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HomeMy WebLinkAbout04-0946 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of Wills for the Deceased. County of ~ 6.,~-t b*E,l:~/- ~4~J-Q in the Social Security No. l ~ I~ ~ ~A' r~ '_._~ ~ ~22. Commonwealth of Pennsylvania The petition of thc undersigned respectfully represents that: named Your petitioner(s), who is/are 18 years of age or old~:r an the execut in the last will of the above decedent, dated ~ tn/'/At~ , 19_<Z:> ~ and codicil(s) dated (state relevanl circumstances, e.g. remlnciation, death of executor, etc.) Decendent was domiciled at death n ~ t)~"~ {~ ~'.~ /~ r~ ~,' ~ County, ~ennsylvania, with h 1% last family or pri~cipal residence at ~_/~ (list street, number and muncipality) Decendem, theo ~ years of age~ died ~4: tq ,~9 C~.q , ExCept as~'ollows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Dccendcnl at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ / (If not domiciled in Pa,) Personal property in Pennsylvania $ (If not domicil~ in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: ~/~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and~:cod~cd(s) presented herewith and the grant of letters (testamentary; administration c. La.; administration ~,b.n.c. La.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF L bUY/15 ~l~.LffN 13 f The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly ad~.)nis~e[ the estate according to law. Sworn to or affirmed and su%cribed .- X//'~t'~/~'Yfi~'///~:~-~"~- M befoi~me this __ q, tZ__kZr? __ day ,0.,~ / " ~' Estate Of ~ i~ /~ ~ ~L~S0~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS ^ND ~ow 0 ~ TO ~5 ~ ;0 -~0 0 ~ }~ , in co~ideration of the petition on · e reverse side hereof, sa~facto~ proof having been pr~ented before me, IT IS DEC~ED ~at the i~t~ment(s) dat~ ~ ~' 0 { d~cfibed therein be a~itted to probate ~d fil~ of record ~ the l~t wiH of ~d Letters ~E6T~ ~ F~ W ; .~,~o~,~, LoX [;~)~ ,,~ Probate, Letters, Etc. S/3~ O 0 Short Certificates(~) '" ....... $ I ~- ~ 0 A~ORNEY (Sup Ct. I.D. No.) Renunciation ........ ~""~'" $ ~ C~O $~ ,~D~S TO~ $ ' ~ ~' .7~ PHONE COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH L10-23-21 / l~uncv.PA r',,..-.,~: ~au~,,,..~: ~^ ] l'~.,,.~~, . c,,,., ~ - []~,~. ~',~-0~ ~,, Pennsylvania Cremato~=,, Harrisburg, PA 17109 RENUNCIATION ' deceased. To the Register of Wills of C- L.~ i~ / 13 ~- ~ ~- ~ ~ County, Pennsylvania. The undersigned 1~ '-} 5 5 [c~. /_ fi of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to (~,~- ~ ~ C' ::'~ ~' WITNESS ~'~o o, ~ (Address) (Address) (Signature) (Address) LAST WILL AiVD TESTAMENT BE IT REMEMBERED THAT I, JOHN A. ANDERSON, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WiLL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not married. My beloved wife, HARRIET L. ANDERSON, having predeceased me and that I have three {3) children, JOHN JEFFREY ANDERSON, LARRY LEE ANDERSON, and GREGORY GENE ANDERSON. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable ~fter my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give and bequeath my wife's jewelry to my nephew's wife, ANNE HOUCK, per capita. V I give and bequeath my wife's cookbooks to my son, JOHN JEFFREY, per capita. VI I give, devise and bequeath all the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, to my sons, JOHN JEFFREY ANDERSON, and GREGORY GENE ANDERSON, in equal shares, per stirpes. VI I nominate, constitute and appoint my son, JOHN JEFFREY ANDERSON, as Executor of this LAST WILL, to serve without bond. If JOHN JEFFREY ~2qDERSON is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my son, GREGORY GENE ANDERSON, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, JOHN A. ANDERSON, have set my hand to this LAST WILL this 3rd day of May, 2001. JOHN A. ANDERSON Signed, sealed, published and declared by the above-named JOHN A. ANDERSON, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. / ,,; x~ / ',/ // ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVAlqlA ss. COUNTY OF CUMBERLAND I, JOHN A. ANDERSON, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. JOHN A. ANDERSON Sworn or affirmed to and acknowledged before me by JOHN A. ANDERSON, Testator, this 3rd day of May, 2001. ~... .: ~ .... / t . ,,~ ,~, p Notary ub~lc N0ta~a, Seal Diaqo M, Smith, Notary Pub c Mechanicsburg Boro Cumber~ar d ~ My Oommiss;on Expires J~ra 22~ 2~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : the witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL; that JOHN A. A/qDERSON signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Test'atorwas at the time 18 years of age or more of sound min~ Cnd~o~n~er~ undue influence. ' /////~///ifonstraint,./~/~"[ or Sworn or affirmed to and acknowledged before me this 3rd day of May, 2001. Notary Public ; O~ane M Smi 3, ~,X . ~ Mechanicsbum ~, .., ,~o[a,'y Public [ ............... ::: 2004, 3 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 01/10/2005 ANDERSON GREGORY G 2410 WARREN WAY MECHANICSBURG, PA 17050 RE: Estate of ANDERSON JOHN A File Number: 2004-00946 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 01/30/2005 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge Sincerely, GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court Name of Decedent: J D f--f-f\l CERTIFICATION OF NOnCE UNDER RULE 5.6(a) A;JD,E ({SoW A. '19 /tUG 0 L{ Will No. 21- ;2z>vtf - D9~ b Date of Death: Admin. No, lOOe( - 6094 b To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' COllI} ,ules was served on or mailed to the following beneficiaries of the above-captioned estate on I f)" (')~ T c:> ~ : ~ Address .J, J €FFIfi1 II ;J])EX52J I\J ,t 52:27 57 s-rfJ. 5T PEiElfs BtI~G ~L C~t:G eRq G /lNPe-i(SiJN :::?.l-I/ D v-J Ii I,~ EJI/ N f5{yJ.,AtJ Ie s (j u!?G,. 'vf ,4 V PA-- Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ~'if%1 gg~0 Signature --t: Date: 1:2. __II!- /oJ C7 ~ Name GA EG ;7 tJ 7/e:.;e 5'"0 AJ o Address ;;2 i/ I D VJ j)-j(!(;5:.J w ft i f'11>c'P j) yt/ I C5 t' u I! c rP II LI._ ClC..- UJ c' Ci-:: ~ - u c:.:) :. c~, .:-.:." t:-~ (.I.~. , C) co ~~ ~ '--," ~ ""-':.: -, ,= ~ = C'-J l.~ _ C >.~~ ~r: ~~-- wi',f: (Co,. 0,,"0. o Telephone ( C- -'" Capacity: ~ Persona] Representative _Counsel for personal representative ; Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court (717) 240-6345 FAX (717) 240-7797 One Courthouse Square Carlisle, Fa, 17013 Ma~orie A. Wevodau First Deputy Kirk S. Sohonage, Esquire Solicitor OFFICES OF l\egister of Wills anb QClerk of tbe <!&rpbans' QCourt l!Counlp of l!Cumberlanb August 9, 2005 Gregory Anderson 4943 Grace Chapel Road Granite Falls, NC 28630 n ~o '21 ~~-~,~ -:r- rn ::-;-::I ;;.... r--.> = (c:::.:;) ~, ".,. = G') c::> INRE: John A. Anderson Estate File No. 21-04-946 :.c, Dear Mr. Anderson: My office is in receipt of the Inheritance Tax Return, REVI500 that you signed on August 5, 2005. Please be advised that there is a $15.00 filing fee for inheritance tax returns and that the returns are to be filed in duplicate. Your return carmot be processed until we receive the filing fee. Please forward a photocopy and a check or money order made payable to the Register of Wills in the amount of$15.00. If you are unable to provide a copy, we will be happy to photocopy the return for an additional $ 1.00. If you have any questions or concerns, please feel free to call the office at the above number. Respectfully, ~~ Glenda Farner Strasbaugh Register of Wills and Clerk of the Orphans' Court p. -.:,.. '''-:1 f'n C) q ......:J t.:-.::-.J ,,, c::J C:) -:-1 ~~~~ ':-:J 'II co r en Marjorie A. Wevodau First Deputy One Courthouse Square Carlisle, Pa. 17013 Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk S. Sohonage, Esquire Solicitor (717) 240-6345 FAX (717) 240-7797 OFFICES OF 3Register of Wins anti Qt[erk of tue C!E)rpuans' Qtourt <!Countp of <!Cumberlanb October 19, 2005 Gregory Anderson 4943 Grace Chapel Road Granite Falls, NC 28630 IN RE: Estate of John A. Anderson File No. 21-04-0946 Dear Mr. Anderson: Enclosed you will find the REV -1500 Inheritance Tax Return that was submitted to our office. Please be advised that we have a $15.00 fee for filing tax returns. They must also be filed in duplicate. If you send a check made payable to the Register of Wills in the amount of $15.00, the original tax return and a copy of it, we will be happy to file the return and forward the original to the Department of Revenue. If you have any questions or concerns, please feel free to call. Respectfully, Glenda Farner Strasbaugh Register of Wills and Clerk of the Orphans' Court GFS :maw Marjorie A. Wevodau First Deputy One Courthouse Square Carlisle, Pa. 17013 Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk S. Sohonage, Esquire Solicitor (717) 240-6345 FAX (717) 240..7797 OFFICES OF ]Regi~ter of WiII~ an)) Q[Ierk of tbe Q&rpban~' (!tourt <!l:ount!' of <!l:umherlanb March 22, 2006 Gregory Anderson 4943 Grace Chapel Road Granite Falls, NC 28630 IN RE: Estate of John A. Anderson File No. 21-04-0946 Dear Mr. Anderson: Enclosed you will find the REV-I 500 Inheritance Tax Return that was forwarded to our office by the Pennsylvania Department of Revenue for filing. Please be advised that we have a $15.00 fee for filing tax returns. If you send a check made payable to the Register of Wills in the amount of $15.00, the original tax return and one copy, we will be happy to file the return and forward the original to the Department of Revenue. If you have any questions or concerns, please feel free to call. Respectfully, ~ J J; ,&;:d. 0 ,~-L..~' ~ 'Glenda Farner Strasbaugh G Register of Wills and Clerk of the Orphans' Court GFS:maw &~ \, , REV-15!ni" IIW~\ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 .... Z W C W o W C w ~ ::.:~(I) uO::::': wD..(J ::l:oo uO::..J D..1X1 D.. <t OFF!CIAL USE O~\1l y INHERITANCE TAX RETURN FILE NUMBER RESIDENT DECEDENT ;kkoE - 4EAZf:- D~EDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) fi1JP&-5vD ~DflN ;4, DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) c:r6 .- ,q, 6 ~ t) -:2.) -;2. (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) m. 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~9-~L- NUMBER SOCIAL SECURITY NUMBER <60 - 6 ., 2.,g;2 , ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required (:) 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0). :\itl;..~!$f;~1IP..':MI.J$:'j~...tgMP~~jEJl'2s;~I4~:~~~~f!O"QeH~~;t~~~:~qN~jQ~~~ ,....,::I~~QR~"QM,'~RQ.~tilll.li[~~J)I~~~tgi.:.~ NAM;.-. A ~ r /J 4 E 1'1 COMPLETE MAILING ADDRESS . b/1 ,:;.:.~o t< N"P /C S""D AJ '1 q q 3 61< ,4cc e/lAf/EL FIRM NAME (If Applicable) G~,4tUJTC FALL) t1lJC, :=2 8'" lo 3 'b t- Z W C Z o D.. (I) W 0:: 0:: o U TELEPHONE NUMBER (1) 15 (2) 0 (3) 0 (4) C) (5) J 0 t 0 I)D,. "0 r , z o ~ -I ::) .... 0: ~ o w 0::: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (6) 7) V (7) (9) -S- 'I S- c , (YO (10) ---=t { 00 . eU= 14. Net Value Subject to Tax (Line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::) a.. :E o o ~ 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate -() 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due ;e 1>, OFFICIAL USE ONLY (8) z; 10 ; 066 I( # (11 ) q5~D.. b-e (12) l{ S-O I C?D (13) 3t:>ob" Q-O ;25""5'0 I ~ --- (14) x.O_ (15) x .0 '12. (16) x .12 (17) x .15 (18) (19) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o ~ o ~~FBE"~U~~\;J"o'ANs~r{~Ei'ClU~SII.PN~.;tJNR~@$~~"Q~:fifjll'iREC..,E<:I$MATH<<<':; y)\.;i.,,/i.;; ",y. .",' '.,.,,'..,<.:.,\ ---. Decedent's Complete Address: STRE~.T ADDRESS (C! l.;v" A/~ R EN (p.) A "I Ee,!/IIJJ ICS e 0(2 & Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount ~ CITY /t- (1 ) Total Credits ( A + B + C ) (2) v 3. Interest/Penalty if applicable D. Interest E. Penalty 4. Total.rest/Penalty (D + E ) 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 (3) (4) (5) (5A) :. (". ~. ~'- ZIP I rr 0 S- <; " ~ . I ~ f) 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. (58) @ Make Check Payable to: REGISTER OF WILLS, AGENT l~a:'1i~~jfr'JN!!f'~,~1m~J!i,;."~~1i&"~.~~~m"~~:r"'~~~'I'Bw.'~1l1 fl>rlll ---~ - -fillf~_~.1!IIIIlli!~-.~ PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... D b. retain the right to designate who shall use the property transferred or its income; ............................................ D c. retain a reversionary interest; or.......................................................................................................................... D d. receive the promise for life of either payments, benefits or care? ...................................................................... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......... ............. ............ ..................................... .............. .......... .............. D 3. Did decedent own an "in trust for" or payable upon death bank ~ccount or security at his or her death? .............. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ... .............. ........... ............ ........ ................................. ................... ......... ........... D No ~ B 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 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. DATE <=>5'~ o~ ;V,e. 2~Cs"1C) DATE ~ tR. A iVtrc ~A L L~ ADDRESS ~. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (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 ~. 99116 (a) (1.1) (ii)]. 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.S. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(a)(1.3)J. 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. Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 ANDERSON GREGORY G 2410 WARREN WAY MECHANICSBURG, PA 17050 RE: Estate of ANDERSON JOHN A File Number: 2004-00946 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 8/19/2006 please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: HtJV ttSD)J -J Of-I /vi H . Date of Death: l)) 19 l2 Dc L{ t I Estate No.: 2 0 D II ~ D 0 9 it t, , Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the achl1inistration of me above~captioned estate: 1. State whether administration of the estate is complete: Ye~ No 0 L. 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 ~personal representative file a fmal 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 perso:t;l~representative state an account informally to the parties in interest? Yes;K.L No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ,~ Date: r7 A u (~ b .'v'\....-,., __, '_. C', J .:; C I), LC,r. .1 ,"" ,- -) <C' ' '- _ ,., _ tf lVYL /(.-"(,'1': Name,,,>, ) c /,L /} F"C'/ L.\ q i '3 (; Fe;f L' 'i.- _, ., I -c:"" ~:; - <::- Co f{ {~fJ (It-- t- iT t L.:' Address !\) . )~ ); t' / ( t..... 'f Telephone No. Capacity: !1trPersonal Representative o Counsel for personal representative ..) '-"'\) , ~ -..., :; \ i} , -- ~ -:) ~ \ '::s- o ~ <~ .~ ''-, '. .J '::"'; ~ '~ ~ ~~ ~~ o '"" ..;, ~ -- -- ~< \~ ~~ ~ e::,- ~'j ~ '" '-- ~ ~ ,- ,... -- ~ ", '0 '!l -a -~ r ~1~';~;5, -;; 9 ;? "2.-. ,-~. .,:;J ~. 10-0< '..} r-t"^, \fl.~ """t/1_ ~~'%~S lISt -t 0 1 .< ~ .;:. ....... ~ c-. ~ ld ~" ,0 ::;, ~ p .c \..,.I .:::- ~~8~,,~ ~ -~ 0,,-,,__ ~ ~ l~ ~~ r&-o -- <J <;;. "8\ <J ~ i::-j " ~ t.,." 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