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PETITION FOH GHANT (>I" u:rnms 01" ADMINISTltATION
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RCl\lSICI of Wills for thc
CounlY of CUMBERLANU---- In thc
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I'clllioIlCrs..-.. lIi'ter iI proper 'cllruh hil.v.e. ilsccrilllllcd Ihlll dcecdl'llllci't 110 wllIlIlld WlIS surl'lvcd by ,
\lic folhl\I'lllg 'pousc (If lIIlY) lIlld hcir,:
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. _._._JAMES-R.---BANKF,R!L- _..EAT-HER"':".......u..6.45JAW.IMa.RE- PIKE 1.....GARDNERS, PA
'__...JlJllY n RANKER'!' ___MO.'filER----- 6.!l5...BAL.T.lM.ORE PIKE ......GARDNERS, PA
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21. If lIn. 18 II greole' Ihon lln. 19, .nlOl Ih. dlll.,ence on line 21. 1 hll II Ihe T AX DUE,
A. Enter the Inlere1' on the balanco due on line 21A.
8. Enl" Ih. 10101 01 line 21 and 21 A on lIn. 218. Ihl, Illhe BALANCE DUE,
_. _h' ,,__.. /,\ak!..C.h.e~~ll'("b!!t.e I ~..@I..ter_ef. W.III.. .~gent.
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2. Slack I and 80nd, (Schedul. 81
3. Clo.ely Held 510ck/Po,'ne"hlp InlOlOlI ISch.dul. q
4. Mo"goge. and Nole. Recelvobl. (Schedule 01
S. Cash, Bank Dapodh & Mltcollonooul Perlonal Propnrly
(Schedule EI
6. Joln"y Owned P,operly ISch.dol. FI
7. T,on.le" (Schedule G) (Schedul. LJ
8. Tulal Grall Aile" (10101 line, 1.71
9. funeral Exponllu, Admlnhlratlve COlli, Mlscellanoous
E,p.nlel (Scf,edule HI
10. D.b", Mo"goge 1I0blllll.., 1I.n. ISchedul. II
11. 10101 Deducllon. (Iololllno. 9 & 10)
12. N., Volu. of Ellale (lIn. 8 mlnullln. III
13. Chollloble and Governmenlol B.qu,".(Schedule J)
14. Nel Volu. .Subi~cl'o la, (line !~mlnu'~~!2L____
15. Spoulul Tronll." Ifo, dole I of d.olh of 10' 6.30,941
See Instructions for Applicable Percentage on Reverie
Side. {Include value. from Schedule K or Schedul. M.}
16. Amount of LIne I A taxoble 01 6% role
I'nclude volu.. !rom Schedule K or Schedul. M.I
17. Amount of line 14 taKable 01 15% role
ilnclude voluol I,om Sch.dule K or Schedul. M.I
18. P,lnclpal IU' duo IAdd '0' I,om lIn.. 15. 16 and 17.}
19, (redill Spoulol Povorty Crodit Prior Peymonh
t
YEAR
11,~ 1
NUM8ER
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II
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S
+
Remainder Relur"
If 01 dOl.. of d.olh prior 1012.13.821
Federal e.lole Tax Relur" Required
36 South Pitt Street
Carlisler PA 17013
----_._-.---- ----.---.-----------.
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CfIC(~ !.Cffllf VOU ClIO ,etlues'in" CI refund 01 VOUI. oV~lpnv'm'nl
(211
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12181
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.----. _n~~ ~BI SURETO ANS~ER 'ALIQUESTIONS ON RIVIRSE 5101 AND TO RICHECK MATH <( <( .
Under penalties 01 perlury, I doclaro that I hovo oll,ominod this rolurn, Includ/nu w.:companying Ichodule, and lIalemenh, and 10 the besl 01 my knowledge and bellof,
it II Irue, corrocl and completo, I declare thai 011 real 01'010 hfll boen reported ollruo market "alve. Do cia ration of propCHor olher Ihan Ihe plHlonal reprllenlali....e Is
baled on all inlormation of which preparer has Clny knowledgo...----'--
i ~ So~~~;1::~;~Jtr(~~~.:~r~Qr~~\;l(tJ5 Daltim~re' Pik~Ga~dn~~SI P~;;~'24:'''APdL_..L9.95
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'~;J~LL{)/.L2/'vr''')' 36 South pitt Street Ca r 1i sle, PlI .__Ap,rll______l..9..95
J- 17013
RIY,1l0llk. (ll-Ill * l j
SCHEDULE A
eOMIAONWIAU~ 01 PlN~IY>>,ANIA REAL ESTATE
1NHi\ITAN I A~ RI ~R,
_____..____ R I~IN ole 0 N _ ., --
ISTAilolf fiLE NUMBER
___._.-CJ:.Y-B.l:.aL.L.~-BanJrAr:'~ _ . 2194-0729 _'
(Propllty lolntly.ownld wllh Right of Su,vlvollhlp mUlt bl dllclo..d on Schldull '1 All "OllltO'1 Ihould bl "portld 01 fol, ma,kll valul
which I. dlflnld a,'hl prlcl 01 which r.roPlrty would bl Ixchangld bllwlln a willing bUYII and a wIlUng..lltr, nlllhll bllng complllld
!.O buy 0' "II,. bolh having "a.onab I knowlldgl of Ihl "llvan' foci.. .
ITEM
NUMBER
DESCRIPTION
1.
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Of DEATH
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IIV.IJOIUtIU11
*
l SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
PleclIe Print or T e
FILE NUMBER .
2194-0729
COMMONW!~L1H Of P!NNml'~NI~
IHHIRIlAHCI l~X mUIH
IIIIDIHl DICIDINl
ESTATE OF
Crystal L. Bankert
(All pr....'lV 1.lntly..wnod with th. Illhl of Surulu."hlp mUlt b. dl"t...d .n Schodul. PI
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
1 Cash on hand 126.61
2 Cash Refund 28.64
3 Proceeds of survival Action (court Order Attache ) 19,815.00
4 Proceeds of Survival Action (Court Order Attache ) 5,979.21
, '
S 25.949.46
IAIIQ(h addlllonaI8V," )( 11/f thll"l' more .poce h n..d.d.1
Plaintiffs, executors of the estate of Crystal L, Bankert, deceased, are authorized to
discontinue the aforesaid actions and to execute and deliver a good and sufficient release of the
claims of the estate under both the wrongful death action and survival action against Samuel
Carannate and Cosimo Matichecchia, and Allstate Insurance Company and Erie Insurance Group,
respectively, specil1cally reserving the right to bring suit against any other organization, person or
torI feasor who may have liability arising out of the accident, ilvuries and death of Crystal L,
Bnnkel1. deceased, including, but not limited to the right to make a claim for underinsured
motorist benefits under decedent's own automobile insurance policy or any other policy under
which the estate may be able to claim,
J( A',,<-<-v-~ ~-<.u...-?A.r.--" ,.,lj~ j;~i./"'_;:;" "" .~ t'~
,.....-.,.'uJ.<.............,- ,,(j ,.-:...(~,4_ _/
Execution ofa release and payment of the sum of Thirty Thousand and no/IOO
($30,000,00) Dollnrs as afor~said shall constitute evidence of complete satisfaction of claims and
demands of whatsoever kind or nature of the estate of Crystal L. Bankert, deceased, under the
survival action ard also of all persons entitled to recover wrongful death damages as a result of
the aforesaid accident and death of Crystal L, Bankert, deceased, against Samuel Carannate and
Cosimo Matichecchia, and Allstate Insurance Company and Erie Insurance Group to the extent
sel forth above; however, said payment shall not constitute evidence of satisfaction of any claim
against any other person, organization or tortfeasor, as aforesaid,
By the Court,
TRUE COpy FROM RECORD
In Testlmon~' whereof, I here unto set my hand V /I, /
and theseal of said c~ ~ ~~"SIo1 Pa, I S( f\ e v, ",' /c:/. tCZ>::!.
This / '7': day of L,~.a'r 19 ~~
i ~ r:;, , (j _kf.&_, ^'f;t. J,
ProlhonotafY
4, Defendant Samuel ClIl'Unllllte, an IIdull individual who at sllld time resided at 214
Eust King Street, Shippensburg, Cumberlund County, Pennsylvania 17257, but whose present
IIddress and whereabouts is unknown, WIIS the driver of the motor vehicle which struck the
vehicle in which decedent was riding liS II passenger, when defendunt failed 10 stop for a stop sign
controlling his lane of travel at the intersection of Pa, Route 174 (Old York Road) and Pa, Route
34 (Holly Pike),
5, At said time, defendant ClIllInnute maintllined an llutomobile insurance policy
issued by Allstate Insurance Company (Policy No, 077764415), with liability limits for bodily
injUlY in the amount of $15,000.00,
6, Defendant Cosimo Mutichecchia, an adult individual residing at 214 East King
Street. Shippensburg, Cumberland County, Pennsylvania 17257, was the owner of the vehicle
. being driven by defendant Carannate at the time of the a,'cident.
7, At said time, defendant Matichecchia maintained an automobile insurance policy
issued by Erie Insurance Group (Policy No, X07 5503145 H), with liability limits for bodily injury
in the amount of $15,000,00
8. At said time Crystal L, Bankert was a member of the household of James R,
Bankert and Judy D. Bankert, your petitioners, who maintained three automobile insurance
policies issued by State Farm Insurance on three separate vehicles, each with stackable
underinsurance policy limits of$15,000,00,
9. Plaintitl's' counsel hilS been advised that State Farm Insurance has perfonned an
asset check on both Carannate and Matichecchia llnd found that neither party has any collectible
IIssets and that, in fact, the present address and whereabouts of Carannate is unknown.
10, Both Allstate Insurance Company and Erie Insurance Group have offered to settle
the claim against Carannate and Matichecchla, respectively, for $15,000.00 each and plaintiffs are
satisfied that these offers and the proposed selllement are in the best Interests of the estate, are
reasonable and just and are willing to acceplthese offers if approved by your Honorable Court,
11, Plaintiffs have not finalized their negotiations with State Farm Insurance on the
underinsurance claim and, therefor, wish to reserve the underinsurance claim as well as the right
to claim and/or bring suit against any other organization. person or tort feasor who may have
liability arising out of the accident, injuries and death of Crystal L, Bankert, deceased, However,
plaintiffs are willing to release defendant Carannate and defendant Matichecchia, Allstate
Insurance Company and Erie Insurance Group, respectively, upon the payment to them of the
$15,000,00 policy limits from each defendant,
12, Plaintiffs, as the parents and sole heirs of decedent, are the only persons entitled to
recover damages for decedent's death,
13. Petitioners have agreed to pay attorney fees based on 25% of the total amount
recovered in Rny out-of-court selllement of this maller,
14, The total funeral bill for the decedent was $7,685,00, of which $5,000.00 was paid
from the proceeds of funeral bill benefits from automobile insurance coverage, leaving a balance
due on the funeral bill of$2,685,OO,
15, The Pennsylvania Department of Welfare has advanced the total sum of
$34,867,97 for the payment of medical expenses allributable to medical treatment rendered to the
decedent prior to her death, for which the Department holds a subrogation lien as provided in the
"
2, $5,979,21 to the survlvalllctlon to be held by petitioners as an asset of the estate,
10 be distributed as follows:
A. $3,431 ,47to the Pennsylvania Department of Public Welfare to satisfY the
subrogation lien held by said Department for the reimbursement of medical expenses pllid
on behalf of the estate by the Depaltment; and
B, $2,547,74 to James R, Bankert and Judy D, Bankert, administrators of the
estate of Crystal L, Bankert for the payment of the bills and expenses listed In ExllibillC"
aUllched to the petition,
Plaintiffs, executors of the estate of Crystal L, Bankert, deceased, are authorized to
discontinue the aforesaid actions and to execute and deliver a good and sufficient release of tile
uninsured motorist claims of the es'ate under the Erie Insurance Group policy ofCllad B, Hurley
and Ihe State Farm Insurance policies of James R, Bankert and Judy D, Banken,
Execution of a release and payment of the sums of Fifteen Thousand and no/100
($15,000,00) Doliars and Forty.five Thousand and no/IOO ($45,000,00) Doliars as aforesald shali
constitute evidence of complete satisfaction of claims and demands ofwllatsoever klnd or nature
of the estate of Crystal L, Bankert, deceased, under the survival action and also of all persons
entitled to recover wrongful death damages as a result of the aforesaid accidellt and death of
Crystal L. Bankert, deceased, against Chad B, Hurley, as weli as the underinsurance coverages of
Chad B, Hurley IInd ofJames R. Bankert and Judy D. Bankert,
By the Court,
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4, . At the time of the accident, decedent was a passenger In a mot~ v'ehicle driviiii by
Chad B, Hurley, who maintained an automobile insurance polley Issued by Erie Insurance Group
(Policy No, QI0-600294\-H), which policy contained limits of bodily injury liability In the amount
0/'$100,000.00 and underlnsured motorists coverage limits of $\ 5,000,00, as indicated on the
dccllll'l\tion page of said policy, a copy ofwhlch is attached hereto as Exhibit "A" and
incorporated herein by reference,
5, Petitioners, after a review of the accident investigation by the Pennsylvania State
Police, lire satisfied that Chad B, Hurley was not at fault In this accident and that the accident and
resultant injuries and death of decedent Crystal L, Bankert were the direct result of the negligence
or Samuel ClIrannate, and believe that it is in the best interests of the estate to release Chad B,
Hurley from any liability claim in this matter,
6, At said time Crystal L. Bankert was a member of the household of James R,
Bankert and Judy D. Bankert, your petitioners, who maintained three automobile insurance
policies issued by State Farm Insurance on three separate vehicles, each with stackable
underinsurance policy limits of $\5,000,00, as indicated on the declaration page of said policies,
copies of which are attached hereto as Exhibit "B" and incorporated herein by reference,
7. Both Erie Insurance Group (on behalf of Chad B, Hurley) and State Fann
IlIsllrllnce (on behalf of James R, Bankert and Judy D, Bankert) have offered pay the
underinsurance limits in this matter, that is, $\5,000,00 from the Hurley policy and $45,000,00
n'oll1lhe Bankert policies and petitioners are satisl1ed that these offers and the proposed
set tlemcnt are in the best interests of the estate, are reasonable and just and are willing to accept
these olTers if approved by your Honorable Court,
8, Peilti~ners, 'as the par~'nts 'and sole heirs of decedeni','are"ilic'o-rilY'personsenlltled
to recover damages for decedent's death,
9. Petitioners have agreed to pay attorney fees based on 25% of the total amount
recovered in any out-of-court settlement of this matter,
10, The Pennsylvania Department of Public Welfare (DPW) has advanced the total
sum of$34,867,97 for the payment of medical expenses attributable to medical treatment
rendered to the decedent prior to her death, for which the Department holds a subrogation lien as
provided in the Public Welfare Code, as amended by Act 1980-105, 62 P ,S, Section 1409 (b)( 1)
et se,!, and Section 1974 et seq. and the Social Security Act, 42 U,S,C, Section 1396a (25) and
Section 1396k,
II, DPW has agreed to accept the sum of $23,246.47 in full satisfaction of its
subrogation claim, of which petitioners have paid $19,815,00 pursuant to the aforesaid Order of
Court, leaving a balance of$3,431.47,
12, At the time of her death, decedent had bills, debts and other financial obligations as
are listed in the attached Exhibit "C", which sums remain due and owing,
13, Accordingly, petitioners propose to allocate the total sum of $60,000,00 in the
. aforesaid settlement proceeds as follows:
A, $54,020.79 to the wrongful death nction, to be distributed as follows:
1.) $15,000,00 for attorney fees representing 25% of the recovery; and
2,) $39;030,79 to James R. Bankert and Judy D. Bankert, surviving
parents and sole heirs at law of the deceased; and
,
--...-. "~'.
PIONEER FAMILY AU~O
AMENDED DECLA2ATIONS 01 * * EFFECTIVE 09/21/94
ATTACH THIS TO rO~R POLICY.
REASON FOR AMENDMENT
~AUTO 1 REPLACED, LIENROLDER ADDED
AA7638 GREGORY A GARRITY
CHAD II ElURLty
51 MOUNTAIN ST LJT 4
":'j' flOLLY SPRINGS PA 17065-1431.
AGE~T - GREGORY A DARRITY
A~~NT PHONE - (717) 2~3-3'67
IT::!,: 4. AU'!'OS COVERED
f.ll,!,O YR ~IAn
1 91 fORD F-150
10/H~/93 TO lfJ/a/94 Q10 60e1294l' A
.,
AS LI STED BELOW
2621 SPRING ROAD
CARLISLE PA 17a13
t'
VIN ST TER SYM RATING CLASS D~P
1FTErHN3MLA46~97 PA 27 5 C2Y
! ''', ,. ,""RA'CE IS 'Rev'DEn "ERE A "'",UM. OR I Net . IS SSO," fO, '" "
COVERAGE. COVERAGES, LIMITS AND ANNUAL PRiMIUMS ARE ~S FOLLOWS-
Ul
PRIVATE PASSENGER VEBICtES.
-'- TEE LIMITED TORT OPTION APPLIES TO ALL
~!A~!LITT PROTECTION-
=':J;!L'i IfiJURY $100M!PERSON $300M/ACC
PR0PfRTY DAMAGE $10aM/ACC
~i~3! PARTI BENEFITS-
~EDICA~ EXPENSE $10M
!~COME LOSS $lM/MONrR, $5M MAXIMUM
ACCIDENTAL DEATH $5M
i'IJIIl'HH lJENEFIT $2.5M
UN!~SIJHED MOTORISTS COVERAGE-
S~D INJ $15M/PERSON $3~M/ACC-ST^CKED
IJNDERI~SURED MOTORISTS COVERAGE-
~DD !NJ $15M/PERSON $33M/ACC-STACKED
PHYSICAL DAMA~E COVERAGES~
~OM?HE5ENSIVE - $50 DED
COLLISION - $500 DED
~?TIONAL COVERA3ES-
ROAD SEllv ICE
TRA~SP EXPENSES - COM. $23/DAY, $5~0/LOSS
T~ANSP EXPENSES - COLL $20/DAt, $B00/LOSS
;C!)l'l,JS ':.V).ILABLE - SEE
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182
117
33
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~1048AACED~":"'I' "ST!> d~'~COtJNT AUTO RATE QUOTE STD DISCOUNT
QUOTE I 2 1978 FORD G TERR1037 *QUO'l'E I 1 1978 FORD
MCD *MCD
IRGl001 CLllB PREM .IRG100l CL:1B
BIPO 50/100/50 $108.50 'II BIPD 50/100/50
FULL TORT 'II FULL TORT
$10000 $26.74 'II MED $10000
$2500 $.98. F $1500
$5000 $8.54 'II Z $5000
$3.60 'II ERS
$9.10 'II U
$21.10 'II W
$8.10 'II Y
$186.66 *
$341.42 'II
$154.76 'II
HED
F
Z
ERS
U
W
V
50/100
50/100
$25000
NEW PREMIUM
CURRENT PREMIUM
DIFFERENCE -
MONTHLV PREMIUM
PFJ-MODIFYRATE QUOTE
,.
"
" '
"
15/30
15/30
$5000
NEW PREMIUM
CURRENT PREMIUM
DIFFERENCE -
$31.11
MONTHLY PREMIUM
ACCEPT TO, OON']:'INUE .
, '.
PF4-VIEW CURRENT POLICY
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G TERR,: 037
PREM
$108.50 '
$~6.74
$.70
$8.54
$3.60
$7.60
$8.50
$1.80
$165.98
$:141.42
$175.44
$27.66
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~QUOTB' 2 ~985 FORD R TERR:037 1/
*MCD 1/
I/IRG:014 CL:9F PREM *
· BIPD 50/100/50 $280.15 .
. FULL TORT .
HED $68.90 · MED $10000 $68.90 1/
F $2.60 1/ F $2500 $2.60 .
Z ~22.10 . Z $5000 $22.10 1/
COf1P 51. 35 . COMP FULL $51.35 1/
COLI, $165.10 · COLL $250 DED $165.10 .
ERS $2.00 · ERS $2.00 1/
U 50/100 $7.70 . U 15/30 $6.50 .
W 50/100 $16.90 1/ W 15/30 $6.80 *
y $25000 $4,50 1/ Y $5000 $1. 00 1/
NEW PREMIUM $621.30 1/ NEW PREMIUM $606,50 .
CURRENT PREMIUM $724.12 1/ CURRENT PREMIUM $724.12 1/
DIFFERENCE - $102.82 . DIFFERENCE - $117.62 1/
HONTHLY PREMIUM
$103.55
MONTHLY PREMIUM
$101. 08
PF1-VIEW ADDL QUOTES PF3-MODIFY QUOTE PF4-VIEW POLICY ACCEPT TO CONTINUE
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W
COMMONWIALlH 0' P1NNIVWANIA
INHIAIlANCI lAX mUIN
!11IDINlDICIDINl
. " .
SCHEDULE F
JOINTLY.OWNED PROPERTY
UTATIOP
___---9rystal L. Bankert
Join' tenantll"
PILI NUMBIR
2194-0729
NAMI
ADDRIII
---iiiiAiioNIHiiiTO DleiiilNT
..---_....--. .-----.....----..--.-..-.-- _..- .-...-...~--_..- -....--.------.- -.-...--.
A.
NONE
B.
C.
"
Jalnlly..wnod proporty.
If 1M LmlR DATI
POR fOTAL VALUI DieD'S DOLLAR VAWI OP
NUMBII JO'W MAD I DISCRlptlON OP PROPIRTY
TINA T JOINT OP ASSIT % INT. DICIDENT'S INTlRIST
-
1. NONE
,
_.
TOTAL IAI.o .ntlr on line 6. Recopllulallon) S ..n.."
.
(iI more 'pac. II n..d.d In..rt additlona',h..t, 0' lam. lilO)
11\tISlIU."'''I"
t . I .
ITIM
NUMBIR
-
~~
COMMONWIAlTH or "NNIVIVANIA
INHIIIIANCI TAK l"UlN
IIIIDINT DICIDINI
1 SCHIDULI H L
FUNERAL EXPENSES, . .
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES _ Plea I. I'rln' or TVI"
Crystal L. Bankert
DESCRIPTION
2194-0729
. AMOUNT
A. Funeral Expen,,"
1.
Gibson-Hollinger Funeral Home
James N. Bankert - Grave Marker
7,685.00
1,242.00
2.
B. Admlnlltrallve COI'II
I. Perlonal Representative Cammllllons
Social Security Number of PeflDnal Representatlvel
Year Commlulonl paid
4,
C.
.1.
2,
3,
4,
5.
6,
7.
8,
2,
Attorney Fe..
Harold S. Irwin III
1,297.47
3,
Family Exemption
Claimant JiJIlO'i~ Judy R"nkAlRIlatlonlhlp p" rAnt...
Addr.u of Claimant at decedenl's death
Str..t Addreu 645 Baltimore Pike
'2,000.00
City Ga rdners
State PA . Zip Code 17~24
Probate Fe..
Register of Wills
Mlleellan.aul Exp.n.."
Commonwealth of Pennsylvania - Accident Report
Prothontary - Filing Fee
Harold S. Irwin III - Tax Preparation Fee
Register of Wills - Filing Fee
Harold S. Irwin III - Notary Fees
38'.00
.8.00
45.50
50.00 f
25.00
12.00 . I
I
/:
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TOTAL IAllo enter on line 9, Recapitulation) S 12,402.97
(If more Ipaee II n..ded, In..,. addlllonal Ih"'1 of lam. I"',)
"V.1S12 ... 11...11 _tuL._o_
...... ~
COMMONWfA~'H o. nNIl'YlVANI'"
INHUIU,NCI tAX lI1U~
.'IIDINr DICIDINI
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
i: PI.a.. Print ar Tv~.
.ILI NUMIIR
2197-0729
i1TA1i O'
Crystal
,
I
"
ITIM
NUMIIR
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
L. Bankert
DISCRIPTION
AMOUNT
Department of Public Welfare - Medical Lien
(Documentation Attached)
Carlisle Hospital - Medical Bill
Chambersburg Imaging - Medical Bill
RWC Emergency - Medical Bill
Bettina McBeth - Medical Bill
,H. Frederick Martin MD - Medical Bill
Chambersburg Hospital - Medical Bill
ECe of Philadelphia - Medical Bill.
Chambersburg OB-GYN - Medical Bill
American Family Publishers - Open Account
23,246.47
40.00
170,.00
54.00
112.31
30.00
470.50
112.34
65.00
12.95
, ,
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i.
TOTAL IAI.o .nl.r on IIn. 10, Recopltulallonl
III more 'po" I. ni.d.d, Inler' addltiona/.h.." of .am. lire,}
$ 24,313.57
ij
,U~,tIfft'~\;;'l,jo;\II"'f."t.UI\"'U ii'..'" 'q'~"i":"
;' C ,':( .
,i"
,;2/-- 91/- 1.;< 9
Invenlory 01 Ihe real and personal eslale 01
"
, " "
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., ,
crvslaJ.. L. Bankert
deoeased
'" ,. " , '!
1 . Cash on hand 126 61
2. Cash refund 28 .64
3. Proceeds of Survival Action (Court Order Attaohed) 19/815 00
4. Additional Proceeds of Survival Action (Court Oder 5197.9 21
attached)
TOTAL
25,949 46
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,
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
PI
James R. Bankert & Judy D. Bankert
bolng duly. S\olOI'n according to law, dapolll and laYI th.tt h.Y are the administ~~s
-------.-----.--.------.--_. 01 the Eltate 0/ .--C.r..Y.!l.tal L. Bankert
lole of ..-_2.45..J,laJ.!:.Jm9J.".!L~t~.9Etrd__ners , Cumberlend County, Pa" d,p'IIf:d. .nd th.t the
within il an Inventory made by ..J.bem ._ ._.._._" the said administrators
01 tho entire estato 0' uld decedent, con listing 0' all the personal prop'~rty and rill "tate, except r..1 "hte ouhlde
tho Commonwealth 0' Pennlylvanla, and that the /lgurll oppollte IIch Item 0/ the Inventory repre..nt lt'l fair value
as 0' the date 0/ decedent'I duth,
~wnrn t'.n
and lublcrlbed be'ore me,
/~ I\~C~AY ~
....... w:l~) \l. n.rn4GA
DB (J
649 Baltimore Pike, Gard ners PA
Addr...
17324
_ Ae}'il______" 7 , 19 95
-~()-
Date 0/ Death
11
Dey
!!.
Month
1994
rur
INSTRUCTIONS
An inventory mUlt be /1I.d within thr.. month I alter appolrltment 0/ perlonal reprllenta"ve.
A lupplement Inventory mUlt be /lIed within thirty daYI 0/ discovery of addltlonalmeh.
Additional Iheeh may be attached 81 to personalty or rulty
See Article IV, Flduclarlll Act 0/ 1949.
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2, $5,979,21 to the survival aotion to be held by petitioners as an asset of the estate,
to be distributed as follows:
A. $3,431.47 to the Pennsylvania Department ofPubllo Welfare to satisfY the
subrogation lien held by said Department for the reimbursement of medical expenses paid
on behalf of the estate by the Department; and
B. $2,547.74 to James R. Bankert and Judy D, Bankert, administrators ofthe
estate of Crystal L, Bankert for the payment of the bills and expenses listed In Exhlblt "C"
attaohed to the pNition,
Plaintiffs, executors of the estate of Crystal L. Bankert, deceased, are authorized to
discontinue the aforesaid actions and to execute and deliver a good and sufficient release of the
uninsured motorist claims of the estate under the Erie Insurance Group policy of Chad B, Hurley
and the State Farm Insurance policies of James R. Bankert and Judy D, Bankert.
Execution ofa release. and payment of the sums of Fifteen Thousand and no/100
($15,000,00) Dollars and Forty-five Thousand and no/1 00 ($45,000.00) Dollars as aforesaid shall
constitute evidence of complete satisfaction of claims and demands of whatsoever kind or nature
Oflhe estate of Crystal L, Bankert, deceased, under the survival action and also of all persons
entitled to recover wrongful death damages as a result of the aforesaid accident and death of
Crystal L, Bankert, deceased, against Chad B, Hurley, as well as the underinsurance coverages of
Chad B, Hurley and of James R. Bankert and Judy D. Bankert,
By the Court,
. " .. . '.,t.. ")'.:.0"...
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1\1~11::J ~_'~I.ll "';'1 i:r.Jl.li1 ~l {;a,1tmG, P~.
'!\',i. .I!';i~:\....:.I,i::.. ()f{~b"".,t le~yX:'
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' .".... . . f'r':>''lI.r,~Mr'')
lL Kev/n /I. J-Iess
],
4, At the time of the accident, decedent was a pass'enger ina niolOf veliJol; anvCii' liy
Chad B. Hurley, who malntalned an automoblle Insurance policy Issued by Erie Insurance Group
(Policy No, QIO.6002941-H), whJch policy contained limits of bOdily Injury liability In the amount
0/'$100,000,00 and umlerinsured motorists Coveragc limits of$15,OOO,00, as indicated on the
declaration page of said policy, a copy ofwhJch is attached hereto as Exhibit "A" and
incorporated herein by reference.
5, petitioners, after a review of the accident Investigation by the PelUlsylvanJa State
Police, are satisfied that Chad B, Hurley was not at fault in this accident and that the accident and
rcslIilant injuries and death of decedent Crystal L, Bankert were the direct result of the negligence
of Samuel Carannate, and believe that it Is in tho best Interests of the estate to release Chad B.
Hurley O'om any liabllity claim in thJs matter.
6, At said time Crystal L, Bankert was a member of the household of James R.
Bankert and Judy D, Bankert, your petitioners, who maintained three automobile insurance
policies issued by State Farm Insurance on three separate vehicles, each with stackable
underinsurance policy limits of$15,OOO,OO, as Indicated on the declaration page ofsald policIes,
copies ofwhJch are attached hereto as Exhibit "B" and Incorporated herein by reference,
7, Both Erie Insurance Group (on behalf of Chad B, Hurley) and State Fann
Insurdnce (on behalf of James R. Bankert and Judy D. Bankert) have offered pay the
underinsurance limits in this matter, that Is, $15,000.00 from the Hurley policy and $45,000,00
from the Bankert policies and petitioners are satisfied that these offers and the proposed
settlement are in the best interests of the estate, are reasonable and Just and are willing to accept
these otTers if approved by your Honorable Court,
I
.... ':"1
I
,
8, Petitioners, as the parents and sole heirs ofdecedeni~'a;:etlieoilly'pcrsoiis'eriiitled
to recover damages for decedent's death.
9, Petitioners have agreed to pay attorney fees based on 25% of the total amount
recovered In any out-or.court settlement of this matter,
10, The Pennsylvania Department of Public Welfare (DPW) has advanced the total
slim of $34,867,97 for the payment of medical expenses attributable to medical treatment
rendered to the decedent prior to her death, for which the Department holds a subrogation lien as
provided in the Public Welfare Code, as v.mended by Act 1980-105, 62 P,S. Section 1409 (b)(I)
et seq. and Section 1974 et seq, and the Social Security Act, 42 U.S,C. Section 1396a (25) and
Section 1396k,
11. DPW has agreed to accept the sum of $23,246.47 in full satisfaction of its
subrogation claim, of which petitioners have paid $19,815.00 pursuant to the aforesaid Order of
Court, leaving a balance of$3,431.47.
12, At the time of her death, decedent had bills, debts and other financial obligations as
are listed in the attached Exhibit "C", which sums remain due and owing,
13, Accordingly, petitioners propose to allocate the total sum of $60,000.00 in the
aforesaid settlement proceeds as follows:
A. $54,020.79 to the wrongful death action, to be distributed as follows:
1.) $15,000.00 for attorney fees representing 25% of the recovery; and
2,) $39;030.79 to James R, Bankert and Judy D. Bankert, surviving
parents and sole heirs at law of the deceased; and
, ,-.
-.-...-..
PIONEER FAMILY AU~O
AMENDED DECLARATIONS 01 ~ ~ EFfECTIVE 09/21/94
ATTACH THIS TO YOllR POLICY.
REASON FOR AMENDMENT
"AUTO 1 REPLACED, LIENHOLDER ADDED
AA76:~8 GREGORY A GARBITr
10/10/93 TO 10110/94 Q10 600294r' H
,
.,
CHAIJ B HURLEY
51 MOUNTAIN S1' LOT'
")'1' HOLLY SPRINGS PA 1706!H431.
"
AS LI STED BELOW
AOE~T - GREGORY A GARRITY
AGENT PHONE - 1'l17) 2'3-3467
ITEM 4, AUTOS ~OVEkEV
~,U'!'O l'R I'IAU;
1 91 l'OItD !'-150
2621 SPRING ROAD
CARLISLE PA 17013
:i'
""" ,,, 1 "URA", " PROm" "IR> . mHm. OR lNeL. IS 'HOWN EOR THE "
COVtRAOE. COV~R^GES, LIMITS AND ANNUAL PREMIUMS ARE AS fOLLOWS-
VIN ST TER SYM RATING CLASS D~P
lrT~rl'N3MLA'6197 PA 27 5 02Y
--. TEE LIMITED TORf OPIION APPLIES TO ALL PRIVATE PASSENGER VESICLES. __.
~!A~!LITY ~nOTECrION-
~":'!)!LY If/JURY $l00M/PERSON $300M/ACO
PROPERTY DAMAGE $103M/ACC
rl~S! 2AHTT ~!NErIIs-
~EDJC^! EXPENSE ~10M
!~;(:O~lE LOSS .lM/t101J1'H, $BM MAXIMUM
ACCIDENTAL DEATH $5M
rUNrHAL hENErIT $2,~M
UNI"SU?EU MOTORISTS COVERAGV-
S~D INJ $15M/'ERSON '3~M/^CO-STACKED
UNDEHINSURED MOTORISTS OOVERAGt"
bOD INJ $15M/PEHSON '33M/ACC-STACKED 13
PHrSICAL ~AMA3E COVERAGES- .
CCI1J'HEHENSIVJ: - ~50 DED 119 I;
COJ,! 1" OH - I'" '" >1, ;:
""0'" '0",.",_ r
ROAD stRVl" 5 r
TRAH5P EXPENSES - COM' $23/DAY, $aZ0/LOSS 3 it.
Tr:I,,'I~j/' j;XPl~NSES - COLt $20/DAY, $B00/LOSS 11 I
(:.}
iOTAL !dl/IVAI. I'REMIUM FOR EACH AlITO 107~ 1'1
!'VTI.!. A/I/IUA!. POLICY PREMIUM $ 1,07~ I:!
,,"'" 'J'l 'm AL co ^"" '" 10 "IS "AN" I "SEE 'EV'", INVOICE sit"
,I" '., ml'!CADlI: 'OLJe,. ""RstH"". EXCEPTIONS TO ""'''''0", ITEMS 11i
,I J, '.:"",' , FA' "/91, ^"U" "I", """ "I". """ "I". UN,,, "~,,,
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264
1112
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117
33
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,COU~rs AVAILABLE - SEE ENCLOS'D FORM UF-5853
tU~_~lIfl 1
-
......-....,...,
S1048AACEDK STD DISCOUNT AUTO RATE QUOTE STD DISCOUNT
QUOTE I 2 1978 FORD G TERRl037 ~QUOTE # 1 1978 FORD G TERRl037 w
HCO ~MCD '"
IRG:D01 CL:18 PREM "'IRGI001 CL:18 l'REH w
l.lIPD 50/100/50 $108.50 '" 8XPO 50/100/50 $108.50 w
FULL 'rORT '" FULL TORT '"
/olEO $10000 $26.74 '" HED $10000 $26.74 '"
P $2500 $.98 '" F $1500 $.70 '"
2 $5000 ~8.54 '" Z $5000 ~8.54 '"
ERS 3.60 ~ ERS 3.60 '"
U 50/100 $9.10 '" U 15/30 $7.60 '"
l~ 50/100 $21.10 '" W 15/30 $8.50 '"
y $25000 $8.10 '" " $5000 $1. 80 '"
NEI~ PREMIUM $186.66 '" NEW PREMIUM $165.98 '"
CURRENT PREMIUM $341. 42 '" CURREN'l' PREMIUM $341.42 '"
DIFFERENCE - $154.76 '" DIFFERENCE - $175.44 '"
140WrHLYPREMIUM
PF3-140DIFY RATE QUOTE
$31.11
MONTHLY PREMIUM
$27.66
PF4-VIEW CURRENT POLICY
ACCEP~ TO CONTINUE
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S104BAACEDl< STD DISCoUNT AUTO RATE QUOTE STD DISCOUNT
QUOTE , 2 1978 FORD G TERRl037 "'QUOTE , 1 1978 FORD G TERRl037
MCD "'MCD
IRG:OOl CL:1B PREM "'IRG1001 CL:1B PREM
BIPD 50/100/50 $108.50 '" BIPD 50/100/50 $108.50
FULL TORT '" FULL TORT
MED $10000 $26.74 '" MED $10000 $26.74
F $2500 $.98 '" F $1500 $.70
Z $5000 t8.54 '" Z $5000 ~8.54
ERS 3.60 '" ERS 3.60
U 50/100 $9.10 '" U 15/30 $7.60
W 50/100 $21.10 '" W 15/30 $8.50
'I $25000 $8.10 '" Y $5000 $1.80
NEW PREMIUM \186.66 '" NEW PREMIUM ~165.98
CURRENT PREMIUM 341.42 '" CURRENT PREMIUM 341.42
DIFFERENCE - 154.76 '" DIFFERENCE - $175,44
MONTHLY PREMIUM
PF3-MODIFY RATE QUOTE
$31.11
MONTHLY PREMIUM
$27.66
PF4-VIEW CURRENT POLICY
ACCEPT TO CONTINUE
Plaintiffs, elCecutors of the estate of Crystal L, Bankert, deceased, are authorized to
discontinue the aforesaid actions and to elCecute and deliver a good lInd sufficient release of the
claims ofthe estate under both the wrongful death action and sUlVival action against Samuel
Car ann ate and Coslmo Matlchecchla, and Allstate Insurance Company and Erie Insurance Group,
respectively, specifically reselVing the right to bring suit against any other organizl:tlon, person or
tortfeasor who may have liabiHty arising out of the accident, injuries and death of Crystal L,
Bankert, deceased, including, but not limited to the right to make a claim for underinsured
motorist benefits under decedent's own automobile Insurance policy or any other policy under
which the estate may be able to claim,
.J( .-/'''-<~ ~^.-Uv?'~-<' ~. ~jt:. ;;""'l ..t:.- r-
c~......... ~ /.....t:.;d-A..'./
EKecution ofa release and payment of the sum of Thirty Thousand and no/100
($30,000.00) Dollars as aforesaid shall constitute evidence of complete satisfaction of claims and
demands of whatsoever kind or nature of the estate of Crystal L, Bankert, deceased, under the
survival action and also of all Fersons entitled to recover wrongful death damages as a result of
the aforesaid accident and death of Crystal L. Bankert', deceased, against Samuel Carannate and
Cosimo Matichecchia, and Allstate Insurance Company and Erie Insurance Group to the eKlent
set forth above; however, said payment shall not constitute evidence of satisfaction ofany claim
. against any other person, organization or tortfeasor, as aforesaid,
By the Court, .
TRUE COpy FROM RECORD
In Testimony whereof, I here unto set my hand
and the seal of said C al Carlisle, Pa.
Thl '1~ day .of 19~
ProthonollrY
I J( )::...., ",' /J, d:.r::s
],
4, Defendant Samuel Carannate, an adult individual who at said time resided at 214
Easi King Street, Shlppensburg, Cumberland County, Pennsylvania 17257, but whose present
address and whereabouts Is unknown, was the driver of the motor vehicle which struck the
vehicle in which decedent was riding as a passenger, when defendant failed to stop for a stop sign
controlling his lane of travel at the intersection ofPa, Route 174 (Old York Road) and Pa, Route
34 (Holly Pike),
5. At said time, defendant Caraonate maintained an automobile insurance policy
issued by Allstate Insurance Company (Policy No, 077764415), with liability limits for bodily
injury In the amount 01'$15,000,00,
6, Defendant Cosima Matichecchia, an adult Individual residing at214 East Klng
Street, Shippensburg, Cumberland County, Pennsylvania 17257, was the owner of the vehicle
, being driven by defendant Carannate at the time of the accident,
7, At said time, defendant Matichecchia maintained an automobile Insurance polley
issued by Erie Insurance Group (Policy No. X07 5503 145 H), with liability limits for bodily Injury
In the amount 01'$15,000,00
I
8, At said time Crystal L, Bankert was a member of the household of James R.
Bankert and Judy D, Bankert, your petitioners, who maintained three automobile Insurance
policies Issued by State Farm Insurance on three separate vehicles, each with stackable
underinsurance policy limits of'$15,OOO,00.
9, Plaintiffs' counsel has been advised that State Farm Insurance has performed an
asset check on both Caraonate and Matichecchia and found that neither party has any collectible
assets and that, In fact, the present address and whereabouts of Caraonate Is unknown,
'I,"
'-
10. Both Allstate Insurance Company and Erie Insurance Group have offered to settle
the claim against Carannate and Matichecchla, respectively, for $15,000,00 each and plalntiffs are
satisfied that these otTers and the proposed settlement are In the best interests of the estate, are
reasonable and Just and are willing to accept these offers if approved by your Honorable Court.
11, PlaintitTs have not finalized their negotiations with State Farm insurance on the
underinsurance claim and, therefor, wish to reserve the underinsurance claim as well as the right
to claim and/or bring suit against any other organization, person or tortfeasor who may have
liability arising out of the accident, injuries and death of Crystal L. Bankert, deceased. However,
plaintitTs are willing to release defendant Carannate and defendant Matichecchia, Allstate
Insurance Company and Erie Insurance Group, respectively, upon the payment to them of the
$15,000,00 policy limits from each defendant,
, f'
i
I,:
I ,
12, PlaintitTs, as the parents and sole heirs of decedent, are the only persons entitled to
recover damages for decedent's death,
13, Petitioners nave agreed to pay attorney fees based on 25% of the total amount
recovered in any out-of-court settlement ofthls matter,
, ,
I., '
I ~
14, The total funeral bill for the decedent was $7,685,00, of which $5,000.00 was paid
from the proceeds of funeral bill benefits from automobile insurance coverage, leaving a balance
due on the funeral bill of$2,685,QQ,
, ,
.
15, The Pennsylvania Department of Welfare has advanced the total sum of
$34,867.97 for the payment of medical expenses attributable to medical treatment rendered to the
decedent prior to her death, for which the Department holds a subrogation lien as provided in the
I'
"
"
~REV01547 EX AFP (12094_
C~A1TH OF rEHNSV1VAHIA
DEPA!TItEHT OF REVEIM
.UREAU OF IHDIVIDUAI TAMES
Il€Pl, IInOl
HARRln~Q, PA 1712'-0601
/L/'~~()~/J,
(Y
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
ACN 101
DAT! 07-31-95
FILE NO.
DATE OF DEATH 08-11-94 COUNTY CUMBERLAND
NOTE 1 TO INSURE PROPER CREOIT TO VOOR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX
PAVHENT TO THE REOISTER OF WILLS. HAKE CHECK PAVABLE TO "REOUTER OF WILLS, AOENT"
REMIT PAVMENT TOl
HAROLD S IRWIN III
36 S PITT ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
f
AIIOunt R.Mlttld
l
CUT ALONG THES LINE ~ RETAIN LOIIER PORTION FOR YOUR RECORDS ~
iiiV': i5ijj "iiC"'\F if"! i2: 94r- iiifr"i or "OP"INiiiiii f Aifcc""fA'x. 'APPitA"i iiM EiiT~" "AtrOWAN-ci. OR..."" no".."...""
DI~ALLOIIANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BANKERT CRYSTAL L FILE NO. 21 94-0729 ACN 101 DAT! 07-31-95
TAX RETURN WAS, 1 X) ACCEPTED AS FILEO
I ) CHANGED
RESERVATION CONCERNINO FUTURE INTEREST 0 SEE REveRSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l E.tot. ISch.dul. A) (1)
~. stock. ond Bond. (Sch.dul. B) 12)
5. Clc,"ly H.ld Stock/Plrtn.r.hlp Intlr..t ISch.dul. C) (5)
4. Hortgog../~ot.1 Rlcllvobl. ISch.dul. D) (4)
S. C..h/Bank D.po.lt./HI.c, P.r..n.l Proplrty (Sch.dul. E) (S)
6, Jointly OWn.d Proplrty (Sch.dul. F) 161
7, Tr...flr. ISch.dul. 0) 171
e. Totol hl.to
.00
.00
,00
.00
251949.~
.00
,00
Ie)
25,949.46
APPROVED DEDUCTIONS AND EXEMPTIONS I
12,402,97
9. Fun.rll E.p.n.../Ado. Co.t./HI.c, E.p.n..1 ISch.dul. HI (9)
10. Debh/Hcrtglg. Llobllltl../Llon. (Schldul. I) lID) 24,313.5l.
11 , Tctol D.ductlcn. 111)
12, Hit VIlu. of To. R.turn (2)
15, ChorUlbl./Oovlrnn.ntol a.qu.lto (Sch.dul. J) US)
14. N.t V.lue of E.t.to Subjlct to T.. (14)
NOTEI If In 1l.....II.nt w.. iI.u.d pl,.dou.1Y, 11n.. 14, 15 .nd/or 16, 17 .nd 11 will
r.f1.ct f1gur.. thlt includ. the total of ahh r.turn. .......d to d.t..
ASSESSMENT OF TAXI
15, AlOOIHlt of L1n. 1<l .t SpoulIl r.to lIS)
16. Anount of Lln. 14 t...bl. .t Lln..l/Cl..1 A r.t. (16)
11. AMOunt cf Lln. 14 t...bl. .t Coll.tlr.l/Cl.l. a r.t. (17)
lB. Prlnclp.l T.N Duo
TAX CREDITS I
PAVHENT
DATE
36.716,~
10,167,08-
,00
10.767.0B-
.00
.00
,00
X .03_
X ,06_
X ,15_
118l
,00
,00
,00
,00
RECEIPT
NUHBER
DISCOUNT 1+)
INTEREST I")
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTlREST
TOTAL DUE
.00
,00
.00
.00
. IF PAID AFTER DATE IHDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TDTAL DUE IS LESS THAN '1, NO PAVHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), VDU HAV BE DUE
A REFUND. SEE REVE'SE SIDE OF THIS FORH FOR INSTRUCTIONS.)
III .~. .'(
, I,') "'iJ..
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&:l.t: F' dO
REHRVATJOHI rlbtll of dIoedlnt. dylnt on or blfor. 0.0...,. U, 1912 .. If IInW future Interllt In the ..twt. 11 ,r",.flrred
In pa..I..lon or enjoVHnt to CStIl I (ooU,.,r.U beneflo!"... 0' thl Mo~t IU,r the Iwp.r.Ubn 0' MY ..tltt for
11" or 'or v..r., thl C~llth hereby IMPrl..lv r...rv.. the right to eppr,I.. and ...... tr""',r Jnhlrlt~. riM"
It thl l.w'ul el'" I (0011",r,1) r.t. on any IUGh future Int.r....
PURPOSE Of
HOnCEI To fulfIll the rlqulrlHntl of ItoUon 2UG of thl Inherltlncl ana E.t,t_ TIM Aot, Act 2Z of 1"1. 12 P.'.
Soc\lon 11\0,
PAYMENT, OItech the top portion 0' thh HotlCI Ind Il.tMIJt with your Ply.."t to th:l Righter 0' Willi printed on thfl rlVlr.1 tide.
..H.... ,,,",,~ or .OM' order p..oIll. 101 REGISTER GF MILLI, AGENT
All PIVlentl recllvld ,hall '.rlt be ",It,d to any lnt.r..t which ..y bt due with Iny ,....Indtr IPPlled to the t..,
RE'UND (CR)I A "food of I tlM crldlt, which "I' not r"",.tld on thl Te. Rlturn, IIV be r.quutld bv callPl.tlnl In "Applloltlon
far Alfund of Penn.vlvIMI. InherltlnO' and E.tlte TIM" (RfY-1S1S). Applloltlon. Ir. IVlllabl. It thl OffiCI
of thl AII..ttr of Willi, MV of the n A,venue DhtrJat Off Jell, or bv CIUJng thl .plaJII U-hour
In.WlrJng ..rvlol nUlblr. for fori' order I",! In renn.vlvanJI 1-100.362-2010, out.l~ Pennlvlvlnll ~
within 10011 Hlrrhbur. Ir.. (717) 717.IOM, TOOl (711) 772"2252 UMarlng 1..lred DrIly),
OIJECTIOHII Anv Plrtv In Intlrl.t not .,tlofled ..Ith thl eppr.I...-nt, Illa..tne. or dl,lllo..1n01 of deductlonl, or 1.lllllent
of tlx Unoludlng dhcOU'It or Jnhr'lt) II .hN1 on thh HotlOI ...t obJlOt within IIxtv (60) d'VI of recllpt a.
thh Hotlel bVI
-...rlttln prot.,t to thl PA OIp,rtaant o' AIVenut, 10lrd o. AppI.I" D.pt. 211021, H.rrl.burg, PA 17121-1021, OR
...l.otJon to hev. thl .Itt.r det.rllned .t IUdlt of thl acoount o' the Plr.onll repr..antltlv., OR
--IPPIII to thl Orphln.' Court.
AllIIIH
ISTRATI\I!:
CllRRliCTlOHI.
FlGtuII .rror. dllcov,rld on thll .....Ilent .hould be Iddr'l.td In ..rltlng tal PA OIplrtaent of A.venua,
lur'llJ of Indlvldull T.x.I. ATTNI Po.t A.....llnt Ravl... Unit. Dept. 210601, H.rrllburg. PA 1712&.0601
Phone (717) 717-6S05, 1M Pili 5 of thl bookl.t "Inttructlon. 'or InhtrltlnCll 'I. A.turn for. Ruldent
Dacldtnt" UtEV-1S0lJ for an Ixpllnatlon of "*Inlttrltlv'lv corrlcttbll "rort.
IHTERf:ST .
If anv tl. due I. Plld within thrM (5) clllnd.r ~th. ..t.r the dlc.d.nt', delth. I flv. plrclnt (SX) dl.count 0'
thl tl. p.ld II Illowtd.
Intar..t It charted btglmlna with flrat d.v o' cMlInquancy, or nine (9) IIOnthl end ant (1) dav frOl the dltl a.
death, to the data a. PIVHnt. TlMII which btc.. dtlUnquent befora Jonuarv 1, 1912 btlr Interllt .t thl rltl o. '
II. (6X) p.roent plr annul o.lculltld .t a dlllv rltl O. .000164. All tl~I' which bee... dlllnquent on and I't.r
Januarv I. 1912 ..111 blar Int.r..t It . ret. Nhlch will v.rv frol c.l.ndlr v.ar to cllendar v'lr ..lth th.t rlt.
announced bv the PA Dtplrtaent o' A.vtnUl. The appllcabll Int.r..t rat.. for 19.2 through 1995 Irll
OIICIlIItT.
'!!!! Inter..t Alt. OIUV Inttr..t~ !!!! Inter..t Aata Olth Inter..t Factor
1.11 2U .0001\1 1917 'X ,0001\7
1911 16X .000\11 1911-1"1 m ,000101
1.14 IIX .000101 1991 'X ,0002\7
1911 UX .000116 1991-1994 /X ,0001'2
1916 lOX ,0001/\ 1"1 'X ,00DU7
--Intar..t It calculated II 'ollowI!
IHTEREST . BALANCE OF TAX UNPAID X NUKlEI OF DAVS DELINqVENT X GAILV INTEREST FACTOR
"'Anv HoUc. luutd Iftlr thl tl. blOOMI delinquent ..Ul raUlat an Intarllt cllculaUon to flft"n US) dIVI,
blVond the dltl a. thl ......IInt. If p,v,,"t II lid. aftlr thl Int.r..t coaput.tlon dati lhewn on the
Hotlc., IdcUtJonll lnter..t ItUlt bl calcullted.