HomeMy WebLinkAbout04-0098
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IN THE MATTER OF THE IN THE COURT OF COMMON PLEAS OF
PERSON AND ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA
HAZEL BEASON, an alleged
mcapacltated person ORPHANS' COURT DIVISION
NO 21- 04 -OQB
ORDER
AND NOW, thiS .3 o' day of January, 2004, pursuant to 20 Pa C S A 5513 and
followmg an emergency telephone conference with the court and Lmdsay Dare Baird, EsqUire,
attorney for Hazel Beason, an alleged mcapacltated person, and Anthony L DeLuca, EsqUire,
attorney for the Area Agency on Agmg, m and for Cumberland County, Pennsylvania, It IS
ordered and decreed that an emergency guardianship IS reqUired for Hazel Beason and that her
mece, Ruby Lmeaweaver, IS hereby appomted Emergency Plenary Guardian of the Person and
Estate of Hazel Beason for the penod of seventy-two (72) hours A hearmg on thiS matter shall
be held m the Orphans' Court of Cumberland County on the 2nd day of February, 2004, at 300
pm m Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA
BY THE COURT,
C /!~
:B .6
lctIJr<) Hess, J
j:::UJ-
r5 "25 Anthony DeLuca, EsqUire
c ) c.) For the Area Agency on Agmg
.J Lmdsay Dare Baud, EsqUire , ~r:IJll~ j
~ F or the Alleged Incapacitated Person - ;,
!) rim Lv EcJ DE Nvr vll.
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IN THE MATIER OF THE PERSON AND IN THE COURT OF COMMON PLEAS OF
ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA
HAZEL BEASON,
AN ALLEGED INCAP ACIT A TED PERSON ORPHANS' COURT DIVISION
NO ~ 1- <l '(-Ore?
DECREE
AND NOW, thiS ;211c;( day of February, 2004, upon consideratIon of the
PetItIon to Extend Emergency Guardianship of the Person and Estate of Hazel Beason, It
IS hereby Ordered and Decreed that the appomtment of Ruby Lmeaweaver as Emergency
Plenary Guardian of the Person and Estate of Hazel Beason be extended until a Heanng
IS held on the Appomtment of a Permanent Plenary Guardian of the Person and Estate of
Hazel Beason
C'rtt....,
It IS further Ordered and Decreed that a-Title e Issued upon Hazel Beason, the
alleged mcapacltated person, with notIce thereof to be given to her next-of-km, and to
such other persons as this Court may direct, to show cause why she should not be
adjudged an mcapacltated person and Ruby Lmeaweaver, be appomted Permanent
Plenary Guardian of her Person and Estate,
A Heanng IS scheduled for .::JJuj fl:; , !J)/U//t1~ d-O ,2004, at
II : 30 LL M , m Courtroom No if , Cumberland County Courthouse,
Carlisle, Pennsylvania for the appomtment of Permanent Plenary Guardian of the Person
and Estate of Hazel Beason.
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BY THE COURT,
fie: [ci 2 - fJJj VO.
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Kev A Hess,
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IN THE MA TIER OF THE PERSON AND IN THE COURT OF COMMON PLEAS OF
ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA
HAZEL BEASON,
AN ALLEGED INCAP ACIT A TED PERSON ORPHANS' COURT DNISION
NO .?(-ot(-o'tfi"
PETITION TO EXTEND EMERGENCY GUARDIANSHIP
AND NOW COMES THE PETITIONER, the Area Agency on Agmg m and for
Cumberland County, Pennsylvania, who represents and avers as follows
1
The PetItIoner IS the Area Agency on Agmg, m and for Cumberland County, with
ItS office located at 16 West High Street, Carlisle, Cumberland County, Pennsylvania
2
The alleged mcapacltated person IS Hazel Beason, age 78, an adult mdlvldual,
who resides at 146 Conodogumet Mobile Estates, NeWVille, Cumberland County,
Pennsylvania and has resided there for a penod exceedmg one (1) year pnor to the filing
of thiS PetItIon
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On January 30, 2004, an oral presentatIOn was made to the Court m a conference, _
. 1 ,
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call that mcluded Anthony L DeLuca, EsqUire, attorney for the PetItIOner, and L}ndsay -.
.'-.l
,I
Dare Baird, EsqUire, attorney for the alleged mcapacltated person resultmg m an--:..Order
bemg entered wherem Ruby Lmeaweaver was appomted Emergency Plenary Guardian of
the Person and Estate of Hazel Beason, which Order was m effect for seventy-two (72)
hours
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4
On February 2, 2004, PetItIOner filed a PetItIon for Appomtment of Emergency
Plenary Guardian of the Person and Estate of Hazel Beason, an alleged mcapacltated
person, to confirm the oral request of January 30, 2004
5
The seventy-two (72) hour penod has elapsed
6
PetItIoner believes and, therefore, avers that the emergency contmues because her
conditIOn contmues to declme precipitously.
7
PetItIoner believes and, therefore, avers that the Emergency Order dated January
30, 2004, a copy of which IS attached hereto, marked as Exhibit "A", and mcorporated
herem by reference, should be extended for twenty (20) days from the expuatlOn of the
mltIal Emergency Order
8
Lmdsay Dare Baird, EsqUire, counsel for Hazel Beason, the alleged mcapacltated
person, does not obJect to the requested extensIOn
WHEREFORE, PetItIoner prays that thiS Honorable Court
1 Extend the appomtment of Ruby Lmeaweaver, as Emergency Plenary Guardian of
the Person and Estate of Hazel Beason, an alleged mcapacltated person, for twenty (20)
days from the expuatlOn of the mltIal Emergency Order, at which tIme a Permanent
Plenary Guardlanslup Hearmg Will be held, and
2 Issue a rule upon Hazel Beason, the alleged mcapacltated person, with
notIce thereof to be given to her next-of-km, and to such other persons as this Court may
direct, to show cause why she should not be adJudged an mcapacltated person and Ruby
Lmeaweaver, be appomted Permanent Plenary Guardian of her Person and Estate
Respectfully Submitted,
~~~
113 Front Street
P O. Box 358
BOllmg Spnngs, PA 17007
(717) 258-6844
.
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VERIFICATION
I hereby venfy that the facts and mformatIon set forth m the foregomg PetItIOn to .
Extend Emergency Guardianship are true and correct to the best of my knowledge,
mformatlOn, and belief. I understand that any false statements contamed herem are
subJect to the penaltIes of 18 Pa C.S SectIon 4904, relatmg to unsworn falsificatIon to
authontIes
Dated' ff\"r-\.lc"'~ ~ 1 Q.oo'f <:::')~ +;:, QQ
Janet Paull
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IN THE MATTER OF THE IN THE COURT OF COMMON PLEAS OF
PERSON AND ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA
HAZEL BEASON, an alleged
mcapacltated person ORPHANS' COURT DIVISION
NO
ORDER
AND NOW, tlus .3 o' day of January, 2004, pursuant to 20 Pa C S A 5513 and
followmg an emergency telephone conference With the court and Lmdsay Dare Baud, EsqUire,
attorney for Hazel Beason, an alleged mcapacltated person, and Anthony L DeLuca, EsqUire,
attorney for the Area Agency on Agmg, m and for Cumberland County, Pennsylvania, It IS
ordered and decreed that an emergency guardianshIp IS reqUired for Hazel Beason and that her
mece, Ruby Lmeaweaver, IS hereby appomted Emergency Plenary Guardian of the Person and
Estate of Hazel Beason for the penod of seventy-two (72) hours A hearmg on tlus matter shall
be held m the Orphans' Court of Cumberland County on the 2nd day of February, 2004, at 300
p m m Courtroom Number 4, Cumberland County Courthouse, Carlisle, P A
BY THE COURT,
/!~
Hess, J
Anthony DeLuca, EsqUire
For the Area Agency on Agmg -- .-
.'
Lmdsay Dare Baird, EsqUire ,:
For the Alleged Incapacitated Person
A TRUE COPY FROM RECORD
rim In Testlmonywherof, I hereunto
set my hand and the seal
Of;JJ1 Court at rll Ie, p~
T IS day of . 20
'. fJAfu ~ ~rL
{ ,
Clerk of the Orphans Court --fJ-l
Cumberland County ;{
EXHIBIT "A" VIYJy.J{u)
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IN THE MATTER OF THE PERSON AND IN THE COURT OF COMMON PLEAS OF
ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA
HAZEL BEASON,
AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION
NO 1/-01-0((B
PRELIMINARY DECREE
AND NOW, thiS )nd day of !!'..tLuw~ ,2004, upon conslderal1on of the
wlthm Pel1tlOn, It IS hereby ordered that Ruby Lmeaweaver be appomted as Emergency
Plenary Guardian of the Person and Estate of Hazel Beason and that she shall serve m
that capacity unl1l ~t21f ~d(Jtl1
A Hearing m this matter shall be held on the 2nd day of ~UA~ ' 2004, at
J:rro p M o'clock, m Courtroom No l at the Cumberland County
Courthouse, Carlisle, Pennsylvania
~ Lmdsay Dare Baud, EsqUire shall contmue to represent the allegedly
mcapacltated person
BY THE COURT,
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SZ Ed Z - 83:1 \70.
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IN THE MATIER OF THE PERSON AND IN THE COURT OF COMMON PLEAS OF
ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA
HAZEL BEASON, .
AN ALLEGED INCAP ACIT A TED PERSON ORPHANS' COURT DIVISION c
NO
PETITION FOR APPOINTMENT OF EMERGENCY PLENARY GUARDIAN
AND NOW COMES THE PETITIONER, Cumberland County Area Agency on
Agmg, 16 West High Street, Carlisle, Pennsylvania and represents and avers as follows
1
The Petitioner IS the Cumberland County Area Agency on Agmg (CCAAA), With
ItS office located at 16 West High Street, Carlisle, Cumberland County, Pennsylvania
2.
The alleged mcapacltated person IS Hazel Beason, an adult mdlvldual, age 78,
who reSides at 146 Conodogumet Mobile Estates, Newville, Cumberland County,
Pennsylvania and has reSided there for a penod exceedmg one (1) year pnor to the filing
of this PetitIOn
3
The only known relatives of the alleged mcapacltated person are
a Ruby Lmeaweaver - Niece
33 Lovers Lane ~~
Newburg, Pennsylvania 17240 ~.:' ~ ~ g .r;
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b. Cynl Cassner - Nephew - rrl .
875 Prospect Dnve co
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Shippensburg, Pennsylvania 17257 N
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Hazel Beason has, for at least four (4) months, been mcapable ofmanagmg and
I
caring for herself
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5
Hazel Beason exhibits symptoms of mental mcapaclty, mcludmg but not limited
to cogmtlve ImpaIrment
6
Hazel Beason's mental mcapaclty prevents her from managmg and carmg for the
affairs of her person and estate
7,
On January 2,2004, due to the medical condItion of Hazel Beason, PetitIOner
sought relief under the Older Adults Protective ServICes Act, 35 P S Sec. 10225 101 et
seq, by contactmg Dlstnct Justice Gayle A Elder who Issued an Abuse of the Elderly
Emergency Relief Order dlrectmg that Hazel Beason be removed from her resIdence and
profeSSIOnally transported to a medical facility for medical treatment A copy of the
Emergency Relief Order IS attached hereto, marked as ExhibIt "A" and mcorporated
herem by reference
8
Upon receipt ofthe Emergency Relief Order, Petitioner's authonzed
representative made the arrangements to have Hazel Beason transported to the Carlisle
Regional Medical Center where she has been a patient up to the present time
9
On January 5,2004, PetitIOner filed a PetitIOn for Involuntary interventIOn by
Emergency Court Order to No 04-46 ClVll Term m the Court of Common Pleas, m and
for Cumberland County, Pennsylvania and a heanng was scheduled for January 7, 2004
At the time of the heanng, the PetitIOn was withdrawn because the emergency no longer
eXisted
10
Upon her admissIOn to the Carlisle RegIOnal Medical Center, Hazel Beason was
found to be suffenng from severe renal failure, hypothyroidism, unnary tract mfectlOn,
diabetes mllletus, and hypertensIOn,
11
As a result of severe renal failure, Hazel Beason reqUired dialYSIS and thereafter
she received that treattnent.
12
On January 24,2004, Hazel Beason pulled out the catheter necessary for the
contmuatlOn of her dialYSIS treatment and, smce that time, her medical condition has
detenorated as a result of severe renal failure
13
Hazel Beason appeared to be heanng Impaired smce she wore heanng aids when
at home A special amplification deVice was purchased to determme Ifher mablhty to
understand questions was the result of confUSIOn or from her heanng loss.
14
The amplificatIOn deVice appeared to help her hear questions because she was
able to state her name and that she reSided m Newville, Pennsylvania but she was unable
to answer any other questions appropnately causmg the treatmg phYSICian to form an
opmlOn that she has underlymg dementia
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15.
The treatmg physIcian has stated that an Emergency Guardianship IS Immediately
necessary because her climcal status IS declinmg precipitously and medical decIsIOns are
needed to be made as soon as possible or she will die m less than two (2) weeks In
addition, whether or not dialysIs IS contmued, Hazel Beason needs to be transferred to a
nursmg facility as soon as possible and no one has the authonty to Sign her mto a nursmg
home and determme her financial assets or to apply for medical assistance If necessary
16
The treatmg physIcian has stated that Hazel Beason IS mcapable ofmakmg or
partlclpatmg m any medical or financial decIsIOns
17
Less restnctlve alternatives are not aVailable because her medical condition has
detenorated precipitously as a result of severe renal failure
18
The approximate gross value of the estate of Hazel Beason IS not presently
known.
19
The Petitioner believes and, therefore, avers that Emergency Plenary Guardians of
the Person and Estate of Hazel Beason should be appomted
20
Petitioner has spoken to the mece, Ruby Lmeaweaver, and she has agreed to
accept the appomtment of Emergency Plenary Guardian of the Person and Estate of
Hazel Beason
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21
PetItIOner has also spoken to the nephew, Cynl Cassner, and he concurs m the
appomtrnent of his sister, Ruby Lmeaweaver, as Emergency Plenary Guardian of the
Person and Estate of Hazel Beason
22
On January 30,2004, an oral presentatIOn was made to the Court m a conference
call that mcluded Anthony L DeLuca, EsqUire, attorney for the PetitIOner, and Lmdsay
Dare Baird, EsqUire, attorney for the alleged mcapacltated person The oral presentatIon
was necessary as a result of mformatIon furnished to PetItIOner's authonzed
representatIve that afternoon concernmg the detenoratmg conditIOn of Hazel Beason An
Order was Issued on January 30,2004 appomtmg Ruby Lmeaweaver Emergency Plenary
Guardian of the Person and Estate of Hazel Beason A copy of the Order IS attached
hereto, marked as Exhibit "B", and mcorporated herem by reference
23
No other Court has ever assumed JunsdlctIon m any proceedmg to de,termme the
mcapaclty of Hazel Beason except as stated heremabove
24
The failure to appomt the PetItIOner as Emergency Plenary Guardian of the Person
and Estate of Hazel Beason Will result m lITeparable harm to the person and estate of
Hazel Beason
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WHEREFORE, Pel1l1oner prays that this Honorable Court appomt Ruby
Lmeaweaver to be the Emergency Plenary Guardian of the Person and Estate of Hazel
Beason
a~:?
Anthony L DeLuca, EsqUire
113 Front Street
POBox 358
BOllmg Spnngs, PA 17007
(717) 258-6844
.
VERIFICATION
I hereby venfy that the facts and mformatlOn set forth m the foregomg Petition for
Appomtment of Emergency Plenary Guardian are true and correct to the best of my
knowledge, mformatlon, and belief I understand that any false statements contamed
herem are subJect to the penalties of 18 Pa C S Section 4904, relatmg to unsworn
falSification to authontles
Dated 'Fe~Nc""d 61, ~oo~ ~~t:cwW
,
Janet Paull
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81/82/2BB4 21. 15 71 77662238 . DISTR,J:CT JUSTICE PAc:j.E 81
.
COMMONWEALTH OF PENNSYLVANIA ABUSE OF THE ELDERLY
COUNTY OF. COMBERLAND PLAINTIF~MERGENCY ~7,~~~f.s?RDER
MillJ. Dial No ""1
09-3-05 ,-- CUMBERLAND COUNTY OFFICE OF AGING
OJName Hon 0 ~gent Janet Paull
GAYLE A. ELDER 16 W. HIGH ST.
M".... 507 N. YORK ST. L CA.\U.ISLE, PA 17013 -I
MECHAliJICSBURG, PA VS.
17055 DEFENDANT, NAME :ll'ld ^DDRES3
T"ophO" (717) 766-4575 ,-- ""1
HAZEL BEASON
1q6 CONODOGUINET MOBILE ESTATES
NEWVIJ,LE, PA 17241 -I
L
Docket No.. -
Date Filed MD-1-04
.. ;'fan. 1. 2004
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ORDER
.
Having found clear and oonvlnclng evldenoe that It Is necessary to provide emergency relief to protect the
Petitioner above. in accordance with 35 P,S, ~ 10220, i hereby order that the following protective services
be provided for 24 hours (not to exceed 72 hours from the lime order is Issued)'
Describe reilef to be provided.
o Administer protective services plans.
o Receive and maintain records of reports of abuse
o Conduct Investigation of reported abuse
o Conduct client assessment and develop service pian
o Arrange tor ava,lable services needed to fulfill service plans
o Purchase temporary Servloes needed to fulfill service plans
IXXJ Other DEFENDANT IS TorBE REMOVED FROM HER ABOVE LISTED RESIDENCE TO
BE PROFESSIONALLY TRANSPORTF.T1 TO A MF.DTCAT. FAr.n,T'I'Y FOR
MEDICAL TREA~NT.
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D I have appOinted legal counsel to represent Petitioner at the emergenoy protll.ctlve s
hearing. (check block If appropnate). J 1-: 'c
,
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Date and Time of Order' r~ C:,y
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THIS ORO~R 16 VALID ONL Y FOR THE PERIOD OF TIME SPECIFIED A80VE PLEASE CONTACT THE COURT OF COMMON PLEAS
OF THIS COUNTY FOR IMPORTANT INFORMATION OF FURTHER PROCEEDINGS IN CONNECTION WITH THIS PETITION
J 635.92 EXHIBIT "A"
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IN THE MATTER OF THE IN THE COURT OF COMMON PLEAS OF
PERSON AND ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA
HAZEL BEASON, an alleged
mcapacltated person ORPHANS' COURT DIVISION
NO
ORDER
AND NOW, thiS .3 o' day of January, 2004, pursuant to 20 Pa C S A 5513 and
followmg an emergency telephone conference WIth the court and Lmdsay Dare Baud, Esquue,
attorney for Hazel Beason, an alleged mcapacltated person, and Anthony L DeLuca, EsqUIre,
attorney for the Area Agency on Agmg, m and for Cumberland County, PennsylvanIa, It IS
ordered and decreed that an emergency guardianship IS reqUIred for Hazel Beason and that her
mece, Ruby Lmeaweaver, IS hereby appornted Emergency Plenary Guardian of the Person and
Estate of Hazel Beason for the penod of seventy-two (72) hours A hearmg on tlus matter shall
be held m the Orphans' Court of Cumberland County on the 2nd day of February, 2004, at 300
p m m Courtroom Number 4, Cumberland County Courthouse, Carlisle, P A
BY THE COURT,
4~
Hess, J
Anthony DeLuca, EsqUire
For the Area Agency on Agmg
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EXHIBIT "B"
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IN RE ESTATE OF HAZEL BEASON
IN THE COURT OF COMMON PLEAS OF
AN ALLEGED INCAPACITATED PERSON CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO 21-2004-0098
IMPORTANT NOTICE
CITATION WITH NOTICE
A petitIOn has been filed with the Court to have you declared an Incapacitated Person If the
Court finds you to be an Incapacitated Person, your nghts Will be affected, mcludmg our fight to manage
money and property and to make decIsIOns A copy of the petition whIch has been filed by Area Agencv
of Agmg IS attached
You are hereby ordered to appear at a hearmg to be held m Court Room No 1, Cumberland
County Courthouse, Carlisle, Pennsylvama, on February 20 , 2004, at 11 30 A M to tell the
Court why IS should not find you to be an mcapacltated Person and appomt a Guardian to act on your
behalf
To be an mcapacltated Person means that you are not able to receive and
effectively evaluate mformatlon and commumcate decIsIOns and that you are unable to
manage your money and/or other property, or to make necessary deCISIOns about where
you Will live, what medical care you Will get, or how your money will be spent
At the heanng, you have the nght to appear, to be represented by an attorney, and
to request a Jury tnal If you do not have an attorney, you have the nght to request the
Court to appomt an attorney to represent you and to have the attorney's fees paid for you
If you cannot afford to pay them yourself You also have the nght to request that the
Court order that an mdependent evalual10n as to your alleged mcapaclty
If the Court deCides that you are an incapacItated person, the Court may appomt a
GuardIan for you, based on the nature of any condll1on or dIsability and your capacity to
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make and commumcate decIsIOns The Guardian will be of your person and/or your
money and other property and will have either limited of full powers to act for you
If the court finds you are totally mcapacltated, your legal nghts will be'affected
and you will not be able to make a contract or gJtr of your money to other property If the
court finds that you are partially mcapacltated, your legal nghts will also be limited as
directed by the Court
If you do not appear at the hearmg (either m person or by an attorney representmg you)
the court will sl1ll hold the heanng m your ab::nce and may Ut the Guardian request,ed
lerk, Orphans' Court DIVISIOn :1>>-1 VI1
Cumberland County, Carlisle, PA
My CommissIOn Expires 1 st Monday, , ,
January, 2006
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of -\-\--f'I;"L€" I j. ~E:ASDtJ No 2\ -OLl -qg
also known as To
Deceased RegIster of ~ for the .J.
County of ~Q "..., 10 the
Soc/al Secuflty No Z-D 2.. - '2.0 - 0 f?3 (", Commonweallh of Pennsylvama
The pellllOn of the undersIgned respeclfully represents that
Your petltlOner(s), who Is/are 18 years of age or older, app1l es for letters of admlOlstratlon
on the estate of
(d b n . pendente lite, durante absentla, durante mmontate)
the above decedent
Decendent was domIcIled at death In C v,^" V:l-R-r \ ov-- cL
h e.-, lasl famIly or pnnclpal resIdence al
years of age, dIed
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Decendent at dealh owned property wllh estlmaled values as follIows
(If domIcIled 10 Pa ) All personal properly $ 4--() 0 0 . 00
(If nol domIcIled 10 Pa ) Personal property 10 Pennsylvama $
(If nol dolmcIled 10 Pa ) Personal properly 10 County $
Value of real estate 10 Pennsylvama $
situated as follows \JO\.I-e
,
PetIl1oner_ after a proper search h,,----- ascertalOed that decedent left no WIll and was survIved by
Ihe followlOg spouse (If any) and helTS.
~~e,
. .
THEREFORE, petllIoner(s) respectfully request(s) the grant of letters of admlOlstratlOn 10 Ihe
I f
appropnate.,form to the underSIgned
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RENUNCIATION
21-04-YS
t-\ A'C-t: L --- ~ E t\SuN
In Re Estate of ~. deceased
To the Register of Wills of C-vW-VJQ.I\ctf\ cl County, Pennsylvama.
Ci r'\ \ K. ~-A:SSNtR I'J (Lf'heu.r-
The undersigned of
) the above decedent, hereby renounce(s) the nght 10 administer the estate and respectfully ask(s) that Letters
M-M.l f\\ <:>l-RfT-~~
be ISSUed to ~0 \:),\-L. L4 /oJ e ~VJ t.:f\-\I-t. R
WITNESS ~~7 hand thiS :it.{ day of M~ --LOp '+
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(Signature)
(Address)
(Signature)
(Address)
H105805 REV 9/86
ThIS IS to cettlfy that the Infotmatlon hete given IS correctly copied from an ongInal cettllicate of death duly filed with me as
Local Registrar The ongInal cettllicate Will be fOlwarded to the State Vital Records Office for permanent filIng
WARNING: It IS Illegal to duplicate this copy by photostat or photograph
Fee for this certlficate, $2 00 ~Jl
, " caJ Reglsttar
p 9913411 -tj:j ~ UJ~~
No Date
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HI05143R.v2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS") N '(if 0
7YPE/PRINT CERTIFICATE OF DEATH l! ~ d .~
" $WffOU!.I\JIOlIEA
'ER"ANENT N.o.MEOI'OECE \f.._lHI '" SCCI"l S!'CURITY NUl.lIlUI D.oJEDFDE....nl.u"'""Do~ _I
lUCk INk eo..Son . F , 202 - 20 - 0 4 Feb 4 0
AGE.(L"~ UN{)ERl UNOER1DoO' 8IRTl1PlACilCrY""" PI...o\CEOI'OE.oJHIC"<<kc<"Y""" _....."""""""".,.,..._1
UDI'IIhII . o.y. -llol- S!.,.",f"'-;JI1Cau'J1'y! HOSPITAL
'" Sh1ppensburg _1ilI ~D
. 78 7O:..m:erlarrl 01 PA.
COUNTY OF OERH AACf "'_no:aIIlndj.,,8I..:~__.'1<
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. QEherlBrd . CarlJ.sle CarlJ.sle .. Wh1te
DECEDENT8USU"LOCCUP.oJION I<INDOFBUSINESS/INDUSTRV .".,SDECEOENTfvERlN IoI.I.AlTAlSTATUSu.mod SUIWWINQSJ'OIJSE
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'" Cook ". S ARMY WAR CIJUmE , ,. Widowed
oeCf:oeNTI!IAAllINGADOfIf:S$(SIr"~$Iol.l",CtIdol DECEDENTS l1cGa___... I~~er M1ff11n Two
...ctu"l 17..s.... ~ ~
0:lncrl0:Juinet M::lbi1e Estates, Lot 146 ~~ -
_..
1" Newvl..l.l.e, PA 17241 --, Cumberland -' 17110:""-=-=",
on -
F.oJHER SN"UE IF.. Mod"'" lPlI loIOTHfR5 N.O.lolf:{F." M_ M_s,,'_l
l' Lawrence Cassner " f
_ClAtMNTSNAM.ElTJ'IIOIP!I1I) INFDRMANT'SIAAllIHQADORESSISlr.....Ctyiboonsa... Zipeoo.l
_Rub L. L~neaweaver - 33 Lovers Lane Newbur PA 17240
METHOOOFDlSI'OSITlOH Pl.ACEOI'DlSPOSmOH ......."'c.m.It<y CmNIlDIy LCC.oJ1OHClIy/"bImSlaol~c:oa.
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DUE'lDIOAAS"CONSEOUENCEOFl ,
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OS DUlE'lOIORAS"CONSEOUf:NCfc:lfl : I
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c!l wERE....UTOP/lVFlNDlNaS """NEROI' DEATH DATE Of"lNJUFlV TlIoIEOI'lNJUFlV lNJUFlV/fI\\ORI\? DESCRlBfl<<JWlHJURYOCGl/RfI:fD
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~ Onll'l.baal...'.......I....lIonandlOflnv..lIpl_ Inmyopk1lo" de.."occurre<l"ll'Icllm. <1.1. an<lpl.c. ancldu.lo'''-COll"C'I'nc1 0
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~ REGIST",..RSS'ON"TURE"NDNUMIlfR cP. ~r~/v1
AUTHORITY TO PAY COURT APPOINTED COUNSEL MAR 0 3 2004 ~
1. COURT 2. VOUCHER -
o District Justice o Common Pleas o Appellate o Other N2 7834
3. FOR (D.J., C.P.. APPELLATE) 4. AT (CITY/STATE) 5. BUDGET CODE
J hJ - I ~-I ::JI h- t ~ .J.1.Ig{)
6. IN THE': _ _..rWSt1n: 2S~1 & 7. CHARGE/OFFENSE (PURDON CITATION) 8. 0 PETTY OFFENSE
vs /Io-:(~ ~oscrn o FELONY 0 MISDEMEANOR
9_ PROCEEDINGS (Describe briefly) 11. PE'XN REPRESENTED 12. CIVIL DOCKET NO.
1 Oelendant. Adult (Y/--% /01-111
E hLL4(j<1"cr c; ~ oL-lctl1~ AlP 2 0 Defendant. Juvenile
3 0 Appellant 13. CRIMINAL DOCKET NO
4 0 Appellee
5 0 Habeas Pelitioner
6 0 Malenal Wllness
7 0 Parolee Charged WlIh Violation aC ~. APPEALS:tIOCKET NO_
10. PERSON REPRESENTED (Full Name) 8 0 Probationer Charged With Violatio!; ;:;~
/A rd &tlson 9 0 Other. :=! - :Om
(D .:-)
0- ." ~I ..
C' :::;:;
,. = .
/'U' ()~ 16. NAME OF ATTORNEY/PAYEE ANUJ ~
Appt Dale MAILING ADDRESS N '-, ,
U1
J &.ss Lindsay Da.re B<lird \:J
37 South ~over St\:8et "'i..
NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE Cani~ie. PAl" 17013..3007
.....
It I ('1
17. TELEPHONE No. 18_ SOCIAL SECURITY NO OR EIN NO
aY$- ~t73.J- /'1' i" 57, . P.J--1'9-
CLAIM FOR SERVICES OR EXPENSES
19. SERVICE HOURS DATES AMOUNTS CLAIMED
a. Arraignment and/or Plea ') Multiply rate per hour limes total
b. Preliminary Hearing . '. hours to obtain "In Court" com-
nsati~ Enter lotal below.
c. Motions and Requests ;. :.L~
d Bail Hearings c'
... "
a: . ..
::I e. Sentence Hearings I - co
0 -- - c"
U f. Trial .. "~ I
~ J '~:I .
g. Revocation Hearings r ~i
h. Juvenile Hearings ( }> r_ --:;-1
i. Appeals Court ), ~9A. TO~ IN cottRf COMPo
~ Other (Specify on additional sheets) MlACVrdran,sh.(/.) I )-0 /. ? -0<1 ..
w
,~d ~RHOUR =$_0 ,-.
TOTAL HOURS .. ~~. ')D
20. a Interviews and conferences .+.;' I . ;M". () (/ - ,;1' dl 'iJ t? Multiply rate per hour times total
b. Obtaining and reviewing records hours. Enter tolal "Oul of Court"
u..... compensation below.
o a:: c. Legal research and brief writing
...::1
::10 d. Investigative and other work (Specify on additional sheets) 20A. TOTAL OUT OF COURT
OU COMPo
~RHOUR ...$ 33. -
TOTAL HOURS '"' ,?~ f~
21- ITEMIZATION OF REIMBURSABLE EXPENSES AMT. PER ITEM
Mileace $.25 oar mile II
a::
w
J: 21A. TOTAL ITEMIZED EXP.
...
0
-$
22. CERTIFICATION OF ATTORNEY/PAYEE 23. GRAND TOTAL CLAIMED
Has compensation and/or reimbursement for work In this caae prevloualy been applied for? 0 YES /;( NO '""$ .s(0. d~
If yes. were you paid? 0 YES }t NO If yes. bywhom_re you paid? How much? 24. DEDUCT. PRIOR PYMTS.
Has the person represented paid any money to you, or to your knowledge anyone else. In connection with the matter for
which you were appointed to provide representation? 0 YES iX'NO~i~~ '!rtails on additional sheets ...$
I swear or affirm the truth or correctness . · ;) .,J, ~ 0'1 25. NET AM~T CLAIMED
of the above statements Signature of Attomey(Payee Date =$ lR.;)'~ v
-
26.A"PROVlol . "". ~ . Dale: -:ils 'l,~ 27. AMT. AP5%'ED ,.
F<)I' Sognature 01
p....yME.NT Judge ...$ .2.S
Copy 1 - Mail to Court Admi~isJator at completion ot service ~-i--
NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND,
PEN
INRE: EST ON, DECEASED
TO:
Ruby L. Lineaweaver
33 Lovers Lane
Newburg, PA 17240
Cyril R. Cassner
675 Prospect Ave.
Shippensburg, P A 17257
Please take notice of the death of decedent and the grant of letters to the
personal representative named below. You may have a beneficial interest in the
estate under the Intestate Laws of the Commonwealth of Pennsylvania.
Name of decedent: Hazel T. Beason
Last known address of decedent: Conodoguinet Mobile Estates, Lot 146,
Newville, P A 17241
Date of Death: February 14, 2004
Place of Death: Carlisle Regional Medical Center
County of Grant of Original Letters: Cumberland
Decedent died intestate
Name, address and phone number of all personal representatives:
Ruby L. Lineaweaver, niece
33 Lovers Lane
Newburg, PA 17240
Phone: 717-245-3924
Name, address and phone number of counsel:
William P. Douglas, Esquire
Douglas Law Office
27 W. High St.
Carlisle, P A 17013
Phone: 717-243-1790
Additional information may be obtained from the undersigned:
- c:tlr\~' .
By.~.
William P. Douglas, Esquire
9S: ZkJ lZ tldV ~W. High St.
lisle, Pa. 17013
717-243-1790
Dated: April 19, 2004
.. )~?U
~\
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ~A2€: \ '1. o EhSOf"i
Date of Death: ..2. { . t\-\O i-'
Will No. ~ l-Oi''' 00'1 g Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name Address
A->-t- ~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ~
Date: ~~.
Signature
Name~.V
DOUGLAS LAW OFFICE
Address
CARLISLE. PA 17013
+-tr..u:\~)
. -: .~) Telephone () ') ) '2.-"f ? - I '7' ()
9r'0 '1::J lZ ~d'tl va. Capacity: _ Personal Representative
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. :J~ ....,,~
/'
"ill .~DH _ Counsel.for personal representative
i
V.
, COMMONWEALTH OF REV-1 500
~' ~ PENNSYLVANIA
i; ,'lil;;, -- , DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
''- DEPT 280601 2 1 0 4 0098
~~ HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ----
COU'rY::;ODE YEA.,~ .\U\15ER
DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAU SOCIAL SECURITY NUMBER
I- -
Z Beason, Hazel J. 202 20 0836
W DATE OF DEATH (Mrvl-DD-YEAR~ i DATE OF BIRTH I,MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
C
W 2/14/04 I 3/12/25 REGISTER OF WILLS
U
W ,IF APPLICABLE I SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INIT,AU SOCIAL SECURITY NUMBER
C
w ~1 Origi:lalReturn D 2 Supplemental Return D 3. Remainder Return ,:d;;:e 8' ~eol'l ~F~r to 12- 3-B2:
>-
::s:::S;1J) D 4. Limited Estate o 4a Future Interest Compromise :12.te cfde~tl J~_'" 12-";:-22 D 5. Federal Estate Tax Return Requ:red
u """
w"-u
,,00 n 6.0ecedentDiedTestate'A.::dr)-c'J'i:/';"1 o 7 Decedent rvlaintained a L,ving Trust IA~acr ,:o~,y of lustl 8_ Total Number of Safe Deposit Boxes
u"'~
,,-",
"- I 9, litigation Proceeds Received D 10_ Spousal Poverty Credit '.,In ~':~"tl ~d,'eer 2-j' -"1 oc"j t 1-9~: ~ 11. Election to tax under See 9113(A) ,Attac1 SCl 01
"
>- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
z COMPLE~i7MAILlNG ADDRESS
w NAME
0 William P. Douglas W. High St., Carlisle, PA 17013
z
0
"- FIRM NAME IlfAp~ll:abe:
In
w -Off; rp
'"
'" TELEPHONE NUMBER
0
u
Real Estate (Schedule A) 1:1)
2. Stocks and Bonds (Schedule B) (2)
3 Ciosely Held Corporation, Partnership or Sole-Proprietorship (3)
4 Mortgages & Notes Receivable (Schedule D) (41 ~
_6,615,75' C'
5 Cash. Bank Deposits & Miscellaneous Personal Property (5) ;
"
Z (Schedule E)
0 6 Jointly Owned Property (Schedule Fj (6)
~ D Separate Billing Requested -..--,
...J ~-.J
::l 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) -,
--...,
!::: (Schedule G or L) -
c.. ,.)
<l: 8 Total Gross Assets (total Lines 1-7) (8) . . 6,615/"5""-
u 9 Funeral Expenses & Administrative Costs (Schedule H) (9) 4,814.85
w
e::: (10)
10 Debts of Decedent, Mortgage Liabilities, & Liens (SChedule I)
11 Total Deductions (total Lines 9 & 10) (11) 4 R74 Ro
12 Net Value of Estate (Line 8 minus Line 11) (12) 1800, '10
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14 Net Value Subject 10 Tax (Line 12 minus Line 13) (14) 1800.10
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES
Z 15 Amount of Line 14 taxable at the spousal tax
0
l- rate, or transfers under See 9116 (a)(1,2) x 0 (151
~ 16 Amount of Line 14laxable at lineal rate xO_ (161
::l
c.. 17. Amount of Line 14 taxable at sibling rate x 12 117)
:E
0 18 Amount of Line 14 taxable al colla!eral rate 1,799.81 x 15 (18) $270.00
U
>< 19 Tax Due (19) $270.-00---
~
20 [l CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENr
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
I ","m,"c", Conodoguinet Mobile Estates, Lot 106, Ne"ville, Pc" l72H I
ZIP
STATE
CITY
Tax Payments and Credits: 270.00
1 Tax Due (Page 1 Line 19) (1)
2 Credits/Payments -
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C ) (2)
3 InterestJPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4) ---
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 270.00
-- --
A_ Enter the interest on the tax due. (5A)
B. Enter the total of line 5 + 5A. ThIS IS the BALANCE DUE. (5B) 270.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and Yes N~
-
a. retain the use or income of the property transferred:.. ..~ -
b. retain the right to designate who shall use the property transferred or its income; ,. y
c. retain a reversionary interest; or,.. .. LJ C'V
d. receive the promise for life of either payments, benefits or care? ,. D Q.---
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .. D IT
3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ,. D [3'
4 Did decedent own an Individual Retirement Account annuity, or other non-probate property which cg/
contains a beneficiary designation? , D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Uecw ~enalties d rer.lJry', I declare that I rave examinee this return. i1clucing accorrpa~ying scnedules and sta:ements, and ~o 'ne best of my knowledge and oelief,t is t,'ue, correct and complete
Declaratio1 of V80arer other than the personal represer~at've 's based on al informatio1 of 'i\'".ic~ pre parer has any kllu,'ilecge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
ATTar f\ "- DATE 7 2,,(
Ol{-
, I (I r-A.
5"1. '------<'< ( ,<; ...:--. I r 0 1'<,
For dales 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 PS S9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S, 99116 (a) (1,1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, nnd the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving 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 death to or for the use of a natural parent, an adoptive parent.
or a stepparent of the child is 0% [72 Ps. s9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P.S. 99116(1.2) [72 P.S_ 99116(a)(1)].
The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. s9116(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
,"m",,,, . SCHEDULE E
COMMONWEALTH Of PENNSY',VANlA CASH, BANK DEPOSITSI & MISC.
,NHERiTANCE TAX RETURN PERSONAL PROPERTY
RESICi=Ni DECEDENT
ESTATE OF FILE NUMBER
Hazel J. Beason 2104-0098
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM r VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Plymouth Station Wagon, 1985, sale price 200.00
2. Orrstown Bank, checking account 5,025.87
3. Household furnishings 1,379.25
4. I Guideposts refund 9.54
5. i News Chronicle refund 1.09
I I
, ,
I
I
I
j
I
I
I
I
i
,
I
TOTAL (Also enter on line 5, Recapitulation) $ (..&> 15 15"
(If more space is needed, insert additional sheets of the same size)
REV-1511 EXI 112-99)
,.;,
C ",- <{ SCHEDULE H
/t.,,'Jt:.;,'\t\
:::~:~~f.~
COMr>10NWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT I
ESTATE OF FILE NUMBER
Hazel J_, Beason 2104-0098
Debts of decedent must be reported on Schedule 1.
--
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
Fogelsanger-Bricker Funeral Home 2,293.00
i I
B ADMINISTRATIVE COSTS'
1, Persona: Representative's Commissions
Name of Persona! Representativelsl --
Social Secu'ity N'Jmber(sliEIN Number oj Personal Representative(s) --
Street Address
City ______ ------ State Z'p --
Year{s) Commission Paid --
,
I
2 I Attorney Fees Douglas Law Office 500.00
I
I
3 I Family Exemption (If decedent's address is not the same as claimant's, attach explanatiolli
I
Claimant --
Street Address
City ------ State Zip -
Relationship of Claimant to Decedent
I
,
4 Probate Fees 55.00
5 Accountant's Fees
6 Tax Return Preparer's Fees
7 Cumberland Law Journal, adv. 75.00
8. Sentinel, adv. 136.31
9. Kough Oil 33.66
10. Adams Electric 186.26
ll. Landfill charge for tash 132.00
12. Shirley, cleaning mobile home 100.00
13. Beverly, cleaning mobile home 100.00
14. Additional landfill charges 27 .16
15. Dr. David Hartzell 2.34
16. Adams Electric 28.85
TOTAL (Also enter on line 9, Recapitulation) S 4,814.85
(II more space is needed, insert additional sheets of the same size)
SCHEDULE H (continuation- page 2)
17. Agway Gas 36 .45
18. John Walters, rent for Feb. 04 600.00
19. Repair windshield on car 74.15
20. Andorra Radiology 9.92
2l. Central Penn Med. Gr. 29.20
22. Spring,Rcad family practice 125.41
23. Vascular Associates 158.71
24. Central Penn Me. Gr. 5.84
25. Blue Mtn Anesthesia 2.56
26. Hershey Kidney Specialists 58.31
27. Cumberland ENT 4.10
28. Newville Ambulance 10.62
29. Rick Stryker, mowing and trimming 30.00
~EV_1~" EX. :197; '*
R SCHEDULE J
~ BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF 2104-0098 FILE NUMBER
Hazel J. Beason
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) DF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Ruby L. Lineaweaver niece one-half
2. Cyril R. Casner nephew one-half
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17. AS APPROPRIATE. ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GDVERNMENTAL DISTRIBUTIONS
1 I
I
,
,
i
____ --.1 _._______________ .__________ ____ _________ ---------- ,-------_... ----- - ---.._-. n
TOf!\L :)F PARr IT. '-", - . ,. ,- ,._,
.'.-
BUREAU OF MOTOR VEHICLES .~...~~'-~. '....~...A;.TACH....PA~Tl1U....:'INsmUCTiciNS FOR THIS FORM ..~~.. ..., ,. ,....,. ~!
l:tU_.'[..;1:Io"l:XI ARE INCLUDED ON MV-1A - TYPE OR PAINT ".1. I
HARRISBURG. PA 17106-8593 MAKE CHECK PAYABLE TO COMMONWEALTH OF PENNSYLVANIA _
MV.4ST (5-00J <D
. ..
~""NTEOONRI!<:VCleOP.o.PEA
~-----------------------------------------_.
No. 3634078
, II r1
A I PA...TIn.E NUMBER (AS SHOW~Nt ON ATTACHED TITLE) E OF IJEHICI..E"'OlLJ I'MOO~ YEAR PURCHASE
'O)r)-"~51.?\l', 'D I,J~~. PRICE V 0
~~ I:' j'/' V V~,I\ 0 '1/r) !VI" J n'--J IS"~"ooffi"''') cin ~ .
~ u VE~~DEf)IFI<tfI?~ N}\MBER _ ~ __, CONDJ1ION
~i r~:~ l'J VY'1-f)l~(.... /)(lnl"-l o GOOD DFAIR o POOR ~~;~E-IN _ _
B. \7\E ~ (OR FU~L BU~I:::'SS NAME) .tIRi ~AMt:. J MIDDLE INITIAL TAXABLE
. l fl. -y 1 , <ltO -.p AMOUNT __
~ . .
III CD-SE~ 1. Sales Tax Due
'6%1.061" iN., m
x 7%07
*(Seenote on reverse) J -
!z C LA ME (OR ULL BUSINESS NAME~ ('n1IRST NAME M~" K<1T1AL I~ATE ACQUIREDI lA Exemption
. - \1 ^ \~ ^ C' i;~E6':~. R"""" Code I"""
~ Olloo(""\UAYlI':") lillP -1-fJU ~2a3n~r"Orrfromt
~ II: CO-PU !CHASE!) 18 First Assignrneot 18 Second Assignment
~ ~ ~.
u
~ r;Q \ ,) f<'lnl? ~ ~J. 0~ 5/1 1 !d,NTJDE 2 Till'F" rUn' .
C([T ~ 1.J STATE I ~ CADr-_ --, REFER TO COUNTY CODES
'- VI ) n Cf)n ~ r;1 [ J /1 I JcJ, ':::J / ~~~~ ~~:~VERSE SIDE 3. Lien Fee _ _
O LAST NAME (OR F'ULL BUSINESS NAME) J FIRST NAME MIDDLE INITIAL I :DATE ACQUIREDI
. - ,- PURCHASED 4. Registration or
ProceSSlll9 Fee
. .
CO-PURCHASER Fee Exempt Number
!Ii: as asslgMd by lhe
~II: ~~U
~ ~ STREET COUNTY CODE 5, Duplicate Reg.
~ ~ 1f I F"
J! i No. 01 Cards _ _
.. J! CITY STATE ZIP CODE REFER TO COUNTY CODES
.. LISTING ON REVERSE SIDE 6 Transfer Fee I ~ 0.0
OF PINK COPY L1!.
E. MAKE OF VEHICLE VEHICLE IDENTIFICATION NUMBER
7,lncreaseFee
~~ - .
~~ MODEL YEAR I 'BODY TYPE (CP, TK, ETC.) I (CONDITION
~ ~ 8. Replacement
/ D GOOD D FAIR D POOR Fee _.
F. ORIGINAL PLATE V Check One (71 TRANSFER OF PREVlOUSLY ISSUED PLATE TOTAL PAID 9 10
O ~D (Add 1 thru 8)
PLATE TO BE ISSUED BY TRANSFER & RENEWAL OF PLATE . ..
BUREAU (PROOF OF IN- 0 TRANSFER & REPLACEMENT OF PlATE Send One I O~
SURANCE MUST BE AT- 1 lGRAND TOTAL Ch0ck in l
TACHE D.) D TRANSFER OF PLATE & REPLACEMENT OF STICKER (Add 9 & 10) This 'Arnount . 1 ::;J
D EXCHANGE PLATE TO BE
ISSUED BY BUREAU PLATE NO. (.1. \1./"\\ ~ X",] ~ I REASON FOR REPLACEMENT
J""I I DLOST 0 DEFACED 0 STOlFN
II: D TEMPORARY PLATE EXPIRES ~ (, t-... I DNEVER RECEIVED {lOST IN MAIL!
s: ~ ISSUED BY FULL AGENT Month J Yeaf-J ......J NOTE: II "NEVER RECEIVED" block is checked. annlicant must com lete Forf!l_~.ilV-~___.__
~~ TRM~f~ntrrDL{fL\ u CDS lVIN
~I. ,. . " SIGNATURE .~OI' PERSON FROM SIGN H., E 1 RELATIONSHIP TO APPLICANT
~II:" TEMP.PlATENQ. ~~~~~D~TfuEI~~~~NKpP~I~~~fi .. i
VEHICLE PURCHASED ~GVWR I UNLADEN WEIGHT REQ, REG_ GROSS WT. IREQ, REG_ GROSS COMB
~E~[I~:eitE) ,.. INCLUDING LOAD WT. (IF APPLICABLE)
INSURANCE COMPANY NAMg '. r n. ~_ POLICY NO. lOR , :>. A. ., il':1 ,..,I ~OUCY\EFF""TIVE"" i 1 ~2.w!'{ Ei'I"iJAqO~
)!/lll r-(~}11T I ATTACHBINOERf _H\\{\ur'-' I (:).-J HI DATE -'X-{)'-1 IDA''"-JJ'x'lJL-1
I CERTIFY THAT ON MONTH DAY ~:EAR r ,r ISSUING "Pf'N:J. (RI NAME) L-" ~... _ AG~_ /~
~~~G I HAVE CHECKED TO DETERMINE ~T THE VEH~<?~E ~~NSURED._~ I ./ I-.... ~I r l lV, { f} a,( 5 f\ '-) '( U..)
ISSUED TEMPORARY REGISTRATION TO THE ABOVE APPLICANT, IN
~:~~N COMPLlANCEWlTHALLAPPLlCABLEPROVISIONSOFTHEVEHICLECODE ~1"f~~E~, ~I~NAT R '>...,. 1]1.1 _"J ~~HO~_, .?-\"V.
AND DEPARTMENT REGULATIONS A I \. ,I T \" J ' Y, \.. 1\ ~ I J t1\ u ) r Jill J) ,\. rJ ) j{ A,..
G I/WE CERTIFY THAT I/WE HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMPLETION AND THAT THE INFORMAT N GIVEN IS TRUE AND CORRECT. IF AN EXEMPTION
. IS CLAIMED, THE PURCHASER FURTHER CERTIFIES THAT HE/SHE IS AUTHORIZED TO CLAIM THIS EXEMPTION. I/WE ACKNQWLEDGE THAT I/WE MAY LOSE MYJOUR OPERATING
PRIVlLEGE(S) OR VEHICLE REGISTRAT10N(S} FOR FAILURE TO MAINTAIN FINANCIAL RESPONSIBILITY ON TH.,~E CURR NTLY REGISTERED VEHICLE FOR THE PERIOD OF
REGISTRATr#EION lJWE ACKNOWLEDGE THAT t/WE MAY BE SUBJECT TO A FINE NOT EXCEEDING $5000 AND 1M MENT OF NOT MORE THAN TWO YEARS FOR ANY
FALSE STATE T THAT I/WE MAKE ON TI-iIS FORM ~
:;!': 1~;...o~lrstrurc~eror,Authonze:dSlgner TELEPHONE NUMBER Si~o Seller(_~ i!. )
~ 1ST L., /dJ. .J_ /)\ '~d {IV.A. ", . 7't ~ .., 'A /<><---.. .
~ ~~I~- Signature of Co Purchaser/Titleol'uthorizedSigner \ j'" ~..Ji)\Y~ Signature of (i)-Seller ,
.
o Signature of Second Purchaser or Authorized Signer TELEPHONE NUMBER Signature of Seller
2ND
ASSIGN- ( ) _"_
MENT Signature 01 Co-PurchaserlTitle 01 Authorized Signer Signature 01 Co-Seller
H. :;!': NOTE: If a co-purchaser other than your spouse is listed and you want the title to be listed as "Joint Tenants With
~ ~ Right of SurvivorshipM (On death of one owner, title goes to surviving owner.) CHECK HERE D. Otherwise. the title
~g~ will be issued as "Tenants in Common" (On death of one owner, interest of deceased owner goes to his/her heirs or
:5 e estate).
<I: i NOTE IF THE VEHICLE IS TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOCK 0 IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-Il
I MESSENGER NUMBER:
Messenger Service Receipt
SOLLENBERGER'S MESSENGER SERVICE INC. Invoice #: 38963
408 EAST KING STREET
SHIPPENSBURG, PA 17257
717-532-3764
Date: 05/07/04
Time: 05:53 PM
For: MARIE HUGHES
69 W KING ST PO BOX 577
SHIPPENSBURG, PA. 17257 Clerks Initials: PAM
717-532-5148 File Name: SHIPP04
Title # or Date of Birth: 373560464 State Fees
VIN or Driver's Number :
Tag Number or Eye Color : EDB4823 Title Fee.. _..... _..._ 22.50
-Year-Make or Soc. Sec.# : Encumbrance Fee. _.. _.. 0.00
Transaction : Transfer Deal Tag Transfer_........_ 6.00
Odometer : 0 Registration. . . _ _ . . . . . 0.00
Comments: Dup. Fee. . . . . _ . . . _ . _ . . 0_00
MAIL Increase Fee........ _. 0.00
Replacement Fee. . . . _ . . 0.00
This item will be Mailed to you. Tax-On $200.00.. .. 12.00
. . 0.00
. . 0.00
WARNING: Bureau regulation require that any
item left in our office for 60 days be Total State Fee. .. _ .. . 40.50
returned to the Bureau of Motor Vehicles as Check #....:.... _.....
unclaimed.
Service Fees
I/We swear that I/we have applied for the
above item(s) . Messenger Fee......... 0.00
Temp Tag Fee....... _.. 0.00
Notary Fee. _.... _...._ 0.00
Copy/Fax Fee. _... _..._ 0.00
Document Fee _ _ _ . . . _ . . . 25.00
Check or M.O. Fee _ _ . . _ 1. 25
MAIL . . 0.50
. . 0.00
Total Service Fee. _ . _ _ 26.75
Service Fee Check #... Cash
Sworn & subscribed to before me on 05/07/04. Grand Total..... _... _. 67.25
Total Due... _.... _..._ 67.25
Amount Paid. _ . . . _ _ .. - 67.25
Paid in Full
Notary
Seal No Refunds on Service or
Notary fees. We are not
responsible for work the
State fails to process.
DUSAHC PT SVS 7172453034 07/29/04 06:37am
P. 002
d{19 ~ -
O~N2/27/04 -
pa.ge 1
~ RIMARY ACCOUNT 5304~_1
ENCJ.,OSU:;<ES
1...11I...1..1.1.1..1...11.1.1.1
liAZEJ., BEASON
146 CONODOGUINET MOBILE EST
NEWVIJ.,J.,E PA 17241
WE PUT THE LOW IN LOANS:
J\.5K ABOUT OUR SPECIAJ., l,OW RATE liOME EQUITY LINE TODAY'
CALL 1-8SS-0RRSTOWN ABOUT THIS LIMITED TIME OFFER!
CHECKING A C C 0 U N T S
ACCOUNT TITLE liAZEL BEASON
CARRIAGE CJ.,UB CHECK SAFEKEEPING
ACCOlTh~ NUMBER 530441 Statement Dates 2/02/04 thYl,J 2/29/04
PREVIOUS BA~ANCE 4,395_36 DAY5 IN THE STATEMENT PERIOD 28
3 DEPOS:TS/CREDITS 716.06 AVERAGE LEDGER 1.264_13
1 CliECKS/DEBIT5 5.100_00 AVERAGE COJ.,J.,ECTED 1,264_13
SERVICE l'BE .00 IntcreE',:;, Earne.d _10
INTEREST PAI:J _lO Annu.al Percentage Yield Earned 0.10%
cuRRENT BA:J...A.NCb 11_ 52 2004 Intermst Paid _46
ACTIVITY IN DATE ORDER
DATE DESCIUPTION TRACE NO AMOlTh"l' BALANCE
2/02 CIVIL SERV US TREASURY 3:2 058191995 76.00 4,47:.35
pp:i)
2/02 DEPOSIT 020049160 16.06 4,487,~2
2/03 sac SEe US TREASURY 303 24 Sl6 8443 624_00 S.LLl_42
PPD
2/09 CHECK 5922 0703307sr. 5,100_00" 11-42
2/29 Interest Deposit .10 11_ 52
-- - CHECK SlJMM"AKY -- -
DATE CHECK NO AM:OUN'I' REFERENCE
2/09 5922 5,100_00 070330750
* ~enctes missing check numbers
DUSAHC P T S'..,YS 7172453034 07/29/04 08:37am P. 001
Ann:
Here is Hazel's bank statement for February.
She passed away on February 14, 20051 and you can see the
$5,100.00 was debited from her account by check number 5922
on February 9, 2005_
I was given court appointed power of attorney for her, and the
money I gave your office and spent for cleanup and bills, etc
came from that $5,100_00.
Would it still be considered inheritance?
I also need to speak with you about her medical bills_
If you get the chance, could you please call me at 245-3924?
Thanks again for all of your help!!!
Ruby
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT_ 280601
HARRISBURG, PA 17128-0601
PENNSYL VANIA
R~C~IV~D "ROM, INH~RITANC~ AND ~STAT~ TAX
OFFICIAL RECEIPT
NO. CD 004265
DOUGLAS WILLIAM P
27 W HIGH STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- lold ________n _____0__
101 I $270.00
EST A TE INFORMATION: SSN: 202-20-0836 I
FILE NUMBER: 2104-0098 I
DECEDENT NAME: BEASON HAZEL J I
DATE OF PAYMENT: 08/12/2004 I
POSTMARK DATE: 08/12/2004 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 02/14/2004 I
I
TOTAL AMOUNT PAID: $270.00
REMARKS: DOUGLAS LAW
CHECK# 1182
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
I nventory of the real and personal estate of
HAZEL J. BEASON deceased
-~_..
.~~~~T-
l. Plymouth Station Wagon, 1985, sale price I 200 00
2. Orrstown Bank, checking account I 5,025 87
3. Household furnishings 1,379 25
4. Guideposts refund 9 54
5. News Chronicle, refund 1,09
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Total " 6,6I51"7J
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COMMONWEALTH OF PENNSYLVANIA
55:
COUNTY OF CUMBERLAND
Ruby L. Lineaweaver
-- ---.--- --- --.--- ---- -- ------ -"-_.__._..~._~_._._-_._------- --- -..--
being duly ~~___~_o.r_~__ according to law, deposes and says that Elle _ is ,~_~_~dmi1.1i~tratri~_ ___
Hazel J. Beason
----- - ------_ of the Estate of ___ _ ______
late of -- - Lower Miff-lin Twp, Cumb-..--C<>.__ __, Cumberland County, Pa., deceased and that the
within is an inventory made by ---- ~~-!-- ________ _______.___~. the said Adm_~nistratr:ix_
of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death,
Sworn to and subscribed before me, __ ~ ~~_ ' ____ _ #
L ) ~,19_.___. Ruby L. Lineaweaver
33 Lovers Ln.
J.1 -Newburg, PA 17240 -----
tary ...--_.- _c.
:' -,:';;-';:11 Seal ___".____.__ _ __ __~
An:J8 rl~.'co~~, ~",:otary Pubi:': Address
::S:B 80~Gugll. C0:~i;j2r\and Ce,
r~is~;iOl EXp;le'~ ..:uiy ~\::..1
--------
Dale of Death _ __lie... ..Leb ~__ ________ ____ __ _ __ 2004
Day Month Year
INSTRUCTIONS
I. An ir.v-entory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personaHy or realty
4. See Article IV, Fiduciaries Act of /949.
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~ 'C.:'-l - R'S.K COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. Z80601 NOTICE OF INHERITANCE TAX
HARRISBURG, PA 171Z8-0601 APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP [Dl-U5l
DATE 10-11-2004
ESTATE OF BEASON HAZEL J
Ii. 02-14-2004
DATE OF DEATH
FILE NUMBER 21 04-0098
'04 DC 1 1 3 :' r, 'r'6 COUNTY CUMBERLAND
WILLIAM P DOUGLAS ,\O.,..J ACN 101
DOUGLAS LAW OFFICE \ Allount Rellitted \
27 W HIGH ST 1..,
CARLISLE ~!lit;913
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=is4j-EX-AFP-coY=oiY-NoTicE--OF-YtiHERiTANci-TAX-APPfiAisEMENT~--AL:rOWANci-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BEASON HAZEL J FILE NO. 21 04-0098 ACN 101 DATE 10-11-2004
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account.
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6.615.75 tax paYllent.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 6.615.75
APPROVED DEDUCTIONS AND EXEMPTIONS: 4.814.85
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) UO) .00
11. Total Deductions (11) 4.814 85
12. Net Value of Tax Return (12) 1.800.90
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (4) 1.800.90
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX: .00 X 00
15. Allount of Line 14 at Spousal rate US) = .00
16. Allount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00
17. Allount of Line 14 at Sibling rate (7) .00 X 12 = .00
18. Allount of Line 14 taxable at Collateral/Class B rate (18) 1.800.90 X 15 = 270.00
19. Principal Tax Due (9)= 270.00
TAX CREDITS:
KC"C.Lr 1: +') AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-12-2004 CD004265 .00 270.00
TOTAL TAX CREDIT 270.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
It IF PAID AFTER DATE INDICATED. SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) '~t
RESERVATION: Estates Df decedents dying Dn Dr befDre December 12, 1982 -- if any future interest in the estate is transferred
in pDssessiDn Dr enjDyment tD Class B (cDllateral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr
life Dr fDr years, the CDmmDnwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes
at the lawful Class B (cDllateral) rate Dn any such future interest.
PURPOSE OF
NOTICE: TD fulfill the requirements Df SectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 Df 2000. (72 P.S.
SectiDn 9140).
PAYMENT: Detach the tDP pDrtiDn Df this NDtice and submit with YDUr payment tD the Register Df Wills printed Dn the reverse side.
--Make check Dr mDney Drder payable to: REGISTER OF KILLS, AGENT
REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cDmpleting an "ApplicatiDn
fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office
Df the Register Df Wills, any Df the 23 Revenue District Offices, Dr by calling the special 24-hDur
answering service fDr fDrms ordering: 1-800-362-2050; services fDr taxpayers with special hearing and I Dr
speaking needs: 1-800-447-3020 (TT Dnly).
OBJECTIONS: Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallDwance Df deductiDns, Dr assessment
Df tax (inclUding discDunt Dr interest) as shDwn Dn this NDtice must Dbject within sixty (60) days Df receipt Df
this NDtice by:
--written prDtest tD the PA Department Df Revenue, BDard Df Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electiDn tD have the matter determined at audit Df the account Df the persDnal representative, OR
--appeal tD the Orphans' CDurt.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errDrs discDvered Dn this assessment shDuld be addressed in writing tD: PA Department Df Revenue,
Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
PhDne (717) 787-6505. Sae page 5 Df the bDDklet "InstructiDns fDr Inheritance Tax Return fDr a Resident
Decedent" (REV-1501) fDr an explanatiDn Df administratively cDrrectable errDrs.
DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5%) discDunt Df
the tax paid is allDwed.
PENALTY: The 15% tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt
paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. This nDn-participatiDn
penalty is appealable in the same manner and in the the same time periDd as YDU wDuld appeal the tax and interest
that has been assessed as indicated Dn this nDtice.
INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day frDm the date Df
death, tD the date Df payment. Taxes which became delinquent befDre January 1, 1982 bear interest at the rate Df
six (6%) percant per annum calculated at a daily rate Df .000164. All taxes which became delinquent Dn and after
January 1, 1982 will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate
annDunced by the PA Department Df Revenue. The applicable interest rates fDr 1982 thrDugh 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate FactDr Year Rate FactDr Year Rate FactDr
~ ~ :ii1imii M"8-1991 -,yr- :oomr m1 ~ . ii'ii'DZ4r
1983 16% .000438 1992 9% .000247 2002 6% .000164
1984 11% .000301 1993-1994 n .000192 2003 5% .000137
1985 13% .000356 1995-1998 9% .000247 2004 4% .000110
1986 10% .000274 1999 n .000192
1987 10% .000274 2000 n .000192
--Interest is calculated as fDllows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days
beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the
NDtice, additiDnal interest must be calculated.
.
INRE: ESTATEOF : IN THE COURT OF COMMON PLEAS
HAZEL J. BEASON : OF CUMBERLAND COUNTY,PENNA.
: ORPHANS' COURT DIVISION
: NO. 21-04-0098
PETITION FOR THE SETTLEMENT OF A SMALL ESTATE
TO THE HONORABLE, THE JUDGES OF SAID COURT:
Ruby L. Lineaweaver, Administratrix of the Estate of Hazel J. Beason, through her
attorney, William P. Douglas, respectfully represents:
I. Hazel J. Beason, who resided at CME, Lot 146, Newville, PA 17241, died
intestate on February 14, 2004. tf
2. Letters of Administration were granted to Petitioner on March 25,2004, and the
estate was advertised in the Evening Sentinel and Cumberland Law Journal on April 20, 27,
and May 4, 2004, and April 23, 30 and May 7, 2004, respectively.
3. The only assets in the c:state were as follows:
1. Plymouth Station Wagon, 1985, sale price 200.00
2. Orrstown Bank, checking account 5,025.87
3. Household furnishings 1,379.25
4. Guideposts refund 9.54
5. News Chronicle, refund 1.09
Total Assets $6,615.75
4. Expenditures in the amount of $5,175.78 have been made on behalf of the said
Hazel J. Beason as is set forth in the attached Inheritance Tax Return in the amount of
$4,814.85, plus additional expenses of $25 to file the inheritance tax return, $17 to file this
Petition, $270 payment for inheritance taxes, and an additional sum of $48.93 to Spring
Road Family Practice, said expenditures totaling the aforesaid $5,175.78:
5. Inheritance taxes of $270 were due on this estate. A copy of the Appraisement
of Deductions from the Department of Revenue is attached hereto as Exhibit A showing that
the taxes have been paid. "'
6. The said Hazel J. Beason was survived by her niece, Ruby L. Lineaweaver and her
nephew, Cyril R. Casner
7. The balance of the estate has been distributed in equal shares to the said Ruby L.
Lineaweaver and Cyril R. Casner.
RECAPITULATION
Total Assets: 6,615.75
Total Credits 5.175.78
Balance distributed to 1,439.97
Ruby L. Lineaweaver 719.98
Cyril R. Casner 719.97
WHEREFORE, your Petitioner prays that Your Honorable Court approve the
distribution of this estate as set forth herein, and that the said Administrator, Ruby L.
Lineaweaver, be discharged from the duties of her appointment.
Douglas Law Office
. Q
By ~
Attorney for Petitioner
Dated: December 7,2004
..,
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Ruby L. Lineaweaver, A<!ministratrix being duly sworn according to law, deposes
and says that the averments of the within Petition are true and correct to the best of affiant's
lmow100"" illf","""oo ood reHer. ~ ~ ~~
by . Uneaweaver
Notary
_., u. .,~__~__,~.,... ..._~"___
NGlarial Seal
Anne M. Cox, Notary Public I
C"'i.,, Borough, Cumberland County I
,'",,0') ExpiresJ.~~~,~:.c:?!
COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 MOrICE OF INHERlrANCE TAX
HARRISBURG~ PA 17128-0601
APPRAISEHENr, ALLOWANCE DR DISALLOWANCE
OF DEoucrIONS AND ASSESSHENT OF TAX REV-1541E1l'FPtl1-UJ
DATE 10-11-2004
ESTATE OF BEASON HAZEL J
DATE OF DEATH 02-14-2004
FILE NUMBER 21 04-0098
COUNTY CUMBERLAND
WILLIAM P DOUGLAS ACN 101
DOUGLAS LAW OFFICE I Alwunt R_Hted I
27 W HIGH ST
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:E;'4Tix-AFP-foY':03rNoT"ici--OF-YNHiifiTANCE-T"AitAPPRAisiiiENT~--Ai.i-ojjANCE-iiR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BEASON HAZEl J FILE NO. 21 04-0098 ACN 101 DATE 10-11-2004
r AX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.l Estat. (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bands (Schedule B) (2) .00 creel! t to your account,
3. Closely Held Stock/Partnership Interest (Sch.~18 C) (3) .00 subMit the upper portion
'f. Mortgages/Notes Receivable (Schedule DJ (4) .00 of this for. with yOUr
5. Cash/Bank Deposits/Kisc. Personal Property (Schedule EJ IS) 6.615.75 tax paYllent.
6. Jointly Owned Property (Schedule f) (6) .00
7. Transfers (Schedule GJ (7) .00
8. Total Assets " (8) 6,615.75
APPROVED DEDUCTIONS AND EXEMPTIONS: 4,814.85
9. Funeral bpenses/AdII. Costs/Hisc. Expenses (Schedule Hl (9)
10. Debts/MOrtgage Liabilities/Lions (Schedule I) (10) .00
U. Total Deductions IlIl <<&.814 81;
12. Nat Value of Tax R.turn (12) 1,800.90
13. CharltQble/Sovern..ntal Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 1,800.90
NOTE: I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
reflect ~igures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX: ---------
1&. A~t of L1na 14 at Spousal rat. (15) .00 X 00 = .00
16. A.aunt of Line 14 taxable at Lineal/Class A ~ate (16) .00 X 045 = .00
17. A.ount of Line 14 at Sibling rate 1l7J .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Clas$ Brat. (18) 1,800.90 X 15 = 270.00
19. PrinCipal Tax Due 1I9)= 270.00
'"'AY TS:
"An .,+,- AHOUNr PAID
DATE NUHBER INTERE&T/PEN PAID 1-)
08-12-2004 CD004265 .00 270.00
, TOTAL TAX CREDIT 270.00
, BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFrER DArE INDrCArED, SEE REVERSE I IF TorAL DUE IS LESS THAN $1, MO PAYHENr IS REQUIRED.
FOR CALCULATION OF ADDlrIONAL INTEREST. IF rOTAL DUE IS REFLEcrED AS A "CREDn" ICR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FoRH FOR INSrRUCrIDNS.)
Inventory of the real and personal estate of
HAZEL J. BEASON deceased
1. Plymouth Station Wagon, 1985, sale price 20 o 00
2. Orrstown Bank, checking account 5,02 5 87
3. Household furnishings 1,37 9 25
4. Guideposts refund 9 54
5. News Chronicle, refund 1 09
,:,. .
Total I 6.615 '7S'
,
I
ff
I
."
REV.l$OO EX (6-00) REV-1500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601 2 1 0 4 0098
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT -
-----
COUNTY CODE YEAR NUMBER
DECEDENTS NAME (LAST, FIRST. AND MI~DLE INITIAL) SOCIAL SECURITY NUMBER
I- Beason, Hazel J. 202 - 20 -
Z 0836
W DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCA TE WITH THE
C
W 2/14/04 3/12/25 REGISTER OF WILLS
0
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
C - -
i!! ~ 1. Original Return o 2. Supplemental Return o 3.RemainderReturn{dateofOealh~1D12.13--82}
::.:::!!;U) o 4. Limited Estate D 4a. Future Inlerest Compromise (date of death after 12-12-82) o 5. Federal Estate Tax Return Required
0.'"
w"o
",00 o 6. Decedent Died Testate (AllachcopyofWlll) o 7. Decedent Maintained a living Trust (A11actl copyofTNst) 8. Total Number of Safe Deposit Boxes
00:--1
..Ill -
.. o 9. litigation Proceeds Received D 10. Spousal Poverty Credit (dale 01 death between 12.31-91 and 1.1.95) o 11. Eleclionlo tax under Sec. 9113(A) 1"""'''''0)
<
..
z COMPlE27MAIlING ~DRES~
w NAME
c William P. Douglas W.Hgh L, Carlisle, PA 17013
z
0
.. FIRM NAME 1'_"')
"
w
0:
0: TELEPHONE NUMBER
0
0
1. Real Estate (Schedule A) (1) OFFICIAL USE ONLY
2. Slocks and Bonds (Schedule B) (2)
....
3. Closely Held Corporation, Parblership or Sole-Proprietorship (3)
4. Mortgages & Notes Rece~able (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 6 . 61:>'07 5'
z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6)
~ o Separate BUling Requested
::l 7. Inter-VIVOS Transfers & Miscellaneous Non-Probate Property (7)
I- (Schedule G or L)
ii:
c( 8. Total Gross Assets (IotalUnes 1-7) (8) 6,615;1'5:...
0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 4,814.85
w
a::: 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) (10)
11. Total Deductions (totalUne' 9 & 10) (11) 4 R?4 Wi
12. Net Value of Estate (line 8 minus Une 11) (12) 1800."10
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (line 12 minus line 13) (14) 1900,10
SEE INSTRUCTIOIIS ON REVERSE SIDE FOR APPUCABLE RATES
Z 15. Amount of line 14 taxable at the spousal tax
0 --
~ rate, or transfers under Sec. 9116 (a)(1.2) '.0_ (15)
I-' 16. Amount of Line 14 taxable at lineal rale '.0_ (16)
::l
ll.. 17. Amount of line 14 taxable at sibling rate x .12 (17)
:iE
0 18. Amount of line 14 taxable at collateral rale 1,799.81 x .15 (18) $270.00
0
g 19. Tax Due (19) $270.09
20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
RfVI"ex."," '*' SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hazel J. Beason 2104-0098
Include !he proceeds of li1igation and !he date !he proceeds were received by !he estate. All property jolntly-owned with the right of survlvo..hlp must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Plymouth Stat~mn Wagon, 1985, sale price 200.00
2. Orrstown Bank, checking account 5,025.87
3. Household furnishings 1,179.25
4. Guideposts refund 9.54
5. News Chronicle refund 1.09
'"
--
TOTAL (Also enter on line 5, Recapilulation) $ vI, , 5", 1S'
(If more space is needed, insert additional sheets 01 the same size)
REV-1511 EX+ (12-99) _
'* SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hazel J. Beason 2104-0098
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home 2,293.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
fl'
Street Address
City State _Zip
Year(s) Commission Paid:
2. Attorney Fees Douglas Lqw Office 500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees 55.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Cumberland Law Journal, adv. 75.00
8. Sentinel, adv. 136.31
9. Kough Oil 33.66
10. Adams Electric 186.26
II. Landfill charge for tash 132.00
12. Shirley, cleaning mobi!e home 100.00
13. Beverly, cleaning mobile home 100.00
14. Additional landfill charges , 27.16
15. Dr. David Hartzell 2.34
16. Adams Electric 28.85
TOTAL (Also enter on line 9, Recapitulation) $ 4,814.85
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H (continuation- page 2)
17. Agway Gas 36.45
18. John Walters, rent for Feb. 04 600.00
19. Repair windshield on car 74.15
20. Andorra Radiology 9.92
21. Central Penn Med. Gr. 29.20
22. Spring. Road family practice 125.41
23. Vascular Associates 158.71
24. Central Penn Me. Gr. 5.84
25. Blue Mtn Anesthesia 2.56
26. Hershey Kidney Specialists 58.31
27. Cumberland ENT 4.10
28. ,Newville Ambulance 10.62
29. Rick Stryker, mowing and trimming 30.00
l/1
.'
REV."""'''.O. SCHEDULE J
BENEFICIARIES
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF 2104-0098 FILE NUMBER
Hazel J. Beason
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Truslee{s) OF ESTATE
L TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Ruby L. Lineaweaver niece one;..hallf
2. Cyril R. Casner nephew one-half
fi
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
,
,
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)
,
~
,~t,. 'j/(/v
. ...... .....
DAN HERSHEY AUCTIONEERING SERVICE 60-15033 2041
DENNIS L. GOTSHALL PROP 313
ESCROW ACCOUNT ~
3 BROWN RD. 717-532-4647
SHIPPENSBURG, PA 17257 DA .2 to?tfe:17/
,11" $~< {It 4%
- oJ- "2J' 6l --
DOLLARS . =:.__
I ~
! ~~~t#:~fi ~A- ;7~ ..
-tI:o 3 B ~ 50 H,I: W3 00 ~ q SOn' Wid
.................................................................. .....-......----..-..-.......-......:.:....-.-.---....---.---.......---.:..U.---., .....-.....-.. .........-..-........-..----...--...-
---_._._-~---_._-_._-------_._.. .-.-"-..- ._----,-
,.... ...." .... .n V."_."~ .
.. . n '0.' .....
...;.~.....; REFUND ACCOUNT . 7S-52~
' f'.uideposts
......_n.... ..__...... '.~1'9
_.- .. - #.... ,
-J ~~u,.i~..~~.~.~/:~i'-:., "." .~.,~. @
1359882
...'...0' ....3J\!."SeIlUnary Ih11 Road
-~EL, NEW YORK 10512 526 2352306B7
;2}ll}054BO
-'.f.i@.iO: REFUND DATE AMOUNT ....
v_~_ .-' ^'.',~.''c"
: "f1\.,('l'P Hazel Beason 04/16/04 $9.54 ".
.. .'l'HE: vom IN EXCESS OF
<.8ihjEl.'l,.OF Nine Dollars 54 Cents - THREE HUNDRED DOllARS
,',v .n. 13~Q~
$OLV1&I\N
Citize'nsState Bank ,
.vv.v~rty",MN 55390 NOO-NEGOTIABlE 90 DAYS AFTER DATE OF ISSUE
730273 :
110 ~ 3 5"1882110 1:0"1 ~"I05 2"151: 7 30 273110
BUREAU Of MOTo" VEHiCLES..... ... -.. w..., ............ ~. ~O-...'" ATTACH "PAL-nilE:': 'INsml.iCTiONS F'O'R THIS FORM' .......".... .. ....., ~ I! I
1:1.. .,'r..:t:Io"1:XI ARE INCLUDED ON MV-1A - TYPE OR PRINT
HARRISBURG, PA 17106-8593 MAKE CHECK PAYABLE 10 COMMONWEALnt OF PENNSYLVANIA
MV~ST 16-001 It\ ...
W~DONAEC'l'a.EDI'N'BI
----------------------------------------.
No. 3634078
II ~"'i~L,iii1{~ "J'M'!'I\f~ E:_ = QO .
i ir':"~IlEt';'rrqcrr;,~C,()()(\ll/ OGOOO '.' OF.... OPOOR ~~-IN . .
I B. rZI~lk~-Y~~) "~;;pj.' '.'. ;;'M" MlIlllLEN!TlAL:,~ ..
"~ ,,'. .',-,' l ;..,.,)-. ~1'.ilM;.;i1tV- .,. 1. Sales Tax Oue
iI - . '6~1.061'" '~
,',} ~".. ,.,.~""" )(7%.07 J .
Seenole on NY8IS8).
C. '-" _lOR LL BUSt<ESS NAME) FIRST NAME NTIAL']OOE-""'UlEDI '" ',,,';',!,>";,;.,, .
I ."" \ I~hi"~') (YY17;p 7':"' 1"1- ,JJu llit."":~"'j,~' i"
;, I"" 'C7 ,',._
~ [;q \~) 1<'1(1/1 ~ I~. ~ 577 11~I}DE 2.T"'Fee ;:rJRi .
qlJ'L ,I SYoTE J '7l '""""10 """"'" COllES
'\J)) ~I>l v/l -'/1 I h1'::J'/'~ =~""SIlE 3.LionF.. . .
D. lAST NAME (OA BUSINESS NAME) J - R1ST NAME MDDLE INTIALI ~~DI 4. Aegistratlon or
I' f>rocee.ImgFee . .
i co-I'URCHASER ~'E_ '. ;""""'),,",r dr' ;'e'r: . f'
8I>~b)'thlt.'<".. .'\
E\ltMu."jt' ;" ,; '. .
I STREET COUNTY CODE 5.l::qlIicate Reg.
I 11 I ,.::c.roa . .
~ COY STATE ZP COOE 'h REfeR TO COUNTY CODES
USIlNOONREVERSEOOE 6. Transfer Fee J. (\f}
Of PINK COPY Le Iv'U .
E. MAKE OF VEHIClE VEHtClE IDENTIFICATION NLt.4BER
7. lnaease Fee
II! MODEl YEAR I BODY TYPE (CP, TK, ETC.) I'CONDIllON ", . ' a Replacement . .
I /' nGOOO DFAlR DPOOR Fee ..
F. 0RtI3ItW.. PlATE t/ Check One ~ TRANSFER OF PREVtOUSlV ISSUED FVJ"E lOTAl PAID 9. 10,
o PlATE 10 BE ~D BY D TRANSFER & RENEML OF PlATE (Add 11hru 8) . .
au:1EAU (PAOClF OF N- D TRANSFER A REPlACEMENT OF PLATE Send Ooe YI O~
SI..AANCE MUST BE /fir. 11 GRANO lOTAl Check In
TACHED.) D TRAN~R OF PlATE & REPLACEMENT OF STICKER (Add 9 & 10) This Amount. \..
D EXCHANGEPlATElOBE ~
ISSUEDBYBUAEAU PlA1tNO:O,.~ :0' *' REASON FOR REPlACEMENT
,",-:.l"I,.:t8; DlOST 0 DeF1CED 0 STOlEN
TEW'ORARY PLATE EXPIRES NEVER RECEIVED ilOST IN MAIL
~I D.. .... ISSUED'" FlU. AGENT Month '" J..J 0 NOTE: tf "NEVER RECElVEb" block IS checked Annlicant must ~tt Form MV-44
I PJ":' f." uvY'-m'rorrt .J(JU~ . I"'"
II! ~'.~'~ WHOM PLATEVI'" IS ~"m" ~ ..;:,IUI'l1"ll:l1l:. 1 RELATK>NSHIP TO APPLICANT
. ,. FEARED (F OTHER ~ APf'IJCANT) 1
weYEHlClEIGHT ~O 0 GVWR IIJNL.AOEN WEIGHT REa. REG, GROSS WT. REa. REG. GROSS COMB.
F~l _I HCLlJONGLOAO WT.(IF APPUCABLE)
NSUW<CE COMPANY "^""'1 \ , I ^ POLICY NO. OR ~".., _. /I' ., POUCYo\EF '" I I~ E
,11111 I t"'1tJ\fY'l Alll'Ol IHI t.""l HOATE -y. ..(J40A"'1,\(ULrI
I CEATFY THAT ON MONTH DAY J YEAR r \( r ISSUING~NAME .-." " . . ~
= IfWECHECKEDlODETE"'""'"'_!""!THEVEHIClE"-_INSURED!...'cI. ~ -or, 1//,( /, CIA S "-.)', V.J
INFOR- ISSUED TE~ REGISTRAT10N TO THE ABOIE APPI.JCANT,IN'
MAllON ~w::r:'-~ I'AO'I1SlONS OF THE VEHIClE CODE' II ~ r ' V P, I R, ~\ \ 1 J +-\ Jf) V J fin"';"'"~ .:>f){ M
G I/m;; CERTIFY THAT I/WE !-WE EXMfIIED AND SIGNED THIS FORM AFTER ns COMPlETION ~ THAT me INFQAMP;~ N IS TRUE AI<<) CORRECT. IF AN EXEMPTION
. IS CLAIMED. THE PURCHASER Flml-ER CERTF1ES nw I-E/SHE IS AUTHORIZED TO ClAIM THIS EXEMPTION.II'NE ACt< DGE THAT I/WE MAY LOSE MY/OUR OPERATING
PRlW.EGE(S) OR VEHIClE REGlSTRATION(S) FOR FAl..URE TO MAINTAIN FINANCW.. RESPONSIBUTY ON THE C Y REGISTERED VEHICLE FOR THE PERIOO OF
REGlSTM~;nQN. IIWE ACKNOWLEDGE THAT I/WE MAY BE SUBJECTlQ A FINE NOT EXCEEDING $5.000 AND 1M NT OF NOT MORE mAN T'MJ YEARS FOR ANY
FALSE THAT I/WE MAKE ON THS FOAM. .- . . - /' .
z 1ST oIF",:~Z:=Z~ TE~PHONE~"'7~r"u h":"'y', A. .., A)......... .
~ :- 1S;gna,"",oICo-"'_/T"'oI~ed"","" !I(i). ~:)~)z:)\y~ Slg"""""oIU>-Selle<' ,
~ Signature 01 Second Purchaser or Authorized SIgner TELEPHONE NUMBER Signature of Seller
"'"
ASSIGN- ( )
MENT S9nature of Co-Purchaser/Title 01 Authorized Signer Signature of Co-Seher
H. ~ NOT€:: If a co.purchaser other than your spouse is listed and ,you want the title to be listed as MJoint Tenants With
~ F. Right of Survivorship. (On death of one owner, title goes to surviving owner.) CHECK HERE D. Otherwise, the title
gf! will be issued as MTenants in CommonM (On death of one owner, interest of deceased owner goes to his/her heirs or
~ ~ estate).
- NOTE: IF THE VEHIClE IS TO BE USED AS A DAILY RENTAl OR LEASED VEHiClE, CHECK THIS BlOCK D . IF BLOCK IS CHECKED. COMPLETE AND ATTACH FORM MV.ll.
, I MESSENGER NUMeER,
Messenger Service Receipt
SOLLENBERGERIS MESSENGER SERVICE INC. Invoice #: 38963
408 EAST KING STREET
SHIPPENSBURG, PA ,17257
717-532-3764
Date: 05/07/04
Time: 05:53 PM
For: MARIE HUGHES
69 W KING ST PO BOX 577
SHIPPENSBURG, PA. 17257 Clerks Initials: PAM
717-532-5148 File Name: SHIPP04
Title # or Date of Birth: 373560464 State Fees
VIN or Driver's Number :
Tag Number or Eye Color : EDB4823 Title Fee............. 22.50
-Year-Make or Soc. Sec.# : Encumbrance Fee....... 0.00
Transaction : Transfer Deal Tag Transfer.......... 6.00
Odometer : 0 Registration....... ... 0.00
Comments: Dup. Fee............. . 0.00
MAIL Increase Fee.......... 0.00
Replacement Fee....... 0.00
This item will be Mailed to you. Tax-On $200.00... . 12.00
. . 0.00
. . 0.00
WARNING: Bureau regulation require that any
item left in our office for 60 days belf'1 Total State Fee....... 40.50
returned to the Bureau of Motor Vehicles as Check #.... ~ . . . . . . . . . .
unclaimed.
Service Fees
I/We swear that I/we have applied for the
above item(s). Messenger Fee..... .... 0.00
< Temp Tag Fee.......... 0.00
Notary Fee............ 0.00
Copy/Fax Fee.......... 0.00
Document Fee.......... 25.00
Check or M.O. Fee.... . 1.25
MAIL . . 0.50
. . 0.00
Total Service Fee..... 26.75
Service Fee Check #... Cash
Sworn & subscribed to before me on 05/07/04. Grand Total........... 67.25
Total Due..........".. 67.25
Amount Paid........... 67.25
Paid in Full
Notary
Seal No Refunds on Service or
Notary fees. We are not
responsible for work the
State fails to process.
\
....,_""T............................ !<:.I...t'L~::UIo:J't \Ob::::l:/am P. lZllZlZ
o&~ -
~N2/27/04 -
page 1
B RIMARY ACCOm.rr 530441
ENCLOSURES
I. ../11...1..1.1.1..1...11.1.1.1
llAZEL BEASON
l46 CONODOGUINET MOBILE EST
NEWVILLE PA 17241
WE PUT THE LOW IN LOANS I
ASK ABOUT OUll- SPECIAL I.oOW RATE HOMEI EQUITY L.INE TODAY!
CAI.L 1-SSS-0RRSTOl'IN ABOUT TlIrS LIMI'l'l3D TIME OPFER 1
CHECKING ACCOUNTS
ACCOUNT TITLE HAZEL BEASON f1'
CARRr1l.GE CLUB CHECK SAFEKEEPING
ACCOUNl' NUMBER 530441 Statement Dates 2/02/04 tM"- 2/29/04
PREVIOUS BALANCE 4,395_36 DAYS IN THE STATEMENT PERIOD 28
3 DEPOSITS/CREDITS 716.06 AVERAGE LEDGER 1,264.13
1 CHECKS/DEBITS 5,100.00 AVERAGE COLLECTED 1,264.13
SERVICE l'EE .00 Inecrest Ba;r;ned .10
INTEREST PAID .10 Annual Percentage Yield Earned 0.10"
CORRllN'I' BALANCE 11-5.0 2004 Ineerest Paid .46
ACTIVITY IN DATE ORDER
OATB DESCRIPTION TRACliJ NO AMOum' BALANCE
2/02 CIVIL SERV US TREASURY 312 058191995 76.00 4,471.36
pl?l)
2/92 IlBl?OSIT 020049160 16.06 (.,487.42
2/03 sac SEC US TREASURY 303 245168443 6:24.00 5,111_42
PPD
2/09 CHECK 5922 070330750 5,100.00' 11.42
2/29 Interest Deposit .10 11. 52
,-- CHECK SUMM1>J<Y ---
DATE CHECK NO AMOUNT RBPERENCE
2/09 5922 5.100_00 070330750
'If Denotes m.i~sing cheek numbers
'-''-'-'......--n- r I ~vo /.1.I':.o:::"+bd\CIo,+ ~1'1'29/04 06:37am P. 001
Ann:
Here is Hazel's bank statement for February.
She passed away on February 14, 2005, and you can see the
$5,100.00 was debited from her account by check number 5922
on February 9, 2005.
I was given court appointed power of attorney for her, and the
money I gave your office and spent for cleanup and bills, etc
came from that $5,100.00.
Would it still be considered inheritance?
I also need to speak with you about her medical bills.
If you get the chance, could you please call me at 245-3924?
Thanks again for all of your help~
Ruby
\,-
l~
JA~' 2 ""'I"
, \i (iNV_n1
INRE: ESTATEOF : IN THE COURT OF COMMON PLEAS
HAZEL J. BEASON : OF CUMBERLAND COUNTY ,PENNA-
: ORPHANS' COURT DIVISION
: NO. 21-04-0098
I-)
AND NOW, this Z"- day of q~....... , 200ft, after a
review of the within Petition, the Petition to settle this small estate is approved and
distribution directed as set forth in the said Petition.
This Estate is closed and Ruby L. Lineaweaver is excused from his duties of
Administratrix of the Estate of Hazel J. Beason.
By the Court,
J.
i
D : .jL,C5-
" , en (1/1 U/~)i ():
' .
j ., V~ 111, Dc l\(j Ll'\'S I L.j(,.
, __0 /t(\J ~
(
. - KL\i)"I! !\jT>i'tVT/W2F\ \L- (1\.1 f{i I..
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: _,." , .. l '.... [,-,01\j
(-..' .-- ~,,\, V KC v I DU> B'/ f\rrl
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~
,-.J
\
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/04/2006
DOUGLAS WILLIAM P
27 W HIGH STREET
PO BOX 261
CARLISLE, PA 17013
RE: Estate of BEASON HAZEL J
File Number: 2004-00098
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsell within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
2/14/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUG&
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
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Date of Death:
STATUS REPORT U1\JDER RULE 6.12
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Name of Decedent:
Estate No.:
.
Pursuant to Ru1e 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Ye~ No 0
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:
a. ~~Dper~~~s_Aep.d~~o~~ .
b. The separate Orphans' Court No. (if any) for lbe personal representative's ~
account is:
c. Did the personal representative state atl account informally to the pa..'iies in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: t ,.,.ti./olo
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Signature
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Name
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