HomeMy WebLinkAbout03-0464PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as To:
Deceased.
Social Security No. I C~. "~ ' ~.2- ~)q~
Register of ~ills for the , ,
County of ~_~ct~'~ Jo~uL,~,~ in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl4 ~ for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in {~ id~ kD~' r-:L~ g3 c] Coat, y, Pennsylvai~ia, with
h~,'-- last family or principal residence at ~:~ ~'3 ].--~-.~¢--~
(list street~ nu~be~'~nd rt~/un'icipality)
at ) ~1~/~ ._,~' '/] ~/d.,) /~J:~3/ / -
Decendent at death owned property with estimated values as folllows:
(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:
after a proper search ha ascertained that decedent left no will and was survived by
Re!ationship
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
co~s~v o~ ~ ~. _~ ~ ~ d
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 affirmd '~-d subscribed c~'~-~)'2v"~~~l//~d)t~
Estate of ----J"-'~/3 C ~/q cv r-e' ,/~o~ c)~ ,Deceased
AND NOW "~'~/_/.v?/~., ~ .~,~fS~, in consideration of the petition on
the reverse side hereo/f, satisf-actory proof ho.King been presented before me
IT IS DECREED that f~P///¥-/~ ._1 I~/~:.,~'~/'.5' .~/~z;
is/are entitled to Letters o~ Administration,'and in accord with such finding~ Letters of Administration
o
OOZES
Letters of Administration ..... $
Short C~rtificates( ) .......... $
Renunciation ................ $
PHONE
RENUNCIATION
In Re Estate of
deceased.
To the Register of Wills of
County, Pennsylvania.
The undersigned c ~/i c~AAeeO of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
be issued to
WITNESS hand this day of ., 19
(Signature)
(AddresS) J
(Signature)
his 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.
'~ '~1~./ Local Registrar
No. JU NDate 9 2003
~os.;~.~ 2~s7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
,T CERTIFICATE OF DEATH
< .lu,~' L. Rhoad.{, ~',(or,~e]'. 197 -- 22 -- 2095
, 75 ~.[ : [ : [2/20/1928 Adams Count~ PA,~,~ ,~ ~ "~
mCumb~rtand ] East PennsboroTw~ /, , o _ ._ r~ -/ ,x - ~ ~"~.
,,~ aeer~r~ ' ~rm~ ~ar Co~g~ ~u ~ I ~"~~ I (,~., I m;~~ '
I". Im I,z IZ I I-. -
1..Camp HZ~ PA 17011
FAI'HER'$ IilAME (First. Mi~:l~.
Ira J. Cou~son
'"~°"~s"^~"~"'~Barry R. Rhoads
OFFICE OF PROBATE STATE Pennsylvania COUNTY Cumberland
PROBATE COURT DEPARTMENT
IN MATTER OF PROBATE
COUNTY CLERK/PROBATE
COURT NO.
NUMBER OBTAINED FROM
RESIDENT COUNTY, Cumberland
DOCKET NUMBE~~
STYLE ~ .JUL 11
ESTATE: June L. Rhoads
Deceased
SWORN STATEMENT SUPPORTING CLAIM AGAINST ESTATE
I, Tyler Jones , hereinafter called Affiant, do solemnly swear that the foregoing and attached Claim
against the above-numbered and served Estate, amounting to the sum of
Six Thousand Six Hundred Twenty Seven 811100 Dollars ($6,627.81) is a just claim, and that all legal offsets,
payments and credits known to Affiant have been allowed and that the sum herein claimed justify due. Chase Account
Number(s)
5183 3798 4012 3448
Account(s) is/am revolving, unsecured line(s) of credit.
NOTARY P~BLIC'S SIGNATURE AND SEAL
Sworn to an~] subscribed before
me on ~ ~/'~'./~'~ ~-~ _ f_ ,2003
PROOF OF SERVICE
The undersigned has this day delivered or mailed a true copy of this claim ( X by U.S. Mail or ~.by registered mail,
return receipt attached) together with a true copy of each written instrument upon which the claim is predicated to the legal
representative of the estate, Barry R. Rhoads, 81 Broadwell Lane, Mechanicsbur.q, PA 17055
Dated June ~)2003
ClaimantJAffiant
Affiant - R~)r~sentative for Chase Manhattan Bank USA, N.A.
P.O. Box 52188
Phoenix, AZ 85072-2188
(800) 352-3234
The within Claim for $
20 , and was denied / allowed on
numbered and styled Estate.
APPROVAL OR DENIAL OF CLAIM
was presented to me on
,2003 as a claim against the above-
NOTARY PUBLIC'S SIGNATURE AND SEAL
Sworn to and subscribed before
me on ,2003
Title
Name of Decedent:
Date of Death:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
!
Will No.
Admin. No. ~Z>O~ - ~:,~q/.ott~
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Omhans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on -~tf~ ~, ~ ·
·
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Telephone
Capacity: ~//Personal Representative
Counsel for personal representative
~EV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I--
Z
LU
W
LU
14.1
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
-g~ P, bs j~4E L.,
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
o(,, - o~, - 2.~o3 o¢.. - ~o
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
¢---'~ 1. Original Return
F--] 4. Limited Estate
[~6. Decedent Died Testate (Attach copy of Will)
-'--]9. Litigation Proceeds Received
OFFiCiAL USE ONt.Y
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
Iq"/ - zz - 20:/5-
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
E~supplemental Return
[~4a. Future Interest Compromise (date of death after 12-/2-82)
~]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)
] 3. Remainder Return (date of death prior to 12-13-82)
~]5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
---] 11. Election to tax under Sec. 9113(A) (Attach Sob O)
FIRM NAME CfApplicable)
TELEPHONE.NUMBED
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
--]Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(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.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
(8)
&,:2../.,.$
/_,,/_,, :~'7. o/
(11)
(12)
(13)
(14)
OFFICIAL USE ONLY
19.tBqo.gl
15.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .o_ (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)
Decedent's Complete Address:
ISTREETADDRESS
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
(1)
zip
InterestJPenalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
Total InterestJPenalty ( 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. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate 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 accompanyin9 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.
SIGNATU. RE OF~RS.,.ON RESP~)N SI~ F.F~I~N_..G .~,~T.U RN /
ADDRESS
SIGNATURE OF PREPAREFI OTHER Ti-lAN F~EPRFvS'E~TATIVE j
DATE
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even
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 paren
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 a
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
Include the proceeds of I~a~n 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
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
MEMBERS 1st
FEDERAL CREDIT UNION
st
Send Inquires to:
5000 Louise Drive Member's I
PO Box 40
I
Mechanicsburg, PA 17055 Statement
www.memberslst.org of Account
Main Switchboard: (717) §97-1161 of (800) 283-2328
Ca11-24: (717) §97-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
JUNE L RHOAD5
820 LISBURN RD APT #213
CARP HILL PA 17011-7427
23
Account Number From
50063 06-01-03
06-T;0-03I Page of
TRANSDA~E DATE :£FF; ~ANSA~I~ DESCRIPTI~ AM~ BA~NCE
SUFF Ix.-o0
SAVINGS 1~7.77
)60203 PAYROLL DEDUCTION 739.18 876.95
US TREASURY 312 - - CIVIL SERV
060203 PAYROLL DEDUCTION -739.18 137.77
US TREASURY 312 - - CIVIL SERV
060303 PAYROLL DEDUCTION 842.00 979 77
US TREASURY 303 - - SOC SEC '
060303 PAYROLL DEDUCTION
US TREASURY 303 - _ SOC SEC -842'00 (~/.//~ _
061103 TFR TO SHARES 50063-11 -112.77 25.00
063003 DIVIDEND
.08 25.08
JOINT OWNERS: BARRY R RHOADS
Y-T-D DIVIDENDS: .52
TRUTH IN SAVINGS INFORNATION
ANNUAL PERCENTAGE YIELD / 1.50~;
ANNUAL PERCENTAGE YIELD EARNED / 1.57~;
SUFFIX: 11 CHECKING ..................
BEGINNING BALANCE 206.50
DEPOSITS 1824.78
DRAFTS 690.82 TOTAL NUNBER DRAF"S CLEARED 6
DEBITS/FEES .00
~ NAINT/SERVICE CHGS {'~.00 YOUR AVI~ ~AILY BA:
ENDING BALANCE ! 1340¥~46 YOUR L'O~/ ~tONTH BAI'ANCE WAS 1359.75
- i ..... ~ ......... i '~,- ..... i , ANCE WAS 206.50
060~0: .P. sAYIIQLL ALLOCATION
U ~' EASURY 3121- 1~n - CI : 739.18 945.68
060 01 ' VII SERV
fiAY~I~)L L ALLOCATI D.
~ ~S ~'RE'ASURY ~.03 i- ', ~/ - SOC dEC 842.00 1787.68
0006 06050 SHA[IE 'DRAFT ~ ~530 i, / 0605021237
0611 36~],)0 S'HAFE 'DRAFT ~ [~532 II / ^~,,,,, ...... -395.00 1392.68
0611 ~ ,'
~61 )0 HAF DRAFT # , / ,., .02
36110 ~FR IRON SHARES 501 -76.57
i63-on 061001119=
)6170 SHALE DEPOSI' I ~ - ~ 112.77 ~u3.86
0620 )6i90 SHAI E DRAFT~ '4-5~-?tl'T'~'~l'T~'~T't ~ 06190 130.83 1534.69
i ~ j - 157/,0
0625 )6,'~§0 SHAI E DRAFT 451}~1 !'~ ?'~/11 i~ t~ i.,~ C~ ~$~ 0624 ...... -159.00 1375,69
0628 )6270 SHAItE DRAFT i~ i~3'r~.~-.~ ~,.-~t--~'ri.~l'%..L.~ .l. v,-//.) -16.44 1359.25
' ' 0627005650 -18.79 1340.46
N0 · M!01JNT NO, AHOUNT N0, AAOUNT N0, AROU#T
453~ 395.00 4532 25.02 453/, 16./,/, 4535 ]8.79
453 76.57 4533 ]59.00 TOTAL.: 690.82
' sEE REVERSE SIDE
~ NOTICE:
REV-1511EX + (1~q7)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1.
5.
6.
7.
FUNERAL EXPENSES:
~OL~6~-~ 6'U-~0E~,L ~E :_~Et~AL _,C_~,,~'r~'.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
State Zip
5'::1
TOTAL (Also enter on line 9, Recapitulation) $ ~, ~Z/-~,,~, ~
(If more space is needed, insert additional sheets of the same size)
STATEMENT OF FUNERAL (;()ODS AND SERVICES SELECTED
Charges are only for those items that you .9.qected or thai are required If we are required by law or by a cemelery or crematory Io use any items, we ~ill
explain the rea. son in writing below.
If you ~elected a funeraJ that may require embaJming, such as a funeraJ with viewing, you may have to pay for embalming. You do not have to pay for embalm
lng you did not approve if you selected arrangements such as direcl cremation or immediate burial. If we charged for embalming we will explain why below.
For the Service of "7 t~ I ~. ~ ': - Date of Death ~ ~: ~' e ,~' "'
A. CHARGE FOR SERVICES SELECTED: Other clothing __
PROFESSIONAL SERVICES
Services of Funeral Director/Staff $
Embalming $ __ Cremation urn
Other preparation of body (Description)
SUB-TOTAL OF PROFESSIONAL SERVICES
2FACILITIES AND SERVICES
Use of facthties and srrwces for
viewing (Visit ation/Wakc) $
Use o[ facilities ano servlces
for funeral ceremon,
Use of faclhties and services fo{
Memorial Service
Use of equipment and services
for graveside service $
Other use of facBilies
SUB-TOTAL OF FACILITIES/EQUIPMENT
AUTOMOTIVE EQIIIPMENT
Vehicle to transfer remains to Funeral Home
Local I
Hearse (Casket Coach
Local
Local
Famih, car
Local
Flower car or floral disposition
Local
Lead car/clergy car
Local
Car for pallbearers
Local
Out of town transportation
SUB-TOTAL'OF AUTOMOTIVE EQUIPMENT
TOTAL OF PROFESSIONAL SERVICES.
FACILITIES AND AUTOMOTIVE
EQUIPMENT .
B. CHARGE FOB IWERCHANDISE SELECTED:
(Description) I
(Description ~
Outer burial c~ntatner S
(Description) L: ', ~ , f C' '/ ~ .c
Acknf~wiedge~ent cara~
Register book,si $ _
Memory folders
Prayer cards $
Femporary gl'ave marger
Burial clothing I
A2 i
OTHER
TOTAL MERCHANDISE SELECTED
C. SPECIAL CHARGES:
Forwarding of remains to
(Funeral Home)
Receiving of remains from
(Fut'~ral Home)
Immediate Burial ......
Direct Cremation ....
SUB-TOTAL OF SPECIAL CHARGES
D. CASH ADVANCED
Opening Grave
Cemetery Equipment
Lot and Deed ..........
Newspaper Notices--Local
Newspaper Notices--Out-of-town
Telephone & Telegrams
Airfarc
Clergy/Mass Offering ......
Pallbearers ............
Certified Copies of the Death
Certificate .... ~ ~..
Police Escort ..........
Flowers .........
Vault Service Charge
A3 I
BI -/ // -
CS.__
SUB-TOTAL OE ADVANCES
We charge you for our services in obtaining:
(specif~ cash advances that are marked-up)
SUMMARy OF CHARGES
A Professional Services, Facilities and
Equipment, and Automotive
Equipment ..................... $
B Merchandise ...........
D. Cash Advances ............... $
TOTAL OF ALL SECTIONS $
PAID AT TIME OF ORPRIORTO
ARRANGEMENTS $
BALANCE DUE I
REASON FOR EMBA~.MING
If any taw, cemetery, or crematory reqofl'~ments have required the purchase
of any of the items listed above the law or requirement is explained below.
I agree that I have examined the items of goods and serv~ees selected above and found them to he correct and according to the arrangements I have requc'~tcd. I acknowledge
receipt {~f a co.py oLtl~is.Statement of Funeral (;oods and ~ervic,es ~!.e~cted. I ~tpresent that I have sufficient funds available for payment of the cash price for the goods
ano servlce~ M'leClg'O.lalso agree to make pavmem of $ : - ' within _ days. [ agree to he jointly and severally liable with anyone else who
signs below. A late charge of ,, · per month amounting to i , ~'.' per year will be applied to the unpaid balance beginning days
from the date of this aj~reement I '· ·
will also pa} to the Funeral Director all ~abk costs paid by the Funeral Director to collect amounts I owe t~lfler this
ose c~ts ma~linclude, attorneys~' fee~.court costs and ot]~r costs. Any additional services or merchandise ordered or requested after the da e of this agreement will
cons~ered'pa~t of this ~greem, lc'or a~d the cost hereof will he reflected on the final b Or s a emen
~ / (P~rchaser) '
"/ ,¢" (Date)
{Purchaser) (Lieen~cd Fnneral~or)
form - 600 Revised 5/02
COMMONWEALTH OF PENNSYLVANIA
INHERITANGE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
oRbS , 3L~E
Include unreimbursed medical expenses,
ITEM
NUMBER
DESCRIPTION
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
$ (.,,&..2. ¢, £?
OFFICE OF PROBATE
STATE Pennsylvania
PROBATE COURT DEPARTMENT
COUNTY Cumberland
IN MATTER OF PROBATE
COUNTY CLERK/PROBATE
COURT NO.
NUMBER OBTAINED FROM
RESIDENT COUNTY, Cumberland
DOCKET NUMBER: 2003-00464
STYLE OF
ESTATE: June L. Rhoads
Deceased
SWORN STATEMENT SUPPORTING CLAIM AGAINST ESTATE
I, Tyler Jones , hereinafter called Affiant, do solemnly swear that the foregoing and attached Claim
against the above-numbered and served Estate, amounting to the sum of
Six Thousand Six Hundred Twenty Seven 811100 Dollars ($6,627.81) is a just claim, and that all legal offsets,
payments and credits known to Affiant have been allowed and that the sum 'herein Claimed justify due. Chase Account
Number(s)
5183 3798 4012 3448
Account(s) is/are revolving, unsecured line(s) of credit.
\ '- [
~".._. / _ - ~;C.:....~
NOTARY P~BLIC'S SIGNATURE AND SEAL
Sworn to and subscribed before
me on ) ~Z../// ~ _ ,2003
Affiant - R~r#sentative for Chase Manhattan Bank USA, N.A.
P.O. Box 52188
Phoenix, AZ 85072-2188
(800) 352-3234
PROOF OF SERVICE
The undersigned has this day delivered or mailed a true copy of this claim ( X by U.S. Mail or by registered mail,
return receipt attjached) together with a true copy of each written instrument upon which the claim ii predicated to the legal
representative ot~ the estate, Barry R. Rhoads, 81 Broadwell Lane, Mechanicsburq, PA 17055
Dated June ~'2003 ~-"~~ Claimant/Affiant
The within Clairhi for $.
20 , ~hd Nas denied / allowed on
numbered and ~led Estate
APPROVAL OR DENIAL OF CLAIM
was presented to me on
,2003 as a claim against the ab(~ve-
.OT^.Y PU., C'S S.G.ATURE A.D SEAL
Sworn tO and subscribed before
me on i! ,2003
Title
Please indicate
Name, or address
Telephone changes
Home ( ) Work ( )
Page:
ACCOUNT NUMBER PAYMENT PAST DUE MIMINUM NEW ~ AMOUNT OF
DUE DATE AMOUNT PAYMENT ' BALANCE ! PAYMENT ENCLOSED
5183 3798 4012 3.448 , 06/30/2003 .00 132.00! 6627.81 $
8134 3700 ZLD i 7 04
JUNE L RHOADS
820 LISBURN RD
APT 213
CAMP HILL PA 17011-7427
ACCOUNT ~ER CREDIT
LINE
5183 3798 4012 3448 I 15800
DATE OF
~NSl POST
0000 0000
0520 0520
0521 0521
0521 0521
0522 0522
0530 0530
0601 0601
REFERENCE NUMBER
78432864Q00BRXSJ8
78432864D00DH4S2T
78432864D00DH4S31
85300214E09FFP6A3
78432864N00VNQM~L
88436874T3H61Z9W8
C~EDIT DAYS IN ~ BILL ! PAYMENT
AVAILABLE BILLING CYCL~ DATE DUE DATE
9172 I 30 106/05/2003 06/30/2003
DESCRIPTION OF TRANSACTIONS
PAI94ENT PROTECTOR AT
NSS*J9H7PJ*NEWYORKM~G
NSS*PI8KPU*TRVLAMERICA
NSS*PI8KPU*WOMAN'S DAX
PAYMENT THANK YOU
NSS*U44HJI*THANKU ITEM
PA ONLINE LTD
MINIMUM
PAYMENT DUE
132.00
$.690 PER $100.00
877-837-2733 CT
STAMFORD CT
STAMFORD CT
800-586-5987 CT
HARRISBURG PA
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*** FINANCE CHARGE PRIOR PURCHASE **
*** FINANCE CHARGE CURRENT PURCHASE
45.41
14.95
30.00-
17.00-
500.00-
23.82
9.95
. CHO.OSE
STEAD. OF
/NOPA.PER
1.28
69.73
7009.67 ; 500i00 47.00 94.13
DEBIT I FINANCE
ADJUs~NTS
.00 I 71.01
OVERLINE i NEW I
150.69 '1 6627.81 I
AN AMOUNT FOLL~D BY A MINUS SIGN(-) IS A CREDIT OR A CREDIT BALANCE UNLESS OTHERWISE INDICATED
· ~S OF CREDIT TO ! FINANCE
WHICH
RATES
A~PLY 1 CHARGE BALANCES
PURCHASES t 6706.21
ADVANCES
PRIOR PURCHASE 78.99
DAILY
P~C~rA~14.65 %~ATES ~ ~ERC~2.~%aA~S ~
.03466 %
· 05477 % 19.99
.0S42~ % 19.80
SEND INQUIRIES TOI p.O. ~OX 1010, HICKSVILLE, NEW YORK 11802. IF YOU TELEPHONE YOUR INQUIRY,
RIGHTS UNDER FEDE LAW
YOU DO NOT PRESERVE YOUR
REV-15!3 EX+ (9-00)
COMMONWF~J.TH O? PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
FILE NUMBER .
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
I!
Sec. 9116 (a) (1.2)]
~ELR~iE J~E ~.~S
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
$
(If more space is needed, insert additional sheets of the same size)
BUREAU OF ZNDZVZDUAL TAXES
ZHHERTTANCE TAX DTVZSZON
DEPT. 280601
HARRISBURG, PA 171Z8-0601
BARRY R RHOADS
81BROADWELL LN
HECHANICSBURG
COHHON#EALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSNENT OF TAX
PA 17055
DATE 11-Zq-2005
ESTATE OF RHOADS
DATE OF DEATH 06-06-2005
FZLE NUMBER 21 05-0q6~
COUNTY CUHBERLAND
ACN 101
Amount: Remi~:'~ed
REV-154? EX AFP COz-Ds}
JUNE L
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF RHOADS ,JUNE L FILE NO. 21 03-0~6~ ACN 101 DATE 11-2~-2005
TAX RETURN #AS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATION CONCERNZNG FUTURE INTEREST - SEE REVERSI;
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks and Bonds [Schedule B) (2)
3. Closely HeZd S~ock/Par~nership Zn~eres~ (Schedule C) (3)
q. Mortgages/No,es Receivable (Schedule D) (q)
5. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) (5)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To~el Asse~s
APPROVED DEDUCTZONS AND EXEHPTZONS:
9. Funeral Expenses/Ado. Cos~s/Hisc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10]
11. To,al Deductions
12. Ne~ Value of Tax Re~urn
1~625.8q
.00
.00 NOTE: To insure proper
.00 credi~ ~o your account,
.00 subei~ ~he upper portion
.00 of ~his form wi~h your
~ax payment.
.00
(8) 1,6Z$.8~,
6,263. O0
6a627.81
(11) 12.890.8!
(12) 11,266.97-
13.
NOTE:
Cheri~ablo/Governmen~al Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
Ne~ Value of Es~e~e Sub~ec~ ~o Tax (lq) 11,266.97-
Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that lnclude the total of ALL returns assessed to date.
ASSESSNENT OF TAX:
15. Aaoun'l: of Line lq
16. Aaoun~ of Line lq ~exable a~ Lineal/Class A re~e (16).
17. Amoun~ of Line lq a~ Sibling re~e (17).
18. Aeoun~ of Line lq ~exeble e~ Collateral/Class B re~e (18)
DISCOUNT
INTEREST/PEN PAZD (-)
19. Principal Tax Due
TAX CREDZTS:
PAYMENT J DATE
· O0 x O0 = .00
· 00 x Oq5= .00
· 00 x 12 = . O0
· O0 x 15 = .00
(19)= . O0
ANOUNT PAZD
RECEIP1
NUMBER
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
· °°I
.00
.00
.00
ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS RE~UZRED.
TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE
REFUND· SEE REVERSE SZDE OF THZS FORN FOR ZNSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decadents dying on or before December 11, 1981 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise end assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of 2000. (71 P.S.
Section 91q03.
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLe, AGENT
A refund of a tax credit, which ems not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ere available at the Office
of the Register of Nills, any of the 13 Revenue District Offices, or by calling the specie1 Iq-hour
answering service for forms ordering: 1-800-362-2050~ services for taxpayers with specie1 hearing and / or
speaking needs: 1-800-q47-3010 (TT onZy).
Any party in interest not satisfied with the appraisement, allowance, or disaZlowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZB10Z1, Harrisburg, PA 17118-1011, 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 writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6S05. See page 5 of the booklet "Instructions for Tnheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (S7.) discount of
the tax paid is allowed.
The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and net
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 time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquencyj or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1j 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1981 will bear interest at a rate which will vary free calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1981 ZOT. . 0005q8 1987 97. . O00Zq7 1999 77. . 00019Z
1983 167. .000q38 1988-1991 117. .000301 2000 87. .000219
198q 117. .000301 1992 97. .000247 2001 97. . O00Zq7
1985 137. .000356 1993-1994 72 .000192 ZOOZ 67. . 000164
1986 102 .00027~ 1995-1998 97. .0002q7 2003 57. .000137
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DEL~Ni~UENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ui11 reflect an interest calculation to fifteen (15) 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: 5/03/2005
RHOADS MELINDA J
622 CEDAR RIDGE LANE
MECHANICSBURG, PA 17055
RE: Estate of RHOADS JUNE LENORE
File Number: 2003-00464
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:
6/06/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
uR
STATUS REPORT UNDER RULE 6.12
Date of Death:
lillo/IDS . JaNE UN{)~;;-
,
..JwJE C:It, ZbD3
)
Name of Decedent:
Will No.
Admin.
No. ZOD'3 -DD'ft,Lj.
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:
State wpether administration of the estate is complete:
Yes V No t.~5r/}TE WSDLVEJJT ')
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
1.
3. I f the answer to No. 1 is Yes, state the following:
a. Did the persqnal reP7esentative 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 sta~e 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
Cerk of the Orphans' Court and may be attached to this report.
4rJ//~Ma<dY
51.gn t-ure
~/l~,R'I } R)/DII])S
Name. LPJ..~ape type or print)
81 !3i!D!lJ)tJELL Z71NE
/YlEt!.f/J1N)C.SI.!::.IL~6 ,fJll ;'lD5 ~
Address
Date:~Jt;?/~~
N
('7;1) '!90 -/:)313
Tel. No.
..
-
-r
Cl-
N
Capacity:
v
Personal Representative
Counsel for personal. p
representative Cf-'1
(MAH:rmf/AM3)
-
Register of Wills of Cumberland County
STATIJS REPORT UNDER RULE 6.12
Name of Decedent: ,Qhoadsy~T~()e..L P'JDr~
Date ofDeath: 010 - CIo - "2003
~stateNo.: '1003 - 004(04
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the aclminis1ration of the above-captioned estate:
1. Stat~ether administration of the estat~is co~lete: "
Yes ~ No 0 (:I:i)so\v~V) t 1=?tat.e...>
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 pers~epresentative 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 pers~epresentative state an account informally to the parties in
interest? Yes R 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: 05 - ) 0- 'l..tX:6
~~~t/?m~
~~ I(Ada ~. ~oad5
Name
012 CedarR,dfe0}) IY)eJranl.csb~~) Pit
Address J7fJSS
-:; J7-ta97- <J320
Telephone No.
Capacity: ~ Personal Representative
. ~unsel for personal representative
N
'.",r-
CL
N
,,,,,-