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HomeMy WebLinkAbout02-27-14 (5) �( 2321-721. ay DECEDENT'S ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION c7 ESTATE OF DAVID L. GEARHART DECEASED' No. 21-11-0432 f " i7 t PETITION FOR ADJUDICATION STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.C. Rule 6.9 This form maybe used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers required under items 8-19 inclusive; and any instrument pertinent to the adjudication. INCL UDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Donis H. Zagurskie Supreme Court I.D.No.: 65682 Name of Law Firm: Johnston&Zagurskie, PC Address: P.O.Box O, 117 Main Street, Mifflin, PA 17058 Telephone: 717-436-8044 Fax: 717-436-2722 Form OC-01 rev.10.13.06 Page 1 of 10 Estate of DAVID L. GEARHART Deceased 1. Name(s) and address(es) of Petitioner(s): Alaw, Troy B.Long address: 503 9th Street Port Royal,PA 17082 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . . . ✓❑Yes ❑ No If not, identify prior accountings,the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on February 26, 2011 ❑✓ Letters Testamentary or ❑Letters of Administration were granted to Petitioner(s) on And 1 5. 2011 Date of Will (ifapplicable): January 3, 2007 Date(s) of Codicil(s) (if applicable): Date of probate (if different from date Letters granted): Was a bond required?❑Yes [Z]No If yes, state amount: Are proofs of advertising of the grant of Letters attached? . . . . . . . . . ❑Yes (Z]No Dates of advertising of the grant of Letters: The Sentinel -April 13th, 20th &27th 2011 and the Patriot News -April 18th, 25th &May 2, 2011 Form oC-01 rev.10.13.06 Page 2 of 10 Estate of DAVID L. GEARHART Deceased 3. Was decedent survived by a spouse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No If yes, name of the surviving spouse: 4. Has the surviving spouse filed to take an elective share? . . . . . . . . . . . . . ❑Yes ©No (See Section 2201 et sue. of the Probate, Estates and Fiduciaries Code) If yes, date of election: 5. In the case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (if none, so state): 6. Did decedent many after execution of Will or Codicil(s)? . . . . . . . . . . . M Yes E] No Were any children born to decedent after execution of Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El Yes © No If yes, give names and dates of birth: Name: Date of Birth: 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. § 1412,was a request for a statement of claim sent to the Department of Public Welfare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El Yes ® No Form oc-01 rev.10.13.06 Page 3 of 10 Estate of DAVID L. GEARHART Deceased 8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest is involved,Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice)must be submitted herewith or at the Audit. 9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or knowledge,having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest(s): Name and Address ojEach Party in Interest I Relationship and Comments i(any I Interest Barbara Ellen Gearhart/held in daughter residuary trust by proposed Trustee, Tracy M. Besselman Shepherdstown United Methodis charitable beneficiary 5%of the net estate Church before inheritance tax deduction Form OC-01 rev.10.13.06 Page 4 of 10 Estate of DAVID L. GEARHART Deceased Name and Address of Each Parry in Imeresi I Relanomhip and Commeros ifa r I Interesi B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth,the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. C. State why a Petition for Guardian/Trustee Ad Lilem has or has not been filed for this Audit (see Pa. O.C. Rule 12.9). D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. 0 Farm OC-01 rev. 10.13.06 Page 5 of 10 Estate of DAVID L. GEARHART Deceased 10. Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Address of Each Claimant I Ann am of Claim I Clain, I Will Claim Admitted? Be Paid In Fall, ❑Yes F-1 Yes ❑No ❑No ❑Yes El Yes ❑No ❑No ❑Yes ❑Yes ❑No ❑No ❑Yes El Yes ❑No ❑No If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. § 3392 and the proposed payments. 11. Was family exemption claimed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ©i Yes ❑No Was family exemption allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes []No Family exemption claimant's name and relationship: Name: Relatianship: Farm oC-01 rev.10.13.06 Page 6 of 10 Estate of DAVID L. GEARHART Deceased 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows: Dole Paymem 1Meresl November 23, 2011 17,276.45 0.00 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond of a fiduciary? . . . . . . . . . . . . . . . . . . . E]Yes ©No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . . . . . . 0 Yes 0 No 15. If Petitioner(s) has/have knowledge that a share has been assigned,renounced, disclaimed or attached,provide a copy of the assignment,renunciation, disclaimer or attachment, together with any relevant supporting documentation. Form OC-01 rev. 10.13.06 Page 7 of 10 Estate of DAVID L. GEARHART Deceased 16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . Q Yes ❑✓ No If yes, attach a copy of the Order if available; otherwise state the Court, term, number, date, and name of Hearing Judge. 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . 0 Yes 0 No 18. if a reserve is requested, state amount and purpose. Amount: Purpose: If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OYes ©No If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . ®✓ Yes ®No As to real estate only? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E]Yes ®✓ No Fern oC-01 rev.10.13.06 Page 8 of 10 Estate of DAVID L. GEARHART Deceased Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled and suggest(s) that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Distribulee(s) Amount/Proportion B. Principal: Proposed Disiributee(s) AmounUProporlion Barbara Ellen Gearhart by Tracy M. Besselman $180,500 in kind real estate Barbara Ellen Gearhart by Tracy M. Besselman $52,221..04/residue Sherperdstown United Methodist Church $13,155.55 Submitted By: (All petitioners must sign. Add additional lines if necessary): �• �6iyi�I Name of Pener:Troy B. Long Name of Petitioner: Form oC-01 rev. 10.13.06 Page 9 of 10 -_ _ _. ��.cY�r..�, . Estate of DAVID L. GEARHART Deceased Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * [that heishe is mle of the above-named name of corporation and] that the facts set forth in the foregoing Petition for Adjudication / Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relating to unsworn falsification to authorities). Sign- N5titioner *Corporate petitioners must complete bracketed information. Certification of Counsel The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/ Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Court, and that no changes to the form have been made beyond the responses herein. tP Signatur6 oo6dnsel for Petitioner 1 Form OC-01 rev.10.13.06 Page 10 of 10 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHAN'S COURT DIVISION In Re: Estate of David L. Gearhart Estate File No.: 21-11-0432 deceased FIRST AND FINAL ACCOUNT OF TROY B. LONG, EXECUTOR Date of Death: February 26, 2011 Letters Testamentary were granted to Troy B. Long on April 5, 2011 First Complete Advertisement of Grant of Letters Testamentary: April 13th, 20th,18th, 25th, and May 2, 2011 Account Stated from February 26, 2011 through February 13, 2014 Purpose of Account: Troy B. Long, Executor, offers this account to acquaint interested parties with the transactions that have occurred during his administration. The account also indicates the proposed distribution of the estate. It is important that the Account be carefully examined, requests for additional information or questions or objections can be discussed with: Donis H. Zagurskie, Esquire Johnston & Zagurskie, PC 117 Main Street,P.O. Box O Mifflin, PA 17058 Dj c� C-. - -7 C}. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHAN'S COURT DIVISION In Re: Estate of David L. Gearhart Estate File No.: 21-11-0432 deceased SUMMARY OF ACCOUNT PAGE Principal Receipts 1 $326,040.81 Less Disbursements Funeral Expenses l $ 13,915.97 Administration Expenses 1-2 $ 27,601.39 Fees and Commissions 3 $ 22,500.00 Debts of Decedent 3 $ 4,350.88 Balance of Principal after $257,672.57 administrative costs Advanced Distribution to Beneficiaries 3 $ 24,951.53 Principal Balance on Hand: 3 $232,721.04 Real Estate $180,500.00 Cash/Investments $ 52,221.04 Proposed Distribution to Beneficiaries: 3 In Kind Transfer of Real Estate to $180,500.00 Troy B. Long, Trustee for Barbara Ellen Gearhart In Trust In Trust for Barbara Ellen Gearhart, $ 52,221.04 Trustee Troy B. Long PRINCIPAL RECEIPTS 1. Real Estate: $180.500.00 11 Field West Dr., Mechanicsburg, PA 2. Ameriprise Annuity $ 56,624.18 3. Ameriprise Mutual Fund $ 3.599.21 4. Ameriprise Mutual Fund $ 3.439.68 5. Ameriprise Mutual Fund $ 3,528.21 6. Ameriprise Mutual Fund $ 3,111.26 7. Ameriprise Mutual Fund $ 51166.24 8. Ameriprise Mutual Fund $ 3,099.67 9. Ameriprise Mutual Fund $ 5,518.89 10. Ameriprise Mutual Fund $ 7,222.13 11. Lanco Federal Credit Union Savings/Checking Account $ 18,324.88 12. State Farm Life Insurance $ 3,763.68 13. State Farm Life Insurance $ 15,547.43 14. Sale of 2008 Ford Fusion $ 14,000.00 15. River Source Life Insurance Refund $ 463.10 16. River Source Life Insurance Co. Surrender $ 459.10 17. Lancaster Hospital Rebate $ 30.00 18. State Farm Fire & Casualty Co. Refund $ 71.50 19. State Farm Fire & Casualty Co. Refund $ 86.79 19. Department of Treasury Refund $ 1,477.17 20. Fidelity Mutual Dist. Trust $ 7.69 Total Principal Receipts $326,040.81 DISBURSEMENT OF PRINCIPAL Amount Check No. Date FUNERAL EXPENSES Malzpezzi Funeral Home $13,915.97 103 4/29/11 Total Funeral Expenses: $13,915.97 ADMINISTRATION EXPENSES 1. Cumberland County Register of Wills Probate fee $240.00 1012 12/1/11 Filing fee Inheritance tax return $ 25.00 130 11/23/11 Filing fees for final documents $500.00 -1- 2. Patriot News - advertising estate $327.83 106 5/16/11 3. Cumberland Sentinel - advertising estate $251.26 105 5/16/11 4. College & Snyder PC - accounting service: $395.00 116 9/6/11 $195.00 125 10/14/11 $165.00 142 5/10/12 $590.00 161 10/8/12 $375.00 166 5/29/13 5. Gray's Car Title Service - transfer title $105.50 112 7/18/11 6. Point Service Station - inspection $21.20 113 7/18/11 7. Pennsylvania Inheritance Tax $17,276.45 129 11/23/11 8. Zimmerman Plumbing and Heating repairs/maintenance $ 338.00 108 6/10/11 $226.00 1016 2/1/12 $1,301.00 143 5/17/12 9. Post Master - postage $16.58 119 9/16/11 10. Chazz Underwood - Lawn Care: $50.00 138 5/1/12 $140.00 141 5/10/12 $105.00 149 6/11/12 $50.00 150 6/11/12 11. Sandy Kittle - Mowing: $140.00 152 6/25/12 $140.00 157 8/28/12 $105.00 159 9/27/12 $ 35.00 162 10/23/12 12. Debra Basehore Wiest, Tax Collector: Cumberland County Real Estate Taxes $403.25 102 4/29/11 $1,154.46 115 8/5/11 $403.25 132 3/2/12 $1,233.27 153 7/10/12 13. State Farm Insurance - auto/home/life: $497.00 101 4/26/11 $66.21 104 5/7/11 $97.57 107 6/9/11 $74.41 110 7/7/11 $5.20 144 5/17/12 $515.00 148 5/21/12 14. First National Bank of Mifflintown $12.00 Automatic Deduction (checks for estate account) $25.95 Automatic Deduction Total Administrative Expenses: $27,601.39 -2- FEES AND COMMISSIONS 1. Johnston & Zagurskie, PC - attorney's fees $7,500.00 2. Troy Long, Personal Representative Commission $15,000.00 Total Fees and Commissions: $22,500.00 DEBTS OF DECEDENT: 1. Willow Valley Retirement Community $3,120.76 111 5/7/11 2. Comcast $251.26 114 8/5/11 3. US Treasury - 2010 Form 1040 $688.00 117 9/16/11 4. Lancaster General Health $172.00 124 10/14/11 5. US Treasury - late fee for return $10.71 126 10/14/11 6. Mobilex - x-rays $24.92 131 2/29/12 7. Department of Revenue - 2011 return $ 66.00 160 9/27/12 8. Department of Revenue -late fee $ 17.23 163 11/16/12 Total Debts of Decedent: $4,350.88 TOTAL DISBURSEMENTS OF PRINCIPAL $68,368.24 ADVANCED DISTRIBUTION TO BENEFICIARIES 1. Barbara Gearhart $11,795.98 (See Attachment "A") 2. Shepherdstown United Methodist Church $13,155.55 139 5/8/12 Total Distributions to date: $24,951.53 TOTALS Principal Receipts $326,040.81 Less Disbursements 68,368.24 Less Advanced Distributions 24.951.53 PRINCIPAL BALANCE FOR DISTRIBUTION $232,721.04 PROPOSED DISTRIBUTION In Trust for Barbara Gearhart: Real Estate (In Kind) $180,500.00 Cash $ 52,221.04 WHEREFORE, your Petitioner asks that distribution be awarded as provided for herein. -3- Distributions Advanced to Barbara Gearhart Check No. Date Amount Purpose 1. 109 6/10/11 $285.00 Zimmerman Plumbing& Heating 2. 118 9/16/11 $500.00 Giant -Food 3. 120 9/18/11 $36.62 CVS - Medication 4. 122 10/3/11 $500.00 CVS - Medication 5. 123 10/14/11 $500.00 Giant - Food 6. 127 11/11/11 $500.00 Giant-Food 7. 128 11/15/11 $500.00 CVS -Medication 8. 1011 12/1/11 $500.00 Giant - Food 9. 1013 12/23/11 $500.00 Giant -Food 10. 1014 2/1/12 $500.00 Giant - Food 11. 1017 2/3/12 $500.00 CVS - Medication 12. 133 3/6/12 $195.00 Craig Lahar DMD - Dental Care 13. 134 3/12/12 $500.00 Giant - Food 14. 135 4/2/12 $500.00 Giant - Food 15. 136 4/12/12 $500.00 CVS - Medication 16. 137 5/1/12 $294.58 Windint Hill Vet. Clinic 17. 140 5/7/12 $500.00 Giant - Food 18. 145 5/17/12 $203.40 Winding Hill Vet.Clinic 19. 146 5/17/12 $94.00 Mechanisburg Dental Association 20. 151 6/20/12 $74.40 Winding Hill Vet Clinic 21. 154 7/16/12 $500.00 Giant - Food 22. 155 8/10/12 $74.40 Winding Hill Vet Clinic 23. 156 8/10/12 $26.00 State Farm Ins.-Barb Life Ins. 24. 158 9/5/12 $1,000.00 CVS - $500 for Medication and Giant - $500 for Food 25. 164 12/21/12 $191.00 Doreen E. Gunder- Dentist Visit 26. 165 2/14/13 $60.00 Don Lenk - Snow removal 27. 167 5/29/13 $2.60 State Farm Ins. - Barb Life Ins. 28. 168 5/29/13 $556.00 State Farm Ins. - Homeowner's insurance for house 29. 169 5/29/13 $444.54 Debra Wiest, Tax Collector - Real Estate taxes for house 30. 170 9/16/13 $1,258.44 Debra Wiest, Tax Collector- Real Estate taxes for house Total Advanced: $11,795.98 VERIFICATION COMMONWEALTH OF PENNSYLVANIA: :ss. COUNTY OF JUNIATA On this, the I "day of February, 2014 Troy B. Long, Executor of the David L. Gearhart, Deceased, declares under oath that he has fully and faithfully discharged the duties of his office; that the foregoing First and Final Account and Schedule of Distribution is true and correct to the best of his knowledge, information and belief. Troy B. LAg E e to Sworn to and subscribed before e this B day of 2014 i Notary Public COMMONWEALTH OF @NNSVLVANtA Notarial Seal Rebecca B.Hess,Notary Public Mifflin Boro,Juniata County My commission Expires Feb.17,2017 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES NOTICE OF INHERI-TANCE TAX pennsytvania � BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE ? INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP C12-11>PO SOX 280401 HARRISBURG PA I7128-0601 DATE 06-05-2012 ESTATE OF GEARHART DAVID L DATE OF DEATH 02-26-2011 FILE NUMBER 21 11-0432 COUNTY CUMBERLAND DONIS H ZAGURSKIE ACN 101 117 MAIN ST APPEAL DATE: 08-04-2012 PO BOX O (See reverse side under Objections) MIFFLIN PA 17058-0915 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4-- REY-1547 EX AFP C12-11) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: GEARHART DAVID LFILE NU. :21 11-0432 ACN: 101 DATE: 06-05-2012 TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 180,500. 00 NOTE: To ensure proper 2. Stocks and Bonds, (Schedule B) (2) .00 credit to your account, submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) {3} .DO of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 89, 124 . 92 6, Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schodule G) (7) 174, 109,7D 8, Total Assets (8) 443,734.62 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)_... 45,898.60 16. Debts/Mortgage Liabilities/Liens (Schedule I) (10) . 00 11. Total Deductions {II) 45,898.60 12, Het Value of Tax Return (12) 397,836.02 13. Charitable/Governmental Bequests: Non-elected 9113 Trusts (Schedule J) {13) 1.3,914 .94 14, Net Value of Estate Subject to Tax (14) _ 383,921 . 08 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: 15. Amount of Line 14 at Spousal rate (15) .00 X 00 - .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 383,,921 .08 X 045 = 17,276.45 17. Amount of Line 14 at Sibling rate (17) . 00 X 12 = . 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) • 00 X 15 - . 00 19. Principal Tax Due (19)= 17,276.45 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-23-2011 CDC15255 .00 17,276.45 TOTAL TAX PAYMENT 17 ,276 .45 BALANCE OF TAX DUE ,p0 INTEREST AND PEN. .00 TOTAL DUE D0 • IF PAID AFTER DATE INDICATED. SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: David L. Gearhart Date of Death: 2/26/2011 Will No. 21-11-0432 Admin. No. N/A TO THE REGISTER: I certifiy that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was mailed to the following beneficiaries of the above-captioned estate on April 11, 2011. Name: Address: Shepherdstown United Methodist Church 1934 S. York Street, Mechanicsburg, PA 17055 PA Office of Attorney General 16h Floor, Strawberry Square,Harrisburg, PA 17120 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE JOHNSTON AND ZAGURSKIE, PC Date: Y I By &dLu.-6 �� Donis H. ZagurWde,7Esq. 117 Main Street, P.O. Box O Mifflin, PA 17058 Phone (717) 436-8044 C. �[.l h cc -- W°__i i {J` rr_ CD