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No. 21 - 96 - 57B
Estate of
DOROTllY HENRY
. I)cccuscd
I)l~CREE OF 1)IWnATE ANI) GRANT 01' I.ETTERS
AND NOW JUL Y 9. II} 96_. in considcrution of Ihc pctilion on
thc rcycrsc sidc hcrcof. salisfaclory proof having hccn prcscntcd hcforc mc,
IT IS DECREED Ilullthc inslrllmcnl(s) datcd OCTOBER 70, 1984
dcscribcd thcrcin bc admillcd 10 probalc and filcd of rccord as Ihc laS! will of
DOROTHY 1 HENRY
TESTAMENTARY
DONALD TRITTLER
and LCllcrs
arc hcrcby gram cd 10
71ff[(2 fi~f!n
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. .,' -Uuro i!O/i~ t . (
Resh'e, of Will, ~
MARY C. LEWIS
FEES
Probatc, LCllcrs. Etc, ,,',"'" $ 25.00
Short Ccrlificalcs(2 ) " , , , , " "S 6.00
~C~lIncialion ................: 5,00
TOTAL _ S 36.00
Filcd ,," ~~,L,X, ~'" ,1~~?"""""""",
i\T10RNE\' (Sup. Ct. 1.0, No,)
Al>l>RESS
PIIONE
Mailed letters and order to attorney on 7-10-96,
PETITION Hm PIWIIATE llnd <alANT OF I,ETTEllS
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Ih'vi,rer 01 Wilh 1m Ihe
/)l'n'owt!. <. 'Utllll\' of ~ ,_. _.__... ___~_._ i,{ the
('ollllriollweallh of I'l'lIl1,yl,allial
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Ihl' pelillo ollhl' IIlull'l...i~Ill'd Il....pl'l.lltlll~ Il'Pll"l'lIl... Ih;ll: //
Your pl'tiliolll 'I, \\110 j... ill..' IS ~l'al" 01 a.!l' 01 u(tlt.'! alllhl'l'\l'1.:1I1 ._ _________,L___. named
inlhl' la\' \\ illl,r I . "h,nl' dl'l'l'lklll. dalf.,'d , )9_
ami <<ulkill,) dalel ~.______..
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Il'lHllhl,llillll. dc.nll llll''''dllur, l'll',1
Ikt..'l'lIdl.'1l1 \\la'" lhHlli..:ih.'d all 'alh in . _ _____ ____________._~_ --_1 ('Ollltt)'. Pennsylvania, with
11____ ____ I'l"jdCIH.:'l' al _.____ .____ _ ________..~__._
Decelldelll, IlIl'lI .~a ~.
al _________._
F\\.:l'l'l ", hllhl\\', lh:~c:dl'1I1 did nOll11arry. \\a\ Illl1 di\'Ofl'!.'{ and did nOI ha\'c a \:hild born or adopled
aflcr l'\I.'l,.'lllion of 1111.' will ollL'll"u ror prnhall'; \\:1\ lI\lltlu: v' lill1 of a killing and was ne\'er udjudicatcd
illi.:mllpl.'ll.'lll: _~__~_~_~_~_________~~_ ___~~ ____"
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I>cl'l.'lUh..nt al ul'ath n\\lll'u prnpl.'T1Y with l.',till1atl.~'illY::' a... follow\:
(If dOlllicikd ill I'a,) "1I1",r""1:I1 properr...
(If nol dOllliciled ill I'a,) I'er,ollal properry in \"I,yll'ania
(II nol dOllli"lkd in POI,) l'e"'lIIal p"'perry in Co'li,"Y
\'a1ul.' \11' r\."all.....lal\." in Pl'm)...~hallia _ \
,irnat,'d ", folio",: __ _ ___ ~_u __~____ _____~
\\ III.KI:1 l)K!:, peli,;one"" r",pe~;I~;II(~Cl~"';;~~-;'~::-~~' the la'l will and codicil(s)
pr\.""'l'l1ll.'d Iu,.'rl.\\ith and Ihl' ~rant of klltJ<------ ________~
/ ' 1!\.',I,lllll'l1I;tn; ..llmll11'1 .11H11l ~.L".: ihlmilll\lriUhm d.h.n.....t.a.)
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..._._._.___._ _________.19
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OATH OF PEllSONAI. I(EPRESENTATlVE
CO:\l\lO:\ 'EAI.TII OF l'E:\:'iS\'I.\'A!,;IA I
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COl' :'iT\' OF _______________ ____
-I III.' 1'1.' IhUlI..It" ahllH'-l1aml.'d "\l'.III"') or aflinn(\) Ihat Ihl' ...tatl'l11l'l1I\ in thl.' foregoing pelitioll a~
lilli,' .!lll \.',HtI.\:llo IIIL' hL....I"III1L. kno\\kdl!l" and hdil'l' of pl.'litionl.'r(\) and thai as pl.'rsonal rcprescn.
laliH'(' ,11 Ihl.' ahn\l. \k',:L',klll pl'lilhlltL'r(\) \\ ill \\\.'11 and ITtlly adl1linbtl'r l11L' estate according to law,
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WARNING: Ills II10gnll0 dupllcnle Ihls copy by pholoslnl or phologrnph,
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COMMONWEALTN OF PENNSYLVANIA' DEPARTMENT OF NEALTH . VITAL RECORDS
CERTIFICATE OF DEATH
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I. Female
OAlE DlIlInIl
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Jan 14,13 r Carlisle, Pa
CITY.IOAO.IWPOIOlAlH 'ACIJIl'HAUljll............\t'4....,.,_,
C.um~rbnd County Nursin.j
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375 Claremont Drive
Carlisle, Pa 17013
Middlesex
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""ORMAHI"IoWUNOAOON:U.sn..~ a...lf'c.-.
731 15th Street New CUmberland Pa 17070
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ril 4, 1996
UCllf5l HUUKR
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ShiraMnstown Pa
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8G5 - 96 - ~G
21 - 96 - 528
REGISTER OF WILLS OJ,' COUNTY
" OATH OJ,' SUnSCRIIUNG WITNESS
"
',,-
codicil
(each) a subscribing whness 10 e will presenled herewith, (each) bei
law, depose(s) and say(s) Ihal
duly qualified according to
present and saw
Ihe testat , sign the same and that
request of test at_ in h_ presence and (in t
other subscribing whness(es)).
signed as a witness at Ihe
resence of each other) (inlhe presence of the
Sworn to or affirmed and subscribed be~
me this dllY of
/
9_
Register
(Nume)
(Address)
/
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REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
being duly qualified according 10 law, depose(s) and say(s) Ihat
familiar whh the signature of DOROTHY I HENRY
X<<<AiJ(i1
will
~K) a subscriber hereto, ~KilQ
SHE IS
testat~ of
presented herewith and
cll,xi'tH
belie\'es the signa lUre on the will is in the handwrhing of
thai
~YJ<)Idjj(~Kl(X~IIHil~x)(~~lQX~XX.x) the
SHE
DOROTHY HENRY
to the best of
HER
knowledge and belief.
(fI - _.!}ILlu;;.
/Nume) , .
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(Address)
Sworn to or affirmed and subscribed before .~(l.? ,,:t,,
me this day of ~
9~.:! a',"tl'..;:",.I(
-vryf') ~1 ,~
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Register '. (/
(Nume)
(Address)
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CERTIFICATION OF NOTICE UNDER RULE 5.6Cal
Name of Decedent: Dorothy T. Henry
Date of Death: March 31, 1996
Will No. Admin No,: 1996-0052R
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(al of the Orphans' Court Rules was served on or mailed
to the following beneficiaries of the above-captioned Estate on
October 9. 1996:
Name
Donald T. Rittler
Address
731 15th Street. New Cumberland, PA 17070
Notice has now been given to all persons entitled thereto under
Rule 5.6(al except No exceptions
Date: October 10, 1996
, ~ LA(4-AJL! y#/\
SJ.gna ure
Name Richard C, Rupp
Address The Waaner Buildina
355 N, 21st Street
suite 303
Camp Hill, PA 17011
Telephone C7171 761-3459
Capacity:
Personal Representative
Counsel for persona~Jf~presentatiye
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NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Dorothy I. Henry, deceased,
No, 1996-00528
TO: Donald T. Rittler
731 15th Street
New Cumberland, PA 17070
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below, You may
have a beneficial interest in the Estate as follows:
The entire Estate
Name of decedent: Dorothy I. Henry
Last known address of decedent: Cumberland County Nursing Home
375 Claremont Drive
Carlisle, PA 17013
March 31, 1996
Cumberland County Nursing Home
375 Claremont Drive
Carlisle, PA 17013
County of grant of original letters: Cumberland
Decedent died testate.
Date of death:
Place of death:
Name(s), address (es) , and telephone number(s) of all personal
representatives appointed:
Donald T. Rittler
731 15th Street
New Cumberland, PA 17070
(717) 774-3785
Name(s), address(es), and
Richard C. Rupp, Esquire
telephone number(s) of all counsel
The Wagner Building
355 North 21st Street, STE 303
Camp Hill, PA 17011
(717) 761-3459
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Signature v ,
Name Richard C, Rupo
Address The Wagner Building
355 N. 21st Street. STE 303
Camp Hill. PA 17011
Telephone (717) 761-3459
Date: October 9, 1996
Capacity:
Personal Representative
Counsel for personal representative
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COMMONWIAUH Of PINNUlV.&NIA
DIPAUMINl Of IIVINUl
Ol" 210001
HAUISlURO.'.& 171'11.0001
OICEOINn NAMllLAU. IIIU. AND MIDOLt INIlIAII
l-tr:;tJp., D~/l.cT1 r
'OCIA~ $leu lilT NUMllt
lCiI 18 J2.~'7
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.01 OATIS a. DIAtlt Ami ,1~/31191 CHIck Hilt
If A SPOUSAL II 4..- ___ .~ '.J.I J
POYlltT CIIDIr IS CLAIMID 0
flU NUMIII
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
'1'-'
YEAR
D5";l.<('
NUMBER
'2.1
COUNIY CODE
D.&II 01 11IUl
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AMOUNI II((lV(O 1$11 lultlluClIONltl
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li] 1. Original R.turn
o 2. Supplem.ntal R,turn
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R.maind.r R,tu,n
(fa, dot.. of deolh pria, to t 2.1 3.821
Fed.rol EUOI, Taa R.tu,n R.quir.d
T010l Numb.r 01 Sol. D.polit Bou.
181
II C. G, IG,
o .t. limil.d Estot. 0 40. Fulult Inte,e.. Comp,omi..
(for dol.. of d.o,h oh.r 12,12,821
S 6. DIC.d.nt Oi.d T..lot, 0 7. O.c.d,nl Moinloin.d a living TrUll
(Anach copy of Willi (Attach copy of T,ulI)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
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1. Rool E.lo'. (Sch.dul. AI 11 I
2, S,oc,. ond Bond. (Sch.dul. 61 (2 I
3. Oo..ly H.ld Sloci/Partn.nhip Inl.r.., (Sch.dul. q ( 3 )
4. Mongag'. and Not.. R.c.ivobl. (Sch.dul. D) I .t J
5. Cash. Bani C.po.ill & Milcellaneou. P.r~onal P,op.rty ( 5 )
(Sch.dul. EI
6, Jointly Own.d Prop.rty (Sth.dul. F) (61
7, Trond... (Sch.dul. GI(Sch.dul. L) (71
8. TOlal G,on Au." (Iolellin.. 1.7)
9. Fun.rol E.p.n..., Admini'lrolive Co.". Mileelloneou. (Q 1
bp.n... (Sch.dul. HI
10. D.bll, Mortgage Uabilititt, li.ns 15ch.dule II 110)
11. Total D.ductions (tolollin.. 9 & 10)
12. Nil Valul of Eliot. (Une 8 minus line 11)
13. Choritabl. and Governm.ntol Bequ.", (Sch,dul. JI
14. N.I Valu. Subj.ct 10 TOllllline 12 minUI line 13)
15. Spousal Trans',rs (for dot.. of death oh.r 6.30.94'
S..lnltruction. for Ar,p!icoble Percenloge on R.nn. (151
Sid.. (Includ. valun rom Schedule K or Sch.dul. M.l
16. Amount of lint ... toaabl. 01 6% rote (161
Ilndud. va lUll from Sch.dule K or Sch,dule M.I
17. Amount of lint 14 laaobl. 01 IS% lole nil
(Includ. valu.. from Sch.dule K or Sch.dule M.I
18. Principal lox due (Add loll. from lin.. 15. 16 and 17.)
19. C,edill Spou.ol Pon,ly Credit Prio, Paymenll
+
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(161
(19)
120)
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20. If lina 19 is graollr than line 18. enler the diff"ence on line 20. Thi. i. Ihe OVERPAYMENT.
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21. If line 18 is greal" than line 19, enter the difference on line 21. Thi. is the TAX DUE.
A. Ent.r th. 1""r..1 on Ih. balance due on line 21 A,
B. Enl., th.lotol of lint 21 and 21A on line 218. Thil is Ihe BALANCE DUE.
Mak. Chell Payable to: R.gllt.. of Will.. Agent
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-<
Ch.ele her. If you are ,.queltlng a ,.fund of your ov.rpaym.nt.
(211
(21A)
(21BI
Under penolli.. of perlury, I d.clor. .hat I ho...e uom,ned Ihi. return. Including accompanYIng achedul.. ond Ilatem,nll, and 10 the bell of my knowl.dge and belief.
il il true, corr.d ond compl'I', I d.t1arfllhot all rt'ol e.lal. hat bun reportea 01 !rue markel ...olue. Declaration 01 prep or., olher Ihan Ihe p,"onal rep'...nloh.... II
bOllld on 011 informallon of which preporer has ony "nowl.dqe.
IUI( 01 'U~Ot4 '(VOtf~I'l( 101 "liNG InUit. ACC'H~ OAt( .
(l ~,' " 'r;;-'/I-' 15''' SINn; CUMf'LIl..I-I\f.Jj) l'^, 17D7C /::.rJ '-/-I'If7
!lIGr.,l,UIE 01 "('Alfl Ott41' '~At4 .f,lrntt',lfIJf A[)P&I ~~ I CAf('
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Last Will and Testament
UlI/IIurriecllllclil'iclualll'illt Dill' Belleficiary
I. .- ~ 1< C + I., J -L \ -\ ,0 ,- I ~ ") pre~ently re~iding at
.:1 (.(1 <: ' r~ t"7. ". . -, - S'-r , ,1-1 ,., ," ,-: -- ,.. ,.", r? .
do hereby make. publi~h and declare Ihi- 10 he my La'l Wlil and Teslameot and ho hereby revoke any and
all other Will> and Codicil> heretofore made by me,
First. I um an unmarried per~on. I do hercby give all my estatc 10 thc named person:
n.. ,., ,.../...\ T I;::>; H- \ ':" re
Second, In the event that the said .I ),.,.",U T P: r+ \ P," shall predecease me,
IgiveaIlOfmyestatetor-::,',.....\"'''',,\,.,...tj .r!., ".....~"'\I..,";\....7 H:,~,.. ,
Third. I order Dnd direclthal my jusI debl~ and funeral expenses. expenses for adminimation or my
estate and any inherltancc and !uccession taxe~. .tate or federal. upon myestate shall be paid as soon aftcr my
death a~ may be practical.
Fourth, I nominate and anpoint i 1-. <"'\ I' l..d I' \:.:?: tLl '" ,-,
as Executor' Executrix Ollnls Will, In tne event tnal he sne ~hall predccca.e mc orlails to survive me orlail>
10 serve as such Exeeulor Executrix then I nominalc and appoint
. Execulor Executrix of this my Last Will and Testament.
I run her direct that no appointce hereunder shall be required to gi\ e any bond for the faithful performance of
his, her duties.
Fifth. I hereby aUlhorize my Execulor Executrix 10 exercise alllhe powers. rights.discrctions. duties
and immunities conferred upon liduciaries 10 the e,'lent permilled by law with full power to ~ell. lea~e.
monsuge. invest. reinve~t. or OIherwi~e dispo.e of Ihe assels of my estatc.
({.., ,.'
Day of {.,..;.. 77;"':;;; . 19 ~
, ---:l
.~.
I ~ubscribc my namc to this Willthi.
at 3 (.,-' ,-:; ~~. .- 'SL;...
~Q .,/f-
~'l I j1
c:-~ "/7J===-r...l',~
U
c- -, _...+- '1 -::0 I
-~=~_..-'--"'. ......>.-
(Sign herel r,) _ : I
7"'~ JJ.. ~')
I IQK.' h\\ FlU' ,\11 f1j:hl\ 'lo.''Io(I\\:O
E::hibi t II A"
A-I
.. .tY.1l0....IU1J
~~
COMMONWUlfH O. '(NN~nVM414
INHlllfANCI fAX UfU.H
USIOINf OICIOIHf
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Plea.e ,Print or Type
FILE NUMBER
-:;2./- q ~ -Ds 2-'3
ESTATE OF
I-l t:l\lj2;Y, f)CR01'Ht J:
IAlI proplfl)' jainlly.awn.d wllh ,h. Righi af S""wiwoflhip m",,, b. diulo,.d on Sdl.dule Fl
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
/,
CUl"'~(lo.r-J ~'''''f ~VU'I~1-l1lJ>.t.
B.l..\c\.~' ~I.\.'!jr rv"'! o.lC'''''I,-t'
\ I /P~o7I",
I
I
TOTAL (AI.a enlor on lino 5, Recapitulation) . S
. "to,?!.
IAllach odd,hO"ol 8'1," )( I'" ,hull II more looee " fllteded I
... IIYI"'''_''''I
.
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COMMONWEAI'H Of 'lNN!lYlVANIA
INH(lll"N([ lAX IlflUlIN
RUIO(NlOlClOUH
PI.a.. Print or TVp.
FILE NUMBER
21-'l6-d521J
ESTATE OF
1-1 ~tJ~y' Dt..'flo1H'/.:r.
ITEM
NUMBER
A. Funeral bp.n....
'2;
DESCRIPTION
1.
My"\"!J'. l1"';<l\lY l="UN:rJ,)-fCl1o:..
!3..}(,i'L. {'('''r'd (o.tf\4{1 !b-v,cc~
R. ~ R".....hsll{1"
lJrl.t>f ~e c.(. di.J( v.. /("'.trl';l-D>-e
1.
B. Admlnl.tratlv. co.t..
2,
3,
4,
C.
1.
2,
3,
4,
5,
6,
7,
8,
Personal Reprosentotive Commissions O~I.r\\. il 17 1:1.. f ITL(,:,~
1 0.7 - TrLJ
Social Security Number of Personal Repr..entalive: I I ~? J
Year C"mminions paid --L!l1l1
Anorney Fees
~ufP W. \"'f\!III./e
Family Exemplion
Claimant
Address of Claimant at decedent'. death
Slreet Add,en
Relationship
City
Stole
Zip Codo
Probate Fees
B..("tt'v r+ lil,h,- ~}>" ~,\( 6>~ ktf-<'" IC;1l\""i-l"lI.'''2:,
Mlsc.llan.ou. Exp.n.e..
rLtr..t'f\le~; ~ .!J'r'+I-;I~f..JTdc
c.J M\'Cr/""d t..... 7)0.:;...( - AJ~<,.-h~I^11::~iio
~""'Is-tcr or W,I~
,-
- 11..~~.1.....,JII."-lt"1
1. .11"''-) r.,; .11.ht".1~':..fIt.. ','i'f\l~,~\.,~
F'p"l I'.:h h~, -It <,rlllt ')vOo\.i (........ ;\",1 "..0.. ,of C,.:\'"\
TOTAL (Also enler on line 9, Recapitulation)
(If more space is need.d, insert additionalsh..ts of same size.)
AMOUNT
53Y.'1/'
,1- 7. (:()
S"-n .3'1
Z-oc"Ctl
:n, ()O
Y7,5D
(,0 ,DO
Ie ,c.,:.
i~,t('
'2..(;'. t""
S I. 1t:3 ~O
RfY.UOOU+11.Q.j
w
...
~:!'"
u"'''
w..u
",00
u"'-'
....
..
'"
,
1 '-7
JD -I \._-'
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
DI;,-;)..Cf,
NUMBER
'OR DA'150' DEA'H A"IA 12/31191 CHECK HEAt
IF A SPOUSAL
POVERTT CREon IS CLAIMED 0
flU NUMBlR
...
z
w
III
u
w
co
~
COMMONWfAlfH Of PENN!.'tlYANIA
DfPAUMfN' 0' R[V[NU[
Of" 110601
HAUI!.IUIlG. 'A 11121.0601
OlCIOIN"!. NAMIIlAU, f..)I, AND MIDDLllNlllAlI
Hr;:jlJp- DclloTl r
)OCtAl $(CUJITY NUMU.
\'1, 13 32'17
OAT( Of tlRTH
r -l'i -1'3
').1 'J f..,
COUNTY CODE YEAR
DIClDlNT'$ COMmn AOO.U$ )
C UMP"I'-l.i1tJl> '-"l""1 1-1"[1' ,,....
:J'I'> t.~nPl.I'1.ltJ, Il/\..C
('I"'LI~~( Pfl 17()':~
Co,", Ilelll-Ar-IO
AMOUNT JICUVID liH Itl$UU".OU$)
HCfl\t!
1" "'P'tICAIlIt UlhlV1NG llOU"I JolUII tun 111\1 "'NO MIOOlI1N''''''1l
fJ
5a1.
04.
S6.
03.
05.
Q.O.
Original R,turn
o 2. Supplemenlal Return
Remainder Return
(fo, dolo. of doo,h prior 1012.13.021
federal Eltat. Tall. R,turn R.quired
';''''
will
"'co
"'z
8~
o 40. future Interllt Campromh.
(for do'o. of doo,h ofro, 12.12.02)
Oeced.nt Died Tlllote 0 7. Deced.nt Maintained a Living Trult
(Alloch copy of Willi IAlloch copy of ',uIII
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
COMPUTE MAiliNG ADDUSS
5u~ 3t? WA!oc(L B.,o-n'N<:-
_~ B' IV l./ 11 .5J(.
'/1 P I L-t. 170 II
limited Eslat.
TOlol Number of Safe Depolil Boxel
71,,1-J'15'"
z
o
S
::>
...
ii:
'"
u
w
'"
I. Rool ElIa'o (Schodulo AI (I I
2. Slock. ond Bond. (Schodulo B) (2 I
3. Clo.oly Hold Slock/Portnonhip Into,o,' (Schodulo q ( 3 )
4. Morlgog.. and No'es Receivabl. (Schedul. D) ( 4 1
5. Cash, Bank Oepositl & MiscellaneouI Per~onol Properly ( 5 1
(Schodulo E)
6. Jointly Ownod P,oporty (Schodulo F) ( 61
7. ',on"on(Schodulo GI(Schodulo l) (7)
8. Tolal Gran Ane" (Iatollin.. 1.7)
9. Funeral bp.""s, Adminis'rative COSIS, MiscelloneauI (9)
Expen..s (Schedul. H)
10. D.b", Mortgag.liobililies, li.ns (Schedul. II (101
11. TOlal D.ductions (Iotollin.s 9 & 101
12. N.t Value of Estatelline a minus line 11)
13. Charitabl. and Governmental Bequests (Schedule JI
14. Nel Volue Subiect 10 Tax llin. 12 minus line 13)
15. Spousal Transfen (for dalll 0' deolh aher 6.30.94)
See Instructions for Ar,plicabl. Percentage on Reverse (151
Sid.. (Includ. values rom Schedul. K or Sch.dule M.I
16. Amount of line 14 loxobl. at 6% ral. (16) D
(Include values from Sch.dule K or Schedul. M.I
17. Amounl of lint 14 tall.oble 01 15% role 1171 C
(Includ. valu.. from Schedule K or Schedule M.I
1? Principal tax due (Add lax from lin.. 15, 16 ond 17.)
19. Creditl Spousal Paverly Credit Prior Pcymenls Discount
o
II G~, 1"
(0 I
IIGG./G,
\ I (,-\ (,[)
5":l.,''lq,.'ii'-l
r.; 1.;;1_,1- .,"/LI
(II)
(121
(131
(14)
ji,/"",-Cf.J"'
l.tl->C
>C._=
. .06 =
o
>C .15 :::I
()
z
o
;::
'"
...
::>
..
'"
o
u
><
""
0-
(101
Inler"l
+
+
(lql
(201
20. If lint 19 is greater thon line lB, ent.r 'he difference on line 20. Thi. is the OVERPAYMENT.
gO
Check here if you ore roquesling a refund of your overpayment.
(J
o
o
(211
(21AI
(210)
21. If line 18 is greoter than line 19, enler the difference 0" line 21. This jl the TAX DUE.
A. Enter the interest on the balance due on Lin. 21 A.
B. Enter the 10101 of line 21 and 21 A on line 21 B. This il Ihe BALANCE DUE.
Make Ch.cle Payable 'a: Regl.'er of Will., Ag.nt
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-<
Under penalties of perjury, I declore that I hove ....omined thil r,lurn, including accompanying Ithedulel and ,'otemenls. and to the best of my ~nawledge and belief.
it is true, corr,ct and complele. I declare Ihot 011 real estate hal been reported 01 true market 'Wolue Decloralton of prepare' olher than the penonol representative is
based on 011 information 01 which preporer has any knowledge.
lIl[ 0' PU$ON 1l[~POU.~I'L[ fOI. filING Il(TUIN AOO'[~~ OA'l .
" ..,' r-;;. . /7<-'/1-' f.lLlPH ET/(\JUJ~UI:'IJlt.,ll.l-I\""-iLr^..ll{)'l' t":,d 2/-1'1?7
~IQNAlu.t 0' PltpAll IOHd IHAN I(PIn:tWAIIVl AOOII~~ OAI(
~t-~.~ 3.55'_N_'k~ <;;T, <i1~LJ\ /l-l.. 03/7.0../1.___ - e~g~!Jo-.J.s~'f'lL
,
Last Will and Testament
UlIl1Iurril'cllllclMcllIU/II'i,h Dill' Bl'Wliciur.l'
I. ...... c .< I' + I... 'J J 1-\ ,<> ,- .0 ') presently residing at
.;1(.0".,..... ('"':;'''h.~ 5:-r . '/-/.."""...:,,1,, "" ~ r;:? .
do hereby make. publish and declare this 10 he my Last Will and Testament and ao hereby revoke any ,lnd
all olher Wills and Codicils heretofore made by me.
First. 1 am an unmarried person. 1 do hereby give all my estate to the named person:
. -r 1::>'.1-1- \
n.,..... ,.../...,) I. 1s....LL...!.-1 e fe
Second. In the event that Ihe said J J"....c,U T 12: t+ \ ~I" shall predecease me.
I give all of my estate to (~I""""\"'r"I;\\d,...,j ,.!... ..'....y'.':-...;'....7 H,~'""',.. .
Third. 1 orderond direct that my just debts and funeral expenses. expenses for admini!lration of my
estale and any inherilllnce and succession taxes. slate or federal. upon my estate shall be paid as soon after my
death as may be practical.
Fourth. I nominate and anpoint i') '" .....,. W I. \::?;tU t:' ,,,,-
as Executor Executrix 01 this Will. In theel'ent thaI he she shall predecease me orrails to survive me or fails
to serve as such Executor Execulrix then 1 nominate and appoint
. ExeClllor Executrix of Ihis my Last Will and Testament.
1 further direct thaI no appointee hereunder shall be required to give any bond for the faithful performance of
his, her duties.
Firth. I hcreby authorize my E.\ecutor Executrix to exercise all the powers. rights. discretions. duties
and immunities conferred upon fiduciaries to the e.\lent permitted by law with full power 10 sell. lease.
mortgage. invest. reinvest. or otherwise dispose of the assels of my estate.
1 subscribe my name to this Will this ~O .,/~ Dayof ('~.77f.;: . 19 !i!L
at 3(..-~,-:; ~~.-.._ <:'Y..k- :-'?:~"rrJ~{L..__ .-+-~,':
U
c-'~cl~'1:~ -=1:) L >___
ISign here) C1 _ : f
~~~.. ~.)
c IQK.\ h\ .\flU-. ^Illl~hh r.:'lCu....d
E::hibit "A"
A-I
I'VISltI.'I"I)
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
_uPloa.o Prlnt_ or T.""o
FILE NUMBER
21-1~-tJ5}..'O
COMMONWlAlTtl Of PWN!tYlVANIA
INttUlITANC( lAX RfluRN
~_ _ R~~!Pf.~.!J:l.rq_~f!H
.u.
ESTATE OF
1-/ '/;NP--y
Dap. ti/ 1!'1 ,J:.
ITEM
NUMBER
A. Funoral Expon...,
B.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
DESCRIPTION
AMOUNT
1.
My"'Y's- ).j~'r(\(~ fUN:"J. )-fOflc-
B~(Jr.t< fr-4{'d (u.e'\4C !\MJlcc~
1;>, .r: RohYhsc"ll,.
Lo+hr, rl.P:e c+ c!f.J( \No. HCJd)tO're
n. 7, to
53Y N/.
'Z;
1.
Admlnl.t,atlvo Co.II,
Personal Represenlalive Commissions Do ,,~c I) 1: I~ I " I(.R
1 0'7 - ~'iSL3
Social Securily Number 0/ Personal Represenlalive: I I
Year Commissions paid -L!jq..1
S""6.3'(
2.
Allarney Fees
~ufP W. ~IKle
Family Exemplian
Claimant
Address of Claimant 01 decedent's death
Slreel Address
Cily
Zip Code
2-oc,Ct)
3.
Relalianship
Slale
Pro bole Fees
1<..(, {trY tI/- W,~~ - r-.t>~'; bI,\l ~ kft<~ -r,rt"""l'lll'';S
Mlscellanoous Expensos:
P..tr..t.f\!c.,J": - "rlU"+''iIl1f-r;..jf~
ell i'^bCI/G'd l.,.. :)"-".,jJ - 1\&~(.+1?I"11:Bi~
~1"91c... or W"I,
3~,{)6
1..j7,SO
(,D,()O
t:" l't'f :l""Jt"'l~'-1
\
r '\'"') Pc . 1,.l-r,.-1M.. i "I \lr.tcl~
\: ,j "') \"d. ho, -\0 ~ rl\" ~JV.ll ~ ,1.1, ;)",1 C,',l.. v ,.j L,~,\
1(') . (,~
i ,\ . t<"
l.c. ['0
TOTAL (Also onlor on lino 9, Recapilulalian)
(If moro spaco I. noodod, lnsort additional shoels of sarno slzo.)
s 1,lu3 ~D
,
;.;.
i
...
COMMONWEALTH OF PENNSYLVANIA l
COUNTY OF CUMBERLAND J
u:
-Donill.d_.I--n i t t 1 .... r
b.lng duly sworn .ccordln9 '0 I.w, dopo"l .nd "y' 'h.t h. l"
Eltllc.u.t.OL-___ 0' tho ell.'. of norol'hy T. lI....nry
I.,. 0' -.- -'''--,,-, ..-. -. CaF li~.!.c, h...._ __ , Cumberl.nd Coun'y, P.., d.c....d .nd that the
wllhln II .n Iny.n'ory m.d. by --Donil-ld--'l'-~R-i-l;t..l.Qt'- ._, the ..Id !LXII,"'! ~ Q ~
of 'h. .nll" "",. 0' ,.Id d.c.d.n', conslltln9 0' .11 the per,on.1 prop.r'y .nd ".1 "t.te, .xc.pt r..1 "t". ouhld.
'h. Commonw..I'h 0' P.nn'yly.nl" .nd 'h.' 'h. fl9urOl opposl,. ..ch lI.m 0' the Inv.nt.ry "p"..nt It', f.lr v.lu.
" 0' the d.t. 0' docod.nt', d..'h.
.nd ,ublcribod bo'o" m.,
,)./ --::-:',~ /l.~/ /
......v ,h~ ,r.rcC-,r. /\(_[~-V
executor. Admlnlthltor
731 15th Street
t:OTJ,:::...1 !-;JI.t
1;1'.il:tCr.-4;.. A\1:'1r.', I:~,:~' r..,'..!;.:
'emit HW hr?, C"'rr.:)C.t1.m~ Co., ,^
My c:-....... [r,>:fft Sopt. 21. IPOlI
New Cumberland. PA 17070
Addr...
D,t. of D..th
31
1996
March
Month
Doy
v..,
INSTRUCTIONS
I. An Inyontory mull b. flI.d wllhin th"o month, after .ppointmont of p'rlon,1 repre"ntetly..
2. A ,upplom.nt inventory mull b. flI.d within thIrty d.YI of di,coy.ry of .ddlllon,1 .u....
3. Additlon.l,heeh m.y b. .'tachod OJ to pOrlon.lty or ".I,y
4. S.. Articl. IV, Flducl.ri" Act of 1949.
'tl
QJ
~ .,;
w ..
M
~ ~ l- I.< "
w ~ ..
ll. l: u co
0 II) QJ ..
e w w C '" ...
:r ~ :c " co
l- ll. ...J U. ... .; ll. E
Z ..J jj 0 I.< ll. 0
W u. -< H III =
> 0 Z ~ () i- -<
z 0 c
c .c: "
- II) Z .., 0
0 ~ U
Z w -< 0 ...
ll. I.< ...
0 c
Q - ~
0 ~
..
.D ... ...
co E 0
- ~
" " 0
..J U it CD
-. ~..
..
r~. ,
'.'
. .
LAW OFFICES
RUPP AND MEIKLE
A PROFESSIONAL CORPORATION
TilE WAONER OUILDING . SUITE 303
3&& NOrn-1I 21ST STREET
CAMP IIJLL, PA 17011
A'(';
:" '1 IJ?
f . .7rr
..:
'.' ~
- ,
\.
,
.-
IP'"'-
--_- ---:-~~. t. _ I, -r:~,
,...
.
C:\WI'W\I!ST ^ TI:.~IIIHNR YII'IITITION, 11111 :O""hcr ltl. I'm
5. The Decedent had no re:11 eslate and her personal estate tolals less limn $25,000.00,
as shown on page I of the Account.
6. The entire distributable balance, as refiected in the attached Account, should be
awarded to the Pennsylvania Department of Public Welfare. Its claim for $52,198.84 is divided
into a Class 3 claim for $18,591.43 and a Class 6 claim for $33,607.41. Claim Letter is attached
hereto and marked Exhibit "C".
7. The Pennsylvania Transfer Inheritance Tax Return was filed with the Register of
Wills of Cumberland County on October 24, 1997, and no Inheritance Tax was due. The assets
of the Estate total $1,166.76 and the allowable deductions for Inheritance Tax total $1,103.60, all
of which are Class I claims.
8. There are no unpaid claimants of whom Petitioner has notice or knowledge other
than the Pennsylvania Department of Public Welfare. Letter approving Account is attached hereto
and marked Exhibit "D" and a Certificate of Service stating that a true and correct copy of this
Petition for Settlement of Small Estate in Accordance with 20 Pa.C.S. !l 3531 is attached hereto
and marked Exhibit "E".
9. The Decedent was not a fiduciary in any other estate and was not a surety on the
bond of a fiduciary.
2
Last Will and Testan1ent
Ulllllllrri('cI/lII/iI'icll/tI/ \\'if" 011(' !J('II('/kitlfr
I. '-c,<"tJ"j 1 \-\,co",?~ IHcscntlyrcsidingat
"''-fl''.[""\ r-:;''''h'_ S't . 1-1..,,-,..,. '" r.-" p,-:? .
do hcrcby makc. (lublbh and dcclarc Ihis In bc illY Lasl Will and Tcswl11cnl and Iln hcrcby rcvokc any and
all othcr Wilb and Codicils hcrctoforc m.ldc by mc.
First. I am an unmarricd (lcr"lI1. I do hcrcby givc all my cstUlc In Ihc namcd (lcrson:
I),,,,,,.., L..\ 7 1~H- \ e f'C
Second. In thc cvcnt thaI thc said ,\"'),....",,1,\ T 12: t-t 1 ""'" shall (lredcecasc me.
I givc all of my estate to (~r "....... \"'1"1) \,...... ,j 1'':. ., ,"'I ~ll' ;>,,; ''''I 7 f-l c'..,...,... .
Third. I order and dircctthat my just dehtsand funcml cX(lenscs. CX(lCr.scs for adminbtralion of my
eSlale and any inheritance and succcssion taxcs. slatc or fcdcral. u(lon my cstatc shall bc (laid as soon after my
dcalh as may bc (lraetical.
Fourth. I nominate and al1(loint i 1 !:) n,' l.d -r I::?; tLJ C" I~
as Executor Executrix of Ih" Will. In thc cvent that hc shc shall (lredeccase me or tails 10 survive mc or fails
to serve as such Executor Exccutrix Ihcn 1 nominale and a(l(loint
. Exceutor Exccutrix of this m\' laS! Will and Tcstament.
I furtherdireetthat no a(l(lointcc hercundcr shall hc rC4uircd In gi\c any bond fo~ Ihe faithful (lcrformanee of
his, her dUlies.
Fifth. I hereby authorizc my Exccutor Excculrix 10 cxcreisc allthc (lowcrs. righls. discretions. duties
and immunities conferrcd u(lon liduciarics to thc CXlcnt (lcrmillCd by law with full (lowcr 10 scll. leasc.
mortgagc. invest. rcinvcst. or olhcrwisc dis(losc of Ihc asscts of my cstale.
((" .
Day of 1L..'t'.77T:::: . 19 5!:L
----:>
.~.
I subscribe my namc to tbis Will this
7 ~y I
at 3 (..-'ii ,-:; /."~." '_ ..--
40";/!-
,,'7/ 1 P
~~'\/l,,::::>-...,l',~
U
c-'" - 1r' r'\ ~
_~~cl _-=----==--~ J"'''' >~
(Sign hcrc) ( , !
-r ~ -i) ~./
f IIIK.\ h~ ,'HtI'. ,\11 rl}!hh fL''oCrwll
E::hibit "A"
A-I
Signed. ,ealed. puhlished allll declaled III he hi> hel 1.01'1 Will alld 'f e'lamemlll Ihe lIilhlllnamed
Te,lalllr in the plesenee Ill' u,. Ilhll in his her fllesenee allll at hi> lier lellue". allll inlile I"e,enee III' each
III her. hllle hereunlll suh,erihed IIur names "' Ililne,w,:
"";.". . ilJ __ d t )
(I) /.//./,-,,-11' o.-'~,...r {.
(2) ').7 Ch..' Q. .5./ ] " trf,
- , .
III' ;t.;;...[.~~~/T:'~'"~~<tc p/,
} (Cill' ) (>(101 eJ.
I / ..., .I
Ill' / CL''I. 'l.t.) t'2L:l.-'l_l-.. I L (7 '.
(Cily) Cl (Slale)
(J)
Ill'
ICily)
(SlillCI
Affidavit
State uf Q A
COUnl)ofC'~~~XO \, f'~
) CIl)'
or . ~
) Town ~oOr-.o~,r \) t.L"\.~
I'e,,"nally appeared (I)
(2) and (3)
who being duly >'Iomed. depose and say Ihat they ane>ted Ihe said Will and Ihey ,ubseribed the SlIme III the
rcljuestand in the pre,enee of the >aid Teslator and in the presence or ellch other. and Ihe ,aid T e,lalllr. signed
>aid Will in their presence and acknowledged Ihat he she had signed said Will and declared the ,ame 10 be
hi> her Lasl Will and Teslamenl. and deponenlS lurther state Ihat atlhe lime olthe execution UI said Will tbe
said Testalorllppeared hI be ofl:mlul age and sound mind and memorYllnd there was noe\'idenee ufundue
inl1uence, The deponent> make this "mda\'it al the Teljuestof Ihe Testator.
(I)
(2)
Sub,cribed and swum 10 before me this
(3)
\d-.
daYOr~.19i3.
(""lary Sellll
(ililllar\' Publici
NOTARIAL SEAL
JUDITH H. HAGENS, NOTARY rUBLIC
CAAP HILL BORO. CUMllERLAfID CO.
MY C~ISSION EXPIRES SEPT. Z:4 1993
A-2
ESTATE OF 1l00tOTHY I. HENRY. DECEASEIl
FInST AND FINAL ACCOUNT
RECEIPTS OF PRINCIPAL:
ASSETS LISTED IN INVENTORY:
(Valued as of Date of Death)
Cumberland County Nursing Home - Balance Guest Fund Account . . . . . . $1,166.76
RECEIPTS SUBSEQUENT TO INVENTORY:
None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -0-
TOTAL RECEIPTS OF PRINCIPAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,166.76
DISBURSEMENTS OF PRINCIPAL:
Myers-Harner Funeral Home Balance Pre-Paid Funeral Services . . . . . . .. $ 534.46
R.J. Romberger - Culling Date of Death in Headstone. . . . . . . . . . . . . . . .. 127.00
Register of Wills - Probate Will and Lcllers Testamentary . . . . . . . . . . . . . . . 36.00
Patriot News - Advertising Estate .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47.80
Cumberland Law Journal - Advertising Estate . . . . . . . . . . . . . . . . . . . . . . . 60.00
Register of Wills - Filing Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.00
Register of Wills - Filing PA Inheritance Tax Return .................. 10.00
Register of Wills - Filing Petition for Selllement of Small Estate (estimated) ... 20.00
Donald T. Rilller - Executor's Commission. . . . . . . . . . . . . . . . . . . . . . . . . 58.34
Rupp & Meikle - Allorney's Fees ....... . . . . . . . . . . . . . . . . . . . . . . . 200.00
TOTAL DISBURSEMENTS OF PRINCIPAL............ ..... ... . .. $1,103.60
BALANCE FOR DISTRIBUTION:
CASH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $63.16
PROPOSED DISTRIBUTIONS TO BENEFICIARIES:
Pennsylvania Department of Public Welfare ....................... $63.16
Exhibit "B"
.
COMMONWEALTll OF PENNSYLVANIA
DEPARTMENT OF PUBUC WELfARE
BUREAU OF RNANCIAL OPERATlONS
TPL SECTION. CASUAL TV UNIT
P.O. BOX B4B5
HARRISBURG,PA 1710S
October 10, 1996
RUPP AND MEIKLE PC
ATTN HERBERT GRUPP JR ESQ
THE WAGNER BLDG SUITE 303
355 NORTH 21ST ST
CAMP HILL PA 17011
Eetate ofl Dorothy I. Henry
CIS 10 #1 310 123 lB9
Case Record #1 21-0071331
Date of Birth I 01-14-13
Social Security #. 191-1B-3237
Dear Mr. Ruppl
Please be advised the Dspartment of Public Welfare maintains a claim in
the amount of S52,19B.84, against ths above-mentioned estate. This claim is
for restitution of med~cal assistance granted on behalf of the decedent for
which the Probate Estate is now rseponsible to reimburse the Department
according to Act 49, 62 P.S. 1412, effective Auguet 15, 1994, ae amended by
Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized
statemsnt of claim. please nots that ths amount shown on the attachsd
statement for long term care for the month of August 1994, has been calculated
to include dates of service 08-15-94 through 08-31-94 only.
A portion of thie medical expense, namely $18,591,43, was incurred
during the last six monthe of the decedent's lifel therefore, it is a Clase 3
claim pursuant to Section 3392 of the Decedents, Bstates, and Fiduciaries
Code, 20 Pa, C.S.A. 3392(3). The balance of the claim, namely $33,6D7.41, ie
to be entered as a priority Class 6 claim against the eatate.
Please acknowledge receipt of this letter and advise whether the
commonwea1th'e claim is admitted and when payment may be expected.
Sincerely,
'-c-~*IV 7.lfl.fG
Susan E. Naylor
TPL Program Investigator
(717 )772-6265
Enclosure: statement of Claim
Exhibit "e"
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBUC WELFARE
BUREAU OF FINANCIAL OPERA nONS
TPL SECTION. CASUAL TV UNIT
P.O. BOX 8488
HARRISBURG.PA 17105
October 27, 1997
RUPP AND HEIKLE PC
ATTN HERBERT GRUPP JR ESg
THE WAGNER BLDG SUITE 303
355 NORTH 21ST ST
CAMP HILL PA 17011
Rei Estate of Dorothy I. Henry
CIS ID #1 310 123 189
Case Record 'I 21-0071331
Date of Birthl Dl-14-13
Social Security 'I 191-18-3237
Dear Mr. Ruppl
I am in receipt of your letter dated October 24, 1997, which provided ms
with a copy of the First and Final Account for the above estate. The account
indicates assets totalling $1,166.76. After administrativs fess and expenses,
and after the balance of funeral expenses are paid, $63.16 remains to be
distributed to DPW. I have no objections to the account.
Thank you for your cooperation.
Sincerely,
SUdll/V -{. 1}U~fU
Susan E. Naylor
TPL Program Investigator
(717)772-6265
SEN/sn
Exhibit "D"
,- I 'I ~I
p-/ ..,- /
BUREAU OF INDIVIDUAL TAXES
IHIl[RI lAHC[ TAlC DIIJI5IDH
DEPI. llhal
HARRISBURG, PA I1IU-06Dl
CDMMONWEALTH DF PENNSYLVANIA
DEPARTMENT OF REVENUE
NDTTCE OF INHERITANCE TAX
APPRAISEHENT, AL~DWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RICHARD C RUPP
WAGNER BLDG STE
355 N 21ST ST
CAMP HIll
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
CDUNTY
ACN
01-21-98
HENRY
03-31-96
21 96-0528
CUMBERLAND
101
303
Allau"t R."itted
PA 11011
c>
*
111.11.'" '" 11t.1I1
DOROTHY
I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ii"iv:i5cjj-EX-"FP--iii9-:97Y"NoricEuOF--iNHEifiTANCf-'T"A'iC"APPRA"iSEHENT".u,U.i-oWAircf-olimmm-----m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HENRY DOROTHY I FILE NO. 21 96-0528 ACN 101 DATE 01-21-98
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT DF TAX:
15. Altou"t of llna 14 at Spousal rat. US)
16. Allaunt of LIna 14 taxabl. at Lin..l/Clals A ~.t. (16)
17. Anou"t of Lina 14 taxable at Cal1.t.,..1/Cla.s 8 rat. (17)
18. Principal Tax Du.
TAX CREDITS:
PAYHENT
DATE
TAX RETURN WAS: (X) ACCEPTED AS FILED
( ) CHANGED
RESERVATION CDNCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE DF RETURN BASED ON: ORIGINAL RETURN
1. R..I Est.t. (Schedule A)
2. Stocks and Bonds (Schedul. 8)
3. Closely Hald Stack/Partn.r,hip Int.,...t (Schedul. CJ
4. Hartg.gal/Nata. Receivable (Schedule OJ
S. Cash/Bank Dapolits/Hisc. Parlonal Property CSchedule EJ
6. Jointly Owned Property (Schedule FJ
7. Transfers (Schedule GJ
8. Total Asset.
11)
(2)
(31
(41
IS)
(6)
(71
.00
.00
.00
.00
1.166.16
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expense./Adn. Costs/Hisc. Expenses (Schedule HI
10. Dabts/Hortgage Liabilitias/Liens (Schedule IJ
11. Total Daductions
12. Nat Velue of Tax Return
13. Charitable/Govern.antal SaquestsJ Nan-elect.d 9113 Trusts (Schedule JJ
14. Net Value of Estate Subject to Tax
(91
110)
1,103.60
52.198. B4
(11)
1121
(13)
114)
NOTE:
.00 X .00=
.00 X .06=
.00 X .15=
U81
RECEIPT
NUHBER
DISCOUNT (t)
INTEREST/PEN PAID (-)
AHDUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TDTAL DUE
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this forn with your
tax paynant.
1.166.16
,3.30:> 44
52,135.6B-
.00
52,135.6B-
.00
.00
.00
.00
.00
.00
.00
.00
. IF PAID AFTER OATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN fL, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS.)
RESERYATIONI E.t.t.. of d.cedent. dyIng on or b.for. Dece.bar 12, 19a2 -- If any futura Intere.t In the a.tata Ie tren.farrad
In po.....lon or anJoy..nt to Cl... a (collatar.11 b.neflclerla. of the d.c.d.nt .ft.r the .xplr.tlon of any ..t.t. for
Ilf. or for y..r., the Co..onve.lth h.r.by .xpr...ly r..erve. the right to .ppr.I.. and ...... tran.f.r Inherltanc. T....
at the I.wful Cl... a Icoll.t.r.11 rat. on any .uch future Inter..t.
pURPOSE OF
HOnCEI
PAYlf[NTI
REFUND (CR I I
OIJECTIONSI
AmtlN
ISTRAlIVE
CORRECTIONS I
DISCOUNh
PENALTY I
INTEREST I
To fulfill the r.qulr...nt. of S.ctlon zl~a of tha Inh.rltanc. and E.t.t. T.. Act, Act ZI of 1995. (12 P.S.
S.cUon 91~al,
D.t.ch the top portion of thl. Notlc. and .ub.lt wIth your p.y..nt to the R.gl.t.r of Will. prlnt.d on the r.v.r.. .Id..
""a... ch.ck or eon.y ord.r p.vabl. tal REGISTER OF MILLS, AGENT
A r.fund of It.. cr.dlt, whIch w.e not r.qu..t.d on the Ta. R.turn, .ey b. r.qua.tad by co,pletlng en -Appllcltlon
for Aafund of PII'II'l.ylvanl. Inherltanu and E1t.t. hx- (REY-UUI. AppllcIUon..re .v.llabl. .t the Offlc.
of the Rlgl.t.r of Will., any of the 2J R.v,nu. Ol.trlct Off lea., or by ceiling the 'Plclal 2~.hour
an.w.rlng ..rvlc. nueb.r. for for.. orderlngl In Plnn'Ylvanle l-aaa-J6Z-ZaSO, out.ld. Penn.ylvant. and
within locll H.rrl.burg .r.. (1111 '.'-.09~, TOO' (1111 l1Z-ZZS2 (H..rlng I'Pllr.d Onlyl,
Any plrty In Int.r..t not ..tl.fl.d with the eppral'I..nt. .llowanc. or dl..llowanc. of d'ductlon., or .......ent
of till. (Including dl.count or Int.r..tl .. .hown on thl. Hotlc. IU.t obJlct within .I.ty (601 d.y. of r.c.lpt of
thlt Hotlc. byl
--wrltt.n prot..t to the PA Dep.rt..nt of Rav.nu., Board of App..l., D.pt. 2110ZI, Harrl.burg, PA
.-.l.ctlon to hlv. the .ettar d.t.r.lned .t .udlt of the account of the p.r.onel r.pr..ant.tlv.,
uapp..1 to the Orphan.' Court.
OR
171n-1021,
DR
F.ctu.1 .rror. dl.coverad on thl. ........nt .hould b. .ddr....d In writIng tal PA D.p.rt.lnt of R.v.nu.,
lur.eu of Indlvldu.1 T...., ATTHI Po.t A.......nt R.vl.w unit, D.pt. Zaa601, Harrl.burg, PA 1112a-0601
Phon. (1111 lal-65a5. S.. p.g. 5 of the bookl.t -In.tructlon. for Inh.rltanca T.. A.turn for. Ae.ld.nt
Olc.d.nt- (REY.15011 for an ..plan.tlon of adllnl.tr.tlvlly corrlct.bll .rtor..
If any te. due I. p.ld within thr.. ()I c.l.nder .onthl .ftlr the d.cadlnt'. d'lth, a flv. p.rcent (5XI dl.count of
thl t.. p.ld I. allow.d.
Thl 15X tl. .-n..ty non-participation plnelty I. co.put.d on the total of the tl. end Inter..t .......d, end not
peld b.for. Januery la, 1996, the flr.t d.y .ft.r the .nd of the te. ..n..ty p.rlod. Thl. non-p.rtlclp.tlon
p.n.lty I. .pp.elabl. In the .... ..nnar and In tha tha .... tl.. p.rlod .. you would .pp..1 the t.. .nd Int.r.et
th.t he. b..n .......d a. Indlc.t.d on thl. not Ie..
lntar..t I. ch.rgad b.glnnlng with flr.t d.y of d.llnqulncy, or nln. C91 .onth. end on. (II day 'roe the d.t. of
d..th, to the detl 0' pay..nt. T.... which bee... dallnqu.nt b,'or. Jenuery 1, 191Z b..r Int.r..t at the r.t. of
.1_ (6XI p.rc.nt p.r annul c.lculat.d et . d.lly r.t. 0' .00aI6~. All t.... which bee... d'llnquent on and ,'t.r
Janu.ry I, 191Z will b.ar Int.ra.t at . r.t. which will very fro. c.l.nd.r y.ar to calend.r yaer with th.t r.t.
announc.d by the PA O.pert.ant of R.v.nu.. Th. appllcebl. Intar..t r.t.. for 1912 through 199. .r'l
'!!!! Int.rut A.t. Deily lntarllt ractor !!!! Intlr..t Aat. Oally Intlr..t ractor
198Z zn .ooos~a 1981 .~ .OO02U
198) l'~ ,aoaoa uaa-I991 llX .0auGI
19a~ lIX .000101 199Z .~ .000lU
19a5 UX .000156 199]-1994 7X .00019Z
19a6 lOX .Oa021~ 1995-199a .~ . unu
-"Intarllt It calcul.t.d .. 'ollowll
INTEREST = BALANCE Dr TAX UNPAID X NunBER Dr DAYS DELINQUENT X DAILY INTEREST rACTDR
--Any Hotlc. I..ued ,'t.r the t.. b.co... d.llnquent will r,'l.ct en Int.r..t c.lcul.tlon to flftaan CISI d.y.
beyond the d.t. of the ........nt. If p.y..nt I. .ad. .ft.t the Intar.st coaput.tlon data .hown on the
Hotlca, additional Intlrllt ltU.t b. c.lculat.d.