HomeMy WebLinkAbout03-0830PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of JOHN PADEN No.
also known as To:
Register of Wills for the
Deceased. County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No. 19 8-10 - 3 5 4 8
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, applies
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 Cumberland County, Pennsylvania, with
h is last family or principal residence at 940 Walnut Bottom Road, South Middleton
Township. (list street, number and municipality)
Decendent, then ~ 84 years of age, died April 14 ,Xlg) 2003 ,
at Manor Care Health Services, 940 Walnut Bottom Road, Carlisle, PA.
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:
5,000.00
Petitioner.__a~erapropersearchha s
the ~llowingspouse(ifany) and heirs:
Name
Daisy Paden
ascertained that decedent left no will and was survived by
Relationship
Sister
I c
~ipple Co~~ent Home
Liverpool, PA 17045
Elizabeth Miller Sister c/o Carl..Ii, Miller
RR1
Millerstown, PA 17062-9801
Both sisters have renounced in favor of the Petitioner herein.
THEREFORE, petitioner(s) respectfully request(s)the grant of letters of administration in the
appropriate form to the undersigned.
Michael L. Norris
405 Fairway Drive
Mechanicsburg, PA 17055
iq-
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERS,AND
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
truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this %0~r~ __ day of [ Michael~ L. Norris
~~ -/- ~ 20o3
~ l~gister [
Estate of
JOHN PADEN
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~)~~x ~ ~ 2003, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Michael L. Norris
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Michael L. Norris
in the estate of JOHN PADEN
FEES
Letters of Administration : .... $~5'~
Short Certificates( ) .......... $
Renunciation ................ $
d.~O $
TOTAL $
Filed .[.Q.'~ ..~...-.~.Oc.~..."~.... A.D.
R~er-o; Wiils d 0~~
Marlin R. McCaleb #06353
ATTORNEY(Sup. Ct.I.D. No.)
219 East Main Street
Mechanicshnrq: PA 17055
ADDRESS
(717) 691-7770
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.
Local Registrar
APR 1 8 2003
Date
m0s. lq aH, 2~7 ~' COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
,,.* CERTIFICATE OF DEATH
· John Pa den ~c~%u"~__."~f;" . .' I
~l ; ~ ~tg~' l,Unknown I~~--~ U ~m I~ ~ ~ -
~..~. ' ' I c~~" ,~<~_ ~
ervices
ManorCare ~mAt ,,..~. PA
~ ~ ~ ~8~ .~s~ ~ ,7~.~ g Mi ddleto~
40 Wa nut o Road ~
,~ arlis e, P 3 ~ Cumberland
Roy Paden
Michael Norris
, 2003
D343-L
Pheobe (Unknown)
1705o
75 Basehore Rd. Suite 1, Mechanicsburg, PA
National Annville, PA
219 N. Hanov
[]
522 S.
Carllsl
17013
DO
RENUNCIATION
~e~- o 3
In Re Estate of John Paden
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned Elizabeth Miller, sister of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
Michael L. Norris
be issued to
WITNESS my
hand tls 25th day of September ., ~ 2003.
RQ/k ~/;~.,a~+/- /'~; I/e,,--
c/o
Eli z~ehil ler
Carl I. Miller RR1
Millerstown, PA 17062-9801
(Signature)
(Address)
/¢-~£ C%--,~r~' L/~!'¢.d
tn,'//er.< ¢~,, ,~, ¢~
- '(~g~u;e)- /
(Address)
N F.. HENCH
:INEY AT LAW
4ARK~I* ST.
~F~r, PA 170]'4
567-3130
,qOWN OFFICE:
,4ARK~T* ST.
/'C)WN. PA 1708~
*17) 589-7787
'~7)
KNOW ALL MEN BY THESE PRESENTS, THAT I, ELIZABETH M.
MILLER of Tuscarora Township, Perry County, Pennsylvania,
Social Security #207-34-6950, Date of Birth December 19, 1921,
do hereby make, publish and declare this to be my Power of
Attorney, hereby revoking any and all Power of Attorney
documents by me heretofore made, have made, constituted, and
appointed and by these presents do make, constitute and
appoint Carl I. Miller of R. D. #1, Box 341, Millerstown,
Pennsylvania and Daisy M. Little of R. D. 1 Box 212,
Millerstown, Pennsylvania, to serve jointly, as my true and
lawful attorneys for me and in my hand on my behalf, to
generally do and perform all matters and things, transact all
business, make, execute and acknowledge all contracts, orders,
deeds, writings, assurances and instruments which may be
necessary, requisite, or proper to effectuate any matter or
thing appearing or belonging to me with the same powers, and
to all intents and purposes and with the same validity as I
could, if personally present and able, hereby ratifying and
confirming whatsoever my said attorneys shall and may do, by
virtue hereof, including the power and authority:
To open, deposit into, or draw checks against my checking
account and/or accounts and/or withdrawals from any existing
or subsequent-created savings account or deposits in any money
market fund, in any bank or savings association or savings and
loan association or other institution, and/or other accounts,
for any part, now or hereafter deposited, of the money
standing to my credit on the book of the said money market
fund, banks, or associations or institutions for the purpose
of paying all indebtedness that should be incurred by me, or
for any other purpose herein or hereby authorized.
To sign and endorse checks, notes, drafts and bill of
exchange, which may require my endorsement for deposits, as
cash or for collection in any bank, association,, institution,
or money market fund.
To make gifts or to make limited gifts.
To create a trust for my benefit; or to make additions to
an existing trust for my benefit; or to withdraw and receive
the income or corpus of a trust.
To lease, rent, to bargain, sell and convey, or grant
options for lease or for sale of my real estate, or any part
thereof, and to duly execute and acknowledge and grant a good
deed of conveyance therefor, or execute and acknowledge any
sales agreement for any property, wheresoever situate and
specifically that tract of land situate in Tuscarora Township,
Perry County, Pennsylvania, conveyed to Paul A. Miller and
N F_ HENCH
INEY AT LAW
M.qKET ST.
)FIT, PA 17074
· 17) 567-31~
'17) 567-3130
,TOWN OFFICF_:
· ~RKET ST.
rC~IN. PA 1fl~2
17) ,~-7'/87
Elizabeth J. Miller, his wife, by deed of Clara H. Fortney,
widow, said deed dated April 19, 1943 and recorded in Perry
County Deed Book 130 at Page 240.
To hire, employ, retain, engage any professional(s) or
other person or persons deemed necessary by my attorney-in-
fact to perform, accomplish, or properly pursue any power set
forth herein.
To execute, acknowledge and file Federal, State and local
income tax and personal property tax returns, or any other tax
return or document.
To serve as my guardian and the guardian of my person,
should I be unable to care for myself or make decisions
regarding my care, residence, placement, and personal hygiene
and well-being.
To authorize my admission to a medical, nursing,
residential, or similar facility and to enter into agreements
for my care.·
To authorize medical and surgical procedures of any
nature, including any extraordinary procedures.
To access and to authorize others to access, any and all
medical and related information or records of mine/or about
me; to employ and discharge medical and related personnel; to
authorize medication, surgical procedures and/or other medical
care for curative purposes, for treatment of specific symptoms
and to relieve pain; to complete insurance, admission and
other health related forms, applications, certifications, and
documentation; to grant releases to health care professionals
and institutions.
Pursuant to the provisions of the Pennsylvania "Advanced
Directive for Health Care Act," to refuse life-sustaining
treatment, if I should be in a terminal condition or in a
state of permanent unconsciousness, including a persistent
vegetative state or irreversible coma, and to direct my
attending physician(s) to withhold or withdraw life-sustaining
treatment that only ~erves to prolong the process of my'dying,
and in such case, to limit treatment to measures to keep me
comfortable and to relieve pain, including any pain that might
result from the withholding or withdrawal of life-sustaining
treatment, even if such measures may ~hasten the moment of my
death.
This Power of Attorney shall become effective only upon
my physical or mental disability and shall cease to be in
effect if and when my disability ceases. For this purpose,
disability shall be determined by a written certification or
certifications of two persons duly licensed to practice
medicine in the State in which I shall be then present, that
~d..LEJ~ E. I-IENI3H
ATTOFIN~-¥ AT I..~,W
NEVd~OF~T'. PA 17074
'TEL (717)
FAX (717)
each of them has examined me and determined that I am
physically or mentally incapable of acting on my own behalf.
Such incapacity shall be deemed to cease upon delivery of a
similar certification or certifications of my Attorney that
the incapacity has ceased. Any third party dealing with my
Attorney may rely upon a copy~of any such certification or
certifications as to my disability in dealing with my Attorney
and shall not be required to make an independent determination
of disability. Medical decisions shall be made only after
consulting with my principal treating physician.
My attorneys-in-fact designated above must act jointly by
decision of both as holders of this Power of Attorney,
provided each is sui juris at the time and the decision and
signature of one alone shall not be effective to act on'my
behalf, unless the other named above is no longer sui juris.
This Power of Attorney shall not be affected by ability
nor disability nor by uncertainty as to the state of life or
death of the principal and shall remain in effect until
revoked in a writing delivered to said attorney in fact, by
the principal or a court-appointed guardian of the principal.
By this instrument, I hereby revoke that Power of
Attorney dated August 7, 1997.-
IN WITNESS WHEREOF, I, after reviewing the above power
and being competent and of sound mind a~ understanding, have
hereunto set my hand and seal this /f~-'d~y of January, .onen
thousand nine hundred and ninety-ei~h~t~L~/3~5~ ,~~
(SEAL)
ELIZ. ABETH J. MILLER
Signed, sealed and delivered
in~he presence/f:
HENCH
Y AT LAW
KET ST.
· PA
567..3139
567-3130
/N. PA 17~2
58g-77~7
589-7556
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF PERRY ~ :
On this, the /_~ay of January 1998, before me, a
Notary Public, in and for the said County and State,
personally appeared ELIZABETH J. MILLER known to me (or
satisfactorily proven) to be the per~on whose n~ is
subscribed to the within instrument, and a~knowl~ed that she
executed -the sa/ne for the purpose here~~
s E A L_ Not~/~~--6W~~ub~ic '" . /
My ~ommlssion Expires: /
d:\co~%mon\miller.poa
RENUNCIATION
In Re Estate Of
John Paden
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned Daisey Paden, sister of
the above decedent, hereby renounce(s) the fig]atto admi~sterthe estate and respectfully ask(s) that Letters
of Administration
be issued to Michael L. Norris
WITNESS my hand this .~2hd day of Auc. tust ,Xl~ 2003.
"D a i s(~na~e~ en
Nipple Convalescent Home
100 South Front Street
Liverpool, PA 17045
(Address)
(Signat~e)
P.O. ~o~ t~
a
(Address)
(Signature)
(Address)
ALLEN E. HENCH
ATTORNEY AT LAW
224 MARKET ST.
NEWPORT, PA 17074
TEL (717) 567-3139
FAX (717) 567-3130
MiLLERSTOWN OFFICE:
1 N. MARKET ST.
MILLERSTOWN, PA 17062
TEL (717) 589-7787
FAX (717) 589-7556
KNOW ALL MEN BY THESE PRESENTS, THAT I, DAISY M. PADEN,
of Nipples Convalescent Home, Liverpool, Perry County,
Pennsylvania, Social Security #205-26-2536, Date of Birth
July 15, 1918, do hereby make, publish and declare this to
be my Power of Attorney, hereby revoking any and all Power
of Attorney documents by me heretofore made, have made,
constituted, and appointed and by these presents do make,
constitute and appoint Daisy M. Little, of Box 118,
Ickesburg, Perry County, Pennsylvania as my true and lawful
agent for me and in my hand on my behalf, to generally do
and perform all matters and things, transact all business,
make, execute and acknowledge all contracts, orders, deeds,
Writings, assurances and instruments which may be necessary,
requisite, or proper to effectuate any matter or thing
appearing or belonging to me with the same powers, and to
all intents and purposes and with the same validity as
could, if personally present and able, hereby ratifying and
confirming whatsoever my said agent shall and may do, by
virtue hereof, including the power and authority:
To engage in financial and banking transactions,
including the power to open, deposit into, or draw checks
against my checking account and/or accounts and/or
withdrawals from any existing or subsequent-created savings
account or deposits in any money market fund, in any bank or
savings association or savings and loan association or other
institution, and/or Other accounts, for any part, now or
hereafter deposited, of the money standing to my credit on
the book of the said money m~rket fund, banks, or
associations or institutions for the purpose of paying all
bills, expenses, and all continuing indebtedness that should
be incurred by me, or for any other purpose herein or hereby
authorized.
To sign and endorse checks, notes, drafts and bill of
exchange, which may require my endorsement for deposits, as
cash or for collection in any bank, association,
institution, or money market fund.
To take custody of and give good receipt for my stocks,
bonds, and mutual funds, and other investments of all kinds,
including U.S. savings bonds, loans, mortgages or other
securities registered in my name, to give orders for the
sale, assignment, pledge, surrender or exchange of any such
investments and to receive the proceeds or other
considerations therefor; to execute and deliver assignments,
stock powers, bond powers and other papers required for any
ALLEN E. HENCH
ATTORNEY AT LAW
224 MARKET ST.
NEWPORT, PA 17074
TEL (717) 567-3139
FAX (717) 567-3130
MILLERSTOWN OFFICE:
1 N. MARKET ST.
MILLERSTOWN. PA 17062
TEL (717) 589-7787
FAX (717) 569-7556
such sale, assignment, pledge, surrender or exchange and to
sell, assign, and transfer securities into any other
individual or appropriate transfer or for the transfer of
same to my agent.
To engage in stock, bond, and other securities
transactions, and well as, in any commodity and option
transactions, including the power to invest in such
investment(s) as is (are) deemed best by my agent(s) and to
give orders for the pUrchase with my funds of said stocks,
bonds, mutual funds, and any other investments of any kind,
including all the above-referenced accounts, to settle and
receipt for the same; to give instructions as to the
registration thereof and the mailing of dividends and
interest therefrom; to clip and deposit coupons attached to
any coupon bonds, whether now owned by me hereafter
acquired, and generally to handle and manage my investments.
To make limited gifts.
To engage in tangible personal property transactions.
To create a trust for my benefit; or to make additions
to an existing trust for my benefit; or to withdraw and
receive the income or corpus of a trust.
To handle interests in estates and trusts.
To engage in real property transactions, including the
power to lease, rent, to bargain, sell and convey, or grant
options for lease or for sale of my real estate, or any part
thereof, and to duly execute and acknowledge and grant a
good deed of conveyance therefor, or execute and acknowledge
any sales agreement for any property, wheresoever situate.
To sell, transfer, or assign title to any motor
vehicle, or other titled trailer or items that I may own,
and to execute, acknowledge, and deliver all documents
necessary to accomplish same, which includes the processing
of a title or other document for PennDot or any other
governmental or official agency or unit.
To borrow money.
To 6ngage in insurance transactions.
To engage in retirement plan transactions.
To pursue claims and litigation.
To receive government benefits.
ALLEN E. HENCH
ATTORNEY AT LAW
224 MARKET ST.
NEWPORT, PA 17074
TEL (717) 567-3139
FAX (717) 567-3130
MILLERSTOWN OFFICE:
1 N. MARKET ST.
MILLERSTOWN, PA 17062
TEL (717) 589-7787
FAX (717) 589-7556
To hire, employ, retain, engage any professional(s) or
other person or persons deemed necessary by my attorney-in-
fact to perform, accomplish, or properly pursue any power
set forth herein.
To pursue tax matters, including the power to execute,
acknowledge and file Federal, State and local income tax and
personal property tax returns, or any other tax return or
document.
To serve as my guardian and the guardian of my person,
should I be unable to care for myself or make decisions
regarding my care, residence, placement, and personal
hygiene and well-being.
To authorize my admission to a medical, nursing,
residential, or similar facility and to enter into
agreements for my care.
To authorize medical and surgical procedures of any
nature, including any extraordinary procedures.
To access and to authorize others to access, any and
all medical and related information or records of mine/or
about me; to employ and discharge medical and related
personnel; to authorize medication, surgical procedures
and/or other medical care for curative purposes, for
treatment of specific symptoms afd to relieve pain; to
complete insurance, admission and other health related
forms, applications, certifications, and documentation; to
grant releases to health care professionals and
institutions.
Pursuant to the provisions of the Pennsylvania
"Advanced Directive for Health Care Act," to refuse life-
sustaining treatment, if I should be in a terminal condition
or in a state of permanent unconsciousness, including a
persistent vegetative state or irreversible coma, and to
direct my attending physician(s) to withhold or withdraw
life-sustaining treatment that only serves to prolong the
process of my dying, and in such case, to limit treatment to
measures to keep me comfortable and to relieve pain,
including any pain that might result from the withholding or
withdrawal of life-sustaining treatment, even if such
measures may hasten the moment of my death.
ALLEN E. HENCH
ATTORNEY AT LAW
224 MARKET ST.
NEWPORT, PA 17074
TEL (717) 567-3139
FAX (717) 567-3130
MILLERSTOWN OFFICE:
I N. MARKET ST.
MILLERSTOWN, PA 17062
TEL (717) 589-7787
FAX (717) 589-7556
This Power of Attorney shall not be affected by ability
nor disability nor by uncertainty as to the state of life or
death of the principal and shall remain in effect until
revoked in a writing delivered to said attorney in fact, by
the principal or a court-appointed guardian of the
principal.
IN WITNESS WHEREOF, I, after reviewing the above power
and being competent and of sound mind and understanding,
have hereunto set my hand and seal this /~/~day of June,
two thousand.
Signed, sealed an delivered
in the presence of:
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF PERRY :
On this, the i~'~ day of June, 2000, before me,
a Notary Public, in and for the said County and State,
personally appeared Daisy M. Paden, known to me (or
satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that
she executed the same for the purpose herein contained.
SEAL
~hary Publ~ic
NY Commission Expires:
d:~lew~poakpaden
[ ' Notadal Seal
I LINDA ,[ HALL NOTARY PUBLIC
!ORT BOROUGH PERRY CO PA
:i~ Cornrnisiion EXpires Nov. 27! ~
ALLEN E. HENCH
ATTORNEY AT LAW
224 MARKET ST.
NEWPORT, PA 17074
TEL (717) 567-3139
FAX (717) 567-3130
MILLERSTOWN OFFICE:
1 N. MARKET ST.
MILLERSTOWN, PA 17062
TEL (717) 589-7787
FAX (717) 589-7556
NOTICE
THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE
PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE
YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE
DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE
NOTICE TO YOU OR APPROVAL BY YOU.
THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR
AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE
EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR
BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE
THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME
INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF
THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON
YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR
AGENT'S FUNDS.
A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT
FINDS YOUR AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF
ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH.56.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO
EXPLAIN IT TO YOU.
I HAVE READ OR HAD EXPLAINED TO ME THiS NOTICE A_ND I
UNDERSTAND ITS CONTENTS.
DATE:
ALLEN E. HENCH
ATTORNEY AT LAW
224 MARKET ST.
NEWPORT, PA 17074
TEL (717) 567-3139
FAX (717) 567-3130
MILLERSTOWN OFFICE:
1 N. MARKET ST.
MILLERSTOWN, PA 17062
TEL (717) 589-7787
FAX (717) 589-7556
I, Daisy M. L~ttle, have read the attached power of
attorney and am the person identified as the agent for the
principal. I hereby acknowledge that in the absence of a
specific provision to the contrary in the power of attorney
or in 20 Pa.C.S. when I act as agent:
I shall exercise the powers for the benefit of the
principal.
I shall keep the assets of the principal separate from
my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions,
receipts and disbursements on behalf of the principal.
DATE: ~-~/~--~O ~d~_~ ~.~ ~'~~SEAL)
DAISY M. L~I~TLE /
REV-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
D
E
C
E
D
E
N
T
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Paden John
DATE OF BIRTH (MM-CD-YEAR)
I
0~3Jz~/~) 03
DATE OF DEATH (MM-DD-YEAR)
05/12/1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1.
cAPB 4.
HpRL
EpIO 6.
CRAC
KOTK
ES [--]9.
Co"
R
E
C
A
P
I
T
U
L
A
T
I
O
N
C
O
M
T
I
O
OFFICIAL USE ONLY
FILE NUMBER
21 - 03 - 0830
COUNTY CODE YEAR NUMBER
Original Return U 2.
Limited Estate ~] 48.
Decedent Died Testate 7,
(Attach copy of Will)
Litigation Proceeds Received [] 10.
SOCIAL SECURITY NUMBER
198-10-3548
REGISTER OF WILLS
NAME
Marlin R. McCaleb Esq.
FIRM NAME (If Applicable)
Law Offices-Marlin R. McCaleb
TELEPHONE NUMBER
717/691-7770
SOCIAL SECURITY NUMBER
Supplemental Retum I I 3,
f h
~,~l~9~[S§~ Comprornise (date of death after 12-12-~] S.
Beqei:tedt Maintained a Living Trust 0 8.
~py of T~st)
Spousal Pove~ Credit ~ 1 1.
~f death ~een 12-31-91 and 1-1-95)
COMPLETEMAILINGADDRESS
219 East Main Street
P. O. Box 230
Mechanicsburg, PA 17055
-None
None
None
None
3,670.63
None
None
3,745.63
None
OFFICIAL USE ONLY
Remainder Retum
Federal Estate Tax Ratum
Total Number of Safe Depo
Election to tax under Sec. 9
(Attach Sch O)
1Real Estate (Schedule A) (1)
2Stocks and Bonds (Schedule B) (2)
3Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4Mortgages & Notes Receivable (Schedule D) (4)
5Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6Jointly Owned Property (Schedule F) (6)
[~eparate Billing Requested
7Jnter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8.Total Gross Assets (total Lines 1 ~7)
9Funeral Expenses & Administrative Costs (Schedule H) (9)
l(IDebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
111'otal Deductions (total Lines 9 & 10)
l~l~et Value of Estate (Line 8 minus Line 11)
(8) 3,670.63
(11) 3,745.63
13Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14~et Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15~,mount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2) X
16~,mount of Line 14 taxable at lineal rate ( 75.00 ) X
17Amount of Line 14 taxable at sibling rate X
18~,mount of Line 14 taxable at collateral rate X
l~ax Due
(12) (75.00)
(75.00)
.0 0 (15) 0.00
.0 45 (16) 0.00
.12 (17) 0.00
.15 (18) 0.00
(19) O. O0
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-I$00 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
940 Walnut Bottom Road
CITY
Carlisle
STATE ZIP
Tax Payments and Credits:
1.Tax Due (Page 1 Line 19)
2Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
17013
Total Credits ( A + B + C )
(1) 0.00
(2) O. O0
$1nteresl/Penaity if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3) 0.00
4Jf 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) 0.00
5Jf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (SA) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1Did 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? ...................
2If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................ r-'] [~]
3Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? [~] [~]
4Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? ................................ [] ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge,
SIGNATURE OF PE~SON_RF_.,~aON~m = FOR' FILING RETURN ~,,_. ~ -, T
~.~/ ~/..~-~" m~cnae± L. Norris
//"~/ 405 Fairwa~ Drive ~ j a
SIGNAT[~J~E OF'PREPAREI~i;)THE~AN REPFIESENTATIVE Law ~f=-' ~. ........ / . -..., T
- - '- ~"--- u lAces-mar±in ti. Flcbaleo []
//~ ~' ~ -/~/~-/~/~-- - 219 East Main Street "
-- :- i,×-- ....................
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.
Copyright (c) 2000 form software only The Leckner Group, Inc. Form REV- 1500 EX (Rev. 6-00)
REV-1508 EX + {1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
John Paden SSf/ 198-10-3548 04/14/2003 21-03-0830
Include the proceeds of litigation and the date theproceeds were received by the estate. All I~roperty jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
VALUE AT DATE
DESCRIPTION OFDEATH
The Juniata Valley Bank - Checking Acct. #37-971783-6, principal 3,670.63
balance as of D.O.D.
TOTAL (Also enter on line 5, Recapitulation)
3,670.63
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-I$08 EX (Rev. 1-97)
THE JUNIA TA VALLEY BANK
MIFFLINTOWN PA 17059
Phone: (717) 436-8211 Fax: (717) 436-8889.
I~ecedent: ~._~d~ Fh I?~
Date of Death: ~.t_~ -- I~..~ ~ ~ ~
ACCOUNT #: ~ r7-
BALANCE DOD: ~
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD: ~
OPENING DATE:
MATURITY DATE:
OWNERSHIP: ..~ IqFl
ACCOUNT #:
BALANCE DOD:
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD:
OPENING DATE:
MATURITY DATE:
OWNERSHIP:
ACCOUNT #:
BALANCE DOD:
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD:
OPENING DATE:
MATURITY DATE:
OWNERSHIP:
ACCOUNT #:
BALANCE DoD:
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD:
OPENING DATE:
MATURITY DATE:
OWNERSHIP:
ACCOUNT #:
BALANCE DOD:
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD:
OPENING DATE:
MATURITY DATE:
OWNERSHIP:
ACCOUNT #:
BALANCE DOD:
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD:
OPENING DATE:
MATURITY DATE:
OWNERSHIP:
ACCOUNT #:
BALANCE DOD:
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD:
OPENING DATE:
MATURITY DATE:
OWNERSHIP:
ACCOUNT #:
BALANCE DOD:
ACCRUED INTEREST:
DOD VALUE:
INTEREST PAID YTD:
OPENING DATE:
MATURITY DATE:
OWNERSHIP:
REV-1511 EX + (1-97) I
I
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John Paden SS# 198-10-3548
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
04/14/2003
FILENUMBER
21-03-0830
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. --UNERAL EXPENSES:
1 Hoffman-Roth Funeral Home -
Bo
funeral expense
~DMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
Attorney's Fees Law Offices-Marlin R. McCaleb
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State ~ Zip
Relationship of Claimant to Decedent
Probate Fees
Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Register of Wills
filing Inventory and Appraisment
3,575.00
TOTAL (Also enter on line 9, Recapitulation) $ 3,745.63
(If more space is needed, insert additional sheets of the same size)
Form REV-1511 EX (Rev. 1-97)
48.00
20.00
Copyright (c) 1996 form software only CPSystems, Inc.
AMOUNT
102.63
Register of Wills of
INVENTORY
County, Pennsylvania
Estate of John Paden No. 21- 03- 0830
also known as Date of Death 04/14/2003
, C~oei~l~bcurity No. 198 - 10 - 3548
Michael L. Norris,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I AVe verify that the statements made in this Inventory are true and correct. I/VVe understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: Marlin R. McCaleb Esq.
I.D. No.: 06353
PersonaIsignature:Representative ~
Michael L. Norris
Signature:
Address:
Telephone:
219 East Main Street Address: 405 Fairway Drive
Mechanicsburs, PA 17055 Mechanicsburs, PA 17055
717/691 - 7770 T~lephone: 717/766- 8651
Dated:
Description
(See continuation page(s) attached)
(Attach additional sheets if necessary)
Value
Total: 3,670.63
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form #RW-7 (1992)
Estate of:
Date of Death:
County:
John Paden
04/14/2003
Cumberland
INVENTORY
PERSONAL PROPERTY:
The Juniata Valley Bank -
Checking Acct. #37-971783-6,
principal balance as of
D.O.D.
3,670.63
TOTAL RECEIPTS OF PRINCIPAL ...............
3,670.63
3,670.63
-1-
lAW OFFICES
MARLIN R. McCALEB
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: John Paden
Date of Death: April 14, 2003
Will No. 21-03-0830
To the Register:
I certify that notice of beneficial interest and estate
administration required by Rule 5.6(a) of the Orphans' Court
Rules was personally served on the following beneficiaries of
the above-captioned estate on November 20, 2003.
Name
Daisy Paden
Elizabeth Miller
Address
Nipple Convalescent Home
100 South Front Street
Liverpool, PA 17045
c/o Carl I. Miller
RR1
Millerstown, PA 17062-9801
Duncannon, PA 17020
Notice has now been given to all persons entitled thereto under
Rule 5.6(a).
Date: November 20, 2003 ~ ~' ~
Marlin R. McCaleb
Attorney I.D. No. 06353
219 East Main Street
P.O. Box 230
Mechanicsburg, PA 17055
(717) 691-7770
FAX: (717) 691-7772
Counsel for Personal Representative
BUREAU OF INDZVTOUAL TAXES
INHERITANCE TAX DZVZSTON
DEPT. 280601
HARRISBURG, PA 17118-0601
COMMON#EALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAISEHENT) ALLO#ANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-i~4? EX &FP {gl-DS)
NARLIN R MCCALEB ESQ
M R MCCALEB LAN OFCS
PO BOX 250
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-02-2004
PADEN
04-14-2005
21 05-0850
CUMBERLAND
101
Amoun~c Remitted
JOHN
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF NTLLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAISEMENT, ALLONANCE OR
DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF PADEN JOHN FILE NO. 21 05-0830 ACN 101 DATE 02-02-2004
TAX RETURN HAS: (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. S~ocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
~. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Nat VaZue of Tax Return
15.
1~.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Net Value of Estate Subject to Tax
3~670.63
.00
.00 NOTE: To insure proper
.00 credit ~o your account,
.00 submit the upper portion
.00 of this form with your
tax payment.
.00
(8)
3,745.63
.00
NOTE:
3,670.63
(11) 3.7t;. ~3
(12) 75.00-
(1:3) .00
(1~) 75.00-
Zf an assessment Nas lssued previously, 11nas 14, 15 and/or 16, 17, 18 and
re~lect ~lgures that include the total of ALL returns assessed to date.
19 ~ill
ASSESSMENT OF TAX:
1.6. Amount of Line 1~ at Spouse1 rate
16. Amount of Line 1~ taxable a~: Lineal/Class A rate
17. Amount of Line 1~ at Sibling rata
18. Amount of Line 1~ taxable at Colla~:aral/Class B rata
19. Principal Tax Due
TAX CREDITS:
PAYflI~NT RI~CETpT DZSCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-)
IF PAID AFTER DATE ZNDZCATED) SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(1.6) .00 x 00 : .00
(16) .00 x 045= .00
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= . O0
AHOUNT PAID
TOTAL TAX CRED'rT I .00
BALANCE OF TAX DUEl .00
TNTEREST AND PEN. .00
TOTAL DUE .00
( TF TOTAL DUE IS LESS THAN $1) NO PAYMENT IS RE~UI'RED.
IF TOTAL DUE 'rs REFLECTED AS A "CREDIT" (CR)) YOU HAY BE DUE .%-~
A REFUND. SEE REVERSE SIDE OF THTS FORM FOR INSTRUCT'rONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of tho decedent after the expiration of any estate for
life or for years, the Coamoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laeful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S.
Section 91~0).
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 NILLSj AGENT
A refund of a tax credit, which ams not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-X315). Applications are available at the Office
of the Register of Hills, any of the Z5 Revenue District Offices, or by calling the special 2q-hour
answering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers ~ith special hearing and ! or
speaking needs: 1-BO0-q~7-5OZO (TT only).
Any party in interest not satisfied ~ith the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sho~n on this Notice must object within sixty (60) days of receipt of
this Notice by:
--~ritten protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 17128-10Z1, 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 Revise Unit, Dept. 28060X, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decadent" (REV-1501) for an explanation of administratively correctable arrors.
Xf any tax due is paid within three (3) calendar months after the dacadent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z 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 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 mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning ~ith first day of delinquency, ar nine (9) months and cna (1) day from the date of
death, to the data of payment. Taxes ~hich became delinquent before January 1, 198Z bear interest at the rata of
six (BX) percent par annum calculated at a daily rate of .00016~. A11 taxes which became delinquent on and after
January 1, 198Z ~il1 bear interest at a rate ~hich wiXX vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZO0~ ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rata Factor Year Rate Factor
X98Z ZOZ .0005~8 1987 9Z .O00Z~7 1999 7X .00019Z
1983 16Z .000~38 1988-1991 llZ .000~01 2000 8Z .000219
198~ 11Z .000301 199Z 9Z .0002~7 2001 9Z .O00Z~7
1985 13Z .000356 1993-199~ 7Z .00019Z ZOOZ 6Z .00016~
1986 iOZ .O0027~ 1995-1998 9Z .O00Z~7 ZOO3 SZ .0001~7
--Xnterest is caIculatad
XNTEREST= BALANCE OF
as follo~s:
TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAXLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ~111 reflect an interest calculation to fifteen (15) days
beyond tho date cf the assessment. Xf payment is made after the interest computation date sho~n on the
Notice, additional interest must ba calculated.
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/03/2005
MCCALEB MARLIN R
219 E MAIN STREET
MECHANICSBURG, PA 17055
RE: Estate of PADEN JOHN
File Number: 2003-00830
Dear Sir/Madam:
It has corne 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:
4/14/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~=~~
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
vJ
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: JOHN PADEN
Date of Death: April 14, 2003
Estate No.: 21-03-0830
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No 0
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 0 No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No ~
Date: Barch
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. ~ _ / /) /. ., Q
15, 2005 ~~~
Signature
Marlin R. McCaleb
Name
219 East Main Street
Mechanicsburg, PA 17055
Address
,-')
691-7770
Telephone No.
Capacity:
o Personal Representative
~ Counsel for personal representative
cf