HomeMy WebLinkAbout04-0683PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
a~o known~
Deceased.
Social Security No. t~ O Uc~ (oa~. ~
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl
To:
Register of ~V-~lls for ,the_ _/~
County of t._~o.a,~ to. bO in the
Commonwealth of Pennsylvania
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
d at death in (.~(-~;'[cx_t~ County, Pennsylvania, with
Decendent was domicile
h k~ last family or principal residence at ~t~c-~ ~ ~-~('~..L-~
(list street, number and municipality)
DecendenL then ~ years of ag?, died ., %L~(~-~ [C5'- ,~ ~:~t3t3~
at ~UO ~0 ~U~U~ ~ k~u~Jac ~ ~
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
Relaji, onship -- Re~iaence~_.~. '
Dc.-
THEREFORE, petitioner(s) respectfully request(s) the grant of letters o~.,)a~inist~tion tn~
appropriate form to the undersigned. 9 ~c~ 'nJx~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA y
COUNTY OF ~~~ ss
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 affirmed, and subscribed c '~'
bef~o~e this c~[ ~ day of ]
-0 /-eg3
Estate of
,Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~ x'o.A_ ~ ~ ~_~ to~ ~ , in consideration of the etition An
the reverse side hereof, sa~s~a~tory proof I~ving been presented before me, ..~ ~ ~'
IT IS DECREED that ~ ~ ~. ~ ~.c~rk ~ ~, ~
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ('k ~
in the estate of ~{~, ~
FEES
Letters of Administration .....
Short Certificates( ) .......... $
Renunciation ................ $.
TOTALs
Filed .-'].?..c~../. F..~...O.9?C.. A.D.
ATTORNEY (Sup. Ct. I.D. No.)
ADDKESS
PHONE
lint
Caucasian
Oahu HonolUlu ueen's Medical Center
Hawaii
CERTIFICATE OF DEATH ~ "~STATE ~ ?,
_ : ~FILE~.151 .~ ~
'~ Jul~ 1, 200~
, ~,~ 21 November 27, 1982 Honolulu
Rawn Eugene
Official U.S. Navy Records
Shunk { A~n Evan Carey
1Jarrett White Road, Honolulu, Hawaii 96859-5000
Removal Husselman's Funeral Home [ Lemoyne ?ennsylvsni
ZJuly 8, 2004 ~0] I Borthwick Mortu.y I ~ ~
Ill. J.,,,, Ir'"
~1~11~ ~. Goodhue~ 3~.~ N.D.~ 835 ~1[e1 goad~ Bo~oZulu~ ~a11 96817
Hultiple internal injuries
Motor vehicle collision, motorcyclist
Yea
Accident June 30, 200Z~ 6:33 p.m.
No Highway on-ramp
Ntmitz Highway (east bound) 0.7 miles east of Hlckam Air Force Base Front Gate, Honolulu, Hawaii
Yes
The decedent becaae unresponsive when he lost
control of the motorcycle he was drivin~ and
struck an off-road barrier.
JUL - 7 200/*
I CERTIFY THIS IS A TRUE COPY OS
ABSTRACT OF THE RECORD ON FILE IN
THE HAWAII STATE DEPARTMENT OF HEA~TH
-U.
STATE REGISTRAR
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a~
Date of Death:
Wll o ooq-
Admin. No.
To the Register:
I certify that notice of (beneficial in.rest) ~ required by Rule 5.6(a) oxf the~ Orphan..s' ,Court ~u!e/s was
served on or mailed to the following beneficiaries Of the above-captioned estate on ~o,.~tk{ .,,~-4. ! '~C :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Name
Telephone C{ I.~ e:~t~ - t--~(2[ 0
Capacity:__~ Personal Representative
Counsel for personal representative
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
I/the ~n.~wer to No. 1 is Yes, state the following:
a. Did the personal represmtafive file a final account with the Court?
Ye~ No [[]
b. The smparate Orphans' Court No. (if any) for the ~ersonal representative's
ao¢ount is: .__._
¢. Did the personal rcprcsmtafiv_,¢ state an a¢oount informally to the
fl~ interest? Yes U] No LJ
¢. Copies of receipts, releases, joinders and approval of formal or
informal ao¢ounis may be filed with the Clerk of the. Orphans' Court
and may be attached to this r~port.
Signature
Capacity:
Address '
Telephone No.
[~/Personal B.¢presentafive
Counsel for personal representative
Date of Death:
STATUS REPORT UNDER RULE 6.12
(If lid W. f( I OiYl ..sit U(L e
--J u. ( '-(
c;{IOLf O~g3
Name of Decedent:
(
Olf
Will No.:
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 ofthe above-captioned estate:
1. State ~ther 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. I is Yes, state the following:
a. Did the personal 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 of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: I-/'?-C~- (l~ C ,S)u_t..JV.-A-
Signature
Jhl) c.
WV1.0-rc:~.r
Name
o
1'-1-3
E ~.
C~'I (J Ie pit-
/7013
Address
Telephone No.
Capacity: ffPersonal Representative
o Counsel for personal representative
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217
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2.. \ - QY
COUNTY CODE YEAR
OLP~ 3
Nu~aER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
CLINT W SHUNK
DATE OF DEATH (MM-DD-YEAR)
204-62-0434
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DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FLED IN DUPLICATE WrTH THE
7/1/2004 11/27/1982
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FJRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
Supplemental Retum
I~h
05
RemajnderRehl"n(dateotdeath pfiorlo 12_13.82j
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Woo
~~~
u~m
.
@1.QriginalR.etum
04 LimitedEslale
o 6. Decedent Died Testale (Attach copy of Will)
o 9. litigation Proceeds Received
+%jjjH!!l,~it9rt9H!j~t!!!:\gpMg~!;i;*,*!;9!m~~!$\!i\1~jij~~!Ml\1PPl!!ljji\~,*~f#!!!lW!!lPRM*TIPI!!jl!jQI1IiQQ~pjR!o/t$ltQii
NAME
02
04a
07
Future Interest Compromise (date of deattlafter 1Z-1'2-62}
Fedet1l\ Estate Tax Retum Required
Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. S~usaIPo~rtyCred~(date 01 death t>etween 12_31_91 and 1-1-95)
8. Tata! Number of Safe Deposit Boxes
011. Election to tal( under Sec. 9113(A) (Attach Sch 0)
...
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ANN C SHEARER
FIRM NAME (If Applicable)
COMPl.ETE MAILING ADDRESS
1438 STREET
CARLISLE PA 17013
TELEPHONE NUMBER
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1)NONE
2. StocKs and Bonds (Schedule B) (2) NONE
3. Closely Held Corporation, Partnership or Sole~Proprietorship (3) NONE
4. Mortgages 8< Notes Receivable (Schedule D) (4) NONE
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule El (5)
6_ jointly Owned Property (Schedule F) (6) NONE
z Dseparate Billing Requested
0
;::
:3 7. Inter.Vivos Transfer & Miscellaneous Non-Probate Property
" (Schedule G or l) (7) NONE
... "
Ii:
<I: 8. TOTAL GROSS ASSETS (total Lines 1~7) (8)
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'" 9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
:-.....)
~~_.:";!
L;J
(,,;'1
()
., ~'-C1
.. r)
'.~IJ
10,415
......,
c:::>
-""'!
i".."l'
10,415
10. Debts of Decedent. Mortgage Liabilities. & liens (Schedule I) :10)
1,679
111
11. TOTAL DEDUCTIONS (total Lines 9 & 10)
(11)
(12)
1,790
8,626
o
8,625
12. NET VALUE OF ESTATE (line 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not
been made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus line 13)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable atthe spousal tax
rate ,or transfers under Sec.9116 (a)(1.2) x .0 (15) 0
Z
0
;:: 16. Amount of Line 14 taxable at lineal rate 8,625 .0 iL..... 388
<I: x (16)
I-
"
"-
,. 17. Amount of Line 14 taxable at sibling rate x .12 (17) 0
C
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~ 18_ Amount of Line 14 taxable at coUateral rate x ,15 (18) 0
19. Tax Due (19) 388
20.0 ll~llilj~ii;;llrflllfiill?ii.IQi$~ljlilli:ii~liillffll_:tlilliix~i_:rl
**j!jg$Q!U$rQNI$WIl!,(Ailli&llg~mN~QNRl$vIlR$i'l$lt!i'lNlpi!lllpHl@;!<MArHiii8'
0'
ece ent s omDle, e ress:
STREET ADDRESS
143 B STREET
CITY rATE I~IP
CARLISLE PA 17013
217
CLINT W SHUNK
D
d
I t Add
c
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
204-62-0434
388
Total Credits (A'" B + C) (2)
o
3. InteresUPenalty if applicable
D. Interest
E. Penalty
4.
TotallnterestlPenalty ( D + E )
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
(3)
o
5
(4)
(5)
(5A)
(58)
Make Check Payable to: RE(3/STER OF.W/LLS, AGENT.
.-," ,-:-,':':';':';';',":,,,'-:-.-;':':':';';':';':"':".-'-~..;.,.:.:.:.;,:...:,:.:..,..:.:,_.:.;,:.:.;...:.....;-..;.;.;.:.;",:'..:....-:-.'..:.,:,:::::.,.....,-:-..,,:::::,'::::.;.....:.,:.:::.:::
.:::::.,:.,..:.:,:.,.,::.:::,::,::':.:':':,:::,:,:::::,:';::':.:.:::.:.:,. '.-.-.
If line 1 + line 3 is greater than line 2. enter the difference. This is Ihe TAX DUE.
A. Enter the interest on the tax due.
S. Enter the lolal of Line 5 + 5A. This is the BALANCE DUE.
o
388
388
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.....--.-.-,._'...._,_.,...,.,-,....-._,.._,_.,....,..'.-..,.-.:-,.'"
.....,.-':...:':...:':-'-:.,:.:,::::;,:,:,:,:;:i'::::..-.'
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
,.
Did decedent make a Iransfer and:
a. retain the use or income of the property transferred;
b. retain the right to designate who shall use the property transferred or its income;
c. retain a reversionary interest; or
d. receive the promise for life of either paymenls, benefits or care?
If death occurred after December 12, 1982.did decedent transfer property within one year of death
without receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
Ves
o
o
o
o
o
o
2.
3.
4.
Did decedent own an Individual Retirement Account. annuity or other non-probate property which
contains a beneficiary designation?
No
o
o
o
o
o
o
o
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPL.ETE SCHEOUL.E G AND FILE IT AS PART Of THE RETURN.
DATE
Under penalties of perjury, I declare that I have examned this retLirn, including accompanying schedules and slatements, and to the best of my Knowledge and belief, it is true,
and complete. Declaration of preparer other than the personal representative is based on all informallOll of which preparer has anv KnowledQe.
SlGNAT~ OF PERSON ~PONSIBLfPOf FlUNG RETURN
LA "I-- c,.: ~ t\J- L'tJuJv
ADDRESS I t.f 3
f)
~-f r ~d
170(5
c~~
PA
/
DATE
/ - 1'1 - c- ,,-
ESENT A TIVE
ADDRESS
}-} JrL
CAtz./.I')/.,"-
($ J.. U<-IL
S, NAlA.vI/"-1-Z
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sr.
p,e
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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. Secti0ll9116 (a}(1.1)(i}}.
For dates of death on or after January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% \12 P.S. Section 9116 (a)(1.1)('1'i)].
The statute does not exerrpt 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 0l'I the net value- of trar.sfers from a deceased child Iwenly-one yeafS 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. Section 9116(a)(1.2)].
I I ( f I OS
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P.S. Section 9116(a)(1)].
The tax rate imposed Of\ tl'.e net I$lue of transfers \0 Of for the use 01 the decedent's siblings is 12% [72 P.S. Section 9116(a)(1.3)] .A sibling is defined, under Section 9102, as
an
individual who has atleasl one parent in COfTY1lOn With the decedent, whether by blood or adoption.
217
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CLINT W SHUNK
Include the proceeds of litigation and the date the proceeds were received by the estate.
All oronertv iointlv..owned with right of survivorshlo must be disclosed on Schedule F.
FILE NUMBER
ITEM
NUMBER DESCRIPTION
1 MEMBERS FIRST
2 NAVY FED CREDIT UNION
3 95 BMW AUTO BLUE BOOK VALUE
VALUE AT DATE
OF DEATH
9,230
10
1,175
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. Insert additional sheets of the same size)
10,415
217
REV.1511 EX+ (12.99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
CLINT W SHUNK
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. ROLLING GREEN CEMETERY MARKER 1,276
AFTER SERVICE MEAL 300
ADMINISTRATIVE COSTS 53
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Number{s) I EIN Number of Personal Representative{s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees 50
7.
TOTAL (Also enter on line 9 Recanitulation' $ 1679
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
. REV-1512 EX+ (12-Q3) 217
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CLINT W SHUNK
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including un reimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
T MOBILE
111
TOTAL (Also enter on line 10 Recaoitulation\ $
(If more space is needed, insert additiooal sheets of the same size)
111
217
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CLINT W SHUNK
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESiATE
I. TAXABLE: DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RAWN SHUNK 490 SHED RD NEWVILLE PA 17241 FATHER 9,240
ANN SHEARER 143 B STREET CARLISLE PA 17013 MOTHER 1,175
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG. PA 17128>0601
AEV-1162 EX(11-96l
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHEARER ANN C
143 B ST
CARLISLE, PA 17013
--Iold
ESTATE INFORMATION: SSN: 204-62-0434
FILE NUMBER: 2104-0683
DECEDENT NAME: SHUNK CLINT W
DATE OF PAYMENT: 01/18/2005
POSTMARK DATE: 01/18/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 07/01/2004
NO. CD 004849
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $388.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$388.00
REMARKS:
CHECK# 3187
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, ESQ
SoliCitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
193
2/3/2005
a.JNT W. SHUNK
21-04-0683
ANN C. SHEARER
143 B STREET
JA
CARLISLE, PA 17013
10.00
Total
$10.00
Qty
1
Fee Description
Additional Probate
Fee
Total:
$10.00
Olecks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.