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HomeMy WebLinkAbout08-01-08oral is 15056041125 '~ REV-1500 EX (06-OS) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year Fi{e Number PO BOX 280601 INHERITANCE TAX RETURN --Y Harrisburg PA 17128-0601 RESIDENT DECEDENT _ ~~ ~~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 1 0 4 0 1 4 4 0 0 4 0 6 2 0 0 8 0 8 3 1 1 9 4 ri Decedent's Last Name Suffix Decedent's First Name MI F R Y S T E V E N L~ +Jlf Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5 Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9 Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number P A U L B O R R E S Q U I R E ~ 1~ ~' r' `~ " r~ `' Firm Name (If Applicable) REGISTER OF WILLS USE ONLY L A W O F F I C E S O F P A U L O R R C~ ~~= First line of address ' t~ -- 5 0 E A S T H I G H S I R E E T ~, ~~ `;~~ ~-' -- , - Second line of address _ -- - ~' -~ i _- , City or Post Office State ZIP Code ~R'~E FILED ~° ~~--, .. C A R L I S L E P A 1? 0 1 3 c» r~~ Corres on nt's -ail ad ss: P RR EMBARQMAIL.COM Under p n Itie of p rlu I ear that I h v e mined this return, including accompanying schedules and statements. and to the best of my knowledge and bebef it is true. rr t and co plete ration f r arer other than the personal representative is based on aN information of which preparer has any know) dge SIGNAT E P ON R SP NSI E ING RETURN T ADDRE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 50 EAST HIGH STREET CARLISLE PA X701 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056041125 15056042126 REV-1500 EX Decedent's Social Security Number decedent's Neme: STEVEN L. FRY 2 1 ~~ 4 0 1 4 4 0 RECAPITULATION 1. Real estate (Schedule A) 1. 2. Stocks and Bonds (Schedule B) .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 4. Mortgages & Notes Receivable (Schedule D) 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 5 3 6 7 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1-7) ....................... .... 8. 5 3 3 6 7 4 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 5 g 2 0 4 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. 2 ~ R 2 5 11. Total Deductions (total Lines 9 & 10) 11. ~ ~~ 5 ~ 6 ~ 12. Net Value of Estate (Line 8 minus Line 11) 12. - 7 2 1 9 ~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. - 7 2 1 9 3 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .o 0 0 0 15. 0 0 0 16 Amount of Line 14 taxable at lineal rate X .0 ~ 0 0 0 16 Q U ~l 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17 ~ (1 18. Amount of Line 14 taxable at collateral rate X .15 0 ~ ~ 18 ~~ _I ~ ~ 19. Tax Due .................. .... ... ..... ..19. ~ ~~ ~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 15056042126 15056042126 ?Jlf/AR6~ttdfa: 6t i~ ittegal to duplicate this copy by phatostat or phut®graph. ?ee for ti]is certificate, $6.00 Certificatio), Number- ['his is to certify tl2at the information here given i~. •on-ectly copied from an original Certificate of Deatt t(Ily filed with me as Local Registrar. The origins :ertil~icate will be forwarded Co the State Vita tecords (9#~fice for permanent filing. ~ocal Registrar Date Issued s } N1054.3 REV nrtooe l: V MMUN W tAL I H Uh F'tNNLi Y LVANIA • UtYAH I MtN l OF HtALI H • VI I AL HtOUHU7i ~R~Nr" CERTIFICATE OF DEATH e+AOC ~ {See instnlcrions and examples on reverse) STATE FlLE NUMBER ~I ~I d fi n 1. Nar d OentlaA IRr.L nidie, beL edfap 2. Su 8. SooW Seouely NunDSr i. DeM d Oeetli IMaiCL d.Y. Mal Steven L. Fry Male 210 - 40 - 1440 April 6, 2008 s. Ape (Lis aruarn ones 1 Uneu i s. ow d ettlr (Maeh, r. ra wb a la FYO a Dees (COetlt ar ~. Oep R•+. e•eer Haepla: Oear. 59 Ya Aug. 31, 1948 Carlisle, PA ^,,,~,+,,,, ^ERlonrorrd ^ooA ~Nugbp Nar ^ReaeaK. ^olw-:;pa,y: ' l0. Cdely d Drs Be CXy, Baq Tnp. d DeaA Bd FWiy Nana pl net Ymxulon, pM rea ra nntaq 1. Na Dendea a Ilepalo OAyn7 ~ No ^ Yr 10. hoe: AmeAon bdrrL BWl, YYNb, ac. Cumberland Carlisle Forest Patk Health Center ("M°'e°"'N`absi' (~ White • aaern, PuMO Nai4 ae.) ++. BeoeaentNlAul d.ax a or aoa a w. w aA aw 12. wr Oeodere.wr b as 1& Deoderfa EAKaIm (sPealr aiy Nphea pace wip leudi It. MNW smi: Married Never MrAea 15. suraaq spa n.01 ave. pM matlen name) Nbd a wale NYa a / Laborer Cr ta~'> u.s. Amre Fawn / Seaerory (a12) Cowpe pa a 5«) WNnee4 Oborrd (spats g. ys ^,,., p~, 2 never married 10. Deoeda/e lainp Aeaen ISe.eL dy I bwi, eW, xb aael Oeoedeae Db Deoedenl S Middleton PA 24 Pine St. . AarRra.ea 1a.aw a»b+ 1Ta®1MOastlallMdb rnp Carlisle, PA 17013 Cumberland T0""d'4a 1Ta^Na ~ u..eaem 1m ~r ~/~ a ,a Fran Nrr IFea, eeeia ra, arep Chester L . Fr y ,/. Mrw. Nar (Fia, Mma e.Ur.m.n.l Clarabelle McBride 20aY`"'""RM'/Pr`1a Clarabelle Fry ~ +`e °~t`~.~/~ar'~is`~e, PA 17013 21a irNroda Olyeewn ^ ~papaa, 21R DMadgepatlai (Maeldry, Mad 21c Phoea DlepoYtlon (lansdorarg aarrpyaoMrpYo) 2ld laeemn(Cly/bnn, wa,lgwde) Qa.w ^ R.nnrlharrare elrpaeelenaDadenAahametl ^ ^ A ril 9 2008 Cumberland V$lley Memorial Carlisle PA 17013 ^ aNee-SVeeir brseakrNaarena/Oamert Yr ab p , ar ens , ' 22aaprwa parraprardp zahlxawwrea 138 25 23.NrreroAdiraFray Hoffman-Roth ~uneral Hom & Crematory, Inc. 1 . - 4 219 N. 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I l I c1 I t I O I - - '~'6n~ mx M'n g o o sE ~ c ,y s 7 n:~a+e H• Fl~:. / 7 2 v i peprNOn Perm Na n ~` ~~~ REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS ADMINISTRATION No . 2008- 00539 PA No . 21- OS- 0539 Estate Of : STEVEN L FRY (First, Middle, Lastl Late Of : SOUTH MIDDLETON TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : 210-40-1440 WHEREAS, STEVEN L FRY (First, Middle, Last/ late of SOUTH MIDDLETON TOWNSHIP CUMBERLAND COUNTY died on the 6th day of April 2008 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: CLARABELLE FRY who has duly qualified as ADMINISTRATOR (RIX) of the estate of the above named decedent and has agreed to administer the estate according to Iaw, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 15th day of May 2008 * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) Senior Checking Plzui Account Statement PNCBANK ?NC Bank (~, ~./ ~ p imary account number: 50-0443-6322 Page 1 of 1 For the period 04/15/2008 to 05/13/2008 Number of enclosures: 0 c H STEVEN L FRY ~] For 24-hour banking, and transaction or 24 PINE ST ~ -''interest rate information, sign on to CARLISLE PA 17013-3136 'iQ' PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espariol, 1-866-HOLA-PNC Movingt Please contact trs at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 ~~.Visit us at pnc.com TDD terminal: 1-800-531-1648 For hc,rin~ impaired rlienrs only Sometimes bigger dreams require larger loans. tl~ith highly competitive rates and low doe~~'I payments, eve can offer more mortgage options and better financing solutions. VlThether yo>,t'tr shopping for a new piltna>y residence, a second ItOII1C, or considerittg a n:finance, we cart tailor a jumbo mortgage that Gts your big plans perfectly. I~orR~ore Information: > Visit your local PNC IIank branch > Visit pncmortgage,com > Call I-300-778-6673 Senior Checking Plan Regular Checking Account Summary Account number: 50-0443-6322 Balance Summary Beginning Deposits and Checks and other balance other additions deductions Ci,185.39 .OU 1~I8.(i5 Ending balance ~i,33f.71 Charges and fees .110 Average monthly balance b,40`f.37 Steven L Fry Please see the Activity Detail section for additional information. Activity Detail Amount Description "°"""""`""-- -- ~d 1#3.tiri I)irrct Payment -CPA EIT IliKhma,l: \Xt~:\?5)99 Daily Balance Detail pate Balance Date Balance 04j 15 ~i,4$fi.3J 04/'23 Ci,3.`t4i %'} There was 1 Online or Electronic Banking Deduction totaling $148.65. Payittg for college? PNC Bank can provide solutions to all your education financing needs. Call now to review your options with an experienced loan counselor. Call PNC Bank: I-800-762-1001 If you prefer to apply onluee, ~risit us at pnconcarnpus.com. FORM953R-1005 REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FIfNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER STEVEN L. FRY Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. HOFFMAN-ROTH FUNERAL HOME & CREMATORY, INC. 4,448.92 B. 2. 3. 4 5 6 7. 8 ADMINISTRATIVE COSTS: Personal Representative's Commissions dame of Personal Representative (s) Social Security Number(s)IEIN fJumber of Personal Representative(s) Street Address Gty State , Year(s) Commission Paid: Attorney Fees PAUL BRADFORD ORR, ESQUIRE Family Exemption Ilf decedent's address is not the same as claimant's. attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE, CARLISLE, PA 17013 Accountant's Fees Tax Reborn Preparer's Fees CUMBERLAND LAW JOURNAL- ESTATE NOTICE THE SENTINEL-LEGAL- ESTATE NOTICE Zip 87.00 75.00 209.50 TOTAL (Also enter on line 9, Recapitulation) ` $ 5,820.42 Zip 1,000.00 (tf more space is needed, insert additional sheets of the same size) Hoffman-Roth Funeral Home & Crematory, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 April 16, 2008 Clarabelle Fry 24 Pine Street Carlisle, PA 17013 The Funeral Service for Steven L. Fry 15303-93 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING 1S AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: Traditional Funeral Service Package $4150.00 FUNERAL HOME SERVICE CHARGES $4150.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $4150.00 Cash Advances Newspaper Obituary Notice- Sentinel , $79.92 Clergy Offering $75.00 Certified Copies of Death Certificates . $60.00 Flowers. $159.00 Clergy declined honorarium, $-75.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $298.92 Total Total Cost . $4448.92 TOTAL AMOUNT DUE $444$.92 This statement is net and payable in full within 30 days of receipt. RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 FRY STEVEN L Receipt Date: 5/15/2008 Receipt Time: 10:33:16 Receipt No.: 1052687 Estate File No.: 2008-00539 Paid By Remarks: LAW OFFICES PAUL BRADFORD ORR AJW ------------------- Fee/Tax Description PETITION LTRS ADM SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 2035 Total Received......... Receipt Distribution -------------------- ---- Payment Amount Payee Name 45.00 CUMBERLAND COUNTY GENERAL FUN 12.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 ---------------- CUMBERLAND COUNTY GENERAL FUN 72.00 72.00 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 2493166 Fax: (717) 249-2663 June 27, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Paul Bradford Orr, Esquire Steven Fry Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: June 13, June 20, and June 27, 2008 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: June 13, June 20 and June 27, 2008 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. r ~` L' a Marie Coyn ,Editor SWORN TO AND SUBSCRIBED before me this 27_day of June, 2008 Fry, Steven, deed. Notary Late of South Middleton Town- ship. Executrix: Clarabelle Fry, 24 Pine Street, Carlisle, PA 17013. Attorney: Paul Bradford Orr, Es- _ _ quire, 50 East High Street, Caz- NOiAR1Al SEA- L lisle, PA 17013. DEBORAH A COLLINS Notary Public CARLISLE BORO, CUMBERLAND COUNTY My Commission Exptres Apr 28, 2010 RETAIN THIS PORTION FOR YOUR RECORDS THE~SENTINEL - LEGAL PAUL BRADFORD ORR P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS SALESPERSON BILLING DATE LINES 350571 10 PUBLIC NOTICES wolfC 06/25/08 42 * 2 AD DESCRIPTION START DATE 06/11/08 STOP DATE 06/25/08 ESTATE NOTICE LETTERS TESTAMENTARY PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 167.58 TOTAL AD CHARGE 167.58 3 PROOF OF PUBLICATION OlPRF 7.00 YS RUN ASE ORDER - _ PAY THIS AMOUNT Est.Steven Fry r es. MESSAGE: Thank you for advertising with The Sentinel. 174.58 209.50* Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 717-240-7176 Fax your legals to 717-243-3754 attention Tammy Shoemaker You can also EMAIL your legal to Classified ads: classified@cumberlink.com Please send a cover letter including your name and address as an attachment o e, ~ ~~ C~ ~ .~~~ .~x ~-, ,.... ~ REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER STEVEN L. FRY Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. FOREST PARK HEALTH CENTER 10.00 WALNUT BOTTOM ROAD CARLISLE, PA 17013 2. FOREST PARK HEALTH CENTER 68.18 WALNUT BOTTOM ROAD CARLISLE, PA 17013 3. COMCAST CABLE 80.17 339 BALTIMORE RD. SHIPPENSBURG, PA 17257 4. ROBERT C. CAIRNS, TAX COLLECTOR 4.90 PO BOX 40 BOILING SPRINGS, PA 17007 5. CUMBERLAND-GOODWILL FIRERESCUE 75.00 PO BOX 12910 PHILADELPHIA, PA 19176-0910 TOTAL (Also enter on line 10, Recapitulation} I $ 238 25 (If more space is needed insert additional sheets of the same size) DATE DESCRIPTION UNITS REFERENCE AMOUNT BALANCE PREVIOUS BALANCE .00 .00 03/28/2008 BEAUTY/BARBER 1 10.00 10.00 i ENDING EAL~'3NCE ~ ~ ~ `~ . ^ 0 YOUR PAYMENT OE C~.~~.1Z ~ ~~-- D ~ ~.-~ 1~~ C~3..5~~ 10.00 IS DUE UPON RECEIPT Forest Park Health Cent 1-888-880-7090 FRY STEVEN L 22720 DATE DESCRIPTION UNITS REFERENCE AMOUNT BALANCE PREVIOUS BALANCE 10.00 10.00 04/14/2008 PRIVATE PAYMENT CK#1356 -10.00 .00 04/02/2008 TRANSPORTATION/FACILITY 1 i 30.00 30.00 04/02/2008 TRANSPORT ATTENDANT 1 8.50 38.50 04/06/2008 TELEPHONE 1 i 29.68 68.18 ~ ~Q,tc,D~' ~ ~S~ l ~ !,~ ~ ~,,~, i y- ~~ i ~ ~~ ~~ ?~ BA:~,NCE YOUR PAYMENT OF 68.18 IS DUE UPON RECEIPT PLEASE ACCEPT OUR CONDOLENCES IN THE LOSS OF YOUR LOVED ONE. GUARDIAN ELDER CARE AND FOREST PARK HEALTH CENTER WILL HAVE YOU IN OUR THOUGHTS AND PRAYERS DURING THIS DIFFICULT TIME. ANY QUESTIONS, PLEASE CALL. Forest Park Health Cent 1-888-880-7090 FRY STEVEN L 22720 comcast® NUMBERT DUEE AMOUNT DUE ~~® C( ^ ^ Visit us on the web at 09547377236-01-8 05/07!08 $$0.17 www.comcast.com services you subs n6e to STEVEN FRY I How to reach us... For service at: 24 PINE sT CARLISLE PA 1 701 3-31 36 News from Comcast Thartk you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Hearing t Speech Impaired Call 71 i ~C3-.lU ~ ~'Q r a~ - ~ ~ How to reach us: 339 Baltimore Rd. Shippensburg, PA 17257 717-243,4918or 800-995-6545 Telephone Customer Service 24 hours a day, seven days a week Summary of Charges statement Prepared 04/14/08 Billed from 04/23/08 to 05122/08 Previous Balance 80.17 Payments {received by 04/14/08) 80.17 cr Comcast Cable Television 79.15 Taxes, Surcharges & Fees 1.02 T Tote! Due $Bp,17 Detail of Charges on back ~w~ -~~~ Cumberland-Gaodwilt FireRescue PO BOX 12910 PHILA, PA 19176-0910 Phone #: (800) 367-0512 Federal Tax ID: 23-2298422 PATIENT NAME: STEVEN FRY INSURANCE: MEDICARE B 210401440A CG0801394 STEVEN FRY 24 PINE ST CARLISLE, PA 17013 DESCRIPTEON OF CHARGE BLS RESPONSE AND TREATMENT A0998 DE5CRIP'T40N OF PAYMENT PATIENT NAME: FRY, STEVEN f PATIENT NUMBER.: 10916 i THIS ACCOUNT IS PAST DUE! Send your payment now or contact our office to make payment arrangements. vrsa ~~a5f '~ ~,~~ Ifr~.A`iTE:R Cdls?E7 Cumberland-Goodwill FireRescue PO BOX 12910 PHILA, PA 19176-0910 PATIENT NUMBER CALL NUMBER: DATE OF CALL.: TIME OF CALL: CALLER FROM: TO: REASON(Sl FOR TRANSPORT INV®lGE 10916 PRIV CG0801394 A o4/os/2oos Police/Fire/911 FOREST PARK NURSING HOME 700 WALNUT BOTTOM RD CARDIAC ARREST QUANTITY UNI7 PRICE 1.0 75.00 RECEIPT PAYMENT DATE AMOUNT 75.00 'Total Charges 75.00 Arnt~uNT i j i Total Credits 0.00 ___ .__W ___._.______ ~W.___.__.__~_. ..._._.~__.~._.___._._____.__~ ~ ._._..._...._._._,_~_a_._~......~..._,.._._..~..; PLEA~F ~'~~`~ ?"i-If ~ Alilff~E.INT' ---~. '; $75.00 i DETACH ALONG PERFORMATSCSN Ara _r LRETJF~N STUB WE i H PAYMENT j AMOLsN° s;~.lr 75.00 CALL NurUiE>EE CG0801394 eaEll4/~"JN ~ ,; -_______._._.~.u_ BR_LiNG CJATE: 05/13/2008 ENCLOi~E~:r ___,__.~____~_.__ i REV-1513 EX ~ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER STEVEN L. FRY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outnght spousal distnbutions and Transfers under Sec 9116 (a) (t 2)] 1. CLARABELLE FRY Lineal 24 PINE STREET 0.00 CARLISLE, PA 17013 2. CHRISTY L. SLOAN Sibling 618 WEST PINE STREET 0.00 MT. HOLLY SPRINGS, PA 17065 3. ROXANNE ROSS Sibling 123 BIG SPRING TERRACE 0.00 NEWVILLE, PA 17241 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET -~. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL D1STR18UTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ IIT more space Is needed, Insert addltlonal sheets of the same size} n PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of Steven L. Fry also known as Deceased COUNTY, PENNSYLVANIA File Number ~ ~ _ . _ ,~ ___ ~ ~ ~ ~ , Social Security Number 210-40;~4~9~ ~ - Petitioner(s), who islare 18 years of age or older, apply(ies) for: ~~' %~ ~ `J (COMPLETE 'A' or 'B' BELOW.) ' ~' ~ ~ ~, ~' ~ `-y~ ~:. _~ . . „- ~ ~7 ~ r ,'-t ® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is !are the ,;~ --i ~amed tn; the: last Will of the Decedent dated and codicil(s) dated ~ -- ~ , (State relevant circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration (lfapplicable, enter: c.t.a.; d.b.n.c.t.a.;pendentelite; duranteabsentia; duranteminoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Clarabelle Fry Mother 24 Pine Street, Carlisle, PA 17013 Christy L. Sloan Sister 618 W. Pine Street, Mt. Holly Springs, PA 17065 Roxanne Ross Sister 123 Big Spring Terrace, Newville, PA 17241 (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 24 Pine street, Carlisle, South Middleton Township Pennsvlvania 17013 (List street address, town/city, township, county, state, zip code) Decedent, then 59 years of age, died on Apri16, 2008 at Forest Park health Center Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 5,485.39 (If not domiciled in PA) Personal property in Pennsylvania $ 0.00 (If not domiciled in PA) Personal property in County $ 0.00 Value of real estate in Pennsylvania $ 0.00 situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Wil] and Codicil(s) presented with this Petirion and the grant of Letters in the appropriate form to the undersigned: Si nature T ed or rimed name and residence Clarabelle Fry, 24 Pine Street, Carlisle, PA 17013 Form nw-oz rev. 10.13.06 Page 1 of 2 0 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed Signature of Personal Representative before me the day of Signature of Persona[ Representative For the Register Signature of Personal Representative rv C7 ~~ ~ ~ i -r C7 ~ ...~ ~.v. ~. r- r ':i~J ,l _~~ t"' _ . ~ - ~ -- - _.7 ~ r', L ~ ._ _~ -~ _- '~ ~ _ ~a"- 1,71 '_ File Number: Estate of Steven L. Fry ,Deceased Social Security Number: 210-40-1440 Date of Death: April 6, 2008 AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT I5 DECREED that Letters are hereby granted to in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Register of Wills Letters ............... $ Short Certificate(s) ........ $ Attorney Signature: Renunciation(s) .......... $ Attorney Name: Paul Bradford Orr, Esquire ... $ • • • $ Supreme Court I.D. No.: 71786 ... $ Address: 50 East High Street ... $ • • • $ Carlisle, PA 17013 ... $ ... $ " ' $ Telephone: (717) 258-8558 ... $ TOTAL .............. $ 0.00 Form RW-02 rev. 10.13.06 Page 2 of 2