HomeMy WebLinkAbout04-0312 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Mary Rita Halex/ No. 2l- O I-J-.~] g
also known as Mary R. I-la'ley To:
Social Security No. ZOT-03- //9{)' Deceased. County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner~ who is/~l~l~ 18 years of age or older an the executor named
in the last will of the above decedent, dated :mi xt 11; Pflfl3 19
and codicil(s) dated - ~ '
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumber[and County, Pennsylvania, with
h._e_r_~ last family or principal residence at 123 7th Street, New ~[ancl, PA 17070
(list street, number and muncipality)
Decendent, then - 83 years of age, died March 10, 2004 1~.
at 1490 A. Mounta±n Roadt D±llsburcjt PA 17019 (Son'.~ home) ....
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was no~ the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(I f domiciled in Pa.) All personal property $ 125,000.00
(If not domiciled in Pa.) Personal property in Pennsylvania $ 25t000.00
(}f not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented h~with and,the grant of letters Testamentary
,,--- '.~- {testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron. ~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland j~ ss
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 represen-
tative(s) of the above decedent petitioner(s)will well and truly administer th, ,~tate a,~,.,ra~,g to law.
No. 2t-o~-~;z .~,
Estate of Mary R. Haley , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
~ND NOW _ i(~ j~' ~ ; ~ 004 l& .... in consideration of the petition on
the reverse side hereof, satisfactory proof having be~n presented before me, .-
IT IS DECREED that the instrument(s) dated July 11, 2003 '-
described therein be admitted to probate and filed of record as the last will of Mary R. Fei ey
and Letters Testamentary
W~]mund A. Haley, Jr.
are hereby granted to
Short Certificates( ) .......... $~ , BaSra ~--Ys~[~IxCO t'a~; N~'~quil~e (ID 32317)
. ~ .... $ ~5 .~ ~9 Bridge Stret, New ~l~d, PA 17070
~~~ ~ $ [O. O~ ADDRESS
TOTAL $ ~% .OO (717). 774-1445
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00 ~ ~ ,~ ~
,,,,,, ~ Local
~ Date
143 Rev 2/87 ~OMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FiLE NUMBER
~ME OF DECEDENT (First. Middle, Last) ~ SEX ~ SOCIAL SECURI~ NUMBER DATE OF D~TH (M~th, Day, Year)
COUN~ OF DEATH [ CI~, BORO, ~P OF D~TH [ FAClLI~ NAME (ff not institution, give strut and numar) IWAS DECEDENT OF HIS$~IC ORIGIN? I~CE - ~m. Indian, Bla~, Whi~, et,
~O ~ NO Yes If yes. s~N Cu~n.(S~c~)
DECEDENT'S USUAL OCCUPATION I ~ I
Give ~n~ of ~ ~e d~ moll U.S. ARMED FORCES? (Spe~ on~ h~he~l grade ~ple~d) [ Never Ma~i~. W~ed, SURVIVING SPOUSE
DECEDENTS ~ILING ADDRESS (S~et, Cityffo~, State, Z~ C~e) J DECEDENTS
ACTU~ ~d 17c. ~ Yes, de~ent lived in
1490 Sou~h HounCa~n Road RESIDENCE ~'.St~t~ Pennsylvania
decedent
16 D~SDUrg~ ~ L/Ul~ [ on other side) 17b. C~nt~ York to.ship? 17d.~ No.~dent~ved
~in a~ual limits of
, FATHER'S N~E (Flint, Middle. Last)
MO~ER'S N~E (Flint, Middle. MaVen Sumac)
~S. flames Purcell ~. ~ Lash
INFOR~N~S ~E (Ty~fint)
~ INFOR~N~S ~ILING ADDRESS (S~t, Ci~own. State, Zip ~e)
~.. Edmund A. Ha[ay, ~. [2ob. 1490 Sou~h Hounca~n Road~ D~[[sbur~ PA 1701~
METHOD OF DISPOSITION DATE OF DISPOSITION ~ P~CE OF DISPOSITION- Name of Ce~te~, Cre~ [ LOCATION - Ci~ff~n, State, Zip ~e
~,. o,.,(s~) ~[~.~rch 15, 2004 [2~. Gate of Heaven Cemece~y[~pper Alien ~p., PA 17055
SIG~T~,~LSERVJCELICENSEEORPERSONACTINGASSUCH LICENSE NUMBER NAME~DADDRESSOFFACILI~ Pa~themo~e~ & CS~
~" ~~ ~.FD 012 848 L ~,.P.O. Box 43I~ ~e~ Cumberland~ PA 17070-043[
,~ tt~'~ on~ ~ ~i~ To ~e ~st of my knoW.ge, dea~ o~uffed at ~e ~me, ~te and p ace s~t~. ~ LICENSE NUMBER DATE SIGNED
~ ~u~ ~ dea~. J2~..(Signature ~d Title)~ ~ ~ ~ (~, Day, Year)
~ i~ms 24-26 musl be ~et~ by
.on who ~o~un~s death. ~ TIME OF D~TH DAT~RONOUNCED D~D (Month, Day, Year) ~ WAS CASE REFERRED TO A MEDICAL E~MINER ~ORONER?
4 ~ +~ ~ ~(~ ~ ',nte.., be--n .~ resul~g in the underlying .... given in ,~T ,.
IMMED~TE CAUSE (Final *. onset and dea~
ESequent"lly~y, ~ading~Stto=di~S~iate [ b, DUE Y~ AS A C~SE~E OF):
~use. Enter UNDERLYING
CAUSE (Disea~ ~ ~ju~~ c.
resullmg ~ death ) ~ST d. '
PERFORMED?WAS AN AUTOPSY J AVAI~LEWERE AUTOPSYPRioRFINDINGSTo I MANNER OF D~TH//' DATE~ OFDav INJURYyear TIME OF N JURY I N JURY AT WORK? I DESCR BE HOW N JURY OCCURRED.
I COU.L~T~ OF C*US~ I",t~ ~ ~i~. ~1 .... I I I
J OF DEATH? I ~dent ~ Pend~g~ ..... igat~n ~ I IYes~
~ I I P~CE OF INJURY - At ho~, fa~ strut, factor, offi~ I LOCATION (S~t, Ci~, State)
CERTIFIER(C~Iy~e) ' ; ~ 4 / ./ ~ I ' ~ . ~ ~
................. , ............... ~on ....... (.) ............ .~.~ ............................ :: ............... : ................. ~3~, ~~[ ~ ~ -
· PRONOUNCING AND CEE~FYING PHYSlC~N (Photon ~ h ~n~ndng dea~ ~d ce~i~ing to ~u~ of dea~l LIC~~ ~ ~ ~ ~1 DATE S GN~M~,~, Y~a~
· EDWAL ~MINE~CORONER i~m 2~D ~DRESS~S~ WH~T~~
On meba~l~o~e~lnatlon a~/~lnv.flgatl~,ln myoplnl~,deam ~curr~ at ~e time, dab, and place, and due to~e cause~ a) and ( )Ty~Pn~ ~/{/~
REGIST~R'S SIGNATURE A NUMBER .. DATE FILED (Mon~,~r)- ~ ~
LAST WILL AND TESTAMENT
MARY R. HALEY
I, MARY R. HALEY, of New Cumberland, Cumberland County, Pennsylvania,
do make, publish and declare this to be my Last Will and Testament, hereby revoking all
Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate taxes becoming due by reason
of my death, whether such taxes may be payable by my estate or by any recipient of any
property, shall be paid by the Executor out of the property passing under ITEM III of this
Will, as an expense and cost of administration of my estate. The Executor shall have no
duty or obligation to obtain reimbursement for any such tax so paid, even though on
proceeds of insurance or other property not passing under this Will.
ITEM II: I direct the Executor to pay my just debts and the expenses of my
last illness and funeral expenses from the property passing under this Will as an expense
and cost of administration of my estate.
ITEM III: All the rest, residue and remainder of my estate shall be divided as
follows:
(a) One-fifth (1/5) to my son, EDMUND A. HALEY, JR., or in the event he
predeceases me, this share shall be paid to his issue, per stirpes;
(b) One-fifth (1/5) to my son, FRANK R. I-IALEY, or in the event he predeceases
me, this share shall be paid to his issue, per stirpes;
(c) One-fifth (1/5) to my son, CHARLES E. ItALEY, or in the event he predeceases
me, this share shall be paid to his issue, per stirpes;
(d) One-fifth (1/5) to my son, MICHAEL B. HALEY, or in the event he predeceases
me, this share shall be paid to his issue, per stirpes; and
(e) One-fifth (1/5) to my son, DAVID J. HALEY, or in the event he predeceases me,
this share shall be paid to his issue, per stirpes.
In the event any beneficiary above predeceases me, leaving no issue surviving, his
share shall be distributed equally to my other named sons.
ITEM IV: In the settlement of my estate, my Executor shall possess, among
others, the following powers:
(a) To retain any investments I may have at my death, as long as the Executor
may deem it advisable to my estate to do so;
2 jr/ ~ j~{
(b) To sell either at private or public sale and upon such terms and conditions
as the Executor may deem advantageous to the estate, any or all real or personal property
or interest therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
(e) To do all other acts in the Executor's judgment deemed necessary or
desirable for the proper and advantageous management, investment and distribution of the
estate.
ITEM V: Any person who shall have died at the same time as I shall have, or
in a common disaster with me, or under circumstance that the order of deaths cannot be
established by proof, or within thirty (30) days of my death, shall be deemed to have
predeceased me.
ITEM VI.' I appoint my son, EDMUND A. HALEY, JR., to be Executor of
my Estate. In the event my son cannot act or refuses to act as Executor for any reason, I
nominate, constitute and appoint my son, FRANK R. HALEY, as alternate Executor.
Any Executor (or) is specifically relieved from the duty or obligation of filing any bond
or other security.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of this and the preceding three (3) pages, at the end of
each page of which I have also set my initials for greater security and better identification
this /7 day of July, 2003.
(SEAL)
MARy HAZY
We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and
Testament, in the presence of each other, have hereunto set our hands and seals the day
and year first above written, and we certify that at the time of the execution thereof, the
said Testatrix was of sound mind and memory.
~_~ .~~ Residing at: 1019 Waterford Way
{d istopher R. Sullivan Mechanicsburg, PA 17050
~'~-~ ( Residing at: 549 Bridge Street, Apt. 2
Laura J/~la~ghes~yle ~ New Cumberland, PA 17070
4
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
I, MARY R. ItALEY, Testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
~-h~;0 c~z~.~,~ ~]~¢4~ (SEAL)
MARY R. HAL~' (/'
Sworn to and subscribed
before me th~ _?/ day
My Commission Expires:
(SEAL)
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, Christopher R. Sullivan and Laura J. Hughes-Doyle, the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw Testatrix, MARY R. HALEY,
sign and execute the instrument as her Last Will and Testament; that Testatrix signed
willingly and she executed said Will as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testatrix signed the Will as
Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen
(18) or more years of age, of sound mind and under no constraint or undue influence.
Sworn to and subscribed
before me th~ /// day
NOT~ARY PUBLIC
" My Commission Expires:
6
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
Name of decedent: Mary R. Haley
Date of death: March 10, 2004
No. 2004-00312
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate as
follows:
Name: Address: Dated Mailed
Mr. Frank Haley 109 Park Road April 7, 2004
HCR Box 23
Waynesboro, PA 15370-2537
Mr. Charles Haley 942 Pisgah Road April 7, 2004
Shermansdale, PA 17090
Mr. Michael Haley RR 41 Box 116 April 7, 2004
Silver Lake, NH 03875
Mr. David Haley 11 Sunny Lane April 7, 2004
Hershey, PA 17033-2455
Mr. Edmund A. Haley, Jr. 1490 S. Mountain Road April 7, 2004
Dillsburg, PA 17019
Notice has now been given to all persons entitled theret..0~)er~le,~~ except: N/A
Date: April 7~ 2004 ' ''~
/" Barbara Sumple-Sullivan, Esquire
7.[:~ct ~-~d~ 170.
549 Bridge Street
New Cumberland, PA 17070
~': -~ :7,~_J (717) 774-1445
j : ~: ,.:r~kl Supreme CT. ID # 32317
Capacity: ~ Personal Representative
X Counsel for Personal
Representative
LAW OFFICES
BARBARA SUMPLE- SULLIVAN
549 BRIDGE STREET
NEW CUMBERLAND, PENNSYLYANIA 17070-1931
PHONE ¢717} 774-1445
FAX ¢717} 774-7059
June 3, 2004
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Mary R. Haley
No. 2004 - 00312 / Cumberland County
Dear Sir/Madam:
Enclosed please f'md a check in the amount of FIVE THOUSAND SIX HUNDRED
SEVENTY-FIVE DOLLARS ($5,675.00) for pre-payment of the Inheritance Tax in the
above-captioned Estate.
Should you have any questions please contact my office. Thank you.
Barbara Sumple-Sullivan
BSS/ld
Enclosure
cc: Edmund A. Haley, Jr., Executor
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE REV-1162 EX(11-96)
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004012
SUMPLE-SULLIVAN BARBARA
549 BRIDGE STREET
NEW CUMBERLAND, PA 17070
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $5,675.00
ESTATE INFORMATION: SSN.' 207-03-7796
FILE NUMBER: 2104-031 2
DECEDENT NAME: HALEY MARY R
DATE OF PAYMENT: 06/04/2004
POSTMARK DATE: 06/03~2004
COUNTY: CUMBERLAND
DATE OF DEATH: 03/10/2004
TOTAL AMOUNT PAID: $5,675.00
REMARKS:
CHECK//114
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BARBARA SUMPLE-SULLIVAN
549 BRIDGE ,~T R E ET
CUMBERLAND, PENNSYLVANIA
Register of Wills :
Cumberland County C6ffrilibuse
1 Courthouse Square
Carlisle, PA 17013
REV-1500 ~ (8-00)
REV-1500
PENNSYLVANIA
DEPARTMENTOF REVENUE INHERITANCE RETURN
' DEPT. RESIDENT DECEDENT
HARRISBURG, PA 17128-0601 COUN~CODE YEAR NUMBER
DECEDENT'S NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER
Haley, Ma~ R. 207-0~7796
DATE OF DEATH ~M-DD-YE~) DATE OF BIRTH ~DD-YEAR) THIS ~ MUST BE F~ IN ~I~TE ~TH THE
March 10, 2004 October 29, 1920 REGISTER OF WILLS
(IF APPLICABLE) SURVIVING S~USE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) S~IAL SECURI~ NUMBER
~X 1. Original Return ~2. SupplementalReturn ~3. RemainderR~um~~2-~
~~ Limited Estate ~ ~4a. Future Inler~t Comprise (date~th a~r 12.12-82) ~5. Federal Estate Tax Return Required
~edent Died Testate (Affach copy of Will) I 17. Decedent Maintained a Living Trust (~ach a ~y of TraM) 8. Total Number of Safe De.sit Boxes
L~igation Proceeds Received ~ 10. Spousal Povedy Credit (date of deaffi b~n 12-31-91 and 1-1-~) ~ 11. Election to tax under Sec. 9113(A)
~ (~ach ~h O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL T~ INFORMATION SHOULD BE DIRECTED TO:
NAME I COMPLETE ~ILING ADDRESS
Barbara Sumple-Sullivan, Esquire ] ~9 Bridge Street
FIRM NAME (If Applicable) / N~ Cumberland, PA 17070
1
TELEPHONE NUMBER
(71 ~ 774-1445
OFFIClA~SE ONLY
1. Real Estate (Schedule A) (1) $1~,~0.~
2. Sl~ks and Bonds (Schedule B) (2) , 5.~ ~::: :..
3. Closely Held Corporation, PaHnemhip or Sole-Proprietomhip (3) .::.:. ~
4. Mortgages & Notes Receivable (Schedule D) (4) , ~ .
5. Cash, Bank De.sits & Misc. Pemonal Properly (Schedule E) (5) $~3~975.53
6. Jointly ~ned Prope~y (Schedule ~ (6) ~::~ ,..... 0.00 ~ ':~:~
Separate Billing Requested
7. Inter-Vivos Tmnsfem & Misc. Non-Probate Pro~dy (~ $ 0.00
(Schedule G or L)
8. Total Gross Assets (total Lines 1-~ (8) $135,391.21
9. Funeral Expenses & Administrative Costs (Sch~ule H) (9) $7,725.43
10. Debts of Decedent, Modgage Liabilities & Liens (Schedule I) (10) $1,233.82
11. Total Dedu~ions (total Lines 9 & 10) (11) $8,~9.25
12. Net Value of EMate (Line 8 minus Line 11) (12) $126,431.96
13. Charitable and Governmental Bequest~Sec 9113 Trusts for ~h an eleven to tax has not b~n (13) $ 0.00
made (Schedule J)
14. Net Value Subje~ to Tax (Line 12 minus Line 13) (14) $126,431.96
SEE INSTRUCTIONS ON R~EA~E SIDE FOR APPLICABLE ~TES
15. Amount of Line 14 taxable at the spousal tax
rote, or transfem under Sec. 9116 (a)(1.2)
x (15) $ 0.~
16. Amount of Line 14 taxable at lineal rate $126,431 .~ x .~5 (16) $5,~9.43
17. Amount of Line 14 taxable al sibling rate x .12 (1~ $ 0.~
18. Amount of Line 14 taxable at collateral rote x .15 (18) $ 0.00
19. Tax Due (19) $5,689.43
20.
I x I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH
I~ecede'nt's Complete Address
STREET ADDRESS 123 7~ Street
· CITY I STATE ZiP
I New Cumberland I PA 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) $5,689.43
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments $5,675.00
C. Discount $283.75
Total Credits (A + B + C) (2) $5,958.75
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) $ 0.00
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) $269.32
5.
If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE (SB)
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 No
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;
c. retain a revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration?
3. Did decedent own an "in trust fo~' or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ~ ~1
IF THE ANSWERTO ANY OF ~I'IE ABOVE CIUES3X3NS IS YES, YOU MUST COMPLETE SCHEDULE G AND RLE ITAS PART OF THE RETURN.
Under penalties of perjury, I d=~.;,~ that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Declaration of preparer other than the personal representative is based on all the informalJon of which preparer has any knowledge.
SICk, tiRE OF PERSON RESPONSIBEE FOR FILING Ii'TURN ~3/DAT~
~/'~/3,,,~//'.,/j~/~ ~) ~)l~/,~.,~_d~' Edmund A. Hale, Jr. Executor
.. ,._ .... - .~. - ~%"~y~/., , ,
/ ~~ - v Barbara Sumple-Sullivan, Esquire
~/ADDR'~s ' ,
~49 Bridge Street, New Cumberland, PA 17070
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3% [72 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116
(a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax
return are still applicable even if the 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 P.S. 9116(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. 9116(1.2) [72 P.S.
9116(a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section
9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502EX + (1-97) (I)
I SCHEDUEEA
CoMMO EAL PENNSYLVAN,A REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Mary R. Haley FILE NUMBER 2004-00312
All real pmpe~y owned solely or as a tenant in ~,~,,.,r.m must be r~F~i~,~-~ at fair i,~-.iket value. Fair market value is de~.~-d as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. 123 7th Street, New Cumberland, PA 17070 $100,000.00
TOTAL (Also enter on line 1, Recapitulation $100,000.00
(If more space is needed, insert additional sheets of the same size)
A~ OMB NO. 2602-02G6
DkPARTMENT OF HOUSING & URBAN DEVELOPMENT I'E~FHA 2,F-~FmHA ;3,[] NS. :VA
S, ~'i~R: s,r-]CONV, leS.
SE'I-rLEMENT STATEMENT 17733 00r1164
8, MORTGA(.~E INS CASE NUMBER:
C, :NOTE: This form ia fur~lshed to git~ you a steternent of a~tuel seltlement costs Amounfa eld to
Item; marked "[POC "were a' ' . , , p ' and by th~
~ ~] p id outside the closing, they are shown here for inrorrnef/onal purposes end are not~ eluded In the totals,
D, NAME AND ADDRI BORROWER: E; NAME AND ADDRESS OF SELLER: NAME AND OF LENDER:
Laura J. Hughes Estate of Mary R, Haley New Century Mortgage Corp
123 Sevenlh Street
New CUmberland, PA 17070 1B400 Von KarmaS, Suite 1000
IrVlne, CA 92512
G, PROPERTY LOCATIONf H, SETTLEMENT AGENT: 25.1876783 -
123 Seventh Street I. SETTLEMENT DATE:
New Cumberland, PA 17070: Abstra~ Settlement and Property Services, In0,
Cumberland County, Pennsylvania PLACE OF SETTLEMENT June 28, 2004
549 Bridge Street
New Cumberland, PA 17070
J. SUMMAR' )F BORROWER'S
BORROWER: K, SUMMARY OF SE
:Contract Sales Price UE TO
Contra~ Sales Price
i102. ?ersonal PropeR), 402. Persorml Property ;
~_~3, Selllement Charges to B~orrower (Line 1400)
5. ' , . 404.
~._~Adjustment$ For Item~ Pe/~-by Seller in advance 405,
stments For Items Paid By Sailer In advance
~own Taxes Io 406. Cl~/Town Taxes Io
~IYTaxes 06/29104 to 01/01/05 ;Z45.54 ' 4__07, CounP/Taxes 06/29/04 to )1/01/05
[108, $chool~-axes '05/29/04 lo 07/01/04 245.54
J 109. , 5;03 408, School Taxes 0612g/04 to )7/01/04 5,03
410,
J?O. GI~O~S AMOUNT DUE Ft~O~ BOR/~OWER 107,905.56 420. GROSS AMOUNT DUE TO SELLER 100,250,57
12.g0, AMOUNTS PA!D BY 0RIiN ~IEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SE LLER:. ' ,
201. I~eposi( or eamesl mone~ 1,000.00 ~01. Excess Deposit (See Inslru~ions
202, Principal AmOunl of Newi~oan(~) 85,000.00 502, Settleme-r~t Char~es to Seller (Line 1400J'
203, I~;xisting Iosn(s) taken sulkiest to -- . 1,02~.83
g041 503, Exislj,~ Ioants) taken subject to --
~r~04. Payoff of first Mortgage .
205, 1505. Payoff of second MOrtgage
206. ' .
~07. 5o~. .! ,
208, ~5g7, (Deposit Oisb. as proceeds)~
209. 508,
, 509.
AdJus~llents For I~edls Un/~ald By Seller AdjUstment~ For Items Unpaid By ~eller
210. City/Town Taxes Io 510. Clty./Town Taxes
211. County Te~es . to
2'12. S, chool Taxes 511, County Taxes Io
lo 512, S~ho01Taxes i . ,
213, to
215. 514,
21~). 518.
220, TOTAL PAID B Y/FOR 80'~.ROWER 86,000.00 520. TOTAL REDUCTION AMOUNT DUE $EL .ER
, ; , , ' 1,029.83
300, C~SN AT SE'l I'LEMENT~ROMfTo BORROWER: -- 60Q, CASH AT 5~1 fERMENT TO/FROM SELI.'ER:
~01; G~'oss AmoUnt Du~ From I~orr0Wer (L, ine'120) · I. 107 905.56 101. Gross Amounl Due To Seller (Line 420~ I 100,250,5'~
302, L~ss Amounl Paid Ely/For ~l°rrow~r tLIne Z20), , I( 80,~00,00~ 6__02. Less R, ed~ctions Due Seller (Line 520~, ( 1,02,9.83)
r ,
~03. CASH( X FROM)( TO)BORROWER I 21,905,56 603, CASH( X TO)( FROM)SELLER
- ~ ~ 99,220.74I
The undersigned hereby acknowledge receipl olr a completed copy of pages 1&2 of Ibis statement & any attachments referred to h=;rein.
L, SETTLEMENT CHARGES
to
Paid ~
.E IN C, CNECTION WITH LOANl°
2~0000 % to New ~
Loan Discounl 2,0000 % to N~w Oenlu~ MoRgage ~orp
Io 1,700.0~
RepoR
Lender's Fe~ {o
~. Fee. to
Fee
Fee to New cen~
Ilion Fee 1o New Cenlu~ortg~ - 310,0~ ~
Unde~riling Fee Io New Centu~ ~oRgage Corp ' 1t.2~
300,00
Doc Pre to New Cenlu~
Fee to New Centu~ Mo~~' 300,0
~UIRED BY BE PAID IN ADVANCE
901, I:ntemst From 06/29/04 to 07/01/04~,onll~i~ia --- %),
.f__ $ 17.230000/day ( 2 days
34.46
905,
].i RESERVES DEPO8 ) WITH LENDER
1001, Hazard ~nsurance
monlhs.....~__$ _.p.e r monlh
Insuranoe
~Taxes ~n~hs~~? ? ~ er monl~
- 3,000 montl~s~$ 18,05 per month
,. 54.1B
1005. SchooITaxes 2.000 monlhs ~ $ 77,53 per monlh ~. 155,06
~'006, month~ ~ ~ per month
1007. months ~ $. per m~nlh :'
1100. TITLE CHARGES ~ -131,7;
1~., $eff~ment or Closin _Fee to
1102, ~Abstract or Title Searoh to
on. . to
1104, Title Insurance Binder Io
~aration to Abstreot Selllement and Prope~_Se~ices~ In~,-
1106. Nola~ Fees to Abstract Settlement an~ln~, - --, 3S.~0
1107. Attorney's Fees Io ~. 16.00 4,0~
~d Pro~d- Sq~ices Ino
include~ above Item ; 772.8~
110g, Lender'~ Coverage ~
1110,; wne~ Coverage ' ~ n~'~'~ .
~ ~ _.. ,~ .... uu 772,88
.... ~v,~,.unts ~uu,~uu,~.] Io AbstractSe~lemen~~
1112. CSL Le~er ~ ~ ~-~-,~ ........ , .....
-- 35.00
' as~ra~ ~et~iemen[ and Property 5e~l~s, Inc, 20_ ,o0
~ Tax Ce, ~e Robin ~rettl to ~~ro~eny Se~lcea, Inc. _ 20.0
1116. 2004-2005 ~c~Tax Bill to Robin Gae~mlfl-Tax ~olleotor -- 4.00
1117, ~143~
04 ' ' OR a e
301, Su~ --
~o
3~3, Final Sewer ~ill to New Cumberland Boro~
304. 21.83
305.
Enter on Lines 103 Section J and
ggge 1 of ~hlg gtalemenl, Ihe 8 P~gg Z o~ INs ~
Abstract Settlement and Property ServloeS,
3~rlified to be a true oopy. SeltlemenI Agent
REV-1503EX + (1-97) (I)
SCHEDULE B
STOCKS & BONDS
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Mary R. Haley FILE NUMBER 2004-00312
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Met Life Stock (40 Shares) $1,415.68
TOTAL (Also enter on line 2, Recapitulation $1,41 5.68
(If more space is needed, insert additional sheets of the same size)
Description: Sale Proceeds Check No. 00598256 $0'937
~ 213
Check Date Investor ID Pay
06/02/04 8063 5034 6721 ****$1,415.68
Pay-to:The Payable at
Order of: Edmund A. Haley, Jr., Ex Est Chase Manhattan Bank, Syracuse, NY o
Mary R Haley The Chase Manhattan Bank, New YOrk
1490 South Moun 'rain Road
Dillsburg PA14019
Authorized Officer Signature
REV-'~50$ ~X+ (1-97)~1)
SCHEDULE E
COMM~"W~.OF.E..S~V^.,^,..ER.T^.CE T*X.~U.. CASH. BANK DEPOSITS. & MISC.
RESIDE~ DECEDENT PERSONAL PROPER~
ESTATE OF3. Ma~ R. Haley I
FILE NUMBER 2004-00312
In~e the ~ ~ ~n and ~ ~e ~ ~ ~ r~ ~ ~e ~e. NI pro~ ~i~l~ ~ ~e ~ ~ ~w~o~lp mu~ ~ di~ on ~u~ F.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. WayPoint Bank, Account No. 1082191~ (plus refund of bank charge $16.90) $33,039.26
2. State Retirement Refund $135.25
3. Keystone Oil Refund $27.67
4. Pennsylvania Employees Trust Refund $22.23
5. Verizon Refund
$0.55
6. Refund of Prope~ Taxes (from Se~lement Sheet) $250.57
7. Furniture purchased by Family:
Edmund A. Haley, Jr. $175.00
Frank R. Haley $180.00
Charles E. Haley $125.00
David J. Haley $20.00
TOTAL (Also enter on line 5, Recapitulation)i $33,975.53
(If more space is needed, insert additional sheets of the same size)
TLR tt:057~_ DD~ DePosit
TR ~: 45 ~ ~T: 33022.36
D~t-e: 04/22/2004 Time: 09:43
- eived tot deposit are subject to the proviSiOnS of the Uniform commercial code. Certain
othe~ ttems rec. - .... iL. according to Bank poticy. _..
deposits are
T~L-m 0
Page 1 of 1
08/07/04
Account: 108219122
Name: NEW ACCOUNT
Address:
The image shown below represents an official copy of the original document as processed by our institution
04/28/04 5861370 16.90
47744114 'ii
O
TO THE ORDER OF
o VOID A~ER180 DAYS
O
~ ED~UHD HALEY ~R ~EOUTOR
~ ]4g0 SOUTH ~OUNTAIN RD
~ DILL5BUR~ PA ~
Page 1 of 1
08/07/04
Account: 031308809503434
Name:
Address:
The image shown below represents an official copy of the original document as processed by our institution
K~'YSTONE OIL1600PRODUCTS HUMMEL Av~.CORPORATION IlIqD~Ba/~K' 214~
ORDER
04/22/04 2770270 27.67
Page 1 of 1
08/07/04
Account: 0433016211350532
Name:
Address:
The image shown below represents an official copy of the original document as processed by our institution
PG]~JSYLvANIA EtlPLOYEES mc ~,,AT, XUd. L~X3KT~,
M~UN~ I~¥ABI.E ACCIXlIT
1~01~2U!!.14M~D ~r.
m~ ~A~~R~
~ ~E~A~JR
~ 14ffi S ~N ~
~O~6~P COhllOL6E?C OOLLtSO$t~
04/22/04 2770280 22.23
:
Page 1 of 1
08/07/04
Account: 0119004467446
Name:
Address:
The image Shown below represents an official copy of the original document as processed by our institution
~ --
: ~ 51-44
119
eomsx~xo~.m~m hc~m~ . . ~,a 6, 2oot
.- ; -.. ~,,. '.~ . .- ...... ..-.
04/22/04 2770290 0.55
Receipt -,~cct. ~: 1C~219!22
TLR ~:0580 DDP, Deposit
TR ~: 4 TR R~T: 50.45
Date: 04/22/2004 Time: 09:41
Checks and other items received for deposit ere subject to the provisions of the Uniform Commercial Code. Certain
deposits ere subject to delays in availability according to Bank policy.
· ~L~0(~) Thank You For Banking At Wa~lpoint ~FO~
Appraisal Furniture Purchased by the Family
Edmund A. Haley Jr. -
Maple Chest/drawers $ 50.00
Bedroom suit $100.00
Wood Cabinet $ 25.00
Total $175.00
Frank Haley
Cedar Chest $ 75.00
Dresser 1940 $ 45.00
Rocker $ 10.00
Pine Chest/drawers $ 50.00
Total $180.00
Charles Hale¥
Library Table $125.00
Total $125.00
David Hale¥
Vanity Bench $ 20.00
Total $ 20.00
Remainder of items on appraisal were dumped, transferred with house
or to charity donation.
FIs,sel&
1302 N. Third St.
............. .~1~. 17102
Phon~ 717 238 3207
Fax 717 238 4634
Estate APPRAISAL:
123 7'th St.
New Cumberland
Living room
Sofa Set $20.00-
Table 10.00
TV N/V
Rocker, $10.00
Stereo NZv'
Lamps $15.00
two small mahogany tables $15.00
Family Room
Upholstered furniture $30.00
Library table $125.00
Lamps $10.00
Stove N/V
Kitchen
Table and chairs $50.00
Refrigerator $20.00
Freezer $20.00
Coat tree $25.00
Front Bedroom
Bedroom set $100.00
Middle bedroom
Cedar chest, as is $75.00
'Dresser, 1940's 45.00
Chest of drawers $40.00
Bed NN
Rocker NN
vanity bench, ¢ 1940 $20.00
Back room
Sewing machine desk $25.00
Maple chest of drawers. $50.00
pine chest 50.00
bedNN
Front closet
wood cabinet $25.00
metal cabinet 25.00
total appraised value. $805.00
The above value is placed at quick sale value in the local market.
Robert L. Fissel
.appraiser.
REV-1511 EX+ (1-97X1)
SCHEDULE H
OOMMO"~VE^L~ OF PEN.$~'V^N.^ FUNERAL EXPENSES &
INHERITANCE TAX RETURN
RE$1DE.~ DEO~O~.T ADMINISTRATIVE COSTS
ESTATE OF Mary R. Haley FILE NUMBER 2004-
00312
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: $0.00
1. Reverend Megr Robert Gribbon 75.00
2. Funeral Lunch $200.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Edmund A. Haley, Jr. $4,059.66
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 1490 S. Mountain Road
City Dillsburg State PA Zip 17019
Year(s) Commission Paid:
2. Attorney Fees 2,000.00
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 Cumberland County Register of Wills; Cumberland County Law Journal; Patriot News $592.17
5. Accountant's Fees $200.00
6. Tax Return Preparer's Fees
7. :~arry DuVall - Removal of household debris and wood $405.00
8. Boyd E. Diller, Inc. $84.02
9. Facet Repair - Lowe's $62.18
10. Waypoint Bank Check Charges $32.40
11. Filing Fee to Close Estate $15.00
TOTAL (Also enter on line 9, Recapitulation $7,725.43
(If more space is needed, insert additional sheets of the same size)
Page 1 of 1
06/03/04
Account: 108219122
Name: NEW ACCOUNT
Address:
The image shown below represents an official copy of the original document as processed by our institution
'll-IE ESTATE OF MARY R. HALEY
EDMUND ~ H_4,LEY JR, EXECDTOR
DIri. LSBU ~G. PA 17[/]9 LI ........
106 05/10/04 3862660 75.00
ACCOUHT CATEGORY: ·- ~ ~ ~-:
[] PRIMARY CHECKING ~:~, .s ~ / ~ /
r-I sECONDARY C~CKING '~ ~
0 MO~ MAR~ ~EOK~ .=Z~.~
~ LINE OF CREDff "~ORD'
~ OTHER
- - ~ ~ ITEM -
FOR'D
' NON ~GOTIABLE
F~ a~~, ~fo~n-
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
April 30, 2004
Cumberland Law J~gu'nal 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:
Barbara Sumple Sullivan, ESQUIRE
RE:
Mary R. Haley, ESTATE
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 following dates:
APRIL 16, 23, 30, 2004
Advertising Cost $ 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment Received $ 75.00
Total Amount Due $ 0.00
Payment received APRIL 14, 2004
by Becky H. Morgenthal/Executive Director
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L. 1784
STATE OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
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:
APRIL 16, 23, 30, 2004
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.
Haley, Mary R., dec'd.
[ate of 12a 7th Street, New Cum- SWORIn~TO AND SUBSCRIBED before me this
berland. 30 day of APRIL 2004
Executor: Edmund A. Haley, dr.,
1490 S. Mountain Road, Dills-
Attorney: Barbara Sumple-Sul-
livan, Esquire, 549 Bridge Street,
New Cumberland, PA 17070,
(717) 774-1445. I NO¥~L SF-AI.
I LOIS E. SNYDER, Nota~/Public
I Carlisle Boro, Cumberland County
[ My Commission,,,,Expires March 5, 2005~,
Order Confirmation
Ad Order Number Customer Customer Account Ordered By PO Number
0001095866 BARBARA SUMPLE-SULLIVAN · 13197 BARBARA
Sales Rep, Customer Address Customer Phone #1 Customer Phone #2
rholton 549 BRIDGE STREET 717-774-1445
Order Taker NEW CUMBERLAND, PA, USA 17070 Customer Fax Customer EMail
rholton
Order Source Payor Customer Payor Account Special PricinR
Fax BARBARA SUMPLE-SULLIVAN 13197 None
Tear Sheets Proofs Affidavits Blind Box Promo Type Materials
0 0 1 <NONE>
Invoice Text Ad Order Notes
Net Amount Tax Amount Total Amount Payment Method Payment Amount Amount Due
$236.17 $0.00 $236.17 $0.00 $236.17
Ad Number _Ad,Type Ad Size Color Production Production Notes
0001095866-01 Legal Liners 1.0 X 19 Li <NONE> Ad Booker
Ad Attributes Ad Released Pick Up
No
Product Information Placement/Classification Run Dates # Inserts Cost
PNCO: :Full Run 800P - Main Legals 4/13/2004, 4/20/2004, 4/27/2004 3 $234.42
Run Schedule Invoice Text Sort Text
ESTATE NOTICENOTICE IS HEREBY ESTATENOTICENOTICEISHEREBYGIVENTHATLETTE
Product Information Placement/Classification Run Dates # Inserts Cost
Online: :Full Run 800P - Main Legals 4/13/2004, 4/20/2004, 4/27/2004 3 $0.00
Run Schedule Invoice Text Sort Text
ESTATE NOTICENOTICE IS HEREBY ESTATENOTICENOTICEISHEREBYGIVENTHATLETTE
4/27/2004 1:14:55 PM Page1
THE PATRIOT NEWS
THESUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Joseph A. Dennison, being duly sworn according to law, deposes and says:
That he is the Asst. Controller of The Patriot News Co., a corporation organized and existing under the laws
of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in
the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The
Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the
City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th,
1854, and September 18th, 1949, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published in
their regular daily and/or Sunday/ Metro editions which appeared on the 13th, 20th and 27th day(s) of April 2004.
That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that
all of the allegations of this statement as to the time, place and character of publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and
adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in
the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
PUBLICATION ~ _~.~~.... .........................................
C O P Y ~~A. D.
. Estate NOtices- RY PUBLIC
""~'- ~=STATE NOTICE " . Member, Pennsylvania As~:x~!aUon Of No~(~ss My commission expires June 6, 2006
NOT IC;E-I'S HEREBY G VEN that Leffers
Testamentary have been granted In-the'ES-
TATE OF MARYR. HALEY,-late,of-123 7th
t~tce~t, ;nNnes~lvCoU&,bor~/l~d~llCe~lm=r~drc~0~ BARBARA SUMPLE-SULLIVAN
2004 to Edmund AJ Uale?, ~Jr,, of 34~0 'S; . 549 BRIDGE STREET
Mountain-Road, DIIIsburg, York County.-
Pennsylvanla17019, NEW CUMBERLAND, PA. 17070
· A!l J3ersone.~lndebted to the said estate are
recruited ,to make paYmerrt, and those 'hay-
Ina claims or~iemands to present the .same
without delayto the Executor or h s altor~ Statement of Advertising Costs
ney namedbetow. ' ." .
'EclmuncLA.-Hale'~, Jr., Executor
'SaCboro Su~le. Sulllv-n;Esaulre - To THE PATRIOT-NEWS CO., Dr.
· 549 Bridge Street .''. -.: .~. ' '
~-~lewCumberland PA1707e :~:-~-I For publishing the notice or publication attached
,-~-~, 774-~44s ' ' ~: .... hereto on the above stated dates
Total $ 236.17
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general
circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have
been duly paid.
By ....................................................................
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004012
SUMPLE-SULLIVAN BARBARA
549 BRIDGE STREET
NEW CUMBERLAND, PA 17070
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold .......... ~ .......
101 $5,675.00
ESTATE INFORMATION: SSN: 207-03-7796
FILE NUMBER: 2104-0312
DECEDENT NAME: HALEY MARY R
DATE OF PAYMENT: 06/04/2004
POSTMARK DATE: 06/03/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 03/10/2004
TOTAL AMOUNT PAID: 95,675.00
REMARKS:
CHECK# 114
INITIALS: JA
SEAl' RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
Page 1 of 1
06/03/04
Account: 108219122
Name: NEW ACCOUNT
Address:
The image shown below represents an official copy of the original document as processed by our institution
THE ESTATE OF lsIARY R.. HALEY m.?ns63 1 0 9
ED~ A. HALE~ JR. EXECUTOR
!0~ 0,5/13/04 32~02~0 !3,5.00
Page 1 of 1
06/03/04
Account: 108219122
Name: NEW ACCOUNT
Address:
The image shown below represents an official copy of the original document as processed by our institution
THE ESTATE OF MARY R. HALEY
~'?~Sa 110
EDMUND A. HALEY JR, EXECUTOR
1490 S MOUNTAIN NIl. 0~ffil~
110 05/14/04 8700860 135.00
DOff ~r~h On-Us CI-eck -.
. TlrOi30n~ 11t0536 BRI~0L8
~'T# 0108,219122 Till 1807 : '
-' '- : ':- ' cxT~' 154C013:19135.0005/14/2004
.q~ount 135.00
THE ESTATE OF MARY R. HALEY ~.~
EDMUND A. HALEY JR, EXECUTOR
~O0 s MOUNTae,t RD.
DILLSBURG, PA 17019 DATE
THE ESTATE OF MARY R. HALEY
EDMUND A. HALEY JR, EXECUTOR
(717)766-8562
-SALE-
SALES ~: S040§00t 13 05-03-04
41117 3.7-Z PLUNBR 600P 3.96
250~4 PVC SNK CNT 3/811 6.70
2 0 3.35
120887 LAY FCT 4" CNTRSE 48.00
SUBTOTAL: 58.66
TAX 38550: 3.52
INVOICE 62665 TO7RL: 62.18
BALANCE DUE: 62.18
CHECK: 41.~2
NERCN/GIFT C~DS: 0.66
NERCH/~IFT CARDS: 20.00
NERCH/GIFT CARD 8969 AUTHCODE 000000
BEGIN B~L TRANSACTION ANT ENDING B~.
0.66 0.66 O.OO
NERCH/GIFT CARD 9075 AUTHCQDE 000000
BEGIN BAL TRANSACTION ~NT ENDING BIlL
20.00 20.00 0.00
0405 TER#IN~L: 62 05/03/04 16:00:23
REV-1512 EX + (1-97)(1)
SCHEDULE I
ooMMO~VE~. OF.E. NSV.V^N,^DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
.ESIOE"~CEDENT MORTGAGE LIABILITIES, & LIENS
ESTATE OF Mary R. Haley FILE NUMBER 2004-00312
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1. Pennsylvania American Water ($12.69, $14.02, $11.20, $8.45) 46.36
2. PP&L Electric Utilities ($15.52, $10.03, $7.67, $5.32) 38.54
3. UGI Utility ($2.00, $18.12, $13.41, $3.86) 37.39
4. Dillsburg Ambulance, c/o Promed Services, Inc. 28.24
5. Fissel & Co. (Appraisal) 46.00
6. Borough of New Cumberland (Sewer) 8.46
7. Settlement charges for sale of real estate $1,029.83
TOTAL (Also enter on line 10, Recapitulation) $1,233.82
(If more space is needed, insert additional sheets of the same size)
00024062314290000000000.001269017
~ 26--0623142-99
PO BOX 578
ALTON, IL 62002-0578 AMOUNT ~UE $12,69|
' DUE DATE
For Service To: 123 7th St I Apr 26, 2004
IAMOONT PAID
000025078 01 FP 0.352
I,,,111,,,111.,,.111,1,,11,,,11,,,i1,,,11,,,i1,.11,,,,,I,II
- E HALEY
1490SOUTH MOUNTAIN RD
DILLSBURG, PA 17019 Pennsylvania American Water
PO Box 371412
Pittsburgh, Pa. 15250-7412
I,- U,l,i-,I,l,l,l,li,,,l.,i,i.i,,,ll.hl,,lhl
or ~o change your a~ress or m,,'ep~one numbe~, and pm~t mformatmn on re~e s~le_
00024062314290000000000002671013
~ P~-nns~Z~mni~
PO BOX 578
ALTON, IL 62002-0578 AMOUNT DUE ~
For Se~ice To: 123 7th St DUE DATE ~2~, ~
AMOUNT PAJD ! ~' O~
000023017 01 FP 0.352: ~
I~,,llh,,llh,,,.llhl,,lh,,lh,,lh,,lh,,lh,,{l,,,,,hl, ~~
" HALEY
149OSOUTH MOUNTAIN RD
DILLSBURG, PA 17019 Pe~'mnsylvaaia Ameri~...an Water
PO Box 3714~2
Pittsburgh, Pa. 15250-74t2
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~-~ P_ t_e?~ ¢hec/< here to. pdd HZO-.He~.p to cona'~on to
or ~o c~ange your a(~0'ress or telephone numoe?, and p~3t information on
THE ESTATE- OF MARY R. HALEY
EDMUND A. I-IALEY ~, EXECUTOR
01062'19122/
D]7~,LS~.G, P^ 1~t9.
BLANK
THE ESTATE OF MARY 1L I'IALEY
149OFr MOUNTAIN RD.
~ o~ oF
00024062314290000000000001120012
~ bx~e~.o.~t~ ~ ~ 24-0623142-9
PO BOX 578 AMOUNT DUE $11.20
ALTON, IL 62002-0578
DUE DATE
For Service To: ~2:3 7th St
AMOUNT PAID //. ~ 0
00002919501FP 0.352 ~~
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,., E HALEY
14905OUTH MOUNTAIN RD Pennsylvania American Water
D ILLSBURG, PA 17019 PO Box 371412
Pittsburgh, Pa. 15250-7412
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[Please check hure to add H20-Help to Others cona~'.~.on.t°.y°ur ?on6~tY ~ Me
or to change your address or telephone number, an¢l pnnt information on reverse sE.
~ ~Ze.~u,[ (I/~.~R,A J~m~/~t~m 24- 0623142
PO BOX 578
ALTON, IL 62002-0578 AMOUNT DUE
For Service To: 123 7th St DUE DATE JUl 21, 2~4
AMOUNT PAID
000025374 01 FP 0.352
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E HALEY · - ~ --
1490 SOUTH MOUNTAIN RD
DILLSBURG, PA t7019 pennsylvania American Water
PO Box 371412
Pittsburgh, Pa. 15250-7412
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Closing Bill
Please check here to add H20-Help to Others contn'bution to
your
monthly
bill
or to change your address or telephone number, and print information on reverse side.
THE ESTATE OF MARY R. HALEY
~-?~'s63 11 9
EDMUND A. HALEY 1~, EXECUTOR
1490 S MOUNTAIN RD. 0106219~2~
Return this part to address below with a check payable to PPL Electric Utilities Corporation
Amount Enclosed
,...,,,...,,,....,.,,,.,..,.,..,...,...,,,..,.,.,..,,...,..,.,
E HALEY PPL ELECTRIC UTILITIES
1690 SOUTH MOUNTAIN RD 2 NORTH9TH STREETRPC-GENN1
DILLSBURG PA 17019 -9718 ALLENTOWN PA 18101-1175
i 1700000155270000015528 1262081006
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PPI. E[ ffff~C
1490 SOUTH ~UNTAIN RD
DILLSBURG PA 17019 -9718
A~O~ PA 18101-1175
~ ~000000~003000000~003~ ~h~OA~OOh
THE ESTATE OF MARY R. HALEY
~°'~23~63 1 1 5
EDMUND A. HALEY JR, EXECUTOR
1490 S MOUNTAEq RD. 0/08219~2~
-~ ~ ,
- ~, ,... -r,
' R~itirn this phi'¥t-O-a-~i?~s-~'6e'--ib--ff w~ffi-a c e~ab ~ lz edlnc~Cb~-OyS~
~ ::: ~: ~mn:~,~m~::.. ;:,:;1 I~:::.:: ~'P~:~::: 4 $ 7.67
12620-81~)6 ' ] Jun22,2004
Amount Enclosed
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E HALEY PPI_. ELECTRIC UTILITIES
1690 SOUIH ~0H~I~I~ RD 2 NORTH 9TIt STREET RPC-GENNI
DILLSSURO Pg 17019 -9718 ALI..ENTOWNPA 18101-1175
i 1100000076710000007678 1262081006
~cmrn m~s part lo address below ~vilh a clwck payai~k: ~,.) PPI. I!lcc~ric Utilities Corporation
'3 "') '
1-~_()-~10~6 Jul 19, 2004 $ 5.32
,,..,,,,..,,,......,,,,,,.,.,,.,...,...,,,..,.,.,..,,..,,..,,,
E HALEY
].~,90 SOUTH HOUNTA[N RD 2 NOR'FII 9TI! S'I'Rt]I]T
DILLSBUR$ PA ]70].9 ~g718 AI-IJ:'NTOWNPA
i 1100000053210000005328 1262081006
THE ESTATE OF MARY R. HALEY
~-72~63
EDMUND A. HALEY JR, EXECUTOR ~ 2[ 2 0
1490 S MOUNT,~IN RD. o~o~2~9~2 i
o
OGI Utilities, Inc. to avoid the late charge.
Post Off~e Box 13009 Please return this partJon
Reading, PA 19612-3009 with your payment.
" NARY R HALEY
2135535t850,;IQ ':;'&,;~Q2QOQQQPQQQQDDD3QQQQQQQQQQQQQQQQOQOQDS
THE ESTATE OF ~RY R. HALEY ~o-7__._~63 1 ~. '?
EDMUND A, HALEY JR, EXECUTOR
D~LSBURG, pA 17019
Please pay by the due date
UGI Utilities, Inc. to avoid the late charge.
Post Office Box 13009 Please return this portion
Reading, PA 19612-3009 w~th your payment.
CPT 213 153 5185 09 1 P,6 Due Date
June 17, 2004
213153518509061701000018120000230000000000000000000004
THE ESTATE OF MARY R. HALEY
EDMUND A. HALEY JR, EXECUTOR
1490 S MOUNTAIN RD.
DILL?BURG, PA 17019
UGI IJtilities. Inc. Please pay by the clue date
Post Office Box 13009 to avoid the late charge.
Reading. PA 19612-3009 Please tatum this portion
~th your paymeflL
213153518509072101000003810000050000000000000000000002
-
4807 JONESTOWN RD SUITE 247
HARRISBURG, PA 17109
' 1-866-678-6855
Patient Bill
Page: '1
MARY R HALEY Pdnted: 04/19/04 06:50
1490 SOUTH MOUNTAIN RD Numbe~ 102
DILLSBURG, PA 17019
DOB: 10/29/1920
Patient: HALEY, MARY R Number: 102 DOB: 10129/1920
Claim Number: 6440~0~l?2Dia~nos!s 1) E888 2) 724.5 3) 780.79 4)
Ins: 1) MC/Asgn 20703,, 96A 2, PEB~Asgn 207037796
01 02/24-02/24/04 007 A0429RH 123 A 375.00 1 232.77 204.53 0.00 28.24 28.24
Your insurance coverage has indicated there is a deductible amount due of $28.24 for this service line.
Procedure: BLS EMERGENCY SERVICE
Date first billed: 03/29/04
Patient Totals: 375.00 232.77 0.00 204.53 0.00 28.24 28.24
Total Amount Due By Guarantor: 28.24j
~,~ $o~t'T'~ /~ot~ ~7'~.ifo ,~0t~I 997
PAY DATE L~,~,/0 ~
"'OOOCt~ ?.' ~.' i~ ~ ], :t ? ;~ ~,.o. ?~:O ],DP- ~ ],~ ;I, ~ ii,~
vvvvvv DETACH HERE vvvvvv
PLEASE MAKE CHECKS PAYABLE TO DILLSBURG AMBULANCE
Legend:
pD~)~ i~,rDo~gn_~o_si..s_~ss, ~eferen.? and refer? t.o ~e ?.umbered diagnosis codes on the claim line above lt.(limit=-4)
u~rs ~n[emal ~ace or ~ennce cooe inolcatmg where the procedure was rendered.
To insure proper credit, please clip and mail ~is section and include with payment
Guar: HALEY, MARY R #: 102 Clms: 64400172
Pa,ge 1 Amt Due: 28.24
1302 N. 3rd Str-~
._ ~_._.~.'.~ ..~___ ~ .....
.~ . ..... l~ ~.~;~ ...........
999
THE ESTATE OF MARY IL HALEY
EDMUND A. HALEYJR, EXECUTOR ~a -- 1 ~ ;3
1490 S/MOUNTAIN RD. o~oa~gl~ ~ [
$
ml 2 ] & :~ ? 2 ~.-fi ?rolo ],Off 2 lq ], 2 2," 0 2. ~, ]
BOROUGH OF NE-'~/CUMB~
1120 MARKET STREET P-O.~BO~~ NEW CUMBERLAND, PA 17070
PREVIOUS BALANCE
PAYMENTS
PAST DUE
PENALTY
INTEREST
OTHER CHARGES
RETURN THIS PORTION
WITH YOUR PAYMENT ~ 4~,;~- [J]~ ........ -~ejoj
REV-1513 EX + (9-00))
SCHEDULE J
co~o~vE,~_T, oF PENNS,~V^.,A BEN EFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Mary R. Haley FILE NUMBER 2004-00312
RELATIONSHIP TO DECEDENT A~ou~rrcR
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) ~
OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
][ transfers under Sec. 9116 (a) (1.2)]
1 Frank R. Haley, 109 Park Road, HCR Box 23, Waynesboro, PA 15370-2537 Son 20%
2 Charles E. Haley, 942 Pisgah Road, Shermansdale, PA 17090 Son 20%
3. Michael B. Haley, RR 41, Box 116, Silver Lake, NH 03875 Son 20%
4. David J. Haley, 11 Sunny Lane, Hershey, PA 17033-2455 Son 20%
5. Edmund A. Haley, Jr., 1490 S. Mountain Road, Dillsburg, PA 17019 Son 20%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHO/VN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 DOVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
TOTAL OF PART ]J - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
~ $ 0.00
(If more space is needed, insert additional sheets of the same size)
~-~ - ~ ~" COHHONNEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. ZB0601
HARRISBURG, PA 17128-0601 NOTICE OF /NHER/TANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCT/ONS AND ASSESSMENT OF TAX
DATE 10-11-200~
~i:;i ESTATE OF HALEY NARY R
DATE OF DEATH 05-10-Z00~
FILE NUNBER 21 0~-051Z
COUNTY CUNBERLAND
BARBARA SUNPLESUL~A~'t~ 13 ;!\6:96 ACH 101
5~9 BRIDGE ST Amoun~ Remi~ed
NEW CUNBERLAND L. PA 17070
I
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF HILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS
REV-15~7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT~ ALLONANCE OR
DISALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF HALEY HARY R FILE NO. 21 0R-0512 ACN 101 DATE lO-11-ZOOR
TAX RETURN NAS: (X) ACCEPTED AS FILED ( } CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1) 100z000.00 NOTE: To insura proper
2. S~ocks and Bonds (Schadula B) (2) 1/115.68 cradi~ ~o your account,
$. Closely Held S~ock/Par*nership In*eres~ (Schedule C) ($) .00 sub. i~ ~he upper portion
~. Not,gages/No,es Receivable (Schedule D) (~) .00 of *his form ~i~h your
5. Cash/Bank Deposits/Misc. Personal Propar~y (Schedule E) (5) $$;975.55 ~ax payment.
6. Jointly Owned Proper~y (Schadula F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (a) 155,$91.21
APPROVED DEDUCTIONS AND EXENPTZONS: 7,725.~$
9. Funeral Expenses/Adm. Cos~s/Nisc. Expenses (Schedule H)
10. Dab~s/Nor~gaga Liabilities/Liens (Schedule Z) (10)
11. To~al Daduc~ions (11) 8.q59.2;
12. Ne* Value of Tax Re*urn (12) 126,~1.96
15. Chari~abla/Govarnaen~al Baques*s; Non-elected 9115 Trus*s (Schedule J) (15) .00
1~. Ne~ Value of Es~a~a Sub~ac~ ~o Tax (1~) 126,¢$1.96
NOTE: If an assess.eat ,as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ,111
reflect flgures that include the total of ALL returns assessed to date.
ASSESSNENT OF TAX:
15. Amoun* of Line 1~ at Spousal ra*e (15) .00 X O0 = .00
16. Amount of Line lq taxable ai Lineal/Class A rata (16) 126,fi$1.96 X Off5 = 5,689.~5
17. Amount of Llna 1~ at Sibling rate (17) .00 X 12 = .00
18. Amount of Line II taxable at Collateral/Class B rata (18) .00 X 15 = .00
19. Principal Tax Due (19)= 5,689.~
TAX CREDITS:
PAYflENT REC~IPI' DISCOUNT
AMOUNT PAID
DATE NUNBER INTEREST/PEN PAZD (-)
06-03-200~ CD00~012 28~.~7 5,675.00
TOTAL TAX CREDIT I 5,959.q7
DALANCE OF TAX DUEl Z70.0~CR
INTEREST AND PEN. .00
TOTAL DUE 270.0~CR
ZF PAID AFTER DATE INDICATED, SEE REVERSE ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUTRED.
FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE~I'~'
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. )
RESERVATION: Estates of decedents dying on or before December 1Z, 19BZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance Taxes
at tho lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOT[CE: To fulfill the requirements of Section ZI40 of the inheritance and Estate Tax Act, Act Z$ of ZOOO. (7Z P.S.
Section 9140).
PAYHENT: Oetach the top portion of this Notice and submit with your payment to the Register of Niils printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILES, AGENT
REFUNO (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for fores ordering: 1-800-362-Z050; services for taxpayers with special hearing and ! or
speaking needs: 1-800-447-30Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assassaent
of tax (including discount or interest) as shown on this Notice must ob]act within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Oepartmant of Revenue, Board of Appeals, Dept. ZDIO21, Harrisburg, PA 1712&-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
AONIN-
[STRATZVE
CORRECTIONS: Factual errors discovered on this assessment should ba addressed in ariting to: PA Department of Revenue,
Bureau of [ndividua! Taxes, ATTN: Post Assessment Revise Unit, Oept. ZD060I, Harrisburg, PA 17lZD-060l
Phone (717) 787-650S. See page 5 of the booklet "instructions for inheritance Tax Return for a Resident
Decedent" (REV-IDOl) for an explanation of administratively correctable errors.
O[SCOUNT: if any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SZ) discount of
the tax paid is allowed.
PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
iNTEREST: interest is charged beginning aith first day of delinquency, or nine (9) months and one fl) day from the date of
death, to the data of payment. Taxes which became delinquent before January l, 198Z bear interest at the rata of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January l, lg&z will bear interest at a rata which will vary from calendar year to calendar year with that rate
announced by the PA Oepartaent of Revenue. The applicable interest rates for 198Z through ZOO4 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ 20X .000548 T~-8-1991 llX .000501 ~'~ 9z ,000247
1984 llZ .000301 1993-[99~ 7Z .00019Z Z003 5Z .000137
1985 13~ .000356 1995-1998 gZ .000Z47 Z004 4Z .000110
1986 IOZ .000274 1999 7Z ,OOO19Z
1987 IOZ .000Z74 ZOO0 7Z .00019Z
--Interest is calculated as Tollows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY XNTEREST FACTOR
--Any Notice issued after the tax bscoaes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest coaputation date shoan on the
Notice, additional interest =ust be calculated.
CONMONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES ZNHERZTANCE TAX
INHERITANCE TAX DIVISIOH
poBox zBo6Ol STATEHENT OF ACCOUNT
HARRISBURG, PA 171ZB-0601
DATE 11-08-2004
ESTATE OF HALEY NARY R
DATE OF DEATH 05-10-2004
F.rLE NUNBER 21 04-0512
~ i*..: i~i ~i COUNTY CUMBERLAND
BARBARA SUHPLESULLIV.... Eo~i~i-~ ACN 101
549 BRIDGE ST Amoun~
MEN CUHBERLAND PA.17070
HAKE CHECK PAYABLE AND REH.rT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
NOTE: To insur-e pr`oper credit: ~o youp ~ccoun~, submi~ ~che upper por`*ion of ~his '~or`m ~i~h your- ~x p~ymen*.
CUT ALONG TH'rS L.rNE I~ RETA.rN LONER PORT.rON FOR YOUR RECORDS ~
ESTATE OF HALEY MARY R F.rLE NO. 21 04-0:512 ACN 101 DATE 11-08-2004
THIS STATEHENT TS PROV/DED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAILED ESTATE. SHONN BELO#
'rs A SUNHARY OF THE pRTNCTpAL TAX DUE., APpLTCATTON OF ALL PAYHENTS, THE CURRENT BALANCE, AND,, .rF APPL/CABLE,
A PROJECTED TNTEREST FTGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 10-04-2004
PRINCIPAL TAX DUE: ............................................................................... 5,689.45
PAYMENTS (TAX CREDITS):
PAYHENT RECEIPT DISCOUNT
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
06-0:5-2004 CD004012 284.47 5,675.00
10-20-2004 REFUND .00 270.04-
TOTAL TAX CREDIT 5,689.4:5
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
ZF pATD AFTER THZS DATE, SEE REVERSE TOTAL DUE . O0
S'rDE FOR CALCULATTON OF ADDTT/ONAL 'rNTEREST.
'rF TOTAL DUE 'rS LESS THAN $1,
NO PAYMENT 'rS REI~U'rRED.
'rF TOTAL DUE 'rS REFLECTED AS A "CRED'rT" (CR),
YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCTTONS. )
PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed an the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check ar money order payable to: COHHONNEALTH OF PENNSYLVANIA.
REFUND (CE): A refund of a tax credit, ehJch was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available
online at www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's
Z4-hour ansmering service for fores orders= 1-800-36Z-Z050; services for taxpayers with special hearing and/or
speaking needs: 1-BOO-4qT-3020 (TT only).
REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of IndividuaI Taxes, ATTN: Post Assessment Review Unit, P.O. Box ZB060I, Harrisburg, PA I7IZB-060I, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (BI) discount
of the tax paid is allowed.
PENALTY: The 1BI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes mhich became delinquent before January l, 19BI bear interest at the rate of
six (67.3 percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January 1, lgBZ will bear interest at a rata which will vary from calendar year to calendar year with that rata
announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOOq are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 207. .O00S~B 1988-I991
198=; 16Z . 000~38 199Z 92 . O00Z~7 ZOO2 62 · 00016~
198~ llZ .000301 1993-199~ 77. .O0019Z 2003 57. .000137
1965 X3Z .000356 1995-1996 92 . O00Z~7 ZO0~ qZ .000110
1986 lOZ ,0 O0 Z7~* 1999 77. .000192
1987 92 . O00Zq7 ZOO0 8Z . O00Z19
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUtlBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Mary R. Haley
Date of Death: March 10, 2004
File No.: 2004-00312
Pursuant to Rule 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 the administration is complete: Yes X No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete: Not applicable.
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court? Yes No X
b. The separate Orphan's Court No. (If any) for the personal representative's
account is: Not applicable.
c. Did the personal representative state an account informally to the parties in
interest? Yes. X No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the ~ ~ourt and may be attached to
this report.
Date: December/_~, 2004 .
[ ~[t~r~ Sumple-Sulhvan, Esquire
Name
549 Bridge Street
Address
New Cumberland, PA 17070
cD ~ ~ (717) 774-1445, Supreme Ct #32317
t~ ~ t:~ ~ __~ Telephone No.
[~-~~5_ocs.~-~J cz m~ c.> t~ cr:~:.-,.~~ Capacity: Personal Representative
c~ ~ a:~ X Counsel for Personal Representative