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Th' fy h h" f h d h' h . fil' h Pl' D" 21-n.1V-.1 OLL d
is IS to certi t at t IS IS a true copy 0 t e recor w IC IS on I e III t e ennsy vama IVISlOn or Iral Recor s
with Acr 66, P.L. 304, approved by the General Assembly, June 29, 1953.
III accordance
WARNING: It is illegal to duplicate this copy by photostat or photograph.
0614308 DEl.; 1 ~ h,~
~II~
Charles Hardesrer
Srate Registrar
No. Date
Hi.S. ''''Rev 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPEJPRlNT
IN -
PERMANENT
BLACK INK
NAMEOFOECEDENTtf"$I,Mod.:.e~--'---"------
.. Harold E. Sorrells
SEX
..male
STATE FILE ~M8ER
SOCIAl. SECURITY NU!WBER
)
..451
-52
.-GE (lasl Sitthdav)
UNDER 1 YEAR
-- 0.,.
BlRTHPl.ACE (Cfy ar:d
S&aleorFaetCJn~
62
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..
COUNTY OF DEATH
RACE - AIMncan \rIcNn. Bladl.. Whit.. _
-,
..~hite
SUAVIV1NG SPOUSE
(1f....~tl1al(]MlnM'l4l1
Cumberland Co.
..
Sanders
,..
FNHER'S NAME IFirst Middle. La"l
James Lee Sorrells
12 Kensington Dr.
camp Hill, PA 17011
"..
Cumberland
No...... Jivltd
l1d.O -'thin.au.llimitsof
MOTHER"S I'U.ME iF"51. ModdIe. Malden Surname,
Ethel Fuller
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INFORMANT'S MAME {TyplWPrinr)
_ Erika Sorrells
METHOOOFDl$POSrTlON . ~ _
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UCENSE NUU8ER
22b.FD-013163-L
red ~Ilhe lime, date and ptJCe Slatlld
Schaefferstown,PA17088
21c1.
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DUE 10 lOA AS A CONSEQUENCE Oft.
.Crt,.lo(V!C, o~ s-;Yl tlc/J V(; 'Pv,-", O'f'V1'r(/.M
{ . OUElOfOOASACONSEOUENCEOf):
c -S f11J"n-<- C<::C--<- C/M-c I '" 0 "'V'"
DUE to (OR AS A CONSEOUENCE 00:
.
23b. 23c:.
W'oS CASE REFERREO TO MEOIC& EXAMINERlCOAONER?
,.. ....J8!, Pi ~. ~ . NoD
I Approxima~ PART U: 0lMr Signil'ic:&r'lll condi&iorw c:ontritluting to death. bull
: ~ ~ IlOl ruuIling n the underfy'ngQUM g;v.n in PJUrr'
I onMt and death
i
ONe PRONOUNCEO DEAD IMoolh. Day. '!ear)
// -? 9- ~ '7
....;-
WERE AlJTOPSY FINDINGS MAHNER Of DEATH
A\AlLA8LE PfUOR 10
COMPlET1OH OF CAUSE ........ )9- 0
OF lleAJH? HomiciW
-- 0 hnding~~lion 0
....0 No 0 Suicide 0 Coutd noI be deI<<rn1ned 0
DATE OF INJURY
(MonI'I,Oay. 'lltar)
TiME Of INJURY
INJURY I: WORK? DESCfUBE HOW' INJURY OCCURRED.
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CERTIFIER ICh8l;ll QI'liy Ol'le\
~CERTJFYWG PHYSICIAN (PhySIC...... ct!flJtyong cavse d dealh wt\er. 3f\Olt>e. ph'fSIC...... has pronovnced death ano CompIeIed I1em 23)
To e.. -.... ot 1ft., knowtecfge. death oa:urr.d dUe to.... uu~s).-net manner... se.ted;, . .
:ro.
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Pl..ACE OF INJURY..'4 hon'W. farm, SI~. laC'lOf'Y. otfIc:e
~ eK. l$peofv)
_.
tot. JOe_
_.
Loc.vK>H(SIr_. ~.~
3CIt.
RTIFIER
"'DlCAL EXAMINER/CORONER
On the basis ot e)faminaUOft ImdlOf' invlts'ig.a.ion. in my opinion, death occurr~ 31t the time, date, and plactt. and due to the cause{s) and
m.nnet' .. ,rated..
11..
RE~TRAR'S StGNATURf ~ER
33 ~~ ~
J:</.:P7/.{ I
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LICENSE N SER G ATE SlGNE'O lMonIh. Day. 'tINt1
J'l,,../I100!{J707- ".. //-'29-99
NAME AND AOQRESS Of" PERSON WHO COMPLETED CAUSE OF DE.ATH
l"em21lT,..",p"", p.'7710"'lf'r-l ~()/L.l::'W~) mP
~'l/.z... T7l.dIVT>i.-tr (l ~I'tc>
032. C/tMp H/~"';, :"ft nOli
:TEFllE~'3't1 /77.5
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"PAONOUNCING ANO CERTIF'fDtG ptt'lsteJAH IPhysoc:...n ~ OJI:JnOuflC'f1g aealh and cerI"yong 10 cause of aeathl
To the ~ of .,..,kl'lOwledgtt. death occurred .t ....1Ime. ~1., M'Ct ptaca, and due 10.... caUMi.) attet "'.nnet _ ."IIN
It.--. aos - .3
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 260601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
ci
I
V
REV-I'D] EX AFP Ul-OQ)
NEILS
425 G ST SW
WASHINGTON
C SORREllS
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-26-2001
SORRELLS
11-29-1999
21 01-0104
CUMBERLAND
00103888
HAROLD
E
Amount Rer.itted
".,DC 20024
: <~ L
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
'REV": i6"ifj-e:3CAFP--fi2':ooY------.*.-iNHERITANc'E--iAX--STAfij;iE-tii-oF'-Accoutif--iE*.------------------ ---
ESTATE OF SORRELLS HAROLD E FILE NO. 21 01-0104 ACN 00103888 DATE 02-26-2001
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-08-2001
PR I NCI PAL TAX DUE: ......................................................................................._..........................................................................................................................
34.58
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-22-2001 AA477924 1.13- 35.72
TOTAL TAX CREDIT 34.59
BALANCE OF TAX DUE .01CR
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .01CR
*
SIDE 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 MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
-
"
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Estate of Paul Robert Shartle, Deceased
Date of Death: 9/19/2001
Estate File No.: 2002-00104
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 X
2. lfthe answer is No, state when the personal representative reasonably
believes that the administration will be complete: The Estate was opened
for litigation purposes. That litigation is still ongoing.
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No
b. Did the personal representative state an account informally to the
parties in interest? Yes No
Copies of receipts, releases, joinders
may be filed with the Clerk of the Orphan's
d approvals of formal or informal accounts
rt and may be attached to this report.
Date: August 5, 2004
~'.J
.'J
0_
Dusan Bratic, Esq.
Name (Please type or Print)
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101 South U.S. Route 15, Dillsburg, PA 17019
Address
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717-432-9706
Tel. No.
Capacity: Personal Representative
X Counsel for Personal Representative
BRATIC AND PORTKO
Attorneys at Law
101 OFFICE CENTER, SUITE A
101 SOUTH U.S. ROUTE 15
DILLSBURG,PENNSYLVANIA 17019
DUSAN BRA TIC, ESQ.
STEPHEN K. PORTKO, ESQ.
(717) 432-9706
(717) 432-2538
FAX (717) 432-9220
August 5, 2004
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013
Re: Estate of Paul Robert Shartle -- 2002-00104
Dear Register of Wills:
Enclosed for filing are an original and one copy of the Status Report for the above
referenced estates. Please return the stamped-in copies in the enclosed self-addressed
envelope.
Thank you.
Very truly yours,
-' ......~
. \ } /~.__..
~-.'<--7:o'>~:~~~~
Deborah L. Graham
Paralegal
DB/dIg
Enclosure
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