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Home My WebLink About02-0401 PETITION FO~R09MTE and GRANT OF LETTERS W "'/111 O;}.. Estate of Ro8el?T EfI-tIHf. cL No. 2/-02.- !.JOt also known as To: Register of Wills for the County of C II m P>6I2LA-^-<.n in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Deceased. Social Security No. 4/ / - / (J - ~ ~ 0 / Your petitioner(s), who is/are 18 years of age or older an the execut.ll XX: in the last will of the above decedent, dated ~.<:: AP,c:XL ~ and codicil(s) dated ,s/II- named , 19-4.L (state relevant circumstances, e.g. renunciation, death of executor, etc.) Oecendent was domiciled at death in C.HI?! ~er.<. L}\ ~ ,,., ~<, last familyr'l: principal residence at ~ IbRA(l-f:'€~ _ . l/,t.m /lJrlfA)'W 1'7 C> 51) (list street, number and muncipality) County, Pennsylvania. with ('BiLl< r (1Yl6fl1iA .Jr('~P,lhf.(j, / Oecendent, then <t 7 years of age, died .~ A p{l.J: L ,-1'9- ,;; i)()0{... at NIQ.F<T f'JtR~ I!-€ALrtt UNrEel? ~(jlWAllvU.T ;a"Tf7)/lI /{b CARL.rSLc PA- /70.13 Except as follows, decedent did not marry, "';as not divorced and did not liave 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: ;.)/.+ . Oecendent 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: R G<,Zbto ^)Cp< :r AJ tI1D A not/. PARk. I',(';,M'H J;R, I A-B~Rj)6tc .u . $ 3/)'00.O(? $ $ $ 11?"i,MlO.OO 1 tr~'l' ,")0 .DO Il1h ' ~/()OL WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TesT A mI'00'rA" y (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron, , .". u " u :g3 U" "'u " -00 C",C ~.;:: -" ~o.. u~ !5 0 ; o '" C;; iJLL..Ic R6t!d.rr.A F'LLr<:: 1(1 .BRA-OXeN fl.DIlRT mEr.JUI\J.I.C'.s su ;:6-1 '* 17rlq) ~lfJ, ~~-- C l I.a.~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA) ss COUNTY OF (',U rv>P.l"-c/:2LAAI^ J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~Qk. K~ ~~~ ~ LLJ:e C 6('/, LLI;S~' '" - " ~ ~ affirmed and 18th 2002 subscribed day of .J Register ''l-58-Q No. 2/-01-401 Estate of ROBERT E ELLIS , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW APRIL 22, 2002 iSbL....-. 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 d:/S;- jf.P>lrL 190/ described therein be admitted to probate and filed of record as the last will of ROBERT E ELLIS and Letters T6.sT~ll1e.vIAi2 V are hereby granted to (') L Lr E RB.[!,c,eCA 6LLI:5 ~"'JILc."j)m{h~ y C _~e~ister of willi 0 FEES Probate. Letters. Etc. ......... $ 235.00 Short Certificates( ).......... $ g nn ~ extra. pages. .. $ 3.00 jcp $ 5.00 TOTAL _ $ 252.00 Filed ~.-.22,.2.o.Q2........................ mailed to atty on 4-22-02 AITORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ~r :=-~,.... " d '" \3:; J REGISTER OF WILLS OF COUNTY OA TH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the request of testat_ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) ~ :. ,,~\ Register ,..., c..,_ (Name) C() (Address) ~ ~- "" "I ~.::J ~ :~ '":;;~ REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS 21-02-401 illY? OTtt Y A- . D e..L t> flJ'/tf A,V')) .J,4 v'A tJ trI. Del-OitCf{ (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that We A-~6 familiar with the signature of Rop,(';(i(.'(' C. 6tLZS co~, testat~ of (one of the subscribing witnesses to) the ~ presented herewith and ~icil that We. believes the signature on th~is in the handwriting of Ii f)6 6<2 T to the best of E. ELI rc;: /) U.e knowledge and belief. Sworn to or affirmed and subscribed before (["on(l.fJ~ A [:)p .A,,8tJ'..f'J-J ~"; 0,,;." "'~. :::~ cr. 1i(~am~;:uo:, fJA- 170g"O y gilTA'> ,/I-iL~ I ( ress Register A ~ (Name) (,~r~r b C+ f1tf'(4 &" I(<;~""J fA 11oso f J (Address) "c_v"""" "'(',;'s',s "C' c('r6~v ~,l~lf r;lC in;:ormation ~lere given is correctly ] 1 I, j I ("I.ol'r"ll u'rtiJ1cJre will he tonvarch:d to ,()~;l "q~~iSI far. ~ le,~ .. copied from an original certificate of death duly filed with the Statl' Vital Records Office for permanent filing. me as WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~fiii7i;;;;;c ",<r~\.\~ Qf f?;;---_ ",~,-/-~ ~,"(4:-'- l~ _ -0~ N~~r. ~~(.:.\ [:Fii. .~ . \~~ ~ 5L.f/r ii>~ IL.._. y*/ ~,,<@~> /A'>",' -;:c~ /~" ";.";._..::r-9"-~-----/~~'rl' '-.-_ IMfNT ~\ """, ~"""~/NN#/'JIIJ';' /1 :1:> .~ Fc< for this ccrrilIGHc, $2.00 >;'......'::.-. ~ (. P 8205080 APR 0 5 2002 Date 15.T43Aav.21117 COMMONWEALTH O~ PENNSYLVANIA" OEPARTMENT Of HEALTH" VITAL RECORDS CERTIFICATE OF DEATH 87 v.... .. COUNTYOf'DEJO"H UNQEl'llDAY HQI.n! MinIoIM .. CITY. ilOFIO. TWP Of OE~TH OATEOF'B1ATH \Uo<1\t\.OiI'I:.'''-'l ." .,Mate STATE FIlE NIJMBEfI SOCIA,~SECURlfYNUMBfR Oi\TEOFDEATH~,o..~,'<'u.ll NAME OF DECEOENT(FirSl. Mid<1l8. L..../ ,. RobVtt E. EU.i..6 AGE(Last6irl!\dll~ \JNDfFll"I'EAA MC)IIIIw Dlya '.411 -10 - 2361 . 4-3-2002 3-10-15 P'I..A(;€ OF OE.4K !Cl>IlC~ oN)i Dna .... ,n"''''CltfJtle on """'" ..Oft) HOSPITAl.., Inpal..,lO =,tylO ... CumbVt.(and Caft.(.i..6te ... DEceOENT'SUSUAL~ (~ngolC:O~::~:r SURVIVING SPOUSE \"......,il"""m_~") ". 6 /l!tacken COUlt./: ... Mechan-ic-6bUlt . PA mHER'$NAME If..., Moddle. 'i'oM ... W.t.eey M. E~t.i..6 ~''''''IJ!e~R:''"El.(.i..6 17..S~ PA Hnmnt:t)J1 "" 17050 m. "" - .... Cumbel/.land towllll>ip? Irill ~~":::<A MOTHER'S N"'ME iF..., Middle. M.OCleOSuttliWf1e) II. Louvine.a. WinegM INFQlUMNrS lU.1UfiG "'OOAESS l$lNOlI. Cilyfli>wn. ~Ie. Z-Ij) yOde) ,... 6 /l!tac~en COUltt, Mec.MMC-6bUltg, PA 17050 PlACE OFOIsPO$ITlQH. Nlm. lltC.mtIl1ry. C"malDty LOCAfION.-~ 131__. Z"IIICod1 0I0th1l~ C1l.emau.on Soc.iety 06 A_.."JrOIf\SIII.O .., JOO;,r ~_J'...J P ECDEAD IMonltl. Day, ~) ". .2 ' ~, . .11,"~, L. .3 ,). 00 ;}... :U.H.RTl: Em...n..~.jIljUl""OIcon\Plic'liot'\a"hic:hClU$ld1l>lclellh_ Oonot"'I"lM_oldying.SUCh'~CllldW:0I"'$Ili1'"i>IOt)Ia"lt$l.lihOC~Dfl'HlaI'111~"'-' lillonlyD/lacaUlltlnHC/IH.... . ~V~~..,....t- DUE ro lOR AS A CONSEQUENCE 0Fl: ~ , DUE 10 (00 AS '" CONSEQUENCE Of\: ,. CUE Ta(OO AS"'CONSEOUENCE OF): ,. WEAE "'UTOPSV FINOlNGS ...........""""ro COt.lPlETlON OF c.wSE OFO'"'''' MA/IINEROFDE"'TH .-- cr-- o o OIITEOF INJUR'" IMOtllh,Oay,_l TIr.lEOF INJURV IHJUR... AT WORK? ~HONItUUfIYOC;ClJfIRED. Homic~ o o o PUlCfOFINJUR........lhQ",.,llllm.Ill....lloCI<>rt.t>llIc:. M. b\l1hfin,g...~.lSp8C"yl ... _0 ",0 ....0 ...lY - """'" P.ndi"liJln"'lligaIlOll SKllNMU <. Could"",Wdll.,."inlKl .... 28b. QRTII'JER(ChlCl<onIyone) .CEIITJF'(lNG.PMY-SIC\AN\~(;e(llIy<ogc;luseold8alh_anOl/le/phySIClanha~ptonCMJ""e<l<lealhan<l~anpjele<l11""'23I Tolhe_IOfIll'k~.d..th_....-.ad...loth.~....-<.I.nd.............at.WQ.. ... '''I'lOHOUNCIHQ "'NO CERTIFYING PttYSlCloUI tl'h"""'>Dil borh O'oni>UflClng oeal/l and Ce<1jly"'9 10 cau... 01 oe;utll TOll\lbNIOI...'kl'lOw~.d..IhO<;~..tred.llh1l1m.. ..1...ndp'K.,.ncId...lolh.c'""...:.\arot........... "Wlat..... 031. LICEN UMBER o 31C.tJS'VO) 31d ;:J N"'ME .-NO omoP-ESSQf' I'EflS9.NWHOC~PleTEDc.wSE (l1em27)TypeOlPnnl.j. //~gp,.d..> IbJ .1'.N/t:./~ /l/ttWVIe-L/ ". OATE FIl.EO (MC>l<l!\,O'f't \'<lal~ ,,~S'J ~OO~ /,,,, /n y 'MEDICAL EXAMINER/COAONlSR Ontt.. b..~ol.>I-.nln.1l0n .ndlorln"a.sllgatlon. In my opinion. du'" occurr.d a'lhe 11m., da'., lUldplace. &nd clualo lhe C.UII(')'nd m.nn.'....l.ted.. ". o ReGnAR.SSIGI<lAT~I<l~ ~/~ ,/'/C ,. ~Lc./;(r~ J2.-- . _/.-L l7l11 PlI /1/ I II :I II I ~iILL ..2/-0:;L - 401 I, ROBERT E. ELLI3, of Harford County, State of Maryland, do hereby make, publish and declare this to be my last will and testament hereby revoking all other wills or codicils heretofore by me made. After payment of all of my just debts and funeral expenses, I hereby give, devise and bequeath all of my property of whatever description, whether real, personal or mixed, wherever situate, unto my wife, Ollie Rebecca Ellis, absolutely. I hereby appoint my said wife, Ollie Rebecca Ellis, executrix of this my last will and testament and request that she be excused from the necessity of giving bond as executrix. If my said wife predeceases me I then give, devise and bequeath all of my said property, after the aforesaid debts and expenses are paid unto such of my children as shall survive me, share and share alike, and to the children or descendants of any deceased child of mine, who shall take their parent's share of my said estate per stirpes and not per capita. And further, if my said wife predeceases me,I hereby appoint my daughter, Dorothy Ellis DeLoach, my son, Robert Earl Ellis, Jr. and my daughter, Betty Jo Ellis, executors of this my last will and testament and request that they be excused from the necessity of giving bond AS WITNESS my hand and as said execu~~. seal this c-~~ day of April, 1961. rJ1~f!,f./.. ~ ~ Robert E. Ellis (SEAL) I' Signed, sealed, published and declared by the above named testator as and for his last will and testament, in the presence of us, who at his request, in his presence, and the presence of each other, have hereunto subscribed our names as witnesses. AfPtUL/~~~ ~ z2m ' 'M_>> j, ~L-.JP-~/-L (,-. ( " ,~,-', l:l.:::: ~-~ ".. :'J P ....-, ,'~ ~ ::0 m ~ f: 0 ~ ~ ~ tr! ~ " 0 "1l [ocJ ~ ~ ~ l> ::0 ~ z C 0 .z '" ,.. >-3 "'.1 H ~ ~ n tz:I t-< ~ ~ ;0 ~ . ~ , 0 t-< r r Z ~ ~ Z tz:I ~ ~ t-< " t-< H en ~ < . . ""._110 PltINTU,. eo "111I11I"" II.AD "'I" ......1:).... A"D .Ia. ...111. NO , -, -.. J~ rY/ RV6~JI OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVAN[A DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ 1-Sf - 02. __.fILL FILE NUMBER dl COUNTYtoDE W\R NUMBER DECEDENT'S NAMt: (LAST, rIRST, AND MIDDLE INITIAL) Ell~s Robert E. DA"'I'!: OF DEA TH (MtJI~DD-YEAR) DATE OF BIRTH (rvlM-D8-YEAR) SOCIAL SECURITY NUMBER 411-10-236:1. THIS RETURN MUST BE FILED IN DUPL.ICATE WlTH THE to- Z W C w 1d c 0?-" 11)') 1_1 --; q - (IF A~PLlCABLE)SURVIVING SPOUSE'S NAME (LAST, FIRST, AI\JD MIDDLE INiTIAL) REGISTER OF WILLS SOCIAL SECURITY NUMBER '-'0.'-' 4. Limited Estate 43. Future Interest Compromise (date of death after 12-12-82) 5. ederal Estate Tax atum squire "'00 [KJ- D L 8. Total Number of Safe Deposit Boxes "'",oJ Deceden~ Died Testate (Atta[;h copy ofWiil) 7. Decedent Maintainec a living Trust (Attach copy of Trust) '-'0.<Xl - o. 0. Ds. L iligation Proceeds Receive:! D 10. Spousal PO\.13rty Credit (d81eofdeathbetween12.31'918rK11.'.95ID 11. Election to tax under Sec. 9113{A) (Attooh Soh 0: .., TH[S BECTlON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ... N..u.hIE COMPLETE MAILING ADDRESS z w 0 DC"o:.t V A, Je ~ c\a:::::', Z 0 FIRM NAME (If Applicable) "- '" w 6 Pracken 0: Court 0: 0 TELEPHDNE NJr\.~8ER L\1echanicsburg, Pi, 1:050-2374 '-' ! 71:-697-=.533 D2 D Supplemental Rerum 228-01-4019 D 3. Remainder Return (date of deClth prior to 12-13-E2) DF R R El1~s Ollie ~ I [K] 1. Original Return ,,~~ D ,\\T. 1. Rea: Estate (SChedule A) (~ ) 1'J 0:"'1 e 2 Stocks and Bonds ISche:Jule B) (2) Closely Held CorporatiDTl, Partnership or Sole-Proprietorship (3) n'J:-:e 4 tv':O'1gages & Notes Receivable (Schedule 0) (4) NC-jE 5. Casll, Bank Deposits & Miscellaneous Pe;sonal Property Non:: (Schedule E;. (5) Z 6. Jointly Owned Property (Schedule F) [6) None 0 D Separate Billing Requested i= :5 ,. Inter-Vivos Transfers & Miscellaneous N:m-Pro!:late Property (7) l\lor.:e ~ (Schedule G or L) a:: 8 Total Gross Assets (total lines 1-7) <C U W 9. Funeral Expenses & Administrative Costs (Schedule H) [81 lr 10. Debts of Decedent, Mortgage Liabilities, & liens (S~hedLJle I) (10) OFFICIAL USE ONLY 3,500- C r',,-, c ~' (8) 3,500 1,175 486 1 i. Tota! Deductions (total Lines 9 & 10) [11) 1,661 1, 839 I 1"2. 13 i , i14 I ts!'15. ;:: CC 16. >- ~ 117 '-' >< .., ... Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Beouests/Sec P113 Tr.Jsls for W'hich an election to tax has not been made (Sc~eduje J) . [12) (13) None Net Value Subject to Tax (Line 12 minus Une 13) [14) 1,839 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line ~4 taxable at the spousal tax rate, o~ transfers under Sec. 9116 (a)(1.2) 1,839 x.D ~\15) 0 '.0 '~(16) 0 x.12 (17) 0 .J x.15 (18) (1S1 ~ Amount of Line 1'; taxable at lineal rate o Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at coliateral rate 19. Tax Due o 128. o CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMEN > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < ~W46'::5 ''JOO Decedent's Complete Address: STREET ADDRESS 6 Bracken Court . CITY I STATE I ZIP Mechanicsbura PA .17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o o o o Tota[ Credits (A + 8 + C) (2) 3. Interest/Pena[ty if applicab[e D. Interest E. Penalty o o Tota[ [nterest!Pena~y (0 + E) (3) n 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Une 2, enter the diffe~ence. This is the TAX DUE. (5) o A. Enter the interest on the tax due. (SA) o B. =:nter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (58) (I PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and" a. retain the use or incc..me of the property transferred;. . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; .... retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [L] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE BCHEDULE G AND FILE IT I>S PART OF THE RETURN. Under penalties of perjury, I deClare that I have examined this return, Including accompanying schedules ami statements. and tothe best of my knowle::lge and belief it is true, correct and complete. Declaration of preparer other than tne persona; representative is based or. all information of which preparer has any knowiedge Yes D D D D ID IRJ IRJ IRJ No IKJ IZJ IF IP <-- '/iP- ( I SIGNATURE OF PE5?O,t-l RESPO)'J~I~LE F~ FILING RETURN ./ C{}([W, l{)\ \9 ~ ADDRESS csbu= , FA :7050 ]: ENTA TIVE AOORESS 5006 E. !rindle Road, Sui~e 20~f Mechanicsburc, FA 17050 Fo~ dates of death on or after Julv 1, 1 99~ and before January 1, 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the surviving SDouse is 3% [72P.S'S9916 (a) (1.1) (il]. . For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfer.: to or for the use of the surviving spouse is 0% 172 P.S. S 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the 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 tlNenty.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. S 9116(a)(1.2)). The tax rate imposed on tile net value of transfers to o~forthe use of the dece<lent's lineal beneficiaries is 4.5%, except as noted in 72 P.S, S 91 16(1.2) [72 P.S. S 9115(a)(1)). The tax rate imposed on the ne: value oft:-ansfers to or for the use of the decedent's siblings is 12% (72 P.S. S 9116(a)(1.3)]. A sibling is defined. under Section 9102, as an individual who has at least one parent in common with the decedent whether by blood or adoption 1W4546 i.OOO W I 1 L ~, ROBERT E. ELLIS, of Harford County, State of Maryland, do hereby make, publish and declare this to be my last will and testament hereby revoking all other wills or codicils heretofore by me made. After payment of all of my just debts and funeral expenses, I hereby give, devise and bequeath all of my property of whatever description, whether real, personal or mixed, wherever situate, unto my wife, Ollie Rebecca Ellis, absolutely. I hereby appoint my said wife, Ollie Rebecca Ellis, executrix of this my last will and testament and request that she be excused from the necessity of giving bond as executrix. 7~ my said wi:e predeceases mQ I then give, devise and bequeath all of my said property, after the aforesaid debts and expenses are paid unto such of lliY children as shall survive me, share and share alike, and to the children or descendants of any deceased child of mine, who shall take their parent '.,$_ share of my said estate per stirpes and not per capita. And further, if my said wife predeceases ma,I hereby appoint my daughter, Dorothy Ellis DeLoach, my son, Robert Earl Ellis, Jr. and my daughter, Betty Jo Ellis, executcrs of this my last will and testament and request that they be excused from the necessity of giving bond AS WITNESS my hand and as said execu~~. seal this 6?~day of April, 1961. C!f'~ ~ ~ Robert E. Ellis (SEAL) Signed, sealed, published and declared by the above named testator as and for his last will and testament, in the presence of us, who at his request, in his presence, and the presence of each other, have hereunto subscribed our names as witnesses. A,pw.J~1c ~~v~_~~ /P~Lp~'#~~"--L REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Robert Ellis All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Un~~ed St2":€S Savings Bonds - Series HE 3,50D Note: all cf the remaining assets were ow~ed jointly with righ~ of survivcrshi:;:.:, h'lth the deced"2n":' s survi.\.Tinq speus;:;. TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) ~, 50C: 1W46961.0DO REV-1511 EX" (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Rotert Ellis FILE NUMBER Debts of decedent must be re orted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: ,. Cremc.tiQn 975 B. I I I ADMINISTRATIVE COSTS: I Personal Representative's Commissions ,. Name of Personal Representative(s) Socia! Securit}' Number(s) i EIN Number of Personal Representative{s) Street Address City State Zip Year{s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5 Accountant's Fees 200 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 1, 175 (If more space is needed insert additional sheets of same size) 1W4cAG I.ooc' REV.1512 EX.. (H;7) COMMONVVEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robert Elli.::: SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical eXDenses. ITEM NUMBER DESCRIPTION AMOUNT ,. 2. Decedent's outstandirlg medical bills at date of death Decedent's final bill d~e nursin~ ho~e 8 478 TOTAL (Also enter on line 10, Recapitulation) $ 486 (If more space is needed, insert additional sheets of the same size) 1W46AH"i,OOO FOREST PARK HEALTH CENTER 700 WALNUT BOTTOM ROAD CARLISLE PA 17013-3699 ACCOUNTS RECEIVABLE STATEMENT Statement Date: 04130/2002 Balance Due: 477.78 ROBERT ELLIS clo J M DELOACH 6 BRACKEN COURT MECHANICS BURG PA 17050 Account Number: 22090 Balance Forward: fth "iJ~~>j -, ,"J.r-;;:,~ 477.78 FOREST PARK HEALTH CENTER: ROBERT ELLIS 22090 REV-1513 CX+ (9-00) COMMONWEALTH OF PENNSYLVANI,'l., INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rober+- ..-:11 is SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER I. NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec, 9116 (a) (1.2)J RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1. O::~e w. Ellis - sole beneficiary Spouse 1 ,..,...,-. '"-,a:)'::) II. I , , I I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE 01, LINES 15 THK~UGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET I NON-TAXABLE DISTRIBUTIONS, A SPOUSAL DISTRIBUTIONS UNDER SECTION 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 DISTRIBUTIONS ON LlI,E 13 OF REV.1500 COVER SHEET $ 1W4€AI2.00:J (If more space is needed, insert additional sheets of the same size) \,. / ?-s:?- ? BUREAU OF INOIVIOUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR OISALLOWANCE OF OEOUCTIONS ANO ASSESSHENT OF TAX DOROTHY A DELOACH 6 BRACKEN CT MECHANICSBURG .IL 1 C) i' :\1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-05-2002 ELLIS 04-03-2002 21 02-0401 CUMBERLAND 101 Allount Rellitt.d PA '.17050 I, ',: *' REV-1541EXAFPCG1_GZJ ROBERT E 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 ... REV=isW-Eif-AFP-[oFozrNOY-iCE--OF-YNHEiiii'AiiCE-YAX-APPRjriSEMENT~--AL1-owAijcE-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ELLIS ROBERT E FILE NO. 21 02-0401 ACN 101 DATE 08-05-2002 TAX RETURN WAS: (X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedul. A) 2. Stocks and Bonds (Schedul. B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgeg.s/Notes R.ceivable (Schedule OJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedul. f) 7. Transfers {Schedule GJ 8. Total Assets III (21 131 (41 (51 (61 (71 .00 3,500.00 .00 .00 .00 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedul. H) 10. Debts/Mortgage Liabilities/Liens {Schedule Il 11. Total Deductions 12. N.t Velue of Tax Return 13. Charitable/Govern..ntal Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subj.ct to Tax (91 1101 1,175.00 486.00 1111 1121 1131 1141 NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ~ ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rat. (16) 17. Amount of Line 14 at Sibling rat. (17) 18. Allount of line 14 taxabl. at Collateral/Class Brat. (18) 19. Principal Tax Due X C TS: NOTE: To insur. proper credit to your account I subllit the upper portion of this forll with your t.x paYllent. 3,500.00 1 661 nn 1,839.00 .00 1,839.00 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. 1,839.00 X 00 = .00 X 045 = .00xI2= .00 X 15 = 1191= DATE AHOUNT PAID NUMBER INTEREST/PEN PAID [-I TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ,00 .00 .00 .00 .00 .00 .00 .00 .00 1 IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I . ! -. CERTIFICATION OF NOTICE (INDER RilLE 5.6Ial Name of Decedent: K0P!E- I< I E. L LIs ~ ,- Date of Death; -3 1/ P I<. ~ J.. d... 0 o~ Will No. ':U)();2 - 00 4 0/ Admin, No, To the Register; I certify """ noIice of (benefIclaIlDterat) ..late admini......lion required by Rule 5.6(a) of the OTphans' Coun Rules was served on or mailed to the following beneficiaries of the above-captioned ..tate on 0"7 J.y / cJ .J. _...; , , ~ AddreS!i ()L.Lz 6. R. €.U-I'S &, BRAC,t:.GtJ rr-, (f/eCJI,.f~~1i:.I7()~7) Notice has now been given to all persons entitled thereto under Rule 5,6(0) ",ccpt Date; /'-1 Au (;./,1-<.7' ,,).,f)Oc:1... . C-/1i1.~, ONW ;e l'J__ ~ Signature Name {')LL~6 R... F.. L-t..,Ic, Address (0 13;< A- C'.k c A.J CnulZI J1Jc. ell If f\J res 8 1.J.../((.1' Pit) 1056 , Telephone (1/1) &'41- :')/,33 Capacity: L Personal Representative _Counsel for personal repre::;entative ,1 CERTIFICATION OF NOTICE UNDER RULE 5,6(a) Name of Decedent: Kn~ R I /~ ~ cLLL~ Date of Death; -5 1/ PI<;: L ~oo~ Will No. ;)()O;2 - 00 q 0/ Admin. No. To the Register; I certify that notice of (beneficial interest) estate administration 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 07,/ /<f / G ,.2 ; Name Address ()L.Lr fi. R E:.U-I S &, 13 R Ii c,t., 6;.J cr;, rrleCJ/ A- J:]::"{':;Af./J<h; f)-/lOb 6 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date; /'-1 Au (YIL<,T' o1.{)Oc:2..- o&W /G~..~ r:~ Signature ~ .' Name (}LL.J:.6 R.., f:. LLIe:, Address (0 13;< A- ct: {3 N .1llE ell If tJ res {3 IJ.j( ("1' , CD u.I? T PA- ) 7{J5Q Telephone (1/1) .fe!:L1- :''), LJ3 3 Capacity: L Personal Representative _Counsel for personal representative C/v STATUS REPORT UNDER RULE 6.12 Name of Decedent: IDBRR'T' R RU, T~ Date of Death: 41110:;> Will No. 21-2002-401 Admin. No. 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 V No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b, The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ,/, No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: /]) cSEI?I dr:t;p- ([)~ ;e~~ x. S~gnat.ure o J-. L-.I:E.. A, f=) / r. S Name (Please type or print) (.p ;?; R. A- Ck:.6 N ('A-: me ctf A-AJr. ~6u.K& Address Pit 170[;,-0 ' J 11/11 (p C?7- /-,- 533 Te I. No. Capacity: x Personal Representative Counsel for personal representative (MAH: rmf/ AM3)