HomeMy WebLinkAbout02-1140PETITION FOR PROBATE
Estate of M•¢e ~ ~ .:1"/te ^rE Ayr<!f R>e.
also known as ?'r ~ FJ : O iJ Nt3 rt /t
- ~~
N ~4 y ~'r a o a~ Deceased.
Social Security No. ~g~ ~ ~ B '~~ ~ 9Z
and GRANT OF LETT. tE~ RS
No. °Z' j ~o~ ~ ti ~ `'~
To:
Register of Wills for the
County of C~ m b e r (cr~,d in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who iS/are 18 years of age or older an the execut R-~ ~ named
in the last will of the above decedent, dated f1f0/~ rvc !a ~ /- /3 , 19~
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C~rn/3 Erg i- r4++/D County, Pennsylvania, with
her last family or principal residence at Sw R r M r~EJ<!~-rH c r~~~~ E,e~ 4i ~-~ ~~/
Roc ~- yr c. ~-,9~6 ~~ arcs B<G SP~~N~' ~-c'~-~
(list street, number and muncipality ~~
,De~C_ .
Decendent, then ~1~2 years of age, died ~ ~ ~ , ~ ~ ~~ ~-
at G P e ~~' FT l'L iJ ~ r / o~ i'1l v_ c,~s 't ~ / ~,~- , r 7
Except as follows, dece ent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real. estate in Pennsylvania
situated as follows:
$ ~ ~_ oy o
WHEREFi~RE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ~~ 5 7` c'p M ~x ~~-~' ~{
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF c'-~i~~SE'.~"%~~ ~ Ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ~v v,
efore me thi ~ day of ~~
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ti~~~«, <u.. ~ ;
Register
J'I -- ~~ e ~. ~ ~
No.
21-02-1140
Estate Of MABEL IRENE DUNBAR A/K/A MABEL B. DUNBAR ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND MOW DECEMBER 16th X~ 2002 , in consideration of the petition on
the reverse side hereof, satisfactory praof having been presented before me,
IT IS DECREED that the instrument(s) dated NOVEMBER 13 1997
described therein be admitted to probate and filed of record as the Iast will of _
MABEL IRENE DUNBAR A/K/A IRENE B. DUNBAR ,
and Letters TESTAMENTARY
are hereby granted to JACQUELINE LEE FERGUSEN AND JERALDINE LOU KNOUSE
Regis er of Wills
FEES
Probate, Letters, Etc. ......... ~ 115.00
Short Certificates(2) .......... e, 6.00
R1~iXd~~~ .EXTRA .SAGES .2 $ 6.OG
~ 10.00
TOTAL ~ 137.00
Filed FEBRUARY 16, 2002
ATTORNEY (Sup. Ct. LD. No.)
ADDRESS
PHONE
LETTERS GIVEN TO EXECUTRIX 12-16-2002
F:\FILES\DATAFILE\WILLS~9029.WII ,,. ~
LAST WILL AND TESTAMENT
I, MABEL IRENE DUNBAR, of Newville, Cumberland County, Pennsylvania, being of
sound ar~d disposing mind and memory, do hereby make, publish and declare this to be my Last Will
and Testament., hereby revoking any and all former Wills or Codicils by me made.
1.
I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes
(whether such taxes may be payable by my estate or by any recipient of any property) shall be paid
from my residuary estate as soon as practicable after my decease and as part of the administration of
my estate. My Executrices shall have no duty or obligation to obtain reimbursement for any such tax
so paid, even though on proceeds of insurance or other property not passing under this Will.
2.
I give, devise and bequeath the sum of Three Thousand Dollars ($3,000.00) to each of the
following: BRUCE JAMES DUNBAR, DOUGLAS NOEL DUNBAR, JEFFERY SCOTT
FERGUSON, JAMES STEWART FERGUSON, JERRY LYNN FERGUSON-WEAVER, JUDITH
MICHELE SMALL, ALBERT BAUER KNOUSE, JACQUE LYNN REAPSOME and MATTHEW
DUNBAR KNOUSE. In the event any of the foregoing beneficiaries shall predecease me, then I
direct that his or her share shall be distributed to his or her issue, per stirpes.
3.
All the rest, residue and remainder of my estate, both real and personal property, I give, devise
and bequeath, in equal shares, unto JACQUELINE LEE FERGUSON, JERALDINE LOU KNOUSE
atiu iL~ir"~RY Du'Pvnrii.. in the event any of said bene ciaries shall pre: ec:,asc me, then I direct that
her share shall be distributed to her issue, per stirpes.
4.
I nominate, constitute and appoint my daughters, JACQUELINE LEE FERGUSON and
JERALDINE LOU KNOUSE, as Executrices of my estate.
L~1~
M.I.D.
5.
I direct that my Executrices shall not be required to file a bond to secure the faithful
performance of their duties in any jurisdiction.
6.
I authorize and empower my Executrices, in their sole and absolute discretion, to purchase
or otherwise acquire and retain any investments of which I die seized or any real or personal property
of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in
regard to any or all property of any kind forming a part of my estate for such terms and such prices
as they may deem advisable; to borrow money for any purposes connected with the protection and
preservation of my estate; to mortgage or pledge any real or personal property forming a part of my
estate or to join in or secure the partition of same; to compromise any claims or demands of my estate
against others or of others against my estate; to make distribution in kind and to cause any share to
be composed of cash, property or undivided fractional shares in property different in kind from any
other share; to employ agents, attorneys and proxies and to delegate to them such power as my
personal representatives consider desirable and to pay reasonable compensation for such services as
maybe rendered by such agents, attorneys and proxies; and to execute and deliver such instruments
as may be necessary to carry out any of these powers. In addition, I direct that my personal
representatives shall have the power to conduct an inventory of any safe deposit box necessary to the
administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this 13th day of November,
l 997.
n~.~~ ~~i~,~..lo~.u~~~a~EAL)
abel Irene Dunbar
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed
our n mes as witnesses thereto, ~ the presence of the said Testatrix and of each other.
l ~ )_
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
I, Mabel Irene Dunbar, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
~~~~C~~ p~2e~~~~~%~
Mabel Irene Dunbar
Sdvurn or affirmed to and acknowledged before me by Mabel Irene Dunbar, the Testatrix,
this 13th dat- of November, 1997.
Nota Pu c
f-ae_..~
Notarial Seal
COMMO?`'WEALTH OF PENNSYLVANIA ) ~ Kelly S. Baker, Notary Public
: SS. Carlisle Boro, Cumberland County
COUNTY OF CUMBERLAND ) ~ My Commission Expires Feb. 7, 2000
-~•~in Pssoriation of Notaries
We,
the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw Mabel Irene Dunbar, the
Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and
that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that
each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best
of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under
no constraint or undue influence.
Aadress /v .fsT li~G.r~ STit~
j,~/ ~'~2L ~ ~ ~ ~' Pi¢- ~ 7o i3
~Y,~ ~
Address ~t
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Sworn or affirmed to and subscribed before me this ~J~~ day of ~t~~'/x~ , 199 ~
Nota Pub c
r
Notarial Seal
Kelly S. Baker, Notary Public
I Carlisle Boro, Cumberland County
~qy ,^,ommis~sinn ~xpire5 f=eb. 7, 2000
:Is '' ;,;?., ~ ~ gs~nci~tion of Nat~ries
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ~i'~'~I~L- --~k'~~/L ~r1r/ /3r9~/'~'
Date of Death: ~~[,c~ vH ,~ ~ r ~ ~ ac> ~
Will No. ~~ -" ~ ~ O ~ ~ ~ ~ `~~ Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: l(~-r L' ~t ~ b : ~Z ~' n
Signature
Name ~- - ~"~
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Address , , , l"/ ~ ,f-Nr _4~-~
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Telephone (~~~i ~ ~ ~ _ ~ ~ ~-~
Address
Capacity: / Personal Representative
Counsel for personal representative
,',EV-1500EX (6-00i
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
f7-/0c;-(f
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
Oec-;e_b~/Z. ~.:z. 00;2., /J/A'-"fC/, / s-: /9/0
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST FIRST, AND MIDDLE INITIAL)
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OFFICIAL USE ONLY
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~1.0riginaIReturn
o 4. Limited Estate
~ Decedent Died Testate (Altaen copy ofWnI)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a, Future Interest Compromise (dateo/death after 12.12-82)
o 7. Decedent Mainla'lned a UV'lng Trust (Attach copy 01 Trust)
o 10, Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95)
FiLE-NUMBEiR------------------
d-.L-~d
COUNTY CODE YEAR
cJ / L 1.0-
$ER
SOCIAL SECURITY NUMBER
1'i5.1. - ~f[ - ~.2. :z.
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12.13-82)
o 5. Federal Estate Tax Return Required
8, Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (il.\\achSch0)
COMPLETE MAILING ADDRESS n
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If/ f?~I<.ve S T,
C.!'1F<lJ.-ISJ.. E" f'A
Or:
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x.O_ (15)
x.O_ {16} <11 :2- 7?&, 73
x .12 (17)
x 15 (18)
(19)$ .:z 78>>' , 73
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NAME.;TAc V:E.//,v~ D_
FIRM NAME (If Applicable)
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---OFFiCIAL USE ONLY
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TELEPHONE NUMBER
717-':;''1'3
3 " S-3
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1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4, Mortgages & Notes Retei"able (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
{Schedule E}
6, Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. InterNivos Transfers & Miscellaneous Non-Probate Property
(Schedule G orL)
13'+-,
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Lv
W
ex>
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedenl, Mortgage liabilities, & liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
..~
(8)
00
(11) ~:?.O'(.,
(12) 6 i) 't.2 7. ?, Cf
(13) 0
(14) (, I . '7 J: 7. 37
(9) :/I .,:z :;1. C> 7,
(ID) .0
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec, 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
.71 :27;,(;,73
17, Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
200
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS I~
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0/3
(1) #.;l7 ;y(.~ 7.3
t>
C>
o
Total Credits (A + B + C) (2) 0
3. InteresVPenalty if applicable
D. Interest 0
E. Penaity 0
TotallnteresVPenalty ( D + E ) (3) 0
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) # ~ 7 ~, 7, '3
A. Enter the interest on the tax due.
(5A)
B. Enter the total ot Line 5 + 5A. This is the BALANCE DUE. (5B) <;t;
Make Check Payable to: REGISTER OF WILLS, AGENT
C>
~7~, 13
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
~
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~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. 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? .
Yes
......0
.......0
.....0
....0
.......0
...0
....0
No
~
~
~
~
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, II is (rue, correct
and complete.
Declaration of preparer other Ihan the personal representative is based on all informalionofwhich preparer has any knowledge
ERS. ON RESPONSIBLE FOR,f[tING Rf>IlJRN .
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ADDRESS /J
1// r/1/fK2./2. Sf: {!n~L.Jo L~j
F PREPARER OTHE THAN REP ESENTATIVE
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ADD RES ;2 0' '? , ~ ~. / .11
IV 7' 0 '-.P? ~"""~N-j((.,
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I 70 I .3
;2
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DATE
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 3%
[72 P.S. 99116 (a) (1.1) (i)l.
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 0% [72 P.S. 99116 (a) (1.1) (ii)
The statute does not exemot 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
the surviving spouse is the only beneficiary.
For dates ot 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 paren
or a stepparenl ot the child is 0% [72 P.S. 99116(a)(1.2)].
The lax rate imposed on the nel value of Iransfers to or for the use ot the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transters to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as a
individual who has at least one parent In common with the decedent, whether by blood or adoption.
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I, DONNA M. OTTO
Register for the Probate of Wills and Granting
Letters of Administration &c. in and for said
County of CUMBERLAND
the 16th day of
do hereby certify
December
that on
A.D. ,
Two Thousand and Two,
Letters
TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of DUNBAR MABEL IRENE
(LAbl, rlKb'l', MllJlJLr:)
a/k/a DUNBAR IRENE B
in said county, deceased, to
KNOUSE JERALDINE LOU
(LAbl, rlKbl, MllJlJLr:)
, late of WEST PENNSBORO TOWNSHIP
FERGUSON JACQUELINE LEE
(LA~l, t~Kbl, M1UUL~)
and
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of said office at CARLISLE, PENNSYLVANIA, this 16th day of December
A.D., Two Thousand and Two.
File No. 2002-01140
PA File No.
Date of Death
S.S. #
21-02-1140
12/08/2002
182-48-6292
. (O~.ar I ~j;j ~
O))")/JmJ WJ. . 11Jf1f'ji"tjj {.,.o fed. . !I
Register
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Receipt Date
Receipt Time
Recelpt No.
12/16/2002
10:07:51
1031418
DUNBAR MABEL IRENE
File Number 2002-01140
Remarks JERRY D KNOUSE
CW
------------------------ Distribution Of Receipt ------------------------
Transaction Description Payment Amount Payee Name
PETITION FOR PROBA
SHORT CERTIFICATE
EXTRA PAGES
JCP FEE
115.00
6.00
6.00
10.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
Check# 4295
Total Received.........
$137.00
$137.00
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register of Wills
Hanover and High Streec
Carlisle, PA 17013
Recetpt Date
Rece:)-pt Time
Recelpt No.
1/09/2003
11:41:21
1031609
DUNBAR MABEL IRENE
File Number 2002-01140
Remarks
AC
------------------------ Distribution of Receipt ------------------------
Transaction Description Payment Amount Payee Name
SHORT CERTIFICATE
6.00
CUMBERLAND COUNTY GENERAL FUN
Cash
Total Received. ........
$6.00
$6.00
Form 55-4 Application for Employer Identification Number 43 - t s' i? '/,20'
(For use by employers, corporations, partnerships, trusts, estates, churches, EIN
(Rev. December 2001} government agencies, IndIan tribal entities, certain individuals, and others.)
Department of the Treasury OMS No. 1545-0003
Il"Ilem~Re'le\1UeSef\l\(;e .... See separate instructions for each line. .... Keep a copy for your records.
1 Legal name of entity (or individual) for whOm the EIN is being requested
H/1t3 6- L I€-f3'" F'c D iJ Jli t3fJ.e
:i- 2 Trade name of business (if different from name on line 1) 3 Executor, tru~~, "care of" n~e . S'( _
..
'" .J /hQY <= 1-1 i?- '- lEG -efl6 v:J"e.'a.fiL DUI G. /-p<J
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U 4. Mailing address (room, apt., suite no. and street, or P.O. box) Sa Street address (if different) (Do not enter a P.O. box.)
c: '" f'/lIf-(<~(I- t;;j-c
'C: 4b City, state, and ZIP code 5b City, state, and ZIP code
Q. !1't1'1{)IJ
.. C-+,L~ I !, L vEl
0
Gl 6 County and state where principal business is located
Q.
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I- 7a Name of principal officer. general partner, grantor, owner, or trustor I 7b SSN, ITIN, or EIN
i,YO
l<:rlc.;Jf
~ (?~ "I)':, t ;l"':l...
La Estate (SSN of decedent),p4 7
o Plan administrator (SSN)
o Trust (SSN of grantor)
o National Guard 0 State/local government
o Farmers' cooperative 0 Federal government/military
o REMIC 0 Indian tribal governments/enterprises
Group Exemption Number (GEN) ....
8a Type of entity (check only one box)
o Sole proprietor (SSN) 1
o Partnership
o Corporation (enter form number to be filed) ....
o Personal service corp.
o Church or church-controlled organJzation
o Other nonprofit organization (specify) ....
o Other (s ecif ) ....
8b If a corporation, name the state or foreign country State
(if applicable) where incorporated
Foreign country
9
Reasol1 for applying (check only one box)
o Started new business (specify typel ....
III Banking purpose (specJfy purpose).... .5E7Tt-E. ,::::. rfl,13
o Changed type of organization (specify ne'lN type) ....
o Purchased going business
o Created a trust (specify type) ....
o Created a pension plan (specify type) ....
10
o Hired employees (Check the box and see line 12.)
o Compliance with IRS withholdJng regulations
o Other (specif ) ....
Date business started or acquired (month, day, year)
II-Inc;"}....
12 First date wages or annuities were paid or will be paid (month, day, year). Note: If applicant is a withholding agent enter date income will
first be paid to nonresident alien. (month, day, year) . . ....
13 Highest number of employees expected in the next 12 months. Note: If the applicant does not Other
expect to have any employees during the period, enter "-0-:' . ,..
14 Check one box that best describes the principal activity of your business. 0 Health care & social assistance Wholesale-agent/broker
o ConstructIon 0 Rental & leasing 0 Transportation & warehousing 0 Accommodation & food service Wholesale-other 0 Retail
o Real estate 0 Manufacturing 0 Finance & insurance 0 Other (specify)
15 Indicate principal line of merchandise sold; specific constructJon work done; products produced; or services provided.
11 Closing month of accounting year
o Ves
Ii] No
16a Has the applicant ever applied for an employer identification number for this or any other business?
Note: If "Yes," please complete Jines 16b and 16c.
16b If you checked "Yes" on line 16a, give applJcant's legal name and trade name shown on prior application if different from line 1 or 2 above.
Legal name'" Trade name ....
16c Approximate date when, and city and state where, the application was filed. Enter previous employer identification number if known
Approximate date when filed (mo., day, year) City and state where (lied Previous EIN
Third
Party
Designee
Complete ttlis section only if you wam to authcril~ the named individual to receive the entity's ElN and answer questions about the completion of this form,
Designee's name Oesignee's telephone number (include area code)
( )
Designee'sfax number (include area code)
Address and ZIP code
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete. ~
V'"
Applical1t's telephol1e number (include area codeJ
Name and title (type or print clearly) ....
Applicant's fax number (include area code)
Si nature ...
Date ....
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 16055N
Form 55-4 (Rev. 12-2001)
Green Ri,dge
VILLAGE
210 Big Spring Road. Newville, Pennsylvania 17241-9486
Phone (717) 776-3192' Fax (717) 776-6266
January 2,2003
To Whom It May Concern:
Irene B Dunbar was a resident of Green Ridge Village/Swaim Health Care Center from
July 8, 1991 until her death on December 8, 2002.
Sincerely,
~)\~
Tina Arnold
Business Office
Swaim Health Care Center
A service oj Presbyterian Homes, Inc.
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DUPLICATE - CLIENT
TRIPLICATE - FUNERAL HOME
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NOUVWHO~Nll::lnOA 1::10.::1
~'51'~."~".
COMMONWEALTH OF PENNSYLVANIA
INHERJTANCE TAX RETURN
RESIDENT DECEDENT
;T'te E/V:i
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
DcJlJ-bfl/2
FILE NUMBER
E IN H 3- I. 8'8"l:J, I,L 1"
ESTATE OF
B.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: C2-{!. f:. flC 1+ {,."./I/ .;: /6:" .s-O. ..~
1. O/,.:<.;z.:.:.; 7 o.-~
.
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D;e.?.A-rY I:;' r '2. S, ...,
-
. rz:,:.
Q &> feo.v 2-1<Z 5
B. ADMINISTRATIVE COSTS: /YcA:/:z:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Number(s) f EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s} Commission Paid:
2. Attorney Fees /I/oA:/Z-
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 yt 137.~
5. Accountanfs Fees
6 Tax Return Preparer's Fees
:jp I ;;. s: "V
7.
TOTAL (Also enter on line 9, Recapitulation) $ :2.:1. 197. bO
(If more space IS needed, insert additional sheets of the same size)
'EV"'3EX'I'~".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF -r-
~t€%-V~
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
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/0, f/<I"'rU!'s (!"taSS/;",? ,I..;.fitz,?,4 17!>-"".
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
I~OI4-'W<>\BL[ 818mIB~Ti0I4~: A/~,uE.
A. Sf0UOAL 5\8'TI\I~tJTleU3 UUBCR 3EGT,0H ~11~ reF!. '.~~lCI-I ~tJ CLCGTlmJ T9 Tl1Y J~ NOT BFIt\I~-l1~
7f/c'vc..//",c t.u: ri:RG.lJsoAl
117 t?11,e~~;Sf: (!AI,d,'5!z. I PA (701'3
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NUMBER
I.
-5.'
(f.(!!.~,. r..
1.
SCHEDULE J
BENEFICIARIES
B.
j/u{IJ ba.~
FILE NUMBER
E/P
RELATIONSHIP TO DECEDENT
Do Not Ust Trustee(s)
1.
~.
3.
II.
f".
7.
?
"(,
o~J.+J:1<
3.
B. CHARiTABLE AND GOVERNMENTAL DISTRIBUTIONS
1. ~It/~
/.f S -" 'i18"f.:z #-?
AMOUNT OR SHARE
OF ESTATE
~ ....
W' ~ooo.
..0
3,DD6.
....
3) e>00.
3 oe>O ..0
" -
-
3) ocP.
., CJa() . eo
"', .
,,/ oCO' 00
_ DO
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g~(:JOO . 6C>
I!.f fIle -tkr /lI1if/E
J I ,.ttf' I>"TI""'~ II /, O~
<1 $oO~"o ~)J
~:J'l.c-h ", f -tJ,.u; c. .
,-I);.. "'ill l'e~c"J~
1z IJT -11.....
f!ZIIIAlivJE Ie of' -t4r.
:S:.s,,,,"fL.
TOTAL OF PART II. ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ N',p It! L
(if more space is needed, Insert additional sheets of the same size)
FEW
TRUST
INVESTMINT ANIlTl\UST SERVICES
/
Statement of_Account
Canuary 1,2003 Through March 31,200':--"
Irene B. Dunbar
Investment Management Agreement
Dated 07/08/02
Account Number: 30195300
Please contact your administrator -
Charles R. Porter, 261-3574
with any questions concerning your account.
Irene B. Dunbar
111 Parker Street
c/o Jacqueline Ferguson
Carlisle, PA 17013-2821
Confidential And Privileged Information
P.O. Box 6010 . Ch,lmhf'rshurg, PA 171i\1.('i\10
F8~
TRUST
INVFS rMlN T /\NIJ TRUST SERVlns
January 01,2003 To March 31,2003
Account Name: Dunbar, Irene B., IMA
Account No : 30195300
Account Summary
Total Receipts;
$ 64,134.39
000
0.00
0.00
-64.686.45
0.00
-86.01
.64,772.46
0.00
607.02
31.18
0.00
0.00
638.20
-0.13
-0.13
$ 0.00
Beginnillg Market Value:
Receipts .-
Cash Deposits:
Asset Deposits:
Payments:
Disbursements:
Withdrawals and Distributions;
Administrative Expenses:
Total Payments:
Investment l1tcome:
Tax Free Income:
Taxable Interest:
Dividends:
Return of Capital (Income Assets Only) :
Other Income:
Total Investment Income:
Investment Growth:
Total Investment Growth:
Ending Market Value:
P.O. Box (,010 . Ch,lmhcrshurg, FA 1720J-I,OIO
Page 2
~Account Summary-MKTHPL
F8)M
TRUST
INVES fMfNT ,"Nil TRI !Sf SIRVICES
Account Name: Dunbar, Irene B., IMA
January 01, 2003 To March 31, 2003
Account No : 30195300
Date
Account Transactions
01/0212003
01/02/2003
01/02/2003
02/03/2003
02/03/2003
02/04/2003
02/13/2003
03/03/2003
03/03/2003
01/23/2003
\)2/04/2003
Description
Starting Balances
Dividends and Interest
Income
$0.00
15.53
0.25
31.18
32.49
0,28
322.50
192.20
43.20
0.57
Sub Total 638.20
Principal
$ 0.00
0.00
65.94
10.000.00
Daily Factor ~ Interest
Dreyfus Treasury Prime Cash Mgt Fund
Interest From 12/01/2002 To 12/31/2002
Daily Factor ~ Interest
Dreyfus Treasury Prime Cash Mgt Fund
Interest From 12/01/2002 To 12/31/2002
Daily Factor M Dividend
Vanguard GNMA Fund #36
Dividend From 12/01/2002 To 12/31/2002
Daily Factor - Interest
Dreyfus Treasury Prime Cash Mgt Fund
Interest From 01/01/2003 To 01/31/2003
Daily Factor. Interest
Dreyfus Treasury Prime Cash Mgt Fund
Interest From 01/01/2003 To 01/31/2003
Interest
Motorola Mand. Putt @ Par 6.450% 02/01/03
Accrued Interest Received
C/D Beal Bank SA 2.050% 06/04/03
Flower Provision
Daffy Factor. Interest
Dreyfus Treasury Prime Cash Mgt Fund
Interest From 02/0112003 To 02/28/2003
Daily Factor - Interest
Dreyfus Treasury Prime Cash Mgt Fund
Interest From 02/01/2003 To 02/28/2003
Sales~ Maturities or Redemotions
Sell
Vanguard Total Stock Market Index Fund #85
3.292 Shares @ $ 20.03
Cost Basis Removed $67.09
Sell
Motorola Mand. Putt@ Par 6.450% 02/01/03
Transactions (2 ~o') - TRNHPL
P.O. Box (,OlO . Chdmhorshllrg.I'..\ 1720)-(,010
Page 3
FBIM
TRUST
INVESTMENT ANI) mUST SERVICES
January 01, 2003 To March 31,2003
Account Name: Dunbar, Irene B., IMA
Account No: 30195300
Date
Account Transactions
Principal
Description
Income
0211312003
0112712003
0212512003
03117t2003
10000 PV@ $ 100.00
Cost Basis Removed $10,096.60
Mandatory Put
Sell
GtD Beal Bank SA 2.050% 06t04103
22000 Units @ $ 1.00
Flower provision
22,000.00
Sub Total
0.00
32,065.94
Payments
Market Fee
Market Value: 64,330.07
Market Fee
Market Value: 64,685.80
Cash Disbursement
Distribution Of Cash
Paid To: Estate of Mabel Irene Dunbar
Deposit to AHfirst Bank Account 990219000
-42.89
-43.12
-64,686.45
Sub Total
0.00
-868.37
868.37
.64,772.46
Net Transfers
9
4
MONEY MARKET ACT/J'ITY
Purchases ( 5 ) For
Sale ( 5 ) For
32,704.14
64,772.46
Eliding Balances
$ 0.00
$ 0.00
ro. Box 6010 . Ch;lmher,hurg,l'.'\ 17201-(,010
'fransactJons (2 col) - TRNHPL
Page 4
dO.'
FgM
TRUST
INVESTMENT AND TRUST SERVICES
January 01, 2003 To March 31, 2003
"Account Name: Dunbar, Irene B., IMA
Account No : 30195300
Portfolio Summary
March 31, 2003
Porlfolio
%
Tax
Cost
Market
Value
Estimated
AnilIne
Current
Yield
No Market Totals Are Available For This Account
Port Sum and Hold w Accmals. HLDACR
pn Rnx (,nln . eh,lmh""'"",, P,\ 17?nl-(,n1()
Page 5
F8~
TRUST
IN V'S I MINT'\Nll mllST S,RVICr:S
January 01,2003 To March 31, 2003
/
Account Name: Dunbar, Irene B., IMA
Account No : 30195300
Summary Of Investment Holdings
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Par Value Category
Tax
Cost
Unit
Value
Market Estimated Curr
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Accrued
Income
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COMMONWEALTH OF PENNSYL\/ANIA REV-1 762 EXI11-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 7 71 26-060 7
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 002618
FERGUSON JACQUELINE D
1 1 1 PARKER STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
fold
ESTATE INFORMATION: ssrv: is2-4s-6292
FILE NUMBER: 2102-1 140
DECEDENT NAME: DUNBAR MABEL IRENE
DATE OF PAYMENT: 05/28/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 1 2/08/2002
101 ~ 52,786.73
TOTAL AMOUNT PAID:
REMARKS: JACQUELINE D FERGUSON
CHECK# 93
SEAL
INITIALS: JA
RECEIVED BY: DONNA M_ nTTn
REGISTER OF WILLS
52,786.73
DEPUTY REGISTER OF WILLS
~`~ ~~ 9~ ~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
r
JACQUELINE D FERGUSON
111 PARKER ST
CARLISLE PA"17013
..~
REV-1547 E% ~FP (01-037
DATE 07-07-2003
ESTATE OF DUNBAR MABEL I
DATE OF DEATH 12-08-2002
FILE NUMSER 21 02-1140
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
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DUNBAR MABEL I FILE N0. 21 02-1140 ACN 101 ____________________
OR
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) .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) (5l 6 4,1 34.39 tax payment.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
134.39
64
8. Total assets (g) ,
APPROVED DEDUCTIONS AND EXEMPTIONS: 2,207.00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11) 2.207.00
61,927.39
12. Net Value of Tax Return (12) 00
13 Charitable/Governmental Bequests; Non-elected 9113 Trusts [Schedule J) (13) .
.
14. Net Value of Estate Subject to Tax (14) 61,927.39
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'.:
0 0
0 0
. 0 0
15 . Amount of L ine 14 at Spousal rate t 15 ) . =
X
16. Amount of Line 14 taxable at Lineal/Class A rate t16) 61,927.39 X 045. 2,786.73
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)= 2,786.73
1MA 4/RGYi 1J•
DATE
NUMBER
INTEREST/PEN PAID (-)
AMOUNT PAID
05-28-2003 CD002618 .00 2,786.73
TOTAL TAX CREDIT 2,786.73
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" (CRI, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B [collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed an the reverse side.
--Make check or money order payable ta: REGISTER OF ifILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special 24-hcur
answering service for farms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty C60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing tc: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (7177 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CS%7 discount of
the tax paid is allowed.
PENALTY: The 15% tax amnesty non participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tine period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, ar nine (9l months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six C6%l percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will hear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rata Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Cumberland County - Register Ot Wl~~S
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/29/2006
FERGUSON JACQUELINE LEE
111 PARKER STREET
CARLISLE, PA 17013
RE: Estate of DUNBAR MABEL IRENE
File Number: 2002-01140
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:
5/08/2006
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
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/29/2006
KNOUSE JERALDINE LOU
398 WEST WOODS DRIVE
LITITZ, PA 17543
RE: Estate of DUNBAR MABEL IRENE
File Number: 2002-01140
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:
5/08/2006
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,
~ ~~"J ,&~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
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STATUS REPORT UNDER RULE 6.12
Name of Decedent:
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Date of Death:
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Estate No.:
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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 O' No 0
2. lfthe 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 0 No 0
b. The separate Orphans' Court No, (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes B No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: llf(~ ~ [..JL
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