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Home My WebLink About04-0805PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as Deceased. Social Security No. ~'~ [ ' To: Register of W~ls for the County of L~t~,g~t~.~-,.~t") 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, appl ~e ~ 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 ~ ~ a,~ crt c ~,OO CouRty, Pennsylvania, with h E'P-~ last family or principal residence at '3~g'-(~c~eea~0~r' /~o{ L*/¥e~.I 5Lt~'" J"~ t70i5 (list street, number and municipality) Decendent, then ~ years of age, died J~q'~ ~- ,g~'?30M at 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 after a proper search ha the following spouse (if any) and heirs: Name ascertained that decedent left no will and was survived by Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the grant of letters o(~f-bdininist~j~ion in'rtt~ appropriate form to the undersigned. : '~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF ~~~ Y The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. · ~-~ Sworn to or affirmed and subscribed I~ore _me thi~ ~ ,ex_ day of I -- Estateof ~-"~ ~ C~ GRANT OF LETTERS OF ADMINISTRATION ,Deceased AND NOW ~ ?')[ c"~F'J~O[ ~[ , in consideration of the petition on the reverse side hereof,,sa~tory prool~ having bee. n, pr,es~nted bel[ore me, IT IS DECREED that ~'qC>'~o.~D>X ~[.. [. ),°X--~O.m~Q~ is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted in the estate FEES Letters of Administration Short Certificates( ) .......... Renunciation ....... ~D" TOTAI~ ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE RENUNCIATION To the Register of Wills of ~"'~td ~t5 t~L~.~ The undersigned "~O~'6-TU~t~ ~, ~-'}~t3~d.~ the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters deceased. County, Pennsylvania. of WITNESS (Signature) (Address) (Signature) (Address) ~t:O~V tggRV ~. (Signature) (Address) 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. Fee for this certificate, $2.00 P 10589858 No. Local Registrar AUG 2 4 200 Date COMMONWEALTH OF PENNSYLVAN~ · DEPARTMENT OF HEALTH * VITAL RECORD~} CERTIFICATE OF DEATH ," Evelyn R. Gtnter female1'.200 - 09 ' ' O " ~ --~ ~D-'~D Laborer ~ ~ '~ ~ ;'~=~ ~ W 375 Claremont Rd. ~m~ ~,~%~ ~r..~ ~ ~ ! ~L Samuel Jacobv a*a. Ron A1 l: l;~ll~ ~rospect Hill Cem ~wville, Pa 9963 I~qer Funeral Home inc ~ El~ I~. ",1~ I~. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: EVELYN R GINTER DATE OF DEATH: 08-22-2004 WILL NO. (INTESTATE) ADMIN. NO. 2004-00805 TO THE REGISTER: I CERTIFY THAT NOTICE OF (BENEFICIAL INTEREST) ESTATE ADMINISTRATION REQUIRED BY RULE 5.6(a) OF THE ORPHANS COURT WAS SERVED OR MAILED TO THE FOLLOWING BENEFICIARIES OF THE ABOVE-CAPTIONED ESTATE ON SEPTEMBER 8,2004. NAME ADDRESS DOROTHY SHENK 7 ALLIANCE DRIVE CARLISLE, PA 170t3 NOTICE HAS BEEN GIVEN TO ALL PERSONS ENTITLED THERETO UNDER RULE 5.6(a). DATE: 09-08-2004 SIGNATURE ,~c~.z ': ' / ~-'- ~ '¢ ADDRESS 30 N SEASONS DR,VE DILLSBURG PA 17019-9554 TELEPHONE(717) 432-1012 CAPACITY: PERSONAL REPRESENTATIVE REV. ltiOOU. (6-$l) *' (~-.->- Off\C\t,l USE ONL 'f REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMOtfflEALTH OF ~NNS'fL"""NlA DEPARTMENT OF REVENUE DEPT,2B0601 HARRISBURG. PA 11128-0601 - - --[DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL) GINTER, EVELYN R. ... ffi : DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM.DD-YEAR) c ~ 108/22/2004 09/12/1919 o j (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDlE INITIAL) '~ 1. Original Return 0 w ... 0 limited Estate 0 !IC:!:cn 4. "~,, w"g 0 6, Decedent Died Testate (Attach copy 0 %~.J "..m of Will) .. <( 0 9. litigation Proceeds Received 0 48. Future Interest Compromise (date of death after 12-12-82) 1. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal poverty Credit (date of death between 12-31-91 and 1-1-95) M& - -Y" '-"'-'~B:nl-1-'''-"'' ~_4"'1_1;-;-_ ---,,--- "_:- ',- ME ,;,!Z 1vo V. Otto 1lI, Esquire ~ ~ fiRM NAME (If applicable)-- - 82 i Martson Deardorff Williams & Otto tELEPHONE NUMBER I 717/243-3341 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 13. Charitable and GovemmentalBequestslSec 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.AmOuntof Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 2. Supplemeota\ Return 3. Closely Held Corporation, Partnership or Sole-Proprietorship z c ~ ~ ... ~ . ill ~ 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Joinfly OWned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) z c 3 ~ ~ ~ c " ~ <( ~ 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due FILE NUMBER 21 04 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 200-09-2292 00805 NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I o 3. Remainder Return (dale of death prlotto 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A) (Attadl Sch 0) ._,/- ",'.'-"-j .( "y,U, COMPLETE MAILING ADDRESS Ten East High Street Carlisle, PA 17013 (1) None (2) None --- (3) None (4) None , (5) 3,235.22 (6) None --. (7) None (9) 5,466.59 --. (10) 92,419.05 OFr:\\-:\f\L.\,J'SEON\.{ (8) 3,235.22 (11) 97,885.64 (12) insolvent CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20. 0 .........,J'V"_n~iliIilfi.0"__~--s_..~I~";l""'1111'iiiili.iMil'i,'i,,:;:,:"1 -<,i'"',,,:;sny0,l,",!iJ!]f':.:lll!liLillili.Jfi,.b ~J~nL_~,,.;,; - ". Copyright 2000 fann software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00) C2 S "- Decedent's Complete Address: STREET ADDRESS 1000 Claremont Road CITY Carlisle ISTATE PA IZIP 17013 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) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is thEOVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is theTAX DUE A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (3) --_JlJl() (4) 0.00 (5) (5A) (5B) 0.00 .Ii~'-- .- . 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 transfeITed;...............................,.......................................,.".. ~ II 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?................. ... ........ ............. ........... .......n.................,.... ....... ... .h....... .......... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?...,.... 0 [gI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............,..,. .................,..,..................".,.................. "..,.............,._............. D ~ Make Check Payable to: REGISTER OF WILLS, AGENT 1 I. 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 peljury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. Dedaration preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE 00 d L. Altland ~ -ADDRESS 30 North Seasons Drive Dillsburg, PA 17019 sf/II&.- . DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Ivo V. Otto III, Esquire ADDRESS ~//ff!.s~ ATE Ten East High Street Carlisle, P A 17013 For dates of death on or after July 1, 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1)(i)]. For dates of death on or after January 1. 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exemDta transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and fiUng 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)1. 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. *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GINTER, EVELYN R. I FILE NUMBER 21 - 04 - 00805 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. Adams County National Bank, checking #154792 VALUE AT DATE OF DEATH -- --- -- -- 2,300,78 ITEM NUMBER 1 DESCRIPTION 2 Claremont Nursing and Rebilbation Center, balance of personal care account 934.44 TOTAL (Also enter on Line 5, Recapitulation) 3,235.22 *' SCI-EDlJLEH FUNERAL EXPENSES & AIlW1IS1RATIVE OOSTS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GINTER, EVELYNR. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. I AMOUNT ---j--~---- 4,449,00 DESCRIPTION FUNERAL EXPENSES: Egger Funeral Home, Newvi11e, PA 2 Egger Funeral Home, Newvi11e, P A, reimbursement for funeral flowers and ministerial donation Eby Granite Works, marker engraving 291.17 3 90,00 B. I ADMINISTRATIVE COSTS: 1. i Personal Representative's Commissions Ronald L Altland Social Security Number(s) I EIN Number of Personal Representative(s): 165.00 Street Address 30 North Seasons Drive City Di11sburg State ~ Zip 17019 Year(s) Commission paid 2005 Attorney's Fees Mattson DeardorffWilliarns & Otto (estimated) 2. 400.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State Zip City Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wi11s 52.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Certified mailing, Department of Public Welfare 4.42 2 Register of Wills, filing fee, Inheritance Tax return 15.00 TOTAL (Also enter on line 9, Recapitulation) 5,466.59 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDeNT ESTATE OF GINTER, EVELYN R. I FILE NUMBER , 21-04-00805 Include unreimbursed medical expenses. - --._"--- ITEM NUMBER I DESCRIPTION AMOUNT Department of Public Welfare, claim for medical assistance 92,217.05 2 Ronald L. Altland, POA services May-August, 2004 202.00 TOTAL (Also enter on Line 10, Recapitulation) 92,419.05 08-01-2005 GINTER 08-22-2004 21 04-0805 CUMBERLAND 101 APPEAL DATE: 09-30-2005 ( See reverse side under Objections) Amount Re.ittedl I 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 ~ REy:is47-Ex-AFP-io3:osi-NOTICE-OF-INHERITANCE-TAX-APPRAISEMENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX EVELYN R FILE NO. 21 04-0805 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE RECORnFn~if!1!l=l!I'[:XNHERITANCE TAX ~.::j\I'rllm~~I\~LDWANCE DR DISALLDIIANCE ii, c'-='OF':DEilllCl':JOI!~c, AND ASSESSHENT OF TAX 2005 AUG - I PM 12: 27 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN IVO V OTTO II I MARTSON ETAL 10 E HIGH ST CARLISLE CLEili< OF oqp' ,."',.,." ('nll"T Ci/' ~', ,CC.:. \ : "'c' '<", I ESQ PA 17013 ESTATE OF GINTER *' REV-1547 EX AFP (06-05) EVELYN R TAX RETURN liAS: I X) ACCEPTED AS FILED ) CHANGED DATE 08-01-2005 I~ an assessment was issued previously, lines 14, IS and,or 16, 17, 18 and r~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. A~unt of Line 14 at Spousal rat. (IS) 16. A~unt of Line 14 t.xable at LinB81/Class A rat. (16) 17. Amount of Line 14 at Sibling rat. (17) 18. Amount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Est.t. (Schedule A) 2. Stocks ...d Bonds ISchedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Kort8ages/Notes Receivable (Schedule D) 5. Cash/Bank D.posits/Hisc. Person.l Property (Schedule E) 6. JOintly Owned Property ISchedule F) 7. Transfers (Schedule G) 8. Tot.l Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 3.235.22 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/nortgage Liabilities/Lions ISchedule I) 11. Tot.l Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subiect to Tax (9) (10) 5,466.59 92.419.05 Ill! (12) (13) (14) NOTE: .00 X .00 X .00 X .00 X NOTE: To insure proper credit to your account, sub.it the upper portion of this fo~ with your t.x papent. 3,235.22 Q7.RRIi ;;4 94,650.42- .00 94,650.42- 19 will 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 (19)= "AX CR . .. "J AIlDUNT PAID DATE _BER INTEREST/PEN PAID 1-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU IIAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) ;.: 1) ~_"t' REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: EVEL YN GINTER Date of Death: August 22, 2004 File No.: 21-04-0805 Social Security No. : 200-09-2292 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 x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state thefollowing: a. Did the personal representative file a final account with the Court? Yes No x 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 x No d. Date: Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Cler of the Orphans' Court and may be attached to this report. August 30, 2005 Signature: ~ r- Name: Ivo V. Otto III, Esquire Address: MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, P A 17013 (717) 243-3341 Counsel for personal representative LJ (~.' '" LL; C) _ c; . . l: I C'-j (~-~" L~i I.. i (..... C,.. t' :", \. ) t!J~