HomeMy WebLinkAbout12-13-05
..
E.V"15tlO EX \6-00)
REV-1500
.' COMMONWEALTH OF
, PENNSYLVANIA
. ' ..~. '." - DEPARTMENT OF REVENUE
'. DEPT. 280601
. "". . _ HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN FILE NU~BER ,/ __ ...-/_
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RESIDENT DECEDENT COUNTY CODE YEAR - NUMBER- - -
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DATE OF BIRTH (MM-DD-YEAR) ./
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(IF APPLICABLE) SURVIVING POUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF DEATH (MM-DD-YEAR)
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m 1 Original Return
. 0 4. Limited Estate
~ 6. Decedent Died Testate (Allach copy of Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of dealh after 12.12-82)
o 7. Decedent Maintained a Living Trust (Allaeh eopy ofTrust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
SOCIAL SECURITY NUMBER ./
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THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECU:TY NUM;;t! / ~
o 3. Remainder Return (dale 01 death prior to 12-13-82)
g. . 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AllachSchO)
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THIS SECTION MUST BE COMPLETED. All CORRESPONDENCE AND CONFIDENTIAL TAXINt=C)RMjl,TION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS ..-
edi/ rye (C'.-/ t-7
f 6- () 1)/ F ec!:./?r~af $* ee.-r
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax d
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
I 7'/ 1-'7 t'J .r
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17. Amount of Line 14 taxable at sibling rate
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18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
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(11)
(12)
(13)
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(14)
x.O_ (15) ~
x.O_ (16) f/ (/; t7 7
x .12 (17) ~
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x .15 (18)
(19) f: ~/7 7
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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> > BE SURE TO ANSWER ALL; QUE$TI()N$ ()NREVERSE S,'Q~ A~Q ~Et;J.lE~K"'jl,tl:f< <
Deceaent's Complete Address:
S,TREET ADDRES~ 0 7 c' ti1 .7;1rt:!.. ~
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
'--
Total Credits (A + B + C ) (2)
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)
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5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
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A. Enter the interest on the tax due.
(5)
(5A)
--
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;........................................................................................ D
b. retain the right to designate who shall use the property transferred or its income; .......................................... D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ................................................................. D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .... ............................................................................................ D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................. ......................................................... ..............................
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
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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)J.
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
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 paren
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 a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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Register of Wills of D~irl County, Pennsylvania
Estate of
Get1 e
INVENTORY
/RO-k4I.1e-YJe/ No.
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also known as
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Date of Death
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, Deceased
Social Security No, U~ -.;? J"_.-ft~ /:2-
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Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, thilt
lhe valuation placed opposite each item of said Inventory represents its fair value as of the dale of the Decedent's death. and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I(We verify that the statements made in this Inventory are true and correct. I(We undfJrsland that
false statements herein are made subject to the penalties of 18 Pa. C.S, Section 4904 relating to unsworn falsification to
authorities.
Name of
Attorney:
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Personal Representative:
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1.0. No.:
Address:
Dated
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Telephone:
Description
Value
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(A ttach Additional Sheets if necessary) j(t.K fjtvl6 7 ('" 7...-
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NOTE: lhe Memorandum of real estate outside the Commonwealth of Penll:.ylvanla nlay, at the election of the personal repfCsBntative. include
the vRluB of each itern, but such Bgutes shoulrt not be extended intu the total of the Inventory.
'W-8
RiOV-1502 EX+ (6-98)
SCHEDULE A
REAL ESTATE
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF r
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T ~;;r,;6C?-ra eJ-
FILE NUMBER __
2/- 03 ~- c:JO-5.5/g.
All real properly owned solely or as a lenanl in common musl be reporle t 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 10 buy or sell, bolh having reasonable knowledge of the relevant facts,
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F,
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
L)iZje-/!), y ,~//J 7 s- /fD7?hre/~# A
C ($....? /-I/f~ f/I) / ? 0 // / :z <;-
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TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,;1' V O~;/{) -
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#
REV.1508 EX -t (1.97)
a.
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER ,-- /'1 ,~ ---!2
;7 /-L)'J ~ V CJ../'-.5./
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Include the proceeds of litigation and the date the proceeds were received by the esta e. All property jointly-owned with the right of survivorship mllst be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
ITEM
NUMBER
1,
DESCRIPTION
Car;) /; ? t'? #ct x/~-
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TOTAL (Also enter on line 5, Recapitulation) $ I tJ R,1/'h'
(If more space is needed, insert additional sheets of the same size)
.
REV-1511 EX+ (12-99) .
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
~ CJ U1 b eyo<<
FILE NUMBER ,,..--c ~ z
dA -- C'...::r - 0 t7:;3 Y..;:7
Debts of decedent must be ported on Schedule L
ITEM
NUMBER
A. FUNERAL EXPENSES:
B.
DESCRIPTION
1.
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1.
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C" c:.-4r . ~1 c;n/" (;rVce-/-1 ye. ()(ciSc'~/ffV.7e
ADMINISTRATIVE S: ' --....-~--------- '
Personal Representative's Commissions
Name of Personal Representative(s) G/? vY' c;;' .R 0 ':1t1I1&.-~ 12.,//
Social Security Number(s)/E/N Number of Personal RepretentatiVe(S) J
SI"" Add"~ /~~ / / F.<? (d ~ (3.re&.-1 IffGt <' e
City p'r;:'; :a.uJ A' State~ZiP 1f!.c?1 P b
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Year(s) Commission Paid: LtL
,
2.
Attorney Fees {..7'?: ql' 19,.- E&-h Te' ') ~ .,
. ( _ ~6k P;:;t?!pt..h('I-/"
Family Exemption: (If decedent's address is not the sa e as claimant's, attach explanation)
JO At/' - If( evtAer
Street Address F 0 7 .s I P" .!!:J.-. sfr'e e r
City CO' J,A-1jJ f/ ; / ( State /JL Zip / 7011
Relationship of Claimalf(to Decedent ...5'0 '1
3,
Claimant
4.
Probate Fees
5.
Accountant's Fees '-J
Tax Return Preparer's Fees I
PC? ..$;/-C''l e.
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6.
------
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7.
f
AMOUNT
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TOTAL (Also enter on line 9, Recapitulation) $ ~P~/ & S
(If more space is needed, insert additional sheets of the same size)
.
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DEC EDENT
INHERITANCE TAX RETURN
ESTATEOF Rf';:DECEDENT MORTGAGE LIABILITIES, & LIENS
L2 t244 c./ R e /1'-/ 6-& -t't2r'
Include unreimbursed medical expenses. t/
ITEM
NUMBER
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FILE NUMBER
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DESCRIPTION
AMOUNT
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. TOTAL (Also enter on line 10, Recapitulation)
(If more space IS needed, insert additional sheets of the same size)
$ I 2-/ "7 /'/
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.. REV-1513 EX+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
G"-
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T
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FilE NUMBER
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AMOUNT OR SHARE
OF ESTATE
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
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RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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.
N?
~e
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
rJ
L.
(If more space is needed, insert additional sheets of the same size)
TOTAL OF PART II - ENTER TOTAL NON,TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
...
.-
Last Will And Testament
I, Gene T. Romberger, residing at Camp Hill, county of
Cumberland, and state of Pennsylvania, being of sound mind, do
hereby declare this instrument to be my last will and testament
and revoke all Wills by me at anytime heretofore made.
I direct that my funeral be conducted in a manner corresponding
with my estate and situation in life and that all my just debts
and funeral expenses be fully paid and satisfied as soon as conviently
may be done after my decease.
I give, devise, and bequeath the whole of my estate, both real
and personal, to my children as follows: one-third (1/3) to my son
Gary G. Romberger, one-third (1/3) to my son John R. Romberger, and
one-third (1/3) to my daughter Lori A. Green, their heirs and assigns
forever.
I nominate, constitute, and appoint Gary G. Romberger, to act
as the executor of this will, to serve without bond. Should
Gary G. Romberger be unable or unwilling to serve, then I appoint
John R. Romberger to act as the executor of this will. I direct
that my executor not be required to enter security in any
jurisdiction in which she or he may act.
..
.
I herewith affix my signature to this will on this the l day
of Auqust, 1921, in the presence of the following witnesses, who
witnessed and subscribed this will at my request and in my presence.
On the date above written, Gene T. Romberger, declared to us
and in our presence, that this instrument, consisting of two (2)
pages, is his last will and testament, and Gene T. Romberger, the
signed this instrument in our presence, and at Gene T. Romberger's
request we now sign this will as witnesses in each other's pressence.
Further that Gene T. Romberger, appeared to us to be of sound mind
and lawful age, and under no undue influence.
Signature:
witness:
Address:
witness:
Address:
witness:
Address:
Date:
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Sworn'O Ill. ,ub'fd,:erore me
t~ay of )' ~ 19 Cf:::5
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/- NOTARI.t-.L SEAL
I' MARY L DEPPEN. Notary Public
East Pen'lsboro. CUmberland Co
L!:l'i_'~:'2=,rrl'ss;(m Expires Dee 21'. 1993
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IRA H. WEINSTOCK
JASON M. WEINSTOCK
JOHN B. DOUGHERTY
JEFFREY R. SCHOTT
MAGGI E. COLWELL
LAw OFFICES
IRA H. WEINSTOCK, p.e.
SUITE 100
800 N. SECOND STREET
HARRISBURG. PENNSYLVANIA 17102
AREA CODE 717
TELEPHONE: 23&1657
"'~137.c
FAX: (717) 238-6691
E-MAIL ADDRESS
weinstock.law@verizon.net
December 12, 2005
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
RE:
Estate of Gene t. Romberget) ""'
.' .
No. 21-05-00553 "'-1
Dear Sir/Madam:
(~;-)
Enclosed please find the following items:
"
1. Two copies ofthe Inheritance Tax Return; ".,)
2. A check in the amount of$15.00 for filing the Inheritance Tax R~urn;
3. A check in the amount of $8,607.00 for the tax due; and
4. Two copies ofthe Status Report under Rule 6.12.
Kindly time stamp the extra copy ofthe Status Report and return it to the
undersigned in the self-addressed and stamped envelope which I have provided. If you have any
questions or need anything further, please feel free to contact me.
Very truly yours, ~
~~::~t r
JBD:lsw
Enclosure
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROMBERGER GARY G
13211 GORDERS GREEN PLACE
BRISTOW, VA 20136
_Uun_ fold
ESTATE INFORMATION: SSN: 186-28-5312
FILE NUMBER: 2105-0553
DECEDENT NAME: ROMBERGER GENE T
DATE OF PAYMENT: 1 2/ 1 3/2005
POSTMARK DATE: 12/12/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 06/15/2005
NO. CD 006093
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $8,607.00
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TOTAL AMOUNT PAID:
REMARKS:
CHECK#126
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$8,607.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
PLEASE FILE, nrrs REPORf WITIIIN 'ThO YEARS OF DAlE OF DFATII R.EX;ARDLESS OF 1HE STATIJS OF 1HE
FSfATE. IF FSI'ATE IS oor a:x-tPI.E1'ED, FILE A 6.12 FORM YEARLY UNTIL C01PIEfION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
(~eJU ~i/l1b~~er
~ c,,/J---:2-.L2(J~
rZ/-b.7_-0(J.7~3 ___ Admin. NO._.;z:. ~=.~5 -=- C)l.9S--S:Y
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.
Stat~fhether administration of the estate is
Yes No
--
complete:
2. I f the answer is No, s tate when the persona 1
representative reasonably believes that the administration will be
complete:
J. If the answer to No.1 is Yes, state the following:
a. Did the perl,onal 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 representa t i ve s,{te 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 maYle . .t...tached to this report.
Dat~i /;;4tJjoy./ .~ 11 ~~
.., I . / s,gn';tu~-----;':-T
" Name ~2e ~pe~:~~~~er
_ {.? ? (I' ~ c (dC'4: .~~&~') <!i,/~~~!--c!- ? '
Address j!Ji"7 :if:Pk:; -v79. ~'&/ /.:76
7/ ?l7 7-- ~ ~ - I~' i5 7
1.'_.~_ ..____._
Tel. No.
" .
(MAH:rmt/AM3)
Capacity: -4-Personal Representative
__Counsel for personal
representative
RW-27
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