HomeMy WebLinkAbout01-1140
PETITION FOR PROBATE and GRANT OF LETTERS
EstateofJAnl~ ~ k~(oc~ No. ~\-D\- 1\4-0
also known as .4C- To:
Register oY)Vills for th,e{ I
, Deceased. County o~ in the
Social Security No. QO'!'?-,2Z/.-;2{ (D Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age ~r older an the execute ;.z
in the last will of the above dftedent, dated t JAn. ,;).~ I
and codicil(s) dated "'::1- - 9 - 19 '1 ~
named
, 19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in n I
la~ family or principal refidence at . . ,-
---D\ I; c 1-1. H 1\ \ ( ~) bl) R :1 L ~ (u {:: J.<.
(list street, nU~r and munclpahty)
Decendent, then 69 years of age, died J"~(", P n, Ge ~
at
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:
h
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, W O(C-c-, I ,
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of reall estate in Pennsylvania
situated as follows:
$ R CYJr)
$
$
$ ~,ncx:')
WHEREFORE, petitioner(s) respectful~uest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters I E.STA M IlL tJ I A Ry
(testamentary; administration c.I.a.; administration d. b.n.c.l.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMON~NEAL TH OF PENNSYL VANIA 1- ss
COUNTY OF CUMBERLAND J
Sworn to or affirmed1 7nf
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The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
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No. ~1 - 01 - 1140
Estate of
JANIS A KRULOCK
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW [)Fr.FMBER_.18+--- _,' _ x~L1Q.QJ, in c,;r:~id<.:r,.llior.., ,t' ;i'- ''1:
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JANUARY ?c3. 1980 CODICIL DATED SEPTEMBER 9, 1996
described therein be admitted to probate and filed of record as the last will of
JANIS A KRlJl Or.K
and Letters TESTAMFNTARY
are hereby granted to JOSEPH M KRULOCK
MARY CLEWIS
FEES
Probate, Letters, Etc. .........
Short Certificates( 2) . . . . . . . . . .
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Mailed letters and orders to Executor on 1?-19-01
? 1 - 01 - 1140
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LAST WILL AND TESTAMENT
OF
JANIS A. KRULOCK
I, JANIS A. KRULOCK, of Camp Hill, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and under-
standing; do hereby make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills
and COdicils heretofore made by me.
FIRST
I direct the payment of my debts and expenses of my last
illness and funeral from my estate as soon after my death as
conveniently may be done.
If there be no cemetery lot available
for my interment owned by me at the tirre of my death, I authorize
my personal representative to purchase such cemetery lot with a
contract for perpetual care, using therefore funds from my estate
in such amount as he shall consider necessary and desirable,
and I ~lthorize my personal representative to cause title to or
ownership of such lot so purchased to be vested in such person
as my personal representative shall designate.
Further, I authorize my personal representative to expend
funds from my estate, in such amount as my personal representative
shall consider necessary and desirable, for the purchase, erection
and inscription of a sui table marker for my grave.
SECON D
I (five, devise and bequeath all the rest, residue and re-
mainder of my estate to my beloved husband, JOSEPH M. KRULOCK,
absolutely and in fee simple, if he survives me by thirty (30)
days.
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In the event that my husband, JOSEPH M. KffiJLOCK, fails to
survive me by thirty (30) days, then I give and bequeath all
my jewel ry to my daughter, LINDA KRULOCK TRE!\1AINE and
remainder of my estate I give, devise and bequeath in equal
shares unto my children, LINDA KRULOCK TREMAINE, JOSEPH M.
KRULOCK, JR., and JOHN KRULOCK, per stirpes.
Provided, however, that the share of any child who predeceases
me or dies on or before the thirtieth (30) day fOllowing my death
shall be distributed equally to his or her issue, per stirpes.
FDURTH
In the event my husband, JOSEPH M. KRULOCK, predeceases me,
I appoint my daugh ter, LINDA KRULOCK TPEMAINE, c:uardian of the
persOns and property of my minor children.
FI FTH
I direct that any and all inheritance, estate, and transfer
taxes imposed upon my estate passing under this Will or otherwise
shall be paid out of the principal of my residuary estate.
SIXTH
In addition to the powers conferred by law, I authorize any
personal representative acting under this instrument, in his or
her absolute discretion:
(a) to retain in the form received, or to sell either at
public or private sale any real or personal property;
(b) to manage real estate;
(c) to invest and reinvest in all forms of property without
beinq conf ined to legal investments and wi thou t regard
to the principle of diversification;
(d) to exercise any option or rights arising from ownership
or investment.
-2-
,
SEVENTH
I do hereby nominate, constitute and appoint my husband,
JOSEPH M. KRULOCK, to act as Executor of this my Last Will and
Testament. Provided, however, that if he is unwilling or unable
to act as Executor, I direct that the duties of Executrix be
performE~d by my daughter, LINDA KRULOCK TREMAINE.
I direct that no personal representative appointed under
this instrument shall be required to give bond for the faithful
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, JANIS A. KRULOCK, have hereunto
set my hand and seal to this my Last Will and Testament, con-
sisting of three typewritten pages, the first two of which bear
my signa ture in the margin for iden tif ica tion, this
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I Janis A. Klock -
Signed, sealed, published and declared by the above-named
Testatrix, JANIS A. KRULOCK, as and for her Last Will and Testament
in the presence of us, who have hereunto subscribed our names at
her request as witnesses thereto, in the presence of said Testatrix
and of each other.
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21 - 01 - 1140
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
ROBERT SADIS AND THE HONORABLE EDWARD GUIDO
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that they were present and saw
JANIS A KRULOCK
the testat.r..ll~, sign the same and that th~y
request of testat~ in h f'r presence and (in the prese
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this 18TH day of (Name)
~()~BER' Xfu~-m
-. 1LrT <J F ddress)
Y C L E WI S Register . ~.-....-..
(Name)
signed as a witness at the
h other) (in the presence of the
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
to the best of
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
will
subscribing witnesses to) the
presented herewith and
codicil
. ature on the will is in the handwriting of
testat_
that
me this ~
and subscribed before
day of
19_
(Name)
Register
(Name)
(Address)
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SAID IS, GUIDO,
SHUFF &
MAS LAND
26 W. High Street
Carlisle, PA
CODICIL
OF
JANIS A. KRULOCK
I, JANIS A. KRULOCK, the within named Testatrix, do hereby
make and publish this Codicil of my Last Will and Testament
dated January 23, 1980.
FIRST
I hereby amend the SEVENTH provision of said Will to
provide as follows:
I do hereby nominate, constitute and appoint my husband,
JOSEPH M. KRULOCK, to act as Executor of this my Last Will and
Testament. Provided, however, that if he is unwilling or unable
to act as Executor, I direct that the duties of Executor be
performed by my son, JOHN DAVID KRULOCK.
In all other respects I hereby ratify, confirm and
republish my Last Will dated January 23, 1980 together with this
sole Codicil as and for my Last Will.
IN WITNESS WHEREOF, I, JANIS A. KRULOCK, have hereunto set
my hand and seal to this Codicil to my Last Will and Testament
this r
, J. ., 1"::__ /." L
day of ~rTL/~
, 1996.
~a.~
nis A. Kru ock, Testatrix
Signed, sealed, published and declared by the above-named
Testatrix, JANIS A. KRULOCK, as and for a Codicil to her Last
will and Testament in the presence of us, who have hereunto
subscribed our names at her request as witnesses thereto, in the
presence of said Testatrix and of each other.
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ADDRESS
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RESS (j/41~t' 'pn I!w~
ONWEALTH OF PENNSYLVANIA:
: SS
COUNTY OF CUMBERLAND
WE, JANIS A. KRULOCK, ROBEHT C. SAlOIS , and JO
SMIT'H , the Testatrix and witnesses, respectively whose
names are signed to the foregoing or attached instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her
Codicil and that she signed willingly and that she executed as
her free and voluntary act for the purposes therein expressed,
and that each of the witnesses, in the presence and hearing of
the Testatrix signed the Codicil as witness and that to the best
of their knowledge the Testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue
influence.
SAIDIS, GUIDO,
SHUFF &
MASLAND
26 w. High Street
Carlisle, PA
Subscribed, sworn to and acknowled d before me by JANIS A.
KRULOCK, the Testatrix, and subscribed to and sworn or affirmed
to before me by R..Q~T C. SAlOIS) ..,...an~<1d ..' JO SMITH. ..' '
witnesses, this C( day of ,Y=Jf~ , 19~ '
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Notary Public
NOTARIAL SEAL
THELMA S. ~cGAUSllN, Notary Public
Camp Hill. Cumberland County
My Commission Expires July 3, 2000
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
J I})V 15 A r kA V LDC.J<..
(Je.c.. 1\ /...()O I
I
Date of Death:
Will No.
Admin. No.
To the Register:
f\-'Z. F-, le ~ aObl -DilL.{ 0
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the ortans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on DeL. . 55, ;Lc)D I :
Name
Address
j 0 SellL/h, kt<.vLDc../L1 5(Jt91.1~- qt>~ ~efLe 'fJ/(.. A1t,c.6hg.IV't.56u~l~1 fh,
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
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Name .JoSR-I,l /J1, I<AuLbLk
Address 1 tJ;)... fJe.4-Le {)/-l, I vC
/YJ uff4tV){J., 5~i.l4..~ lA, / 70S6-t.(LjLf~
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Telephone (717) ~1'1- -3 ;).:75
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Capacity: rlrsonal Representative
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REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYL VANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: Janis A. Krulock
Date of Death: December 11, 2001
Will No.
21-01-1140 Admin. No.
To the Register:
I certify that notice of Estate Administration required by Rule 5.6(a) of the
Orphans' Court Rules was served on or mailed to the following beneficiary of the above-
captioned estate on March 18, 2002.
Name
Address
Joseph M. Krulock
902 Peace Drive, Mechanicsburg, P A 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Date:
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Robert C. aidis, Esquire
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity:
_ Personal Representative
X Counsel for Personal
Representative
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REV-1500 i:x + (6-00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OEPT.280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Kru10ck Janis A.
DATE OF DEATH (MM-DO-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLlCATEWfTH THE
DATE OF BIRTH (MM-DD-YEAR)
12/11/2001 08/23/1932
IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, FIRST, AND MIDDLE INITIAL
OFFICIAL USE ONLY
Il
27-7
21-011140
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
j;cd -/.0- 'hlrJ
Kru1ock, Jose h M.
X 1. Original Return
4. Limited Estate
X 6. Decedent Died Testate
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Oecedent Maintained a Living Trust
o
(Attach copy of Will)
D 9. Litigation Proceeds Received
3. (date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of Trust)
D 10. Spousal Poverty Credit D 11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1-1 ~95) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDeNtiAL TAX INFORMATIONSIlOULll. BE DIRECTSD TO:
NAME COMPLETE MAILING ADDRESS
Robert C. Saidis
FIRM NAME (If Applicable)
Saidis, Shuff, Flower & Lindsa
TELEPHONE NUMBER
2109
Camp
Market Street
Hill, PA 17011
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17 737-3405
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)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non~Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 rrtnus Line 11)
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)
(1)
(2)
(3)
63 ,99Ci';'O'
N"6ne
None
(4)
(5)
None
9,888.24
(6)
None
None
7,289.00
None
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
66,589.24
x
X
X
X
o 0
.0 45
.12
.15
20,
AlIill FlEQUIl$TING A RIlFUND OF #l OVERPAYMENT
ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MAl"H < <
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(8) 73 , 878. 24
(11) 7.289.00
(12) 66,589.24
(13)
(14) 66,589.24
(15)
(16)
(17)
(18)
(19)
0.00
0.00
0.00
0.00
0.00
Form REV-1500 EX (Rev. 6-00)
.Decedent's Complete Address:
STREET ADDRESS
5401-21 Oxford Drive
CITY I STATE TZIP
Mechanicsbur2: 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)
0.00
3. Interest/Penalty jf applicable
D. Interest
E. Penalty
Total Credits ( A + B + C) (2)
0.00
Totallnterest/Penalty ( 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. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WillS, AGENT
0.00
0.00
0.00
0.00
0.00
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN
1.
'j;'xi,
IN THE APPROPRIATE BLOCKS
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?
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death?
4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property
which contains a beneficiary 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
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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 ls true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF
Joseph M. Kru10ck
902 Peace Drive
- - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Mechanicsbur , PA 17055
Saidis, Shuff, Flower & Lindsay
2109 Market Street
09/7/2) ;J,
o;n L/ 01-/
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) (il].
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. 9116 (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. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(a)( 1 I].
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. 9116(a)(1.3)]. A sibling is defined, under
Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright (c) 2000 form software only The Lackner Group. Inc.
Form REV-1S00 EX (Rev, 6-00)
REV-1502.EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Janis A. Krulock SS# 208-24-2770 12/11/2001 21-011140
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
DESCRIPTION
NUMBER OF DEATH
1 5401-21 Oxford Drive
Mechanicsburg, PA 17055 (county tax assessed value) 63,990.00
SCHEDULE A
REAL ESTATE
(other real estate owned jointly with decedent's spouse
located at 902 Peach Dr., Mechanicsburg, PAl
TOTAL (Also enter on line 1, Recapitulation) $ 63,990.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97)
REV-150&EX + (1-97)
COMMQNWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Janis A. Kru10ck
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SSII 208-24-2770
12/11/2001
FILE NUMBER
21-011140
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
2
DESCRIPTION
PNC Bank, checking acct. 1151-4026-0931
PNC Bank, money market acct. 115000853153
(see copy of statement attached)
VALUE AT DATE
OF DEATH
997.12
8,891.12
TOTAL (Also enter on line 5, Recapitulation) $ 9,888.24
(If more space is needed. insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. Inc Form REV-15GB EX (Rev. 1-97)
-
REV-1511~EX + (1-97)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Janis A. Kru10ck
SSfI 208-24-2770
12/11/2001
FILE NUMBER
21-011140
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES,
7,289.00
B. ADMINISTRATIVE COSTS,
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / ErN Number of Personal Representative(s)
Street Address
City State Zip
-
Year(s) Commission Paid:
2. Attorney's 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. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) $ 7,289.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems,lnc.
Form REV-1511 EX (Rev. 1-97)
REV-1S1yEX + (9-QQ)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Janis A. Kru10ck
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 91 16{a)(1.2)]
Joseph M. Kru10ck
902 Peace Drive
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-011140
AMOUNT OR SHARE
OF ESTATE
SSff 208-24-2770
12/11/2001
NUMBER
I.
spouse
entire estate
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group. Inc.
0.00
Form REV-1513 EX (Rev. 9-00)
.
Total Banking Statement
PNC Bank
........--
0. PNCBAN<
Primary account number: 51~4026-0931
Page 1 013
For the period 11/10/2001 to 12/11/2001
p
Number of enclosures: 15
JANIS A KRULOCK
5401-21 OXFORD DR
MECHANICS BURG PA 17055-5429
!t For 24--hour customer selViee or
current rates: Call1-8SS.PNC-BANK
~ Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
S Visit us at www.pncbank.com
~ TODlerminal: 1-800-531-1648
For hearing impaired clients only
Relationship Overview
Bank Deposit Accounts
Description
Interest Checking
Money l\'hrket Dil"eet
Total Deposits
ACcount Number
Deposit Balance
51-4026-0931
50-0085-3153
997_12
8,891.12
9,888.24
Choice Plan
Interest Checking Account Summary
Account number: 51-4026-0931 Account Link @ number: 0208242770
Janis A Krulock
Balance Summary
Please see the Activity Detail section for
additional information.
Beginning
balance
Deposits and
other additions
645.61
1,211.00
Checks and other
deductions
859-49
Ending
balance
997.12
Average monthly
balance
56o.!.86
Charges
and fees
80-49
Transaction Summary
Checks paid/
withdrawals
Bank card/PeS Account Information
transactions assistance calls
Teller
transactions
15
1 0
1
Total ATM
transactions
PNC Bank MAC Other MAC ATM
ATM transactions transactions
Other A TM
transactions
o
o 0
o
Activity Detail
Deposits and Other Additions
Date Amount Description
11/28 800.00 Deposit Reference No. 029792242
12/03 411.00 Direct Deposit. Soc See
US Treasury 303 203209663B
Checks
:heck Date Reference
'umber Amount paid numbar
3550 5.00 11/15 028321849
3555 * 11.75 11/21 025135032
3556 10.00 11/16 0258995] 4
3557 37.00 11/15 028279019
355.'~ 5.00 11/19 029073207
J559 22.02 11/16 025907592
There were 2 Deposits and Other Additions
totaling $1,211.00.
:hecks Paid continued on next page
Check Date Reference
number Amount paid number
3560 56.50 Il/H 024298700
3561 42,46 11/15 028323042
3562 5.00 11/19 029073210
3563 31.75 12/04 024312719
3564 74.14 11/26 027116704
3565 50.00 11/26 022260838
FORM953R
I
CODICIL
OF
JANIS A. KRULOCK
.
I, JANIS A. KRULOCK, the within named Testatrix, do hereby
make and publish this Codicil of my Last Will and Testament
dated January 23, 1980.
.
FIRST
I hereby amend the
SEVENTH provision of said Will to
provide as follows:
I do hereby nominate, constitute and appoint my husband,
JOSEPH M. KRULOCK, to act as Executor of this my Last Will and
Testament. Provided, however, that if he is unwilling or unable
to act as Executor, I direct that the duties of Executor be
performed by my son, JOHN DAVID KRULOCK.
In all other respects I hereby ratify, confirm and
republish my Last Will dated January 23, 1980 together with this
sole Codicil as and for my Last Will.
IN WITNESS WHEREOF, I, JANIS A. KRULOCK, have hereunto set
my hand and seal to this Codicil to my Last Will and Testament
this
r
day of ~
, 1996.
~ q~~atrix
SAIDIS, GUIDO,
SHUFF &
MASLAND
26 W. High Street
Carlisle. PA
Signed, sealed, published and declared by the above-named
Testatrix, JANIS A. KRULOCK, as and for a Codicil to her Last
Will and Testament in the presence of us, who have hereunto
.
AIDIS, GUIDO,
SHUFF &
MASLAND
26 W. High Street
Carlisle. PA
-
subscribed our names at her request as witnesses thereto, in the
presence of said Testatrix and of each other.
//~~
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ADDRESS
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RESS (j14~. pn 1/(;0[.
,
ONWEALTH OF PENNSYLVANIA:
: SS
COUNTY OF CUMBERLAND
WE, JANIS A. KRULOCK, ROBERT C. SAlOIS ,and JO
SMITH , the Testatrix and witnesses, respectively whose
names are signed to the foregoing or attached instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her
Codicil and that she signed willingly and that she executed as
her free and voluntary act for the purposes therein expressed,
and that each of the witnesses, in the presence and hearing of
the Testatrix signed the Codicil as witness and that to the best
of their knowledge the Testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue
influence.
Subscribed, sworn to and acknowled
KRULOCK, the Testatrix, and subscribed
to before me by ~~T C. SAIDISj d
witnesses, this If day of ~
d before me by JANIS A.
to and sworn or affirmed
JO SMITH ,
,195
VJn~
blic
NOTARIAL SEAL
THELMA S. McCAUSLIN, Notary Public
Camp Hill, Cumberland County
My Commission Expires July 3, 2000
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1
LAST WILL AND TESTAMENT
OF
JANIS A. KRULOCK
I, JANIS A. KRULOCK, of Camp Hill, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and under-
standing; do hereby make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills
and COdicils heretofore made by me.
PI RS T
I direct the payment of my debts and expenses of my last
illness and funeral from my estate as soon after my death as
conveniently may be done.
If there be no cemetery lot available
for my interment owned by me at the time of my death, I authorize
my personal representative to purchase such cemetery lot with a
contract for perpetual care, using therefore funds from my estate
in such amount as he shall consider necessary and desirable,
and I authorize my personal n~presentative to cause title to or
ownership of such lot so purchased to be vested in such person
as my personal representative shall designate.
Further, I authorize my personal representative to expend
funds from my estate, in such amount as my personal representative
shall consider necessary and desirable, for the purchase, erection
and inscription of a suitable marker for my grave.
SECON D
I give, devise and bequeath all the rest, residue and re-
mainder of my estate to my beloved husband, JOSEPH M. KRULOCK,
absolutely and in fee simple, if he survives me by thirty (30)
days.
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In the event that my husband, JOSEPH M. KRULOCK, fails to
survive me by thirty (30) days, then I qive and bequeath all
my jewel ry to my dau gh ter, L IN DA K RULOCK TREMAINE and
remainder of my estate I qive, devise and bequeath in equal
shares unto my children, LINDA KRULOCK TREMAINE, JOSEPH M.
KRULOCK, JR., and JOHN KRULOCK, per stirpes.
Provided, however, that the share of any child who predeceases
me or dies on or before the thirtieth (30) day following my death
shall be distributed equally to his or her issue, per stirpes.
FOURTH
In the event my husband, JOSEPH M. KRULOCK, predeceases me,
I appoint my daughter, LINDA KRULOCK ';I'PEMAINE,."g1ardian of the
persons and property of my minor children.
FT FTH
I direct that any and all inheritance, estate, and transfer
taxes imposed upon my estate passing under this Will Or otherwise
shall be paid out of the principal of my residuary estate.
SIXTH
In addition to the powers conferred by law, I authorize any
personal representative acting under this instrument, in his or
her absolute discretion:
(a) to retain in the form received, or to sell either at
public or private sale any real or personal property;
(b) to manage real estate;
(c) to invest and reinvest in all forms of property without
beinq COnfined to legal investments and \vithout reqard
to the principle of diversification;
(d) to exercise any option or rights arising frOm ownership
or in ves tmen t.
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SEVENTH
I do hereby nominate, constitute and appoint my husband,
JOSEPH M. KRULOCK, to act as Executor of this my Last Will and
Testament. Provided, however, that if he is unwilling or unable
to act as Executor, I direct that the duties of Executrix be
performed by my daughter, LINDA KRULOCK TREMAINE.
I direct that no personal representative appointed under
this instrument shall be required to give bond for the faithful
pervormance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, JANIS A. KRULOCK, have hereunto
set my hand and seal to this my Last Will and Testament, con-
sisting of three typewritten pages, the first two of which bear
my signature in the margin for identification, this
9-6
J
day
of
~o
, 19110.
v..,,-m.J R :~~:~> 1--,,-<,.6 /
I Janis A. Klock -
Signed, sealed, published and declared by the above-named
Testatrix, JANIS A. KRULOCK, as and for her.Last Will and Testament
in the presence of us, who have hereunto subscribed our names at
her request as witnesses thereto, in the presence of said Testatrix
and of each other.
CI~
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Address CN> t-< /116#
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ROBERT C SAIDIS 'OZ ;11\'( 24
SAIDIS ETAL
2109 MARKET ST L
CAMP HILL C\F\~ 17011
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-20-2002
KRUlOCK
12-11-2001
21 01-1140
CUMBERLAND
101
, l)
w
REV-1547 EX AFP (01-02)
JANIS
A
Allount Rellitted
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 = iS4-j-EX--AFP--foY:o2Y-NoTicE--oF-YNHErfifANCrTAX-A-PPRjrisEifENT~--ALrowAN-cE-irR------------ -- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KRUlOCK JANIS A FILE NO. 21 01-1140 ACN 101 DATE 05-20-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Dep()sits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Asseb
U)
(2)
(3)
(4)
(5)
(6)
(7)
63.990.00
.00
.00
.00
9,888.24
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value o,f Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
7,289.00
.00
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ~
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. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax IlJue
TAX CREDITS:
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
73.878.24
Ul)
(2)
(3)
(4)
7.289 00
66.589.24
.00
66.589.24
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
..~... .6. (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
66.589.24 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
· IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF AllDITIONAL INTEREST.
.00
.00
.00
.00
.00
IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. [72 P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF MILLS, AGENT
REFUND [CR):
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" [REV-13l3). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 [TT only).
OBJECTIONS:
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax [including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" [REV-150l) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent [5%) discount of
the tax paid is allowed.
PENALTY:
The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one [1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six [6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 n .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 n .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 llZ .000301 2002 6% .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen [15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
o
~/,
-.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Janis A. Krulock
Date of Death: December 11, 2001
Will No.
21-01-1140
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.
complete: Yes
State whether administration of the estate is
X; No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: Within next three months - after income tax returns have
been prepared and filed.
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes ; No X
b. The separate Orphans I Court No. (if any) for
the personal representative's account is:
c. Did the personal representative
account informally to the parties in interest? Yes X;
state
No
an
Date:
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
/12
S~natuv'e _/
Name: Robert C. Saidis, Esquire
I.D. No. 21458
SAIDIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
.-7 I ~
II IS! ()V
I I
Capacity:
Personal Representative
X Counsel for Personal
Representative
O.
I'.".
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
Estate of Janis A. Krulock
also known as
File Number 21 01 1140
,Deceased Social Security 1`iumber 208-24-2770
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' OR 'B' BELOW.)
X^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the John D. Kf UIOCk named in the
last Will of the Decedent dated 1/23/1980 and codicil(s) dated September 9. 1996
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
B. Grant of Letters of Administration
(/f applicable, enter.• c. t. a.; d. b. n. c. t. a.; pendente lite~ durance absentia•
t.
s)
~."`,
a -
Z ,~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if an} ,~rtd heirs: (!f"
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at
5401-21 Oxford Drive Mechanicsburg PA 17050 Upper Allen Cumberland
(List street address, townlcity, township, county, state, :ip code)
Decedent, then 69 years of age, died on 12/11 /2001 at
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 0.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 0.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature Typed or printed name an~i residence
John D. Krulock 2690 V'Jesthampton Terrace
Elizabethtown PA 17022
Page 1 of 2
Form RW-02 rev. 10.13.06
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA ;
SS
COUNTY OF Cumberland
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 Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ ~~ day of
I ~ ~J
For e Register
Attorney Signature:
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File Number: 21 '- ~ I - II yU ~ _
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Estate of Janis A. Krulock , D~eased W - "
Social Security Number: 208-24-2770 Date of Death: 12/11/2001
AND NOW, ~ ` ~-- ,~, in consideration of the foregoing Petition, satisfactory proof
having been presented before me` T I CREED tl a Letters
are hereby granted to __~
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
Letters ............................. $
Short Certificate(s) •••••••••••• $ °L
enunciation s) •••••••••••••••• $
.... $ AIL
.... $
.... $
.... $
.... $
.... $
.... $
.... $
.... $
TOTAL ............................. $~-
Signature of eBersonal Representative John D. Krulock
Signature of Personal Representative
Signature of Personal Representative
Attorney Name
Michael ~~. Palermo. Jr. ~''
Supreme Court I.D. No.: 93334
Address: 155 South Hanover Street
Carlisle.
PA 17013
Telephone: 717-241-6070
Form RW-02 rev. 10.13.06 Page 2 of 2
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/17/2009
PALERMO MICHAEL O JR
155 SOUTH HANOVER STREET
CARLISLE, PA 17013
RE: Estate of KRULOCK JAMS A
File Number: 2001-01140
Dear Sir/Madam:
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This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET N0. 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 is due by: 12/11/2009
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincere~~'ly~~ ~~ ~ ~~
/~~Z211dRil~~G7fK/
Glenda Farner Strasbau h
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Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 11/17/2009
KRULOCK JOHN D ~,,,~
2690 WESTHAMPTON TERRACE o ?:
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ELIZABETHTOWN, PA 17022 m
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RE: Estate of KRULOCK JAMS A pp '
File Number: 2001-01140
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is .due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103
SUPREME COURT RULES DOCKET N0. 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 is due by: 12/11/2009
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
/~~~FrflG~4il~.~~GLN~Ji~I'~/C~
Glenda Fa
rner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
REGISTER OF `VICES OF C/ ~~~N~ COU~vTY, PET~~iS~'L`JANIA
Name of Decedent: ~"i~ ~S
~~
Date of Death: ~~/ ~GG/ File Number: ~«~~ %~~
D. - ++„ D., !1 !~' D 1 ~ 7 ~ T 0,~ tl.e fr\llnzx~ino ~zn'li racnPr~.t to r.nmplPtion pf t~~e ad7ll7ii75tratlCn of
x uisuu:ii w L Q. \/•\.'. 1\Ule V.lY, L lep --p r--- r-
the above-captioned estate:
1. Sate ',Vl;,=*li°:: dnalist'3ti0P. of tl:., e~'ate '_S cornple.tP.: .. .. ....... ...... ~~1~eS ~ NO
Z. If the answel"is No, state when the personal representative
reasonabiv believes that the administration will be complete:
~. Ifthe answer to No. 1 is YES, state the following:
a. Did tl:e personal representative file a f?na_l accou:,t with the Court? ....... ]Yes
L. The separate Orphans' Court No. (if any) for the personal
tepresentative's account is:
~N o
c. Did the personal representative state an account
informally to the parties in interest? ............................... Yes [~No
d. Copies of receipts, releases, joinders acid approvals of fo~-mai or inf~.~rnial a~ccll:,ts Ti.a-y ,e
fled with the Clerlc of the Orphans' Court and maybe attached to this report.
Dare ~~~-'~'" ~ 2~~ /
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Cauacity: QPersonal Representative Counsel
.'~`nn:e of Person Filing this Form `
Aadress
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