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Home My WebLink About04-0715 ~JUMBI~RLAND COUNTY, PENNSYVLANIA PETITION FOR GRANT OF LETTERS Estate of GLADYS L, SELLER No.~ also known as , Deceased Social Security No..210-18-7552 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: {COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut __ named in the Last Will of the ~ Decedent, dated and codicil(s) dated State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: ] B. Grant of Letters of Administration (c.t.a., d.b,n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence Teresa Owen Daughter 17 Campbell Place, Camp Hill, PA Peter A. Seller, Jr. Son ~ 18 Hi hland Ave, Shi ensbur , PA (COMPLETE IN A~,~. CAS~:) A~h~ additional sheets if necessary. rDe:;~ednecn; aWtas2~adt;t~;tnhu~ ~sTpb:~an;dboro Townsh Cam County, Pennsylvania, with h s/her last family or principal ~-~ ~, ' , p, p Hill, PA 17011 ~ ;~i: ~ ~ (list street, number and municipality uecedent, theni~;' ~ears o~;ag~l~ died March 30 , .2004 , at Holy Spirit Hospital Decedent at deathbed prop~[ty with i~ti~ated values as follows' (Location) C~(i~ornicile~n PA) ? ~. ' All personal property ......................................... $., 2,500.00 (if not domiciled in pA) Personal property in Pennsylvania .................... $., (If not domiciled in PA) Personal property in County ............................ $ Va ue of rea estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ 2,500.0~) Real Estate situated as follows: n/a Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of Petters in the appropriate form to the undersigned: Signature Typed or printed name and residence Teresa Owen 17 Ca~ll Place ~ PA 17011 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County o[ Cumberland The Petitioner(s) above-named swear(s) and 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 Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn'to and affirmed and subscribed before me this ~_ ~.~_D ~")'~ ),.~-- C~OO~ day of DECREE OF REGISTER Estate of GLADYS L SEILI~R Deceased also known as_ -- Social Security No: 210-18-7552 Date of Death' 3/30/04 AND.OW._ .2004 .'nco s,d- on the reverse s~de hereon, satisfa~r~ proof having been presented before me, erat~on of the Petition IT IS DECREED that Letters [~ Testamentary [~ of Administration. (c.t.a., d,b.n.c.t.; pendente lite; durante absentia; durante rninoritate) are hereby granted to Teresa Owen in the above estate and that the instrument(s), if any, dated_ described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES .................................... to,~, Shod:Certificate(s) ............... $ Renunciation .......................... $ Extra Pages ( ) .............. $ Codicil ................................. $ JCP Fee ................................. $_ I O , ~ Attorney: David W. Readier, Esciuire inventory & Tax Forms ............. $- I.D. No: 20868 Other ...................................... $ Address; 2--331 Market Street TOTAL ............................. $. ~q ,00 .Camp Hill PA 17011 - Telephone: 7--17-763-1383 DATE FILED: _ RW-7A CUMBERLAND COUNTY RENUNCIATION Estate of GLADYS L. SELLER No. also known as , Deceased The undersigned,PETER A. SELLER, JR. of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters ADMINISTRATION be issued to TERESA OWEN Witness hand this day of 2004 (Signature) r-- 18 HIGHLAND AVENUE, SHIPPENSBURG PA 17257 ~ (Address) ~ ~ N (Signature) ~D ¥.,} 2~ (Address) '~ (-~ (Signature) (Address) Sworn to or affirmed and subscribed before me this ] 5~'~d~)~.~ COMMONWEALTH OF PENNSYLVANIA ] ANN NEIDIGH, Notary Notary Public ~" My Commission Expires: (Signature and seal of Nota~/or other NOTE: Renunciations executed outside the Office of Register of Wills are official qualified to administer oaths, Show required in some counties to be notarized. date of expiration of Notary's commission ) RW-3 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ ~ ~ I Local Registrar ' , ~ u ~: APR 0 1 2004 No. (~ ] ~ Date ~""'"* CERTIFICATE OF DEATH ,::~ 208 Senate Ave. [~ .. Y ~ ~t~ 11, PA 17011 ~ ~m c~ C~rland ~, ~ .~.~ Teresa ~en ,~. 17 7011 ~. ~-01-2~4 ~st Harrisburg C~. Harrisburg, PA ~t n..~,, ~- ~. ~.- .... ~rch ~o~ zooq ~ v"ffi "* D CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Gladys L. Seiler Date of Death: March 30, 2004 Will No. 2004-00715 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 August 6, 2004. Name Address Teresa S. Owen 17 Campbell Place Camp Hill, PA 17011 Peter A. Seiler, Jr. 18 Highland Avenue Shippensburg, PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A Date:August ~"~,2004 4 ~__ David'S'. Reager~Esqui~'~'-'- Reager & Adler, PC 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative ¥c; "c~ ~.~ ~qum0 INVENTORY Estate of Seiler, Gladys L. No. 21 04 0715 also known as Date of Death 3/30/2004 , Deceased Social Security No. 210187552 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. I/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 unswom falsification to authorities. Personal Representative: Name of Attomey: David W. Reager I Address: 2331MarketStreet Dated Camp Hill PA 17011 Telephone: (717) 763-1383 Description Value Stocks & Bonds Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property ---I ~ '__.' ~'/~ 0 Highmark Refund 101.76 Commerce Bank 632.35 Checking Account Total (Attach Additional Sheets if necessary) 1,140.56 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 Seiler, Gladys L. 21 04 0715 Page 1 Description of Inventory Description Value Refund Security Deposit 164.45 Cash 242.00 Real Estate Subtotal $ 406.45 Grand Total $ 1,140.5R COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004802 OWEN TERESA S 17 CAMPBELL PLACE CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $176.95 ESTATE INFORMATION: SSN: 210-18-7552 FILE NUMBER: 2104-0715 DECEDENT NAME: SELLER GLADYS L DATE OF PAYMENT: 01/06/2005 POSTMARK DATE: 01/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 03/30/2004 TOTAL AMOUNT PAID: $176.95 REMARKS: TOWENS CHECK# 2404 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX * (6-00) ~ ~ COMMONWEALTH OF I R E ti- OFFICIAL USE ONLY - 1500 INHERITANCE TAX RETURNDEPARTMENT °F REvENuE ~ HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1 - 0 4 "~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 0 7 1 5 SOCIAL SECURITY NUMBER z [J.I DATE OF DEATH {MM-DD-Year} I 2 1 0 - 1 8 - 7 5 5 2 t"t DATE OF BIRTH (MM-DD-Year) LU THIS RETURN MUST BE FILED IN DUPLICATE WITH THE O 03/30/2004 06/17/1925 REGISTER OF WILLS ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE iNITIAL) SOCIAL SEC'"--"--'--'"--~RITY NUMBER ~ ['~ 1. Original Return ["-'J 2. Supplemental Return ,,, ~, ~ ['"-] 3. Remainder Return (date of death prior to 12-13-82) ~ ,, ~ [] 4. Limited Estate r-1 4a. Future Interest Compromise (date o, death a~r,2-~2-82) ~ 5. Federal Estate Tax Retum Required ,,, O,~, "' o~'I ~ 6. Decedent Died Testate (Attach copy of Wi,) r-~ 7. Decedent Maintained a Living Trust (A~ch copy of Trust} ~ 8. Total Number of Safe Deposit Boxes < ~ 9. Litigation Proceeds Received ['~ 10. Spousal Pored7 Credit (date of death between ~2-3~-9~ and ,-~-95) [] 11. Election to tax under Sec. 9113(A)(A~ch Sch O) ,,z, NAME '" COMPLETE MAILING ADDRESS z David W. Rea§er o 2331 Market Street a. FIRM NAME (If Applicable) I~J ,,, Reager & Adler, PC n,' ' o TELEPHONE NUMBER ~ 717 763-1383 ~-o 1. Real Estate (Schedule A) (1) 2, Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) .. 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) ~ 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested ::::) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 7~ 794.61 ~-- (Schedule G or L) ,¢[ 8. Total Gross Assets (total Lines 1-7) (J (8) 8,935.17 I.U 9. Funeral Expenses & Administrative Costs (Schedule H) .~. ~v' (9) 4~051 o,~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 950.94 11. Total Deductions (total Lines 9 & 10) (11) 5~ 002.8~ 12. Net Value of Estate (Line 8 minus Line 11) (12) 3,932.20 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) _. made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X (15) 16. Amount of Line14 taxable at lineal rate 5~C[~'~'"~ X , ~/"J"-~(16) . I *'"}~. ~ ~" 17. Amount of Line 14 taxable at sibling rate X .12 (17) 18. Amount of Line 14 taxable at collateral rate X .15 (18) 19. Tax Due (19) 5' 20. ~] Decedent's Complete Address: STREET ADDRESS 208 Senate Avenue CITY Camp Hill J STATE PA J ZiP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) A. Spousal Poverty Credit B. Pdor Payments C. Discount 3. Interest/Penalty if applicable Total Credits ( A + B + C ) (2) D. Interest E. Penalty Total Interest/Penalty ( 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 l + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) [ '"7(~ .~'- A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (EB) Make Check Payable to: REGISTER OF WILLS, AGENT 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 transferred or its income; ........................................ [] [] c. retain a reversionary interest; or [] [] d. receive the promise for life of either payments, benefits or care? ........................ [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons derat on? 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-probate property which contains a beneficiary des gnat on? ............................................................................................. [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penaltJas of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the Pest of my know edge and belief, it is true, correct and complete. Declara§on of preparer other than the personal representative is based on all information of which preparer has any know edge. DRETLB~J=~PERSQN RESPONSIBLE FOR FILING RETURN j DA~E I ss ' 2163 Market Street Camp Hill SIGNATURE OF PREPAR OT ~NTA PA 17011 TIVE ' DATE, ADDRESS 2331 Market Street //~'-/'/O Camp Hill PA 17011 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. §9116 (a) (1.1) (i)]. For dates of death on or after 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 exempt a transfer to a surviving spouse from tax and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the 0nly benefic ary. 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 stepparent 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 decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §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 decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. 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. I SCHEDULE E COMMONWEALTH OF PENNS- '=" - YLVANA ~ CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN / ~"~ mm m"~ AA ~, m a, m ~ m,,,~ ~ m,,,~ m-,, m,,,~ ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. Highmark Refund OF DEATH 101.76 2. Commerce Bank Checking Account 632.35 3. Refund Security Deposit 164.45 4. Cash 242.00 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) SCHEDULE G / INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA J MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reveme side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER, % OF NUMBER An'ACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DECD'S TAXABLE VALUE VALUE OF ASSET INTEREST 1. IDS Annuity - Peter A. Seller, Jr. 3,897.30 100. 0.( 3,897.30 2. IDS Annuity - Teresa S. Owen 3,897.31 100. 0.00 3,897.31 TOTAL (Also enter on line 7, Recapitulation) (If more space is needed, insert additional sheets of the same size) SCHEDULE H COM~.O~W~..EA.L..T~H_O_F. PE_N_NSYLVANIA / FUNEEAL EXPENSES & / ~-~H ~NL;~- 1AX RETURN ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1. Myers-Harner Funeral Home, 1903 Market Street, Camp Hill, PA 17011 2. Gingrich Memorial Services 2,990.00 3. Cemetary - Grave Opening 95.00 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. AttomeyFees Reager & Adler, P.C. 450.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 108.60 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Advertisement Fees (The Sentinel, Cumberland Law Journal, Patriot News) 208.34 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) l REV-1512 EX + (1-97) ~ I / SCHEDULE I COMMO.WE*.T. Of PE..S~.V^.,^ / DEBTS OF DECEDENT, ESTATE OF ~ FILE NUMBER Include unreimbursed medical expenses. ~'~"~--~--'~'~' ITEM NUMBER DESCRIPTION 1. MCI AMOUNT 20.00 2. East Pennsboro Taxes 20.00 3. Quantum Imaging 10.94 4. Ambulance 900.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 950.94 REV-1513 EX + (9-nm ~ ! COMMONWEALTH OF PENNSYLVAN A / BENEFICIARIES ~ BENEFICIARIES ESTATE OFFILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include ou~ght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Teresa S. Owen 2163 Market Street Daughter 1/2 of Estate Camp Hill, PA 17011 2. Peter A. Seller, Jr. 18 Highland Avenue Son 1/2 of Estate Shippensburg, PA 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDU4;l.rtA,XE$ INHERITANCE TAX DIVISION' " PO BOX Z8D6Dl HARRISBURG PA 171Z8-06Dl NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX iF' 112-841 is II: t}5 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-21-2005 SEILER 03-30-2004 21 04-0715 CUMBERLAND 101 GLADYS L C! r=,~1V 'i.-t_+ H \ 0,00' "It,"'"' , '1 Hnl-..'~i-\4 0 DAVID \(;~~~E,R REAGER & ADLER 2331 MARKET 51 CAMP HILL Allount Rellitted PA 17011 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:rA1t"'-I;tAFP--CoY--6!'--NOT-I-cl-0'i!-YNHlitifANCE-i"-AX-APPRA-fsIM€N'~--ALl'b"'QANCE-OR------------- - --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SEILER GLADYS L FILE NO. 21 04-0715 ACN 101 DATE 03-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 1.140.56 .00 7.794.61 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 8.935.17 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GovernMental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 4.051.94 950.94 nl) (2) (3) (4) 5.002 88 3.932.29 .00 3.932.29 I~ an assessmen~ was issued previOUSly, lines 14, IS and/or 16, 17, 18 and 19 will r~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. A.ount of Line 14 at Spousal rate 16. AlIOunt of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due NOTE: US) .00 X 00 = (6) 3.932.29 X 045 = (7) .00 X 12 = (8) .00 X 15 = (9)= .00 176.95 .00 .00 176.95 ~ fAX CREDITS: ..---.. . {+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-06-2005 CD004802 .00 176.95 TOTAL TAX CREDIT 176.95 BALANCE OF TAX DUE .00 INTEREST AND PEN. .16 TOTAL DUE .16 . IF PAID AFTER DATE INDICATED. SEE REVERSE fOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) mdz\forms\estadm\statusreport. form March 31, 2005 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: Gladvs L. Seiler Date of Death: March 30.2004 Will No.: 21-04-0715 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X 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? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: e. Did the personal representative state an account informally to the parties in interest? Yes X No Date: 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.~ // ~llffO{ __~ ---- David . eager, Esquire Reager & Adler, P.e. 2331 Market Street Camp Hill, P A 17011 (717) 763-1383 Counsel for Personal Representative D. Z i :1 J 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: MARY R. BRANDT Date of Death: JULY 21, 2005 21-05-00715 Will No.: 21-05-00715 Admin No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ No 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 No ~ B. The separate Orphans' Court No. (if any) for the personal representative's account is:. C. Did the personal representative state an account informally to the parties in interest? Yes ~ No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 1l~ /O(,,? ~ ){JJt4v Signature ' ...~ Edmund G. Myers, Attorney Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemovne. PA 17043-0109 Address (717) 761-4540 Telephone No. Capacity: Personal Representative ~ Counsel for Personal Representative 6 ~