HomeMy WebLinkAbout02-0369 Register of Wills of ~/~r~ ~l'a r)~ County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Pro~te ~d Grant of Leffers Tostamenta~ ~ .~r ~t Pe~e(,)~ ~ ex~ ' ' .... ' ....
/
Except a~ Ioilows. De<~dent did not man',/, was not divorced, ~1 did not hay. a child bom or adopted aider execulton of the documente
offered for probate; was not the victim of a Idlling a~d wa8 nove~ adjudicated incompetent:
a B. Grant of Letters o! Administration,, -
Petitioner(s) after a prope~ search haUhave ascertained I~at Decedent left no ~ md was survived by the following spouse (if an,/) and
helm:
Dec~nt at cleath owned properly v4th eslimated v~Jt. Je8 u
(lf domlc~d in PA) All per~naJ properS).
(If not domiciled in PA) Personal properS/in Pennsylvania
(If not 6omic~d in PA) Pe~o~ prope~y in County
Vdue o~ real estate in Pe~mXtVa~la
$ , ~,~,000, ~
-!
$,
$.
Wherefore. Petitioner(s) respectiully request(s} ~e probate of the last Will a~d Codicil(s) presented with Ihls PetY~on ~ the gra~t of
bner~ in Ihe appmprlete form to ~e undersigned:
,"~,~ IRW. I ~ ! o1'2
I~el:)~ed by Ihe PennsylvanAa Ba~ .4jBoda~,n 190!
Oath of Personal Representative
Commonwealth of penns)'lvanta
County of
The Petltloner(s) above-named swear(s) or affirm(s) that the statements In the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the est, ,at~, ac~o~ng, to law.
before me this iotn dm/of
APRIL ~ 2,O02
AND NOW,
No. 21-02-369
Eststeof ~1/~.,~ J~, ~11~ Deceased
Social Security No: . Date of Death; j~ dt/Kc ~1 //~ / ~ 0 ~
APRIL 10 ,:~) 2002 , In consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters I~ Testamentary I~1 Of Administration
~; p,~dente ate; du~a,'Y4 mb,le~Lia; d~zm~le ffiho~aaie
are hereby granted to JENNIFER H BARKER
in the' above estate and that the Instrument(s) dated APRIL 10 ~ 2001
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
Letters ..................... $ 115.oo
Short Certificate(s) .... $ 9. O0
Renunciation ........... $
Nfldavtts ( ) ........ $
Extra Pages ( ) .......$ 3. O0
Codicil .....................
JCP Fee ................. $ 5. oo
Inventory .................
Other ....................... $
TOTAL ......... $ 135.00
Fcm11 fRW-I Plge2
Prepered by I~e Penn~h~M B~ .~aK~,C..'~ Ig~1
Attorney:.
LD. No:
Address:
Telephone:
LAST WILL AND TESTAMENT
I, BARNES H. BARKER, of Carlisle, Cumberland County, Pennsylvania, do
hereby make, publish and declare this to be my last will and testament, hereby revoking
all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this Will,
shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefore, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at my
death, for such period of time after my death as seems expedient to said representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate as follows:
A. To my son, David B. Barker, my fishing equipment and all related
~¢cessor~es; and all the
B. Rest, residue and remainder of my estate of whatever nature and
wherever situate, I give, devise and bequeath to my children, Jennifer H. Barker,
David B. Barker and Michael P. Barker, share and share alike, the child or
children of any deceased child taking the share their parent would have taken if
living.
4. I nominate-and appoint my daughter, Jennifer H. Barker, to be the
personal representative of my estate, to serve without bond. If my daughter cannot or
does not serve, then I appoint David B. Barker to be the substitute personal
representative, also without bond.
5. I suggest that my personal representative retain theVservices of Harold S.
Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
~. Or'
IN WITNESS WHEREOF, I have hereunto set my hand and sea~ th.~5-.~/ day
of April, 2001. ·
~,1,,~-~-~-~ ._ (SEAL)
BARNES H. BARKER
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
ACKNOWLEDGMENT AND AFFIDAVIT
WE, BARNES H. BARKER, RHONDA S. IRWIN and HEATHER A. BARBOUR,
the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that
the testator signed and executed the instrument as his last will and that he had signed
willingly, and that he executed it as his free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the presence and hearing of the testator,
signed the will as a witness and that to the best of their knowledge the testator was, at
that time, eighteen years of age or older, of sound mind and under no constraint or
undue influence.
BARNES H. BARKER
HEATHER A. BARBOUR
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by BARNES H. BARKER,
the testator herein, and subscribed and sworn to before me by RHONDA S. IRWIN and
HEATHER A. BARBOUR, witnesses, this/(~~
Notadal Seal
Harold S. Irwin III, Notary Public
Carlisle Bore, Cumberland County
My Commission Expires Sept. 23, 2002
Member Pennsylvania .~ssociation of Notaries
Name of Decedent:
Date of Death:
Wi. No.
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Admin. No.
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Q~ha~s' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ._ffJJitd[~ ·
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) ~xc.e. pt
Date:
Signature
Name
Address b0/'~
tSlour4tr , I
Telephone ~l.q g30 -!oo
Capacity: Vt/Personal Representative
Counsel for personal representative
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 0014OO
BARKER JENNIFER H
604 GRACE LANE
FLOURTOWN, PA 19031
........ fold
ESTATE INFORMATION: SSN: 096-12-1093
FILE NUMBER: 2102-0369
DECEDENT NAME: BARKER BARNES H
DATE OF PAYMENT: 07/12/2002
POSTMARK DATE: 07/1 0/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 03/14/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $2,009.93
TOTAL AMOUNT PAID:
$2,009.93
REMARKS: JENNIFER BARKER
SEAL
CHECK//130
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ILE NUMBER
21 02 00369
COUNTY CODE YEAR
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
i Barker, Barnes H. 096-12-1093
DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE wrrN THE
03/! 4/2002 07/22/] 920 REGISTER OF WILLS
IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
z
'[] 1. OdginalReturn [] 2. SupplementalReturn [] 3. Remainder Retum (date of death pdor to12-13-82)
[] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after [] 5. Federal Estate Tax Return Required
12-12-82)
] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach __ 8. Total Number of Safe Deposit Boxes
o~ Will) copy of Trust)
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (data of death between [] 11. Election to tax under Sec. 9113(A)(AttachSchO)
12-31-91 and 1-1-95)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIALTAX iNFORMATION sHOOLD a~ DIRE~D TO:
~AME
Bonnie G. Ostrofsky
:IRM NAME (If applmable)
Bonnie G. Ostrofsky, Attorney at Law
'ELEPHONE NUMBER
215/233-5344
. COMPLETE MAILING ADDRESS
· ~0rd7elAlhetWi~r~,SA 19038
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. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (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.
13.
14.
Nonei!1
None
None
55,699.52 [ ':'
None [ '~
None
4,623.21
6,411.22
Net Value of Estate (Line 8 minus Line 11 )
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)
(8) 55,699.52
(11) 11,034.43
(12) 44,665.09
(13)
(14) 44,665.09
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
16.Amount of Line 14 taxable at lineal rate x .045 (16)
17.Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .1 5 (18)
19. Tax Due (19)
44,665.09
2,009.93
2,009.93
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
~Decedent's Complete Address:
IST ~R. EET ADDRESS
CITY
3 E. High Street
Carlisle
STATE PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
zm 17013-3048
(1)
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
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 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
2,009.93
0.00
0.00
2,009.93
2,009.93
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ......................................................................
b. retain the right to designate who shall use the property transferred or its income; ....................................
c. retain a 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-prebate 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 perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of
preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUU PERSON~
FOR FILIN~G RETURN .~DDRESS
A:ER OTHER THAN REPRE,<
ADDRESS
604 Grace Lane 10 I / ]' J 1 [ DATE
Flourtown, PA
DATE
107 Atwood ~J
Erde~e~ PA 19038
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value Df transfers to or for the use of the surviving spouse is 0%
[72 P.S. {}9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116
1.2) [72 P.S. {}9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood Dr adoption.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Barker, Barnes H. 21 - 02 - 00369
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 !VALUE AT DATE OF
NUMBER DESCRIPTION D F_...~T H
M&T Bank# 15004200021191
M&T Bank interest accrued to date of death on item #1
M&T Bank account 000539716
40,120.41
12.18
15,566.93
TOTAL (Also enter on Line 5, Recapitulation) 55,699.52
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Barker, Barnes H.
21 - 02 - 00369
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
AD
Bo
FUNERAL EXPENSES:
Cremation Society of PA
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Bonnie G. Ostrofsky, Attorney at Law -- Bonnie G.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
C~ty
Relationship of Claimant to Decedent
Probate Fees Probate tee
State Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
UGI Gas Service - for apartment
PPL Electric Utilities- for apartment
Sprint - for apartment
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
1,010.00
135.00
135.00
2,626.00
56.11
40.10
621.00
4,623.21
COMMONWEALTH OF PENNSYLVANIA
· INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
n ~,ar,.er, Barnes H. 21 02 - 00369
4 330.00
Duncan Properties - rent for April (until decedent's personal property was removed)
M&T Bank fee for check return
Duncan Properties - fee owed to landlord for cleaning out apartment
1.00
290.00
Page 2 of Schedule H
COI~NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Barker, Barnes H.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
21 - 02 - 00369
Include unreimbursed medical expenses.
ITEM
NUMBER
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
DESCRIPTION
Lanc HMA Phys Mgmt
Central Penn Med
Belvedere Medical
INTL Therapeutic
Belvedere Medical
Masland Assoc
Carrlisle Regional Hospital (812 + 45.60)
Spring Road Family Practice
NCO Financial Systems ($1142 + 35.12)
Carlisle Imaging Assoc
West Shore EMS (71.06 + 469.82)
2002 Personal Tax to Darlene Moyer, Tax Collector
Bonnie G. Ostrofsky, Attorney
Harold S. Ira, in III, Attorney
Chapel Pointe at Carlisle (nursing home)
Return of Social Security payment received 3/3/02
Remm of VA benefit payment received 3/1/02
Belvedere Medical Corporation
AMOUNT
52.04
30.30
2.05
53.21
10.96
1.74
857.60
19.72
1,177.12
3.92
540.88
9.90
75.00
131.25
2,507.86
653.00
199.00
85.67
TOTAL (Also enter on Line 10, Recapitulation) 6,411.22
COMMONWEALTH OF PENNSYLVANIA
· INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Barker, Barnes H. 21 - 02 - 00369
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY AMOUNT OR SHARE
OF ESTATE
1
2
3
II.
TAXABLE DISTRIBUTIONS (include outfight spousal distributions)
Jennifer Barker, 604 Grace Lane, Flourtown, PA 19031
David B. Barker, 3330 Wiehle Street, Philadelphia, PA 19129
Michael P. Barker, 10500 Irma Drive, #207, Building 5, Northglen, CO
80233
RELATIONSHIP TO
DECEDENT
13o Not U~t
daughter
son
son
Enter dollar amounts for distributions shown above on lines 15 through 17, 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
14,888.36
14,888.37
14,888.36
LAST WILL AND TESTAMENT
I, BARNES H. BARKER, of Carlisle, Cumberland County, Pennsylvania, do
hereby make, publish and declare this to be my last will and testament, hereby revoking
all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, ~=uneral and
administrative expenses as Soon as convenient after my'decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this Will,
shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefore, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at my
death, for such period of time after my death as seems expedient to said representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate as follows:
A. To my son, David B. Barker, my fishing equipment and all related
=.ccessories; and all the
B. Rest, residue and remainder of my estate of whatever nature and
wherever situate, I give, devise and bequeath to my children, Jennifer H. Barker,
David B. Barker and Michael p. Barker, share and share alike, the child or
children of any deceased child taking the share their parent would have taken if
living.
4. I nominate.and appOint my daughter, Jennifer H. Barker, to be the
personal representative of my estate, to serve without bond. If my daughter cannot or
does not serve, then I appoint David B. Barker to be the substitute personal
representative, also without bond.
5. I suggest that my personal representative retain theVservices of Harold S.
Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and sesl ~i';,i.,-.~,,,__LO.O~'
of April, 2001. day
BARNEs H. BARi~E~''''~'''''~'' ~ _(SEAL)
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses,
WE, BARNEs H. BARKER, RHONDA S. IRWIN and HEATHER A. BARBOUR,
the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly SWorn, do hereby declare to the undersigned authority that
the testator signed and executed the instrument as his last will and that he had signed
willingly, and that he executed it as his free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the Presence and hearing of the testator,
signed the will as a witness and that to the best of their knowledge the testator was, at
that time, eighteen years of age or older, of SOund mind and under no constraint or
undue influence.
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND :ss:
Subscribed, sworn to and ack
the testator herein, and .-,.h ....... no?edged before me -..,
HEATHE A n~,-,r,...,.°...u~.c.'r~oea ana swo n to b by BAR~ES.H. BARK=R,
R .... .-,,.ouuh[, witnesses, this'~,~ -,e-!0re. me by R.O. NDA S. IR IN and
J Harold S. Irwin Ill, Nc~ary Public
J Carlisle Boro, Cumberland County ....... ~ ~
[ My Commission Expires Sept. 23, 2002 [
Member. ;~ennsyivania A ssocia/ion ot Notarie~s
Sent By: 8prlngf±eld Abstract, Zno.; 215 836 1141;
, HA.Y-o4-ia:2 '!E,14 F'ROM,DUNCAH + HARTIdAN
May-24-02 15:46j
ID;
Page 1/1
Duncan Properties
I Irvtne Row
Carllsle, Pennsylvania 17013
Fa~ (7.17)249-
Total Due /or Cleaning $290.00
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PATIENT NAME:
F:tIRKI!:R., E':ARNE'.:'i; H
INSURANCE:
i~E'D I CAR 'i'
0961210'.:.~:3 A
BARNES H BARKER
:3'7~5 CLAF, E)?IO[,IT DR
INVOICE
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
REASON(S)
FOR
TRANSPORT
Y.,IF/.C I :.:i;U P 2
:3 E HIGH :3T
C.ARLI:!.:;LE RE(3IOI, I.P,.L ~.IEDICAL C. TR
SHOI:{T}~E:[i::.'!; OIY BREA'rH
a OF:, CHARGE
/tr.,:.--.-;. EI~L~:R(3ENCY LEVEL 1.
O.~y.,..]en A dr, i n i .~.~ t' r'.a t- i ,:,n'
Arr, hulanc:e NJ. leage Char. g--.
TOTAL .CHARGES 'rHI.S CALL
QUANTITY
~ UNIT PRICE,
:[ ,, O ~" ,'-.-, =-; ..
1 ,, 0 ~-:;. '7
9:3 ,, .'.UO
4 5. :!36
..... 7.3
"745 ,, :[ 1
/'I,:.-: d i <:a.r.,:.-, A s .':-.~ i 9nrr,¢-:n t' A d.j u..!~
M,:-:d::icar. e Par. i- ~3 Paymer~t
· OIA,L ~' r'~ ~', ,-..
}5: A~IIE, I~IT.:, IHI'-' CALL
RECE PT
(:):::-:,'44
01 I 17 / C) 2
O ]. / l '7 / O 5.::
PLEASE PAY THIS AMOUNT ..~
WEST SHI]RE EHS CARL .It ....
,:.~ I... E'.
.5():"..~ Ixl 21 ST' ST
C(:tMP I"i]:LJ.., F:'A 17011
F'HONE ( 800 ) :367-05 ~.'.71'I"A X I D 2:3.-.-246 3()02
PATIENT NAME: BARKER, BARNES H
INSURANCE: PtEO I C~IRE B
BARNES H BARK'ER
:375 CL...AREMON'T DF;:
CARLISLE:, F'A .1.701:3
INVOICE
0 9 61 :'2.1 (),',9 3 A
PATIENT NUMBER: ':'
CALL NUMBER:
DATE OF CALL: O::'/1 "~/O"',
TIME OF CALL:
CALLER:
FROM:
TO:
REASON(S)
FOR
TRANSPORT
HDIP f'lD I FI
CL-AREHON'f' NRSG REt-lAB C'T'R
CARLISI...E I:{E'.'GIONAL MED I CAL C'I'R
D Y SI:'N E~
CONGESTIVE HEAR"r' F"' .......
- A.[ LURE.
DESCRIPTION OF CHARGE
B~t.~,e Rate-Non Tr~anspl:~r,t: i n
CARDIAC MONI'TOR
ANG~ODATH (14-24)
EKG ELEC'I'RODES
IOGTT TUBING
NORMAL IS~L. INE 1000CC
DF' S.TTE
5CC/10CC SYRINGE
NI TRDB[..YCER~N O. 4MG
L~S I X .1.
']'O]'AL CHARGES THIS CALl_
DESCRIPTION OF PAYMENT
'T'O]"AL. F'AYMENT'f.S THIS [:ALL
QUANTITY
1.0
1.0
1.0
1.0
1.O
AMOUNT
O. 00
PLEASE PAY THIS AMOUNT
RECEIPT FOR PAYMENT
Cumberland County - Register Of Wills
Hanover and High Stree~
Carlisle, PA [7013
Receipt Date
Receipt Time
Receipt No.
4/10/2002
12:05:45
1028969
BARKER BARNES H
File Number
Remarks
2002-00369
JENNIFER BARKER
AC
........................ Distribution Of Receipt
Transaction Description Payment Amount
PETITION FOR PROBA
EXTRA PAGES
SHORT CERTIFICATE
JCP FEE
Check# 142
Total Received .........
115.00
6.00
9.00
5.00
135.00
135 00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
Law Offices of Harold S. Irwin, III
35 East High Street
Suites 201 and 202
Carlisle, PA 17013
invoice submitted to:
Barnes H. Barker
c/o Jennifer M. Barker
604 Grace Lane
Flourtown PA 19031
April 09, 2001
Invoice # 207
Professional Services
4/9/01
Phone call with Jennifer and draft new will and living will
For professional services rendered-
Balance due
, Hrs/Rate
0.75
175.00/hr
0.75
Amount
131.25
$131.25
$131.25
BONNIE G. OSTROFSKY
Invoice
ATTORNEY AT LAW
604 Grace Lane
Flourtown, PA 19031
107 ATWOOD ROAD
ERDENHEIM, PA 19038-7301
(215) 233-5344
FAX (215) 233-1797
Client Matter
)eare d~
rate to $75)
Description of Service or Charges
si-I,
rate is
or Qty
1
Amount
75.00
/
0
Total
Payments/Credits
$75.00
Balance Due
$75.0~
Sent By: Sprlng?ield Abstract, Inc.; 215
C.ECKS STATEMENT
PAYADI. E 1'O:
BELVEDERE MEDICAL CORPORATION
850 WALNUT BOIl-OM ROAD
=, -~,,~,,,,, x~ CARLISLE, PA 17013-3698
836 1141
PAGE 1
Uay-24-02 13:42;
PI-~%~E CHECK TYPE OF PAYMENT:
CARD NO .......
Page 2/2
[]CHECK DV~SA ~M~ARD
EXP, DATE:
BARNES E ~BARKER BELVEDERE MEDICAL CORPORATION
C/O C/O JENNIFER BARF_ER 850 WALNUT BOTTOM ROAD
604 GRACE LANE
FLOURTOWN, PA 19031 CARLISLE. PA 17013-3698
--] Please check box if above address is incorrect or insurance iclentified has changed, indicate change(s) on reverse side.
PLACE OF OV- OFFICE VISIT OH- OUT'PATIENT HOSPITAL
SERVICE IH- IN PATIENT HOSPITAL NH. NURSING HOME
BELVEDERE MEDICAL CORPORATION
850 Walnut Bottom Road
Cedisle, PA 17013-3698
Phone 717-243-3120
FED ID NO. 23-1869105
i ACCOUNT BALANCE
INSURANCE PENDING
PATIENT DUE AMOUNT
PAYMENT DUE BY
u*;¢~ 1;hap~l Pointe at Carlisle 717-249-9511
Chap. el
770 South Hanover Street ..... '!~IC'~i~fi~'717-249-1363
Carlisle. PA 17013 Fax: 717-249-95 ! 1
Website: www. chapelpoin~e.org
July 25, 2001
Ms. Jennifer Barker
604 Grace Lane
Flourtown, PA 19031
I am enclosing copies of'~ s~_ements for Mr. Barker that were seat to you previously
and also a copy of the most recent statement. As of the above date we have not rec~ved
any sort of payment towards Mr. Barker's care.
Would you kindly remit a cheek payable to Chapel Pointe in the mount of $2507.867 If
you have already done so, please disregard this letter. Should you hnve any questions or
concerns please feel free to contact me at the ab°ve number. My extemion is 262.
Sinoerely,
eries.
A retirement community of The Christian and Missionary AIi/ance
.... .=~ molnte at Carlisle 717-249-95~!
p.8
770 South Hanover Street
Carlisle, PA 17013
Telephone: 717-249-1363
Fan: 717-2~9-951 I
Website: www. chap~lpoime.com
September 28, 2001
Ms. Jennifer Barker
604 Grace Lane
Flourtown, PA 1903
Re: Barnes Barker
Dear Ms. Barker:
This letter is a follow up to our conversation on September 28, 2001. As I stated on the
telephone, if we do not receive the amount of $2,507.86 by Oototnn 10, 2001, I will be
forced to turn his account over to our attorneys. I have enclosed a copy of page 4 of the
Health Center ~ent, which states that you will be responsible for ali attorneys' fees
and cost should it 8° this far.
Should you have any questions or concerns, please feel flee to contaa me at the above
number. My extension is 262.
SincerelY,
Financial Services
~ A retirement community of The Christian and Missionary Alliance
Cb.ap. el
770 South Hanover Street
Carlisle, PA 17013 Telephone: 717-249-1363
Fax: 717-249-951 I
November 15, 2001 Website: www. chapelpointe.com
Mr. Barnes Barker
3 East High Street
Carlisle, PA 17013
Dear Mr. Barker:
On November 1, you were contacted by Judy Notz of my staffregarding an outstanding
balance due us as a result of your stay in om'Health Center in April and May of this year.
You were informed that this account must be paid or we will take legal action. If we hire
an attorney to collect the balance of $2,507.86, you will also be responsible for paying
the attorney's fees involved in the collection process.
I do not want to add any additional financial burden to you other than your legal
obligation to pay us the balance due on your account. Therefore, I am extending one last
opportunity to pay us in full before. I turn this matter over to our attorney. If we do not
receive your payment on, or before, Friday, November 23, 2001, we will have no choice
but to start the legal process. I am enclosing copies of our statements that document your
financial obligation to Chapel Pointe.
I have spoken with your attorney, Mr. Harold Irwin III, about this matter and he suggests
that you contact him to discuss your options. I recommend that you do so.
Sincerely,
Richard A. Lehmann
Director of Financial Servies.
CC: Mr. Harold Irwin III, Esquire
retirement community of The Christian and Missionary Alliance
Mov O1 O1 01:27p Chapel Pointe mt Carlisle 71'7-249-9511
p.5
STATEMENT
14/30-04/30
HAIR CARE
CUT
MEDICARE
SEMI-PRIVATE
SEMI-PRIVATE
ROOM @ $149.08
ROON ~ $145,80
171.
nov U1 01 01:26p Chapel Pointe at Carlisle 717-249-9511
STATEMENT
p.4
BARNES H. BARKER
JENNIFER PARKER
684 GRACE LAN~
FLOURTOWN~ PA 190~
For: BARNES H. BARKER
O~O-B
-05 / 13
-~5/31
SEMI-PRIVATE ROOM ~ $149.00
SEMI-PRIUATErROOM 8 $149.00
5~171.0~
1~937.(Z~
For: ~qRNES H. BARKER
0~'8 -B
7Z0 & HMOV~ ~r.
~ pA 170~8
(7~Z) 24e-l~z
Chapel Pointe at Caplis]e
717-249-9511
STATEMENT
p.3
BARNES H. BARKER
SENNIFER .BARKER
604 8Ri:tC'E LANE
F'i-OURTOWN~ PA 19031
For': BARNES H. BARKER
Balance
PHYSICIAN -- BMC --
489.00
18.86
,.) :j ~.':.
FOP: BARNEB H. BARNER
O~O-B
.M
E~o ~;07. 86
"The Simple Dignified Choice"
Nationwide
1-800-722-8200
Jennifer H. Barker
604 Grace Lane
Flourtown, PA 19031
3-14-2002
220340
MARSHA WI]
X
X
Barnes H. Barker - Deceased
X
X
Direct Cremation
Special 48 Hour Or Weekend Cremation Service
Nationwide Guarantee Program
Worldwide Travel Protection Program
Private Family Viewing/Witnessing Cremation
Cremation Container
Medical Document/Courier Fee
Honorarium
Cardboard
Urn Burial Vault
Arrange For Burial
Cemetery Charges
Arrange/Deliver Remains To A National Cemetery
Burial At Sea
Scattering Charge
Packaging And Forwarding Of Cremated Remains
Express Mall
Certified Copies 10 @ $2 00
Register Book ·
Memorial Folders
Thank You Cards #
Do-It-Yourself Memorial Service.
Flowers
Newspaper Placement Fee
$895.00
$55.00
$20.00
X County Coroner Cremation Approval Fee
DNA Preservation
X Membership fee
X Discount
$25.00
$35.00
-820.00
TOTAL $1,010.00
3-14-2002 PAID $1,010.00
BALANCE DUE $0.00
FgJ~
(717) 541-9943
With five office locations to serve you...
in Harrisburg, Philadelphia, Pittsburgh & Scranton.
O0
BARNES H BARKER
3 E HIGH ST
CARLISLE PA 17013-3048
1 04~19M N OPl
q30
I OF 2
ACCOUNT
TYPE
N & T FIRST
N&T MARKET INDEX ACCOUNT
TOTAL DEPOSITS
ACCOUNT
NUNBER INTEREST EARNED
YEAR-TO-DATE
00000000539716
15004200021191
0.00
239.25
NATURITY ENDING
DATE BALANCE
16,417.93
40,181.31
M & T F.TRST ]
ACCOUNT NO. 539716
HIGH STREET-CARLISLE
03-09-0:
03-12-0~,
03-1q.-02
Ofi-Ol-02
Off - 03 - 0 ~,
06-09-02
kCTIVITY
OEPOSIT
US TREASURY 220 VA BENEFZT
US TREASURY 303 SOC SEC
FEE FOR CHECK RETURN OPTION
ENDING BALANCE
540.36
199.00
653.00
330.00
$15,356.$7
15~026.$7
15,76S.93
16,4~7.93
367 03-12-02 330.00
BARNES H BARKER
TAKE ADVANTAGE OF N&T HEB BANKZNG, HHERE YOU CAN CHECK BALANCES, VZEH ACCOUNT HZSTORY, TRANSFER FUNDS
AND NUCH, NUCH NORE. ZN FACT, N&T HEB BANKZNG GZVES YOU ACCESS TO PRACTZCALLY YOUR ENTZRE
RELATZONSHZP, 2fi HOURS A DAY, SEVEN DAYS A WEEK - AND BEST OF ALL, ZT'S FREE! START SAVZNG TZHE -
ENROLL ZN N&T WEB BANKZNG TODAY! SZNPLy VISZT WWW.NANDTBANK.COH OR STOP BY ANY MgT BANK BRANCH.
T~T O ~UNT
ACCOUNT NO. Z-.-.R 00q 2 0 0 0 2'11. 9'm
INTEREST EARNED FOR STATENENT PERZOD 60.89
HIGH STREET-CARLISLE
~ kCTIVITY
03-09-02 BEGINNING BALANCE
0q-09-02 INTEREST PAYNENT
E~DIN~'BALANcE
60.90,
ANNUAL PERCENTAGE YZELD EARNED =
fi0,181.31
1.7q Y.
END OF STATEHENT ~
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of Barker, Barnes H. No. 21 - 02 - 00369
also known as Date of Death 3/14/2002
, Deceased Social Security No. 096-12-1093
Jennifer H. Barker
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. INVe verify that the statements made in this Inventory are true
and correct. INVe understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Attorney: Bonnie G. Ostrofsky
I.D. No.: 32225
Representative
Signature: ~er
Signature:
Signature:
Address:
107 Atwood
Erdenheim, PA 19038
Address: 604 Grace Lane
Flourtown, PA 19031
Telephone: (215) 233-5344
Telephone:
Dated:
Personal Property
M&T Bank#15004200021191
40,120.41
M&T Bank interest accrued to date of death on item #1
12.18
M&T Bank account 000539716
15,566.93
Total Personal Property
$55,699.52
(Attach additional sheets if necessary) Total Personal Property and Real Estate $55,699.52
BURE^U OF T'B VTOU^' T^XES
INHERITANCE TAX DZVTSTON
DEPT. Z80601
HARRISBURg, PA 17128-060!
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF ZNHERZTANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
BONNIE 60STROFSKY ATTY
107 ATWOOD
ERDENHEIN PA 19058
DATE 09-02-2002
ESTATE OF BARKER
DATE OF DEATH 05-1q-2002
FZLE NUMBER 21 02-0369
~!cOU~TY CUMBERLAND
ACN 101
I Amount Remitted
REV-15~i7 EX AFP C01-02)
BARNES H
MAKE CHECK PAYABLE AND REMIT PAYNENT TO:
REGTSTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LZNE I1~ RETAIN LOWER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-02) NOTICE OF ZNHER]:TANCE TAX APPRAISEMENT, ALLOWANCE OR
DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BARKER BARNES H FILE NO. 21 02-0569 ACN 101 DATE 09-02-2002
TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERS;
APPRAISED VA~UE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks end Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits~Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTZONS:
9. Funeral Expenses/Adm. Costs~Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabil~tlas/Liens (Schedule 1) (10)
11. Total Deductions
12. Nat Va/ua of Tax Return
55~699.52
.00
.00 NOTE: To insure proper
.00 credit to your account,
.00 submit the upper portion
.00 of this form with your
tax payment.
.00
(8)
q,625.21
15.
NOTE:
ASSESSMENT OF TAX:
15. Amount of Line lfi et Spousal rata (15)
16. Amount of Line lq taxable et Lineal~Class A rata (16)
17. Amount of Line lq et Sibling rate (17)
18. Amount of Line lq taxable at CoZlateral/Class B rata (18)
19. Principal Tax Due
55,699.52
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULAT/ON OF ADDZT/ONAL INTEREST.
DISCOUNT {+)
INTEREST/PEN PAZD (-)
.00
AMOUNT PAID
2,009.95
TAX CREDITS:
PAYMENT
DATE
07-10-2002
CDOOlqO0
RECE/PT
NUMBER
· O0 x O0 = . O0
~q,665.09 x Oq5= 2,009.95
· O0 x 12 = . O0
· 00 x 15 : .00
(].9)= 2,009.95
TOTAL TAX CREDZT 2,009.95
BALANCE OF TAX DUEI .00
INTEREST AND PEN. I .00
TOTAL DUE I .00
( ZF TOTAL DUE ZS LESS THAN $1) NO PAYMENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND· SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0
Nat Value of Estate Sub.~ect to Tax (lq) qq,665.09
Zf an assessment was Sssued prevSausZy, Z~nes :14, :15 and/er :16, :17, :18 and :19
reflect figures that include the total of ALL returns assessed to date.
6,q11.22
(~1) 11.034.q3
(~a) qq,665.09
ST.~TUS RBPORT U'NDBR~.ULB 6.1_2
Will No.: ~0 ~ -~o ~ ~
No.:
Pursuant to Rule 6.12 of thc Supreme Court Orph~u.~' Court Rules, I r~ort the
following with msp~t to completion oft. he ~r~r~ion of the above-captioned estate:
1. S~¢~wh~ ~m;u~str~on of the estate is complete:
Yes [~ No [~
2. It' the answer is No, m wh~ t~e personal repr~e~t~five rcs~on~bly believes
that the a~fion will be complete:
3. If the answer to No. 1 is Ye% state the following:
a. Did the ~rzon~l r.~re~eat~ve file a finsl ~ccount with the Court?
Ye~ _~ No ~ ,
b. The s~p~ra~e Orp ,hans' Court No. (~ any) for the p~rsonal r~pre~ent~:iv~'s
c. Did the p~r~oaal r~rgsent~ve state sa ~x, ount/nfor~uY to th~ p~-'tics
in interest? Yes [~ No [-]
Telephone No.
~e~ o~ Kcpcesentafive
[] Con,vel for personal represent~tiw
Capaci~