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HomeMy WebLinkAbout04-0677 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Leah May Masonheimer No. _~\ --04-- ~3 also known as To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 202-46-526'1 Deceased. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the in the last wilt of the above decedent, dated June 18 and codicil(s) dated N/A execut°r named ,1993 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family orA~rincipal residence at 4769 Brian Road, MechanJ_¢sburq, Pennsylvania 17055 (list street, number and muncipality) Decendent, then 49 years ofa~e, died June 30 ,Xi~' 2004 at Holy Spiri~ Hos~.{tal, ~amp Hill, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: 15,000.00 (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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) es R. Mhsonheimer 9~5 Maple Mall MechanlcsDurg, PA 1/0Db OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND? SS The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to i. he best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the aboye decedent petitioner(s) will wyynd truly administer the estate according to law. Sworn to or affir~e~ and subscribed ,~_.l~,,-,-.,~-- before me this ~{0 day of ~///)' ,. July, / ~,* ~4{ ~20041f)--~- Estate of Leah May Masonheimer , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW '~-t__ }~ X/ g. _(~'k~ ~ 200,4in consideration of the petition on the reverse side hereof, sa/tisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated June 18, t 993 described therein be admitted to probate and filed of record as the last will o'f Leah May Masonheimer ; and Letters Testamentary are hereby granted to James R. Masonheimer FEES Probate, Letters, Etc .......... Short Certificates( ) .......... TOTAL Filed ................................... anEnony L.~Q~e~uca, ~squire 113 Front Street ADD.SS Boiling Springs, PA 17007 717-258-6844 PHONE m. ,,s,~a, J? ph ~ ograph COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Leah 49 ws 4769 Brian Road ACTUAL ~echanicsburg, PA 17055 (see instruct James R. Masonheimer James R. Masonheimer 17109 4100 aonestown Road, °~PAllI09 muse ~nter UNDERLYING LAST WILL AND TESTAMENT OF LEAH MAY MASONHEIMER I, LEAH MAY MASONHEIMER, of New Cumberland, Pennsylvania, declare this to be my Will and hereby revoke all prior wills and codicils. FIRST I give all my tangible personal property not specifically bequeathed elsewhere in this will, including but not limited to, any and all automobiles, furnishings, jewelry, and wearing apparel, together with any insurance thereon, to my father, JAMES R. MASONHEIMER. If he fails to survive me by thirty days, then I give my tangible personal property to my brother, JAMES W. MASONHEIMER. If neither of the above beneficiaries survive me by thirty days, this bequest shall lapse and be distributed as part of my residuary estate. SECOND I give the residue of my estate to my father, JAMES R. MASONHEIMER, provided that he survives me by sixty days. If he fails to survive me, then I give the residue of my estate to my brother, JAMES W. MASONHEIMER. In the event none of the above beneficiaries survive my death by sixty days, the residue of my estate shall be distributed to THE FIRST CHURCH OF THE BRETHREN, located at 2~9 Hummel Street, Harrisburg, Pennsylvania. ~.~ THIRD · -~ No interest of any beneficiary under this Will or any C~icil hereto shall be subject to anticipation or voluntary o~J involuntary alienation. .cD ~' FOURTH I appoint JAMES R. MASONHEIMER, Executor. In the event he is unwilling or unable to act, I appoint JAMES W. MASONHEIMER, substitute Executor. FIFTH My Executor shall not be required to file a bond in this or any other jurisdiction. 1 SIXTH In addition to powers given them by law, my Executor and any successor Executors shall have the following powers, applicable to all property held by them, effective without court order and until actual distribution: (a) To retain any property received by them, including the stock of any corporate fiduciary acting hereunder; (b) To sell real estate for any purpose, publicly or privately, for such prices and on such terms as they deem proper, without liability to the purchasers to see to application of the purchase monies; (c) To compromise controversies; (d) To distribute in cash or kind or both at such valuations as they may fix; (e) To distribute property passing to a minor under this will either to the minor or to any person to hold for a minor; (f) To sell articles passing to a minor under this will if the Executor, in his sole discretion considers such articles unsuitable for a minor and to use the proceeds of such sale to equalize the shares of the other beneficiaries of this will; and (g) To hold investments in the name of a nominee. SEVENTH Ail federal, state, and other death taxes payable because of my death on the property forming my gross estate for tax purposes, whether or not it passes under this will, shall be paid out of the principal of my probate estate so that the burden thereof falls on my residuary estate, and none of those taxes shall be charged against any beneficiary, or any outside fund. IN WITNESS WHEREOF, I have hereunder set my hand and seal this ~'~J day of ~ .... , 1993. 2 The preceding instrument, consisting of this and two (2) other typewritten pages, was on the day and date thereof signed, by the above-named Testatrix as her Last Will, in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ~'l;."~,~,.~/,~.~residing at residing at COMMONWEALTH OF PENNSYLVANIA : : ss. COUNTY OF d~! ( ' J~/~; ,' r'/.b ~. ~q : I, LEAH MAY MASONHEIMER, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed this instrument as my Last Will; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. LEAH MAY ~ASON~EIMER Sworn to and subscribed before me this /Z~ day - of ~ , , 1993. Notary~ublic 3 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF SS. We, :/f. ~6:~,//,/"7~/,L ,~ '~and , the witnesses who~e names a~'signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw LEAH MAY MASONHEIMER, Testatrix, sign and execute the instrument as her Last Will; 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. residing at $%;o:~n to and subscr, ibed before me this ../ta day of N~tar~ 'Public 4 Cumberland County - Register Of Hanover and High Street Wills Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 KELLY KAREN L 240 POPLAR AVENUE NEW CUMBERLAND, PA 17070 RE: Estate of PALMER JOHN C JR File Number: 2004-00673 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 J~ly.1, 1992, the personal representative or his Counsel, within te~ (10) days 9fter glvln? proper notice to the beneficiaries and Intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the ', of the Orphans, Court his/h ........ Register of Wmlls or Clerk ' =~ ~r~l~lcat~on of Notice. This filing will become delinquent on 10/29/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge Sincerely, GLENDA FARNER Clerk of the Orphans, Court Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 DELUCA ANTHONY L ESQ 113 FRONT ST BOILING SPRINGS, PA 17007 RE: Estate of MASONHEIMER LEAH MAY File Number: 2004-00677 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 10/30/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge Sincerely, ENDA FARNER S~ Clerk of the Orphans' Court Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 MASONHEIMER JAMES R 985 MAPLE MALL MECHANICSBURG, PA 17055 RE: Estate of MASONHEIMER LEAH MAY File Number: 2004-00677 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 ORPH3~NS, 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 10/30/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Leah May Masonheimer Date of Death: June 30, 2004 Will No. 21-04-0677 Admin. No. To the Register: I certify that notice of (beneficial interest) 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 October 22, 2004. Name Address James R. Masonheimer 985 Maple Mall, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Anthony L. DeLuca, Esquire Address 113 Front Street, P. O. Box 358 Boiling Springs, PA 17007 Telephone (717) 258-6844 Capacity: Personal Representative X Counsel for personal representative NO?ICI~ OF RI~NFRFICIAT, INTI~R RSIT IN I~RTAT}~ BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate afl ,eah May Ma~anheimer, deceased, No. 00677 of 2004 TO: Jame~q R Ma~anhelmer (beneficiary) 985 Maple Mall; Meehanie~hnrgc,; PA 17055 (address) Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: 100% nf Re~idnary F.~tate and all Tenable Pemnnal Prnperty (if additional space is needed, use back of page) Name of decedent I.eah May Ma~anheimer Last known address of decedent 4760 Rrlan Road; Meehanle~hnr~; PA 17055 Date &death June 30; 2004 Place of death Cumberland County of grant of original letters Decedent died X testate__ Intestate. Acopyofthewill is X is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Nalne Jame~ R Ma.qanheimer Address Telephone 085 Maple Mall. Meehanle~hnrg. PA 17055 (717)706-1455 Name(s), address(es) and telephone number(s) of all counsel Name Address Anthony 1. DeI.nca: F, sqnire 113 Front ~qt P.O. Ray '~58; Railing Rpring~; PA 17007 Telephone (717) Additional information may be obtained from the undersigned. Name Anthony T?x~heI ,nee. l~,~qnlre ~ /." Address 113 Front ~qt; P O Ro~c 35R Floiling ~qpring~: PA 17007 Telephone (717) 258-6844 Capacity: Personal Representative X Counsel for Personal Representative REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT '~ ' ~ COMMONWEALTH OF ~ PENNSYLVANIA ~~,~ DEPARTMENT OF REVENUE F'f~,~,,~'~ DEPT. 280601 -~t,t,~ HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY FILE NUMBER COUN~ CODE YEAR E~[1. Odginal Retum [~]4. Limited Estate E~6. Decedent Died Testate IAttach copy E~9. LdigatJon proceeds Received [~]2. Supplemental Return [~4a. Future Interest Compromise (date of death at, er 12-12-82) [~]7. Decedent Maintained a Living Trust (A~C~ copy ol [~10. Spousal Pored7 Credit (date oldea~h between 12-31-91 and 1-I-S5) NAMEAnthony L. DeLucar Esquire TELEPHONE NUMBER 717--258-6844 1, Real Estate (Schedule A) (1) - 0- 2. Stocks and Bonds (Schedule B) (2) $1 ,, 4 8 7. 0 4 3. Closely Held Corporation, Padnership or Sole-Prophetorship (3) - 0- 4. Mortgages & Notes Receivable (Schedule D) (4) - 0- 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1 5 r 9 6 8.3 0 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) - 0 - ~'~ Separate Biffing Requested 7. inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) - 0- (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 3,4 3 0.8 4 I0. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made {Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES ~]5. Federal Estate Tax Return Required O 8, Total Number of Safe Deposit Boxes E~] 11. Election to tax under Sec. 9113(A) (A~c~ Sch O) COMPLETE MAILING ADDRESS 113 Front Street P.O. Box 358 Boiling Springs, PA 17007 ~-'" ~ OFF!¢IAL. USE ONLY ? 2,121.08 (11) (19) (13) (14) $17,455.34 5,551.92 11,903.42 1'1k903.42 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 Une 14 taxable at collatsml rate 19. Tax Due 11,903.42 x .0_ (15) x .0 45 (16) x .12 (17) x .15 (18) ¢9) $535.65 $535.65 z NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE iNITIAL) SOCIAL SECURITY NUMBER ~ Masonheimer Leah May Z 202 - 46 - 5261 U.J DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) f"~ THIS RETURN MUST BE FILED Iff DUPLICATE WITH THE LU June 30, 2004 December 23, 1954 REGISTER OF WILLS Ill (If APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER DeCedent's Complete Address: tSTREETADDRESS 4769 Brian Road I CiTY Mechanicsburg, I STATE PA I Z~P I 7055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments - D- A. Spousal Poverty Credit - 0- B. Prior Payments C. Discount - O- (1) $535.65 3. Interest/Penalty if applicable - O- D. Interest E. Penaify - 0- 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. Total Credts (A+ 8 + C) (2) -0- Total Interest/PenaifY ( D + E ) (4) (5) (SA) (5B) Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT -0- (3) 535.65 535.65 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: - transferred [] [] retain the use or income of the property ; ............................................................................ a, ' .... f fred o~; its income [] [] b. retain the dght to designate who shall use the property trans e '. ........................................... [] 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 decadent transfer property within one year of death [] [] without receiving adeq..u, ata consideration? .............................................................................................................. 3. Did decedent own an in trust for or payable upon death bank account or secudty at his er her death? .............. [] [] 4, Did decedent own an Individual Retirement Account, annuity, or other non-prebate 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 TIlE RETURN. Under penalties of perjue/, I declare that I have examined this return, including accompanying schedules and s~atements, and to the best of my knowledge and belief, it is true, correct and complete. DATE ATURE OF P SON RESPONSIBLE FOR FILING RETURN · Mr~~ %. . / ., '-'/ 'lb ~DDRES~- ~ . ~ ' ~ - · For dates of death on or after July 1, 1994 a~d before Januau 1, 1995, the tax rata ~mposed on the net value of transfers to or for the use of ~e su~iving spouse is 3 ~0 F2 P.S. ~9~S (a) ¢.~) (i)], For dates of death on or after JanuaU 1, 1995, ~e tax rote imposed on ~e net value of ~ansfe~ to or for the use of the suNiving spou~ is 0% ~2 P.S. ~9116 (a) (1.1) (ii)]. The statute ~oes not exemot a transfer to a su~iving s~use from tax, and ~e s[atutou requirements for disclosure of asse~ and filing a ~ return are still app{icable eve~ if ~e sumiving spous~ is the only ~ne~ciau. For dates of death on or after July ~, 2000: The t~ rats imposed on ~e net value of transfers from a deceased child ~en~-one years of age or younger at death to or for the use of a natural parent, an adoptive pabst, or a stepparant of the child is 0% F2 P.S. ~9116(a)(1.2)~. The ~x rate ~m~sed on the net value of transfers to or for the use of ~e decedes['s ~ineal benefidaHes ~s 4.5%, except as noted in 72 P.S. ~9116(1.2) ~2 P.S. ~9116(a)(1)]. ~e ~x rate imposed on the net value of trensfe~ to or for the use of ~e de~den~s siblings is 12% ~2 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as a~ i~dMdua~ who has at least one parent i~ ~mmon wi~ ~e dec~ent, whe~er by bi~d or adop~on. Ri:V-1502 EX+ J12.85) ~ COMMONWEALTH OF PENNSYLVAINIA INH~RITANC~ TAX R~TURN RESIDENT DECEDENT ESTATE OF Leah May Ma$onheimer SCHEDULE A : REAL ESTATE FILE'NUMBER (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which 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 reasanable knowledge of the relevant facts. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None -0- -0- TOTAL (Also enter on I~ne I, Recapitulation) S ,'Ir ......... ;, n.*.,4.r; ;n~H additlnnal sheets of same slze.) R~V-1503 EX,+ I'~-S'Sl ~ COM,~ONWEA~.TH OF ~'ENN$¥~.V~,NI~, INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS AND BONDS ESTATE OF Leah May Masonheimer FILE NUMBER (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM NUMBER DESCRIPTION 1. 32 shares common stock of Prudential Financial, Inc. @ $46.47 per share VALUE AT DATE OF DEATH $1,487.04 TOTAL (Also enter on line 2, Recapitulation) $ 1 , 487.04 ESTATE OF ITEM NUMBER SCHEDULE C CLOSELY HELD STOCK, PARTNERSHIP AND PROPRIETORSHIP DESCRIPTION Leah May Masonheimer TOTAL (Also enter on line 3, None Please Print or Type FILE NUMBER VALUE AT DATE OF DEATH -0- -0- (If more space is needed, insert additional sheers of same size.) EX*- (7.85) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES AND NOTES RECEIVABLE Please Print or Type ESTATE OF T'eah May Ma$onhe±mer FILE NUMBER (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F.) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 4, Recapitulation) -0- (If more space is needed, insert additional sheets of same size.) ESTATE OF SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Type FILE NUMBER Leah May Masonheimer (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NUMBER DEgCRIPTION Regular shares @ at PSECU Lender Number 0202 Checking shares at PSECU Lender Number 0202 TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH $ 12,380.83 3,587.47 $~5,968.30 (Attach additional 8V~" x 11" sheets if more space is needed.) SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF PILE NUMBER Leah May Masonheimer Joint tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. None Jalntl¥-owned prope~y: LETTER i r ITEM FOR DATE NUMBER JOINT MADE DESCRIPTION OF PROPERTY TOTAL VALUE iDECD'Si DOLLAR VALUE OF TENANT JOINT OF ASSET i % INT. DECEDENT'S iNTEREST 1. TOTAL (Also enter on llne 6, Recapitulation) S (If more space is needed insert additional sheets of same size) ~ SCHEDULE H FUNERAL EXPENSES, CO~ONWe^:T. O~ PeNaS~LV^~,^ ADMINISTRATIVE COSTS AND INHERITANCERE$1~EN? DECEDENt'TAX RETU,N MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF FILE NUMBER Leah May Masonheimer ITEM NUMBER DESCRIPTION AMOUNT ~. Funeral Expenses: 1. Cremation Society of Pennsylvania $ 1,434.00 2. First Church of the Bretheren 75.00 3. Belita Mitchell- Pastor 100.00 4. George Rohder- Church organist 100.00 ~. Administrative Casts: 1. Personal Representative Commissions Social Security Number of Personal Representative: -- -- Year Commissions paid 2. Attorney Fees 1 , 400.00 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State -~ Zip Code 4. Probate Fees 87.00 Miscellaneous Expenses: 1. The Cumberland County Law Journal. Legal Advertising 75.00 2. The Sentinel- Legal Advertising 134.84 3. Filing of inventory and inheritance tax returns 25.00 4. $. 6. 7. 8. TOTAL (Also enter on line 9, Recap;tu~ation) $ 3,4 3 0.8 4 (If more space is needed, insert additional sheets of same size.) I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R ESI DENT' DECEDENT ESTATE OF Leah M. Masonheimer SCHEDULE "1" DEBTS OF DECEDENT, MORTGAGES, AND LIENS FILE NUMBER ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. DESCRIPTION AT&T - Telephone Bank One - credit card Capital Area Surgical Associates, P.C. Medical Comcast Cable - TV Cable Cremation Society of Pennsylvania - Obituary East Pennsboro Ambulance Service, Inc. Noreen k. Garney- cleaning Roy D. Gottshall, Auctioneer - Appraisal Hampden Township Ambulance Holy Spirit Hospital - Medical M&T Bank, NA - Loan MSHMC Physicians Group - Medical PP&L - Electric Processing Center - credit card West Shore EMS-BLS - wheel chair/transportation AMOUNT TOTAL (Also enter on line 10, Recapitulation) $ 2,1 21 . 08 25.12 207.40 27.35 84.22 111.94 149.00 350.00 60.00 365.00 30.00 25.00 534.30 62.77 31.84 57.14 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Leah May Masonheimer ITEM AMOUNT OR NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP SHARE OF ESTATE A. Taxable Bequests: I. James R. Masonheimer Father 100% ITEM AMOUNT OR NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE B. Charitable and Governmenta~ Bequests: NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on llne 13, Recapitulation) S -0- (If more space is needed, insert additional sheets of same size} LAST WILL AND TESTAMENT OF LEAH MAY MASONHEIMER I, LEAH MAY MASONHEIMER, of New Cumberland, Pennsylvania, declare this to be my Will and hereby revoke all prior wills and codicils. FIRST I give all my tangible personal property not specifically bequeathed elsewhere in this will, including but not limited to, any and all automobiles, furnishings, jewelry, and wearing apparel, together with any insurance thereon, to my father, JAMES R. MASONHEIMER. If he fails to survive me by hlrty days, then I give my tangible personal t ' property to my brOther, JAMES W. MASONHEIMER. If neither of the above beneficiaries survive me by thirty days, this bequest shall lapse and be distributed as part of my residuary estate. .SECOND I give the residue of my estate to my father, JAMES R. MASONHEIMER, provided that he survives me by sixty days. If he fails to survive me, then I give the residue of my estate to my brother, JAMES W. MASONHEIMER. In the event none of the above beneficiaries survive my death by sixty days, the residue of my estate shall be distributed to THE FIRST CHURCH OF THE BRETHREN, located at 219 Hummel Street, Harrisburg, Pennsylvania. THIRD No interest of any beneficiary under this Will or any Codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. FOURTH I appoint JAMES R. MASONHEIMER, he is unwilling or unable to act, I MASONHEIMER, substitute Executor. Executor. In the event appoint JAMES W. My Executor shall not be required to file a bond in thi~ or any other Jurisdiction. SIXTH In addition to powers given them by law, my Executor and any successor Executors shall have the following powers, applicable to all property held by them, effective without court order and until actual distribution: (a) To retain any property received by them, including the stock of any corporate fiduciary acting hereunder; (b) To sell real estate for any purpose, publicly or privately, for such prices and on such terms as they deem proper, without liability to the purchasers to see to application of the purchase monies; (¢) To compromise controversies; (d) To distribute in cash or kind or both at such valuations as they may fix; (e) To distribute property passing to a minor under this will either to the minor or to any person to hold for a minor; (f) To sell articles pasSing to a minor under this will if the Executor, in his sole discretion considers such articles unsuitable for a minor and to use the proceeds of such sale to equalize the shares of the other beneficiaries of this will; and (g) To hold investments in the name of a nominee. SEVENTH Ail federal, state, and other death taxes payable because of my death on the property forming my gross estate for tax purposes, whether or not .it passes under this will, shall be paid out of the principal of my probate estate so that the burden thereof falls on my residuary estate, and none of those taxes shall be charged against any beneficiary, or any outside fund. IN WITNESS WHEREOF, I have hereunder set my hand and seal this /,)~r// day of %~,~.. , 1993. SON EIMER The preceding instrument, consisting of this and two (2) other typewritten pages, was on the day and date thereof signed, by the above-named Testatrix as her Last Will, in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ff COMMONWEALTH OF PENNSYLVANIA : : SS. I, LEAH MAY MASONHEIMER, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed this instrument as my Last Will; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. of -~-- , 1993 arF/Public - j BO~LI.N.]~ $£~.,~. CUt~5£RLAND COUNTY AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS. ~he witnesses who~e name? a~'slgned to the attached or ' zoregolng instrument, being duly qualified according to law, do depose and say that we were present and saw LEAH MAY MASONHEIMER, Testatrix, sign and execute the instrument as her Last Will; and that she execrated 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. ~ ~ residing at //3 .~- ~?~ coMMONWEALTH OF PENNSYLVANIA 'L ss: cOUNTY OF CUMEERLAND J James R. Masonheimer being duly sworn according fo law, deposes and says fhef he is Leah May Masonheimer the Executor of fhe Esfafe of b~e of Borouqh gf Me~_ha3~icsblu~g , Cumberland County, Pa., ~ecea~e~ a~ ~ha+ ~he him ., ~he sam Executor wffh;n is an ~nvenfory ma~e ~y ~ ~,~ fhe enHre esfafe of sa~ ~ece~enf, consisfing of a~l fhe personal proped~ an~ real es~a+e, excep+ rear es~afe oufside ~ne ~ommonweaffh of Penn,sylvania, and fhaf fhe ~igures opposffe each ifem of fhe lnvenfory represenf frs fa;r value  E~eCUfO~ -Admlnisfrafor 7 ~ 2004 ~ '/ 985 Maple Mall ~~ ~,~_. r :130hanicsburg, PA 17055 ,_ I I INSTRUCTIONS An [nvenfor¥ musf be Fiied wlfhin fhree monfhs affer appolnfmenf af personal represenfefive. 4, supp[emen+ ]nvenfory musf be Filed wifh;n fhi~y days o~ discovery of add;Hona~assefs. Add[fionaJ sheers may be affached as fo personally or really See Arficle IV, Fiduciaries Acf of 1949. inventory of the real and personal estate of Leah May Masonheimer deceased 1. 32 shares common stock of Prudential Financial, @ $46.47 2. Regular shares @ PSECU - Lender Number 0202 3. Checking shares @ PSECU - Lender Number 0202. ,487. ~4 380. B3 3,584. 47 17,455. 34 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 REV-1162 EXI11 96) NO. CD 004713 DELUCA ANTHONY L ESQ 113 FRONT ST BOILING SPRINGS, PA 17007 f01d ESTATE iNFORMATION: SSN: 202-46-5261 FILE NUMBER: 2104-0677 DECEDENT NAME: MASONHEIMER LEAH MAY DATE OF PAYMENT: 12/09/2004 POSTMARK DATE: 12/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/30/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $535.65 TOTAL AMOUNT PAID: $535.65 REMARKS: SEAL CHECK# 11 8 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMOHWF.ALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDiJ,A(',iT~"~~i.1 INHERITANCE TAX DIVISION..~"." PO BOX Z80601 HARRISBURG PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. AllOWANCE DR DISAllOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1541 EX AFP Ill-DO n2 ,,,,., DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-21-2005 MASONHEIMER 06-30-2004 21 04-0677 CUMBERLAND 101 Allount Rellitted LEAH M ANTHONY CJ,. ... DElOcA ESQ 113 FRONT ST PO BOX 358 BOILING SPGS PA 17007 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ IrV' =1!\"f-Ex--AFP-CB1'":cJJ'r-Noi"Ici-oF-IliRiR"!TANci-i'-Ax-APiiRA-fSE'iEN'~--ALt'bWANCE-OR------._----- - --. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MASONHEIMER LEAH M FILE NO. 21 04-0677 ACN 101 DATE 02-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 1.487.04 .00 .00 15.968.30 .00 .00 (8) NOTE: To insure proper credit to your account. subMit the upper portion of this forM with your tex paYlIBnt. 17.455.34 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdM. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage liabilities/liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governll8ntal Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax (9) (10) 3,430.84 2.121.08 (11) (12) (13) (14) 5.551 92 11,903.42 .00 11.903.42 (Schedule J) I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of line 14 at Spousal rate (IS) 16. AlIOunt of line 14 taxable at lineal/Class A rate (16) 17. Amount of line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due AX C TS: NOTE: .00 X 11,903.42 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 535.65 .00 .00 535.65 DATE 12-09-2004 NUMBER CD004713 + INTEREST/PEN PAID (-) .00 AMOUNT PAID 535.65 ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 535.65 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Leah Mav Masonheimer Date of Death: June 30, 2004 Will No. 21-04-0677 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No J( 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: ~u~v 2~oc~ I 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 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 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk ofthe Orphans' Court and may be attached to this report. .~~0Z~~#~~ Signature . Date: r/.2r~ Anthonv L. DeLuca, Esquire Name (Please type or print) 113 Front Street, P.O. Box 358 Boiling Springs, P A 17007 Address (717) 258-6844 Telephone number Capacity: _ Personal Representative ~ Counsel for personal representati ve J Cumberland County - Reglster ur Wl~~~ One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/08/2007 r'- MASONHEIMER JAMES R 985 MAPLE MALL MECHANICSBURG, PA 17055 -...;:: RE: Estate of MASONHEIMER LEAH MAY File Number: 2004-00677 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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 is due by: 6/30/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~#~ . ~7 .~,~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel L.UllLUt::::L.l.c:t.llU \.....UUllL..'y - l\.C::':::1..LOl.-l.:;,;;.J.. V.L n..J....J.....L....... One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/08/2007 DELUCA ANTHONY L 113 FRONT STREET l?O BOX 358 BOILING SPRINGS, PA 17007 o ::~ ,-.,,1 ~....=- RE: Estate of MASONHEIMER LEAH MAY File Number: 2004-00677 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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 is due by: 6/30/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ '-' Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) In Re: Estate of MASONHEIMER LEAH ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00677 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: MASONHEIMER JAMES R Counsel for Personal Representative: DELUCA ANTHONY L Date of Decedent's Death: 6/3012004 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 Court 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: 7/3/2007 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File liD Il"IC'{ "\ (; :.,'\f\...i(~UO ......-, IV',," ',-.'i~ f I ,uD :(' \ l I]l" :l'J )\b::JJ 10 : I Wd S- -lIlf lOOl 'JUN ~ '1 2007 IN RE: ESTATE OF MASONHEIMER LEAH ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00677 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: MASONHEIMER JAMES R Counsel for Personal Representative: DELUCA ANTHONY L Date of Decedent's Death: 6/30/2004 Date of Delinquency Notice: The under~igned, Glenda Farner-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: 6/26/2007 ~~~ Glenda Farner Strasbaugh ':./ .,'; 2 :o-_-:-{ _! Clerk of the Orphans' Court .. ':'i j.=~ _ '.....I..J.,.....'.... Distribution: Personal Representative Counsel for Personal Representative Estate File -'J~,~ "-.._c"' ::;c: .)---1 )> A hearing is scheduled October 1. 2007 at HAM in Courtroom NO.2. If the Status Report is filed prior to th~te, th. e.hearing will automatically be cancelled. (.~ r. ll~ J.< ~..'. . . \.' I,. \. \ ~ ' ..or .. O~~~ Edgar B. Bayley, 1. . \ "" (;:::-:-) = --.I '-- c= r- I w > -,,"" - :-) ~ ---;-1 -:d ~ (~) fTl :~~;~ a -.J In Re: Estate of MASONHEIMER LEAH ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00677 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: MASONHEIMER JAMES R Counsel for Personal Representative: DELUCA ANTHONY L Date of Decedent's Death: 6/30/2004 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 Court 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: 7/3/2007 ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File , ,'I~(" ""'-' ".,{ IJ .L1 Hlr~(y\ C' ":"~'..!riuor W I\JV \..,',1 ., 'II i...JO jl') >10318 10:1 Hd C-lnr LOOl I \ !.~ \ ~\../ ,..." "J"'"1 1 ''\ 1,) :...) .:1:<..1 " JUN 212DDi IN RE: ESTATE OF MASONHEIMER LEAH ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00677 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: MASONHEIMER JAMES R Counsel for Personal Representative: DELUCA ANTHONY L Date of Decedent's Death: 6/30/2004 Date of Delinquency Notice: The undersigned, Glenda Farner-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. Distribution: ~~l~ Glenda Farner Strasbaugh irj i ~ Clerk of the Orphans' Court~: ~ ~ ~!(J ~ ?.;:f:; I " (~;::G! w .~i ~~ C~ " ::0 ::u-4 .J> A hearing is scheduled October 1. 2007 at HAM in Courtroom No.2. If the Status Report is filed prior to th.~ e... nn.g '1te, the hearing W. ill automatically be cancelled. ((' ,/~ \ ~~v ili-,,-,-~~~.. Edgar B. Bayley, J. \ 6/26/2007 Date: Personal Representative Counsel for Personal Representative Estate File :P> :z o -.J Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Leah May Masonheimer File Number: 21-04-0677 Date of Death: June 30, 2004 Pursuant to Pa. O.C. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . ., !lmYes DNo 2. If the answeris No, state when the personal representative reasonably believes that the adririnistration will be complete: 3. lfthe answer to No.1 is YES, state the following:' a. Did the personal representative file a finar' account with the Court? . . . . . . DYes IDNo 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 DNo d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date h-~ ~O()\\ Capacity: DPersonal Representative rn Counsel '- ts-' [7"' Lt:. C:. ':_) E~ n:: "=~ !-LJ C) 1-. E~ f~~ U_.I CL- L $2 .x: oq: :sJ: I--_cc a::: - -, '-LQ OU__ ~cn'." 0:::"..:_. 1..LJ.c:... '. Cr"": c: ::r: I . QF: r..- -0. &...i-. ""<::;~- O~,. :5 <..) Anthony L. DeLuca. ESQuire Name of Person Fi!ing thi$ FOl'm t.f) , -..J :::> -, r-- <::::) <::::) ('...f 113 Front st., P.O. Box 358 Address Boiling Springs, PA 17007 717-258-6844 Telephone Form R I'V.! 0 rev. J O. J 3. 06 ~-