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Register of\lViHs or Cumberland COlli'1~Y
STATUS REPORT lJNDER R1JLE 6.12
Name of Decedent: ....,]) fJnl) C{ G t S-f, <.l-f7-
Date of Death: \h{n,€- /'6/;2-CJ '0 'I-
Estate No.: c2- t96J L/ - (5)(3 7 G /
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 sep~rate 01Jans' Court No. (if any) for the personal representative's
accountlS:~fjL
c. Did the person~ !}'Presentative state an account informally to the plli.-ties in
interest? Yes M No 0 .
Date:
c. Copies of receipts, releases, joinders and approval of fonnal or informal
accounts maybe filed with the Clerk o~the o hans' Court and .ma. y be
attached to tills report. _ ~ ti4/ .
k"1"ob ~ ~..>/ .-
Signature' 'V
_ Roser L S--/-ur+;z-
Name
17 1&-SIYnfTIot1 ]Jr_ ,B,;/;jj,tf-''{js/1J
Address . /1eo1
0/7) gsS-lt!:2.7
Telephone No.
Capacity: ~ersonal Representative
o CouD.sel for personal representative
',-J,
Name of Decedent:
Date of Death:
Will No.:
To the Register:
CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
-'-~/-Pg- 07{~/ AdminNo.:
I certify that notice of (beneticial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules
was served on or nlailed 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/~_q e- t- /-~ ' '~-'M ~'~/~.?~-
A~ddres~* !
Telephone
Capacity: [~ersonal Representative
[] Counsel for personal representative
PETITION FOR PROBATE and GRANT OF LETTERS
a[xo k~town ax
Social Security No. /'~:~ 5~ '- 5,/~2 - 5/.~'7 oo~-.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut
in the last wilt of the above c~ecedent dated
and codic (s) dated /~/c~t)/ '~c~ '~ /.~ c~o 5/
TO:
Register of W~ls for ,the /i f
County of (--t4t:~ /o-~Ft'4td~q~ in the
Commonwealth of Pennsylvania
named
ecendent was domiciled at death in ~ {4 ~//k /~ qt,~_ __,County,
h last family or principal residence at ~ '~)~'t ~-,e__..- Pennsylvania, with
(list sneel, nurI1Der anXd~uncipa~lty) ~.J
at Decendent, then ,~/ __ years of age, died
Except as follows, decedent did not marry, was not divorced and did not have a child horn or adopted
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property ia County
Value of real estate in Pennsylvania
situated as follows:
~fter execution of the will offered for probate; was not the victim of a killing and was never adjudicated
~ncompetent:
CD
WHEREFORE, petitioner(s) respectfully request(s) the probate of the :lfist will :h~d codi~:ii(s)
presented herewith and the grant of letters co
theron. (testamentary; administration c.t.a~ administr~l~n d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF (-'cL~I~LPi~,40 j~ ss
Ihe 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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ,~ \. //~ -, ~ ,, ~
before me this 26 dav of [ __ ~ ~ ///_...~ ~ ~-
x .' ~ , ', x ,"D n 9Register k =~
Estate Of ~r.~ , ~ \ ~-3.~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereof, satisfactory proof having been presented before
IT IS DECREED that the instrument(s) dated ~ - ~'~) - ~D
described therein be admitted to probate and filed o[~_~d ~s_~_the last will of
and Letters ~r-o ~&---~ ~
are hereby granted toC"~c:o.~ v~ ~-..
consideration of the petition on
FEES
Probate, Letters, Etc .......... $4~-~-
Short Certificates( ) ......... $ .'~ ,Cf._3
TOTAL __ $~4t4. c)0
Filed ..~..' .~.-...d)..~. ......................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
UN ~ 4 200~
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Register of Wills of Cumberland County
OATH OF NON-SUBSCRIBING WITNESS
Also known as
No.
Deceased
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
_~_ /t{~,~ familiar with the signature of ~{)h~Nt/~ "~"[-l~i~TT'- ,testat~/~ of
(one of the subscribing witnesses to) the codicil/will presented herewith and that ~ believe,s'
the signature on the codicil/will is in the handwriting of })0i~ ~,]h ,5~-L(f~ ~-Z.-
to the best of gq knowledge and belief.
SB eW~o~e ~ ? r t 1~? n n~iba n~d~4s u T~b/ydp f
:yu. k'q ,20
/ Fo~eeRegiste~T ' ? I ~'
(Address,
(Name)
(Address)
LAST WILL AND TESTAMENT OF
DONNA G. STURTZ
I, DONNA G. STURTZ, of Cumberland County, Pennsylvania, being of sound mind and
memory, do make, publish and declare this my Last Will and Testament, hereby revoking and
making void any and all wills by me heretofore made.
FIRST: I order and direct that all of my just debts and funeral expenses be paid by my
hereinafter named Executor as soon after my death as may be found convenient.
SECOND: I wish my organs to be donated. I wish to be cremated and my ashes to be
disposed of by my Executor as he shall determine appropriate.
THIRD: To my husband, ROGER L. STURTZ, I give, devise and bequeath the tract of real
estate which is improved with my residence and which is known and numbered as 12 Hope Drive,
Boiling Springs, Pennsylvania, and any cars which I own.
FOURTH: To my daughter, SHEILA L. ROBBINS, I give all of my jewelry and Merrill
Lynch IRA account. In the event that she fails to survive me, I direct that the Merrill Lynch IRA
account be divided equally between JEFFREY R. ROBBINS and my husband, ROGER L. STURTZ.
FIFTH: To my stepdaughter, AMY STURTZ, 1 give the sum of One Thousand ($1,000.00)
Dollars.
SIXTH: To my stepdaughter, LISA STURTZ, I give the sum of One Thousand ($1,000.00)
Dollars.
SEVENTH: To my stepson, RICHARD STURTZ, I give the sum of Two Thousand
($2,000.00) Dollars.
~}~IGHTlt: To my husband, ROGER L. STURTZ, I give all remaining cash and accounts
1 DonnaG. S rt
in financial institutions.
NINTH: All the rest, residue and remainder of my estate, real, personal and mixed, of
whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time
of my death I give, devise and bequeath to my beloved husband, ROGER L. STURTZ.
TENTH: I hereby nominate, constitute and appoint my husband, ROGER L. STURTZ, as
Executor of this, my Last Will and Testament, and I do direct that no bond shall be required of such
Executor hereunder. My said Executor shall have full power at his discretion to do any and all things
necessary for the complete administration of my estate, including the power to sell at public or
private sale and without order of Court, any real or personal property belonging to my estate, and
to compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and
demands, whatsoever, against or in favor of my estate, as fully as I could do if living.
In the event that my husband, ROGER L. STURTZ, does not survive me or fails to qualify,
then I nominate, constitute and appoint JUDITH WAGNER, as the alternate Executrix. Said
alternate Executrix shall have all of the powers, privileges, duties and immunities as hereinbefore
more fully set forth for my original Executor.
IN WITNESS WHEREOF, I, DONgqA G. STURTZ, the above Testatrix have set my hand
and seal to this my Last Will and Testament, which consists of two (2) pages, to each of which 1
have affixed my signature this 3c day of,/ /4 [6 "'l' , 2004.
Donna G. Sturtz - './
Signed, sealed, published and declared by the above named Testatrix as and for her Last Will
and Testament, in the presence of us, who at her request and in her presence and in the presence of
each other have hereunto subscribed our names as witnesses.
Estateof .~) onr~ q ~'t'l ~7[~''
Also known as .-~ ~h ~
OATH OF NON-SUBSCRIBING WITNESS
.,Deceased
(each) a subscriber hereto, (each) being duly quaJified accordin[ to law, depose(s) and sa,y(s) that
(one of the subscribing witnesses to) the codicil/will presented h~ewith and t,~t ~ believes
the signature on the codicil/will is in the handwriting of ~)o ti nM ,~/"la F~[ ? -
to the best ot[~h~ knowledge and belief.
Sworn to or affirmed arid subscribed
~B. efore me this ~r-~ da~lof
For the Re=ister ~ k~. ~ ~ ~, ~ -
~ ~ -~ (Address)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 12/06/2004
STURTZ ROGER L
12 HOPE DRIVE
BOILING SPRINGS, PA 17007
RE: Estate of STURTZ DONNA G
File Number: 2004-00761
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 12/13/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
Sincerely,
GLENDA FAP~NER S
Clerk of the Orphans' Court
REV-1500 EX (6.00)
REV-1500
~~
*' COMMONWEALTH OF
PENNSYLVANIA
. ~ DEPARTMENT OF REVENUE
'. DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN aLM~Eo L/
RESIDENT DECEDENT COUNTY CODE veJ-
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
StUrtz, Donna G.
DATE OF DEATH (MM-DD-YEAR)
01/17/1953
NUMBER
SOCIAL SECURITY NUMBER
183-42-4992
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAl SECURITY NUMBER
220-58-0805
o 3. Remainder Return (dale 01 death prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under See. 9113{A) (Attach Sdl 0)
NAME
Ro er L. Sturtz
FIRM NAME (W Applicable)
COMPLETE MAILING ADDRESS
12 Hope Drive
Boiling Springs, PA 17007-9756
0.00
0.00
0.00
0.00
0.00
DATE OF BIRTH (MM-DD-YEAR)
06/18/2004
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Sturtz, Roger L.
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o 1. Original Return
o 4. limited Estate
~ 6. Decedent Died Testate (Attach copyolVl1lI)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death afler 12-12-82)
o 7. Decedent Maintained a living Trust (AttachcopyolTrusq
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
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TELEPHONE NUMBER
(717) 245-9427
(8)
4,893.00
43,487.00
(II)
(12)
(13)
c..n
143,342.00
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Misoellaneous Personal Properly
(Schedule E)
6. JoinUy Owned Properly (Schedule F)
o Separate Billing Reques1ed
7. Inter-Vivos Transfers & Misoellaneous Non-Probate Properly
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
143,342.00
48,380.00
94,962.00
0.00
(14)
94,962.00
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to 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, or transfers under See. 9116 (a){1.2)
~O,~g?J)9 x .000m (15)
nmmmmm 4'0QQ,QQ x .0 4~ (16)
(19)
0.00
180.00
0.00
0.00
180.00
16. Amount of line 14 taxable at lineal rate
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
20.~
CHECK HERE iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
12 HODe Drive
CITY B T S . I STATEpA I ZIP 17007
ollng pnngs
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credns/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
180.00
Total Credits (A + 8 + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( 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)
0.00
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)
(58)
180.00
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
0.00
180.00
0.00
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
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property wnhin one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [KI
No
[KI
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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
12 Hope Drive Boiling Springs. PA 17007-9756
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE
03/16/05
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. ~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 retum 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 stepparent ofthe 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)J.
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.
REV-1510 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Donna G. Sturtz
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.
FILE NUMBER
DESCRIPTION OF PROPERTY DATE OF DEATH
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE Of TRANSFER ATTACH A COPY Of THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST !IF APPUCAIlLEl VALUE
1. Merrill Lynch - CMA Account 90,238.00 100 90,238.00
2. Merrill Lynch -IRA Account 76,322.00 100 0.00
3. Putnam Investments 2,055.00 100 0.00
4. Nicholas Funds 49,883.00 100 49,883.00
5. M & T Checking Account 3,221.00 100 3,221.00
6. Mid South Supply Co - ESOP 3,467.00 100 0.00
100
100
100
TOTAL (Also enter on line 7 Recapitulation) $ 143,342.00
(If more space is needed, insert additional sheets of the same size)
Date of Death Values
872-39885
Donna G. Sturtz
6/18/04
Quantity Security Cusip Number Price Per Share Total Value
903 ML Fundamental Growth 589958404 $16.83 $ 15,197.49
841 Aim Premier EQuity 008879728 $8.74 $ 7,350.34
2,234 Eaton Vance Tax Managed 277911848 $20.28 $ 45,305.52
297 ML Global Tech 589983402 $7.24 $ 2;150.28
383 Alliance Bernstein 01877C200 $15.54 $ 5,951.82
1,772 Delaware Tax Free 233216100 $8.06 $ 14,282.32
Total Value as of 6/18/04 $ 90,237.77
THE INFORM,l\TION SE1' FORTH H.ERE1N WAS OBTA,I~E~
.... \Oji!;:;::.[i':';c'. : 8UTVJr:.D,,)
.~ p ';~,~~ r~'1~: t\~..
", ~i~':'.'"''::'';;(''' .',:'>/>;:;i:;,~. .; ..~. .::....:.:~:i:.~.t~ CONSTiTUTX.':;
"< .., '...,..... .>.~.l..i ::;.i ;J.......;: 1 de n.)f\ChA.:.7E.~ OR SALE
'. -.1.!! ,. .i . -\ 1 ~.....' ; __ I .- '..,1 ....,
o~' Ai;~' SECURiliES OR COMMODITIES.
Alfred G. Farina, Jr.
First Vice President
PIA Portfolio Manager
The Farina Group
~ Merrill Lynch
Kim Lee Kenawell-Hoffecker, CFM
Assistant Vice President
Senior Financial Advisor
PIA Portfolio Manager
214 Senate Avenue; Suite 501
P.O. Box 810
Camp Hill, PA 17011
800-937-0735 - Toll Free
717-975-4602 - Direct
717-975-4663 - Fax
www.fa.ml.com/FARINAGROUP
March 9, 2005
Roger Sturtz
12 Hope Drive
Boiling Springs, P A 17007
Dear Mr. Sturtz:
Enclosed is an approximate breakdown of the value of Donna's account as of
June 18, 2004.
If you have any questions or need additional information, please do not hesitate to
contact me directly at (717) 975-4604 or toll free at (800) 937-0735. I can be
reached Monday - Friday between 8:30 a.m. and 4:30 p.m.
.
On behalf of the Farina Group
Re rds,
Tres a L. Easton
Global Private Client Group
Client Associate for
The Farina Group
enclosure
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PUTNAM
INVESTMENTS
2004 ANNUAL STATEMENT
1/1/2004 - 12/31/2004
I"')
"-
co
"-
N
o
Client number:
0486687839
[)()f\NA G STURTZ
12 HOPE DR
BOILING SPRGS PA 17007-9756
1...111...111...11...1...11.1..1...1.1.1..11.....11..1.1.1.1.1
Representative:
PLEASE PROVIDE
Investment firm:
ESSEX NATIONAL SECURITIES
INC
For Putnam assistance: 1-800-225-1581
www.putnam.com
The 12131/04 total value of your retirement account(s) is being furnished to the IRS. This will be your only record of your fair market value if
you do not contribute for tax year 2004. Always include withholding instructions if you take a distribution or 10% will be withheld. You have
until April IS, 2005 to make a 2004 contribution.
Summary of your Putnam accounts
TRADITIONAL IRA
Betanninf balance Exchanges Earnings Total value
Fund name as of /1/2004) Additions in/out Withdrawals gain/loss (as of 1213112004)
Putnam Growth &
Income CI-A $1,993.67 $0.00 $0.00 $2,055.49 $61.82 $0.00
Total year to date $1,993.67 $0.00 $0.00 $2,055.49 $61.82 $0.00
Total this quarter $2,033.91 $0.00 $0.00 $2,055.49 $21.58 $0.00
IRA contributions for tax year 2003 $0.00
IRA contributions for tax year 2004 $0.00
Share Number Share Total
Date Account activity detail Amount price of shares balance value
01/0112004 Beginning Balance 17.70 112.637 $1,993.67
03/15/2004 Dividends Reinvested 5.63 18.54 0.304 112.941
Price Date: 03/0512004
($ .050000 Per Share)
06/15/2004 Dividends Reinvested S.65 18.17 0.311 113.252
Price Date: 06/07/2004
($ .050000 Per Share)
09/15/2004 Dividends Reinvested 5.66 18.18 0.311 113.563
Price Date: 09/07/2004
I ~~II ~I ~ ~III~III~ ~I~ ~II ~III~ 1111111111
PAGE IOF3
e
DONNA G ROBBINS /*vf~
12 HOPE DR
BOILING SPRGS PA 17007-9756
1'1111111.111'1111'11111.11.111111.1.1.1..111111111111.1.1.1.1
003316
Portfolio at-a-Glance
Investor Services:
Internet:
www.nicholasfunds.com
Portfolio Value Beginning 01/01/2004
+ Purchases
~
C\l
'"
o
C\l
It)
e
XNI.. .161 00..0522530004. 06355. 06355.CNSfSTO 1.INV MNI.. _.._. .XN I. _..... 040020367
~~ M8IT'Bank
I i .<<....r... .
840149
ACCOUNT TYPE
STATEHENT.PERIOD PAGE ..
JUN.OI-JUN.30,2004 1 OF 1
M&T FIRST WITH INTEREST
00
o 04319M NH 017
60652
DONNA G STURTZ
12 HOPE DR
BOILING SPRGS PA 17007-9756
INTEREST PAID YEAR TO DATE
1.88
HIGH STREET-CARLISLE
ACTIVITY
DEPOSITS"INTEREST CHECKSlOIHER .
& OTHER ADDITIONS .SUBTIUCUONs
06-01-04 BEGINNING BALANCE
06-30-04 INTEREST PAYMENT
0.26
$3,219.21
3,219.47
ENDING BALANCE
$3,219.47
ANNUAL PERCENTAGE YIELD EARNED = 0.09 %
EFFECTIVE AUGUST 20, 2004, IF THE AMOUNT OF A WITHDRAWAL, TRANSFER OR OTHER TRANSACTION MADE OR
ATTEMPTED TO BE MADE BY ANY MEANS EXCEEDS THE BALANCE AVAILABLE FOR WITHDRAWAL WHEN THE WITHDRAWAL,
TRANSFER OR OTHER TRANSACTION IS CHARGED OR ATTEMPTED TO BE CHARGED AGAINST YOUR ACCOUNT, A $32
INSUFFICIENT FUNDS FEE WILL BE ASSESSED TO YOUR ACCOUNT UNLESS THE EXCESS IS LENT UNDER A LINE OF
CREDIT ACCOUNT OR MADE AVAILABLE FROM ANOTHER DEPOSIT ACCOUNT YOU HAVE WITH US THAT IS LINKED TO YOUR
ACCOUNT AS PART OF AN OVERDRAFT ARRANGEHENT. IF YOU HAVE ANY QUESTIONS, CALL THE M&T TELEPHONE BANKING
CENTER AT 1-800-724-2440.
LO08A (1/03)
r'
<t-
MIDSQ!IT!!@
100% Employee Owned Distributor of Building Products
November 17,2004
Roger L Sturtz
12 Hope Drive
Boiling Springs, P A 17007
Dear Mr. Sturtz:
Enclosed is a check for $2,773.62 which represents the final distribution of Donna Sturtz
ESOP company stock account. This is based on a gross distribution of $3,467.02 less
20% mandatory Federal income tax withheld of $693.40. You will receive a Form 1099-
R sometime during January 2005 reflecting this taxable income and tax withheld.
Should you have any questions concerning this, please feel free to contact me at
(703) 321-4016.
Si"2:e1Y., /.
~ ~12LA
. .
Greg Mutchler,
Controller
Enclosure
I)endot~:
40001 Our Customer #:
Check #:
208"
Date
Ty Invoice #
Refet~ence
Gt~OS S
Discount
Net
--------------------------------------------------------------------------------
11/17/04 IN 111704
Cash dist
3467.02
693. 40--
2773.62
Totals:
34E,7.02
693.40-
..=:'773.62
REV-1511 EX+ (12-99).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Donna G. Sturtz
FILE NUMBER
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Hollinger Funeral Home & Crematory
1,349.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
0.00
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
0.00
3.
Family Exemption: (If decedent's address is not the same as daimant's, attach explanation)
Claimant Roger L. Sturtz
Street Address 12 Hope Drive
3,500.00
City Boiling Springs
State PA ,Zip 17007
Relationship of Claimant to Decedent Husband/Survivng Spouse
4.
Probate Fees
44.00
5.
Accountant's Fees
0.00
6.
Tax Retum Preparer's Fees
0.00
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,893.00
1,1
.. .. ~
111"-
"'"
.-..
HoIIinSJer Funeral Home & Crematory, Inc.
Eric L. HoIlinlJer. Supervisor
June 21, 2004
Roger Sturtz
12 Hope Drive
Boiling Springs, PA 17007-
The Funeral Service for Donna G. Sturtz
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff. . . . . . . . . . . . . . . . .
995.00
FUNERAL HOME SERVICE CHARGES . . . . . . . . . .
mE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
995.00
995.00
Cash Advances
Newspaper Notices - Local. . . . .
Certified Copies of the Death Certificate.
Register Book, MF, AC. .'. . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
214.08
20.00
120.00
354.08
Total
Total Cost. . . . . . . . .
TOTAL AMOUNT DUE .
1349.08
1349.08
; '/1.
501 NORTH BALTIMORE AVENUE. MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 · (717) 486-3433 · FAX (717) 486-3215
www.hoIIin~erfuneralhome.com
RECEIPT FOR PAYMENT
Cumberland County - Register Of Wills
Hanover and Hiqh Streec
Carlisle, PA 17013
Receipt Date:
Recetpt Time:
Recelpt No. :
8/17/2004
10:42:00
1037551
STURTZ DONNA G
Estate File No.:
Paid By Remarks:
2004-00761
D G STURTZ
VZ
------------------------ Receipt Distribution ------------------------
Fee/Tax Description PaYment Amount Payee Name
PETITION FOR PROBA
SHORT CERTIFICATE
EXTRA PAGES
JCP FEE
Check# 6162
Total Received.........
25.00
3.00
6.00
10.00
----------------
$44.00
$44.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
REV-1512 EX+ (12~3) .-
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABILnlES, & UENS
ESTATE OF
Donna G. Sturtz
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
FILE NUMBER
1.
Capital One Auto Loan
6,554.00
2.
Oculoplastic Consultants
290.00
3.
SunTrust Mortgage Inc.
(50% share of $73,286 remaining balance)
36,643.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
43,487.00
capital Une Auto Finance Customer Account Services: Account History
Page 1 of2
,,~~~~jOn. :ry"
~"g"''\pv:l!i1l41i1:' '. ~.
10109104
ACCOUNT INFORMATION & PAYMENT HISTORY
Account Number: 5534897
Customer: Donna G Sturtz
LOAN TERMS
I Principal Loan Amount- I Fixed Interest Rate I Term
Original: I $10,000.00 I 6.60% I 60 months
*This amount does not include accrued interest. Please go back to the Account Summary
screen and select GET A PAYOFF QUOTE from the drop down box to receive the amount to
use to payoff your loan.
INTEREST PAID
Interest Paid This Year: $371.30
Interest Paid Lest Year: $559.55
Lifetime Interest Paid: $1,201.73
Send an e-mail c;onlirmation of interest paid to rdrsturtz@.aol.com:
(If your e-mail address or other personal Information has changed,
please go to Thank you.)
PA YMENT HISTORY
Date Amount Interest Miscellaneous Principal Balance
07lO9l2OO2 $0.00 $0.00 $0.00 $0.00 $10,000.00
07/1912002 $15.00 $0.00 $15.00 $0.00 $10,000.00
0811212002 $196.13 $61.48 $0.00 $134.65 $9,865.35
0011012002 $196.13 $51.73 $0.00 $144.40 $9,720.95
1011012002 $196.13 $52.73 $0.00 $143.40 $9,577.55
11/1212002 $196.13 $57.15 $0.00 $138.98 $9,438.57
1211012002 $196.13 $47.79 $0.00 $148.34 $9,29023
0111012003 $196.13 $52.06 $0.00 $144.05 $9,146.16
0211012003 $196.13 $51.27 $0.00 $144.86 $9,001.32
0311012003 $196.13 $45.51 $0.00 $150.56 $8,650.76
0411012003 $196.13 $49.61 $0.00 $146.52 $8,70424
0511212003 $196.13 $50.37 $0.00 $145.76 $8,558.48
0611012003 $196.13 $44.88 $0.00 $151.25 $8,407.23
07/1012003 $196.13 $45.61 $0.00 $150.52 $8.256.71
0811112003 $196.13 $47.77 $0.00 $148.36 $8,106.35
0911012003 $196.13 $43.99 $0.00 $152.14 $7,95621
1011012003 $196.13 $43.16 $0.00 $152.97 $7,803.24
11110/2003 $196.13 $43.74 $0.00 $152.39 $7,650.85
12/1012003 $196.13 $41.50 $0.00 $154.63 $7,49622
01/1012004 $196.13 $41.99 $0.00 $154.14 $7,342.08
0211012004 $196.13 $41.04 $0.00 $155.09 $7,186.99
0311012004 $196.13 $37.58 $0.00 $158.55 $7,028.44
10/9/04
https:llmy.capitaloneautofinance.com/pfflonline_view_terms.cfm
CapItal une Auto J:'Irtance t:ustorner Account Services: Account History
0./1012004 "96.13 $39.29 $0.00 $15U4 $6,871.60
05/10/'2004 $196.13 $37.18 $0.00 $158.95 $6,712.85
0811012004 $196.13 $37.52 $0.00 $158.81 $6,554.04
07/1012004 $196.13 $35.46 $0.00 $160.87 $6.393.37
0811012004 $196.13 $35.74 $0.00 $160.39 $6,232.98
0911012004 $198.13 $34.84 $0.00 $161.29 $6,071.69
10lO8l2OO4 $6,102.35 $30.66 $0.00 $6,071.89 $0.00
No payment is due.
If you require further assistance. please feel free to mail or phone us at:
Capital One Auto Finance
3905 North Dallas Parkway
PIano, TX 75093
(800) 946-0332
.~~
~ --:. -_.~.-:?~.:~~.-.;~-~:_.:.:~~-=-=-~~
https:/lmy.capitaloneautofinance.comlpfflonline_view_terms.cfrn
Page 2 of2
10/9/04
LOIl6 ~Oj 3IVa-OI-dn ION VIva
I ,< · I Oculoplastic Consultants of Central PA, P.C.
~ 4700 Union Deposit Road · Suite 230
~ Harrisburg, PA 17111
I'~ T 717~541~9700 866-888-0CCP (6227)
Fax: 717-541-9705
John J. Schietroma, M.D., F.A.C.S.
March 10, 2005
Mr. Roger Sturtz
12 Hope Drive
Boiling Springs Pa. 17007
Re:Account for Donna G. Sturtz
Balance Due: $ 290.00
Dear Mr. Sturtz:
After months of waiting and several re-submissions to the insurance company, Blue
Cross notified us that they paid for the office visit dated 10-13-03 directly to the member.
However, because of privacy laws they would not release a copy of the explanation of
benefits; therefore I can not adjust the bill to the proper amount.
Blue Cross indicated that you could request a copy of that explanation of benefits be sent
to you and then you could let me know their allowable rate and in-turn I could make the
proper adjustments that would lower the bill.
Please feel free to contact me if I can answer any questions or I can help in any way.
Eliza th H rris
Office Manager
Board Certified Ophthalmologist
American Society of Ophthalmic Plastic and Reconstructive Surgery
EH 03/10/05 ACCT# 6
PH# (717)-245-4992
.
Estate of DONNA G STURTZ
12 Hope Drive
Boiling SPNGS, PA 17007
LAST BIL: 02/10/04 CURRENT 30 60 90
TTL BAL: $290.00 290.00 0.00 0.00 0.00
ASIGN'D : $0.00 0.00 0.00 0.00 0.00
COLL (Z) : $0.00 0.00 0.00 0.00 0.00
WC/NF (W) : $0.00 0.00 0.00 0.00 0.00
PERS (*) : $290.00 290.00 0.00 0.00 0.00
RECORD#
FROM/TO DATES
FEE DIAG
SCH #1
PATIENT
CPT/HCPCS DESC
:::::: ::: :::: :::::::::::::::::::: :::::::::::::::: :::::::::::::: ::::::: ::::::::::::: :::::::::::::::::::::: ::::::::::::::::::: :::: ::::
1 1
N N 08/31/04 $290.00
$290.00*
23A
10/13/03
(d) DONNA OFFICE CONSULTATIO 99245 190.1 375.15
SIGNATURE:
PLEASE NOTE:
LEDGER CARD
FOLD AT . . MARKS FOR STANDARD #10 WINDOW ENVELOPE.
THE ABOVE INFORMATION REFLECTS ONE ACCOUNT MEMBER ONLY, -.
(d) INDICATES THAT PATIENT IS DECEASED.
120+
0.00
0.00
0.00
0.00
0.00
LAST PER PD:
YTD NCHG:
YTD PPAY:
YTD OPAY:
DIAG
#2
DIAG
#3
FROM: 00/00/00 TO: 03/10/05
PAGE 1
Oculoplastic Consultants of Central Pa.
4700 Union Deposit Rd 230
Harrisburg, pa 17111
(717)-541-9700
-20.98 on 02/17/04
$0.00 INS# 35 = BC CAPITAL
$0.00 Cov: (*None, !Some)
$0.00 DR #-NAME I.D. #
l-Schietroma, Jo 20-0186518
L D
PER CHG
CHARGES RECEIPTS BALANCE
I A CLAIM
GROSS CHARGES:
TOTAL ADJUSTS:
TOTAL BALANCE:
ASSIGNED BALANCE:
COLLECT BALANCE:
WCOMP/NF BALANCE:
PERSONAL BALANCE:
$290.00
$0.00
$290.00
0.00 290.00
$0.00
$O.OOZ
$O.OOW
$290.00*
SUNTRUST
Mortgage Account Statement.
SunTrust Mortgage, Inc.
P.O. Box 26149
Richmond, VA 23260-6149
Toll Free: 1-800-634-7928
Internet: www.suntrustmortgage.com
Statement Date
Payment Due Date
Loan Number
Account Information
:::bii:'~pff!i::::::::::::
Balances
Principal Balance *
Escrow Balance
Other Fees
Unpaid Late Charges
Payment Factors
Int Rate
Principal & Interest
Escrow Payment
Optional Products
Other
Total Payment
Year to Date
Interest
Taxes
Principal Paid
A 1700797561252
BT 017738
ROGER L STURTZ
DONNA G STURTZ
12 HOPE DRIVE
BOILING SPRINGS PA 17007-9756
111.111...11111.1111.111.1 I .1111...1 .1.1..111111111111.1.1.1.1
Property Address:
12 HOPE DRIVE
BOILING SPRINGS PA 17007
Home Phone: 717-245-9427
Other Phone: 717 -691-6066
* This Is Not A Payoff Amount
06/14/04
07/01/04
0131432056
:::::\.WiMf:??
....................................... .
.. .............................
73,286.40
1,766.06
.00
.00
5.75000%
664.33
203.58
.00
.00
867.91
Transactions Summa
}j)lItli) f::::~~MWNMt .:...:...:.::::::NIl~~:::..:/::::JM~~~~t:f?::: .:.:::J~t:ffi~l~W :?:?:~M~#\'f!~W::@tWMt::!##~imAA:r~M~MqJMW
06/14 PAYMENT
$867.91
$352.66
$311.67
$203.58
Special Messages
Visit Our Online Customer Service Center
Check out our website www.suntrustmortoaae.com. go to Current Customers
and click Log On to view your existing loan information and update
address/phone/E-mail contact information online. You may also view and pay
your mortgage payment online, sign up for SurePay automatic drafting, review
account balances and various other loan detail.
t:i:r Eaual Housina lender
REV-1513 EX+ (9-00) '*
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Donna G. Sturtz
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Amy L. Sturtz 1682 Oxford St. Berkeley, CA Step-daughter 1,000.00
2. Lisa N. Sturtz 3411 Brookside Dr. Harrisburg, PA 17109 Step-daughter 1,000.00
3. Richard J. Sturtz 3223 Wakefield Dr. Harrisburg, PA 17109 Step-son 2,000.00
4. Roger L. Sturtz 12 Hope Drive Boiling Springs, PA 17007 Husband! Spouse 143,342.00
143,342.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
I .
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LAST WILL AND TESTAMENT OF
DONNA G. STURTZ
I, DONNA G. STURTZ, of Cumberland County, Pennsylvania, being of sound mind and
memory, do make, publish and declare this my Last Will and Testament, hereby revoking and
making void any and all wills by me heretofore made.
FIRST: I order and direct that all of my just debts and funeral expenses be paid by my
hereinafter named Executor as soon after my death as may be found convenient.
SECOND: I wish my organs to be donated. I wish to be cremated and my ashes to be
disposed of by my Executor as he shall determine appropriate.
.
THIRD: To my husband, ROGER L. STURTZ, I give, devise and bequeath the tract of real
estate which is improved with my residence and which is known and numbered as 12 Hope Drive,
Boiling Springs, Pennsylvania, and any cars which I own.
FOURTH: To my daughter, SHEILA L. ROBBINS, I give all of my jewelry and Merrill
Lynch IRA account. In the event that she fails to survive me, I direct that the Merrill Lynch IRA
account be divided equally between JEFFREY R ROBBINS and my husband, ROGER L. STURTZ.
FIFTH: To my stepdaughter, AMY STURTZ, I give the sum of One Thousand ($1,000.00)
Dollars.
SIXTH: To my stepdaughter, LISA STURTZ, I give the sum of One Thousand ($1,000.00)
Dollars.
SEVENTH: To my stepson, RICHARD STURTZ, I give the sum of Two Thousand
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~IG~it To my husband, ROGER L. STURTZ, I give all remaining cash and accounts
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in financial institutions.
NINTH: All the rest, residue and remainder of my estate, real, personal and mixed, of
whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time
of my death I give, devise and bequeath to my beloved husband, ROGER L. STURTZ.
TENTH: I hereby nominate, constitute and appoint my husband, ROGER L. STURTZ, as
Executor of this, my Last Will and Testament, and I do direct that no bond shall be required of such
Executor hereunder. My said Executor shall have full power at his discretion to do any and all things
necessary for the complete administration of my estate, including the power to sell at public or
private sale and without order of Court, any real or personal property belonging to my estate, and
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to compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and
demands, whatsoever, against or in favor of my estate, as fully as I could do ifliving.
In the event that my husband, ROGER L. STURTZ, does not survive me or fails to qualify,
then I nominate, constitute and appoint JUDITH WAGNER, as the alternate Executrix. Said
alternate Executrix shall have all of the powers, privileges, duties and immunities as hereinbefore
more fully set forth for my original Executor.
IN WITNESS WHEREOF, I, DONNA G. STURTZ, the above Testatrix have set my hand
and seal to this my Last Will and Testament, which consists of two (2) pages, to each of which I
have affixed my signature this j 0 day of fl-1o..../
L:~~
, 2004.
(SEAL)
Signed, sealed, published and declared by the above named Testatrix as and for her Last Will
and Testament, in the presence of us, who at her request and in her presence and in the presence of
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each other have hereunto subscribed our names as witnesses.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT.280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
STURTZ ROGER l
12 HOPE DRIVE
BOILING SPRINGS, PA 17007
n______ fold
ESTATE INFORMATION: SSN: 183-42-4992
FILE NUMBER: 2104-0761
DECEDENT NAME: STURTZ DONNA G
DATE OF PAYMENT: 03/28/2005
POSTMARK DATE: 03/17/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 06/18/2004
NO. CD 005121
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $180.00
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TOTAL AMOUNT PAID:
$180.00
REMARKS:
CHECK# 518
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 4/25/2006
STURTZ ROGER L
12 HOPE DRIVE
BOILING SPRINGS, PA 17007
RE: Estate of STURTZ DONNA G
File Number: 2004-00761
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 is due by:
6/18/2006
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,
~~PJ~d~~L
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
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