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Home My WebLink About04-1113 PETITION FOR PROBATE and GRANT OF LETTERS Es,a,e oS No. --0'4- //! also known as ~l~J~e~; , Deceased. Social Security No. ~/~ ~:~ -- /~ ~ t~_J~ ~ To: Register of Wills for the ,, __ County of ~ in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of ag~,pr o der an the exgcut~',~ named in the last will of the above decedent dated .,,'~56~-e~ff~,,,.S-~'~- f , 19~__~ and cod cil(s) dated - ' ~' (stale relevant circumstances, e.g. renunciation, death of execlltor, etc.) Decendem was domiciled at death in ~"'~e...,~.,,~..~/,,afl~/,~ County, Pennsylvania, with h ~'..s' last family or principal residence at (list street, number and muncipality) atDec~%~n ~.~ ~,~years~age, died ~'~,e.~?~-~ ~/~.- Ex__~..., ,u,,uws, ueceuent om not marry, was not uivorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: ,,.,e-.~,~-. .. ~. Decendent at death owned property with estimated values as follows: (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: $ Lo WHEREFORE, petitioner(s) respectfully re~/~est(s) the probate of the last will an~°d codicil(s) presented herewith and the grant of letters_ theron. (testamentary; administration c.t.a.; administralion d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COM ONW TU P NNSY WN A -I COUNTY OF ~../,~/'.,,,~s,~J ~ ss 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affigmed, /and subscribed bef~ ~m~ Ih. is_. O (') ~ -- day qf~ Estate Of '~'~"~ ~.~./Z ~, ,;~:~r~,~Z._ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW'-~ ~' ~ ~xx_V'~c- .~ g~.CX3~L 30 ., in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ~ ~'~'~" '~ described therein be admitted to probate and filed of record as the last will of are hereby granted to ~ ~.~t O.~ FEES Probate, Letters, Etc .......... $ Short Certificates( ) .......... S- TOTAL Filed ... ~a~7.-.~ :.~ .................. ATTORNEY (Sup. Ct. I.D. No.) PHONE his is to certify that the information here given is correctl3 copied from an original certificate of death duly filed with me as l,ocal Registrar. The original certificate will be 'fi~rwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 10837069 No. (,1[ oc al }~egistrar Date CERTIFICATE OF DEATH Samuel Harrison Moyer L Male 169 -- 18 --6108 lI00 Grandon Way Mechanlcsburg, PA 17055 Kermit S. Barber Shop of Creekview ~ ~,~ October Florenc, Hone HUFF & LAKJER FUNERAL HOHE I, SAMUEL H. MOYER, a resident of St. Cloud, Florida, hereby make this Will and revoke all prior Wills. 1. I desire and direct that I be buried in a manner suit- able to my circumstances in life, and that my funeral expenses and debts be paid by my Personal Representative, as soon as practicable after my death. 2. I then give, devise and bequeath all the rest, residue and remainder of my estate, whether real, personal or mixed, wherever situated, of which I may die seized or possessed, or to which I may be or become in any way entitled or have any interest, or over which I may have any power of appointment, to my beloved wife, Irene B. Moyer. 3. Should my beloved wife predecease me, said rest, residue and remainder shall be distributed as follows~i~ ~ ~ a. One third (1/3) to Bruce Moyer ~-~ b. One third (1/3) to Dale Moyer ~ c. One third (1/3) to Kermit Moyer Should any of these sons predecease me, his share shall pas~ to his children surviving. Should any of my sons refuse his share, this share shall pass to his children surviving, or if further refused for and on behalf of his children, this share shall be redivided among my other two sons. 4. I hereby nominate, constitute and appoint my wife, Irene B. Moyer as Personal Representative of my Will, to serve wit bond. Should she predecease me, fail to qualify or cease to act as such Personal Representative, I then appoint my son, Bruce Moyer as alternate Personal Representative, also to serve without bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal at St. Cloud, Florida, this /~.~--~ day of~_~~_~, 1979. .~~. ~ (SEAL) ~amuel Hi'Mofer ~ ' This instrument was signed, sealed, published and declared by SAMUEL H. MOYER, the Testator above named, to be his last Will in our presence, and we, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as wit- nesses all on the day and year last aforementioned. ~ ~~ residing at - .~/~--~o~--~ residing at STATE OF FLORIDA COUNTY OF 0SCEOLA WE, Samuel H. . Mary E. Davis Moyer, Michael J. Barber , and , the testator and the witnesses respective- ly, whose names are signed to the foregoing instrument, were sworn and declared to the undersigned officer that the testator signed the instrument as his last Will, that he signed, and that each of the witnesses in the presence of the testator and in the presence of each other, signed the Will as a witness. S-amdel H. Moyer,' Te~tatQ~ Subscribed and sworn to before me by Samuel H. Moyer, the testator, and by Michael J. Barber and Mary E. Davis the witnesses, on this /S~/~ day of ~ ~, 1979. ~O~~orida My commission expires Page - 2 - COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV- 1162 EX( l' -96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DANIELS WILLIAM S 1 W HIGH STREET CARLISLE, PA 17013 ___nn_ fold ESTATE INFORMATION: SSN: 169-18-6108 FILE NUMBER: 2104-1113 DECEDENT NAME: MOYER SAMUEL H DATE OF PAYMENT: 01/12/2005 POSTMARK DATE: 01/12/2005 COUNTY: CUMBERLAND DATE OF DEATH: 10/17/2004 NO. CD 004834 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,700.00 I I I I I I I I TOTAL AMOUNT PAID: $5,700.00 REMARKS: CHECK# 1550 SEAL INITIALS: CCP RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent SAMUEL H. MOYER Date of Death: October 17,2004 Will No. 2104-1113 Admin. No. To the Register: [certity that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries ofthe above-captioned estate on January 28,2005. Name Address Bruce H. Moyer Executor 602 Halteman Road Souderton, P A 18964 Dale E. Moyer 1730 I Redwood Springs Drive Fort Bragg, CA 95437 Kermit S. Moyer 1 Clearview A venue Carlisle, P A 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Date: January 2.~, 2005 k~~ ffi ~~ Signature Name: William S. Daniels Address: 1 West High Street, Suite 205 Carlisle, P A 17013 Telephone: 717-243-3831 Capacity: Personal Representative x Counsel for Personal Representative .- ..- .,-:. 'Cl,.. cO c-J '-',' .- ::r --1 15056041046 REV-1500 EX (05-04) .PA Department of Revenue f, Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death /61 /8.,/"otJ OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT A/ 01' c;- If 13 Date of Birth /o/r;Lao~ d41 /8/ 'lZ:3 Decedent's Last Name Suffix Decedent's First Name MI 1'1 If) y i!"~ SA./,,/4 Gz~ /1 (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLIICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return C) 2. Supplemental Return C) 3 Remainder Return (date of death prior to 12-13-82) 5 Federal Estate Tax Return Required C) C) 4a. Future Interest Compromise (date of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C) 10. Spousal Poverty Credit (date of death C) 11 Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8 Total Number of Safe Deposit Boxes C) 4. Limited Estate c::> .. f,?/l-IY / L=LS r-/'7-.~43 S 83/ Firm Name (If Applicable) /1f{Mt:J!.. ,c /)/I/Y /:L.?L S REGISTER OF WILLS USE ONLY First line of address 0#"6' west- Iflcil ,sr Second line of address Stt../ Te AO..s- City or Post Office C-/17< L I sL G State ZIP Code DATE FILED Correspondent's e-mail address: ~. - C~2~ Under penalties of perjury, I declare that I have examined this return, Including' companying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the persona representative is based on all information of which preparer has any knowledge. DATE -~.... ,. ~/ .- },"'-' L /'/1- ,/ l:;?' '7 ~ .cr DATE PLEASE U ORIGINAL FORM ONLY Side 1 L 15056041046 JJ5056041046 --1 --.J 15056042047 REV-1500 EX Decedent's Name: Decedent's Social Security Number /'(;;7 / 8~; 168 RECAPITULATION 1. Real estate (Schedule A). 2. Stocks and Bonds (Schedule B) . 3 Closely Held Corporation. Partnership or Sole-Proprietorship (Schedule C) 4. Mortgages & Notes Receivable (Schedule D) . 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) c:::::> Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::::> Separate Billing Requested. 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) . 13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14 Net Value Subject to Tax (line 12 minUS Line 13) 2. 3. 4. 5. 6. 7. 8. 9. . . 10. 11. . . 12. 13. . . 14. 1. . 42. C;3. ~Lj . . 3c7c'O.68 /3034.40 /24883.~/ /4S?S'~..33 1/8': 7../0 :373.0.9 / .2-20/0. /7 13 2-7q~ 1'7 . . TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(1.2)XO~ 16 Amount of Line 14 taxa.~~ at lineal rate X.O -:-. 17 Amount of Line 14 taxable at sibling rate X .12 18 Amount of Line 14 taxable at collateral rate X .15 . I:? 2 1'1 z. / '1 . . 19 TAX DUE 15. 16. 17. 18. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT {\ \f::\O\ '" -' Ii +J Side 2 ~o 47 . (..59 <:.9A. L/.c) . . ..s-?82ffa> ~ 15056042047 -.I REV-15<l? EX Page 3 File Number STREET ADDRESS 6>f-/"1' t./ E L. G/(/f/J/,!Jt::/A/ # /r/Jj/ r CITY I !/;ZO~S mEC/f~/l/1 CS 13<< /<~ STATE ?-?2- Tax Payments and Credit~: . 1. Tax Due (Page 2 line 19) 2. CreditslPaymenl$ A. Spousal Poverty Credit 8. Prior Payments C. Discount (1)., ~ 98.~ ~'4"c? I <3;?CJr::J.OO .~ ~..,,/ /k Total Credits ( A + 8 + C ) (2) Jf;? ~9" / ~7 3. InterestlPenalty if applicable. D. Interest E. Penally ". TotallnterestlPenalty ( D + E ) 4. If Line 2 IS greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, L1n.e 20 to request a refund. (3) -0- (4) /' c: I ;Z Z- 5. If Line 1~pne 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax du~. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) Make Check Payable to: REGISTER OF WILLS, AGENT ~'.":~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE: APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.,.........................................:............................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 E'l c. retain a reversionary interest; or..............................................................................................,........................... 0 g] d. receivej'le promise for life of either payments, benefits or care? ...........................................:.......................... 0 21 ., . '-, . ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. rg'J 0 3. Dia decedent own an "in trust for" or payable upon death ~ank account or security at his or her death? .............. 0 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ gJ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ;T'<f'>!"~~d",f 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 three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. . . For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer t6 a surviving spouse from tax, and ttJe statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)). . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half'(4.5) percent, except as noted in 72 P.S. S9116(1.2) [72 P.S. S9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent (72 P.S. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parentin common with the decedent, whether by blood or adoption. - -- 1E&st Dill &ttb mest&mettt I, SAMUEL H. MOYER, a resident of St. Cloud, Florida, hereby make this Will and revoke all prior Wills. 1. I desire and direct that I be buried in a manner suit- ab le to my circumstances in life, and that my funeral expenses and dE'bts be paid by my Personal Representative, as soon as practicable after my death. 2. I then give, devise and bequeath all the rE!st, residue and remainder of my estate, whether real, personal or mixed, wherever situated, of which I may die seized or possessed, or to which I may be or become in any way entitled or have any interest, or over which I may have any power of appointment, to my beloved wife, Irene B. Moyer. 3. Should my beloved wife predecease me, said rest, residue and remainder shall be distributed as follows: a. One third 0/3 ) to Bruce Moyer b. One third (1/3) to Dale Moyer c. One third 0/3 ) to Kermit Moyer Should an&, of these sons predecease me, his share shall pass to his children surviving. I I share shall pass to his children surviving, or if furthel' refused fori and on behalf of his children, this share shall be redivided among my I I I 1 4. I hereby nominate, constitute and appoint my wife, i j Irene B. Moyer as Personal Repre,sentati ve of my Will, to serve wi thou~ Should any of my sons refuse his share, this other two sons. bond. Should she predecease me, fail to qualify or cease to act as I \ alternate Personal Representative, also to serve without bond. I IN WITNESS WHEREOF, I have hereunto set my hand and seal at St. C{~Ud, Florida, this Ii! day of f/tA...:Jw..Sf ,19'79. I 4 vL-' LeRk ~ (SEAL) l , amuelH.'Moyer i I This instrument was signed, sealed, published and declared ! such Personal Representative, I then appoint my son, Bruce Moyer as by SAMUEL H. MOYER, the Testator above named, to be his last Will in our presence, and we, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as wit- nesses allan the day and year last aforementioned. ~,~~ 'rY) ~::t'jJa~ residing at ~~!~~~~l~~ residing at ~~~.~--fu(~ I~ Michael J. Barber , and Mary E. Davis the testator and the witnesses respective- ly,whose names are signed to the foregoing instrument, were sworn and declared to the undersigned officer that the testator signed the instrument as his last Will, that he signed, and that each of the witnesses in the presence of the testator and in the presence of each other, signed the Will as a witness. ~.J witness 1r)tYy- :t" Subscribed and sworn to before me by Samuel H. Moyer, the testator, and by Michael J. Barber and Mary E. Davis the witnesses, on this I S.( day of '/ My commission expires: /J. "')..f)- Fz) Page - 2 - STATEMENT TO ACCOMPANY PENNSYLVANIA INHERITANCE TAX RETURN FOR ESTATE OF SAMUEL H. MOYER, DECEASED, NO. 2104-1113 Absent the implementation of pre-death or post-mortem estate planning measures, the probate assets of this Estate are exceeded by non-probate assets, the debts and deductions, and inheritance taxes liability, respectively, all of which are set forth herein. The beneficiaries of this Estate acknowledge their obligation for all liabilities incurred as estate settlement costs. They further have paid or shall pay in equal shares all of the said estate settlement costs from the proceeds of collective assets which they have individually received as a result of the administration of this Estate. This statement is to certify that the three conditions for accommodating the acceptance of this inheritance tax return, in so far as the sources of payment are concerned under the circumstances, are fulfilled. Very respectfully submitted, ~/- ..,(/.../. .' /y . ('~J/j~~~7 ~./:;/ /-'.:;/;'-2" 77?c:K WILLIAM S. DANIELS Attorney for the Personal Representative ~~a.,,.,. '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF/V'J 0 yell:... J .:;;;;'Aj/?1~CL. ~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. SCHEDULE B . STOCKS & BONDS FILE NUMBER 7-/ c;I..y -.1// 3 J 2. DESCRIPTION ~ ~I ~ V/ltCS ,8::;::/YZ)) g>zJru6S. e6 /~5~O~e ffi7J7/ I~ /S?9Lj . ,~>7-ce --9/7? ;;:') :P6YJ ~ 00 -#- 7"'?- ~2t,?~-q?- /?J2;/V?t2 ~ Q!&788) 3 8 S',/s~. 35,':;' /!/ #//:3-7 / j t S')> C? 35, Sj/S'J VALUE AT DATE OF DEATH ITEM NUMBER 1. 39( 3(; )....... /'C '-;;>" '''': ,::/ ;I '..,' /' / ,/. ,../ .' ~ -",/ ," , J Q/ I( 3; 3 ' c-/ w 3, LC@P #- 0'a:7 5) !;lCk// 8) 3;6' S'~ @ ,O:}L /~~. 2;;- s:/; ~ ,O'7'SJ /Jl27 c!J ~!!Sr -Ii ~?8t- 3 co' .;"--v /17) k;, /; ~9C, 08 ., TOT AL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) $~20:3?~9f ' / ,r,' "j:~:' '* CAS~;.~~~~a;SI~S AND COMMONWEALTH Of PENNSYLVANIA MISCELLANEOUS 'NHmI~~~EJta~lt1~RN PERSONAL PROPERTY ESTATE' OF , /110 c-/(, S'",~~et- IfV.l~ EX + (1-'7) Ii Please Print or Type FILE NUMBER ..~C7"1- ),113 j (All property jointly-owne with the Righi of Survivonhlp mu,' be di,do,ed on Schedule f) ITEM NUMBER / 2./ 3, ~, DESCRIPTION 7~~rcLC~S C:~CC~/~~/2Jq/fl f3VtV~$!, 2)1 VI j)C-<';~:, C ,4/cC-(c:.S : /?7 c'?T t-I Fe.. C-c?V/.sC/LY~N ,///9/ICOcl=- )?e-i='-I/VO..) ; ----- .' VALUE AT DATE OF DEATH Ql ,..201 Cc? ;< ~ I 08' .:J 2.3. 00 8 39 cC; ) 7-5'Lj/ 5U /02. co TOTAL (Also enter on line 5, Recapitulation) S '3 Ce,O I s--B - / (Attach a'dditlonal 8\12" X 11" ,hull if more 'pace j, 'needed.) . SCHEDULE F JOINTLY-OWNED PROPERTY . COMMONWEAlTH OF PENNSYLVANIA . 'INHERITANCE TAX RETURN RESI ENT E NT /iSTATEOF/J') 0 r t!72., .s-'~ ~"" e-L )"L; If an asset was mad. joint within on. year of the decedent's date of death, It must be reported on Schedule G. FILE NUMBER ~ ';2.,/{::7 9 - /'/1 ~ J SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Aj)/)LE E) 0oye~ /? 3<:7/ i2ez; t/./c;>O.i) JEo-~ t3/49:?'3.J &J Stp,e~;;) ~)--' C}5-'Y3r S'ePJ B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY 'foOF DATE OF DEATH ITBA FOR JOINT MADE Include NI'll8 of financial lnatibJtion rod balk a:c:ount number Of simn.ldentifylng number. Attld1 DATE OF DEATH . DECO'S VAlUE OF NUlABER TENANT JOINT, . deed lor jolntiy-held real estate. V AlUI; OF ASSET INTEREST DECEDENTS INTEREST 1. A ?V~t-/C' . f)/?~ F ~ 1/ Ct70 /L,,- ?-3 SO :7'?-3 I.- , If , ~/7.rNfL ?L #-307 2(; c~31 -.?U /3 OP&.t ;, jDu 13 ?-?c c. J ) ,) . - ~, - III , TOTAL (Also enter on line 6, Recapitulation) $ /3 )o3L/ ~O t (If more space Is needed, Insert additional sheets of the same size) PUBLIC BANK 2500 13th Street Saint Cloud, FL 34769 ~ P~~!i~ ~~~d~ EIlIC! u<f- f3v6 J DALE MOYER 17301 REDWOOD .SPRINGS DR FORT BRAGG CA 95437 Date 11/15/04 Primary Account Enclosures Page 1 162087806 --- I 'i?omF~ 'y /...../...~ ,./ ~."....~.J ~, . --------. Senior Checking Account Number Previous Balance Deposits/Credits 1 Checks/Debits Total Service Charge Interest Paid Current Balance CHECK I ~87~06 '~at~~e~f ~~f~~S~6ii4/04 thru (lb~L 14.73 .--Days in the statement period "-'-'-T4:~~ ~~~~~g~ ~;f~~~ted - .00 .00 .00 2004 Interest Paid o 11/15/04 33 6.24 6.24 .69 Activity in Date Ord~y"'------'~ Date Description ~ Trace No , 10/28 Transfer To DpA \ 919000026 _ 1U;l; L No. (. 1 J...~~__~~__o-:. 5::;;:-- ~ J I ~ Daily Balanc~ ation C PO bl rif Bank Amount 14.73- /' r' V" - --- r r r I 1Iit1111~~ Flc)rida I l .'" /(Mpt/ ~t-;ftul ~~/tttf Q/ - nt{!; 0 ,~ _{!/dV c . t'; L-/t/t{l1 (yPL.. ) \ J{rIM.- ~((f:,A /L~~~~~-1-q c'CL-rj' - }'r',ffvf-r/ / /L~1_: ' >Lt, w;- d t'c;VfC'l - . ; tt~((A . 0 I to ~ r!lA ,/-8 {}~:uy !;f/ t Wt:f fr,1N c , U1f irP " ',. hd, <2<1. . t.W/ fC~~; ~i:-C VJ ~.. Nl1TI=' C::CC CC\lCCC::C C::lnc I:nc IMcnCTdNT IN~nl~l\AdTlnN PUBLIC BANK 2500 13th Street Saint Cloud, FL 34769 ep~~!i~ ~~~d~ EPIC! ?i3j DALE MOYER 17301 REDWOOD SPRINGS DR FORT BRAGG CA 95437 Page ~\ 1437~ En ~') 'NJJN Ov Of t}/1 (u L <it CHECKING ACCOUNTS EFFECTIVE 1l/01/04,MONEY MARKET ACCOUNTS WILL NO LONGER AUTOMATICALLY SWEEP FUNDS TO COVER OVERDRAFTS IN ANOTHER ACCOUNT. SUCH TRANSFERS M GENERATED BY OUR CUSTOMERS. . 4 8.00 4.82 3.18- umber of Enclosures' 0 tatement Dates 10/01/04 thru 10/31/04 Days in the statement period 31 Average Ledger 22,691.61 Average Collected 22,691.61 Interest Earned 4.81 Annual Percentage Yield Earned 0.25% 2004 Interest Paid 43.30 Inveitm~nt Checking Account Number Previous Balance Deposits/Credits 1 Checks/Debits Total Service Charge Interest Paid Current Balance , Activity in Date Order Date Description . 10/28 Transfer To DDA . Acct 10/29 Total 10/31 Inter ,- . Trace No 919000024 Amount 26,053.34- 10/29 63056306 gPublic Bank ....,...~__" 'M~~ Flc)t10da nance fee Statement Code Summary Code DescriptioD Overdraft Code Description SC Total Service Charge .< Date 10/28 Date 10/29 Daily Balance Information Date Balance ,/' 10/01 26,053.34 ~ Balance .00 Balance L:J I ()/ ( t ? J , I \ to.InT~' Cl:l: Cl:\fl:CCl: C::lnI= J::('U:~ IMPORTANT INFORMATION REV-1510 EX. (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY . COMMONWEAL TH"OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /1 oV ~/Z.I Sl'trnu.eL I I/, FIL.E NUMBER /3 2/(;J~ -1/ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes_ ITEM NUMBER 1 ;2, J. 1 j, DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE_ S b/JJC # /jJ;?ofJaJ8 GO (9' /8/C.y vr) ?Gt j/; e-- (J/}?v'//C::- /)- L % -1/ /~ 'JOSe. 30~ to/polo.) / CJr; ) m6'7' c!/rc 4l/l.//V~-;;;- ;tJ .;r; C)J- 31- if 7Q I--IV/ 92 ~'1/ ?i S;l>9--7c S'77Z-,ec-~ ~/2-/) ,#531--- OS3/02 0,1 s-/O i, N ,IJ c/?",o V/ ~ i/- cf { ::;-8 ~ (/0/2-7)03; :Jt-;) !v1flV/O r / /T 71- 8 { (~' % C:/O/d,3) cJt,) c3 /}/)J c::l :J~ Of L3or/~/r.v~ - 7, DATE OF DEATH VALUE OF ASSET 11 / (/ 0::70, Co J /3) ! 01...2/ /1;3)~91-- '72 ?53/ gJ / , ~~o/13 %OF J DECD'S INTEREST cflJ Z c3U~ /cv'Z~ /00 /0 /::::'0 '/ EXCLUSION IF APPliCABLE) TAXABLE VALUE 3 00::7 / ::J- CC-'Q / 3;(/00 /~ lell 2-i - /' / '2 1'5~ S~I 1;;/ 'rlF 91 ') .'~ -;;' ,.'--; :.L: 0' !..;/r _/ -'" / - '2 / /-L.I L_ /7_\0(../ 7(''1._ ) o ?-2/' $'4 JCOO Cy / ~ ill- 50 ?, ~ uoo_ q; cS~ % (0 31vt90 I TOTAL (Also enteron line 7, Hecapitulation) $ / 21 8831 Li; (If more-space is needed, insert additional sheets of the same size) J-/( ~UBLlC BANK . " 2500 13th Street ( l"'2. h'L- S~tCIoUd, FL 3476B (' r> (0( 't' U fPJ ~uJ.--/ ~7--f92 ~ 1/31 {, 3(/'~ It P~~!~,~ ~~~d~ EPIC! ?:Vb \)&j f1til1t ad- \ \ i / I I / CHECKING ACCOUNTS ~ Number Of'E~losures 163056306 Statement/Dates 10/15/04 thru 13,109.21 Days in the statement period 26,068.07 Average/Ledger 780.24 Average Collected . 00 Inte~est Earned 3.87 Annual Percentage Yield Earned 38,400.91 2004 Interest p~id ~//y /~----"'< Date 11/16/04 ) Prim Acc(~ Enclos DALE MOYER 17301 REDWOOD-SPRINGS DRIVE FORT BRAGG CA 95437 C Page 1 ,163056306 ~G Senior Checking Account Number Previous Balance 2 Deposits/Cfedits 3 Checks/Deblts Total Service Charge Interest Paid Current Balance o 11/16/04 33 28,496.15 28,496.15 3.87 0.15% 21.49 Activity in Date Order Date Description 10/18 BILL PAYMT VERIZON [ PPD 10/28 Transfer Acct No. 10/28 Transfer Acct No. 10/29 BILL PPD 11/09 BILL PPD 11/16 Inter Trace No 782459383 , Amount V 19.89- ----------- Daily Bala .1 Date, 10/15 10/18 From DDA 162087806 From'DD\;iii.. 919000023 26,053, 34 II. 'ratilie BaDIl 919000025 14 :73'" --.._--~,- , lIT c.. r "1llr~p . v HI JIiIf r Till I _1III~"fI-=nl-"""""""~~~'JOI)tJ-'i'!.~Ul-M<'li Date 10/28 10/29' Balance 39,157.39 38,528.96 F " ''')'' r i r~ \..~ Da1i:U - 11/09 11/16 Balance 38,397.04 38,400.91 J:"' Interest Rate Summary Date Rate 10/14 0.1500% I I i i ~ ~lnTa::. ecc oC\lcoec clnc c('\o IUC(,\OTl\"IT 1f\JJ:'('\Of..lll\Tlnf\J REV.15!1 EX. (12.85) Please Print or Type FNUM.BER ~~~f-/I/.3 .:J '* SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ /YJor€~, -S19n?~e~ ITEM NUMBER AMOUNT DESCRIPTION A. 21 Funeral Expenses: 1. #u",c/ ~ L/lI<7C/Z. .FY-A/c124L /7b-/l?6. )-/jmILr ~cco~n//1Oj;)A9-i/c;?'V..5' / ~?/r7)-L-(0 B. Administrative Costs: 1. 2. Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid , Attorney Fees MC/l?clL.rX 2>9""""/tC:.LS 3. Family Exemption Claimant 4. C. 1. ,< 3, 7"r --s; (."., Relationship Address of Claimant at decedent's death Street Address City State Zip Code Probate Fees R EC/SrC/<.. ~ t::v/.Y /S ~/T7C1N'9'- ;Pb:;;6)tjTcE ;=cE Miscellaneous Expenses: . .' ~~b~n0/.(/ .I~C1~<<~.4L /lcls, Lf/,.fl'Es7;tJ. / /#ESb"V1/N~L-Lfi~L Aaf, iraS', iEst,AtJ, I / ;2!X./srEZ 1 W/*/ S'/fb/Zr CC/ePs. L' OM ,i)5;?;;WC<::?- ;//P/Vc/ P-1.{' I ;>c:. fJc/5:/79. C,6' /2 (5::/-> /C7L- l' c:;./ T p/ :;;~,v; RLS:.>C/Lv~ rr- ~E;;r-U/VC- Gs7'-~7L TOTAL (Also enter on line 9, Recapitulation) (If more space iSfteeded, insert additional sheets of same size) q ~333/CG ~~8. 73 7-vcrvC / at:, '7 CiJ 0/ .--< r % I 2100 :2 ;J... I O:.l 7-5; ctJ ) l' 7" 0'/ ..-?~/ OG / 9vI 00 -42, a:; :]00, 00 s / I; 8& 1, /U .~ SCHEDULE I COMMON'WEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INH~R1Si~~OTt"2E~~~RN MORTGAGE LIABILITIES & LIENS ESTATE OF i II FILE NUMBER /YJC)re-~t ..s''''1Ynt,,{G'- '7; ;2./O~-1/13 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION A~OUNT ~ , A '~/1 S;/IZ'~~YI;l/l~,/S1r~5 POI lJ, Gc(~-!.f?L c; /.J~(Cf7c/"NCC/C/ ~/;t-IfJ/'~'.4L j/C/2.- s C?~ /9-L-_7t s u 5 Qt( &#;t)~ IN re/L./v/}-c J'?76:f)ICYNGj Src ~, :;31 CP r , ' 2, \ 30,co 8, BS- --1/ V' ./2/2-1 2--0?l/ ? ~ e- S vc. . J /9/ 8 9 s P/JIJ!l2mllCr (O/Y7Nf C-1/2.:) r . /3)/ 92- 0. ? C- C-- U T7 L/ ~./e-S: / )SOAL;:;2., 7-, VCl2-rZ-C7N) r/V4~ DIll 8,OLJ ~, TOTAL {Also enteron line 10, Recapitulation) $ 37-.3 ( 0,--'1 (If more space is needed, insert additional sheets of the same size) REV .1513 EX + 12.87) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX lETURN RESIDENT DECEDENT SCHED'ULE J , BENEFICIARIES ESTATE 0/11 CJ rE~1 r"lrn't&L )I I FilE NUMBER ';:;'/CJ~ -1/13 I ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP .. AMOUNT OR NUMBER SHARE OF ESTATE A. T oxable Bequests: S'C::;1 tIV ?3 1, J]/U1 cE ~ /1 or~ Rd. ~O2. ~~L1?!; "'1# . $"'0 "'- /) ~4..;I'C;,n,)1 ~ /896, 'i 1... Z;~t.e ~, /YJare/L. S Co:-;,,; 1'3 I I ~ EO I A?e~tW(;C;/) Sj;r;;yj! ~, ,c" ILl- ,6,e,;GC1 ~ 95"4' 3 '?- 3, ,K'e ~ ~ /r,g', h) or erz...... ~ 0- ~f1./ Y3 ~ C-i..e<'9/<. Vle-~ ~r~, .0 C/1~'-I.$" 8/ pet:) I :;.GI 3 ~ .- ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: 1. " TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter onJine 13, RecapitullJtion) S (If more spact is needed, insert additional sheets of same si:z:el Cumberland County - Register Ot--Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 DANIELS WILLIAM S ONE W HIGH STREET STE 205 CARLISLE, PA 17013 RE: Estate of MOYER SAMUEL H File Number: 2004-01113 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or ,uncompleted administration. This filing is due by: 10/17/2006 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 - :RegisE-er OfWills--- One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 MOYER BRUCE H 602 HALTEMAN RD SOUDERTON, PA 18964 RE: Estate of MOYER SAMUEL H File Number: 2004-01113 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 10/17/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel -~ ..J"<' ;..,........ c> .. ..~ .t o 0 , Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 L110Y~1 s:',;ymJ I/r Name of Decedent: Date of Death: Estate No.: ;;2ec/Lj - all /3 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: Date: a" U"> ~ ,c 0.- N N ~ ~ ~ 1. State whether administration of the estate is complete:' Yes 0 No JXf 2. If the answer is No, state when the personal represen the administration will be complete: j/'1/oy 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 formal or informal accounts may be filed with the Clerk of the Orphans' urt and may be, attached to this report. 'j -2.). - ~6 C/ ,~ 0,- Signature c2J#J-/I/ .?e 4:::5' w, e ,/ Name ...:'s 0.::: I---. . ff)c \.' C)':- c5C~} --L cr . cc::>, '. ':j ~r~ (.~ - 00:;, r:. a::. -~" 05 <..) / W. ~r~ &. %- ~,S- Address ~~~/ ,PA-c~/ 3 777--~~~-383/ Telephone No. Capacity: o Personal Representative ~ounsel for personal representative ~ 09-25-2006 MOYER 10-17-2004 21 04-1113 CUMBERLAND 101 APPEAL DATE: 11-24-2006 ( See reverse side under Objections) A.ount R..ittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS 4- iEv:i5~7-Ex-AFP-ioi:05i-NOTicE-oF-iNHEiiTANCE-TAi-APpiAiSEMENT:-AiioWANCE-oi--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX SAMUEL H FILE NO. 21 04-1113 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 210601 HARRISBURG PA 17121-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~-r'('\n...,,...~~,~F'i[INHERITANCE TAX ,', :::'-RAiSEMENT'T'~Al:LOWANCE OR DISALLOWANCE ~:E:Jl!~~T:fdN(~ND ASSESSHENT OF TAX 2006 OCT - 2 Pi112: 35 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CLERK OF OR'"" ",, I'I" {'('I lOT i'1-i:'-\.l\j \) uUlJi II r"llh,u:r'd)l iif': . P,I\ v .. I., ,-'__, ~,._. ... WILLIAM DANIELS HUMER & DANIELS 1 WEST HIGH ST STE 20 CARLISLE PA 17013 ESTATE OF MOYER . REV-1547 EX AFP (06-05) SAMUEL H TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED DATE 09-25-2006 If an assess.ent 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: IS. A.ount of Line 14 .t Spousel rate (1S) 16. A.ount of Line 14 taxable at Lineal/Class A rate (16) 17. A.ount of Line 14 at Sibling rata (17) 18. A.ount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX "KII:.&I~.::ll: .. .. ...n . .---. ."J AMOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 01-12-2005 CD004834 299.12 5~700.00 09-18-2006 REFUND .00 16.72- TOTAL TAX CREDIT 5~982.40 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 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. HortgageslNotes Receivable (Schedule D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. JOintly Owned Property (Schedule F) 7. Transfers (Schedule S) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 4.203.94 .00 .00 3.060.58 13.034.40 124.883.41 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/A~. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Lians (Schedule I) 11. Totel Deductions 12. Net Value of Tax Return 13. Charitable/Gover~tal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 11 ~867 .10 373.09 (11) (12) (13) (14) NOTE: .00 X 132~942.14 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= · IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your eccount~ SUbBit the upper portion of this for. with your tax P.~t. 145~182.33 1~ ~tiO 19 132~942.14 .00 132~942.19 .00 5~982.40 .00 .00 5~982.40 ( IF TOTAL DUE IS LESS THAN $I" NO PAYHENT IS REQUIRED. t:\ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE DU~ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE C;:(Y'tDr,(:"n r.cC"!('r" n~ BUREAU OF INDIVIDUAL TAXES I il_\/'/i,i:~;~ I~I' ',cut ;/' ZNHERZTANCE TAX INHERITANCE TAX DIVISION ; STATEMENT OF ACCOUNT PO BOX 280601 HARRISBURG PA 17128-0601 '* REV-1607 EX AFP (03-05) 2005 NOV -3 At111: 24 CLH. WILLIAM DANIELS HUMER I DANIELS 1 WEST HIGH ST STE 20 CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-02-2006 MOYER 10-17-2004 21 04-1113 CUMBERLAND 101 AlIOUI'It R_l UH SAMUEL H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper crHlt to your IICcount, subIIit th. upp.r portion of this for. with your tax p.~.nt. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MOYER SAMUEL H FILE NO. 21 04-1113 ACN 101 DATE 10-02-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUltttARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-25-2006 PRINCIPAL TAX DUE: 5,982.40 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-12-2005 CD004834 299.12 5,700.00 09-18-2006 REFUND .00 16.72- TOTAL TAX CREDIT 5,982.40 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PA YHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~ Register ofWill~ of Cumberland County Name of Decedent: STATUS REPORT UNDER RULE 6.12 5-9-;n~ ;-I, Date of Death: /hO/4r/ (C)-I'} ,. 0'1 Estate No.: }bo'1 - II I'; Pursuant to Rule 6.12 ofthe 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. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: /2-- 3/ -0 7-- 3. lfthe 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 formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ,; _ /) /~-S--C'?- c:::;~~ Signature Date: 'ri-J "'V", ' "", ,", _H," .u U", ',..,. ,.-........,.rJfi '- ,...J." '.' ,~,_,_,jU~ ~j v ItlnO:) S,N\jHdtJO ::JO >18310 NamHUMER & DANIELS 1 WEST HIGH SI STE. 205 CARUSLE. fA 17013 Address 9'/?- - z...f1~ -3?' / Telephone No. 60 :8 Wd S-lJO IDOl Capacity: 0 Personal Representative Ga Counsel for personal representative 11 Via. ®.C. yule 6.12 ST,~T'~JS P®~~' REGISTER OF WILLS OF (sGl/??~1~~~- COUNTY, PENNSYLVANIA Name of Decedent: Date of Death: (J~~4~~/~' ~ /, /~ File Number: ~y[J~ ~Q~~~~Z---- D ++„ p~ !l !-' D 1 ~ 1 ~ T , ~~ the f~ll~~z,ino tiuitl-i racner.t to nmm~~P.tiClrl llf the ad1111T11Stratl011 of i Lirsuaii~ w • u. v.`• i~iiie v. <., i :ep --p r--` r----'-- the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~ -Yes ~ No 2. If the aiiswei°is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ....... ]Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account infoln~ally to the parties in interest? ............................... Yes (~ No d. Copies of receipts, releases, joinders and approvals of folznal or informal accounts maybe filled with the Clerk of the Orphans' Court and. maybe attached to this report. Dnte ~~~ ~r ~ ~~v Signature of Perso+z Filing this Form Capacity: Personal R,e/present/ative Q Counsel Name of Person Filuzg dzis Form ~ ~~~ ~~ bra ~~~ Address ~ Telephone ronn R6P-JO rev. 10.13.0/ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF~~~~~'' o/~%~ CONY, PENNSYLVANIA G~ v ~^ l~ Name of Decedent: ~ '~/ ~' "- ~ ~ File Number:-_~~r--, ~// -~ Date of Death.: Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: ....... ~ Yes ~10 1. State whether administration of the estate is complete :........... . 2. If the answeris No, state when the personal representative reasonably believes that the administration will be complete: ~l /. 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 ~Z'es ONo ...................... informally to the parties in interest? ........ . d. Copies of receipts, releases, joindersCnodrt and may be attachedrto this rep ccounts may be filed with the Clerk of the Orphans Dnte L ~~ ~ Signature of Person Filing thts 1~orm _' C'~ -~-- ~ ~ _ _ r_; Ca aci Personal Representative ,r~Counsel 1 !i_t •""= ~~' t ~' - Name of Person Filing this Form `~_~_,- C U ~ ~ q- Q ~ c~ Address 1 WEST HIGH ST. STE 205 Telephone y ~~~/ ~~'~, ! ,~ For-ni R N~-! 0 rev. 10.13.06