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Home My WebLink About01-0390 PETITION FOR PROBATE and GRANT OF LETTERS Estate of FO:EST WALTER MADDEN No. ~l-O\ - ~O also known as To: Register of Wills for the . Deceased. County of Cumberland in the Social Security No. 183-18-8743 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 executor in the last will of the above decedent, dated June 22 and codicil(s) dated None named ,19~ It is suggested that Janet C. MAoopn, wife of Decedent. predeceased him on 2./"1Jt1tt. (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in h is last family or principal residence at 17055 (Hampden Township) Cumberland County, Pennsylvania, with 504 Breezewood Court. Mechanicsburg (list street, number and muncipality) Decendent, then 75 years of age, died A r r; 1 7 , ~ 2001 , at Camp Hill Care Genter. East Pennshoro Township, r.tlm"hprJflnn r.mlflty, PA Except as follows, decedent 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: None Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ lTnpstimAtpd (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ None situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters tes tamen tarv (testamentary; administration c.La.; administration d.b.n.c.La.) theron. V) 'tr v C <l.> ~3 <l.> .... ~v = -00 t:'= Clj',= _<l.> ~c.. <l.> '- :; 0 ~ c eo c;:j 6~~ Matthew Shawn Madden 2 San Juan Drive Mechanicsburgt PA 17055 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 "0'< ~ S~ COUNTY OF CUMBERLAND j The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are tru.e and correct to the best o,f the ~~lOwledge ~nd belief of petition~~~. s and that as personal represen- tatlve(s) of the above decedent petltlOner(s) wIll well and tr~l~mJ~~ ye estate according to law. Sworn to or affirmed and subscribed #dk ~~ V:l before me this 17 th day of Ma t thew Shawn Madden ~. A r' 2Q Qn. _ ~ MAR ~ ~ \~- (;2~~-\\ N 21 - 01 - 390 o. Estate of . I ~~\J'i FOREST WALTER MADDEN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW April 18 ~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated June 22, 1993 described therein be admitted to pr~bate and filed of record as the last will of Forest Walter Madden and Letters Te.strlIDPntrlry are hereby granted to Matthew Shawn Madden BRENNEMAN & FEES $ 40.00 $ q 00 $ $ 12.00 ~.uu TOTAL_$ 66.00 Filed ....... ~ P.R. T. ~ . J .8. '- . ?- P.Q 1 . . . . . . . . . . . Probate, Letters, Etc. ......... Short Certificates( 3) . . . . . . . . . . Renunciation ................ X-Pages JCP By Rich~TtdRNE~~~~ef.~~.Ng96355 44 West Main Street Me.~hanicsburg~ PA 17055-0318 ADDRESS (717) 697-8528 PHONE Mailed letters to attorney on 4-18-2001 \'his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as LOl.',J! Registrar. The original certificate will 'be forwarded to the Stare Vital Records Office for permanent fIling, WARNING: It is illegal to duplicate this copy by photostat or photograph. No. Fee for this certificate, $2.00 P 7255906 Date Hl05. i4J Aev 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYPE/PRINT IN PERMANENT 8l.ACK INK CUMBERLAND CAMP HILL STATE FILE NUU8€R NAME Of oeCEDENTlf:;;M,;;.;;,~----'----"------------------ sEi--- I. FORREST WALTER 75 UNDER 1 YEAR MGnIh. Doya UNOER I DAY M;E. (la.. Bot1t><lay) v,. __ ! loIinu'" . .1.1 5. COUNTY Of OERH .... Ie. IoIAA1TAl. SWU$- M_ Novo< MonOId. W_. ~(Specoly) 14. WIDOWED 17c.0 ....___.. SURVIVING SPOUSE In ...... \If'/W """""" name, DECEDENT'S USUAL OCCUP,qJON (GwelllnCl 01 WOf' <lOne dUllng ..- 01 WOfk"'ll k1.; do no( """ ,."'ed I . 110. SHOP FOREMAN 11... FEDERAL PRISON DECEDENT'S MAILING ADOAESS (SI,..1. CoIy/lOwn. SIaIe. Z",CodeI DECEDENT'S 504 BREEZEWOOD COURT ~~~~ MECHANICS BURG , PA 17055 ~='~~ It. FATHER'S NAME Ifir", "''''dIe, last) It. LAURENCE MADDEN INFORMANT'S NAME (T ypelP'""1 ~~ATTHEW MADDEN METHOD OF DISPOSITION BunaI Q1J C..mat_ 0 Ol'* (SjJ8coIy\ CUMBERLAND Did - live WI . _",1 - 17b. Coun 17d!l ::i.=-':::Ol MECHANICSBURG coly_ r.tOTHER'S NAME ,F... Moddte. Ma.den Suonamel ~ ~ };l o lL o W ~ 0( Z 2001 II. :~ANSANAJUANRDSSRivt4yMECii'ANICSBURG, PA 17055 PLACE Of DISPOSITION. N.me of Ceme.ery. C,.....loty lOCATION - CityITown, SI.l0. rip Code 0< 0Ihe< PWoce 21!..ROSPECT HILL CEMETERY 2110RK, PA 17404 NAME AND ADDRESS Of FACILITY 22J:TZWEILER FUNERAL' :HOME 1111 YORK~ PI ENSE NUMBER .. I t<J "l 3 3 L (Monl/l, Day, Yearl 3. N ~ ~:r ? ~ - - 230. H -')-01 WAS CASE RefERRED TO MED EXAIoIINERiCOf\ONER1 ~I[) ~ --l; ~ "-.:. \f /YJ E-r A-S-r A--r I c- DUE 10 (OR AS ACONSEOUENCE Of): L-IIJVr G~ le. I Approlumare ~ interval betw..n : onset and death l PART N: OChe' s.gnillc.... 00_ COflI'_ing to deolll. bul not ,esulting...... unde<\yIng <:IlA81lN8n in PAAT I 2'. '" 25. 27. p~ I: Ent8' tn. dtseases, InJurHts Of comphcat.ons which C4lu$ed the (Jealh Do nol enr8llhe mode of dying, such is CatdliC or '859lfaIOt)' IIH8$1, ihock or heart 'alkl,. L~~~ca~M~~~ . l: DUE 10 (OR AS A CONSEOUENCE Of); DUE 10 (OR AS A CONSEOUENCE Of): -~ ~ 3:. WERE AUlOPSY FINDINGS MANNER OF DEATH AVAIL\BlE PRIOR 10 COMPLETION OF CAUSE OF DENH1 N~Uf" GATE Of INJURY (Monlll, Ooy, Yearl lllolE Of INJURY INJURY AT WORK? DeSCRIBE HCMIlNJURY OCCURRED. No 0" Yes [) No~ Suacidol 0- Ham". 0 [) Pending lnlfelst;.gatioo [) [) Could noc be dell(mU\80 0 ---- ... [) No g... Accldenl 29. :JOe, 3lllt. PLACE Of INJURY. AI_.ta,m, sU",. lactory, offico butkJing, tlC_ CSpec,I.,) :JOe. M. 3lIc. o 2... 21b. CERTIFIER lC~ec. my one) .CERTIfYING PHYSICIAN IPhySlClcl1l cerhlYl1lg cause oI_~alh wher .lIlQlt'er ptWSaC,an has pt'ooounced deal" ano cc.-npleled Item 2Jl To..... beet o. my knowMtdC)e, de.th. OCCUlted due to the c.u~e(s) and mJinn.r .. .t.ted. _ ~ .PROMOUHClNG AND Ct.Rllf"1lNG PHYSICIAN tPhVSICld.n Dolt: iJl3IIOuflCIOg Oe.Jlh dlld ..:erllly.ng 10 Cduse of t1e.alh\ To the bait 01 my knowledgft, deilth occurred.1 the time, dale. ind pllce. and due to the cau5e(s).and m.nner.. staled.. 'MEDICAL EXAMINERlCORONER On the ba.i. 01 .xaminatlon and/or investigation, in my opinion, death occurred a' the time, dale. and place. and due to the cause(a) and manner I. stated.. . . . . . . . . . .. ........... - . . . . . . .. .................. - . - .. . . . . . . , . . . . . . . . . . . . . . . . , , . , . , . . . . . . Ib;1 t. "~,, I LAW OFFICES ETTER, KESS\..ER & PERSING 8 NORTH THIRD STREET P. O. BOX 512 EWISBURG, PA 17837-0512 LAST WILL AND TESTAMENT OF FORREST WALTER MADDEN BE IT REMEMBERED that I, FORREST WALTER MADDE~, of 900 N.E. 48th Street, Lot No. 12 - Highland Woods, Pompano Beach, Florida 33064, being of sound mind, memory, and understanding, do make, publish, and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all \,,'i1ls and Testaments, or writings in the nature thereof, by me at any time heretofore made. 1st: I direct that all of my just debts and funeral expenses be paid and discharged as soon as may be convenient after my decease by my executrix or alternate executor, hereinafter named. 2nd: All of the rest, residue, and remainder of my estate, of whatsoever nature and wheresoever the same may be situate, whether real, personal, or mixed, I give, devise and bequeath unto m~ beloved wife, JANET C. MADDEN, to be hers absolutely and forever, provided that she survives my death for a period of thirty (30) days. 3rd: In the event that my wife, JA~ET C. MADDEN, should predecease me or Hl the event that that she s110uld fail to survi\e my death for a period of thirty (30) days, then: A. gi ve and bequeath any automobile that I may OFn at the time ()f my death unto my son, MATTHEW SHAWN MADDEN, to be his absolutely and forever; and 4 . . /J /~'z!.~b;~/~:/>~ Forrest Walter Madden LAW OFFICES ETTER, KESSLER & PERSING 8 NORTH TH IRO STREET P. O. BOX 512 LEWISBURG. P'" 17837-0512 In the event that MATTHEW SHAWN MADDEN should lIUt be living at the time of m~ death, then I give and bequeath such automobile unto my stepson, FREDERICK MICHAEL PAUP, to be his absolutely and forever. B. r direct my alternate executor, hereinafter named, to convert all of the rest, residue, and remainder of my estate, of whatsoever nature and whereso ever the same may be situate, whether real, personal, or mixed, into cash, at either public or private sale, whichever m~' said alternate executor may deem to be for the best interests of my estate; and, for this purpose, I do hereb:'T authorize and empower my said alternate executor to make good and sufficient deeds, in fee simple, for any and all real estate, which I may own at the time of my death, the same as I might do if then living. c. The cash fund so realized from the conversion of my estate, I do give and bequeath as follows: [1] Fifty per cent (50%) thereof unto my son, MATTHEW SHAW~ MADDEN, or to Ilis children in the event that he should not survive me, to be his or theirs absolutely and forever. [2J Twenty-five per cent (25%) thereof unto my stepson, FREDERICK MICHAEL PAUP, or to his children in the event that he should not survive me, to be his or theirs absolutely and forever. [3] Twenty-five per cent (25%) thereof unto my daughter, REBECCA ANN MAXFIELD, to be hers absolutely and forever. In the event that my daughter, REBECCA A~N MAXFIELD should not be livilIg at the time of distribution of my estate, then this share shall be equally divided between the parties named in ~./"- --:f!0/lA/J /// .l;t: <-zi-L/-;J/~d...-/r~L) Forrest Walter Madden 2 LAW OFFICES ETTER, KESSL.ER & PERSING 8 NORTH THIRD STREET P. O. BOX 512 EWISBURG, PA 17837-0512 the foregoing paragraphs 3rd:C.[1] and 3rd:C.[2]. LASTLY, I hereby nominate, constitute, and appoint my hlle, JANET C. MADDE~, to be the executrix of this, my Last Will and Testament. In the event that my wife JANET C. MADDEN, should not survive me or in the event that she should f ai I to qual i fy, then I hereby nominate, const 1 tu te and ;:tPPO i n t my son, MATTHEW SHAWN MADDEN, to be the alternate executor of this, my Last Will and Testament; and in the event that neither my Kife, JA~ET C. MADDEN, nor my son, MATTHEW SHAWN MADDE~, is living at the time of my death, then I hereby nomirlate, constitute and appoint my stepson, FREDERICK MICHAEL PAUP, to be the alternate executor of this, my Last Will and Testament, my named executrix and alternate executors shall serve without bond, irrespective of her or his place of residence at the time of my death. IN WITNESS WHEREOF, I, the said FORREST WALTER MADDEN, have to this, my Last Will and Testament, written and contained on three (3) pag~s of paper, subscribed m~ name and affixed my seal to each of the thre~ (3) pages thereof, this 22nd day of June , one thousand nine hundred ninety-three (1993). I .:-/' , ~~C //.hL~""-;))wd~AL) torrest Walter Madden 3 LAW OFFICES ETTER, l'IESSL.ER & PERSING 8 NORTH THIRD STREET P. O. BOX 512 .EWISBURG, PA 17837-0512 * * * * * * * * * * * * The aforegoing instrument, written and contained on threE (3) pages of paper, was subscribed by the said FORREST WALTER MADDE~ on each of the three (3) pages thereof and sealed, published, and declared by }1im, the said FORREST WALTER MADDE:\, as and for his Last 'Will and Testament, in our presence and in the presence of each of us, and we, at the same time, at his request, in his presence and in the presence of each other, have hereunto subscribed our Hames as attesting witnesses, this 22nd of , one thousand June nine hundred ninety-three (1993). .-....f .. _.-'_...--;t' ,,'" /" . ,( .......-t ..' ?~. ,/ /2~~? ~7ybr(7 < . Y " ~r'esiding at 5 Jefferson Ave.. Le~isbu~__PA 17837. _~~e/.LL f( S; I< LJCLc?' .~ resi~at .f20_NorJJL_:lt}L_St..~ewisburg_L_PA 17837~ -1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF UNIO~ We, FORREST WALTER MADDEN and _______~~LENE K. SCHWARTZ__, the testator and the \,itnesses, respectively, SS ____~_ RO~ER f~ETTEIi ----, whose names are signed to the attaclled or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and Testament, and that he signed \'-"illingly, and that he executed it as his free and voluntary act for the purposes Ilerein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the h'ill as witness and that to the best of his or her knowledge the testator was at that time eighteen (18) years of age or older, ()f sound mind, and under no constraint or 'undue inf luence. ~/?/ s ;! LL1--.;z.L~-L/ /'/7 &~ "--/6/<"'4"'-: /1 / .../" /7 /"..T6taJQr .' ,,'/7 r f/fi ~. >.t.~~/ 7 .V"/~. t: {'i:::~~=' '-/G-f Witness (=-YYJCLZ-~ '-- S;~-()a<-~ \,'i tness ~ Subscribed, sworn to and ackno\'-"ledged before me by _ FORREST WALTER !\'lADDEN LAW OFFICES ETTER, KESSLER & PERSING and __~ALEN.E_K. SCHWARTZ testator, and subscribed and sworn to before me by _ June W. ROGER FETTER _, witnesses, this 22nd_ day one thousand nine hundred ninety-three (1993). 8 NORTH THIRD STREET P. O. BOX 512 LEWISBURG, P^ 17837-0512 Notarial Seal Mt1y M. Qohmam, Not8IY PltlIic lBWisbufQ Boro, Union County1994 My CommlssiOl1ExPres JaIl. 16, Member, ennsytvania A.ssocia.tiah of 7~)Jl f+J~ .~,~/ ! Notary PublIC ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: FORREST WALTER MADDEN, Deceased Date of Death: April 7, 2001 No. 20001-00390 PA No. 2101-0390 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 about April 26, 2001: Name Addre ss Matthew Shawn Madden 2 San Juan Drive Mechanicsburg, P A 17055 Frederick Michael Paup 720 West King Street York, PA 17404 Re becca Ann Maxfield 532 Ludlow Avenue York, PA 17403 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. Date: April 26,2001 ichard C. Snelbaker, Esquire 44 West Main Street Mechanicsburg, P A 17055-0318 (71 7) 697-8528 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SNELBAKER RICHARD C 44 W MAIN STREET MECHANICSBURG, PA 17055 _nnn_ fold ESTATE INFORMATION: SSN: 1 83-1 8-8743 FILE NUMBER: 21 - 2001 - 0390 DECEDENT NAME: MADDEN FORREST WALTER DATE OF PAYMENT: 01/07/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/07/2001 NO. CD 000725 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $191.76 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: RICHARD C SNELBAKER ESQ. CHECK# 1460 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $191.76 MARY C. LEWIS REGISTER OF WILLS ~ REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 /6' -c2~//- // DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FilE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 0390 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Madden, Forrest Walter 183-18-8743 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 04/07/01 06/19/1925 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return 8 (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach acopyofTrust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit(date of death between 0 11. Election to taxunder5ec. 9113(A) 12-31-91 and 1-1-95) (Attach Sch 0) tijl$.f;ll$tIO~.'MUSTBE 'COM~4ETEI).. AL~ .PQi'!IlE$f>Q!'!DeNPE.'.a,..PQNFII)!;!'!TIMTl\X .INFORM.!f.TION...~HOI.I~DB!;.D!R~CTED.T9: NAME COMPLETE MAILING ADDRESS COR- Richard C. Snelbaker 44 West Main Street RE- FIRM NAME (If Applicable) Mechanicsburg , PA 17055 SPON DENT Snelbaker, Brenneman & Spare, P.C. TELEPHONE NUMBER 717-697-8528 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) NODel C ::oir? 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) Nonef- ~ . ~ roO 4. Mortgages & Notes Receivable (Schedule D) (4) Noni," l,Ci <2 "",, Cash, Bank Deposits & Miscellaneous Personal ~.". '- ::,.:; 'I.". 5. "" I; , (5) 19,044 . 6~: z Property (Schedule E) I ,- . 6. Jointly Owned Property (Schedule F) . -.J 0 Separate Billing Requested (6) 4,442.43,. -0 ,;T, RECA- ~ Q. PITULA- 7. Inter-Vivos Transfers & Miscellaneous "TJ :.;. "t';;, ., -.J TION Non-Probate Property (Schedule G or L) (7) None" a. Total Gross Assets (total Lines 1-7) (8) 23,487.09 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 3,441. 25 10. Debts of Decedent, Mortgage Liabilities, & Liens(Schedule I) (10) 15,784.54 11. Total Deductions (total Lines 9 & 10) (11) 19,225.79 12. Net Value of Estate (Line 8 minus Line 11) (12) 4,261.30 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value SubJect to Tax (Line 12 minus Line 13) (14) 4,261.30 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amountof line 14taxableatthe spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 (15) TAX 16. Amount of line 14 taxable at lineal rate 4,261. 30 X .0 45 (16) 191.76 0.00 - 0.00 COMPU- 17. Amountof line 14taxableatsiblingrate x.12 (17) TATION 18. Amount of line 14 taxable at collateral rate 0.00 X .15 (18) 0.00 19. Tax Due (19) 191.76 20. ~ 1~!~*j;ji$$ii!yQijf4i!EREQjjE$TIi<!G*RERli!!Pi::>>%l\ij~R1!A_r#1 >> BE SURE TO ANSWER ALIL QUESTIONS ON PAGE 2 AND p,ECHECK MATH<< o PA15001 NTF 29755 Copyrrght 2000 Greatland/Nelco LP- Forms Software Only PA REV-1500 EX (6-00) Page 2 Decedent's Complete Address: STREET ADDRESS 504 Breezewwod Court Township CITY I STATE I ZIP Mechanicsburq PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 191.76 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable O. Interest E. Penalty Totallnterest/Penalty (0 + E) 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 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check (3) 0.00 (4) (5) 191.76 (5A) 0.00 (5B) 191.76 2. 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? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~ I B ~ 3. 4. D ~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of which fe arer has an knowle e. SIGNATURE OF P~N ,)ZSIBLE FOR FILING RETURN ADDRESS See Sch SIGNATURE 0 DA%~ /i! . 'P "I I , P hed OTHER THAN REPRESENTATIVE DATE /.oj.llk- ADDRESS 44 West Main Street, Mechanicsburq, PA 17055 :::?(,){)\\))}Y:)J'U})::)):X?\t:))))<:',:,:::,:::.::,;.i/):)\::\)}}'::.i/:,,::)))::)),:;/,:/:))}j\}))}})}))}{))})))))::}::)}}))))\),:)):,:::;/:))):/}(:})})))\\:::::(},}:<:::/)))'(:",.:,:".,.,,:,:,:,: .:,:,": For dates 'of deatti' on'or att'er July' 1, 1994 and before January 1: 1995, the'tax'rate imposed on the net'value of tra~sf'ers to or for the use of the'surv'iv;;;g '~p~use is 3%' [72P.S.1i9116(a)(1.1)(i)). For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Ii 9118 (a) (1.1) (iill. The statute nOR" not f'!xp.mnf a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on orafterJuly 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years at age or younger at death to or tor the use of a rlatural parent, an adoptive parent, ora stepparent of the child is 0% [72 P.S. !i9116(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%, exceptas noted in 72.P.S.!i 9116(1.2) [72 P.S.!i9116(a)(1)]. The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. !i9116(a)(1.3)J. A sibling is defined. under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood oradoption. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco LP- Forms Software Only Estate of: Fo=est Walter Madden 21-2001-0390 The following person(s) are signing the return as representative(s) of the estate: Matthew Shawn Madden 2 San Juan Drive Mechanicsburg, PA 17055 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF -Forrest Walter Madden SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-2001-0390 Include proceeds of litigation & date proceeds were received by the estate. All prop. Jointly-owned with rlqht of survivorship must be disclosed on Sch. F. VALUE AT DATE OF DEATH ITEM NO. DESCRIPTION 1 Household goods sold at Public Auction by Bricker's Auction 1,405.50 2 Property Management Inc _, refund of security dep::lsit on apartment 9.16 3 Matthew S. Madden, payment for household items purchased from the Estate 13 0':'0 0 4 1999 Chrysler Eagle, sale value 17,500.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets 01 the same s'12e) 19,044.66 ;' CPA81 NTF 10908 ~.)oYrlght Forms Software Only, 1997 Nelco, Inc. REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF .Fo=est Walter Madden SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-2001-0390 If an asset was made Joint within one year of the decedent's date 01 death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A Matthew Shawn Madden ADDRESS 2 San Juan Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Son JOINTLY-OWNED PROPERTY: LETTE R DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH Include name of financial institution and bank ITEM FOR MADE account number or similar identifying number. DATE OF DEATH DECO'S VALUE OF JOINT NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 11/10/98 M&T Bank, checking account 4,598.39 50.00 2,299.19 #27056456 2 A 11/10/98 M&T Bank, savings account 4,286.48 50.00 2,143.24 #15004201911771 TOTAL (Also enter on line 6, Recapitulation) $ 4,442.43 7 CPA91 NTF 10909 (If more space is needed, insert additional sheets of the same size) :::::)pynght Forms Software Only, 1997 Nelco, Inc. REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Forrest Walter Madden SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-0390 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1 Etzweiler Funeral Home, funeral services 1,270.51 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address 0.00 City State Zip Year(s) Commission Paid: 2. 3. Attorney Fees Name: Snelbaker, Brenneman & Spare 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 900.00 0.00 4. Probate Fees 66.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 See Schedule attached Total frcrn continuation page (s) 1,204.74 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 3,441.25 7 CPA11 NTF 10911 :Jynght Forms Software Only, 1997 Nelco, Inc;, Estate of: Forrest Walter Madden -Item No. SCHEDULE H, PART B -- Administrative Costs Description 7 Bricker's Auction, commission on sale of household goods 8 Bricker's Auction, appraisal fee 9 Register of Wills, Cumberland County, filing fee for Inheritance Tax Return 10 Patriot-News, advertising Executor's notice 11 Cumberland Law Journal, advertising Executor's notice 12 Reserve for filing fees, accounting costs and other fees associated with the administration of Decedent's estate. 'IOI'AL. (Carry forward to main schedule) . . . . . . Page 2 21-2001-0390 Amount 465.50 50.00 15.00 99.24 75.00 500.00 1,204.74 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF -Fo=est Walter Madden Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2001-0390 DESCRIPTION AMOUNT 1 Chrysler Credit, loan #10110265674, payoff value 15,784.54 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 15,784.54 :o)::yrlght Forms Software Ortly, 1997 Nelco, Inc. REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES 'Forrest Walter Madden No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Matthew Shawn Madden 2 San Juan Drive Mechanicsburg, PA 17055 2 Frederick Michael Paup 720 West King Street York, PA 17404 3 Rebecca Ann Maxfield 532 Ludlow Avenue York, PA 17403 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not Ust Trustee{s) Son Stepson Stepdaughter 21-2001-0390 AMOUNT OR SHARE OF ESTATE 4,261.30 0.00 0.00 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 "yroght Forms Software Only, 1997 Neico, Inc. (If more space is needed. insert additional sheets of the same size) '" AW OF'F'tC~S ~ES5LF;R .. PCRSING fH THIRO $TRE:CT . O. BOX ala ~. PA 17837-0&12 ~ LAST WILL AND TESTA.'IENT OF FORREST WALTER MADDEN BE IT REMEMBERED that I, FORREST WALTER ~~DDEN, of 900 N.E. 48th Street, Lot No. 12 - Highland Woods, Pompano Beach, Florida 33064, being of sound mind, memory, and understanding, do make, publish, and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all \"i11s and Testaments, or wd tings in the nature thereof, by me at an,' time heretofore made. 1st: I direct that all of my just debts and funeral expenses be paid and discharged as soon as may be convenient after my decease by m~ executrix or alternate executor, hereinafter named. 2nd: All of the rest, residue, and remainder of my estate, of whatsoever nature and wheresoever the same may be situate, whether real, personal, or mixed, I give, devise and bequeath unto my beloved wife, JANET C. MADDEN, to be hers absolutely and forever, provided that she survives my death for a period of thirty (30) days. 3rd: In the event that my wife, JA:-iET C. MADDEN, should predecease me or in the event that that she should fail to survive my death for a period of thirty (30) days, then: A. I give and bequeath any automobile that I may own at the time of my death unto my son, MATTHEW SHAWN ~~DDEN, to be his absolutely and forever; and ~ i . :..-rl//..J2/~://""?//~~ Forrest Walter Madden LAW OF'F'IC~S K~SSL~R .. P~RSING HH THIRD STR~~T '". O. BOX 15'. JAG. PA 1?~"-oI5I. in the event that MATTHEW SHAWN MADDEN should not be living at the time of my death, then I give and bequeath such automobile unto my stepson, FREDERICK MICHAEL PAUP, to be his absolutely and forever. B. I direct my alternate executor, hereinafter named, to convert all of the rest, residue, and remainder of my estate, of whatsoever nature and "hereso ever the same may be situate, whether real, personal, or mixed, into cash, at either public or private sale, whichever my said alternate executor may deem to be for the best interests of my estate; and, for this purpose, I do hereby authorize and empower my said alternate executor to make good and sufficient deeds, in fee simple, for any and all real estate, which I may o"n at the time of my death, the same as I might do if then living. C. The cash fund so realized from the conversion of my estate, I do gi':e and bequeath as follows: [1] Fifty per cent (50%) thereof unto my son, YIATTHEW SHAW~ HADDEN, or to his children in the event that he should not survive me, to be his or theirs absolutely and forever. [2] T"enty-five per cent (25%) thereof unto my stepson, FREDERICK MICHAEL PAVP, or to his children in the event that he should not surviYe me, to be his or theirs absolutely and forever. [3] Twenty-five per cent (25%) thereof unto my daughter, REBECCA ANN MAXFIELD, to be hers absolutely and forever. In the event that my daughter, REBECCA ANN HAXFIELD should not be living at the time of distribution of my estate, then this share shall be equally divided between the parties named in - - ~J // / )" /bu-:77:l ~:;>.-/-/J ,.1 s;{{~) Forrest Walter Hadden 2 ,OF"f"lctS SSl..i:A So P't.RSING THIRD STRE:E:T '.80)( 15102 . PA 1,..3,.-061:11 the foregoing paragraphs 3rd:C.[1] and 3rd:C.[2]. LASTLY, I hereby nominate, constitute, and appoint my ..ife, JANET C. MADDEN, to be the executrix of this, my Last Will and Testament. In the event that my wife JANET C. MADDEN, should not survive me or in the event that she should fail to qualify, then I hereby nominate, constitute and appoint my scn, MATTHEW SHAWN MADDEN, to be the alternate executcr of this, my Last Will ill1d Testament; and in the event that neither my wife, JANET C. MADDEN, nor mo' son, MATTHEW SHA\;N "IADDE:;, is living at the time of my death, then I hereby nominate, constitute and appoint my stepson, FREDERIC~ MICHAEL PAUP, to.be the alternate executor of this, my Last Will and Testament, my named exe~utri:( and alternate executors shall serve without bond, irrespective of her or his place of residence at the time of my death. : I \ , \ IN WITNESS wl1EREOF, I, the said FORREST WALTER MADDEN, have to this, my Last Will and Testament, written and contained on three (3) pages of paper, subscribed my name and affixed my seal to each of the three (3) pages thereof, r r ~. , t~ 'f ;, . this 22nd day of , one thousand nine hundred ninety-three June (1993) . . / ~/ 7-o_~r //.hLzZu--?).lr'd~AL) Forrest Walter Madden 3 1 I I \W OFFICCS :CSSL.CR C ,"CRSING H THIRQ STRCCT O. BOX .12 to. po" ,,.8,3"-0$12 t. f; ************ The aforegoing instrument, written and contained on three (3) pages of paper, was subscribed by the said FORREST WALTER ~\ADDE" on each of the three (3) pages thereof and sealed, published, and declared by him, the said FORREST WALTER MADDEli, as and for his Last ""ill and Testament, in our presence and in the presence of each of us, and we, at the same time, at his request, in his as attesting witnesses, this presence and in the presence of each other, have hereunto subscribed our names nine hundred /' / ./ 22nd of June , one thousand at 5 Jefferson Ave., Lewisbur~. PA 17837. at 220 North 4th St., Lewisburl. PA 17837. 4 CO~~ONWEALTH OF PENNSYLVANIA 55 COUNTY OF lNION We, FORREST WALTER ~iADDE:i Ii. ROGER FETTER and DALENE K. SCH!iARTZ , the testator and the Kitnesses, respectively, ~hose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will anel Testament, and that he signed willingly, and that he executed it as his free and voluntary act for the purposes herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as witness and that to the best of his or her kno~ledge the testator was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. .~ ~;/5 /~'d'2L/~,I/ //.1 /~~...--/fV"......u / ", ./_".,.-;? - ~a,~.Q.r ." //1 ...,.. c#-. /, /v0 "","7 y~'i"/-~ _ /, '_' t:;::o ~ Witness C:1YJJ:'LC --iC S~.()a<-~ ~itness ~ Subscribed, sworn to and acknowledged before me by testator,and subscribed and sworn to before me by FORREST WALTER MADDEN W. ROGER FETTER LAW' OF'FICE:S ~, KCSSU::A oC; PERSING DALENE K. SCHWARTZ , witnesses, this 2Znd day June and one thousand nine hundred ninety-three (1993). )RT~ THIRD STREE:T P. o. BOX 8'2 aURG, p" 17837-0512 NoIaJia\ Seal M<lyM,~u~ t.tf=~ "EJ<i;resJan.16, 1994 _c. f'ennsyIvaI1iaASSociaOOll of IQciErieS y , ! f / b - r:2,::2 "-/ - / / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU Of INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE Of INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT Of TAX Fk( DATE ESTATE OF DATE OF DEATH /1\..1/ :,' .r;: fILE NUMBER .J COUNTY ACN 02-18-2002 MADDEN 04-07-2001 21 01-0390 CUMBERLAND 101 '02 FEB 25 RICHARD C SNELBAKER SNELBAKER ETAL 44 W MAIN ST MECHANICSBURG C;8i PA 170~UmL\: *' REV-1547 EX AFP Cl2-DDl FOREST W Amount Remitted ) CHANGED (1) (2) (3) (4) (5) (&) (7) .00 .00 .00 .00 19,044.66 4,442.43 .00 (8) 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-Y=is4"7-Ex--AFP--fi'2=ooi--NO,.-icE--oF-iNHEifiTANci-i'-AjrA-ppRAISEMENT-,--ALiowAifci-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MADDEN FOREST W FILE NO. 21 01-0390 ACN 101 DATE 02-18-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED 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. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) &. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage 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 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 1&. Amount of Line 14 taxable at Lineal/Class A rate (1&) 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: NOTE: (9) (10) 3,441.25 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 23,487.09 19 2?5 79 4,261.30 .00 4,261.30 (19)= .00 191.76 .00 .00 191.76 15,784.54 (11) (12) (13) (14) .00 X 00 = 4,261.30 X 045= .00 X 12 = .00 X 15 = PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-J 01-07-2002 CDOO0725 .00 191.76 TOTAL TAX CREDIT 191.76 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 PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH fOR INSTRUCTIONS.) .. . , ' ., r ~\\a\~ /~ j/ L/ oIL STATUS REPORT UNDER RULE 6.12 Name of Decedent: Forrest Walter Madden Date of Death: April 7, 2001 Will No.: 21-01-0390 Admin. No.: 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 0 No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Approx. 90 dGlY s 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 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 0 No 0 c. Copies of receipts, releases, joi informal accounts may be fi d w' and may be attached to th' s and approval of formal or t of the Orphans' Court Date: 6/12/03 ~ .J: Signature Matthew Shawn Madden Richard C. Snelbaker 2 San Juan Drive Snelbaker, Brenneman & Spare, p.e. Mechanicsburg, PA 17~~e 44 West Main Street Mechanicsburg, PA 17055 0\ Address N (717) 697-8528 Telephone No. :5 -J rr'\ P ::'1 :'0: ~ '....r~ -~ Capacity: [Xl Personal Representative IKJ Counsel for personal representative JRD/June 30, 1992/17858 MAY 0 6 Z003 e' - - J ' .-'" .. In Re: Estate of Forrest Walter Madden Late of Hampden Township ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-2001-0390 NO. 21-2001-0390 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: Counsel for Personal Representative: Richard C. Snelbaker, Esquire Date of Decedent's Death: 04-07-2001 Date of Delinquency Notice: 3-10-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, 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 Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Register of Wills on 03-10,2003 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. Distribution: Personal Representative Counsel for Personal Representative Estate File Date: 05-05-2003 U, -/3 -0 3 ~ 3p 4-Hz 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 cane !\ Q." ~'\\~. {"I"\ \J ,,' ~\\' Geor "'. Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 . , Date: 3/10/2003 MATTHEW SHAWN MADDEN 2 SAN JUAN DRIVE MECHANICSBURG, PA 17055 RE: Estate of MADDEN FORREST WALTER File Number: 2001-00390 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. 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 will become delinquent on: 4/07/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: J File Counsel Judge . . . . 08301006122003 ROW621 File No 2001-00390 Decedent MADDEN FORREST WALTER Cumberland County - Register Of wills Page 1 6/12/2003 PA File No 2101-00390 Docket Entries D/E Date No. Filed 001 04/17/01 PETITION FOR PROBATE AND GRANT OF LETTERS TESTAMENTARY OATH OF PERSONAL REPRESENTATIVE DEATH CERTIFICATE 002 04/18/01 DECREE OF PROBATE AND GRANT OF LETTERS TESTAMENTARY 003 04/27/01 CERTIFICATION OF NOTICE UNDER RULE 5.6(A) 004 01/07/02 INHERITANCE TAX RETURN - DOCKET 16 PAGE 224 LINE 11 005 01/07/02 INHERITANCE TAX PYMT PAID - 191.76 ACN - 101 RECEIPT - CD0000725 SNELBAKER RICHARD C 006 02/25/02 REV 1547 NOTICE INH TAX APPRAISEMENT Docket: 16 Book: Page: 224.00 ACN 101 ~f ~i - Postal Service ~TIFIED MAIL RECEIPT stieMail Only; No Insurance Coverage Provided) -- Postage I s ru ..D CO Lll Certified Fee , Postmark Here ..D CJ CJ o CJ .-=1 Lll ru Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) .--=I CJ CJ ('- 'ilZ::~~ I/'IW.~~ ~;O~ 17116"5" B. Received by (Prinled ame) .. G- "to< b.h D. Is delivery address different from item 1? If YES, enter delivery address below: C. Date of Delivery s-.I . &J DYes o No SENDER: COMPLETE THIS SECTION . 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. 3. ServJ>:e Type liJ.'tertified Mail o Registered o Insured Mail D Express Mail D Return Receipt for Merchandise DC.a.D. ./--J96 4. Restricted Delivery? (Extra Fee) DYes 2. Article Number (Transfer from service label) PS Form 3811 , August 2001 7001 2510 0006 5862 2016 Domestic Return Receipt 102595-02-M-0835 ESTATE NO. 21-01-0390 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY MATTHEW SHAWN MADDEN, EXECUTOR OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF FORREST WALTER MADDEN, DECEASED, LATE OF HAMPDEN TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA Matthew Shawn Madden, Executor as aforesaid and Accountant herein, avers as follows: DATE OF DECEDENT'S DEATH: DA TE LETTERS TESTAMENTARY ISSUED: April 7, 2001 April 18, 2001 DATES EXECUTOR'S NOTICE ADVERTISED: Cumberland Law Journal Patriot-News Co. May 4,11,18,2001 May 1, 8, 15, 2001 FIRST AND FINAL ACCOUNT PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountant charges himself with the receipt of the Decedent's Personalty, goods and chattels as set forth in his inventory heretofore filed in the amount of: TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: PERSONALTY - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Decedent's Personalty Account: 1. Bricker's Auction, commission paid on sale of household goods 2. Register of Wills, filing fee for Inheritance Tax return 3. Register of Wills, Agent, Inheritance Tax due 4. Chrysler Credit, payoff loan #10110265674 5. The following items will be paid subsequent to the confirmation of the Final Accounting: a. Snelbaker, Brenneman & Spare, P.C., costs advanced: ,. Register of Wills, probate fees 2. Cumberland Law Journal, advertising Executor's notice 3. Patriot-News, advertising Executor's notice b. Snelbaker, Brenneman & Spare, P.C., payment on account for services rendered in the settlement of the Estate TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: PERSONALTY - INCOME ACCOUNT DEBITS LAW OFFICES SNELBAKER BRENNEMAN & SPARE The Accountant charges himself with the receipt of the following Income from the investment of Personalty Principal: TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: Page 1 $ 19,044.66 $ 19,044.66 $ 465.50 15.00 191.76 , 5,784.54 240.24 66.00 75.00 99.24 632.16 $ 17,329.20 $ $ NONE NONE LA W OFFICES SNELBAKER BRENNEMAN & SPARE PERSONALTY - INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Personalty Principal Account: TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: $ $ NONE NONE REAL EST ATE - PRINCIPAL ACCOUNT DEBITS The Accountant charges himself with the receipt of Decedent's Real Estate as set forth in his Inventory heretofore filed in the amount of: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: $ $ NONE NONE REAL ESTATE - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Real Estate Principal Account: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: $ $ NONE NONE REAL ESTATE - INCOME ACCOUNT DEBITS The Accountant charges himself with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: $ $ NONE NONE REAL ESTATE - INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items From the Real Estate Income Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: $ NONE $ NONE Page 2 RECAPITULA TION PERSONALTY: PRINCIPAL ACCOUNT: Debits $ 19,044.66 Credits $ 17,329.20 Balance $ 1,71 5.46 INCOME ACCOUNT: Debits $ NONE Credits $ NONE Balance $ NONE TOT AL PERSONALTY $ 1 ,71 5 .46 REAL EST ATE: PRINCIPAL ACCOUNT: Debits $ NONE Credits $ NONE Balance $ NONE INCOME ACCOUNT: Debits $ NONE Credits $ NONE Balance $ NONE TOT AL REAL EST ATE: $ NONE TOT AL FOR DISTRIBUTION: $ 1,715.46 LAW OFFICES SNELBAKER BRENNEMAN & SPARE Page 3 LA W OFFICES SNELBAKER BRENNEMAN & SPARE COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) Matthew Shawn Madden, being duly sworn according to law deposes and says: that he is the Executor of the Estate and under the Last Will and 55. Testament of Forrest Walter Madden, Deceased; that he is the Accountant herein; said Estate; that the attached list or schedule [*] contains the names, that the foregoing is a true and complete accounting of his administration of addresses and amounts due unpaid creditors who have given proper 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 information and belief. the facts set forth herein are true and correct to the best of his knowledge, Sworn to and subscribed before me this~(', day Of~u-\'1 2003. ~(\mJAQ '-k ~~AXJ '..- .....---... '~""";':"""" '~""""'"'-:'l\_''''' '.""'PI',_"....._..__..._" Notarial Seal SaOOra K Showers, Notary Pubtic ~~~~ Member. F\1nnsvtvan~ A.s9odatfon of Notali9s Page 4 ~s~~ Matthew Shawn Madden, Executor LAW OFFICES SNElBAKER BRENNEMAN & SPARE * UNPAID CREDITORS: ** PERSONS INTERESTED IN DISTRIBUTION OF ESTATE: 1. Matthew Shawn Madden 2 San Juan Drive Mechanicsburg, PA 17055 2. Frederick Michael Paup 720 West King Street York, PA 17404 3. Rebecca Ann Maxfield 532 Ludlow Avenue York, PA 17403 Page 5 NONE LAW OFFICES SNELBAKER BRENNEMAN & SPARE STATEMENT OF PROPOSED DISTRIBUTION Matthew Shawn Madden, Executor and Accountant herein, proposes to distribute the balance of the Estate of Forrest Walter Madden, Deceased, to wit: $ 1,715.46 in accordance with the Last Will and Testament of said Decedent as follows: 1. TO: Matthew Shawn Madden a. Proceeds from sale of automobile, as per Item 3A of Will b. 50% of residue as per Item Third C1 of Will $ 1,715.46 0.00 2. TO: Frederick Michael Paup a. 25% of residue as per Item Third C2 of Will 0.00 3. TO: Rebecca Ann Maxfield a. 25% of residue as per Item Third C3 of Will 0.00 TOTAL DISTRIBUTION: $ 1,71 5.46 Page 6 LAW OFFICES SNEL8AKER BRENNEMAN & SPARE COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND: Matthew Shawn Madden, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Statement of Proposed Distribution are true and correct to the best of his knowledge, information and bel~ 5L 6 Matthew Shawn Madden, Executor Sworn to and subscribed before me this<~~' day or.~-,t\v( 2003. ~Cvdce ~ s1cSjQJ\o Notarial Seal Sera:Ira K. Showeal. Notary Public ~ Bofo, CUrilertand Cwnty My EXpires N<w. 22. 200S , MemtJer, . Msodstion. Of NctArtc'" Page 7 <P Z ~ rii r11 r ~ > ~\ rz '"' v 'P ~r: ~~. c:~ o~~ 'V (Cl IJ', (J '6 (~ 00--\\~Z~ . '"iJ~ ~~L-. or11'> V'nZ -xZ'i >~rii wL..iJ' ~v~ _ lJ1 --\ 0 \fJ ~~ ;;~~ <~ ~jL-. )> --\ ~ 0 7'. Z ~ :; :::j o (jl 1J1 <P ""U )- ~ Inventory of the real and personal estate of FORREST WALTER MADDEN, Deceased PERSONAL TV: 1. Household Goods sold at Public Auction by Bricker's Auction 2. Property Management, Inc., refund of security deposit on apartment 3. Matthew S. Madden, payment for household items purchased from Estate 4. 1999 Chrysler Eagle, sale value $ 1,405.50 9.16 130.00 17,500.00 TOTAL PERSONAL TV: $ 19,044.66 REAL ESTATE: Decedent owned no real estate at the time of his death 0.00 TOTAL PERSONALTY AND REAL ESTATE: $ 19,044.66 ".~; .;- ~>J +.~ ~ Page 1 ~Qi \\~ \$)\ ()," STATUS REPORT UNDER RULE 6.12 Name of Decedent: Forrest Walter Madden Date of Death: April 7, 2001 Will No.: 21-01-0390 Admin. No.: 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 [Xl No 0 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. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes l' 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed wit Cler of the Orphans' Court and may be attached to this rep Date: 8/28/03 G~K Si Richard C. Sne1baker ~nplh~kpr, Rr~nn~m~n h ~p~rp-, P.C Name 44 West Main Stret Mechanicsburg, PA 17055 Address (717) 697-8528 Telephone No. Capacity: 0 Personal Representative IKJ Counsel for personal representative