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HomeMy WebLinkAbout02-0115EA ~ T OF . Estate of Richard K. Lautsbaugh No. ~~'"d d`_~ also known ¢s To: Register of Wills for the Deceased. County of Cutr~berland in the Socrvt Securrry No. - - Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/;~18 years of age or older an the execu rt lx named in the last will of the above decedent, dated June 21 , lg 90 and codicil(s) dated (state relevant cimtmstanccs. e.g. renunciation. death of executor, etc.) Decendent was domiciled at death in Cumberland nt P ns lvania, with lLi_,s~.~,_ last famit or ncipal residence at 375 Claremont . , ' dod~esY~x ~capy, Cumberland Coun~y, (list street, number and murtcipality) Decendent, then 79 ye~r s of~t e, died January 8, 2002 , ~ at Claremont Nursing~~el'iab. Ct~. , Car is e, ' Esr:spt as follows, decedent did not marry, waz not divorced and did not have a child born or adopted after execution of the will :~fferccl for probate; waz not the victim of a killing and was never adjudicated ~rcompetent: 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 (-f not domiciled ir, Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: __ ~..~r S 1,000.00 S S a WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codiciI(s) presented heretivith and the grant of letters testamentarv (testamentary: administration c.t.a.; administration d.b.n.c.t.a.1 theron. ' ~,~~~~ ,~ ~.. ~~ ~ Wen y a un evy z 509 Quail Court Mec~ianics urg, I?>755 ..~ J ~n C u ~. e c - m f!7 C~-ATH OF PERSONAL REPRESENTATIVE COM.i1'IiONWEALTl~I OF PENNSYLVANIA ~ ys COUNTY OF ~~~'~ The petitioner(s) above-named :wear(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 az personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate acc rding to law. Sworn to or affirmr a:td subscribed ~-- ~ ~ ~~ before me this ~~st ~~,{ end Mae evy o'o' JANUARY '-~ a ~ ,~ ~ ~ ' Register /7-~~~ ~~ 21-2002- 115 No. Estate of Richard K. Lautsbaugh ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW February 1.st I~?~ 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 June 21 , 1990 described therein be admitted to probate and filed of record as the Iasi will of Richard K. Lautsbaugh and Letters Testamentary ' are hereby granted to Wendy Mae Dunlevy FEES Probate, Letters, Etc.......... S 18.00 Short Certificates(1) .......... S 3.00 Renunciation ................ S x-Panes (3) S 9.00 JCP TOTAL S 35~ Filed bn~arX.lst, 2002 j cer of Wills MARY C. LEWIS ~~ David H. Stone #39785 ATTORNEY (Sup. Ct. I.D. No.) 414 Bridge St., rdew Cumberland, PA 17070 ADDRESS (717) 774-7435 PHONE ..., ,.- ~.~. Wn .... t'r Ci ~ ~,C =i -, r. _ N :=~ W -~ y.. ~' MAILED LETTERS TO A'TT'ORNEY DAVID H. STONE A~ ~1 his is to certify that the i:zforniation here given is correctly copied from an original certificare of death duly filed with me as Local Registrar. The origin~~l certificate will be fo(-w~u~ded to the State Viral Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for tE~is certificate, $2.00 ~,,r Local Kegistrar ~ P 788781 ~)~. 21-2002-115 ~~ ~yl ? ~ 200 Date I~ e3 Rev. 2187 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER NAME lS DECEDENT (First. Midtlle. Lavl SE% SOCIAL SECURITY NUMBER GATE OF DEATH iMCnM. Oay,'aar) +• Richard K. Lautsbau h anale 7.18$ -12 -4523 aJan.8,2002 AGE (Last Bvd+dayl UNDER 1 YEAR UNDER 1 DAY ORE OF BIRTH BUiTHPLACE (Coy era PUCE OF DEATH ICneck orvy Wass - iee,nstructam a. dMr s+de1 MonMS r Days ligaa r Mkwlp !MOnIh. Day 'brl Sate a Faegn Caurury) HOSPIUL OTHER: 192 Harrisburg PA 79 Yra July 22 Ir'~•h•^t ^ E+~^+ ^ ~^ ^ ~ (~ R.aiwn~. ^ ~~N) ^ _ , . , a. e. 7. tla. COUNTY OF DEATH Cff V, BORO. T WP OF DEATH EAGLET' NAME pl na nsl~wwn. glue street antl numoerl NM$D€GEDENT OF HISPANK:ORIGIN7 RJ1Cf • American In6an, Slack WDi1s. s1c. • Cumberland Co, Middlesex Ztap. Claremont Nursing & Rehab. Ctr. NO 1rH 1M ^ Kyp.sWpM Cwan. M.arcan,PUeneRkan.ac. (Sp•oM) white b. K. W. 9. 10. DECEDEM'S USUAL OCCUPATION KIND OF SUSINE5S71NWSTRV NMS DECEDENT EVER IN DECEDENT'SEWCATION MARITAL STATUS-M4Md SURVIVING SPOUSE (Give kxrtl of work dory duruugxJ mo9 U.S. ARM O FORCEST S n ode can tr>4 Never Monied, Wrdosved, lit wde. grog mardrr name) d wWkeq We: dD nd use r~red.1 ^ Elementary/Secondary CaTaga Disorpd FPer:M nechanic railroad Vss Ntl LJ 7 (Df2) nda5~1 never married . „j „D, 12 „ , ,B DECEDENT'S WRING ADORESS15treet. CMy~•n. Stal•. Zip Cdeel DECEDENT'S Pennsy vania ~( Mi esex 375 Claremont Dr. ACTUAL 17a SUN Did 77e. Yp,decedaM eyed in ^•D. RESDENDE dscadartl ISee mshuctms Ova n ^ PA 17013 Carlisle ~^oprersltl•) Cumberland T ^ ~ ; ~ , ,a. „~. „d. , , „ cAyfbmo FRHER'S NAME (F'vsL Middle. Las11 MOTHER'S NAME (Fist. Mxltlle. MaidenSwnarnel ,~. Samuel K. Lautsbaugh „Hazel Weaver 1~ MANT's NAME Rypa.Prim) Wendy Dlulleavy ~O~NTQuai~'AC~..ss~lec~ianicsbu g; PA 17055 METHOD OF DISPOSITIDy DATE OF DISPOSITION PUCE OF DISPOSRION - Nama M Cemetery Cramatay LOCATION - CiN/Town. SIaN. ZW CoW Burial 1hFt1~ ramatgn ^ Removal Irom Slats ^ Donation^ olllr,specry ^ (Mantas. Day. Mbar) Jan.11 , 2002 or OIMr Place Rolling Green Cemetery er Allen Ztap, , PA1701 Zta. ~ 210. tte. 21d. ' SIG OF FUNERAL ER E LICENSEE OR P AC71 AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY - gyp-013163-L Ffi & 6, 324 Iix[m?1 A~e.,l~r~ne,PA17043 aGams 23sc onlyw rtlNirg Toth Wal of mykrowletlge, death occwred allM bma, dale and place staled. LICENSE NUMBER OrQE SIGNED .. phyticun 0 rot avaaabN M lima of death to ' prtdypw.aaam. (Sgnalure and TAIe) iZtv"3~4~41c~-~- (Maim, Day Vprl ©'i ~b~3 C ~ 27a. 2w. ,c . 2x. Kerns 21@B mlpt W competed try TIME OF DEATH DATE PRONOUNCED DEAD (MOnm. Day, Vearl WAS CASE REFERRED 70 MEDICAL E7UMINEWCORONER7 h d h • parson w o prpauncea eat . Y.a ^ No~vJ O ~ c a " ~~ rS 21. M. 28. Ie. 27. PART 1: Eller the diseases, inryries or complkal' which posed tM death. Do ndl enter IM Wads of dying, such as cardiac a respiratory arreal, snack or Wean IaiWre. 1 Approximels PART II: OIMr signiBCaM corldaiona cpnlriblrtirp b deaM, but LW onN orr cause on each kM. ~'eaervtl behvpn nd nwWp kt the urlderlyirg pup given n PART 1. 1 onar arw dell t11YED1ATE CAUSE (Final 1 ~( I assawacorwaion r/}'~ ~ / ewnxlq n druthl -+ a. aVr i- ' 1 Ol1E TO (OR AS A CONSEQUENCE ~' SrarMiary ar carlditiona b. _ Y ony, kwdkvgto irMMdiaN DUE TO (OR AS A CONSEQUENCE OF]: I crass. EMr UNOFJiLYIHG 1 CAUSE IDlsaass a nryry c. ~ 1 • IlulvWaletl e.eMS DUE TOIOR AS ACONSEQUENCE OF): ' I reyMuq n aeaml LAST r d. _ YYAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH GATE OF INJURY TIME OF INJURY INJURY AT VlORKT DESCRIBE MOW INJURY OCCURRED. PERFORMEOT AWUUBLE PR10R TO (MOnm. Day, Year) KNi qF CAUSE l N l ~ H i i ^ OF DEA M urs a om c M Yes ^ ~ ^ AtttlsM ^ PerMirg lnvesligation ^ 7a M Toe 7a Tod ~~~~77 Yes LJ No ~ !'~ ~s Yes ^ No lJ Sukids ^ CouU rqt Ds defmmine0 ^ . . . . PUCE OF INJURY - Al lams. farm, street. factory. oIOCS . LOCATION ISheet. GNROwn. Stale) buil6nq, etc ISPecAvl 2M. 2ae. 29. 70e. 701. n I~.rwa aay unel 'CERTIFYING PHYSICIAN (Pnyscan cal,Ning cause o1 Ceatn when anomer phvs¢ian has ponouncetl Aeam ono completed Item 291 To W Wet of my kmwNdge, death occurred dw b Me caua<(al and manner oa elated ..................................................... 'PRONOUNCING ANO CERTIFYING PHYSICIAN (Pnysuan nom pr~nourc }tieaP. and ceNly,ng lu cauw of dearnl To tM Wet of my knowledge, death otcuned at tM Ilme, dNa, arW piece, and due to tM cauae(a) and manner as Mated .......................... 'MEDICAL EXAMINERICORONER On the baala of eaaminetlon and/or Investigation, in my opinion, death occurred al the lime, dale, and place, and due to the cause(s) and manner as Mated ............................................................................ ...................... ]ta. REGISTRAR'SS ATURE AND Ny~Y1BER Jaya ~ ~ ,~~J(]~ ,s / SIGNRIUHt ANU LIT ~ FJiI1hIEH / 1D. //~~ LICEN NNU~M'/R~E1~R~ DATE SIG fMm ~ay, Vear1 ^ 71 e. V J `~ `r "/ Z ltd. ' NAME ANO ADDRESS OF PERSON WHO COMPLETED CAU TH (Item 271 Type w Print 72. DATE'. FILEDI~onm Day. veal) G1-GVV!_ 117 C, 'T^ `>; i' C_- 1~.1 ...~ . a.+ ~~, ... . tj7 `~' w ~t ~" ~ 21-7.002-115 LAST WILL AND TESTAMENT OF RICHARD K. LAUTSBAUGH I, RICHARD K. LAUTSBAUGH, of the Township of East Pennsboro, County of Cumberland, and Commonwealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate, of every nature and wherever situate, in equal shares to such of my following named nieces and nephews as survive me; WENDY MAE DUNLEVY, LUANN MARIE SMITH, WARREN TODD LAUTSBAUGH, and PATRICIA ANN BALM. Should any of my above-named nieces and nephews predecease me, I devise and bequeath the share of such deceased niece or nephew to his or her issue, per stirpes, living at the time of my death; and should any of the above-named nieces and nephews predecease me leaving no such issue living at the time of my death, the share of such deceased niece or nephew shall be added to the other shares created for my nieces and nephews in this Item I. ITEM II: I appoint my Executrix and her successors guardian of any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to Page 1 time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM III: I appoint my niece, WENDY MAE DUNLEVY, Executrix of this my last will. Should my niece, WENDY MAE DUNLEVY, fail to qualify or cease to act as Executrix, I appoint my niece, LUANN MARIE SMITH, Executrix of this my last will. ITEM IV: I direct that my Executrix or guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. r RICHARD K. LAUTSBAUGH SIGNED, SEALED, PUBLISHED and DECLARED by RICHARD K. LAUTSBAUGH, the Testator above named, as and for his Last Will and Testament, and in the pre- Bence of us, who at his request, in his presence and in the presence of each other, have sub cri ed our names as witnesse . ~- ~ ~.: C ..~ 1. ~ . ~~_ Tc~itness' Ad ress Witn s dress Page 2 COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND I, RICHARD K. LAUTSBAUGH, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. RICHARD K. LAUTSBAUGH Sworn to or affirmed to and acknowledged before me by RICHARD K. LAUTSBAUGH, the Testator, this,~~ay c NOTARIR,L SEAL DECINDA M, RITCNIE~ i::^~Tt1R'r PUBC.IC NEW CUM6ERLAND BQ?C1. Cl.'~~•1B[P,CI,fvD CO. MY COMMISSION EXPIRES N.i,RCH 29, 1993 Page 3 COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND 1 We, :~ r~~~ -.5~ ~v and ~C - ~.c~~ ~ the witnesses whose names are signed to the attached or foregoing ins rument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence., -~ '~itnes ~~ ~ Wit rn to or affirme~d~to and~knowle~dged before me by 1 this~~ day of ~.~J1.a, / lJt and witnesses, 1 ~~ r Notary pub~.ic NOTARIAL SEAL ~ ~.. NEWS CUMBERLAND BORO.~ NOTARY FUBL1!' MY COMMISSION EXPIRES MARCiRL~;:D CO, 1993 Page 4 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: RICHARD K. LAUTSBAUGH Date of Death: Will No. To the Register: January 8, 2002 2002-00115 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 May 10, 2002: Wendy Mae Dunlevy 509 Quail Court Mechanicsburg, PA 17055 Warren Todd Lautsbaugh 120 Lancaster Avenue Enola, PA 17025 Luann Marie Smith 8 College Hill Road Eno1a, PA 17025 Patricia Ann Baim 16 S. Chestnut St., Apt. 4 Palmyra, PA 17078 Notice has now been given to all persons entitled thereto under Ru 1 e 5 . 6 (a) .----- --~.. Date : ~ `~ t ~ - ci Z_ -~., , ~ ~ DAVID H`. TON Es u`ire 414 Bridge Street '~` New Cumberland, PA 17070 717-774-7435 ;J = Capacity: Personal Representative X Counsel for Personal Representative REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY INHERITANCE TAX RETURN FILENUh48ER RESIDENT DECEDENT 21 2002 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL. SECURITY NUMBER Lautsbau h, Richard K 188•-12-4523 DECE- DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 01/08/2002 7/22/1922 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL. SECURITY NUMBER 3. Remainder Return CHECK 1. Original Return 2. Supplemental Return ~ (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained a living Trust g. Total Number of Safe Deposit Boxes BLOCKS (Attach copy of Will) g. Liti ation Proceeds Received g (Attach a copy of Trust) l0. Spousal Poverty Credit (date of death between ~ 11. Election to tax under Sec. 9113(A) 12-31-91 and 1-1-95) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDENTIAL TAX INF=ORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS COR- David H. Stone, Es ire 414 Bridge Street RE- SPON FIRM NAME (If Applicable) New Cumberland, PA 17070 DENT Stone LaFaver & Shekletski TELEPHONE NUMBER 717-774-7435 RECA- PITULA- TION 1. Real Estate (Schedule A) (1) 0 , 00 2. Stocks and Bonds (Schedule B) (2) 0 , 00- 3. Closely Held Corporation, Partnership orSole-Proprietors hip (3) 0 , 00 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 7 , 2 61.81 6. Jointly Owned Property (Schedule F) Separate Billing Requested (6) 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (7) 0.00 OFFICIAL USE ONLY 8. Total Gross Assets (total Lines 1-7) (8) 7 , 2 61.81 9. Funeral Expenses & Administrative Costs (schedule H)(9) 4 , 375.00 l0. Debts of Decedent, Mortgage Liabilities, & Liens(Schedule I) (10) 56 , 398.95 11. Total Deductions (total Lines 9 & l o) (11) 60 , 773.95 12. Net Value of Estate (Line 8 minus Line 11) (12) (53 , 512.14 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) 0.00 has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) (53 , 512.14 ) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (ax1.2) X .0 (15) Tom( 16. Amount of Line 14 taxable at lineal rate X .0 (16) COMPU- 17. Amount of Line 14 taxable at sibling rate X .12 (17) TATION l8. Amount of Line 14 taxable at collateral rate X .15 (l8) 19. Tax Due (19) 20. ~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT » BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND RECHECK MATH« 0115 ~v 0 PA15001 NTF 29755 Copyright 2000 Greatland/Nalco LP-Farms Software Only PA REV-1500 EX (6-00) Page 2 Decedent's Complete Address: STREET ADDRESS 375 Claremont Dr. CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 0.00 C. Discount 0.00 Total Credits (A + B + C) (2) 0 . 0 0 3. Interest/Penalty if applicable p. Interest 0.00 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Llne 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TFiE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................... . b. retain the right to designate who shall use the property transferred or its income : ................ . c. retain a reversionary interest; or ....................................................... . d. receive the promise for life of either payments, benefits or care? ............................. . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF~ THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of which preparer has any knowledge. SIGNATI~RE OF PERSON R ~N~ S~IBLE FqR FILING RETURN DATE ADDRESS ~ U y SJL~1 J_ hour Mecharii;~~k~urg, PA 17055 SIGNATUR O ER THAN REPRESENTATIVE -~~-~ and, PA 17070 For dates of death on or after July 7, 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. 6 9118 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0 % [72 P.S. § 9118 (a)(1.t) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and tiling a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 % (72 P.S. §9116(ax1.2)]. 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. § 9178(1.2) [72 P.S. § 9118(aX1)]. 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. § 9118(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 oradoption. 0 PA15002 NTF 29758 Copyright 2000 Greatiand/Nalco LP-Forms Software Only REV-1508 IX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MASC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NIJMBER Lautsbaugh, Richard K 21-2002-0115 include proceeds of litigation & data proceeds were received by the estate. All prop. jointly-owned with right of survivorship must be disclosed on Sch. F. ITEM VALUE AT NO. DESCRIPTION DATE OF DEATH ~. Claremont Nursing Home-house account 1,893.66 2 Railroad settlement proceeds from 4,530.00 lawsuit 3 Blue Cross/Blue Shield-refund on premium 158.45 4 Internal Revenue Service-refund for 2001 658.00 income tax 5 US Treasury-refund 21.70 TOTAL (Also enter on line 5, Recapitulation) I $ 7 , 2 61.81 (If more space is needed, insert additional sheets of the same size) 0 PA15081 NTF 33305 Copyright 2000 Greatland/Nalco LP-Forms Software Only ,REV-1511 EX + (1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE IVUMBER Lautsbaugh, Richard K 21-2002-0115 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL IXPENSES: 1. Musselman's Funeral Home-funeral expenses 3,295.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AttorneyFees Name: David H. Stone, Esquire 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 0.00 750.00 0.00 Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 50.00 5. Accountant's Fees 0.00 6. Tax Return Preparers Fees 0.00 7. H&R Block-prep. of income 62.00 tax 9 Commerce Bank-service charge 18.00 10 Reserve for filing First and Final Acccunt and 200.00 closing expenses TOTAL (Also enter on line 9, Recapitulation) $ 4 , 375.00 to more space is neeaea, rnsen adtlitional sheets of the same size) 0 PA15111 NTF33308 Copyright 2000 Greatland/Nalco LP-Forms Software Only REV-1512 EX + (~ -97) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT IN RES DENT DE EDENTRN MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Lautsbaugh, Richard K 21-2002-0115 0 PA15121 NTF 33309 Copyright 2000 Greatland/Nalco LP-Forms Software Only (It more space is needed, insert additional sheets of the same size) REV-1513 EX+(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lautsbaugh, Richard K FILE NUMBER 21-2002-0115 RELATIONSHIP 7'O DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst 1"rustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Wendy Mae Dunlevy 509 Quail Court Mechanicsburg, PA 17055 niece .00 2 Luann Marie Smith 8 College Hill Rd. Enola, PA 17025 niece .00 3 Warren Todd Lautsbaugh 120 Lancaster Ave. Enola, PA 17025 nephew .00 4 Patricia Ann Baim 16 S. Chestnut St., Apt. 4 Palmyra, PA 17078 niece .00 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON R EV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBS. ON LINE 13 OF REV-1500 COVER SHEET S 0.00 (It more space is needed, insert additional sheets of the same size) SCHEDULE J BENEFICIARIES 0 PA15131 NTF 33293 Copyright 2000 Greatland/Nalco LP-Farms Software Only ~~~. ,mss. .:,~;~,~ ONE $ STORE I;~RIV£Y$ AT t.A~V f 3 3~.,., .k,r,!~~ ~, f ~~• ~~d~, ~ ~ ~` n~~r~-v~r35~j~~ 4 f a#r~ ax S~ F~.PiR.Mi~~~176"~0 ,~"- .. r ` ~M.'3~~':Nf d... ~.i.d'~ v.~t AST WILL AND TESTAMENT OF [2ICHARD K. LAUTSBAUGH };7.~: {ARD K. LALtT6 ~_~UGH, of the Township of Ealst Pennsboro, County o` Cum~~.'~ .inc., nd Commonwe. Ch of Pennsylvania, declare. this to be my last will a-:. ~vck.r any will pr~.~ iously made by me. ":r I devise .:jd bequeath all of my estate, of every nature and w~erev~- .scat , in equal ,,{tires to such of my following named nieces and n~~phe.a;; :r, ;~ur~ ve me; WEND'( ~IAE DUNLEVY, LUANN MARIE SMITH, WARREN TODD LA~;TS3?~a Ali any: PATRICIA ANtJ BAIM. Should any of my above-named nieces and nephew< ~~, dece se me, I dev ise and bequeath the share of such deceased niece or nepl~ ~.a ' u hz or her issu : , per stirpes, living at the time of my death; anti 5'ru;,_ ..: ~cn ~ E the above-• : timed nieces and nephews predecease me leaving no such ' s ~; :.r ].i ri. at the ta>i:~ ~ of my death, the share of such deceased niece or ne};~he~• ~r~~: 1 ~t~. added to the ether shares created for my nieces and nephews in t h :i 5 i t: -'.:, ''].M_~~ I appoint: rr~ Executrix and her successors guardian of any Pry%i>E • ° -.~ ich .~ rases either ruder this will or otherwise to a minor and with respe, ~ ,;r ahl r.} I am authc-ri :ed to appoint a guardian and have not otherwise specirt,,.a!~ can so, provid:c'. that this appointment of a guardian shall not ` su~er~ .,i,. r,~ ii.:ht of any fac.uciary in its discretion to distribute a share wht're ,,I;r ~> i:1e C.~ the minor .;r to another for the minor's benefit. Such guardi,a- X71 .:_1 ku ve the powers to use principal as well as income from time to s,' Page 1 .. time for the minor's support and education (including co:Llege education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payme~tt for these purposes, without further responsibility, to the minor or to the manor's parent or to any person taking care of the minor. ITEM III: I appoint my niece, WENDY MAE DUNLEVY, Executrix of this my last will. Should my niece, WENDY MAE DUNLEVY, fail to <tualify or cease to act as Executrix, I appoint my niece, LUANN MARIE SMITH, Executrix of this my last will. ITEM IV: I direct that my Executrix or guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand acid seal the day and year first above written. RICHARD K. L,AUTSBAUGH " SIGNED, SEALED, PUBLISHED and DECLARED by RICHARD K. LAUTSBAUGH, the Testator above named, as and for his Last Will and Testament, and in the pre- sence of us, who at his request, in his presence and in the presence of each iother, have sub cri ed our names as witnesse . ,.~ 1 ~ ,~-- t~ ~ ~ •~, -r~ i,41,, (n Witness Address /~ ~ /9 Witn s Address Page 2 COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND I, RICHARD K. LAUTSBAUGH, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this ir.~strument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. RICHARD K. LAUTSBAUGH -~ Sworn to or affirmed to and acknowledged before me by RICHARD K. LAUTSBAUGH, the Testator, this ~" day c NOTARIAL SEAL DELINDA M. RITGf;IE, !::'STAR', PUBLIC WEW Cl7MBERLAND LOBO. Ci''~ioCRLi+R'0 CO. MY C0~"~MISSiON EXPIRES Mi,RCH 29, 1993 Page 3 COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND ,, We , \~ ~.{; ~ ,~~ j -~ S ~ ~ ~ and ,7C ~~.c~/> > ~_ the witnesses whose names are signed to the attache or foregoing ins rument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of a.ge, of sound mind and under no constraint or undue influence. Witnes ~-. orn to or affi J~~~ / U: and this day of ~1 Wit to and~knowl 1 before me by ~ ~ witnesses, ~vV~~ ' ~,- Notary 1?~ub~ic GELIfdGA h., NG7ARIA~ SEAL _____.~ ~ RI7CF;~., N07ARY PUBLIC NEW CU~SBERLAND BORO. CUh16ERLAND CO. MY COh"^IISSION EXPIRES MARCH 29, 1993 Page 4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105.8486 April 15, 2002 STONE LAFAVER & SHEKLETSTCI DAVID H STONE ESQUIRE 414 BRIDGE ST PO BOX E NEW CUMBERLAND PA 17070 Re: RICHARD LAUTSI3AUGH CIS #: 460145388 SSN: 188-12-4523 Date of Death: 01,08/2002 Dear Mr. Stone: Please be advised that the Department of Public Weli'are maintains a claim in the amount of $56,398.95 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $20,658.28_, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $35,740.67, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, ~kd~.41.• C ' Susan E. Naylor TPL Program Investigator 717-772-6265 717-772-6553 FAX Enclosure COMMONWEALTH OF PENNSYLVANW DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCWL OPERATIONS TPL SECTION -CASUALTY UNIT PO BOX 8486 HARRISBURG PA 17105-0488 April 11, 2002 STATEMENT OF CLAIM SUMMARY NAME Estate of LAUTSBAUGH, RICHARD ID 460 145 388 MEDICAL CLASS 3.: r- r~ CIASS 6 ~ • TOTAL INPATIENT .00 .00 .00 OUTPATIENT .00 20.00 20.00 LONG TERM CARE 17,219.50 29,788.10 47,007.60 DRUG 3,438.78 5,932.57 9,371.35 REIMBURSEMENT TO DPW 20,658.28 3b,740.67 56,398.95 COMMONWEALTH OF PENNSYLVANIA ~+~~.~+~ ~-' DEPARTMENT OF PUBLIC WELFARE ti ~~ ~~F ~~r_, EIN - `23~6Q3113 ;;'«~;4~.~'~~t~» ~, Inventory of the real and personal •estafe of Richard K,. Lautsbaugh deceased Inventory Estate of Richard K Lautsbau~~h From 01/08/2002 To 10/08/2002 Description Accrued Income Value Cash on Hand Railroad settlement proceeds Savings Accounts Claremont Nursing Home-house acct. Refunds Internal Revenue Service-refund 658.00 Blue Cross/Blue Shield-refund 158.45 US Treasury-refund 21.70 ~~ Total ~ 4,530.00 I ! 1,893.66 6, 423 66 ~` 838 15 II -7,261 81- COUNTY OP CUMBERLAND ss: Wendy Mae Dunle being duly sworn according to law, deposes and says that ~e is the Executrix of the Esta+e of Richard K Lautsbaugh Middlesex Twp. ,Cumberland County, Pa., deceased and that the late of ^- -- --- -- - ----- within is an inventory made by Wendy Mae Dunlevy ~ _ the said Executrix of the entire estate of said decedent, consisting of all the personal proparty and real estate, except real estate outside hhe Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death . and subscribed before me, -ni ~ f r, ^~ (l..J (v~.~~ ~' ~ ~ , en y Mae z Tutor-. i4d,,,;rristra+er 19 Dunlevy ~ 509 Quail Court Mechanicsburg, PA 17055 _ Address 08 Date of Death _-. O1 2002 Day Month Year INSTRUCTIONS I. An inventory must be filed within three m onths after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. $ee Article iV, Fiduciaries Act of 1949. , ul ~ ~ w ~ ~ ~~ ~ ~, 3 M '-~ ~ -- ,~ ~ ~ ~ Q ~ Ei '0 r[S ' ~ O I ~ N I Q w C w I ~ ~ d ~i o D i O o' N ~ = a Z Q O -I, N - ~ a i w .~ N ~ > ~ z ~ ~ ~ ~ '~ t `~ ~ Z O ~ x I ~ o I I Z z ; I U ; .c ' "` I '~ ~ o ~ j ` ; ;~, ''~` + ~ ' o ~ U ~ I ~ .~ ~ ~ ~ ~~ ~ o ~ -.i U ii o m r m C O Q ~~~-/~3 -~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION WEPT. zso6ol NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-6601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCIE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (O1-D2) DATE 11-25-2002 ESTATE OF LAUTSBAUGH RICHARD K DATE OF DEATH iD1-08-2002 FILE NUMBER 21 02-0115 COUNTY CUMBERLAND DAVID H STONE ACN 101 414 BRIDGE ST Amount Remitted NEW CUMBERLAND PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HDUSE CARLISLE, P'A 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ -------------------------------------- ----------------------------------------------------------------------- REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LAUTSBAUGH RICHARD K FILE NO. 21 02-0115 ACN 101 DATE 11-25-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHAIVGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1l .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest [Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 71,261.81 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 s. Totai Assets (8) 7,261.81 APPROVED DEDUCTIONS AND EXEMPTIONS: 4,375.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses [Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) [10) 56.398.95 11. Total Deductions (11) b0.773.95 53,512.14- 12. Net Value of Tax Return (12) 00 13. Cheri#able/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . t t T t t (i4) 53, 512.14- 14. o ax e Subjec Net Value of Es a NOTE: 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: 00 00 .00 15. Amount of Line 14 at Spousal rate (15) . = X 16. Amount of Line 14 taxable at Lineal/Class A rate (16) •UO X 045 . .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Coll~terallClass B rate (18) .00 X 15 .00 19. A Principal Tax Due r1.T Tl.. (19). .00 + AMOUNT P112D DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE: .00 * IF PAID AFTER DATE INDICATED, 5EE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class 8 [collateral) beneficiaries of the decadent after the expiration of any estate far life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B [collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13137. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount ar interest) as shown on this Notice must object within sixty (6D) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Bcard of Appeals, Dapt. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal tc the Orphans' Ccurt. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (7171 787-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (37 calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the sane manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1l day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will hear interest at a rate which will vary from calendar year tc calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 Il% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (157 days beyond the date of the assessment. If payment is made after the interest computation date shown on the 1'~±;. Notice, additional interest must be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 12/01/2004 STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 RE: Estate of LAUTSBAUGH RICHARD K File Number: 2002-00115 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in t]ze above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedent: 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 z~dministration. This filing will become delinquent on: 1/08/?005 Your prompt attention to this matter will be ~ippreciated. Thank You. Sincerely, GLENDA FARMER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge y.; v; STATUS REPORT UNDER RULE 6.12 Jame of Decedent: Richard K. Lautsbaugh Date of Death: January 8, 2002 Will No. 21-02-0115 To the Register: 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 No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: approximately six months 3. If the answer to No. 1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes No (b) The separate Orphans' Court No. (if any) for the personal representative's account is: N/A (c) Did the personal representative state an account informally to the parties in interest? Ye s__ 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 : ~ Z~~ ~ "~`1 David `tone,- Esquire 414 Bridge `'~treet New Cumberland PA 17070 Geri u~ ~, 717-774-7435 r r...i e ;- _-- ,~ ,~a Capacity: Personal Representative „ ,__;=; ~ ~~ ~. X Counsel for Personal ~.~; ~~' `=-~~~ ~ ~. ~ Representative v ~~ ~ _.c° ~ T L STATUS REPORT UNDER RULE 6.12 Name of Decedent: Richard K. Lautsbaugh Date of Death: January 8, 2002 Will No. 21-02-0115 To the Register: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state th.e following: (a) Did the personal representative file a final account with the Court? Yes No X (b) The separate Orphans' Court No. (if any) for the personal representative's account is: N/A (c) Did the personal representative state an account informally to the parties in interest? Yes X 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 be attac e to this report. Date : /U j Z-~~' David S e;l,, Esquire ~-~ 414 Bridge Street New Cumberland, PA 17070 - 717-774-7435 .- Capacity: Personal Representative X Counsel for Personal Representative I, est\rel\lautsbaughwendy IN RE: ESTATE OF RICHARD K. LAUTS-: IN THE COURT OF COMMON PLEAS OF BAUGH, LATE OF MIDDLESEX CUMBERLAND COUNTY, PENNSYLVANIA TOWNSHIP, CUMBERLAND ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA N0. 21-02--0115 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, WEI~'DY MAE DUNLEVY, being one of the beneficiaries under the will of RICHARD K. LAUTSBAUGH, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RICHARD K. LAUTSBAUGH, in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally :bound, that I hereby waive my right to require the filing of a First ,end Final Account and Proposed Schedule of Distribution in any Court o:E Common Pleas having jurisdiction over the same, and I acknowledge th~~t I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had keen filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, WENDY MAE DUNLEVY, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and assigns, from the acts of the Executrix as said, and of and from all actions, suits, payments, accounts, reckon- ings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, ar.~d I do hereby consent to the discharge of the said Executrix. IN W~TDTE3S~WHEREOF, I have hereunto set my hand and seal the day o f~~-'~_.C~t~~C,~ ~-' 2 0 0 5. ,~ ~ ~ ,i i, (~ I \~r ~W triess,~ WENDY MAE ,_UNLEVY ' COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF CUMBERLAND On this, the ~~r~' day of - 2005, before ~ _. me a Notary Public, the undersigned officer, per:>onally appeared WENDY MAE DUNLEVY, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument. and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. ,~ CUMMONWEALFH OF PENNSYLVANIA ~f NOTARIAL SEAL Notary Public DANIEL M. HARTMAN, Notary Public New Cumberland Boro., Cu~,~berland Co. My Commission Expires Jan. 21, 2009 -2 est\rel\lautsbaughpat IN RE: ESTATE OF RICHARD K. LAUTS-: IN THE COURT OF COMMON PLEAS OF BAUGH, LATE OF MIDDLESEX CUMBERLAND COUNTY, PENNSYLVANIA TOWNSHIP, CUMBERLAND ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA N0. 21-02~-0115 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, PA~I'RICIA ANN BAIM, being one of the beneficiaries under the will of RICHARD K. LAUTSBAUGH, do hereby acknowledge that I have received all sum: of money and property due me by virtue of the death of RICHARD K. LAU~CSBAUGH, in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge treat I have had an opportunity to examine copies of the books and z~ecords of the said estate, and I agree to the final distribution of- the estate without further formalities, and with the same force anti effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, PATRICIA ANN BAIM, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and assigns, from the acts of the Executrix as aforesaid, and of and from all actions, suits, ~?ayments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. IN WITNESS WHEREOF, day o f ~~~~ ~i-~ v'. ~~~~ I have hereunto set my hand and seal the 2005. Witness COMMONWEALTH OF PENNSYLVANIA: / • SS. COUNTY OF <~'~ ~'~`-~ ~/ ~- R. ~,'~-Le.~~ (~ ~~~: -rte ~ c,~-z tiy~ PATRICIA ANN BAIM On this, the ~, l~., day of ( ~ ±~~~ 2005, before me a Notary Public, the undersigned officer, personally appeared PATRICIA ANN BAIM, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within ir..strument and acknowl- edged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. ~_. r. Notary Public CcxSUncmweal#h of Pa~lvania NOTAL S~~eL. F"A~TTIyf"c1 ~JCIT~, ~~i~ll b[y C~ ~~ 10, 2~ -2- est\rel\lautsbaughwarrer. IN RE: ESTATE OF RICHARD K. LAUTS-: IN THE COtJRT OF COMMON PLEAS OF BAUGH, LATE OF MIDDLESEX CUMBERLAND COUNTY, PENNSYLVANIA TOWNSHIP, CUMBERLAND ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA N0. 21-02--0115 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, WARREN TODD LAUTSBAUGH, being one of the beneficiaries under the will of RICHARD K. LAUTSBAUGH, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RICHARD K. LAUTSBAUGH, in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally ~~ound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of- Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had b~=en filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, WARREN TODD LAUTSBAUGH, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and assigns, from the acts of the Executrix as aforesaid, and of and from all actions, suits, ~>ayments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. IN WITNESS WHEREOF, I have hereunto set my hand and seal the "~ day o f ~`~~~ °""~-' 2 0 0 5. ;' ~ .. ; ri ~ { ~ _...... Plj '" / Witne'ss' 1 ~~ WARREN TODD LAUTSBAUGH COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF CUMBERLAND On this, the day of ~/~1 2005, before me a Notary Public, the undersigned officer, personally appeared WARREN TODD LAUTSBAUGH, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my h~~nd and seal the day and year first above written. Notary ublic IVOTARIAL SEAL _ 2 _ LOUIS .,f, LORE, Notary Public Camp Hill Boro, Cumbe~iand County MY Commission Expires Apri114, 2007 est\rel\lautsbaughluann IN RE: ESTATE OF RICHARD K. LAUTS-: IN THE COURT OF COMMON PLEAS OF BAUGH, LATE OF MIDDLESEX CUMBERLAND COUNTY, PENNSYLVANIA TOWNSHIP, CUMBERLAND ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA NO. 21-02--0115 RECEIPT, RELEASE AND_WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, Warren Todd Lautsbaugh, Executor of the LUANN MARIE SMITH ESTATE, being one of the beneficia- ries under the will of RICHARD K. LAUTSBAUGH, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RICHARD K. LAUTSBAUGH, in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally round, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had b~=en filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, Warren Todd Lautsbaugh, ExF~cutor of the LUANN MARIE SMITH ESTATE, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and as- signs, from the acts of the Executrix as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or. any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. ~7 ~ IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of ~~~~y~' , 2005. ~, ;, ', ~ tjjj....~,.,//_/~~// // ~~ (~ f - Witness j Warren Todd Lautsba~- Executor of the LUANN P~IARIE SMITH ESTATE COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF CUMBERLAND Q~~ (x~ On this, the O day of V ~ ~ ~-Q~_ 2005, before me a Notary Public, the undersigned officer, personally appeared Warren Todd Lautsbaugh, Executor of the LUANN MARIE SMITH ESTATE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the wWltf]1I1 instrurnent and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. ti Notary is _ 2 _ IUOTARlAL SEAL LOUIS J. LOF~E, Notary Public Camp Hill Boro, Cur--berland County My Commission Expires April ~4 2a07