HomeMy WebLinkAbout04-0700PETITION FOR PROBATE and GRANT OF LETTERS
also known as /~7~l/grTQ,~ ~
M~'~m,~ ~?.i~'~r' ' '
Social Security No. /~ . ~'c~ ? 5}',7 ~ceased.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age ox older an the execut ~r'
in the last will of the above decedent, dated /'~4
and codicil(s) dated / '
No. ~n,~l -Oq - 700
To:
Register of Wills for the. /
County of ~ in the
Commonwealth of Pennsylvania
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (Ot2/jqfl)p f/,c.,rt~ C.~unty, ~_ennsylvania, with
h P~ last family or principal residence at ~
(list street, number and muncipality)
Decendent, ~hen ~ ~ars of ge, died ~ ~
Except as follows, decedent did not marry, was not divorced and did not have a child born or ~opte~
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: ~]/~
D~endent at d~th owned property with estimated v~ues as follows:
(If domiciled in Pa.) All personal property $ ~.
(If not domiciled in Pa.) Person~ property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania
situated as follows: ~ D~
WHEREFORE, petitioner(s) respectfully request(s) the probate of~h.~,~st will and codicil(s)
presented herewith and the grant of letters ~.-~g'/~t.n r-c~,~e~t,r/ ·
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTAT!yE ~
COMMONWEAL~FH OF PENNSYLVANIA -~ ~::' ~~
COUNTY OF ('!xcc~0~. j ss ~ ~ ~
The petitioner(s) above-rimed swe~(s) or affirm(s) that the statements in the foregoing ~ition are
true and correct to the best of thc knowledge and belief of petitioner(s) and that as person~ represen-
tative(s) of the above decedent ~titioner(s) will well ~d truly administer the estate according to law.
~orn to or af~d~,~nd subscribed r ~,~ ~~
ezore~thjs ~1 ~ day of I ,~m ~ ~ ~ ~
, $1 Aq E OF PENNSYLVANIA
IN THE MATTER OF
ESTATE OF:
MEIANIE A. PALMER
IN THE ORPHANS COURT
OF CIIMBERLAND COUNTY
'04 tx',
"~:~ - 1 ~ ', .- ESTATE #: 1189/2004
~1/~ .~l
DATE OF DIe. TH: 12/25/03
',~',;.. STATEMENT OF CI&IM
1. ERI Fiuancial Services, thc creditor, certifies that there is due mid owing by
MEI~ANIE A. PAI,MER, deceased, thc anmunt of SEVEN HUNDRED SIXTY' ONE' DOLLARS
AND NINETY SIX CENTS ($761.96).
2. rFhe naturc of thc claim is a Wolf Furniture account nutnbcr 0499601100476426
wlficb was established on November 1,5, 2003.
,'4. The nmnc yard address of lira creditor is: ERI Financial Se~xiccs, P.O. Box 3542,
Bahimorc, Maryland 21214.
4. The claim is not contingent as~d is not secured by any liens or judgqncnts.
.5. Tiffs claim is not based on any one instrument. The balance has accrued since
account was established.
I do solclnnly declare and attinn under the penalties of perjury that the intbnnafion in tim
tbrcgoing claim is truc and correct to thc best of my knowledge, inlbnnation and belief. I have made
diligent inquiry and exmninafion, and I believe the claim is just and 'all legal otl~cts, payments, m~d
credits made known to the alliant have bccn allowed.
P. O. Box 3542
Baifimorc, Marylm~d 21214
(410) 4.44-8022
State of Maryland, County of Baltimore:
IN WITNESS WHEREOF, I hereunto set my hand and Notarial Scal lifts 23rd, day of November
2004.
My Commission Expires: Augnsl 1, 2008
NNIFF~R L. STREHLEIN, Notary Public
No. O-~ - Oq - '7 00
DECREE OF PROBATE AND GRANT OF LETTERS
the reverse side hereof, s~sfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated ~ - ~' ~ ~'~--) (5 ~
described therein b.e admittedxo probate and filed of record as the lasl:will of ,, ;~~
FEES
Probate, Letters, Etc .......... $
Short Certificates( ) .......... $
Renunciation ................ $
$
TOTAL $
Filed ...................................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
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 permanen~t filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 10545248
No,
Local ~e~g~ strar
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEAL'IH * VITAL RECORDS
CERTIFICATE OF DEATH
LAST WILL AND TESTAMENT
OF
MELANIE A. PALMER
I, MELANIE A. PALMER, of Cumberland County, Pennsylvania, being of sound and
disposing mind, memory, and understanding, do hereby make, publish and declare this as and
for my last will and testament, hereby revoking all other wills and codicils heretofore made by
me.
FIRST
I direct the payment of my debts and expenses of my last illness and funeral
from my estate as soon after my death as conveniently may be done. It is my wish to be
cremated. If there be no available space for my interment, owned by me at the time of my
death, I authorize my personal representative to purchase such interment space with a contract
for perpetual care, using therefore funds from my estate, in such amount as my personal
representative shall consider necessary and desirable, and I authorize my personal representa-
rive to cause title to or ownership of the interment space so purchased to be vested in such
person as my personal representative shall designate.
Further, in this connection, I authorize my personal representative to expend funds
from my estate, in such amount as my personal representative shall consider necessary and
desirable, for the purchase, erection and inscription of a suitable marker for my final resting
place.
SECOND
I state that I have two children, they being my daughters, LINDSEY A. FISCUS and
JILLIAN R. PALMER.
I give and bequeath all tangible personal property owned by me at the time of my
death, together with all insurance policies thereon in as nearly equal shares as is practicable
unto such of my children as survive me by sixty (60) days, provided, however, that if a child of
mine does not survive me by sixty (60) days, the share which that child would have received
is bequeathed to that child's issue, per stirpes.
THIRD
I give, devise and bequeath all the rest, residue and remainder of my estate, in equal
shares, unto such of my children as shall survive me by sixty (60) days, provided, however, that
if a child of mine does not survive me by sixty (60) days, the share which that child would have
received is bequeathed to that child's issue, per stirpes. In default of such surviving issue, I
then give, devise and bequeath all the rest, residue and remainder of my estate unto my step-
son, JUSTIN PALMER. In the event that JUSTIN PALMER also fails to survive me, I then give,
devise and bequeath ail the rest, residue and remainder of my estate unto my siblings, per
stirpes.
I authorize my Executor to deliver such articles to which a minor may be entitled
under this testament to the guardian of the minor or to the person having custody of the minor,
or to retain such property until an age at which my Executor considers it appropriate to deliver
the property to him or to her, provided in no event shall such property be retained by my
Executor beyond the time the minor attains his or her majority. The receipt of such of the
Page 2 of 7
above enumerated persons as may be selected to receive delivery of such property shall be
a full and complete discharge to my Executor. In the event my Executor at any time decides
it is desirable to sell any item or items of tangible personal property held hereunder for a minor,
the proceeds of such sale or sales shall be delivered to the guardian of the property of the
minor appointed in paragraph SIXTH hereinafter to be held under the terms and conditions
thereof.
FOURTH
I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my
estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
FIFTH
In addition to the powers conferred by law, I authorize my Executor, in his or her
absolute discretion:
(a) to retain in the form received, and to sell either at public or private sale any real
or personal property;
(b) to manage real estate;
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principle of diversification;
(d) to exercise any option or rights arising from ownership of investments;
(e) to compromise claims without court approval, and without the consent of any
beneficiary, and to abandon any property which, in my Executor's opinion, is of little or no
value;
Page 3 of 7
(0 to file any state or federal income tax return for any year for which I have not filed
such return prior to my death.
SIXTH
I appoint JUNIATA VALLEY BANK of Miffiintown, Pennsylvania, g uardian of any prop-
erty, including but not limited to all proceeds of insurance on my life, which passes to a minor
and with respect to which I am authorized to appoint a guardian and have not otherwise specifi-
cally done so. In addition to the powers given by law, I authorize the guardian of the property:
(a) to use such amounts of both income and principal as they in their sole discretion
deem proper for the support, education and welfare of such minor without leave of any Court;
(b) to invest in any property without leave of any Court;
(c) to invest in any property without restriction to legal investments.
t The guardian shall not be required to give bond or furnish sureties in any jurisdiction,
and shall hold the property IN TRUST for the minor. I hereby direct majority to be defined as
the age of eighteen [18] and that no funds be turned over to the minor or adult until they attain
he age of eighteen [18] years.
If my trustee, in its sole discretion, determines that it is desirable to do so, my trustee
may end any trust under this deed. This may be done by paying the then-remaining principal
and income of that trust to the person then eligible to receive the income. If any person is a
minor or is, in my trustee's opinion, disabled by illness or other cause and unable to properly
manage the funds, my trustee may pay the funds to his or her guardian or to any person or
organization taking care of the person. In the case of a minor, my trustee also may deposit the
funds in an interest bearing account in the minor's name payable to the minor at majority, or
Page 4 of 7
appoint and pay the funds to a custodian for the minor under the Uniform Gifts to Minors Act
of any state. My trustee shall have no further responsibility for funds so paid or deposited.
I further direct my trustee, in the case of my children, to maintain one trust for the
benefit of all of said children, and to distribute his or her share of the corpus and any
accumulated earnings to the beneficiaries upon the attainment of majority of the youngest child,
each surviving child to then receive as nearly equal shares as is practicable. I also direct my
trustee, in the case any other minor takes under my will, to distribute his or her share of the
corpus and any accumulated earnings to the beneficiary upon the attainment of their majority.
SE VENTH
In the event JILLIAN R. PALMER'S father predeceases me, I appoint LINDSEY A.
FISCUS, guardian of her person.
EIGHTH
Any and all payment or payments of any sum or sums, whether in cash or in kind and
whether for principal or income, payable to the said beneficiaries or any of them, shall be made
upon the sole receipt of the respective individual to whom the payment is made, and free from
anticipation, alienation, assignment, attachment, and pledge, and free from control by the
creditors of any such beneficiary. All shares of principal and income herein given shall be free
from anticipation, assignment, pledge, or obligations of any beneficiary, and shall not be sub-
ject to any execution or attachment.
NINTH
Page 5 of 7
I hereby relieve my Executor from the necessity of posting security in connection with
the Executor's duties as such in any jurisdiction in which my Executor may be called upon to
act insofar as I am able by law to do so.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will
and testament, consisting of six pages, the first five of which bear my signature in the margin
for the purpose of identification this 8th day of May, 2003.
'e'A. Pa'~m6fi -'""
Signed, sealed, published and declared I~y the above named Testatrix, MELANIE A.
;rAeLseMnEcR, as ande, a,j~ in t~' hlaaSntdWi;Ireasnedn tceeSto~aecn~' 'or~htehre, hPraevSee~eCleeu°fn;JoS~uWl~s°;ri~ehde~uSirgnhat maneds
/ /// x_ J POBox51
Ri~)~ L.'Bushman Spring Run, PA 17262
Sherry ~. Rosenberry ~'
1272 Brechbill Road
Chambersburg PA 17201
Address
Page 6 of 7
A CKNO WLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF FRANKLIN
I, MELANIE A. PALMER, having been duly qualified according to law, acknowledge
that I signed the foregoing instrument as my will, and that I signed it as my free and voluntary
act for the purposes therein expressed.
We, having been duly qualified according to law, depose and say that we were
present and saw MELANIE A. PALMER sign the foregoing instrument as her will; that she
signed it as her free and voluntary act for the purposes therein expressed; that each of us in
her sight and hearing and at her request signed the will as witnesses; and that to the best of
our knowledge she was at that time eighteen (18) or more years of age, of sound mind and
under no constraint or undue influence.
Subscribed, sworn to or af-
firmed, and acknowledged
before me by the above-
named testatrix and by the
witnesses whose names_j..
appear opposite on the ~
day of May, 2003.
~Notary ~ublic
Notarial Seal
Sherry A. Rosenberry, Notary Public
Fannett Twp., Franklin County
My Commission Expires May 5, 2007
Page 7 of 7
Name of Decedent:
Date of Death:
Will No.
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5.6fa/
Admin. No. dJOL~700
I certify that notice of (benefid~i interest) ~Sff~lffi.iBll~ 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 :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Name
^ddress
Telephone ~]'~ ~73~-- - ~,..~
Capacity: 1/Personal Representative
__Counsel for personal representative
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
.ESIDENT DECEDENT
I'-
Z
iii
UJ
UJ
C~
0
DECED~S 1~sAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM~DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
7-/¢- Zooy -£/- 195
(IF APPLICABLE) SURVIVING SPOUSE'S~/~T, FIRST, AND MIDDLE iNiTIAL)
~1. Odgleal Return [] 2. Supplemental Return
[] 4. Limitad Estate [] 4a. Fulure interest Compromise
[] 6. Decedent DiedTestale(Atad~c~pyo~w~l) [] 7. Decedent Maletaleed a Living Tmst(.~hc~w~fT~)
[] 9. Litiga~on Proceeds Received [] 10. Spousal Pover~ Credit (,~ ~f
SOCIAL SECURITY NUMBER
-
FIRM NAME
TELEPHONE NUMBER ~,) g.
1. Real Estate (ScheduleA) (I)
2. Stocks and Bonds (Sshedule S) (2)
3. Closely Held Cofporatton, Partnership or Sota-Proprietorship (3)
4. Mortg~ & Notes Raneivalfle (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Pemoeal Pmport.j (5)
(Schedule E)
6. Jointly Owned Pmpo~ty (Schedule F) (6)
]Separate Silting Requested
7. Inter-Vivos Transfers & Miscelleeaous Nan-Probete Properly (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & AdmleistrntJve Costs (Schedule R) (9)
10. Debls of Decedent, Mortgage Uabilitiea, & Uens (Schedule I) (10)
11. Total D~duetlons (tatal Lines 9 & 10)
12. Net Value of Estate (Une 8 minus Une 11 )
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITYNUMSER
COMPLETE MAILING ADDRESS
13. Char~able and Governmental Bequests/Sec 9113 Trusts for whid~ an elec~an to tax has not bean
made (Scheduta J)
14. Net Value Subject to Tax (Line 12 minus Une 13)
x.0
x .12
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or ~ransfers under Sec. 9116 (aX1.2)
16. Amount of Une 14 taxable at lineal rata
17. Amount of Llee 14 taxable at sibling rate
18. Amount of Liea 14 taxable at collateral rata
19. Ta~ Due
OFFICIAL USE ONLY
(13)
(15)
(1~
(18)
Decedent's Complete Address:
Tax Payments and Credits:
1~ Tax Due (Page 1 Line lg)
2. Credi~Payments
A, Spouse{ Pove~ Credit
B. P~r Payments
C. Discount
3. Intarest/Penatiy if applicable
D. Infemst
E. Penalty
I STATE f~
(1)
17025'
Total Credifs (A + B + C ) (2)
Tofal Interest/Penalty ( D + E )
If Lice 2 is greater than Line 1 + Lice 3, enter the difference. This is the OVERPAYBENT,
Check box on Page I Line 20 to request a refund
If Line 1 + Line 3 is greater than Lice 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE,
(5A)
(5al
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
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 property trensfermd er its income; ............................................ []
c. retain a revemieaary 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 security at his or her death? .............. []
4. Did decedent own an individual Retirement Account, annuity, or other non-probato property which
contains a beceficiary designation? ........................................................................................................................ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS tS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
SIGNATURE OF PERSQN RESPONSJBLE~FOR FILIN.G J~.[-URN
SIG~TURE OF PRE~RER O~ER ~ REPRESENTATIVE
DATE
ADDRESS
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 sun, lying spouse is 3%
F2 P.S. §9115 (a) (1.1) (i)].
For dates of death on or alter 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 exerant a transfer to a sui~iving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return ara still applicable even if
the surviving spouse is the only becetidary.
For dates of death on or alter July 1, 2000:
Tim tax rate imposed on the net value of transfers from a deceased dlild twenty-oce years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a steppemet 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 desedent's lineal benefidaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the dacadant's siblings is 12% [72 RS, §9116(a)(1:3)], A sibling is defined, under S~ction 9102, as an
individual who has at least one Darner in common with [he decedent, wflether by b~o~d or adoplJon.
SCHEDULE A
COMMO"VV~^LT' O~PENNSYLV^"'^ REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
All real property owned solely or as a tenant in common must be reported at fair market value, Fair market value ~s defined as the price at which property would be exchanged
belween a willing buyer and a willing seller, neither bein~ compelisd to buy or sell, both having reasonable knowiedge of the relevant facts. Real property which is jointly-orated with (~ght of
survlvomhip must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
zF /.//
VALUE AT DATE
OF DEATH
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT nEcr:rl~:NT
SCHEDULE B
STOCKS& BONDS
FILE NUMBER
All pmpelty jolnfly-ovmed with right of suwivorshlp must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, ineert additional sheets of the same size)
REV-1504 EX+ (1~97~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
FII~E NUMBER
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/padnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships,
ITEM NUMBER VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Aisc enter on line 3, Recapitulation)
(If more space is needed, insed additional sheets of the same size)
COM~TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT CECECENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
2. Federal Employer I.D. Number
3. Type of Business
Zip Code
Product/Service
FILE NUMBER
State of Incorporation
Date of Incorporati~
Total Number of Shareholders
Business Reporting Year
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Commoc $
Preferred $
5. Wes the decedent employed by the Corporation?
If yes, Position
6. Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
7.
Provide all dghts and restrictions pertaining to each class of stock.
[] Yes [] No
Annual Salary $ Time Devoted to Business
[] Yes [] No
Wastherelifeinsurancepayabletothecorperationuponthedeathofthedecedent? [] Yes [] No
If yes, Cash Sun'ender Value $ Net proceeds payable $
Owner of the policy
Did the decedent sell or transfer stock of this company within one year prior to death or within two yearn if the date of death was prior to 12-31-827
[] Yes [] No Ifyes, [] Transfer [] Sale Number of Shares
Transferee or Pumheser Consideration $
Altach a saparete sheet for additional lmnsfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? [] Yes [] No
If yes, provide a copy of the agreement of sale, etc.
11.
[] Yes [] No
12.
Was the corporation dissolved or liquidated alter the decedent's death? [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
Did the corporation have an interest in other corporations or partnemhips? [] Yes [] No
If yes, report the necessary information on a separate sheet, Including a Schedule C-1 or C-2 for each interest.
Date
A. Detailed calculations used in the valuation of the decedent's stock,
B, Complete copies of financial statements or Federal Corporate Income Tax returns (Fon'n 1120) for the year of death and 4 preceding yeem.
C. If the corpomtiofl owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If teat estate appraisals have been
secured, attach copies.
D. Ust of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. Ust of officers, their salaries, bonuses and any other benefits received from the corporation,
F, Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE,~ DENT DECEDENT
ESTATE OFM ) , ~
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
FILE NUMBER
1. Name of Partnership ! I ~l'"
City State __ 71p Code
2. Fods~at Employer I,D. Number
3. Type of Business Product/Service
4. Decedent was a [] General [] Umitedpartner, ifdecedentwesalimitodparmer, provide initial inveatment $
Date Business Commenced
Business Reporting Year
pERCENT OF PERCENT OF BALANCE OF
PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Wes the Partnemhip indebted to the decedent? [] Yes [] No
If yes, provide amount of indebtedness $
8. Wes there life insurance payable to the partnership upon the death of the decedent? [] Yes
If yes, Cesh Surrender Value $ Net proceeds payable
Ownes' of the policy
[] No
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death wes pdor to 12-31-82?
[] Yes [] No Ifyes, [] Transfer [] Sale Percentagetransferred/sold
Traeafereaor Pumhaser Consideration $ Date
Attach a separate sheet for addi~onal transfers and/or sates.
10. Wes there a wdtten partnership agreement in effect at the 0me of the decedent's death? [] Yes [] No
If yes, provide a copy of the agreement.
10. Was the decedent~s partnemhip interest sold? [] Yes [] No
If yes, pmv'~e a copy of the agreement of sale, etc.
11. Wasthepa.'lnershipdissolvedorliquidatedarterthedecedent'sdeath? [] Yes [] No
~f yes, provide a breakdown of distributions rec~ved by the estate, including dates and amounts received.
12 Westhedecedentrelatedtoanyofthepartnem? [] Yes [] No Ifyes, explain
13. Did the parmership have an interest in other corporations or partnerships? [] Yes [] No
if yea, rep(~ the necessary infon'n~on on a separate sheet, including a Schedule C-1 or C-2 for each interest
A. De{ailed calculations used in the valuation of the decedent's partnemhip imerest
B. Complete copies of finandat statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. if the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s, If mai estate appraisals have been
secured, attach copies.
D. Any oth~ information relating to the valuation of the decedenfs partnemhi0 interest.
REV-15~)7 EX+ (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 4, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R~SIDENT D~CEDENT
ESTATE OF ~ -) ·
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONALPROPERTY
FILE NUMBER
include the proceeds of lifiga~n and the date the proceeds were received by the sstete. All pmpen~y jointly-owned with the rigM of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL <Aisc enter O. line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
COMMOI~NEALTH OF PENNS'~ LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAMi:- ADDRESS RELATIONSHIP TO DECEDENT
A.
JOINTLY-OWNED PROPERTY:
TOTAL(Also enter on line 6, Recapitulation) $
(If mom space is needed, insert additional sheets of the sarr~ size)
COMMONWF. ALTN OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE ~E NA~ OF T~ TP'ANSFEREE* THEIR RELAT/ONSHIP TO D~'CEDENT AND THE DATE OF TR'N'~ScER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER VALUE OF ASSET INTEREST er AP~-~C~,~-E)
1.
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-~511 EX+ (12-99)~.
',~'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule ].
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
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 claimaet's, atlach explanation)
Street Address ~ d~
Relationship of Claimant to Decedent
Stere ~"'~ Zip /70Z~'
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
~o
~3"oo
TOTAL
(A~so enter o. line g, Reoapitu~ation) $ 7~r/''/
(If more space is needed, inse~t additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGELIABILITIES,& LIENS
Include unreimbursed medical expenses,
iTEM
NUMBER DESCRIPTION AMOUNT
1.
TOTAL
(If more spac~ is needed, ir)seri additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
II,
1.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
£o k
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE
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 II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
ON REV 1500 COVER SHEET
COMMOfl~LTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
{Check Box 4 on Rev-1500 Cover Sheet)
FILE NUMBER
This schedule is to be used for all single life, joint or.successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single lifo calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
[] Will [] Intervlvos Deed of Trust [] Other
NAME(S) OF NEAREST AGE AT TERM OF f'EARs LIFE ESTATE IS
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
[] Life or [] Term of Years __
~ [] Life or [] Term of Years
,~ [] Life or [] Term of Years
[] Life or [] Term of Years
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate- [] 3 1/2% [] 6%
3, Value of life estate (Line 1 multiplied by Line 2)
[] 10% [] Variable Rate %
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
[] Life or [] Term of Years __
[] Life or [] Term of Years __
[] Life or [] Term of Years __
[] Life or [] Term of Years __
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - [] Weekly (52) [] Bi-weekly (26)
[] Quarterly (4) [] Semi-annually (2) [] Annually (I)
3. Amount of payout per period
4, Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate []31/2% []6% []10%
6. Adjustment Factor (see instrdctions)
7.
[] Monthly (12)
[]Other()
[] Vadable Rate %
Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and pedod payout is at end of period,
calculation is: Line 4 x Line 5 x Line $ $
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line $) + Line 3 $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
RECEIPT FOR PAYMENT
Cumberland County - Register Of Wills
Hanover and Hiqh Streen
Carlisle, PA I7013
Receipt Date: 7/27/2004
Receipt Time: 11:38:03
Receipt No.: 1037349
PALMER MELkNIE ~
Estate File No.:
Paid By Remarks:
2004-00700
J~_NE LLrNDSFORD
Fee/Tax Description
LETTERS ADM ISSUED
EXTRA PAGES
SHORT CERTIFICATE
JCP FEE
JA
Check# 8253
Total Received .........
Receipt Distribution
Payment Amount
235.00
18.00
30.00
10.00
~293.00
293.00
Payee Name
CUMBERL~ND COUNTY GENERAL FUN
CUMBERIJ~ND COUNTY GENERAL FUN
CUMBERLA/qD COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
NEILL
Funeral Home Inc.
Ms. Lindsey Fiscus
6 Cedar Court
Enola, PA 17025
July 23, 2004
Ref No.: 1002589 / C04-057
Services For: Melanie A Palmer
Cremation Package/Memorial Service ................. $
RENTAL CASKET .................................
Elite Wood - Cherry Rose ...........................
Flowers .........................................
Medical Examiner's Charge ..........................
Honorarium/Clergy ................................
Crematory Service Fee .............................
Patriot News .....................................
Death Certificates 50 @ $2.00 .......................
Total Funeral Charges $
Adjustments (Payments) $
3,190.00
995.00
205.00
731.00
25.00
200.00
215.00
220.02
100.00
$5,881.02
0.00
Balance Due on Account (Due date: 07/23/2004) $
$5,881.02
3401 Market Street
Camp Hill, PA - 17011-4428
tel 717 737-8726
fax 717 737-1859
Robert J, Pramik, Supervisor
3501 Derry Street
Harrisburg, PA - 17111-1817
tel 717 564-2633
fax 717 561-9918
Stephen J. Wilsback, Supervisor
Member of
ALDERWO~,DS
GROUP
PS
KU. ~ox Ct u I ,~ L/I/) L~-~q~/HamsL~urg)
Harrisburg, PA 17106-/013 (800) 237-7328 (N~tionwide)
weh$ite - http-'//ww~.psecu.¢om'
VISA'
PAGE
O192XXXXX)
9q59.76 87.00 188.00
h,,llh,,llh,,,,hhhh,,hllh,,,Ih,,Ih,lh,,,Ih,,hhl
NELANTE A PALHER
6 CEDAR CT
ENOLA PA 17025-2066
and PIN hled:ly,)
309019252797&
ZD 09 VISA LOAN
POST TRAN REFERENCE
0650 0629 Zq69216JSOO76XNA5 q816
0701 0629 2~OT3~qJ6S66HGZfi7 8220
0708 0706 2q16qOSJDBO18XRLS 55q2
0716 0715 Zq610qSJHOSPHQFYT q899
0727 0726 Zfi69216KO0017579Z fi81~
0750 0729 Zq69216KSOO6D7PPY q816
DESCRIPTION
THXNAOL SERVICE 060fi 800-827-656q VA
SCAD TUITION PROPES-07 SAVANNAH GA
EXXONHOBILZ6 09655551ENOLA PA
COHCAST OF CENTRAL PA 800-COHCAST PA
T-HOBILE 800-957-8997 NA
TNXNAOL SERVICE 070q 800-B27-656~ VA
YTD FINANCE CHARGE: YEAR TO DATE
0.00
AHOUNT
Z$.90
qSO0.O0
ZZ.O0
88.57
25.00
25.90
q380.35 0.00 0.00 q983.17 0.00 76.26 J 9fi39,76
o.oo o.oo o.oo o.oo o.oo o.ooI o.oo
s 1 12.9oo% 1. o7soo% o. oo o. oo o. oo o. oo
2290612
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
web$ite - http://www, psecu.com
USE YOUR PSECU VISA FOR
BACK TO SCHOOL PURCHASES.
MELANIE A PALMER
JOINT OWNER
PAGE 2
0701 PAYMENT~ BY CHECK 159q.00 4197.06
0705 PAYHENT= ATM REBATE 4.00 4Z01.06
JUNE
ATM ZNO 326 E PENN DRTVE ENOLA PA
07Z6 NITHDRAHAL TRANSFER TO LOAN 1Z 294.76- 5506.05
07Z8 PAYHENT: TRANSFER FROi't SHARE Oq 1015.97 qSZZ.OZ
07Z8 PAYMENT: BY CHECK 5Z8.80 555.80
07Z8 HITHDRAHAL TRANSFER 5Z5.80- 10.00
TO FISCUS,LINDSEY A XXXXXXXXXX SHARE 04
0751 ENDING BALANCE 12.13
DIVIDEND YTD: YEAR TO DATE 8.73
.... == ............... ====== ................................... = ...................
07Z5 PAYMENT: TRANSFER FROM SHARE Oq 50.00 591.44
07Z8 PAYMENT: DIVIDEND 0.20 591.64
ANNUAL PERCENTAGE YIELD EARNED 0.76% FROM 07/01/0q THROUGH 07/Z7/04
0q020001 2290615
PSEC
P.O. Box 67013 (717) 234-8484 (l'ionisburg)
HorrJsbwg, PA 17106-7013 (800) 237-7328 (Notionwide)
websHe - http://www, psecu.com
USE YOUR PSECU VISA FOR
OACK TO SCHOOL PURCHASES.
HELANIE A PALNER
JO~dT OWN ER
PAGE 3
07Z8
391.64-
1.6~
070I
0702
60.00- ZTOZ.OZ
0705
0706
PA
~00.00 17ZZ.15
1~6.9~- 1575.Z1
O706
0706
CHECK 00~111
85.8~- 1Z86.91
150.00- 1136.91
229061q
PSECd
KV. Uox dlgl.~ ~1 ~ I) L6~-~ ~Mmnsuurg)
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
website - http://www, psecu.com '
USE YOUR PSECU VISA FOR
BACK TO SCHOOL PURCHASES.
NELANIE A PALNER
JOINT OWNER
PAGE 4
0709
0711
NITHDRAHAL TRANSFER TO SHARE 05
NZTHDRAHAL POS #00~19055
po~ GIANT FOOD STO 310 E PENN DRIVE ENOLA
30.00- 1892.12
ZO.OZ- 1872.10
0711
PA
NZTHORANAL DIRECT DEPOSIT HOHENTUH FITNESS
TYPE= AUTO PYHT ZD= 90000008~0
~.00- 16fi5.75
07~6
0716
51
0725
0728
NITHDRANAL TRANSFER TO SHARE 05
PAYHENT~ DIVIDEND
ANNUAL PERCENTAGE YIELD EARNED
50.00- 1015.75
O.Z~ 1015.97
0.15~ FROH 07/01/0~ THROUGH 07/17/0~
OqO~O001 2290615
PSEC
I~.0. Rex 67013 (711) 234-8484 (Han~omg)
Har~omg, F'A 17106-7013 (800) 257-7328 (NalJonwJde)
website - hltp://www, psecu.mm
USE YOUR PSECU VZSA POR
BACK TO SCHOOL PURCHASES.
MELANIE A PALMER
JO~IT OWNER
PAGE 5
I Ol,2×xx×xx o7,31,'o~ ]
1015.97- 0.00
0.00
2.86
00~108 57.1Z 00~111 150.00 00~11~ 1~.00
0.00
0751
1Z59~.71
Z89.~7
Z290616
PSEC:
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
website - http://www, psecu.com'
USE YOUR PSECU VISA FOR
BACK TO SCHOOL PURCHASES.
NELANTE A PALNER
JOINT OWNER
PAGE
POST EFF DESCRIPTION
PRINCIPAL ~FIN CHG~ BALANCE
YTD FINANCE CHARGEs YEAR TO DATE 1456.77
~ ANNUAL PERCENTAGE RATE 6.000~ ~ PERIODIC RATE (DAILY) .016458~
4941.$5
51.18- Z4.57 4910.17
==================================================================================
TOTAL DIVIDEND YTD: YEAR TO DATE 15.Z$
TOTAL YTD FINANCE CHARGE: YEAR TO DATE 18Z$.06
IF THE ABOVE STATEHENT ADDRESS IS NOT CURRENT, UPDATE IT NITH US AT ONCE.
0~.0q0001 2290617
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 004408
FISCUS LINDSEY ANN
6 CEDAR COURT
ENOLA, PA 17025
........ fold
ESTATE INFORMATION: SSN: 192-52-7974
FILE NUMBER: 2104-0700
DECEDENT NAME: PALMER MELANIE ANN
DATE OF PAYMENT: 09/21/2004
POSTMARK DATE: 09/21/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 07/19/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $5,362.90
REMARKS:
TOTAL AMOUNT PAID:
$5,362.90
SEAL
CHECK#103
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
MBNA AmericB
P,O. Box 2.53.37
Wilmington, DE
877-7~7-g383
19850-5137
09/20~04
REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
1 COURTHOUSE SQUARE, #102
CARLISLE, PA 17013
Re: In the Estate of
MELANIE A PALMER
Probate Case No.
Social Security No:
Last known residence:
Our Client:
Account Number:
Amount of Debt:
21-04-700
192527974
6 CEDAR CT ENOLA, PA 17025
MBNA AMERICA
5490998803014191
$ 5870.00
Dear Sir or Madam
Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate.
Please retum a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for
your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll free at
1-877-767-9383.
Cordially,
MBNA America
Enclosures
A check for $5.00 for the filing fee.
cc:
Attorney for Estate
Personal Representative
This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter
is from a debt collector.
5044 9/13/2004 1191283
COMMONWEALTH OF PENNSYLVAN]:A
NOTICE OF CL,~II~
COURT OF COMMON PLEAS
OF CUMBERLAND ,COUNTY
ORPHANS' COURT DZVZSZON
Zn Re: The Estate of:
Court File No: 21-04-700
MELANIE A PALMER
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DZVZSZON:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,
Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2).
MBNA AMERICA
1)
2)
3)
Claimant's name:
Claimant's address:
P.O. BOX 15137
WILMINGTON, DE 19850--5137
877-767-9383
Creditor listed below is the owner and holder of a claim in the amount of
$ 5870.00
4)
s)
6)
7)
8)
The facts upon which this claim is based:
This claim is based on an account for credit evidenced by: ,~J?. ~ attached
Affidavit of Account Stated.
Decedent's address: 6 CEDAR CT ENOLA, PA 17025
Date of Death: 07/19/04
r~
That the claim arose prior to the death of the decedent on or about
That the claim is secured by
On behalf of the claimant, ! do solemnly declare and affirm under the penalties of
perjury that they Tnformation and representations made herein are true and correct
to the best of my knowledge, information and belief.
Dated'
Lucille Rober~s/dessica L.~,~uthoriz,~' Representative For MBNA America
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
LYNDSEY FISOUS
Name
6 CEDAR CT
Address
ENOLA, PA 17025
City/Sta~/f~_P~//0~/
Date notic~ ma~le~
IN RE ESTATE OF: MELANIE A PALMER
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly swom deposes and states the follows:
Your Affiant is authorized by the Claimant as its Authorized Representative-
In-Fact to make this Affidavit.
Your Affiant has reviewed the account records of the Claimant with respect
to the decedent. Your Affiant is familiar with these records and accounts and
reviews them as a regular part of his/her duties.
The Decedent purchased merchandise in the amount of $ 5870.00
evidenced by account number 5490998803014191
The unpaid balance does not include any post-death late payment charges,
accrued interest, collection costs or attorney's fees.
Further your affiant sayeth not
MBNA America.
One of it~uthorizej~/Represefitatives:
Lucille Roberts
Jessica Lerbs
MBNA America
P. O. Box 15137
Wilmington, DE 19850-5137
Subscribed and swom before me
This ~-t day of ~e/~d6~r, 2004.
t/~'(~l NOTARY PUBLIC - MINNESOTA
4 ~o~-~.~J HENNEPIN COUNTY
~ ~My...Co.~mm~s,o.~n Ex~p,re..~s J~ 3~1 2~O08~
BUREAU OF TNDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 180601
HARRISBURG, PA 17118-0601
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRA/SENENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-X547 EX AFP (09-04)
JANE E LUNSFORD
971 HT PLEASANT RD
NOODBZNE
NJ 08270
DATE 11-15-2004
ESTATE OF PALHER
DATE OF DEATH 07-19-2004
FILE NUHBER 11 04-0700
COUNTY CUHBERLAND
ACN 101
q Amoun4: Remi4:4:ed
NELANIE A
HAKE CHECK PAYABLE AND REN]:T PAYHENT TO:
REGISTER OF NZLLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG TH]:S L]:NE ~ RETA]:N LONER PORT/ON FOR YOUR RECORDS ~
REV-1547 EX AFP [01-03) NOTICE OF ]:NHER/TANCE TAX APPRA]:SEHENT, ALLONANCE OR DISALLONANCE OF DEDUCT]:ONS AND ASSESSNENT OF TAX
ESTATE OF PALHER HELANIE A FILE NO. 21 04-0700 ACN 101 DATE 11-15-2004
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVAT]:ON CONCERNING FUTURE INTEREST - SEE REVERSE
APPRA/SED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Es4:e4:a (Schedule A) (1)
2. S4:ocks and Bonds (Schedule B) (2)
$. Closely Held S4:ock/Par4:nership In4:eres* (Schedule C) ($)
4. Nor4:gages/No4:as Reca/vable (Schedule D) (4)
$. Cash/Bank Deposi4:s/Nisc. Personal Propar4:y (Schedule E) (5)
6. Join4:ly Owned Proper4:y (Schedule F) (6)
7. Transfers (Schedule G) (7)
B. To4:al Asse4:s
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expanses/Ada. Cos4:s/H/sc. Expenses (Schedule H) (9)
10. Deb4:s/Hor4:gage L/eb/1/4:/as/L/ans (Schedule Z) (10)
11. To4:al Deduc4:/ons
12. Ne4: Value of Tax Ra4:urn
192z141.00
.00
.O0
.00
25~161.00
.00
.00
(8)
9,874.00
81~980.00
(11)
(12)
15.
14.
NOTE:
Cher/4:abla/Governman4:al Beques4:s; Non-elec4:ad 911:5 Trus4:s (Schedule J) (15)
Net Value of Es4:a4:e Subjac4:4:0 Tax (14)
Zf an assessment was issued previously, lines 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Amoun4: of L/ne 14
16. Amoun4: of L/ne 14
17. Aeoun4: of L/ne 14
18. Amoun4: of L/ne 14
19. Pr/nc/pal Tax Due
TAX CREDITS:
PAYHENT ~'~.~'RECEZPT '
DATE :*~NUHBER
09-21-2004 ~004408
NOTE: To /nsura proper
crad/4:4:0 your accoun4:,
subm/4: 4:he upper por4:/on
of 4:h/s form w/4:h your
4:ax payment.
DISCOUNT (+)
INTEREST/PEN PAID (-)
282.26
217,$02.00
125,448.00
ZF PA/D AFTER DATE 1NDZCATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
125,448.00
18 and 19 will
(15) .00 x O0 = .00
(16) 125,448.00 x 045= 5,645.16
(17) . O0 x 12 = . O0
(18) .00 x 15 = .00
(19)= 5,645.16
ANOUNT PAID
5,$6Z.90
TOTAL TAX CREDIT I
BALANCE OF TAX DUEI
ZNTEREST AND PEN.
TOTAL DUE
5,645.16
.00
.00
.00
( ZF TOTAL DUE 1S LESS THAN $1~ NO PAYHENT 1S RE~U/RED.
ZF TOTAL DUE ZS REFLECTED AS A 'CRED/T" (CR}, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND [CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1981 -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of tho decedent after the expiration of any estate for
life or for years, tho Comaonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laafuI Ctass B (cottateral) rate on any such future interest.
To fulfill the requirements of Section ZI¢O of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (TZ P.S.
Section
Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A ra~und 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
online at www.revenua.stata.ca.us~ any Register of gills or Revenue District Office, or from the Department's
lC-hour answering service for forms orders: 1-800-361-Z050; services for taxpayers with special hearing and/or
speaking needs: 1-800-¢¢7-$010 (TT only).
Any party in interest not satisfied with the appraisaent, allowance or disallowance of deductions or assessment of tax
(including discount or interest) as shown on this Notice amy object within 60 days of the date of receipt of this notice
by filing one of the following:
A) Protest to the PA Department of Revenue, Board of Appeals. You amy object by filing a protest online at
waw.boardofappaals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for
an electronic protest to ba valid, you must receive a confirmation number and processed date from the
Board of Appeals wabsite. You amy also send a written protest to PA Department of Revenue, Board of Appeals
P.O. Box 181021, Harrisburg, PA 17116-1021. Petitions may not be foxed.
B) Election to have the matter determined at tho audit of the account of the personal representative.
C) Appeal to the Orphans' Court.
Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
[f any tax due is paid within three ($) calendar months after the decadent's death, a five percent (51) discount of
the tax paid is allowed.
The 151 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 and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the data of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .00016¢. A11 taxes which became delinquent on and after
January 1, 1961 will bear interest at a rate which ail! vary free calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200¢ are:
Interest Daily Interest Daily
Year Rate Factor Year Rata Factor Year
1982 20Z .0005¢8 ~'~'8 - 1991 llZ .000301 ~
1985 162 .000¢38 1991 92 .0001¢7 2002
198¢ 112 .OO030l 1993-199¢ 7Z .000192 2003
1985 132 .000356 1995-1998 92 .0002¢7 2004
1986 101 .OOOZ7¢ 1999 71 .OO0192
1987 IOZ .00017¢ ZOO0 7Z .000191
--Interest is calculated as follows=
INTEREST = BALANCE OF TAX UNPAID X NU~IBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
Interest Daily
Rata Factor
91 .0002¢7
61 .00016¢
51 .000137
CZ .000110
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additionat interest must be calculated.
JAMES A. BALOGH - MN
GARY W. BECKER - DC, FL, IL, MN, WI*
*CREDITORJS Pd G HTS SPECIALIST
AMERICAN BOARD OF CERTIFICATION
CHELSEA A. WHITLEY - MN, WI
ANGELA M. HORN -- MN
MICHAEL D. JOHNSON - MN
/9~.RY ELLEN WEEM~N - KS, MN, MO
THERSlA O. LEE -MN
CHAD J. BOLINSKE - MN
STE~N M. TOMS - MN
MICHAEL L. MCCAIN - MN
JOHN E. OLCHEFSKE - MN
JASON R. FOSTER - MN
ME~.GAN M. PROBST - MN
MICHAEL J. DOUGHERTY - MN
MICHAEL D. BOLINSKE - MN, OR
REGISTER OF WILLS
BALOGH BECKER, LTD.
AT[ORNEYS AT LAW
SEND ALL WRITTEN REPLIES TO:
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA S5422-4811
TELEPHONE 763-852-8440
FAX 763-852-8499
TOLL-FREE 866-884-2862
CUMBERLAND COUNTY COURTHOUSE
1 COURTHOUSE SQUARE, #i02
CARLISLE, PA 17013
Re: In the Estate of
MELANIE A PALMER
ARIZONA OFFICE:
64 E. BROADWAY ROAD
SUITE 175
TEMPE, AZ 85282
DIANA THEOS - AZ~ CO
SAN DRA TANG - AZ, CA
OF COUNSEL:
LITOW LaW OFFICES, P.C.
(IOWA)
LUSTIG, GL~SER & WILSON, P,C.
(MASSACHUSETTS)
11/12/04
Probate Case No.
Social Security No:
Last known residence:
Our Client:
Account Number:
Amount of Debt:
21-04-700
192527974
6 CEDAR CT ENOLA, PA 17025
MAY DEPARTMENT STORES CO
00000081982402
$ 421.17
Dear Sir or Madam:
Enclosed please f'md a Creditor's claim to be filed in the record with the above-referenced Estate.
Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you
for your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll free at 1-
866-884-2862
Cordially,
Balogh Becker, Ltd.
Attorneys at Law
Enclosures
A check for $5.00 for the filing fee.
cc: Attorney for Estate
Personal Representative
This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This
letter is from a debt collector.
5361 11/1 lZ2004 1191283
COMMONWEALTH OF PENNSYLVANTA
NOTICE OF CLAIM
COURT OF COMMON PLEAS
OF CUMBERLAND ,COUNTY
ORPHANS' COURT DTVZSI'ON
Tn Re: The Estate of:
MELANIE A PALMER
Deceased
Court File No: 21-04-700
TO: THE CLERK OF THE ORPHANS' COURT DTVTSTON:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,
Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2).
MAY DEPARTMENT STORES CO '
1) Claimant's name:
C/O BALOGH BEOKER LTD,41§00L$ON MEMORIAL
2) Claimant's address: HWY#200
MINNEAPOLIS, MN 55422
866-884-2862
3) Creditor listed below is the owner and holder of a claim in the amoun~f
$ 421.17 .
4) The facts upon which this claim is based:
This claim is based on an account for credit evidenced by the attached
Affidavit of Account Stated.
s)
Decedent's address: 6CEDARCTENOLA, PA17025
6) Date of Death: 07/19/04
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by.
On behalf of the claimant, ! do solemnly declare and affirm under the penalties of
perjury that they Information and representations made herein are true and correct
to the best of/my kn/owled~e, information and ~l'i~f.
Dated: ///,//_~.//~ .~/ ~
Wr,tten n~t/i~e"o{cla ~m~[:;sA ~:=/~;~rM;oH~~r~i; Lr e~ ,n Fact
as stated below:
LYNDSEY FISCUS
Name
6 CEDAR OT
Address
ENOLA, PA 17025
City/State/Zi)l~//~'/0
Date notice ma[iie0(
IN RE ESTATE OF: MELANIE A PALMER
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of his/her duties.
The Decedent purchased merchandise in the amount of $ 421.17
account number 00000081982402
evidenced by
The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney's fees.
Further your affiant sayeth not
Subscribed and sworn before me
This /09`, day of ~,
By: ._ ~.~/
One of its attorneys: /~ ~-~ ~-- '
Chelsea A. Whitley~M. Horn __
Michael D. Johnson __ Mary Ellen Weeman __
Thersia O. Lee __ Chad J. B~o]inske __
4150 Olson Memorial Highway, Su_ 200
Minneapolis, MN 55422-4811~::~, ~
,2004
. MINf<ESOTA OFFICE:
JAMES A. BALOGH - MN
GARYW. BECKER - DC, Fl, Il, MN, WI.
.CREDITOR'S RIGHTS SPECIALIST
AMERICAN BOARD OF CERTIFICATION
CHELSEA A~- WHITLEY --MN, WI -
ANGELA M. HORN - MN
MICHAEL D. JOHNSON - MN
MARY ELLEN WEEMAN - KS, MN, MO
THERSIAO.leE-MN
CHAD J. BOLlNSKE - MN
STEVEN M. TOMS - MN
JOHN E. OLCHEfSKE - MN
JASON R. FOSTER - MN
MEAGAN M. PROBST - MN
MICHAEL J. DOUGHERTY - MN
MICHAEL D. BoUNSKE - MN, OR
JILlM. GEMLO~MN
EMILY L. FINGEIl:-MN
ANDREW S. MILLER - MN
BALOGH BECKER, LTD.
ATTORNEYS AT LAw
SEND ALL WRlnEN REPLIES TO:
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
TElEPHONE 763-852-8440
FAX 763-852-8499
TOll-FREE 877-768.4502
REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
I COURTHOUSE SQUARE, #102
CARLISLE, PA 17013
Re: In the Estate of
Probate Case No.
Social Security No:
Last known residence:
Our Client:
Account Number:
Amount of Debt:
Dear Sir or Madam:
MELANIE A PALMER
21-04-700
192527974
6 CEDAR CT ENOLA, PA 17025
WORLD FINANCIAL NETWORK NATIONAL BANK
000000000276708005
$125.69
ARIZONA OFFICE:
64 E. BROADWAY ROAD
SUITE 175
TEMPE, AL 85282
DIANA THEOS - AL, CO
SANDRA TANG - AL, CA
OF COUNS~L:
lirow LAw OFFICES, P.C.
(IOWA)
LUSTIG, GLASER & WILSON, P.c.
(MASSACHUSETTS)
12/21/04
':.:..:}
il
cr,
bnclosed please tind a Creditor's claim to be tiled 'n the record With the above-relerencedEsldle.
Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you
for your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll free at 1-
877-768-4502
Cordially,
Balogh Becker, Ltd.
Attorneys at Law
Enclosures
A check for $5.00 for the filing fee.
cc: Attorney for Estate
Personal Representative
This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This
letter is from a debt colleclor.
~.
5132
119l2&3
9mnr:JJ4
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of:
MELANIE A PALMER
Deceased
Court File No: 21-04-700
TO: THE CLERK OF THE ORPHANS' COURT DIVISION:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,
Estates, and Fiduciaries Code, 20 PA.C.S.A. g3532(b)(2).
WORLD FINANCIAL NETWORK NATIONAL BANK
1) Claimant's name:
2)
CIO BALOGH BECKER LTD. 4150 OLSON MEMORIAL
Claimant's address: HWY #200
MINNEAPOLIS. MN 55422
877-768-4502
3) Creditor listed below is the owner and holder of a claim in the amount of
$ 125.69
(;".
4) The facts upon which this claim is based:
This claim is based on an account for credit evidenced by the attached
Affidavit of Account Stated.
5) Oecedent's address: 6CEDARCT ENOLA. PA 17025
6)
Date of Death:
07/19/04
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm under the penalties of
perjury that they Information and representations ma herein are true and correct
to the best of kno e e, i and beli .
G
Dated:
Chelsea A. Whitley/Angela M. Horn/Mary Ellen Weeman/Chad BolinskefThersia Lee, Attorney.in-Fact
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
L YNDSEY FISCUS
Name
6 CEDAR CT
Address
ENOLA. PA 17025
City/State/Zip I k
I /'-GO)
Date notice mailed
IN RE ESTATE OF: MELANIE A PALMER
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
I. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of hislher duties.
3.
The Decedent purchased merchandise in the amount of$125.69
account number 000000000276708005
evidenced by
4. The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney's fees.
Further your affiant sayeth not
By: _
One of its attorneys: ~
Chelsea A. Whitley _ Angela M. Horn_
Michael D. Johnson _ Mary Ellen Weeman_
Thersia O. Lee Chad J. Bolinske
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
Subscribed and sworn before me
This <I- day of F ' 20~
'~.: 0)
....,
otary Public
.1I~ S. lEA. JOHNSON
..'" NOTARY PUBl.lC - MINNESOTA
ij HeNNEPIN COUNTY
._ My ConmssIon ExpInls Jan. 31, 2006
:",n
OJ
In Re: Estate of
P ALMER MELANIE ANN
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-00700
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: FISCUS LINDSEY ANN
Counsel for Personal Representative:
Date of Decedent's Death: 7/19/2004
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 healing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
Date:
7/28/2006
~.,,{ . J ~(7 L,.' {J
~ . , _ J
'/ ". ,',' ! I.
.(' - - - I. .' _ ,: -, /:....
;t h .~, r, 'W&':-{.../ ~~/~u.;r.fl1-'
~ !
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
In Re: Estate of
P ALMER MELANIE ANN
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-00700
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative:
PALMER JILLIAN RAE
Counsel for Personal Representative:
Date of Decedent's Death: 7/19/2004
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
-'"
/Iff ~r.;:> .' f
/ .. f.>> . L
,ak,' #,w'-/' jj:ziMh~jf/~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
SENDER: COMPLETE THIS SECTION
1. Article Addressed to:
D. Is delivery dress different from item 1?
If YES, enter delivery address below:
. 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 mail piece,
or on the front if space permits.
Pl\.LMER JILLIAN Rl-\E
6 CEDAR COURT
ENOLA PA 17025
3. Service Type
D Certified Mail
D Registered
D Insured Mail
D Express Mail
D Return Receipt for Merchandise
DC.a.D.
4. Restricted Delivery? (Extra Fee)
2. Article Number
(Transfer from service labeQ
PS Form 3811, February 2004
7005 0390 0003 2638 8008
Domestic Return Receipt
UNITED STATES ~"".I>...J!l~~...' ~.....j.f.;>.~G. .fC>AJ7U
O..:~ .1.:\ LJG .~~ 1:)0,6 pr-., L II
.....
· Sender: Please print your name, address, and ZIP+4 in this box ·
~
()tf -7 C'('j
\ i
HJV-
Glenda Farner Strasbaugh
Register of Wills and Clerk of Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, P A 17013
'.-..-.
.-.-..-..-.
:_:_:~_:.~
j.. .111.. I ill..... ,j J.. il. ..11... U."ll, II. .,11.,..., Ill.. l.j
"
SENDER: COMPLETE 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.
D. Is delive address different from item 1?
If YES, enter delivery address below:
1. Article Addressed to:
FI Sl~US LINDSEY Al'JT'\
6 CEDAR COURT
ENCLA?Z\ 1702:';
Service Type
D Certified Mail
D Registered
D Insured Mail
D Express Mail
D Return Receipt for Merchandise
DC.a.D.
4. Restricted Delivery? (Extra Fee)
2. Article Number
(Transfer from service label)
PS Form 3811 , February 2004
7005 0390 0003 2638 8015
Domestic Return Receipt
102595-02-M-1540
UNITED STATES PQ~,Ah, SER.\.l'fE- ,-' ~'"\<'\ "I" ",,\11'
-['1 };.tur( r,,~ r~) t) .,.J. r( ~,~:l? ~t.r--i,._" ..1.
CJ;~~! ..l:;;~~~LJ:(:~ ;?()(~t:j tF/'r~I~?~f i,.
l",-"
" '''',--,\",~'& ..
· Sender: Please print your name, address, and ZIP+4 In this box ·
-10
. ~~
litr \f't~_yr
''iJ 7 --,
V"J ~ 0 v
(-l :\ V.J
Glenda Farner Strasbaugh .
Register of Wills and Clerk of Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PAl 70 13
:,:::::c.: Ci:;;:i'.:;:
I,., III. , ,111,.",,11. ,II.., J 11,,11'1, J I) II, ! III.... .,111. .1 ! I
.. ,
.
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: JDcl10 t e. A. ~()J mer
1 / ll1 - 200+
j) - 04- o '1 CO
Date of Death:
Estate 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 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 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 'R 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.
::2~R.~ j
Si ature
1l11an R. Pl1lMif
Name
-L~ CedM (1u[} t;olo-- f (r ( 1ti 5
Address
Date: ~WJl(J
.)
am 13'2 - CDs'-f1
Te ephone No.
, ,., r c. '.! \:tiJl .
Z ;.t : li '. ;'.' .," '. l i. ,-,apaclty:
l8l.fersonal Representative
o Counsel for personal representative
-_\j
c
~ . ...
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ifl.f./antf, A. P.aJ~('
7-/9-;200+
Estate No.: ~/- oi'- 0 7tJ ()
Date of Death:
Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State ;hhether a~nistration of the estate is c~,mplete:
Yes JfJ. 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 person~epresentative file a final account with the Court?
Yes 0 No pi.
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? yesJ. 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: ~ 3, ~\J.(J
j
J:b0~~
Signature
--L ()dse~ A. POll m6'
Name
_10 C1d(l( rk- I5lnk PA-
Address
1/ '1 - 13 2-(P3,-/-'7
0:'1 -;' I ~
C. . t i ,
Telephone No.
Capacity: ~ersonal Representative
o Counsel for personal representative
! ,
.<" -',-..
;1 .' ,.' ;.; 'LV) n'-",-, ~ .
-'v .JvI1;IJ ' ;..1; r" 'n', I
-- \J...JoJOl"./vl.::]c
c
une courcnouse ~quare
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/31/2006
FISCUS LINDSEY ANN
6 CEDAR COURT
ENOLA, PA 17025
RE: Estate of PALMER MELANIE ANN
File Number: 2004-00700
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 lS due by:
7/19/2006
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
Counsel
Cumberland County - Reglscel v~
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/31/2006
PALMER JILLIAN RAE
6 CEDAR COURT
ENOLA, PA 17025
RE: Estate of PALMER MELANIE ANN
File Number: 2004-00700
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. I, for decedents dying on or after
July I, 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:
7/19/2006
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,
ik -,~ ~ ,IJ
, ./' V
, ulLL~' ~
/- ,/
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel