HomeMy WebLinkAbout03-0775 PETITION FOR PROBATE and GRANT OF LETTERS
also known as ~/~/t~./~ C~?tq To:
Register of 3IVills for the
Deceased. County
Social Security No. ~ ~ / t~- ~ ? 7_:5 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of ague or, older jt_n ~i~.e
in the last will of the above decedent, dated e..)i.tLU I,.9
and codicil(s) dated
in the
named
,19__
sin
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (~.I/3t~l~/~[ ~l.t~.~L Col,l~ty, P.~nrlsyl~gnia~with ~,
h'~.Lrff, lastfamilyolprincipalresi~lenceat Iq_% t~ o?(~ ~ q59~ )~]t[[,~, t'-IOIt
~/ /') - (list street, number and muncipality)
Decendent, then t] g years of age, died /qq~q:~ Iq x4&x , ~t~900 ~ ,
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:
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 l~n~.vlv~,
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(t~st~ntary; adminis~tion c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAl-TH OF PENNSYLVANIA
COUNTY OF ~/~/~ ~ } 88
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 the estate according to law.
Sworn to or af[irme~ and subscribed
before me.this ~r'~ day of
t/.~'t' ~L~[J-lx~ ~ Register
, / J
No.
Estate Of HELEN N CAIN A,K,A, HELEN CAIN , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW .~ ~ ~9~0~)3, 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 7-6-q 994
described therein be admitted to probate and filed of record as the last will of
HELEN N CAIN A.K.A. HELEN CAIN ;
and Letters TESTAMENTARY
are hereby granted to KATHERYN E HATTER
FEES
Probate, Letters, Etc ..........
Shor~ Certificates( ) ..........
~ x2u~.~....
TOTAL
Filed .9.: .'~..'.~.7.Q. ~ ....................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
,,g,i - ~- "7'/5
ep\wills\cain.hn\k\6-94
LAST WILL AND TESTAMENT
OF
HELEN N. CAIN
I, HELEN N. CAIN, of the Borough of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I: I direct that my Executor hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease.
ITEM II: I devise and bequeath all of my estate, of every nature
and wherever situate, in equal shares to such of my following named
children living at the time of my death: CANDACE R. CAIN, KATHRYN E.
HATTER, WALTER L. CAIN, JR., and CHRISTOPHER A. CAIN.
ITEM III: I appoint my daughter, KATHRYN E. HATTER, Executrix of
this my last will.
ITEM IV: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of her duties in
any jurisdiction.
IN WITNESS WHEREOF, I, HELEN N. CAIN, have hereunto set my hand
and seal this ~ day of ~QI~
1994.
~' HELEN N. CAIN
Page 1 of 3
SIGNED· SEALED, PUBLISHED and DECLARED by HELEN N. CAIN· the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed our names as witnesses.
W J ~ ' Address - - '
Witness
Address '
COMMONWEALTH OF PENNSYLVANIA:
:SS:
COUNTY OF CUMBERLAND :
I, HELEN N. CAIN, the Testatrix whose name is signed to the at-
tached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
HELEN N. CAIN
Sworn to or affirmed to and acknowledged before me by HELEN N.
CAIN, the Testatrix, this ~ day of ~U~.~
1994.
·
Notary Public
Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF CUMBERLAND :
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix signed willingly and that she executed
it 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; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint
or undue influen~
itne~ 9'~
Witness
Sworn to or affirmed to and acknowledged before me by
~~ ,, ~5~c and
witnesses, this , ~+k day of ~-~1~
Notary Public
Page 3 of 3
/.N~E~W~'~i~?L,~,ND, PA CU,6BERLAND CO. /
EXPIRES APRIL 13, 19951
LAST WILL AND TESTAMENT
OF
HELEN N. CAIN
STONE, LAFAVER & STONE
A PROFESSIONAL CORPORATION
ATTORNEYS AT LAW
414 BRIDGE STREET
bier6r CU/%IBERLAND, P.% 17070
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Al.
Date of Death: ~l iq [03
Will No. 6:~/° ~- /~r/~'" Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~//g/O 4/ :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ~/~h~/~/..~
Signature
Name ~ ~f~/,D
Address
Telephone (TIG 73 7- 5
Capacity: /Personal Representative
Counsel for personal representative
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 _ 03 0775
COUNTY COOE YEAR NUMBER
Z
Z
o
LU
D~
0
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
CAIN, HELEN N
DATE OF DEATH (MM-OD-YEAR) / DATE OF BIRTH (MM-DD-YEAR)
08/19/2003 / 01/18/1925
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
NONE
SOCIAL 'SECURITY NUMBER
209-16-6973
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~'~1. Original Return
[~]4. Limited Estate
r~-] 6. Decedent Died Testate (At. ch copy of Will)
r--i 9. Litigation Proceeds Received
E~2. Supplemental Return
~14a. Future Interest Compromise (date of death a~ 12-12-82)
r"--] 7. Decedent Maintained a Living Trust IAac~ co~)y of Trust)
---]10. Spousal Poverty Credit (dat~ of death between 12-31-91 and 1-1-95)
r---] 3. Remainder Return (date of dea~ ~ to 12.13-82)
['--~ 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
~11. Elect~on to tax under Sec. 9113(A) (Attach Sc~ O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME I COMPLETE MAILING ADDRESS
Kathryn E Hatter t 833 Meadow Lane
FIRM NAME (~fApp~ica~e) _ Camp Hill, PA 17011
N/A
~L E~)-N[ I~MB E R
(717) 737-3383
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (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)
--]Separate Billi~ Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Pmpe~ (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
193,000.00
~' · ~'~':'~ ::2
16 194 50~: ',~
'{ :,,:) :::¢:) ,
1,807.17
(8) ~ 211,001.67
23,113.68
47,710.32
- (11)
70,824.00
140,177.67
140,177.67
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling tale
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
.... x .0 (15)
_. __ x .o 4~5 (16)
x .12 (17)
x .15 (18)
(19)
6,308.00
6,308.00
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
145 N 26th Street
C~TYcamp Hill I STATEpa
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits~Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
(1)
] Z~P17011
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
6,308.00
0.00
6,308.00
6,308.00
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 properly transferred or its income; ............................................ [] []
c. retain a reversionary 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 one year of death
without receiving adequate consideration? ...................................................................... :~._: ................................ :.. [] []
3. Did decedent own an "in trust for" 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? ........................................................................................................................ [] []
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 pequry, I declare that I have examined this return, including accompanying schedules and statements, and to the best o~' my knowt~sdge and belief, it is true, con'ect and complete.
Declaration oi' preparer other than the personal represenlative is based on all iMormation of which preparer has any knowledge.
ADDRESS
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.t) (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 benefidary.
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.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
CAIN, HELEN N 21-03-0775
All real property owned solely or as a tenant in common must be reported at fair market value. Fair mad(et value is defined as the pdce at which property would be exchanged
be~een 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Frame
145 N
Two-Story 2 Unit
26th Street
SOLD at Auction to
mentioned amount
SETTLED on 1/14/2004
TRANSACTION COMPLETE
50% Owner Occupied
Camp Hill, PA 17011
Public 12/15/2003 for above-
- SETTLEMENT SHEET
193,000.00
TOTAL (Also enter on line 1, Recapitulation) $ 1 9 3,0 0 0.0 0
(If more space is needed, insert additional sheets of the same size)
Conestoga Title Insurance Co.
Settlement Statement
u.s. Department of Labor and Urban Development
123 East King Street, Lancaster PA 17602
Phone 1-800-732-3555 In l.~ncaster 299-4805
FAX 717-295-7155
OMB No. 2502-0265
A. HUD-1 UNIFORM SETTLEMENT STATEMENT
B. Type of Loan
1. [ ] FHA 2. [ ] FmHA 3. [ ]Conv. Unins. 16. File Number: 17. Loan Number:
4. [ ]VA 5,[ ]Conv. lns.
I
I
C. NOTE: This form furnishes a statement of setUen
were paid outside the closing; they are shown
8. Mortgage Insurance Case Number:
D. Name & Address of Borrower:
Kenneth S. Holllnger, Anna L. Hollinger
250 Beetem Hollow Road
Newvllle, PA 17241
~tUement costs. Amouts paid to and by the settlement agent are shown. Items marked "(p.o.c)"
,r informaUonal purposes and are not included in the totals.
E. Name, Address and TIN of Seller. F. Name & Address of Lender:
Estate of Helen N. Cain, Kathryn E. Hatter, Executrix
833 Meadow Lane
Camp Hill, PA 17011
TIN of Seller: I
Place of Settlement: I
44 West Main Street H. Settlement Agent:
Mechanicsburg, PA 17055 Richard C. Snelbaker
(717) 697-8526 FAX-(717) 697-7681
Date of SetUement: I January 14, 2004
K. Summary of Seller's Transaction
400. Gross Amount Dueto Seller
$193,000.00 401. Contract sales price $193,000.00
402. Personal property
$1,969.50 ¢03
404
405
~ce Adjustments for Items paid by seller In advance
406. City/town taxes to
407. County taxes to
408. Assessments to
~/30/04 $832.45 409. School Tax 01/14/04 to 06/30/00 $832.45
~/04 $55.41 410. Sewer 01/14/04 to 06/30/04 $55.41
412
413
$195,857.36 420. Gross Amount Due to Seller $t93,887.0,3
500, Reductions in Amount Due to Seller
$12,000.0(1 501. Excess deposit (see instructions) $12,000.00
502. Settlement charges to seller (line 1400) $2,005.88
503. ExlsUng loan(s) taken subject to
504. Payoff of first mortgage $42,205.98
'505. Payoffof second mortgage
506
507
508
509
Adjustments for items unpaid by seller
/14/04 $26.36 510. City/town taxes) 01/01/04 to 01/14/04 $26.36
511. County taxes) to
512. Assessments to
513 to
514. Escrow for Pa. Inher Tax to
515 Snelbaker, Brenneman & Spare, P.C. $8,685.00
516
517
519
$12,026.36 520, Total Reduction of Amount Due to Seller $64,923.22
600. Cash at Settlement To/from Seller
$195,857.36 601. Gross amount due to seller (line 420) $193,887.81;
) $12,026.30 602. Less reductions In amount due seller (line 520) $64,923 ??
$183,831.00 503. Cash [ X]to [ ] f~o,, Seller $128,964.64
G. Property Location:
145 North 26th Street
Borough of Camp Hill
Cumberland County, Pennsylvania
J. Summary of Borrower's Transaction
100. Gross Amount Due from Borrower
101. Contract sales pdce
102. Personal property
103. Borrower's settlement charges (line 1400)
104. Mortgage Payoff
105
Adjustments for items paid by seller In advanc~
106. City/town taxes to
107. County taxes to
108. Assessments to
109 School Tax 01/14/04 to
110. Sewer 01/14/04 to 06/;
111
112
113
120. Gross Amount Due From Borrower
200, Amounts Paid by or in Behalf of Borrower
201. Deposits or earnest money
20Z Principal amount of new loan(s):
203
204
205
206
2O7
208
:209
Adjustments for Items unpaid by seller
210. City/town taxes) 01/01/04 to
211. County taxes) to
212. Assessments to
213 to
214
215
216
217
218
220. Total Paid By/for Borrower
300. Cash at Settlement From/to Borrower
301. Gross amount due ;rom borrower (line 120)
302. Less amounts paid by/for borrower (line 22£
303. Cash tX]from [ ]to Borrower
tute Form 1099 Seller Statement
The information in Blocks E, G, H, I & line 401 (or if line 401 Is asterisked, line 403 and 404) Is important tax Information and is being furnished to
the Internal Revenue Service. If you are required to file a retum, a sanction will be Imposed on you if this Item is required to be reported and the
IRS determines that it has not been reported. If this real estate is your principal residence, file FORM 2119, Sale or Exchange of Principal
Residence, for any gain, with your income tax retum; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or
Schedule D (Form 1040). You are required to provide the SetUement Agent (named above) with your taxpayer identification number. If you do not
provide the Settlement Agent with your taxpayer identification number, you may be subject to civil or criminal penalties imposed by law, Under
penalties of perjury, I certify that the number shown on this statement Is my correct taxpayer identification number.
Seller Seller
L. Settlement Charges
700. Total SaleslBroker's Commission: (based on price) @ Paid from Paid from
Division of Commission (line 700) as follows: Borrower's
701 Funds at i Seller's Funds at
702 Settlement Settlement
703. Commission paid at Settlement
7O4
800. Items Payable In Connection with Loan
801. Loan Origination Fee
802. Loan Discount
803. Appraisal Fee
804. Credit Report to
805. Lender's Inspection Fee
806, Mortgage Insurance Application Fee
807. Flood Cerfilication Fee to
808. Tax Service Fee to
809. Document Preparation Fee
810. Plan Review to
811. Construction Administration to
812
813
814
900. Items Required by Lender to Be Paid In Advance
901. Interest from to @ per day 0.00
902. Mortgage insurance Premium for
:903. Hazard Insurance Premium for
904
905
1000. Reserves Deposited with Lender
1001. Hazard Insurance months @ per month 0.00
1002. Mortgage Insurance months @ per month 0.00
1003. City property taxes months @ per month 0.00
1004. County property taxes months @ per month 0.00
1005. Annual assessments months @ per month 0.00
1006. School taxes
1007 months @ per month 0.00
1008
1009. Aggregate Accounting Adjustment
1100. Title Charges
1101. SetUemenUclosing fee
1102. Abstract/tile fee
1103. Title examination to Snelbaker, Brenneman & Spare. P.C. P.O.C.
1104. Title insurance binder
1105. Document preparaUon
1106 Notary fees
1107 Attorney's fees to Samuel L, Andes, Esquire
(includes above Item numbers P.O.C.
1108. TrUe Insurance to Kelth O. Brenneman, Agent, Conestoga TrUe Insurance Company
(includes above item numbers 1101-1106)
109. Len-'"~'~eCs ~_,o~ ~
1 110 Owner's coverage
1111. Insured Closing Letter from Conestoga Title Insurance Company to
1112. Endorsements -
1113
1200. Government Recording and Transfer Charges
1201. Recording Fees: Deed: $39.50 Mortgage: MIL SUp: 39.50
1202. City/county tax/stamps Deed: $1,930.00 Mortgage: 1,930.0"--'--'---'-"--'~
1203. State tax/stamps Deed: $1,930.00 Mortgage:
1204 ~ ~ 1,930.00
1205
1206
1300. Additional Settlement Charges
1301. Survey
1302. Pest inspection _._.._.________
1303. Sewer Bill (1/2 year) to Borough of Camp Hill
1304 Overnight delivery re mortgage payoff to Snelbaker Brenneman & Spare, P.C. (Fed. Ex.) ~ ~60'00
!1305 ~ 15.88
1306
1307 --------------.----
1308
1400. Total Settlement Charges (This number transfers to Lines 103 & 502 Above) ~1,969.5--~
2,005.8~
Certification
I have carefully reviewed the HUD 1 SetUement Statement and to th~ h,~
ge and belief, it is a true and accurata statement of all
S[atementreciepts and disbursements made on my account or by me in this transaction. I further certify thai I have received a copy of the HUD-1 Seltiement
[',,./?c')g~. ~'-' '~/C.~¢?~,.. .... ~-~- Estate of Helen N. Cain
· ' - ~ ' ,-- Purchaser
~Anna~ L. Hollinger ¢- ~" ",
'~"~?-'~"<'-'~'-'"'--(" "~ ~' *'~.'~ "~--%:--, ,Purohaserr
Ken'~eth S. HolJinger (¢ f:(athryn E. ¢l~tter. Executrix
Seller
To the best kn,0~ the HUD-1 Settlement Statement which I have oreoared is tnm ~nd
REV-1508 EX * (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF -- FILE NUMBER
CAIN, HELEN N 21-03-0775
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
Mid Penn Bank
4622 Carlisle Pike
Mechanicsburg, PA 17055
Acct # 901-510-8
in the name of Kathryn E Hatter onl~'~
for the sole use of the funds of the decedent
for bill paying during illness and hospitalizatoion
and for the purpose of holding the security funds
Date of Death Bank Balance'Attached
1990 Plymouth Sundance
SOLD privately on 1/13/2003
Transfer paperwork Attached
Household Furnishings
Clothing and Personal Items
Jewelry
TV/VCR
Silverware
Misc Housewares and Tools
Prepaid Funeral Expenses
Malpezzi GFuneral Home
8 Market Plaza Way
Mechanicsburg, PA 17055
Sale of Home Settlement CredO.ts
School/Real Estate Taxes Paid and Credited
Sewer Charges Paid and Credited
TOTAL (Also_enter on line 5, Recapitulation)
VALUE AT DATE
OF DEATH
5590.64
1800.00
1275.00
425.00
225.00
110.00
75.00
200.00
5606.00
832.45
55.41
$ 16194.50
(If more space is needed, insert additional sheets of the same size)
Main Office:
349 Union Street
Millersburg PA 17061
Dauphin County
(717) 692-2133
(717) 896-3140
Mortgage Center:
(717) 692-2133
Trust Division:
(717) 692-2133
December 30, 2003
Re: Kathryn Hatter
833 Meadow Lane
Camp Hill, Pa 17011
MID PENN BANK
www. tnidpennbank, corn
Capital Reaion Offices:
4098 Derry Street
Harrisburg PA 17111
(717) 558-2144
2615 N, Front Street
Harrisburg PA 17110
(717) 233-7380
4622 Cadisle Pike
Mechanicsburg PA 17050
(717) 781-2480
1001 Peters Mtn. Road
Dauphin PA 17018
(717) 921-8899
Other Offices:
School Road, PO Box 205
Dalmatia PA 17017
(570) 758-2721
2 E Main Street
(717) 362-8147
Halifax Shopping Plaza
3763 Peters Mtn Road
Hatifax PA 17032
(717) 896-3140
550 Main Street
Lykens PA 17048
(717) 453-7185
Tower City PA 17980
(717) 647-2157
7*9 E Main Street
(570) 695-3358
Member FDIC
To Whom It May Concern:
I am writing this letter in verification of the balance of checking account 901-510-8
owned by the above referenced customer. The balance in this account as of August
19,2003 was $5,590.64.
Sincerely,
Kelly Kunkle
Head Teller/CSR
Carlisle Pike Branch
Since 1868
October 14, 2003
Kathryn E. Hatter
833 Meadow Lane
Camp Hill, PA 17011
Malpezzi Funeral Home
8 Market Plaza Way
Mechanicsburg, PA 17055
(717)697-4696
The Funeral Service for Helen N. Cain
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can.
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff $3260.00
FUNERAL HOME SERVICE CHARGES ............ $3260.00
SELECTED MERCHANDISE:
Poplar Casket $1865.00
Grave Liner $640.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $5765.00
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO
OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Opening Grave $500.00
Cemetery Equipment $95.00
Newspaper Notices - Local $166.50
Newspaper Notices - second day $88.8(I
Clergv/Mass Offering. $100.00
Organist $75.00
Certified Copies of the Death Certificate ................. $24.00
Flowers $106.00
Food for reception $90.00
Church caretaker 550.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES ........ $1295.30
CONTRACT PRICE ................... $7060.30
HISTORY
08/24/2003 Payment '"~. $-5606.00
TOTAL AMOUNT DUE .................. $1454.30
Pleas.~
REV-1509 EX * {1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
CAIN, HELEN N 21-03-~775
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A.Kathryn E Hatter
833 Meadow Lane Camp Hill, PA 17011
JOINTLY-OWNED PROPERTY:
Daughter
LE~ER OATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT ~DE Include name of financial inslilution and bank account numar or similar identi~ing numar. A~h DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT de~ for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES'
1. A. 10/02 PNC BANK
Firstside Center
500 First Ave, 4rth Floor
Pittsburgh, PA 15219-3128
Account # 5140117334 Checking 1507.17 100% 1507.17
Account # 5130063512 Savings 300.10 100%
300.10
NOTE: Entire value ofeAccounts
is included because the
funds were held for the
benefit of the decendent
Helen N Cain
TOTAL (Also enter on line 6, Recapitulation) $ ~ ~)~. j q
(If more space is needed, insert additional sheets of the same size)
PNCBAbK
January 9, 2004
Ms. Kathryn Hatter
833 Meadow Ln
Camp Hill, PA 17011
scp
RE:
Estate of Helen L Cain (Deceased)
SSN: 209-16-6973
DOD: 08-19-2003
Dear Ms. Hatter:
In response to your request for Date of Death balances for the customer noted
above, our records show the following:
Checking Account
Account-g5140117334 Established 10-08-2002
HELEN N CAIN
KATHRYN HATTER
DOD balance: $1,507.17 Non interest bearing account
Savings Account
Account#5130063512 Established 10-08-2002
HELEN N CAIN
KATHRYN HATTER
DOD balance: $300.00 + $0.10 accrued interest
Safe deposit box
The decedent maintained safe deposit box #657N. It was in one name only.
HELEN N CAIN
It is located at:
CAMP HILL
2101 MARKET STREET
CAMP HILL PA 17011
717-761-2372
Page 1 of 2
Please note that this office only provides date of deatl~alances for deposit
accounts (IRAs, CDs, Checking and Savings accounts). We do not process any
financial transactions or provide statements. If you need assistance with any of
these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local
PNC Bank branch office.
Sincerely,
Erica L Schlegel
PNC Decedent Reporting
Firstside Center
500 First Ave, 4th F1 CIF
Pittsburgh PA 15219-3128
1-800-762-1775
Member FDIC
Page 2 of 2
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CAIN, HELEN N
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 -03-0775
Debts of decedent must be reported on Schedule I.
DESCRIPTION AMOUNT
ITEM
NUMBER
5.
6.
7.
FUNERALEXPENSES:
Malpezzi Funeral Home. Mechanicsburg, PA
DuPont Memorial - Headstone and Placement
West Shore Baptist Church Service Supplies
After-Service Reception-Supplies,Food,Cleaning
Hospital Staff ICU
Decedent's Burial Attire
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Kathr_vrt E
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address ~q M~c']c~ T,~
City C~.?,p Hill
Year(s) Commission Paid: 2 0 0 4
Attorney Fees Samuel L Andes, Esq
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
State PA Zip ] 7 0 ] I
Street Address
City
Relationship of Claimant to Decedent
State __ Zip
Probate Fees
Accountant's Fees
~x Return Preparer's Fees
SEE ATTACHMENTS
E~tate Advertising Costs
Auctioneer - Sale of Home Only 1%
Ads For Home Sale as required by above
Settlement Costs - Sale of Home
Taxes Due at Settlement (School)
Bank Service Charges 9/03 thru 1/04
7060.30
880.00
54.73
227.20
112.23
110.24
6330.00
3468.00
268.00
220.84
1930.00
394.00
2005.88
26.36
25.90
TOTAL (AIso enter on line 9, Recapitulation) $ .,,,~¢ il'~.~
(If more space is needed, insert additional sheets of the same size)
STATEMENT
DDRESS
DC5812
PROOF OF PUBLICATION
State of Pennsylvania,
County of Cumberland.
Richard Canazaro, Internet Director of THE SENTINEL,
of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of
general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th,
1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice
or publication attached hereto is exactly the same as was printed and published in the regular editions and
issues of THE SENTINEL on the following dates, viz
Copy of Notice of Publication
' EXECUTRIX NOTICE
Letters Testamenta~ on
~the Esta. ta of H EL_._._._._._._._.~N~...~.
;~ ~AIN,.late of. the..' ~
~Bo~ugh otCamp Hill, ~
~'Cuh~be~and Coun~¢
~pennsytvania, dece~ed. ~
have been granted to
the undersigned.
All persons knowing them*
selves to be indebted to
said Estate will make
payment immediately,
and those having claims
will present them for,
,ii. Kathryn E. Hatter
..... , .~ ~. Executrix,
833 Meadow Lane
Camp Hill, PA 1701,1
October 3, 10 & 17, 2003
Affiant further deposes that he is not interested in
the subject matter of the aforesaid notice or
advertisement, and that all allegations in the
foregoing statement as to time, place and character
of publicati~j
October 22, 2003
Sworn to and subscribed before me this 22th
day of October ,2003.
Notary Public
My commission expires:
I'¢OTARIAL SEAL
i ELLEN B. RUNDLE, Notary Public
Mechanicsbur9, Cumberland County
vly Come s.t~__o_n_ ~xP res_S_e, ptember-t
THE PATRIOT NEWS
THESUNDAY PATRIOT NEWS
Proof of Publication
UnderAct 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-New~ and The
Sunday Patriot-News newspapers of general circulation, printed and publishe~ 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 4th, 11th and 18th day(s) of October 2003.
.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 .-...'-¢,,-q~~ ..... ~ ............................
COPY s rv~o/*' 'and subscribed before ~..thi~_2.9th day/~Oc~03 A.D.
TerryL. RusselI, NotaryPubiic i/'~'~ - /~' L./' ~/ .... [.
City Of Harrisburg, DauCin County I NOTARY PUBLIC
Uy~ExCresJune6,2006 I-~y commission eXPires June 6, 2006
ESTATE OF HELEN CAIN
C/O KATHRYN E. HA'FI'ER
833 MEADOW LANE
CAMP HILL, PA. 17011
Statement of Advertising Costs
To THE PATRIOT-NEWS CO., Dr.
For publishing the notice or publication attached
hereto on the above stated dates
Total
$ 146.59
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-New8 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.
REV-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & UENS
ESTATE OF /~ ~j ~ ~l~)
Include unrelmbur~ed medical expenses.
ITEM
NUMBER DESCRIPTION
FILE NUMBER
I-0-5 - d77_
Wachovia Home Equity Loan Acct # 4386542211832982
Security Deposit Return on Rental Unit on Second Floor _.
EMS Transport on 7/23/03 and 8/6/03
Car Insurance Pending Sale of Decedent's Vehicle (Copy of transfer attached)
Homeowner's Insurance Pending Sale (Copy of Settlement Statement attached)
Mortgage Payments for Loan #-4386542211832982
Home Maintenance Pending Sale
Snow Removal
Light Fixture Repair
Cleaning
Locks Change for New Owner
Cat Vet Treatment, Food and Supplies
Utilities
~hone
Gas
Oil
Electric
Water
Cable TV
Sewer
Appliances for Rental Unit Pending Sale
Preparation of Home for Sale Painting and Supplies
Carpet Rmoval, Installation and Purchase due to Cat Damage
Blinds, cleaning, supplies for sale of honme
Additional Interest Charges at Settlement for
Wachovia Home Equity Loan accumulation of interest
NOTE? Death Balance ~NE I. $41680.55
Settlement Amount $42205.98
Refund due to pay-off Date - 31.97
Actual Pay Off 42174.01
Differnce charged to Estate -41680.55
=493.46
TOTAL (Also enter on line 10, Recapitulation) $
VALUE AT DATE
OF DEATH
41,680.55
300.00
119.50
151.00
125.00
288.80
90.00
35.00
96.00
144.50
143.01
75.97
327.98
257.38
152.55
35.86
35.00
477.00
1631.19
831.87
173.84
493.46
(~f mo~e space is needed, insert additional sMets of the same size)
Wachovia Bank N.A.
Balance Confirmation Services
P O Box 40028
Roanoke, VA 24022-7313
November 17, 2003
Reference ID: 752288
KATHRYN HATTER
833 MEADOW LANE
CAMP HILL, PA 17011
SUBJECT:
Verification / Confmmtion of Account and Balance Information provided for:
Customer: HELEN CA!N-(SSN# 20946-697~)~ ....
Date of Death: August 19, 2003
Revolving Credit Information
Account Account Date of Death Credit Date Date Times Legal Title
Type Number Limit Opened Closed Late
$41,680.55 5/14/2003 --- - HELEN N. CAIN
EQUITY LINE 438654221183298
No Safe Deposit Box found for customer.
* Date of death balance does not include accrued interest.
* If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were
made during that time period.
Servicenter Associate
Phone: (540)563-7323
ssp; ag
0000 000614
GOOD [] FAIR [] POOR TRADE-IN
~ CO-SELLER · 1, Sales Tax Due
x 7% (.07)
·(See no~e on reverse). ·
i C. LA.S/T..~E (OR FULL BUSINESS NAME) FIRST NAME MIDDLE INITIAL DATE AC.~UIRED/ lA Exem0tion : .
to 23'or O) ....
me: CO'PURC~-IASr;:R 1B~rst~t ' , 1B Second Assignment : '
- ' ..'~t':,5::~.'~::'~,~,~,~' .~ ' , '~ ' . .' .:
I COUNTY CODE
OF PINK COPY · ·
D. LAST NAME (OR FULL BUSINESS NAME) FIRST NAME MIDDLE INITIAL DATE ACQUIRED/
NO. of Cards · ·
CATY STATE ZIP CODE REFER TO COUNTY
USTING ON REVERSE S~DE ~ 6. Tran~for Fee
E.~... N~KE OF VEHICLE VEHICLE IDENTIFICATION NUMBER
~ 7. Inor~3~e Fee
~ MODEL YEAR .BODY TYPE (CP, TK, ETC.) CONDiTION · ·
8. Replacement
[] GOOD [] FAIR [].OCR Fee
F. ORIGINAL PLATE ~ Check One [] TRANSFER OF PREVIOUSLY ISSUED PLATETOTAL PAID9. 10.
BUR"'"U'PROOFOP""'[]'.' SFER..RE.OEMENTOFP._ATE --
TACHED.) [] TRANSFER OF PLATE & REPLACEMENT OF STICKER [Add 9 l 10) This Amount a~. ·
] EXCHANGE PLATE TO BE
ISSUED BY BUREAU PLATE NO:' ;: '~i" . · ! · ', ~ - '54."~, i'. ' REASON FOR REPLACEMENT
~ ~ TEMPORARY PLATE EXPIRES [] NEVER RECEIVED ILOST IN MAJL
i~~ ~'~"~d~ ~_'/ Year NOTE: If "NEVER RECEIVED" block is checked, a~plicent must complete Form MV_44.
i: TR~SFERRED FROM ~J~ NO. ~N
W.O~ ~ ~S .EIN~ ~S-m I RELATIONSH~P~O~UCAI'rr
WEIGHT INFO. REQ. REG. GROSS VV~
NCLUDING
(~= APPUC~LE)
LOAD
WT. (IF N:'PUCABLE)
I S CE COMR Y NAME POUCY NO. OR ' p
INFOR- ISSUED TEMPORARY REGISTRA'F1ONTO THE ABOVE APPMCANT, iN IS -;-- '-.:r----- ~- ~- -~- --,~
MATION COMPLIANCE wI'rH ALL APPUCABLE PROVISIONS OF THE VEHICLE CODE S~ ~_..~.GNATU~RE_. ~..~(..~,~._~.
G. ~/W~.?~H-?~Y--TH-A~-~T~-~/-~EHAVEEXAM~NEDANDS~GNEDTH~SFORMA:~r~H[TSC~M~t~ET1C~H~DTHATTHE~NF~RMATI~NG~VEN~STRUEANDC~RRECT F AN EXEMPTION
~ ~M~-U, ~ H~- ~'UHC. HASER FURTHER CERTIFIES THAT HE/SHE S AUTHORIZED TO CLAI IS EXEMPTION I/WE ACKNOWLE
PR~LE~E s)OR VEHICLE REG S~ONCS)FOR PAILURE TO ~=AIN ~,~C~ ~.~.I. ...... ' ........... ~Z~_V_~.~' LOSE MY/OUR OPE~TIN~
REGISTRATION. I/WE ACKNOWLEDGE THAT I/WE MAY BE SUBJECT TO A ........ ~R .,~?~,N.,S:B'.%'2~'"2_:,,.y.~_'fv_ns:~L¥L nc.I~II:H~-L) VEHICLE FOR THE PERIOD OF
FALSE STATEMENT THAT I/WE MAKE ON THIS FORM. ,.*~ ~*~. =~.m=tc~u ~o,utxO ~U~t~ IMVHI"5(JNMENT OF NOT MORE THAN TWO YEARS FOR ANY
i 1ST R.~~t ~or Authorized Signer (717)TELEPHONE'775/ '/NUMBER~! ~-. ISigna~lr/~~
ASSIGN- Signature of Co-Purchaser/TItle of Authorized Signer
[ MENT Signature of Co-Se~er
2ND Signature of Second Purchaser or Authorized Signer TELEPHONE NUMBER Signature of Seller
ASSIGN- ( )
MENT Signature of Co-Purchaser/TItle of Authorized Signer Signature o! Co-Seller
~"1' 1~I NOTI=: I'ac°'purchas°r°th°rthan¥°uropouso'slistodandyou ws~tthotitloto~ol,stod 8s'~o,RtTona~tsWith
Right of Survivorship' (On doath of OhO ownor, titlo goos to sur¥i¥1ng ownor.) CHECK HfiFIE [2. Othorwiso, tho titlo
will bo issuod as 'Tonants in Gommon' {On d.ath of oho owner, int~r~st of doeBasod ownor goo~ to his/h~r holm or
ostato).
NOTE: IF THE VEHICLE IS TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOCK [] . IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-IL.
MESSENGER NUMBER:
2. DEALER/ISSUING AGENT
RTl ' '
92]~7,7,O01:T500027.~ :
~.'t,
LN.2143,43 :-.
HELEN N CAIN
145 N 26TH ST
CAMP HILL PA 17011
.~., ~ f, (T~,PE OR PRINT) Certificate of Title must be submitted within 20 days, unless the purchaser la a registered de-_~r holding the vehicle for resale..
... ::l... ~ . . ...; .,.~ ... LAST . FIRST M.I. /
· '!- SUBSCRIBED AND SWORN ".' j' .,~ · ' ~dd-..'?-'~'.~" ..' ':"'/~'. / ' _/ .~.,...~ es,.- e.../, oflolN J/~""~"'~/'~'~-'"'
TO BEFORE ME: . /' "~ ~,'"~- ,, /~ ~a ~ ~. ~.~...~m.NA-
~ ' -...-'"-} ' Mo. 'D&z .;,.," .m~.4~' .
, .:'.. ! .,:, .. .' . ,'..
· ':"
SUBSCRIBED AND SWORN . .':~-'-, .
]'0 BEFO4RE ME: - . '" '
,'.::: .,?..~ . .:.., . . .:' '",',-' . .~:~, -: .
~ F~K~E
Conestoga Title Insurance Co. 123 East King Street, Lancaster PA 17602
Phone 1-800-732-3555 In Lancaster 299-4805
Settlement Statement F~X 7 i7-295-7155
U.S. Department of Labor and Urban Development
OMB No. 2502-0265
A. HUD-1 UNIFORM SE'i-rLEMENT STATEMENT
B. Type of Loan
1. [ ] FHA 2. [ ] FmHA 3. [ ]Conv. Unlns. 16. File Number: 17. Loan Number: 8. Mortgage Insurance Case Number:
4. [ ]VA 5~[ ]Conv. lns.
I
I
C, NOTE: This form furnishes a statement of settlement costs, Amouts paid to and by [he settlement agenl are shown. Items marked "(p,o.c)"
were paid outside the closing; they are shown for informational purposes and are not included in the totals.
D, Name & Address of Borrower: E. Name, Address and TIN of Seller: F. Name & Address of Lender:
Kenneth S. Hollinger, Anna L. Hollinger Estate of Helen N. Cain, Kathryn E. Hatter, Executrix
250 Beetem Hollow Road 833 Meadow Lane
Newvllte, PA 17241 - Camp Hill, PA 17011
TIN of Seltsr:
G. Properly Location: Place of Settlement:
145 North 26U3 Street 44 West Main Street H. Settlement Agent:
Borough of Camp Hill Mechanicsburg, PA 17055 Richard C. Snelbaker
Cumberland County, Pennsylvania (717) 697-8526 FAX-(717) 697-7681
of SeHJemen~: I January 14, 2004
J. Summary of Borrower's Transaction K. Summary of Seller's Transaction
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller
101. Contract sales pdce $193,000.00 401. Contract sales pdce $193,000.00
102. Personal property
402. Personal property
103. Borrower's settlement charges (line 1400) $1,969.50 403
104. Mortgage Payoff 404
105 405
Adjustments for Items paid by seller In advance Adjustments for items paid by seller in advance
106. City/town taxes to 406. City/town taxes to
107, Count), taxes to 407. ,County taxes Io
108. Assessments to 408, Assessments to
109 School Tax 01/14/04 to 0~30/04 $832.45 ~409. School Tax 01/14/04 to 06/30/04 $832,45
110. Sewer 01/14/04 to 06/30/04 $55.41 410. Sewer 01/14/04 to 08/30/04 $55.41
111 411
112 412
113 413
,120, Gross Amount Due [~rom Borrower $195,857,36 420, Gross Amount Due to Seller $193,887.8C
200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amouni Due to Seller
201. Deposits or earnest money $12,000.00 501. Excess deposit (see Instructions) $12,000.00
202. Principal amount of new loan(s): 502. Settlement charges to seller (line 1400) $2,005.88
203 503. Existing loan(s) taken subject to
204 504. Payoff of first modgage $42,205.98
205 505. Payoff of second mortgage
206 506
207 507
208 508
209 509
Adjustments for items unpaid by seller Adjustments for Items unpaid by seller
210, City/town taxes) 01/01/04 to 01/14/04 $26,36 510, City/town taxes) 01/01104 to 01/14/04 $26.36
211. County taxes) to 511, County taxes)
212. Assessments to 512. Assessments to
1213 to 513 to
214 514. Escrow for Pa. Inher Tax lo
215 515 Snelbaker, Brenneman & Spare, P.C. $8,685.00
216 516
217 517
218 519
220. Total Paid By/for Borrower $12,026.36 520. Total Reduction of Amount Due to Seller $64,923.22
300. Cash at Settlement From/to Borrower 600. Cash at Settlement To/from Seller
301. Gross amount due from borrower (line 120) $195,857.36 601, Gross amount due to seller (line 420) $193,887.8~',
302. Less amounts paid by/for borrower (line 220) $12,026.36 602. Less reduclJons In amounl due seller (line 520) $64,923.??
303. Cash iX]from [ ]to Borrower $183,831.00 603. Cash [ X]to [ J from Seller $128,964.64
Substitute Form 1099 Seller Statement
The information In Blocks E, G, H, I & line 401 (or If line 401 Is asterisked, line 403 and 404) is important tax informalJon and is being furnished to
the Internal Revenue Service. If you are required to tlts a return, a sancUon will be Imposed on you if this item is required to be reported and the
IRS determines that it has not been reported. If this real estate Is your principal residence, file FORM 2119, Sale or Exchange of Principal
Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts o1' Form 4797, Form 6252 and/or
Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your taxpayer identification number. Ii you do not
provide the SetUemen[ Agent wilh your taxpayer identil~ca[Jon number, you may be subject to civil or criminal penalties imposed by law. Under
penalties of perjury, I certify that the number shown on this statement Is my correct taxpayer IdenUi'icatlon number.
Seller Seller
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00'0 qlUO~ ~ ~ ~uo~ ~uems U l p~ez~H ' ~ O0 ~
~pu~q ql]~ p~l]~O~ s~ '000~
~OB
~0~
Jo~n~sJd~3Uem~uID~ezeN '~0~
~o~ ~nl~d ~uem~u[ ~e~o~
ol uofie~s~u~pV UO]l~l~UOD 'L ~g
ol ~A~ Ue[d 'O~g
~ uo~le~e~d lu~n~ofl '~Og
o~ ~ uoBe~O pOOl~ 'LOg
~ uofl3~Ul s,~pu~q '~Og
_ lu~o3~ ueoq '~Og
~uofleu~POU~O~ 'LOg
~OL
lu~11~8 le p~e~ uo~s~]~oo '~OZ
~e ~pun~
le spun~ s~ll~ s,~o~o~ :~OllO~ ~e (OOL ~uH) uo~oo ~o uo~s~
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Helen N Cain --- c~ I '" O b" 0 '77~''
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Kathryn E Hatter, Executrix 181-42-8628
833 Meadow Lane
Camp Hill, PA 17011
717-737-3383
CandaceRuth Cain
650 Losh Road
Shermansdale, PA 17090
717-582-2275
184-38-0189
WalterL Cain, Jr
16220 A 49th Avenue West
Edmonds, WA 98020
425-787-9311
181-42-8629
Christopher A Cain
486 Dahlia Way
Louisville, CO 80087
303-664-1102
181~2-8630
Daughter
Daughter
Son
Solq-
25~
25~
25~
25~
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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If rno~e space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT 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 003625
HATTER KATHRYN E
833 MEADOW LANE
CAMP HILL, PA 17011
........ fold
ESTATE INFORMATION: SSN: 209-16-6973
FILE NUMBER: 2103-0775
DECEDENT NAME: CAIN HELEN N
DATE OF PAYMENT: 03/02/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 08/19/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,308.00
TOTAL AMOUNT PAID:,
$6,308.00
REMARKS:
SEAL
SNELBAKER, BRENNEMAN & SPARE
CHECK# 1949
INITIALS: AC
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COHMONHEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171ZB-0601
REV-~3 EX AFp cog-oB)
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
FILE NO. Z1 05-0775
ACN Oq1117q:5
DATE O$-Z6-ZOOq
'04 ,rtpR 1_~7
KATHRYN HATTER
8:55 MEADOW LN
CAMP
HILL
EST. OF HELEN N CAIN
S.S. NO. 209-16-697:5
DATE OF DEATH 08-19-Z00:5
~i~-~-,~OUNTY CUMBERLAND
TYPE OF ACCOUNT
[] SAVINGS
[] CHECKING
[] TRUST
[] CERTIF.
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
PNC BANK has provided the Department aith the information listed below ahich has been used in
calculating the potential tax due. Their records indicate that et tho death of the above decedent, you were a joint owner/beneficiary of
this account. Xf you feel this information ]s incorrect, please obtain written correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance aith the Inheritance Tax Laos of the Coa.onaealth
of Pennsylvania. Questions may be ansaared by calling (717) 787-85Z7.
COMPLETE PART ! BELON ~ # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
PART
Account No. 51:5006:5512 Date 10-08-2002
Established
Account Balance .00
Percent Taxable X 100.00
Amount Subject to Tax .00
Tax Rate X .15
PotentZa! Tax Due .00
TAXnAYER RFSPONSE
To insure proper credit to your account, t~o
(Z) copies of this notice must accompany your
payment to the Register of Mills. Make check
payable to: "Register of Mills, Agent".
HOTE: If tax pay. ants are made aithin three
($) months of the decedant's date of death,
you may deduct a SZ discount of the tax due.
Any inheritance tax due ai11 become delinquent
nine (9) months after the date of death.
A. ~/The above information and tax due is correct.
~ 1. You lay choose to remit payment to the Register of Nills with tam copies of this notice to obtain
CHECK
ONE
BLOCK
ONLY
PART
TAX
LINE
a discount or avoid interest, ar you may check box "A" and return this notice to the Register of
Mills and an official assessment mill be issued by the PA Department of Revenue.
B. [] The above asset has bean or wil! be reported and tax paid eith the Pennsylvania ~nheritance Tax return
to be filed by the dacedent's representative.
C. []The above information is incorrect and/or debts and deductions aero paid by you. You must complete PART []and/ar PART []below.
If yOU ~ndZcate a different tax rate, please state your
relat~onshlp to decadent:
RETURN - COMPUTATION OF TAX ON dOZNT/TRUST ACCOUNTS
1. Da~e EstaDlishe~ i
2. Account Balance 2
$. Percent Taxable $ ~
q. Amount Subject to Tax q
E. Debts and Deductions 5 -
6. Amount Taxable 6
7. Tax Rate 7 ~
B. Tax Due 8
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMEI~
PAYEE DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation)
Under panaltAes of perjury, X declare that the facts I have repor_~ed above ara true, correct and
c,~. 4:0 the b~..'l: of .y knowl.dg, and b. XJ..f. HOME (///"~),~...~':~-- ,.~,~'~
TELEPHONE NUMBER DATE
CONNONHEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
BUREAU OF INDZVZDUAL TAXES
DEPT. 280601
HARRISBURG, PA 171ZB-0601
REV-1;li3 EX AFP (09-00)
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
FZLE NO. Z1 05-0775
ACN 041117qq
DATE 05-Z6-200~
KATHRYN HATTER
855 MEADON LN
CAMP HiLL PA 17011
TYPE OF ACCOUNT
bl;i~, , EST. OF HELEN N CAIN E~SAVIN6S
~'~::' S.S. NO. 209-16-6975 [] CHECKXNG
DATE OF DEATH 08-19-2005 [] TRUST
~ .N~ ~ CUMBERLAND [] CERTZF.
'04 APR 15 , I~ ,~ REHZT PAYHENT AND FORHS TO:
RE6~STER OF NILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the informatian listed below which has been used in
calculating the potential tax due. Their records indicate that at the death o~ the above decedent, you were a joint omner/bena~iciary o;
this account. I~ you ~aal this information is incorrect, please obtain written correction from the ~inancial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws o; the Commonwealth
o~ Pennsylvania. Questions may be anseerad by ceiling (717} 787-8527.
COMPLETE PART 1 BELOW # # # SEE REVERSE SZDE FOR FTLTNG AND PAYMENT TNSTRUCTZONS
Accoun~ No. 51~0117554 Data 10-08-2002
Established
Accoun~ Balance .00
Percon~ Taxable X 100.00
Amoun~ SubSoc~ ~o Tax .00
Tax Re~B X .15
Po~on~ial Tax Due .00
To insure proper credit to your account, tho
(Z) copies of this notice must accompany your
payment to the Register oF Nills. Hake check
payable to: "Register o; Mills, Agent".
NOTE: I; tax payments are made within three
(5) months o; the dscedant's date oF death,
you may deduct a 5Z discount o; the tax due.
Any inheritance tax due will beco~a delinquent
nine (9) months a~tar the date o~ death.
PART TAXPAYER RESPONSE
A. r~a above information and tax due is correct.
· You may choose to remit payment to the Register of Hills I~ith t#o copies o~ this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register o~
CHECK ~ Hills and an o;ficial assessment will be issued by the PA Department o~ Revenue.
ONE
BLOCK B. [] Tho above asset has been or w111 be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be ~ilad by the dacedent's representative.
C. F~ Tho above in;oraation is incorrect and/or debts and deductions wars paid by you.
You must complata PART ~]and/or PART I~-Ibsloa.
PART Tf yOU ind/ca~o e difforon~ ~ax re~o, please s~a~e your
relationship ~o decedent:
TAX RETURN - COHPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
LZNE 1. Da~. Es~ablishe~ I
Account Balance ~
Percen~ Taxable $ ~
Aeoun~ Sub3ec~ ~o Tax q
Debts and Deduc~ions ~ -
Amoun~ Taxable 6
Tax Ra~e 7 ~
Tax Due 8.
PART
DAlE PAID
DESTS AND DEDUCTTONS CLATMED
PAYEE DESCRIPTION AHOUNT PAID
TOTAL (Enter on Line $ of Tax Computation) $
Under penalties of porjury~ Z declare ~ha~ ~he fac~s Z have reported above are ~ruo~ corroc~ and
com/Dl~te to the bast of my knowled~ and belief. HOME ( ~ )~~ ~
TA~AYER ~GNATURE TELEPHONE NUHSER DATE
BUREAU OF INDTV/DUAL TAXES
TNHER/TANCE TAX D/VZSTOH
DEPT. 280601
HARRISBURG, PA 17118-0601
KATHRYN E HATTER
855 MEADON LN
CAMP HILL
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
RE¥-I;,~? EX AFP COl-OS)
~E ~ DATE
~ ~ ~r. ~ .~: ESTATE OF
DATE OF DEATH
FILE NUMBER
'04 APR26 ?l :3.5 COUNTY
ACN
I~.A':.,,17 011
Oq-26-200q
CAIN
08-19-2005
21 05-0775
CUMBERLAND
101
Amoun~ Ram i'l:'l:ed
HELEN N
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR
DZiALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CAIN HELEN N FILE NO. 21 03-0775 ACN 101 DATE Oq-26-200q
TAX RETURN WAS: (X) ACCEPTED AS F/LED ( } CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~m (Schedule A) (1)
2. S~ocks and Bonds (Schedule B)
:5. Closely Held S~ock/Par~narship Zn~eres~ (Schedule C)
q. Mortgages~No'cas Receivable (ScheduZo D)
5. Cash/Bank Daposi~cs/Misc. Personal Proper~y (Schedule E) (E)
6. Jo/n~ly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Assm~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expansas/Adm. Cos'cs/N/sc. Expenses (Schedule H) (9)
10. Dab,s/Mortgage Limb/Ii'ties/Liens (Schedule Z) (10)
11. To,al Daduc~/ons
12. Na~ Value of Tax Rm~urn
195~000.00
.00
.00
.O0
16~19q.50
1~807.17
.00
(8)
25,115.68
NOTE: To /nsura proper
cradA~ ~o your account,
subm/~ ~hm upper por~ion
of ~his form w/~h your
~ax payment.
1:5.
lq.
NOTE:
211,001.67
q7,710.52
(11) 70.82~.. O0
(12) lq0,177.67
Char/~ablm/govarnman~al Bequests; Non-alac~ad 911:5 Trusts (Schedule J) (15) . O0
Ne~ Value of Es~a~a Subjac~ ~o Tax (lq) lq0,177.67
:If an assessment was issued previously, lines lq, 15 and/er 16, 17, 18 and 19
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amoun~ of L/ne lq a~ Spousal ra~e
16. Amoun~ of LAne lfi *axabla a* Lineal/Class A ra~o
17. Amoun~ of L/ne lfi a~ S/bl/ng ra~e
18. Amoun~ of L/nm lq ~axabla a* Collateral/Class B ra~e
19. Pr/nc/pal Tax Due
TAX CREDITS:
PAYMENT RECEZP1 DXSCOUNT {+J
DATE NUMBER INTEREST/PEN PAID (-)
O~-02-ZOOq CD005625
.0O
(1.,;) .00 X O0 = .00
(16). lq0,177.67 X Oq5 = 6,$08.00
(17) .00 x 12 = .00
(lB) .00 x 15 = .00
(19)= 6,$08.00
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
AMOUNT PAID
6,~08.00
TOTAL TAX CREDIT I
I
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
6,308.00
.00
.00
,00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REgUZRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVAT[ON:
PURPOSE OF
NOT[CE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (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 the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S.
Section 91qO).
Detach the top port[on of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office
of the Register of gills, any of the 23 Revenue Olstrict Offices, er by calling the special Z4-hour
answering service for forms ordering: 1-800-362-Z050~ services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter deters[ned at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6S05. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of
the tax pald is allowed.
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assesse¢, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (13 day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent an and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ .000548 ~'~'a-1991 112 .000301 ~ 92 .O00Zfi?
1983 162 .000438 1992 92 .000247 ZOOZ 6Z .000164
1984 llZ .000301 1993-1994 7Z .000192 ZOO3 SZ .000137
1985 132 .000356 1995-1998 9Z .000247 Z004 4Z .000110
1986 10Z .000274 1999 7Z .000192
1987 102 .000274 ZOO0 72 .O0019Z
--Interest is calculated
ZNTEREST= BALANCE OF
as follows:
TAX UNPAID X NUHBER OF DAYS DELINQUENT X DA/L¥ INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation ta fifteen (1S) days
beyond the date of the assessment. If payment is made after the interest computation data shown on the
Notice, additionat interest must be calculated.
.
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name ofDecedent: l-/--el f (t (! 0 (n
Date ofDeath: a I / 0, I () 3
Estate No.: d 7- 0 '3 ~ 77'5
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 ~~r administration of the estate is complete:
Yes.Ed" No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the person~e~ntative file a final account with the Court?
Yes 0 No ff
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the person~ ry;presentative state an account informally to the parties in
interest? Y es ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
d)-)!oS
~~~v Co tJi-krf6tAJ
Si ature
&Y!J/"fI /7 C 'f-ktftr.? r
Name
X33 f/1'wtf ~ 4U1-t'
Addressca1Jl-f' Ml! / fie /7tJ II
{7/7 )-;7i7- :~333
Telepho;e -No.
cJ
Date:
CJ
("^)
Capacity: ffPersonal Representative
o Counsel for personal representative