HomeMy WebLinkAbout04-1039 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as ~ { C. l.~ ~ ~,~/ To:
Register of Wills for the
Deceased. County of ~ O~ ~J~c~ ~in the
Social Security No. [ ~ ~ '~ ~ ~" J f ~J Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl i &= 2 for letters of administration
on the estate of
(d.b.n.; pendentc lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in () U ~ t~ ~ ~ ~ ~ County, Pennsylvania, with
h ~ last family or principal residence at ~
(list street, number and municipality) /
Decendent, then ~ ~ years of age, died
at
D¢cendent 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: ~)~ ~ ~' ~/ ~
Petitioner ~ter a proper search ha ~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF C.d~ ~'~. ~3~ X. Ll~X,J b
J
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 c r/~ -
bef, ore, r,/me this t{P da~y~of
- r : ~ ,' R~glstet
No.
Estate of 0~/ LLF__" ':':' ~: : +:- f~f-- Deceased
~T O~ [E~TE~$ OF ~OMI~IST~TIO~
ANDNOW t~. ~ [,_l~,i,/~k'~ [(~ ~ , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that ~-~{) N ~t~hL~
~ entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ~L~'i
in the estate of [,l~ ~kPE ~ ~E~U~{ ~.~ ~f~ ~ - ~(Z: '~'~
~ ~ Register of Wills
FEES
Letters or Administration ..... $zSt5 cc j'~ ~ ~
Short Certificates( ) .......... :~ ' (,~ ~; ~Y ~up~7)~.)
Renunciation ................
$ -, ~ ~ ;h ~ ADDRESS
TOTAL ~ 3!~ '--' ,,
Filed ~?~(,.~.~.. ~-.,~.'~... A.D. 19~ ~ ~ ~') ~ ~ ) ~ ~/ ~, ~
PHONE
RENUNCIATION
In Re Estate of (*~ ~ l,/~[- L L [.~ L,~: ~'<~ t-~ &- ~ '~"~, ,, ~ ~, deceased.
To the Register of Wills of ~ L' b'l,,~ ~ k~,~l~/~/,.\ 1,6~ Q County, Pennsylvania.
The undersigned lA f~ \/ ~ IA fi ~ ~ N ~- & .~-~_~x~ ( of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
be issued to
'T
WITNESS
(Address)
(Signature)
(Address)
(Signature)
(Address)
%,.~R.,T CERTIFICATE OF DEATH
........ Orville William Kelsey, Jr. 2 Male t93 28 0115 ~ Oc[0~er ~ ~0(~4~
.... ~' 12 14~ ....... Divorced
....... ,u.,.., n .......... ~ ................... ~ I ............... J ............. I .....
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COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT ulVISlON
NOTICE OF CLAIM
In Re: The Estate of: Court File No: 2120041039
ORVILLE KELSEY
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. §3532(b)(2).
1) Claimant's name: CHASE AS SUCCESSOR TO BANK ONE Acct#4791338002668563
cio NCO Financial Systems, Inc
2) Claimant's address: Probate Department,~[450
1804 Washington Boulevard
Baltimore, MD 21230
(443)263-3300, ext 3304
3) Creditor listed below is the owner and holder of a claim in the amount of
$3,2s2.28
4) The facts uoon which this claim is based is a credit agreement between
Creditor an~ Decedent, identified as account number which is evidenced by
the attached affidavit of account stated.
5) Decedents address: 4820 E TRINDLE RD. MECHANICSBURG, PA 17050-3617
6) Date of Death: 10-29-04
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
If of the claimant, I do solemnly declare~nd affirm under the pel;~ties of
On beha . · ' e true correct
perjunJ that they ,.format, on an~d rep[?oSne~tnac¥.o~,ie~ad~nere'~l' ue~J;~i
to the best of my knowledge, inm~a ~,~ ~. NI ~ ·
~. 'December29,2004 ~ fi{' ~~ ~AGENT
uatea: Claimant P94834
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
JUDY ENGLE
Name
104 MAPLE AVE.
Address ~o
CA~ HILL, PA 17011
_
Ci~/State/Zip
12/29/04
Date notice mailed
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
ORVILLE W. KELSEY
Date of Death:
October 29, 2004
Will No.:
21-04-1039
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on January 21, 2005.
Amy Susan Kelsey
320 S. Middlesex Road
Carlisle, PAl 70 13
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
COYNE & COYNE, P.C.
Date:
2 I ::J~ 0 c;-
BY:
L sa arie Coyne, Esqui e
3 0 Market Street
Camp Hill, PA 17011-4227
(717) 737-0464
Pa. Supreme Ct. No. 53788
Counsel for Personal Representative
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IN THE ST ATE OF Pennsylvania
COUNTY OF Cumberland
IN RE: The Estate of
Orville Kelsey, Deceased
PROBATE FILE NO. 21-2004-1039
STATEMENT OF CLAIM
The undersigned, being duly sworn, deposes and states that:
1. TSYS Total Debt management, Inc., whose address is Post Office Box 6700,
Norcross, Georgia 30091-6700, is the attorney-in-fact for LOWE'S CREDIT C
(hereinafter "Claimant"), whose Account Number is C81923390914606 , and as attorney-
in-fact is authorized to submit this Statement of Claim on its behalf.
2. Claimant is the holder of a claim against the Estate of Orville Kelsey
deceased, the basis of which is the unpaid balance of charges incurred or authorized by the
deceased or on behalf of the deceased in the total amount of $394.70 , as ofthe date of
the death of the deceased.
3. The said sum is now justly due this Claimant; and the claim is not contingent or
unliquidated.
4. No payment has been made thereon, and there are no offsets against the same,
and the same is not secured by judgment or mortgage upon or expressly charged on the real
estate of the deceased or any part thereof.
This
() /21:
day of
J"h,,~
TSYS Total Debt M ag ment, Inc.
As attorney-in-fact for Claimant
,2005
Notary Public. Gwinnett County. GA
My Comm. Expires Nov. 7, 2008
Sworn to and subscribed before me this
J-f:J: day ofpdfwa~ ,2005
~~~~ ~~\
Notary Public
By:
Nyla Ja
TSYS oba e Representative
Copy mailed to attorney for Representative or to
Representative, ifnot represented by attorney.
-r
this 'd-/9-aay of ~.A~ ' 2005
TSYS Probate Representative
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of:
Court File No: 2120041039
ORVILLE KELSEY
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DIVISION:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,~
Estates, and Fiduciaries Code, 20 PA.C.S.A. !j3532(b)(2). :;0
CITIBANK USA, NA (SEARS ROEBUCK & CQ}':
1) Claimant's name:
:::rr.:
-<
2)
C/O BALOGH BECKER L TO, 4150 OLSON MEMORIAL
Claimant's address: HWY #200
MINNEAPOLIS, MN 55422
877-768-4494
Creditor listed below is the owner and holder of a claim in the amount of
$ 2359.75
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3)
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4) The facts upon which this claim is based:
This claim is based on an account for credit evidenced by the attached
Affidavit of Account Stated.
5) Decedent's address: 4820 E TRINDLE RD MECHANICSBU, PA 17050
6)
Date of Death:
10/29/04
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm under the penalties of
perjury that they Information and representations made herein are true and correct
to the best 0 my k wi edge, information and belief.
~ OS-
Dated:
Chelsea Whitley/Angela Horn/Mary Ellen eman!Chad BolinskefThersia Lee/Kamille Dean, Atty-in-Fact
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
JUDY EAGLE
Name
104 MAPLE AVE
Address
CAMP HILL, PA 17011
City/State/ ip
.'5-
Date noti e m
IN RE ESTATE OF: ORVILLE KELSEY
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
I. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of his/her duties.
3.
The Decedent purchased merchandise in the amount of $ 2359.75
account number 5121071820463960
evidenced by
4. The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney's fees.
Further your affiant sayeth not
By: _ ______ _ _.___
Attorneys-in-Fact: ~
Chelsea A. Whitley _ Angela M. Horn_
Mary Ellen Weeman _ Thersia O. Lee_
Chad J. Bolinske Kamille R. Dean
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
Subscribed and sworn before me
This 627 day of 1/tJM, 2005.
<-..
No P
. ST pHANI 'A. JOHNSON
'. NO BUC - MINNESOTA
,. W!f COMMISSION EXPIRES 1/31 /OB
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of:
Court File No: 2120041039
ORVILLE KELSEY
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DIVISION:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probatec)
Estates, and Fiduciaries Code, 20 PA.C.S.A. 93532(b)(2). "'~5
CITIBANK USA, N.A. (SEARS ROEBUCK & CO},'
1) Claimant's name:
2)
C/O BALOGH BECKER LTD, 4150 OLSON MEMORIAL
Claimant's address: HWY #200
MINNEAPOLIS, MN 55422
877 -768-4494
Creditor listed below is the owner and holder of a claim in the amount of
$ 2359.75
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3)
4) The facts upon which this claim is based:
This claim is based on an account for credit evidenced by the attached
Affidavit of Account Stated.
5) Decedent's address: 4820 E TRINDLE RD MECHANICSBU, PA 17050
6)
Date of Death:
10/29104
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm under the penalties of
perjury that th y Information and representations made herein are true and correct
to the best of y kno ed' . belief.
Dated:
Che a Whitley/Angela Horn/Mary Ellen W man/Chad BolinskefThersia Lee/Kamille Dean, Alty-in-Fact
Written notice 0 claim was given to Personal Representative and/or his/her counsel
as stated beiow:
JUDY EAGLE
Name
104 MAPLE AVE
Address
CAMP HILL. PA 17011
City/State/?ip /
.tJ / /2 (QS-
Date notide mailed
IN RE ESTATE OF: ORVILLE KELSEY
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of his/her duties.
3.
The Decedent purchased merchandise in the amount of $ 2359.75
account number 5121071820463960
evidenced by
4. The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney's fees.
Further your affiant sayeth not
BALO~R,LTD:
By: _______u _______
Attorneys-in-Fact: /
Chelsea A. Whitley _ Angela M. Horn_
Mary Ellen Weeman _ Thersia O. Lee_
Chad J. Bolinske Kamille R. Dean
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
Subscribed and sworn before me
This C:Z7 day of ~ ,2005.
No ary Public
e. S IE A. JOHNSON
: NOTARY PUBUC - MINNESOTA
, MY COMMISSION EXPIRES 1/3110B
REV-'-'U+l"*!
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DeFT.2BC60'
HARRISBURG, PA 17128-0601
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
KELSEY, JR., ORVILLE W.
~
QFiO"lCiAl USE ONLY
ALE HUMBER
21 2004 1039
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
193-28-0115
THIS RETURN MUST BE ALED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
3. Remainder Retum (date of deatn priof'to 12-13-82)
~ 1. Original Return
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o 2. Supplemental Return
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4a. Future Inleresl Compromise (dale of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy ofTrus()
10. Spousal Poverty Credit (dale of death between
12-31-91 and 1.1-95
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec, 91 13{A) (Attach Sch 0)
O;:"FICIAL USE ONLY
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COMPLETE MAILING ADDRESS
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194,705.42
(18)
(11) 244,878.17
(12) insolvent
(13)
(14)
(15)
(16)
(17)
(19)
Form REV-1500 EX (Rev. 6'{)())
118. Amount of Line 14 taxable at collateral rate
119. Tax Due
20.0
.
DATE OF DEATH (MM.DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
10/29/2004
03/0111936
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FiRST AND MIDDLE INITIAL)
4. Limited Estate
6. Decedent Died Testate (Attach copy
ofWiU)
9. Litigation Proceeds Received
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LEPHONE NUMBER
717/737-0464
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II!
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corpor.ltion, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
o Separate BlIJing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
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17.Amount of Line 14 taxable at sibling rate
3901 Market Street
Camp Hill, PA 17011-4227
(1) 173,500.00
(2) None
(3) None
(4) None
(5) 21,205.42
(6) None
(7) None
(9) 40,501.61
(10) 204,376.56
x .15
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Decedent's Complete Address:
STREET ADDRESS
4820 E. Trindle Road
CITY
Mechanicsburg
jSTATE PA
I ZIP 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Creditslpayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + 8 + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
4. If Line 2 is great~r than Une 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 Une 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA. This is theBALANCE DUE.
(3) 0.00
(4)
(5) 0.00
(SA)
(58) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
1. Did decedent make a transfer and:
a. retain the use or income of the property tTansferred;............................._..........................m.................
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? .........................................................................................._..................... 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 0
4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which
contains a beneficiary designation?............................._.................. ........................................--.................... 0
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
'~ I
181
181
181
IF THE ANSWER TO ANy OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
104 M;lple Avenue
CampHil~PA 17011
Qj-
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Lisa Marie Coyne
ADDRESS
DATE
3901 Market Street
CampHiIl,PA 17011-4227
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 statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disdosure
of assets and filing a tax return are still applicable even if tk1e surviving spouse is the only beneficiary.
Far 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
paren~ an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)J.
The tax rate Imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .S. 99116
1.2) [72 P.S. ~9116 (a) (1)J.
The tax: rate Imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~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 A
REAL ESTATE
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF KELSEY, JR., ORVILLE W. I FILE NUMBER
21 - 2004 - 1039
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the pricE
at which property would be excl1anged between a willing buyer and a wining seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which Is jolnlly-owned with right of survivorship must be disclosed on
schedule F.
ITEM
NUMBER
I
DESCRIPTION
VALUE AT DATE OF
DEATH
173,500.00
4820 East Trindle Road, Hampden Twp., Cumberland County, P A
Per Attached HUD-I Sheet
TOTAL (Also enter on Line 1, Recapitulation)
173,500.00
A Settlement Statement
U.S. Department of Housing
and Urban Development
~
,..
OMB I>.ppT!)'or.Il No. 2502-0265
S. T eofl-aa<l
1. 0 FHA 2..,0 FmHA 3.00 COrN. Unins. O;.~H\Jrnbe<
4. OVA 5.0Conv.ll'ls.
7. L""n Number
8. MotlQ8ge In.urano;:eC..e Numt;er
84306
C. Note; TIlls form is ~mished to give you a statement of actual settlement costs. Amounts paid tIJ and by the settlement agent are
shown. Items marked "(p.o.c:)" were paid outsIde c1osJng; they are shown here for informaUOI1al purposes and not
inclu<ledlnthelotals
D.tlameandJlda'eQo(Borrawer E. Name and Addr<ls.ofSojler F.N"rne"rnlAd<ku.(l(l....,;..
EASTERN 1031 STARl<ER EXCHANGE JUDY EAGLE, ADMINISTRATRIX MEMBERS 1ST
LLC. As ACCOMMODATOR FOR: ESTATE OF ORVILLE W. KELSEY,JR. FEDERAL CREDIT UNION
J. MARC BAUERLE 5000 LOUISE DRIVE
. MECHANICSBURG ., PA 17055
G.prllpl!r\YlP<3~""- H.S~m""lAgMl MEMBERS 1ST SEITLEMENT SERVICES, LLC
TAX PARCEL NO. 10-22-0527-117
1820 EAST TRiNDLE ROAD f'jaCflofSelUem&ll1 \.~~lo.lf:
V1ECHANICSBURG PA 17055 5000 LOUISE DRIVE 711512005
MECHANICSBURG PA 17055 l~~u~;;~ oale
~. ,- 11 12 05
I. Su"mmary of Borrower's Trc.ns=\1oIl
00 Gro"s Am<lunt Ou. From Barrow"':
K. Summary-of Seller's Tramrou::l1on
400 Gron Amount Due To Seller
01. Contractsa!es rice 173500.00 401. Contract sales "nee .. 173 500.00
02.Personalproer\ "+02. ?ersonal ro""rt
"'. Settlementcha esto oorrower line 1400\ 11560.13 .""
N. . '04.
" 405.
Ad'ustmentsfor\telMor>aidbv"e\\erlnadvanc. Adlu"lm"ntsforlt"m. lIaldhvseU"rln advance
'" Citvllownlaxes . "". Cllvltownlaxes '"
07. Colmtvt3X6s 711512005 to 12131/2005 166.43 407. Counlvtaxes .7/15/2005 to 12/3112005 166.43
'". Assessments to .". Asse'SsmeI1\s "
"'. '" 409. "
10 10 410. to
" " 411. "
" " ", to
"- 10 413. "
1.. . to 414. "
15. " 415. to
20. Gross Amount Due From Borrower 1 85,226.56 420. Gl-OS$ Amount Due TI> Sener 173,666.43
lO. Amount!iPaldB ", eharOrBorrower 500. RedU1::-tlons In Amount Due TI> Seller
)1. Deposit or eamest mone 501.Exc$SS slt(~\rn;\ru(:\ions\
)2,. Pri~oal amount of new loanls} 144 000.00 502. Settlllmenlcha to seller(\lM 1400\ 14075.00
". Existilmklan:s\takensubiec\to 503. Exlstinoloanl...ltakensublectto
>4. 1031. EXCHANGE PROCEEDS 41 158.80 '04. Pa olfoffirstmort..ao"Joan
". 505. pa . ffofseeond morloaoe loan
" '"". REGIONS.MORTGAGE #9830:3305813 13486.80
~. 507, CHASE HOME FINANCE #1964681610 146 036::87
.. ''"
,g. '"'.
Adustmentsforltell1!iunuaidlwseller Adlustmentsfl>ritemsunoaldbvseller
o CllVltownlaxes " 510. Cllvllownl!lxes "
,. Countvtaxes 10 511. CounNlalles "
2. Assessments " 512.. AsSMsmemS "
,. SCHOOL TAX7/1/2005 107/15/2005 55.67 513. SCHOOL TAX7!1f200S 1071'\512005 55.67
< " 514. " .
, REFUSE 7Iif2GOS 10 711512005 12.09 515. REFUSE 7/112005 to 7/1512005 12.09
,. 10 516. "
7 . 517. '"
,. " 51S. 10
,. " 51~. " ..
O. Total PaId By/F'o. Borrower 185,226.56 52\). TObl ReducUon Amount Due Sellsr 173,666.43
o .
} Cash AI Settlement FrornlTo Borrower
SOO. Ca.h At SetU.m.ntTolFr<>m Seller
1. Gross Amount due from borrower nne 120 185,226.56 601. GroS$amounldue!oseller Ilne4201 . 173666.43
, LI:!ssamount aidb lforbc>rr<IWer nine 220 185226.56 602.. Lesll.~oct\orlslnamtduesellermnet5201 173,666.43)
I. Cash 00 From o ,0 BO!"Jtfflt1' 0.00 603. Cash DTo rzJ FromSeU~r 0.00
SUBSTITUTE FORM'1099. SELLER STATEMENT.
,informa~onc:onlajnedinBI1lCksE,G,H,andlsrWonline401 (or,lJna40Jand404}isimpor1antiaxinformelionllndisbeingfumistWld'\01he.lntemalRevenue
vice. If you ara I1lqulred to tile a return. a negligel'lCS pellalty or Qlher sanction wm belmposecl on you if this i\flm is T1!qlJired Iv be reported..nod the IRS determin8s
ljt has not been reported. Ilthis real estall! is your plincipai resi(lence. fila Form 2119, Sale or Excha.nge. ofPOr.cipal Residenca, fur My gain, with ytIur Income lax
1m; fDr o\Tlertrans.aclklns, comp\e\e\neapplk:able parts ofform4797, Ftlrm 623.2 and/or Schedule D, Form 1040). YQlJ 8l"8 required to provide the Setllement,l\.gerl(
mad above) with yollrcorred taxpayer identfflCiltkln numbor.lfyou do not provide the SettlementAg&l1t with yourcorrecl taxpayer IdenlificatiOfl numb$r, you may 00
:Ie<;\. to dv~ orcrlminal penallies ImpOsed by I"w. Under penalUes of pe~Uly, I csrtify that th6 number shown on this slatement 1$ my COlTI!ct taxpayer identifICation I\\lmber.
(Sell8r'sSignatllreJ
';"
ettlementCh'lr<les
TctaISales/Brcker'sCcmmissionb'l5edon rlce$
Division of Corrmlssion nine 700 _as follows:
6047.50 to REMAX REAL1Y ASSOCIATES, INC.
6,097.50 10 RSR REALTORS
173 500.00 ~ 7.00
'to" 12,145.00
Paid From
Borrower's
Funds At
Seltlemeot
Paid From
Seller's
Funds Al
Settlement
12145.00
150:00
Commission aid at Settlement
SETTLEMENT FEE
IlemsPa able In Conneellon WlIh Loan
Loan Ori .nalion Fee 144000.00 %
Loan Discount 144,000.00' %
praisal Fee to THE DYNAMIC TEAM INC.
575~OO
CredltRe rt
Lender'slnsectionFee
Mort -elnsuranceA IlcallonFeetu
Assum lion Fee
LOAN OOCUMENTATION FEE
FLOOD CERTIFICATION FEE
"
MEMBERS 1ST
MEMBERS 1 ST
275.00
15.00
Items Re ulred B Lender To Be paklln Advance Exclllde Iastda in cales-line 901
Interest from 10 @$ Ida
Mort e Insurance Premium for monlhlito-
HazardlnsurancePremiumf01
araw
aOlto
. Reserves De siled With Lender
.Hazardinsurance
. Mo a elnsurance
. CI ro lal<es
. Coun ro 1;J;I(e&
. Annual_assessments
~.,
moo.
~"
~".
months
~-
~.,
rmonth
month
perrnOl1lh
per month
er month
er month
er month
teAccountin Alfustmeot
. Tille Charges
. Settlementorclosin fee.
.Abstractortlllesearch
. l1~eexamins.lIon
. 1i1le insmanoe binder
. Document ralion
,Nota fees
. Atlome sfees
neludesaboveilemsnumt>ers:
.1lUelnsurance
includes abov"ltems numbel'5:
.Lender'sC<:>Verae
, Owner'scov
'"
'"
'"
'"
10
to CASH
to L1SACOYNE ESQUIRE
10.00
10.00
P.o.C.
10 MURREL R. WALTERS 111 ESQUIRE
1101-1104 1108 PENN ATTORNEYS TITLE INS. co.
$ 144,000,00 endorsements 1003008.1
$ 173500.00
1" 303.75
.GovernmentRecordln andTransfl!rCharnes
. Recordina fees; Deed $ 38.50 ; Mort~a"e $
. CltvlcounlvtaYJstamos: Deed $ 1,735.00 ;Mo""a"8
. Slatetaxlslam"&: Deed $ 1,735.00 ;Mo 'a"8
. RECORD ASSIGNMENT OF RENTS
52.50 ; Releases $
91.00
1 735.00
1,735.00
24.50
. Addltlonai Settlement ellar es
.SUTVe tu
.Peslinseclloo tu
. REPAIR ESCROW
. 3RD QTR. REFUSE
.2005106 SCHOOL REAL ESTATE TAX
. REAl ESTATE TAX CERTIFICATION FEE
. OVERNIGHT MAIL MORTGAGE PAYOFFS 2
6000.00
79.44
1451.44
HELD BY MEMBERS 1ST
HAMPDEN TWP. MUNICIPAL AUTH.
MARIE HUBER
MARIE HUBER
5.00
30.00
. T"1lI1 Settlement Charges (enter on.llnes 1113,Sectlon J and 502, S.ctlon K} 11 560.13 14075.00
CERTIFICATION
e carefullr reviewed the HUQ-.1 Settlement Statement and to the best of my knowledge and 'belIef, Ills a lrue and aCQJrale statement of all receipts and disbursements -
oxcun or melnthistransaction_lfurthercertlfylhall-haverec:eivedacapyofthe_HUD-1SettlemenIStatemenl
., .
B_~
eller
EASTERN 1031 STARKER EXCHANGE
Bo_'
Seller
L.L.C. AS ACCOMMODATOR FOR:
STATE OF ORVILLE W. KELSEY,JR.
~lfient Statement which I have prepared is a tnJe and aCQJrBle account of the funi:ls wlich were received and have been or wiU
. settlement of this 1ransactlon.
Settlement Agent
J.
MBE
SERVICES, LLC
lN1NG; It is e c:ri e to knowingly make false statements to the United States on this or eny .other imilar form. Penalties upon CQI'1viclion Win include a fine aoo
isonmlilnt. Fordeta~s s": TiUe 18 U_S. CodeSecllon 1001 and Section 1010.
U.1i.'."IE"IKllTPI\I"",,"OfFI<:E:1.n~-'lS
~"
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESlOENT DECEDENT
ESTATE OF
KELSEY, JR., ORVILLE W.
I FILE NUMBER
21 - 2004 - 1039
Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of
survivorshIp must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
I Personal Property-- Per Public Auction (Haar's Auction) 16,642.00
2 Misc. Personal Property-- Wood in Workshop 318.00
3 PSECU-- Checking Account No. 019328011554 1,841.28
4 PSECU--Savings Account No. 019328011551 106.01
5 PNC Bank-- Checking Account No. 5140033755 1,185.21
6 Members 1st FCU-- Savings Account No. 120077-00 32.02
7 Members 1st FCU-- Checking Account No. 120077-11 1,080.90
TOTAL (Also enter on Line 5, Recapitulation)
21,205.42
Checkinl! Accounts:
Number: 0 Iq 3~l? O}lS sc.f
Date Opened: I k 15' ~ I q 7 f
Balance at Date
of Death:
$/.'6'-1/. ~t
Name of Joint
Owner, if any:
rJ /".
Saviul!s Accounts:
Number:
0!.i3),~ 0 1/ 5 S I
{{-I'5-I'i 7Y
Date Opened:
Balance at Date
of Death:
i1 1010 ,0 I
Name of Joint
Owner, if any:
fII(1t'
Certificates of Deposit:
Number:
rJ If!-
Date Opened:
Name of Joint
Owner, if any:
Balance at Date
of Death:
Maturity Date:
Interest Rate:
Interest Paid Quarterly,
Semi-Annual, etc.
Debts: ?~.,..Q. ~ Jl,"'lIh/ L1 ~SI IDOS'.Ol
\l';;a. ~ea..+--- VI -5A<.}.qI5.1(~
Estate of: Orville W. Kelsey, Jr.
Date of Death: October 29, 2004
j."
, i/l!
;:,/ ,:'
;~'d! rd - 9 2OJ5
f -____.. . .
.-- ------::---10
---...J
f~ e;o.JJ ."Jk.... u~<6
~.
Name of Bank: PSECU
1,fdh
e of Bank or Savings Assoc. Official
JUL-22-05 11:55 AM MEMBERS1ST Feu INS. DEPT 7177955178
P.01
.'.,".
"'f
MEMBERS 111
n:DIRAltaarrUNIDN
REGULAR SAVINGS ACCOUNT:
Account Number/SuffIX
Date Acco4.lnt eatabllshed
Principal SlIlance at Dale of Death
Accruecllntel'Q.t to Date of Death
Totar Principal and Acx:rued Interest
Name of Joint Owner
120077 -00
04/2311991
$32.02
$.00
$32.02
None
CHECKING ACCOUNT:.
Aooount Number/Sufllx
Date Account Established
Princlpal Balance at Date of Death
Accrued Interest to Date of Death
Totel Principal and Accrued Interesl
Name of Joint Owner
120077 .11
07/0311991
$1,080.90
$.00
$1,080.90
None
PERSONAL SERVICE LOAN:
~untNumbeffSuffix
Date Account Established
Principal Balance at Date of Death
Narne of Co-Borrower
120077 -01
02107/2000
$4,444-40.
None
"Loan paid In fuR by ctlldll life Insuranee
MrfBERS 1ST FEDERAL CREDIT UNION
I.Utt~~ 1~
Denise A. Wrfre t
Insurance Services upervisor
February 16, 2005
Estate of: O. WlLl.IAM KELSEY
Date of Death: 1012812004
Social Security Number: 1113-21-0115
soon \.0\115(-' Drive. P.O. Bn,1( 41) II M(',,'hanicsburg:, I"cnn~v.mb "055 . (717) 697-1161 . www.rncmbl..'rsht.org
.c/::''''
PNCBANK
412 768 3458
P.Ol
o PNCBAN<
March 8, 2005
,". ,:: .,,<
Lisa Marie Coyne
3901 Market Street
Camp Hill, P A 17011-4227
RE: Estate of Orville W. Kelsey, Jr., (Deceased)
SSN: 193-28-0115
DOD: 10/29/2004
Dear: M
~ i
,;:-,,'
In response to your request for Date of Death balances for the customer noted above, our
records show the following'
Checking Account
Account # 5140033755
Established 04/01/1973
OW KELSEY, JR
. non balance: $1,185.21 + SO.OO accrued interest
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do Dot process any financial
transactions or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bani:: branch
office.
Sincerely,
~ ~
~ller
1-800-762-1775
P7-PFSC-04-F
500 first Ave.
PittsburghPA 15219
Member FOle
*'
SCHEDULE H
FUNERALEXPENSE.S&
ADMINISTRATIVE COSTS
COMMONIr'or'EALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF KELSEY, JR., ORVILLE W.
I FILE NUMBER
21 - 2004 - 1039
Debts of decedent must be reported on Schedule I.
ITEM I DESCRIPTION AMOUNT
NUMBER
A. I FUNERAL EXPENSES:
I
B. ADMINISTRATIVE COSTS: 9,735.27
1. Personal Representative's Commissions
Judy Eagle
Social Security Number(s) I EIN Number of Personal Representative(s):
171-40-7603
Street Address 104 Maple Avenue
City Camp Hill State PA Zip 17011
-
Year(s) Commission paid 2005
2. A.ttorney's Fees Coyne & Coyne, P .C. 9,000.00
3. I Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register ofWills-- Advanced by Amy Kelsey 310.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
I Postage 37.00
2 Legal Advertiscment--Cumberland Law Journal 75.00
I
L Total of Continuation Schedule(s) 21,344.34
TOTAL (Also enter on line 9, Recapitulation) 40,501.61
.
Schedu/e H
Funeral Expenses &
Actninistralive CosIs continued
COMMONWEALTH OF PE:.NNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
3 Legal Advertisement--Patriot News-- Advanced by Judy Eagle
I FILE NUMBER
21 - 2004 - 1039
I
97.00
ESTATE OF
KELSEY, JR., ORVILLE W.
4
RSR Realtors-- Commission
12,290.00
5
Closiog Costs
1,847.76
6
Carey & Associates
150.00
7
Filing Fee--lnberitance Tax Return
15.00
8
Dnty's Locksmith
71.62
9
Shippley Oil--Advanced by Judy Eagle
400.00
10
Hampden Twp. Sewer & Trash
217.33
II
PP&L
481.07
12
PAWC-- Water
204.48
13
Shippley Oil
1,244.97
14
State Employees Retirement Fund Repayment-- Overpayment
1,779.II
15
VA Repayment-- Overpayment
2,321.00
16
200.00
Reserves
17
Estate Checks and Bank Fee
25.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVA.NIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21 - 2004 - 1039
ESTATE OF
KELSEY, JR., ORVILLE W.
Include unreimbursed medical expenses.
ITEM
NUMBER
1 Members 1stFCUVisa
DESCRIPTION
AMOUNT
4,444.40
2
Chase Mortgage (paid Through Foreclosure Commencement and Settlement)
147,654.62
3
Regions Mortgage
34,804.30
4
Lowes Charge Account
394.70
5
Universal Savings Bank Charge Account
8,027.52
6
Bank One/Chase Charge Account
3,252.28
7
Stephenson's Flowers
53.64
8
Central Medical Equipment
85.00
9
Holy Spirit Hospital
12.72
10
Sears Charge Account
2,359.75
11
CitiBank (Home Depot)
2,096.22
12
West Shore EMS
516.72
13
Vascular Associates
49.52
14
Pinnicle Health
216.00
15
94.61
Comcast
16
Verizon
45.56
17
Checks Cleared after Death
269.00
.
TOTAL (Also enter on Line 10, Recapitulation)
204,376.56
REV.t513.EX+ (9..(]O)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYl,.VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KELSEY, JR., ORVILLE W.
I FILE NUMBER
21 - 2004 - 1039
NUMBER
NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY
RELATIONSHIP TO
DECEDENT
I. TAXA8LE DISTRIBUTIONS (indude outright spousal distributions)
Amy Kelsey
Daughter
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover she t
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEr
AMOUNT OR SHARE
OF ESTATE
100% of Residual
.
10-18-2005
KElSEY JR
10-29-2004
21 04-1039
CUMBERLAND
101
APPEAL DATE: 12-17-2005
( See reverse side under Objections)
Amount Remittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
9YT_~~9~~_T~!~_~!~~______~___~~!~!~_~~~~~_~~~!!~~_E~~_Y~~~_~~9~~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ORVILLE W FILE NO. 21 04-1039 ACN 101
If an assessment was issued previously, lines 14, 15 and/or 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)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Anount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
.
""'..,;,, T+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
BUREAU OF INDIVIDUAI:--r~XE&-," ("___','., ,_,
INHERITANCE TAX DIVISI(JIC, ", - " ,
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
" ')
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
LISA MARIE COYNE
COYNE & COYNE
3901 MARKET ST
CAMP HILL
PA 17011
ESTATE OF KELSEY JR
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. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
173,500.00
.00
.00
.00
21.205.42
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adn. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
40,501.61
NOTE:
204.376.56
(11)
(12)
(13)
(14)
.00 X
.00 X
.00 X
.00 X
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
REV-1547 EX AFP (06-05)
ORVILLE
W
DATE 10-18-2005
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax paynent.
194,705.42
244.878 17
50,172.75-
.00
50,172.75-
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
(19)=
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. ~
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DU
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
Cumberland C-ounty -Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
COYNE HENRY F
3901 MARKET STREET
CAMP HILL, PA 17011-4227
RE: Estate of KELSEY ORVILLE W JR
File Number: 2004-01039
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: 10/29/2006
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
Personal Representative(s)
~
Cumberland County - R~gister or Wl~~S
One Courthouse Square
Carlisler PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
EAGLE JUDY
104 MAPLE AVENUE
CAMP HILLr PA 17011
RE: Estate of KELSEY ORVILLE W JR
File Number: 2004-01039
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 RULESr NO. 103
SUPREME COURT RULES DOCKET NO. lr for decedents dying on or after
July lr 1992r the personal representative or his counselr within two
(2) years of the decedent's deathr shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 10/29/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Reportr please disregard
this notice.
SincerelYr
~~~LAJ
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
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Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
0(2V1lL€
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Estate No.:
/0 -1- '1 -0'1
!:J;2()u"';; -010S1
Date of Death:
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 0 NO~
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete: <.0 - 200 7
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of fonTIal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
'3 crtJ/
Address C.~ ')W {J It- . .
1(0\\ (ill)7-S7-O'-{bY
Telephone No.
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Date: ~
Name
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j-Ca~acity: · 0 Personal Representative
'.; _ ' rT~ounsel for personal representative
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COYNE & COYNE
A PROFESSIONAL CORPORATION
ATTORNEYS AT LAW
Henry F. Coyne
Lisa Marie Coyne
3901 Market Street
Camp Hill, Pennsylvania
17011-4227
717-737-0464
Fax: 717-737-5161
November 3, 2006
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Orville W. Kelsey, Deceased
Dear Madam:
We represent the Estate ofthe Late Orville W. Kelsey.
Enclosed are an original and one copy of the Status Report. Kindly docket the original and
return to this office a "clocked-in" copy with the enclosed envelope.
Thank you for your assistance. If you have any questions, please contact me.
Very truly yours,
COYNE & COYNE, P.C.
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Li~r[e vcoyne \
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Enclosure
cc: Mrs. Judy Eagle, Administrator, wlencl.
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SENDER: COMPLETE THIS SECTION
. 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
-!() \!U:ll"
"-' "'JO~ I.)
COYNE HENRY F
3901 MARKET ~:'Tfirl'p,t LJd
C'7I M, It!> ro. 9
-'""i.l'l.r.) HILL PA l"O:'1~42:--'
COMPLETE THIS SECTION ON DELIVERY
~ Signk---
B. Received by ( Printed Name)
L. D.:J e.. f7\ v<-
D. Is delivery address different from item 1?
If YES, enter delivery address below:
fJ'^
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(1"'"':
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)3)!. lCeType
. , "', rtified Mail
Registered
D Insured Mail
D Express Mail
D Return Receipt for Merchandise
DC.a.D.
4, . Restricted Delivery? (Extra Fee)
7005 0390Y0003 2639 0582
2. Article Number
(Transfer from service labelj
PS Form 3811, February 2004
Domestic Return Receipt
DYes
1 02595-02-M-l 540
UNITED STATES PAA~RG f'A J7ll
03 NO\l2006PM! U
· Sender: Please print your name, address, and ZIP+4 in this box ·
No. DY -\ ~q
Initials ~
Glenda Farner Strasbaugh
Register of Wills and Clerk of Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, P A 17013
c.C::":.;.2.
ill! Hi!! ! ill I! I! II i \ III i 1111 i!1! Ii III i Ii! II i Ii! j 11 i Ii l! i! i Iii
In Re: Estate of
KELSEY ORVILLE W JR
ORPHANS' COURT DNISION
COURT OF COMMON PLEAS OF
ClTh1BERLAND COUNTY
PENNSYLVANIA
NO. 2004-01039
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: EAGLE JUDY
Counsel for Personal Representative: COYNE HENRY F
Date of Decedent's Death: 10/29/2004
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 delinquent personal representative or counsel for
the delinquent personal representative.
Date:
11/1/2006
~~~
Glenda ~^ . ,
Clerk of
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U.S. Postal Servicer!
CERTIFIED MAIL RECEIPT
(Domestic Mail Only' No Insurance Coverage PrOVided)
-
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r OFFICIAL .
USE 1
Postage $ df/;t)k
Cel1Ifted Fee J() ~
Rerum R~ Fee Postmark
(Endorsement Required) Here
Restricted Delivery Fee It ~/6U
(Endorsement Required)
Total Postage & Fees $
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
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In Re: Estate of
KELSEY ORVILLE W JR
ORPHANS' COURT DNlSlON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-01039
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: EAGLE JUDY
Counsel for Personal Representative: COYNE HENRY F
Date of Decedent's Death: 10/29/2004
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.
lfthe 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 delinquent personal representative or counsel for
the delinquent personal representative.
~~j~
Date:
11/1/2006
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OFF I C 01 A L USE
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Po8fIIge $
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
Glenda F~m
Clerk of
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Cl CertIfIed Fee
Cl
Cl Retum Rege/pt Fee
(Endorsement Required)
Cl R88IrIcIed DeI!WrY Fee
~ (Endorsement Requfl8c:l)
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TotaJ Postage & Fees $
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Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Name of Decedent: ORVILLE W. KELSEY
Date of Death: OCTOBER 29, 2004 File Number: 21-04-1039
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of
thf: 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:
MARCH 2009
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 ox informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this report.
Date SEPTEMBER 15, 2008
Signa r of Person fling this Form
Ca ity: Personal Representative Counsel
LISA MARIE COYNE, ESQUIRE
Name of Person Filing this Form
3901 Market Street
~~7 t '', r ~ '.,°,,(~r'1 Address
1~l,~1~~, , „~~.,,'~ , i~_,~p ~..JJ Camp Hill, PA 17011
~) ;'Y~'~ 1;~ (717) 737-0464
Telephone
60 ~ I ~d ° ~ ~+?~ 9Cu'
Form RW-!0 rev. 10.1,3:DL
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 9/21/2009
COYNE HENRY F
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RE: Estate of KELSEY ORVILLE W JR
File Number: 2004-01039
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, N0. 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: 10/29/2009
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
'~ Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 9/21/2009
EAGLE JUDY
104 MAPLE AVENUE
CAMP HILL, PA 17011
RE: Estate of KELSEY ORVILLE W JR
File Number: 2004-01039
Dear Sir/Madam:
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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: 10/29/2009
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,
cc: File
Counsel
/~~ZNddRi l~~~X~C~/i~z+r4'ra
Glenda Farner Strasba
ugh
Clerk of the Orphans' Court
e
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Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: ORVILLE W. KELSEY, JR.
Date of Death: October 29, 2004 File Number: 21-04-1039
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete :...... . ............ .
®Yes ~ No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
FEBRUARY 2010
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 persona] 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
f
iled with the Clerk of the Orphans' Court and may be attached to this report.
Hare 9/28/09
Signalu of rson •iling this Fo n
Capaci ®Personal Representative Counsel
~_ ;, ~
/~ LISA MARIE COYNE
i~
fy 4. "~ (V ~
Lr Name ofPerson Filing This Form
~_ '-" _ ~~:-? 3901 MARKET STREET
Chi '~~ j O.. QU,.. Address
,1; ~_; o ~ "' ~= CAMP HILL, PA 17011
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Form RW-!0 rev. !0.13.06
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Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER. OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: ORVILLE W. KELSEY
Date of Death: October 29, 2004
File Number: 21-04-1039
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete :.................... ^ Yes ^ No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to No. 1 is YES, state the following:
a. Did the personal representative file a final account with the Court? ....... ^Yes ONo
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
infornlally to the parties in interest? ............................... ~ Yes ^ No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and. may be attached to this report.
Date October 4, 2011
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Form RW-l0 rev. 10.13.06
Signnture of Person Filing this Form
Capacity: ^Personal Representative ~ Counsel
Lisa Marie Coyne
Name of Person Filing this Form
3901 Market Street
Address
Camp Hill, PA 17011
(717)737-0464
Telephone
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