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HomeMy WebLinkAbout01-0359PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~ ~. K ~ S . L L.~J ~ also known as Deceased. Social Security No. ~ ~ "-~ ~ - No. ~1 - ©~ c3c.5~ To: Register of Wills for the County of 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, appl for letters of administration _ on the estate of (d.b.n.; pendente life; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in ~~ ~~= v J z~~ C` Count , Pennsyl ania, with ha.r- last family or principal residence at ~ ~r9//r9/Z G~ :~~c,~ ~.~ ~t,.S v (list street, number ar~d municipality) at Decendent, then of age, died /s JLG ~Yr ~?_h ~ /_ K r~ ~v 19~, Decendent at death owned property with estimated values as folllows: l 00 (If domiciled in Pa.) All personal property $ / ~ V _ (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: Petitioner after a proper search ha ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: game Kelationship Residence ~n THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. 8 aci ~ 1 ~ c N ~. vw V Q f0 G _~ v1. l~-~~~ -~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~- ss COUNTY OF C'ilMF3FRT.AND 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 t 1 d inister tYte estate according to law. ~-; t t~ ru y a m Sworn to or affirmed and subscribed before me this ~'$~ day of ~~~Q4~ Register l ~~ ~ .. a NO. 21-00-359 Estate of VICKY S CLOUSHER ,Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW APRIL 6 Irq:2001 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that FRED E CLOUSHER is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to FRED E CLOUSHER in the estate of VICKY S ~ CLOUSHER _ _____ /iii' ~ //,U'~~.L''ii.i~~C/~' Jac 7" R~er of V/ills FEES Letters of Administration ..... $ 18.00 Short Certificates( ) .......... $ 3.00 Renunciation ................ $ JCP $ 5.00 TOTAL $ 26.00 Filed ..................... A.D. 19 ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ~ ns.o~a ..,~~, ~~~r, This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 7295354 No. .~ /- v r - ~3T6-'~ u R« vs', GG~ Local Registrar MAR 2 9 2001 Date COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH SW E FlE NUMBER NAME OF DECEDENT (Fe%. Middq, lay X SOCIAL SECURITY NUMBER DATE Of DEAN MOM. Oay.'MrI '• Vic S. Clousher a•Female 7.209 - 50 - 9367 ~ March 28 2001 AOE ILaa Bnlw„ UNDER, YEM UNDER, DAY DATE Of BNRN BIRTHPLACE ICM aM PLACE OF OEATM ICnece cnlY N`e - ve Vquucl,«y an ana ew1 MaaN r Deye !1•laa = ,aYenw !M«ph. DaT.'Arerl "aIW «F«•gr~CauNYI N09PRAL: 54 Yz 12-25-46 ,Philippine Isle "P"""' ^ ER1O1"P"''^' ^ ~^ ^ a» ° ^ R.aOatldYd ^ COUNTY Of DERH CRY. BfAtO. TVYP OF DEATH fACIIITY NAME PI na yl%eaion, pne tlea and raprlcarl WAS DECEDENT OF IN8IYINIC 011pN1'1 RACE • AINrkMI byrL Bgek, WNtl. ae. Cumberland Lower Allen TWp. 7 Mallaxrl Court "° ® `M ^ N y.., •P.ar coe.IL ao•ay1 Meainn, nr.r,a Rhin. ao. +. ,.. Phili ino DECEDENT'S Al OCCUPATpN IUND Of BUSINE88ANDUSTRV YE18 DECEDEM EVER W DECEDENT'S EDl1CIQIDN MARITAL SLOUS • MarriN SUryyryNq gOD„SE (GiN gMaw«k mrr d«np moa U.S. ARMED FONppCEST Never Mengd, Wtmaw, a.Ara111B Nq;mrbluN r'efrea.) ya^ No~O ElemaMaryBecaWery CoNepe DnwaroeelSPecAy1 pwea qne maden n.nlq „ Janitorial ,,,, School District ,,, , ~'~ +2"'«8" ,. Married „ Fred E. Clousher DECEDENT'B MAN.WLi AaoRESS ISraa.CN7TO•n, S,a-Z4Code1 OECEDENr3 Penns 1Vanla 7 Mallard Court r~swEN~ ,Tti,.sl.tl-- y Die /R.~tea.daeeNraEredq Dower Allen ~ hanicsburg, PA 17055 ~•••~•on• ~e°:e m arw ed.1 benW:p7 No, decedae Nred ,a ,,,. Cumberland R`^ erMin aoaw Enwa ~ FIQIIEq•S NAME IFe%. McTdls. La%1 MOTHER'S NAME Ifr%, Mgdq. Haden Swnarrl Gaucelcio Sumile Felecula "Un~own" o. EEFORMANT'8 NAME RyPe~vrinh WFDRMANrS MAILNa ADDRESS Isrea. GIY~TO•*, elate, LO CaNI METHOD DF DISPaWTIDN Cemaay, Crematory L • CEy/Town, sUtl, aP Com OaW ^ G«orlon ® Rantlva cam SIW ^ D/vE ~ b•r) ~ «~aNr wapp • wma a :, °oi"°"^ °Yir ^ a,l• 3-30-01 mast Harrisburg Cemetery "~" Harrisburg, PA BNWATURE OFF RYN~ ACTNq AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY CarripMtl ibrna tare venal cenNyaq b eea a my hnowgrlBe• Natl ac«nred M Nle «N. Ntl as pace aged. aZe - OM,afetlngrtll agMadeanb eendTM) LICENSE NUMBER gl(;yEp aar0ly ooNa PAOM.Day. tYar1 "•nl•2e•1B nNI,lWcaeOgledM OF DEATH L DATE PRDIIOUFICED DEAD IMaen, Day, Yea) WAS CASE REFERREDTO ME E11AMN,ENCORDIIERT Organ edro0rorlourlcae mein. 71. •'p M. a4 3• ~~_oI ~ 'aFD No^ 37. RAII'T 1: Engr dtl dMeeaes, inOrrip «eanpicabrr Mich raeeed tlw Nan. lb na enter Ule rrwN a dyirp, tuc11 N tadiae «reapiralory ureM, arndl «Marl gilure. i • PAIR N: Oder anNriDaMgtl dwdL Gf live only err uuae on earn Mr. ~~~ rrel npnAWa mrl4ierle 1 tlNINYp n the uWaMl•Berr P.ee n PART I. NMELDIATN CAUK (Fna I orwl aq Nan drNN a COrldaion I r~~npaaeenl-- e.~~ ~i.1 ~ DUE W TOR AS A COHSE NCE OFl: Ne"1t MEdrWtlimrgrE (( a DUE TO pR ASACON5E0UENCE OFY. , arNr. Erra 1N,DBItLYBEB ~ i IDirer«erOrry e. r E'i1 aeeaetl tl+ye DUE 10(CR AS ACONSEOUENCE OF): - realrlrq n daenl WT I 0. r WAS AN AUTOPSY WERE AUTOPSY FYiDINfiS MANNER OF DEATH DATE OF INJURY 71,1E OF NlJURY NUURY R WORKS DESCRIBE NOW IILIIIRY OCCURRED. PERFORI/ED7 NRN.AKE P,110R W I,SJ,(/ IMmn. tAV. riarl COaMLETIDN Oi CAUSE OF DEATN7 Naval HaniciN ^ Accident ^ Perwq Yaplipaion ^ YN ^ No ^ tee ^ No ® xee ^ No ^ snow ^ c«Ad na a eegnneud ^ PLACE oP INn1RY • IU lame, qrm, %rea, legpry, elnce M LOCATNJN ISOea. Cey/bwn, SqW aM. 1EN. ~, WeilQ eb. lSPacev) 70e. ap. Cf1TTIPIM (pack ONytnel SIGNATURE TRIE OF CERTIFIER 'CMTMYBIB PNYBICIAII IPhyecuncuMyeg tauN d seen when arwaur a+yecan nN pon«wced NM ano compelW gam Zal lq Btl Wt N nyy Artlededge, metl eeeorred dw b Me eeaee(e) end manner N •qqd ..................................................... 10. ~~ 'PRDIgUNCINO AND CERTN'YWD PNYSICtAN IPlrye¢ren nan Wonouncep wean and c•rMy+q b cwm d Nanl LICE NUMBER !~ DATE SIONEDIMaen, Dey. Marl A Nr Oeet a my fubwbdBe, male oeewrW a, tlla tltla, Nq, and Place, and dw tl Mtl ewNlal eb meruwr r wl.d ......................... ^ ate. t) L 2-~ ~e ~~ E at ~• V NAME AND ADDRESS OF PERSON WNO COMPLETED CAUSE OFD H 'MEDICAL E)fAY1NER/CORONER (ham 271 Tyq ar Pna ~~~L~~~ ~ ~~J' v~_^~~~Lr Ln~ On Nle bola of eaaminNlon andfor ImreallBaUOn, In my opinion, dealA occurred el IM time, dale, and pgee• and dw to,M ceuNlsl and ^ ?(O Y lc/e L! S s O~ 7'~'l t<f ~+9 • 4 [ 71(2. wrwter a seaw ............. ................................................................................... _ eta. 7a REGIST 'S SIGNATUR NW/ DATE FILEDIM«ar. Day, Veen ~. ~ ~ / >•. Q • CLAM FORH ' ' ORP?~_AiVS ' COURT DIVISION 0:' COURT OF OMMON PLEAS OF ~ ` _ (, U ~~~~~~~ COUNTY ESTATE OF_ V ~L~~ ~~OV~ `~i~ ~~' .~~ NO. ~-\ Off. ~c~~ Notice of claim by~.~~-~~~t'~ in the amount of $~iR$ Q ~~ filed pursuant to section 3384, Probate, Estates and Fiduciaries Code Laws of 1972, Act No. 104 effective July 1, 1972 as amended. Date ~ •-~'~ ~ ` 0441 L8J FREEWAY Tq, THE'~L`LERx OF THE ORPHANS' COURT DIVISION: Lock ~©x 30 Enter the claim of ~,~.s~_~0 \O ~~ Dallas; ~X 75243 (Claimant aQnd Address) in the amount' of $ ``e S 1 r ~~~1 against the above entitled Estate. The decedent who resided at 1`^O I - (Address) ~ Written notice of said claim was g to died on 3 ~'~-~ -E'$ } (Date) ntative ozZ2aunsel) at on (Address) (Date) . The hasis of aforesaid claim is as follaws: (Itemize fully to enable personal representative to make proper investigation). Claimant's Counsel {Name) (Address} BY Name] 441 L3J F~ "~F'~i~~A~' Lock 3cx 3C Dallas, ~~ ~" ~~~3 (Address] ,;- PROBATE COURT Clamberland County, State of Pennsylvania Vicky Clousher, Deceased Case #21-O1-359 Proof of Mailincr I mailed the creditors claim to the fiduciary (and attorney, if applicable) as follows: I deposited a copy/copies of the claim with the United States Postal Service in a sealed envelope with the postage fully pre-paid. I used first-class mail. I am employed in the county where the mailing occurred. The envelope(s) was/were addressed and mailed as follows: Mr. Fred Clousher 7 Mallard Ct. Mechanicsburg, PA 17055 Date of Mailing: "~ _ ~~~ ~p County of Mailing: Dallas, Texas I declare under penal of perjury that the foregoing is true and correct. Date : ~ . "~ -O The Bon Ton P.O. Box 741026 Dallas, TX 75374 .- ~. +, _ _ _ _ _ _r :~Y.~~.'~. i~1;:.i: I-'~ ~ iGui 11,:v ?''.!i~L~ii_ ~_•+.~~..i~v~,. -a~_ _ - J. c f,i ' iT~+ic : f~~ • A` ~~r+~ v-~~ +1la"J i' 1 i in+~ - , yu i JRD/June 30, 1992/17858 In Re: Estate of Vicky S. Clousher Late of Lower Allen Township Estate No.: 21-O1-359 AUG 01200ir/' ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA N0.21-O1-359 r'1-10-©~ NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: Fred E. Clousher Counsel for Personal Representative: Date of Grant of Original Letters: Apri16, 2001 Date of Delinquency Notice: July 16 , 2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common 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 certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on July 3, 2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) 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. r Date: July 31, 2001 Mary .Lewis, Register of Wills Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ,.~ ~ / at ~-346f. do Courtroom No. 3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. George o fer, P. . ~~ , ^ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ^ Print your name and address on the reverse so that we can return the card to you. ^ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: ~r~'~ d ~c.. C.louslne.c~ '-l 1'Y~c~ M a r a Co u~.r~ I~1 e~l~ar, ; c. sl~c~Y ~~~~ 11 OS! A. Received by (Please Print Clearly) B. Date of Delivery ~QF D -F, C~ou<SNftC~ ~ 3 D / C. Signature /~ Is Salivary address different from item 1? L.~ Yes~es If YES, enter delivery address below: fSNo 3. S~ervi~c Type ~ L?Certified Mail ^ Express Mail ^ Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (Extra Fee) ^ Yes 2. Article Number (Copy from service label) `l 0(9b 1 ln`t 0 00l ~ 9 l l0 3 1q 5~ PS Form 381 1 ,July 1999 Domestic Return Receipt 102595-00-M-0952 , 3 0 ~' m .D Postage $ a Q' Certified Fee 0 Return Receipt Fee rl (Endorsement Requiredi O O Restricted Delivery Fee (Endorsement Requiredi O t` rl 0 0 0 [~ Postmark Here Total Postage & Fees I ~ ~ A Sent To Street, A t. No.; o PO Box No. _'1 1~„t ~a~r~--- ~-~---------------------------------------- ~City State, IP+4 1`1 ASS F: \ FILES\DATAFILE\ESTATES\8878-wtice. cer CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: VICKY S. CLOUSHER Date of Death: File No. To the Register: March 28, 2001 21-01-0359 I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following heirs of the above-captioned estate on or about September 10, 2001. Fred E. Clousher, Clousher Productions, P.O. Box 1191, Mechanicsburg, PA 17055 Michelle Lively, 2627 Riverside Drive, Williamsport, PA 17702 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: September 10, 2001 Signature ~ ~ ` Name ark A. Den nger, Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative -~ F: \FILES\DATAFILE\ESTATES\8878. ffa IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO.21-01-00359 ESTATE OF VICKY S. CLOUSHER, Deceased Late of Lower Allen Township, Cumberland County, Pennsylvania FIRST AND FINAL ACCOUNT OF FRED E. CLOUSHER, ADMINISTRATOR Date of Death: March 28, 2001 Date Letters Testamentary Issued: April 6, 2001 Date of First Complete Advertisement of Grant of Letters: August 24, 2001 Account Stated to March 15, 2002 SUMMARY PRINCIPAL: Receipts $ 2,866.27 Disbursements -3,677.67 Principal Balance Remaining $ -811.40 INCOME: Receipts 3.47 Disbursements 0.00 Income Balance Remaining 3.47 COMBINED BALANCE REMAINING $ -807.93 PRINCIPAL RECEIPTS Commerce Bank, Checking Account No. 0023081995 $1,980.08 Central Dauphin School District, wages for week ending March 25, 2001 506.43 Central Dauphin School District, wages for week ending March 25, 2001 141.56 Central Dauphin School District, reimbursement for purchase of supplies 9.10 Refund 44.10 Susquehanna Health System, refund of overpayment 35.00 Household goods and personal property 150.00 TOTAL RECEIPTS OF PRINCIPAL: $2,866.27 PRINCIPAL DISBURSEMENTS Myers-Hamer Funeral Home, funeral services Bixler's Flowers, funeral service Register of Wills, filing fee for Petition for Letters of Administration Reserved for later disbursement: MARTSON, DEARDORFF, WILLIAMS & OTTO, Costs advanced: Advertising Letters of Administration Filing fee, inheritance tax return Reserved for filing fee, First and Final Account MARTSON, DEARDORFF, WILLIAMS & OTTO, attorney's fee TOTAL DISBURSEMENTS: INCOME RECEIPTS 165.59 10.00 150.00 Commerce Bank, Checking Account No. 0023081995, interest through closing TOTAL INCOME RECEIPTS: INCOME DISBURSEMENTS None TOTAL INCOME DISBURSEMENTS: UNPAID CLAIMS OF CREDITORS NCO Financial Systems, Account No. A69560, for Great/Chemical Bank Credit Account #6011002062520259 Universal Card Services Corp., AT&T Universal Card Account No. 4492280100733851 The Bon Ton, Account No. PC#61792 PCS One TOTAL UNPAID CLAIMS OF CREDITORS: $2,504.00 72.08 26.00 325.59 750.00 $3,677.67 3.47 3.47 0.00 $0.00 $4,208.31 2,877.37 1,659.48 15.58 $8,760.74 COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) Fred E. Clousher, being duly sworn according to law, deposes and says: That he is the Administrator of the Estate of Vicky S. Clousher, deceased; that he is the Accountant herein; that the foregoing accounting is true and complete; that the attached list or schedule [*] contains the names and addresses and amounts due unpaid creditors having given notice of their claims; that the attached list or schedule [**] contains the names and addresses of all persons interested in the distribution of said Estate; and that the facts set forth in the within Account are true and correct to the best of his knowledge, information and belief. .~ red E. Clousher (Administrator and Accountant) Sworn to and subscribed before me this / 9 ~ day of %~~~. , 2002 7ARIAL SEAL otary Public JANE K. NAVNAER, Notary Public Camp Nill Boro, Cumberland County My Commission Expires June 24, 2'?C2 *UNPAID CREDITORS: 1. NCO Financial Systems P.O. Box 7400 Philadelphia, PA 19101-7400 2. Universal Card Services Corp. P.O. Box 44167 Jacksonville, FL 32231-4167 3. The Bon Ton PC #61792 P.O. Box 741026 Dallas, TX 75374 4. PCS One P.O. Box 742501 Cincinnati, OH 45274-2501 **PERSONS INTERESTED IN DISTRIBUTION OF ESTATE: 1. Fred E. Clousher (Spouse) P.O. Box 1191 Mechanicsburg, PA 17055 2. Michelle Lively (Daughter) 2627 Riverside Drive Williamsport, PA 17702 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION N0.21-01-00359 SCHEDULE OF PROPOSED DISTRIBUTION No distribution is proposed by the Administrator, Fred E. Clousher, in this estate. STATEMENT OF THE REASONS FOR THE PROPOSED DISTRIBUTION There are insufficient funds for the payment of Creditors listed in the Schedule of Unpaid Creditors. There are no funds remaining for distribution to intestate heirs of the decedent. C red E. Clousher, Administrator COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND Fred E. Clousher, being duly sworn according to law, deposes and says: That he is the Administrator of the Estate of Vicky S. Clousher, deceased; and that the facts set forth in the foregoing Schedule of Proposed Distribution are true and correct to the best of his knowledge, information and belief. [ { ~l C red E. Clousher, Administrator Sworn to and subscribed before me this 19?~ day of ~?'I.~~t--.. , 2002. '~ otary Public ._.,.._ N07ARIAL SEAL JANE K. HAVNAER, Notary Publ~ Camp HiH Boro, Cumberland Coup*.y My Commission Expires June ?_~, ~;it2 ! t~ ~r~~by <;ertfy q~;.~t art?%1' , ca~3tfc:~ ~ this t'ilin~ ;.~3 ?t~is ~;c~punt, iii +i ttte date, ~tne and place when the same vaiil be presented m the Court abjectbons said Aooount, hey ~'' ~~ e„~y unpaid daiment and b ee+ery other person known to the aocourrlsrrt b have or ciairn an interE.^~3t M the e~siate ss cxeditar, benelk~Y. tYeir or next of kin. ~ n~ ~ a ~ Y Z ~ (~ o ~ m Z o C~ O~txiy z .c z r! •-3 T m ~ r d °~a ~ Sao z z~ r~ ~~ ~~do~ ~ Z z~~~ W ~ ~ a r W °r y °~~o r rO~h ~ ~ ~ ba~~ d rn b W ~ ~ ado x ~' ~S~°z o ~~y °~ r ~a zr~' c ~~ ao o z~ ~~- °_~c, , ~:~ ~ a ~„~'~ ~ ~~ W --~.. ~~ .. ~ ~~~ ? p ~- ~ ~p ~ m ~ ~_ 'p ~ a O ~~~ ~~•~ A ~ O ~ ~ ."tlG1' .~ ',; ~ ~~'~ ~ '«' 1 Z ~I~l!•! Z0. .~ ~ 8 B~ s ~ ~~~ ~~ ~'~ '~ .S~ ~$ ~ '~ ;r ~~~ ~ ,~~ ,~,~ ~y ~ B . ~ ~ . ~- ~ ~ ~ ~~ ~ ~ $ >3 ~~ ~~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TA% DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 MARK A DENLINGER MARTSON ETAL 10 E HIGH ST CARLISLE ESQ (Li~rt ESTATE OF CLO DATE OF DEATH 03-28-2001 ~ ILE NUMBER 21 01-0359 ' ~OUNTY CUMBERLAND ACN 101 ...~ Amount Remitted 3 ~1=~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 S CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR ---------- YOUR RECORDS ----------------- t ------- --------------------- --------------------------------------------------------- REV-1547 EX AFP (12-00) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CLOUSHER VICKY S FILE N0. 21 01-0359 ACN 101 DATE 01-29-2002 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 fora with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 2,866.27 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (g) 2,866.27 APPROVED DEDUCTIONS AND EXEMPTIONS: 3,277.67 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) [9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 9,110.7 4 11. Total Deductions (11) 12.388.41 12. Nst Value of Tax Return [12) 9,522.14- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts [Schedule J) (13) .00 14 Nat Value of Estate Subject to Tax (14) 9,522.14- . 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 = .0 0 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 15 = .00 19. Principal Tax Due (19)= .00 TAY f`DC1fTTC• ENT DATE RECEIPT NUMBER DISCO (+) INTEREST/PEN PAID (-) AMOUNT PAID COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 E% AFP (12-007 RG`'`" `' ~"` DATE 01-29-2002 ~F=~~ ~ - "1~ USHER VICKY 'a2 FEB -~ P 1 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 Sl, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A '•CREDIT•• (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ F'- r~~ P ._.. V~ REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: VICKY S. CLOUSHER Date of Death: March 28, 2001 File No.: 21-01-0359 Social Security No.: 209-50-9367 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 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? Yes No x d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may befiled with the Clerk of the Orphans' Court and may be attached to this report. ~ ~ /~ Date: May 20;`2002 Signature: ' Name: Mar A. Denlinger, Esquire L. Address: MARTSON DEARDORFF WILLIAMS & OTTO ~-, Ten East High Street - Carlisle, PA 17013 ~- (717) 243-3341 ~: Counsel for personal representative ;,~ ~~ F: \FILES\DATAFILE\ESTATES\8878.srcp G afv-.SOO F2•Ieaal COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280001 HARRISBURG. PA 912&0001 rDECEDENT'S NAME (LAST, FIRST. AND N CLOUSHER, VICKY S. ~ DFATFT(I D ~ 03/28/2001 w o nP eoP, ~rea,ncl CLOUSHER, FRED E. OFFICIAL IiSE ONLY a.ad -~ INHERITANCE TAX RETURN FILE NUMBER - - RESIDENT DECEDENT zl of oo3s9 COUNTY CODE YEAR NUMBER 12/25/1946 a, x 5 m ^ 4. Limited Estate ^ 4a. Future Interest Compromise (dale of death O ~ r after 12-t2-82) ~ '. ^ 6. Decadent Died Testate (Adech copy ^ 7. Decetlent Maintained a Living TNBt (Attach 0.m Or WII) copy otTNSq ~~ ^ 9. Litlgation Proceeds Received ^ 10. Spousal Poverty Credit (date of death oehveen i 12-31-91 and 1-1-951 ~ Mark A. Denlinger, Esq. m IRM NAME (kapPlipble) 0 o Martson Deardorff Williams & Otto U6 717/2433341 0 a v it z :' 5 f 0 %U Q 1. Real Estate (Schedule A) 'i 2. Stocks and Bonds (Schedule B) i 3. Closely Held Corporation, Partnership or Sole-Proprietorship i ~, 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property ~ (Schedule E) 6. Jointly Owned Property (Schedule F) i ^ Separate Billing Requested I 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ', (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) ' 9. Funeral Expenses & AdministmOve Costs (Schedule H) it 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 8 10) 12. Net Value of Estate (Line 8 minus Line 11) 209-50-9367 THIS RETURN MUST BE FlLED IN DUPLICAT REGISTER OF WILLS ^ 5. Federal Estate Tax Return Required O 8. Total Number of Safe Deposit Boxes ^ 11. Elemion to tax untler Sec. 9113(A) (Anach Sch O) 10 East High Street Carlisle, PA 17013 (1) None (2) None '} ~, _. (3) NonrJ', ~ - -- --- --Gt- (4) NOR~1 ." (6) Nonq ; ----~ , (7) None ~ti: (9) 3,277.67 (70) 9.110.74 13. Charitable and Governmental Bequests/Sec 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) 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) 76. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 141axable at collaterel rate 19. Tax Due 20. Q f7 t= t7 I v 7~ (~j (11) (12) (13) (14) x .00 (15) x .045 (76) x .12 (17) x .15 (16) (19) Z row ~t c,-^ c1 - -~ G_". ce UT---- " 2,866.27 12,388.41 insolvent Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 7 Mallazd Court ctrv Mechanicsburg STATE PA ztr 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount (1) 3. InteresVPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total InteresUPenalty (D + E) (3) q. If 1. ine 2 is greater than Line 1 + Line 3, enter the differen x. This is the OVERP.^.YMEHT. (4) Check box on Page 1 Line 20 to request a refund 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILL$ AGENT (SA) (5B) 0.00 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property Vansferted :............................................................................. ^ 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 occurted after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................ ^ 3. Did decedent own an "in Wst 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 designafion? ............................................................................................................... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pedury. I dedare that 1 have examined Nis return, indutling accompanying schedules and statements, end to the Desl of my knowledge ana EeliM, it is bue, coned and complete Dedaratien N preparer other than the personal representative Is Eased on all In(orma0an o! which p<narx has any tnmkedge. SIGNA~TS{RE OF PEgS99pNNN RESPONSIBLE FOR FILING RETURN ADDRESS ` / / ( ~~~vr/L~'~'1 P.O Box 1198 ,Fy~{~r / Mechanicsbur PA 17055 - 10 East High Street _, Carlisle, PA 17013 DATE / 2~SG ~o( DATA 12/SJo 1 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% [/2 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9176 (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 fling a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 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 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 72°/a [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. DONMDNWEA~TN Dr RENNSYLVAN~A PERSONAL PROPERTY INHERITANCE TA%RETURN RESIDENT DELEDEM ESTATE OF CLOUSHER, VICKY S. FILE NUMBER 21 Ol - 00359 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 DESCRIPTION NUMBER 1 Commerce Bank -Checking Account No. 0023081995 2 ~ Central Dauphin School District ,wages for week ending 3/25/01 3 ~ Central Dauphin School District, wages for week ending 3/25/01 4 I Refund 5 ~ Centml Dauphin School District, reimbursement for supplies 6 (Susquehanna Health System, overpayment refund 7 I Household Goods VALUE AT DATE OF DEATH 1,980.08 506.43 141.56 44.10 9.10 35.00 150.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 2,866.27 SCFIEDULE H FI~RALD~ENSES& COMMONWEALTH OF PENNSttVANIA Ary~~A~~ INHERITANCE TAx RETURN fYAtY`EN r EV'E RESIDENT DECEDENT ESTATE OF CLOUSHER, VICKY S. FILE NUMBER 21 - OI - 00359 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER -- - - -- _ - q. FUNERAL EXPENSES: 1 Myers-Hamer Funeral Home, Camp Hill 2,504.00 2 Bixlers Flowers, Lemoyne 72.08 I I B. 1 ADMINISTRATIVE COSTS: Personal Representatlve's Commissions Street Address 2. 3. 4. City State Zip Year(s) Commission paid Attorneys Fees Martson Deardorff Williams & Otto (estimated) Family Exemption: (It decedent's address is not the same as daimant's, attach explanation) Claimant FRED E. CLOUSHER Street Address 7 Mallazd Court City Mechanicsburg State FA Zip 17055 Relationship of Claimant to Decedent Spouse Probate Fees 5. Accountant's Fees 6. I Tax Retum Preparel's Fees 7. ! Other Administrative Costs 1 Cumberland Law Journal, Advertising Letters of Administration 2 Sentinel, Advertising Letters of Administration 3 Register of Wills, filing fee, Inheritance Tax Retum TOTAL (Also enter on line 9, Recapitulation) 500.00 26.00 75.00 90.59 10.00 3,277.67 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMNpNWEFLIHOF PENNSYLVRNIR LIABILITIES, & LIENS INHERITANCE TW(RETURN RESIDENL DECEDENT ESTATE OF CLOUSHER, VICKY S. FILE NUMBER 21 - Ol - 00359 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER - - _ _ -- 1 Lower Allen Township Emergency Medical Service 350.00 2 PCS One, account payable 15.58 3 The BonTon, see claim attached 1,659.48 4 AT&T Universal Card, account payable 2,877.37 5 NCO Financial Systems, account payable 4,208.31 TOTAL (Also enter on Line 70, Recapitulation) 9,110.74 CLOUSHER PRODUCTIONS 717 766 1490 s P al a i A ) 'S ] _ ~is:ar~ of ~ ..C.~--1 i iNOC'_ca at claim bye 3. )s.n the amqunt qP S ~ I..~S, Q `~\ l ~~ `^S~uciar_es Cade Lane of 192, :.{ q, 'CHE ~LF.:IK'OF THE ORPHANS' C tzrthe claim of ( alman ' n the 3moun c.' of `$ ~(a~~ S yhc res!ded 'at ~^OC.a4ae`4-~ ..' ~ (Addre ' ~ Wc. ~aa not?ce of said claim vas !- i. (~' :i ,,', .3 .:..~ d~' '~ -~ ~ , §~ ::, a e ~ .t j D - :~ !~; ..3 ' ~::. ~~ _; 4 n"~.. Y ry' ~: i ~; I 1 ~ . Q !'p P~ q 3~1 ` ~. j 4 I "j'' 1 u4+ - : en ~~{ ~, . ORPFI~l475' COURT OF °`^ ~c~ .~ NO. ~c~l~ ar_ ~4~~ ,tiled pureuane to aoc:ign ]384, Probaka Ne. 104 eiteccive July 1, 1912 as amerid~ Gate Z r2 -9441 L&1 ~f ornszoN: Lock BOX 30 o \~ ~ pallaS; T'X ~ Addr@se) ~againet the above entailed estate:. __~~ ~^d_ad dn~ was is pE afgreeaid claim is as f llovs; (Itemise fully tq onaAle mafc~ arGPe.C inveetigaCion) . s Cqunael (Namel s sc 441 ~BJ FR ~~~IiVA~ lock Box 3G , P . 0 r 4 ' IV7, ~ION.O _Yro wloF j i ~? :E YA . ,. ~ ~ ~ , t :.. ;. Thy de4 ~dggt;: _i ~ t , <. :( tel ~. trs~) I .. :. ipr~aenk3ti`ve ~ I A ~~d~ ~ { i(! ir ,axj , M1y btattsment '~~ `' ~ :. ' VICKY CLOUSHER Aeeo,mt A482 2801 DD77 3657 ' Calling Card 9451679898+ PIN No Annual Fee/Platinum Card iiii ayY W yi ~eaY W 5V ~~- i i ~ i~wil ( . 5l I Mlnirttum Payment Due ................................. ...........$241.37 Ow Dsts" ........................................................ April 16, 2001 i •Pryme,d must w reulved ry 1:00 pm Iwal eme en iM prymmrt dw dale. Amount Past Dw ........................................... .............$98.00 Amowt Over Limit ........................................ ...........$127.37 Credit Line ....................................................... .......$2,750.00 Available Credit ............................................... .............. $0.00 Cash Advance limit ........................................ .............. $0.00 Page , 014 ~ ATbT How to Reach Us Account Online: www.universalcard.eom Account OnCall: 1 800 636-6330 (For Automated Service Only) Customer Service: 1 B00 423-4343 or writs Universal Card Services Corp., PO Box 44167. Jarlssonville, FL.32231-4,1;7:;' Tha Annual Percentage Rate on your account has been increased due to one of the following reasons ctated in your Card Agreement with us: you failed to make a payment to us or any other creditor when due, you exceeded your credit line or you made a payment to us that was not honored by your bank. Our records show home phone 717-540-5208 and business phone 717-652-8802. Please update remittance coupon if incorrect. Previous Balance $2 764.35 ' Payments and Adiusiments O.DO IMPORTANT PROGRAM Visa Card Activity t 13.02 UPDATE: Total ATBT Services 0.00 Visa renewed the insurance coves e 9 New Balance $2,877.77 with Virginia Surety Company, extending Auto Rental insurance and Note: Detailed activity starts on page 3. Warranty Manager through February 26, 2002. Payment Record Amount Date Get Top-Ranked Internet Access! Only $4.85 a month from the ATB:T WorldNet Service 1495 Offer Call 800-787-3900 ext. 7977, or visit www.download.att.net/ucsmsg for details. Terms and conditions apply. Pay ALL your bills online! Pay any bill -mortgage, utilities, credit card, and more - with a click of your mouse using the Citibank Bill Manager. See page 2 fir details. Check NumEer: Please follow payment Insiructlons outlined in <he "Important instructiana for Makinq Payments" seNlon of the statement. Arco nl Num er P ment Due Balance Minimum P meM nter Amount Enclos 4492 2801 Oo73 3651 04/16!01 52,877.37 $241.37 Initial here to enroll in optional Credit Protector. I have read and understood the enclosed wst and other disclosures. on of a u oaoane ~nr~~~nr~ur~~~~ur~o~nu~r~u~~nu~~r~~u~ur~u~~o~~ur~ VICKY CLOUSHER 269A N ARLINGTON AVE HARRISBURG PA 17109-2316 Mew ehw w to aldms ant hew numav aelow. Addnns Apllauib ciy arts np Home phow Buainwa Phew ( 1 ~ 1 1 Make check payable to: Universal Card PO BOX 8213 SOUTH HACKENSACK NJ 07806-8213 ~~~no~no~r~~n~~nn~~u~u~ru~o~nr~~u~~un~~u~~ur~~r~ 44922801007338510000241370002877371 ~'~ \\~I~~-~'`-""t' ~' P O BOX 7627 FT WASHINGTON PA 19034 NCO FINANCIAL SYSTEivIS IN( 888 831-6761 OFFICE HOURS: 8AM-9PM MON THRU THURSDAY SAM-SPM FRIDAY 8AM-12PM SATURDAY Apr 3, 2001 18A69560 TOTAL BAL DUE: $ 4208.31 I~~~'~ ~~'~~ ~I~'I~ ~~~~ ~~~~~ ~~I~I'~~~~ ~~~~~ ~'~~ ~~~~ (SEE BACK FOR DETAIL) VICKY CLOUSHER 269 N ARLINGTON AVE HARRISBURG, PA 17109-9505 You have chosen to ignore our previous communications regarding the debt referred to above Failure to respond to this notice will mean that we will recommend to our client that they review this matter to determine if they should pursue this account further to protect their interest. THIS IMPENDING ACTION MAY STILL BE AVOIDED BY SENDING PAYMENT IN FULL TO THE ADDRESS BELOW. To assure proper credit you must enclose the lower portion of this letter with your payment. This is an attempt to collect a debt. Any information obtained will be used for that purpose. This is a conununication from a debt collector. PLEASE RETURN THIS PORTION WITH YOUR PAYMENT (MAKE SURE ADDRESS SHOWS THROUGH WINDOI Account # Due Date otal Bala A69660 $ 4208.31 VICKY CLOUSHER _ Payment Amount l Check here if your address or phone number has chen0ed end proNde the new Information below. tvieke Payment To: ~nr~~~r~uur~~~~n uu~~~n r~r~n~~~r u~~nr~~ur~~ur~u ~~~ NCO FINANCIAL SYSTEMS PO BOX 7400 PHILADELPHIA PA 19101-7400 NCOE 011800A6956U900000U11000DBODB004208315 ~-~'~~ w=art--L~ S The following account(s) have been placed with NCO: Creditor/Original Institution Account Number Regarding Amount Owed GREAT/CHEMICAL BANK CREDI CREDIT CARD - DISCOVER 4208.31 The above account{s) were previously serviced by CFS after being purchased from the original institution noted above by one of the following companies. GREAT- Global Rated Eligible Asset Trust SMART975- Securitized Multiple Asset Rated Trust 1997-5 SMART976- Securitized Multiple Asset Rated Trust 1997-6 34543