HomeMy WebLinkAbout04-0712PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as To:
Deceased.
Social Security No. / ~ ~ - ~/- 7 ~ ~/
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl. L2<5
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in ~/A ~ ~/~'7~ County, Pennsylvania, with
h~/t~ lastfamilyorprincipalresidenceat %~'~ L~--~2Vq~vi'~"~ '~/~'6g.A/[/fflc& ~.
{list/street, number and mu'nicipality)
Decendent then years of age, died ~
at ~)M~'~r>~r~c-3~4~'~;>'x ~t2r'<. /~.~(~q~Tlc~t~:::
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: i iC~24f~...-,~c,, ~LD ]w17'/}, ~,z¢-
, oq¢.
$
$
$
Petitioner after a proper search ha ~- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name _,_q ~)7Relati°nship~rlfl - Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters o ~f?~a~binistl~ion
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY or (~c~\~_~,.. 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.
Estate of ~x¢ P~ ~ '-q-~crax.C~'~ ~
,Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~N,k.)'-X~tLt~li' & c~r.~- ~/ ,,n conslderaUon of the petition on
the reverse side hereof, sa~fac.~y proof, havingJ~en r~nted before me,
IT IS DECREED that ~.,..,N~X,~'&-.k~ ~'~
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ~--~(3_9'~k
in the estate of IcL
1
FEES
Letters of Administration .....
Short Certificates( ) ......
Renunciation ................ $~--
TOTAL. $ '~-'/o.
Filed .-'] .': .~.~..q .~.'.~'~.. A.D. flt0
Register of Wills ~
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
Register of Wills of Dauphin County, Pennsylvania
RENUNCIATION
also known as D- '~-
, Deceased
' ' ~(Relationship) (C]pacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters (~ 1~('~l['6L4~a4 be issued to ~5'lg'r'~ I'~ ~" /~-~r~ Z~.CO~
' I
Witness hand this __ day of , 20
(Address)
(Signature)
(Address)
(Signature)
(Address)
Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
RW-I~ (Rvsd 9/92)
RENUNCIATION
m ~e rotate o~ ~l i ~l
To the Re~ister of Wills of
The undersigned
0_.,~{/~4 6~ (~ [-'~ )X,) ['3 County, Pennsylvania.
the a~ove d~ent, hereby renounce(s) the right to administer the estate and resp~ffully ask(s) that Letters
b~ issu~ to ~^ e.~vt
WITNESS hand this day of ., 21)
(Address)
(Signature)
(Address)
(Signature)
(Address)
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 tbrwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by phqtostat or photograph.
Fee for this certificate, $2.00
~'~E~I
No. ~ Date
#29-297
Local Registrar
JUL 0 8 2004
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDF~,
CERTIFICATE OF DEATH ~ ~
(Coroner)
Thompson Female ]*. 187-44-7551
Vtckt R
50 v,,,.
Cumberland
Reg. Nurse
567 Brighton Place
~.echanicsburg, Pa.
Oct. 12, 1953 Harrisbur¢
Upper Allen 567 Brighton Place
~hite
Thompson
Doris J. Lukens
lling Green Mem. Park Pa.
F.H.& C.S.Inc. 324 Hummel Ave
Pendin$ Investigation
July 6, 2004
Michael L. Norris, Coroner
6375 Basehore Road, Suite #1
Mechanicsburg, Pa. 17050
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Vicki R. Thompson
Date of Death: July 2, 2004
Will No. 2004-00712
To the Register:
I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
September 23, 2004.
Name Address
Jeff Thompson
119 North 26th Street
Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A
Date: September~,~-~ , 2004
~ah Deni~__~tor, Esquire
Reager & Adler, PC
2331 Market Street
Camp Hill, PA 17011
(717) 763-1383
Counsel for Personal Representative
CLAIM FORM
ESTATE OF
VICKI R. THOMPSON
Notice of claim by THE BON TON
ORPHANS' COURT DIVISION OF
COURT OF COMMON PLEAS OF
COUNTY
CUMBERLAND
NO. 21-04-712
in the amount of $ q??.R3 filed pursuant to section 3384, Probate, Estates and
Fiduciaries Code Laws of 1972, Act No. 104 effective July 1, 1972 as amended.
TO TH~ CLERK OF THE ORP3EANS' COURT DIVISION~
Enter the claim of THE BON TON
(Claimant and Address}
922.83
Date
9441 tE~J FREEWAY
Lock Box 30
Dallas, TX 75243
19
in the amount of $
.against the above entitled Estate. The decedent
who resided at 119 N. 26TH ST. , CAMP ,HILL PA 17011
( Address ) died on 7 / 2 / 04
(Date)
Written notice of said claim was given to SARAH E. THOMPSON c/o DEBRA DENISON CANTOR,
ESQ.
· (Personal RepresenCa=ive or Counsel)
at .... AMP HILL PA 17011
(Address) on
(Da=e)
The basis of aforesaid claim is as follows: (Itemize fully to enable personal representative
Co make proper investigation).
Acct. #051-070-498
Claimant's Counsel
(Name)
(Address) ,, £7;
Lock Box 30
PROBATE COURT
Cumberland County, State of Pennsylvania
Vicki R. Thompson, Deceased
Case #21-04-712
Proof of Mailinq
I mailed the creditors claim to the fiduciary (and attorney, if applicable) as
follows:
I deposited a copy/copies of the claim with the United States Postal Service in
a sealed envelope with the postage fully pre-paid. I used first-class mail. I
am employed in the county where the mailing occurred. The envelope(s) was/were
addressed and mailed as follows:
Ms. Sarah Thompson
c/o Debra Denison Cantor, Esq.
2331 Market St.
Camp Hill, PA 17011
Date of Mailing:
County of Mailing:
Dallas, Texas
i declare unde~D~ity of perjury that the foregoing is true and correct.
Date: //./.,~y
~°rThe Bon Ton
P.O. Box 741026
Dallas, TX 75374
PACKE'~ .~E: 18
BTS-C02~ J*'IF-OO1 RUN ON: 9/ 2/2004 23:24:41
NAME
+ ADDRESS
ADDRESS
CITY STATE
SPOUSE
EMPLOYER
ADDRESS
CITY STATE
PHONE:
VICKI R THOMPSON
119 N 26TH ST
CAMP HILL
EXT:
HOME PHONE
DATE OPEN
OTHER ACCT
PA17011 REQ PAYMENT
A/R BAL
CURR PAY
MEMO PUR
MEMO CR
HOL-BON
TOTAL
THE ~_,;-TON MED[,
REPORT # 979
ACCT# O51-O70-498 F COLLECTOR 12 B
717/737-3421 L[MIT 0 NAC
02/74 ADd CODE
ADd AMT
OOOOOOOO IN/COLL 11/84
STATUS DLTZH
938 CYCLE ?9
0 MPI 2
0 HIMPITY 2
O HIMPILY O
HIMPIMO 8
938
COMMENTS:
PREV-BAL
PURCHASE PAY/RET FIN-CHRG NEN BAL PAST/DUE AMT-DUE
16 03 938.86 .00 .00
~ "',
"-'J
'" \ ~
Date: 2-24-05
Estate No: 21-04-0712
Date of Death: 7-2-04
In the estate of:
VICKI R. THOMPSON
CLAIM AGAINST DECEDENT'S ESTATE
The Claimant certifies that there is due and owing by the
VICKI R. THOMPSON deceased,
in accordance with the attached statement of account the sum of $ 460 . 87
together with interest at the rate of from
until paid.
On behalf of the claimant I do solemnly declare and affirm under the penalties
of peIjury that the information and representations made herein are true and correct
of the best of my knowledge, information and belief.
ROSCOV'S
Name of Claimant
S. ature of Claimant or person
authorized to make verification
on behalf of creditor
Address of Claimant
Ad~f~~1 LBJ FREEWAY
,-ocT< Box 30
Dallas. TX 75243
972-644-6360
Phone Number
Phone Number
FILED:
THIS FORM MAYBE FILED WIlli TIlE ORPHANS COURT UPON PAYMENT OF A
FILING FEE OF $10.00. A COPY MUST ALSO BE SENT TO TIlE PERSONAL
REPRESENTATIVE.
J-
PROBATE COURT
Cumberland County, State of Pennsylvania
Vicki R. Thompson, Deceased
Case #21-04-0712
Proof of Mailina
I mailed the creditors claim to the fiduciary (and attorney, if applicable) as
follows:
I deposited a copy/copies of the claim with the United States Postal Service in
a sealed envelope with the postage fully pre-paid. I used first-class mail. I
am employed in the county where the mailing occurred. The envelope(s) was/were
addressed and mailed as follows:
Ms. Sarah Thompson
c/o Debra D. Cantor, Esq.
2331 Market St.
Camp Hill, PA 17011
Date of Mailing:
J~~/
County of Mailing:
Dallas, Texas
T. de~la-e "nA~771tyy f
:ate~~ ~d~~/ ..
'l?E':":"'j,_'.ry
that the foregoing is true and correct.
Boscov's
P.O. Box 741026
Dallas, TX 75374
Page: 1 Document Name: BARBARA CASSIDY
BOSCOV'S CREDIT DIVISION
ACCOUNT INQUIRY
ORGANIZATION 100 LOGO 110 ACCT 0000000000206239484
SHORT NAME THOMPSON ESTATE STATE PA HOME PHONE
TOT CR LMT 0 EMPL CD STATUS Z
CA CR LMT 0 CSH AUTH .00
CASH BAL .00 TOT DISP 0 .00
CASH AVAL .00 CASH DSP 0 .00
O-T-B **********0 CYCLE DB 0 .00
PCT LEVEL / ID S PA CYCLE CR 0 .00
CURR BAL 460.87 CYCLE PMTS .00
\Rl~ (
PAGE 01
REL
7177619178 BLOCK
NBR PLANS
CARD USAGE
BILLING CYCLE
DATE OPENED
CARD FEE DATE
DTE LST BILL
^ ^ ......"..,1':" rHo.X'" T"\TTL;"
10/16/2004
11:18:43
CODES
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12/04/2000
10/09/2004
11 /nQ !')nnLl
IN THE STATE OF Pennsylvania
COUNTY OF Cumberland
IN RE: The Estate of
Vicki R Thompson, Deceased
PROBATE FILE NO. 21-2004-712
STATEMENT OF CLAIM
The undersigned, being duly sworn, deposes and states that:
1. TSYS Total Debt management, Inc., whose address is Post Office Box 6700,
Norcross, Georgia 30091-6700, is the attorney-in-fact for JCPENNEY CREDIT SERVICES
(hereinafter "Claimant"), whose Account Number is 6008895714733960, and as attorney-
in- fact is authorized to submit this Statement of Claim on its behalf.
2. Claimant is the holder of a claim against the Estate of Vicki R Thompson
deceased, the basis of which is the unpaid balance of charges incurred or authorized by the
deceased or on behalf of the deceased in the total amount of $213.86 , as of the date of
the death of the deceased.
3. The said sum is now justly due this Claimant; and the claim is not contingent or
unliquidated.
4. No payment has been made thereon, and there are no offsets against the same,
and the same is not secured by judgment or mortgage upon or expressly charged on the real
estate of the deceased or any part thereof.
This
~7 /--j
,2005
day of J &v;u ~
TSYS Total Debt Management, Inc.
As attorne -i -fact for Claimant
. )
Notary Public. Gwlnnett County. G^
My Comm. Expires Nov. 7, 2008
Sworn to and supscribed before me this
J- ;.J4.ay of JO/V\UOv<.!) ,2005
~~ ~fl
Notary Public
By: -",,~r
Nyla Ja ~,
TSYS Pr ate Representative ,--
Copy mailed to attorney for Representative or to cr..
Representative, if not represented by attorney.
~~ ~
this 9-- ~ "--1ray of JIVl u~ ' 2005
TSYS Probate Representative
r-.. ~ V
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
July 11, 2005
717-783-6893
Monica D. Zercher
2331 Market St.
Camp Hill, Pa. 17011-4642
Re: Estate of Vicki R. Thompson
File Number 2104-0712
Dear Ms. Zercher:
This is in response to your letter of July 7,2005, concerning the Inheritance Tax return
due in regards to the above referenced estate.
Since it is apparent that you will be unable to file a tax return in the near future, the
estate record will be placed in an informal hold status for an additional period of six (6) months
so that the Department will initiate no enforcement activity. At the end of that period we would
ask that you contact us to provide an updated status for our file.
Thank you for your cooperation and if I may be of any further assistance, please feel free
to contact this office.
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REV_1500EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.()601
REV-1500
INHERITANCE TAX. RETURN
RESIDENT DECEDENT
OFFICiAl USE ONLY
FILE NUMBER
2 1 -0 4 0 7 1 2
COUNTYCOOE -YEAR- - - NUMBER- -
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DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL)
Vicki R. Thorn son
DATE OF DEATH (MM-D[}.Year)
DATE Of BIRTH {MM-DO-Year}
socrAl SECURITY NUMBER
187-44-7551
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
2 0 8 - 4 2 - 6 536
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07/02/2004 10/12/1953
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
(RJ 1. Original Rerum
o 4. Limited Estate
o 6. Decedent Died Testate (Altach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (Gatto( deattl a 12-12-B2}
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
03. Remainder Retum (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113{A) (AttachSchO)
THIS SECTION MUST BE COMPLetED. ALL CORReSpONDeNCE ANDCONFIDENTIALtAXINFORII1ATIONSHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
David W. Rea er Es 2331 Market Street
FIRM NAME (If Applicablel
Rea er & Adler PC
TELEPHONE NUMBER
7177631383 Carn Hill PA 17011
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
14)
(5)
,
OFFICI~$E ONLY -:0 l
L-J"l In
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3. Closely Held Corporation, Partnership or Sole~Proprietorshjp
4. Mortyages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Ooned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Tlltal Grllss Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I)
11. Tlltal Deductillns (total Lines 9 & 10)
12. Net Value of Estate (Lille a minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
"
(6)
(7)
.'
4,491.19
-,
C1
T.:
86,510,00
~- -l.
(::)
en
(9)
(10)
14. Ne!Value Subject!1l Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, ortransle" under Sec. 9116 (a)(1.2)
19. Tax Due
65,022.52 X .:2!L- (15)
X _(16)
X .12 (17)
X .15 (18)
(19)
(8)
91,001.19
13,116.90
12,861.77
(11)
(12)
(13)
25,978.67
65,022.52
16. Amount of Line 14 taxable at \ineal rate
(14)
65,022.52
17. Amount of Line 14 taxable at sibling rate
0.00
0.00
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
:>:> BE SURE TO ANSWER ALL QUEStiONS ON REVERSE SIDE AND RECHECK MATH < <
18. Amount of Line 14 taxable at collateral rate
Decedent's Complete Address:
STREET ADDRESS 567 Briahton Place
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + 8 + C) (2)
3. InterestlPenalty If applicable
D. Interest
E. Penalty
TotallnteresVPenalty (D + E) (3)
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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the 8AlANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
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 ofthe property transferred; ........................................................................... 0 IZ]
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IZ]
c. retain a reversionary interest; or ...........m........................................................................................ 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IZ]
2. >>death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate oonsideration?...... ............................... ......................................................... 0 IZ]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 IZ]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .............................................................................................. ......... 1KI 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
't-?~'
fYlo.vk r r::},ty.e~f-; Camp HfI/, pIJ
/701/
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. 99116 (a) (1.1) (I)].
For dates of death on or after January 1, 1995. the tax rate imposed on the net value oftransfers to or for the use of the surviving spouse is 0% [?2 P.S. 99116 (a) (1.1) (11)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and ftling a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparenl of the child is 0% [72 P.S. 99116(a)(I.2)].
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. 99116(1.2) [72 P.S. 99116(a)(I)].
The lax rate imposed on the netvalue oftranslers to or lor the use of the decedent's Siblings is 12% [72 P.S. 99116(a)(I.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
'EV""''''I,.en*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Vicki R. Thomoson
FILE NUMBER
21 04
0712
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointfy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
DESCRIPTION
Belco Community Credit Union - Regular Savings
403 North 2nd Street, P.O. Box 82
Harrisburg, PA 17108
Belco Community Credit Union - Whatever Club
VALUE AT DATE
OF DEATH
1,796.26
1,304.86
3.
Beico Community Credit Union - Checking
1,390.07
TOTAL (Aiso enter on line 5, Recapitulation) $
(It more space IS needed, Insert additional sheets of the same size)
4491.19
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Vicki R Thomason
if an asset was made joint within one year otthe decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
21 04
0712
SURVIVING JOINT TENANT{S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Jeffrey Thompson
119 North 26th Street
Camp Hill, PA 17011
husband
B
c
JOINTlY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR J01NT MADE Include nClme of financial institution and bank account I'lumber or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSn INTEREST DECEDENT'S INTEREST
1. A. real estate located at 119 North 26th Street, Camp Hill PA 173,020.00 50 86,510.00
As of the Tax Assessment Database, the
date of death value was: $173,020.00
TOTAL (Also enter on line 6, Recapitulation) $ 86510.00
(If more space is needed, insert additional sheets of the same size)
'''''''''''''.971.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
ESTATE OF
Vicki R. ThomDson
FILE NUMBER
21 04
0712
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 INCLlJDETl1ENAMEOFTHETRANSFEREE,THEIRRELATlONSHIPTOOECEDENTANOTHEDATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
NUMBER AITACH ACOPYOFTHE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST
(IFAPPLICABLE)
1. Pinnacle Health 403(b) retirement account 39,466.16 O.
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets ot the same size)
'''''''''".,,'''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Vicki R Thomoson
21
04
0712
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Musselman Funeral Home 5,482.68
2. Nevin Schenck (mausoleum) 6,135.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Number(s) I E1N Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2 Attorney Fees Reager & Adler, PC 1,052.11
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 270.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Cumberland Law Journal (legal notice) 75.00
8. The Sentinel (legal notice) 102.11
TOTAL (Also enter on line 9, Recapitulation) $ 13116.90
(If more space is needed, insert additional sheets of the same size)
""'''''".,''''w
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Vicki R. Thomoson
FILE NUMBER
21
04
0712
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
DESCRIPTION
AMOUNT
4,775.91
BELCO unsecured loan
BELCO unsecured signature loan
985.59
JC Penney (Account # 571-473-396-0)
222.81
Auto PridelGE Capital Con CC (Account # 6019180032062271)
211.00
Providian National Bank (Account # 4185 6468 5889 2374)
476.94
AT&T Universal Card (Account # 5491 130094009743)
2,115.62
T Mobile (Account # 170219977)
23.11
Comcast (Account # 09547 234566-03-7)
126.36
Wolf Funiture Co. (Account # 499 6010 0004 2096)
213.48
Hecht's (Account # 500-980-454)
80.72
Boscov's (Account # 0206239484)
460.87
The Bon-Ton (Account # 051-070-498)
922.83
Citicorp Credit Services Inc. (Account # 5491 130094009743)
2,183.07
J.Jill (Account # 6011 65530604 9623)
63.46
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets at the same size)
12861.77
REV.,S13EX,t*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Vi"ki R. Thnmnsnn ')1 n4 n712
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trusteels) OF ESTATE
L TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Jeffrey Thompson spousal 65022.52
119 North 26th Street
Camp Hill, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II, NON.T AXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1-
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1-
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)
Cumberland County
INVENTORY
Estate of Vicki R Thompson
No.21
04
0712
, Deceased
Date of Death 7/2/2004
Social Security No. 187447551
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: David W. ReaQer, Esq.
1.0. No.: 020868
~:--~-^'{~ ~(hvjf-
Dated X /22 J b,~
I
Address: 2331 Market Street
Camp Hill
Telephone: 717 763 1383
PA 17011
Description
Value
Stocks & Bonds
Closely-Held Corporation, Partnership or Sole-Proprietorship
,...,
'.'~)
~-~
1;,.'1
Mortgages & Notes Receivable
':-)
'-'J
; , 'i
jC)
,-,
, -:J
"
r"~J
~::J
C")
- i-I
-".. "!
C) : ~~~
c.n ~-, ,-")
n
1,796.26
G"")
r--,)
(..:.1
Cash, Bank Deposits, & Misc. Personal Property
,.,.
Belco Community Credit Union - Regular Savings
403 North 2nd Street, P.O. Box 82
Harrisburg, PA 17108
Belco Community Credit Union - Whatever Club
1,304.86
Total
4,491.19
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
Continuation of Inventory
Vicki R. Thompson
21
04
0712
ParJe 1
Description of Inventory
Description
Belco Community Credit Union - Checking
Value
1,390.07
Real Estate
Subtotal $
1,390.07
4,491.19
Grand Total $
DATE 11-21-2005
ESTATE OF THOMPSON VICKI R
DATE OF DEATH 07-02-2004
FILE NUMBER 21 04-0712
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 01-20-2006
( See reverse side under Objections)
Amount Remittedl I
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 +-
-------------------------------------------------------------------------------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF THOMPSON VICKI R FILE NO. 21 04-0712 ACN 101 DATE 11-21-2005
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX OIVISION
PO BOX 2B060 1
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
n::"00'\[I', n::j:"1r;r: r:.~TICE OF INHERITANCE TAX
,,-~, _ 1-"0 1 j \.: /: -.) .- i I __ I.,~ -'"
!c.,}'-,- -'. 'APFi'RAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ZCD:} \. 28
Fi'; 3: 04
01 ;: ,
DAVID REAGER ESQ'J'
2331 MARKET ST
CAMP HILL PA 17011
REV-1547 EX AFP (06-05)
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)
5. 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
.00
.00
.00
4,491.19
86,510.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
13,116.90
12,861.77
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
91,001.19
?1i.978 6.7
65,022.52
.00
65,022.52
NOTE: If an assess.ent was issued preViously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of !h!.. returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) 65,022.52 X 00 .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 .00
19. Principal Tax Due (19)= .00
TAX CR~DITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH
REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED,
FILE a 6.12 FORM YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Vicki R. Thompson
Date of Death: July 2,2004
Will No.: 2004-00712
PA File No.: 21-04-0712
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 --J
No
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?
c::)
Yes
No
--J
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 --J
No account was stated to the parties because the estate is insolvent.
Date:
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. , . ' ~
?It.~/Jb tide;. ~___/
/ David W. R~,ger, Esquire
Reager & Acr~r, P.C.
2331 Market Street
Camp Hill, PA 17011
(717) 763-1383
Counsel for Personal Representative
.~
cumner 1. and. coun 1::. y - .l,-c;..'::1. ~ ___
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/31/2006
CANTOR DEBRA DENISON
2331 MARKET STREET
CAMP HILL, PA 17011
RE: Estate of THOMPSON VICKI R
File Number: 2004-00712
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:
7/02/2006
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
Personal Representative(s)
Cumberland County -KegJ.CiLC.J.. '""~
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/31/2006
THOMPSON SARAH E
119 N 26TH ST
CAMP HILL, PA 17011
RE: Estate of THOMPSON VICKI R
File Number: 2004-00712
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6012 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:
7/02/2006
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,
~.dL~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel