HomeMy WebLinkAbout03-0225PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also kr~wn, as
Deceased.
Social Security No. ~ 0 ~ ~ ~ '3 ~ ~ ~
No.
To:
Register of Wills for the
County of
Commonwealth of Pennsylvania
in the
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, app[
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in
h I t. last family or principal residence at
(list street, number and municipality)
Decendent, then S 0 years of age, died ~'o,./~ ~0
at ~6rr) $~3C',p~, ~c~..Otffca/
Decendent at death owned property with estimated values as foIllows:
(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:
for letters of administration
on the estate of
Comity, Pennsylvania~ with
Petitioner.__ after a proper search ha
the following spouse (if any) and heirs:
Name Relationship
ascertained that decedent left no will and was survived by
Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
March 13, 2003
ATTN: Jackie
Register of Wills
1 Court House Square
Carlisle, PA 17013
Dear Jackie:
Here is the information for Paul E. Myers, Jr., SSN:
February 20, 2003 in the Harrisburg Hospital.
Paul resided at:
1280-B Boiling Springs Road
Boiling Springs, PA 17007
and had his mail delivered to a Post Office Box at:
P. O. Box 181
York Haven, PA
If you have any additional questions, contact me.
Very truly yours,
Doreen E. Winchell
Sister to Deceased
208-42-7175, who passed away on
COMWO~LTH OF PENNSYLVANIA
Department of Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REbKNE A WILL OR CEME~Y DEED
Fab. 21. 2003
[Date of Efitry)'
1. Name of decedent: pa,,1 E. My.,r.~: .Ir.
2. Address of decedent: P- O. Box 181 (LIVED IN CHURCHTOWN, PA)
3. Date of death:
4.
Ynrk .qnrin~.~. Da.
Feb. 20, 2003
1 7qT,-D181
Name and address of person who requested the opening of the box:
Paul E. Myers 4115 Wertzville Rd. Enola, Pa. 17025
0
7..Title under which box is registered:
Name and address of the financial institution where the safe deposit box is
located: First National Bank of Marysville
)OO South Stat~ Road
M~-~'svi!!e, Pa. 17053
Number of box: !79
Paul E~ Myers, Jr.
8. Was there a will in the box? Yes No XX
9. If yes, state date of will, name and address of personal representative, if
named in the will, and name and address of attomey, if any:
And now this 21st day of FebruarY , ~03 , I hereby certify
under penalty of pe'r'jury that the above record is correc~d complete to the
best of my knowledge and belief.
S-~/~ff~g~. e~~~etcalf'
~, ., . i~/ Assistant Vice President
Print Name and Title
Name of Decedent:
Date of Death:
Will No.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Admin. No.
To the Register:
I certify that notice of (benefcia' interest)estate _administration required by Rule 5.6(a)_of ?a,~]O_~.~ans' 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 .A/~
Date:
:,~ r'r-' S ,:. :;2
Signature
Name ~
Address s~'///d
Telepho.e ' 7/~
Capacity: ~/Personal Representative
Counsel for personal representative
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
GREGG HAHH
BOYER & RITTER
PO BOX 8500
CAHP HILL
COHHONWEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
,.-~ Of DATE 01-1Z-200~
.... .; ~ '¥'~/i~lS ESTATE OF HYERS JR
DATE OF DEATH 02-20-2005
FZLE NUHBER Z1 05-0225
FEB 25 [~,8:30 COUNTY CUHBERLAND
ACN ] 0 ~
~ I Amoun~ Rem~ed
I
REV-IS47 EX AFP (01-05)
PAUL E
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LZNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF HYERS JR PAUL E FILE NO. 2105-0225 ACN 101 DATE 01-12-Z00~
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule D) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Nortgagas/Notas Receivable (Schedule D)
5. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly O~nad Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEHPT~ONS:
9. Funeral Expanses/Ada. Costs/Hisc. Expanses (Schedule H) (9}
10. Debts/Nortgaga Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
O0
618 O0
O0
O0
R/Z76.00
508 O0
O0
(8)
2,~25.00
55,98Z.00
(11)
(12)
15.
1~.
NOTE:
ASSESSHENT OF TAX:
15. Amount of Line 1~ at Spousal rate
16. Aaount of Line 1~ taxable at Lineal/Class A rate
17. Amount of Line lq et Sibling rata
18. Aaount of Line 1R taxable at Collateral/Class D rata
19. Principal Tax Due
TAX CREDITS
PAYMENT RECEZPT D/SCOUNT (+)
DATE NUNBER ~NTEREST/PEN PAID (-)
Charitable/govarnaental Bequests; Non-elected 9115 Trusts (Schedule J) (13)
Nat Value of Estate Subject to Tax (lq)
Zf an assessment was issued previously, lines lq, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
NOTE: To insure proper
credit to your account,
submit the upper portion
of this fora with your
tax payment.
5,~OZ.O0
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
31,003.00-
.00
51,005.00-
18 and 19 gill
(15) .00 x O0 = .00
(16) .00 x Or*5= .00
(17) . O0 x 1Z = . O0
(18) .00 x 15 = .00
(19)= . O0
AHOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUEl ~000
~NTEREST AND PEN. O0
TOTAL DUE
( IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DU~yI~
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CA):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 11, 1981 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class 8 (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILES, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ars available at the Office
of the Register of #ills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-800-362-Z050~ services for taxpayers with special hearing and / or
speaking needs: 1-800-447-S020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 181011, Harrisburg, PA 17118-1021,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three ($) calendar months after tho decedent'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 end of the tax amnesty period. This nan-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 date of
death, to the date of payment. Taxes which became daIinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 wilt bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOS are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 Z02. , 000548 1987 92 . 000Z47 1999 72. . 000192
1983 162 .000438 1988-1991 112 .000301 ZOO0 82 .000219
1984 112 · 000301 1992 97. · 000247 2001 92 . 000247
1985 157. · 000356 1993-1994 72. .000192 2002 62. .000164
1986 102. .000174 1995-1998 92 .000147 Z003 52 .000137
--Interest is calculatad as folloes:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
REV-1500 EX (6-00)
X~' COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF: REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
Z
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
MYERS, JR; PAUL E.
DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DO-YEAR)
02/20/2003 08/30/1952
(IF APPLICABLE)SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
FILE NUMBER
2 1
COUNTY CODE
OFFICIAL USE ONLY
-- 0 3 0 2 2 5
YEAR NUMBER
SOCIAL SECURITY NUMBER
208-42-7175
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~-] 1. Odginal Return ~ 2. Supplemental Return ~] 3. Remainder Retum (date of death prior to 12-13-82)
~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required
[---]6. Decedent Died Testate (Attach copy of Will) [~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) __ 8. Total Number of Safe Deposit Boxes
~ 9. Litigation Proceeds Received ~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) E~ 1 1. Election to tax under Sec. 9113(A)(Attach Sch O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
COMPLETE MAILING ADDRESS
NAME
GREGG HAMM
FIRM NAME (If Applicable)
BOYER & RITTER
P.O. BOX 8300
CAMP HILL PA 17001-8300
TELEPHONE NUMBER
717 -761-7210
618
4,276
508
OFFICIAL USE ONLY
(8)
5,402
2,423
33,982
(11)
(12)
36~405
0
(13)
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Preprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
---]Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
1 1. Total Deductions (total Lines 9 & 10)
1 2. Net Value of Estate (Line 8 minus Line 11)
1 3. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
1 4. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
1 5. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)
1 6. Amount of Line 14 taxable at lineal rate
1 7. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate.
19. Tax Due
20.
x .0 __ (15)
x .0 __ (16)
x .12 (17)
x .15 (18)
(19)
> · BE SURE TO ANSWER .ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
2W4645 1,000
Decedent's Complete Address:
STREET ADDRESS
BOX 18~1
YORK SPRINGS
STATE ZIP
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable D. Interest
E. Penalty
(1)
Total Credits (A + B + C) (2)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(4)
(5)
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(5B)
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 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-probate property which
contains a beneficiary designation? ................................ ~] [--~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN~RE OF P~;~S,ON~ESP~NSIBLE FOR FILING RETURN/,"')
/
4115 W~..RT~.V'rT,T,I~. KOAD, ~..NOT,A, ~ [7025
DATE
/i-/o
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
~s 6re~j ort H ~
P.o. Bo× s3oo, c~P ~z~.~., PA ~ooz-s~oo
DATE
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.§ 9916 (a) (1.1) (i)].
For dates of death on or after Jan uary 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 only beneficiary.
For dates of death on or after July I, 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 efthe 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.
2w4646 1.000
105.905 REV.(01/03)
This js to certifi/that this is & ~r. ue Copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Charles Hardester
State Registrar
2972859 OCT 0 1 2003
No. ~ Date
H105.143 Rev 2/87
TYPE/PRINT
PERMANENT
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
014478
Paul E. Myers Jr. Male, 208 --
; 8/30/52 Hbg, Pa ~ E~O~ ~[]
~ e.
Welder ,,~ ,,. ~ ~ ,,. ~ ~nk ,-~+) ,. Sin
~,u~ ,~ Pennsylvania ~ ,,.~
P.O. Box 181 "~a~ -
York Sprinqs, Pa ,w.~, York ~ ,~,~
Paul E. Myers Sr. ,,. Doris Lovejoy
Paul E. Myers Sr. ~4115 Wertzville Rd, Enola~ Pa 17025
~D ~ ~..~eb 21, 2003 I,..East Hbg Crematory ~,,, Hbg, Pa
~ ~a~ E ~:
~' : I
INK
RE'~-1503 EX + (~-98)
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
PAUL E. MYERS, JR. 21-03-0225
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
U.S. SAVINGS BONDS
E560116630; 15964829; E65112356
618
TOTAL (Also enter on line 2, Recapitulation) $ 618
2w4696 4.000 (If more space is needed, insert additional sheets of the same size)
EV-1508 EX + (6-98)
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
PAUL E. MYERS, JR. 21-03-0225
Include the proceeds of litigation and the date the proceeds were received by the estate.
NI property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2
3
4
5
6
7
8
MEMBERS FIRST CREDIT UNION
CHECKING ACCOUNT # 0100067685
FINAL UNEMPLOYMENT COMPENSATION CHECK
2001 PA INCOME TAX REFUND
2002 FEDERAL INCOME TAX REFUND
LES PAUL GUITAR - SALES PRICE
MISCELLANEOUS MUSIC EQUIPMENT - SALES PRICE
1988 CHEVROLET BLAZER - SALES PRICE
1985 BUICK - SALES PRICE
TOTAL (Also enter on line 5, Recapitulation) $
270
566
68
804
700
50
418
1,400
4,276
2W46AD 3.000 (If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
PAUL E. MYERS, JR. 21-03-0225
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) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. PAUL E. MYERS, SR. FATHER
4115 WERTZVILLE ROAD
ENOLA, PA 17025
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION ANO BANK ACCOLIINT DATE OF DEATH DECD'S VALUE OF
I~J~IBER OR SIMILAR IDENTIFYING NUNIBER. ATTACH DEED FOR
NUMBER TENANT JOINT JOINTLY-FF-LD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 1980 U.S. SAVNGS BONDS 1,0161 50 50~
TOTAL (Also enter on line 6, Recapitulation) $ 508
2W46AE 3.000 (If more space is needed, insert additional sheets of the same size)
his is to certify that the information here given is correctly copied fi'om an original certificate of death duly filed with mc as
Local Registrar. The original certificate will be fbrwarded to the State Vital Records ()fi]ce for permanem
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 8914000
No.
tx<al Rcg~stra, i~
FEB 2 1201
43 Rev ~87
t lAME OF DECEDENT (F*rsL M~Ole. L~)
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FtLE .NUMBER
E~. Dauphin
t~CE~m's usu^~
,,,. Welder
P.O. BOX 181
1'. York Sprinqs. Pa
,,. Paul E. Myers Sr.
SEX I SO~:IAL SECURITY NUMBER lDq~ QEATH ~Momh. Day.
Paul E. Myers Jr. ,. Male[,. 208 -- 42 -- 7175~~~ ~ ~~ ~ff~
~ ,.8/30/52 ,. Hbg, Pa .... ~ ~,,.~ ~0 ~ ,~ ~s~
,.Harrisburg ,. Harrisburg Hospital 1~-~.~o,~ .... ' J,o. White
oiv~c~
Single
Paul E. Myers Sr.
I-. is Lovejoy
[INFORMANT'S MAILING AOORE~ IStree{. C~y/To~m. ~41e, Zip Co(tel
1~.~4115 Wertzville Rd~ P..nola~ Pa 17025
J,,~.East Hbg Crematory I.. Hbg, Pa
[51
[]
Enola Dr. Enola. Pa
LICENSE NUMBER DATE SIGN~iO
IwAs CASE REFERRED TO MEDIAL EXAMINER~NER?
c~y/tx~
/
NAME~ND AOO~ ~ PER'ON ~O~OMPLETEO C~ ~DE~H ¢
On the bllil of examination in~lnvestigat on, in my opinion delth ~curred II the me dill and place and due to the cause I and
REV-1511 EX+ 2-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
PAUL E. MYERS, JR. 21-03-0225
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
3
4
5
5.
6.
7.
8
10
11
FUNERAL EXPENSES:
HIGHSPIRE CEMETARY
SULLIVAN FUNERAL HOME
TIM HOFFMAN - SERVICE
FUNERAL MEAL
GINGRICH MEMORIAL
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 claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees
REGISTER OF WILLS
Accountant's Fees
Tax Return Preparer's Fees
MET ED - ELECTRIC
POSTAGE
AAA TITLE
VITAL RECORDS - BIRTH
WASTE MANAGEMENT
AND DEATH CERTIFICATES
250
1,359
150
100
220
58
140
61
4
23
20
38
TOTAL (Also enter on line 9, Recapitulation) $ 2,42:3
2W46AG 3.000 (If mere space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
PAUL E. MYERS, JR. 21-03-0225
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2
3
4
5
6
7
8
9
10
12
13
14
15
16
DONNA PARKS - BACK RENT
MOFFIT HEART GROUP
LOANS USA - CAR LOAN
MET ED
SPRINT
CENTRAL PENN MEDICAL GROUP
APPALACHIAN ORTHOPEDIC
ROBERT KANTOR M.D.
MID PENN UROLOGY
QUANTOM IMAGING
ASSOCIATED CARDIOLOGY
CARLISLE IMAGING
DONALD C DONAGHER
PINNACLE HEALTH
CARLISLE REGIONAL
MEDICAL REVENUE
2,300
3O
3,450
32
198
352
120
193
2OO
413
25
1,065
4O
45
15,397
10,122
TOTAL (Also enter on line 10, Recapitulation) $ 33,982
2W46AH 3.000 (If more space is needed, insert additional sheets of the same size}
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/10/2005
MYERS PAUL ESR
4115 WERTZVILLE RD
ENOLA, PA 17025
RE: Estate of MYERS PAUL ECKERT JR
File Number: 2003-00225
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within 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 will become delinquent on: 2/20/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: PAUL E. (Y) ';j ElZS ) J L
Date of Death:
o 21~ 200"3
Will No.:
Admin. No.: 03 - 02.2<;
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Ru1es, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administratioD of the estate is complete:
Yes JXl No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. I is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No ~
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? Y es ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts maybe filed with the Clerk of the Orphans' Court
and may be attached to this report.
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Capacity: ~ Personal Representative
o Counsel for personal representative
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