HomeMy WebLinkAbout02-1041PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~~ n u_l ct ~... ~e ~ ~ ,,
also known as
Deceased.
Social Security No. /~~ / -.j y - ~ `7/ 5
No. ~~` 6~Z- /O ~//
To:
Register of Wills for the
County of ('~~?6~l'~4 /J'C in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
(d.b.n.; pendente liter durante absentia; durante minoritate)
the above decedent.
-~ II f
Decendent was domiciled at death in L[.c rn}'~eC ~C~r1Cx County, Pennsy vania with \
his last family or principal residence at ~ ~ «~~T `Lc~U~c r ~ ~~~ n
(list street, number and municipality) ~
Decendent, then In ~_.years of age, ied _ ~~r~' . ~~ ~ , ~..~Gp4~,
at ~ ~ ~s~,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:
17oi1
~k
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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Your petitioner(s), who is/are 18 years of age or older, appl ~~ s for letters of administration
on the estate of
Petitioner after a proper search ha~_ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) ,that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this ~d ~ day of
~A'Y/ ,^ r
~G
~~~'CCCC Register
No.
Estate of RONALD L. FELTY
Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW NOVEMBER 21th ~I2002 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that PATSY A. FELTY
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to PATSY A. FELTY
in the estate of RONALD L . FELTY
FEES
Letters of ::Administration ..... $ 18.00
Short Certificates( ) ...... 1... $ 3.00
Renunciation ................ $
JCP $ 10.00
TOTAL $
Filed NOVEMBER. 2.lth. , ... A,D, ~ 2002
.1'JO ~' ? CC ~,
i •~ ~
Register Wills
ATTORNEY (Sup. Ct. LD. No.)
ADDRESS
PHONE
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21-02-1041
MAILED TO ADMINISTRIX NOVEMBER 22, 2002
ILt)S.8n5 RFl rl~Nr;
This is to certit~~ that the intorruation here given ~s corlectLy copied from an original certiflcac° or tear,l QuLti~ riled .~it~ n;~ ;~s
Local Re~,iscrar. "1_'iie original certi~Icate will he forwarded to the State Vital Records Oftice fog perm I~~.~I_ t~'lin~,
WARNING: !t is illegal to duplicate this copy by photostat or photograa~'r1.
lee tc~r this cer~iticare. $2.00
P8607281
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,~ lay. tee? COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
PE. PHIN I
IH _ - ___-__^~ _ STATF FILE NUMBER
14MANEN I NAME CF DECEOE NT Ifus'I Mu1dl6. Lael
Ronald Lee Felt SE%
Male SOCIAL S~~URITV NU~BfrR 071 C
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ECEDEMOF HISPANIC ORIGIN? RACE~Amsr¢an lMMn. BIKK, Wnee Nc
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~ DECEDENT'S USUAI OCCUPATION KIND OF BUSINESSlINDUSTRV WAS DECEDENT EVER IN DECEDENT'$EDl1CATbN MMITAL STATUS~MUrvq SURVIVING SPOUSE
IG~ve kind d worts dor4 Wampqq nqR U.S. ARMED FORCES? S I as nl eR om ed
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CdNga DKUrcad (Spocdy)
„a '~ ~ ,a,zl "'°$a1+2 Married Pats A. Grassier
Press rator „a. Printi ,:. ,]. ,,. ,,. y
DECEDENT'S MAILING ADDRESS (SlreY. CeylTOVm, SIYe. Zp COM/ DECEDENT'S Pennsylvania ~ nc® n. aac.dera lK.dm LOWer Allen TWp.
ACTUAL 17a. Sure ,r.P
7 Essex Road RESIDENCE a.p.a.m
Camp Hill, PAe 17011 ISeelnYn%%IpM Cumberland a,,.%la
on Omer e0e1 IowMhip7 No, aluaNe a..d
». ,m. coa na.^ reniB.aa.l tanlMY _cllyerao
FATHER'S NAME (Fag. MK,We. Lasg MOTHER'S NAME IFxY. Middle. MaIWn Swnamal
,,, Ray Luther Felty „_ Doroth Mumma
INFORMANT'S NAME (TypYPrud) INFORMANT'S MMLINO ADDRESS (SOM. CAY/iorn, $1Y1, Zp Cowl
,a Patsy Ae Felty ,D,_ 7 Essex Road Hill PA. 17011
METHOD OF DISPOSITION ((pp GATE OF DISPOSITON PIACE OF DISPOSRION ~ Name W DemYery. Glemaory LOCA710N - CM/TOrn. Slate. Zy Ca4
Bunt ^ Cremeliu Ldl RwnovY bam Slue ^ (Haan, DYY• Yeazl a Omer Plan
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ants c uw a aam.
2]e. 270. 2x.
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person wM pronoYncea WAN. TIME OF DEATH_/~]//y (L/y
~ DAT ONOU CE//D)DE/ADA,IMpIm. Da .fear(
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/ yYAS CASE REFERREDTO MEDICAL
Y • ERICORONERi
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ORE OF PERSON WHO7COMPLETED CAUSE OF DEATH
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NN$AN Al1TOP5Y WERE AUTOPSY FINDINGS MANNER OF DEATH r GATE OF INJURY TIMEd
PERFORMED] AWIUBLE PRgR TO
COMPLETION OF CAUSE (Honor. Day. Year)
OF DEATH? NYUrY Homu:iW LJ
AccMaM ^ Pending lnwYgallon ~~
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twodinq, etc.ISpacavl
2N. 2ab. 29. ]de.
CERTIFIER ICnecK OnlyoMl
'CERTIFYIiq PHYSICIAN IPnYac~an ceruylny cau se d neYn when anolner Pnys,can has announced death ano cun t>Ie1ex] nrm 2JI ,r
TO dN Dee, OI my aMrYdge. Ham xcurred dw W Me uueelal and manwr w sated.........
.......... L~J
............................... ...
' PRONOUNCIND ANO CERTIFYIND PHYSICIAN IPnysF~an nosh anndunang uaam and cttUly~ng l0 cause of deeml
^
To IM Owl of my OMwYdge, deed' Occurred el da time, date, and place, aM dw to the ceuwle) and manner ae staled ..........................
'MEDICAL E%AMINEP/CORONER
On,M lama of •%amina,lon and/or Invasllg
manner as slated ...................... alion, in my opinion, death occurred al tM lime, date, an
... ......... .............. ....... d place, and due to Ins uuae(e( end
_.. .... ........... ^
]ta
REGIS 'S SIGNATURE AND NUMBER
_ . , . . _ ~ : it ~--
CERTIFICATION OF NOTICE UNDER RULE 5.6~
Name of Decedent:
Date of Death: ~
_- e, ~, ~ _ ~~' ~ ~ y ~ Admin. No.
Will No.
To the Register:
,- , .~
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans Court Ru es was
served on or mailed to the following beneficiaries of the above-captioned estate on ~ '~' ° -~ ~ ~~ ~ '~ `" --~
Name
~ ,,
--i< Y ~~~.-,
Address
"° ' 1 u7 ~;r r 4
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
'7 ,,
~- ,~.
Date: ~°~
Signature
Name ~ ~ ~ ~ ~ ,,
Address ~ ~ ~ S' ~ X ~~.~~ ~
<~~~~,~.,~ I-~, ~~ ~~~ 17aJf
Telephone (7 ~~~ ~jC ,j ~~ ~ `~ L~ '7
Capacity: ~_. Personal Representative
Counsel for personal representative
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
DIANE G RADCLIFF
3448 TRINDLE RD
CAMP HILL
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX OFF (R1-R3)
DATE 09-09-2003
ESTATE OF FELTY RONALD L
DATE OF DEATH 10-27-2002
FILE NUMBER 21 02-1041
'" _ - -'_-' ;C~iUNTY CUMBERLAND
ATTY ACN 101
Amount Remitted
PA 17001
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 1
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FELTY RONALD L FILE N0. 21 02-1041 ACN 101 DATE 09-09-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN SASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(i) .00
(2) .00
(3) .00
(4) .00
(5) .00
(6) .00
(7) .00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this fora with your
tax payment.
.00
APPROVED DEDUCTIONS AND EXEMPTIONS: .00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9l
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11) .00
12. Net Value of Tax Return (12) .00
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00
14 Net Value of Estate Subject to Tax (14) .00
.
NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15 ) . 0 0 X 0 0 = . 0 0
16. Amount of Line 14 taxable at Lineal/Class A rate (16) . 00 X 045 = . 00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 = .00
19. Principal Tax Due (19)= .00
rw3n~m I ~~..~~~ ~ I ~~~~~~^~ • • • I 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 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A ''CREDIT'' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.]
REV. 1$(lO ex. l6-00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after
12-12-82)
o 7. Decedent Maintained a Living TruSI(Altach
copy of Trust)
o 10. Spousal Poverty Credit(date of death between
12-31-91~nd1:1:95)
iTH1S,SECTIONMUSTBE <:O.MfLETEO.ALL CO~RESPONOENCE AND CONFIDENTIA.L TAX INFORMATION SHOUL~BE DIRECTEQTO:
~AME COMPLETE MAILING ADDRESS
I Diane G. Radcliff
FIRM NAME (If applicable)
Diane G. Radcliff, Attorney at Law
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG.PA 17128-0601
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I DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
'FELTY, RONALD L
rbATE OF[)EATH(MM~DD-YEAR)
: 10/27/2002
NUMBER
21 02
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
1041
NUMBER
I DATE OF BIRTH (MM-DD-YEAR)
, 06/08/2041
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITiAL)
I FELTY, PATSY A
'181 1. Original Return
o 4. Limited Estate
o 6.
o 9
Decedent Died Testate(Attach copy
of Will)
Litigation Proceeds Received
jfELEPHONE NUMBER
717/737-0100
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
161-34-0715
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12.13-82)
o
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
I 3448 Trindle Road
Camp Hill, P A 17001
(1) None
(2) None c .
c.:.:
(3) None r-
1'0
(4) None oc
(5) None _...~
..
(6) None
(7) None
(8)
(9)
(10)
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Line 8 minus Une 11) (12)
20. 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Une 14 taxable at the spousal tax rate, x .00 (15)
or tra Sec. 9116(.)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
!i
~
~
~ 17. Amount of Line 14 taxable at sibling rate x .12 (17)
~
0
U
E 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>> B.ESURE_TO AN$!JER ALL QUESTIONS ON Re~ERSe SiDE AND. RECHECK MATH <<
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-ll0)
Decedent's Complete Address:
STREET ADDRESS
,-
7 Essex Road
CITY
:STATE PA
Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE
Make Check
to: REGISTER OF WILLS, AGENT
I
,ZIP 17011
(1)
(2)
0.00
(3) 0.00
(4)
(5) 0.00
(5A)
(5B) 0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
'~ i
1. Did decedent make a transfer and:
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.,................... .........u..,.. .........,..... .................,. ..................
d. receive the promise for life of either payments, benefits or care? m......>>>.... ............_... m.................
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 security at his or her death?..
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.......... ................m... ................ ................ .................
o
o
o
~
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
7 ESSEX ROAD
CAMP HILL, P A 17011
AODRESS
\ ADDRESS
3448 Trindle Road
Camp Hill, PA 17001
7 /~f/o3
7 /~ilo3
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% (72 P.S. 99116 (a) (1.1) (i)l.
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%
172 P.S. ~9116 (a) (1.1) (11)]. The statute does not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are stilt applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)).
The tax rate imposed on the net value of transfers to odor the use of the decedent's lineal beneficiaries is 4.5%., except as noted in 72 P .S. ~9116
1.2) [72 P.S. 99116 (a) (1)).
The tax rate imposed an the net value oftransfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (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.
DIANE G. RADCLIFF, ESQUIRE
Attorney at Law
3448 Trindle Road
Camp Hill, Pennsylvania 17011
Phone: (717) 737 ~01 00
Facsimile: (717) 975~0697
July 24, 2003
Commonwealth of Pennsylvania
Department of Revenue
Department 280601
Harrisburg, PA 17128-0601
Re: Estate or Rona~d L. Fe~ty
No. 2~-02-~041
Dear Sir/Madam:
Please be advised that this office represents the Estate of
Ronald L. Felty who died intestate on October 27, 2002. At the
time of Mr. Felty's death, all assets were owned jointly with his
surviving spouse, Patsy A. Felty.
Following the death of Ronald L. Felty, his wife attempted to
deposit his last paycheck earned prior to his death into their
joint account at Members 1~t Federal Credit Union. She was told by
a bank employee that she could not deposit his check into their
joint account but would have to open an estate in order to cash the
check. Following this employee's advice, Mrs. Felty went to the
Register of Wills of Cumberland County and filed a Petition for
Letters of Administration. After the estate had been opened,
Members 1" Federal Credit Union informed her that it was not
necessary and that she could deposit the check into their joint
account.
There were no assets owned individually by the decedent.
Therefore, no tax is owed on this estate.
very truly yours,
\
3
~l
DGR/dd
cc: Patsy A. Felty
File
JRD/June 30, 1992/17858
In Re: Estate ofRonald L Felty · ORPHANS' COURT DIVISION
Late of Lower Allen Township · COURT OF COMMON PLEAS OF
· CUMBERLAND COUNTY
Estate No.: 21-02-1041 ' PENNSYLVANIA
NO. 21-02-1041
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: Patsy A Felty
Counsel for Personal Representative:
Date of Decedent's Death: 10/27/2002
Date of Delinquency Notice: 08/11/04
The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance
with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on April 30,
2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in
accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned
requests that a Court conduct a hearing to determine whether sanctions should be imposed upon
the delinquent personal representative or counsel for the delinquent personal representative.
Date: 11/08/04 ~. Cr~.~.a.~_~,~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for at in Courtroom No. 3. If the Status Report is filed prior to
the hearing date, the hearing will automatically be cancelled~~~
Ge°~'ge ~¢~l~°~r'~'J'~ -~
STATUS REPORT UNDER RULE 6.12
NAME OF DECEDENT: Ronald L. Felty
DATE OF DEATH: 10/27/2002
WILL NO.: ADMEN. NO. 21 02-1041
Pursuant to Rule 6..12 of the Supreme Court Orphans' Court Rules, I report the following with
respect to completion of the administration of the above-captioned estate:
1.State whether administration of the estate is complete:
Yes X No
2. If the Answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the Answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the court?
Yes No x
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 x No
d. Copies of receipts, releases, j oinders 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: November~_ 8, 2004 '-Sigr~ature
~,_ E CLIFF, ESQUIRE
c-q Name (please type or print)
~ 3448 Trindle Road, Camp Hill, PA 17011
-~' Address
.-,: (717) 737-0100
- Telephone number
Capacity: ~ Personal Representative
X Counsel for personal representative