HomeMy WebLinkAbout02-0019PETITION FOR' PROBATE and GRANT OF LETTERS'
Estate of D..Anne S. Hilton No.
also known as · . Anne S. Hilton To:
Daisey~Anne Hilton ~
Deceased.
Social Security No. 168-36-290'9
The petition of the undersigned respectfully represents th~at:
Your petitioner(~, who is/al~18 years of age. or, older an the execut rix
in the last will of the above decedent, dated
and codicil(s) dated ~' '
Register of Wills for the
County of Chmberlanit,
Commonwealth of Pennsylvania
in the
.named
,19'7'9
(state relevant circumstances, e.g. renunciation, death of executor,' etc.)
Decendent was domiciled at death in Cumberland Countyl Pennsylvania, with
h er last family or principal residence at Green Ridge Village _ ~ --
210 Big Spr, ing,~Road, Newville, PA 17241
' ~ ~ "// (list street, number and muncipality)
Decendent, then ~,- ' years of age, died December 29 ~ .¢c1~. 2001 .,
at .Green Ridge Village, ?
Except as follows, decedent did no[marry, was not divorced and did not have a child born or adopted
after execution of the will offered'for probate; was.not the victim of a killing and was never, adjudicated
incompetent: none
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) A!l'personal property $
(If not domiciled'in Pa.) ;.'. Personal property in Pennsylvania $
(If not domiciled in Pa.) ,' Personal property in County ' $
Value of real estate in Pennsylvania $
situated as follows:
68,000.-
WHEREFORE, petitioner(g) respectfully request(s) the probate of the last will and-codicil(s)
presented herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
~xecutrix of Estate
D. Anne S. Hilton
3655 S.
'Denver,
Verbena Street~ H-104
CO. 80237
-', .OATH..OF PERSONAL REPRESENTATIVE
COMMOI~IWEALTH ~OF -PENNSYLVANIA ~
COUNTY OF c~nberl~nd
The petitioner(s) above-nam_e_d sWear(s) or affirm(s) that the statements in the foregoing petition' ar~~
true and correct to the best oLthe!knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent p~titioner(s) will w~nd tru, l~ister the ~, ~ccording to law.
Sworn to or affirmed and subscribed ~Z4~.~CC~O ~~ ~
before me this ~ _ day of -~ ~
~,a~ ~Lewis ' Regtster ~ ~ ~
-
REGISTER OF WILLS OF Cumberland COUNTY
OATH OF SUBSCRIBING WITNESS
codieib
{-eaeh9 a subscribing witness to the will presented herewith, ~ being duly qualified according to
law, depose(s) and say(s) that ~J~ e._ coa5 present and saw
the testat r ~ X , sign. the same and that 3/x e._ signed as a witness at the
request of testatrq ~c in ti ,.~.r presence and (in the presence of each other) (in the presence of the
other subscribing w,tness(es)). - ./- ~./.~~;.
Sworn to or affirmed and subsCribed before
me this 8th '_ ~ day of
_ ~ C. ~~{ _~~
(Address)
'-, ~ R.~3~GIST~R OF WILLS OF COUNTY
'~ ':~ , TH OF NON'SUBSCRIBING WITNESS
0'[%
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of ,
codicil
testat~ of (one of the subscribing witnesses to) the will presented herewith and
codicil
that believes the signature on the will is in the handwriting of
to the best of knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19__
Register
(Name)
(Address)
(Name)
(Address)
21-2002-00]_9
I, D. ANNE S. HILTON, of Carlisle, Cumberland county, Pennsylvania, ~eclare this
to be my last will and revoke any will previously made by me
ITEM ONE. I direct that all my.debts and funeral exPenses, including my grave-
marker, shall be paid from my residuary estate as soon as practicable after my
decease, as a part of the expense of the administration of my. estate.-
ITEM TWO. I give, devise and bequeath my entire~estate, real, personal and mi~ed
of whatever nature and wherever Situated, to my daughter, MARY LOUISE BALL, of 687
Ridge Road,' Hampden,.-Connecticut 06517.
ITEM THREE. In the event that my daughter, MARY LOUISE BALL, predeceases me, I
give, devise and bequeath my entire estate to her children, equally, share and
share alike, per stirpes.
ITEM FOUR. I appoint my daughter, MARY LOUISE BALL, Executrix of this my last will..
In.the event that MARY LOUISE BALL fails to qualify or renounces, then I appoint
ALLEN J. NADEAU of 2~5 South West Street, Carlisle,~Pennsylvania, Executor. In the
event that MARY LOUISE BALL predeceases me,'then I'appoint 3AMES PRESCOTT of 210
South College Street, Carlisle,.Pennsylvania, Executor of this my last will.
ITEM FIVE. I appoint JAMES PRESCOTT of 210 South College Street,.Carlisle,.
Pennsylvania, guardian of any property which passes to a. minor and wi~h respedt to
which I am authorized to a~point a guardian and have not oth~erwise specifically done
so. Said guardian shall have the power tO use principal as-well as income from time
to time for the minor's education, support and'welfare without regard'to his or her
parent's ability to provide for such education, supPort or welfare, 0r~to make pay-
ment for these purposes,' without further responsibility, .to the minor or to the
minor's.parents or to any person taking care of the minor. Said guardian, shall
administer the separate and equal~share of each minor until he or she becomes 21
years of .age, at which, time the share of said minor remaining in the guardianship
account shall be paid to said' minor in full. In the event.of the death'of, any minor
after my decease and prior to reaching the age of 21' years, his or her'share Shall be
distributed equally tO the surviving children. ShoUld he fail to qualify or cease'to
act I appoint ALLEN J.' NADEAU of 245 South West Street, Carlisle, Pennsylvania, as~
guardian. Should he fail to qualify Or cease to act I appoint JOHN H. BROUJOS of
4 North Hanover Street, Carlisle, Pennsylvania, as guardian.
ITEM SIX. Ail estate, inheritance, succession and other taxes, imposed Or payable
by reason of my death, and interest and penalties thereon, with resPect to all proC
perty comprising my gross estate for tax purpOses, whether or not such property passes
under this will, shall be paid Out of the principal of my residuary estate, Without
apportionment or right of reimbursement.
ITEM SEVEN. I direct that my personal representative' or guardian shall not be required
to give bond for the faithful performance of their duties in any jurisdictidn.
ITEM EIGHT. In addition to the rights and powers.given to fiduciaries by law and
elsewhere in this will, I give to my Executor during the full time necessary for
the. administration of my estate the followi.ng rights and powers to be exercised-in
his sole discretion..
A. To retain any rea.1 or personal .property which may at any time form a part of my
estate so long as he or she deems it advisable.
B. To invest in any real or personal property without.restriction to !~egal invest-'
Page one of two pages
ments.
C. To repair, alter, improve or lease for any period of time .any real or personal
property and to give options for leases.
D. To sell at public or private sale, for cash or credit, with or.without security,
to exchange or to partition real or personal property and to give options for leases.
E. To make distribution'in kind.
F. To compromise claims.
IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of July, 1979.
SIGNED
The preceding instrument, consisting of this and one other typewritten page, each
identified by the signature of the Testatrix, D. ANNE S. HILTON., was on the day and
date thereof signed, published and declared by D. ANNE S. HILTON,'the Testatrix
therein named as and for her last will, in the presence of us, who at her request,
in her presence, and in the presence of each other have subscribed our names as
witnesses hereto.
P~ge two of two pages
Recorded..O,rfice .of
Regisl:e.r of Wills
'02 JI~N-3 P4:00
l,.,lerk-~..,:~.!~i ;~:i~!;~, Coi. Jrt
Cumbel'land Co, PA
CLAIM
ESTATE OF
Deceased
No ........... of 19 ..........
Notice~of elai~ ]~~i~ ,~ I/T[.~..., .[..~, ~ in the arnount
of
and Fiduciaries Code Laws of 1972, Act. No. 164, effective July 1,
1972, as amended:
TO THE CLERK OF THE/~ /~.-.~_ ~ ,I- COURT DIVISION: , .
Enter the claim °f.....~)~.~b. LJ~/~...~!..~...a..~......~...[..~...~.~'~' "" ....... ~ ................ '_" .........
· e above entitled Es~te ~e'decedent, who resided at ~C~OEtO~...~UCSI m ~( I. ~ ....
(date)
Wfiflen notice of said claim was given to ...................................................................................................
~ onalr e a' or ' ~el)
(aa~ess) (aate)
~e b~is of ~ores~d claim is as follows:
~Itemize ~lly to ~able personal reprgsentative, to m~e proper~vestigatio~}.. ,--
Cme) (cla~mt)
(ad.ess) (ad.ess)
~ ~ S T AT E M E N T ~ ~
Statement Date: 10/31/01 Page: 1
Account ~: 3656
GRE
ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date
Description Qty
Previous Balance
10/01/01 DOC~4834
10/08/01 RF 743329
10/12/01 RF 874637
10/12/01 RF 874638
10/12/01 RF 909967
10/12/01 RF 909968
10/12/01 RF' 909969
10/12/01 RF 915575
10/12/01 RF 915576
10/12/01 RF 941225
10/12/01 RX~ 973289
PAYMENT' - THANK YOU
COMBIVENT 14. TGM INHALER
DOCUSATE SOD W/CASANTH CA
FUROSEMIDE 80MG TAB
DAILY VITE TAB W/IRON
COREG 3.125MG TAB
ACCUPRIL 20MG TAB
ARICEPT 10MG TAB
FLUOXETINE 20MG CAP
FOSAMAX 70MG TAB UD
MOBIC 7.5MG TABS 100
Amount
3,688.95
2,638.16-
15 44.37
30 1.55
30 15.54
30 1.55
15 26.57
30 32.32
30 125.09
30 76.04
4 62.29
60 119.83
** continued on next page **
CONTINUING CARE RX
28 S 2ND ST /PO BOX 355
NEWPORT PA 17074
Statement date: 10/31/01
Account #: 3656
GRE
Name: ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
~ ~ ST ATEMENT**
Statement Date: 10/31/01 Page: 2
Account ~: ~6~6
GRE
ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date
Descript ion Qt y
10/12/01 RXff 973290
10/20/01 RF' 941584
10/20/01 RF 951523
10/23/01 RX~ 990304
REMERON 15MG TAB 45
ADVAIR DISKUS 500/50MCG 60
NITREK 0.2MG/HR PATCH (30 30
DURAGESIC 25MCG/HR PATCH 10
Amount
111.41
170.32
50.12
119~33
Ending balance - Pay this amount
Past Due Past Due
Current 31-60 days 61-90 days
956.33 1,050.'79 .00
> 2,007.12
Past Due
90+ days
.00
Please cut here and remit this portion with payment
Remit to: CONTINUING CARE RX
28 S 2ND ST /PO BOX 355
NEWPORT PA 17074
Statement date: 10/31/01
Account ~$: 3656 GRE
Ending ba].ance: 2,007. 12
Name: ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
Amount enclosed:
~ ~ S T A T EME N T* ~
Statement Date: 11/30/0i Page: 1
Account ~: 3656
GRE
ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
If you have any questions regarding your bill please call
(717) 567-2147 or 1-80~-67~-~,=79 Thank you!
Date
11/01/01
11/09/01
11/09/01
11/li/01
11/11/01
11/11/01
11/11/01
11/11/01
11/11/01
11/11/01
11/11/01
Descri pt ion Qt y
Previous Balance
RX~ 999784 BACITRACIN ZINC OINT 30G 30
RF 915575 ARICEPT 10MG TAB 1
RF 973290 REMERON 15MG TAB 2
RF 874637 DOCUSATE SOD W/CASANTH CA 30
RF 874638 FUROSEMIDE 80MG TAB 30
RF 909967 DAILY VITE TAB W/IRON 30
RF 909968 COREG 3.125MG 'TAB 15
RF 909969 ACCUPRIL 20MG TAB 30
RF 915575 ARICEPT 10MG TAB 30
RF 915576 FLUOXETINE 20MG CAP 30
RF 941225 FOSAMAX 70MG TAB UD 4
Amount
2,007.12
2.00
8.03
8.77
1.55
15.54
1.55
26.57
32.32
125.09
76.04
62.29
** continued on next page **
CONTINUING CARE RX
28 S 2ND ST /PO BOX 355
NEWPORT PA i7074
Statement date: 11/30/01
Account ~: 3656
GRE
Name: ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 802~7
*~ ST ATEME NT ~ ~
Statement Date: 11/30/01 Page.' 2
Account $~: 3656
GRE
ANNE HILTON
MARY LOUISE BAI_L.
3655 S VERHENA ST H-104
DENVER, CO 80237
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description
11/11/01 RF 973289
11/11/01 RF 973290
11/16/01 DOC~4839
11/17/01 RF 951523
11/26/01 RX~ 1024266
11/29/01 RF 941584
MOBIC 7.5MG TABS 100
REMERON 15MG TAB
PAYMENT - THANK YOU
NITREK 0.2MG/HR PATCH (30
DURAGESIC 25MCG/HR PATCH
ADVAIR DISKUS 500/50MCG
Qty Amount
60 119.83
45 111.41
1,050.39-
30 50.12
10 119.33
60 171.65
Ending balance - Pay this amount
Past Due Past Due
Current 31-60 days 61-90 days
932.09 956.33 .40
> 1,888.82
Past Due
90+ days
.00
Please cut here and remit this portion with payment
Remit to: CONTINUING CARE RX
28 S 2ND ST /PO BOX 355
NEWPORT PA 17074
Statement date: 11/30/01
Account $~: 3656
GRE
Endihg balance: 1,888.82
Name: ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
Amount enclosed:
~ ~ S T A T E M E N T ~ ~
Statement Date: 12/31/01 Page: 1
Account $~: 3656
GRE
ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date
12/01/01
12/10/01
12/10/01
12/10/01
12/10/01
12/11/01
12/11/01
12/11/01
12/11/01
12/11/01
12/11/01
Descript ion Qt y
Previous Balance
RX~ 1030323 COMBIVENT 14. TGM INHALER 15
RF 973290 REMERON 15MG TAB 2
RF 10331'72 ARICEPT 10MG TAB 1
RX~ 1042437 BENZONATATE 100MG CAP' t86
RX~ 1042440 HYDROCODONE BIT/HOMATRAPI 120
RF 909967 DAILY VITE /~'AB W/IRON 30
RF 909968 COREG 3.125MG TAB 15
RF 909969 ACCUPRIL 20MG TAB 30
RF 915576 FLUOXETINE 20MG CAP 30
RF 941225 FOSAMAX 70MG TAB UD 4
RF 973289 MOBIC 7.5MG TABS 100 60
Amount
1,888.82
44.37
8.77
8.03
132.81
8.49
1.55
26.57
32.32
76.04
62.29
119.83
** continued on next page **
CONTINUING CARE] RX
28 S 2ND ST /PO BOX 355
NEWPORT PA 17074
Statement date: 12/31/01
Account ~: 3656
GRE
Name: ANNE HILTON
MARY LOUISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
**STATEMENT**
Statement Date: 12/31/0! Page: 2
Account ~: 3656
GRE
ANNE HILTON
MARY LOLIISE BALL
3655 S VERHENA ST H-104
DENVER, CO 80237
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date
12/11/0t
12/11/01
12/11/01
12/li/01
i2/17/01
12/17/01
12/17/01
12/17/01
12/20/01
12/21/01
12/24/01
Description Qty
RF 973290
RX~ 1033170
RX~ 10331'71
RX~ 1033172
RX~ 1050457
RX~ 1050464
RX~ 1050466
RX# 1050468
RX~ 1055228
RX~ 1056279
RF 951523
REMERON 15MG "FAB 45
DOCUSATE SOD W/CASANTH CA 30
FUROSEMIDE 80MS TAB 30
ARICEPT 10MS TAB 30
PRi]METHAZINE 25MG/ML AMP 1
PROMETHAZINE 25MG/ML AMP 10
PHENERGAN 25MG SUPP 10
LOPERAMIDE 2MG CAP 12
CIPRO 500MG 'TAB 20
DURAGESIC 25MCS/HR PATCH 10
N!TREK 0.2MG/HR PATCH (30 30
Amount
111.41
1.55
15.54
125.09
6.14
25.46
44.79
10.78
91.60
119.33
50.12
Ending balance - Pay this amount
Past Due Past Due
Current 31-60 days 61-90 days
1,122.88 932.09 956.33
> 3,011.70
Past Due
90+ days
~40
Please cut here and remit this portion with payment
Remit to: CONTINUING CARE RX
28 S 2ND ST /PO BOX 355
NEWPORT PA 17074
Statement date: 12/31/01
Account ~$: 3656 GRE
Ending balance: 3,011.70
Name: ANNE HILTON
MARY LOUISE BAI_L
3655 S VERHENA ST H-104
DENVER, CO 80237
Amount enclosed:
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent:
Date of Death:
Will No.:
To the Register:
Anne S. Hilton
December 29, 2001
Admin. No.:
21-02-00019
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
January 23, 2002:
Name Address
Mary Louise Ball
3655 S. Verbena Street, H-104,
Denver, CO 80237
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
Date: January 23, 2002
John H. Broujos, Esquire #06268
4 North Hanover Street
Carlisle, PA 17013
(717) 243-4574
Capacity:
__ Personal Representative
X Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYL~JANiA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 001015
BROUJOS JOHN ESQ
4 N HANOVER ST
CARLISLE, PA 17013
fold
ESTATE INFORMATION: SSN: 168-36-2909
FILE NUMBER: 2102-001 9
DECEDENT NAME: HILTON D ANNE S
DATE OF PAYMENT: 03/28/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 1 2/29/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $2,000.00
TOTAL AMOUNT PAID:
$2,000.00
REMARKS: JOHN H BROUJOS
CHECK# 0369
SEAL ',
INITIALS: SK
RECEIVED BY:
'REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL
HILTON, D. ANNE S.
DATE OF DEATH (MM-DD-Year)
12/29/2001
REV-1500 '
INHERITANCE TAX RETURN
RESIDENT DECEDENT
IDATE OF BIRTH (MM-OD-Year)
04/03/1909
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 2 0 0
0 1 9
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
1 6 8-3 6- 2. 9 0 9
THIS RETURN MUST RE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
I'~1 1. Original Retum
r--I 4. Limited Estate
I'~-'1 6. Decedent Died Testate (Altach copy of Will)
I----'1 9. Litigation Proceeds Received
--12. Supplemental Return
O4a. Futura Interast Compromise (date of death after 12-12:82)
---]7. Decedent Maintained a Living Trust (Attach copy of Trust)
[Z] 10. Spousal Poverty Cradit (date of death between 12-31-91 and 1-1-95)
1~13. RemainderRetum (dateofdeathpriorto12-13-82)
--15. Federal Estate Tax Return Requirad
i 8. 'l:otal Number of Safe Deposit Boxes
F"] 11. Election to tax undei Sec. 9113(A) (A~ach Sch O)
THiS sECTION MUST:BE COMPLETED ALE:CORRESPONDENCE :AND:CONFIDENTIAE TAX,4NFORMATION :SHOULD.BE'D RECTEO:TO · '.
NAME
JOHN H. BROUJOS, ESQUIRE
FIRM NAME (If Applicable)
BROUJOS & GILROY~ P.C.
TELEPHONE NUMBER
717-243-4574 OR 717-766-1690
COMPLETE MAILING ADDRESS
4 NORTH HANOVER STREET
CARLISLE PA 17013
t
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
.6. Jointly Owned Property (Schedule F)
I--"1 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)
(1)
(2),
(3)
(4)
(5)
(7)
(9)
(10)
60,720.00
13. Charitable and Govemmental Bequests/Sec 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)
(8)
3,013.697
18,183.32
(11)
(12)
OFFICIAL USE ONLY
67,770.16
21,196.99
46,573.17
(13)
(14)
46,573.17
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
46,573.17
X
X · 045
X ,12
X .15
(15)
(16)
(17)
(18)
(19)
2,095.79
2,095.79
~' ~:'~r~ > > BE SURETO ANSWERALL QUESTIONS ON REVERSESIDE AND: RECHECK: MATH':<
Decedent's complete Address: '. . .
STREET ADDRESS Green Ridge Village, Swair~ Health Center
210 Big Spring Road
c~Ty Newville
Tax Payments and Credits:
1. Tax Due(Page 1 Line 19)
2. Credits/Payments ' ·
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
ISTATE PA
2)000.00
Interest/Penalty if applicable
D. Interest
E. Penalty'' " ' ....
100.00 .
Total Credits ( A + B + C)
4. If Line 2 is, greater than Line.1 + Line 3, enter the difference. This is the OVERPAYMENT. ./, ...
Check box ¢i Page 1 Line 20 to reques..t a r, efund ...... .
5. If Line 1 ,~- Line 3 is greater than Line 2, enter the difference. Thii is. the FAX DUE.
A. Enter the interest on the tax due. : . · "',; .. ',' · '
Total Interest/Penaity ( D + E )
ZIP 17241 '
2,095.'79
(1)
(3)
(4)
(5)'-
(SA)
' 2,100'. O0
4;21
B. Enter the total of Line 5 + EA. This is the BALANCE DUE. ' (EB) ..'
Make Check payable to: REGISTER OF WILLS, AGENT
· ,: ,i:': ~, '~'] ,"i:~ ,' ~: i ."!'. : ;; ~ ..,: ;J: :. :.'~'.~. :~i'~;,'' ~'~ "::.;.>: = ' =, ~ = ~. :~:~,~:~i: .~ h: .'~ ~:'~ : .,,:= :;:~ ~=~ ?j f !i !.j; ~!~:: ~: ~/.:,!~:·,!i:~ :,::,:~'~:~ ~!~? ~i:;'! ~' ' !~ ~;~ ~; :: : ;i~!~:?.~ :'- *:' ~ ~ ,.-:: ..,'i¥,.,_'::'; J:/2:'"~ ·.:
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent mak~ a tra,sfer and: Yes No
a. retain the use or income of the property transferred; '..: .......... '.'..: ....... -....'.....i ......... - .............................. i. []
b. retain the right to designatewho sha!l use the property transferred or its income; .................... ............. ;..~:.. [] []
c. retain a reversionary interest; or ...:......:..........:.:..::;:. ........................... :... ........................................... .. [] []
d. receive the promisefor life of either payments, benefits or care? ' · [] .. []
2. If death occurred after December 12, 1982, did decedent'ti'ansfer property within bne year of death '
without receiving adequate consideration? .................. i ................... ......................................................... [] []
3. Did decedent own an "in trust for" or payable upon death bank account or securit); at his or her death? ................. []" []
' 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?: ................................. : ............. ' .......... . ............... :..i ...... ;.; ................. -[-~" []
IF ~HE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of prepamr~ther than the personal r~'esentative is based on,~l information of which preparer has any knowledge.
SIGNATURE OT---EE,,~ON RESPONSI~[/E FOR FILING RE~/0~N ,,,-7 ,,~) . ,
,DATE:
ADDRESS , 3655 S. ~rb~na Street, I--1~-104 ' / /
' D~nv,e,r {) ~ " cO 80237
ADpR, ESS 4~,,1~. Hanover Street [,, ) '
. C~lrlisle. "-' .
DATE
Pa 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net'~,alu'e of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surv.iving 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 d(~ath to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the us~e of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined,.under Section '9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
JOHN H. BROUJOS
HUBERT X. GILROY
BROUJOS &: GILROY, P.C.
ATTORNEYS AT LAW
4 NORTH HANOVER STREET
CARLISLE, PENNSYLVANIA 170i3
717-243-4574
FAX: 717-243-8227
NON-TOLL FROM HARRISBURG
AREA: 717-766-1690
e-mail: jbroujos@broujosgilroy.com
hgilroy~broujosgilroy.com
sePtember 26, 2002
Departmem of Revenue
Inheritance Tax Division
Dept. 280601
Harrisburg, PA 17128
To Whom It May Concem:
The safe deposit box listed on the attached REV-1500 has not been inventoried due to the
Executrix living in Colorado.
She is authorizing me as attorney for the estate to make the inventory with a representative from'
the bank or your Department. This will be done in the next few weeks.
The daughter of decedent had entered the box at her mother's re. quest prior to her death and the
daughter found papers from sale of house and old documents only. If there are any probate
assets, we will file an amended return.
,Jo~ H. Broujos
/js
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDs
ESTATE OF
HILTON, D, ANNE S,
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21 02 00019
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 9,200.00
Fortune Brands (formerly American Brands, Inc.) common stock, 230 shares @ $40
Cert. No. M263312
Fortune Brands (formerly American Brands, Inc.) common stock, 230 shares @ $40
Cert. No. M484602
Fortune Brands (formerly American Brands, Inc.) common stock, 460 shares @ $40
Cert. No. 605552
Gallaher Group PIc stock, 920 American Depositary Shares @ $26
Cert. No. GLH-012867
TOTAL (Also enter on line 2, Recapitulation) $
9,200.00
18,400.00
23,920.00
60,720.00
(If more space is needed, insert additional sheets of the same size)
"'RE~/-1508 EX +~'1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK BEPOSlTS,& MISC.
'PERSONAL PROPERTY
ESTATE OF FILE NUMBER
HILTON, D. ANNE S, 21 03 00019
Include the proceeds of litigation and the date the proceeds were received by We estate. All property jointly.owned with the right of survivomhip must be disclosed on Schedule F.
ITEM VALUE AT DATE
· NUMBER DESCRIPTION OF DEATH
1. Citizens Bank (serviced by Mellon Bank) checking acct. 182-109-8371
There were no household items since she lived in a nursing center.
7,050.16
TOTAL (Also enter on line 5, Recapitulation) $ 7,050.16
(If more space is needed, insert additional sheets of the same size)
'REV-1511 EX + (I-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSes &
ADMINISTRATIVE COSTS
ESTATE OF
HILTON. D. ANNE S,
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 02 00019
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1.
8.
9.
10.
11.
12.
FUNERAL EXPENSES:
Ewing Brothers Funeral Home - for Westminster Cemetery
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees Broujos & Gilroy, P.C.; EIN 23-2267691
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
c ty
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Fee for estate checks
Register of Wills - Inventory
Register of Wills - Inheritance Tax Return
Register of Wills - Final Settlement Statement
Charles Schwab - processing fee to sell stock
Charles Schwab - quarterly fee
State Zip
TOTAL (Also enter on line 9, Recapitulation) $
265.00
0.00
2,450.00
0.00
138.00
9.00
10.00
15.00
17.00
64.67
45.00
3~013.67
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX * (1-97) j~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
HILTON, D. ANNE S. 21 02 00019
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1. 15,040.60
2
Presbyterian Homes, Inc. - nursing care
Swaim Health Center, 210 Big Spring Road, Newville, PA 17241
Continuing Care RX - prescriptions and medications
28 S. 2nd St, Newport, PA 17074
Carlisle Regional Medical Center - outpatient test or treatment
246 Parker Street, Carlisle, PA 17013
St. John's Episcopal Church - altar flowers from Flowers by Mountain Lakes
Carlisle, PA 17013
Rytel Cardiac Services
Deborah Piper, Tax Collector - personal tax
Mellon Bank - safe deposit box rental
TOTAL (Also enter on line 10, Recapitulation) $
3,011.70
24.32
53.00
20.20
5.50
28.00
18~183.32
(If more space is needed, insert additional sheets of the same size)
'~'1513 F'X +~(1'97) ~
COMMONWEALTH OF PENNSYLVANIA
~NHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
HILTON, D, ANNE S,
NUMBER
I1.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Mary Louise Ball
3655 S. Verbena Street, H-104
Denver, CO 80237
FILE NUMBER
21 02
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
daughter
00019
AMOUNT OR SHARE
OF ESTATE
100%
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET
INVENTORY OF THE REAL AND PERSONAL ESTATE OF
Anne S. Hilton, deceased
File No.: 21-02-0019
Date of Death: December 29, 2001
o
o
o
Fortune Brands (formerly American Brands, Inc.) common stock
230 shares @ $40; Cert. No. M263312
Fortune Brands (formerly American Brands, Inc.) common stock
230 shares ~ $40; Cert. No. M484602
Fortune Brands (formerly American Brands, Inc'.) common stock
460 shares ~ $40; Cert. No. 605552
Gallaher Group Plc stock, 920 American Depositary Shares ~ $26
Cert. No. GLH-012867
Citizens Bank (serviced by Mellon Bank) checking acct. 182-109-8371
$ 9,200.00
9,200.00
18,400.00
23,920.00
7,050.16
$ 67,770.16
Date:
~Iary. L~e~Ball, Execu~trix / '
BUREAU OF INDIVIDUAL TAXES
TNHERTTAHCE TAX DTVIS/ON
DEPT. 280601
HARRXSBURG, PA 17128-0601
JOHN H BROUJOS ESQ
BROUJOS 8 GILROY
~ N HANOVER ST
CARLISLE
COHHONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHEriTANcE T~X
APPRATSEMENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCTTONS AND ASSESSMENT OF TAX
RC,¢';3';:: ..... : ,~ ,, ~.~DATE
ESTATE OF
DATE OF DEATH
dm~u.~ ~.~/:~!,.~r,tj .Dt~'~"'F~LEcouNTyNUH~ER
ACN
pA 17~1~
11-11-2002
HILTON
12-29-2001
21 02-0019
CUMBERLAND
101
Amount ReeAtt~d
RE¥-1547 El[ AFP
ANNE S
HAKE CHECK PAYABLE AND RENTT PAYMENT TO:
REGISTER OF NILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-0~) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR
DZSALLOgANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HILTON ANNE S FILE NO. 21 02-0019 ACN 101 DATE 11=11-2002
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: 1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
$. Closely Held Stock/Partnership Interest (Schedule C)
~. Nortgages/Notes ReCeivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. doAntly O~ned Property (Schedule F)
7. Transfers (Schedule G)
8. Total*Assets
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage LAabAIAtAes/LAens (Schedule 1)
11. Total Daductions
12. Net Value of Tax Return
15.
lq.
ORIGINAL RETURN
(1)
(2).
($)
($)
(6)
(7}
.00 NOTE: To Ansure proper
60~720.00 credA* to your ~ccount,
.00 .subeit the upper port/on
.*00 of thAs'fore ~ith your
71050.16 tax payment.
.00'
.00
(8) 67,770.16
3,013.67
(;)
(10) 18~183.$2
· (11)
(12}
Charitablo/Governeental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Net Value of Estate Subject to Tax (1~)
~6,575.17
.00
~6,575.17
NOTE:
Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATZONOF ADDITIONAL ZNTEREST.
ASSESSMENT OF TAX:
15. Amount of LAne 1~ at Spousal rate
16. Amount of Line 1~ taxable at Lineal/Class A rate
17. Amount of LAne 1~ at SAbllng rate
18. Amount of LAne 1~ taxable at Collateral/Class B rate
19. PrincApal Tax Dun
TAX CREDITS:
PAYMENt RECEIPT DISCOUNT
DATE NUMBER INTEREST/PEN PATD (-)
03-28-2002 CD001015 10~.79
11-0~-2002 REFUND .00
(15) .00 X O0 = .00
(Z6) ~6,575.17 X 0~5= 2,095.79
(17) .00 X 12 = .00
(18) .0.0 x 15 = .00
(19)= 2,095.79
AMOUNT PATD
2,000.00
9.00-
TOTAL TAX CREDZT
BALANCE OF TAX DUE
*INTEREST AND PEN.
TOTAL DUE
Z,095.79.00.00.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
reflect figures that include the total of ALL returns assessed to date.
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
ODJECTIONS:~
ADHIN-
ISTRATZVE
CORRECTZONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 1982 -- if any future interest*in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of tho decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To ~ulfill the requirements of section 2110 of the Inheritance and Estate Tax Act, ,Act 23 of 2000. (71 P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REG/STER OF HZLLSj AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance. and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Nills, any of the Z3 Revenue District Offices, or by calling the special Z~-hour '
answering service for forms ordering: 1-800-36Z-lOS0; services for taxpayers with special hearing and / or'
speaking needs: 1-800-~q7-30ZO (TT only).
Any party in intaras~ not satisfied aith the a~p~aisement, allowance, or disallowance of deductions, or assessment·
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by: ' '
--written protest to tho PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
T-election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to:. PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. zgo601j Harrisburg, pA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid mithin three (3) calendar months after the decedent's death, a five percent (BI) discount of
the tax paid is a11oaed.
The 15Z tax amnesty non-participation penalty is computed on the total Of the tax and interest assessed, and not
paid before January 18,.1996, the first day after the end of the tax amnesty period· This non-participation
'penalty is appealable in the same manner and in the the same time period as you wautd appeal the tax and interest
that has been assessed as indicated onthis notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of .
death, to the date of payment.' Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .00016¢. A11 taxes which became delinquent on and after
January 1, 198Z mill bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Oapar.tment of Revenue. The applicable interest rates for 1982 through 2002 ara:
Year Interest Rate Daily Interest Factor
1982 ZOZ
1983 16Z
198~ 111'
1985 13Z
1986 101
1987 9Z
1988-1991 111
--Interest is calculated as
TNTEREST = BALANCE OF
.0005~8
.O00~3&
.000301
.0003S6
.00027~
.0002~7
.000301
follows:'
TAX UNPAID 'X
Year Interest Rate Daily Interest Factor
1992. . 91 .0001~7
1993-199~ 72 .000191
1995-1998 9Z .0002~7
1999 72 .000192
ZOO0 8Z .O00Z19
2001 92 .0002~7
ZOO2 6Z .00016~
NUHBER OF DAYS DELINQUENT
X DAILY THTEREST FACTOR
--Any Notice issued after the tax become~ delinquent will reflect an interest caXculation to fifteen (15) days
beyond the date of the pssessment. Xf payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Final Settlement Statement
File No. 21-02-0019
THIS is a statement made this o2 ff'P~day of /4-~-~ ,2003, by Mary Louise Ball
3655 S. Verbena Street, Apt. H-104, Denver, CO 80237, sole beneficiary and Executrix of the,
Estate of D. Anne S: Hilton, Decedent, and whose name is set forth as signatory at the end of this
Statement.
WITNESSETH:
A. D. Anne S. Hilton of Green Ridge Village, Swaim Health Center, 210 Big Spring Road,
Newville, Cumberland County, Pennsylvania, died on December 29, 2001.
B. On January 9, 2002, Letters Testamentary were granted to Mary Louise Ball at File No.
21-02-0019 in the Register of Wills Office for Cumberland County, Pennsylvania.
C. Executrix has administered the estate until the present time and has paid all debts of the
estate, including inheritance tax owed.
D. Decedent died testate, providing for the residue of decedent's estate to pass to her only
child, whose name is subscribed hereunder.
E. The assets of the estate are set forth in Exhibit A attached hereto and made a part hereof.
F. Executrix has paid the debts of the estate as set forth in Exhibit B attached hereto and
made a part hereof.
G. There remains to be distributed to the beneficiary the assets set forth in the Schedule of
Distribution in Exhibit C attached hereto and made a part hereof.
H. The party desires to forego a formal account and schedule of distribution and desires to
conclude the estate by virtue of filing of this Statement.
NOW, THEREFORE, the said party intending to be legally bound sets forth the following:.
1. Executrix of the estate of deceased will not file a formal accounting or schedule of
distribution.
2. Inheritance Tax was paid.
3. The party will distribute the assets in accordance with Exhibit C.
4. The beneficiary designates this Statement as a "satisfaction of award" and hereby
authorizes and directs the Clerk of Orphans' Court to mark satisfied of record any award which
may subsequently be made by the Court with respect to the distribution made to the distributee in
this Statement.
5. The said beneficiary acknowledges that this Final Settlement Statement shall be filed
with the Clerk of Orphans' Court in final settlement of the estate of decedent D. Anne S. Hilton.
IN WITNESS WHEREOF,_ the Executrix/Beneficiary, intending to be legally bound hereby, sets
her hand and seal the day and year first above written.
WITNE S S:
ITEM
NUMBER
'EXHIBIT A - ASSETS
DESCRIPTION
VALUE AT DATE
Of DEATH
Fortune Brands (formerly American Brands, Inc.) common stock
230 shares @ $40, Cert. No. M263312
Fortune Brands (formerly American Brands, Inc.) common stock
230 shares @ $40, Cert. No. M484602 .
Fortune Brands (formerly American Brands, Inc.) common stock
460 shares @ $40, Cert. No. 605552
Gallaher Group PIc stock, 920 American Depositary Shares @ $26
Cert. No. GLH-012867
Citizens Bank (serviced by Mellon Bank) checking acct. 182-109-8371
$ 9,200.00
9,200.00
18,4O0.OO
23,920.00
7,050.16
TOTAL ASSETS
$ 67,770.16
ITEM NUMBER
EXHIBIT B -.DEBTS AND DEDUCTIONS
DESCRIPTION
AMOUNT
FUNERAL EXPENSES
1. Ewing Brothers Funeral Home - for Westminster Cemetery
ADMINISTRATIVE COSTS
1. Personal Representative Commissions
2. Attorney Fees- Broujos & Gilroy, P.C.; EIN 23-2267691
3. Register of Wills - Probate Fees
MISCELLANEOUS EXPENSES
2.
3.
4.
5.
6.
Register of Wills - Inventory
Register of Wills - Inheritance Tax Return
Register of Wills - Final Settlement Statement
Fee for estate checks
Charles Schwab - processing fee to sell stock
Charles Schwab - quarterly fee
MISCELLANEOUS DEBTS
1. Presbyterian Homes, Inc. - nursing care
2. Continuing Care RX - prescriptions and medications
3. Carlisle Regional Medical Center - outpatient test or treatment
St. John's Episcopal Church - altar flowers
from Flowers by Mountain Lakes
Rytel Cardiac Services
Deborah Piper, Tax Collector- personal tax
Mellon Bank - safe deposit box rental
Inheritance "~ax
TOTAL
TOTAL DEBTS AND DEDUCTIONS
$ 265.00
-0-
2,450.00
138.00
10.00
15.00
17.00
9.00
64.67
45.00
15,040.60
3,011.70
24.32
53.00
20.20
5.50
28.00
21,196.99
2,095.79
$23,292.78
EXHIBIT C - DISTRIBUTION
Assets
Debts and Deductions
Balance for Distribution
$ 67,770.16
$ 23~292.78
$ 44,477.38
Paid to Mary Louise Ball
STATUS REPORT UNDER ROLE 6.12
Name of Decedent:
D. Anne S. Hilton
Date of Death: 12-29-01
Will No. Admin. No. 21-02-00019
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the followirig
with respect to completion of the administration of the above-captioned estate:
1.State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
ao
Did the personal representative file a final account/statement with the
Court? Yes X No
b. The separate Orphans' Court No. (if any) for the personal representative's
. account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes X No
.e~.. ~ ~opies of receipts, releases, joinders and approvals of formal or informal
~ a?counts may be filed with the Clerk of Orphans' Court and may be
,~ :> ~., ~tached to this report.
Da~ ~~
~'? ~ m~.~ Si~a~re~
O'~ M~ Louise Ball
3655 S. Verbena Street, Apt. H-104
Denver, CO 80237
720-529-3879
Capacity:
X Personal Representative
Counsel for Personal
Representative