HomeMy WebLinkAbout04-0651PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as
No.
To:
Social Security No. ~4-?? -,z~ ~ --/? ~ff'O
Register of Wills for the
Deceased. County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl
for letters of administration
0n the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in ~'~,,, /[d'~ _ ~ Co_unty, Pennsylvania, with
h last family or principal residency ~t 'V ~ o [')o,9/~r, (_~,,4o,~ ~ ,~.,.
! '(list street, number and municipality)
at Decendent, then.~70. ~9 ~ "7'~'d)~years'/~'~°f age,o fi o** ,, ~died . (3'"~,/,~d [y C ~4~ ,.,~ '~/,///'¢5-'~ ,~_ ,~1~ ,:~/. 0 O,5'.
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
Petitioner
the following spouse (if any) and heirs:
Name
after a proper search ha
ascertained that decedent left no will and was survived by
Relationship Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF
'The petitioner(s) above-named swear(s) or affirm(s)that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirm~ and subscribed
before me this I ~ ~ day of
-"~_c- Q~.~.~~~ Register3 L
No. l-o4-us
Estate of~c~c~ ~ ~ ,~v, , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~'(.x'\~ \ ~2~ a(30~ 1~. , in consideration of the petition on
the reverse side hereof, stifisfactory_proof having been presented before me,
IT IS DECREED that ~ ~ ~,~x~
is/~e entitled to Letters of AdmiMstration, and in accord with such finding, Letters of Administration
~e hereby granted to ~o~ ~. ~ ~x~
in the estate of~~. ~o ~,~ ~ ~ L ~~k ~
FEES
Letters of Administration .....
Short Certificates( ) ..........
Renunciation ................ $
$10
TOTAL __ SqB ,0
Filed ~ .-...~."~..'7... 4~z~ A.D.
- R;gister of W lls r'''
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
Register of Wills of Dauphin County, Pennsylvania
RENUNCIATION
· Deceased
No.
(Relationship) (Capa(Sty)
of
the above Decedent, hereby renounce(s) the right to adn~pister the estat~and respectf~jlly re,quest(s) that
·
Witn.ess handthis /~"~ dayof ~~-~ , 20 ~ .
(~lnature)
(Signature)
Sworn to or affirmed aod subscribed
My Commission Fxpires:
(Address)
(Signature)
(Address)
RW-13 (Rvsd 9/92)
NOTE: Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal [
Dorothy M. Scott, No .t~ry Public
City of Harrisburg, Dauphin County
My Commission Expires Sept. 11, 2004
Member, Pennsylvania As$oc!ation of Notaries
Register of Wills of Dauphin County, Pennsylvania
RENUNCIATION
also known as . .
· Deceased
No,
/ (Relationship) (Capacity)~
the above Decedent, hereby renounce(s) the right to adrr~ister the estate~and respec, tfully~ request(s) that
?.
~ -- -(~g~tdre}
.... ~{Address~ ~ ~ / / ......
(Signature)
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
b~his !~ ~"~ d~/~'
, 20 ~/~
Notary Pubti(Y
My Commission Expires:
RW-13 (Rvsd 9/92)
NOTE:
iOMMONWEALTH OF PENNSYLVANIA~
Notarial Seal
Dorothy M. Scott, No .t~ry Public
City of Harrisburg, Dauphin County
My Commission Expires Sept. 11, 2004
Member, Pennsylvania Association of Notaries
Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
Date
Local Registrar
JUL 1 g 2004
H105 143 Rev. 2/87
,IT
NAME OF DECEDENT (First. Middle, Last)
~. Rosa L. Smith
s. 82 Yrs.
COUN~ OF DEATH
sb. Cumberland
DATE OF BIRTH
(Munth. Day. Year)
,.8-21-1921
CITY, BORO, TV~m OF DEATH
k. East Pennsboro
DECEDENT'SUSU~ OC~PATION
~a. Homemaker
770 Poplar Church Road
Hill, PA 17011
FATHER'S ~ME (Fi•t, Middle, Last)
Theodore Jarvis
2o.. Iris Williams
Other (Specify)
phys~an is not availat:fle at time of death to
certify cause of death
KIND OF BUSINESS I iNDUSTRY
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE N~JM~R
SEX I SOCIAL SECURITY NUMBER
zFemaie J~. 577 -24 -1950
BIRTHPLACE (City and
Slate or Foreign Country)
Atlanta, GA ~,,~t r~ E~,,,, [~ DOA~ ~
L give street and number) IWAS DECEDENT OF H
West Shore Health and Rahab IMe~can, P~R~n. etc
I~,
EVER IN J DECEDENT'S EDUCAT ON J MARITAL STATUS. Manied,
U S. ARMED FORCE.~2 I (sp~ct~ Only h~hest ~'ade con,et°d) ! Never Marhed. V~Jowed.
r--i -. ~ I Elemantaq,/Secondaty J C~lege J Divorced (Specify)
Yes,, ~ i..12 t.,2i i,.,~s., l~4. Widowed
~a. sat, PA
persun who pronounces death
DECEDENT'S
ACTUAL
RESIDENCE
(See instructions
on other Side)
l?b. County
DATE OF DISPOSITION
LICENSE NUMBER
dealh occurred at the time. date and place stated
IMMEDIATE CAUSE (Final
cause. Enter UNDERLYING
CAUSE (DIsease or injury c.
resulting on death ) LAST d.
WAS AN AUTOPSY ~ WERE AUTOPSY FINDINGS [ MANNER OF DEATH
PERFORMED? I AVAILABLE PRIOR TO I
I COMPLETION OF CAUSE I Natural []
IOF DEATH? IAccident []
Y"ONomI Y.,• Nom---Is . []
.t~. 1~.
DUE TO (CR AlS A CONSEQUENCE OF):
DLI~ TO (OR AS A CONSEQUENCE OF):
Homicide
Pending Invesligahon
DATE OF DEATH (Month. Day. Year)
(Spec/fy)
Black ·
NAME AND A[X)RESS,
DESCRIBE HOW INJURY OCCURRED
LOCAT ON (~St~eet C y/Town. Slate}
3AUSE 'H
DATE OF INJURY I TIME OF INJURY
PLACE OF INJURY - A home farm sires factory office
I ' , , ,
CERTIFIER (Check only one)
'CERTIFYING PHYSICIAN (Ph~sioan cerlifyin(i cause of death when another sic. lan has renounced death and co~pletad item 23)
To the best *34 myknow~edge death occarr~d due to the causes(s) and ~a~ner as ata~d ................................................................. []
'PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and certifying to cause of death)
To the best of my know~edge death occurred at the time, date, and place, and due to the;
*MEDICAL EXAMiNER/CORONER
On the basle of examination and/or investigation, In my opinion, death occurred at the time, date and p ace and due to the causes(s and
manner al ltated ............................................................................................................................................................
Did 17c. ~es, decedentlivedln East Pennsboro
decadent twp
Cumb e r land township? 17d. [] NO. d~'~_nt lived
wi/h• actual limits of
cfly/boro
MOTHER'S NAME (Firsl, Middle, Maiden Surname) I
INFORMANT'S MAILING ADDRESS (Street, City/Town. State, Zip (Jade)
~.32 North
PLACE OF DISPOSITION- Name of Cemelery, Crematory LOCATION - City/Town, State, Zip Code
orOlhe~Placa Cremation Societ'
Harrisbu
Cremation Soci,
~.4100 Jonestown xoa~,I HarrisoN:
LICENSE NUMBER
{Month, Day, Year)
Year) WAS CASE REFERRED TO A MEDICAL EXAMINER/CORONER?
not resuti~lg in the underlying cause given in PART I
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 10/05/2004
WILLIAMS NOVEL R
32 N 18TH ST
HARRISBURG, PA 17103
RE: Estate of SMITH ROSA LEE
File Number: 2004-00651
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 10/23/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
Name of Decedent:
Date of Death:
Will No.
To the Register:
CERTIFICATIO~N)OF NOTICE UNDER RULE 5.6(a)
- ov-- oo,/
Admin, No.
I certify that notice of (beneficial interest) ~ 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
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Address
Telephone
Capacity: ~ersonal Representative
_Counsel for personal representative
In Re: Estate of
SMITH ROSA LEE
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-00651
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: WILLIAMS NOVEL R
Counsel for Personal Representative:
Date of Decedent's Death: 7/5/2004
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Comi Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
Date:
7/28/2006
tJ,V hl/J
A]bd~. t\z!:M.4?<<:..J ~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
/
WILLIAMS NOVEL R
32 N 18TH 81'
HARRISBURG PJ\ 1'7103'
3. Service Type
D Certified Mall
D Registered
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D Express Mall
D Return Receipt for Merchandise
DC.a.D.
SENDER" ,-,- - ".-i...ETE THIS SECTION
. Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse
so that we can return the card to you.
. Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
4. Restricted Delivery? (Extra Fee)
DYes
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
7005 0390 0003 2638 7971
~
Domestic Return Receipt
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UNITED STATES POSTAL SERVICE
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Postage & Fees Paid
USPS
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· Sender: Please print your name, address, and ZIP+4 in this box ·
ut- C['SI
- \
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Glenda Farner Strasbaugh
Register of Wills and Clerk of Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, P A 17013
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Ma~orie A. Wevodau
First Deputy
One Courthouse Square
Carlisle. Pa. 17013
Glenda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court
(717) 240-6345
FAX (717) 240-7797
Kirk S. Sohonage. Esquire
Solicitor
OFFICES OF
l\.e.gi~ter of WiIl~ anb (!Clerk of tbe <!&rpban~' (!Court
QCountp of QCumberlanb
11/20/2006
WILLIAMS NOVEL R
IN RE: SMITH ROSA LEE
2004-00651
Dear Sir/Madam
It has come to my attention as solicitor for the Office of the Register of Wills and Clerk
of the Orphans' Court in and for Cumberland County, Pennsylvania, that the above estate
has failed to file a report of the status of administration as required by Pennsylvania
Orphans' Court Rule 6.12.
Subsection (f) of Rule 6.12 requires that the Register of Wills notify the Court in the
event the personal representative or counsel fails to file this notice after (10) days written
notice thereof. You have already received written notice of this delinquency by the
Register.
.. .... .1' . .. ..-
U.S. Postal Service""
CERTIFIED MAIL" RECEIPT
(Domestic Mall Only; No Insurance Coverage Provided)
Kindly accept this letter as written notification that unless the required 6.12 Status Report
is filed with the Register of Wills Office within ten (10) days of your receipt of this
correspondence, I will be compelled to file a Motion for Sanctions for Failure to Comply
with Orphans' 'Court Rule 6.12. Ifrequired to do so, I will request that the Court grant
"sessed against the offending party.
[I'"
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Sincerely,
~Ji~ .
Kirk S. Sohonage O/.jJfY
Solicitor
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IN RE: ESTATE OF
SMITH ROSA LEE
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-00651
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: WILLIAMS NOVEL R
Counsel for Personal Representative:
Date of Decedent's Death: 7/5/2004
Date of Delinquency Notice: 8/1/2006
The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance
with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day
notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court
is hereby notified of such delinquency and the undersigned requests that a Court conduct a
hearing to determine whether sanctions should be imposed upon the delinquent personal
representative or counsel for the delinquent personal representative.
Date:
8/15/2006
G~=~
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled November 20th. 2006 (a), 11 A.~M
in Courtroom NO.2. If the Status Report is filed prior t e hearin ~' 'ng will
automatically be cancelled. ~
v \ 0-'1
Edgar B. Bayley, J. '
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NOTICE OF INHERITANCE TAX pennsytvania
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-12)
PO BOX 280601
HARRISBURG PA 17128-060ER~.i
~qr` =a DATE 12-24-2012
ESTATE OF SMITH ROSA L
Cu C DATE OF DEATH 07-05-2004 rill 1, k? 1412
4.u1 C L i FILE NUMBER 21 04-0651
COUNTY CUMBERLAND
NOREL R WILLIAALERj` 0 _ ACN 101
32 N 18TH SDRPHAS' C'`)APPEAL DATE: 02-22-2013
H B G C U $ E R EA N M, P (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT-ALONG -THIS -LINE --RETAIN-LOWER-PORTION-FOR-YOUR-RECORDS-
REV-1547 EX AFP (12-12) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SMITH ROSA LFILE NO.:21 04-0651 ACN: 101 DATE: 12-24-2012
TAX RETURN WAS: ( ) ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
. submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) .00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) .0 0
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0
11. Total Deductions (11) 00
12. Net Value of Tax Return (12) 00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0
14. Net Value of Estate Subject to Tax (14) .00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .0 0 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) -00, x 045 = .00
17. Amount of Line 14 at Sibling rate (17) - 00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 = .00
19. Principal Tax Due (19)= .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE D
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
as
REV-1470 EX (n1-1~'"`
pennsytvania INHERITANCE TAX
DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES 577-24-1950 DOD: 07/05/2004
PO Box 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Rosa Lee Smith 2104-0651
REVIEWED BY ACN
Amber Heimbach 101
ITEM
SCHEDULE NO, EXPLANATION OF CHANGES
Efforts to file an Inheritance Tax return have been exhausted in the above-referenced
estate. Therefore, the filing requirements have been waived. The Department however,
reserves the right to assess any assets that may be recovered at a future time.
Page 1