HomeMy WebLinkAbout02-0516
PETITION FOR PROBATE and GRANT OF LETTERS
Estate oj t-JeJ\\~ ~--N\V\~ Lrr/IAQIl1 No.2.\.02.-~11D
also known as N'i-' L L II" ~,.. L..-r- {lA,. K To:
Register of Wills for the
Deceaserj, County of Cill':BERLAND in
Social Security No. ~ C, f-- 1 (j- L\ \) '2, 'L Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut '" P-
in the last will of the above decedent, dated -:5"" ('~AA ('~ ':2 1<;
and codicil(s) dated . ~
_:') ,.,J',,,q-, ? h \<, '- \ IV 10',\/1 - b~ c: CO (~ c; 0' If)
named
, 19-E:;3
the
(state relevant cirCllmstac' e.g. renunciation, death of executor, ctc.)
Decendent was domiciled at death in " ~ 1o->'C,lC\ A.\J () County, Pennsylvania, with
last family or principal res'dence at 4
'CJ~
h
Decendent, then 'S. '3
at
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 not the victim of a killing and was never adjudicated
incompetent:
years of age, died
~.
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2('" '2..,
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Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$'J-csc..<C5
$ I
$
$
WHEREFORE, petitioner(s) respectfully re
presented herewith and the grant of letters .
'V" ) c, -t-''L,
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I _~
COUNTY OF __ CUMBERLAND J 8:;
Sworn to or aff~med and
before me this 3rd
vy\', (. L.h ..0J.
~.
Register
, 7 - (.0(.;' . I
No. 2...J-Cz.- ~II<,
.
Estate of NELLIE ANNIE LITMAN AKA NELLIE S LITMAN
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MAY 29. 2002 19_, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 1-28- 1983
described therein be admitted to probate and filed of record as the last will of NELLIE ANNIE LITMAN
AKA NELLIE S LITMAN
and Letters ADMINISTRATION CTA
are hereby granted to MICHAEL J BARTELL
@ ~~)
0/1 , ..(~~
MARY LEWI~ter of Wills
FEES
jcp
25.00
3.00
10.00.
5.00
43.00
$
$
$
$
TOTAL _ $
Filed ... ?-.~~;-?oq~ . . . . . . . . . . . . . . . . . . . . .
mail to exec.
Probate, Letters, Etc. .........
Short Certificates( )..........
Renunciation ................
ATTORNEY (Sup. Ct. J.D. No.)
ADDRESS
PHONE
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This is to certifv that the information here given is correctly copied .ft:q'Dl an .original certificate or death duly flied with me as
I'ocd Registrar.' The origin,-l! ccrtincate \Nill he forwarded to tht' StalL' Vita! Records O~llct' ~(H permanent fIling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Local !Zt:gistrar Q
Fcc for this cenitlcw:" ~2.()O
P 8207335
MAY 1 7 2002
Dale
43Ae~ 2lB7
COMMONWEALTH OF PENNSYLVANIA. . DEPARTMENT OF HEALTH. "ITAL RECORDS
CERTIFICATE OF DEATH
L
N~iii~ S. Litman
S~--
2. F e.male
S'ATE "'Lf "U"'OEA
---.-
SCC'Al SECUAllI' NUMBER
AGE,laotS>f1naav)
UNDER 1 YEAR
Mcmhe Da.,.
UNOER 1 DAY DATE OF BIRTH BIRTIiPLACE IC.TV ..r.<;I PlACE OF OEATIi 10."", oP'v ""e-
Ho"" l.linul.. ,Momn, Day '8"'1 SIaI"",rcre",,,C,,,,,,,,y) PA liospiTAl--'~-
12- 26-18 Shi..ppeMbWl.g J lnpal..nlD EAlOUlpal..nl [J
8. 7 ...
CITY, BORO. TWPOF DEATH FACILITY NAl.lE (II nol '''>I'1'l>I",,,, >>"'iI 'lreel aM ",umbe',
"""'I"~~_",!!:!~I
DATE OFOEATIi ,Monlll,Oaj. "'an
..May 15, 2002
NAME OF DECEDENT IF,;.. i'.lId<JIe,uSlI
,.206
- 10
83
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R..odoI""" 0
gr=,ty) 0
,
COUNfYOF 0EJ(T1i
KINDOFBUSINESS/INOUSTRY
WAS DECEDENT EVER IN
US.ARl.lEDFQflCES?
1'8.0 NolXl
12. lJ.
WAS.m=:CEDt:NT OF HISPANIC ORIGIN7
No~ "...Ultvw......,JIyCublln.
M..M:aI'l.P...."oA.::.n....c
,
RACE-Am.""atllndi.n.61IlC~.Wh..,.IC
(SptlCtvl
D. Cumbvtiand
OECEDENT'S USUAL OCCUP,(J'ION
(~;:"~Ii~;"d~e,,~~,~
Homemak.VI.
k.
Camp Hili
Manol{ CMe
w.
whit~
MARITAlSTATUS-Matrl<Kl
~.'rl.l""ie<l,Wldow<Kl
O"'....CIf<lISPBCI!y)
18. Wi..dowed
...
SURVIVING SPOUSE
(1I..,lo,g.""maoOenn,""",1
1700 Makket Stk~et
". Camp HiU, PA 17011
FATHER'SNAME(h$l,,,.,,,dj.,laSl)
". Alonzo V. SommeJtv.i.lle.
INFORtolANT'S NAME fTYjl8lP''''l),
'k. Mk. Micnae~ J. Bakt~ii
UETHOO OF DISPOSiTION I-i
O Bunlll 0 Cr.mation Ifl R.mo~all'om SI.I.O
Don.loon QUVO'(Spec"v'
21..
SIGNATURE Of F
17o_Sla'.
e.YlYl-6Y VaYl-ta
17b.Cou<>IV
Cumb'kiand
,.
_..
~... on 0
townsnip?
17c.Oy..,dIc.denllivedin
l1d.8i :~~~~II=OI
Camp HiU
o~_
MomER'S Ph~'~btd~t16 re'X'el
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INFORMANT'S l.l-\llINO AOOAESS(St'eel, CotviTown, SI.tJ., lip CJXIEIl
,,;j12 Ai~"on Av~nue, M~cnaMc"bWtg, PA 17055
PLACE OF OISPOSITION. Name 01 C.m.lerv, C..malO<y lOCATION .CitylTown, Stal..lipCode
....OIhefPlac.CJr.e.maUOYl Soc.i.ety
21c. 0 PA CJte.matoJt 21d. HaAJt.i.-1bWl. PA 17109
NAl.lEANOAOORESSOFFACllITY CJtemat-LOYl Soc-te.,tlj O!l PenYl-61{ :VQfUa
"0.4 Jon t Road Hakk.wbWt PA 171 09
liCENSE NUMBEA DAlE IGNED
(l.lonlll,o..y,""'..-I
'k. t! -:'ZOoz.
WAS CASE REFERRED TO ~~bA~'!lirwORONEA? "..,0
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,ApprCJlimal. PART II: 01 rs' ""'.nlcondlli,,,,*contnbulinglode.ltl.bul
:'nl.tv"~ uttinginltvo undMylng_g..... "'PART I
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DUE TO lOR AS A CONSEOUENCE OF)
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WERE AUTOPSY FINDINGS
AVAILABLE PRlOR TO
COMPLETION OF CAUSE
OF OEATIoi?
MANNEROFOEATH~
Nal",aI [/ Homlc,d.
OATEOF tNJURY
(MOllm Oay,,,*,,,,)
TIME OF INJUAY
INJURY AT WORK? oe:SCRIBE HOW INJURY OCCURRED
o~m
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CERTlfIEAICt>fl(;~onIY"""1
'CERTIFYING PHYSICIAN (Pt>~s""an c"""'v'''q Cause 01 <l~elt> ",t>~n ""cloe' ph",",an has l>'O<lO~nce<l dealr, ",,,-, "",np'~led lIe,n 231
ToUvot>oo.lolmyl<nowl-..!g..d8"l'ooccu<t<Kld""lolh.c."se(.).ndmann..a..I.lltd
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'PIlONOUNCINQ AND CERTIFYING PHYSICIAN .Phv''''''''' bo'h ~'onou'""n\l u".'h ", ,<) cewlv"'<J '0 ""'''~ ,,' <1e"'hl
TOlh.bHlol"'yk""wlltdg.., <;IUlhOCC",,8<lal 11l.1I",., dal...ndplace. andd u.la III. eausel') and mann.'USlalltd.
'MEOICAL EXAMINER/CORONER
On Ih. b..il of u.min.lIon .nd/o. In~esllgalion, in my opinion. d.8th acc""ed allhe 11m., dal.. and place. and d"e 10 Il'o. c.un(.) and
ll.mlnn.r...tet8<l__ ...................... .... ................... .... ... ........... ......... ..... .
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AEGIS A-SSIGNAT~ANO~fif\..o"
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OATEFllEOiMo'"'' Day,fea',
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2.1-02.-511.
I, Nf-~11ic nniQ Lii:r:ldI1, 0:2 Country <-::lubP~1r>, 1~;L::y of .fickcnburg, H8.rico;)a
.~ount~f, 3;~;t::2 o::':_rL;on,-~; Lein;,,: or lJound ;--,dn.l, r.lemory and underGtanding, do hcr_~by
In,~ikl1 publish and declare this to be my Last oIil1 and 'restd.ment, hereby naking
void and rc...,-o].:.ing all other Hills heretofore made by me.
I direct my hereinafter named Executor to pay my just debts and funeral
ex:?enscs as soon after my demise as T:lay be con""lcnient.
I hereby gi"fe, de~fise and be.queath. .:all lilY property resl, pernon;Ll <..'_;.1
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I.Aft lIILL AN1:) "'S7~
1. W.llie ba1. l.i..... of C...trJ' Cl.. P.rk. City of Wiak....r.. Wariaop.
COII.'y. SCali. of Aria_; "olaa of aOllad ailld. .-I"J' &ad ....ra&&adias. do Il.n.,
.lr.. ....u..1l aM 4..la1:8 ,lti. 110 ... .., ...n Will aad 11:0'-:_11. Il.r..., Mltias
yoi4 aad r...okias .11 ol;llar Will. au.tofon _do ..., _.
1 direct a,. uroiaatller ....d baa.tor 1;0 ,a., ., j".1I dNca .ad ta.ard
Olt,..... .. ._ .f,or .., d_b. .. ., "0 oo......i..c.
1 Iler"'" aiv.. d...teo aad ...'1....,. .11 ., .ropeR, r.d. ,.......1 _ad
a1xed. of ...Cao&y.r ..'..r. ..d ..oro....or ahu.'.. to .., Ilua..ad. Joe.,1l larl
Lit.... to aold to lliMe.lf. Ili. Il.ir. _ad ...i.... for...r .ad i. f.. at.p1..
I. t.. ....e Claac ., .......d. Joe... Karl Lb.... ..0II1el .red...... ..
,... 1 do Il.r..,. ai... di.i.. ..d ..'1......
Aad. laatly 1 ....iut.. o_lIhut;e _ad ."oiat .,. IllS....ad. Jo..,il lad
Litaall 1;0 .. I;lla baautor of Illlia .,. ....t Will .... 1I:..'_..t.
1a .it..u vlluaof w. u.. ller_to ..t our leaada &ad ...1 tilia d/Y
ciay ot. h.nUa'I't bl tile year of _r J.ord InU.
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REGISTER OF WILLS
TH OF SUBSC
COUNTY
BING WITNESS
codici
(each) a subscn 'ng witness to the will pr
law, depose(s) and y(s) that
being duly qualified according to
present and saw
the testat , sign t e same and that
request of testat_ in presence and (in th
other subscribing witness(es)),
signed as a witness at the
) (in the presence of the
Sworn to or affirmed and subscrib before
me this
\
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(Name)
Register
~Address)
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REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
21-C>2-5HD
Shc\,y/c (VI. 't3C\v"kl!
(each) a subscriber hereto. (each) being duly qualified according to law, depose(s) and say(s) that
SHE IS familiar with the signature of NRT,T,TR 111\l1\lTR T.FrMlI1\l 11"'11 1\!ELLIE S LITMJl
codicil
testat~ of (one of the subscribing witnesses to) the will presented herewith and
codicil
that SHE believes the signature on the will is in the handwriting of
NELLIE ANNIE LITMAN AKA NELLIE S LITMAN
to the best of HER - knowledge and belief. I!J .
Sworn to or affirmed and subscribed before ff~i)l/'l-.{.2. hc/ '~f ~J2f2./
me this 28th day of I' INaf'e)
CZZz~ (1. ~;~ rlfct14dC::::~ss~/~ 70!"s
Register
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witne to the will presented herewith, (each) being duly qu ' ied according to
law, depose(s) and say(s) that
present and saw
the testat ,sign the same and th~
request of testat in l~_ presence
other subscribing witness(es)).
Sworn to or affirmed and su
me this _ _
signed as a witness at the
the p nce of each other) (in the presence of the
_ day of
19
Register
(Name)
(Ad
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
_`
_ MICHAEL J BARTELL
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
HE IS familiar with the signature of NRT.T,TF AniATTF T rmM.a~i nun
:~ A7EL7[,IE S LITMA
OR ' ~'" codicil
testat_ of (one of the subscribing witnesses to) the will presented herewith and
HE codicil
that believes the signature on the will is in the handwriting of
_=; _
NELLIE ANI~7IE LI
to the best of HT SS ___ knowledge and belief.
h
Sworn to or affirmed and subscribed before
me this 23RD day of
MF.Y 2402
C IS Register
(Name)
C
!Name)
(Address)
(Address)
RENUNCIATION
2'-02-51t~
In Re Estate of
Lt ~E.II~'t S, Ll'((\I\A!\J
N1l.-(/ i e.. 1\ "-IN i'C.. I yY\ AN Af=. r::t deceased.
To the Register of Wills of c: ~ VV"\. bE- tC I AN jJ County, Pennsylvania.
L .;;. ~Al..Jtt-^'~
The undersigne(K...e ...z~ LotJt^1\ Nr2;d"<jA)J~ aCtdL} ~ 11-;,r
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
be issued to rVhc l~'<... \. ~ f6u:\R -Tc.L L I ~"9",",~...... \c;.\.Q...~-C,,~
WITNESS
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.:10 oyt/8a /(//2 lJ)< y /.-.IJ;ve
ChC,'l$be()$bl./. 71-/7;20/
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hand this
day of
.19_.
(U;C~~J
f,/ (Signature)
</? ~~~.tJw/ .de/.
?vAL;V/fT /7&//';'/>1 ,..0.., / ?oJt:1
(Address)
YL~3::,t115^
"JD N. 0t Q3'/
..,iJ AnY\ \J ~ I k 1 tit- /7 DD,~
(Add(ess)
Gd;JJ/~ it ~,jL'
(Signature)
4/0 ~ ((kt~ N,(4llt'TS
(Address)
vV\ \( ~''A z LT. 0 r~ rZ ~_l L . A D f\It I N' I ~ 1i' v1~~
,
be issued to
WITNESS
hand this
~
day of
,19_.
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Ma~ 28 02 09:43a
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Stat~5vlll~ Branch
117041873-2639
f- ,2
717 ,-E.91-b 1':,<:',
Mli::HAt.L J BAF.'i"ELL DC
PAG!:. 0::'
RENUNCIATION
21-02-5110
In Re E"... "I jJ~ll \ t_
~ . ~ 'i- if fJ e~f2U. 5. ~I-r~~
'Vt~~ CJ..hu.....
--'---.. decellted,
To the Re,,,,c of W,U,ot ~) CIJ IN\ ~:r'2...lA~:~_c"y,penn'YI. rJ -;/
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7 . I ' C.!-"" l~;, /- / ' "
The undorsi_.neo' / /, , --=<c< / c'~/-'i ......... *<--
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the oboy< dW'lent. hereby tenounee(s) lh,: lh~ eSl... an'tl-e,;;"tfuIIy !Uk(l) th.t lell...
be 1~~uC'd to
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',ESS _
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State of Nortll C~.("
~ounty of Tredell
I, A. Scott Hal;ris, ~. sctid county
and s:tate, do hereby Ctrtli t.i::,d,:. ~,ames E. Sommerville:
persmnl1y 8ppeaI"8d },of )1l,;! .-.;E! thi~: (1.:.1.)-' unci o..::knowled~ed
th~ foregoing instrument. Witness my nanJ and official
seal the the 28th Jay of May, 2002,
~H1ua.P~-q,' .
, .'.~ '
Kotar:' l'ublic
~ly Cummi~si(fn Expi res !.~~_: ~O_0 _
-
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
L;1(Vl~
.~~
Date of Death: I1t d' { S; ;< Q(\?-
Will No. -l/p/lfA".K. ~
~ I t rJ/VL/~
Admin. No.
0(;)-5/(,.-,
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
!jbAO f ~2M"~ ~.~ W,~ ~
~ G: 0' ~x: M(J~ - tJ o-L02 vu~f-,
01(~1l ~ ~. GU'~d CHJ~~.
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
~
o s-. 2.00 '2---.
I
~l :L~~f3c<;flifZ{
Date:
Signature
Name
-c \ 2.- A LIs <i N f'l-v<2"
vtA Ec b~c=.bcv:iJ r2J.
U f7eE.;:;
Address
7r'l
Telephone ( )
r;;cr 7- b '?- L{ C(
C""""" 1f- ,,=~, R."""","""! A ~~
_Counsel for personal representative
" BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-06Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RH'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-15-2004
LITMAN
05-15-2002
21 02-0516
CUMBERLAND
101
'i!
R MARK THOMAS ESQ
101 S MARKET ST
MECHANICSBURG
'04 MAR 12
P 1 :43
*'
REY-1S41EXlFPC01_05J
NELLIE
A
1l!I,,11055
CUlni>.
Allount Rellitted
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=is'4TiY-AFP--fiiFiiiY-Noi'"iciuoF-YNHiifiTAi.fcE-TAinrppR7risi'~'-ENT~--Aii.-owAN-ciniri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LITMAN NELLIE A FILE NO. 21 02-0516 ACN 101 DATE 03-15-2004
TAX RETURN WAS, I X J ACCEPTED AS FILED
J CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule BJ
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule OJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule GJ
8. Total Assets
(lJ
12J
13J
(4J
15J
(6J
17J
.00
.00
.00
.00
6,148.67
156.49
.00
IBJ
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule HJ
10. Debts/Mortgage Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule ~l
l~. Net Value of Estate Subject to Tax
(9J
IlOJ
2,808.13
3.340.54
IllJ
112J
113J
(14J
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
6,305.16
6 148 67
156.49
.00
156.49
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:
15. Amount of Line l~ at Spousal rate
16. Amount of Line l~ taxable at Lineal/Class A rate
17. Amount of Line l~ at Sibling rate
18. Amount of Line l~ taxable at Collateral/Class B
19. Principal Tax Due
115J .00 X 00 = .00
116J .00 X 045 = .00
1171 .00 X 12 = .00
rate 118J 156.49 X 15 = 23.48
119J= 23.48
TAlC CRI"DITS:
r"mcn. 'c~c"ro I+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID I-J
INTEREST IS CHARGED THROUGH 03-30-2004 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 23.48
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1.26
TOTAL DUE 24.74
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.J
BUREAU OF TNDZVZDUAL TAXES
INHERITANCE TAX DTV/SZON
DEPT. 280601
HARRISBURG, PA 17128-0601
COMNONNEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
R HARK THOHAS ESQ
101S MARKET ST
HECHANICSBURG
~/<:<-, DATE 05-15-2004
~/~ ' ESTATE OF LITHAN
BATE OF DEATH 05-15-2002
FILE NUHBER 21 02-0516
'04 APR -5 pl.c'~gNTY CUNBERLAND
ACN
101
REV-l$47 EX AFP (nl-OS}
NELLIE A
PA 17055 ~ ~!t. Amount Remitted I
I
HAKE CHECK PAYABLE AND REHZT PAYHENT TOt
REGISTER OF HILLS
CUH~ERLAND CO COURT HOUSE
CARLISLE, PA 1701~
CUT ALONG THZS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-15~7 EX AFP ~01-03} NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLONANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF 'FAX
ESTATE OF LZTHAN NELLIE AFZLE NO. 21 01-0516 ACN 101 DATE 0~-15-200~
TAX RETURN NAS: { X) ACCEPTED AS FILED ( } CHANGED
RESERVATION CONCERNZNG FUTURE INTEREST - SEE REVE~S~
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1}
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
~. Nortgages/Notas Receivable (Schedule D) (~)
$. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Asse~s
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expanses (Schedule H) (9)
10. Debts/Nortgege Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Nat Value of Tax Return
.00
.00
.00
.00
6;148.67
156.49
.00
(8)
2,808.15
NOTE: To insure proper
credit to your accoun*,
submit the upper portion
of this form with your
tax paynant.
15.
lq.
NOTE:
6,$05.16
(11) 6.1~8.67
(12) 156.49
.00
156.~9
ASSESSNENT OF TAX:
15. Amount of Line 1~ at Spousal rate
16. Amount of Line lq taxable at Lineal/Class A rata
17. Amount of Line 1~ at Sibling rata
18. Aeount of Line 1~ taxable at Collateral/Class B rata
19. Principal Tax Due
TAX CREDITS:
PAYNENT J RECEZP1
DATE NUHDER
INTEREST TS CHARGED THROUGH 05-$0-2004 TOTAL TAX CREDIT
AT THE RATES APPLICABLE AS OUTLTNED ON THE BALANCE OF TAX DUE
REVERSE SIDE OF THIS FORH INTEREST AND PEN.
TOTAL DUE
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(z.r,) .00 X O0 = .00
(16) .00 X 045 = .00
(17) .00 X 12 = .00
(18) 156.49 x 15 = 25.48
.00
25.48
1.26
24.74
( TF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REI~UZRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
D/SCOUNT (+)
INTEREST/PEN PAID (-)
ANOUNT PAZD
(~9)= 23.48
reflect flgures that include the total of ALL re~urns assesseo ~o aa~e.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Nat Value of Estate Subject to Tax (1~)
If an assessment ~as issued previously, lines 1~, 15 and/or 16, 17,
18 and 19 Nill
COI~ .NWEALTH OF PENNSYLVANIA
DEPt ,MENT OF REVENUE
BUREAU OF iNDIVIDUAL TAXES
DEPT. 280601
HARriSBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
iNHERiTANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003762
BARTELL MICHAEL J
712 ALISON AVE
MECHANICSBURG, PA
17055
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I 524.74
ESTATE iNFORMATION: SSN: 206-10-4082
:ILE NUMBER: 2102-0516
DECEDENT NAME: LITMAN NELLIE ANNIE .-------
DATE OF pAYMENT: 04/05/2004
~OSTMARK DATE: 04/02/2004
CUMBERLAND
COUNTY: ~
DATE OF DEATH: 05/15/2002
!R~MARKS:
SEAL
CHECK# 2182
TOTAL AMOUNT PAID'
INITIALS: JA
RECEIVED BY:
524.74
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
R. MARK THOMAS
Attorney at Law
101 South Market Street
Mechanicsburg, Pennsylvania 17055-3851
Telefax: (717) 796-3600
Telephone: (717) 796-2100
April 2, 2004
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
RE: Estate of Nellie A. Litman
File No. 21-02-0516
Dear Register of Wills:
Enclosed please find a check made payable to Register of Wills, Agent, as
payment to be made on the inheritance tax in the above captioned case. Kindly return a
receipt to me for the payment of this tax.
Very truly yours,
R. Mark Thomas
RMT/ac
cc: Michael J. Bartell, Executor
C:~
0
BUREAU OF ZNDIVTDUAL TAXES
ZNHER/TANCE TAX D/VZSTON
DEPT. 280601
HARRISBURG, PA 171Z8-0601
'0~ 1~*,' 24
R MARK THOHAS ESQ
101 S HARKET ST
.ECHANICSBURG PA ':1. F~55
CONHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
DATE 05-17-200q
ESTATE OF LITNAN
DATE OF DEATH 05-15-2002
FILE NUMBER 21 02-0516
COUNTY CUHBERLAND
ACN 101
Amoun"lc Rem/~ed
REV-IS07 EX AFP C01-03)
NELLIE A
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credL~ ~o your account, subm/~ ~he upper portion of ~his form wi~h your *ex payment.
CUT ALONG TH'rS LINE ~.~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1607 EX AFP (01-03)
ESTATE OF LITHAN
#~ INHERITANCE TAX STATEHENT OF ACCOUNT ~.
NELLIE A FILE N0.21 02-0516 ACN 101 DATE 05-17-200q
THIS STATEHENT IS PROVIDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHO#N BELO#
IS A SUNHARY OF THE PRINCIPAL TAX DUE, APPLICAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTHENT: 05-15-Z00~
PRINCIPAL TAX DUE: .........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
PAYHENT
DATE
0~-02-200~
RECEIPT
NUHBER
CD005762
DISCOUNT (+)
INTEREST/PEN PAID (-)
1.26-
AMOUNT PAID
IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1~
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CREDIT IS.q8
BALANCE OF TAX DUE .00
INTEREST AND PEN. .01
TOTAL DUE .01
YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS.
Z~.7q
Plf.V.l!iOOEX.~
COMMONWEALTH OF
PENNSYLVANIA
OEPARTMENT OF REVENUE
DEPT. 260601
HARRISBURG, PA 17126-0001
I-
Z
W
C
W
(,.)
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Litman, Nellie Annie
DATE OF DEATH (MM-DO-Year)
v
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONL '(
FILE NUMBER
2 1 -0 2 0 5 6
""CQijNrvCOO'E ---vEA~ - - NUM'BER--
SOCIAL SECURITY NUMBER
DATE OF BIRTH {MM-DD-Year)
2 06- 1 0 - 4 0 8 2
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
05/15/2002 12/26/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
3 Closely He~ Corporation, Partnership or Sole-Propnetorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. JoinUy Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter.vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
6. Total Gross Assets I!otallin.. 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts 01 DeceUenl. Mortgage liabilities, & liens (Schedule I) (10)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estale (Line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
w
!;j
",-Ill
,,"''''
w~8
:1:",...
CJ~fD
..
z
o
i=
:3
::l
I-
0:
c:z:
(,.)
w
a:
cnON MUST BE COMPLf:TEO ALL 0
!RIl. Onginal Retum
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
I-
Z
W
o
z
o
"-
III
W
'"
'"
o
"
NAME
R. Mark Thomas, Es
FIRM NAME I" Ap.'cable,
TELEPHONE NUMBER
717.796.2100
SOCIAL SECURITY NUMBER
o 2. Supplemental Retum
o 4a. Future Interest Compromise (drte of death aftef 12.12.S2j
o 7. Decedent Maintained a Living Trust (Allach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prklrto 12.13.82)
o 5. Federal Estate Tax Return Required
_ 6. Total Number of Safe Deposn Boxes
D 11. Election to tax under Sec. 9113(A) 1_''''0)
I, Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
ENCE AN CON '1NFORMAllON SHOUl
COMPLETE MAILING ADDRESS
101 S, Market Street
OlRE EO TO:
Mechanicsbur
PA 17055
OFFICIAL USE ONLY
(1)
(2)
6,148.67
156.49
6,305,16
6,148,67
14. Net Value Subject to Tax (Line 12 minus Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
0,00
z
o
S
::l
D.
:2
o
(,.)
~
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
X _(15)
X _(16)
X .12 (17)
X .15 (16) 0,00
(19) 0,00
20 D
> > BE SURE TO ANSWERALL C1UESTlONSON ReYERSE SIDE AND RECHECK MATH < <
.
.
Decedent's Com
STREET ADDRESS
lete Address:
Rr~
f\'\tA..- lLe--\.. s+- -
W--Hl
STATE P A-
ZIP
17Dl/
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + 8 + C) (2)
3. InteresUPenalty if applicable
O. Interest
E. Penalty
TotallnteresUPenalty (0 + 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 Ihe difference. This is the TAX DUE. (5)
A. Enter the interest on the lax due. (5A)
8. Enler the total of Line 5 + 5A This is the BALANCE DUE. (58)
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; u.u.uuuuuuuuuu___u.uuuuuuuuuuuuuuuuuuuuu. 0 IXI
b. retain the righl to designate who shalt use the property transferred or its income; uuuuuuu.uuuuuuuuuuu.u 0 IXI
c. retain a reversionary interest; or Uu.UuUuuuuuuuuuuuuuuuuuu___uuuuuuuuuuuuuuu.uuuuuuuuuu. 0 IXI
d. receive the promise for life of either payments, benefits or care? u.uuuuuuuuuuuuuuuuuu.u.uuu,.uuuuu 0 IXI
2. If dealh occurred after December 12,1982, did decedent transfer property within one year of dealh
without receiving adequate consideration?....,.... ............... ...u..................uu................................... .... .... 0 IXI
3. Did decedent own an 'in trust for' or payable upon dealh bank account or security at his or her death? uuuuuuuu. 0 IXI
4. Did decedent own an Individual Retirement Account, annuity, or olher non-probate property which
contains a benefiCiary designation? uUUu.uuuuuuuuuuuuuuuuuuuuuuu.uuuuuu.uuuuuuuuuuuuuu.u.u 0 IXI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have ex;vnined this return, includinQ accompcYlying schedules and slatemeflls, and 10 the best of my knowledge and belief, it is true, correct
and compjete.
Declaration of preparer other than the personal representative IS based on all mformation of which preparer has any kn e.
SIGNATURE pF PE SON RESP SI OR Fill ETURN DAT
tJtVl , It- L"".3
ADDRESS 712 Alison A
Mechanicsburg
SIKN~cpz~~SENTATIVE
ADDRESS 101 S. Market Street
Mechanicsburg
PA 17055
,//5 r./11_3
/ ,
PA 17055
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 PS. 99116 (a) (1.1) (i)l.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers 10 or forthe use of the surviving spouse is 0% 172 P.S. 99116 (a) (1.1) (ii)].
The stalute does nol exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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% 172 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of Iransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, excepl as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)J.
The tax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is 12% [72 P,S. 99116(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.
.
"',....".,,"'.
COMMONWEAL lH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
I ilman Nellie Annie
FILE NUMBER
?1 02
0516
Include the proceeds of titigation and the date the proceeds were received by the es\ate. All property jointly-owned with the right of ,urvivorshlp must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
Payments (refunds) from Manor Care Trust Fund
VALUE AT DATE
OF DEATH
6,148.67
TOTAL (Also enter on tine 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6,148.67
'''''''".,,'''.
COMMDNW'EAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Litman NAUiA Annip.
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
fiLE NUMBER
21
02
0516
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Michael J. Bartell
712 Alison Ave.
Mechanicsburg, PA 17055
Nephew
B
c
JOINTL Y.OWNED PROPERTY
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FQRJOINT MADE Include name 01 financial inslitulkm and bank accounl number or similiY identifying number. AUoch DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOiNT deed lorjoinrty-lIeld real estale VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A. 1999 Pennsylvania State Bank 312.97 50. 156.49
PO Box 487
Camp Hill, PA 17011
TOTAL (Also enter on line 6. Raeapilulalion) $ 156.49
(If more 508ce is needed. insert additional sheets of !he same size)
. '.~
"v."''''.('.''(~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Litman Nellie Annie
21
02
0516
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES
1 Cremation 250.00
2. Memorial Service 175.00
3. Dinner
4. Travel (Decedent lived in Arizon for 28 years until her husband died in 1999. Just 1,511.76
prior to her death she requested that her nephew take her ashes to Arizona and spread
them where her husband's ashes had been spread. Travel expenses include airfare,
lodging, and medication for air sickness)
B. ADMINISTRATIVE COSTS
1 Personal Representative's Commissions
Name of Personal Representative (s) Michael Bartell 441.37
Social Secunty Number(,) I EIN Number of Personal Representative(,)
StreefAddress 712 Alison Ave.
City Mechanicsburg State PA Zip 1 7055
Year(s) Commission Paid:
2. Attorney Fees R. Mark Thomas, Esq. 300.00
3. Family Exemption: (If decedenrs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 40.00
5. Accounlanrs Fees
6. Tax Return Preparer's Fees
7. Veteran's Administration Reimbursement 90.00
TOTAL (Also enter on line 9, Recapitulation) $ 2,808.13
(If more space is needed, insert additional sheets of the same size)
. .
"',.""".,,..".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Litman Nellie Annie
Include unrelmbursed medical expenses.
ITEM
NUMBER
1.
2.
Holy Spirit Hospital
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
DESCRIPTION
Department of Public Welfare
FILE NUMBER
21
O?
0516
AMOUNT
222.54
3,118.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
3,340.54
.
,
R'V1513'X"9*.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
1 ;'mon ~IQ"iQ /lnn;Q
NUMBER
I.
1.
2.
3.
4.
5.
6.
7.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include oulr~ht spousal distributions. and transfers under
Sec. 9116(a) (1.211
FILE NUMBER
'01 I'l'O
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
I'l'"''
AMOUNT OR SHARE
OF ESTATE
Michael J. Bartell
712 Alison Ave.
Mechanicsburg, PA 17055
Mima J. Willis
1267 Ritner Hwy.
Shippensburg, PA 17257
Sally Shaul
47 Hale Road
Shippensburg, PA 17257
Richard Sommerville
377 Pleasanlview Rd.
New Cumberland, PA 17070
James Sommerville
254 Scotts Creek Road
Stalesville, NC 28625
John Sommerville
47 Hammond Road
Walnut Bottom, PA 17266
Lou Ann Neidigh
1110 N. RI. 934
Annville, PA 17003
Nephew 1/11
Niece 1/11
Niece 1/11
Nephew 1/11
Nephew 1/11
Nephew 1/11
Niece 1/11
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
" , NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRiBUTIONS
,.
TOTAL OF PART 1\ - 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)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Litman, Nellie Annie
21
02
0516
Paae 1
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONfSI RECEIVING PROPERTY Do Not List Trustee/sl OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
8. Patricia Carelli Niece 1/11
410 Sharon Ave.
Mechanicsburg, PA 17055
9. Herbert Sommerville Nephew 1/11
126 W. Burd St.
Shippensburg, PA 17257
10. Garry Sommerville Nephew 1/11
2604 Banbury Lane
Chambersburg, PA 17201
11. Donald Chamberlain Nephew 1/11
10639 Tonyard Hill Rd.
Orrstown, PA
-
000584
P2 1539307
Check Dlle: 03 19 2003 Check No. 0002386011
Invoice Number Invoice Date Voucher 10 Gross Amount Discount Available Paid Amount
99026 03-05-2003 00012839 4090.82 .0. 4090.82
.-..........................
. .
Vendor Number Name Total Discounts
0000200248 NELLIE LITMAN .00
Check Number Date T Dial Amount Discounts Taken Total Paid Amount
0002386011 03-19-2003 4090.82 4090.82
.
,
+
REMOVE DOCUMENT ALONG THIS PERFORATION
+
THIS DOCUMENT IS PRINTEO IN TWO COLORS. 00 NOT ACCEPT UNLESS BLUE AND BROWN ARE PRESENT.
I",~',:!'~,'t:/..::"~"...',';:':~""';,'~":~,:,"I" \'i.~.:%."'<' H,'r,'),'~."Zj,h~,i.....1lCR<'. ""'~-'~.. - ,--," ..' ':~:: .,,:'1,"
.. '..~ .' '. "~""'Il '111'''''"' ' , " .' .. . .
ManDt. . ~I;t:u...alril!"li',t .",
170""'M', k 'st..~.,..i'.'.i ,I., .. .. .. ." .
u"'",OO t 1,"'"" r,ee ",""'1 :~,\"','~,,,'''', ."',, _'. :"'",.' ,'" ",
CamJl'.... ',II ",:,;'r""." . '~' '!"""i:1'lll ". VOlll AFtER 60 DAys
,,,,,. ""',,, .~,!~., "A ...'."..'w., 10 .,",
."." .' .'.".., .' "" DATE 03-19-2003
,:::",':,:',"i _ r'~? f;.;i\~h~, ,i':"'",,,~,,:,,:, .","",,:,:,'.
.F6u~f;fl~~us.ftd '., Nine\V;' ~~J.~21 i 60
'm' 'k i<;',t" .,:;.[~. ~a...."..,....""..,..'....."" .',
~'" ,;J"tI.J:i?' ..1..1; , ,', '",!,~:>"f,\',,''' -":w"'''',''''/'
1 SF AliLISt>'A VE ~ "W,!:~:'~r' ,I".:;,,,, W'.i '
IJb.,' 6002386011
"'"
1o"l!11
.ot
~~IJ;:
f"M~"
.J~f
ORDER
OF
AMOUNT
...........4,090.82
MEcitANrcSBURO
:~',,?I'th.Hdat~.p N~t~~.fAi-~kj
" Wutt"iIW,'Ohlo c" -', ',1
pA 17066
4kl~h:':fZ.~7
""-;,,'-',,.'",,''''''''''
11'000 2:181;0 ~ ~II' ':01.,1., ~ ~5 ~ 21;1: 0 ~L,7 2 ~ ~71; ~L,II'
.
.
HCR - ManorCare
ManorCare Health Services - Camp Hill
Resident Trust Statement
06/051200201:39 PM
05/01/2002 Through 05/31/2002
Page I
Legal Representative
Resident # 99025
Litman, Nellie S
1100 Grandon Way
Mechanicsburg P A 17055
f'(\~J (6~
-, \.;).. ~OY\.. Av-t..
me"JIO""..Cl>bU PA \'1()SS'
Bank:
Acct #:
Admit:
Disch:
First Union
2020000104913
0811711999 J2:42:oo P
05115120021:55:00 A
$1,246.85 I
Beginning Balance
Date
Description
Check#
Withdrawals Deposits
Balance
0510312002 US Treasury
0511712002 Closing RTF
$811.00
$2,057.85
$0.00
$0.00 I
1119
$2,057.85
Ending Balance
Resident Trust Fund Statement - This is not a bill
First Union
2020000 104913
'.
.
COMMONWEALTH OF PENNSYLVANIA
OEPARTM~T OF PUBLIC WELFARE
BUREAU OF ~INANC'AL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 6486
HARRISBURG, PA 171~
July 09, 2003
R MARK THOMAS
ATTORNEY AT LAW
101 SOUTH MARKET
MECHANICS BURG PA
STREET
17055-3851
Re: NELLIE LITMAN
CIS #: 040152882
SSN: 199-07-6717
Date of Death: 05/15/2002
Dear Mr. Thomas:
please be advised that the Department of Public Welfare maintains a
claim in the amount of $26,796.26 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $16,860.04, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $9,936.22, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copi.. of the deed, the latest tax assessment,
and a current appraisal, if available.
2iTc:/0d;
Nic\ne L. Early .
TPL Program Investigator
717-772-6606
717-772-6553 FAX
Enclosure
--DEe 2J 2003 10
14A1~
DPW ?RD PARTY llABlllTY
"", -^" ^
I~\.J ) d.::' ~
~
1
,
. .
*'
COMMONW~l."'H Or peNNSYlVANIA
OEF'A~TMENT O~ "'UBL.IC welFARE"
BuJl:f,AU OF FINANC'''l OPERATIONS
OIV!SJON OF Tl-IjRD PARTY LI.Uurv
E!JTA'TE ~ECOVERY PROGRAM
PO BOX Bite
HARRIS&URO. PA 17105-Il~H
December 23, 2003
R MARK THOMAS ESQUIRE
101 SOUTH MARKET STREET
MECHANICSBURG PA 17055-3651
Re, NELLIE LITMAN
CIS #, 040152882
SSN, 199-07-6717
Date of Deatn' 05/15/2002
Dear Mr. Thomas,
Th,a letter is to advise you that according to the information you
provided to our office regardiug the assets of the above'-referenced estate,
the Department of PUblic Welfare will accept the balance, namely S3,274,49
remaining in the estate for payment of our existing claim.
Pleaee have the check made payable to the Department DE Public Welfare
and forwarded to my attention at the above address.
Your cooperation in resolving this matcer is appreciated.
Sincerely,
lM/2~
Nlcole t. Early
TPL program Investigator
717-772-5606
717-772-6553 FAX
. '
..
.
g;enn ~~~I
PO BOX 966
HARRISBURG, PA 17106-0966
800 900-1381
Hours: Mon-Fri 6am-l0pm, Sat6am-2pm
(Eastern Standard Time)
2003/02/10
~G~O.' '"
,,~~.....~
( ,&:1. .., i
"~~:il' ~
... .;'-OW ...,
~)o:~ .""
""M.U10. .
11111111111111111111111111I11111111111111111111111
ID C1590256
NELLIE LITMAN
1700 MARKET ST
CAMP HilL, PA 17011-0000
CLIENT: Holy Spirit Hospital
TOTAL BALANCE DUE: $222.54
The below referenced accouni(s) has been referred to this office for collection. All future payments and communicaUons
should be directed to Penn Credit Corporation.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion
thereof, this office will assume this debt is valid. If you notify this office in wrtting within 30 days from receiving this notice,
this office will obtain verification of the debt or obtain a copy of a judgement and mall you a copy of such judgement or
verification. If you request this office in writing wtthin 30 days after receiving this notice, this office will provide you wtth the
name and address of the original credttor, If different from the current credttor.
SERVICE RENDERED
SERVICE DATE ACCOUNT NUMBER
BALANCE
MEDICAL BILL
LITMAN, NELLI E
2001/08/04 17302746
$222.54
This letter is from a debt collection agency. This is an attempt to collect a debt.' Any information obtained will be used for
that purpose. If you have an Attorney to represent you or have flied bankruptcy, please disregard this letter and furnish us
with the appropriate information so we may mark our flies accordingly.
Detach and return with payment to expedite credit to your account
2003/02/10
Call our toll free number and pay using check by phone.
If you wish to pay by credit card, please enter the requested
Information in the spaces provided.
Check one: 0 Visa
o Mastercard
~~~----------------
Expiration Date: --.J /
NELLIE LITMAN
1700 MARKET ST
CAMP Hill, PA 17011-0000
,.
ID NUMBER: C1590256
BALANCE DUE: $222.54
Signature:
0000022254 201590256000 01
PENN CREDIT CORPORATION
NBlPCOl
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 4/07/2005
BARTELL MICHAEL J
712 ALISON AVE
MECHANICSBURG, PA 17055
RE: Estate of LITMAN NELLIE ANNIE
File Number: 2002-00516
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 counsel, 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:
5/15/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~=~~
REGISTER OF WILLS
cc: File
Counsel
Judge
~
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA
Name of Decedent: Nellie Annie Litman
Date of Death:
5/15/2002
File No.
2002-00516
Pursuant to Rule 6.120f the Supreme Court Orphans' Court Rules, I report the following with respect
to the completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
YES X NO
2. If the answer is "No", state when the personal representative reasonably believes that the
administration will be complete:
3 If the answer to NO.1 is "Yes", state the following:
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:
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 Orphans' Court and may be attached to this report.
~r
~~~
Signature
R. Mark Thomas, Esq.
Name (Please type or print)
101 S. Market St.
Address
Date 5/3/2005
Mechanicsburg
PA 17055
717-796-2100
Tel. No.
Capacity: Personal Representative
X Counsel for personal representative
o
cI'
.
"
NOTICE
TO: Michael Bartell, Personal Representative
FROM: Kirk Sohonage, Solicitor for the Register of Wills
DATE: January 14, 2005
SUB: Additional Probate Fees
Decedent:
Nellie Litman
Estate No.:
21-02-516
In an annual review of all estates and accounts, it has come to our attention the above
listed estate owes additional probate fees in the amount of$ 15.00.
Our records indicate that you are the personal representative or counsel for the same in
the above listed estate. Probate fees are estimated at the time of petitioning for letters.
Final probate fee amounts are determined by the value of the estate as reported on the
inheritance tax return filed in our office for the Department of Revenue.
The additional probate fee should be made payable to "Register of Wills" and be
forwarded in the enclosed envelope within 15 days of this notice.
If you feel you have received this notice in error, kindly contact the Register of Wills
directly at (717) 240-5411 and she will be happy to review the matter.
.
Marjorie A. Wevodau
First Deputy
One Courthouse Square
Carlisle, Pa. 17013
Glenda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court
(717) 240-6345
FAX (717) 240-7797
Kirk S. Sohonage, Esquire
Solicitor
OFFICES OF
!\eg{ster of mtus anb <!Clerk of !be ~rpbans' <!Court
((ount!> of ((umbedanb
NOTICE
TO: Michael Bartell, Personal Representative
FROM: Kirk Sohonage, Solicitor for the Register of Wills
DATE: January 14,2005
SUB: Additional Probate Fees
Decedent:
Nellie Litman
Estate No.:
21-02-516
In an annual review of all estates and accounts, it has come to our attention the above
listed estate owes additional probate fees in the amount of$ 15.00.
Our records indicate that you are the personal representative or counsel for the same in
the above listed estate. Probate fees are estimated at the time of petitioning for letters.
Final probate fee amounts are determined by the value of the estate as reported on the
inheritance tax return filed in our office for the Department of Revenue.
The additional probate fee should be made payable to "Register of Wills" and be
forwarded in the enclosed envelope within 15 days of this notice.
If you feel you have received this notice in error, kindly contact the Register of Wills
directly at (717) 240-5411 and she will be happy to review the matter.
'V~
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