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Home My WebLink About02-0993PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of WILLIAM H. BARER also known as Deceased Social Security No. 174-20-8497 No. 21-02- R~3 To: Register of Wills for the County of CIIMBERLAND in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: (d.b.n.; pendente liter durante absentia; durante minori[ate) the above decedent. Your petitioner(s), who is/are 18 years of age or older, apply for letters of administration on the estate of Decendent was domiciled at death in CUMBERLAND County, Pennsylvania, with h is last family or principal residence at 121 WALNUT BOTTOM ROAD, SHIPPENSBIIRG BO~tO (list street, number and municipality) Decendent, then 76 years of age, died OCTOBER 15 2002 at SHIPPENSBURG HEALTH CARE CENTER 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: Name Relattonshtp est ence L S~ B -SWART DAIIGHTER 214A EAST ORANGE STREET SHIPPENSBURG PA 17257 CHERIE FINREY DAIIGHTER 382 MAINSVILLE ROAD SHIPPENSBURG PA 17257 Petitioners after a proper search ha Ve ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: R 'd THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ., ~~ a = LISA BARER-SWARTZ ~ .~ ~~ 214A EAST ORANGE STREET ~~ SHIPPENSBURG, PA 17257 _° 717-530-9333 :~ ~: 50,000.00 CHERIE FINREY °_ 382 MAINSVILLE ROAD SHIPPENSBURG, PA 17257 717-532-9456 -~ i? .- .. ri ~ ~~' i}t { is ,c. ~7f~ ~ 7~ c.Tls~ n. l)~ i~ r i i :., c ~,Y ~ ~ ~i~~~d~x _`~s~ R9i~~~~ iii ~~a~~$C~t~ tI1ES t;C)(3~! .s~jr ti .•=3if35~:iL :i+ ~'^ "~ .. tt~ _. .. 4 ' ~ ,:~ P 8642779 r,~. ,'~~s/ - G ca ". ~-' r bt ' ~ 'i' c°~ ~~' ~' ~ .. ,:.,•. ~. ocr ~ ~ zc~2 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 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 and 1 ss truly admimsier the estate according to aw. ~ Sworn to or affirmed and subscribed before me this 5th day of Nnvu~xFR ., , „ 2002 onna M. Otto,lst Deputy No. LISA BAKER-SW Z ~' ~ a o '~ ~{.[..~ CHERIE FINKEY 21-02- 9 9 3 Estate of WILLIAM H. BAKER ,Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW NOVEMBER 6th 2002 ~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that LISA BAKER-SWARTZ and CHERIE FINREY is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to LISA BAKER-SWARTZ and CHERIE FINKEY in the estate of WILLIAM H. BAKER Register of Wills Donn M Utto,l~~s IRWIN, 1rIeKNIGHT Ts HUGHES Deputy rrr~ ~c ,.'~~ .;.if ~, ,..':Et ~ :3~~' Vc;i. ~~ .JYr{'.CC~y COp~{t~ ~ii~'.~'1 ~. ~ ~._ _ _ j j~ , _ _ . _ ~ .w .t _. kl[. ((%jL ,.c:f~.~ IO C~Iti ~~iai-<` ~ 1{r.. t > _ ,` =~.~.~~~'~:_ I~„ rll~~~l ~~;~ ~3~p1~c~ts~ this ~~py ~ ~3~~.:t~3~~1~~~ ., ;• _. ~. ~,' (,. P 8642779 '' ~?rlQtp ,~, t,,j, '~ , ~~ :: ~ ~~ ~. -_ ~. J vet ~ ~ ~~'PTifl'1EN~ ~3~~~~~,` --- ~,J .3'~ „%iY.-X/ .r' r / F..~~ i. •.L..r.;.°.~ i - - fir; ~-'--....~:_ ,,,. - _ f OCT 1 8 2002 _ _ rr~.ti~ # y S~i-iOULD READ AS NOL~~:.~'~`~<'`')~ D,c~• i.s', aoa ~ n~, a3 Rev ue7 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • 41TAL RECORDS CERTIFICATE OF DEATH <TATF FILE NUMBER ~ SGCIAL SECURITY NUMBER DATE OF UEATH,MCnm. Day. ^ean ~ --- SEK NAME OF DECEDENT (Fast. M~dWe.Lasl 1925 Ue.taben 15 20 - 8497 . 174 d , . = e ]. :. Ma GhK.~~.am H. Bah en ,. - -- - _ n AGE (Last B~nnoayl UNDER 1 YEAR UNDER 1 DAY DATE OF BIRTH BIRTHPLACE :Cry and PUCE OF DEATH IfhecM a•ly ~x~e -._ ~.ee +~svrx.lxxn n rnne~ sWel ____ OTHER: StaleaFCregn L;ounuVl HOSPITAL r -- . eert Monti Dav. -. OIWf Mordna . Days Ho«s ., Mlnulss r """'9 ~] Resgenci ^ ;spec~Iy~l ^ ariem u DOA ^ "a A ^ ERIO ,, e I p Chamben~bung, P I"D°'""' 11-16-192 5 Yr, , . . 7 6 S WAS DECEDENT OF HISPANIC ORIGIN? RACE - Amerrnn InWan, Black, While. etc. mear ~ d r t an w COUNTY OF DEATH CITY, BORO. T WP OF DEATH FACILITY NAME (Il riot x+vluuon. rwe shee IS~cM) No ® v.. ^ N yea. apace CYben, ' wh~..te Sh~ppen~bung Hea.~zh Cane Cen~ten ; °""'" P'""°R"'"~°" ,e _ Sh~.ppenebung w 2and Cumben V . . K. M. ~ve "u'oe^nx^al DECEDENT'S USUAL OCCUPQION KIND OF BUSINESSnNDUSTRV WAS DECEDENT EVERIN DECEDENTSEDUCATION NAeRver Marrted.WWOww. la ale ARMED FORCES? S ~ ore n est a cmr IN U S . . Dlv«Ce0 (Specrly) (Gne kaW d work tlone durng rtwq Elememary/SacorMary Colage d w«kmy Ffe;wna useretbedl ves® No^ (012) 12 (IJ «S.1 vanced D~ " ~~. . ' Pede~a~ Gavennmen ,_ ,]. an e~ t~c~ ~ ~ee - „b• . . . . ,,.. ^' Cay/Tpwrl. Slate. ZV Codel EDENT'S MAILING ADDRESS I$lreet P. ~TUµ NTS PennhN~.van~.a ad t7c.^1tY. deced.rK wean . DEC 17e. Slay ° d°'e 121 tua.2nu~ Ba•ttom Raad i' RESIDENCE nvructaru 1V°Me N cedere aed f S ppen~sbung, PA 17257 Sh~ ee, o, r s I on«hervwl Cumbe~e~and taer,Wep? i70.^ ehn.Owlameeol--Shs _ ""'°°'° 17b. County . ,.. MOTHER'S NAME tFasl. Middle. Maiden Swname) FATHER'S NAME jF,rs1. Middle. Last) Bah en wti~~~ G S ova R~ e ,s . 11. . NJFORMANT'S MAILING ADDRESS ISIreW. CAyRow". Slate. Zip Codel INFORMANT'SNAME(fypa'PrinO 382 Ma~n~v~..~ke Raad, Shy. en~sbun , PA 17257 b ~e F~nfze Ch y ri . en Zoe. PUCE OF DISPOSITION ~ Narrw d Cemetery. Crematory LOCATION - Cay/foam. Staa. Zq Cow POSITION DATE OF DISPOSITION + PM O ez a6 S IMr Ce METHOD OF DIS « y '. ac.c ^ (MOnm.Da%Yearl C/Cema~L-~.an ® RMrgr+IbdmSlaa Burtal^ Crema,an Penn~yxvan~a Cnema~on ,,,. Hahnebun PA 17109 O 2002 Oe~aben 18 ^ „~, , Other,Specyy „b. D«l«ien an SrJC~.e.ty o Pennae van~ea MBER NAME AND ADDRESS OF FACILITY Cnema~~ ]/e ' ' . • LK:ENSE NU SIG ATUR OF FUNERAL R E LICE E,E OR PERSON ACTT ; S SUC r ::.4100 Jone~s~tawn Road Hann~abun A 1710 _ ~ ,, „b ' ~ ~ LICENSE NUMBER DATE M,NED ore Wet d my a ad9e, Sw occ«r M l W tans, date and place slated. (Monet. Day tbarl l yr items 27at o wwn nnr n nd evade Moms o/watl~ i ($,gnalweaM7 _ R~ ~~6 G/_O.,_ L D.-.~3 -GT `.. O O Y7 ,7 ~ e. - ~/~ ,7b. LAM Of warn. ~ ~• WAS CASE REFERRED TO MEDICAL EX/I~dtNER/CORONER9 , TIME H DATE PRONOUNCED DEAD (Ma,m. Day, Year1 _J (, ~ ^ at b Y W y • p ea h 2t ri mwt person wtn pronounces wa,h. ~D "~~ ""O ri. a 00 3rd R M. :s. a er PART 11: O _ :. t _ ~ u~~ G~ ~,«t ~~ „ q . om" ~ PART 1. ]7. PART t: Enar tM disaaxs, inryras a campbcalKKai whKn nosed tM warn. Oo n« enter IM rtlode of dyitg, such as cardiac or respnatory arrest. slwck or W an lailure wtterval W Lill ordy one calwse on ea«l IIrN. ~ «lael and waN 1 IYYEDIATE CAUSE IFnat I 1 -- a~sease«o«wnr«+ ~YX,tc rl'I ca-Ki1. rendting n Oealh)-+ a. DUE TO (OR AS A CONSEQUENCE OF): SeVUerNtaWY e9 car,dAions b. - , d arty. aedinq a irrlmedaa DUE 70 (OR AS A ENC OFI: t ' ~) G, / ~. caws. Enter UNDERLTMiD ~ ' CAUSE (D,sease«mryrY c TO (Oq AS ACONSEOUE EOF~~ ~ • Nat rwated everds _ esultrq n deem) UST ~ ES- ~ ~~ N T / ~ __ ~ TIME OF IWURV INJURY AT WORK7 DESCRIBE HOW INJURY OCCURRED. _ d GATE OF INJURY WAS AN AUTOPSY WERE AU70PSY FINDINGS MANNER Of DEATH (Mmm. Day. Veen PERFORMEDT AVAIUBIE PRIOR TO rf-pp ETION OF CAUSE ^ COMPL Natwal l1'l +~n'cid• Yes ^ No ^ OF pF~VH7 ^ Li 70c ,~ - - _ _ -. Accdem ^ Pandrrg mwslgatan 7W _ ]w. 10 not W wannmed ^ PUCE OF MIJURY - At home. term, street. rectory, olbce LOCATION ISbeet. Cay/fown. SMtel ^ C ou Yss ^ No (~1 YH ® No ^ ~Kpe L_Y buildirg. etc. ISP~~IV) 7a. -_ ]BS. ri. ]N. Yeb. SIGNATUR N I LE OF CERTIFIER ~N J, ' CERTIFIER ICha:k oniy onel .p ~ ~~ 'CERTIFYING PHYSICIAN IPnysc,an certdyrng cwx d deem when ananer ohvsc~an has ponounced deem arw completed Vern 271 ........................ ~ ]lb . "`" . . To Ills We, of my krowNdpe, wem oxurred dw,o ore caux(al and manner ae sated ........................... L DATE SIGNEDIMUnm. DaY. Y art BER LICENSE NU ~~II ~)) ml '" /~I/ / ~ c/ ~~ t/ ], d -.- d n . ee 1 ]ic. 'PRONOUNCING AND CERTIFYING PHYSICIANIFRryxw,ta,m WOnwrx:,ny deem and cerulymy wcause N , and dw Io me uuxlal arW manner as atatrw .......................... ' ~ NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF OEAT and place dale l tW ttme a . `1 ~ , , , a - To ma bp, of my krowad9n, death oeeurre (Item 271 Type «Pnn1 i , .7 r) J~ rt.L ~ fi /C~ f, ~ /-V 1 ~ ~L f l Y V t _ J 'YEDICAL EXAMINER/CORONER death occurred at the Ume, dale, and pace, and due to the cause(s) and (_~ .? E /- r / t 7/~ /~{.L ~_ " opinion in m auon ti t , , y g nves On the buffs of examination and/or ..... - ... ........ .. .......... .... .... C:./ L.#.,.. a n . . t - .. ~ ( ~ f t) - / ~..t C• / - ]]. manner as stated ................................ __ r s.-{ 7,e. DATE FILEDIMavh. Day. Pearl _ REGISTRAR S SIGNATURE AND NUMBER / ...! .. '7 ~ L..y / , /~ ~/ DATE: November 12, 2002 ESTATE NO.: 21-02-993 DATE OF DEATH: October I5 , 2002 IN THE ESTATE OF WILLIAM H. BAKER CLAIM AGAINST DECEDENT'S ESTATE The Claimant certifies that there is due and owing by William H. Baker, deceased, to Claimant, the sum of $79,492.74 together with late charges calculated as being $3,974.63 and attorney fees and costs. On behalf of the Claimant, I do declare and affirm under the penalties of perjury that the information and representations made herein are true(a~nd correct to the best of my wledge, information and belief. / \ /1 ~ Shippensburg Health Care Center C~vUv~~~ ~ , ~ ~. , c/o O'Brien, Baric & Scherer 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 David A. Baric, Esquire for Claimant, O'Brien, Baric & Scherer 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CERTIFICATE OF SERVICE I hereby certify that on November 13, 2002, I, David A. Baric, Esquire of O'Brien, Baric & Scherer, did serve a copy of the Claim Against Decedent's Estate, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Marcus McKnight, Esquire Irwin, McKnight & Hughes 53 West Pomfret Street Carlisle, Pennsylvania 17013 David A. Baric, Esquire to the Estate of: ~''~' ~ ~ Estate No. ~ ~ " ~ ~- 1 "f ~l i11~I~i;'~ na k~r Date__ I ~ /~3~oa CLAIM AGAINST DECEDENT'S ESTATE The claimant certifies that there is due and owing by the decedent in accordance with the attached statement of account or other basis for the claim the sum of ~. I~Ua,~C I solemnly affirm under the penalties of perjury that the contents of the foregoing claim are true to the best of my knowledge, information, and belief. Pharmacare Name of Claimant Signature of claimant or person authorized to make verifications on behalf of claimant Jeanne Zaladonis, Billing Name and Title of Person Signing Claim One James Day Drive Address Cumberland, MiD 21502 (301) 777-1773 Ext. 117 Telephone Number FILED: RECORDED: Claims Docket Liber Folio Instructions: 1. This form may be filed with the Register of Wills upon payment of the filing fee provided by law. A copy must also be sent to the personal representative by the claimant. 2. It a claim is noc yet due, Indicate the date when it will become due. If a claim is contingent, indicate the nature of the contingency. If a claim is secured, describe the security. PS-3: PHARMACARE ONE JAMES DAY DR. CUMBERLAND, MD 21502 PHONE: 301-777-1773 11/30/2002 30 DAYS.. 465.20 60 DAYS.. 91.48 90 DAYS.. 1022.34 AMT DUE. 1602.71 PHARMACARE **** PREVIOUS BALANCE ** THIS AMOUNT PAST DUE ** 1579.02 823.77 YTD MED DEDUCTION .00 A LATE CHARGE OF 1.5~ PER MONTH (18.0 ANNUALLY) WILL BE ADDED TO AMOUNTS 31 DAYS PAST DUE ATTN: KIM--SHIPPENSBURG H WILLBAKE FOR BAKER,WILLIAM GRP-GS 121 WALNUT BOTTOM ROAD PAGE 1 SHIPPENSBURG PA 17257 ONE JAMES DAY DR. CUMBERLAND, MD 21502 23.69 1602.71 .00 1579.02 .00 1602.7 CERTIFICATION OF NOTICE UNDER RULE 5.6 a Name of Decedent: WILLIAM H. BAKER Date of Death: OCTOBER 15 2002 Estate No.: I_Q2-9~ To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on January 9 2003 . Name Address Lisa Baker Swartz 214A East Oran e Street Shi ensbur PA 17257 Cherie Finkev 382 Mainsville Road Shippensbur~ PA 17257 Notice has now been given to all persons entitled thereto under ule 5.6 except none . =- Date: O 1 /09/03 Signa e IRWIN, McKNIGHT & HUGHES Name_ Marcus A. McKnieht III Esquire Address 60 West Pomfret Street Carlisle PA 17013 Telephone (717) 249-2353 Capacity: Personal Representative X Counsel for Personal Representative DATE: May 7, 2003 ESTATE NO.: 21-02-993 DATE OF DEATH: 10/15/02 IN THE ESTATE OF WILLIAM H. BAKER CLAIM AGAINST DECEDENT'S ESTATE The Claimant certifies that there is due and owing by William H. Baker, deceased, to Claimant, the sum of $1,626.76. On behalf of the Claimant, I do declare and affirm under the penalties of perjury that the information and representations made herein are true and correct to the best of my knowledge, information and belief. Pharmacare c/o O'Brien, Baric & Scherer David A. Baric, Esquire 17 West South Street for Claimant, Carlisle, Pennsylvania 17013 O'Brien, Baric & Scherer (717) 249-6873 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CERTIFICATE OF SERVICE I hereby certify that on May~3 , 2003, I, David A. Baric, Esquire of O'Brien, Baric & Scherer, did serve a copy of the Claim Against Decedent's Estate, by first class U.S. mail, postage prepaid, to the party listed below, as follows: r• ~,; ~- ~ Marcus McKnight, Esquire ~'- Irwin, McKnight & Hughes ~ 63 West Pomfret Street ~ ~ Carlisle, Pennsylvania 17013 ;.~ ~~:a o =n` /~J li .~ C.: 7 David A. Baric, Esquire ~!?- 94-i BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-Ob01 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX w1 MARCUS A MCKNIGHT ESQ.`S I MCKNIGHT & HUGHES 60 W POMFRET ST CARLISLE PA x.7013 REV-1547 EX AFP (O1-V3) DATE 07-07-2003 ESTATE OF BAKER WILLIAM H DATE OF DEATH 10-15-2002 FILE NUMBER 21 02-0993 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ----------------------------------------- -------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE --------------------- OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BAKER WILLIAM H FILE N0. 21 02-0993 ACN 101 DATE 07-07-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 59,000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)_ 3,96 4.57 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (g) 62,964.57 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 8,939.46 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 85.141.51 11. Total Deductions (11) 94.080.97 12. Net Value of Tax Return (12) 31,116.40- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14 ) 31 , 116.4 0 - NOTE: If an assessment was issued previously, lines 14, 15 andior 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) •00 X 045 . .00 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 1 5 - .00 19. Principal Tax Due (19)= .00 TAY CRFIITTC• DATE I NUMBER ~ INTEREST/PEN PAID (-) ~ AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SFF REVERSE STnF nF THTC rnow rno TNCTOIIf•TTnu[. . \1-q~ - \ REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~. OFFICIAL USE ONLY REV-1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N FILE NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA OEPAATMENTOFREVENUE DEPT. 280601 HARRISBURG,PA 17128-0601 DECEDENT'S NAME (LAS", FIRST, AND MIDDLE INITIAL) Baker William H. DATE OF DEATH (MM-DD-YEAR) NUMBER 21-02-993 COlJNTYCQDE YEAR SOCIAL SECURITY NUMBER 174-20-8497 THIS RETURN MUST BE FILED IN DUPUCATE WItH THE DATE OF BIRTH (MM-DD-YEAA) INITIAL REGISTER OF WILLS SOCIAL SECURITY NUM fR X 1. Original Return 4. limIted Est.;lte 6. Decedent Died Testate Supplemental Return Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust (Attach copy of Trust) 3 . R date of death . Remainder eturn prior to 12- 13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Soxes 2. 4.. 7. (AttaCh copy of WIH) o 9. litigation Proceeds Received 010. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-9S) (Attach Sch 0) ,'THt$.,sEcTIOItMUST III!.COMPLEtP..Al,LCOlilRE$PO~n: cof#FlDENTlAI:.TAx,INFOlilMAT\ON SHQULIJBE DIRECTED to:. . NAME COMPLETE MAILING ADDRESS 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 IRWIN McKNIGHT & HUGHES TELEPHONE NUMBER R E C A P I T U L A T I o N 49- 35 Real Estate (Schedule A) Stocks and Bonds (Schedule B) Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (Iolal Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (31,116.40) (1) (2) (3) 59,000. NeW; N,,!/e L O.tJFFICIAL US!:j>NL Y W ::O<li <Dn r~,;:.g ::!: ~ N W (4) (5) None 3 ,964 ~5,7 (6) N~e, -0 N d \0 None (8) 62,964.57 8,939.46 85,141. 51 (11) (12) (13) 94.080.97 (31,116.40) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 141axableatlinealrale (31,116.40) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. (15) (16) (17) (18) (19) o 0 045 .12 .15 0.00 0.00 0.00 0.00 0.00 x X X X Copyright (c) 2000 form software only The LacknerGroup, tnc, Form REV-1500 EX (Rev. 6~OO) Decedent's Complete Address: STREET ADDRESS 121 Walnut Bottom Road CITY I STATE I ZIP Shiooensburg PA 172.57 Tax Payments and Credits: 1. Tax Due (Page' Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E) (3) 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 Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) Make Cheek Payable 10: REGISTER OF WILLS, AGENT "nu::::;::::::W:l[:::::lHn:';' n::':><::i:::iiu:::unH;"""-" -, '.. . ":":::::;UT" .,.....'-...'..-,.....-..--..-,-.,-......-...,..-.,-...-"'-"---"--""'.,.,.-,_..-.._-,.-",.-".,--_.,,,-,.-,,,,-,,,,,,,,___,".,.,,.,.,....,_.,.,-.,.,..,_,,.,..._,.,,,""""''''''-'''''''''''0,,:;:1:>,.,_ . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 1. 0.00 0.00 0.00 0.00 0.00 Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. !~~mf~~:~~~~~~~'l~~~'!~t~~~!~m' Yes No ~~ o o o rn rn rn Under penalties of perjury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct and complete. Declaration of preparer Qther than the personal representative is based on all Information of which preparer has any koowledge. SIGNATURE OF PERSON RESPONS LE FOR FILING RETURN Lisa Swartz _ _ _2.~,,~_ _ E:~~_t. _ 9!_":,,g~_ _ ~!-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Shi ens bur . PA 17257 IRWIN McKNIGHT & HUGHES 60 West Pomfret Street - - -ca~fisi";'- - - PA - - i'i61 '3- - - - - - - - - - - - - - - - - - - - - - - - - -- DATE ()SJ303 DATE surviving spou For dates of death on ua 5, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.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 ooneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (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 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(aXl)j. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S, 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. Copyright (c:) 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00) ADDITIONAL Personal Representatives Estate of William H. Baker SS# 174-20-8497 10/15/2002 ***************************************************** Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature c ~u,~ rU(/~l'~ Name Address Line 1 Address Line 2 City, State, Zip Cherie Finkey 382 Mainsville Road Date Shippensburg, PA 17257 ..s /(;)0,)O"~ AEV~ 1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER William H. Baker SS# 174-20-8497 10/15/2002 21-02-993 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, bath having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 195 Thompson Hollow Road, Shippensburg, Southampton Twp. - 59,000.00 Cumberland County (settlement sheet attached) SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1. Recapitulation) S 59,000.00 (It more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV...1502 EX (Rev. 1-97) REV~ 1508 ~X + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF William H. Baker SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SSlf 174-20-8497 10/15/2002 FILE NUMBER 21-02-993 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 Citizens Bank DESCRIPTION VALUE AT DATE OF DEATH 3,964.57 TOTAL (Also enter on line 5, Recapitulation) $ 3,964.57 Of more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV~ 1511 EX .. (1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF William H. Baker 10/15/2002 FILE NUMBER 21-02-993 SSjf 174-20-8497 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, 1 Fogelsanger Funeral Horne 125.00 2 Minutemen 75.00 3 Norland Cemetery 175.00 B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions 1,500.00 Name of Personal Representative(s) Lisa Swartz / Cherie Finkey Social Security Number(s) I EIN Number of Personal Aepresentative(s) Street Address 214A East Oran~e St/382 Mainsville Road City Shi ppensbur gJ Shi ppens burg Stat. PA Zip 17257 Year(s) Commission Paid: 2003 2. Attorney's Fees IRWIN McKNIGHT & HUGHES 2,000.00 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 Register of Wills 93.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland Law Journal - estate notice publication 75.00 2 Register of Wills - filing fee 0.00 3 Settlement charges on sale of real estate 4,896.46 4 The News Chronicle Co. - estate notice publication 0.00 TOTAL (Also enter on line 9, Recapitulation) $ 8,939.46 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, !nc. Form REV-1511 EX (Aev.1-97) ~EV~1512 EX "'(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF William H. Baker SCHEDULE I DEBTS OF DECEDENT, MOR TGAGE LIABILITIES, AND LIENS SS!I 174-20-8497 FILE NUMBER 21-02-993 10/15/2002 Include unreimbursed medical expenses. ITEM NUMBER 1 Chambersburg Dermatology 10 11 12 13 14 DESCRIPTION AMOUNT 28.84 2 Chambers burg Imaging Assoc. 37.18 3 Chambersburg ALS 603.85 4 Chambersburg Anesthesia 31. 53 5 Chambersburg Hospital 64.24 6 County of Franklin, 2001 delinquent taxes 33.00 7 Cumberland Valley Medical Service 120.00 8 Jeffrey S. Craig, judgement 1,003.50 9 Keystone Pathology Assoc. 270.00 Orthopededic Assoc. 128.50 Pharmcare 1,626.75 Robert E. Sheep MD 104.64 Shippensburg Health Care Center 79,492.74 Symphony Mobi1ex 128.16 15 Yogindra S. Balhara MD 1,468.58 TOTAL (Also enter on line 10, Recapitulation) $ 85, 141 ~ 51 (If more space is needed, jnsert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV~ 1513 EX t (9-00) COMMONWEAL TH OF PEN NSYLVANIA INHERITANCE TAX RETURN ~ESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF William H. Baker SSlf 174-20-8497 10/15/2002 FILE NUMBER 21-02-993 RELATIONSHIP TO OECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include olltrlght spousal distributions, and tra.ns1ers under Sec. 9116(a)(1.2)} 1 Cherie Finkey Daughter 1/2 remainder 382 Mainsville Road Shippensburg, PA 17257 2 Lisa Swartz Daughter 1/2 remainder 214A East Orange Street Shippensburg, PA 17257 ENTER DDLLAR AMTS. FDR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 S 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (cl 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9~OO) ," A. Settlement Statement FINA.L LAW GFACES U,S. Department of Housing and Urban Development IRWIN, McKNIGIIT & HUGHES """ .'^ ?no.no.. c '''^"' \-\EST POMFRET PROFESSIONAL BUILDING 1. DFHA 2. OFmBA 3. DConv. Unins. 60 \-\ESTPOMFRETSTREET 4 n;,', < nr. ,. CARLISLE, PENNSYL VANIA 17013-3222 6 FILE NUMBER r 7. LOAN NUMBER rRAWFORDR 8. MORTGAGE INSURANCE CASE NUMBER I C. Note: This form is furnished to 91\1& you a statement 01 actual..UI.ment cost.. Amounts paid 10 and by the ..Wement agent are shown. Items mal1led "(p.o.e.)~ were pakl outside the closing; Ihey ere shown h.... for Infonn_Uen ~~r::..~i.. and .rll not acluded In the total.. WARNING: Ir Is a crime to knowin$l'Y make false stllt_ments to the Uniad Staffs on this or an other Ilmila, fonn. Penalti.. upon conviction can I"dude it fIrtl....amlJmpdlonmeo1..fgu1.taU. .... Tltt& 18 use D, NAME OF BORROWER: ROBERT A. CRAWFORD and ROBIN L. CRAWFORD AD~h~"". 232 SP n~." V'LT "NnVA PA 1QO"< E. NAME OF SELLER: WILLIAM H. BAKER A 121WAL OM ROAn SillPPl'NSBURr. PA 172"7 F. NAME OF LENDER: N/A G. PROPERTY ADDRESS: 195 THOMPSON HOLLOW ROAD, Shippensburg, PA 17257 ~outhamntnn Tnwnshin It SETTLEMENT AGENT: IRWIN, MCKNIGHT & HUGHES, Telephone: 717-249-2353 Fax: 717.249-6354 PLN'E "" <"TTL . West p^mfr.' Prnfeso;nnal HId" ~() weo' Pn;;'f~t '<ree' rorH<I. PA 1701' _.LSUn,EMlliUlAIE' 1 0/24/2002 K. SIIMMARY OF SEll ER'S TRANSAC":TION: ~~ SUMMARY OF RORROWER'C: TRANSACTION: ...Jon "R"<< "'~""T ""~ ~"m. AM """.<< u'~OO"'T ' "n. 101 Contract 5~'-- 59,000.00 ... "--..--. --,-- -,-- 59 000.00 ...J~2 PersonalEr.ogerh, 'M , 103 Settllment charQes to horrower HInt!. 1400' 970.50 'h' ...1'" AhA ... ... AdjU"---" .-- ,,--. --'; hv ..,'.' i ' no'" ." ..".. .__JOZ~tv taxes 10~0~2/31/02 32.22 'h' 10/24/02..12/31/02 32.22 ...1JlL.Sl; 10/24-'02'.06130103 517.10 ... 10/24/02..06/30/03 517 .10 'hO 'hO ... ... L111 ... ... A" ...120 GRO<< "'~oom 60 519.82 AOn '".- 'T"""" ~". 59.549.32 ZOO AMOU"T< ,,,,,,.,., _a. ,., ~,,~ .M _an' ""'T n, ,~ T~ ""' , _n ... uoam 1,000.00 'h' .. 'M .._.,.. -, .. 'h' .. d. _,,__ m, , ..... 4,896.46 _.2.IJ.J___.ExJ.u1nQ loan(s) taken !Illlhjec. .h. .. .". ....___ '0 8~ 'h' ft." 'f .',d .h. ..2ll6~__ ... \.2G1~ 'h' . ...2[1L 'h. 1_.I1Jl~ 'hO I-__----Ml fM a.... "^M'" h" ..".. dn, l....m ... iJ14 ... ~;: ... ... j...z" ... I..m ... I ... ....lIS 220 TOTAL PA1l2.B.YLEQB.B.omi':;;;;;;;;- 1,000.00 .on T"nl "O'lIIr.1'ION ...~, 'm n, ,- --I r 0" 4 896.46 . OM _'_00'1' c~~, OM -.... ,- " c, ...ID GrD~sa~ldu~- , "h. 60,519.82 0"' n.... ._."., ".... .... 59.549.32 . 30. les~ amounts paid bvHor bor{Q'u-. 1fI__ .,.,,,, 1,000.00 OM 4,896.46 ono 59,519.82 .n. ,c~" ~" 54 652.86 TilleExprcss Settlement System Printed lQ124/2oo2 at l2:06 REV. BUD.I (3/86) U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: eRA WFORDR SETTLEMENT STATEMENT "AroP' F'" A1 I !';FTTI PAID FROM PAID FROM 7nn TClTAI R""'~o'e I no..ri M n';~ <59 000.00 @ 4.000 . 2 360.00 BORROWER'S SELLER'S .700\ .R fnllnw.' FUNDS AT FUNDS AT 7n. . tn SETTLEMENT SETTLEMENT ,n, , 2,360.00 tn SPENCER I< SPENCER 'M . 800. ITEM ' IN CONNECTIClN \AnTH I ClAN 2,360.0_0_ 0.. I non "- on, 'non 'L . on' ., <. gO' C,o.1t Ron",' gn. '.nri.'. , <.. 0.. . <. .n, . <. gng 0.. ..n a.. 900. ITEMe "P"'IIRED BY I ; RF PAin IN A gn. IntOM.t Fmm 'n "" '.0. gn2. ."' 'n on. ~..a'" . 'n, OnA gn5. 1000 RF!';FRVF!'; DFP '\AnT" 'P"R 1nn. ~a..'" mn "'. 'mn .nn, ce mo @$ '_n .nn' . T. mn ..... -- 100.. Cnuntv P,nn."" To... _n ...., 14.21 'mn .nn. ~,hM' Tn -. 62.91 ,-- 1nn. 0.00 0.00 1100. TIT' ~ ~u.~~~~ 11n. 11n, .h 1103. T;\I., 110.. Till. I . hln... 11n. tn Irwin, McKnight I< Hughes 200.00 11n. tn NOTARY PUBLIC 2.00 2.00 1107. .. .~n' , 11no . Itom. Nn' , 1109. , Cnv..an"-'--. 111n nwn.', " 59.000.00 - 1111 M Irwin, McKniaht I< Huahes 350.00 ..., .." 1200. GOVER 1201. In.... 28.50 ., . .... .. 28.50 1'20'2. CI~un'ty taxfstamD8 DeedS590.00 . Mortqaae S 590.00 11n. n.. ..590.00 590.00 .,n. "n. nnn AnnIT'''''^' e~TT' EO:: "n. ., 13n2. nn. ,nn1 T AXF~ ~AX CLAIM BUREAU 802.35 nn. ,nn, M' ..,~ TAXF~ tn VIVAN P. COY TAX COLLECTOR ~87.~4 11n. nT,^, n^"M TAX.. t, VIVAN F. COY. TAX COLLECTOR 754.97 11n. "n, -- 13ng 140n. TOTAL !';ETTLFMENT C"ARGES '.n'" nn lin.. .n. n. . ,K' 970.50 4.896.46 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 s.ttJ.~.nt Stale t and to the best of my knowledge and belief, Ills a lrue and accurate statement of all receipts and dlsburnmenb mllde on my account or b In this transaction. I further cerUfy that I h..,e nl copy of the HUD-1 Sehlement Statement. .~ -- '":," ROBIN L. CRAWFORD WILLIAM H. BAKER nl which I haw prepared Is a true and accurate account of this transactio lis to be disbursed In accordance wllh Ihls statement. ~~ WARNING: IT IS A CRIME TO KNOWINGLY M FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMIlAR FORM. PENALTIES UPON CONVICTION CAN INCLUDe /II. FINE AND IMPRISONMENT. FOR DETAILS SEe TITLE 18: U.S. CODe SECTION 1001 AND SECTION 1010. By: /cJ/,N;02. . "\ REV. HUD-! (3/86) ( TitleFxpress Settlement Sy:>tem Printed 10/2412002 at 12:06 ~ (j ~ ~ ~ (/) ~ ~ ~ s' ~ ~ ~ C" ~. .-< ('> 'A ~ 0 ('> ...-1 g 0' ~. ~ d 8 e- ~ 0 ~ ('> .... ('> s' oj oj ('> ;::. 0 r ('> ('> g s e- e- o C" 0 ..... ~ ~ ~ g ~ g .... C" <-+ ~ 'A ('> ~ ('> .... .... C" C" ~ g ...-1 '0 ~ 0 .... %- 'A ~ C" C. 0 .... C" P- C" 0 i% 0 ~ g ,......, ...... 0 '0 0 g 0 0 g d ~ ~ 0 t;. 0-- 9 - if' if' v.> ~ 0 if' v.> if' v.> t:3 0 ? \.0 0 1.0 C" 1.0 -.l 0-- 0\ ~ - ';:C \.0 0 -?- 0 .I'> - N 0 Vl 0 Vl ;; . \.0 oj r::fJ -.l -.l \6Q r::fJ ~ 0 ~ \ ';d \ DATE: November 12,2002 ESTATE NO.: 21-02-993 DATE OF DEATH: October 15, 2002 IN THE EST ATE OF WILLIAM H. BAKER CLAIM AGAINST DECEDENT'S ESTATE The Claimant certifies that there is due and owing by William H. Baker, deceased, to Claimant, the sum of $79,492.74 together with late charges calculated as being $3,974.63 and attorney fees and costs. On behalf of the Claimant, I do declare and affirm under the penalties of perjury that the information and representations made herein are true and correct to the best of m~Wledge, information and belief. ~ (~. Shippensburg Health Care Center c/o O'Brien, Baric & Scherer 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 David A. Baric, Esquire for Claimant, O'Brien, Baric & Scherer I 7 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CERTIFICATE OF SERVICE I hereby certifY that on November 13,2002, I, David A. Baric, Esquire of O'Brien, Baric & Scherer, did serve a copy of the Claim Against Decedent's Estate, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Marcus McKnight, Esquire Irwin, McKnight & Hughes 63 West Pomfret Street C"di''''P'b:~ ~ 4 . David A. Baric, Esquire ~, Y ~. _ ' ~, STATUS REPORT UNDER RULE 6.12 Name of Decedent: WILLIAM H. BAKER Date of Death: October 15 2002 No. 21-02-0993 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: X Yes 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 X 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? X Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk rphan's Court and maybe attached to this report. Date: 9/25/03 Signature IRWIN, McKNIGHT & HUGHES Marcus A McKnight III Esquire _ Name (please type or print) 60 West Pomfret Street Address Carlisle PA 17013 City, State, Zip (717) 249-2353 Telephone Number Capacity: Personal Representative X Counsel for Personal Representative