HomeMy WebLinkAbout02-0289 IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO.
ESTATE OF DOUGLAS JAMES PETERSON
PETITION UNDER SECTION 3102
OF THE PROBATE, ESTATES AND FIDUCIARIES
CODE FOR THE SETTLEMENT OF A SMALL ESTATE
TO THE HONORABLE JUDGES OF SAID COURT:
1. Your Petitioner, David A. Baric, Esquire, 17 West South Street, Carlisle,
Pennsylvania 17013, is an adult individual who has been appointed administrator of this estate by
virtue of Renunciations being signed by the children of the decedent. Christina Lea Peterson,
Douglas Warren Peterson and Danielle Marie Orellana are the children of Douglas James
Peterson but are not the natural children of Linda Ann Peterson. Attached hereto as Exhibit "A"
are copies of the Renunciations signed by the children.
2. The Decedent, Douglas James Peterson, was born November 6, 1946 and was 46
years of age at the time of his death. His residence at the time of his death was 526 Third Street,
Carlisle, Cumberland County, Pennsylvania. He was a married man at the time of his death. A
copy of the Death Certificate is attached hereto as Exhibit "B."
3. The Decedent, Douglas James Peterson left no Last Will and Testament at the
time of his death on October 4, 1993.
4. Decedent had no interest in real property at the time of his death.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT
IN RE: ESTATE OF DOUGLAS JAMES PETERSON, DECEASED
TOWNSHIP OF CARLISLE BOROUGH,
CUMBERLAND COUNTY, PENNSYLVANIA
t - Damrn �, c
NO. 21-)X- X. C"' rn
r-
-»
PETITION TO APPOINT ADMINISTRATOR OF ESTATE-01 _ '
DOUGLAS JAMES PETERSON
The petition of Linda A. Peterson, surviving spouse and beneficial of the above- r
captioned estate, respectfully states that:
1. Douglas James Peterson ("Decedent"), of 526 Third Street, Carlisle,
Pennsylvania, departed this life on October 4, 1993, intestate. A copy of Decedent's
Death Certificate is attached hereto as Exhibit"A".
2. Petitioner Linda A. Peterson is the surviving spouse of Decedent. Her
address is not being disclosed in this Petition due to privacy concerns.
3. Decedent had three children, namely: Douglas James. Peterson, Jr.,
Danielle M. Orellana, and Christina L. Goldson. The children are not issue of Linda A.
Peterson.
4. Linda A. Peterson, Douglas James Peterson, Jr., Danielle M. Orellana, and
Christina L. Goldson are the only beneficiaries of the estate of Decedent.
Law Offices of
Saidis 5. At the time of his death, Decedent was the sole owner of two bank
Sullivan accounts at Members 1st Federal Credit Union ("Members 1st Accounts") which have a
& Rogers
26 West High Street combined balance of approximately Twenty-Three Thousand Dollars ($23,000.00).
Carlisle,PA 17013
1,
6. The Members 1st Accounts are the only asset of Decedent's estate. They
have escheated to the Commonwealth of Pennsylvania and may only be released to the
heirs through the authority of a properly probated estate of Decedent.
7. Linda A. Peterson signed a Power of Attorney on February 26, 2013,
appointing her son, William D. Engberg, of 104 Calais Drive, Maumelle, Arkansas, as
her Attorney-in-fact. A copy of the said Power of Attorney is attached hereto as Exhibit
8. Linda A. Peterson suffered a stroke on approximately April 10, 2014, and
is in immediate need of the funds in the Members 1st Federal Credit Union accounts for
her current medical bills and future care.
9. William D. Engberg in on active military duty with the Air Force and
resides in Arkansas and would be unable to come to Pennsylvania to be sworn in as
Administrator of Douglas James Petersons's Estate as Linda A. Peterson's Attorney-in-
fact.
10. Petitioner desires to have undersigned counsel, Sean M. Shultz, Esquire,
appointed as Administrator of the Estate of Douglas James Peterson. A completed Estate
Information Sheet and Petition for Grant of Letters of Administration is attached as
Exhibit "C".
Law Offices of 11. Under the laws of intestate succession pursuant to 20 Pa.C.S. §2102, when
Sardis there are surviving issue of the decedent, one or more of whom are not the issue of the
Sullivan
& Rogers surviving spouse, the surviving spouse is entitled to one-half of the balance of the
26 West High Street
Carlisle,PA 17013 intestate estate. Therefore, due to the limited assets involved, the administration of this
estate will be relatively simple.
WHEREFORE, Petitioner requests that Your Honorable Court issue letters of
administration appointing Sean M. Shultz, Esquire, as Administrator of the Estate of
Douglas James Peterson.
Respectfully submitted,
SAIDIS SULLIVAN & ROGE
di
June 16, 2014 r
Sean M. Shu tz MI
Attorney ID No. 90946
26 W. High Street
Carlisle, Pennsylvania 17013
(717) 243-6222
Attorney for Petitioner
•
Law Offices of
Saidis
Sullivan
& Rogers
26 West High Street
Carlisle,PA 17013
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT
IN RE: ESTATE OF DOUGLAS JAMES PETERSON, DECEASED
TOWNSHIP OF CARLISLE BOROUGH,
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 21-14-
VERIFICATION
I verify that the statements made in the foregoing Petition are true and correct to
the best of my knowledge, information and belief. I understand that false statements
herein are made subject to the penalties of 18 Pa. C. S. Section 4904, relating to unsworn
falsification to authorities.
Date: lf' �54 dis"
William D.Engbe' Attor� -in
fact for Linda A. erson
•
Law Offices of
Saidis
Sullivan
& Rogers
26 West High Street
Carlisle,PA 17013
• Exhibit "An
Law Offices of
Saidis
Sullivan
& Rogers
26 West High Street
Carlisle,PA 17013
H105.905 REV.(8/11)
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with
the Viral-Statistics-Law•of 1953;as-amended:-- — — — --.. _. ..-_.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
,IL�� by
eyI•`'@ IG_ Marina O'Reilly Matthew
$ �,�„ y State Registrar
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••S 143 Rev. COMMONWEALTH OF PENNSYLLNINIA•
1 DEPARTMENT OF HEALTH•VITAL'•- .
` , CERTIFICATE OF DEATH'- ; . :y,.
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'
Exhibit ,, B,,
Law Offices of
Saidis
Sullivan
& Rogers
26 West High Street
Carlisle,PA 17013
STATUTORY SHORT FORM
POWER OF ATTORNEY
MINNESOTA STATUTES SECTION 523.23
IMPORTANT NOTICE: The powers granted by this document are broad and
sweeping. They are defined in Minnesota Statutes Section 523.24. If you have any
questions about these powers, obtain competent advice. This power of attorney may be
revoked by you if you wish to do so. This power of attorney is automatically terminated
if it is to your spouse and proceedings are commenced for dissolution, legal separation,
or annulment of your marriage. This power of attorney authorizes, but does not require,
the attorney-in-fact to act for you.
PRINCIPAL
(Name and Address of Person Granting the Power)
Linda A. Peterson
2800 Hamline Avenue North,#130
Roseville,MN.55113
ATTORNEY-IN-FACT
(Name and Address)
William D. Engberg
104 Calais Drive
Maumelle,AR. 72113-6588
SUCCESSOR ATTORNEY-IN-FACT
To act if the named attorney-in-fact dies,resigns,or is otherwise unable to serve.
(Name and Address)
First Successor: NONE
Second Successor: NONE
Notice: If more than one attorney-in-fact is designated,make a check or"x" on the
line in front of one of the following statements:
X Each attorney-in-fact may independently exercise the powers granted;
All attorneys-in-fact must jointly exercise the powers granted.
EXPIRATION DATE: None
I, Linda A. Peterson, (the above named Principal) do hereby appoint the above named
Attorney-in-Fact to act as my attorney-in-fact:
FIRST: To act for me in any way that I could act with respect to the following matters,
as each of them is defined in Minnesota Statutes Section 523.24:
(To grant to the attorney-in-fact any of the following powers, make a check or "x" on
the line in front of each power being granted. You may, but need not, cross out each
power not granted. Failure to make a check or"x" on the line in front of the power will
have the effect of deleting the power unless the line in front of the power of (N) is
checked or x ed.)
Check or"x"
(A) real property transactions; I choose to limit this power to real property in
, Minnesota, described as follows: (Use legal description.
Do not use street address.)
(If more space is needed,continue on the back or on an attachment.)
(B)tangible personal property transactions;
(C)bond,share, and commodity transactions;
(D)banking transactions;
(E)business operating transactions;
(F)insurance transactions;
(G)beneficiary transactions;
(H)gift transactions;
(I)fiduciary transactions;
(J)claims and litigation;
(K) family maintenance;
(L) benefits from military service;
(M)records,reports,and statements;
X (N)all of the powers listed in(A)through(M)above and all other matters.
SECOND: (You must indicate below whether or not this power of attorney will be
effective if you become incapacitated or incompetent. Make a check or "x" on the line
in front of the statement that expresses your intent.)
X This power of attorney shall continue to be effective if I become incapacitated or
incompetent.
This power of attorney shall not be effective if I become incapacitated or
incompetent.
(The remainder of this page left blank intentionally)
THIRD: (You must indicate below whether or not this power of attorney authorizes the
attorney-in-fact to transfer your property to the attorney-in-fact. Make a check or "x" on
the line in front of the statement that expresses your intent.)
X This power of attorney authorizes the attorney in fact to transfer my
property to the attorney-in-fact.
This power of attorney does not authorize the attorney in fact to transfer
my property to the attorney-in-fact.
FOURTH: (You may indicate below whether or not the attorney-in-fact is required to
make an accounting. Make a check or "x" on the line in front of the statement that
expresses your intent.)
X My attorney-in-fact need not render an accounting unless I request it or the
accounting is otherwise required by Minnesota Statutes Section 523.2.1.
My attorney-in-fact must render annual accountings to me during my lifetime,
and a final accounting to the personal representative of my estate, if any is appointed,
after my death.
In Witness Whereof, I have hereunto signed my name this 26th day of February, 2013.
Linda A. Peterson
STATE OF MINNESOTA )
) ss.
COUNTY OF RAMSEY )
/7
The foregoing instrument was acknowledged bef '.m this 26th day of February, 2013
by Linda A. Peterson: ,
..,e4 CFi•IS LINDEM f,
.�
ie
"li-4 Notary Public-Minnesota
My Commlabn Expires Jan 31,2017 Notary Pu ]
' i/4-,, LA-2
•
This Instrument Drafted by:
Chris D. Lindem, Attorney at Law
2960 Snelling Avenue N., Suite L-105
Roseville, MN. 55113
Atty. License No. 0259287
(651) 789-0551
Exhibit ,,C"
Law Offices of
Saidis
Sullivan
& Rogers
26 West High Street
Carlisle,PA 17013
REV-346 EX(03-09) 3460007120
inummel ESTATE INFORMATION
SHEET
pennsylvania FOR REGISTER'S OFFICE USE ONLY
DEPARTMENT OF REVENUE County Code Year File Number
DECEDENT INFORMATION: Enter data as it will appear on all
documents submitted to the Department. 21 14
Decedent's Social Security Number Date of Death Date of Birth
538 44 2288 10 04 1993 11 06 1946
Last Name Suffix First Name MI
PETERSON DOUGLAS J
TYPE FILING: Enter mark(x)to indicate the nature of the return to be filed with the department.
® Probate Return ❑ Joint Assets Only 0 Non-probate Assets Only ❑ Litigation Purposes(No Other Assets)
LETTERS GRANTED: Enter mark(x)to indicate the nature of the proceedings at the register of wills office.
(Attach additional sheets if explanation is necessary.)
❑ Testamentary ® Administration ❑ No Letters ❑ Other(Please Explain)
ATTORNEY/CORRESPONDENT INFORMATION: Enter all data concerning the attorney or other individual to receive all tax
information and correspondence.
Last Name Suffix First Name MI
SHULTZ SEAN M
Supreme Court I.D.# Telephone Number
90946 717 243 6222 Attorney/Corrrespondent's e-mail address:
dhockenberry@ssr-attorneys.com
First line of address
26 W. HIGH STREET
Second line of address
City or Post Office State ZIP Code
CARLISLE PA 17013
PERSONAL REPRESENTATIVE INFORMATION: Enter all data concerning the personal representative(s)of the estate
Executor/Administrator authorized by the Register of Wills.
Social Security Number Telephone Number
(717) 243 6222
Last Name Suffix First Name MI
SHULTZ SEAN M
First line of address
26 W. HIGH STREET OFFICIAL USE ONLY
Second line of address TRANSACTION COUNT
City or Post Office State ZIP Code
CARLISLE PA 17013
Complete general estate information questions,and indicate additional personal representatives on reverse side.
PLEASE USE ORIGINAL FORM ONLY
Side 1
3460007120 3460007120
3460007220
Decedent's Social Security Number
Decedent's Name: DOUGLAS JAMES PETERSON 538 44 2288
Co-Executor/Administrator
Social Security Number Telephone Number
Last Name Suffix First Name MI
First line of address
Second line of address
City or Post Office State ZIP Code
Co-Executor/Administrator
Social Security Number Telephone Number
Last Name Suffix First Name MI
First line of address
Second line of address
City or Post Office State ZIP Code
General Instructions:
This form should be filed with the Register of Wills of the county of which the decedent was a resident at death.
Please be aware the correspondent identified will receive all correspondence from the department.It is the responsibility of the
personal representative to notify the department if the correspondent contact information changes.
The department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Social Security numbers in connection
with administering state tax laws.The department uses the Social Security number to identify the decedent and personal representatives
of the estate.The commonwealth may also use the information in exchange-of-tax-information agreements with federal
and local taxing authorities.State law prohibits commonwealth personnel from disclosing confidential tax information except
for official purposes.
Side 2
3460007220 3460007220
PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner(s)named below,who is/are 18 years of age or older,apply(ies)for Letters as specified below,and in support thereof aver(s)the
following and respectfully request(s)the grant of Letters in the appropriate form:
Sean M.Shultz
Decedent's Information
Name: Douglas James Peterson File No: 21-14
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 538-44-2288
Date of Death: 10/04/1993 Age at Death: 46
Decedent was domiciled at death in Cumberland County, PA (State)with his/her last
principal residence at 526 Third Street,Carlisle 17013 Carlisle Borough Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Carlisle Hospital Carlisle Cumberland PA
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania All personal property $ 23,000.00
If not domiciled in Pennsylvania Personal property in Pennsylvania $
If not domiciled in Pennsylvania Personal property in County $
Value of real estate in Pennsylvania $
TOTAL ESTIMATED VALUE $ 23,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets,if necessary.)
Street address,Post Office and Zip Code City,Township or Borough County
❑A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated and Codicil(s)
thereto dated
State relevant circumstances(e.g.,renunciation,death of executor,etc.)
Except as follows:after the execution of the instrument(s)offered for probate,Decedent did not marry,was not divorced,was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g),and did not have a child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
0 NO EXCEPTIONS ❑ EXCEPTIONS
[ B. Petition for Grant of Letters of Administration (If applicable)
d.b.n.,d.b.n.c.t.a.,pedente lite,durante absentia.durante minoritate
If Administration,c.t.a or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heirs.
Except as follows:Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been established as defined
in 23 Pa.C.S. §3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑X NO EXCEPTIONS EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
Goldson,Christina L. daughter 7 42nd Street E.
Williston,ND 58801
Orellana,Danielle M. daughter 702 S.Oak Street
Spokane,WA 99204
Peterson,Douglas James Jr. son 2015 N S Highway 4
Lewiston,ID 83501
Peterson,Linda A. spouse 200 Hamline Avenue N.
Saint Paul,MN 55113
See continuation schedule attached
Form RW-02 rev.10-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc. Page 1 of 2
•
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland
Petitioner(s)Printed Name Petitioner(s)Printed Address
Sean M.Shultz 26 W.High Street
Carlisle,PA 17013
The Petitioner(s)above-named swear(s)or affirm(s)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 Decedent, Petitioner(s)will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before Date
me this day of Date
By: Date
For the Register Date
BOND Required? El YES NO To the Register of Wills:
Please enter my appearance by my signature below:
FEES:
Letters $ Attorney Signature:
( )Short Certificate(s)
( )Renunciation(s)
( )Codicil(s)
( )Affidavit(s) Printed Name: Sean M.Shultz
Bond Supreme Court
Commission ID Number: 90946
Other
Firm Name: Saidis,Sullivan&Rogers
Address: 26 W.High Street
Carlisle,PA 17013
Phone: 717-243-6222
Automation Fee
Fax: 717/243-6486
JCS Fee
TOTAL $ E-mail: dhockenberry@ssr-attorneys.com
DECREE OF THE REGISTER
Date of Death: 10/04/1993
Social Security No: 538-44-2288
Estate of Douglas James Peterson File No: 21-14
a/k/a:
AND NOW, ,in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters of Administration
are hereby granted to Sean M.Shultz
in the above estate and(if applicable)that the instrument(s)dated
described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Decedent.
Register of Wills
Copyright(c)2011 form software only The Lackner Group,Inc. Page 2 of 2
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT
IN RE: ESTATE OF DOUGLAS JAMES PETERSON, DECEASED
TOWNSHIP OF CARLISLE BOROUGH,
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 21-14-
CERTIFICATE OF SERVICE
AND NOW, this 16th day of June, 2014, I, Dolly M. Hockenberry, Paralegal,
hereby certify that I have this day served the following persons with a copy of the
foregoing Petition by U.S. Regular and Certified Mail, Restricted Delivery, Return
Receipt Requested, addressed as follows:
Douglas James Peterson, Jr.
2015 N S Highway 4
Lewiston, Idaho 83501
Danielle M. Orellana
702 S. Oak Street
Spokane, Washington 99204
Christina L. Goldson
7 42" Street E.
Williston,North Dakota 58801
SAIDIS, SULLIVAN & ROGERS
Law Offices of
Saidis
Sullivan
II
& Rogers �,
26 West High Street D. y .�y o o,e Ferry, Para egal
Carlisle,PA 17013 Attorney 7. No. 90946
26 W. High Street
Carlisle, Pennsylvania 17013
(717) 243-6222
5. The Decedent's sole assets are as follows:
Members First Credit Union Savings Account with a balance of
$12,759.18
Li~ insurancethroughMembers First Credit Union ofapproximately
$10,000.00
6. Your Petitioner believes that all creditors of the Decedent have been paid. It is
requested that the remaining assets of the Decedent be turned over to the Petitioner to pay the
administration expenses and for disbursement to heirs.
7. Petitioner will prepare and file an inheritance tax return and will pay the tax due.
8. Attempts have been made to contact Linda Ann Peterson, the wife of Douglas
James Peterson without success, these efforts include the following:
mo
Correspondence being sent to Linda Ann Peterson, a copy of which is
attached hereto as Exhibit' ....C,
Filing a postal address request which did not return a changed address;
and,
Co
Intemet searches for Linda Ann Peterson through telephone and address
directories. Telephone calls have been placed to all individuals identified
through the search but no person stated that they were the spouse of the
Decedent.
9. Petitioner proposes to distribute the proceeds of the Members First account and
life insurance policy, after deducting for the debts and administrative expenses of the estate as
follows:
one-half of the balance equally divided amongst Christina Lea Peterson, Douglas
Warren Peterson and Danielle Marie Orellana as the children of Douglas James
Peterson
one-half to Linda Ann Peterson as the wife of Douglas James Peterson, pursuant
to 20 Pa.C.S. Section 2102
10. Petitioner proposes to place the share of Linda Ann Peterson into an interest
bearing account and will take additional steps to contact Linda Ann Peterson.
WHEREFORE, Your Petitioner prays that an Order be made authorizing distribution of
the accounts as set forth in the foregoing to Petitioner.
Respectfully submitted,
BY:
O'BRIEN, BARIC AND ~,,~,IflERER
David A. Baric, Esquire
ID# 44853
17 West South Street
Carlisle, PA 17103
(717) 249-6873
dab.dir/estates/peterson/estate, pet
RENUNCIATION
In Re Estate of
DOUGLAS JAMES PETERSON
To the Register of Wills of
CUMBERLAND
County, Pennsylvania.
The undersigned H E T ]~ ~q
of
the above decedent, hereby renounce(s) the fight to administer the estate and respectfully ask(s) that Letters
OF ADMINISTRATION
beissuedto DAVID A. BARIC, ESQUIRE
WITNESS
hand this 2 5 day of Ma ¥ , 11~....2 0 01.
-C~IsTINA (Signature) -£E~'~'PETERSON
1847 WEST COLLEGE AVENUE
SPOKANE, WA 99201
(Address)
DANIELLE (Signat~e) MARIE PETERSON
1847 WEST COLLEGE AVENUE
SPOKANE, WA 99201
(Addr~)
DOUG~'~ (Signature) WARREN PETERSON
32 EAST KEIRANAN
SPOKANE, WA 99207
(Address)
EXHIBIT "A"
~ N~9;, this ~423- day of ~{~ , 2001, before me, the
undersigned officer, personally appeared Christina Led Peterson, known to me
(or satisfactorily proven) to be the person whose name is subscribed to the
within instrument, and acknowledged that she executed ssa~ for the purposes
therein contained.
IN ~~, I hereunto set my hand and official seal.
Notary Public
~ NOg;, this day of , 2001, before me, the
undersigned officer, personally appeared Danielle Marie Peterson, known to me
(or satisfactorily proven) to be the person whose name is subscribed to the
within instrument, and acknowledged that she executed same for the purposes
therein contained.
IN Wi~S ~, I hereunto set my hand and official seal.
Notary Public
~OF 5t~ ~W~t~ : :SS.
~ N~, this ~4~-- day of ~ ~ , 2001, before me, the
undersigned officer, personally appea~ed Doulgas Warren Peterson, known tome
(or satisfactorily proven) to be the person whose name is subscribed to the
within instrun~nt, and acknowledged that he executed same for the purposes
therein
I hereunto set my hand and official seal.
Notary Public
RENUNCIATION
In Re Estate of Douglas James Peterson
To the Register of Wills of Cumber 1 and
County, Pennsylvania.
The undersigned .~~'_t_~/~O ~ , _~t~ }.0_; ~-~"~_ J~O~4 t"~ , of
the above decedent, hereby renounce(s) the fight to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to David A. Baric, Esquire
WITNESS
hand this 7 day of October , 19_2001.
Danie~d~7~ar ie (Signature) O~lana
(Address)
(Signature)
(Address)
(Signature)
(Address)
STATE OF Washington
COUNTY OF Spokane
SS.
AND NOW, this 7 day of October , 2001, before me,
the undersigned officer, personally appeared Danielle Marie
Orellanna, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, and
acknowledged that she executed same for the purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
~_~tary Public
Robert L. O'Brien
David A. Baric
Michael A. $cherer
Law O.~ces
O'BRIEN, BARIC & SCHERER
17 West South Street
Carlisle, Pennsylvania 17013
VIA CERTIFICATE OF MAILING
Linda Ann Peterson
7750 Silver Lake Road, #12
Mounds View, MN 55112
RE: Estate of Douglas J. Peterson
Dear Ms. Peterson:
February 20, 2001
(717) 249-6873
Fax (717) 249-5755
E-mail: obs(~obslaw, com
direct: dbaric~obslaw, com
I am an attorney in Carlisle, Pennsylvania and I have been contacted by an heir of
Douglas J. Peterson regarding opening an estate in Pennsylvania.
There are assets available for distribution to the heirs which would appear to include you.
Please contact me as soon as possible to discuss this matter.
Very truly yours,
DAB/jl
cc: ~ Peterson
dab.dir/estates/peterson/lindaann.ltr
O'BRIEN, BARIC &2~CHERER
David A. Baric, Esquire
U.S. POSTAL SERVICE CERTIFICATE OF MAILING
MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAIL, DOES NOT
PROVIDE FOR INSURANCE--POSTMASTER
Received From:
O'Brien, Baric & Scherer
17 West South Street
Carlisle, PA 17013
One piece of o~ina~ mail addressed to:
Linda Ann Peterson
7750 Silver Lake Road, gl2
Mounds View, MN 55112
EXHIBIT "C"
FS Form 3817, Mar. 1989
RENUNCIATION
In Re Estate of. DOUGLAS JAMES PETERSON
deceased.
To the Register of Wills of.
CUMBERLAND
County, Pennsylvania.
The undersigned HE T R S of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
OF ADMINISTRATION
DAVID A. BARIC, ESQUIRE
be issued to
WITNESS hand this 25 day of May , 11}2001.
CHRISTINA (Signature) LE~ PETERSON
1847 WEST COLLEGE AVENUE
SPOKANE, WA 99201
(Address)
DANIELLE (Signature) MARIE PETERSON
1847 WEST COLLEGE AVENUE
SPOKANE, WA 99201
DOU~
32 EAST
SPOKANE ,
(Address)
('gnature) WARREN PETERSON
K E X RANAN
WA 99207
(Address)
AT~) N~X~, this ~~4~3- day of ~ , 2001, before n~, the
undersigned officer, personally appeared Christina Le~ Peterson, known to me
(or satisfactorily proven) to be the person whose nam~ is subscribed to the
within instrument, and acknowledged that she executed same for the purposes
therein contained.
I hereunto set my hand and official seal.
Notary Public
S~tTE OF :
: SS.
OC~Ti~ OF :
A~3N~W, this day of , 2001, before n~, the
undersigned officer, personally appeared Danielle Marie Peterson, known to me
(or satisfactorily proven) to be the person whose name is subscribed to the
within instrument, and acknowledged that she executed same for the purposes
therein contained.
IN~SWHE~OF, I hereunto set my hand and official seal.
Notary Public
: SS.
~ N~X~, this ay~1- day of ER ~ , 2001, before m, the
undersigned officer, personally appea~ed Doulgas Warren Peterson, known to me
(or satisfactorily proven) robe the person whose nam~ is subscribed to the
within instrument, and acknowledged that he executed sam~ for the purposes
therein
I hereunto set my hand and official seal.
Notary Public
RENUNCIATION
In Re Estate of Douglas James Peterson
deceased.
To the Register of Wills of C umb e r 1 a n d County, Pennsylvania.
The undersigned, __~;~0 ~']/~ ~_ .i0'- ~'-'3 ~"0_ )~ 0~ · of
the above d~edent, hereby renounce(s) the right to adjuster the estate and res~tfully ~k(s) that Letters
of ~dminisera[ion
beissu~ to David A. Baric, Esquire
WITNESS
handthis 7 dayof October , 19 2001.
Dani e~-ar ie (Signature) O~;~lan~
(Address)
(Signature)
(Address)
(Signature)
(Address)
STATE OF Washington
COUNTY OF Spokane
SS.
AND NOW, this 7 day of October , 2001, before me,
the undersigned officer, personally appeared Danielle Marie
Orellanna, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, and
acknowledged that she executed same for the purposes therein
contained.
seal.
IN WITNESS WHEREOF, I hereunto set my hand and official
~tary Public
1 '
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT
IN RE: ESTATE OF DOUGLAS JAMES PETERSON, DECEASED
TOWNSHIP OF CARLISLE BOROUGH,
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 21-02-0289
PRAECIPE
TO THE REGISTER OF WILLS:
Please withdraw the Petition to Appoint Administrator of the Estate of Douglas
James Peterson, filed on June 16, 2014, in the above-captioned matter.
Respectfully submitted,
SAID , SULLIVAN & ROGERS
August 21, 2014 Nl
Sean M. Shultz
Attorney Attorney ID No. 90946
26 W. High Street
Carlisle, Pennsylvania 17013
(717) 243-6222
Attorney for Petitioner
Law Offices of
Saidis
Sullivan
& Rogers _
26 West High Street
Carlisle,PA 17013 C7.'- CT."C)
r`—Dr--
QG.-
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT
IN RE: ESTATE OF DOUGLAS JAMES PETERSON, DECEASED
TOWNSHIP OF CARLISLE BOROUGH,
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 21-02-0289
CERTIFICATE OF SERVICE
AND NOW, this 2)l day of August, 2014, I, Dolly M. Hockenberry,
Paralegal, hereby certify that I have this day served the following persons with a copy of
the foregoing Praecipe by e-mail and by First Class U.S. Mail, addressed as follows:
Douglas W. Peterson
c/o Danielle M. Orellana
2802 N. Smith Street
Spokane, Washington 99207
Danielle M. Orellana
2802 N. Spring Street
Spokane, Washington 99207
Christina L. Goldson
2309 Euclid Avenue, #43
Spokane, Washington 99207
SAIDIS, SULLIVAN & ROGERS
Law Offices of
Saidis ofly XT. ck ber y, ara egal
Sullivan Attorney I No. 90946
26 W. High Street
& Rogers Carlisle, Pennsylvania 17013
26 West High sneer (717) 243-6222
Carlisle,PA 17013
PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner(s)named below,who is/are 18 years of age or older,apply(ies)for Letters as specified below,and in support thereof aver(s)the
following and respectfully request(s)the grant of Letters in the appropriate form:
Sean M.Shultz
Decedent's Information
Name: Douglas James Peterson File No: 21-02-00289
a/k a:
(Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 10/04/1993 Age at Death: 46
Decedent was domiciled at death in Cumberland County, PA (State)with his/her last
principal residence at 526 Third Street,Carlisle 17013 Carlisle Borough Cumberland
Street address,Post Office and Zip Code City,Tovimi or Borough County
Decedent died at Carlisle Hospital Carlisle Cumberland PA
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania...................... All personal property $ 23,000.00
If not domiciled in Pennsylvania................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania................ Personal property in County $
Value of real estate in Pennsyl vania................................................................... $
TOTAL ESTIMATED VALUE $ 23,000.00
Rest estate in Pennsylvania situated at
(Attach additional sheets,if necessary.)
Street address,Post office and Zip Code City,Township or Borough County
❑A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated and Codicil(s)
thereto dated "
cc,
State relevant circumstances(e g.,renunciation,death ofe ecutor,etc)
Except as follows:after the execution of the instruments offered for probate, Decedent did not mar was not divorce
P O P § wss not a pa0xto a peptiif i
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(9),and did sieve a child-born or_r_t
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. CDC—,
❑NO EXCEPTIONS ❑ EXCEPTIONS ^CD
❑X B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d..b.n.c.t.a.,pedente lite,durante absentia.dura minontate -
%C
If Administration,c.ta or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of hem .
Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been established as defined
in 23 Pa.C.S. §3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑NO EXCEPTIONS ❑ EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
Goldson,Christina L. daughter 2309 E. Euclid Avenue#43
Spokane,WA 99207
Orellana,Danielle M. daughter 2802 N.Smith Street
Spokane,WA 99207
Peterson,Douglas W. son 2802 N.Smith Street
Spokane,WA 99207
Peterson,Linda A. spouse 200 Hamline Avenue N.
Saint Paul MN 55113
See continuation schedule attached
Form RW-02 rev.10-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc Page 1 of 2
Oath of Personal Representative official Use Only
- O"D Fn. [-�-�n O r
COMMONWEALTH OF PENNSYLVANIA } �'�- `L� ' �L'-' I-,, �11j_ )-
COUNTY OF Cumberland }
Petitioner(s)Printed Name Petitioner(s)Printed Address n1:i ii AUG G
Sean M.Shultz 26 W.High Street
Carlisle,PA 17013
CUMBERLAND CO., PA
The Petitiondr(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and correct to the best of the knowledge and
belief of Pei tioner(s)and that,as Personal Representatives)of th ecedent, Petitioners)will well and truly administer the estate according to law.
Sworntooraffirmeda sub Cubed!before G'�_ Data 'g`ir'=t zo1 4
met'j�,,.'.,�// day.ot _ `T- LUi`f Dale
Date
Forthe Regislar Data
BOND Required? ❑ YES 0 NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters.......................................... $ 60.00 Attorney Signature:
( 3 )Short Certi6cate(s)......... 15.00 A ,,
( 3 )Renunciation(s).............. 15.00
( )Codicil(s).............._........
(
)Affidavit(s).,................... Printed Name: Sean M.Shultz
Bond............................................. Supreme Court
Commission.................................. ID Number: 90946
Other Inheritance Tax Return 16.00
Inventory 15.00 Firm Name: Saidis,Sullivan&Rogers
Address: 26 W.High Street
Carlisle,PA 17013
Phone: 717-243-6222
Automation Fee............................ 5.00 Fax: 717/243.6486
JCS Fee...................................... 33.50.
TOTAL......................................... $ 158.50 E-mail: dhockenberry@ssr-attorm ys.com
DECREE OF THE REGISTER
Date of Death: 1010411993
Social Security No:
Estate of Douglas James Peterson File No: 21.02-00288
alkta:
AND NOW, ,in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters of Administration
are hereby granted to Sean M.Shultz
in the above estate and(if applicable)that the instruments)dated
described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Decedent.
Register of Wills
Copyright(c)2011 form software only The Lecturer Group,Inc. Page 2 of 2
J REV-346 EX(03-09) 3460007120
ESTATE INFORMATION
SHEET
pennsylvania FOR REGISTER'S OFFICE USE ONLY
DEPARTMENT OF REVENUE
County Cotle Year File Number
DECEDENT INFORMATION: Enter data as it will appear on all
documents submitted to the Department. 21 02 00289
Decedent's Social Security Number Date of Death Date of Birth
538 44 2288 10 04 1993 11 06 1946
Last Name Suffix First Name Ml
PETERSON DOUGLAS Of
TYPE FILING: Enter mark(x)to indicate the nature of the return to be filed with the department.
® Probate Return ❑ Joint Assets Only ❑ Non-probate Assets Only ❑ Litigation Purposes(No Other Assets)
LETTERS GRANTED: Enter mark(x)to indicate the nature of the proceedings at the register of wills office.
(Attach additional sheets if explanation is necessary.)
❑ Testamentary ® Administration ❑ No Letters ❑ Other(Please Explain)
ATTORNEY/CORRESPONDENT INFORMATION: Enter all data concerning the attorney or other individual to receive all tax
information and correspondence.
Last Name Suffix First Name MI
SHULTZ SEAN M
Supreme Court I.D.# Telephone Number
90946 717 243 6222 Attorney/Conrespondent's e-mail address:
dhockenberry@ssr-attorneys.com
First line of address
26 W. HIGH STREET
Second line of address
C7
City or Post Office Slate ZIP Code >.0
CARLISLE PA 17013
PERSONAL REPRESENTATIVE INFORMATION: Enter all data concerning the personal rgtresentative(a s)of the-6s'tke
n
authorized by the Register of Wills. C, CD
Executor/Administrator OC_ ZZ
Social Security Number Telephone Number .', �p
(717) 243 6222
Last Name Suffix First Name MI
SHULTZ SEAN M
First line of address
26 W. HIGH STREET OFFICIAL USE O�NLY�
Second line of address TRANSACTION COUNT NL
I
City or Post Office State ZIP Code i
CARLISLE PA 17013
Complete general estate information questions,and indicate additional personal representatives on reverse side.
PLEASE USE ORIGINAL FORM ONLY
Side 1
3460007120 3460007120
.ECORDE ORP411OF
RENUNCIATION 2914 AUG 2 ! AN 9: 39
REGISTER OF WILLS ORPHF:N.J COURT
CUMBERLAND CUMBERLAND CO., PA
COUNTY,PENNSYLVANIA
Estate of Douglas James Peterson Deceased
I, Christina L. Goldson in my capacity/relationship as
(Print Name)
daughter of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Sean M. Shultz,Esquire
(Date) (Signature)
2309 E. Euclid Ave. #43
(SovetAddress)
Spokane, WA 99207
(City,State,Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before me this day party executing this renunciation and certified
of that he or she executed the renunciation for the
purposes stated within on this 1 L, day
of C/c C mA%I—
Deputy for Register of Wills Notary
My Commission Expires: 1 m1i k-
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
pll IIII11t11iI1R 111111 lllllilllll ll ll ll 1111110
Notary Public
5 State of Washington
Form RW-06 rev.10.13.06 = SAMANTHA J. HARPER
MY COMMISSION EXPIRES
JANUARY 15,2018 c
I�Itll Ill 1 111 ltll 111 111 IIIIIItIR Illl 111 1111 llp
flEGJ DFf ;FFICE OF
RENUNCIATION
21714 AUG 21 All 9: 39
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN`S COURT
CUNIBERLAND CO., PA
Estate of Douglas James Peterson Deceased
1, Danielle M.Orellana In my capacity/relationship as
daughter of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
j Sean M. Shultz, Esquire
1
Danielle M.Orellana
2802 N.Smith Street
� (Street Pdarea:)
Spokane,WA 99207
(CRY,stele,YJp)
I
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
j party executing this renunciation and certified
-r
before me this 1 _da y that he or she executed the renunciation for the
of �Ul`1, purposes stated within on this W day
of s �t
I
Deputy for Register of Wills Notary Public
i }
My Commission Expires: 11(S[ L(R'
(SlpraW a.d seal d Ngery a olhoroflbkl yual6leo to
atlMnlaror oafs. ^ tlelede)rdllcnol NoZY.tommisabnJ
I
oluuuuugunuguuuununnnuuul7
= Notary Public
State of Washington
SAMANTHA J. HARPER
Form RW06 Rev.fats-zoos Cop00(c)2006 form ao6ware only The Leclawr Group,lnc. MY COMMISSION EXPIRES
i = JANUARY 15,2018 =_
� (]IIIIIUIIIIIIIIIII1111i11111tifl111111fIB111�
F r_,�P,CEr oCF10E OF
RENUNCEAT`16 p i'V''-`c
�Lk AUG 21 AM 9: 39
REGISTER OF WILLS OF CUMBERL D COUNTY, PENNSYLVANIA
ORPHAN') COURT
CUMBERIIIND CO., PA
Estate of Douglas James Peterson Deceased
i
1
Douglas W. Peterson in my capacity/relationship as
I
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Sean M.Shultz, Esquire
i Mot&) "8°Bf uglas W. Peterson
2802 N.Smith Street
(S6oef Add")
Spokane,WA 98207
(Cwy,Sroro,Du)
Executed in Registers Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
I before me this -day party executing this renunciation and certified
I y that he or she executed the ran ugqc`'�11 for the
of purposes stated within on this =day
of .
I
Deputy for Register of Wills Notary Public l
My Commission Expires: l 1151 lsr
(9lerefw anct wet d Nd y or olrorditlAl WWee00e�d to
adm 1.ooha. Snow dato d cordlon d Namya oomrtiaebn.)
�IIIIININIINIIIIIillilllllllllllllllllll IIp
Notary Public
c' State of Washington
SAMANTHA J. HARPER =_
{ Form RW-06 Rov.fo-f3-2ooe Co,ydoN(o)2006 form ad monly Tito Lodv rGrow.too MY COMMISSION EXPIRES
t = JANUARY 15,2018 =_
Ir]Illl I I Itl 111 l I I III I II I I II I I I I I I I I I I I I I I I:;1 110
I
Oath of Personal Representative Official Use Only
-_a.f:IL-CJ
COMMONWEALTH OF PENNSYLVANIA } OFFICE Y
COUNTY OF Cumberland } SS: fi
Petitioner(s)Printed Name Petitioner(s)Printed Address 7(;' !r
Sean M.Shultz 26 W.High Street
Carlisle,PA 17013
„LI_hi.
OR MAN 6 "OUR I
CUMBERLAND CO., PA
The Petitioners)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and correct to the best of the knowledge and
belief of Petitioners)and that, as Personal Representative(s)of th ecedent,Petitioner s)will well and truly administer the estate according to law. 'I
Sworn to or affirmed an subscribed before n � Data �'Lr zoig
me t day of G Dale
gy. 1 Q/Ld/ / Date
forthe Register{a Date
BOND Required? ❑ YES ❑X NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters.......................................... $ 60.00 Attorney Signature:
( 3 )Short Cerlificate(s)......... 15.00 AA ,^,
( 3 )Renunciation(s).............. 15.00 /�z y
( )Codicil(s)........................
( )Af fidavit(s)...................... Printed Name: Sean M.Shultz
Bond............................................. Supreme Court
Commission.................................. ID Number: 90946
Other Inheritance Tax Return 15.00
Inventory 15.00 Firm Name: Saidis,Sullivan&Rogers
Address: 26 W.High Street
Carlisle,PA 17013
Phone: 717-243.6222
Automation Fee............................ 5.00 Fax: 7171243-6486
JCSFee.......................................
TOTAL.........................................
E-mail: dhockenberry@ssrattorneys.com
DECREE OF THE REGISTER
Date of Death: 10/0411993
Social Security No:
Estate of Douglas James Peterson File No: 21-02-00289
a/k/a: r n
AND NOW, W ,in consideration of the foregoing Petition,
satisfactory proof having bee resented before me, IT IS DECREED that Letters of Administration -
are hereby granted to Sean M.Shultz
in the above estate and(if applicable)that the instrument(s)dated
described in the Petition be admitted to probate and filed of record as the last Will(and Codi (s))of Decedent. -
gi er of Wills //—�[/,///row
--'
Copyright(c)2011 form software only The Lackner up, n 1 �- ge 2 of 2
eQ�P
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA ADMINISTRATION
of CEI
No. 2002- 00289 PA No. 21- 02- 0289
�Z ` '\�� Estate Of: DOUGLAS JAMES PETERSON
,C }1' ��w (First.Middle,Last)
Late Of: CARLISLE BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No:
1750
WHEREAS, DOUGLAS JAMES PETERSON
(First,Middle,Last)
late of CARLISLE BOROUGH CUMBERLAND COUNTY
died on the 4th day of October 1993 and,
WHEREAS, the grant of Letters of Administration
is required for the administration of the estate.
THEREFORE, I, LISA M. GRAYSON, ESQ. , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, have
this day granted Letters of Administration to:
SEAN M SHULTZ
who has duly qualified as ADMINISTRATOR (RIX) of the estate
of the above named decedent and has agreed to administer the estate
according to law, all of which fully appears of record in my office at
CUMBERLAND COUNTY COURTHOUSE, CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 26th day of August 2014.
tf� t eL X l 14 1
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**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
Cumberland County - Register Of Wills
One Courthouse Square .
Carlisle, PA 17013 RECORDED OFFICE OF
Phone : (717) 240-6345 REGISTER OF MILLS
1014 SEP 15 flPi 10 38
CLERK OF
ORPHANS' COU3T
CUM8ERLAGC C ?<�
Date : 9/15/2014
SHULTZ SEAN M
SAIDIS SULLIVAN & ROGERS
26 WEST HIGH STREET
CARLISLE, PA 17013
RE: Estate of PETERSON DOUGLAS JAMES
File Number: 2002-00289
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: 10/04/2014
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 .
Sinc
Lisa M. Grayson, Esq.
Clerk of the Orphans ' Court
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: Douglas James Peterson
Date of Death: 10/04/1993 File Number: 21-02-00289
Pursuant to Pa. O.C. Rule 6.12, 1 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:
Approximately 6 months to a year
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 Orphans' Court and may be attached to this report.
Date 09/16/2014
Signature of Person Filing this Form
LL_ [�- Capacity: ❑ Personal Representative ® Counsel
J
LLJ J T
iL ar E U- o « Sean M. Shultz
U_ (y Q. G3 Name of Person Filing this Form
26 W. High Street
CO
(fj 0— UW Address
f g Carlisle, PA 17013
W City,State,Zip
717-243-6222
CN!
Telephone
Form RW-10 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc.
coMmoNwen�.�,oFvervrvs�vnwn aEv-ne2ex[" "n
.JiTMENT OF F WENUE
9UAFAU OF INUIVIOVAL TMES
P! IBO601
HnaAisauac,vn n,ze-oso, pEN NSV LVAN IA
flECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 020523
SHULTZ SEAN M
SAIDIS SULLIVAN & ROGERS
26 WEST HIGH STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---- ---
101 51,031 .80
ESTATE INFORMATION: ssN: saa-aa-2zes I
FILE NUMBER: 2102-0ZHJ I
oeceoeNT rvanne: PETERSON DOUGLAS JAMES I
DATEOfPAYMENT: O4/1B/2015 �
POSTMARK DATE: O4/�6/2015 I
couNrv: CUMBERLAND I
DATEOFDEATH: 10/04/1993 I
TOTAL AMOUNT PAID: 51 ,031 .80
REMARKS:
CHECK# 21150
INITIALS: CJ
sEA� RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
� pep�s Ivama 1505618403
� �'°""`"'�x(oa-ta�
REV-7 500 OFFICIAL USE ONLY
County CMe Year Flle Number
BureauoflntlivitlualTaxes INHERITANCETAXRETURN
POB0X28os01 21 02 00289
HarrisEur PA 1]128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Num�er
Dd�2 01�2d�h MM�OYVYV D2[E OI Birth MMODVYVY
10 04 1993 11 �6 1946
DecedenfsLastName Sut(x DecedenfsFlrsiName MI
PETERSON DOUGLAS �
(If Applicable�Enler Surviving Spouse's Information Below MI
Spouse's Lasl Name SuHix Spouse's Flrst Name
PETERSON LINDA A
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O t OnglnalReWm � 2. SupplementalReWm � 3. RemaintlerReWm(da�eoitlea�M1
pdor�0 12-1382)
� d, AgricWWral Exemp�ion(Date of � 5. Future In�eres�Compmmise(Ga�e o� � 6. Federal Es�ate Tax ReWrn Requlred
Oea�M1OnoraXer9-�-20t2j Oed��aftert2-12-92)
� ]. Decetlent DIeO Testate � B. Decedenl Maintalnetl a Llving Tmsl 9� To�al Numberof Sale Depovt Boves
(AttaohmDYolwlll) (AtlacM1copyol�mst)
� ID. LltigationPmceetlsFeceivetl � 1t Non-Pro�a�eTransiereeRe�urn � II. �eferral/ElecOonotSpousalTmsls
(Sc�e�ule F arb G Asse�s Only)
� 13. Busin¢SSHsse�s � �a- �No�usfl V�IveE�neOcidry
CORRESGONOENi-TNIS SECTON MUST eE LOMPLETED.ALL CORRESPON�ENCE AHO CONFI�ENTAL TA%INFORMATION SNOUL�BE OIREQE�T0:
Name Oaylime Telephone NumEer
SEAN M SHIJLTZ 717 243 6222
Firsl Line of AtlCress
26 W HIGH STREET
Secentl Line oi Atltlress
CityorPoslOHice SWte ZIPCotle
CARLISLE PA 17013
�
� c"i+ ?� m
CorrespondenPs email atldress: tlh k b (o� - tt Y � 0 � p—
REGISTE F�AL�S US LY N �
-�
REGiSTEROFWLLL5u5E0NLY '� 1_ �'r-t � r� j
OATEFlLE�MMD�YYri � n
. . .".� _O ]vl -1
� �1
— 1
� C)
� f— T
�AT�FIL�STMIP � O
�
Side 1
L IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ///���
15056184�3 1505618403 � �
JLsase1av11
REV4500 E% DecetlenPs Social5ecurity Num�er
oeceoe�r:r+ame� Peterson, Dou IasJames _ __ _ 538 . _ _
RECAPITULATION
1. RealEsta�e(SchetluleA)__.... ........._. ____. _............ 1.
2. StocksandBontls(ScheduleB) ......._.. ._...... ......... z�
3. Closely Held Coryoration,Partnership or Sole-Proprie�orship(Schedule C�......... 3.
4. Motlgages antl No�es Receivable(Schedule�) .......__ ._...._ 4.
5. Cash,BankDeposilsandMiscellaneousPersonalPmpehy(ScheduleE)......__ 5. 23,408 • 42
6. Jointly Ownetl Pmpetly(Sc�etlule F) I�� Separa�e Bllling Requestetl.......__. 6.
]. In�er-Vivos Trerefers 8 Miscellaneous Nron,-Probate Propeny
(Schetlule G) u Separale Billing Reques�ed........... �.
8. TOWI Gmss Asse[s (total Lines 1 Umug�1�.... ...._.. ........ 8. 23.408 • 4 2
9. Funeral Expenses and Adminislrative Costs(Schedule H) ____. ......... 9. 6 +2 L 1 • 81
10. Deb�s of Decetlent, Moegage Liabilities antl Liens(Schetlule p........_.._._........_. 10.
11. TOWIDetluctions(�otalLines9and10)..._.__ _....... ..-___. 11, 6 .211 • 81
12. Net Value of Estate(Line B minus Line i i)...._ _........ _-..-. 12_ 17.196 • 61
13. C�ari�able antl Govemmen�al BequeslslSec 9113 Tmsls for which
an election b tax has not been matle(Schetlule J).._..........____._....____......_.. 13.
14. NeNalueSubjecUoTax(Linel2minusLinel3) _._.... ...___. iq. 17,196 • 61
TAX CALWLATION-SEE INSTRUCTIONS FOR APPLICA9LE RATES � �
15. Amount o(Llne 14laxable
a�the spousal tax rate,or
�ransfe�s untler Sec.9116
(a)(t2)X.os 8.598 • 31 �5. 515 • 9�
16. Amoun�o(Line 14 taxable
a�linealratexo6 8 +598 • 30 is. 515 • 90
il. Fmount of Line 14 taxable
at sibling rate X .12 0 • 00 »� 0 • 00
18. Amounl of Line 14[axa0le
atcollateralrale %.15 0 - 0❑ 18' ❑ • �0
19. TAXDUE... .__. .__.._ __._.. ____. ....__ 19. 1�031 . 8❑
20. FILL IN TME OVAL IF YOU ARE REpUESTING A REFUNO OF AN OVERPAVMENT �
UnEer penalties ol perjury,I tleclare I�ave examine0 iM1ls reW rn.IncWUing acmmpanying sc�etlules and sta�emenls,an0 b t�e Eest ol my knowl�etl�antl belie(
itlsVue,wrreclanticomplele.Declarationoipreparerot�er�M1anOepersonresponsDlelor01ing1�ereNmis�aseConall'mforma�lonofwM1i<� er�as
any knowletlge.
SIGNATURE OF PERSON RESPONSIBLE FOR FlLING RETURN Sean M. Shultr C u 9�E /
Ja� �� G /�
nooaEss
26 W. Hi h Street, Carlisle, PA 17013
SIGNNTUREOFPREPNREROTHERTHANREPRESENTATIVE SeanM.Shultz �� �// �A���
� �4
nooaEss
26 W. Hi h Street, Carlisle, PA 17013
II��I�III��I�IIIIIII�IIIII��IIIIII��II�III�I��III��IIIIII��I Side2
L 1505618411 1505618411 �
REV-1500 EX Page 3 File Number 21-02-00289
DecedenPs Complete Address:
DECEDENT'SNAME
Peterson, Douglas James . _ _ .
STREETADDRE55 � � � � �
526 Third Street _ __ _ _ -_.
.— . _ .._— _ _ _.
QTY STATE ZIP
Carlisle Pp' �����
Tax Payments and Credits:
1. Tax Due(Page 2.Line 19) (i� . 1,031.80
2. CreditslPayments
A. Prior Payments
B. Discount 0.00
Tolal Credlts(A �B) (Z) 0.00
3. Interest (3) _ _ . 1.315.51
q, If Line 2 is greater than Line 1 +Line 3,en�er�he tliRerence. This is�he OVERPAVMENT. (4) __
Check boz on Paga Z.Line 30[o requesl a re(untl
5. I�Line 1 +Line 3 is greater�han Line 2,enter[he ditterence. This is Ne TAX DUE (5) 2�347.$�
Make Check Payable to: REGISTER OF WILLS, AGENT.
��� PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. OiG tlecedenl make a�rensfer antl� Yes No
a relain ihe use or income of the property Vansferre4.. ._._.. -__ ._ � I �
b. retain�he righ[to tlesignate who shall use Ihe property�ransferretl or its ncome _.. .._ � �x
J
c. re[ain a reversionary Interes(oc.._. _._.... ........_ ____. .... •'�
tl. receive Ihe promise for life of eil�er paymenls,bene(�s or care� ._ ._ ......... ..__. �] =
2. If tleath occurred after Dea 12, 1962, tlitl tlecedent [ransfer propetly within one year o( tleath without �J �,
receivingadequateronsitleraton9 ...__._ ._._._ _. ..._.. ___.. ._.
3. Ditl tlecetlent own an"in�ms�Por or payable upon tleath bank accoun!or secunry at his or her tlea[M ._. �I ! �:�
4. Ditl tlecetlent own an intllvidual retiremen[accoun�,annuity,or other non-pwba[e property which — ❑
containsabenefciarydesi9na�ion�_.__.. __ ._..__ __........ .._._ �- x
IF THE ANSWER TO ANV OF THE ABOVE OUESTIONS IS YES,YOU MUST COMPLETE SCHEUULE G ANO FILE IT AS PART OF THE RETI/RN.
Porda�esofdeathonorafteNuly1,1999andbebreJan 1 19951helaxra�eimposetlonihenelvalueof�ranskrstoor�o�iheuseo��M1esurvivingspouse �
is 3 pe¢ent I]2 P.S.4911fi(a)(1.1)(ill.
For tlales o(tlea�h on or afler January 1,1995.�he�ax rale imposea on the net value oi Vansfers to or tor the use ot the surviving spouse is 0 percent
�]2P.S.§9116�a�(1.1)(ii)J. T�es�aWtetloesnolexemptaVansfertoasurvivingspouse(romtax.andthes�aWtoryreQuirementslortliscbsureo(asse�sand
filing a tax reNrn are s�ill applica�le even i!Ne surviving spouse Is�he only beneliciary.
Por tlates of tleat�on or a8er July 1,2000�.
• The�ax ra�e impoutl on ihe ne�value o(�ranste�s i�om a deceased chiltl 21 years o�age or yaunge�al dea�h�o o�for the uu of a naWral parent.an
adop6ve parent or a step-perent ot the chiltl is 0 pemenl[]2 P-5.§9116(a)(12)�.
• The�ax rate imposetl on ihe net value o�transters to or tor Ihe use o(ihe tlewtlenfs lineal beneficiaries Is 6.5 percent excepl as no�etl In�I2 P.S.§91161a)(i)�.
. The tax mte Imposetl on ihe net value of Iransiers lo or for�he use af Ihe decetlenfs siblings is 12 perce^t I72 P 5.§9116(a)(t$)]. A sibling Is tlefned,
under Seclion 9f 02,as an intlividual who has a�leas�one parent in common wi�h the deceden�,whether by blooC or atlop�ion.
ee..isoe ex.�oa.�x�
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
°""aT'"`"'°`RE�E"�E pERSONALPROPERTY
INMERIiANCETMRETURN
RESI�ENTOECE�ENT
ESTATE OF FILE NUMBER
Peterson DouglasJames 21A2-00289
m�wae ma oror.�ew min�aa����a�a me aaie ma v�eea:were ra�o��ee o�ma e.ima
PII pmpetly jolnllyowmtl wll�I�a ngM o�survlvon�lp musl Ee EIeCIoaeE on sc�etlule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DENTH
7 MembersistFCUCheckingAccounl-SeeattachedletterdatedNovember12,20'14from 5,795.27
Department of Treasury
2 Members ist FCU Savings Accounl-See attached letter tlated November 12,2074 from �8.213.75
Department of Treasury
TOTAL(Also enter on Line 5, RecapitulatioN 23,408.42
Qf more space Is nee0e4 atlCi6onal pages oi�ne same slze)
Copyri9ht(c)2�12 form soffware only The Lackner Group, Inc. Form PA-05U0 SCM1etlule E(Rev.OB-12)
�� 1 $ 2014
PbNNSYLVAN[A
..........................
TREASURY
� U4CLAIMND AAOPBRTY
November 12, 2014
� Shultz Sean Michae]
. 26 W.High Sheet
��� Cazlisle,PA 17013
Re: Claim ID 78045266
Dear Claimant:
� I writc[o you about the following property(or properties)tor which you have 61ed u claim:
I
� Property ID: 7493679 j
� Property'I�pe: STATEMEN7'SAVINGS �
� � Hulder: Members First Federal Ctedi[Union
�� Claim Amound $ 18,213.15 i
��� Owner(s) of Record: Peterson Douglas l ''�,
. � � 52( 3Rd St, Carlisle,PA 17013-1808 ��,
', Property ID: 7493680 � .. �. . .. . ��
PropertyType: CHECKIIVGACCOiJN7;. , .,
� Holder: . Membeis Frzst Federal Credit U,niun . . . �
� ClaimAmouut: $ 5,19527 � .
� Owner(s)of Rewrd: Peterson Douglas J �
' S26 3Rd St,Carlisle,PA 17013-1808 ,
'' To c�snre Ihnt property is retumed only to its righ[fid owncr,we curry out a thorough review '
�. during which we look al vazious types of evidence. In thz case of your claim,we need the �
following:
� • Enclused is�x Propased Distribution Schedule which mus[ be campletcd in its �
�� enHrety as it relates to your unclaimed property claim.
� Please submit this evidence[o the Bureau of Unclaimed Properig P.O. Box 1837,Haxrieburg,
' PA 17105-1837, along with a copy of[his let[er. Wc will the�resnme work on your claim.
� We ask for your patience duri�g lhe claims process. As much as we would like to retum your
� property immediately, it may.lake up to 8 weeks, sometimes]onger tu complete tlie
app.ropriate rescarch,verification,and apprqvals ttiat are necessary to prove e�titlement arid
preve�t frapd. In Ihe meantime;if you haVe auy qucstions, please call thc Bureau of
, Unclaimed Property at 1-800-222'-2046 from 7:30 a.m.to 4:30 p.m. Eastern Time; or call me
directly�[ from. � . � � � ' � �
Rob MCCord,Treasurer� Pennsylvanla Treasury � P,O.Box 183] � Harrisburg,PF ll105-183% � 800-222-204G
www.paheasury.gov
.
' PiNNSNI.VANi,4
TREASLIRY
UNCLAIMEUPROPCR'fY
CLAIM NUMBER 78045266
DECLARATION OF DISTR][30TION OF lJNCLAIMED PROPSRTY(P.dministratocs)
'� In auwrdancc wi1L the Pennsylvania State Treasiver's fiduciary duty under the Dispositiou uf Abandoned
and Unclaimed Properly Act� and lhe 7'reasurcr's zuthority W prescribe the nncleimed properly claim
' form'',a11 Admirustrators aze requirod to complete this declaration as part of the claim process.
. 1, Sean Michael Shultz, hemby swear and declare that all unclaimed pmperty paid by the Pennsylvnnia
Tceasuey Depariment for the Eatale of Douglas 1. Peterson pucsunnt m this claun, will 6e distributed as ,
follows: I
DISTRIBUTEE RELATIONSHIY PERCBNTAGE OF DOLLAR VAi.UE AUPgOR1TY POR
. (VpME) TODBCRDBNT DISTRIk3U1'ION OF DISTRIB�ITION i
DISTRIBUTION (e�s�heir,will,emJ
' 7'OTALDISTRIRi1TION
��, (Must incluAe ali fces or costs in o�dcr ro mtol tAc
� xmomrt claimcA)
�I +Pleneallore:Anindividmlmaynotbuthaetnsenmimiuiahabnndcolluln"l1ilrdl'artyFee"pucsnantm"I2Y.S.§U01.11(g).
�I "fhe-Pfoposed DisVibutiou of Unolaimed Propcity opplies onlv to w�clanned properry.No infomiation is
� necessuty conecrning any other estate pcoperty or dis[ributio�s.
I acknowlcAgc and unders'land that if any in£ormation provided herein is false, I will be subjcct to
prosecutiou undee 18 Pa.QS.§4904 eela6ug to unswom falsificxUou to authocities,tho cowiction of whiub
i could subject me to a prison lertn of up to lwo years and u finc of up to$5,000.
�I Signamre�of Administrltor
' Dute
, �72P.S.§ 1301.1Y.
� '72P.5. § 1301.19.
'�, Rev. 11l3
p`�,�„EX.,��," gCHEDULE H
pennsylvania
oeaue�meH.oraevee�ue FUNERALEXPENSESAND
'""ER"""°E�"`RE'�a" pDMINISTRATNE COSTS
ESTATE OF FILE NUMBER
Peterson Douglas James 21-02-00289
DecetlenYs debts must he repoRed on Schetlule I.
ITEM DESCRIPTION AMOUNT
MBER
p, FUNERALEXPENSES:
HoHman-Roth Funeral Home
�,�s�.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Represen�a�ive(s)
SVeetAdtlress
Ciry Siate _ Zio
Year(s)Commission Paid
z, Atmmey's Fees Saidis, Sullivan & Rogers 2,eo9.00
3, Family Exemption'. (If tlecetlenfs atltlress is no��he same as claimanFs,aUach explanation) 2,000.00
Ga�mant Linda A. Pelerson
so-ee�naa�e:s 2800 Hamline Avenue North Apt. 130
Ci�v Roseville State MN zio 55115
RelationshioofClaimanttoDaretlent Spouse
4. Pmba�e Fees 160.50
5. AccountanCSFees
6. Tax ReWm Preparer's Fees
�. O�her Administra�ive Cosis 61.37
See continuation schedule(s) attached
TOTAL(Also enler on line 9, Recapitulation) 6,2t7.81
Copyrigh[(c)2013 form soihvare only The Lackner Group, Inc Portn PA-'1500 Schedule H(Rev. �8-13)
SCHEDULE N
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Peterson Douqlas James 21-02-00289
ITEM
NUMBER �ESCRIPTION AMOUNT
Other Atlminislrative Costs
7 FilingfeeforPetition 15.00
2 Filing Fee for Renunciation S.OU
3 Posfage 41.31
H-67 61.3'I
Copyright(c)2002 form sofiware only The Lackner Group, Ina Fortn PA-0500 Schetlule H(Rev.6-98)
awnsv ex.�ai-io�
pennsylvania SCHEDULE J
�EPARTMENTOFREVENVE
�„„Ea�.AH�E.�RE,�aN BENEFICIARI ES
ESTATE OF FILE NUMBER
Peterson, Dou las James 21-02A0289
NAMEANDADDRESSOF RELATIONSHIPTO SHHREOFESTATEAMOUNTOFESTATE
NUMBER PERSONl51RECEIVINGPROPERTV oDECE�ENT (yyords) (S$$)
I TAXABLEDISTRIBUTIONS [indudeoWrightspousal
tlishibutions,antl Vansfers
untlerSec.9116a 12
1 ChristinaL Goltlson daughter 16.66%of
2309 E.Euclid Avenue#43 residue
Spokane,WA 99207
2 DanielleM.Orellana daughter 16.66%oT
2802 N.Smith Street resitlue
Spokane,WA 992U7
3 Douglas W. Pe[erson son i6.66%of
2802 N. Smith Streel resitlue
Spokane,WA 99207
4 Linda A. Peterson spouse 50%of resitlue
200 Hamline Avenue N.
SaintPaul, MN 55t13
Total
En�er dollar amoun�s for tlis[ribNions shown above on lines 15 t�rou h 18 on Rev 1500 cover sheet,as a ro ria�e.
NON-TAXABLE DISTRIBUTIONS.
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOTTAKEN
B.CHARITABLE AND GOVERNMENTAL OISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 130F REV-7500 COVER SHEET
Copyrighl(c)2010 form soNware only The Lackner Group, Inu Form PA-0500 Schetlule J(Rev.Ot-10)
Law Of(iccr of
SAIDIS, SULLNAN & ROGERS
A PROFESSIONAL CURYORAl10N
26 WEST HIGH S"fREET �
I:OHF:RT C SAID6 CARLISLE, PENNSYLVANIA I]Ul3 LEMOYNE oFE10E:
DANILLL.SUI.LIVAV TQLCPIIONE:�717)293-6222-PACSIMILE: (717)243fi486 635NOH'1'HIF"SI�REET,S�G.4W
RYS[F.ROGERS EMNL:attorney`iDssr-attomeys.mm L[MOYNF.,PA V W]
JOHf�'A.FEICHTEL www.ssrva[[orneys.mm 'pELEPHONG.(Tll)512-38W
MARYLOUMAI'AS YACSI.ViILE: (/1�612-3R05
ANNA NORRO HAYS O(Cmnisri
DEAN E.ItEYNOSA
SPEPHEN L.CROSL
TODD F.TRUMZ
SFA�-Vi_SI NL�"Z R[PLY TO CARLLSLL'
HrANNAI l WIIITFLIHSJN
April 16,2015
� s, � m
� o J m c�
� .,� � :� o
Pennsylvania Department of Revenue �,-� -o � � ��� �
6ureau of Individual Taxcs — �-' ��� �'�
Inheritance'�axDivision � � � �� �
-, o
PO Rox 280601 . . ..� � -„
��
Ilzrrisburg. Pennsylvania 17128-0601 � �� 3 �- n
.� �- m
_ �
Rli: Estale ot Douglas James Petersun . � ��' -n
Dute of lleath: Octobcr 4, 7 993
l;sintc No. 21-02-00289 '
To Whom it May Concern:
Gnclosed please find an Inheritance Tax Rewrn fo�the above-ceferenced estate.
The only assets oCthe estate w�ere two Members 1" Federal Crcdit Union accounts which were
not claimed after thc UccedenPs dea[h, and bccame unclaimed property held by the Pennsylvania
Dcpartmen[of Treasury.
Due to[he fact that the Commonwealth hdd this moncy, we are axking that inteces[be waived.
The amoimt of iNcrest is calculated on [he Inheritance �Pas IZcturn,but has not been paid. Endosed
is a copy of the check from lhc Dcpartmwt of Trcasury for the money in thc Dccedent's accounts, as
well as an c-mail �rom Jared Russell of the DcpnrtmcN of Revcnue dated April 13,20 L5. Please notc
that the subject of the e-mail should have been the l:state of Douglas James Pete�son, and not Linda
Peterson.
-I'he famila exemption is being cleimed by the spouse of the Decedent. �fhe�efore, her addcess
is irrelecant ro the claim for the exemption.
�
- Penn.rylva�ifnDepartmen[ofRevenuz
Eslate oj'Douglas./amev Pe[erson
Apri[ !6. 20l5
P��ge lleo
If you have any questions plcasc do not hcsitate [o contact me or my pazalegal, Dolly
Hockenberry, Co� assistance.
Very iruly yours,
SA IS, SULLNAN Xc ROGERS
�I/ C ��_
`_(� �.
�4Ean M. Shulti �
SMS/dmh
F.nclosu[es
Commonwcalth of Penns}h-xnia �„e1C = of ,
��� RfI171CY8[ICC �'�(jVLCC c000i9 asve seomaaese
Pennsylvania Treasury - Bureau of Unclaimed Property Payment �-
�' CLAIM #-]8095266 �
"__""______________"""____"____"__'_"____"__p_____""_"___'"__ ___
—' � Ptopexty sn Holder Name Descri tion Amount
9A936�9 M'eM68R5 E'iRST kEDGW+L C STATSN�ENT SAViNCS 1(t,213 .15
9493080 MEMBER� PIRST FE�BkAb C CHECKING ACCOI%N1' S,195.2'/
TOCal: 23�408.42
T•
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� PAYEE INPORMI�TION: NOTE: DiceCt paysent inquliles to:
— POTERSON DOUGLAS J GSTA:E: OF PA Uvclaimed Proper[y 1.800.222.2C46
26 W HSGF3 S'L P.O. Box 1839
CAI2LISLE YA 19013-2922 Ha[ri�bu[g, PA ll105-183"1 �
FOL�ON PERFORAIION,TMEN DEfACH CRREFULLY
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Dolly Hockenberry
From: Russell, lames <jamesrusse@pa.gow
Sent: Monday,April 13, 2015 2:55 PM
To: Dolly Hockenberry
Subject: RE'. Estate of Linda Peterson 21-02-0289
Dolly,
Interest should be waived for the undaimed property with the documentation you sent me. Make sure you
ask for interest to be waived when the return is filed and attach the undaimed property check. I will also
put a note and put copy of check into imaging system.
Sincerely,
lared Russell I TACT
PA Department of Revenue
Bureau of Individual Taxes
PO Box 280601 � Harrisburg, PA 17128
Phone: 7llJ83.6077 � Fax: 7llJ72.0412
Email: jamesrusse@pa.gov
From: Dolly Hockenberry [mailto:dhockenberry@ssr-attorneys.com]
Sent: Monday, April 13, 2015 2:24 PM
70: Russell, James
Subjec[: RE: Estate of Linda Peterson 21-02-0289
My apologies That was my mistake—the dienYs name is Linda Peterson but the Decedent is Douglas 1. Peterson. My
email should have been titled the Estate of Douglas J. Peterson.
Thanks.
Do!!y
SaidLa.Sullivan C Ro`6en — 7ra•t Dfarrer.
_ _ . . .. . . . . . _.. . _ . . _. . . .. .. . . . .. . . ._ .
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1
From: Russell,James [mailto�iamesrusseCdpa.Qov]
Sent: Monday, April 13, 2015 2:16 PM
To: Dolly Hockenberry
Subjectr RE: Estate of Linda Peterson 21-02-0289
Confused why check is written out to Estate of Douglas 7. Peterson when [he Estate of Linda Peterson is
the one we are currently dealing with,
Thanks,
]ared Russell � TACT
PA Department of Revenue
Bureau of Individual Taxes
PO Box 280601 � Harrisburg, PA 17128
Phone: 717.783.6077 � Fax: 717.772.0412
E-mail: jamesrusseaoa.aov
www.reve n u e.state.ua.u s
From: Dolly Hockenberry [mailto;dhockenberNC�ssr-attomeys.mm]
Sent: Friday, April 10, 2015 828 AM
To: Russell, James
Subject: RE Estate of Linda Peterson 21-02-0289
Good Morning lared,
Attached is a copY of the check we received from [he Sta[e Treasury.
7hanks.
Dol(y
ti���{is,Sullivan.4 Rogecs- Trutt Sferlers
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del.n.�Thnnknn Saidi..SvlLmnSlio,.m ��eM1sittu= �r�1c.
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n�.nmr nddmmd In rh��x.vnail.
From: Russell,James [malto�lamesrusse(�pa.¢ov]
Sent:Thursday, April 09, 2015 3:50 PM
2
. 70: Dolly Hockenberry
Subject: RE Estate of Linda Peterson 21-02-0289
Dol ly,
If you have documentation showing it is income from unclaimed property. Like a check written from
undaimed property from The Department of Treasury. Most likely interest will be waived. Send me the
proof please.
Sincerely,
Jared RusseII � TACT
PA Department of Revenue
Bureau of Individual Tazes
PO Box 280601 � Harrisburg, PA 17128
Phone: 717.783.6077 I Fax: 717.772.0412
E-mail: iamesrusseCo�oa.aov
www.revenue.state.oa.us
From: Dolly Hockenberry [mailto:dhockenberrvCassra[torneys.mm]
Sent: Thursday, April 09, 2015 2:30 PM
To: Russell, James
Subject: Es[ate of Linda Peterson 21-02-0289
HiJarred,
We are preparing to file an Inheritance Tax Retum on the above-referenced estate.
The Decedent passed away in 1993 and he had two bank acmunts(totaling$23,408A2) which were not daimed,so[hey
became undaimed property with the Department of Treasury. We have now received Ihat money from the Department
of Treasury.
At[orney Shultz was questioning the fact that The Department of Treasury has been holding the money all these years
and presumably getting interest on it. And now we have to pay approximately$1,5600.00 in interest on top of paying
[he inheritance tax of approximately$1,230.00.
Is there a way around the interest due to the special circumstances?
Thanks!
Dol/y
Saidis,Sullivan 6i Rogers - Tiust M tten�
�olly M.Houkcnbem I �'����e��
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ddrm. Th��nk wu. S i�_�S�Il�n�on �u R x�cbehv I r r�y�_n�m
Wa a.lnse p,u�Lai un��JL�a.=.lon n((edenl eu�ixm��in chls e.n�ail'a w�m ho u.ed.ond ranmv b.�
Rf,ed upo�bYtiau(il m�raid an�prnalp�;mpur<d under�Le
3
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: Douglas James Peterson
Date of Death: 10/04/1993 File Number: 21-02-00289
Pursuant to Pa. O.C. Rule 6.12, 1 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:
Approximately 6 months
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 Orphans' Court and may be attached to this report.
Date 09/21/2015
Signature of Person Filing this Form
Capacity: ❑ Personal Representative ® Counsel
L` C.:>
Sean M. Shultz
Name of Person Filing this Form
C) '- '' 26 W. High Street
N { Address
c Lo
=. Carlisle, PA 17013
<D W O City,State,Zip
0 rte-, U
717-243-6222
C-11 Telephone
Form RW-10 Rev.10-13-2006 - Copyright(c)2006 form software only The Lackner Group,Inc.