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HomeMy WebLinkAbout03-0461Estate of also known as Social Security No. 202-20-145~ Deceased. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor in the last wilt of the above decedent, dated October 23 and codicil(s) dated August 9, 1999 PETITION FOR PROBATE and GRANT OF LETTERS s. Koons No. - 05- q To: Register of Wills for the County of Cu~berlfind Commonwealth of Pennsylvania in the , 19~]ned (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cm~herland County, Pennsylvania, with er ..last fa~nily or_principol residence at Green R_idge Vil 1 age, 210 Big Spring Avenue, West rennsooro xownsnxp (list street, number and muncipality) Decendent, then 92 years of age, died 14arch 13 ,1~ 2003 at C. rm~n Ridgm Village. 210 Big Spring Avenue, Newville, PA 17241 ' Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: 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 in County Value of real estate in Pennsylvania situated as follows: $ 1,500.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) Richard L. Webber, t/l~..~ ~9,~?..~ 126 East King Street Shippensburg. PA 17257 OATH OF'PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF cmm~ j~ 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 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 befqre me this ~'~ day of ~ 'O-~'j~.Ot~_Register Estate Of ~_ary s. Koons , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW x~.]l.lA~_ ~ ~1~_ 2003., in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 23, 1992 and August 9, 1999 described therein be admitted to probate and filed of record as the last will of lqary S. Koons and Letters Testamentary are hereby granted to Rivhnrd l._ ~lohhor: Ir_ Q~',c[L FEES Probate, Letters, Etc .......... Short Certificates( ) .......... TOTAL Filed . ~.Z ~r.O~ ...................... ( Register of Wills Richard L. W Esq. ATTORNEY(Sup. Ct.I.D. No.) 126 F~st'King Street ShipPensburg, PA 17257 ADDRESS 717-532-7388 PHONE his is to certify that the information here given is correctly copied fi'om an original certificate of death duly flied 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 9190397 No. ~ Local Registrar &*,~ ~~~ .AR 15 2003 ~ Date mos.;,~l nw. zm? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH I, Sharp Koons ~emale J ' 202 20 .... ] ' '~ v~. : ~ : ~ q Newville PA I,~ ~ ~ ~ ~' [ ' I ; I,, l,- I~ I~ ~::::::~ ~ ~,,'~ zlU Blg Sprlng Rd ~TU~ ,?,.m,. o~ ~ ,z,.~.~ West Pennsboro ,.. . Charles Sharp Koons Della -- Elizabeth A McElw=4~ ~ ..... ~__= uarixsie ~Q. Newvzlle PA 17241 ,,~ u ~ ~l ~/14/2003 [-~'~ng~r ~'uneral HomeI HR; ~ springs ~ I~~ I ~/ I~%~ I''"'~'~' I~'~ I~"~'~0. I~' I~ ~ ~-- ~1 I I /I I~ ~ ".~,~.- QI I I~ 0 ~0 I I I ~ .,~ ,, ~. ,~ . - ~ .......... . ............ -., ........................................ = ,,,.~ o//o s e ~ ·-..~ ~-,..~o.o... i~5~~'~~0 LAST WILL AND TESTAMENT I, MARY S. KOONS, of South Middleton Township, Cumberland County, Pennsylvania, revoke my prior wills and declare this to be my last will: FIRST: - I direct that funeral be paid from my done. the expenses of my last illness and estate as soon as may conveniently be .SECOND: - I give, devise and bequeath all the rest, residue and remainder of my estate as follows: One-third to SHIPPENSBURG UNIVERSITY SCHOLARSHIP FUND CLASS OF 1933. One-third to CHILDREN'S SPECIALIZED HOSPITAL of Mountainside, New Jersey. One-third Hershey, purposes. to MILTON S. Pennsylvania, HERSHEY MEDICAL CENTER, to be used for research THIRD: - To the greatest extent permitted by law, before actual payment to a beneficiary, no interest in income or principal shall be (i) assignable to a beneficiary or (ii) available to anyone having a claim against a beneficiary. FOURTH: - Ail federal, estate and other death taxes payable on the property forming my gross estate, whether or not it passes under this will, shall be paid out of the principal of my probate estate Oust as if they were my debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which I have a general power of appointment for federal estate tax purposes. FIFTH: - I authorize my Executor, as follows: A. Retain/Invest: To retain and to invest in all forms of real estate and personal property, including common trust funds, mutual funds and money market deposit accounts and certificates of deposit, regardless of any limitations imposed by law on investments by executors or any principle of law concerning investment diversification; PAGE 1 B. Compromise: To compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value; C0 Borrow: To borrow from and to sell property to my beneficiaries or others, and to pledge property as security for repayment of any funds borrowed; D. Sell/Lease: To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property and to give options for sales or leases; E. Capital Changes: To join in any reorganization, voting-trust plan or other action of security holders, and to discretionary duties with respect thereto; merger, concerted delegate F. Distribute: To distribute in kind and to allocate specific assets among the beneficiaries (including any custodian hereunder) in such proportions as my trustee may think best, so long as the total market value of any beneficiary's share is not affected by such allocation. These authorities shall extend to all property at any time held by my Executor or my Trustee and shall continue in full force until the actual distribution of all such property. Ail powers, authorities and discretion granted by this will shall be in addition to those granted by law and shall be exercisable without court authorization. SIXTH: - I appoint GUY EDWARD McELWAIN, Executor of my Will. In the event of the death, resignation, renunciation or inability of GUY EDWARD McELWAIN to act as Executor, I appoint WAYNE WOOD, Executor of this, my Will. Neither my Executor, nor any successor shall be required to give bond. IN W%TNESS WHEREOF, I have hereunto set my hand and seal this ~'~ day of October, 1992. K~ons, TEstatrix (SEAL) PAGE 2 In our presence, the above-named Testatrix signed this and declared it to be her Will, and now, at her request and in her presence and in the presence of each other, we sign as witnesses: STATE OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : I, Mary S. Koons, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Will, and that I signed it as my free and voluntary act for the purposes therein expressed. We, having been duly qualified according to law, depose and say that we were present and saw Mary S. Koons, sign the foregoing instrument as her Will; that she signed it as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing and at her request signed the Will as witnesses; and that to the best of our knowledge she was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Subscribed, sworn to or affirmed, and acknowledged before me by the above-named Testatrix and by the witnesses whose names ~appear opposite on this ~ day of October, 1992. Notary Public Notarial Seal _, .Richard L. Webber, Jr., Notary Public ~,n, lpf:~ nsburg Boro, Cumberland County ~v~y L;ommission Expires Dec. 20, 1993 PAGE 3 FIRST CODICIL TO LAST WILL AND TESTAMENT OF MARY S. KOONS I, MARY S. KOONS, of West Pennsboro Township, Cumberland County, Pennsylvania, being of sound and mind, memory, and disposition, declare this to be a First Codicil to my Last Will and Testament dated October 23, 1992. ITEM I: I hereby revoke Paragraph SIXTH of my Last Will and Testament dated October 23, 1992. I hereby insert the following in its place: "SIXTH.. EXECUTOR - I appoint RICHARD L. WEBBER, JR., ESQUIRE, as Executor of my Will. If he is unable to serve as Executor, I then appoint ALLEN A. McELWAiN, as Executor. Neither my Executor or any successor shall be required to post bond for the faithful performance of their duties." ITEM II: I hereby republish and reaffirm my Last Will and Testament dated October 23, 1992, as herein modified, amended, and supplemented by this First Codicil as if such Last Will and Testament were set out here in full and do incorporate it by reference hereto, and do hereby republish and declare my Last Will and Testament as amended, modified and supplemented by this First Codicil as my Last Will and Testament. IN WITNESS WHEREOF, I hereunto have signed my name to this, my First Codicil to my Last Will and Testament dated October 23, 1992, consisting of TWO (2) pages, this ~"~ ~' day of ~ v-~ ~.. F/L ,1999. I MARY S. KOONS Signed by Mary S. Koons, testatrix, as a FIRST Codicil to her will dated October 23, 1992, in the presence of us, who at her request, in her presence, and the presence of each other, have signed our names as witnesses. Witnes. s/'~ Witness ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : We, MARY S. KOONS, the testatrix in and the undersigned witnesses to the First Codicil, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law, do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed the instrument as a First Codicil to my will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her First Codicil, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the First Codicil as witness and that to the best of our knowledge that testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. MARY S. KOONS Witness /! ' Witness Sworn to or affirmed and subscribed before me this ~'~'A. day of ~'tx ~r~ ,1999. Notary Public Notarial Seal r Vicki L. Hopkins, Notary Public West Pennsboro Twp. Cumberland County My Corem 8sion Expires Jan. 15, 2000 M tuber Pennsylvat~a Aasoc~aborl of N'otaiie~ 2 IN RE: MARY S. KOONS, LATE OF TOWNSHIP OF WEST PENNSBORO, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : ESTATE NUMBER 21-03-0461 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Mary S. Koons Date of Death: March 13, 2003 Will No. 21-03-0461 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 18, 2003: Penn State Hershey Medical Center Jim H. Brucker, Dir. Of Development And Alumni Relations Office Administration Development A120 PO Box 852 Hershey, PA 17033 Children's Specialized Hospital Phillip Salerno, Executive Director 150 New Providence Road Mountainside, New Jersey 07092 Shippensburg University Foundation Attn: John Clinton 1871 Old Main Drive Shippensburg, PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Signature Name: Address: Telephone: Capacity: Date: Richard L. Webber, Jr., Esquire Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 (717) 532-7388 Personal Representative X Counsel for Personal Representative REV-1500 ,~v-~5oo Ex COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21-- 03 COUNTY CODE YEAR LU ~]1. Original Return [~4. Limited Estate [~]6. Decedent Died Testate (Attach copy of Will) [~9. Litigation Proceeds Received NAME Richard L. Webber, Jr., Esquire FIRM NAME (IfApplicable) W~igl~ & Associates, P.C. TELEPHONE NUMBER (717) 532-7388 ~]2. Supplemental Return r--] 4a. Future Interest Compromise (date of death after 12-12-82) [~]7. Decedent Maintained a Living Trust (Attach copy of Trust) [~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) -----' ' .... COMPLETE MAILir~ ADD'F~ESS 126 East King Shippensburg, ~_._~ 3. Remainder Return (date of death prior to 12-13-82) ~_._~ 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [~] 11. Election to tax under Sec. 9113(A) (Attach Sch O) Street PA 17257 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 3928 o 77 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 2751,50 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 9547.92 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) OFFICIAL USE ONLY 3928.77 12,299.42 (8,370.54) (8,370.65) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) 16. Amount of Line 14 taxable at lineal rate x .0 __ (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) 0oO0 I- z LLI C~ Z 0 LU 0 LU CJ' ~. rn 0 0 4 6 1 NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z Koons, Mary S. 202 - 20 - 1454 t't DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE O 3-13-03 11-15~10 REGISTER OF WILLS LLI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A -- -- Decedent's Complete Address: STREET ADDRESS 210 Big Spring Road CITY Newville STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income 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 al,~,nformation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING R~RN D~Te~../ "~.~' ~.-v~ / Richard L. Webber, Jr., Executor /5~-~o ADDRESS 126 East King Street, Shippensburg, PA 17257 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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. REV-1508 EX+ (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Type FILE NUMBER Mary S. Koons (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) 21-03-00461 iTEM NUMBER me DESCRIPTION Farmers National Bank checking Account # 182036 Presbyterian Homes, Inc. ~ Escrow account balance TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH 3778.45 150.32 S 3928.77 (Attach additional 8¥2" x 11" sheets if mare space is needed.) REV-1511 EX+ (7~88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF FILE NUMBER Mary S. Koons 21-03-00461 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses: Bo C. 2. 3. 4. 5. 6. 7. 8. Administrative Costs: Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid Attorney Fees Weigle & Associates, P.C. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State __ Zip Code Probate ~es Cumberland County Register of Wills Miscellaneous Expenses: Cumberland Law Journal ~ legal advertisement The Valley Times-Star - legal advertisement Allen McElwain - Preparation of 2002 income tax returns Cumberland County Register of Wills - filing fee for inheritam tax return Cumberland County Register of Wills - reserve for filing of First and Final Accounting 2250.00 60.50 75.00 56.00 150.00 10.00 150.00 TOTAL (Also enter on line 9, Recapitulation) $ 2751.50 (If mere space is needed, insert additional sheets of same size.) REV-1512 EX+ (1-93) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Please Print or Type ESTATE OF FILE NUMBER Mary S. Koons 21-03-00461 ITEM NUMBER DESCRIPTION AMOUNT 1. Swaim Health Center Commonwealth of Pennsylvania - Department of Public Welfare Estate Recovery Program 4220.81 5327.11 TOTAL (Also enter on llne 10, Recapitulation) $ 9547.92 (If more space is needed, insert additional sheets of same size.) COMMONWEALTH OF P~NNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Mary S. Koons 21-03-00461 ITEM AMOUNT OR NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP SHARE OF ESTATE A. Taxable Bequests: 1. ITEM AMOUNT OR NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE Be B. Charitableand GovernmentalBequests: Shippensburg University Scholarship Fund~Class of 1933 c/o Shippensburg University Foundation 1871 Old Main Drive Shippensburg, PA 17257 Children's Specialized Hospital Phillip Salverno, Executive Director 150 New Providence Road Mountainside, New Jersey 07092 Milton S. Hershey Medical Center c/o Office of Planned Giving and Endowments The Pennsylvania State University 102 Old Main University Park, PA 16802 One-third (1/3) of residue One-third (1/3) of residue One-third (1/3) of residue TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of same size) ADAMS COUNTY NATIONAL BANK & -- FARMERS NATIONAL BANK OF NEWVILLE A Division of Adalns County National Bank CHECKING STATEMENT Statement Date: 07/07/03 Account #: 182036 Enclosures: I 801 MARY S KOONS 9 CARLISLE ROAD NEVVVILLE PA 17241 Page 1 Internet Banking at www.acnb.com. Banking that fits your schedule... 24 hours a day, 7 days a week! check account balances, transfer funds, pay bills...and more! stop by one of our offices or click on the Web site for a demo. ESTEEM CHECKING Account Summary Account # 182036 Previous Statement Balance + Deposits and Other Credits - Checks Paid or Other Debits - Service Charges + Interest Paid Ending Balance Days in Statement Period Account Detail 06108/03 1 29 Beginning Balance $3,776.26 Activity Ending Balance .00 3,778.45- .00- 2.19 $.00 Date 06-30 06-30 07-07 Activity Description BEGINNING BALANCE INTEREST PAYMENT CLOSING TRANSACTION ENDING BALANCE Interest Sun~n~ary from 06~08~03 to 07~07~03 Days in Period Interest Earned Annual Percentage Yield Earned Interest Paid This Year Interest Withheld This Year END OF STATEMENT Deposits/Credits Checks/Debits 2.19 3,778.45 29 $2.19 .97% $21.27 $.0o Balance 3,776.26 3,778.45 .00 .00 P.O. Box 3129, Gettysburg, PA 17325 · 888/334-ACNB (2262) www. acnb.corn PRESBYTERIAN HOMES, INC. 8/08/2003 No. 2148 8/06/2003 RT72588. Refund to Estate 150.32 0.00 150.32 CHECK AMOUNT: i50~32 · ~'/~ · . /~.~i" .ToTALs "i'~. 150'32 ' 0~00 ~ 15'0¥32 THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAl. WATERMARK--HOLD AT AN ANGL ,"00081, h8," ':0 5&O ?& ~. 50,:& ;,O00 7 7[, 58,. SWAIM HEALTH CENTER 210 BIG SPRING ROAD NEWVlLLE PA 17241-9486 (717) 776-8256 ACCOUNTS RECEIVABLE STATEMENT Statement Date: 11/30/2003 Presbyterian ¢lome s , Inc. Balance Due: 4,220.81 MARY KOONS cio RICHARD L WEBBER ATTN 126 E KING ST SHIPPENSBURG PA 17257 Account Number: 60633 Balance Forward: 4,220.81 check includes a donation to GRV of $. to be used for the GRV fund or SWAIM HEALTH CENTER: MARY KOONS 60633 WEIGLE & ASSOCIATES PC RICHARD L WEBBER JR ESQUIRE 126 EAST KING ST SHIPPENSBURG PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 April 09, 2003 Re: M3%RY KOONS CIS #: 360157242 SSN: 202-20-1454 Date of Death: 03/13/2003 Dear Attorney Webber: Please be advised that the Department of Public Welfare maintains a claim in the amount of $5,327.11 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $2,411.46, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $2,915.65, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, Edna L. Guido Claims Investigation Agent 717-772-6614 717-705-8150 FAX Enclosure BUREAU OF INDIVIDUAL TAXES TNHERXTANCE TAX DXVTSTON DEPT. 180601 HARRISBURG, PA 1711&-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15q? EX AFP RICHARD L WEBBER JR ESQ WEIGLE B ASSOCS 126 E KING ST SHIPPENSBURG '04 FEB 27 PA 17L:'~'~l¥~bei'i&f~O CO., PA ,,¢ ('2~ DATE O2-2q-Z00q Wills ESTATE OF KOON5 DATE OF DEATH FILE NUMBER 21 03-0q61 P1:01cOUNTY CUMBERLAND ACN 101 Amount MARY S MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KOONS MARY S FILE NO. 21 03-0q61 ACM 101 DATE 02-2q-200q TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule B) (2) 3. Closely Held Stock/PartnarshAp Interest (Schedule C) (3) q. Mortgages/Notes Rmca/vabla (Schedule D) (q) 5. Cash/Bank DeposAts/Misc. Personal Property (Schedule E) ($) 6. JoAntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Ada. Costs/MAsc. Expanses (Schedule H) (9) 10. Debts/Mortgage LiabilAtAas/Lians (Schedule I) (10) 11. Total DaductAons 12. Net Value of Tax Re~urn 3/928.77 .00 NOTE: To insure proper .00 credit to your account, .00 submAt the upper portion .00 of thAs fora HAth your tax payment. .00 .00 (8) 2,751.50 13. lq. NOTE: 3,928.77 9,5q7.92 (11) ]2.29g ~2 (za) 8,570.5q- Char/table/Governmental Bequests; Non-alec*ad 9115 Trusts (Schedule J) (1:3) Nat Value of Estate Subject to Tax (lq) Tf an assess, ent was issued prev/ously, 11nes 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 8,370.65- ASSESSMENT OF TAX: 16. Amount of LAne lq at Spousal ra*a 16. Aaount of Line 1~ taxable at LAnaal/Class A rate 17. Aaount of Line 1~ et SiblAng rata 18. Aaount of LAne lq taxable et Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DZ$COUNT DATE NUMBER INTEREST/PEN PAID (-) IF PAID AFTER DATE ZNDZCATED~ SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. 18 and 19 w111 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( XF TOTAL DUE IS LESS THAN $1, NO PAYMENT XS REQUIRED. AMOUNT pA'rD (1.6) .00 X O0 : .00 (26), .00 X Oq5= .00 (17), .00 x 12 = . O0 (18) .00 x 15 : .00 (19)= . O0 RESERVATION: Estates of decedents dying on or before December 12, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after tho expiration of any estate for life ar for years, the CoamonHealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateraI) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADmIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (71 P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF N/ELS, AGENT A refund of a tax credit, mhich ams not requested on the Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the ZS Revenue District Offices, or by calling the special Z4-hour ansaerin9 service for forms ordering: 1-800-362-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-~7-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalloaance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object aithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBiOZ1, 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 be addressed in mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviem Unit, Dept. 280601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for e Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid aithin three (S) calendar months after the dacedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .O0016q. AIl taxes which became delinquent on and after January l, 1982 mill bear interest at a rate ehich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 201 .OOOSq8 1987 91 .OOOZ~7 1999 72 .000192 198S 16Z .000~38 1988-1991 111 .000301 ZOO0 82 .000119 198q llZ .000301 1992 9Z .O00Zq7 2001 91 .O00Zq7 1985 13Z .000356 1993-199q 7Z .000191 ZOOZ 6Z .OOOl6~ 1986 lOX .OOOZTq 1995-1998 92 .OOOZq7 2003 52 .0001~7 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2005 WEBBER RICHARD L JR ESQ 126 EAST KING STREET SHIPPENSBURG, PA 17257 RE: Estate of KOONS MARY S File Number: 2003-00461 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: 3/13/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~ GLENDA FARNE~~~H REGISTER OF WILLS cc: File Counsel Judge p ci' , Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Hary S. Koons Estate Date of Death: March 13 . 2003 Estate No.: 21-03-00461 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 .I!J. 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Hay 15, 2005 3. lfthe 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 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: 2-21-05 (?:,/ 4~/~ Signature -- L{'') c-,; Richard L. Webber, Jr., Esquire Name 126 East King Street Shippensburg, PA 17257 Address (717) 532-7388 Telephone No. Capacity: 0 Personal Representative rn Counsel for personal representative vA Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2006 WEBBER RICHARD L JR 126 EAST KING STREET SHIPPENSBURG, PA 17257 RE: Estate of KOONS MARY S File Number: 2003-00461 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. 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: 3/13/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, .~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) JUdge ~ ?~~...~ I~f ~ v\ ~.J '~f ~ Re~is~(er of"V"llRls 0f CTULlll1beiL"~ajJ.ld COlllill~i "-'" STATUS REPORT lJl'JTIER RULE 6.12 l'[ alne c f Decedent: Mary S. Koons Date o"Death: 3/13/03 E - 2003 - 00461 state )>~o.: I) Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules) I repurt the following with respect to completion oithe administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes n No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: May 30" 2006 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final accoiuitwith 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 pa.."i.ies in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval offonnal or informal , accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ,!.t' ~u ,l-0L~ Signature / Richard L. Webber. Jr. E~qllire Name Weigle & Associates" p.e. 126 East King Street Date: 2/6/06 .A..ddress Shippensburg, PA 17257 (717) 532-7388 Telephone 'f\.To. ~!'l:! I' (. Ca.pa.city": ~ Petso~al Represen:2.ti"/e o COi..l.:."1sel for personal representative 02: Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/20/2007 WEBBER JR RICHARD L WEIGLE & ASSOCIATES PC 126 E KING STREET SHIPPENSBURG, PA 17257-1397 RE: Estate of KOONS MARY S File Number: 2003-00461 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' COUR.T 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: 3/13/2007 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 Personal Representative(s) ~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF r.llmhpTl~nil COUNTY, PENNSYLVANIA Name of Decedent: Mary S. Koons Date of Death: March 13, 2003 File Number: 2003-00461 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: . . . . . . . . . . . . . . . . . . .. 0 Yes [i No 2. If the answeiis No, state when the personal representative reasonably believes that the administration will be complete: August 1, 2007 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 D 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 DNo 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. c.-) f." c: Dale . '.~ Ma;r;c,h~5, 2007 Signature of Person Filing this Form C"\ I Capacity: [3Personal Representative 0 Counsel r--_ Richard L. Webber, Jr., Esquire Name of Person Filing this Form Weigle & Associates, p.e. Adw~s 126 E. King Street Shippensburg. PA 17257 717-532-7388 Telephone Form RW-IO rev. 10.13.06 cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/11/2008 WEBBER JR RICHARD L WEIGLE & ASSOCIATES PC 126 E KING STREET SHIPPENSBURG, PA 17257-1397 RE: Estate of KOONS MARY S File Number: 2003-00461 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. AE3 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 lS due by: 3/13/2008 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) In Re: Estate of KOONS MARY S ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00461 NOTICE OF FAILURE TO FILE STATUS REPORT ~o ~::c cO:o ("':r""" ::0 ... J r)>r- .3:-: :z sg ..c~ <t5 ;;s.;: 0("") ob~ oc::: ~ ::0 :;p-i ~ Personal Representative: WEBBER RICHARD L JR ESQ Counsel for Personal Representative: WEBBER JR RICHARD L Date of Decedent's Death: 3/13/2003 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 by that the you have ten (10) day 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 requests 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: ~.. ~.d.~tuk~ 3/2612008 Glenda Famer Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File -0 :x ~ "f:'- (.,,) ~ <::::J a:. :boo -0 ::0 , :x]'~ r'"10 <: ') (~) ()"5 :::5 ........'..J C~i rn ...J C) o -., ~'=~ t~ f . - , ~ } (./)C> ''(1 Pa. D.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Mary S. Koons --nCifeofDeatn:---}tcircn 13, 2003 -Tile Numbei:--- ?003-0046l 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: . . . . . . . . . . . . . . . . . . .. D Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: September 1, 2008 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 DNo 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 DNo 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 J 1;-, / tJy- --l }.~~. / Signatur;;J PersOIl Filillg this Form Capacity: ~Personal Representative o Counsel Richard L. Webber, Jr., Esquire \./. . lid C.', (1 ..... ItJn9jj~:N'~Hd~~IJ ..0 ){H31Q 1 Z :ZI Wd 8- ~dV BOOl Name Qf Pe,rsol,t Filil).g tl,is Form . We1gLe ~ aSSOc1ates, P.C. 126 East King St. Address Shippensburg, PA 17257 (..- (717) 532-7388 Telephone ....: : L:. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: Estate of Mary S. Koons, O.C. No.: 21-03-0461 Deceased . CLAIM AGAINST DECEDENT'S ESTATE ~o -~ ~ ~ -~~n ~ ` ~ n m - ~ - - , . ~ r L } O - ~_7d - ''~ ~ v = ~ rn The Claimant, Green Ridge Village, certifies that there is due and owing by Mary S. Koons, Deceased, in accordance with the attached invoice, the sum of $4,220.81, together with attorney's fees and costs, accruing interest at the highest rate permissible at law, and accruing late fees for goods and services. The sum of $4,220.81 is a priority claim under 20 Pa. C.S.A. § 3392(3) for the value of nursing care and services rendered to the Decedent within (6) months of death. On behalf of the Claimant, I do solemnly declare and affirm under the penalties of perjury that the information and representations made herein are true and correct of the best of my knowledge, information and belief. Written Notice of said Claim has been given to Richard Webber, Jr., Esquire, WEIGLE & ASSOCIATES, P.C., located at 126 E. King Street, Shippensburg, PA 17257 on June 4, 2008. Respectfully submitted, SCHUTJER BOGAR LLC Claimant Information: Green Ridge Village 210 Big Spring Road Newville, PA 17241 (717) 776-3192 By: u~'7~~->ri~ ~-- Maria G. Macus-Bryan Attorney I.D. No. 90947 417 Walnut Street, 4th Floor Harrisburg, PA 17101 (717) 909-8640 Attorneys for Claimant ~" RESIDENT STATEMENT FROM GREEN RIDGE VILLAGE 210 BIG SPRING ROAD NEWVILLE, PA 17241 BUSINESS OFFICE 717-776-8256 MAIN 717-776-3192 Statemen# Date Due Data ACCOUNT NUMBE~ 04/30/2008 Upon Receipt 60633 1 AMOUNT PAID $ MARY S KOOKS c!o RICHARD L WEBBER ATTN 126 E KING ST SHIPPENSBURG, PA 17257 Comments ENJOY THE NICE SCHEDULE AN AF NT PH) 717-776-8256. Please make check payable to PHI Remit To: GREEN RIDGE VILLAGE P.O. BOX 34309 NEWARK, NJ 07189-4309 Please detach and return this portion with your remittance to the address above. 830AM-4PM, 1-3PM, PLEASE CALL Balance Forward $4,220.81 $4,220.81 TOTAL BALANCE DUE: $4,220.81 FACILITY NAME RESIDENT NAME ACCOUNT NUMBER SWAFM HEALTH CENTER MARY S KOOKS 60633 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Claim Against Decedent's Estate and Notice pursuant to 20 Pa. C.S.A. § 3384 was served via first-class, United States mail, postage pre-paid, upon the following: Richard Webber, Jr., Esquire WEIGLE & ASSOCIATES, P.C. 126 E. King Street Shippensburg, PA 17257 (Attorneys for the Estate of Mary S Koons) Dated: 6-, '~ By: Christy .Long, Paralegal Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 2/17/2009 WEBBER JR RICHARD L n f`~' .._~ WEIGLE & ASSOCIATES PC ~-C~ . _~~ ,~ 12 6 E KING STREET ~~ r`-~ c7 .T SHIPPENSBURG, PA 17257-1397 °? ~' ~``~ - r-,. N __~_ _.T I` " ~ ~ ..=- r.~ RE: Estate of KOONS MARY S o .File Number: 2003-00461 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 SLJPREME 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: 3/13/2009 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) ~a. ®.C. ~~~e 6.12 S'I+~L~'tiS P®~~' COUti"TY, PEN~iSY"L`'~NI~ REGISTER Op WILLS OF CUMBERLAND Mary S. Koons Name of Decedent: Date of Death: March 13, 2003 File Number. 2003-00461 D n „ „* +„ ~„ (~ ~' D.,lo ti 1 7 T -o ~+-+ the fclle~xJing ixrith recpe~t to r.nmpletinn of the administration of 1 U1JU(111~ LV 1 u. V•~-.'• 1\Ltly v.l~, t ivpvl~ the above-captioned estate: 1, State whether administration of the estate is complete :.................... Yes No 2. If the answei is No, state when the personal representative reasonably believes that the administration will be complete: December 31, 2009 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 separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account []Yes []No ..................... informally to the parties in interest? ......... . d. Copies of receipts, releases, joind srsCodrt apd may be attached to this reportounts maybe filed with the Clerlc of the Orphan 2/23/09 - ~ '.d~O s~, , ~ , ~,_ , '~ 5 _ Form Rbl'-1 D rev. 10-13.Oh ~~~ ~ Signature of Person Filing this Form Capacity: [Personal RepresentativeCounsel Richard L. Webber, Jr., Esquire jJame of Person Filing this Fa•m 126 East King Street Address Shippensbur PA 17257 717-532-7388 Telephone C ~r Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 _,,, ~ ._,,. ,.- ~..1~- Phone: (717) 240-6345 -- -- '~- - r ~'~ ~ ~,"i .,. ~~. _ _ ,~ Baia ~~~ ~ ~ ~r~ ~= Zs /n~ pRP!-~t~i'S}~~av~7h Date: 2/16/2010 WEBBER JR RICHARD L WEIGLE & ASSOCIATES PC 126 E KING STREET SHIPPENSBURG, PA 17257-1397 RE: Estate of KOONS MA12Y S File Number: 2003-00461 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: 3/13/2010 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, ~,-- ,t---~ /> Glenda Farne:r Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wil:1s One Courthouse Square f -,~~ ~ r Carlisle, PA 17013 _~ ; ` f(`~ ,, Phone: (717) 240-6345 {L - L,++-~ °, - '°~ 4 i r; v ?010 FE:B I ~ PM ~: 2S GLERK r~r ORF~~~.r~ COURT ~~., PA. Date: 2/16/2010 WEBBER RICHARD L JR ESQ 126 EAST KING STREET SHIPPENSBURG, PA 17257 RE: Estate of KOONS MARY S File Number: 2003-00461 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: 3/13/2010 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 Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Mary S. Koons Date of Death: 3/13/03 File Number: 2003-00461 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: September 1, 201(1 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. aou February 25, 2010 ~7 c.. C7 G' ' ~ d p~ T :_ N ~ t L ~ ~ Cf~ :~'r:.' ~ ...~ t 7 E ~ ~ _ 4.. _~ S ~., ( ( 4~Y. ~v ~~ ^ f ~= ~ v N ~~~ Signatwe ojPerson Filing this Form Capacity: Personal Representative (Counsel Richard L. Webber, Jr., Esquire Nmne ojPerson Filing this Form 126 East King Street Address Shippensburg, PA 17257 717-532-7388 Teleplane Form RW-10 rev. 10.13.06 Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Mary S. Koons Date of Death: 3/13/03 File Number: 2003-00461 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: September 1, 201(1 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. ~~ February 25, 2010 L"~ ~.w .. .. ~ C° ~ .~.~> ' ~ C~:~ _.. r f.~ v ~.. ~,, W yci ~-1 i U ~-;, ; ;~ r ~ ~.~ .-,.. G ~a ~ ~ ~. C3.. ~ ~ 4^V Signattve of Person Filing this Form Capacity: ~ Personal Representative Counsel Richard L. Webber, Jr., Esquire Name of Person Filing this Form 126 East Kind Street Address Shippensburg, PA 17257 717-532-7388 Telephone Form RW-10 rev. 10.13.06 Pa. O.C. Rafe 6.12 STATUS REPORT REGISTER OF tiVILLS OF CUMBERLAND COUNTY, PENNSYLVAIv'I A Name of Decedent: Mary s. Koons Date of Death: March 13, 2003 File Number: 2003-00461 Pursuant to Pa. O.C. Rule 6.12,1; report the folloc~~g with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :............... . . .... ~ Yes LJ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: December 31, 2011 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? .................. DYes ............. ~No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and maybe attached to this report. Drtte February 23, 2011 ~~ ~ ~ ''' ,lti ~ Signature ojPerson Filing this Form ,Q Capacity: Personal Representative [/jC u cv ounsel j ~ ": ~~ '^ Richard L. Webber, Jr., Esquire . _ ~ ~.~ Name ojPerson Filing this Form ~- ' ~.. C~~~ ~u~~ 126 East King Street y ~ ~ ~ . ~ a ~ '; Address t_ ,, ~ c n U~~ Shippensburg, PA 17257 ``~ `~ nc -- ©~ ~ (717) 532-7388 Telephone na evun~y xeg~sz~r One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 2/18/2011 WEBBER JR RICHARD L WEIGLE & ASSOCIATES PC 126 E KING STREET SHIPPENSBURG, PA 17257-1397 RE: Estate of KOONS MARY S File Number: 2003-00461 Dear Sir/Madam: ~:~~ SEC-~~~ ~;'~ ~~,~~ ~ c ~'~I! FE8' I $ P!~ t~ ~-3 ELK 0~ ©R "S C(JUR3 CUF~~~ !_~~1~ ~~., PA. This notice is to serve as a reminder that the Status Re~drt by Personal Representative under Rule 6.12 is due on the be dw listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT R nS, NO. 103 SUPREME COURT RULES DOCKET NO. 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 lister of Wills a Status Report of completed or uncompleted admini tsation. This filing is due by: 3/13/2011 Please feel free to contact this office with any questio s you may have. If you have already filed your Status Report, ple~s'~e disregard this notice. Sincerely, i ~~~ Glenda Farner Str s~baugh Clerk of the Orph~ns' Court cc: File Personal Representative(s) na ~oun~y =~ xegis~er One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 ~~!~ ~~ ~ Date: 2/18/2011 WEBBER RICHARD L JR ESQ 126 EAST KING STREET SHIPPENSBURG, PA 17257 RE: Estate of KOONS MARY S File Number: 2003-00461 Dear Sir/Madam: ~ ~ f ! FE$'~ I $ f'H i ~ ~ 3 C' ERK OF OR ~~ Cat1RT 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~law listed date. '~ As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RUES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on,ojr after July 1, 1992, the personal representative or his counsel, '.within two (2) years of the decedent's death, shall file with the R g~,ister of Wills a Status Report of completed or uncompleted admini tlration. This filing is due by: 3/13/2011 Please feel free to contact this office with any questios you may have. If you have already filed your Status Report, ple se disregard this notice. ~ Sincerely, ~• ~' ,~;~.~ Glenda Farner Strsbaugh Clerk of the Orph ns' Court cc: File Counsel Cumberland County - Register One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Of Wills ~r. ~,'_ ,aa. ~' ~ C ' e r..4~J' ~ tt;, ~ ~~ ~~ft{~ ~~ d~~~~~~ l~~t~Mr CU~~,~`3I A~~~D ~~ . PA Date: 2/15/2012 WEBBER JR RICHARD L WEIGLE & ASSOCIATES PC 126 E KING STREET SHIPPENSBURG, PA 17257-1397 RE: Estate of KOONS MARY S File Number: 2003-00461 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, N0. 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: 3/13/2012 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, s __. ._. _ ... sue,. ~ ~~:~~ 'L.(/t/;5 .,.:'.~.. `~a Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square ~f f ~ ~' , '~"~.,~,~. ~ Carlisle, PA 17013 ~ i :; ~ - ,~, ~ ~, Phone: (717} 240-6345 ~ ~ ' •~~ ~~i ~ , ~~~~~ ~~ ORFH.~N'S :~~,-A'' Date: 2/15/2012 WEBBER RICHARD L JR ESQ 126 EAST KING STREET SHIPPENSBURG, PA 17257 RE: Estate of KOONS MARY S File Number: 2003-00461 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, N0. 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: 3/13/2012 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, ,, t ~ , _ ~ °"_.'R Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Name of Decedent: Mary S Koons Date of Death: 03/13/2003 File Number. 2003-00461 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: September 1, 2012 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 Orphans' Court and may be attached to this report. vacs 02!20/2012 ::. C~ v ~ l'~ rs - Y _ ~ .,;~. G ~ ~T ~ ' N ~ `- .~ a` - r(. ~~ C~l U ~ ~' , ~ t r' ~-r- "'' O =' Cr Form RW-!0 ae~ na~~-zoos LJ 7 ~ ~'~V sgnawre ofPerson r-an~ Hrs r-o~ Capacity: ^ Personal Representative ® Counsel Richard L. Webber, Jr. Esquire Name d Person ling tlps Fam 126 East King Street navniss Shippensburg, PA 17257 ~: scans, za 71732-7388 TelepM1one ~oPY~!!M (c) 2006 form software ony The LarJoier Graiq, Inc. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 ° ~_=' ~ ~ rn Date: 2/1.4/2013 ~ ° -r n ~ WEBBER JR RICHARD L ~o ~ r ~-• ,,., ~,rt WEIGLE & ASSOCIATES PC r- :Y rn _~ ~ ~~ 126 E KING STREET ~ ~ ~ ~' ~~ SHIPPENSBURG, PA 17257-1397 ~ c~ ~' :~ ~~ `~~ µ ~~ ~; -~ rv : ~~ r., t-~t ~~ r~.~ ~ ~._ ~~~ u RE: Estate of KOONS MARY S File Number: 2003-00461 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 COTJRT 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: 3/13/2013 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~ . Sinc rely, 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: 2/7L4/2013 WEBBER RICHARD L JR ESQ c o ~_: , `~-' ~ ~ ~ ~; ~ rn 6'7 q 12 6 EAST KING STREET ~ T' m -r. ~ r ~' ~" "'~ ._,~ ~s SHIPPENSBURG PA 17257 ~ ~' r' ~"' r"~` s~ , -3 'y`"t t7 ~-` ~..7 C.': ~ C'7 ~" :~:1 N §" C'TI _i ~. , t._.. u~ ~ RE: Estate of KOONS MARY S ~ File Number: 2003-00461 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 ~'_isted date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 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: 3/13/2013 Please fee:1 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' ~^ourt cc: File Counsel Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Name of Decedent: Mary S Koons Date of Death: 03/13/2003 File Number. 2003-00461 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: November 1,2013 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 Orphans'Court and may be attached to this report. 3 '1 ( _ (13 Date Signature of Person Filing this Form `' - Capacity: ❑ Personal Representative ® Counsel `") c' c Richard L.Webber,Jr. Esquire c' Cn Name of Person Filing this Fornr i LI ' " •—+ . < 126 East King Street cr : x la. co C3 E= 1:= Address LLJ Shippensburg,PA 17257 Ca,;Slate,Zip 717-532-7388 Telephone Font R W-10 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner croup.Inc. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone : (717) 240-6345 JI-HUt Of 1i_.vl 201',FES 18 Ph 12: 4 9 ORPHAN'S LOUR T CUMEERLN D Co_'PA Date : 2/18/2014 WEBBER JR RICHARD L WEIGLE & ASSOCIATES PC 126 E KING STREET SHIPPENSBURG, PA 17257-1397 RE: Estate of KOONS MARY S File Number: 2003-00461 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: 3/13/2014 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 OC/ Lisa M. Grayson, Esq. Clerk of the Orphans ' Court S e Pa. O.C. Rule 6.12 STATUS REPORT REGISTEROF WILLS OF CUMBERLAND COUNTY,PENNSYLVANIA Name of Decedent: Mary S. Koons Date of Death: March 13, 2003 File Number: 2003-00461 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: . . . . . . . . . . . . . . . . . . . . aes Zko 2. If the answer is No,state when the personal representative reasonably believes that the administration will be complete: November 1, 2014 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . . . Des ao 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0Yes ao 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 March 7, 2014 — Signature of Person Filing this Form w tV Capacity: OersonalRepresentative E�ounsel °c `o n¢ Richard L. Webber, Jr., Esquire Name of Person Filing Jhis Form LLa ; -cc CDC) 126 East King Street GL_ p ✓JZ Address w Shippensburg, PA 17257 f a s o= (717) 532-7388 � V Telephone RW-10 Fmm RW-10 w.10.13.06 CO Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone : (717) 240-6345 rn C` Date : 2/19/2015 ; WEBBER JR RICHARD L ) ' _- ,_. r WEIGLE & ASSOCIATES PC 126 E KING STREET SHIPPENSBURG, PA 17257-1397 fi RE : Estate of KOONS MARY S File Number: 2003-00461 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: 3/13/2015 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, Lisa M. Grayson, Esq. Clerk of the Orphans ' Court Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF COUNTY, PENNSYLVANIA . Name of Decedent: Mary S Koons Date of Death: 03/13/2003 File Number. 2003-00461 Pursuant to Pa. O.C. Rule 6.12, 1 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: December 31,2015 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 Orphans'Court and may be attached to this report Date 03/06/2015 Signature ofterson Fling this Form I �^ L17 a _ Capacity: ® Personal Representative ❑ Counsel C� U� _T' C LiJ _..J e^t �••j t CJ <- Richard L Webber LI_ LL� Cl_ C) 1 Name of Person Filing this Form c/o Weigle Associates, P.C. n r= rn Lu LJ .-J c 126 East King Street C7 �' CD L.3 address C U, t= n_ CD M Shippensburg, PA 17257 mss:tee.Zp (717)532-7388 Telephone Farm RW-10 Rev.10-132006 Copyright(c)2006 form software only The Lackner Groep,Inc.