established to organize, preserve
and maintain my literary works and appoint Patricia Sunday, to be the trustee of
this trust.
B. All the rest, residue and remainder of my estate, I give, devise and
bequeath as follows:
1.) The sum of $500.00 to Simon Wiesenthal Institute, of
California, for general purposes;
2.) The sum of $250.00 to Caroline H. Kramer;
3.) The sum of $250.00 to Bernice H. Mandel; and the
4.) Balance I give devise and bequeath as follows:
a.) 50% to fund and maintain the Literary Trust
established in paragraph 3. A. above; and
b.) 50% to Beth Tikvah Congregation, Carlisle,
Pennsylvania, for the Sam Freiberg Fund and for the perpetuation,
care and maintenance of the Beth Tikvah Cemetery on McClure's
Gap Road, Carlisle, Pennsylvania.
4. I nominate and appoint Thomas Drucker to be the personal representative
of my estate, to serve without bond. If he cannot or does not serve, then I appoint
Harold S. Irwin, III, to be the substitute personal representative, with the same powers
and also without bond.
5. I suggest that my personal representative retain the services of the Law
Offices of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
March, 2001.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 22nd day of
KAY gARKtJS FREIBERG /// . EAL)
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
ACKNOWLEDGMENT AND AFFIDAVIT
WE, KAY MARKUS FREIBERG, RHONDA S. IRWIN and HEATHER A.
BARBOUR, the testatrix and witnesses respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument as her last will and that
she had signed willingly, and that she executed it as her free and voluntary act for the
purpose herein expressed, and that each of the witnesses, in the presence and hearing
of the testatrix, signed the will as a witness and that to the best of their knowledge the
testatrix was, at that time, eighteen years of age or older, of sound mind and under no
constraint or undue influence. ~~~~KA,~_;~; ~R E2 _R.~~j] /
s ' --
HEATHER A. BARBOUR
COMMONWEALTH OF PENNSYLVANIA ·
:SS:
COUNTY OF CUMBERLAND ·
Subscribed, sworn to and acknowledged before me by KAY MARKUS
FREIBERG, the testatrix herein, and subscribed and sworn to before me by RHONDA
S. IRWIN and HEATHER A. BARBOUR, witnesses, this 22ND day of March, 2001.
BONNIE L. COYL.B, NOTARy PUBUC
I._BORO OF CARLISLE, CUMBERLAND COUNTY
COMMlUlON EXPIRES OCTOBER 17 2(X~I
Notary Public
,,?
KAY MARKUS FREIBERG
LAST WILL
AND
TESTAMENT
RENUNCIATION
S£p 2 9 2003
In Re: Estate of Kay Markus Freiberg, deceased. ,,?. ~o'~- oO 2-.~'~'
To the Register of Wills of Cumberland County, Pennsylvania:
The undersigned, Patricia Sunday, appointed Trustee of a certain "Literary Trust
to be established to organize, maintain and preserve [the decedent's] literary works"
under Article 3(A) of the Last Will and Testament of the above decedent, hereby
renounces the right to administer the said literary trust and respectfully asks that
DeAnna Spurlock be appointed to serve as the said literary trustee, in accordance with
my understanding of the decedent's wishes.
WITNESS my hand this ~2~%ay of~~ , 2003.
/
~;tricia Sund~-0 W. Trindle"~ad
Mechanicsburg, PA 17055
BR~)KERAGE SERVICES THROUGH
FISER¥ INVESTOR SERVICES, INC.
MEMBER NASD/SIPC
April 25, 2003
~PR -~
THE PERSONAL INVESTMENT CENTER
i90.) RITNF. R t'IIGH',V.W
C,\~LISLE, PA 1701':~
('7! 7) 960-[400
F~x (717;) 960-~ !400
Thomas E. Flower
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17011
Re: Estate of Kay Markus Freiberg
Dear Sir:
Following is the information you requested on investment accounts held
by Fiserv Investor Services, Inc. for Kay Markus Freiberg as of
February 15, 2003:
Investment account #67600921
Titled: Kay M. Freiberg
Established: June 8, 2001
Value as of2/15/03:$9,876.14
IRA account #67602072
Titled: Kay M. Freiberg, Std IRA
Established: October 30, 2001
Value as of2/15/03:$7,569.10
There were no joint accounts for this client at our institution.
Sincerely yours,
Philip 3. Huntzinger, III CFP, CLU, ChFC
Personal Investment Counselor
Securities offered through Fiserv Investor Services, Inc. at F&M Trust are not insured by the FDIC or any other governmental agency. They are not
deposits or other obligations of or guaranteed by Fiserv Investor Services, Inc. or F&M Trust and are subject to investment risk including possible loss of
the principal amount invested.
Gleason
June 10, 2003
Gleason Corporation
1000 University Avenue
RO. Box 22970
Rochester, NY 14692-2970, USA
fei: (585) 473-1000
Fax: (585) 461-4348
www. gleason.com
Mr. Thomas E. Flower, Esquire
Estate of Kay Markus Freiberg
2109 Market Street
Camp Hill, PA 17011
Re:
Estate of Kay Markus Freiberg
GLE Stock 00016114 - 10 shares
GLE Stock 00019766 - 10 shares
Enclosed is a check in the amount of $460.00 for the surrender of the Gleason
Corporation shares (a total of 20 shares) referenced above for a cash payment of $23 per
share, in connection with the Merger of Torque Merger Sub. Inc. and into Gleason Corp
Sincerely,
Jennifer A. Carr
Senior Financial Analyst
Eric.
i063
GLEASON CORPORATION
DELAWARE ACCOUNT
DATE
~une
10 r 2003
1 o-4/22o
BRANCH 684
%Y
THE Rstate of Kay. Freiberq
RDER OF
*****FOUr Hundred SiXty Dollars and 00/100'***
Manufacturers and Traders Trust Company
Commercial Banking Office
OR 20 shares GLE stock
J $-4~o.oo
FSe¢~rHy
DOLLARS b:~:Y~;=.
Gleason
M~Y ~ 0 200~
May 27, 2003
The Gleason Works
1000 University Avenue
RO. Box 22970
Rochester, NY 14692-2970, USA
Tel: (585) 473-1000
Fax: (585) 461-4348
www. gleason.com
Mr. Thomas E. Flower
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17011
Re: Gleason Stock for Kay M. Freiberg
Dear Mr. Flower:
In response to your letter, I have enclosed a Letter of Transmittal Form and a Lost
Certificate Affirmation and Indemnity Agreement Form to cash out the outstanding
shares of Gleason Corporation Stock.
Our records show Ms. Freiberg has the following shares outstanding:
· Certificate number 00016114, 10 shares
· Certificate number 00019766, 10 shares
Please return the enclosed Letter of Transmittal Form and the original certificates to the
address listed on the forms for further processing. Each share of Gleason stock is being
cashed out at $23.00 per share. If the original certificates are lost, please also return the
lost share form.
Sincerely
Jennifer Carr
Senior Financial Analyst
Enclosure
LOOK FOR US. WE'LL GET YOU THERE.
APR ~.
04/22/2003
SAIDIS SHUFF FLOWER & LINDSAY
2109 MARKET ST
CAMP HILL PA 17011
The information which you requested on the account(s) of KAY FREIBERG
(Social Security Number 064-28-8230) is/are as follows:
Account Number 20087979 90869546
Class of Account C~CKING CHECKING
Date Opened 11/23/99 09/23/97
Principal Balance 17098.71 3116.29
Accrued Interest 1.64 .02
Balance at Date of .17100.35 3116.31
Death
Account Ownership SOLE SOLE
Name of Joint
Owner, if any
Date Ownership
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owne:, if any
Date Ownership
Was Established
Additional
Information
Requested
S, ~cerel7, D
SENIOR SERVICES REP.
P.O. Box 171 I, HARRISBURG, PENNSYLVANIA 17105-1711
Toll Fete 1-866-WAYPOINT (I-866-929-7646) · IN YORK AREA 717/815-4500 · vvvvw, wagpOintbank.com
ACCOUNT INFORMATION
RE:
KAY M. FREIBERG
DATE OF DEATH 2-15-2003
X
CHECKING
SAFE DEPOSIT
SAVINGS CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 1-15-2002 DATE CLOSED 4-25-2003
ACCOUNT NUMBER 34-13217
ACCOUNT BALANCE AT DATE OF DEATH $266.45
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
ACCOUNT INFORMATION
-0-
$266.45
KAY M. FREIBERG
INDIVIDUAL ACCOUNT
CHECKING
SAFE DEPOSIT
X SAVINGS CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 11-28-2000
ACCOUNT NUMBER 08-10449
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST -0-
TOTAL ACCOUNT BALANCE -0-
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
DATE CLOSED
'--0--
1-15-2002
KAy M. FREIBERG
INDIVIDUAL ACCOUNT
MAY 2 ? 2003
SUNTRUST
Verification of Deposits / Installment Loans
Request Date: 05/21/2003
Re: Estate of Kay Markus Freiberg
Requesting Party
Saidis, Shuff, Flower & Liadsay
2109 Market St.
Camp Hill, PA 17011
Applicant
Thomas L. Dmcker
Deposit Account(s) of Applicant
Account
Type
Interest Checking
Account
Number
0404003132683
Balance As Interest As Interest
of 2/15/03 of 2/15/03 Rate
$8,203.15 $0.84 0.16%
Names On
Account
Blanche Markus
Kay M Freiberg
No other accounts found.
Signature of Deposlto~O~f~
Rosemary Martine~-~4t ~L~IAx
Please direct additional in~u~
SunTrust Service Corporation
Credit Verification
FL-Orlando-7149
P.O. Box 620547
Orlando, FL 32862-0547
(877) 841-8443
Title Date
Supervisor 05/21/2003
This letter is confidential and written without prejudice as a matter of business courtesy with the understanding that its source
and contents will not be divulged and that no responsibility is to attach to this bank or any of its officers or agents for
information herein. It contains information solely as to transactions or experiences between the above designated customer
and this bank.
A.Robertson
SunTrust
P.O. Box 622227
Orlando, FL 32862-2227
Re:
Estate of Kay Markus Freiberg
Date of Death: February 15, 2003
Social Security No. 064-28-8230
Dear Sir/Madam:
The following is a complete record of the above decedent's accounts as of February 15, 2003,
decedent's date of death. If the decedent had a safe deposit box, indicate number__
Balance on Date of Death
Account No. Type of Principal Accrued Names on Date
Account Interest Account (All Opened
Owners)
INTEREST BLAmcn,. MAR~o~ OR
P404003132683 CHECKING $8,203.15 $8,204.20 KAY M FREIBERG 12/12/1
t89
ROWE'S AUCTION SERVICE
Bill Rowe (AU 1538L) 2505 Ritner Highway * Carlisle, PA
Ben Rowe (AU 1092L) 249-2677 697-4794 249-1978
Auction Is Action Call 'q:~owe" For Satisfaction
SELLERS NAME
AUCTION DATE/LOCATION
Bob RoWe (AU 2276L)
Dave Rowe (AU 2295L)
DATE ~ ~//~J~-~
PHONE ~7~'~ ~ t~''/
AUCTIONEER % ~-~.~
DESCRIPTION OF MERCHANDISE
I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise, goods and or property and have good title and the right to sell and that they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in
this agreement.
AUCTION SIGNATURE
Total Sales (Clerking Tickets Attached) $
Less Sale Expense:
~ Commission Auctioneer $
/ ~> % t~omrmss,on eaerrs- $
OTHER:
Ii
SELLERS SIGNATURE
TOTAL SALE EXPENSE DEDUCTED $
SELLERS NET $
'- AUCTION S~I~;NATURE
SELLERS SIGNATURE
O. C
164 · 80
387-00
328.~0
lOl.O0
108.~0
34.00
61.~0
31.00
86. O0
~3-00
39- DO
11.00
62-00
41.00
~0.00 +
73,00 +
~,1.00 +
37-00 +
21-00 +
80.~0 +
~;'6- O0 +
64.~0 +.
41-00 +
193.~0 +
212.00 +
216,§0 +
710.00 +
3~,237-~0 .~
Lot Number ".-~?'~:~'"~ -,~ [ , ~. ~ ~
/:
' .~"Th;s '~.ipt've, fiespayment and deliv.~
.. ~ ~ld as is, w~e'ls: AII. sal~'final. ~nk. you.. - :~
Lot ~ ~ ~ ~ o .~"'L"C
.. .... ~s' -"--_ s
.... ~.-' .~"-~td ~ is~ w~e:is. All ~las final.'~nk
@ S ....... -= $ .,.~.
Item or ~
Lot Number
__~ s = $ _....- ~
REMARKS: /~ ~
This receipt verifies payment and delivery of the above.
Sold as is, where is. All sales final. Thank you.
· FleorderFo~mCTMbm:~dAuelio~ Sds:ag. t-8(30-83~t9~S
11
REMAIRKS: '~ S
This receipt verifies payment' and delivery of the: above.
~Sold as is, where is. All sales final. Thank you.
· Re<~derFofTnCTMbsouf~Au~onS~hool 1-800-B35-1~5~
~5. JO
= $
-': . :Thia re¢_ elpt verifies payment and delivery of the above
..... ' :-:.!: S01d.as is where is. All* sales final. Thank you.
BUREAU OF IND/VIDUAL TAXES
INHERITANCE TAX DIVISTON
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
RE¥-lS47 EX RFP (01-03)
THOMAS E FLOWER ESQ
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
DATE 01-ZT-ZOOq
ESTATE OF FREIBERG
DATE OF DEATH 02-15-2005
FILE NUMBER 21 05-0259
COUNTY CUMBERLAND
ACN 101
KAY M
Aaoun~ Raai~ad t
PA 17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FREIBERG KAY MFILE NO. ZZ 03-0259 ACN 101 DATE 01-27-200q
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVER$~
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (SchaduZa A)
2. S~ocks and Bends (Schedule B)
3. Closely Held S~ock/Par~:nership In~eras~ (Schedule C)
q. Mortgages/No,as Raca/vabla (Schedule D)
$. Cash/Bank Dapos/~s/Misc. Personal Propar~y (Schedule E)
6. Jointly Owned Propar~y (Schedule F}
7. Transfers (Schedule G)
8. To,al Asso~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Exponsas/Adm. Costs/Misc. Exponsos (Schedulo H)
10. Dobts/Mortgago Liab/lities/Lions (Schadulo l)
[1. To,al Deduc~/ons
12. Nat: Value of Tax Re~urn
15.
lq.
NOTE:
ASSESSMENT OF TAX:
15. Amount: of Line lq a~ Spousal ra~e
16. Amoun~ of Line lq ~axabla a~ Lineal/Class A ra~a
17. Aaoun~ of Line lq a~ S/bling ra~e
18. Aaoun~ of Line Zq '~axabZa a~: CoZZa~araZ/Class B ra~a
19. Pr/nc/pa[ Tax DUB
TAX CREDITS:
PAYNENT I RECeTpT '
DATE I NUHBER
11-17-2005 I CD003257
11-17-2005 / CD005258
BALANCE OF UNPAID INTEREST/PENALTY AS OF
(1) 80zO00.O0
(:,) 17z905.2q
($) .00
(~,) . O0
(s) $1/q29.$1
(6) .00
(7) .00
(8)
(9) 30,190.72
(20) 11,338.3q
(11) .
NOTE: To insure proper
crad/~ to your account,
subai~ ~ha upper portion
of ~h/s fora w/ih your
~ax payment.
129,35q.55
q].S29.O&
87,805.q9
5,000.00
1,585.ql
.00
.00
AMOUNT PAID
D/SCOUNT
INTEREST/PEN PAZD (-)
11-18-2005 TOTAL TAX CREDIT I 6,585.ql
BALANCE OF TAX DUEI .00
INTEREST AND PEN. I 1.80
TOTAL DUE / 1.80
( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT KS REQUZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE/~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ' h} /
(KS) .00 X O0 = .00
([6) .00 X Oq5= .00
([7) . O0 X 12 = . O0
(18) q$,902.7q x 15 = 6,585.ql
(19)= 6,585.q1
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(12)
Char/~abla/Governman~al Bequests; Non-eZac~ad 9115 Trusts (Schedule J) (13) q3,902.75
Na~: Va[ua of Es~:a~:a Subjac~ *o Tax (lq) q$,902.7q
If an assessment ~as Sssued prev$ous[y, [$nes :tO, :tS and/or [6, [7, 18 and
reflect f~guees that ~nc[ude the fora! of ALL returns assessed to date.
RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 [collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Common#leith hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the 1aclu1 Class D (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S.
Section 91~0).
PAYNENT: Detach the top portion of this Notice and submit eith your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #ILLS) ASENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office
of the Register of Hills) any of the ZS Revenue District Offices, or by calling the special Z~-hour
answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or
speaking needs: 1-800-~7-50Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Net[ca by:
--erittan protest to the PA Department of Revenue, Beard of Appeals, Dept. [8lOll, Harrisburg, PA 171Ia-lO[I, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADHIN-
ISTRATIVE
CORRECT[OHS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid ~ithin three (3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allo~ad.
PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you ~auld appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9} months and one (1) day from the date of
death, to the date of payment. Taxes ~hich became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .00016~. A11 taxes ~hich became delinquent on and after
January I, 198Z Hill bear interest at a rate which ~ill vary from calendar year to calendar year ~ith that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO5 are:
Interest Daily Interest Daily [ntarest Daily
Year Rata Factor Year Rate Factor Yea.~r Rata Factor
198Z ZOZ .0005~8 1987 9Z .O00Z~7 1999 7Z .O0019Z
1983 1SI .000~38 1988-1991 Ill .O0030X ZOO0 8Z .000Z19
198~ IIZ .000301 199Z 9Z .0002~7 ZOOl 9Z .O00Z~7
1985 132 .000356 1993-199~ 72 .O00lPZ ZOOZ 62 .00016~
1986 lO[ .O0027~ 1995-1998 9Z .O00Z~7 2003 SZ .000137
--Interest is calculated as follo~s:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ~ill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sho~n on the
Notice, additional interest lust be calculated.
FIRST AND FINAL ACCOUNT OF
THOMAS DRUCKER
FOR THE
ESTATE OF KAY MARKUS FREIBERG
NO. 2003- 00259
Date of Death:
Date of Executor's Appointment:
First Complete Advertisement of
Grant of Letters:
Accounting for the Period:
02-15-03
03-24-03
04-11-03
03-24-03--06-01-04
Purpose of Account: Thomas Drucker, Executor, offers this account to acquaint interested
parties with the transactions that have occurred during his administration. The account also
indicates the proposed distribution of the estate.
It is important that the account be carefully examined. Requests for additional information or
questions or objections can be discussed with:
Thomas E. Flower, Esquire
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17001-0737
[717] 737-3405
SUMMARY
Proposed Distribution to Beneficiaries
$ 41,537.38
Principal Receipts:
Less Disbursements:
Debts of Decedent
Funeral Expenses
Administrative Expenses
Federal and State Taxes
Fees and Commissions
Balance Before Distributions
Distribution to Beneficiaries
Balance for Distribution
Balance of Fees to be Disbursed
Proposed Schedule of Distribution
Page
No.
3
4-5
5
6-7
8
8
8
8
9
6,622.08
8,655.58
14,941.64
6,592.14
5,000.00
45,750.00
(5,000.00)
(41,537.38)
I34,098.82
(41,811.44)
92,287.38
46,537.38
(46,537.38)
00.00
2
05-01-03
05-20-03
05-27-03
06-17-03
07-13-03
07-24-03
07-30-03
07-30-03
08-05-03
11-20-03
11-24-03
PRINCIPAL RECEIPTS
F&M Trust, account liquidation
Highmark Blue Shield, reimbursement
Pa. Blue Shield, reimbursement
Waypoint Bank, account liquidation
Gleason Corp., stock redemption
SunTrust, account liquidation
Capital Self Storage, refund of rent
Health Management Assoc., refund
Change, found at house
Rowe's Auction, proceeds of personalty
Rowe's Auction, proceeds of personalty
Yard Sale Proceeds
Net Proceeds of Sale, real estate
05-18-04 Fiserv, redemption of IRA
Redemption, investment account
Total principal receipts
351.03
28.02
36.69
24,214.34
460.00
8,208.83
13.00
272.93
12.13
2,105.00
413.00
150.72
78,041.08~
10,060.61
9,731.44
134,098.82
Gross sale price $80,000, less $250 credit to buyers for mowing and final cleaning, less
S800 real estate transfer tax, less $2,121.15 for septic tank installation, paid at settlement, plus
$1,212.23 pro-rated property tax recovered at settlement.
DEBTS
03/31/03
PPL Electric, utility bills
Shipley Energy, heating fuel
Carlisle Apothecary, pharmacy bill
227.90
540.00
30.76
05/27/03
Craftmatic, account pay-off
Jewish Family Svces., home care
Ariz. Mail Order, account pay-off
York Waste, trash removal service
Sprint, phone bill
848.00
465.00
45.75
29.91
48.06
05/28/03 BankCard Services, credit card bill 106.84
Comcast, TV cable bill 163.82
05/28/03
Carlisle Regional Medical Center
Glenn Bmbaker, personal services
Judie Gillette, personal services
4,267.30
1,000.00
150.00
05/29/03 Judie Gillette, personal services
42.00
05/30/03 Cumberland Goodwill EMS, ambulance 364.00
06/25/03 Bosler Free Library, lost book fee
47.90
07/09/03 Life Alert, monitoring fee 99.90
Sprint, phone bill 83.982
08/13/03 Cumberland Goodwill Fire & Rescue
30.16
2 Total payments made by the Estate to Sprint break down as follows:
05/27/03 Sprint, phone bill payment 48.06
07/09/03 Sprint, phone bill payment 83.98
07/30/03 Sprint, phone bill payment 217.63 349.67
10/09/03 refund of overpayment (77.06)
Net total paid .............................................................................. $ 272.61
Of that total:
$160.27 is treated in this account as a debt of the decedent incurred prior to death;
$ 112.34 is treated here as an administrative expense consisting of a $5 charge for change of
billing, and $107.34 for continuing service at $21.47/mo. for five months while the house was
readied for sale.
09-24-03
10/09/03
11/05/03
02/04/04
Comcast TV cable bill 114.17
Penn's Wood Physical Therapy 12.92
Carlisle Regional Medical Center, refund
Carlisle Regional Medical Center, refund
Life Alert, medical monitoring unit 300.10
Andorra Radiology 95.00
04/33/04
Cumberland Goodwill Fire & Rescue
Central Penn Medical Group
(840.00)
(2,713.77)
Family Home Health Care, power wheelchair 1,050.14
36.69
28.02
Net Refund of Overpayment,
Carlisle Regional Medical Center
Total Debts of Decedent
(52.47)3
6,622.08
FUNERAL EXPENSES
05/27/03 Hoffman Roth Funeral Home 6,528.58
05/28/03 Congregation Beth Tiikvah, grave opening 425.00
Carlisle Memorials, grave marker 1,492.00
10/09/03 Dickinson, memorial service room rental 210.00
Total Funeral Expenses 8,655.58
Carlisle Regional Medical Center, 2004 payments and off-setting insurance reimbursements:
01/09/04 refund (196.89)
payment 140.00
payment 782.00
02/25/04 refund (671.77)
04/30/04 refund (105.81)
Net Refund (52.47)
03/25/03
03/31/03
04/08/03
04/14/03
04/24/03
04/30/03
05/01/03
05/15/03
05/20/03
05/27/03
05/28/03
05/30/03
06/10/03
06/11/03
06/17/03
06/25/03
ADMINISTRATION EXPENSES
Register of Wills, probate fees
Cumb. Law Jml., estate notice
York Waste Disposal, dumpster rental
York Waste Disposal, dumpster rental
York Waste Disposal, dumpster rental
Jim & Donna Gordon, refuse removal
Capital Self Storage, rent and lock drilling
PNC Bank, check printing fee
Charlie Carothers, mowing
Orkin, pest extermination
PPL Electric, utility bill
Shipley Energy, heating fuel
Patriot News, Estate notice
F&M Bank, fee for balance stmt.
Jim & Donna Gordon, refuse removal
Robin Sollenberger, county r/e taxes
Boiling Springs Pet Adoption Service
Penn National, property insurance
James Morrison, mowing
James Morrison, mowing
Capital Self Storage, rental
York Waste Disposal, dumpster rental
Vital Statistics, death cert. Blanch Markus
N. Middleton Twp., septic repair permit
UPS, shipping charges
284.00
75.00
411.00
559.00
559.00
870.00
106.62
27.60
150.00
78.27
53.52
360.00
123.55
5.00
1,820.53
513.84
500.00
573.00
200.00
150.00
88.62
184.38
19.00
80.00
24.10
07/03-03 Craig Anderson, hedge trimming
PNC Bank, check printing fee
07/09/03 PPL Electric, utility bill
07/20/03 James Morrison, lawn care
07/24/03 James Morrison, lawn care & hauling
Sollenberger's, auto title transfer fee
07/30/03 Robin Sollenberger, school taxes
Sprint, phone bill
PPL Electric, utility bill
08/13/03 Shipley Energy, heating fuel
09/04/03 Russ Shughart, replace septic drain pipes
James Morrison, mowing (twice)
09/24/03 PPL Electric, utility bill
The Hartford, insurance of Buick
10/09/03 James Morrison, mowing
Sprint, refund
10/30/03 PNC Bank, check printing fee
11/03/03 Terry Lindsay, hauling
Record p.o.a, to sell real estate
The Hartford, premium refund
11/07/03 Register of Wills, tax return filing fee
11/18/03 PPL Electric, utility bill
11/25/03 MISC., Inc., crate and shipping charge
12/12/03 PPL, Electric, utility bill
02/25/04 Penn Nat'l. Ins., refund of premium
06/__/04 Register of Wills, fee to file account
Total Administration Expenses
45.00
27.60
95.66
265.00
230.00
10.00
1,922.47
217.63
51.67
681.30
2,724.10
200.00
86.71
84.20
160.00
(77.06)
27.60
150.00
17.00
(84.20)
15.00
97.52
325.61
29.80
(299.00)
122.00
14~941.64
11/07/03 Inheritance Tax
05/14/04 PA Income Tax
Total taxes paid
TAXES
$ 6,585.41
6.73
$ 6,592.14
11/28/03
FEES AND COMMISSIONS
Saidis, Shuff, Flower & Lindsay,
Partial payment of atty. fees $5,000.00
DISTRIBUTIONS TO BENEFICIARIES
12/16/03
Simon Wiesenthall Institute
Bernice Mandel
Carol Kramer
DeAnna Spurlock, literary trustee
Beth Tiikvah Congregation
500.00
250.00
[250.00]
10,000.00
10,000.00
05/28/04 DeAnna Spurlock, literary trustee 10,000.00
Beth Tiikvah Congregation 15,000.00
Total cash distributions, to date
45,750.00
- in kind distribution
ITEMS REMAINING TO BE DISBURSED
Saidis, Shuff; Flower & Lindsay,
Balance of counsel fees:
$5,000.004
4 The amount requested, resulting in total counsel fees of $10,000, including a prior
disbursement of counsel fees, exceeds the ordinary fee as calculated according to the law firm's
standard percentage-fee schedule, due to the following factors: (a) actual attorney time expended
exceeded ninety (90) hours; (b) counsel independently produced a buyer for the real estate who
paid $15,000 more than the best offer presented by the real estate agent; and (c) counsel
negotiated a rescission of the agent's listing agreement, saving the estate the cost of the agent's
commission.
8
PROPOSED SCHEDULE OF DISTRIBUTION
DeAnna Spurlock, literary trustee
Beth Tiikvah Congregation
Total Proposed Distributions:
19,972.62s
21,564.76
41,537.38
CASH ON HAND
Estate checking account balance:
46,537.38
s Taxes in the amount of $6,592.14 were allocated to the share of the literary trust, which was
not deemed to be charitable in nature, and no taxes were allocated to the Beth Tiikvah
Congregation, which is acknowledged to be tax-exempt.
9
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
Thomas Dmcker, Executor under the Last Will and Testament of Kay Markus
Freiberg, deceased, hereby declares under oath that he has fully and faithfully
discharged the duties of his office; that the foregoing First and Final Account is tree
and correct and fully discloses all significant transactions occurring during the
accounting period; that all known claims against the estate have been paid in full; that,
to his knowledge, there are no claims now outstanding against the estate; and that all
taxes presently due from the estate have been paid.
THOMAS DRJ, JCKER, Executor
S~vom to and subscribed before me
this //'/~ day of ~~,2004.
Notary Public
OMMONWEALTH OF PENNSYLVANIA
Notarial Seal ]
Sallie AIIshouse, Notary Public
omm~ss[on Expires Mai'. 29, 2008 ~
10
FIRST AND FINAL ACCOUNT OF
THOb~S DRUCKER FOR THE
ESTATE OF
KAY ~%RKUS FREIBERG
No. 21-03-0259
Thc~as E. Flower, Esquire
LAW OFFICES
SAIDIS, SHUFF, FLOWER & LINDSAY
26 WEST HIGH STREET 2109 MARKET STREET
CARLISLE. PA 17013 CAMP HILL, PA 17011
TEL: (717) 243-6222 TEL: (717) 737-3405
FAX: (717) 243-6486 FAX: (717) 737-3407
FIRST AND FINAL ACCOUNT OF
TH0~%S DRUCKER FOR THE
ESTATE OF
KAY ~qKUS FREIBERG
No. 21-03-0259
a~bs' I~,~-- ~)1~ Account Confirmed
olutely and distribution decreed
in accordance with proposed
ale of distribution h~ewlth.
~ms E. Flor,
LAW O~[CES
SAIDIS, SHUFF, FLOWER & LINDSAY
26 WEST HIGH STREET 2109 MARKET STREET
CARLISLE, PA 17013 CAMP HILL, PA 17011
TEL: (717) 243-6222 TEL: (717) 737-3405
FAX: (717) 243-6486 FAX: (717) 737-3407
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISZDN
DEPT. 280601
HARRISBURG, PA 171ZD-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
RE¥-1~07 EX AFP ¢D1-~$)
THOMAS E FLOWER ESQ
SAIDIS ETAL
2109 MARKET ST
CAMP HILL F~t~?Dll
DATE 10-18-200q
ESTATE OF FREIBER$
DATE OF DEATH 02-15-2005
FILE NUMBER 21 05-0259
COUNTY CUMBERLAND
ACN 101
Amoun't Rmm:L*l:'l:md
KAY M
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To /nsurm proper cred/~ ~o your account, submi~ ~he uppmr potation of ~hJs form wi~h your- ~cax payment:.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ESTATE OF FREZBERG KAY M FILE NO. 21 05-0259 ACN 101 DATE 10-18-200q
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM IN THE NAHED ESTATE. SHONN BELOW
ZSA SUHNARY OF THE PR/NC/PAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-27-200q
PRINCIPAL TAX DUE= ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
6,585.~1
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
11-15-2003
11-15-2003
CD003237
CD003238
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDIT'
.00
.00
5,000.00
1,585.~1
TOTAL TAX CREDIT 6,585.~1
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Z~-hour
answering service for forms ordering: 1-800-56Z-ZO50; services for taxpayers with special hearing and / or
speaking needs: 1-800-~qT-30ZO (TT only).
REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171ID-D601, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI) discount
of the tax paid is allowed.
PENALTY: The 15g tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January LB, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, L98Z bear interest at the rate of
six (DX) percent per annum calculated at a daily rate of .O00L6q. All taxes which became delinquent on and after
January L, 198Z will bear interest at a rats which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for L982 through 200~ are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z ZOZ .OOOS~D 1988-1991 LXZ .O003OL gOOL 9Z .O00Zq7
1983 L6Z .O00q~8 L99Z 9X .O00Z~7 200Z 6X .OOOL6q
198q LLg .000501 I995-I99~ 7X .O00L9Z gO05 5g .0001~7
1985 X~X .000356 1995-L998 9Z .O00Zq7 ZO0~ qX .O00LXO
X986 LOX .O0027~ 1999 72 .O0019Z
1987 9Z .O00Zq7 ZOO0 8Z .O00Z19
--Interest is calculatad as follaws:
ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELTNQUENT X DAZLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/10/2005
FLOWER THOMAS E
2109 MARKET STREET
CAMP HILL, PA 17011
RE: Estate of FREIBERG KAY MARKUS
File Number: 2003-00259
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 2/15/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc:
File
Personal Representative(s)
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STATUS REPORT UNDER RULE 6.12
.
NameofDecedent:-1-aN) /lA..-Mk-V..-.$ ~v-e( bevi
Date ofDeath: "2 - (S - 0 'S
Will No.:
2&0 S ~ {90 2-1J"'(
Admin. No.: 2-1-o?~ 62';-1
Pursuant to Rule 6.12 of the Supreme Court Orphans' Comi Rules, I repOli the
following with respect to completion of the administration of the above-captioned estate:
1. State wh9her administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the wrrsonal representative file a final account with the Court?
Yes::/ No 0
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 0 No 0
c. Copies of receipts, releases, joinders and approval offormal or
informal accounts may be filed with the Clerk of tile Orphans' Court
and may be attached to this report.
Date:l:J3'-()~ ~~ ~
Signature
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Name
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Address
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Capacity: 0 Personal Representative
[!;}Counsel for personal representative
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Telephone No,
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