HomeMy WebLinkAbout01-0346
Estate ofGeJ1~ v/p.t/e K. C Ip:~r:jn
also known as j~ VI Yl )' ~. r: I p M~~ (?f!
PETITION FOR PROBATE and GRANT OF LETTERS
-<1-01 -3t./.1a
No.
To:
Register of Wills for the
. Deceased. County of in the
Social Security No. ; t, J - ::z.. 'i.- f:"7 (; (] 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 executnr
in the last will of the above decedent, dated 7T ~ YlIA.. t:i r v i ,~
and codicil(s) dated ~ /
named
,19S+-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C' C;}7; b '2 r I ~ ~ COU!1ty, Pennsylvania, with
h e yo- last (amily or principal r~idence at 6 () J./ 1"/ ~L-Lr2 ,-h.-eT S1. J
m~ (i~ '? Y) ,1 r ': Io.L 'rr; (OOf'rJ
(l1st street, number and munclpal1ty)
Decendent, t,hen {; '7 , years off\ge, died GJ'~,P Y'Y'.1?-F;. r ::., '9 , 19 ~1 9 ,
at f"t 0:} r Y,;~' t, I L "4-- fj t7S' f I -r~ I .
Except as follows, decetlent 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: -. 0
-0-
$
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.La.; administration d. b.n.c.La.)
theron.
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f)o'lHe--lJf~ (?/P/YY~A/"\~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ,.n
r S~
COUNTY OF l'TJMBERLAND j
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
.x-hM~eP ./f ae'~C9.~~~
subscribed {
day of
)til2llilL
Register
~
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:::s
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.....
s:::
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~
Sworn to or affirmed and
before me this 2no.
APRHJ
ny" C ;6, R~ ~ f:\" ,\::;
-" - ""~-r~ \
J C: ~ ~2 \ - II
No. 21-01-346
Estate of GENEVIEVE K. CLEMSON, a/k/a JENNY K. CLEMSO~ Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW APRIL 2 ~2001 , in consideration of the petition em
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 01-13-1997
described therein be admitted to probate and filed of record as the last will of
GENEVIEVE K. CLEMSON, a/k/a JENNY K. CLEMSON
and Letters TESTAMENTARY
are hereby granted to DANIEL R. CLEMSON
1m',,! c
( \
-J' J!). \-l.
~~:: l;,;:1l .1 cr' '-'\
FEES
~18'iOO
$ 3.00
$
$ 18.00
~.oo
TOTAL _ $ 44.00
Filed ...... .~~~.I.~ .?! ?O.q~. . . . . . . . . . . . . .
Probate, Letters, Etc. .........
Short Certificates( )..........
Renunciation ................
x-pages
JCP
, · Q.S ~ . >J:. ~ (
'/1 DJ ~t1\ L I If )YYuA~" . (~~b
A TIORNEY (Sup. Ct. I.D. 0.) .
~t~{ ~t~- ~-
1J1DV",
ADDRESS
PHONE
~ast _ill mrb m~sfmtrent
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GENEVIEVE K. CLEMSON
I, Genevieve K. Clemson, of Cumberland County, Pennsylvania, being of sound and
disposing mind, memory, and understanding and considering the uncertainty of life, do therefore
make, publish and declare this to be my Last Will and Testament, hereby revoking and making
null and void any and all Wills and Testaments or writings in the nature thereof by me at any time
heretofore made.
FIRST:
I direct the payment out of my estate of the expenses of my last illness if
any, my funeral expenses, and my just debts, the same to be paid out of my estate by my Executor
hereinafter named, as soon as conveniently may be after my demise.
SECOND: I give, devise and bequeath all the rest, residue and remainder of my estate
and property, real, personal or mixed, of whatsoever nature and character and wheresoever
situate, of which I may die seized or possessed, or to which I am in any way entitled at the time of
my death, or over which I have any power of testamentary disposition unto my spouse, if my
spouse survives me by thirty (30) days.
THIRD:
In the event my spouse predeceases me or does not survive me by thirty
(30) days, I give, devise and bequeath all the rest, residue and remainder of my estate as follows:
A. Thirty-one percent (31 %) thereof, in trust, unto the Trustee of the Trust which my
spouse and I established, naming Daniel F. Clemson as the beneficiary, on July 7, 1993; and
Initials: r=- Date: ~
Page 10f7
Last Will and Testament of Genevieve K. Clemson
naming my spouse and myself as Trustee, so long as such Trust is in existence at the time of my
death; and if such Trust is not in existence at the time of my death, then I give, devise and
bequeath this thirty-one percent (31 %) portion of the remainder of my estate, in equal shares,
unto my daughters, Kathleen T. Stouffer, Jennifer K. Stouffer and Michele B. Lebo, if they shall
survive me, and if any of my said daughters do not survive me, then I give, devise and bequeath
the share of this thirty-one percent (3 1010) of the remainder of my estate which such deceased
daughter would have received, if living, unto such deceased daughter's issue who survives me,
per stirpes; and if any of my said daughters does not survive me and leaves no issue who survive
me, then I give, devise and bequeath the share of this thirty-one percent (3 1 %) of the remainder of
my estate which such deceased daughter would have received, if living, unto those of my
daughters, Kathleen T. Stouffer, Jennifer K. Stouffer and Michele B. Lebo, or their issue, who
survives me, per stirpes.
B. The remaining sixty-nine percent (69%), in equal shares, unto my daughters, Kathleen
T. Stouffer, Jennifer K. Stouffer and Michele B. Lebo, if they shall survive me, and if any of them
shall not survive me, then I give, devise and bequeath the share of this sixty-nine percent (69%) of
the remainder of my estate which such deceased daughter would have received, if living, unto
such deceased daughter's issue living at the time of my death, per stirpes; and if such deceased
daughter shall leave no issue living at the time of my death, then I give, devise and bequeath the
share of this sixty-nine percent (69%) of the remainder of my estate which such deceased
beneficiary would have received, if living, unto the survivors of my said daughters, or their issue,
living at the time of my death, per stirpes.
Initials: ~ Date: ~
Page 2 of7
Last Will and Testament of Genevieve K. Clemson
C. The guardian of my son, Daniel F. Clemson, shall have the first right to purchase the
family home located at 604 North Market Street, Mechanicsburg, Pennsylvania, from the estate.
The purchase price shall be set at fair market value to be determined by a real estate appraisal.
FOURTH:
A. If any beneficiary other than my child Daniel F. Clemson, is entitled to a share
of my estate, but such beneficiary has not attained the age of thirty (30) years at the time of
distribution to such beneficiary, then I give, devise and bequeath the share of such beneficiary to
Kathleen T. Stouffer, as Trustee, IN SEPARATE TRUST, NEVERTHELESS, to hold, manage,
invest and reinvest the share so received and the accumulation of income thereon, and to use and
apply the income and principal or so much thereof as in the Trustee's discretion may be necessary
or appropriate for such beneficiary's maintenance, support, and education (including any formal
education or training beyond high school), without regard to any other means for maintenance,
support of education or to make payment for these purposes without further responsibility to such
beneficiary or to such beneficiary's guardian or to any person taking care of such beneficiary.
When each beneficiary attains the age of twenty-one (21) years, the beneficiary may then or
thereafter withdraw, in the aggregate, one-half (1/2) of the value of the remaining principal and
accumulated income thereof as of that beneficiary's twenty-first birthday, by written notice or
notices delivered to Trustee and intended to take effect during lifetime. When each beneficiary
attains the age of thirty (30) years, such beneficiary's trust shall terminate and the principal and
accrued income thereof shall be distributed to such beneficiary absolutely. If a beneficiary for
whom a trust is created hereunder dies before attaining the age of thirty (30) years, such
Initials: ~ Date: ~
Page 3 of7
Last Will and Testament of Genevieve K. Clemson
beneficiary's Trust shall terminate, and the principal and accrued income thereof shall be
distributed to the issue of such deceased beneficiary living at the time of such distribution, per
stirpes~ and if such deceased beneficiary shall leave no issue living at the time of such distribution,
then the same shall be distributed unto those of my daughters, Kathleen T. Stouffer, Jennifer K.
Stouffer and Michele B. Lebo, or their issue, who are living at the time of such distribution, per
stirpes.
B. I hereby appoint Kathleen T. Stouffer as Trustee of any testamentary Trust created
under this will. In the event Kathleen T. Stouffer predeceases me or is or becomes unwilling or
unable to serve as Trustee hereunder for any reason, I do hereby nominate, appoint and confirm
my daughter, Jennifer K. Stouffer, as and to be successor Trustee hereunder, whereupon she shall
administer these trusts and shall have the duties and powers of Trustee as herein set forth. In the
event both Jennifer K. Stouffer and Kathleen T. Stouffer predecease me or are or become
unwilling or unable to serve as Trustee hereunder for any reason, I hereby nominate, appoint and
confirm my daughter, Michele B. Lebo, as and to be the second successor Trustee, whereupon
she shall administer these Trusts and shall have the duties and powers of Trustee as herein set
forth. In the event all of my aforenamed daughters predecease me or are or become unwilling or
unable to serve as Trustee hereunder for any reason, I hereby nominate, appoint and confirm my
son-in-law, James A. Stouffer, as and to be the third successor Trustee hereunder, whereupon he
shall administer these Trusts and shall have the duties and powers of Trustee as herein set forth.
In the event all of my said daughters and my said son-in-law predecease me or are or become
unwilling or unable to serve as Trustee hereunder for any reason, I hereby nominate, appoint and
Initials: ~ Date: Hu
Page 4 of7
Last Will and Testament of Genevieve K. Clemson
confirm my son-in-law, Daniel L. Stouffer, as and to be the fourth successor Trustee hereunder,
whereupon he shall administer these Trusts and shall have the duties and powers of Trustee as
herein set forth. In the event all of my said daughters and my said sons-in-law, James A. Stouffer
and Daniel L. Stouffer, predecease me or are or become unwilling or unable to serve as Trustee
hereunder for any reason, I hereby nominate, appoint and confirm my son-in-law, Michael T.
Lebo, as and to be the fourth successor Trustee hereunder, whereupon he shall administer these
Trusts and shall have the duties and powers of Trustee as herein set forth.
C. Should the principal of any trust established pursuant to this Paragraph Four be or
become too small in the Trustee's discretion so as to make establishment or continuance of the
trust inadvisable, my Trustee or my personal representation may make immediate distribution of
the then remaining principal and any accumulated or undistributed income outright to the person
or persons and in the proportions they are then entitled to income. If any such person is a minor,
distribution may be made to the guardian of such minor. Upon such termination, the rights of all
persons who might otherwise have an interest as succeeding income beneficiary or in remainder
shall cease.
FIFTH: I nominate, constitute and appoint my husband, Daniel R. Clemson, to be the
Executor of this my Last Will and Testament. In the event my said husband should predecease
me, or is unwilling or unable to serve as Executor for any reason, I nominate, constitute and
appoint my daughter, Kathleen T. Stouffer, as Executrix. In the even both my said wife and
Kathleen T. Stouffer are or become unable or unwilling to serve as Executrix for any reason, I
nominate, constitute and appoint my daughter, Michele B. Lebo, as Executrix.
Initials: ~ Date: ~
Page 5 of7
Last Will and Testament of Genevieve K. Clemson
SIXTH: All federal, state and other estate, inheritance and death taxes payable because of
my death, with respect to the property passing under this Will, including any interest or penalty
which may be imposed thereon, shall be considered a part of the expense of the administration of
my Estate and shall be paid out of my residue of my Estate before distribution of the residue is
made, so that all residuary beneficiaries, whether charitable or otherwise, shall proportionately
share in the payment of the same.
SEVENTH: I direct and request that any fiduciary under this my Last Will and
Testament, shall not be required to enter bond or security of any nature whatsoever in any
jurisdiction in which such fiduciary may act.
IN WITNESS WHEREOF, I have hereunto set my name and affixed my seal to this my
Last Will and Testament which consists of a total of seven (7) pages, including the AFFIDAVIT,
this 13th day of January, 1997.
SIGNED, sealed, published and declared by the above-named Testatrix as and for the said
Testatrix's Last Will and Testament in the presence of us who have hereunto subscribed our
names at the Testatrix's request as witnesses thereto, in the presence of the said Testatrix and of
each other.
~~\dV'-
~m.~
Page 6 of7
.
Last Will and Testament of Genevieve K. Clemson
AFFIDA VIT
We, Genevieve K. Clemson, Randall L. Hartman, and ()VJtJ L tV\, ~,r<:...~ , the testatrix
and the witnesses, respectively, whose names are signed to the attached or foregoing instrument in
those capacities, personally appearing before the undersigned authority and being first duly sworn,
declare to the undersigned authority under penalty of perjury that:
1) the testatrix declared, signed and executed the instrument as his last will;
2) she signed it willingly or directed another to sign for her;
3) she executed it as her free and voluntary act for the purposes therein expressed; and
4) each of the witnesses, at the request of the testatrix, in his presence, and in the presence of each
other, signed the will as witness and that to the best of her knowledge the testatrix was at that time
offull l~...:~::~:nd mind and under no constraint or undue influence.
Testatn: "<V~
Witnes~ w..8-~
Witness: Chv-ru. m.~
Subscribed, sworn to and acknowledged before me by Genevieve K. Clemson, the testatrix, and
by Randall L. Hartman and AN"':>€.. M. ~\.,..L
, witnesses, this 13th day of
January, 1997.
c'
j' ~
/J ~~J; v. ~"'-.
I
Notary Public
Nota:ial Seal
Michele J. Hartman, Notary Public
Lemoyne Bora, qumberland County
My CommiSSion t::xplres Aug. 3, 1998
!\.~O'T:\.;~r. PC~1r:~,::v:\~-3,,";:'" ~"-':~:.\--..:iJ5.\')n of t\l~)tr.\~,2S
Page 7 of7
[.,. '. . "'f'f" fl1'lr ('l-'~ inform'nion here given IS correctly copied from an original certificafe of death duly fded with me as
. III ~ 1" r l) C l: 1 I \ c' c . C L . <.. . - - ,~ I'
LJK;ll RegisrLH.' The' original certificate will he forwarded to the Statl' Vital Records Office tor permanent tl mg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
f't'l' for rhis ceHilIGHl:. S2.00
21-01-346
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COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
I Rev 2187
NAME OF DECEDENT I,F"sl ~Mdle. La",)
SEX
1 Genevieve Clemson
2, f ema 1 e
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
rJl.OFOEA.JH IM-..C-~;r,Da~-.ea;S~
4./A-A 9- '17
AGE (I as! B."hdaYI
UNDER 1 YEAR
Months Days
BIRTHPLACE Ic'.y and
Slale Of FOH:lgn CO\JflIIY)
5766
PlACE OF DEATH ICt'eci< only I)fle - -..ree Ifls!ruch0tl$ on other StOe~
HOSPITAl,u<
Bell e f 0 n t e, P A Inpallenl W ERlOutpallont Li OOA 0
7. lie.
NAME (It nQllnsNullOfl give sUeet and nu
R_nee 0
MOTHER'S NAME IF"sl M.ddle. Malden Swnamo)
19. Catherine Capets
INFORMANT' S)A~II"NG ADDAl'pS (StrOOt <;,tylTjl.wn, S""e. lip Codoil. .
201>. b U 4 N. Mar K e t J t r e e t, IV) e c h a nl C s bur g, P A 1 7 0 5 5
PLACE OF DISPOSITION. Name 01 Comolery. Cromatory LOCATION. CitylTown, Slalo. Zip Code
or Othef Place
Stc .loho.thehEvangelist Bellefonte, PA
21c. atno 11 C L urcn Lerneter 21d.
NAMEANDADDRESSOFFACILlTYParthemore FH & CS Inc.
22c. P.O. Box 431 New Cumberland,PA17070-0il31
::bEM N~M~~ 3770 &: :;?17~C)lf9'---
WAS CASE REFERRED TO MEDICAL EXAMINERiCORONER? ... .. --
Yes D NoD
a MYOCA-K.~/AL fIJFI+I2C[7oAJ ____~__
I :d~~E~:~~--jL"-_l>(=~~_=H=--- (_~S
1 DUE TO (OR AS A CONSEOUE NeE Of)
_._-_.~-----------~-----~--
WERE AUlOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY
AVAILABLE PRIOR TO (Monttl. Day. Veal)
COMPLETION Of' CAUSE
OF DEATH?
UNDER 1 DAY
Hours i Minules-
67
Yrs
5,
COUNTY OF DEATH
llc.
Harrisburg
KIND OF BUSINESSilNDUSTRY
. II.. Homemaker lIb. Domestic
DECEDENT'S MAILING ADDRESS ISI'''''', CltylTown Slale. l,pCodel DECEDENT'S
ACTUAL
RESIDENCE
(SLoe _nSlIUCIK>nS
un Diner SIde)
12,
17.,Slalo~__ Did
decedenl
lMt In a
township?
604 N. Market Street
Mechanicsburg, PA 17055
Cumberland
17b. CouOlY
1..
FATHER'S NAME IF"S1, M,ddle Last)
John F. Kozar
1'.
INfORMANT'S NAME (T yptllP"nl)
Dan1el R. Clemson
2001.
METHOD OF DISPOSITION
BUrial ~ CHtmal100n 0 Remo\olaJ "om Slate U
DATE OF DISPOSITION
IMonth, Day, 'l\>ar)
--[] January 3,2000
21b.
F E L S RVICE LICENSEE OR PE'RSON ACTING AS SUCH . LICENSE NUMBER
22bJD 012 848 L
, ~st:ed
. httm:!i 24.26 muSI b6 completed by
--=-person whO pronounces dealh
.;u
I......EDI...TE CAUSE rf"ldl
dasaas8 01 CQnO,hon
resuAJl'W;J _n death} ------..
-~
-.
-~ Sequenually hst conditIOns
~ if any, teadlnglo ImmedIate
~QI,de Enl'" UNDERLYING
:a;:'~~~:I~ ,njUIY
'-.II.esulIlng 10 dealh) LAS T
i!1 WAS AN AUlOP SY
~..... PERFORMED?
Natural
HomIcide
o
[]
[J ~~CE OF INJURY . Alt;;;;;;-o-:-~r~o:.;eel. lactory. offico
building.8tC ISpoclllo'1
30e.
o
[]
[]
Could 001 be ueltumlfleo
Acc_denl
Pending Investk]auon
No 0
Nol]
Y.. 0
Y1lsU
SWClde
211e.
28b
29
I
CERT IftER \Ct"OCk onlY I'flel
.CERTIFYING PHYSICIAN IFhySlCldn celilty"H] CdU~;~ ul de"Utl ......t)er anOIPt::' pnv~lC.an hJS plOflO\JnCed ('ealll ann comPlded ltem 231
To &he beet ot my knowle-dge, death occurred due to the caus.e(s) and manner as s1aled.
.PRONOUHCING AND CERTIFYING PHYSICIAN tPt"'r"siCldn IlUlt\ J(:lI'U'J(.c~(t(j uUdH: J(ld \.:t:(ll'Ylng 10 CduSC 01 uCdU'1
To Ihe tM.t of my knowledge, death occurr~ ill the lime, daleo. and place, and duelo (he cause(s) and manner as staled
.MEDlCAL EXAMINER/CORONER
On the basis 0' examination and/or InVesligallon, in my opinion, death occurred allhe time. date, and plact:, and due to the cduse(s) and
manner as stated
ll~
REGISTRAR S SIGNATURE AND NU'.IBE R
l3
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-~. -....-----------------.------fl----
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l.
191
24
OTHER'
=~D
g'~dy)D
WAS DECEDEffT OF HISPANIC ORIGIN?
No fXJ Yes 0 "yM. specify Cuban.
MeXICan, Puerto Rw;an, etc.
9.
RACE. Amencan Indi~n, Black. Whii.~ etc,
(Speedy) .
14,
MARITAL STATUS. Married
Ne.er Married. Widowed.
DilfOfcod (Speedy)
married
SURVIVING SPOUSE
{II Wile, give maKien name)
wh ite
Daniel R. Clemson
He.D Yoa. dec_nt IMld In
17d.[ZJ :h~~~~I~of
Mechanicsburg
cltylbc
2..
I Approximate
: Inlervai between
I onset and dtialh
!.
PART I':
Other signiflcanl condiVons contnbtJling 10 death, bUI
nol resulting in the undeny;ng cause QNen in PART I
1P ~(D PLksTY _,_~~
6j(J -fJ.A~(Q((_t:JJ~
. f\€<.ltlL,/ BY~~
~~
INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED
Yes D
NoD
lA. lOC.
JOel.
LOCATION (51'..... C,tylTown Stale)
[1
[]
e.
..;--
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
G ~nr' ~ /~ l/~# k C/e.IJ1:5rJ(J
Date of Death:
lJ......-7-.9-9J
Will No.
------
Admin. No.
"-.-(JO I - 1')(7 ::~ II h
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 ~~r j I 9,' /~ 00 j
Name Address
k<i--j-j,/~.pJ~ r- c\+nqff'f{- oJ-:J....i-g Rn;/~1 O.r /J/fJ~(~l1n-Y:;csf7 F;IJ 1)~S<....l.r-
Cahl f fiJI/
:r;5 )/I Y)J fr") r "'. ,5'Too+f P V-- / .:3 G Sed r$ del Ie Cr, ~J, . .~~~ Fry i '7(/( f
/Y/ ,;'f.f.J ~
6 - 1- e f, ~
-'
3"7
Cdrva,', Dr
Ol))~,,:j,ur<f f'/9
i 7ni~
(Jq')1JP /;:: r:. /~)1/}5();7 / (;/)'1 /1/ II)~rfr;>f-' J:-t / /1tf'l1 i1 n!r.5. ".5'" fYJ j?(',j-J
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ---
Date:
I' r "7 (". (} Ie,
~{,I Y - Q. _. - -
y /
.I'Yn~11:{-P (f1 &bA~i1/1~
Signature
Name
v'd niP. I R. C }(J-/YJ~-:n i/;
,
Address
6oJ/ /'J /l4 ~.1-/(e-t S--t-~
/)1 t?r:'jy :l. /1 ~ r: .S); jJ r-'7J P:h' i 'i O':J0
./
Telephone (717) ~7--1f 7-7 /
Capacity: X Personal Representative
_Counsel for personal representative
209 State Street 717.232.6300
Schmidt, FlonCd & KTanler PC Harrisburg, Pennsylvania 17101 Fax 717.232.6467
INJURY LAWYERS
www.srklaw.com
July 10,2001
Cumberland County - Register of Wills
Attn: Anne
Hanover and High Street
Carlisle, PA 17013
Re: Estate of Genevieve Ko Clemson
File Number: 2001-00346
Dear Anne:
My office has received a copy of your letter dated July 3, 2001 regarding the
estate of Genevieve K. Clemson. This letter is sent to advise you that my office
does not represent the estate of Genevieve K. Clemson. Rather, the personal
representative of the estate is Daniel R. Clemson who is the executor of the
estate and was appointed such on April 2, 2001. I am not the attorney for this
estate.
Our law firm is merely reviewing a potential cause of action on behalf of the
estate.
As a result, you should direct all future correspondence regarding the estate
directly to Daniel R. Clemson and not to my office.
I have forwarded a copy of your letter and the certification required by
Orphans' Court Rule 5.7 to Mr. Clemson.
If you have any questions regarding this matter, please feel free to call me at
any time.
Very truly yours,
SCHMIDT, RONCA & KRAMER, PoCo
--;J;dz:/Y v~
Todd D. Getgen
Attorney at Law
TDG/ smh
cc: Daniel R. Clemson
n
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STATUS REPORT UNDER RULE 6.12
Date of Death:
G ej1~v/e~)p f(. r//(~yf).s0r1
i 1. - ':;... 9.- 9 9
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Name of Decedent:
"'"
Admin. No. r ::tr)(J f - rJO'2Jt!h
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wi 11 No. r
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No X-
2. If the answer is No, state when the personal
representative reasonably b~li"eve?_.that the administration will be
complete: "J... ~ve...?('." ('YJ liTi7;:;//rvl )
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
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Capacity: ~ Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: Genevieve K. Clemson
Date of Death: December 29, 1999
Will No. 2001-00346 Administration No. 21-01-00346
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 X No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No X
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 X No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report.
Date: ffVtrr:-A G -]..(}d.3
.)
f)o~/V(.P 11 &~
Daniel R. Clemson, Executor
604 North Market Street
Mechanicsburg, PA 17055
(717) 697-4271
oil11 ~
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JRD/June 30, 1992/17858
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Estate No.: 21-2001-0346
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
In Re: Estate of Genevieve K. Glemson
Late of Mechanicsburg Borough
NO. 21-2001-0346
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: Daniel R. Clemson
Counsel for Personal Representative:
Date of Decedent's Death: 12-29-1999
Date of Delinquency Notice: 11-05-2002
The undersigned, :Nfary C. Lewis, Register of Wills, in accordance with Rule 6.12,
Suprenle Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Conlnlon Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Suprenle Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Suprenle Court
Orphans' Court Rules, was given by the Register of Wills on 11-05, 2002, and that the ten (10)
day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the
Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a
hearing to determine whether sanctions should be imposed upon the delinquent personal
representative or counsel for the delinquent personal representative.
Date: 01-07-2003
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
Ea ~~C~ /~ -#-
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Register of Wi~.IS ;;/ . ?j)?JfL
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A hearing is scheduled for at in Courtroom No.3. If the Status Report is filed
prior to the hearing date, the hearing will automatically be cancelled
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15405401162003
ROW621
File No 2001-00346
Decedent CLEMSON GENEVIEVE K
Cumberland County - Register Of Wills
Page 1
1/16/2003
PA File No 2101-00346
Docket Entries
D/E Date
No. Filed
001 04/02/01 PETITION FOR PROBATE AND GRANT OF LETTERS TESTAMENTARY
OATH OF PERSONAL REPRESENTATIVE
DEATH CERTIFICATE
002 04/02/01 DECREE OF PROBATE AND GRANT OF LETTERS TESTAMENTARY
003 07/19/01 CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
004 11/16/01 INCOMPLETE STATUS REPORT 6.12
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FAMILY AGREEMENT
Agreement made this 6th day of March, 2003 by and between Daniel R. Clemsonr (the
~~Executor"), individually and Daniel R. Clemson as Executor of the Estate of Genevieve K. Clemson
deceased (the "Estate").
BACKGROUND
A. Genevieve K. Clemson, who resided at 604 North Market Street, Mechanicsburg, P A
died December 29, 1999, having left her last will and testament dated November 17, 1995, which
was duly admitted to probate by the Register of Wills of Cumberland County at the above number
and term on April 2, 2001 (the "Will"); and
B. Daniel R. Clemson has been duly appointed as Executor of the Estate of Genevieve
K. Clemson, Deceased; and
C. The parties in interest under the last will and testament of Genevieve K. Clemson,
Deceased, are:
1. Daniel R. Clemson, husband, adult, Executor
D. Daniel R. Clemson, the above-identified party in interest is sole surviving heir and
is entitled to the entire residuary estate; and
E. It is the desire of Daniel R. Clemson that final distribution of this Estate be
accomplished without a formal accounting to the Orphans' Court Division of the Court of Common
Pleas of Cumberland County, it being his desire to avoid the expense, delay and publicity of a formal
accounting; and
NOW THEREFORE, in consideration of the mutual promises, covenants and agreements
hereinafter contained, the parties hereto agree as follows:
1. Approval of Distribution. Daniel R. Clemson does acknowledge that he has
not received any assets from the executor. The only property received by Daniel R. Clemson, spouse
of the deceased, was as a joint tenant with the right of survivorship or as a tenant by the entirety.
2
.
_ lo.
2. Waiver and Release. Daniel R. Clemson:
a. specifically waives the requirement that the Executor file an Account
with the Orphans' Court Division, Court of Common Pleas of Cumberland County;
b. hereby accepts and approves the final distribution to Daniel R.
Clemson, and agrees to refund to the Executor of the Estate any amounts which may be necessary
in the future, to discharge any liabilities of the Estate which arose before the date hereof, which are
properly chargeable against and payable out of the assets of the Estate compromising the distribution
set forth in the account (such as additional expenses of administration, death or income taxes), and
of which the undersigned may hereafter receive notice;
c. hereby remises, releases, and discharges the Executor and the Estate,
individually, and collectively, of and from all manner of act, suits, claims, accounts, accountings,
debts, dues, and demands whatsoever for or by reason thereof in connection with the administration
of the Estate.
3. Miscellaneous.
a. Daniel R. Clemson acknowledges that this agreement shall be indexed
and recorded in the Estate proceedings and the terms hereof shall be binding upon their respective
heirs, successors, administrators, and assigns.
b. This agreement shall be governed by and construed in accordance with
the laws of the Commonwealth of Pennsylvania.
c. Daniel R. Clemson agrees to execute such other or additional
documents as may be necessary to effectuate the agreements set forth herein.
d. This Release may be executed in separate counterparts and when duly
executed by all parties hereto, shall constitute a single agreement binding upon all such parties.
IN WITNESS WHEREOF, the parties hereto have placed their hands and seals as of the day
and year above first written.
WITNESS:
c~
j){4M;dfi~frJ
Daniel R. Clemson, as
Executor of the Estate of
Genevieve K. Clemson, Deceased
g~~
~~d ~ it 0 eft?J1P .rv~
Daniel R. Clemson, individually as
Beneficiary of the Estate of Genevieve K. Clemson
3
j2
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: GENEVIEVE K. CLEMSON
Date of Death: December 2~ 1999
Will No. 2001-00346
Admin. No. 21-01-00346
To the Register:
I certify that notice of beneficial interest 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
or before April 30, 2001:
Name
Address
Daniel R. Clemson
604 North Market Street, Mechanicsburg, P A
Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except
None
Date: March 6, 2003
A;Jp,.~
Signature
Daniel R. Clemson, Executor
604 North Market Street
Mechanicsburg, P A 17055
(717) 697-4271
\
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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
F, ij; ,~, .
'DATE
ESTATE OF
DATE OF DEATH
P 1'ti.i NUMBER
COUNTY
ACN
04-21-2003
CLEMSON
12-29-1999
21 01-0346
CUMBERLAND
101
.03 APR 28
DANIEL R CLEMSON
604 N MARKET ST
MECHANICSBURG
PA 17055
\.r. '=-;
Cwn00f;;:!
REV-1547 EX AFP (01-05]
GENEVIEVE K
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V-: iS47-Ex--AFP--foY:03Y-No'ficE--oF-INHEiiiTAifci-TAx-A-PPRA-isEMENT~--Ai'rOWANCi-cfR-------------- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CLEMSON GENEVIEVE K FILE NO. 21 01-0346 ACN 101 DATE 04-21-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
NOTE: I~ an assessment was issued previously, lines
re~lect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 = .00
.00 X 06 .00
.00 X 00 .00
.00 X 15 = .00
(19)= .00
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
.00
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
.00
(1lJ
(12)
(13)
(14)
7.89; 00
7,895.00-
.00
7,895.00-
(9)
nO)
7,895.00
.00
t"AYMt.NI 1(t.l,;t.~t"1 l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
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