HomeMy WebLinkAbout01-0865
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~IMU~ a. I-~
also known as
No. Q\-O\- ~~S--
To:
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. d/JO - 4,,2 - ~/.J X .<'"
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl '~<J)
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in
h LO J\ ~ last family or principal residence at
Decendent 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:
J;~.C'"
$
$
$
$
Petitioner_ after a proper search ha.b.L.... ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
N e
17011
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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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.
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No. 21 - 01 - 865
Estate of
DARLENE A RUSH
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW SEPTEMBER 20, x~2001 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that fH)( leD ROTHENBERGER
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
DIXIE 0 ROTHENBERGER
DARLENE A RUSH
9izs~
are hereby granted to
in the estate of
FEES
Letters of Administration
Short Certificates( 1) . . . . . . . . . .
Renunciation ................
JCP
$ 25 . 00
$ 3.00
$
$ S.OO
TOTAL _ $ ~1 no
Filed .. ?~~T.. ..~Q,.. .. .. .. A.D. ~ 2001
ATTORNEY (Sup. Ct. J.D. No.)
ADDRESS
PHONE
Mailed letters to Administrix on 9-20-01.
WARNING: IT IS IllEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
lOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 4 9 4 6 0 2 9
/ !Jiml "..,;..,.,. ',,:-
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'~~--I;"ENT ~, ~ 11'\\/
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8..20...2001
Date of Issue of This Certification
Name of Decedent Darlene
FI~st
__m._..___.L._____
~',1 i ct,~: I (-
R1Hsh
Last
Sex ___~~'!1 a_~___ SocIal Security No.
200-22-6085
_ Date of Death
8..16...2001
Date of Birth Sept. 13, 1921 Birthplace _' Newport~
Place of Death
Residence
Cumberland
F~()cil)ty Name
(;0(./11',
Camp Hill
City 80rougr1 or T owoshlp
Pennsylvania
Race_..__~~J.._~(3__0ccupation Homemaker ______.________ Armed Forces? (Yes or No) No
Decedent's
Mar-ital Status .__Wid~~__ Mailing Address _1~~;; November p(~ive C::~T~wn Hill
lnformant___~ixie_~ot!:!.~!:'.berg~~ _Funeral Director David M. Myers
Name and Address of
Funeral Establishment._..Q~.'!.~(L.fuers Funeral Home__L_]ewp_ort-------PA 17074
PA 17011
SIal"
Part I.
Immediate Cause
I Interval Between
Onset and Death
(a) _______.~~ u ~. e my 0 card i a I in far f!.!..o n.____
(Severe hypertension
b) _________..____.__.__.______._________.____..__~_...
I
..--1.
I
(c) ._._.____......__________._____.__._.._______. .___..____._...._____..._......_ _
Part II:
( d) ________
Other Significant Conditions
L.....-
Manner of Death
Describe how injury occurred:
Natural
Accident
[)(
Homicide
Pending Investigation
Could not be Determined
Suicide
Name and Title of Certfier __________
Judy Ca.rhart
M .0.
(MD., D.O., Coroner, M.E.)
Address_.______.___2~Ol Park Drive, Harrisburg, PA
This. is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. The original certificate will be forwarded to the
State Vital Recor'ds Office for permanent filing.
8..18..2001
a,~
L Ht'1,_,:slr ;-H 'If \/'I;:1! RF'C(H(1s
~n-455
D:stflct No
St., New Bloomfield, PA 17068
--_.__._--_.._.,._._._~._~------,--- ---_.----
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~trc,:-l AC!(YI'c
(,ny, Borough. fov/rlsrllfJ
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
~~AIUl~ 12. /?of-
~/'lo2aJj
Date of Death:
Will No.
Admin. No.
~/-OI- ~(pC;-
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
0-'?e~Z;t,~r
/-'Z~~ C~~ ~.JiJ: a/17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 71f1lJ /~ j ~ I
Signature
Name ,)) ~/~ J ~ I/,/Jf~~)
Address / 1"~r; r!I-rr'1LeU IcL
Vd
11 n "")--,
OUBpequulO
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~~ ?/f/701/
Telephone (,11) 73cJ - 3olk2?
(~: 6 ti 9Z AON [tl-
~apacity: ~ Personal Representative
,~~)ISi6atl
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_Counsel for personal representative
'v /~-p-IY
BUREAU OF ~IVIDOAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-13-2002
RUSH
08-16-2001
21 01-0865
CUMBERLAND
101
'0'2 1';\ f' '( 1 -J f)? 1\ 'I
'11\ I i L- ..;
DIXIE ROTHENBERGER
1466 CLOVER RD
CAMP HI L L ...~. PA 17011
CUL..
*
REY-1547 EX AFP (01-02)
DARLENE
A
Allount Rellitted
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
2,626.45
.00
.00
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y-=is4-j-Eif-AFP--((ff:021--Noy-iCE--oF-YNHEifiTiircE-Y-Ai-jrppijrisEMENT~--ALi-owii'-cE-ifR------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RUSH DARLENE A FILE NO. 21 01-0865 ACN 101 DATE 05-13-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
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)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental 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. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. A.ount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
NOTE:
(9)
(10)
71070.10
NOTE: To insure proper
credit to your account 1
subllit the upper portion
of this forll with your
tax paYllent.
(8)
21626.45
.00
(11)
(12)
(13)
(14)
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
7.070 10
41443.65-
.00
41443.65-
(19)=
.00
.00
.00
.00
.00
.- ft. lI;;n I .n........... . II (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR) 1 YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
. .
REV.1470 EX (&-88)
'* INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME FilE NUMBER
Darlene A Rush 2101-0865
REVIEWED BY ACN
Sandra J Eslinger 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
ROW
Page 1
0/
STATUS REPORT UNDER RULE 6.12
Date of Death:
t /)(~A.t/YLf2, If _ud
V'?f' It;, ~LM /
Name of Decedent:
Will No.
Admin. No. vl/-oj- 00 r6J-
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes /~ No
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 perssnal representative file a final
account with the Court? Yes ~ No ~~~
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
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Name (Please type 0 print)
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Address .
Date: \-i//O)/)2
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Tel. No.
Capacity: ~Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)
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STATUS REPORT UNDER RULE 6.12
Name of Decedent:
~ Q.J(~
t~ /~OOJ
~ ~~ Admin. No.
Date of Death:
Will 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 .
Statj(Whether administration of the estate is complete:
Yes 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 rep~esentative file a final
account with the Court? Yes No ~ .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative st~te an
account informally to the parties in interest? Yes ~. No
.0~~
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.
s~r~~
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Name (Please type rint)
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Address /
(7/7) 7.3;;'3~ Yo
Te 1. No.
Date:
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Capacity:
Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I {l. ~~
D~ OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ ItP, dlOOJ /~ /9~ /
(IF AP ABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, A D MIDDLE INITIAL)
Jill
o 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1500
DFHCt/\,L U;;E ONLY
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FILE NUMBER
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COUNTY CODE
YEAR
NUMBER
SOCIAL SECURITY NUMBER
ot.o~ -;{~
(;,C) "$6-
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 of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate 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. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
03. Remainder Return (date 01 death pnorto 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 0)
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COMPLETE MAILING ADDRESS
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(1)
(2)
(3)
(4)
(5)
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pb=FICI,I\L.Use ONLY
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(7)
(8)
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(9)
(10)
7.1 t/ 3(), It)
(11) 7 c3t, , J!J
(12)- <I- L( C,n# Cc f
(13) - (l-
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
/'"
(14).... '/'1 U ") , &, )
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
20.0
x .0_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19) It). cO
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
';0
ZIP /7CI/
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
""...'.. ..
(1) I~C
~-.,-.l
r '
Total Credits ( A + B + C ) (2) '~J
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B) It ~
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 B'
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 0'
c. retain a reversionary interest; or.......................................................................................................................... 0 IT
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 0'
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 G
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 IT
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of 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 all information of which preparer has any knowledge.
DATE
SIGNATURE 0 PER~ON RE~LE F
ADDRESS
If~&
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
01/
L
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exempt 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 or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
..;
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
"4"-1508 EX. (1.97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
\)\u~.11~ a t"kJ.
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUNivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
" ..., /. </)
.x(/ 0-',?l " '
':p nc ale <1/0.?0 '0-' t1 ("J :;- / '-I j -7
-0\ t,/':.
TOTAL (Also enter on line 5, Recapitulation) $ ci l{-;~ {..
(If more space is needed, insert additional sheets of the same size)
. REV-1511 EX+ (12-99) .
j;~?~
'~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
,)JO~/JU- () I~
FILE NUMBER
v{ I - 6/ -c1(1 F 6.1-
Debts of decedent must be reported on Schedule l.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
jCcu-<-<~ (;. 7Jf~.k V> ~fU"/L.Lf lI07hC
7/ (7J 0 _ / {)
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 \IJ~ .3% dc/(1 h.R-~A-
Street Address / if t {'Inth hk---
City LC:1! l' 11--<- if
Relationship of Claimant to Decedent
stateLZiP /70 {/
/)(;, J j !;:
00.00
4.
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
-:tn h./'-,hl'':Srfe.--
/()I()C
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
Ii; ---
,~
Established in 1895
By Samuel D. Myers
18 August 2001
Dixie Rothenberger
David M. Myers
Jack & Sally
IN ACCOUNT WITH
DAVID M. MYERS FUNERAL HOME
SECOND AND WALNUT SlREETS
NEWPORT, PENNSYL V ANlA 17074
PHONE (717) 567-3138
16 August 2001
Complete funeral expenses for:
Darlene M. Rush
Traditional funeral with Reynoldsville
Poplar Casket with crepe interior
Wilbert Monticello Burial Vault, grave
casket placer, grass and tent
Grave opening- George Stuber
Clergy honorarium
Organist
(7) Death Certificates
Flowers- Newport Greenhouse
Newport Hotel
Mark stone- Rice Memorials
Solid
$ 4,490.00
945.00
350.00
100.00
40.00
14.00
127.20
888.90
75.00
$ 7,030.10
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Account Number
File 10
AMOUNT $
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Client Name
PNC Bank, National Association
Prepared By (PRINT Namel
logon 10
FOR BANK USE ONLY
BranchlDept #
Date
Address
Customer's Advice Of Charge