The URL can be used to link to this page

Home My WebLink About01-1082 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Deceased. Social Security No. I if 2 ~'Z. '2. - 2r- I ? No. To: Register of Wp!'s for the I" / County of tJ"'h~/"""- t1 in the Commonwealth of Pennsylvania ~/-DI-I () 8;1.. Estate of (?,b~ ~ 11, frio /tj also known as The petition of the undersigned respectfully represents that: Your petitioner~, who is/are 18 years of age or older, appl L ,.,/1 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 ~ - \w..,-t.-.! County, Pennsylvania, with h ~-:l last family or principal residence at ? II' C{l~ 'it""'l'\ '!::>rOo \JC- I L ~ A-11 e.t"'\.. TWf (list street, number and municipality) Decendent, then .., I at l~ ~ years of age, died No"~ T" _,~ 2Clc:lJ 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: $ ~ 000, $ $ $ ~ Us 0Jw,.e/.., t/ If I '22DlI) s~" I PA /1QSr THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ~ V> '-' '" u = '" ~~ V> '-' " .... ~;g .,,0 t::OO CI:S"O 3~ "''- :;0 '" = Ol) en ~<I_ ~. r~ :It:- f~J ~~ t~~rI ~ ~. cd~ /)no M ~. 'r ~ b <-, /'4- /7'd S""'r '" / 7-d3 -II OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANMO.~Cie}~" {~:H;~t3 of ReQiSle. iiS~'JiHs COUNTY OF CUMBERLAND ~. .. . .01 NOV 16 AB :46 The petitioner(s) above-named swear(s) or affirm(s) that th~ statements in the foregoing petition are true and correct tofl.H,t*st of the knowledge and belief of petitioner(s) and that as ~lJlQ.f:l representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. affirmed and subscribed f ft;~ ~. fbfL 16TH day of l~ 7.001. Register ~ p~ , . l-\ .::IL --- "" '-' CI) .... ;:s ..... tIS = I:lI) Ci5 No. 21-2001-1082 Estate of RICHARD M. HOLLIS , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW NOVEMB E R 28 t h 19 200 1, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, lT IS DECREED that RTrHb.RD M H()T,T,T~ is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to RICHARD M. HOLLIS II in the estate of _~ RTGll\RD :,>1. HOLTJIS C. L~ FEES Letters of Administration $ 2 5 . 00 Short Certificates(2) ........ .. $ 6.00 Renunciation .. ( .7. ) . . . . . . . . .. $ ]. 0 . 00 JCP $ 5.00 TOTAL _ $ 46.00 Filed .N.O.\!EMBEB..2 8.th.. Ac.X>od9xxxxx 2001 ATTORNEY (Sup. Ct. I.D. No.) Lisa Marie Coyne 53788 ADDRESS 3901 Market Street Camo Hill. FA 17011 (717)737-0709HONE MAILED LETTERS TO THE ATTORNEY ~_l' 0c;.,GJ'c; Rr.:'Y 0.,r,Q,(, This is to certify that the information here given is correctly copied from an original certificate of death d~ly filed with me as Local R~gistrar. 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. No. ~ ~ (=l-/(L Local Registrar Fee for this certificate, $2.00 p 7902235 ~v'f!~ B f; ~ 13, 2001 Date I ~~11 "=5 r.\.i:fv\ .., ~lc....l ~ ~ "1 3-{'-~O 21-2001-1082 (?~/L tV!~ ~ 'lu{.U /~~~ & LC //-dY H105144AEll/l/91 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) TYPE/PRINT IN PERMANENT BlACl< INK ,- if, 51 :;l o ~ o w " ~ M Hollis SEX 2. Male STATE FILE NUMBER SOCIAL SECURITY NUMBER ,. 182 22 8, 2001 UNDER 1 DAY Hours Minutes DATE OF BIRTH BIRTHPLACE (Clly and PLACE OF DEATH (Ch9Ck. only one see lfI5Crucllons on other side) (MonU\. Day. 'taar) Stale Of FUlelgn Countf~) HOSPITAL. Yeagertown, Pa Inp"~nl 0 7. ... FACILITY NAME (11 flulln!>llluUon. gIve sHeet and numb6l) g:~;;'IY) 0 CITY, BORO. RACE - Amerlcilln Indian. Black. White, atc ISpeclfy) White 17b. Count Did decadenl lil/elna Cumberland lownshlp? 17d.O ::.=..nt:::OI MOTHER'S NAME iFirsl, Mldelle, MaidenSYroame) Mary Waggoner MARITAL STATUS. Married Nev... Married, Widowed, Di\'Ofced (Speedy) Widowed 17c.119 Yo..........h'..'" Lower Allen SURVIVING SPOUSE (II wlte Qlverna'dun r'<lm,,) DECEDENT'S USUAL OCCUPATION (~V:~k\~:kf~~d~eu~r;~r~l' ".. General office Manager "". DECEDENT'S MAILING ADDRESS (Slreet CilylTown. Slale. Zip COde) Accounting WAS DECEDENT EVER IN us ARMED FORCES? Ve, [l No iU 12. 2116 Cedar Run Drive Camp Hill, Pennsylvania 17011 Joseph Foster Hollis Richard M. Hollis II DECEDENT'S ACTUAL RESIDENCE (See inSllUClions on other Slde) 17.. Slale I.. _Clly/bolO 1.. INFORMANT'S MAILING ADDRESS (Streel. QtylTown. Stale. Zip Code) ". 1 Schollside Drive Mechanicsburg, Pa. 17055 PLACE OF DISPOSITION - Name of CemeI"Y, CMmatory LOCATION. CilyfTown, Stale, Zip Code or Other Place 21c. Conolite Crematory SChaefferstown, Pa. 17088 Nov 15, 2001 , . LICENSE NUMBER FD-012662-L NAME AND ADDRESS OF FACiliTY 22c. Myers Funeral Home. Inc. 37 East Main Street Mechanicsburg, Pa 17055 LICENSE NUMBER DATE StONED (Montll. Day. 'rl.ldlj Occlusive Coronary Artery Disease DUE m {OR AS A CONSEQUENCE 01-1 23b. 2 . W\S CASE REFERRED TO ME~A.l. EXAMINERfCOAONER? ""!X NoD ZO. iApptoximate PART a: Ol.n.f signilicanl conditions conlrjbuling to oealh. but : inlelv. betwHn not rnulting in In. undIIrtvll\g cause gil/en in PART I ! OOMI and death i Remote CABG DATE PRONOUNCED DEAD (MQ(lth, Da~. Year) 24. .. 2.. November 10, 2001 27. PART I: Ent... 'hi di....... kljurieS Of complkalions which c.used lhe death, Do nol eOl&( Ute mode 01 d~ing, such as cardiac or respiratory arrest, $hOCk or heart failure. List only one cause on each line DUE TO (OR AS A CONSEQUENCE Of) DUE TO (OA AS A CONSEQUENCE OF) d. WERE AUTOPSY FINDINGS AVAILABLE PRIOA. TO COMPLETION OF CAUSE OF DEATH? DATE OF INJURY (Month, DJy, 'ie..H) TIME OF INJuRY 3Dc. MANNER OF DEATH INJURY AT WORK? Natural ~ U HomiCide [] [J 30. 3Gb. M. [] :U~~~~:'~~~~:~I~tl home, farm, slrael. lactory. office .... Yo. Ves 0 1'40)( Yes [] 2a.. 2'b. CERTifiER IChocl< unly one) 'CERTlfYtNG PHYSICIAN (Ph'{"-'Cldll Lcltlll',ng CdtlSOt.ll dtMlh wtl6fl dnolhef ph~::iI<:Odll has IJlonouocoo d..alt. dlld n~llplt!k<J ""111 23) To the tMsl O. my knowledu-, death ac:curr1td due to the cau.el_) .nd n\llnnef" stated. . No 0 Aceidenl Pending Inl/esligahon Suicide 2.. o Could nol be determined [J Coroner IZ 11 l2.rL I~ I DATE SIGNED (MOl.ltl. Ui.lY. (""I I o "c. "d. November 11. 2001 NAME AND A.OORESS OF PERSON WHO COMPLETED CAUSE OF DEATH (ltem27)TypoorPrlnl Michael L. Norris. Coroner "" 6375 Basehore Road, Suite 111 AI '2. Mechanicsburg. Pa. 17050 DATE ILED (Monm. Day, Year) 34. Ifo"~)..( .::~ 13 ZooL . PRONOUNCIHG AND CERTifYING PHYSICIAN (PhystCli;llllJoUl pronOlJOClng dUdlh dnd co;l\lIyll'lg to C<lIlW 01 dt'..llll) To lhe best 01 my knowledge, deslh ac:cur," at the Ume, dale, and place, and d~ 10 the cau..(s..nd manner.s .taled 'MEDICAL EXAMINER/CORONER On the b..,. of ...mln.lIon Md/or Inve.llg.llon,ln!1'V opinion, death occurred at the time, dat., and place, and due 10 the causeraland mann.rua'.teel..,'.........,.".'......'..................',..'.,..'.........."..,.."".............."..'... . Jh. RENUNCIATION 21-2001-1082 In Re Estate of ~c~ /11. M,/Irr deceased. To the Register of Wills of eu~k-~ County, Pennsylvania. The undersigned "D I A N A s. IIER~A of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters o.f ti-J ""j Il \s.~ ~ be issued to 3?-~ I(A.. . l-b.H r~. JC , WITNESS hand this I ~ day of ~IIFJYI h ,a::2 ()O! CfJ~~~/ 2, T~ / (Signature) cJ.tJ Ol() Fa /Is yarrntJu fit (IT (fj/t;!:. ~ fI I IIA ;;(;) () V:3 (Address) (Signature) 1.0 ~:::J 0:. ~ CO (i) d: (Address) I,.Q ..- ;,"~~ e; I::C .' Z ~'1) ..., ;~~ ,n .=t:..D (Signature) .... 0 (1) .-- ...."-:: <Da: p J.>= c:c: aU (Address) NOV-16-01 FRI 1:11 PM 4367913126963 FAX NO. 7177375161 In Re Estate or 't?,"I;:,(." ~ To the Register of Wills of RENUNCIATION 21-2001-1082 tt\. ~;.., ~Ah.M~I~ .... . P. 2 Q)llj l~ d..CEa~et1. County, Pennsylvania. The uQdersiped ~ .\-.J ~ ^ "" E. ~ Qk'f"Sor\ e:j ~f the abovo dec:edatt, hereby renounce(l) the ript to administer the estate ud respectfully uk(s) that l~ett~n IA~~....;"C os.fr..e. ~\ ~ be issued to <1?~~ WITNESSJ)" b.-,Le~ M.. \U~s p~ J[ hand this \~ day of --AI mr ...~. ~ JWg ~N~Ll \ tJ OA/~f~ . (A~) CJ/\CvJo~svl II e.. J U Ii l-"L '1 /I ~ (sIp.tuR) (Adclral) (SI.nature) ~rt:..) . ;:;C't' 0 ~ - - c::r~ (t,' , z - CJ -=:: EL:: I:':' ;1: 11/16/01 14: 07 TX/RX NO.2393 ~ :::D' - '- - ::X::l<tl mo (() {) :;"; ~i:, ,.,,"1. I... N -J ;E - w v.l P.002 . Name of Decedent: Date of Death: Will No.: To the Register: CERTIFICATION OF NOTICE UNDER RULE S.6(a) RICHARD M. HOLLIS 11-8-2001 21-01-1082 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 February 26, 2002: Name: Richard M. Hollis, II Diana S. Tierra Catalina McChesney Address: 1 West Schoo1side Drive, Mechanicsburg, PA 17055 2020 Yarmouth Ct., Falls Church, VA 22043 2619 English Oaks Cr., Charlottesville, VA 22911 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 1--2~-O2. 1"". '7':' ..- ! tX ::::c z: ij) a: N P COYNE & COYNE, P.c. BY: . a Marie Coyne, Es lre 901 Market Street Camp Hill, P A 17011-4227 (717) 737-0464 Pa. Supreme Ct. No. 53788 Counsel for Personal Representative ~~ .~ I)) = - - ~jG It-. ~3 -/1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-01-2002 HOLLIS 11-08-2001 21 01-1082 CUMBERLAND 101 '02 Am-S :59 LISA M COYNE ESQ COYNE & COYNE 3901 MARKET ST CAMP HILL , C.,;;'! r~l 'II)~ p~' 1"lltH Allount Rellitted *,iY/ REV-1547 EX iFP IOI-D21 RICHARD M 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=is4j-i3f-AFP-COY':0'2Y-NOYici--OF-YNHiiiiTANCi-YA'SrAPPRAisiifENT~--Ail-oWAi"-ci-('-R----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOLLIS RICHARD M FILE NO. 21 01-1082 ACN 101 DATE 04-01-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 589.60 .00 .00 5,945.92 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due CR TS: NOTE: + INTEREST/PEN PAID (-) DATE NUMBER 6.465.55 1.981.33 (11) (12) (13) (14) (9) (10) .00 X .00 X .00 X .00 X AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 6.535.52 8.446 88 1.911.36- .00 1.911.36- 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 (19)= .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . . .. OJ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF RICHARD M HOLLIS , Deceased No. 21-01-1082 of 2001 To the Clerk of the Orphans' Court: Enter the claim of DISCOVER FINANCIAL SERVICES, INC. Acct. 6011003439501550 In the amount of $431.00 , against the above entitled estate. The decedent, who resided at 1 W SCHOOLSIDE DR, , MECHANICSBURG PA 17055 died on 11/08/2001 . Written notice of said claim was given to RICHARD M HOLLIS II ,if known to claimant, at (Personal Representative or counsel) 1 W SCHOOL SIDE DR, MECHANICSBURG, PA 17055 on May 22, 2002 (Date) ~'. fllLLM0t.A.lJU (Claimant) . ~"'. Address: P.O. BOX 8003, HILLIARD, OH 43026 ...- ..- Claimant's Cou,ll.~el ;,,"'-:: ...~; ......; Address . . . () r )> ~ "U )> s: m :::c 0 )> C/) 0 0 z ~ Z :::0 -I 0 m m CJ5 0 C/) z m :::0 ........ C/) "U :::;; )> 0 :::c D> ........ "U s: "TI )> "0 co m :::0 z "0 0 0 0 () C/) ~. .......... 0 w OJ :::c () 0" ~ 0 C/) )> 0 (l) ~ >< () 0 :::0 C ~ I 0 0 :::0 CJ1 co ~ Z CJ1 0 < s: -I ...... 0 m 0 co w :::0 s: :::c z -I 0 0 )> :::c "TI Z r I\) "U r r ...... "U r )> C/) I )> 0 r Z 0 ...... () :::0 () I m ...... )> 0 )> () 0 OJ 0 r m co r C/) I\) m :::c )> m C/) ~ ~ m w 0 0 () I\) (j) m C/) z () r=t ..lI 0:0 Lr) Po~;t3.ge ~ Certif ,eel Fee ...n Return Receipt Fee c:J (Endorsement Required) c:J c:J Postmark Here Restricted Delivery Fee (Endorsement ReqUired) c:J r=t Lr) ru Sent To '- /.' - I- - '~ Z; r=t -Sireei;APl~';'Q-, ~u'~?::~mu-~-----J-~uu--tL-- c:J or PO Box No. -j' 'i)/ ):ta.~ A1~ ~ -t;ty,-Staie:Z,P+/<ui .~~ ~~ 00 - 00 mummu 00 00 ~p;~- -; -7;;-; 00;- 00 00 00 m_ Total Postage & Fees $ , p~it8m$1. 2, and 3. Also 00.... 4 tfR881:ricted Delivery is desirecJ. your'~ and adcnlss on the '*-" .. 'eo that we can return the card to you. '.,i\ttachthi$ card to the back of the maI!pIece, ()r on the frontlf space permits. .~~~;.~ ,;aqrJ/~'~: .~ ~/ ?"'- 17tJ/r c:ll-O I ~6>RdL ~. ~=--,'.~ 'C8laf"J', ,'~ 7001 2510 0006.58619917 ".. .' 11, gult'2od1 \..1/111 I~RetumRecelpt' ...... .......... . 'j , . ~:!~'Iln~? .' " JRD/June 30, 1992/17858 DEe U 4 2003 ~ . ... "" Estate No.: 21-2001-1082 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of Richard M. Hollis Late of Lower Allen Township NO. 21-2001-1082 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Counsel for Personal Representative: Lisa Marie Coyne,Esquire Date of Decedent's Death: 11-08-2001 Date of Delinquency Notice: 10-10-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, 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, was given by the Register of Wills on 10-10-2003, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned 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. Distribution: Personal Representative Counsel for Personal Representative Estate File Date: 12-3-2003 ~ -(, -0 t./ C;;3 (J !P)1, A hearing is scheduled for at in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be canc /~.,()"J ~, \'d: \ Geor ~ ~v' aK ---- STATUS REPORT UNDER RULE 6.12 Name of Decedent: rr:~ '1 ~ Date of Death: Will No.: ;;00/- tJl()~z., Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether ad~stration of the estate is complete: Yes 0 No~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: n6. p;eJ tj 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 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 Date: /v/i'/,3 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk ofthe Orphans' Court and may be attached to this r.eport., _q ~.~-- ~ L~.4 ~'" (''''/1'1<[: Name 31D) ~ <I, Address C, 7M!'~~J( 7/7 - 7 ~ 7-0 if b Y Telephone No. Capacity: 0 Personal Representative 1itCounsel for personal representative COYNE & COYNE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW Henry F. Coyne Lisa Marie Coyne Austin F. Grogan Sharon F. Clark 3901 Market Street Camp Hill, Pennsylvania 17011-4227 717-737-0464 Fax: 717-737-5161 September 20, 2004 Register of Wills Cumberland County Courthouse Carlisle, P A 17013 :<1-OI-ID8a Re: Estate of Richard M. Hollis, Deceased Dear Sir/Madam: We represent the Estate of the Late Richard M. Hollis. Pursuant to Orphans' Court rule No. 6.12 of the Pennsylvania Supreme Court Orphans' Court, enclosed is an original Status Report regarding this Estate. Please docket the original and return a "clocked-in" copy to this office with the enclosed envelope. Thank you for your assistance. If you have any questions, please contact me. Very truly yours, COYNE & COYNE, P.C. a::~ LMC/amd Enclosure STATUS REPORT UNDER RULE 6.12 Name of Decedent: RICHARD M. HOLLIS Date of Death: November 8, 2001 Will No. No. 21-01-1082 Admin.No.~/-61- /O~~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe 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 the following: a. Did the personal representative file a final account with the Court? Yes No - - b. :""} C .." the separate Orphans' Court No. (if any) for the l~onal~preser\~ive's f~' c' " account is: c. (,./) j""'I1 Did the personal representative state an account informally ~ the parties in w interest? Yes X No d. Copies of receipts releases, joinders and approval~' of fOrrQQI or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this rt&ort. Dated: q - I t1 -0-\ MARIE COYNE, 9 Market Street Camp Hill, PA 17011-4227 (717) 737-0464 Counsel for Estate V. 15<l6 EX + IS-llol . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT O,FICIAL USE ONL Y ;1 - J?l - ii -FILE NUMBER 21 01 COUNTY CODe YEAR SOCIAL SECURITY NUMBER ~~ .; COMM(,N'NEAL TH OF PENNSYLVANIA OE"ARTMENT OF REVENUE DEPT. 280601 HARH1SBURG. PA 17128-0601 ~ Z w a w U w a DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) HOLLIS, RICHARD M. Il/O~~~ ~MM-UlmAKJ I ~~;~;;'~~~(~M-UlmAKJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) 1082 NUMBER 182-22-2513 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER IllI ,. Original Return 0 2. Supplemental Return w ~ 0 4. Umited Estate 0 4a. Future Interest Compromise (date of death ","'" u<<lI:: after 12-12-82) w"-u Decedent Died Testate (Attach copy Decedent Maintained a Living Trust (Attach ",00 0 6. 0 7. u~~ "-,, of Will) copy of Trust) ~ 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. emam er eo ea pnor 0 o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A) (Attach Sch 0) chi ~ ~ IRM NAME (If applicable) ~~ Coyne & Coyne. P.C. U,,- ElEPHONE NUMBER 717/737-0464 z o ~ ~ ~ ii: ., U w ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Crosely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly 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) 3901 Market Street Camp Hill, PA 17011-4227 (1) None (2) 589.60 (3) None (4) None (5) 5,945.92 (6) None (7) None (8) (9) 6,465.55 (10) 1,981.33 ::0 'JFFI ...,., rr1 c:::l '0 6,535.52 (11) 8,446.88 (12) insolvent (13) (14) x .00 (15) x .045 (16) x .12 (17) x .15 (18) (19) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES ~ 16. Amount of Une 14 taxable at lineal rate " g !i 17. Amount of Une 14 taxable at sibling rate o U ~ 18. Amount of Une 14 taxable at collateral rate 19. Tax Duo CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 120. 0 Iyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) - Decedent's Complete Address: STREET ADDRESS 2116 Cedar Run Drive CITY I STATE PA I ZIP 17011 Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty (0 + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0.00 (4) (5) 0.00 (5A) (5B) 0.00 Make Check Payable 10: REGISTER OF WILLS, AGENT 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?................... ................... ................. ............................... ........ ................ Under penalties of perjury. I declare that I have examined this retlJn1. including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS 1 Schoolside Drive ~&J.(l~JJi,dNf~N~:l'Jrlr ;:"1~ Mechanicsburg, PA 17055 OATE (- /t-/-or-- UAlt:. SlliNA 1 UKt:. 01''' 1-'H.t;I-'AKt:H. U I Ht:.H. I HAN H.t:.I-'H.t:.SI;.N I A IIVI: AUUH.t:.:sS UAlt:. 3901 Market Street Camp Hill, PA 17011-4227 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) ~)]. 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. 39116 (a) (1.1) (iill. The statute does not exemot 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 .8. 39116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs 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 .8. 39116 (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. -~-,~.,_....._~..,_.._-"'""._.._._.._~--"._-_.. I .' ~ I SCHEDULE B I ~ STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA I I INHERITANCE TAX RETURN RESIDENT DECEDENT L -------- ---------__------1_ --.- ----- -._----- ESTATE OF HOLLIS, RlCHARD M. ---------- I FILE NUMBER I 21-01-1082 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM I DESCRIPTION NUMBER 1 - 1 I 61.098 Comillon Shares, Ikon Office Solutions, Ioc - - - - I I . - . -. - -. . - ---..------------- - -- - ---._--- --.._------- --.- -..- I UNIT VALUE I VALUE AT DATE -i OF DEATH --. 1-- -9.1--589.60 I I I I -------------------~ TOTAL (Also enter on line 2, Recapitulation) - -1-- 589.60- '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF HOLLIS, RICHARD M. --'-'- -.--.----...-----.-.---.-.-- --- --'---.- ---"--'- -.- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN L RESIDENT DECEDENT . ---------- . -- --. -- -._- - ---,-- --- "--'-----.--..---'------- -'---.- ---'- --'-- I FILE NUMBER ---_________L~~l~~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER -1 -.-...--..----.....-.-.- ---...--..---.----.- DESCRIPTiON VALUE AT DATE OF DEATH - - 4,000.00 1995 Dodge Neon (Proceeds from Sale) - 2 Waypoint Bank -- Checking Accl. No. 1800032938 1,047.31 3 Waypoint Bank -- Savings Acel. No. 1860010191 222.61 4 Misc. Personal property and furnishings 200.00 5 Security Deposit-- Cedar Run Apartments 476.00 -.--------..------- -.---------.-.- -----'--'--'-'---"- TOTAL (Also enter on Line 5, Recapitulation) 5,945.92 . Checkinl! Accounts: Number: Date Opened: Balance at Date of Death: Name of Joint Owner, if any: Savinl!s Accounts: Number: Date Opened: Balance at Date of Death: Name of Joint Owner, if any: Certificates of Deposit: Number: Date Opened: Name of Joint Owner, if any: Balance at Date of Death: Maturity Date: Interest Rate: Interest Paid Quarterly, Semi-Annual, etc. Debts: Others: 1800032938 <61(.1~9 1,041,7;>\ NJI} 1860010191 ~ / ~ Iq~ , . J 2.:2. .IJ I IV/II tVOt'e -iou..Jd Estate of: Richard M. Hollis. Deceased Date of Death: November 8, 2001 Name of Bank: Wavpoint Bank Signature of Bank or Savings Assoc. Official '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ----.----..-.- ---.- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -'-'--'.-..- ----.~ ----'--"--"-.--.---- -- - ---'-'-- Debts of decedent must be reported on Schedule I. ITEM I NUMBER I A. - -[FUNERAL EXPENSES,-- --- I. I Myers Funeral Home 2. I Reception I I I I --'-- ----'--'-- --'---.------ - - --,-- ---- -------,--- - - -'--"---.- DESCRIPTION I -------~-------- 4,951.40 AMOUNT 300.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Coyne & Coyne, P.e. -- Lisa M. Coyne, Esquire 2. 500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills State Zip 4. 56.00 5. Accountant's Fees 6. Tax Return Preparer's Fees Income Tax Retums--200 1 100.00 7. 1 2 Other Administrative Costs Mileage for Executor @$.32/mile Toll Calls for Executor 120.00 25.00 3 Postage I 34.00 I I I Total of Continuation Schedule(s) I 379.15 ------------------------------f- --- ----- TOTAL (Also enter on line 9, Recapitulation) I 6,465.55 '* --.---------------..-------- ---- --- ESTATE OF HOLLIS, RICHARD M. - :;- T Patriot News-- Legal Advertisement- - - - - - - -- I 5 I Cumberland Law Joumal-- Legal Advertisement 6 I National Grange-- Car Insurance Premium 7 Certified Mail 8 Reserves 9 Filing Fee-- Inheritance Tax Return ~--------------- ------------ -1-----85.95 -- I I I I I I 75.00 100.20 8.00 100.00 10.00 ----~-- - --- Page 2 of Schedule H \ I .~ SCHEDULE I I ~ DEBTS OF DECEDENT, MORTGAGE I COMMONWEALTH 0' PENNSYLVANIA I LIABILITIES, & LIENS I INHERITANCE TAX RETURN I RESIDENT DECEDENT - - - --- -- __L- _.__ _____ _ ___ _ __ _ __ _ _ __ _ __ --.----------.---- - --.- -- -----._- -..---- -- - --- - .-...-....--.-.- - - -- -- - - --- ESTATE OF HOLLIS, RICHARD M. ----------- Include unreimbursed medical expenses. - --._-- -----..-------------..-...----- -...- -------- - --- - - - ------ -.- ITEM NUMBER -1 DESCRIPTION AMOUNT Cedar Run Apartments --------------------- 1,025.00 2 PP&L 74.83 3 Verizon 15.40 4 Discover Card 431.37 5 Lutheran Brotherhood-- MBNA 434.73 -------------------------- TOTAL (Also enter on Line 10, Recapitulation) 1,981.33 . .. SCHEDULE J I _-=M~N;~~!';,~~E!iE!~~';.'~ANIA _L _ _ _ BENEFICIARIES_ _ __ _!___ __ _ ___ __ ESTATE OF HOLLIS, RlCHARD ~~ - - - ---- - - - - -- - fALE N2~~~~~ 1082- - - - - I -;:UMBE;-II- --:-AME AND ADDRESS~F PERSON(S) RECEIVING PROPERTY - -I REL~~6~~~~~ TO -IAMO~~~~T~~~ARE - - + ----.Oo~t..!.JH'I!:Ylt~l_ t-- - -__ -I:--ITAXABLE DISTRIBUTIONS (include outright spousaldistributionS) - - I I Richard M. Hollis Son 111/3 of Residual II Schoolside Dr, I Mechanicsburg, PA 17055 I 2 I Diana S. Tierra Daughter I 11/3 of Residual I 2020 Yarrnouth Ct. Falls Church, VA 22043 I I 3 I Catalina McChesney Daughter 11/3 of Residual 2619 English Oaks Cr. I Charlottesville, VA 22911 I I I I I I I I I I I I I Enter dollar amounts for distributions shown above on lines 15 through 17, as appropri~te, on Rev 1500 cover she~ . II. I NON-TAXABLE DISTRIBUTIONS: IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I I I I I lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I I I I _ _ _ _ TOTAL OF PART '~ENTEfl.TOT~NON-TAXABLE DISTRIBUTIONS ON LINE 13 OI'REV-1500 COVER SfiE~T _ _ _ __ _ COYNE & COYNE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW Henry F. Coyne Lisa Marie Coyne 390 I Market Street Camp Hill, Pennsylvania 17011-4227 7! 7-737-0464 Fax: 717-737-5161 February 14,2002 Mrs. Mary C. Lewis Register of Wills Cumberland County Courthouse Carlisle, PAl 70 13 Re: The Estate of Richard M. Hollis, Deceased No. 21-02-1082 Dear Mrs. Lewis: Enclosed is the original and three copies of the inheritance tax return for this insolvent estate. Kindly docket the original Return and forward two "clocked-in" copies to me with the enclosed envelope. Enclosed is check no. 995 in the amount of $1 0.00, which represents the filing fee for the Return. Thank you for your assistance. Very truly yours, HFC/amd Enclosure COYNE & COYNE, P.C. ~~~f Cc: Mr. Richard M. Hollis, II STATUS REPORT UNDER RULE 6.12 Name of Decedent: RICHARD M. HOLLIS Date of Death: November 8, 2001 WillNo. No. 21-01-1082 Admin. No. c~]--~/'" /Ogo~ 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 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~..g~s~ onal~c~epreser~tatiYe's account is: F-T-1 c. Did the personal representative state an account infOrmally t'~the parties in interest? YesXINo 27.2 d. Copies of receipts releases, joinders and approvals':? of forrNtl or informal C~ accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Dated: ~_ i el_c~ '~~4~~ MARIE COYNE, 92{g0q Market Street -- Camp Hill, PA 17011-4227 (717) 737-0464 Counsel for Estate