The URL can be used to link to this page

Home My WebLink About04-0986 Register of Wi Us of Cumberland County Name of Decedent: STATUS REPORTlJNDERRULE 6.12 WAY /fie f{ {)H R B II U (; 1-/ Date of Death: I - 0/ - 200'1 Estate No.: ;)/ - o'l-r$~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rilles, 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 0 No .IZl 2. If the answer is No, state when the personal representative re onably believes that the administration will be complete: tu;~;n a :r' /~ //1,. '4A'o.n 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 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 U No U c. Copies of receipts, releases, joinders and approval offonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report t/~~./~? , Date: r,/2/bG . Signature Ch4rks E Sl/~ Lit: Name Address , ~~tt5erRd/JlteAlU/lC5)J(~dj J h' 17oS'5~ / 7/7 -7~" -020 i Telephone No. Capacity: QrPersonal Representative p COlli"1Sel for personal representative PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~d//y~/~ l(9~,q~'~ll6t/ also known as ]4),4YAt~r ~. ~A/~l~At Deceased. Social Security No. I..5'~- ~q- ~t38'.~ To: Register of Wills for the County of ~sttm6~e~/,c'~b in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitionerO0, who is/a~e 18 years of age or older, applits 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 Cu~J~er/~t/ Co~?~, Penne~lvania ~ h,~ lastfamdyorprlnclpalrestdenceat 12~ ,,9/, C,~II Z>~.; /l~e~a~ld-~'..~,~ ~i, ~ . (list street number an~unicipalit~y)~ Decendent, then ___7_L. years of age died ,//4/)/ // ,-~gr ~m~t , 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: ~'~.~e~,.r~? /'~'e~a/~ a~' /a~,~ '~en~ Petitioner the following spouse (if any) and heir: Name after a proper search ha,5~ ascertained that decedent left no will and was survived by Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } COUNTY OF C~-~v-~__~-~_~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in thc foregoing petition are truc and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and Sworn to or affij[n~ijand subscribed [- ~,~ No. Estate of ~,×":~x~, GRANT OF LETTERS OF ADMINISTRATION ,Deceased AND NOW G ~-~3b~3 ~ ~ oQC~ DC~D4 ~_.___, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented beforg me, is/are entitled to Letters of Administration and in accord ~ith such ' ' * ' ' ' fin&ng, Letters of AdmxmstraUon are hereby granted to ~\0%~ Ix3 ~r~c~ 0~ (',37~, fl~ ~c-~ (3 in the estate of FEES Letters of Administration ..... $lq Short Certificates( ) .......... $ Renunciation ................ $ .% .tS~ TOTAL __ $. q~' Filed .1(~ ;x~..c?..~ .~.c/ ..... A.D. Register o f Wil~0~- ~ ~.~--3~ ^xro~m¥/sup. ct. i.~. No.) ADDRESS PHONE RENUNCIATION In Re Estate of ~ To the Register Thc O~dersi~ .m~d County, Pennsylvania. of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to ,J~/~N /,v'. /~/~,4U~H WITNESS (Address) WEST VIRGINIA DEPARTMENT OF HEALTH & HUMAN RESOURCES BUREAU POR PUm~C HEALTH- WTAL RE~,ST.AnO. ""VS~C~A.S / MEmCA' EX^MInER'S CERnF~CATE OF DEATH ROOM 165, 350 CAPITOL STREET, CHARLESTON, WV 25301 0 I 0 2 7 L~ 159-24-4383 r~ ~,o~ YES CITY HOSPITAL I MARTINSBURG I BERKELEY ~'~'~ ~'~" ~"~ .... ~ TRANSPORTATION WIDOWED DISPATCHER PA CUMBERLAND MECHANICSBURG 1223 MITCHELL DRIVE Form VS-002(Rev. 6/92) WALTER ROHRBAUGH I HARRIET !'UNKNOWN JDHN N. ROHRBAUGH I 107 ESSEX CIRCLE, STEPHENS CITY, VA 22655 [] ~..,,~ [] c~'"~'~r' MECHANICSBURG CEMETERY MECHANICSBURG, PA STATE COPY 0234098 STATE OF WEST VIRGINIA This !S to certify that this document is a true and acr_~rate reproduction of an ofhcial record, or the facts abstracted from an official record, on file with: V~al Statistics Bureau for public Health , west ~v g~r 'n a-Department of Health ,and Human Resou,~ces Charleston, West Virg n a. Ga~ L~ Thompson State; Registrar; STATUS REPORT UNDER RULE 6.12 Name of Decedent: Wayne H. Rohrbauqh Date of Death: 07-04-04 Will No. Admin. No. 21-04-0986 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 ab?ve-captioned estate: 1. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: within 6 rronths 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 personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. (J&~8~~ Signature Date: 01-20-05 i.l_ C' (/~ In N Charles E. Shields, III, Esquire Name (Please type or print) 6 Clouser Road, Mechanicsburg, PA 17055 Address c .' ;;..~ "- '---": -/ , G~ C') ( " u.:; c.: 0J , i:;-I _~J .:c:, eli{:' B~-; () (717 ) 766-0209 Tel. No. ~,' L.r~.t C~) = c-, Capacity: Personal Representative x Counsel for personal representative ~ (MAH:rmf/AM3) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Wayne Rohrbaugh, aJkJaJ Wayne H. Rohrbaugh Date of Death: July 4, 2004 Will No. Admin. No. 21-04-0986 TO THE REGISTER: 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 January 3, 2005: Name Address John W. Rohrbaugh Michael P. Rohrbaugh Kathryn J. Rohrbaugh Gregg E. Rohrbaugh 107 Essex Circle, Stephens City, V A 22655 4398 NE 16th Avenue, Pompany Beach, FL 33064 11 West Green Street, Mechanicsburg, PA 17055 1223 Mitchell Drive, Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: January 3, 2005 l..J... 00:0 l,..U_l 2~ LI._ L! OC) a.-r" '4-' ;". , CJt--:::: c.. (~/, 86 Ei:!?l:! =c a.. I.r) I ;;:e: ~ "" = = '" I.r) o ~fl/~b CHARLES E. SHIELDS, III 6 Clouser Road Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Representative " - ~'~, f-- c.:: cc " =Jr-' ~t-'",'':, 00.: ~r./)~- E5:c-.::. --1 "'? c> U:;r>. Q~' ct:~". O~ -, o )- Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: rnARLES E SHIELDS III 6 CLOUSER RD InvoiceNo: Invoice Date: Estate of: Estate No: 261 3/21/2005 lohn W. Rohrbau~h 21-2004-0986 vz MEa-IANICSBURG, P A 17055 Qty 3 Fee Description Short Certificates Fee Total 4.00 $12.00 Total: $12.00 , t Checks should be made payable to the Register of Wills. Tenns: Net 30. Please return one copy of this invoice with your payment. Thank you. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 April 5, 2005 Telephone (717) 787-3930 FAX (717) 772-0412 Charles E. Shields, III Attorney at Law 6 Clouser Road Corner of Trindle and Clouser Roads Mechanicsburg, PA 17055 Re: Estate of Wayne Rohrbaugh File Number 2104-0986 Dear Sir/Madam: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 10/04/05. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. /)~incerely, ,(. ,'. " ~~/~!f~ Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division I,;" s'< q... Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE I Bill To: a-IARLES E SHIElDS III 6 ClOUSER RD InvoiceNo: Invoice Date: Estate of: Estate No: 392 6/7/2005 Wavne RohrbaUl!h 21-2004-0986 vz MEaiANICSBURG, PA 17055 Qty 7 Fee Description Short Certificates Fee Total 4.00 $28.00 Total: $28.00 Olecks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone October 26,2005 717 -787 -6677 Charles E. Shields, III 6 Clouser Rd. Mechanicsburg, Pa. 17055 Re: Estate of Wayne H. Rohrbaugh File Number 2104-0986 Dear Mr. Shields: The Department has been advised that the above-referenced estate is presently involved in litigation. The Department will suspend further activity on this estate until October 26,2006. You are required to notify the Department when the status changes or the extension date expires. If you have any questions, please contact me at (717-787-6677). ~ Sincerely, ~ Emerson Luciano "'----- Inheritance Tax Division E-Maileluciano@state.pa.us FAX 717-772-0412 C. L..Ll .__. <;). U"' I.n L.L L_~_: (_.) ~-- (::) C"'.: tr", t~:-:-_~- C:::' c'.'" Rt. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/31/2006 SHIELDS CHARLES EDWARD III ESQ SIX CLOUSER ROAD MECHANICSBURG, PA 17013 RE: Estate of ROHRBAUGH WAYNE File Number: 2004-00986 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: 7/04/2006 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, ~L~J~ 01:en~~ ~a~nc~ St~~sba,,~h U....L J..I.\...AGi.. J.. ..L.J..J.."-...L ..L.Ci, l..A':::::IJ..J.. Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County- Register Ot Wllls One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/31/2006 ROHRBAUGH JOHN W 107 ESSEX CIRCLE STEPHENS CITY, VA 22655 RE: Estate of ROHRBAUGH WAYNE File Number: 2004-00986 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: 7/04/2006 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 St~asbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/31/2006 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 RE: Estate of ROHRBAUGH WAYNE File Number: 2004-00986 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: 7/04/2006 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, h,./ ~(p~/#~ Gl~rner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ". ...J 1505b0410"+6 REV-1500 EX (05-04) PA Department of Revenue '* Bureau of Individual Taxes Dept. 280601 Harri$burg, PA 11128-0601 ENTER DeCEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECED~NT OFFICIAL USE ONLY County Code Year File Number Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Infonnation Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return c:::J 2. Supplemental Return c:::J 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::J 4. Limited Estate c:::J c:::J c:::J 4a. Future Interest Compromise (date of death after 12-12-82) c:::J 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::J 10. Spousal Poverty Credit (date of death c:::J 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received JL 8. Total Number of Safe Deposit Boxes - f--"'o,,) c::;, ,~ ....... ):<b --tl .::::0 f\v -&:- -0 ~"'~ Correspondent's e"mail address: bed me-res ~ epi X . net g; Under penalties of perjury, I declare at I have examined this retum, including accompanying schedules and statements, and to Ihe besl of my knowledge and belief, il is true, correct and complete. c alion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG NSIBLE FOR FILING RETURN DAT C~ VA ~~'5~ DATE tt/Z.3/()1 , , Side 1 L 15056041046 15056041046 -.-.Js " .....J '1505b042047 REV-1500 EX Decedent's Name: RECAPITULATION 1. Real estate (Schedule A). .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. ,2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership,or S9ie-prpprieto~il> (Sched\J,l~ G} ,,",' , ,~, 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Pr~perty (Schequle F) c:;:) Separat!!' Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:;:) Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . .. . . . .. . .. . . . ... . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . .. .. 11. 12. Net Value C?f E~tate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . .. . . . . . . . . . 13. 14. Net Value Subjectto Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount 'of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .OCL 16. Amount of Line 14 taxable at lineal rate X.O<< 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable' at collateral rate X :15 15. 16. 17. 18. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . : . . . ,. . . . . . 19. \ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:;:) Side 2 L 1505b042047 1505b042047 .....J REV-1500 EX' Page 3 Decedent's Complete Address: File Number ,;21-1) '1- 9 ~6 DECEDENT'S NAME IT, /(()II~SAu, H WAYNE' STREET ADDRESS 1~3 hf/TCHEtL ;;pet,E' CITY /HEt!NAA'ltS8UIf{; I STATE ~A I ZIP 17fJ.>a Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Paymenlll A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o o o o Total Credits (A + B + C ) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty o D Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (3) (4) (5) (SA) (5B) o o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. o B. Enter the total of Line 5 + SA. This is the BALANCE DUE. o o A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did de~dent make a transfer and: Yes No 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 00 c. retain a reversionary interest; or................................;...:.....~.:............................................................................. D KI d. receive the promise for life of either. payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 198.2, 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 account or security at his or her death? .............. D IXI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 00 D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Janua,ry 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent [72 P.S. ~9116 (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 zero (0) percent [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 four and one-half (4.5) percent, 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 deceoent's siblings is twelve (12) percent [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. REV-1p02 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF R f) Hit SA taJ f./, /fJ /I YAlE I-/, FILE NUMBER .2/-~'1- '1i~ All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION D~eE'J)EN'" PJeJ/lII:1> ,4# A-L.L.G(;eD IN rsetsr /AI;eerl PSTA- 'IE SIT'JI/Jre:- AT 1223 IH/m#€/..L. .l>tell/e, /J1 E' eN If All t5 IS/(I( ~ .I C tl If! (j Ple LAA! () &;U N~ ,a,l/. #lIS IAlre-,,(!ES-r ~~ .A-SSEl2TEt) oN ~~~F t!?t:" {)E(!.E.!JENTS STArE' /$}I 7#e- (!.e;-"tfj)IJ1/AI- IS r/l./t ~Rs of 7H€" E57>>n;" #s #()J"BeSE {!.LA/I'J//fAlTS /N ?;V€ $.4A/K,etl~my (],HE t:'F QU=6(;. tW~ I7AHl/l- ter;N/C8/1-U~1{ eASF ~~ , / - ~.5 - 0 S' f 7/) - /J1./);::: / &MiK /j' II ,0 rc! Y ?'.2II.r~ " /H/f-,(K//I,v SU;19of)/~ .ESt;. 7-4'e 5TA-rG /V~ ~R.ESE/l/TEt::> /AI 7H€" /k.#774:~ 4y ~k/i.5G:lS t!#/lTJUiS E' ~/CZi:>S:or :J$HES ~ YtP/JIES (r/A/~ L!J4.A/keHP7(!'y ~/T/6A-7l1!)A/ (L)ttN.5€Zl ~tJ ~r '&6-E2r(6G'~/N'~ ~/f/ll~~J{,lJ7l!Y /L 17/~..4771t?4/ t211/YSR.) /i-5 4- /tE"Stltr OJ!: /W'E S4-/LJ ~A1 ,t7LC)c AN.iJ ;P~7le/Iar€tJ L/Tl~,4.7?~AI.. /1 ~H,er- ~Ma!.Id) /}fnJ/A-77/)# C!.eIf/FC72l:W(!t ~-;[) ~ A- S7/tPt1~A7/~/J/ #y RtB'/cw 7Ns- ~?;1/-~ W~ ~kJ,{.;ef}S) ,.zc26//)t)tJ~ /K) W'h'/~ Stt'Af P/~ '" ,4,<7,4;toJ"nJ tBY 7.<1€ &<</27: /fIJ.lJI7j'#Ai PE"7/H~.s /heF Av/4-ILR-atLE 7P 71IE" ])dA-/2771/Bl/T t{//11'# ~tI E5 r: C5E~ ~65~IYIl8JI~ 4#11 Cb,Py f ME!!/< II-- 7'7/It!N E""~ ). VALUE AT DATE OF DEATH ~. :2,(p, 000,00 TOTAL (Also enter on line 1. Recapitulation) $ ,;(4,/ t'JOO_ 00 (If more space is needed, insert additional sheets 01 the same size) .Adt ~/~tr,6 THE LAW OFFICES OF MARKIAN R. SLOBODIAN # / / 1S 801 NORTH SECOND STREET, HARRISBURG, PA 17102 MARKIAN R. SLOBODIAN, ESQ. ANDREW R. EISEMANN, ESQ. June 6, 2006 VIA CERTIFIED MAIL Charles E. Shields, III, Esq. 6 Clouser Road Mechanicsburg, P A 17055 Re: Gregg & Paula Rohrbaugh Case No. 1-03-05970-MDF Dear Charles: Enclosed pursuant to the Stipulation in the above-referenced case is a check in the amount of $26,000.00 made payable to the Estate of Wayne H. Rohrbaugh. Thank you for your assistance in this matter. Very truly yours, ~ ~'^--- Markian R. Slobodian Enclosure cc: James K. Jones, Esq. MRS/jlh Da.te c 06/06/2006 $' '****'**26 ,'OOD:'O,O . ---Twenty-Six Thousand Dollars and 001100 Pcir~::~~ Estate of Wayne H. Rohrbaugh clo Charles E. Shields, III, Esq. 6 Clouser Rd. Mechanicsburg PA 17055 ~4v'- Markian R Slobodian, Trustee .:: 1.:r.,..t"'J:aI:I~'I"tllh'jl:li'..It:'I~."'I"""""UI"':..I'l:IltI'.'.'&'/.'.:t:h1jf.UI;W!II:iI.I....'...'......,i"et......'..,:tY "'~~\"""~ ~, ~.... ~'-'."'.'. ~'rllro-~\~"~~'" "f 'l...".~'.'.'~.'~ ~ ~ ~ , ,.." '-,'. _cl';"'So~' -~ ~~J~\H_~~~~!i "~n?~1 t' iOO~:IIT~~:~~~~~-=:~~ {-1:IIJ:l~~",",'hlo:r~'1 0' ~~~,R~~ :111~jrL:BI~i I~ IJJ:JJ.~':I:~ p Ll~:=" ~~1 ~~I~ THE LAW OFFICES OF MARKIAN R. SLOBODIAN 801 NORTH SECOND STREET, HARRISBURG, PA 17102 MARKIAN R. SLOBODIAN, ESQ. ANDREW R. EISEMANN, ESQ. June 6, 2006 VIA CERTIFIED MAIL Charles E. Shields, III, Esq. 6 Clouser Road Mechanicsburg, P A 17055 Re: Gregg & Paula Rohrbaugh Case No. 1-03-05970-MDF Dear Charles: Enclosed pursuant to the Stipulation in the above-referenced case is a check in the amount of $26,000.00 made payable to the Estate of Wayne H. Rohrbaugh. Thank you for your assistance in this matter. Very truly yours, ~ ~^-- Markian R. Slobodian Enclosure cc: James K. Jones, Esq. MRS/jlh (717) 232-5180 FAX: (717) 232-6528 LAW.MS@VERIZON.NET , _w.:"., '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF a oH R 6A fA GH, fA),4YNE J./. FILE NUMBER ::2-/- 0 l/ - ;;,,~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. !J.. VALUE AT DATE OF DEATH DESCRIPTION sk Ct>MtH-I1I A-~e,re Shc../< J',J.,.. 2. 2tJo4 h; "I:J..'~ 10 ~~.'D] _ I.IJ~ L' , I ., 6.JJe. == ~.o8 )< r = 1', ~t 200,/ .,. '2..01 0 1.~8 . [PIt.Q.~ t'lDtt. ~ ClJst of -Iru1S/1c,J.,'I'IJ ~;s sha.re a. c.c.DrdvJ-(j 1z, Ct>MfluSho..re LUou./d be. 1, S.IA . TJ1R.~!r>te we. hfA.VL ~o..r~eol 1+ a s net zero tor l>u.r o...c.eolJ..rJ.I,''Y (jJ<<rpDStS OuWIbIl1.st ~urieJv'e.s J,..d- (),.t-e tnlt.;.,~;n;~ ---J-&. ~c.e. vlilu.Lj,~1t) nel"e J. ~ ;2. 08 I \ 6h. A T ~ T :J ~ 2, 2Do4 r '411., z.o04 &t\.\M.D11 h; ~".11 h.f . '2'1.21 1: ID..231 ,J .,; 8.JJe. ::: ,j 'I. / f) x / / .::: lo~v ~ dlbS; /0 J. ~of s~. CoIlll.rv\D~ v'E:RIzoA! rtoriW'erb ~1IJ'w\ d &u fr.Tf..AAlr,e) h; -"3b.30 l' ] t 1 .:r ~ 1, 'ZOoC/ 10 35.17 '03",1'1 I ~ aile. = 3'.o;t x 308 = 1/10'11./-.'" 3~ fo, "lee. 'I h; o 35. "3 '/. 7~ st CotnlMt1 LUC!.EN7" TE~IIIVDLOr;./IFS, /4Je.. .J~ 2, ~'I h; ~3,S' \0 ''3.3~1 · ? ~S ::1...1:(, h' 7f . ()J/e. ~,Sl ,.:7-:1.. = :::r ~ to.. z.ool.f I 3.{pZ Ib l' 3.SD TOTAL (Also enter on line 2, Recapitulation) $ I / J 'I if. () , (If mnrp <:n~r.p i<: nAArlArl in<:Art ~rlrlition~1 l'lhAAtl'l of thA l'l~mp. l'li7P.\ . REV.l508 EX' (1-97) ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~ of! If 811 tt G 1-/1 NII-Y Ale.: FILE NUMBER fl. 2/-041- 7?~ 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. 2, 3, f; s: DESCRIPTION VALUE AT DATE OF DEATH ~ ;;;'0 $i. ZS;- :r/tltl~Al17;,eY()1= t!R;/LJ reJTS 0/= tVA-LLeT (~ ~ Dt hvutb'J #/fluk.J) (!./7/'ZE#J ~II-NI(, S4V'Izf'! kJ. -# 6, :ltl()- 853,1.7() -:r: nt', A-(!er. Ii ])..0' D. (St:.e l1t~kl/t?11 ~fler ~hI ~'1"ren.5 AfIllc4u/) ~~va/ IEJrI'r!S.s E/Itf/Dyee /tpSiDH fJk ~ C"-wr,,/t;t e~fr ,'cr.. ~t)JcJ Fo,. ~ 5, 835'.9/ ~.<J() 1":1.7, 1&" ~ ()oa~{) TOTAL (Also enteron line 5, Recapitulation) $ /0; IPS. 32.. (If more soace is needed. insert additional sheets of the same size) ~:E Citizens Bank'" 525 William Penn Place Suite 153-2618 Pittsburgh, PA 15219 September 3, 2005 CHARLES E SHIELDS III Esq 6 CLOUSER RD MECHANICSBURG P A 17055 Estate of WAYNE H ROHRBAUGH Date of Death: July 04, 2004 SSN: 159-24-4383 Dear Sir: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his date of death. The decedent had 1 active account at the time of his death and he had no Safe Deposit Box. For TI- or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 t>Jjp ~MJ Phillip Lynch ()UVJ VV ""\ Operations Services 1'1 Citizens Ba!nk'~ Account Number 6240-853270 Account Title WAYNE H ROHRBAUGH Date Opened 12/2412002 Account Type Savings Principal Balance as of DOD $5,835.91 Interest from Last Posting to DOD $ .40 Account Balance as of DOD $5,836.31 YTD Interest to DOD $25.78 PATIENT VALUABLES ENVELOPE .t.- THIS FACILITY CANNOT ASSUME RESPONSIBILITY FOR ITEMS RETAINED IN YOUR POSSESSION. PATIENT UNDER- STANDS THAT BY SIGNING BELOW, HE/SHE IS AWARE OF THIS POLICY AND VERIFIES THAT THE ITEMS LISTED BELOW AS INVENTORY ARE CORRECT AND THAT THE ENVELOPE HAS BEEN SEALED IN HIS/HER PRESENCE. '\ CURRENCY: 4. 5. 6. I '- 7.. l- B. 9. 10. 11. 12. 'r 13. 14. 15. / II ....:;:..jt"l'- '~-.-~:. ~ ' ~!~1Jfl1 I~ '8'593'85 NAME __ ROOM NO. .' ROHRBAUGH, WAYNE V001218483 REG ER 10/29/1932 71/M BOYKO MD,MICHAEL J No Family Physician M0179655 07/04/04 HOSP, NO_ PHYSICIAN DATE CHECKS: f ,-KIO :S~ / / / (/ HOSPIT~'~~TIVE /-.. . -','DAJ'E . '7 (..1 _-"t.."';:"'~r ,..-' N"":j CA. " '/'/~'-7 i REV.l!119EX'(1-97) '* SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /(Of..lt2.I3AU&I-I, WItYI/I~ II. FILE NUMBER ,;? /-0'1- 9t!6 If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JoHN bJ. I?DHRBA()'~!{ / b7 ESSB'X CIR.et.G' 5/EP/Ytn'S t!./T~ }/A. :{ ~'5~ <5aIII B. c. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar Identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. '* {jEll!.O ()MMU/JrTy Cl!S)IT UJ.}IDIJ Ac.erS! (aJ ncer.~. 7'" D7' I S/l-YIN(;S ~ I, /7'1. .2f ~t, ~7: /1{ (h) !fat/. AlP. p{" '1,a 9()" SA-J'INt:.S ~ So'3 .5Z>~ ~ ~ .'2 (c.) ACt!:T. Alo. o "f/39o I ~HE~/(I/"6 0>1If,fJ.w.. G/Vr , 'K 1''1.. s-S' S?>~ S' 1f~~78 1\ CJrM> /4./JIS"'flA..,D12 . ..JOliN tJJ. hl1l1.8AU&/: BGtJ~YE5 7JlESG ~ I4iL. ntlhlJE jO/hr A-T ~~ /!(b()/II.7 7H6 7/m€ HIS FA-~" ~e- "l)(R!Ii()eN T 11M A sr~~ 71{1.5 If)f/lft../) .&E /hfIIt.Rf;X. I y~ - 2 )"F/MS /JEFrJRE ];J..o.l:>. TOTAL (Also enter on line 6, Recapitulation) $ I, 03 if. 51 (If mnr" "'n::II~" j", n""rlArI in"'Arf ::Irlrlllinn::ll ",hAAt", nf th" "'::1m" ",i?,,' REV-1510 EX. (t-97) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /J_ ICPI! R /j 1,." ~H , IVII- Y III ~ 'I. FILE NUMBER j..;-o'l- 9ffo This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY lNa.UDE THE NAME OF THE TRANSFEREE. THEIR REIATlONSHP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAl ESTATE. ITEM NUMBER 1. aFL Co f.DMIKLUIlI'Ty WDI-r UNION It~r: I.teR -2. (; I r:r IVI 'PI'A' JMlE Y iEFl9-/( ~F ]). D. .1>. Ib (}~~6. R.IHII4H~1f t IIYF'I'J /ff)"fE : 7ild C1UitJ/t t!L.Glf-IU:""7) nt~ CII/?(JKIN6 Ifeer: /frr~ 7h'E]), P. 1>, ~ 1.5 77IBl€P()I2!f ilS re-"D /Ie A L./IlI/f" Jrt/JI ~A' S eJ.IE"D. r.. %OF DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE VALUE OF ASSET INTEREST lIF APPLICABLE \ ~ It 3, Sio. 38 , 00 tD - 0- 3,Stfa.3~ ~ ~~(), DD (. .3,000 AR'T ZBPL; TOTAL (Also enter on line 7, Recapitulation) $ 3, S- C'~,,3 3 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF,O B II LI .,oHf( ITlAGnJ . REV-1511EX -11-971 . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ;2./-tJl!- ji~ {;JII YNE H. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. B. 1. 2. 3. 4. ADMINISTRATIVE COSTS: Personal Representative's Commissions It' Name of Personal Representative (s) .Jo HN w. ICDI-l (( l3 A- M firH Social Security Numbe~s) I EIN Number of Personal Representative(s) StreetAddress /~7 ESSe Cllfa(.~ City S7G/lIIEN'S t/ry Yea~s) Commission Paid: loo-:f f: CHlfllLes F. SH/~S or IS H50 SE'AJ/ING AS Cc-.4J>/HIIVIS71t!IIToR " AttomeyFees (J/-IIf/llGS E. SHIELDS 1iL, E'S{jj. (.sEE::!E/'. SIl~GrA7r~'I#t)) I Cf,'f17.tff; Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) I'D 7'.It'L DF AU ,dA~ ~~ !'. Claimant c; A!€ GG /2IJH fl8IJ.U6H 3, Sf)O, b 0 Street Address I ~ :Z.3 1J1/7aHG7..t. Z/A!!/J/t: City /JtECN/fAllc-S 8tt"e(;. State /,1'1 Zip /7DSD DESCRIPTION FUNERAL EXPENSES: /YJ )lE"~S FulJEtelH.. Home: oF" /U,€{},t/AN/CSBk,RG State V'A Zip ~ :21. sf: Relationship of Claimant to Decedenl SoAJ Probate Fees fJ.Mi or~;"tt.1 iss Uc: of short certifr'co..fe.s 5. Accountanfs Fees 6. 7. 5', 'I. /0, /I. 1:(. /3. Tax Retum Preparer'sFees ,Floyd FahnesToc.k I 7~ A-cc.o"nto..nt, fr". slra~M t.I'\i ~ oJ .b~ w , s~Uf5, 'tl &fo , 'otH&, PI\- LH , lti.. (e~ h'tk.) Cu.lJI~Ia.nJ [..A..uJ JDlArnDwI A-dllert/siIJ3 Co.r/;s/e Sen-ni1el A-tAtle.rt,"SinJ fI~t'sfet" Pi IJi//s ~ Short Cerf/~'ca.l-es A '~'h"lIa/ 1/'6/'..t, .fee ;://,'''/ J(!.~p,u,61 If.tI,(/j,'ltal sh,,,t cer/i'hiAlb 41//;"1/111/ skl't t!f.rt/h'c4/i.1 AMOUNT ,..~ 79~.()O ~ d 2,()/). ~t:) I , V tf. "0 ~ '-f 50. f)() , 7 s: DO fllS".2.S" "I;t . 00 " '1 ~ .00 it J o~ f)f) "- '/;? i. 00 .2 1, Of) TOTAL (Also enter on line 9, Recapitulation) $ S ~ 531, 15:" (If more space is needed, inserl additional sheets of the same size) I I IP,w,€ 2. iJE="67: pp h;;(/<t3I1-"G~ tv/lY/fE /I. :U-o'l-9'Jtt6 ..5MEt> 11 . .____.___...____ M" ___ ._" __u_.________u __._.___.L_7-.I':_____..~_______.______ _..__m.______________ ..._-+.......____..__ __~__ .._____ _______._____________ .... _._.____._...__.__.._.__.,____~___..~_____~_____._.__... ,_. -----------L'i----lfIul-lir~A~~.. --=_~:6JL___$&/;lil~5_~d~_dWi-~______.___~~~_'__~f?~______ _______ ________l~_I__ ,t~'" 'I!~/)41_ ~ ~_;h~~~s.______________________.____ ' ~. ~o ____________~. i__~rJe~--$ DLrltA'_~__~~~& ?ff ._~~--;~~:;~~/~~~~~~=~=-~-~ ~_______~.d;;,'d At4JT~ ~~, e4.+j..,_~-<Lu.//.r'_~-~.-_!I..fI. 5lJ _ ______._m__ _____LZ!-_T~~_&~.!L____~ 6/L._cf/1,e ___~A 1_f._T _~~k_____.______________.___ ~~~ ~_______ _____--11:.._ __/rld:1~IJ~I;I1__& _.N:l__~__~I'/~_..s~~________________~~ ~a___ u____._____L!'-__~_~';~_~__~f2~~~1e _______________.____________~ ~______ ____________~~'_ _ F:!:~'!7- ~~_ t-_ R~~-ijv, ~~_____________ _________J.s:: ~______ , --~~--~-- .-.. ~---_.._-_.__._----------_._--'-------------~._------------------- r n_ -- !'t 77i1-MAG1II7 ~ SC!HGl:> 1(. (fJ~ I) EST: f);:= ~/I/l8AJl.H UJ/l-YIfIF /I. ::Z/-ol/-l1c:PiG _ _ ________.__.________.______u.___L_______.__.._ _______.___._._u_.___u__.._.___.________________.____.__u____uu.___.______ ~_____~____f"!!V~/!.$__E.~_s._un_~~___??(.~__~J" __~~~ ~~______________u_ ______________ . ...____~__I2~u~ ~!!!Af'__lt!~__!<l~~LJ1 q)'!.~_~_~t!(___~_u_h~ ~I'_____________ __u__U"__U_____ -~.L-rl2ll>~;o/-- A~_' Ml.r _plrUl'~--~-'-~~~d.~?--~-~d-L-!?l!:~----_---u--uu-- ___._____ u___n____u_u_ Ji~~'_J.__~~~_~,'_!~~A_/-~~/--Lflk~Hf-i ~L-h.J1..."r~!{~l-----.------_.--.-m_- ____________ _1bI/JM.1"eJ( ~ ~______1ftAll)!--~/I{e>fr ~U:/.._. f!:~__/~~M e ________.u____ _______n________fi/;L/L~!._~I$t__t'hJ,i4rfl~~~~__~_u "'~J'_ h~L_u/4A~q:~k_/!.-u~--_- ..___ ________.____tt._111t4Il/;iH~_~flr;; _!!,,~re /]tAt:U _~ _~~r___!:..~~1!~_______u.m_ ______ __u________. ;1L~__b./ILeJ"hut_4HL~_tt~Ht__~4nL..___~_C!!I1J/p-J!-4;Jt:;~~-----h-- __________ j!!)~r I< ;--f:kAA't;t---/e/t--~AI~ifL"--~ ~__c:l.e~ /red__~--_--_------- ----u-U----j-Il~1f_ .~&r.___d /t.f..$-/_~__..RtIe....L'e__._/~~tI~.s_ 4~ ~ de~_t;r;;k4______ ---- ____u_ --t!Iftll!./~-mtL //t/Mt u~.L!t.4AJ-.-eJJ_tU.Lo/__LI:2_":/;;~M__uu__ _________llLi&_ :t/1/Jkr~I2--a;ft-~1t.ri--~/')#--J;I~r-r_~.Jf u ~,.,_______u__ --"______ut&_..a~7-...&--/~Mt!:L..--~-~li--:.-6 ~_~~il~'--k....skJ.rJ1J---- -~u.~ckL~--A-~~IJfU/L..~&__e.f~i9'_~~Gk.d ______._.______ _____u___________u_ -----u-LLb-fIlb..~h __&.ltLl.gL__U/~5 ___~i~il1~~_ ht ' -l&---t2f!L~ttb.L----------- _________u 4__Ji1J11tL#M..5~_p-/......_ ~ dL~~J:k,~t__u~$___~_____u__ ___u__u______._____Uu ..-CA~t.~___~~d/d4'~__~_~u--~rd~-~ __&__e..(f~_,,-~~---..---------- _______..________~u___ItJP _u(}tpl':"e~_n_(!I._&_uk6j.~u;f~~~-~-u-~~--~~-u------________ u__________u_....__.______ u_a.2._t:i____~-~L/1L~.P;j;L__h!Llh:u_u_;!.t:d.~__~,{~~~~-~-.~_~_____u____ __u__.___u______m.__.___u__ -&-LiP~--~~/~1f-. -e~~f!.~u_~.__td.IJ_L4X~ll~~?-@-~/l.. .-.--___ ...- - ... ....-T~&/.CL~~~..L'~ FYIi~h . /:f!.~.../~&/J~,-'.q'~,^",,1:7 /~-___ - ...... ___u._ _uu______ -i--d!t:S!..4/'r:.~-'-----fl~Lt~!..---ult: _ #t.u_(6;Z.i___~--~(l_$"~~~~~~u ___ .. _______J -t'kI1t2@-.g~/Ptf_~--.~~Il4e./~-~Cl!'.-&t:I4.,tft _u~et;:..,. _____u..__ __uu___________unn__._h__ __~_ .__fi.??__Ji1_(!._UI'r~_. ..~_u___~_..._I/t!lI:XP_f{~_ ._ __~t(,.IJ~!.....~..___u__ ---_______________t&/~r.-- ;11//6 f:.ql4t"..c.t2lr:..r.tUe___R.$".. _ utfu((~JP.~'____ . \ A 7f/feIl/J1EA1T To SCHa; I/. (~tt.t;e.2.) _~Sl__~F__~llil1A:tlljfl-)~rA!EE#._ ______ d__________ _~.7l!__ljf(!!P/'_.f._E~._~l]!f?(~. _._7:/.=~lf~tt~_ .-..- ---._.-.-.%--.g,'.tI:t:~.-?-~~€~[;.~'$._tp.=__~~~'!?f_~/I/._l!.~~~rA:.i?'0n- .. ___.__n_... ___m__ ___ __r1td_(l&1t&L__(LQV___~f?€~~~n__~_~~~__~~~'Y.!~~~~~!: . _. __ .... __......._. ..___.__. ..._ .MI!!{_j~__t..7~._f{~4&~d~___(A/-?.~/f~~C ~~~_~J!!!!~~ _._..__ LEGA-i L.m6,f77~# s-r/Glf~ v UI/I'/t!/t' tV/'!$" uL 7//II/fTeY +____., .......___.._,__..._,~____k.__ ~,.___ ,._.,___.._ _...__~__--.___...___.'___' '_'~_____'_'__'____.' ~_+__... ,._____....._..._n._.__.m..._..._.__.___..__ ....0..___..._... _____~_. _____....___ ._'__.__~_ __ _. __. ._~__....___________ .._________+.._...___.._..... _ '._._____..___,_._ .. It' ._n._.___. _.._.....__ ... ..._ _5ttCI!5.~EJ(?_._. .._.. ___.___...m____._m___. ..___._7J:?2:;f(.._~.____=__~/-_t2.2..~.~___. .__._____m__._._______ ___~.L._fLt)j{ffS.n~/J!~._~~=._.d;f#J!.;t!!./!.~ r:.?!ZZ~/fiJ f!I! ._____.___..._____._ ___...____._.___.._____ ...j~~lt!1i?[._=.{IttA!.IJ.~@.___&Zttlfj~~_._.S ttl1;._/!~~(~tE?..__,f'~1P~________.__. .._____..__..__...n__ _b12_A! E !J..P.ll~Z2t?1!~__0!l'Lc.tt._45ul~.?E2.___LA!... ~.f'€7lk'~._____.....n._ ___.__ -...-.-.-.-.. .---.-... ..-- _.t?.E~~'II?C!Q~_'!~________. ..----...---__ .._____n_~Z~.f~_~_ =:-6.tJ.z ~J~___._u .._ _.___...__m_.._.._.__..._.... __.__tt.E.L_C!IIMf..!2.._g-~_~a:L~S -g_4!:.~71N~.&_~:::.AtI/!!IA!LSZ~/t7ae. _.____._____.._ ~-'2._. (!~lLI}IS.El..._~.SL~~_._._??!~.LA//l24_~Gfr2.(!!(__._..__________ 111J~ ~ 5rA7~ 777ZE {!L./f/A1~ ~p/L~ -.-.-.- .--....--..-.--.----...-.- -.---.-..--.--.---..-..-....-----.----..----.-.-----.-- .----.--..---.-.--.-----.,!----.--..----.-.-..----. -.-----.---.....---. ___ ______.__._.________ ..Q!l./6~~/7Z.l"__B_!!?:'# _ .t!( ~~f._ _~(!?i.€~~_~_.._~~~~-.___.___..__.._ _...__.__._...._._.__________ _zee/5__L~"[_.L1!.._.~__&..~//f.6?~_R~{(I{~_~..._~~~A1~~______ h_._..__.._._.________ _~ 1l._&!~~?2~1l ,t)A!~,-_ ~f.~_._Ji2.tfNC_ !It.aI!ft__71 At &......_ / p ._._.u._._._..__ ..__........._....m _lJ.IJIM.~gy_~.__._Z~~~lZ~/iLnu/A!_.__P!~e.tL~_._ ~!!..__.. . ___._........ ....___.__.._...____. _7h.>:LM~.._7i__._2~L<__.i}_'!!&___~~.!/P~Y_--..~.?7lA!!i..___...____.__. ..--.-..........._..__...___.. -.-. __._5~.r!.l?f___M!J._._f2t1lf&!2..._._!{/J!~!i.,f_.1l._ _ .f!€__./~_..~~!lf!!!~_ .____ ......... -.....- ... ..-.-...-.. . !f[-:Zlll1_E~E_._.lJE1tZJj_.__lf._._t!€!l!i!!lf?y..L$___lP/t:E.._~If/)....__m_n_._.__ p~ 't:Ctf1r5e1J HIM. At.so ;/ /t.t: ,tJ4-I2.A-71~ AI e F- _. .~= ~CJ;~~;l~Co:I_;;~~~ ~~e,/=- .__j~#Ei"':5:;;_j$3~~-- . ...-~;-u-7i;~....-...-=-.~iu-~-;.;~.~-;....- __un__._... __..... _._.. ......_ .../..___.____..._._______ . REV.1513 Et'.(1.97) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~I-/ If J1A IA..~/'I / PtI/f Y /f/ E #. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. .Jofllf/ u/. ~NJt/E,4a~ 101 Ess~ e/,.c/~~ Sk,alaurs ~ ~ Y.I! ;f2'SS ~. h/It!.lIA& //. ~#/lf1A-U&H if..37i' AlE /6& /lPe. / /*/J1/AIW 1hL:A~ 1="1. '33"11 t/ 3_ K/f7'A//L.YAl J: ~N~$AIt6# /1 PJ. (;reel/ SI; /)feeliUlies6~ ~~ ,4(-/7oSS Yo GlE(;G E. ~H~.t5A-ub.~ Id;J 3 /I1:ldtdl Ilr." /If~AA"cs~,p7A /7oS7P FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SD~ ~;f ~ 5~h -7/- 0,/- 9 J>~ AMOUNT OR SHARE OF ESTATE )14 t~ Yt,t Y/f ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /J A- ICLJI-/~S tlGI-/J REV.ISt1 EX. (1.91) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ttlAYAlE II FILE NUMBER :ll-b~- ?'tf" Include unreimbursed medical expenses. ITEM NUMBER 1. ~. .3. '1-. 5. (" DESCRIPTION Ftt!era! ~me ~ ~AzUd ~flEek -ID G~~ ~hrbAd-l1h wk,'c:.h A- W . 4ffir d, /). I(', ilEl{!P ~€f)JT ,4(!,t r: # f) b9 3 f/) -1..' ~~,"'A'(!,E. PILE' "AJ ~/l-IY A-T :po f).P. (JIIiIEt!.HhFb L1A1IF ~F tJR.S>n:J eleo.red J!>e,JCf) ~W<;11J S".t.J,c ns EIJ1EI?(;EII1t!.y SFRVIC,5 (~ee. sl-afentel1f A-!f4&k.II) SA-/..u rls EI1tE'~cfEJ1lCY SE1'lYIc.s SA-i./,.( TIS EII'/IF~~EAley se-IU'I~E"S 7. rBeIZR/V - FJ1L. uf7/J","7}N~ &J.I"~JtE $/UtlIlI6S M/ //(JuR. (!,p Y E"12/J-6e f/Jlf M.B>/T efti'll> d lSele.o. AMOUNT " till. beJ ~ o~.oo ~ S; i'-z./.'i3 . 'f2? '11 ~ 3/,7/) , 372.9'1 ~ 6/t;,.3tf .,$-'13. Kt 11. ;U.DO I, ,. 7. I2.S ft;if() ,A7G",eStur! A-L / A/~1JtE TOTAL (Also enter on line 10, Recapitulation) $ J ( ,., 5" 00 , P( Of. (If more space is needed, insert additional sheets of the same size) ~ NCO FI1\ANClAL SYSTEMS 14J 002 08 :I (J .. 06 13 : 44 FAX 9 3i 4 29:J 9 8 5 -.---.--. .___._...__ _'_ ___ _.._0_" "::.::.::;.::::::.:"::>:';..;:::'..:~.::';::.>::':.'::,\::;:":.:.:' \~:~':::.':.:i::':,.'::"~: <':~':::::.:~::~t..)::.'~:.~.:\::.:..:..:S\'::~;(S':":'~':::;,'.~'i~::':~iC:::::\~~.T~i.8:.".':.:"\ :,'.:..:N(JI~:..:.F1Ni\:N::(S:tA)L:.:: '. ":"::l'.~0W.;DilV'1:;J.'::.II~:'V:': '.: ',."::'::::."::'. ':";:::':':::"","'.: ':.':..:,:'}::'.-"'::,:.: .::..........:. c,."'. "::':::::::"" ..:.::.:::':.:::.'::.'. .:': '. '. ::.....:..... 'c. 'c' ......:::::::::.....::.:. '.':". ..::.....:: '. ...::.: .....,:.:' ':: ::.::......:..:::::,:..:':....:,...:. .......,::.:::::. ..:.: ::.'::. ':'.':" PO BOX :15630 WILMINGTON DE 1985D ACCOUNT INFORMATION Aug 4, 2006 55ESX3 !'{OHRBAUGH, WAYNE %C~~LES E SHIELDS III ESQ 6 CLOUSER RD MECR~ICSBURG, PA 17050-3162 =~=-====~===~~~====;=~==~=~=~~=~==;====~~==:=-==~=;~=~==-=======~==;==:=====~= Client ff: Acct #: Regarding: Principal: Total Owed: MSALUT-1 SALUTIS EMERGENCY SPECIALI H179655 ROHRBAUGH, WAYNE-070 429.91 429.91 ======~==~==~=======~=~==_=~==_====~~=====_=====~=====_==~==_==~=_N~=~======~= Client #: Acct #: Regarding: Principal: Total Owed: MSALUT-l SF~UTIS EMERGENCY SPECIALI H179655 ROHRBAUGH, WAYNE-070 31.70 ===~_====:~=e==~==:=~~====-==~==~==~==~=~===-=====-======~=====~======~==:==-= 31.70 Client #: Acct #: Regarding: Principal: Total Owed: MS~~UT-l SALUTIS EMERGENCY SPECIALI H179655 ROHRBAUGH, WAYNE-070 372.94 372.94 ':"1111" !C' Hi ^TTr-~APT Til r.n\ \ Fr.r . -.-'-'-- @003 08:10:06 13:44 FAX 93i4293985 NCO FI1\ANCIAL SYSTEMS _.-- --..--- --.,-' SALUTIS EMERGENCY SPECIALISTS ROHRBAUGH, WAYNE Client Acc.t# H179655 DATE OF SERVICE: 070Ll2004 A1v10UNT DUE: 429.91 CPT CODE: 31500 C11ent Acct# H179655 DA TE OF SERVICE: 07042004 AMOUNT DUE: 3] .70 CPT CODE: 71010-26 Client Acet# H179655 DATE OF SERVICE: 07042004 AMOUNT DUE: 372.94 CPT CODE: 99285M-25 T:..l!.~ !.~ At\! ATIi=MPT Tn r.OLL.ECT GEORGE M. HOUCK (1912-1991) Register of Wills Cumberland County Court House 1 Court Square Carlisle, P A 17013 , Dear Register of Wills: CHARLES E. SIDELDS, III A1TORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 TELEPHONE (717) 766-0209 FAX (717) 795-7473 April 24, 2007 Re: Estate of Wayne H. Rohrbaugh No. 21.04-0986 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Wayne H. Rohrbaugh Estate as well as Check No. 818, in the amount of$15.00 for the filing fee and Check No. 819, in the amount of $72.00 for additional Probate. Thank you for your kind attention to this matter. CES/mjj Enclosures Very truly yours, ~,F~;g;, Charles E. Shields, III Attorney-At-Law o .~Cj -~--- r-::- .-:~: i-I: :.-r.J "./.... :/""'-0 r:::::) CO> -.l 7'_'"'D _0'0 :::-:::1 N ..::- -0 f',.') co Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 phone: (717) 240-6345 SHIELDS CHARLES EDWARD III ESQ SIX CLOUSER ROAD o So ~~~ :IJ )-0 "1 :;;s 0 "," ..,-;: \--n ->();~ )00 -',0" , ~,c ~~ :IJ ::p~ --'~~ r--.) <:::) <:::) --.I c- C Z N en Date: 6/22/2007 MECHANICSBURG, PA 17055 ;po ::n::: - .. -.I RE: Estate of ROHRBAUGH WAYNE File Number: 2004-00986 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.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: 7/04/2007 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 Personal Representative(s) <t cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 107 ESSEX CIRCLE STEPHENS CITY, VA 22655 () ~o 1'S~ ..~;IQ ---~~~~ en=^ no O-n C: . ::0 -o-i :t"'> r-...> = r..=,:) --.l <- c= Z N CT\ Date: 6/22/2007 ROHRBAUGH JOHN W :l'> ::::m: -.I RE: Estate of ROHRBAUGH WAYNE File Number: 2004-00986 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.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: 7/04/2007 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, I/j V ,,#-:.L.uJ7 ~~~j~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel J P.", 0- C- R'uTe 61"" ST' AT' U' TS RE" P'O- -DT . ao ' .' Cl.j C' : 1- 'e: 1:' !.I..'"'"'".J;... 1: ,',;;' "J:.."\:... ; REGISTER OF WILLS OF C{.L fit 9ElU/l-NJ) COUNTY, PENN"SYL VA:N1A Name of Decedent: /,.JA-Y IIIE /(f)/'I~ $AIJG# 1/~Aoo", File Number: U-()'/ - 9tfb Date of Death: Pursuant to Pa. O.c. Rule 6.12, I report the follo'wing with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . ., DYe$ ~No 2. If the answeris No, state when the personal representative - _ reasonably believes thatthe a&ninistration will be complete: he ~ ~ ~ fum: ~?'~tUtJ/~~ ~ .~#.Ut/~ ~.~t~~~ 3. lfthe answer to No.1 is YES, state the following: a. Did the personal representative file a final'account with the Court? . . . .,. DYes DNo b. The separate Orphans' Court No. (if any) for the personal representative's account is: Co. Did the personal representative state an account informally to the parties in interest? ..............,................ DYes DNa d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Dale 7/2-/1) 1- ~f!~~ Signature of Person Filing Ihis Form Capacity: OPersona] Representative ~Coul1Sel t!Mr/e~ E: sA'N~ ttr Name of PerSOll Filing this FOJ'm " . ~"':"J ' .. ' ~! i ~i"'~'-' "\ i' ' _1.11 .i..::iI iUv ~),i'J'iHdtJO -'n >' iWT1'l _h..l ".J..! Iv ~ ~~~ A'~ Address /JtetltUl/Cs.h""'1~ ~~ 171)SS" V 717 - 7Q~ -~.l.4 f Zf; :Zll~d S- lnf LDOZ Telepholle vJ 06-18-2007 ROHRBAUGH 07-04-2004 21 04-0986 CUMBERLAND 101 APPEAL DATE: 08-17-2007 ( See reverse side under Objections) Amount Remittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX OIVISION PO BOX 280601 HARRIS8URG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE "'-' (, ""."'I<<I1',IClOO!lif":'-I NHER IT ANCE TAX ~PPRA1:'SE+iE'N~i~ ,'A'l.[OWANCE OR DISALLOWANCE -OF"ofj:fiJCTiONS, 'AND ASSESSMENT OF TAX . .~. - . ~I . CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG 2001 JUN 25 PM 3: 5~TE ESTATE OF CLERK OF DATE OF DEATH RP 1\1'8 ("OIJRT FILE NUMBER 0, H.A.:,I u -" I COUNTY cur, I.rr'-, i " pA ". " ,,'"IACN PA 17055 REV-1547 EX AFP (06-05) WAYNE H TO: CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROHRBAUGH WAYNE H FILE NO. 21 04-0986 ACN 101 DATE 06-18-2007 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) (1) (2) (3) (4) (5) (6) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return (9) (10) 13. 14. CHANGED 26,000.00 11,614.06 .00 .00 10,103.32 1,034.54 3,580.38 (8) 54,531.75 11.252. 70 (11) (12) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of Ahh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: PAYMENT DATE NOTE: (15) (16) (17) RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) .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. submit the upper portion of this form with your tax payment. 52,331. 92 (13) (14) 611.784 411 13,452.53- .00 13,452.53- 00 045 12 15 .00 .00 .00 .00 .00 (19)= .00 .00 .00 .00 ~ ( 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.) * IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. " IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA. ORPHANS' COURT DIVISION FILE NO. 21-04-0986 FIRST AND FINAL ACCOUNT OF JOHN W. ROHRBAUGH, and CHARLES E. SHIELDS III, CO-ADMINISTRATORS For ESTATE OF WAYNE ROHRBAUGH, a.k.a. WAYNE H. ROHRBAUGH Date of Death: Date of Incapacity, if any: Date of Administrator's Appointment: Date of First Complete Advertisement: Accounting for the period: 7/4/2004 None 10/29/2004 1/28/2005 10/29/2004 8/31/2007 PURPOSE OF ACCOUNT: The Co-Administrators offer this Account to acquaint interested parties with the transactions that have occurred during the Administration, It is important that the Account be carefully examined. Requests for additional information, questions or objections can be discussed with: Charles E. Shields III 6 Clouser Road Mechanicsburg, Pennsylvania 17055 Phone Number: (717) 766-0209 Supreme Court I.D. No. 38513 (-) ') -_J _'fT, .1 ..--1 r.) (>) 1 " . " SUMMARY OF ACCOUNT PRINCIPAL RECEIPTS PAGES Real Estate 3 $ 26,000.00 Common Stocks 3 11,611.98 Bank Accounts 3 5,836.31 Personalty, Cash, etc. 4 4.267.01 $ 47,715.30 Net Losses 5 - 1.553.25 Adjusted Principal Balance 5 $ 46,162.05 Less Disbursements: Administration Expenses 6-7 $ 607.75 Fees and Commissions 7 22,127.00 Family Exemption 7 3,500.00 Funeral Expenses I medicals within 6 mos. 7 9,624.55 Payments Prior to DOD 8 800.00 Tax Payments 8 21. 00 Sub- Total Priority and Pre-death Payments 8 $ 36,680.50 Debts of Decedent I Proposed Distribution 9 $ 9,576.15 INCOME Receipts 8 $ 731.42 Less Disbursements 8 -0- COMBINED BALANCE OF PRINCIPAL AND 8 $ 10,213.17 INCOME ON HAND DEBTS OF DECEDENT I PROPOSED 9 $ 10,213.17 DISTRIBUTIONS PAYMENT TO CREDITORS 9 $ 9,576.15 PROPOSED DISTRIBUTION TO HEIRS 9 $ 637.02 2 PRINCIPAL RECEIPTS REAL ESTATE Decedent owned an alleged interest in Real Estate situate at 1223 Mitchell Drive, Mechanicsburg, Cumberland County, Pennsylvania. This interest was asserted on behalf of decedent's estate by the co-administrators of the Estate as adverse claimants in the Bankruptcy case of Gregg and Paula Rohrbaugh, case No. 1-03-05970, MDF, Bankruptcy Trustee, Markian Slobodian, Esq. The estate was represented in the matter by counsels: Charles E. Shields, ITI, James Jones (final bankruptcy litigation counsel), and Albert Z. Bogert (original bankruptcy I litigation counsel). As a result of the said complex and protracted litigation, a court-ordered mediation conference led to a stipulation by which the estate was awarded $26,000.00, which sum was approved by the court. $ 26,000.00 COMMON STOCKS One (1) share of the common stock of AGERE * .00 Informational note: The date of death value of this stock based on an average of the high and low trades on July 2 and July 6, 2004 was $2.08. The cost of transacting this share via Compushare, the designated agent has been quoted to us at $15.12. We are therefore regarding its effective value for all practical purposes as net zero. Eleven (11) shares of the common stock of AT&T $ 265.10 Three hundred eight (308) shares of the common stock of VERIZON (f.k.a. BELL ATLANTIC) $ 11,094.16 Seventy-two (72) shares of the common stock of LUCENT TECHNOLOGIES, INe. $ 252.72 $ 11,611.98 BANK ACCOUNTS Citizens Bank Savings Account #6240-853270 Interest accrued to D.O.D. on said account $ 5,835.91 .40 $ 5,836.31 RECEIPTS OF PAYMENTS Federal Express Employee Pension Plan Check $ 62.76 3 '. . PERSONALTY Chevrolet Caprice Automobile $ 4,000.00 CASH Cash in wallet $ 204.25 TOTAL PRINCIPAL RECEIPTS 4 $ 4,267.01 $ 47,715.30 PRINCIPAL GAINS OR LOSSES ON SALES OR OTHER DISTRIBUTIONS REAL ESTATE Informational Note: Records were in disarray and absolute knowledge as to stock ownership only resulted from inquiry and research. Hence the disparity in dates of sales and liquidations. GAIN LOSS 8/25/05 11 Shares - AT&T Net Proceeds: Acquisition Value: $ 196.29 265.10 $ 68.81 2/28/06 308 Shares - Verizon Net Proceeds: Acquisition Value: $ 9,717.16 11,094.16 $ 1,377.00 11/6/06 72 Shares - Lucent Technologies Net Proceeds: Acquisition Value: $ 145.28 252.72 $ 107.44 Informational Note: Sale and transfer of Chevrolet Caprice was for the acquisition value, resulting in neither loss nor gain. TOTALS $ -0- $ 1,553.25 NET LOSS TRANSFERRED TO SUMMARY: $ 1,553.25 RECAPITULATION AND SUMMARY OF PRINCIPAL TOTAL UNADJUSTED PRINNCIPAL RECEIPTS: $ 47,715.30 $ 1,553.25 $ 46,162.05 NET LOSS ON SALES: ADJUSTED PRlNCIP AL BALANCE 5 DISBURSEMENTS OF PRINCIPAL COSTS OF ADMINISTRATION GENERAL: Probate fees and original issue of short certificates $ Additional probate fees $ Filing Fee to Register of Wills for Inheritance Tax Return $ Filing Fee for Accounting with Orphans' Court (estim.) $ Photocopies, certified mailings to creditors, etc. (estim.) $ Advertising in Cumberland Law Journal $ Advertising in Carlisle Sentinel $ Additional short certificates $ Additional short certificates $ Additional short certificates $ Additional short certificates $ Vital Statistics of West Virginia-additional death certs. $ Additional short certificate $ 48.00 72.00 15.00 130.00 41.50 75.00 115.25 12.00 28.00 28.00 4.00 35.00 4.00 $ 607.75 Informational Note: Transaction and brokerage fees in connection with the sale and liquidation of the aforementioned common stocks are not itemized here separately as they are reflected as part of the losses on the sales as transferred to the ultimate principal balance hereinabove. FEES AND COMMISSIONS AS TO VARIOUS FEES AND THE REASONS THEREFORE: Decedent passed away in West Virginia. At the time of his passing he was elderly and beginning to fail. One of his four children, Gregg Rohrbaugh (and Gregg's spouse) had moved into the family homestead. Gregg became financially embarrassed and later filed bankruptcy. In the meantime efforts were made to transfer interests in the homestead and to obtain loans. The conveyancing work's quality left something to be desired and, among other things, there were issues as to decedent's capacity and intent. The matter ended up in litigation in the bankruptcy court with Gregg, the Trustee, the Estate, the lender, and its title Company. A settlement was eventually reached. Litigation counsel was obtained in the persons of James Jones, Esq. and Albert Z. Bogert, Esq. and Charles E. Shields III, attorney for the Estate, who also was involved in the litigation. He also served as a Co-Administrator with John Rohrbaugh so as to more efficiently proceed in unraveling decedent's affairs and records which were in considerable disarray. Hence the 6 '. . multiple and considerably above average counsel and accountant fees. The fees incurred by the various counsel and their particular roles are as follows: RE: Albert Z. Bogert, Esq. - Former Bankruptcy Attorney, Judgment Lien Collector, etc. for Dauphin Deposit Bank in its heyday. Was instrumental in devising legal litigation strategy which was ultimately successful. Total Fees = $ 3,097.50 RE: James Jones, Esq. - Bankruptcy Litigation Specialist. Handled actual suit, pleadings, hearings and negotiations which resulted in recovery of $26,000.00. Total Fees = $ 1,994.50 RE: CHARLES E. SHIELDS III, acting as Co-Administrator and as counsel for estate, did initial research into real estate title claims, worked diligently with Messrs. Bogert and Jones, took part in all pleadings, filings, hearings and negotiations. Also, spent much time in unraveling transactions in dispute and trying to track down allegedly existing stocks and shares known to be in existence at time of death of decedent's wife who predeceased him. Also preparation of accounting, etc., etc. (estim.) Total Fees = $ 14,385.00 Fees Grand Total = $ 19,477.00 John H. Rohrbaugh, Co-Administrator Floyd Fahnnestock, Tax Accountant $ 2,200.00 $ 450.00 $ 2,650.00 Total of all Fees $ 22,127.00 FAMILY EXEMPTION Claimed by decedent's son, Gregg Rohrbaugh $ 3.500.00 $ 3,500.00 FUNERAL EXPENSES AND MEDICAL SERVICE EXPENSES WITHIN SIX (6) MONTHS OF DEATH Myers Funeral Home of Mechanicsburg Salutis Emergency Services Salutis Emergency Services Salutis Emergency Services $ 8,790.00 $ 429.91 $ 31.70 $ 372.94 $ 9,624.55 7 " PAYMENTS MADE BY DECEDENT BEFORE D.O.D. WHICH CLEARED PAYMENT FROM PNC ACCOUNTS AFTER D.O.D. Gregg Rohrbaugh, Payee $ 800.00 $ 800.00 TAX PAYMENTS IRS - Personal Income Tax $ 21. 00 SUBTOTAL OF ALL PRIORITY AND PRE-DEATH PAYMENTS $ 36,680.30 RECEIPTS OF INCOME AT&T Dividends (including partial stock dividend) $ 201.51 Verizon Dividends $ 529.91 TOTAL RECEIPTS OF INCOME $ 731.42 DISBURSEMENTS OF INCOME $ -0- RECAPITULATION ADmSTED PRINCIPAL BALANCE $ 46,162.05 DISBURSEMENTS FROM PRINCIPAL $ 36,680.30 BALANCE OF PRINCIPAL ON HAND $ 9,481.75 $ 731.42 INCOME BALANCE ON HAND TOTAL CURRENT BALANCE ON HAND $10,213.17 8 ," CLAIMS OF PRIVATE NON-GOVERNMENTAL AND NON-SECURED CRREDITORS FOR DEBTS OF DECEDENT Belco $ 8,421.93 Verizon - for updating overdue billings on insurance coverage $ 610.34 VISA Credit Card at BELCO $ 543.88 TOTAL CLAIMSIPROPSED PAYMENTS $ 9,576.15 ADDITIONAL RECAPITULATION PAYMENTS TO UNSECURED CREDITORS $ 9,576.15 $ 637.02 COMBINED BALANCE ON HAND PROPOSED DISTRIBUTION PER INTESTACY STATUTE AMONG DECEDENT'S NATURAL BORN CHILDREN JOHN W. ROHRBAUGH MICHAEL P. ROHRBAUGH KATHRYN 1. ROHRBAUGH GREGG E. ROHRBAUGH (1/4) (1/4) (1/4) (1/4) $ 159.26 $ 159.26 $ 159.25 $ 159.25 * * Informational Note: Co-Administrators currently hold in Escrow certain amounts not subject to claims of creditors nor typically itemized in an Accounting. For example, by agreement of the heirs, certain proceeds checks from the IRA Account, life insurance, the family exemption, and other similar funds. The three first above-named heirs claim an equitable set off against the share of Gregg Rohrbaugh therein in view of the fact that the above-referenced Belco Credit Account debt in the amount of $8,421.93 was for the equitable benefit of Gregg Rohrbaugh although taken out in the name of his father, Wayne Rohrbaugh. The face amount being so held is $45,354.88. By way of further information, Gregg Rohrbaugh did not deposit a check for $4,875.00 into the Escrow. Therefore, before distribution, an adjustment shall be made for that as well. The above proposed payments and distributions will render the account zero. 9 . ,. ~~~ (SEAL) CHARLES E. SHIELDS,llI, Co-Administrator of the Will of Wayne Rohrbaugh, a.k.a. Wayne H. Rohrbaugh, Deceased 10 . . VERIFICATION JOHN W. ROHRBAUGH and CHARLES E. SHIELDS, III, Co-Administrators of the Estate of Wayne Rohrbaugh, a.k.a. Wayne H. Rohrbaugh, deceased, hereby declares under oath that he has fully and faithfully discharged the duties of his office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the Estate have been paid in full; that, to his knowledge, there are no claims outstanding against the Estate; that all taxes presently due from the Estate have been paid; and that the grant of Letters of Administration and the first complete advertisement thereof occurred more than four months before the filing of the foregoing First and Final Account. This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. (Seal) . ~~~?(Seal) CHARLES E. SHIELDS, III Dated: I OltS/o ., 11 DECEDENT'S ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION WAYNE H. ROHRBAUGH ESTATE OF , DECEASED This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. I{~ space is insufficient, riders may be attached Attach the spouse's election, if anY'(:-~6papers.:; required under items 8-19 inclusive; and any instrument pertinent to the adjudication ". -J n (~ ',.J l -r--- No. 21-04-0986 PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.c. Rule 6.9 INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Charles E. Shields, III , --. . ~ .,.~ ~'l ) II f') c.) Supreme Court J.D. No.: 38513 Name of Law Firm: Address: Telephone: Fax: Form OC-OJ rev. 10.13.06 6 Clouser Road, Mechanicsburg, PA 17055 (717) 766-0209 (717) 795-7473 Page 1 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased 1. Name(s) and addressees) ofPetitioner(s): Name: Charles E. Shields, ill John W. Rohrbaugh Address: 6 Clouser Road 107 Essex Circle Mechanicsburg, PA 17055 Stephens City, VA 22655 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: None Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . .. IZJ Yes 0 No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on July 4, 2004 o Letters Testamentary or lZ]Letters of Administration were granted to Petitioner(s) on October 29.2004 Date of Will (ifapplicable): N/A Date(s) ofCodicil(s) (ifapplicable): N/A Date of probate (if different from date Letters granted): Same Was a bond required? DYes lZ]No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ......... D Yes ~ No Dates of advertising of the grant of Letters: Cumberland Law Journal: January 14, 21 and 28, 2005; Carlisle Sentinel: January 4, 11 and 18, 2005 Form DC-01 rev. 10.13.06 Page 2 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased 3. Was decedent survived by a spouse? ............................. DYes IZINo If yes, name of the surviving spouse: 4. Has the surviving spouse filed to take an elective share? ............. DYes D No (.See Section 2201 et seq. of the Probate, Estates and Fiduciaries Code) If yes, date of election: 5. In the case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (ifnone, so state): John W. Rohrbaugh NtichaelP.Rohrbaugh Kathryn J. Rohrbaugh Gregg E. Rohrbaugh 6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . .. DYes 0 No Were any children born to decedent after execution of Will or Codicil(s)? . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . '" '" . .. DYes 0 No If yes, give names and dates of birth: Name: Date of Birth: 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. ~ 1412, was a request for a statement of claim sent to the Department of Public Welfare? .............................. IZIYes DNo Form OC-01 rev. 10.13.06 Page 3 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased 8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest is involved, Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice) must be submitted herewith or at the Audit. 9. List all parties (charitable and non-charitable) of whom Petitioner(s) haslhave notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest(s): Name and Address of Each Partv in Interest Relationship and Comments, if anv Interest John W. Rohrbaugh 107 Essex Circle Stephens City, VA 22655 Son 1/4 Michael P. Rohrbaugh 4398 NE 16th Avenue Pompano Beach, FL 33064 Son 1/4 Form DC-Ol rev. 10.13.06 Page 4 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased Name and Address of Each Party in Interest Relationship and Comments, if any Interest Kathryn J. Rohrbaugh Daughter 11 West Green Street Mechanicsburg, PA 17055 1/4 Gregg E. Rohrbaugh Son 1223 Mitchell Drive Mechanicsburg, P A 17050 1/4 B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). F or each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. None C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for this Audit ($ee Pa. o.c. Rule 12.4). N/A D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. N/A Form OC-01 rev. 10.13.06 Page 5 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased 10. Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Address of Each Claimant Amount of Claim Claim Will Claim Admitted? Be Paid In Full? Belco $8,421.93 IZJ Yes IZJ Yes c/o Arthur M. Feld Esq. DNo DNo 1309 Bridge Street New Cumberland, PA 17070 Verizon $610.34 IZJYes IZJ Yes PO Box 28010 DNo DNo Lehigh Valley, PA 18002-8010 VISA Credit Card at Belco $543.88 IZJYes IZJ Yes c/o Arthur M. Feld Esq. DNo DNo 1309 Bridge Street New Cumberland, PA 17070 DYes DYes DNo DNo If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. ~ 3392 and the proposed payments. 11. Was family exemption claimed? . . . . . .. . . . . .. ... . . . . . . . . . . . . . . . . IZlYes DNo IZJYes DNo Was family exemption allowed? . . . . . . ... . . . ... .. .. . . . .. ... . . . .. Family exemption claimant's name and relationship: Name: Gregg E. Rohrbaugh Relationship: Son Form OC-OI rev. 10.13.06 Page 6 of 10 Estate of WAYNEH. ROHRBAUGH , Deceased 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) ofpayment(s), and the interest(s) upon which paid, are as follows: Date Payment Interest The Department waived any claims to collection of any tax by zero balance sheet. 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond of a fiduciary? . . . . . . . . . . . . . . . . . . . 0 Yes IZJ No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: N one known at this time. B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .................. 0 Yes 0 No 15. IfPetitioner(s) haslhave knowledge that a share has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation. Form DC-OJ rev. 10.13.06 Page 7 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased 16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . 0 Yes IZl No If yes, attach a copy of the Order if available; otherwise state the Court, term, number, date, and name of Hearing Judge. 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. None as of this date. B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? ............. 0 Yes 0 No 18. If a reserve is requested, state amount and purpose. Amount: Purpose: There is no technical reserve as such. By agreement of children, money was put in escrow to pay for litigation expenses if the Estate Recovery was insufficient and to provide for possible set-offs among the children. (See informational notes in Account.) If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? ........................................ DYes DNo If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? .... . . . . . . .. .... . . .... . . . . DYes lZINo As to real estate only? ........................................ DYes IZINo Form OC-01 rev. 10.13.06 Page 8 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled and suggest( s) that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Distributee(s) AmOWltlProportion John W. Rohrbaugh 1/4 Michael P. Rohrbaugh 1/4 Kathryn J. Rohrbaugh 1/4 Gregg E. Rohrbaugh B. Principal: 1/4 Proposed Distributee(s) AmOWltlProportion John W. Rohrbaugh 1/4 Michael P. Rohrbaugh 1/4 Kathryn J. Rohrbaugh 1/4 Gregg E. ROhrbaugh 1/4 Submitted By: (All petitioners must sign. Add additional lines ifnecessary): John W. Rohrbaugh Form OC-Ol rev. 10.13.06 Page 9 of 10 Estate of WAYNE H. ROHRBAUGH , Deceased Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies 'Ie [that he/she he of the above-named name of corporation Estate IS title Co-Administrator and] that the facts set forth in the foregoing Petition for Adjudication / Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904 (relating to unsworn falsification to authorities). * Corporate petitioners must complete bracketed information. Certification of Counsel The undersigned counsel hereby certifies that the foregoing Petition for Adjudication! Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Court, and that no changes to the form have been made beyond the responses herein. ~ ~viJ r;) Signature of Counsel for Petitioner Farm OC-01 rev. 10.13.06 Page 10 of 10 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNYSLV ANIA ORPHANS' COURT DIVISION Docket No: 21-2004-0986 INRE: FIRST AND FINAL ACCOUNT OF JOHN W. ROHRBAUGH AND CHARLES E. SHIELDS, III, CO- ADMINISTRA TORS FOR THE ESTATE OF WAYNE ROHRBAUGH, A.K.A. WAYNE H. ROHRBAUGH, LATE OF MECHANICSBURG BOROUGH, CUMBERLAND COUNTY, PENNSYL VANIA, DECEASED. AND PETITION FOR ADJUDICA TION/ST A TEMENT OF PROPOSED DISTRffiUTION ORDER OF COURT AN NOW, this 27TH day of NOVEMBER, 2007, the herein account is confirmed absolutely and distribution is decreed in accordance with the proposed schedule of distribution herewith. BY THE COURT, I...L, C) Li:.: !-L.. c.) c', q.) c} Cr::: C') C:. L~J n. co M en x: c:r ~ 1-_ n::. ~ ~6 \..-J Co.) ~""r 0::: :::-..' LL1 :;::~ _.J:OO:.~~ u-~ &~... 0::"::0; U ,..... N .>- <:::> z r-- <:::;:) <:::;:) C"-..J ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 6/13/2008 SHIELDS CHARLES EDWARD III ESQ SIX CLOUSER ROAD MECHANICSBURG, PA 17055 RE: Estate of ROHRBAUGH WAYNE File Number: 2004-00986 Dear Sir/Madam: C7 ~' Q fc`~-; ~,. T p C . i -- .1 _i n _.., - ~' v3 ~ ca c. C::>~ .-. --i y .~- rn This notice is to serve as a reminder that the Status Report by Pe~.rsonal 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. 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: 7/04/2008 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 Personal Representatives} Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/13/2008 ROHRBAUGH JOHN W 107 ESSEX CIRCLE S'TEPHENS CITY, VA 22655 RE: Estate of ROHRBAUGH WAYNE File Number: 2004-00986 Dear Sir/Madam: n ~~ ~ ' ~~ c . _ ~, z ~? -: ~„ _z c,~ ~-, ~ ~~ r= ~; -~ --+ -~, V 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. 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: 7/04/2008 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, ~1~ ~~ul Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: WAYNE ROHRBAUGH Date of Death: July 4, 2004 File Number: 21-04-0986 Pursuant to Pa. O.C. Rule 6.12, 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 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 personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... Yes ^No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date 6/ 17/2008 ~ ~~ Signature of Person Filing this Form Capacity: ^Personal Representative Counsel ~' ~. I,1 ~ ~ ~ Charles E. Shields, III Name of Person Filing this Form 6 Clouser Road Address Mechanicsburg, PA 17055 (717) 766-0209 Telephone Form RW-10 rev. 10.13.06