HomeMy WebLinkAbout03-0373 PETITION FOR GRANT
also known as To:
Deceaxed.
Social Securit. v It,. '%_LZ-~ 01 ~.'~_ 2-5
Register of Wills for the [
County of ~: ,~.,...~~ in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(~5, who is/~ 18 years of age or older, appl~ ~%.
(d.b.n.; pendenle lilt; durante absenlia; durante minorilalc}
the above decedent.
for letters of administration
on the estate of
Decedent was domiciled at death in ~ , .... ~t,,,_r~c~, & %County.,.Pennlylvania,,with
~ last family or principal residence at -~7~( ~~ .[~. ~ ~_~ ~o ~ I~ ~ ~
(list~r~ number, Twp. or Boro.) ~{ {~
Decedent, then ~ years ~{_age, died_ _ {%J~ t~\-e~
Decedent 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 in County
Value of real estate in Pennsylvania
situated as follows:
$
$.
$
$
Petitioner
the following spouse (if any) and heirs
Name
after a proper search ha ~
Relationship
· ascertained that decedent left no will and was survived by
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 ~ ss
COUNTY OF
The petitioner(s) above-named swear(s) or affirm(s) that the
EV 9/H6
This is to certi~, that the information here given is correctly copied from an original certificate of' death duly flied with me as
Local Registrar. The original certificate will be. forwarded to the State Vital Records Of'rice £or permanent fiiing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee £or this certificate, $2.00
P 9190358
No.
Local Registrar
MAR 1 3 211113
Date
93
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
[ce R. Moore
Staten Island
Cumberland
North Middleton ,. Church of God Home
Editor
Church of God'~me~'~°~
801 North Hanover St.
17013
Unknown
~,.D ..[~
,~..~m PA
White
Widowed
,,~.E~~ . North Middleton
,,~March 15, 2003
O1 ~a-~ L
21
Drive, Carlisle, PA 17013
219 N. Hanover Carl]
17013
E SPRINGS F~ ',',!LY PRACTICE
¥ SPR.,.j$. PA 17065,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002663
BROUJOS JOHN ESQ
4 N HANOVER ST
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 322-01-4325
FILE NUMBER: 2103-0373
DECEDENT NAME: MOORE BEATRICE R
DATE OF PAYMENT: 06/10/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/11/2003 j
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $2,300.00
REMARKS:
TOTAL AMOUNT PAID:
BRIAN D MOORE
C/O JOHN BROUJOS ESQUIRE
82,300.00
SEAL
CHECK# 101
INITIALS. JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent:
Date of Death:
Will No.:
To the Register:
Beatrice R. Moore
March 11, 2003
Admin. No.:
21-03-0373
I certify that notice of estate administration required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
·
Name
Address
Brian D. Moore
21 Moongale Drive, Carlisle, PA 17013
Sharon M. Peirce
5337 Shannon Park Drive, Dublin, OH 43017
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none
Date: ~-~-03 /~?_~
Signature
Address:
Phone:
Capacity:
Brian D. Moore, Administrator
21 Moongale Drive
Carlisle, PA 17013
717-243-7143
X Personal Representative
Counsel for Personal
Representative
IN RE:
ESTATE OF BEATRICE R. MOORE
: IN COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
: ORPHANS' COURT DIVISION
: FILE NO. 21-03-0373
PETITION FOR APPOINTMENT OF ADMINISTRATRIX D.B.N.
Sharon M. Peirce, through her attorney John H. Broujos ofBroujos & Gilroy, P.C., sets forth the
following Petition for Appointment of Administratrix DBN (De Bonis Non) in the above estate.
1. Petitioner is an adult individual residing at 5337 Shannon Park Drive, Dublin, Ohio
43017.
2. On March 11, 2003, Beatrice R. Moore deceased. She was a resident of Cumberland
County, 21 Moongale Drive, Carlisle, PA 17013.
3. On April 29, 2003, Letters of Administration were granted, appointing Brian D. Moore,
son, as Adminstrator.
4. On August 29, 2003, the Adminstrator, Brian D. Moore, deceased.
5. The only child surviving of decedent Beatrice R. Moore, other than the deceased son
Brian D. Moore, is Sharon M. Peirce, of 5337 Shannon Park Drive, Dublin, Ohio 43017.
6. The husband of Beatrice R. Moore had predeceased the decedent.
7. Shannon M. Peirce requests the Court to appoint her as Administratrix D.B.N.
8. Petitioner is prepared to perform the duties of Administratrix D.B.N.
9. The estate is near completion of administration, with Inheritance Tax Assessment,
Beneficiary Notices and Certificate of Notice, and other aspects of administration completed,
leaving only the filing of the Inheritance Tax Return due December 11, 2003; and Family
Settlement.
WHEREFORE, Petition requests the Register of Wills t{ ~Peirce
Administratrix D.B.N.
September 2, 2003 ~o~hn
H. Broujos, Attorney for Petitioner
4'q~. H) rover Street
Carlisle, PA 17013
717/243-4574; FAX 243-8227
I verify that the statements made in this pleading are true and correct. I understand that false
statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to
unsworn falsification to authorities.
Sharon M. Peirce ~
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION D.B.N.
Estate of P o_o.'Pc-,,ce~., g. ~/~ o~,c e_~ No.
also known as To:
Deceased.
Social Security No. ~ ~-- z. ~ <D I - ~ 3 ~- g-
Register of Wills for the
County of C~n-.bec{,t,,,_¢~., in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(~, who isAac.~ 18 years of age or older, appD' ~-s: for letters of administration
g,La.
(d.b.n.; pendenle lile; durante absentia; durante minorilate} on the estate of
the abovedecedent. See Pet:i.t-{on for Grant of Letters of Adm'inistrat-ion D.B.N.
attached.
Decedent was domiciled at death in C_o. ~,..~ ~ ~. ~/~ ~x d, County, Pennsylvania, with
he'r- last family or principal residence at 2! Oaoo-~,~.a_l~_ "~r-,, C~c,r~;~;{e_}~o/~ l-rol3~ zgtf
{list street, number, Twp. or BorG.)
Decedent, then. ~ ~ years of age, died c~ ~ i I , t'9 Z_o,~
Decedent 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 in County $
Value of real estate in Pennsylvania $..
situated as follows:
Petitioner after a proper search ha,5'
the following spouse (if any) and heirs
Name
ascertained that decedent left no will and was survived by
Relationship 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
COUNTY OF O~nber] and
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.
Sworn to or affirmed and subscribed
elate me this 2nd day of
Donna M. Otto,lst l~put~r ~ Register/~
I
No.
21-2003-373
Estate of
Beatrice R. Moore
, Deceased
GRANT OF LETTERS OF ADMINISTRATION D.~.N.
AND NOW Septenber 24th ~ in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that ,qha,-on M_ p~,i,-c~.
is/a~ entitled to Letters of Administration, and in accord with such finding, Letters of Administraiio,
/xj:lministrat ion D.B.N.
are hereby granted to~ Sharon M. Pe~_cce
in the estate of
Beatrice R. Moore
L~ters of Administration .....
Short Ccnifi~tes(~ ..........
Renunciation ................
~ ~ TOTAL
Fil~ Sept~ .~, 2~'D'
Call Attorney on 9/23/03
ADD~
PHONE
H 105.805 REX,' 9/86
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, $2.00
P 96096;03
No.
Local Registrar t.~
SEP ,3 2003
Date
.~.T ~29-102
INK
Brian
68
Cumberland
Professor
Carlisle PA 17013
COMMONWEALTH OF PENNSYLVANIA., DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
D Moore Male 010 - 26 - 4623
Feb. 17, Elgin, IL ,.~,.~[q E~o~.~. [] ~o~[]
North M1ddleton 21 Moongale Drive
T. l~Do~'e
Rosemary Moore
Slate PA
Donleay
_[]
4, 2003
Quantico National Cem.
[7013
Quantico, VA
August 28, 2003
White
Carey
11:00 p 2~, 2003
r~eu~).__~ {ORASACO~QUENCEO~: va c ar Disease
y~ co.dem~
Remote CVA A-FIB
3oe.
has pconou nce~ Oe~ a~ comp~me~ rlem 23)
.................................................... []
Coroner
29, 2003
Mlchae: Norris, Coroner
6375 Basehore Road, Suite #1
Mechanicsburg, Pa. 17050
21-2003-373
Bond No. 98 LX 3661 2
21-2003-373
BOND OF EXECUTOR, ADMINISTRATOR
OR GUARDIAN
STATE FARM FIRE AND CASUALTY COMPANY
BLOOMINGTON, ILLINOIS
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
FB-9062.1
SS.
COURT OF COMMON PLEAS
IN THE MATTER OF THE
OF BEATRICE R MOORE
[] Estate
[] Guardianship
KNOW ALL PERSONS BY THESE PRESENTS:
Bond of
[] Execut
[] Administrat or
[] Guardian
That we, SHARON M PEIRCE
as Principal, and State Farm Fire and Casualty Company, a corporation of Illinois, as surety, are held firmly bound unto
the Commonwealth of Pennsylvania, inthe penalsum of ONE HUNDRED AJND TWENTY-TWO THOUSAND AND
NO CENTS
Dollam ($ 122,000.00 ),
~rthe payment of which we ~imly and severally bind oumelves, our heim, executors, administrator~-,~-~e--s~, and
aSSigns.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, that if the above bound principal shall faithfully
discharge the duties of his, her, their trust as ADMTNISTRATOR , of the estate of
(EXECUTOR, ADMINISTRATOR, GUARDIAN, ETC.)
BEATRICE R MOORE according to law, then the above obligation is to be void, else to
remain in full force.
Dated, signed anct-~aled with our seals this 12TH
Approved this
day of SEPTEMBER, 2003.
Principal
day of
STATE FARM FIRE AND CASUALTY COMPANY
A Eo me y-k~-fa ct
Attest:
COMMONWEALTH OF PENNSYLVANIA
I swear that I will faithfully discharge the duties of my trust as
of the person and estate of BEATRICE R MOORE
Subscribed and sworn to before me, the
Rd ,. ,h Ts +'-~-'f'~-r-
( EXECUTOR, ADMINISTRATOR, GUARDIAN, ETC.)
according to lawhso help ~me God.
day of
ACKNOWLEDGMENT OF SURETY
STATE OF ILLINOIS } SS
County of MC LEAN
, in and for said county in the state
I, TRUDY A SPENCE , Attorney-in-Fact of STATE
aforesaid, do hereby certify that DEBPJ~
FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois, a corpo, aEon duly org&aized and existing under the
laws of the State of Illinois, personally known to me to be the same person whose name is subscribed to the foregoing
instrument as Attorney-in-Fact of STATE FARM FIRE AND CASUALTY COMPANY, appeared before me this day in
person and acknowledged that he signed and delivered the said instrument as his and State Farm Fire and Casualty
Company's free and voluntary act for the uses and purposes therein set forth.
Given under my hand and official seal this 12TH day of SEPTSMBER, 2003.
My Commission Expires
JULY 29TH ,2004 .
ACKNOWLEDGMENT OF PRII~IPAL
~5~--~'r~'- o~ OH ~O~._.,.,~.v' ~^~1~
SC:?~;;viONW~LT:: OF r ................
County of .--~'.~~ '~.otary Public
in and for said County, do hereby certify that ~{ ~, ,~,_~ ',~ V~L {~)~_ ! ~L_~"-
personally known to me to be the same person(s) whose name . ~;~{.~---- subscribed to the foregoing
instrument as Principal, appeared before me this day in ~nd acknowledged that
signed, sealed and delivered said instrument as free and voluntary act, for the uses and
purposes therein set forth.
Giv~.p,~rlqler. my hand and seal this l~'~''~ day of ~~t-~
c iYs
My ~ ~ ~. KEVIN R, HARRIS, JR.
~ ~ j Notary Public, State o! Ohio
~ ,~', O; ~v Commission Ex~lres 11-12-08 -
Notary Public
· -;.;.'.-E o~ _':...,"' ~ []
Zz
~O
IN RE: ESTATE OF BEATRICE R MOORE :
LATE OF :
NORTH MIDDLETON TOWNSHIP :
CUMBERLAND COUNTY :
DECEASED
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
ESTATE NO: 21-2003-373
ORDER OF THE REGISTER OF WILLS TO REVOKE LETTERS
ADMINISTRATION
AND NOW, the 23rd day of September 2003, I Donna M. Otto, 1 st Deputy
Register of Wills in and for Cumberland County, do hereby revoke Letters of
Administration issued to Brian D. Moore, on April 29th, 2003. Brian D. Moore died
August 28th, 2003. New Letters of Administration D.B.N. are being issued to Sharon M.
Peirce daughter of the deceased.
Donna M. Otto, 1 st Deputy
Register of Wills
Power of Attorney
STATE FARM FIRE AND CASUALTY COMPANY
/~NOW ALL PERSONS BY THESE PRESENTS: That STATE FARM FIRE AND CASUALTY COMPANY, an Illinois corporation, with itl
principal office in Bloomington, Illinois, does hereby constitute and appoint: Mary Allen, John C. Anderson, Teresa L. Brown, Jessica Bryant,
Kelly Butterfield, Ceola Campbell, Pamela Chancellor, Mary Clodfelter, Kim Filter, Julia Freed, Brooke Furry, John Gibson, Christine M.
Goben, William L. Gordon, Christy Herald,, John R. Horton, Cynthia Johnson, Susan K Johnson, Ma K Kerfoot Jul
Krawcyk Donna K O'Crowl Michael D O D · . ry . , ia Klinzing G.F.
~ · . ' .. A'.. Y, _ . onnell, James Platt, Debra Prater, Lynn Rakowskl Vicki Redman Linda Rie
r~oDenson Alice SChuler An ie Scott Trud .... ' , ck, Suzanne M
....... : ...... , g . , . y Spence, .He~dl Stevens, Cindy R. Swlck, Perry Tracy, Susan M Wagoner. Diana Watt Kar '
weber, VV~lma L. wemz~.en o.f Bloomington, Illinois its true and lawful Attorne s in-Fact · . :. _ L. , .e.n
behalf as surety, any uno all Ponds, undertakings or other writings obligatory i~lY~l~e nature' ot~amb~kne(j ae:~:~lto~sS:eal and dehver for, and on it
~ Any such obligation in any amount J
This appointment is made under and by the authority of a resolution which was passed by the Executive Committee of the Board of
Directors of State Farm Fire and Casualty Company on the 24th day of July, 1974, as is duly authorized by the Board of Directors in Article II,
Section 6 of the By-Laws of the Company, which resolution is:
Res.olv. ed, t_hat the Executive Vice-President or a Vice-President of the Company is hereby authorized to appoint and empower any
representative of the Company or other person or persons as Attorney-in-Fact to execute on behalf of the Company any bonds, undertakings,
policies, contracts of indemnity or other writings obligatory in the nature of a bond, which the Company might execute through its duly elected
officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney-in-Fact shall be as binding upon the
Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney-in-Fact, so
appointed, may be removed for good cause and the authority so granted may be revoked as specified in the Power of Attorney.
Resolved, that the signature of the Executive Vice-President or any Vice-President and the seal of the Company may be affixed by
facsimile on any power of attorney granted, and the signature of the Secretary, Vice-President or Assistant Secretary, and the seal of the
Company may be affixed by facsimile to any certificate of any such power and any such power or certificate bearing such facsimile signature
and seal shall be valid and binding on the Company. Any such power so executed and sealed and certificate so executed and sealed shall,
with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company.
IN WITNESS THEREOF, STATE FARM FIRE AND CASUALTY COMPANY has caused this instrument to be signed by its Vice-President,
and its Corporate Seal to be affixed this 14th day of September 2001.
This APPOINTMENT SHALL CEASE AND TERMINATE AUTOMATICALLY AS OF DECEMBER 31, 2004, UNLESS SOONER
REVOKED AS PROVIDED.
f.e' .' .......... ~,,., % STATE FARM FIRE AND CASUALTY COMPANY
~ ~:..' ... ~. i/~
,,,, ... $.['J[~ ...,, ~ By:
", '~," ........ '~' ~ Vice-President
"..,,~,,,,,,,o..
STATE OF ILLINOIS
COUNTY OF McLEAN
On this 14th day of September 2001, before me personally came Brian Boyden to me known, who being duly sworn, did depose and say
that he is Vice-President of STATE FARM FIRE AND CASUALTY COMPANY, the corporation described in and which executed the above
instrument; that he knows the seal of said corporation; that the seal affixed to said instrument is such Corporate Seal; and that he executed
said instrument on behalf of the corporation by authority of his office under the By-Laws of said corporation.
"OFFICIAL SEAL" * -" ~
Heidi J. Stevens ~'o~ry Public
Notary Public, State of Illinois My commission expires March 12, 2005
My Commission Expires 3/12/05
CERTIFICATE
I, the undersigned Vice-President of STATE FARM FIRE AND CASUALTY COMPANY, do hereby certify that the original Power of
Attorney of which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth
are now in force.
Signed and sealed at Bloomington, Illinois. Dated this ] ,,~-day of ~Li~Jr- ~-eo ~,
Vic~-Pre~;ieht
If you have a question concerning the validity of this Power of Attorney, call (309) 766-2090.
FB6-9043A.33
(4~03)
Printed in U.S.A.
PETITION FOR GRANT
O yff F INISTRATION
also known as To:
Register of Wills for the ~
Deceased. County of ~:~ ,~,...~.~.r-~c,,~a- in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(v), who is/ave 18 years of age or older, appl ~ ~ ~
for letters of administration
on the estate of
(d.b.n.; pendcnle lilc; durante ab,enlia; durante minorilatC)
the above decedent.
Decedent was domiciled at death in ~x ..... ~ac,__~c~_& ,,. County_, Penn~yivania,.with
~ last family or principal residence at-~'~(- ~,~ltx .~tc. l.~· ~ ~.r--~
· (list(,~ree~-number. Twp. or ~ro~)
Decedent, then ~ ye:hrs,{age, died
Decedent 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 in County
Value of real estate in Pennsylvania
situated as follows:
$
$
$
Petitioner__ after a proper search ha
the following spouse (if any) and heirs:
Name
. ascertained that decedent left no will and was survived by
Relationship
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 ~
COUNTY Or 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.
Sworn to or affirmed .,and subscribed r' '¥/~ r~
before me this ~N~- , __ day of 1
. ,q~,~// ~ ~o~ J
~.,~.e_.~~ Regtster-{
No.
Estate of ~'~~,c-c~ P~oo~
,Deceased
]RANT ,O~? LETTERS OF ADMINISTRATION
bED
AND NOW "~OP.', I ~LO ~C'a~.C~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
in the estate of ~--~_~ ~'T R'~
FEES
Letters of Administration
Short Certificates(t~) ..........
Renunciation ................
O'C. P ~
TOTAL
Fil~ ~,/. '~n ........
ATTORNEY (S-up. Ct. I.D. No.)
ADDRESS
PHONE
RENUNCIATION
In RE: Estate of
To the Register of Wills of
Beatrice R. Moore
Cumberland
deceased.
County, Pennsylvania.
The undersigned daughter , one of the two children of the above decedent, hereby
renounces the right to administer the estate and respectfully asks that Letters of
Administration be issued to and appointment be made of Brian D. Moore
WITNESS my hand this ! 6~--- day of April ,2003.
(Signature)
Sharon M. Peirce
Dublin, OH ~ ~c.~c i 7
(Address)
Sworn to and subscribed before me
this /ct, day of //~-.{ ,2003.
~:f::~:~2 ~ ROBERT W. GRAY
REV-1500 EX + (6,-00)
Z
LU
Z
0
0
~J
Z
Z
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
MOORE, BEATRICE R.
DATE OF DEATH (MM-DD-Year)
03/11/2003
DATE OF BIRTH (MM-DD-Year)
08/16/1909
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
NA
OFFICIAL USE ONlY
FILE NUMBER
2 1 -0 3 0 0 3 7 3
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
3 2 2-0 1 -4 3 2 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
r~l. Original Return
E~4. Limited Estate
[~]6. Decedent Died Testate (Attach copy of Will)
[--"~ 9. Litigation Proceeds Received
[~2. Supplemental Return
---J 4a. Future Interest Compromise (dateofdeath after 12-12-82)
--"]7. Decedent Maintained a Living Trust (A~ch copy of Trust)
~]10. Spousal Poverty Credit (date of death between 12-31-91and 1-1-95)
[~3. Remainder Return (date of death pdorto 12-13-82)
El5. Federal Estate Tax Return Required
0__0 8. Total Number of Safe Deposit Boxes
E~]I 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:
NAME
JOHN H. BROUJOS~ ESQUIRE
FIRM NAME (If Applicable)
BROUJOS & GILROYI P.C.
TELEPHONE NUMBER
717-243-4574 OR 717-766-1690
COMPLETE MAILING ADDRESS
4 NORTH HANOVER STREET
CARLISLE ;~::~ PA 17013
1. Ream 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)
E] 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)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
OFFICIAL USE O~LY
64~075.65 !
2,'975.50
(8)
(11)
(12)
15~468.92
4,644.09
67,051.15
(13)
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)
16. Amount of Line 14 taxable at lineal rate
46,938.14 X
.045
(15)
(16)
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)
20, ~'~
20,113.01
46,938.14
46~938.14
2~112.22
2,112.22
> · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH
Decedent's Complete Address:
STREET ADDRESS
Church of God Home
801 N. Hanover Street
Carlisle
ISTATE PA
CITY
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
IZIP 17013
(1)
2,300.00 lO5.61
2,112.22
Total Credits ( A + B + C ) (2)
2,405.6'~
Total Interest/Penalty ( D + E ) (3)
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
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
293.39
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 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.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR!j~_PERSON RESPONSIB~)FOR FILING RETURN
ADDRESS Sharon M. Peirce,~337 ~non Park Drive
ubli t )
AOD~ESS ~N~ Hanover S~ree~
~lisle
DAlE/
~-I ~1~ '~
OH 43017
DATE
5'. I~O~
PA 17013
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 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 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE'E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
MOORE, BEATRICE R. ~1 Q;~ 00373
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
M&T Bank checking acct # 8892174114
Jnion Planters Bank checking acct # 1113170193
¢IML Investors Services Money Market Fund acct # BMA-958042
;hutch of God - refund on monthly rent
Carlisle Regional Medical Center- medical expense reimbursement
Mobile X-Ray Imaging - reimbursement for x-ray
CIGNA/Connecticut General Life Ins. Co. - reimbursement for medical expenses
Household items (no value; limited nursing home space)
Oil painting of landscape
TOTAL (Also enter on line 5, Recapitulation)
VALUE AT DATE
OF DEATH
1,485.54
6,345.69
50,345.94
2,795.58
17.93
26.77
58.20
0.00
3,000.00
$ 64~075.65
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (1 G7) ~
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
MOORE, BEATRICE R.
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
21 03 00373
SURVIVING JOINT TENANT(S) NAME
A. Sharon Moore Peirce
C
5337 Shannon Park Drive
Dublin, OH 43017
ADDRESS RELATIONSHIP TO DECEDENT
daughter
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
',lUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES'
1. A. 2000 Carterville State and Savings Bank, Carterville, Illinois 5,951.00 50. 2,975.50
Checking Acct.# 442615
TOTAL (Also enter on line 6, Recapitulation) $
2,975.5C
(If more space is needed, insed additional sheets of the same size)
OMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
MOORE, BEATRICE R.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 03
00373
ITEM
NUMBER DESCRIPTION AMOUNT
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
FUNERAL EXPENSES:
Riggin Pillatch Funeral Home, Carterville, Illinois
Riggin Pillatch Funeral Home, Carterville, Illinois
Hoffman-Roth Funeral Home, Carlisle, PA - preparation for funeral in Illinois
Weller's Florist, Carterville, IL - flowers for funeral
Rock of Ages, Vienna, IL - charge to move family headstone
Rock of Ages, Vienna, IL - grave marker
Brian Moore - reimbursement for funeral meal
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Sharon M. Peirce
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 5337 Shannon Park Drive
089-30-8109
city Dublin State OH
Year(s) Commission Paid:
AttomeyFees Broujos & Gilroy, P.C.; EIN: 23-2267691
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip 43017
Street Address
City
Relationship of Claimant to Decedent
Probate Fees - Register of Wills
State Zip
Accountant's Fees
Tax Return PrepareCs Fees
Register of Wills - Inventory filing fee
Register of Wills - Inheritance Tax Return filing fee
Register of Wills - Family Settlement Agreement
M&T Bank - fee for check return option
Brian Moore - reimbursement for initial deposit to open estate account.
5,000.00
488.25
1,765.00
212.50
125.00
525.94
110.23
3,500.00
3,500.00
160.00
10.00
15.00
17.00
15.00
25.00
TOTAL (Also enter on line 9, Recapitulation) $ 15,468.92
(If more space is needed, insert additional sheets of the same size)
REV?512 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES~ & LIENS
ESTATE OF
MOORE, BEATRICE R.
Include unreimbursed medical expenses.
FILE NUMBER
21 03 00373
ITEM
NUMBER DESCRIPTION AMOUNT
1. Brian Moore - reimbursement for medicines from Brockie Pharmatech 70.86
Brockie Healthcare - medical expense
Rosemary Moore - reimbursement for decedent's moving expenses from Illinois 1/02
(see attached Atlas Van Lines bill of lading)
AD&D Insurance - quarterly payment
Sharon Peirce - reimbursement for:
settlement of house sale $95.24
Sharon Peirce - reimbursement for:
shipping painting to Sharon $298.08
appraisal of painting $290.00; back tax missed at
bond for Administratrix outside PA $438; cost for
35.88
3,412.73
3.30
385.24
736,08
TOTAL (Also enter on line 10, Recapitulation) $ 4~644.09
(If more space is needed, insert additional sheets of the same size)
pw
~ ~ STANDARD HOUSEHOLD GOODS BILL OF LADING AND FREIGHT BILL
· ~k O BINDING COST OF SERVICE BILL OF LADING AND FREIGHT BILL
Atlas.Van Lines ~'~ GENERAL OFFICES [ REGISTRATION NO.
· 1212 ST, GEORGE ROAD, P,O. BOX 509 -- --
EVA.SV,'LE ,NO,A.A4,,03-050, "/L"O. Y 06128 0
NOT NEGO~ABLE DOT ~125~0 t ~ I I L~ t I ~" ~ ~
IN CASE OF NEED CONTACT SHIPMENT INFORMATION MCR AT ABOVE ADDRESS ~R TEL.~2-424'2222 REFER TO'HIS'REG. NO. ~
SHIPPER Mrs. Rosemary Moore CONSIGNEE/OWNER Mrs, Rosemary Moore
ADDRESS 922 S Division Street ADDRESS 21 Moon Gall Drive~v~,/~'?&~/'/ ....
FLOOR TEL. 618--q85--2014 COUN~~ FLOR TEL 717--243--7143 COUN~
c~ Cmrte~lle ST~T~PROV IL ZiP 62918 c~ Carlisle STAT~PROV PA z,P 17013
~~ ~-Q~ D~r must call dest 24 hrs prior to del
CUST~S~TA: SU~ECTTO CHECK IN U.S, FUNDS PAYABLE TO ATLAS VAN LINES STAMPEDOR TARIFF ~OON
~RT OF EX~RTAT~0N GENERALOTHERWISESEFORE PROPERTYsTATED.IS RELINQUlSHEDoN EM~LOYERBY CARRIERpAiD UNLESSMoVES, PRINTED TERMS,
EMPLOYER FALLS TO MAKE ~AYMEN~ AS PROMISED. ON ~E R~ERSE,
& CHARGES IN CASE OF
To T~, ~E~.OT*~ ~ame as above TEL
ADDRESS ADDRESS
-- FULL VALUE PROTECTION; LUMP SUM $
MILES B/L .... D BY:T ~r ~ n ~ RATE CHARGE
1~ LBS ] 000~ TOTAL BCS WEIGHT TOTAL BCS CHARGES
S~G ~/~ ~ I
BOOKED BY ~ H&~ ~ ~7~5 EXCESSIVE DISTANCE CARRY FEET
ORIGIN AGENT ~n H&~ ~ ~7~ EXTRALABOR HRS
DEST AGENT ~eoaa~d-~e~elev
SITD % OF $ (
porated include (i) limit, on lhe Carrier's liability for Iosl, BILL CHARGES TO
price of the tranlpo~aDon. CITY, STATE
~T31
(WAREHOUSE)
BY PER (WAREHOUSEMAN'S SIGNATURE) DATE
DELIVERY ACKNOWLEDGMENT: SHIPMENT WAS RECEIVED tN APPARENTLY GOOD CONDITION EXCEPT AS NOTED ON ~NVENTORY
AND SERVICES ORDERED WERE PERFORMED
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
MOORE.
NUMBER
II.
1.
3EATRICE R
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Brian D. Moore, Estate of cio Rosemary Moore
21 Moongale Drive, Carlisle, PA 17013
Sharon M. Peirce
5337 Shannon Park Drive, Dublin, OH 43017
FILE HUMBER
21 03
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
son
daughter
00373
AMOUNT OR SHARE
OF ESTATE
1/2
1/2
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX iS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
INVENTORY OF THE REAL AND PERSONAL ESTATE OF
Beatrice R. Moore, deceased
File No.: 21-03-0373
Date of Death: March 11, 2003
2.
3.
4.
5.
6.
7.
8.
9.
M&T Bank checking acct # 8892174114
Union Planters Bank checking acct # 1113170193
MML Investors Services acct # BMA-958042
Church of God - refund on monthly rent
Carlisle Regional Medical Center - medical expense refund
Mobile X-Ray Imaging - reimbursement for x-ray
CIGNA/Connecticut General Life lns. Co. - medical reimbursement
Household items (no value; limited nursing home space)
Oil painting of landscape
Subtotal
$1,485.54
6,345.69
50,345.94
2,795.58
17.93
26.77
58.20
0.00
3,000.00
$ 64,075.65
Property held jointly with Administratrix:
Carterville State and Savings Bank checking acct #442615
Decd's Value of
DOD value Interest Decd's Int
5,951.00 50% 2,975.50
TOTAL
$ 67,051.15
Sharon M. Peirce, Administratrix of the Estate of Beatrice R. Moore, late of Carlisle,
Cumberland County, Pennsylvania, has made an inventory of the entire estate of decedent,
consisting of all the personal property and real estate, except real estate outside the
Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory
represent its f({~ value as of the date of decedent's death.
April 26, 20:I~
Sharon M. Peirce, Administratrix
BUREAU OF 'rNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COHHONNEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-10q7 EX &FP (01-05)
JOHN H BROUJOS ESQ
BROUJOS & GZLROY
4 N HANOVER ST
CARLISLE
PA 17015
DATE 07-19-Z004
ESTATE OF HOORE
DATE OF DEATH 05-11-2005
FILE NUHBER 21 05-0575
COUNTY CUHBERLAND
ACN 101
Amoun~ RemJ~ed
8EATRICE R
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGTSTER OF NTLLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS -~
REV-1547 EX AFP ¢01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF HOORE BEATRICE R FILE NO. 21 05-0575 ACN 101 DATE 07-19-2004
TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:
1. Real Es~a~e (Schedule A)
:5.
5,
6.
7.
8.
ORIGINAL RETURN
(1)
S~ocks and Bonds (Schedule B) (2)
Closely Held S~ock/Par~narship Zn~ares~ (Schedule C) (:5)
Nor~gages/No~es Receivable (Schedule D) (~)
Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) ($)
Jointly Owned Proper~y (Schedule F) (6)
Transfers (Schedule G) (7)
To,al Asse~s
64z075.65
Z0975.50
.00
.00 NOTE: To insure proper
.00 credi~ ~o your account,
.00 subei~ ~he upper portion
.00 of ~his for. wi(h your
~ax payment.
(8) 67,051.15
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Adm. Cos~cs/Hisc. Expanses (ScheduZa H)
10. Deb~s/Hor~gege Liebili:~ies/Liens (Schedule 'r)
11.
12.
1:5.
1~..
NOTE:
15,468.92
(9)
(lO) 4~644.09
To,al Deductions (11)
Ne~ Value of Tax Re~urn (12)
Char/~able/governmen~al Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5)
Ne~ Value of Es~a~a Sub~ec~ ~o Tax (1~)
20.115.fll
46,958.14
.00
46,958.14
Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 wlll
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Aeoun~ of L/ne 1~ a~ SpousaZ ra~e
16. Amoun~ of L/ne lq ~axable a~ Lineal/Class A ra~e
17. Amoun~ of L/ne 1~, e~: S/bl/ng ra~:e
18. A.oun~ of L/ne 1~, ~axable a~: Collateral/Class B re~e
19. Pr/nc/pal Tax Due
TAX CREDZTS:
PAYNENT RECEIPT DISCOUNT (+)
DATE NUNBER TNTEREST/PEN pAID (-)
06-10-2005 CD002665 105.61
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(15) .00 x O0 : .00
(16) 46,958.14 X 045 = 2,112.22
(17) x . oo
~ : (19)= ~ cj2,112.22
AHOUNT
TOTAL TAX CREDIT
BALANCE OF TAX DUE
2,405.61
295.59CR
INTEREST AND PEN. .00
TOTAL DUE 293.39CR
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT- (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December 1Z, 1962 -- if any futura interest in the estate is transferred
in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Comeonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the taefuZ Class B (collateraZ) rate on any such futura interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S.
Sect[on 9140).
Detach the top portion of this Notice and submit ~ith your payment to the Register of Rills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF RILLSj 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" (RE¥-1515). Applications are available at the Office
of the Register of Rills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-56Z-ZO50; services for taxpayers ~ith special hearing and / or
speaking needs: 1-800-447-50Z0 (TT only).
Any party in interest not satlsfiad ~ith the appraisement, alIo~ance, 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:
--~rittan protest to the PA Department of Revenue, Board of Appeals, Dept. ZB1021, Harrisburg, PA 171Z8-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revie~ Unit, Dept. 280601, Harrisburg, PA 17128-060!
Phone (717) 787-6505. See 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 (5) calendar months after the decadent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15X tax amnesty non-participation penalty is computed on tho total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa 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 fram the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which ~Jll vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 ara:
Interest Daily Interest Daily Interest
Daily
Year Rata Factor Year Rate Factor Year Rata Factor
~ ZOZ .000548 1986-1991 IIX .000501 ZOO1 9Z .000247
1985 16Z .000438 1992 9Z .O00247 ZOOZ 6Z .000164
1984 11Z .000501 1995-1994 7Z .O0019Z 2005 SZ .000157
1985 152 .000556 1995-1998 9Z .000247 2004 42 .000110
1986 lOX .000Z74 1999 7Z .00019Z
1967 1DX .000274 2000 7Z .OOOlgZ
--Interest is calculated
as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELTNI;~UENT X DAllY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ~ill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation data shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVI*SZON
DEPT. 180601
HARRTSBURG, PA 17128-0601
JOHN H BROUJOS ESQ
BROUJOS & GILROY
q N HANOVER ST
CARLISLE PA 17013
COMMONI,/EALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
DATE
ESTATE OF
DATE OF DEATH
FILE NUHDER
COUNTY
ACN
REV-1687 EX AFP
08-23-200q
MOORE BEATRICE R
03-11-2003
21 03-0373
CUNBERLAND
101
Amount Remitted
MAKE CHECK PAYABLE AND REMXT PAYMENT TO:
REGISTER OF ~S
CUHBERLAND CIT':'~I~URT ~J:DUSE :.L ~
CARLISLE, PA :71~7013 "~ ::
NOTE: To J,sur. proper credj* *o your account, submj~ *ho upp.~ portion o~ *h~:~ form w~ ::':
~ou~ ~ax payment.
CUT ALONG THIS LZNE ~ RETAIN LONER PORTZON FOR YOUR RECOR~ ~ '
REV-~607 EX AFP (0~-03) ""- INHERITANCE TAX STATENENT OF ACCO~T'-~ ....................
ESTATE OF MOORE BEATRICE R FILE NO. 21 03-0373 ACN 101: ~..~DATE i308:~23-200~
THIS STATEMENT TS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN
IS A SUNHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 07-12-200q
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
PAYHENT
DATE
RECEIPT
NUMBER
CD002663
REFUND
06-10-2003
08-Oq-ZOOfi
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYNENT IS REQUIRED.
DISCOUNT (+)
INTEREST/PEN PAID (-)
105.61
.00
AMOUNT PAID
2,300.00
293.39-
TOTAL TAX CREDIT
DALANCE OF TAX DUE
2,112.22
.00
INTEREST AND PEN. .00
TOTAL DUE .00
ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
2,112.22
cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/02/2005
BROUJOS JOHN ESQ
4 N HANOVER ST
CARLISLE, PA 17013
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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: 3/11/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~-~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
vi
Name of Decedent:
.
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Bea."tric...e.
gill Jd.-003
~/-CJ6-{J3?-3
K
VY\.oo r e..
Date of Death:
Estate No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
DatE
I
I. State whether administration of the estate is complete:
" Yes 0 No ffi
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete: ~"..:\ \ "7 ~o')
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 0 No 0
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 0 No 0
a
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
'-. ,<005" """""" '" "" -~ ~ ~~~.. ..I,
Signatu e 0
3ol,n Ii. 'Rrou..jo,::>, E'5<L
Name J I _ "
1- NOi'+n rttLILo V<"I'~ 5-rre-e-f-
COr li6k fit 17-013
Address I
'-
,.,
"..'
(-=10) .;24'1-%, q8
Telephone No.
Capacity: 0 Personal Representative
~ Counsel for personal representative
cI
Curnberland County - Regjster or WLLlS
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/02/2006
BROUJOS JOHN
4 NORTH HANOVER STREET
CARLISLE, PA 17013
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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 is due by:
3/11/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
:,-~/
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: G P Q -tv' I G e-
R.
Hoc r-e-
Date of Death:
:? - 11- C}:?
Estate No.: J..DD:S - Oo:r 73
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 0 No .ISl
2. Ifthe answer is No, state when the personal representative reasonably believes that
the administration will be complete: uJa " -h il J ~/J (' t"1:! tb r Vl e-<l}
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 0
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 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: ;,'1-.)- o~
~h GlAIDu
Signature
h
1)
:LP j! ~~-
~ha 0-011
Name
(y
P <2. ; ,.... c... e--
S-Z,? 7
Address
S~G\AI.u'V1 Pk Dt.
1.(3017
OJbl'l.{,c)H
(6/'-1) 76Y /9;io
Telephone No.
Capacity: I1lPersonal Representative
o Counsel for personal representative
~1
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/21/2006
PEIRCE SHARON M
5337 SHANNON PARK DRIVE
DUBLIN, OR 43017
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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:
3/11/2006
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,
~V~~~J~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~=t:
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/20/2007
BROUJOS JOHN
4 NORTH HANOVER STREET
CARLISLE, PA 17013
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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:
3/11/2007
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.
s.~erelY~~. '.
,9~~
",,'0' ~l
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/20/2007
PEIRCE SHARON M
5337 SHANNON PARK DRIVE
DUBLIN, OH 43017
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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:
3/11/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
q)
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Name of Decedent: {3..e. a.--+r I'G ("'_
Date of Death: 3/1} } 0.)
R H/)/J rt'"~
File Number: J.-OD3 - CJO.? 7.1
Pursuant to Pa. O.C. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. DYes ~o
2. If the answeris 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? . . . . . .. 0 Yes 0 No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. DYes ONo
d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this report.
Date
J/5")07
-A~ /-t.
Signature of Person Filing this Form
..f].-l ./}',~
Capacity: DPersonal Representative DCounsel
s~ce.rlO"14 H. Pe..,'rGe.-
Name of Person Filing this Form
,(" 337 IS ~& ~ 1I1c1 H Pad' l {) f.
Address
Llu b L "'. D H ~,? LJ 17 - J CJo 7
.
(&It.f) 7ftJ'-f-Jcr?D
Telephone
8 J ::~ ;.!d
,_
L
I ~. 7
n.""
FormRW-IO rev. 10,13.06
\
eN-
\4
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF Cumber/an d COUNTY, PENNSYLVANIA
Name of Decedent: 1? e..a-t r j 1': e.
Date of Death: ,0/ / 1/ ~ tJO,-;:;
/?t /vt;() r ~
File Number: ~ J - tJ3 -/Je'::? ~'L":;3
Pursuant to Pa.O.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . ., DYes ~No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
LlJ 11-), ; /1 '-<:? ;)( ~) ffJ CJ rr!-:J16
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . .. DYes ONo
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? ................................ DYes ONo
Date
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
. filed with the Clerk of the Orphans' Court, d may ~ed to this report.
)jt:1r~h--2J~(}O~ ,~
. aturt of Person Filing this orm
,---)
Capacity: OPersonal Representative
. I
Lr)
0'")
I
c,::
c!_,~
~~
-=-
0"'
(:)
A~;;!.:;f1_::;~/g
Telephone
Form RW-IO rev. 10.13.06
c
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/11/2008
BROUJOS JOHN
4 NORTH HA}JOVER STREET
CARLISLE, PA 17013
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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.
A:3 per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
J~ly I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Hills a Status Report of completed or uncompleted administration.
This filing 18 due by:
3/11/2008
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 - Register Of Wills
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
Date: 2/11/2008
PEIRCE SHARON M
5337 SHANNON PARK DRIVE
DUBLINI OH 43017
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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 I NO. 103
SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July 11 19921 the personal representative or his counsell 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:
3/11/2008
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report I please disregard
this notice.
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
STATUS REPORT UNDER RULE 6.12
Name of Decedent: BEATRICE R. MOORE
Date of Death: 3/11/2003
Will No.
Admin. No. 21-03-0373
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 X
2 . If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: Within six (6) months
3. If the answer to No. 1 is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
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 t.\\. ~ri , r7
Date ~.2 I ( nR- ~~~> ~
'- " ... ~ 1
Signatu~/
"'.
JOHN H. BROUJOS
Name (Please type or print)
4 North Hanover Street
Carlisle PA 17013
Address
( 717 ) 2434574
Tel. No.
Capacity:
Personal Representative
'-', '\-\<r -:- ~i~;!. JJ
,...I,.'iduU
')1,;"""':)'
ilL..:J I'
X
Counsel for personal
representative
Z[;:IJH~ ZI
\ ''', I
d ~,.;,.;
r);
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 2/17/2009
~a
BROUJOS JOHN {~ ~~ ---~
:x~ --~ _'
4 NORTH HANOVER STREET ,_, t-? ~_~ ~`
~.,, `-
C.ARLISLE, PA 17013 -_ ~~ ,. F
r~~ --~
_.~.
-=-~ _.
a _
-- r:a
c~
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
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.
A:~ 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
l2) 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: 3/11/2009
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 - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 2/17/2009
n
PEIRCE SHARON M r-0 ~ -'
,..
:-) -r~ - ,-'~t
`~ ~~ i
5337 SHANNON PARK DRIVE _~T - _
DUBLIN, OH 43017 '="~ -~ _
- ~. _ --
i -~ +:;~ i
~~ :. -
C7
RE: Estate of MOORS BEATRICE R
File Number: 2003-00373
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.
A~; per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103
SUPREME COURT RULES DOCKET N0. 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: 3/11/2009
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,
~`~
r '.
~^~- `~ k~.4~,ca,~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
L%
6e12 S'I'~~~TS ~®~~
~a. ®.C. R~~e
' ~~N~ COUNTY, PE~~SYLVANI~
REGISTER OF WILLS OF ~•-`~M~L
_ ~, /~i/Gc~/ZC'
Name of Decedent: ,~EA ~~ _~
File Number: ~fJ0..3 " C> ~`~ 73
Date of Death:
~ -t tha f~ll~.znna a ith r?cper.t to r.nmpletion of the administration Of
D llrsl,t alLt tv Pa. v.
the above-captioned estate:
... ° []Yes o
1. State whether administration of the estate is complete:... • • ° • • • ° ' ° ~ ' ' °
ersonal representative
If the answei is No, state when the p ~ t ~~
reasonably believes that the administration will be complete: l n ~ ~ ~ ~ ~` ~vr
;. If the answer to No. 1 is YES, state the following: ONo
resentative file a final account with the Court? ° • • • • • • (Yes
a. Did the personal rep
bans' Court No. (if any) for the personal
b. The separate Orp
representative's account is:
---.-
. Yes ^No
c. Did the personal representative state an account
informally to the parties in interest? • • • ' ' ' ~ ° ~ 'formal accounts may be
ies of receipts, releases, joinders and approvals of formal or rn re ort.
d. Cop bans' Court and~ay be attached tarp
filed with the Clerlc of the Orp ` ,~„ ` \ ~~
k _ -..
,.
Dnte
~`
-~
tt~ c~_.
~
N ,
~ L:_` i,
t3- r.• ~ ,
~! ,
Us •~
~ -
•
o f p so ilu this Forn2
Representative []Counsel
v ~ `%~t
Nmne of Pe~rso/n Ftlu,g this Fot m V ~ JT
// ~ /V~ ~
Address / 703
~~~~~ -~y~-ys~
Telephone
Font R b1~-10 re». l0 H.O~
R~CISTEP, OF WILLS OF ~ im /~,or I ~ l1 COU`'vTY, PENNSYLtiANIA
Name of Decedent:~Q rl ~ °~-r~' ~D-Q~~ ~- -
File Number: ~~~ ~-~~~~~
Date o: Death:
~ ~ T ~,+ t1yP f.~,ll,~~zri»a with recrzPra to ('nmrlP.ii(lt1 Qf the adll1ir11.>tratlOIl Of
P ILL JII alll lV 1 µ• V •~'• D ~ii'v v. l., L iep ~ ~
the above-captioned estate:
.... ~ YeS ~ No
1. State vrhetl~er administration of tlr~ estate is complete :... . ........ .. .
2. If the aiiswei is No, state when the personal representative
reasonably believes that the administration will be complete:
~- f
3. If the answer to I~,To. 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 - []yes LINO
..........
..........
informally to the parties in interest. .... • • - ~ •
d. Copies of receipts, releases, joinders and approvals of foam h d to this ieportounts may be
filed with the Clerlc of the Orphans' Court anc~~rn~Y be~,t~a~ ^
l ~~
I D
~ ~,.. ~-~~.-.- -
pole /~ D
~
~ fe /1 / Si,;nan~re rson Filing this Form
Capacity: ~ Personal Representative ~Counse]
e:._
i.3 ~ t~'>
lh
~
v
uJ , t'7 ~
~~ Nome of Person Filing dais Fm~nc
._,
~. ~
s
~Qr~ e
i_:: ._
i
-
r"
' ~ C~U~
.
_
_
t , ,~ r";
~'
~
`~ ~ Address
C'ar ~~ ~e /~
1
~ / //~ Or ~J~/~i
~~' `~= ca
t':,.,_ O (,~ Telephone
-
N '
na county ~ ~~~~st~°r
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 2/18/2011
BROUJOS JOHN
78 E RIDGE STREET
CARLISLE, PA 17013
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
Dear Sir/Madam:
This notice is to serve as a reminder that the Status
Personal Representative under Rule 6.12 is due on the
date.
~L~~
r~'Y v,""' ¢~~~.~
20'(1 r~EB 18 PM 1 ~ 43
CLERK OF
QRPHAN'S COURT
~UMRFRLr~,j~l CO., PA.
I
I
~qrt by
LcDw listed
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT R~~S, NO. 103
SUPREME COURT RULES DOCKET N0. 1, for decedents dying o or after
July 1, 1992, the personal representative or his counsel, ',within two
(2) years of the decedent's death, shall file with the egister of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 3/11/2011
Please feel free to contact this office with any questio s you may
have. If you have already filed your Status Report, please disregard
this notice.
S'ncerely~
L.iL~L/J
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
~-- z.~erlana ~~uncy xe+g~~~~r ~~-wxl.~~- ...~,r r T__
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
A~'C~RD FACE
Date: 2/18/2011
PEIRCE SHARON M
5337 SHANNON PARK DRIVE
DUBLIN, OH 43017
RE: Estate of MOORE BEATRICE R
File Number: 2003-00373
Dear Sir/Madam:
2f 1 FHB' { 8 Pt9 1 ~ ~+~
C RK OF
ORPN 'S COURT"
CU'~"R~ ~I ;~,~i~7 CO., PA
II
~~
This notice is to serve as a reminder that the Status Re art by
Personal Representative under Rule 6.12 is due on the be aw listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT R nS, N0. 103
SUPREME COURT RULES DOCKET N0. 1, for decedents dying on ar after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the R glister of
Wills a Status Report of completed or uncompleted admini tration.
This filing is due by: 3/11/2011
Please feel free to contact this office with any questio~s you may
have. If you have already filed your Status Report, ple se disregard
this notice.
Sincerely,
~.:~~?~ttaCJJ
Glenda Farner Str~s~baug~
Clerk of the Orph ns' Court
cc: File
Counsel
In Re: Estate of
MOORE BEATRICE R
ORPHANS' COURT DIVISION
COURT OF COMMON PLE,~S OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2003-00373
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: PEIRCE SHARON M
Counsel for Personal Representative: BROUJOS JOHN
Date of Decedent's Death: 3/11/2003
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given that you have ten (10) days to file the Status Report. If
the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notii:ied of such
delinquency and the undersigned will request that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
~'`, ~~
Date: 4/26/2011 ~ ~~`~~~}~,~- v,,.:~s•/~"Y,~Si'''C.. ;'~:I c~d7~~, ~ , ~ 4„-, ' ,„
,,
Glenda Farner Strasbaugh ~ .
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
i~ ... ~Z L~ r...._,
r.v., ~+1 `~ K-:.,
.. - C4~ ~
Li-- ,_ ( 7
1~~- ...
ORPHANS' COURT DIVISION
COURT OF COMMON PLI?AS OF
In Re: Estate of CUMBERLAND COUNTY
MOORE BEATRICE R PENNSYLVANIA
NO. 2003-00373
NOTICE OF FAILURE TO FILE STATUS REPORT'
~_
~ G• :~
ice; -
LY
Personal Representative: PEIRCE SHARON M
Counsel for Personal Representative: BROUJOS JOHN
Date of Decedent's Death: 3/11/2003
The Orphans' Court record indicates that neither the above named personal representative nor the above
named counsel for the personal representative have filed with the Register of Wills oar Clerk of the Orphans'
Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the
requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given that you have ten
(10) days to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court
will be notified of such delinquency and the undersigned will request that a Court conduct a hearing to
determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the
delinquent personal representative.
~:~~ ~
~s~ ~ ~
Date: 4/26/2011
Glenda Farner Strasbaugh k
Clerk of the Orphans' Court
Distribution: Personal Representative
-> Counsel for Personal Representative
~~" ~ Estate File
...~`;
.~ ~ ~-.
~....._ ~,~~,C CJ .~'
_7 ~-
r.,r J =~
'
1_° ~ ~'.
- ._ ~.~
...
~~
~~~
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Name of Decedent: Beatrice R. Moore
Date of Death: 3/11/2003
File Number: 2003-00373
Pursuant to Pa. O.C. Rule 6.12, 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:
Within 6 months
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_ ~~v~
Signature of Person Filing this Form
'~ Capacity: ®Personal Representative Counsel
~,~~ ~~ Q
t i ! -.~ ~+ tea- Sean M. Shultz Esquire
~"~ '~~~ ~ r' Name o P '
~ .~__ - ^~; ~ Q ~~ f erson Filing this Form
~~ ~ ~,~~ Law Office of Sean M. Shultz, P.C.
Address
c~- 4~~`' ~ c.~ 4 Irvine Row, Carlisle, PA 17013
r~ ~ tr~ :~
~..~ u~
~,~ °L ~~ ~ (717) 701-8412
~ a Telephone
Form RW-10 rev. 10.13.06
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF Cumberland
Name of Decedent: Beatrice R. Moore
Date of Death: 3/11/2003
Pursuant to Pa. O.C. Rule 6.12, 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.
09/6/2011 ~~~._ ---
Signature of Persott Filing this Form
~ ''
O ~-~ ._... .
~,'. = ~
~ ~; .
_.>
___ .. '..,51.. ~ V
tt!
rw --' `~
U ~, ;
_
_~
~
COUNTY, PENNSYLVANIA
File Number: 2003-00373
Capacity: ®Personal Representative ~~Counsel
Sean M. Shultz, Esquire
Name of Person Filing this Form
Law Office of Sean M. Shultz, P.C._
Address
4 Irvine Row, Carlisle, PA 17013
717-701-8412
Telephone
Form RW-10 rev. 1013.06