HomeMy WebLinkAbout04-1098
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of J;~,.; H. s~ y J~v; 'J' y-
also known as
No.
To:
J\ - 04 - \OCi8
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
_ j)eceased.
Social Security No. J 6" '" - Cf7 - iJ.S I a
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appll Q4
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in C........ b,..,.. L",...,I <;:opnty, Pennsylvania. with
h .8 last family or principal residence atS.. " T.c14 ,.,. 41 M.I"I!!!,,;- ljb IN:;J .
(list street, number and municipality)
years of age, di d
~<ln~
. "a..<<l(
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
J DOC. b <!l
I
$
$
$
$
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C"">4.1o...,.4~-I
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well an
truly administer the estate according to law. f \~ r;
Sworn to or affirme~ and subscribed ....
before me this _ 2 ~daY f
NOVEIYIBER ~ ~
'fJ.u lClCl..F<UJ\...U ~ I
'-fMVrvl~U.ll.c...L~ Register l
No. .;Li - 04- - 10'/8
~).... H. $"'1 JQy J .:J,
Estate of
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<Ii
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
~o05
-- .,
1I -, , in consideration of the petition on
presented before me,
.0.--
to
are hereby granted to ::J"I..,.; H. ~""1..l.,.., :rrr
in the estate of 'J"" oi,. /.) H- $11111 J tyo ~ \.J .....
~1 Dj/JdcrfD.u~cu1
J -~ Register of Wills pL1 V rn
Letters of Administ:a~~~ ..... $ I Z. 00
Short Certificates(3) . . . . . . . . .. $~
~:Clatlon ......~~~
'-L.AJND TOTAL _ $ 15 f) 0 -.
Filed .. .... ... .... ... ..... A.D. l~_.
0~.UD
::- -
-~
~\>GF-~ f:\, &.J-v -tt:/S'f(p(..
ATTORNEY (Sup. Ct. J.D. No.)
Sr:t<O 'y.J. cJ....CJ:)L+.~ 1\'lJQ, 8~)..,oJl.f fl
ADDRESS J'l>~
"11 ~-S8'3-~1
PHONE
RENUNCIA nON
.:ll- 04 - I cqS
In Re Estate of
-JO '" JJ
H, 5 llJ'f Jel""'a ;j V-
deceased.
To the Register of Wills of c.... M be-,. LA.t.lJ
The undersigned TCleLJ b.. 5 N V d t.r + po.., III /J
County, Pennsylvania.
C."',LJ~N
K. KQ.\O,o....hQV"A. of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of 1\01 ""1 N I ,,+t-A.+, D''f\J
be issued to J" C) ~ ~ H , .$ N'1 d.(! r 7II.
WITNESS
01.lY'
han~ this gc;
day of tltlU/
.20~.
~~,~
Tool ~ s.:ignatur;5 tJ V d Qv"
p", Box (,6
P-;; /;., PA I t5> " 7 i!)
) (Address)
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A t,...LSignat~ l
"'AI A. f,Qt""'C./"IQy"
~~~
/c;3c,,_)~ 1R ~ao...-,
X. (Address) .... 7. /
a~ ~ V&<.- ~ 0 / l=-
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(Signature)
(Address)
Thi\ i\ 10 certify" that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate ,^'ill he fOr\vardcd ~n th(: Stale Vital Rcc(wds Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, S2.00
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COMMONWEALTH OF PENNSYLVANIA' DEf'ARTMENT OF HEALTH' VITAL RECORDS
TYPf/PRlNT
"
PERMANENT
8I..ACK1NK
CERTIFICATE OF DEATH
NAME OF DECEDENT (FiM, MH;dle, L~sl)
Sf'X
Jr.
,
P ACE OF
HOS~ITAl
,,,p.',."'D
Dalmatia. PA Sa. _
FACILITY NAME (II n...t In.lillllion, give ~~eul and "ll'ob~")
BIRTHPLACE (Cily and
Slate or Fo,e'gn COllnuy)
86
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.
CQUNTYOFDEATH
".
Cumberland
Be. Carlisle Boro
KINDOFBUSINESSIINDUS1R~
DECEOfNT'S USUAL OCCUPATION
\~::~4~"="'::~'j,'::j'
1,. sales 11b etro turn
DECEDENT'S MAILING ADDRESS (Slreet CltylToWll, Stale. Zip Codo<\ DE<::EDEtH.S
ACTUAL
RESIDENCE
(St!.. ios~ucli"".
O/lolherside)
17&,Slal..
PA
STA'r, f'rL.,lIJMHHl
SOCIAl$EcuRi'fYNij~iUfli-~OfDEAHI(M""th.Day.Y"mi
, 18.o..::.J2lL_:- 2 2!Q.~ 0 30 2004
EATH'henonlo''',.,u"irl'I",c"u!!:<>nOlh.",;u~~_
=n"""
"R/Du",.,,,,,,,O [lOAD NU"'"tlr.a- " 0 O'hor 0
HOII'.A...4. fi."d."", (S,,"<,I)).
WAS OECFOFNr or HI~PANIC<iR'IGIN? RACE. A,"oflc"n I"eli"", BlaeJ<, While...1
Nor.:1.V".n 11\"'5. srcdfyCllbaO, (Spadlyl
M..~"P",~,ro'R'L"n,"tc,
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whj.te
SUllVlVINGSPOUSE
If''';'', 0". ,"""io" '""'~I
17c.Dv".,deced"nlll""din
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19365 Cypress Ridge Terrace
Landsdown. VA 20176
Did
decado",
liveina
111>. 01llnt~ Cnrnnp 'I" 1 ;\nn IOwn$h",?
MOfl~ER'S NAME (F~.t, Middle. Mdiden Su"'~me)
19 Florence Miller
city
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FATHER'S NAME lFilsl. Middle. la.l}
18. John H. Sn der. Sr.
INFGR.M/l..Nl'Sl'l,o,M€ \T~pelP.illIl
20a. Ann Kercher
METHOD Of DISPOSITION
. Dor>a\iQn 0 Burlal 0 C,emlllion fi~emovalfromS,al<l 0 0
. 2,.., '-lSpedIy) 21b
, SI(.iNATURE OF F L SERVICE LlC OR PERSON ACTING AS SUCIi
INFORMANrs MAiliNG ADDRESS (SUOOI. Ci'yHown, SIdle, lip C,;>de)
20b, 19365 ~ress Ridge T~rrace Land~dOt e A' Qll..6.~
PLACE OF DISP0'31T10~. Name of COmele'Y. Cf~mJlol-'" LOCAl ION - Cily[TQWn, State, Zi~ COJ<le.
010Ih",Pla~'
21<; Hoover FH & Cremator
r4AME AND ADDRESS Of FAG I!..!,,'
Hoose 'H Crt2mntory. Roxl~
liCENSE NUMIJER DAH:~IGNED
(Monl~, DliY. Yea,)
~3b, ~'Q.....~ ''1- -- 2k \O/\C1lu......\
WA.$ CASE REFEflHE TO A MfDIC L E~"NER ICOllONER'! '
a Yu v/~ No 0
Q',....,. ~'. on.." .hQ." 0' ho.<lI'''~I' . Appro."""le PART II' Ol~'" .ignilicdfll wndili,,"" contli~"ling 1<> 0,,"'1>, bu'
: ime"'alb<lIWU'lll nOI'''.llllinginthellnderly;ogC""seg"cnir>PARTI
; o"sffi "00 &"1"
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To !rle b\l~l 0
lSigna~,.lldTille)
23",
TIME OF DEATH
U. 0
"22;1.
CO/nplalelt""lS23a-cQrllywh'lll rtifyill!l
phy5icianisootavailableclDm ordeall'llo
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21. PART 1: fnl.''''.d'.......'"ju,~...c....pl.ao'".o'''h'."<."..dlh.....''', OQ.OI_.l.,t,,"mod.oldyl"U,..<h..<o'dl
Llo1 0.',0"'''.'' o"...h II".
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OOET010RASACONSEQl1ENCEOf'j
r
DUE lD(OIlASACONSEOl!ENCE Of'1
\7d,!!l ~~~~~~ll~~\~~i~~ <>1
CarsIile
21d, H<lrri Rhurf" PA 1711?
DllE TO lOR AS "'CONS~QUENCE OF)
Se<\llenliallyl:islC<Kld.llio<\o
nany,lelldillgloimm'l/:HIlI..
<:a<>se.Enle,UNOERlYIHG
CAUSE{O<$ell5eorinj<>ry
U\al.inilialfl<l_nt..
,,,,,u~ing ondealh ) LAST
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMEO? AVAILABLE PRIOR TO
COMPtETION OF CAUSE
OF DEA nn
MANNER OF DEATH
DATl:OfINJURY
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Nalu'al
Homidde
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midcnl
Suicide
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CERTIFIER (Check ""I~ onel
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'PRONOUNCING AND CERTIfYING PKYSLCl....K\Ph~5ici..nl>olh l"tlffi'Uncing _ amI eer\rtjling 10 e~use ,,\ dealh)
To tt.. be.t of my knowlsdll8, d....,h oecll,nd.t \h. time. d.l., ..nd "I.e., aod duo to the ea.....(.) ..nd mann.'" .tatod...
.MEOIC....l EXAMINERlCORONER
On u... b&st. of s,,_lM.tIOl\ .\\4I01ln.....\\ga\.lon, In rrrt t>p\nloo, d"lllli o<;clIrr"d lIl. th.llms, lIale. and plan. and due to the cau.u(.) and
maon.,..el.lt.d,..
315.
REGISTAAR'S SIGNATURE AND NUMBER
(l~JLCLftQl=':'-M!.;'L_B)1 ,)ht.!IJ
TIME OF INJURY
INJUI'll' AT WORK? DESCRIBE IIOW INJURY OCCURRED
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Ye.D NoD
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Alhoma,f..nn.sl'etll,laCIuI)'.<>ffice
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LOCA.nOr~ (Slre"l. City[Town, Sldte)
301.
SiGI'lAT AND liJ::lf 05Rl1FIER
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31b.
liCENSE NUM8EJl lJATESIGNE.O (Mmrtl\, O..~. y"",)
31c, r.-..Da{l."2....(lc.. 31d. f'I()\J ':1..,2.~~"-f
NAME AND ADDRESS OF PERSON WHO COM?LETE.D CAUSE OF DEA Iii
(llel<:;~T~e;lP~fll C:-. ~rLn'St..l)V\o J.... ~\)
032 tJ ~'tI-.f'\\...'T ~1l1()..... (l,~ ct~
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DATE FILEO(MQnlh,O",~, y"",\
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CERTIFIED COPY OF POWER OF ATTORNEY
THE OHIO CASUALTY INSURANCE COMPANY
WEST AMERICAN INSURANCE COMPANY
No. 37-994
Know All Men by These Presents: That THE OHIO CASUALTY INSURANCE COMPANY, an Ohio Corporation, and WEST AMERICAN
INSURANCE COMPANY, an Indiana Corporation, pursuant to the authority granted by Article III, Section 9 of the Code of Regulations and By-Laws of The Ohio
Casualty Insurance Company and West American Insurance Company, do hereby nominate, constitute and appoint: Kerry A. Enders, Beth A. Seibert, Kimberly A.
Klinger, Judy Shields, Christine Arthur or Steve Salazar of Harrisburg, Pennsylvania its true and lawful agent (s) and attorney (s)-in-fact, to make, execute, seal
and deliver for and on its behalf as surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES excluding, however, any bond(s)
or undertaking(s) guaranteeing the payment of notes and interest thereon
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and
purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative ottlces in Fairfield, Ohio, in
their own proper persons.
The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s)-in-fact.
In WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance
Company has hereunto subscribed his name and affixed the Corporate Seal of each Company this 7th day of December, 2004.
~~\I.'~lI;'~~. .;0""" \NS(J~",..
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=f.SEAL~ It;; SEAL ~,:I
='~. /~~ ~ $
#-"~l\!.!~Y ''VOjA''\'-
A"""^
4~..c.e..
Sam Lawrence, Assistant Secretary
STATE OF OHIO,
COUNTY OF BUTLER
On this 7th day of December, 2004 before the subscriber, a Notary Public of the State of Ohio, in and for the County of Butler, duly commissioned and qualified,
came Sam Lawrence, Assistant Secretary of THE OHIO CASUALTY INSURANCE COMPANY and WEST AMERICAN INSURANCE COMPANY, to me
personally known to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of the same, and being
by me duly swam deposes and says that he is the officer of the Companies aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of
said Companies, and the said Corporate Seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the
said Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Hamilton, State of Ohio, the day and year first above
written.
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.....-" 0 ("- Notary Public in and for County of Butler, State afOhio
C: . l.....j t:_-, :'_: My Commission expires AU2ust 6, 2007.
Tl~rpower of attm'Jley is ~\'rled under and by authority of Article III, Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company
and-~est_ Ameri~Insuranc~o'Dlpany, extracts from which read:
C' '"Articll\,lJ,I. SectionC9-i' :AQoointment of Attomevs~in~Fact. The Chairman of the Board, the President, any Vice.President, the Secretary or any Assistant
Sec~ri-of the ~oration shalHSe and is hereby vested with full power and authority to appoint attorneys-in.fact for the purpose of signing the name of the
corporation as sur~to, and to execute, attach the seal of the corporation to, acknowledge and deliver any and all bonds, recognizances, stipulations, undertakings or
other instruments of suretyship and policies of insurance to be given in favor of any individual, finn, corporation, partnership, limited liability company or other entity,
or the official representative thereot~ or to any county or state, or any official board or boards of any county or state, or the United States of America or any agency
thereof, or to any other political subdivision thereof
This instrument is signed and sealed as authorized by the following resolution adopted by the Boards of Directors ofthc Companies on October 21,2004:
RESOL YEn, That the signature of any officer of the Company authorized under Article III, Section 9 of its Code of Regulations and By-laws and the
Company sea! may be affixed hy fac~imlle t;) <my power of attomey or copy thereof issued on behalf of the Company to make, execute, seal and deliver tor and on its
behalf as surety any and all bonds, undertakings or other written obligations in tne nail~le thertuf; tf! presClibe their respt:ctive d~lties and the respective limits of their
authority; and to revoke any such appointment. Such signatures and seal are hereby adopted by the Company as original signatures and seal and shall, with respect to
any hond, undertaking or other written obligations in the nature thereof to which it is attached, be valid and binding upon the Company with the same force and effect as
though manually affixed.
CERTIFICATE
I. the undersigned Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby CC11ify that the foregoing power of
attorney, the referenced By-Laws of the Companies and the above resolution of their Boards of Directors are true and correct copies and arc in full force and effect on
this date.
IN WITNESS WHEREOF, I have hereunto set my hand and the seals of the Companies this 22nd day of December, 2004
t:.\\I~I'!l't~ ,,,,l""'tlsu,?4.j,,,
....... ..._1(.. "S "''0
;{ SEAL \~ :'ili SEAL~..:;
~}.._ /~1 7 !
'4.liJ!i;i$/ 'lvo,.....!'
~-./'./ /~
Assistant Secretary
'1;, j~
..'
Fonn S-3006
ADMINISTRATORS
County of Cumberland
BOND
, Pennsylvania.
deceased
1
~ No
J
of
Estate of
late of
John H. Snyder, Jf.
KNOW ALL MEN BY THESE PRESENTS, That we John H. Snyder, III
as Principal, and The Ohio Casualty Insurance Company ,a corporation of the State of Ohio ,and authorized to
become sole surety in the Commonwealth of Pennsylvania, are held and firmly bound unto the Commonwealth of Pennsylvania, for
the use of those interested in the estate, in the sum of Ninety-Eight Thousand and No/Cents ( $ 98,000.00
Dollars, to be paid to the said Commonwealth, to which payment, well and truly to be made, we do bind ourselves, jointly and
severally, for and in the whole, our heirs, executors, administrators, successors and assigns, and each and every of them, firmly by
these presents.
Sealed with our seals and dated 12-22-04
THF. CONDITION OF THlS OBLIGATION IS, That if the ab:Jve bounder:
John H. Snyder, III
Administrator or any of them, shall well and truly administer the estate
according to law, this obligation, shall be void as to those who shall so administer the estate; but otherwise, it shall remain in force.
Sealed and delivered in the presence of:
(Seal)
y't VLAt~
By
y
Attorney-in-fact
County of Cumberland
1
f ss:
J
State of Pennsylvania
I.
John H. Snyder, III
do solemnly swear that, as the Administrator
of the estate of John H. Snyder, Jr.
deceased, I
will well and truly administer the estate of said decedent, according to law.
Sworn and subscribed before me
this day of
A.D. and letters of administration granted
unto
}
REGISTER
Notarial Seal
Barbara L. Latz, Notary Public
Derry 1\vp., Dauphin County
My Commission Expires Apr. 29, 2007
Hl(\~-'\n~\1S I~EVJ01"'1.)5'
This is co certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records 10 accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
CjJ /I~
Charles Hardester
State Registrar
0539817
NOV 1 0 2004
Date
Kl05.143 Rev. 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
TYPElPRlNT
.
PERMANENT
IlLACKINK
CERTIFICATE OF DEATH
NAMEOf' DECEDENT (FIrst, Middle. Laal)
'"
,.
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
)\
..
COUNTY OF DEATH
66
,.
HOSPIT^,-
In.....ntD
7. Dalmatia PA e..
FACILITY NAME (lfnollnstiMi"", gl"" .tl'881gnd number)
BIRTHPLACE(C/tyMd
St.a1e Of Foreign COIlnlry)
,.
'" "
- 2510
DATE OF DEATH (Monlt1. Dey, Yeer}
< 10 30 2004
...
Cumberland
k. Carlisle Bora
KIND OF BUSINESS I INDUSTRY
MARITALSTATUS-Memed,
N_MaIT\ed,WIdowed.
Dworced(Spedfy)
ROIIO.n""D ~JD
RACE_Amertcen Indian. Bleck. While. el
(Speclfy)
10. white
SURVIVING SPOUSE
1~_.gl.....,.IO.""",,,.)
DECEDENT'S USUAL OCCUPATION
~of~==-:O-::-:~I
11g. sales 11b.
DECEDENT'S MAILING ADDRESS (SlrHt. CilylTown. SliIte, lip Code)
oecEDENrs
AC"'''-
RESIDENCE
(SeoIllngtnJcIlon.
""olhergjde)
lTg.SliIte
PA
...
lTc.DYel,<laatdentlivedln
'"'
27.PARTI, EnloflMdl_"'l........__........'.........d........Ih.bon....Io.....mod.ofdyln8,........_
Uotooly......._......ftu....
,.
......,
17b. Coon!\' C':nmhPThnn :::"~ip? 17d.1!l ~:==0I Carslile
MOTHER'S NAME (FI..t Middle. Mlklen Sumlme)
10. Florence Miller
INFORMANr5 MAILING ADDRESS (Slrwt. CltylTO'Ml. Sl8te. Zip Code)
2Ob. 19365 Cress Rid e Terrae Lan
PLACE OF DISPOSITlON- Neme 01 Cemelery, CremIIory LOCATION _ CllylTown. SttIte. Zip Code
orOlherPlgce
'"
~
19365 Cypress Ridge Terrace
11. Landsdown~ VA 20176
FATHER'SNAME(Flm,Middle,LaoI)
n. John H. Sn der Sr.
INFORMANl'S NAME (Type/PI1nl)
2Oa. Ann Kercher
METHOD Of' DISPOSITION
-Dor1.t1ooD BurilllDerem.tion~emovalfl"ClmsliIteD
2h. ($pec:if)'} 21b.11
SIGNATUREOf'F SERVlCELlC OR PERSON ACTING AS SUCH
....
ConopeleIteml23t1-(:only~
p/'JyIlciMIllInoIaYItMabIII.t oImlhlo
oertIf1_afdHlh.
21c.
Hoover FH & C
NAME AND ADDRESS OF FACILITY
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2ld,
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TESIGNEO
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L E~~ER /CORONER?
Ir'~ "'0
Olherslgnllk:arJ1condllloo8rorllribu!lnglodeelh,but
noIresulling Inlheunderlyir!g<:lluseglvenirl PART I.
1_2"'26muatbece>rTo?leledby
pononwooprollClunee8deatll.
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D\.iETOORASAcotlSEQu~()FJ;
Seq"""tWyliatcondltlonll
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<:lillie, Enter UNDERLYING
CAUH (DlNne orlrlury
llwllntu.lId.......,1lI
l1IIulling""dalIlh)LAST
WAS ~ AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAlLAllI..E PftIQR TO
CDMPLE'nON OF CAUSE
OF DEATH?
E
EllORASACOHSE;QUENCEOFl
ETOOR A
V"O NoKl
'.0
MANNEROf' DEATH
Nalurlll Il!l "'- 0
""'"" 0 Pendlngln"".llgali"" 0
SUlddg 0 Could not be detennlr1ed 0
DATE OF INJURY
l_,Day,Y_)
TIMEOf'I~JURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
2&L lib.
CEFmFIER (Chllck ""Iy ""e)
l:~~GJHrnrve.l.7.~~ni.fj=:=~g=l:r=~.rn:~,r:~~~.~.~.~~~.~~~.~.~~.~
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PLACE Of INJURY
tlulldlog,oto.(Sp.oo1lyJ
.... .
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LOC"T10N(Slreel,CllylTOWI'I,SliIle}
...
SIGNA AND TI~ Of.iERTIFIER
................1S lib. 'J .;...j """""........... \'\...,
LICENSE NUMBER DATE SIGNED (1.4011111. Dey. Year)
............Dalc.l""I>o.'Dol~'2Y{" :ald. \'ICi\J :z../2-l:lil~~
IIWolE AND ADDRESS OF PERSON WHO CQMPLETli:D CAUSE OF DEATH
(Item~~T~;)PZ'1 (?v '3rt..V'\~<.1.:a~ J..... '""9
1) <..>>'1:""", "" "'~ C-
DATE FILED (Monlt1. Dey,Ye.r)
"'0
"
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o
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~~:.11:,G:k~:==:::c.=~~:'tI:,n.~;:::,~lh=:~i:u~~~i.:.,=~.r...llll11d.
....EDlCAL EXAMIN!!RICORONER
. :""'n:. '=1~~~~~~~.I:.~~~.~~~~:.I.~.~~.~~~:,~.~~.~:.~~.~.~.~.~.~:.~~:.:.~.~~~:.~~~.~.~:.~.~:..~:.~~~~.~~.. 0
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REGlS7RAR"t t1GNA1\lRI! AND NUMBER
b.:lJdld--"I1
M.
\\- 3-0'{
JEFFREY A KEITER
ATTORNEY AT LAW
226 WEST CHOCOLATE AVENUE
HERSHEY, PENNSYLVANIA 17033
PHONE: 717.533.8889
FAX: 717.534.9190
EMAIL: jeff@keiterlaw.com
January 19, 2005
VIA FIRST CLASS MAIL
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Attention: Vicki
Re: Estate of John H. Snyder, Jr.
Dear Vicki:
I am enclosing the Administrators Bond signed by John H.
Snyder, III, Administrator for the Estate referenced above.
A check in the amount of $15.00 to cover the cost of the
Bond fee is also enclosed.
Please send the Letters of Administration and the three
short certificates requested to this office.
Thank you for your assistance.
Jef e
Jak
Pc: File; John H. Snyder, III, Admin.
-.
Register of Wills of Cumberland County
CERTIFICATION OF NOTICE UNDER RULE S.6lA)
John H. Snyder, Jr.
Name of Decedent:
Date of Death: October 30,2004
Estate No.: 2141-t098
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
Name
John H. Snyder, III
Address
8103 Mulligan Circle, Port SI. Lucie, FL 34986
Anne K. Kercher
19365 Cypress Ridge Terrace, Landsdown, VA 20176
Todd E. Snyder
P.O. Box 66, Palm, PA 18070
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 3
05
Jeffrey . Keit ,J.D.
Name
226 West Chocolate Avenue
Hershey, PA 17033
Address
717.533.8889
Telephone
c.dl1::apacity: 0 Personal Representative
o Counsel for personal representative
6Z -',.
) :{i
~
0.
crrll'
..i'.a;'..>
v
JEFFREY A. KEITER
ATTORNEY AT LAW
226 WEST CHOCOLATE AVENUE
HERSHEY, PENNSYLVANIA 17033
PHONE: 717.533.8889
FAX: 717.534.9190
EMAIL: Jeff@KeiterLaw.com
l'mgust 7, 2006
()
~~-~-_:\!:)
VIA FIRST CLASS MAIL
Cumberland Cowd::y C::,urt House
Glenda F. Strasbaugh
Register of Wills
One Courthouse Sq.
Carlisle, PA 17013-3387
, \.,l-\
d()V
Re: Estate of John H. Snyder, Jr., deceased
Release of Executor
Dear Ms. Strasbaugh:
Enclosed is check # 8407 in the amount of $50.00 dollars for the
filing fee in the above captioned estate. Please apply this fee
for filing purposes for the inheritance tax return which you
ived on August 4, 2006.
jak
pc: File
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
998
8/8/2006
TOHN H SNYDER TR
21-04-1098
JEFFREY A KEITER
226 "WEST rnOCOLATE AVENUE
AJW
BE RSHEY, P A 17033
Qty
1
Fee Description
Additional Probate
Fee
Total
$7.00
7.00
Total:
$7.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
....J
15056051058
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~\ cJ+
1098
Date of Birth
186-09-2510
10/30/2004
07/31/1918
Decedent's Last Name Suffix
Decedent's First Name
MI
Snyder Jr
John
H
(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 DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
l. 1 Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 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 DIRECT~D TO:
Name Daytime Telephone Number
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Jeffrey A. Keiter, Esq.
Firm Name (If Applicable)
(717) 533-8889
REGISTER Of WILLS USE ONLY
First line of address
226 West Chocolate Ave.
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
Hershey
PA
17033
Correspondent's e-mail address:
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, carre nd co plete. D laration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE
() .Jill V 20(J&
7
NTATIVE
7/ G~A1~,JJ~ b
I I
, Hershey, PA 17033
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
....J
_..J
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
John
H Snyder
186-09-2510
RECAPITULATION
1. Real estate (Schedule A). 1.
000
2 Stocks and Bonds (Schedule B) 2.
0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3.
000
4. Mortgages & Notes Receivable (Schedule D) 4.
0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5.
25,715.26
6. Jointly Owned Property (Schedule F) Separate Billing Requested . 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested.. 7.
000
0.00
8. Total Gross Assets (total Lines 1-7). 8.
25,715.26
4,7 4024
9. Funeral Expenses & Administrative Costs (Schedule H). 9.
11 Total Deductions (total Lines 9 & 10). 11.
20,97502
20,715.26
000
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . 10.
12. Net Value of Estate (Line 8 minus Line 11) . . . . .. 12
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . 13.
000
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . 14.
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 taxable
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
0.00
19. TAX DUE.
15. 0.00
16. 000
17. 0.00
18 0.00
. . 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
l_
15056052059
....J
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
John H Snyder
STREET ADDRESS
Sara Todd Memorial Home
1---"
21-04-1098
DECEDENT'S SOCIAL SECURITY NUMBER
186-09-2510
_m_"___
-------.---
CITY
Carlisle
I STATE
PA
---pr-
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + B + C ) (2)
000
3. IntereslJPenalty if applicable
D. Interest
E. Penalty
TotallnterestJPenalty ( D + E ) (3)
4. If Line:2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + 5A This is the BALANCE DUE.
(5A)
(5B)
0.00
0.00
0.00
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DU E. (5)
A Enter the interest on the tax due"
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 [iJ
b retain the right to designate who shall use the property transferred or its income;.. .................... .... .."" 0 [iJ
c. retain a reversionary interest; or.". ........................... ............. 0 [iJ
d receive the promise for life of either payments, benefits or care? "... ............................................... ......... 0 [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ......................." .. ................................... ..................... .... 0 [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............ 0 [iJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ". ................................. .................................. ......................... [iJ 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,
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. S9116 (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. S9116 (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 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. s9116(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 PS. s9116(a)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-15Cb EJ<+ ((1..98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANiA
INHERiTANCE Ti\X RETURN
Rt,SIDENT DE.CEDENT
ESTATE OF
John H. Snyder Jr.
FILE NUMBER
21-04-1098
I nclude the proceeds of litigation and the date the proceeds were received by the estate
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Wachovia Bank, no interest checking Acct. #1010072170038 (P.OA acct.)
a
1011.58
2. Columbus Life Insur. - Remaining baL of death benefit on life policy insuring life of Jean Snyder, deceased
a
3. John H. Snyder, Jr. - Schwab IRA nO.2175-4627 (payable to account)
3.42548
a
8.869.46
4. Distributive Share of Jean H. Snyder Estate (Spouse of Dec.; includes Family Exemption of $3,500)
a
12.23719
5. Mobile pension
45.35
6. Highmark Blue Shield - refund of unused Medigap insurance premium
a
126.20
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
25,71526
II!
-,.,...~
--~
WACHOVIA
Fl ee Checking
01 1010072170038
752
30
o
18
00050153 1 MB 0,30902 MAAD 218
1.,1,111""" 111".1.11" ,1,,11
JOHN H SNYDER JR
ANN KERCHER POA PB
JEAN L SNYDER POA
19365 CYPRESS RIDGE TERR UNIT# 1108
LANSDOWNE VA 20176
174,263
Free (:hecking
9/29/2004 thru 10/27/2004
Account number:
Account owner(s):
1010072170038 ~-~
~ -" I) {
~,JOHN H SNYDE,R R J JRRr-', \2 C' c, "C,
~RCl=tE~-~- C "\;
JEAN L SNYDER POA
{Ir (
Account Summary
Opening balance 9/29
Deposits and other credits
Checks
Closing balance 10/27
$951,55 ^
\r'"
1,198.35 + fir , \>J"';')!l
1,138.32-, tA<'()\
"V' .
$1,011.58 _4
/. ~ - ~ 1,1. '. c;C-(\
Lt..c(,'_<' j .-'
Deposits: and Other Credits
Date
Amount Description
1,182.00 TRANSFER FROM CHECKING #1000012474173
16.35 TRNSFR 1000012474173 10/16
INTERNET CONFIRMATION # INl 01616385200
1 0/04
10/18
Total
$1,198.35
Checks
Number
Amount
Date
Number
Amount
1026
90.00
10/20
1027
1,048.32
10/22
IS STUDENT LOAN DEBT WEIGHING YOU DOWN? CONSOLIDATE
AND CUT YOUR PA YMENTS BY 50% OR MORE WITH EDUCAID,
WACHOVIA EDUCA nON FINANCE. APPL Y TODA Y BY CALLING
1-800-338-2243 OR ONLINE AT EDUCAID,COM
Date
/1
./. ,_ ,'~j
!
;', J_ ',-!
/.} l~. /
Number
Total
/ () // :.~)
~-Affl9f:Im._ Date
Y- ')
\~1,138.32 /
,--~
sIr\. )-, -ft Iv I" 1
'-, 't -':-'..1 L.
I,) ('i/; , ,,' r i .
-- /L'fiyoy
WACHOVIA BANK, N.A., HERSHEY
page 1 of 2
FROM .
PHONE NO.
5612299816
Apr. 27 2006 11:09AM Pi
Coi'lj.mbus Ufe Insurance Company
Life Accou /'It
STATEMENT
.;~.,
. ",
~:. ~ .
--. . ,
[- --. . .. L.....1
t LiFI~"f\CCOliNT}
--r- _._1
ACCOUNT NUMB ER ;
JOHN H SNVDER JR
5109 PINE SHADOW LANE
NORT~ PORT, FL 34287
BEGINNING
MONDAV
10/01/04
10/04/04
10/11/04
10/18/04
10/25/04
Summary 'I)' BENEFITS. It.lTERESr, and C/ieCK REDEMPTIONS for the pe.riod: :JCTOBER 1,
Opening 8alanc@ Credit!; Interest Debits
$3,"22.1;7 $ 00 $2.91
tt:t+i::{i/i:J.~t~:::::::.:;:" <:: '.;)'=:~i#(~~,#:!~~:/n:::;;?:::::,;::V::':::,::;:;:"::: .:;..':.>. ::"';.::~':;.'." ~f~~~~)f::;'::;:.'::::: :.....#~~~'.lI~~it#'.:<,........... .
9(,14008252'1
RATE
ANNUAl
VIELD
1 00
1 00
1 00
1.00
1 00
1 00
1 00
1 00
1 DO
1 00
2004 THROUGH oCToaE~ 31, 2004
Other Charges Closil'g Balanc~
'-00 $3,425-48
$ 00
~ __..J,o..l:S:jl/.!'.~._.
JNTERES":. PAlO ...
2.91
._3~4.ZS."'8
Rema~:'"
::':::)::;:::
Columbus Lifo
Life Account
INFORMATION
regarding this
statement can
be obtained by
calling TOLL-FREE
The Nurthqrn "(rust Co.
1-877-7S2-6350
- ~_~'~i:;~~~~ :1::'~_i\f~~~~;!(\ ;f;0Iia"~~'~~ ;!ii~jJfJ~~f~~"$:~~
The fotnl below ma\.' be used to ",ake an Ac:ldren Change on your accol.ll1t. (DETACH HERE)
The Columbus Ufe Insurance Life Account
Change of Address Form
:::::~~,1::~~~~~'.::::: Please compl@te the Change of
9 44 0 0 8 252 9 Address Form on t~e reverse side
JOHN H SNVDER JR
P/l~alle return t"is Change of Address
anCl any other written correspondence to:
Columbus Life Insurance Co.
Ufe Account
P.O. BOX 92987
Chicago. II. 60675-2987
II
FROM :
PHONE NO.
5612299816
Apr. 25 2006 03:56PM P5
charleS'SCHWAB
Account Statement
Rot,,,,' for Your Records
Schwab Independent Investing I Foundational"'
Statement Period: October 1, 2004 to October 31,2004
Last Stat~~~~t; __~~.~t~mber~,_~~
Rollover 'RA
Account Number: 2175-4621
Going paperless Is easy. Log on ro:
www.schwab.comlestalemenfS
Questions? Call HJoo-435-4()()()
Banking Inquiries: Call1-800-435-4DOO
Account Opened In: 1996
Page 1
291100..AllI101-006:l1G-9Ml-34297000000s 211519 '4-6
JOHN H SNYDER JR
CHARLES SCHWAB & CO INC GUST
IRA ROLLOVER
5109 PINIE SHADOW LANE.
NORTH PORT FL 342B7
o
o
~
~
o
-
:;;;;;;;;;;;
-
==
~
-
-
j;Account Value Summary
. .Casn;MoooyMarl<et; and geposit Accounts. .
Investments
I Total Accou'nt Value
I
$7.131.44
$ 1,738.02
$ 8,869.46\
-
-
-
-
I,
$ 1.14 . ;;;;;;
$ (347.46) -
-
.. .
-
-
-
1-
I Change In Value Summary
Change in Valu@ Sincs September 30, 2004:
Cha"ge in Value Since January 1. 2004:
I Rate Summary
Deposit Accounts: Interest rate as of 10/29 (Y)
0.38% -
-
iiiiiiiiiiiiii
-
-
I Investment Detail
1==
Descrl"tion
Cash, Money Market, and Deposit Accounts
DEPOSIT ACCOUNTS (W, Y)
SvmboJ
Quantity
Lonq/Short
Price
Market Valt18
- .
J, .Ir8nsactIOrLDetall.. .~...-
Settle Trade
Date Date T1~ns"ction DescrJplion
Cash, Money Market, and Deposit Accounts Activity
10/06 10/06 iQual Dlv Reinvest HEWLtIT-PACKAFlD COMPANY
10/18 10/15 Bank Interest (W.Y) BANKINT091GQ4.101504
Quantitv
Pdce.
,.
...
$7.131.44 a
8
c
$1,738.02 ~
~
0
~
$ 8,869.46) ~
,.
L
Total
$ 7.4.2
2.22
$ (7.42)
Investments
HEWLETI.PACKARO COMPANY ~
HPQ
93.1417 L
$ 18.6600
I Total Account Value
Investments Activity
10/07 10/07 Reinvested Shares
HEWLETT.PACKARD COMPANY
0.3899
$ 19.0282
PIBaSB SBB "F.ootnot6s for Your Account" section for an explanatlofl oflhe footnote codes and symbols on this srarBmsnt.
~2002 Charles Schwab &. Co" Inc, All Clghts rCSCM':d, MCr'1ber: $1F'C/New York Stock Eltchange. eRS 1111170(0001-0386) STP10479R2-02(o3/011)
',-'ibt-.I
...."A'.('fl"\.. _^,",~o:ll'^ ,",011'0
REV-'511 EX+ (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
John H Snyder Jr
FILE NUMBER
21-04-1098
Debts of decedent must be reported on SChedule 1.
ITEM
NUMBER
A
DESCRIPTION
AMOUNT
FUNERAL EXPENSES
Pre-Paid Funeral
0,00
B, ADMINISTRATIVE COSTS
Personal Representative's Commissions
000
Name of Persa~al Representative{s)
Social Security Number(s)/EIN Number at Personal Represenlative(s)
Slreet Address
City
Stale
Zip
Year(s) Commissio~ Paid'
2.
Morney Fees
3,671. 00
3
Family Exemption (It decedent's address is not the same as claimant's, attach explanation)
000
Claimant
Slreet Address
City
State
Zip
Relationship of Claimant to Decedent
4
Probate Fees
0.00
5.
Accountant's Fees
0.00
6
Tax Retur~ Preparer's Fees
000
Administration Expenses
2
Register of Wills - Letters of Administration (reimburse JS III)
KHB Insurance - Administrator's bond- (reimburse JS III)
Register of Wills -Bond fee (reimburse JS. III)
FedEx - delivery expense (reimburse J.S. III)
Cumberland Cty Legal Journal - advertise Letters of Admin (reimburse JS. III)
4260
36200
1500
23.39
7500
3
4
5
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, Insert addit\o~al sheets of the same Size)
4,740.24
Continuation
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF John H. Snyder Jr.
Item
Number Description
7.
KHB Insurance - Administrator's bond- (reimburse J.S. III)
Harrisburg Patriot New - advertise Letters of Admin. (reimburse J.S. III)
6.
TOTAL
FILE NUMBER
21-04-1098
Amount
$189.25
$362.00
$4,740.24
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John H. Snyder Jr.
FILE NUMBER
21-04-1098
ITEM
NUMI3ER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
DESCRIPTION
Depart. of Public Welfare - med. ex. paid (6 months), (Class 3 claim - insufficient funds to pay in full)
VALUE AT DATE
OF DEATH
D
20.97502
TOTAL (Also enter on line 10, Recapitulation) $
20,97502
(If more space is needed. insert additional sheets of the same size)
REV<':;13 t)<+
SCHEDULE J
BENEFICIARIES
COlvIMCNWE.I\LTH c~ PENNSYLVAtJiA
INHERITANCE TAX RETURN
RESiDENT DECEDENT
ESTATE OF
John H. Snyder, Jr.
FILE NUMBER
21-04-1098
NUM
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Bm NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. John H. Snyder, III son 1/3
8103 Mulligan Circle
Port St. Lucie, FL 34986
2. Ann K. Kercher daughter 1/3
19365 Cypress Ridge Terrace
Landsdown, VA 20176
3. Todd E. Snyder son 1/3
PO Box 66
Palm, PA 18070
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
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Cumberland County - ~egister Of WilTs
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
KEITER JEFFREY A
226 W CHOCOLATE AVENUE
HERSHEY, PA 17033
RE: Estate of SNYDER JOHN H JR
File Number: 2004-01098
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 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 10/30/2006
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 - Register Of Wills-
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
SNYDER JOHN HIlI
8103 MULLIGAN CIRCLE
PORT ST LUCIE, FL 34986
RE: Estate of SNYDER JOHN H JR
File Number: 2004-01098
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 10/30/2006
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
-
PLEASE FILE TinS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEA~l:
UNTIL COMPLETION .
STATUS REPORT UNDER RULE 6.12
Name of Decedent: John H. Snyder Jr.
Date of Death: 1 I) IiI) I 7004
Estate No.:
21.,..04-1098
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 xx
2. If the answer is No, state when the personal representative reasonably believes
that the admiiJistration will be complete: By 11/30/2006
(date)
3.
If the answer to No. 1 is yes, state the following:
A. Did the personal representative file a final acc~t with the court?
Yes No .
B. The separate Orphans' Court No. (if any) for the personaI representative's
account is: (Not Applicable in Dauphin County)
C. . Did the personal representative state an account informally to the parties in
interest? Yes No
D. Copies of receipts, releases, joinders and approvals offormal or informal
accounts may be filed with the Cleric of ' Comt and may be attached
to this report.
Date:
10/13/2006
Si
226 W. Chocolate Ave., Hershey, FA 17033
Address
(MAH:nntlAM;J)
'--;
(717) 533-8889
Telephone No.
12:Z '-;
Capacity:
Personal Representative
xx
Counsel for Personal Representative
~
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JEFFREY A. KEITER
ATTORNEY AT LAW
226 WEST CHOCOLATE AVENUE
HERSHEY, PENNSYLVANIA 17033
PHONE: 717.533.8889
FAX: 717.534.9190
EMAIL: Jeff@KeiterLaw.com
October 13, 2006
VIA FIRST CLASS MAIL
Glenda F. Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Sq.
Carlisle, PA 17013-3387
Re: Estate of John H. Snyder Jr., Deceased
0.0.0. October 30, 2004
Dear Ms. Strasbaugh:
Please file the enclosed original copy of the Status Report
under Rule 6.12. I have enclosed an extra copy to be
clocked in and returned to me in the enclosed, self-
addressed, stamped envelope.
Thank you for your prompt attention to this matter.
y at Law
File; John H. Snyder, III
", -\
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Appeal Date: 11-24-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
-ReV~154-i EX-(06-ifsypc - - - - - - - - - - - - - -Notic-e-b-':-fN~fERW A-riiCE-TA)( AP-PRAis-eME-Nt-, -Ai:LOWA~fcE- 0 R - - - - - -- - - - - - - - - - -- - _ _ _ _ _ _ _ _ _ _ _ __
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
SNYDER JR JOHN H FILE NO. 2104-1098 ACN 101
TAX RETURN WAS: t8] ACCEPTED AS FILED 0 CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
4,74024
20,97502
(11 )
(12)
(13)
(14)
17 and 18 will reflect figures
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
-'r"^"~"~~rrf\tE~T OF REVENUE
t"r-I...1. .1.:''-:~ /;~J_) \...F I ;\..)L iJ;
~. ~ ,~::'~ ':-~()TIOE {DF INHERITANCE TAX
-APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NO.
COUNTY
ACN
2006 SEP 22
9: 57
JEFFREY A KEITER ESQ
226 W CHOCOLATE AVE
HERSHEY PA 17033
(",~.J
vi',
('1 "i'-"
V\..:":
ESTATE OF
1, Real Estate (Schedule A) (1)
2, Stocks and Bonds (Schedule B) (2)
3, Closely Held Stock/Partnership Interest (Schedule C) (3)
4, Mortgages/Notes Receivable (Schedule D) (4)
5, Cash/Bank Deposits/ Mise, Personal Property (Schedule E) (5)
6, Jointly Owned Property (Schedule F) (6)
7, Transfers (Schedule G) (7)
8, Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, Funeral Expenses/Adm, Costs/Mise Expenses (Schedule H) (9)
10, Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11, Total Deductions
12, Net Value of Tax Return
13, Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14, Net Value of Estate Subject to Tax
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16,
that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15, Amount of Line 14 at Spousal rate
16, Amount of Line 14 taxable at Lineal/Class A rate
17, Amount of Line 14 taxable at Sibling rate
18, Amount of Line 14 taxable at Collateral/Class B rate
19, Principal Tax Due
TAX CREDITS:
(15)
(16)
(17)
(18)
09-25-2006
SNYDER JR
10-30-2004
21 04-1098
Cumberland
101
0,00
000
000
0,00
25,71526
0,00
000
(8)
0.00 XOO
0,00 X 045
0,00 X12
0,00 X 15
(19)
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX CREDIT 0,00
BALANCE OF TAX DUE 0,00
INTEREST 0,00
TOTAL DUE 0,00
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
REV-1547 EX (06-05) PC
JOHN
H
DATE 09-25-2006
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
25,715,26
25,715.26
0,00
0,00
0,00
0,00
0,00
000
0,00
000
(IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/26/2007
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KEITER JEFFREY A
226 W CHOCOLATE AVENUE
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HERSHEY, PA 17033
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RE: Estate of SNYDER JOHN H JR
File Number: 2004-01098
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: 10/30/2007
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,
Is ~ _LL- fJ
/@~;&e_ t~JVJ.J:fZ&:t,~h~
(
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
SNYDER JOHN HIlI
C)
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Date: 9/26/2007
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8103 MULLIGAN CIRCLE
PORT ST LUCIE, FL 34986
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RE: Estate of SNYDER JOHN H JR
File Number: 2004-01098
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: 10/30/2007
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,
~~~
/ i
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
In Re: Estate of
SNYDER JOHN H JR
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-01098
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: SNYDER JOHN H III
Counsel for Personal Representative: KEITER JEFFREY A
Date of Decedent's Death: 10/30/2004
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The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or coun::e' for
the delinquent personal representative.
Date:
10/31/2007
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
B (
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/~,,~ f....7i141U.{j J:!l"~~~.t:.
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Glenda Farner Strasbaugh
Clerk of the Orphans' Court
In Re: Estate of
SNYDER JOHN H JR
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-01098
(,)
NOTICE OF FAILURE TO FILE STATUS REPORT
_l
Personal Representative: SNYDER JOHN H III
"'f-"J1
Counsel for Personal Representative: KEITER JEFFREY A
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Date of Decedent's Death: 10/30/2004
The Orphans' Court record indicates that neither the above named personal representati ve
nor the above named counsel for the personal representative have filed with the Register of'YIlills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
dt/} Cz~ ^. LJ-- I .l/'
;:...hJUh~ ~J}/.z~tU$Jt~~
Date: 10/31/2007
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
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