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Home My WebLink About01-0403 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of P;9V.N) /1<~v ~r"rE~ also known as No. To: ::l\-D\ - \..\03 Register of Wills for the County of C~""'D"'''~I</;oJ in the Commonwealth of Pennsylvania Deceased. Social Security No. ~o- yy.C.V/P The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl; l?_s, for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante lllinoritate) the above decedent. Oecendent was domiciled at death in e(J,,"1KA{~N/ County, Pennsylvania, with hlf last ~amily or prin~_ lresiqence at /.ftil<P ~AI~~~ ~~ t"?rld {,r-.J~ ~ r JO{ 1 (C/VA I ,-:7tEc,-':;)~'k ) (list street, number and municipality) Oecendent, then ~~ years of age, died ""'1fI~e1Y /2. ~ .:lOt:t( , at Oecendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: ,..y / d $ //().~ $ $ $ Petitioner__ after a proper search haL- ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: N 1 amI;' Relationship Residence PDIl, J :r: ~,M";('~ "", t> Tdf'1(. /.r-l, "7t"" A All"1c ~ ~~. ~4d ~4A' E. .:rv....,..o-~ 1:J ~rl7'~r.t! ..r A...c- (fJr I"A~ Nt) , THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration III the .' appropriate form to the undersigned. <JJ V U t:: v ~3 v... 0:: v c -00 c'= ~.= 3d:: v,- ~ 0 (;J c CllJ Vi ~~,.(I /.1 ..r-:- ::r;:; ~~rA /r~, -?'"ER"'~"- #~ C'4;pC~~t:'/ ~4. r7c::>/.J 1Y~j g-C}74 ~ta - ~~;;- q OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. D~.-'. 9 C}-,.. . - Vl -- Q) .... ;::I ..... ~ = 00 i:i5 N 21 - 01 - 403 o. Estate of DAVID A L1UMPER , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW AP R I L 23, xf~2 001 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that DOR IS J JUMP E R is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration DORIS J lJUMPER are hereby granted to i~he estate ~i ------MVro-A-JUMPER---- ~G.VJ~~rJm~+... Register of Wills ~'VI! MARY CLEWIS FEES Letters of Administration Short Certificates( 1 ) . . . . . . . . . . Renunciation ................ JCP $ 18.00 $ 3.00 $ [:) .00 $ 5 00 TOTAL _ $ l1 no Filed ... !\~~ ~ ~..~ ~. .. .. ... A.D.x~ 2001 ATTORNEY (Sup. Ct. J.D. No.) ADDRESS PHONE Mailed letters to Administratrix on 4-23-01 I ('1'1,'( 'I"l' 1!","il.-lll,ltlt)!1 hl'n: L.,'l\'l't1 i, (Orr,-',I;'" L' 11) (crt 1-\ \ \- -, , ., I) nil' origin,c\ cnrif~c;w... \vill he \(lr\v,irclcd l(I th~: \. ,epst t.lr, c' .,11 ',ntlliciL' ,k~1!il lily tiled \'\irh :11e as (' \ >IJl Rl',llrd, (Htt:c lor pLJ']Lli,~il' iiling, WARNING: It is illegal to duplicate this copy by photostat or photograph ',( ). - ~/JlI.;/i"U' '.->' ;;"'~\:~\1 OF ii/V-' f~.~":\" --~....<'t.t\ T ~.' _ (~ - '.':=~: '.. ) ...~ 'A~! \1~ ';:"~;;~' ,-.,;' '* J.f \~ ~A,~,:/ (\~~~:9" - '.' ~~':>~. ~-:-~~~:: MEN \ \,\\~,,'\\ ~"'~!!!/~~"LJ!-tl".../ l]~ ~ ~.~ ~. ~eu..&Q~ ----,---,,--,_.... ._.\------'-'-" -.-. .---'--_.._'-----~ !t'l' t()! !l,t;, lI~rrHIUlC -';.1(lO P 7247701 >R l' 1)0.0': M1\1. 1 J i.. v' l :. ,( r, Hl05_144Rev_ 1/91 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) IPRINT iN 'ANENT :K INK A Jumper DATE OF BIRTH (Monlh_ Day Year) SEX 2. Male March 12, 2001 NAME OF DECEDENT (First. M,ddle. LaSt) UNDER 1 YEAR UNDER 1 DAY Days Hours Minutes BIRTHPLACE (Clly and Slate Of Foreign Country) g';':;,ty) 0 1528 Terrace RACE. American Indian, Black. White, ele (SPeclly) 10. White SURVIVING SPOUSE (If wife, give maiden name) WAS DECEDENT EVER IN U_S_ ARMED FORCES? Yes 0 No IWx 12. 17.. Slale Pa Cumberland Did i7e.D Yes, decedenllived in decedent live in 8 township? 11d.O ~~h~e~~I~~~~i~~Of Carlisle MOTHER'S NAME (First. Middle. Maiden Surname) 19. Doris Rynard INFORMANT'S MAILING ADDRESS (Slreet. C"ylTown. Slale. Zip Code) 20b. 1528 Terrace Ave. Carlisle Pa 17013 PLACE OF DISPOSITION. Name 01 Cemelery, Crematory LOCATION. CitylTown. Slate, Zip Code or Other Place Iwp 17b. Counl city/boro 21~estminster Mem Gardens 21d. Carlisle Pa NAME AND ADDRESS OF FACILITV Hoffman-Roth Funeral Home 22<219 N. Hanover St. Carl isle, Pa 17013 LICENSE NUMBER DATE SIGNED (Month. Day. Year) 238. TIME OF DEATH Aprx. DATE PRONOUNCED DEAD (Monlh. Day. Year) 24. 1:00 A. M. 25, March 12, 2001 27. PART I: Em&f the diseases, injuries or complications which caused the death. Do not enter the mode of dying, such as cardiac or respiratory arrest, shock or heart failure List onty one cause on each line Seizure Disorder DUE TO (OR AS A CONSEQUENCE OF)' 23b. 23c. WAS CASE REFERRED TO ME~AL EXAMINERICORONER? vesPJ No 0 2e. : ~pproxjmate PART II: Other significant condihons contributing 10 death, but I Interval between not resulting in the underlying cause given in PART I ! on.el and death DUE TO (OR AS A CONSEQUENCE OF): DUE TO (OR AS A CONSEQUENCE OF)- d WERE AUTOPSV FINDINGS MANNER OF DEATH AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? Natural v.. 0 No 0 Accident ~ Homicide D 0 Pending Investigation 0 0 Could not be determined 0 DATE OF INJURY (Monlh. Day. Year) TIME OF iNJURY M. 300. INJURY AT WORK? Ye. 28.0. 2sb. CERTIFIER (Check only one) .CERTIFYING PHYSICIAN (PhySICian cenltying cause of death when another phYSICian has pronounced death and completed Ilem 23) To the best of my knowledge, death occurred due to the cause(s} and mlnner as stated Suicide 29. 30.. 30b. PLACE OF INJURY. At home, farm, street, factory, office building, etc. (Specify) 30a. o Coroner . PRONOUNCING AND CERTIFYING PHYSICIAN (PhYSician both pronounc,ng death and cerllfYlng 10 cause 01 dealh) To tl'le belt of my knowl~oe, delth occurred at the time, dlle, Ind pllce, Ind due to the cause(s) and mlnner II stated.. . . DATE SIGNED (Month, Day, Year) o 31e. 31d. March 12, 2001 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (Item 27) Type or Print Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 Mechanicsburg, Pa. 17050 DATE FILED (Month. Day. Year) . ~ G-rc" \3 d.OO' 34. "MEDICAL EXAMINER/CORONER On the basis of examination end/or Investigation, In my opinion, death occurred at the time. dete. and place, and due to the causers) and manner as stated.. . . .. .. . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . 31.. REGISTRAR'S SIGNATURE AND N~ . "-. "'..... ... ~ \ ~ t'1 '\.;...u....cJt'\ ~ 19J. \ Id.J \ 0 I ~ 32. RENUNCIATION In Re Estate of k)4V/.L} /9(41\~ ~""'~,,~ deceased. To the Register of Wills of ~c.J~6'",~~../ County, Pennsylvania. The undersigned C A" , IE. .:::rz ,-~ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to ;iJtJ1l,.1 :r: ~ ,.....tt'.1l. WITNESS AV/ hand this / ./ day of A/"~/( 1-9 ,t at:' I , -' Mr~I'$J: ~ -t;)-~---- a L :;J7J~;(.. IAr/1td~P/l. Zb,l~",,"d 40ACb II' y.n .2... /r-u ;;,~""~.,~ CAlft,J(, ,4I/76/.:s (Address) (Signature) (Address) (Signature) (Address) 09 06 01 13:04 FA\ 3307425003 I~LS U~ESS BA;\K I \G I4J003 r- oC CERIlfl(~\]lQ..N~lE-1"i O_TI C~ lJNQE R R CLE-_S.6W Name of Decedent: 2J~?//~_d.l~~J -- ~~,t!&_----~---------------- Date of Death: /1?r1,R~ /./. ~ tX'J../ Will \.0 Admin. 00. ~J_=-D \ ___4-0 ~ To the Register: r certify (hat notice of (beneficial interf'sU !,'5~at~~-Hlmini.':!tration required by Rule 5.6(a) of the Orphans' Court Rules .va::; ser\'t~d on or mailed to the follo\l\/1ng beT)'; ." :M1eS of (he above-captioned estate on _ </-A:/-", i'atTlG. Add res:,> _LJo~,d .L_y;;"..,.,/u____ ,/ -.,i~~__Z/#~At"'<::_!!!:~~ ~ ~~.L,./ (; ~;Cf -LZ~ .<?_______ C:-4.~'--.E .JV~~E~___/L..J.QF:'__~~~~(,~~C'Lc" ~ ,70 /3 ~otice has now been gi yen [0 (-.1 1 persons uHlt.ed thereto under Rule 5.6(ai except Vate __V/:~"'-._________.____ ____ 7'---- / ~(\ 7\.1~~. - ~- ~O / . CI~F7"" Signature ~ame ~a._ L ..h'~..e / ad/./ r~~ Address -L"P/ %,,-"-4r:Y ",,~~ C'"~4-r C /~ /...:b/J '_(-.1 Telephone Of)) J "''''/ ~/~ Y Capacity: _~ Personal RepresentatIve '])Dt;I.I J JV~ __Counsel ror personal representative ? . _i ,.J -. ,,,,,- ./ ,~ ST ATE OF PENNSYLVANIA IN RE: ESTATE OF DAVID A. JUMPER IN THE REGISTER OF WILLS COURT: CUMBERLAND COUNTY ESTATE NO. 212001403 STATEMENT OF CLAIM 1. MBNA America hereby presents for filing against the above estate this statement of claim in the amount of $ 2,509.00. 2. The basis for the claim is MBNA account number 7499 3879 3472 65 which was opened on 12/31/2000. 3. The tax identification number of the claimant is 510331454. 4. The name and address of the claimant is MBNA America, 1000 SAMOSET DRIVE WILMINGTON, DE 19884 5, This claim IS NOT contingent. 6. This claim IS NOT secured. 7. The last payment made on the account was $ N/A on N/A. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. ) / C/. i? , 2001 Claimant State Of Delaware, County of KENT IN WITNESS WHEREOF, I have set my hand and notarial seal this ;(lc, day of JA~~ DAWN M PEUGH NOTARY PUBLIC STATE OF DELAWARE MY COMMISSION EXPIRES ON 12112/02 '~D{4vy:J () 1 (~ 0' , Notary Pub ic I , 2001 My Commission Expires: \ d l~) r> L \ - DAVID A*JUMPER CUSTOMER INFORMATION SYSTEM * 74993879347265 * CURBAL: 2745.63 CYCLE: 12 N CR LIN: 2500.00 STATUS: 5 CHANGED: 05/09/01 ***************************** MARCH STATEMENT ***************************** POST -------REFERENCE------- TRAN --------DESCRIPTION------- BC ---AMOUNT--- 07/26/01 12:37:23 X165-1 **** NO ACTIVITY FOUND **** ***************************** MARCH STATEMENT ***************************** PREV BAL - S2460.03 PAY + SO.OO SALE + SO.OO CASH + SO.OO F/C S48.97 = NEW BAL $2509.00 PF10=PAGE FORWARD PF11=TRANSACTION SUMMARY -..-- - - ------- - -----.- --...-. -- 4-@ 1 MBNAIS PF15=APRIL STMT PF21=FEBRUARY STMT 192.168.16.20 PA1=BEGIN AGAIN 1 PA2=SYSTEM MENU IBWZ ---------- WDA43H5E 2/31 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE OF: DAVID A. JUMPER SOCIAL SECURITY NUMBER 210-44-6419, Deceased NO. 212001403 OUR ACCOUNT NUMBER 4465-6115-0045-7720 Notice of claim by ** PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK file pursuant to Section 3532(b) (2), of the PEF Code. To the Clerk of the Orphan's Court: Enter the claim of PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK in the amount of $199.25, against the above entitled estate. The decedent, who resided at 1528 TERRACE AVE CARLISLE P A 17013 (street address) , died on ~- D-01 . Written notice of said (date) claim was given to DAVID JUMPER PERSONAL REPRESENTATIVE (personal reprcsentatlVe, or hIS counsel) if know to claimant, at 1528 TERRACE AVE CARLISLE P A 17013 (datc) (add"ss) . ~ /~~- , aimant LAURA GRESENS PROBATE MANAGER ITS DULY AUTHORIZED REPRESENTATIVE on JUL 2 3 2001 C/O PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK P. O. BOX 9053 PLEASANTON, CA 94566 (address) Claimant's counsel N/A (address) COURT OF COMMON PLEAS OFCUMBERLAND___COUNTY ORPHANS' COURT DIVISON No. 212001403 of Estate of DAVID A mMPER Deceased. Notice of claim by PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK filed pursuant to Section 3532(b) (2) of the PEF Code. N/A Attorney J.D. No. ( address) (telephone) ,. .' \ **** TCSI 001 CODE IHB ACCT 4465611500457720 CYCLE 14 AGENT 2835 ( 12 MONTH HISTORY ) : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : SCREEN SELECTION ( 1 2 3 4 ) CURRENT (01) 07/18/01 (02) o I 0 I .00 I .00 I 15.00 I 75.00 I o I 0 I .00 I .00 I o I 0 I .00 I .00 I o I 0 I .00 I .00 I o I 0 I .00 I .00 I .00 I .00 I .00 I .00 I .00 I .00 I .00 I .00 I .00 I .00 I 2,400.00 I 2,400.00 I 199.25 I 199.25 I PAYMENT 022301 MIN PYMT PURCHASE 031601 CASH ADV CREDITS 062700 MISC CHG INS FEE LATE CHG OVRL FEE PURC F/C CASH F/C LIMIT BALANCE 06/15/01 (03) o I .00 I 60.00 I o I .00 I o I .00 I o I .00 I o I .00 I .00 I .00 I .00 I .00 I .00 I 2,400.00 I 199.25 I => JUMPER DAVID A 05/17/01 (04) 04/17/01 010 .00 I .00 45.00 I 30.00 010 .00 I .00 010 .00 I .00 2 I 0 37.40 I .00 o I 0 .00 I .00 .00 I .00 .00 I 29.00 .00 I .00 .00 I 3.92 .00 I .00 2,400.00 I 2,400.00 199.25 I 236.65 ................................................................... .... ........ .............................. ......... ..... ........... ........................ .. ............. (J/- ?/C\3 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE OF: DAVID A. JUMPER SOCIAL SECURITY NUMBER 210-44-6419, Deceased NO. 212001403 OUR ACCOUNT NUMBER 4031-1745-0079-8572 Notice of claim by ** PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK file pursuant to Section 3532(b) (2), of the PEF Code. To the Clerk of the Orphan's Court: Enter the claim of PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK in the amount of $681.74, against the above entitled estate. The decedent, who resided at 1528 TERRACE AVE CARLISLE P A 17013 (street address) , died on ~-12-01 . Written notice of said (date) claim was given to DAVID JUMPER PERSONAL REPRESENTATIVE (personal representatIve, or hIS counsel) if know to claimant, at 1528 TERRACE AVE CARLISLE PA 17013 (date) , Claimant on JUL 2 3 2001 L URA GRESENS PROBATE MANAGER ITS DULY AUTHORIZED REPRESENTATIVE C/O PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK P. O. BOX 9053 PLEASANTON, CA 94566 (address) Claimant's counsel N/A (address) COURT OF COMMON PLEAS OFCUMBERLAND___COUNTY ORPHANS' COURT DIVISON ~0.212001403 of Estate of DAVID A mMPER Deceased. ~otice of claim by PROVIDIA~ ~A TIO~AL BANK FKA FIRST DEPOSIT ~A TIO~AL BA~K filed pursuant to Section 3532(b) (2) of the PEF Code. N/A Attorney J.D. No. l address) (telephone) TCSI 001 CODE IHB ACCT 4031174500798572 CYCLE 25 AGENT 0961 ( 12 MONTH HI STORY ) : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : SCREEN SELECTION ( 1 2 3 4 ) => JUMPER DAVID A CURRENT (01) 06/25/01 (02) OS/25/01 (03) 04/26/01 (04) 03/27/01 010 000 .00 I .00 .00 .00 .00 20.00 103.00 83.00 63.00 41.00 o 0 0 0 0 .00 .00 .00 .00 .00 o 0 0 0 0 .00 .00 .00 .00 .00 o 0 2 0 0 .00 .00 83.80 .00 .00 o 0 0 0 0 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 29.00 29.00 .00 .00 .00 .00 .00 39.84 .00 .00 13.24 12.56 .00 .00 .00 .00 .00 1,200.00 1,200.00 1,200.00 1,200.00 1,200.00 681.74 681.74 681.74 765.54 723.30 ). PAYMENT 022601 MIN PYMT PURCHASE 110600 CASH ADV CREDITS MISC CHG INS FEE LATE CHG OVRL FEE PURC F/C CASH F/C LIMIT BALANCE **** ......... ............. ............. ............. ........................... ......... ............. ............. ............. ........................... / IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF DAVID A JUMPER , Deceased No. 21-01-403 of 2001 To the Clerk of the Orphans' Court: Er'!ter thp ~Iaim ()f C.A'pITAL ONE AceL 412174164729.1.1 02 In the amount of $187.21 , against the above entitled estate. The decedent, who resided at 1528 TERRACE AVE, ,CARLISLE PA 17013 died on 03/12/2001 . Written notice of said claim was given to DORIS J JUMPER ,if known to claimant, at (Personal Representative or counsel) 1528 PARIS AVE, CARLISLE, PA 17013 on July 8, 2001 (Date) Address: 5330 East Main Street, Suite 200 Columbus, Ohio 43213 Claimant's Counsel Address () r )> ~\ -0 b $ :r. )> m -\ 0 0 ~ ~ -< z ;0 6 m m ci> ~ 0 (j) z ~ --- f!? m ~ ~ Q) --- (J1 0 :r. "'0 (Xl " ~ -g. -.l c..v P:' -.l c..v 0 0" ...- 0 () ~ (f) Q) -.l m () rr ~ ~ CD ~ $ 0 6 0 ";-':' ~ =i r" )> C Z c..v Z )> )> c.... ~ -.l r 0 c..v (f) 0 i c Z -\ <.0 :-' z $ 9 -0 )> (f) m m -0 -\ ;0 N -0 m ~ r 0 I 0 0 N m ~ 0 I )> 0 () ~ OJ m 0 r () )> c..v m 0 (f) r m c 0 $ OJ c ~ 0 :r. ~ c..v N ~ c..v ,... ~ '" COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE OF: DAVID A. JUMPER SOCIAL SECURITY NUMBER 210-44-6419, Deceased NO. 212001403 OUR ACCOUNT NUMBER 5542-8509-0085-7600 Notice of claim by ** PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK file pursuant to Section 3532(b) (2), of the PEF Code. To the Clerk of the Orphan's Court: Enter the claim of PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK in the amount of $455.85, against the above entitled estate. The decedent, who resided at 1528 TERRACE AVE CARLISLE PA 17013 (street address) , died on ~-1 /.-01 . Written notice of said (date) claim was given to DAVID JUMPER PERSONAL REPRESENTATIVE (personal representatIve, or hIS counsel) if know to claimant, at 1528 TERRACE AVE CARLISLE PA 17013 on JUl 2 3 2001 (address) (date) C/O PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK P. O. BOX 9053 PLEASANTON, CA 94566 (address) Claimant's counsel N/A (address) COURT OF COMMON PLEAS OFCUMBERLAND___COUNTY ORPHANS' COURT DIVISON No. 212001403 of Estate of DAVID A JUMPER Deceased. Notice of claim by PROVIDIAN NATIONAL BANK FKA FIRST DEPOSIT NATIONAL BANK filed pursuant to Section 3532(b) (2) of the PEF Code. N/A Attorney I.D. No. ( address) (telephone) TCSI 001 CODE IHB ACCT 5542850900857600 CYCLE 26 AGENT 0741 ( 12 MONTH HI STORY ) : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : SCREEN SELECTION ( 1 2 3 4 ) => JUMPER DAVID A CURRENT (01) 06/26/01 (02) OS/25/01 (03) 04/26/01 (04) 03/28/01 001 0 0 0 .00 .00 I .00 .00 .00 15.00 75.00 I 60.00 45.00 30.00 o 0 I 0 0 2 .00 .00 I .00 .00 59.92 o 0 I 0 0 0 .00 .00 I .00 .00 .00 o 0 I 2 0 0 .00 .00 I 76.18 .00 .00 001 0 0 0 .00 .00 I .00 .00 .00 .00 .00 I .00 .00 .00 .00 .00 I .00 29.00 29.00 .00 .00 I .00 .00 .00 26.25 .00 I .00 9.49 8.69 .00 .00 I .00 .00 .00 1,000.00 1,000.00 I 1,000.00 1,000.00 1,000.00 455.85 455.85 I 455.85 532.03 493.54 ~ ~ PAYMENT 022301 MIN PYMT PURCHASE 030501 CASH ADV CREDITS MISC CHG INS FEE LATE CHG OVRL FEE PURC F/C CASH F/C LIMIT BALANCE **** ::::::::::::: :::::::::::::::::::::::::::::::::::::: ::::: ::::::::::: :::: ::::::: t\) () -::r:: \ () \ ~~ ~ ~~ ~ ~ ~o OU i~ ~~ o~ ~~ ~ U 8~ -..... \'1j ~ r:. % ~ 5 u rJ1 ~ ~ % ~~ ~~ ~ g~ ~ ; ~ e ~ ~ ~ ~ t"l o 0 z ~ ~ ~ ~ rJ1 P rJi ~ ~ ~ ~ ~ ~ ~ .S ~ ~! ~ ~ s 0 -d '\ ~ ~j UO o~- ~ae~ ~~t"l~ rJ1 Po ~ 5-d~ ~e ';; .s o ~ o <o.l .~ o Z ~ U '"!f ~~ ~ ~rJi ~ ~~~~ ~~\I) ~ ~~~$. .a6 ~ i rJ1.u~~ ~~oe <o.l ~ ~ ~ ~ to- .~ ~:..t ~ ~~ ~ ~ t"l t"l c:;i r$) I '"!f '"!f '"!f G' ...-I ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION * * * File No. 21-2001-403 Estate of David Jumper , Deceased * * * NOTICE OF CLAIM by KATHLEEN M. SPINELLA. AGENT FOR HOUSEHOLD RETAIL SERVICES. USA Filed Pursuant to Section 3532 (b) (2) of the Probate, Estate, and Fiduciary Code, 20 Pa. C. S. A ~ 3 5 3 2 (b) (2) To the Clerk of the Orphans' Court Division: Enter the claim of KATHLEEN M. SPINELLA. AGENT FOR HOUSEHOLD RETAIL SERVICES. USA ( Claimant) in the amount of $241.14 against the above entitled estate. The Decedent, who resided at 1528 Terrace Avenue (Street Address) , Cumberland County, Carlisle, PA 17013 (City) Pennsylvania, died on March 12. 2001 Written notice of said claim was given to Doris J. Jumper (Personal Representattve, or . If known to claimant, at 1528 Terrace Avenue his Counsel) Carlisle, P A 17013 ( Address) .on September 26. 2001 (Date) ) ~l/~J/ KATHLEEN M. SPINELLA, AGENT Post Office Box 24566, Baltimore, Maryland 21214 ( Address) , Claimant Claimant's Counsel: ( Address) STATE OF PENNSYLVANIA IN THE MATTER OF ESTATE OF: DAVID JUMPER IN THE ORPHANS' COURT OF CUMBERLAND COUNTY ESTATE#: 21-2001-403 STATEMENT OF CLAIM 1. The creditor, Household Retail Services, USA, certifies that there is due and owing by DAVID JUMPER, deceased, the sum of TWO HUNDRED FORTY ONE DOLLARS AND FOURTEEN CENTS ($ 241.14). 2. The nature of the claim is a Q V C account 0000061390226837. 3. The name and address of the claimant is: Household Retail Services, USA, Post Office Box 15522, Wilmington, Delaware 19850-5522. 4. The name and address of the claimant's agent is: Kathleen M. Spinella, Estate Recoveries, Inc., P. O. Box 24566, Baltimore, Maryland 21214. 5. This claim is not contingent and is not secured by any liens or judgments. The last payment on the account was made on 3/4/01 in the amount of $25 .00 . 6. This claim is not based on anyone instrument. Said balance has accrued since the account was established. On behalf of Household Retail Services, USA, creditor, I do solemnly declare and affirm under the penalties of perjury that the information in the foregoing claim is true and correct to the best of my knowledge, information and belief. ( , THLEEN M. SPINELLA ~ Estate Recoveries, Inc. P.O. Box 24566 Baltimore, Maryland 21214 (410) 444-8022 County of Baltimore, Maryland: IN WITNESS WHEREOF, I hereunto set my hand and Notarial Seal this September My Commission Expires: August 8, 2004. ""...."" ~,'\"('..t.R VAN "'" ..,,~~~'......o..o. 8/~', ..... .~..... o. Vn' J ~ y:; .0' '0. u: -:. ~ 'S.... ~OTA~ ....~ ~ : i 'TJ-~::P: : OJ : : -==" : :y~ ,() :: ~~\ UBL\C ....~ E , ....-::; o. .__~ .,. -:. ~ ". ..- ~..... ""'~~ i' C(iU~~, ~".... '",.....",' ;{SD ( e: 1 Document Name: untitled .... ~ BLOCK CODE 1 BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC INS STAT GUl\RANTOR ST CP # SPCL CLASS EMPLOYEE CODE CREDIT CLASS RECENCY FLAG DAYS IN CYCLE NBR OF PLANS PF1=ARMU G HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY Date: 09/13/2001 Time: 2:40:21 PM ORGANIZATION 649 LOGO 604 ACCOUNT *-------- INFORMATION BELOW REFLECTS THE ACCOUNT BILLING CYCLE 06 DATE THIS STMT 02072001 STATE OF RESID PA DATE LAST STMT 01062001 . INTERNAL STATUS A CYC/DATE DUE 01 03052001 GRACE EXPIRE 03052001 CREDIT LIMIT .00 OPEN TO BUY **********.00 CASH LIMIT .00 CASH AVAIL .00 Y-T-D INTEREST .00 Y-T-D LATE CHG .00 Y-T-D OVLM CHG .00 LAST YTD INTR .00 INT THIS STMT 3.30 F/S BEG BAL Fls EARNED o F/S ADJ 32 F/S DISB 1 F/S END BAL PF2=ARTD PF3=ARIQ o o o o PF4=ARIH 09/13/2001 11:39:38 0000000061390226837 AT STATEMENT TIME ---------* SHORT NAME JUMPER, DAVID CUST NBR ALT CUST REL NBR STORE ORG 649 OVRLIMT INCLUDED CURR PMT DUE TOTAL PAST DUE TOTAL PMT DUE FIXED PMT AMT INTEREST FREE BEG BAL DEBITS CREDITS END BAL PF5=ARQB 1 1 ID 002664921 21.00 .00 21.00 .00 .00 154.26 95.83 40.00 210.09 PF6=ARQE ge: 1 Document Name: untitled ------ ----- --- -~._----~~.~- RSD ( HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 09/13/2001 11:39:46 ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 CR AMOUNT TXN PLAN *-------- DES C RIP T ION -------* 52.55 D162 8 2708196727 o 0 DEPT= REF= 000000000000000000000 AUTH= STORE=002664921 SKU=OOOOOOOOO GLS=O SALESCLERK= P/O= R/REF=OOOOOOOOOOOOOO ITM=OOOOO MERCH=OOOOOOOOO CAT=OOOO CARD#/SEQ#= 0000 40.00 C510 8 PAYMENT - THANK YOU o 0 DEPT= REF= 000000000000000000000 AUTH= STORE=002664921 SKU=OOOOOOOOO GLS=O SALESCLERK= P/O= R/REF=OOOOOOOOOOOOOO ITM=OOOOO MERCH=OOOOOOOOO CAT=OOOO CARD#/SEQ#= 0000 39.98 D162 8 2706286294 o 0 DEPT= REF= 000000000000000000000 AUTH= STORE=002664921 SKU=OOOOOOOOO GLS=O SALESCLERK= TKT= P/O= R/REF=OOOOOOOOOOOOOO ITM=OOOOO ORG=OOO MERCH=OOOOOOOOO CAT=OOOO CARD#/SEQ#= 0000 *** END OF TRANSACTIONS *** PF1=ARMU PF2=ARTD RQ EFF POST DATE DATE 0128 0201 PTS= TKT= ORG=OOO 0129 0129 PTS= TKT= ORG=OOO 1011 0125 PTS= PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 09/13/2001 Time: 2:40:28 PM , ~ }R'SD ( Pagf;~-=_~ Document Name: untitled BLOCK CODE 1 BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC INS STAT GUARANTOR ST CP # SPCL CLASS EMPLOYEE CODE CREDIT CLASS RECENCY FLAG DAYS IN CYCLE NBR OF PLANS PF1=ARMU HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY o o o o PF4=ARIH 09/13/2001 11:39:57 0000000061390226837 AT STATEMENT TIME ---------* SHORT NAME JUMPER, DAVID CUST NBR ALT CUST REL NBR STORE ORG 649 OVRLIMT INCLUDED CURR PMT DUE TOTAL PAST DUE TOTAL PMT DUE FIXED PMT AMT INTEREST FREE BEG BAL DEBITS 1 CREDITS 1 END BAL PF5=ARQB ID 002664921 24.11 .00 24.11 .00 .00 210.09 56.05 25.00 241.14 PF6=ARQE ORGANIZATION 649 LOGO 604 ACCOUNT *-------- INFORMATION BELOW REFLECTS THE ACCOUNT BILLING CYCLE 06 DATE THIS STMT 03072001 STATE OF RESID PA DATE LAST STMT 02072001 INTERNAL STATUS A CYC/DATE DUE 01 04022001 GRACE EXPIRE 04022001 CREDIT LIMIT .00 OPEN TO BUY **********.00 CASH LIMIT .00 CASH AVAIL .00 Y-T-D INTEREST .00 Y-T-D LATE CHG .00 Y-T-D OVLM CHG .00 LAST YTD INTR .00 INT THIS STMT 3.50 F/S BEG BAL F/S EARNED o F/S ADJ 28 F/S DISB 1 F/S END BAL PF2=ARTD PF3=ARIQ Date: 09/13/2001 Time: 2:40:40 PM Page: 1 Document Name: untitled ARSD HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 09/13/2001 11:40:06 ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 RQ EFF POST CR DATE DATE AMOUNT TXN PLAN *-------- DES C RIP T I o N -------* 0304 0305 25.00 C510 8 PAYMENT - THANK YOU PTS= 0 0 DEPT= REF= 000000000000000000000 AUTH= STORE=002664921 SKU=OOOOOOOOO GLS=O SALESCLERK= TKT= P/O= R/REF=OOOOOOOOOOOOOO ITM=OOOOO ORG=OOO MERCH=OOOOOOOOO CAT=OOOO CARD#/SEQ#= 0000 0305 0305 52.55 D162 8 2708196727 PTS= 0 0 DEPT= REF= 000000000000000000000 AUTH= STORE=002664921 SKU=OOOOOOOOO GLS=O SALESCLERK= TKT= P/O= R/REF=OOOOOOOOOOOOOO ITM=OOOOO ORG=OOO MERCH=OOOOOOOOO CAT=OOOO CARD#/SEQ#= 0000 *** END OF TRANSACTIONS *** PF1=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 09/13/2001 Time: 2:40:50 PM ARSD ( Page: 1 Document Name: untitled BLOCK CODE 1 BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC INS STAT GUARANTOR ST CP # SPCL CLASS EMPLOYEE CODE CREDIT CLASS RECENCY FLAG DAYS IN CYCLE NBR OF PLANS PF1",ARMU HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY o o o o PF4=ARIH BEG BAL DEBITS CREDITS END BAL PF5=ARQB 1 o 09/13/2001 11:40:15 ID 002664921 24.51 24.11 48.62 .00 .00 241.14 3.98 .00 245.12 PF6=ARQE Date: 09/13/2001 Time: 2:40:58 PM ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 *-------- INFORMATION BELOW REFLECTS THE ACCOUNT AT STATEMENT TIME ---------* BILLING CYCLE 06 DATE THIS STMT 04072001 SHORT NAME JUMPER, DAVID STATE OF RESID PA DATE LAST STMT 03072001 CUST NBR INTERNAL STATUS A CYCIDATE DUE 02 05032001 ALT CUST GRACE EXPIRE 05032001 REL NBR CREDIT LIMIT .00 STORE ORG 649 OPEN TO BUY **********.00 OVRLIMT INCLUDED CASH LIMIT . 00 CURR PMT DUE CASH AVAIL .00 TOTAL PAST DUE Y-T-D INTEREST .00 TOTAL PMT DUE Y-T-D LATE CHG .00 FIXED PMT AMT Y-T-D OVLM CHG .00 LAST YTD INTR .00 INTEREST FREE INT THIS STMT 3.98 Fls BEG BAL FIS EARNED o Fls ADJ 31 Fls DISB 1 FIS END BAL PF2=ARTD PF3=ARIQ Page: 1 Document Name: untitled ARSD ( HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 09/13/2001 11:40:24 ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 RQ EFF POST DATE DATE CR AMOUNT TXN PLAN *-------- DES C RIP T ION -------* *** END OF TRANSACTIONS *** PF1=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 09/13/2001 Time: 2:41:06 PM ARSD ( Page: 1 Document Name: untitled BLOCK CODE 1 BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC INS STAT GUARANTOR ST CP # SPCL CLASS EMPLOYEE CODE CREDIT CLASS RECENCY FLAG DAYS IN CYCLE NBR OF PLANS PF1=ARMU HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY o o o o PF4=ARIH 09/13/2001 11:40:35 0000000061390226837 AT STATEMENT TIME ---------* SHORT NAME JUMPER, DAVID CUST NBR ALT CUST REL NBR STORE ORG 649 OVRLIMT INCLUDED CURR PMT DUE TOTAL PAST DUE TOTAL PMT DUE FIXED PMT AMT INTEREST FREE BEG BAL DEBITS CREDITS END BAL PF5=ARQB 1 o ID 002664921 26.91 48.62 75.53 .00 .00 225.12 44.04 .00 269.16 PF6=ARQE ORGANIZATION 649 LOGO 604 ACCOUNT *-------- INFORMATION BELOW REFLECTS THE ACCOUNT BILLING CYCLE 06 DATE THIS STMT 05072001 STATE OF RESID PA DATE LAST STMT 04072001 INTERNAL STATUS A CYC/DATE DUE 03 06022001 GRACE EXPIRE 06022001 CREDIT LIMIT .00 OPEN TO BUY **********.00 CASH LIMIT .00 CASH AVAIL .00 Y-T-D INTEREST .00 Y-T-D LATE CHG .00 Y-T-D OVLM CHG .00 LAST YTD INTR .00 INT THIS STMT 4.04 F/S BEG BAL F/S EARNED o F/S ADJ 30 F/S DISB 1 F/S END BAL PF2=ARTD PF3=ARIQ Date: 09/13/2001 Time: 2:41:20 PM Page: 1 Document Name: untitled ARSD HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 09/13/2001 11:40:43 ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 RQ EFF POST CR DATE DATE AMOUNT TXN PLAN *-------- DES C R I P T I o N -------* 0507 0507 20.00 D102 8 LATE FEE DEBIT ADJUSTMENT PTS= 0 0 DEPT= REF= 000000000000000000000 AUTH== STORE=002664921 SKU=OOOOOOOOO GLS=O SALESCLERK= TKT= P/O= R/REF=OOOOOOOOOOOOOO ITM=OOOOO ORG=OOO MERCH=OOOOOOOOO CAT=OOOO CARD#/SEQ#= 0000 *** END OF TRANSACTIONS *** PF1=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 09/13/2001 Time: 2:41:26 PM ARSD ( Page: 1 Document Name: untitled BLOCK CODE 1 BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC INS STAT GUARANTOR ST CP # SPCL CLASS EMPLOYEE CODE CREDIT CLASS RECENCY FLAG DAYS IN CYCLE NBR OF PLANS PF1=ARMU HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY ORGANIZATION 649 LOGO 604 ACCOUNT *-------- INFORMATION BELOW REFLECTS THE ACCOUNT BILLING CYCLE 06 DATE THIS STMT 06072001 STATE OF RESID PA DATE LAST STMT 05072001 INTERNAL STATUS A CYC/DATE DUE 04 07032001 GRACE EXPIRE 07032001 CREDIT LIMIT .00 OPEN TO BUY **********.00 CASH LIMIT . 00 CASH AVAIL .00 Y-T-D INTEREST .00 Y-T-D LATE CHG .00 Y-T-D OVLM CHG .00 LAST YTD INTR .00 INT THIS STMT .00 F/S BEG BAL F/S EARNED o F/S ADJ 31 F/S DISB 1 F/S END BAL PF2=ARTD PF3=ARIQ Date: 09/13/2001 Time: 2:41:34 PM o o o o PF4=ARIH 09/13/2001 11:40:51 0000000061390226837 AT STATEMENT TIME ---------* SHORT NAME JUMPER, DAVID CUST NBR ALT CUST REL NBR STORE ORG 649 OVRLIMT INCLUDED CURR PMT DUE TOTAL PAST DUE TOTAL PMT DUE FIXED PMT AMT INTEREST FREE BEG BAL DEBITS CREDITS END BAL PF5=ARQB o o ID 002664921 26.91 75.53 102.44 .00 .00 269.16 .00 .00 269.16 PF6=ARQE Page: 1 Document Name: untitled _.__._-~-------~- ARSD ( HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 09/13/2001 11:40:58 ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 RQ EFF POST DATE DATE CR AMOUNT TXN PLAN *-------- DES C RIP T ION -------* *** END OF TRANSACTIONS *** PF1=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 09/13/2001 Time: 2:41:40 PM ARSD ( Page: 1 Document Name: untitled BLOCK CODE 1 BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC INS STAT GUARANTOR ST CP # SPCL CLASS EMPLOYEE CODE CREDIT CLASS RECENCY FLAG DAYS IN CYCLE NBR OF PLANS PF1=ARMU HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY o o o o PF4=ARIH 09/13/2001 11:41:06 0000000061390226837 AT STATEMENT TIME ---------* SHORT NAME JUMPER, DAVID CUST NBR ALT CUST REL NBR STORE ORG 649 OVRLIMT INCLUDED CURR PMT DUE TOTAL PAST DUE TOTAL PMT DUE FIXED PMT AMT INTEREST FREE BEG BAL DEBITS CREDITS END BAL PF5=ARQB o o ID 002664921 26.91 102.44 129.35 .00 .00 269.16 .00 .00 269.16 PF6=ARQE ORGANIZATION 649 LOGO 604 ACCOUNT *-------- INFORMATION BELOW REFLECTS THE ACCOUNT BILLING CYCLE 06 DATE THIS STMT 07072001 STATE OF RESID PA DATE LAST STMT 06072001 INTERNAL STATUS A CYC/DATE DUE 05 08022001 GRACE EXPIRE 08022001 CREDIT LIMIT .00 OPEN TO BUY **********.00 CASH LIMIT .00 CASH AVAIL .00 Y-T-D INTEREST .00 Y-T-D LATE CHG .00 Y-T-D OVLM CHG .00 LAST YTD INTR .00 INT THIS STMT .00 F/S BEG BAL Fls EARNED o F/s ADJ 30 F/S DISB 1 Fls END BAL PF2=ARTD PF3=ARIQ Date: 09/13/2001 Time: 2:41:48 PM Page: 1 Document Name: untitled ARSD HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 09/13/2001 11:41:14 ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 RQ EFF POST DATE DATE CR AMOUNT TXN PLAN *-------- DES C RIP T ION -------* *** END OF TRANSACTIONS *** PF1=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 09/13/2001 Time: 2:41:58 PM ARSD ( Page: 1 Document Name: untitled BLOCK CODE 1 BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC INS STAT GUARANTOR ST CP # SPCL CLASS EMPLOYEE CODE CREDIT CLASS RECENCY FLAG DAYS IN CYCLE NBR OF PLANS PF1=ARMU HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY o o o o PF4=ARIH 09/13/2001 11:41:25 0000000061390226837 AT STATEMENT TIME ---------* SHORT NAME JUMPER, DAVID CUST NBR 0000000061390226837 ALT CUST REL NBR STORE ORG 649 ID 002664921 OVRLIMT INCLUDED N CURR PMT DUE TOTAL PAST DUE TOTAL PMT DUE FIXED PMT AMT INTEREST FREE BEG BAL DEBITS CREDITS END BAL PF5=ARQB o o ORGANIZATION 649 LOGO 604 ACCOUNT *-------- INFORMATION BELOW REFLECTS THE ACCOUNT BILLING CYCLE 06 DATE THIS STMT 08062001 STATE OF RESID PA DATE LAST STMT 07062001 INTERNAL STATUS A CYC/DATE DUE 06 09012001 GRACE EXPIRE 09062001 A CREDIT LIMIT .00 K OPEN TO BUY **********.00 o CASH LIMIT .00 CASH AVAIL .00 02 Y-T-D INTEREST .00 Y-T-D LATE CHG .00 Y-T-D OVLM CHG .00 08 LAST YTD INTR 11.95 INT THIS STMT .00 F/S BEG EAL N3 Fls EARNED 1 Fls ADJ 31 Fls DISB 1 F/S END BAL PF2=ARTD PF3=ARIQ Date: 09/13/2001 Time: 2:42:08 PM 27.00 128.91 155.91 .00 269.16 269.16 .00 .00 269.16 PF6=ARQE Page: 1 Document Name: untitled ARSD ( HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 09/13/2001 11:41:33 ORGANIZATION 649 LOGO 604 ACCOUNT 0000000061390226837 RQ EFF POST DATE DATE CR AMOUNT TXN PLAN *-------- DES C RIP T ION -------* *** END OF TRANSACTIONS *** PF1=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 09/13/2001 Time: 2:42:16 PM : /6 - 02c:20~ 9 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 GREG JUMPER 125 ALBURN DR YOUNGSTOWN DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-05-2001 JUMPER 03-12-2001 21 01-0403 CUMBERLAND 101 REV-1547 EX AFP (12-00) DAVID A Amount Remitted OH 44512 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 ~ REV :is4j-Ex-AFP--ci"2=ocff-NoYicE-oF-INHEifiTANci-"-Ax-'A-PPR'A-isEMENY-;-ALi-ciwAN-CE-OR------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF JUMPER DAVID A FILE NO. 21 01-0403 ACN 101 DATE 11-05-2001 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) 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 (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 1,416.88 .00 .00 (8) 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 (9) (10) 8~035.50 8.079.15 ll1) (12) (13) (14) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1,416.88 16.114 6E; 14,697.77- .00 14,697.77- 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. NOTE: If an assessment was issued previously, lines reflect 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. .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = ll9)= .00 .00 .00 .00 .00 . PAYMENT RECEIPT DISCOUNT (+) 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" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) c STATUS REPORT UNDER RULE 6.12 Name of Decedent: ];)~Vlj) /}L/I/V .J"b~p~~ . Date of Death: /7)~~C~/ 1,1. -<COt Will No. Admin. No. 2/-&:>/- ~e>:7 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 wi th 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 ~ 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. Date: 9 --,2/- &:J/ Lv 'w . j- , " (~"L- \.. ,I <' ~'''J:....... Signa ture./. J ~, J)OR/f T JV~ f/C"~ Name (Please type or print) /">.1.8 n-A~/lC~ /lv~ Add re sse tl'912L/.f t t!', jJ~ I~I:'/.:l (~) 7/7-~Y.::l- tP/~ Y' Te 1. No. Capacity: X Personal Representative Counsel for personal representative (MAH: rmf / AM3 ) i'lE\l"500EX'~) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 w '"' ~~(I) u"'>: w..u ",00 u"'~ ..Ill .. '" /6-,;2~ 7' REV-15,OO INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER A/-O/ COUNTY CODE YEAR' PlOY.:>"? NUMBER SOCIAL SECURITY NUMBER .;z /0 - yy I- Z W C W U W C DECEOENT'S NAME (LAST, FIRST. AND MIDOLE INITIAL) NflJ r; A ])-9 ~.4 A. DATE OF OEATH (MM-OO-YEAR) DATE OF BIRTH (MM-DD-YEAR) 0.7- /~-~U>>/ OY-.27-/'?S'.I' (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, ANO MIDDLE INITIAL) N/A '"' z w o z o .. Ul W '" '" o u NAME t31l1F't!: :JUJ#f '/!~ FIRM NAME (If AP!lI~e) TELEPHONE NUMBER 130. 783. cx:.o/ I.:8r 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Allal;hCOllyofWi~) o 9. Litigation Proceeds Received " f.//? THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 2. Supplemental Return o 4a. Future Interest Compromise (date ofdealtl aftef 12-12-82) o 7. Decedent Maintained a Living Trust (Altad1oopyotTrosl) o 10. Spousal Poverty Credit (date ofdealh I:leIween 12-31-91 and 1-1-95) o 3. Remainder Return {date ot death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch OJ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) COMPLETE MAILING ADDRESS /~ /I~ Jlutt"" ~liltP€ .Ye>u~rnu,,~. ,M-o 'l't/J" 1-2. OFFICIAL USE ONLY 3_ Closely Ji.eld Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Ba~k Deposits & Miscellaneous Personal Property (Schedule E) z o ~ ~ I- 0:: <( u W 0:: " 6. Jointly Owned Property (Schedule F) o S~~rate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. De~ts O,f _~~:"t. Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Une 8 minus line 11) "IIU"> , (8) /. Y/t',.88 e.r (11) /~//y.- (12). (/</.,U'- ?7J (13) NoNI' (14) ( If. 6-1''- 7,) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax has not been made (SchOdUl~ J) 14. Net Value Subject to Tax (Line 12 minus Line .13t ~~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES NlWt" N_t" N-C:: /V'~(: x.O_ (15) x.O_ (16) x _12 (17) x .15 (18) (19) -61 z o ~ I-' :::l c.. :i: o U ~ 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a){1.2) 16. Amount of line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 Decedent's Complete Address: STREET ADDRESS /''-' ~.... oJ .... "" 1I!.t'#~~ RP'E 'CITY CH~L/./ Tax Payments and Credits: 1, Tax Due (Page 1 Line 19), " (1) 2, Credits/Payments A, Spousal Poverty Credit B. Prior Payments C. Discount ZIP / /0/1 e- Total Credits (A + 8 + C) (2) '.' 3, InteresUPenally if applicable O. Interest E. Penally TotallnleresUPenally ( 0 + E ) (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) -& .e-- -er 5, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) ...t:)... A. Enter the interest on the tax due. (SA). -e- 8, Enter the total ~(Line 5 + SA. nii~ is the BALANCE DUE. ' '," (58) Make 'Check Payable to: REGISTER OF WILLS, AGENT ~ PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes """""""""""""",0 mu""""O o o mu 0 uO 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 paytn6nts, bene~ts or, care? ................... 2, If death occurred after December 12, 1982, did de~edent transfer property within one year of death without receiving adequate consideration? ..........,~.:;................................. .h................. .................. 3, Did decedent own an "in trust for" or payable upon death bank account or secunly at his or her death? ,",", 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .....................:..........:..... .................................................................................... 0 No [g ~ ~ ~ ~ ~ ~ IF THE ANSWER TO ANY OF JHE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties af pe~ury, I declare that I have examined this rebJm, including accompanying schedules and statements, and to the best af my knowledge and belief, it is true. correct and complete. Declaration of preparer other than the personal representaUve is baSed on all information of which preparer has any knowledge. . .'~ ADDRESS /.r.Jd'7'2"'~drl~~. ~ C',#~C//e:, ,,:?,-? SIGNATURE OF REP !,R.l}IAN REPRESENTATIVE ..... /;h/.2 .... -.. ADDRESS /-<.5" #a1~"/V' ;rJ#W'. Yi>VN,Y./;r,u.v ,#c.>9".s-"..I/"~ DATE 9A.-~1' DATE 9~.b/ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P,S, ~9116 (a)(1.1) (i)l, '. . For dates of death on or affer January 1,1995, the tax rate imposed on the net value of transf~rs to or for the use of the surviving spouse is 0% [72 P,S, ~9116 (a) (1.1) (ii)], The statute does not exemot a transfer to a sUlViving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even jf the sUlViving 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' 01" younger at death 10 or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S, ~9116(a)(1,21l, The tax rate imposed on the net value of transfers to or lor the use of the decedent's lineal beneficianes is 4,5%, except as noted in 72 P,S, ~9116(1.2) [72 P,S, ~9116(a)(11l, The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P,S, ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in oommon with the decedent, whether by blood or adoption. """,,,,,,",,,,"W COMMONWEALTH OF PENN$YL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 7>-9.tY,~ ,po FILE NUMBER '?/-.:::>/- ~c>::r Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 2. 3. 19// hl/.s:r g<9~/( rsv fn..z/ ?&'1U#N4(. #",,""t\-?i"..<: /If(~ /I~. " . /V/lt'~/ tt::h'.4/.e. .. foo .- - 80::>.- TOTAL (Also enter on line 5, Recapitulation) $ /Y/t:;...!! (If more space is needed, insert additional sheets of the same size) r..-;-', .,-' "'.--,.. <>;._ ---"00', ;"'-'J~~,;;:;,: -!- .!W REV-1511 EX+ (12-99) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlOENT OECEDEN\ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF P4P"/P ~. $~p~J( . FILE NUMBER ~/-ol- .,oJ ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t.. I{ r9. .f!> 1. ;'/0/"'-,..",# ~i>7N /p~~~ /tb~,,: "'VC ~",4V1((, /~NO /.:JYr)-e.o ~ tv EfT ~u-VfTt'd. a:"~4' q"}L , /"'ic,/ No V-I/- 007}.:;1 /. .> rO. . B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip Relationship of Claimant to Decedent 4. Probate Fees ;.,,"~ 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ flP25".~ Debts of decedent must be reported on Schedule 1. (If more space is needed, insert additional sheets of lhe same size) I.~ ~!~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT >181-15128<-(1':;/1 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ;?J-"1V'/P rJ. JVfl1jJe,e FILE NUMBER tR/ - C>/- Y't::>J' ITEM NUMBER Include unreimbursed medical expenses. .1. ~ "- $. (,. 7. tf. 9- ,0. I/. 1.;1.. 1:1, DESCRIPTION /Y E Jr T CAJ!.R. '1..1... 7t:-h .:-1 j.r ":1.29 L"LJAY '1t'IJ /.ly'/-fYIJ?.r9? /I.rA/ $'-70 6~1.2:J'1t/ /)IA,.cr-""'A<!!'H4.., .$"vrr ':-D~.r S"tleo .2<<>:1... C'A,/I'Tif' D-V~ V I.J./ "7 r 1(,. Y'") J. '7 Sfl" l. r6.....y C'~d ry'z,/, IJbI J'7f7 <=/I?) /Jr pJ'9 V'IIJ /..lzy9-'/? Pr~/ fJI~t:l(ndl-' v'/c-r (,I/r .:-e>V.r 7)l.a 1'1~/~ $Iu.:J/ /}'1fOo]"'FJ7l.. P."',a.-'A/ Sf,/.1. .Fro,? <<>J'.r J(,~ (1 t!,qttR ~~ "13" O..lz<..<fJ 7 .('/l0/197,v..",< '6:1.r ~ '<>1 037,J'1o?, /11 DA/~ ?Y9<! :un .:J'fJ.l(,J AMOUNT 7ft>. ..rl 1(,"'" :1/ In.w .lV'f.'I1( /.t'}. .t./ 9J: /'f ..OJ. (', 'i .103.7:1 7.z3. Jo f( '1.:1. 5'f ;:J.'(/.d 179~ - :1....$"09. - if TOTAL (Also enler on line 10, Recapilulallon) $ 8019 .- (If more space IS needed. insert additional sheets of the same size) """',"~"'D. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF p>#V/P ;9. ::J~""'PE-< FILE NUMBER ;1I-0/~ $1'01 RELATIONSHIP TO OECEDENT AMOUNT OR SHARE 00 Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY r. TAXABLE DISTRIBUTIONS (indude outright spousal distributions) 1. t'/I~ E. .J{;,.,.. p~A. /F ~ n,tJ,hiC(" #v~ c-"IdLdt" f'I<9 /70/:/ fJ/I~I!'^,'" 50l' .l. Po ,e /J :r: Ji.. ,.,.f'lt5-e />.v ~dd4C(" ~ e4-4t:./fc, ,;74 /;bP 7"u"..,r 9>% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRiBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additlanal sheets of the same size}