HomeMy WebLinkAbout04-1003 PETITION FOR PROBATE and GRANT OF LE~FERS
also known as To:
Register of Wills for t?,
( 0- ~ ~ ' ~-,o~, '/ , Deceased. County of C ,:~/~:4Z ,. ~ t/.,:. ~/ in the
· ~v '~ ,7 Commonwealth of Pennsylvania
Social Security No, 19 ~ - 2 ¢ - ~. ~ /
The petition of the undersigned respectfully represents that: .
Your petitioner(s), who is/arc 18 years of age or older an the execuC~ ~t'/~', ~¢/~ ~, .:/:0 ' ~ nam~
in thc last will of the above decedent, dated.
and codicil(s) dated
Decendent was domiciled at death in c ~< ,~ Ce':, ")~/ / County Pennsylvania wi
h last familyorprincipalres~denceat /~- c°/;:r~'z~'~' /~Ji ~/;Y/ ~ f~ [~ ~
(list s~r~n~, number and muncipality)
Decendent, then ,~ '- years of age, died . _ / '~ ~__% '~- , .t-~.o~ c,C, ~
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopt
after execution of the will offered for probate; was not the victim of a killing and was never adjudieat
incompetent: . -
D~cendent at death owned property with ~fimated values as follows:
(If domiciled in Pa.) All personal property $ ~/00(' ,:0
(If not domiciled in Pa.) Personal prop~ty in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania S-
situated as follows:
WHEREFORE, petitioner(s) resl~:tfully request(s) the probate of the last will and codicil ',s)
presented herewith and the grant of letters ~ ,'/',, ,/~ - ~',, '.' / '
{tes~ary; $dmlni~tration c.t.a.; administration d.b.n.c.t
theron.
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~. aa
COUNTY OF C~\ t.~ ~:~ L ~ D
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition zre
true and correct to the b~st of thc knowledge and belief of petitioner(s) and tlmt as personal repre~ m-
talive(s) of the above decedent petitioner(s) will we~ truly a~minist~.~aff estate accordlnE to l~ tw.
Sworn to or affirm~ ano sonscno~ · c/ ,--: r' ~:
be,fo, re me this 5 ch3K 9.f.~ / : ]
- R~gi~ar L ~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/01/2004
FOSTER PETER B
121 SOUTH ST.
HARRISBURG, PA 17101
RE: Estate of CONKLIN CONNIE M
File Number: 1994-01003
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
Jul y I, 1992, the personal representative or his counsel, within two
(2 ) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 11/09/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
.~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
EstateOf k~tq~i~"~ '~L~-I~'~L[! i~']~3LL~ ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein be admitted to probate and filed of record as the last will of
and Letters
~e hereby granted to
FEES
Probate, Letters, Etc ..........
Short Certificates( ) ..........
., TOTAL S
. ..................
NOV 0 2, 20O
S!40U~ 0 READ AS POLLOW$:
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF flEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
~9~..,/x~,× ~_n.-.~,_]
Laborer I
~ ~ / .
WILL OF
HARRY D. MIXELL, SR.
I, Harry D. Mixell, Sr., of Enola, Cumberland County,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
I leave all my guns to my stepson, Kenneth Robinson,
except for the 350 Caliber Deer Rifle which I leave to my
grandson, Grant Wyant.
4. I leave the remainder of my estate of whatever nature
and wherever situate to Alice P. Mixell. Should Alice P.
Mixell predecease me, I leave my entire estate in equal
shares to Doris Shoemaker, Paul E. Robinson, Kenneth
Robinson, Dennis Robinson and Dale Thomas. In the
event that any of the above named children should
predecease me, their share shall lapse and go to the
remaining children.
5. I appoint Paul E. Robinson as Executor of this my last
Will. If Paul E. Robinson should predecease me or
cease to act in such capacity, I name Stephen J. Hogg,
Esquire, as the Executor.
6. The Executor of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
7. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
IN WITNESS WHEI~OF, I hav~.~reunto set my hand this
'~? -;7 day of ~; '.-/- (~-~"¢:Y'/T- ,2002.
/
LAW OFFICES OF
Harry D. Mixell, Sr.
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
The preceding instrument consisting of this and one other page
was on the day and date hereof signed, published and declared by
Harry D. Mixell, Sr., as and for his last Will in the presence of us, who
at his request, in his presence and in the presence of each other have
subscribed our names as witnesses hereto.
WITNESS W~/S
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
ACKNOWLEDGMENT
State of Pennsylvania
ss
County of Cumberland
I, Harry D. Mixell, Sr., the 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 willingly and as my free and
voluntary act for the purposes therein expressed.
Mixell, Sr.
Sworn to or affirmed and acknowledged~before me by Harry D.
Mixell, Sr., the testator, this : :,:?day of
-
20o2.
AFFIDAVIT
State of Pennsylvania
ss
County of Cumberland
We,/J.~j:u t~. ~.,/~¢'f? and /~l:r-~
witnesses whose names are signed to the atta~:hed or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testator sign and execute the
instrument as his last Will; that the testator signed willingly and
executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the'i, estator signed the Will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn to or affirmed and sub~c_r.[b, ed to before me by witnesses,
~-~0.02.
this D. ~?~ day of (~ ( ~,-~:. (,~7'
STEPHEN J. HOGG
~'~. ' COMMONWEALTH OF REV-1 500 OFFICIAL USE ONLY
~ PENNSYLVANIA
w,~J~,~. DEPARTMENT OF REVENUE
DEPT. 28060 INHERITANCE TAX RETURN
~HARRISBURG, PA17128-0601 RESIDENT DECEDENT c~E~ ~EA~ ~ ~E~ ~ ~
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
/0 ~- ~00~ 03-d~- I~{ REGISTEROFWILLS
~ 4. Limited Estate ~ 4a. Future Interest Compromise (d~m of death a~er 12-12-82) ~ 5. Federal Estate Tax Return Required
6. Decedent Died Testate (A~ch copy of Will) ~ 7. Decedent Maintained a Living Trust (A~ach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes
9. Litigation Pr~eds Re~ived ~ 10. Spousal Pove~y Credit (date el death ~n 12-31-91 a~d 1-1-95) ~ 11. Elation t0 tax under Sec. 9113(A) (A~ch Sch
O)
/ ~ ~ ~ COMPLETE MAILING ADDRESS
FIRM NAME {If Applicable)
TELEPHONE NUMBER )
OFFICIAL USE ONLY
1. RealEstate(Sch~uleA) (I) R~ ' -
2. Stocks and Bonds (Schedule B) (2) ~ ~ ~
3. Closely Held Corporation, Pa~ne~hip or Sole-P~prietomhip (3) ~0~ ~ r:-~
4. Uodgages & Notes Receivable (Schedule D) (4) ~O~ ~ c~
5. Cash, Bank Deposits & Miscellaneous Personal Properly (5 ~ ~ , ~ ~ ~
(Schedule E)
6. Jointly Owned Prope~ (Schedule F) (6) ~O~ ~ ~;
~ Separate Billing Requested ;;; "
7. Inter-Vivos Transfers & Mis~aneous Non-Probate Properly (7) ~ ~
(Schedule G or L)
8. Total Gross Assets (total L~nes 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) ~ / ~*
10. Debts of Decedent, Uodgage Liabilities, & Lens (Schedule I) (10) ~ ~, ~ ~'
11. Total Dedu~ions (to~l Lines 9 & 10) ~ (11)~/~ /~?. ~
12. Net Value of Es~te (Line 8 minus Line 11) (12)~ ~) ~ ~ ~. ~O
13. Charitable and Governmen~l Bequests/Sec 9113 Trusts for which an e~ection to tax has not been (13) ~
made (Schedule J)
14. Net Value Subje~ to Tax (Line 12 minus Line 13) (14) ~
SEE INSTRUCTIONS ON REVERSE BIDE FOR APPLICABLE ~TES
15. Amount of Line 14 taxable at the spousal tax
rote, or transfers under Sec. 9116 (a)(1.2) x .0 (15) ~
16. Amount of Line 14 taxable at lineal rate x .0 (16) ~
17, Amount of Line 14 taxable at sibling rate x .12 (17) ~
18. Amount of Line 14 taxable at ~llateml rate x .15 (18) ~
lg. Tax Due (19) ~
Decedent's Complete Address:
STREET ADDRESS /.,~ Z~ ~ &/'(.~ ~' O//'/~ /~o/~ ~/
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments O
C. Discount
Total Credits ( A + B * C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................................... []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjurT. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ) DATE
ADDRESS
I1~11'
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a} (1.1) (ii)].
The statute does not exemat a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
' I
The tax rate ~mposed on he ne value of ransfers to or fo the use of the decedent s I~nea beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decadent's siblings is 12% [/2 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE E
COMMONWEALTH OF PENNSYLVAN;ACASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF 'FILE NUMBER
Include ~e pm~s of I~afion and ~e da~ ~e pm~s were ~iv~ by ~e ~. All pmpe~ ~ln~-o~ed ~h ~e right of suwbomhip mu~ be disclo~d on Sch~ule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF D~TH
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
. SCHEDULE H
COMMONW~LTH OF PENNSY'V^N~A FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
~b~ of d~ent mu~ be reposed on Sch~ule I.
ITEM
NUMBE~ ~ESC~IPTiON AMOUNT
A. FUNE~L EXPENSES:
g. D~T~°~ T° CI~TY~ IOO, ~o
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
NameofPemonalRepreseotative(s) ~;. / ~. ~
Social Secu dty N umber(s) / EIN Number of Personal Representative(s) /~~~-
StreetAddmss Z~,2.~D,5'"" CJ(4~
city uJ'~'¢/'/O'~'."/' s~ate ,'U,Tzip
Year(s) Commission Paid: ~'~
2. Attomey Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City. S~te __ Zip
Relationship of Claimant to Decedent
4. Probate Fees ~. ~
5. Accountant's Fee~
6. Tax Return Pmpam(s Fees /O0, ,DC,
7,
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insed additional sheets of the same size)
.~,,~,2E×..., ~ SCHEDULE I
COMMONWEALTH OF PENNSYLVANrA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RES,DENTDCCEDE.T MOETGAGE LIABILITIES~ & LIENS
ESTATE OF FILE NUMBER
Include unreimbumed medical expenses,
ITEM
NUMBER DESCRIPTION AMOUNT
TOTAL (Also enter on line 10, Recapitulation)
(if more apace Es needed, insert additional sheets of the same size)
REV-1513 iX+ (9-OO~
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16, AS APPROPRIATE, ON REV-1500 COVER SHEET
1! 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 U - 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)
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death: /~) - ~,~g~'-
To ~e Regismr:
I ce~ ~at nofi~ of ~efi~l in~) ~ requir~ by Rule 5.6(a) of ~e ~h~s' Co~ Rules was
se~ed on or mailed to ~e following benefici~es of Ee above-captioned estate on /[ - ~- ~ o~ ~ :
N~e Address
NoOee has now been given ~ aH pe~ons en~fled thereto under Rule 5.6(a) txcept
Date: /t/- ~.- ~.0~ ~
Address ~ O~ ~L
Telephone( ) 7o ~ - ?~
Capaci~: ~ PersonaiRepresentative
Counsel for personal representative
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be deter-
mined wholly or partly by the decedent's will. If the decedent
died without a will, whether you will receive any money or prop-
erty will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA
In re Estate of /~/~,~' /Sqik~.J~ ,deceased,
Estate No. ,,~0 ~
(Name and Address)
· ', '
Please t~e notice of ~e death of decedent and the grant of letters to the person~ representa6ve(s) n~ed bemw.
The Decedent tT~'~f . J , died on the
dayof ,at C-t-~ r~ ~ ~/'~'~ County,
Pennsylvania.
~e Decedent died testate (wi~ a Will); or
The Decedent died intestate (wi~out a Will).
The personal representative of ~e Decedent is
(nme, ad.ess and telephone number).
If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1
Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the
Register of Wills of Cumberland County, I Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345
A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication.
Name (print) ~O~4Lt[ ~"' ~"'~0~'~'~0~
Address ~0~'~ C~Q,.~ COqtqf
Telephone (70P ~ - y/~Z
Capacit~Person~ Representative
Counsel for person~ representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: /7/,~-/(,F
Date of Death: /o -~ - ~oO ~
Will No.: ~,.cO ~ ~:_ O/D C>,~ Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes i21 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 [~1 No ~
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.
Signature
)
-' :\:3 Address
c, ~ ~ ...... :'"~ Telephone No.
Capaci~: ~ Personal Representative
~ Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
.'"\f'. ,--,r-_.,:_";^,_..n
BUREAU OF INDIVI~A~JtA~$
INHERITANCE TAX DIVISlOlt.-. .
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-15~7 EX AF' 112-D~)
nF'~
Uc:.
DATE
ESTATE OF
DA TE OF DEATH
FILE NUMBER
COUNTY
ACN
02-21-2005
MIXEll
10-26-2004
21 04-1003
CUMBERLAND
101
A.ount R_i Hed
HARRY
D
PAUL E('.Ro'jfNSON
4205 CLUB COURT
WATCHUNG
NJ 07069
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv:rA\"'f-!'St-AFJr-(ol-:cYJ'--No't-ic!-o'F-iNHERYfAN-cE-"-AX-A-PJSRA-isEii'€NT~-A[toQANCE-(rrr------._----- - --.
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MIXELL HARRY D FILE NO. 21 04-1003 ACN 101 DATE 02-21-2005
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
7.636.00
.00
.00
(8)
NOTE: To insure proper
credit to your account,
subnit the upper portion
of this for. with your
tax pay.ent.
7,636.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule 1)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
6,189.00
8.940.20
(1)
(2)
(3)
(4)
11;.]29 20
7,493.20-
.00
7,493.20-
US) .00 X 00 =
(6) .00 X 045 =
(7) .00 X 12 =
(8) .00 X 15 =
(9)=
~
TAX CREDITS'
, ~..._... ..-..-. . l+} AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO 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.}
Cumberland County - Register ur Wl~~S
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
ROBINSON PAUL E
4205 CLUB COURT
WATCHUNG, NJ 07069
RE: Estate of MIXELL HARRY DEHAZE
File Number: 2004-01003
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: 10/26/2006
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
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. Complete itemS 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse
so that we can return the card to you.
. Attach this card to the back of the mail piece,
or on the front if space permits.
1. Article Addressed to:
A. Signature
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C. Date of Delivery
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
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ROBINSON PAUL E-" .F\ :?c\j\~
44S LAKE FRONT DRIVE
1,EBlul\lON OR 45.z. ~ ~.Z\ ~d
)..j -"J'700S 0390 0003 2639 0612
Domestic Return Receipt
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3:)IM:13S Tv'lS0d S31'v'lS 0311Nn
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: IIAVVV .f)('d.A'i!., /11/' >< e..L.L
/
Date of Death: 10 -.:<,t, - 0 'f
Estate No.:
;Z<:/D 'f - () / () 0 3
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
I. State whether administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes ~ No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No 0
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: / /-"9- - 0 t;:
f7~ ~ &~
Signature
.PAul L. ~6INSC)'1oJ
Name
'fr-$~ }",-r ke... .f'VdIJ T Dje t v-c. I--.J/C/J:J~ I 0,1-..
Address / rso3{,
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Telephone No.
Capacity: N Personal Representative
o Counsel for personal representative
~
In Re: Estate of
MIXELL HARRY DEHAZ
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-01003
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: ROBINSON PAUL E
Counsel for Personal Representative:
Date of Decedent's Death: 10/26/2004
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the del~quent personal representative or counsel for
the delinquent personal representative.
Date:
11/1/2006
~~~
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
Glenda]
Clerk of ru
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CERTIFIED MAIL" RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
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