HomeMy WebLinkAbout03-0043 PETITION FOR PROBATE ,and GRANT OF LETTERS
also known as To:
'R~ister of~itls for the
Deceased. County of~s_~ ~~d:, _~ the
Social Security No. ~ ~ ~' ~ ~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut ~,~ ~ named
in the last will of the above decedent, dated ~_~ ~ i [~ ~ 19
and codicil(s) dated I ' '
/ ,~ ~
'(state relevant circumstances, e.g. renunciation, death of execmor, etc.)
Except as follows, decedent did not marry, was ~ot~r~ed~d~i~ not ~a~a chil~born or adopted
.afte~ ex~:ufion 0f the will offered for probate; was not the victim o~killing and was never adjudicated
hmompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ [ ~.
(If not domiciled in Pa.) Personal property in Pennsylvania $ ~
(If not domiciled in Pa.) Personal property in CoUnty $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALLYH OF PENNSYLVANIA
COUNTY OF ~.LL~q~ ~.o.~
The petitioner(s) above-uamed 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) °f the ab°ye decedent petiti°ner(s) will ~well and truly administertt r~~/a[ f~i ,r~d subscribed , ~.~.,~ ~'"
he estate according to law.
Sworn to or and ~ ay of
~ -4--~
No. o~1- O~-q3
Estate of ~a~- ~"~ ~, ~ ~,~- , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~q~x~ \~0: e~fOr~ ~ , in consideration of the petition on
o
the reverse side hereof, satisf~ictory proof having been presented before me,
IT IS DECREED that the instrument(s) dated IO- o~ 5- I q'?be
described therein be admitted to probate and filed of record as the last will of ~11~0 '~-~- .44~,1~
and Letters ~ ~ ~ ~ar~,.~,
FEES
Probate, Letters, Etc .......... $~ ' ~oh~n R. Broujos, l~q. ~.~06268
· Short Certificates(/O'~ ......... $ ._~g~d.~ ATTORr,~¥ (Sup. Ct. I.D. No.)
R~uuu~;a~un~. ~ .... $ ~ .0~ 4 N.Hanover St~ Carlisle~PA 17013
~C ~ ~o_~. ~ $ ! ~or,'D ADDRESS
TOTAL__ $ Ok~,~
717-263-457/4
Filed ...... l..--: ~. ~,.a.'r. O..~ ................ PHONE
REGISTER OF WILLSu~ COUNTY
OATH OF S IU~S~NG WITNESS
each ~-" codicil
( )a suu, c~mmg ~ness to the will presentecl n~rewith, (each)be~ qualified according to
trhe testat ~. sign the same an'n'n~at '~ signed as a~tness at th;
equest of testat---~._ in h-~-pr~nd (in the pres~ce of each othe;;~i~'~ ~res~e"'ce of the
other subscribing wit/~(es)). ~
Sworn to or affirmed anl~subscribed before
me this ~ 19day of '~~ (Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF C--,.,,~b¢ r~i~ ~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
()a subscriber fiereto, (each) ~e~ng duly ~ualified according to 13w, d~¢ose(s)a~d say(s)th
~~[ ~ familiar with the signature of
testat~of (one of the subscribing witnesses to) the Q~ presented herewith and
~ ~ codicil
that believe~ the signature on the will is in the handwriting of
to the best of ~~,~nowl~dge. . . a~ belief. _ ._
Sworn to or affirmed and subscribed before ~
. ~ (Name) ~ ~.]
(Address)
m~2 n~.v aaa WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
tFEE FOP, YHIS TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
CERTIFICAT~ ,52 CX'~ CCMMONWEALTI~ OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 5 2 8 0 8 9 ~~~2.~¢ January 8, 2003
D .... ,I ..... f This Oedification
Name of Decedent Mary Jane Hardy
Fret Middle , asr
Sex Female Social Security No. 211-26-1747 Date of Death Jan. 6, 2003
Date of Birth June 21, 1915 Birthplace __ Tyrone, PA
Place of Death Forest Park Health' Center Cumberland County Carlisle
Pennsylvania
Race. White __Occupation Homemaker Armed Forces? (Yes or No) NO
Decedent's
Marital Status Widow____ Mailing Address 700 Walnut Bottom Rd., Carlisle, PA 17013
Informant Terry L. Hardy Funeral Director LarrieA. Derman
Name and Address of Derman Funeral Home, Inc., Tyrone, PA
Funeral Establishment
Part I' Immediate Cause Interval Between
Onset and Death
(al End Stage Alzheimer's Disease
(b)
(c)
(d)
Part I1: Other Significant Conditions '
NIDDM- HTN ',
Manner of Death Describe how injury occurred:
Natural ~ Homicide ~
Accident [] Pending Investigation []
Suicide L~r-~ Could not be Determined []
Name and Title of Certfier Jay Townsend, MD
Address 100 S. High St., Newville, PA 17241 (M.D., D.O., Coroner, M.E.)
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. The original certificate will be forwarded to the
State Vital Records Office for permanent filing.
/ - LocAl Regi ....... ~REE~erds~' D ...... ri.
_ 1616 Hamilton Avenue - Tyrone, PA 16~686
WILL OF MARY JANE HARDY
I, MARY JANE HARDY, of Tyrone Borough, Blair County,
Pennsylvania, do make, publish and declare this as and for my
last will and testament hereby revoking and making void any and
all other wills by me at any time heretofore made:
FIRST. I direct that all my just debts and funeral expenses,
including my gravemarker, shall be paid from my residuary estate,
as soon as practicable after my decease, as a part of the expense
of the administration of my estate.
SECOND. Ail the rest, residue and remainder of my estate,
real and personal, of whatsoever kind and wheresoever situate, I
give, devise and bequeath to my beloved husband, Leonard D. Hardy, Sr.,
absolutely.
THIRD. In the event my said husband shall have predeceased me,
or in the event that he and I shall die simultaneously, or as the
result of the same accident or common disaster, or under such
circumstances that the order of our respective deaths cannot be
determined, then and in such event I give, devise and bequeath all
the rest, residue and remainder of my estate, real and personal, of
whatsoever kind and wheresoever situate in equal shares per stirpes
to my children, Stella Jane Hardy, Saundra Kay Shaner, Leonard D.
Hardy, Jr., Terry L. Hardy and Kathy L. Egley.
FOURTH. I constitute and appoint my husband, Leonard D. Hardy, Sr.
to be the Executor of this my last will and testament; provided, how-
ever, in the event my said husband shall have predeceased me or shall
be for any reason whatsoever unable or unwilling so to act, then and
in such event I constitute and appoint my son, Terry L. Hardy, to be
such executor.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of October, 1976.
~/~,!~/ ~-~/~:.? //'~'~ ~f~.~ (SEAL)
Signed, sealed, published and declared by the said Mary
Jane Hardy the within named TESTATRIX as and for her last will
and testament in the presence of us who have signed our names as
witnesses thereto at the request of the said TESTATRIX in her
presence and in the presence of each other.
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Mary Jane Hardy
Date of Death: January 6, 2003
Will No.: Admin. No.: 21-03-0043
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
~..~~U O 4,~,Y,D
Name Address
Stella Jane Allen 39238 Shamrock Court, Pittsburgh, PA 15239
Saundra Kay Shaner 1620 Jinn Court SE, Palm Bay, FL 32909
Leonard D. Hardy, Jr. 9 Donegal Drive, Carlisle, PA 17013
Terry L. Hardy 2205 N. Pewter Drive, Macungie, PA 18062
Kathy L. Egley 1270 Eastman Street, Platteville, WI 53818
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none
Signature ' '
Terry L. Hardy
2205 N. Pewter Drive
Macungie, PA 18062
610-395-6583
Capacity: Personal Representative
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE T. O( RETURN F,LE.U.BER
DEPT. 280601
HAR.,SBURG, PA17128-0601 RESIDENT DECEDENT 2 1 - 0 3 0 0 ~ 3
COUN'~' CODE YEA,q NUMBER--
DECEDENT'S NAME {LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z HARDY, MARY JANE 2 1 1 - 2 6- 1 7 4 7
~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
ILl REGISTER OF WILLS
O 01/06/2003 06/21/1915
III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (dateofdemp~o 12-13-82
LLI
~"o ~'''''~L_J 4. Limited Estate r'~ 4a. Future Interest Compromise (dateor~em at~r 12-12-82) ~'~ 5. Federal Estate Tax
Return
Required
oo
o~.m [] 6. Decedent Died Testate (A~achco~yofWi,,) [] 7. DecedentMaintainedaLivingTrust(^t~achcopyofTrust) 0___0 8. Total Number of Safe Deposit Boxes
'~ [] 9. Litk:Jation Proceeds Received [] 10. Spousal Poverty Credit (date ordea~ be~en 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (A~ach Sch O)
~_ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
,,,z NAME ~ COMPLETE MAILING ADDRESS
z JOHN H. BROUJOS, ESQUIRE 4 NORTH HANOVER STREET
o
,', FIRM NAME (If Applicable)
,,,"' BROUJOS & GILROY~ P.C.
o TELEPHONE NUMBER
~ 717-243-4574 OR 717-766-1690 CARLISLE PA 17013
1. Real Estate (Schedule A) (1) OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) - ;~
3. Closely Held Corporation, Partnemhip or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Prope~ (5) 19,732.35
(Schedule E) ,.
Z
~O 6. Jointly Owned Properly (Schedule F) (6) -
[] Separate Billing Requested
'-t 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Propert7 (7)
I-- (Schedule G or L)
<1: 8. Total Gross Assets (total Lines 1-7) (8) 19,732.35
U.I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 2,529.24
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 48,895.58
11. Total Deductions (total Lines 9 & 10) (11) 51,424.82
12. Net Value of Estate (Line 8 minus Line 11) (12) -31,692.47
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) -31,692.47
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z
O 15. Amount of Line 14 taxable at the spousal tax
~ rate, or transfers under Sec. 9116 (a)(1.2) X ~ (15)
I-- 16. Amount of Line 14 taxable at lineal rate X .045 (16) 0.00
EL 17. Amount of Line 14 taxable at sibling rate X .12 (17)
O 18. Amount of Line 14 taxable at collateral rate
(..1 X .15 (18)
X 19. Tax Due
,,~ (19) 0.00
20.
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address: ~,~ '
STREET ADDRESS
Forest Park Health Center
700 Walnut Bottom Road
ISTATE IZ'P
c~w Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0.00
2, Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
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 I 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) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes 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-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEBULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying sc,hedules a~ statem?nts, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative s based on all information of which preparer nas any Knowmnge.
SIGNATU?.~_~E OF PERSON RESPONSIBLEfOR FILING RETURN __ I DAT_.E
ADDRESS Terry L. I--iardy, Executor, 220.'~'N. Pewter Drive
M~cungLe. ~_ PA 18062
ADDRESS 4t Nodh Hanover Street ~
C'a~le PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)],
The tax rate imposed on the net value of transfers to or for the use of the decedenrs 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.
"~"~"-'"' ~'~~" SCHEDULE E
COMMONW~'TH OFPENNSY~V^N,^ CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONALPROPERTY
ESTATE OF FILE NUMBER
HARDY. MARY JANE 21 03 004~,
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorehi ~ must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T Bank checking acct # 11230802 6,670.89
2. M&T Bank savings acct # 15004200331730 12,474.23
3. Penn State Medical Plan A - reimbursement for medicine 250.03
4. Forest Park Health Center - refund on nursing care 242.44
5. PSERS Retirement Benefit 38.69
6. Pa SERS Surviving Spouse Benefit 29.33
7. Central PA Medical Group - reimbursement of overpayment 26.74
TOTAL (Also enter on line 5, Recapitulation $ 19~732.35
(If more space is needed, insert additional sheets of the same size)
REV-1511EX ~ (1-97)
SCFIEDULE FI
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
HARDY, MARY ,,lANE 21 03 0043
Bebts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Terry L. Hardy - reimbursement for funeral luncheon 250.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Terry L. Hardy 1,000.00
Social Secudty Number(s) / FIN Number of Personal Representative(s) 208-34-1353
Street Address 2205 N. Pewter Drive
city Macungie State PA Zip 18062
Year(s) Commission Paid: 2003
2. AttomeyFees Broujos & Gilroy, P.C.; FIN 23-2267691 1,000.00
3. Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) 0.00
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees - Register of Wills 93.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Register of Wills -Inventory filing fee 10.00
8. Register of Wills - Inheritance Tax Return filing fee 10.00
9. Register of Wills - Family Settlement Agreement filing fee 17.00
10. Terry L. Hardy - reimbursement for mileage 141.84
11. Terry L. Hardy - reimbursement for postage stamps 7.40
TOTAL (Also enter on line 9, Recapitulation) $ 2,529.24
(If more space is needed, insert additional sheets of the same size)
p~-V-1512 EX~ (1-97)
SCHEBULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES~ & LIENS
ESTATE OF FILE NUMBER
HARDY. MARY JANE 21 I)3 0043
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1. Continuing Care RX - medicine 230.21
28 S 2nd Street, Newport, PA 17074
2. Forest Park Health Center - nursing home care Oct, Nov, Dec. not covered by insurance 8,120.00
3. Central Penn Medical Group - emergency services 28.02
4. Department of Public Welfare, Estate Recovery Program, Class 6 claim 40,517.35
TOTAL (Also enter on line 10, Recapitulation) $ 48t895.5R
(If more space is needed, insert additional sheets Of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCtAL OPERATIONS
TPL SECTION - CASUALTY UNIT
PO BOX 8486
HARRISBURG PA 17105-8486
April 9, 2003
STATEMENT OF CLAIM SUMMARY
Estate of HARDY, MARY I
790 150 202
INPATIENT .00 .00 .00
OUTPATIENT .00 .00 .00
LONG TERM CARE .00 39,277.80 39,277.80
DRUG .00 1,239.55 1,239.55
~I~I~',SE[~[~ .00 40,517.35 40,517.35
SCHEDULE J
COMMO.W LT. OF .NSYLV^N,^ BENEFICIARIES
.N.ER,T^NCE T*X RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HARDY. VIARY JANE 21 03 004:3
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 outfight spousal distributions)
1. Stella Jane Allen daughter 1/5
39238 Shamrock Court, Pittsburgh, PA 15239
2. Saundra Kay Shaner daughter 1/5
1620 Jinn Court S.E., Palm Bay, FL 32909
3. Leonard D. Hardy, Jr. son 1/5
9 Donegal Drive, Carlisle, PA 17013
4. Terry L. Hardy son 1/5
2205 N. Pewter Drive, Macungie, PA 18062
5. Kathy L. Egley daughter 1/5
1270 Eastman Street, Platteville, WI 53818
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
WILL OF MARY JANE HARDY
I, MARY JANE HARDY, of Tyrone Borough, Blair County,
Pennsylvania, do make, publish and declare this as and for my
last will and testament hereby revoking and making void any and
all other wills by me at any time heretofore made:
FIRST. I direct that all my just debts and funeral expenses,
including my gravemarker, shall be paid from my residuary estate,
as soon as practicable after my decease, as a part of the expense
of the administration of my estate.
SECOND. All the rest, residue and remainder of my estate,
real and personal, of whatsoever kind and wheresoever situate, I
give, devise and bequeath to my beloved husband, Leonard D. Hardy, Sr.,
absolutely.
THIRD. In the event my said husband shall have predeceased me,
or in the event that he and I shall die simultaneously, or as the
result of the same accident or common disaster, or under such
circumstances that the order of our respective deaths cannot be
determined, then and in such event I give, devise and bequeath all
the rest, residue and remainder of my estate, real and personal, of
whatsoever kind and wheresoever situate in equal shares per stirpes
to my children, Stella Jane Hardy, Saundra Kay Shaner, Leonard D.
Hardy, Jr., Terry L. Hardy and Kathy L. Egley.
FOURTH. I constitute and appoint my husband, Leonard D. Hardy, Sr.
to be the Executor of this my last will and testament; provided, how-
ever, in the event my said husband shall have predeceased me or shall
be for any reason whatsoever unable or unwilling so to act, then and
in such event I constitute and appoint my son, Terry L. Hardy, to be
such executor.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~.5
day of October, 1976.
~'~'~/ ~-~) /~-~ ' (SEAL)
Signed, sealed, published and declared by the said Mary
Jane Hardy the within named TESTATRIX as and for her last will
and testament in the presence of us who have signed our names as
witnesses thereto at the request of the said TESTATRIX in her
presence and in the presence of each other.
INVENTORY OF THE REAL AND PERSONAL ESTATE OF
Mary Jane Hardy, deceased
File No.: 21-03-0043
Date of Death: January 6, 2003
1. M&T Bank checking acct # 11230802 $ 6,670.89
2. M&T Bank savings acct # 15004200331730 12,474.23
3. Penn State Medical Plan A - reimbursement for medicine 250.03
4. Central PA Medical Group 26.74
5. Forest Park Health Center - refund on nursing care 242.44
6. PSERS Retirement Benefit 38.69
7. Pa. SERS Surviving Spouse Benefit 29.33
TOTAL $19,732.35
I, Terry L. Hardy, Executor of the Estate of Mary Jane Hardy, late of Carlisle, Cumberland
County, Pennsylvania, have made an inventory of the entire estate of decedent, consisting of all
the personal property and real estate, except real estate outside the Commonwealth of
Pennsylvania, and the figures opposite each item of the Inventory represent the fair value as of
the date of decedent's death.
September 30, 2003
Family Settlement Agreement
File No. 21-03-0043
THIS is an agreement entered into this / 7~'gday of January, 2004, by and between Terry L.
Hardy, Executor and Beneficiary under the Estate of Mary Jane Hardy, and Stella Jane Allen,
Saundra Kay Shaner, Leonard D. Hardy, Jr., and Kathy L. Egley, Beneficiaries, whose names are
set forth as signatories at the end of this Agreement.
WHEREAS:
A. Mary Jane Hardy, of Forest Park Health Center, 700 Walnut Bottom Road, Carlisle, PA
17013, died on January 6, 2003.
B. On January 16, 2003, Letters Testamentary were granted to Terry L. Hardy ,at File No.
21-03-0043 in the Register of Wills Office for Cumberland County, Pennsylvania. ~
C. Executor has administered the Estate of Mary Jane Hardy up until the present time and
has paid all debts of the estate, including any Inheritance Tax owed.
D. Mary jane Hardy died testate, thereby vesting all rights and interest in her personal
property to her five children: Stella Jane Allen, Saundra Kay Shaner, Leonard D. Hardy, Jr.,
Terry L. Hardy, Kathy L. Egley.
E. The Estate of Mary Jane Hardy has received assets as set forth in Exhibit A attached
hereto and made a part hereof and has paid debts and expenses as set forth in Exhibit B attached
hereto and made a part hereof.
F. There are no assets to be distributed to beneficiaries. Assets remaining in Exhibit C are
to be paid to the Department of Public Welfare to settle their claim.
G. Executor and Beneficiaries desire to forego a formal accounting and schedule of
distribution and desire to conclude the estate by virtue of the filing of this document.
NOW, THEREFORE, Executor and Beneficiaries intending to be legally bound, state as follows:
1. The Executor and Beneficiaries agree that the Executor of the Estate of Mary Jane Hardy
need not file a formal accounting or schedule of distribution.
2. Executor states that all costs of the estate are paid.
3. Beneficiaries agree that the final distribution of all estate assets remaining after payment
of debts and expenses shall be paid to the Department of Public Welfare to settle their claim.
4. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
5. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Mary Jane Hardy, subject to the provisions
hereof.
IN WITNESS WHEREOF, Executor and Beneficiaries, intending to be legally bound hereby set
their hands and seals the day and year first above written.
Terry L. Hardy, Executor & Beneficiary
2205 N. Pewter Drive, Macungie, PA 18062
Stella Jane Allen, Beneficiary
39238 Shamrock Ct., Pittsburgh, PA 15239
Saundra Kay Shaner, Beneficiary
1620 Jinn Court SE, Palm Bay, FL 32909
Leonard D. Hardy, Jr., Beneficiary
9 Donegal Drive, Carlisle, PA 17013
Kathy L. Egley, Beneficiary
1270 Eastman Street, Platteville, WI 53818
4. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
5. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Mary Jane Hardy, subject to the provisions
hereof.
IN WITNESS WHEREOF, Executor and Beneficiaries, intending to be legally bound hereby set
their hands and seals the day and year first above written.
// ~'~~~' Terry L. Hardy, Executor & Beneficiary
2205 N. Pewter Drive, Macungie, PA 180¢i2
Stella Jane Allel(~/Bendficiary
39238 Shamrock Ct., Pittsburgh, PA 152:
Saundra Kay Shaner, Beneficiary
1620 Jinn Court SE, Palm Bay, FL 32909
Leonard D. Hardy, Jr., Beneficiary
9 Donegal Drive, Carlisle, PA 17013
Kathy L. Egley, Beneficiary
1270 Eastman Street, Platteville, WI 53818
4. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
5. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Mary Jane Hardy, subject to the provisions
hereof.
IN WITNESS WHEREOF, Executor and Beneficiaries, intending to be legally bound hereby set
their hands and seals the day and year first above written.
2205 N. Pewter Drive, Macungie, PA 18062
Stella Jane Allen, Beneficiary
39238 Shamrock Ct., Pittsburgh, PA 15239
Leonard D. Hardy, Jr., Beneficiary
9 Donegal Drive, Carlisle, PA 17013
Kathy L. Egley, Beneficiary
1270 Eastman Street, Platteville, WI 53818
4. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
5. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Mary Jane Hardy, subject to the provisions
hereof.
IN WITNESS WHEREOF, Executor and Beneficiaries, intending to be legally bound hereby set
their hands and seals the day and year first above written.
2205 N. Pewter Drive, Macungie, PA 18062
Stella Jane Allen, Beneficiary
39238 Shamrock Ct., Pittsburgh, PA 15239
Saundra Kay Shaner, Beneficiary
1620 Jinn Court SE, Palm Bay, FL 32909
· /
,L~~,-~ ~/~ Leonard D. Hardy, Jr., Benef~mi~'
9 Donegal Drive, Carlisle, PA 17013
Kathy L. Egley, Beneficiary
1270 Eastman Street, Platteville, WI 53818
4. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
5. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Mary Jane Hardy, subject to the provisions
hereof.
IN WITNESS WHEREOF, Executor and Beneficiaries, intending to be legally bound hereby set
their hands and seals the day and year first above written.
Terry L. Hardy, Executor & Beneficiary
2205 N. Pewter Drive, Macungie, PA 18062
Stella Jane Allen, Beneficiary
39238 Shamrock Ct., Pittsburgh, PA 15239
Saundra Kay Shaner, Beneficiary
1620 Jinn Court SE, Palm Bay, FL 32909
Leonard D. Hardy, Jr., Beneficiary
9 Donegal Drive, Carlisle, PA 17013
Kath¥.L. Egla~p, Beneficiary 67
270 Eastman Street, Platteville, WI 53818
EXHIBIT A
ASSETS and INCOME
ASSETS
1. M&T Bank checking acct # 11230802 $ 6,670.89
2. M&T Bank savings acct # 15004200331730 12,474.23
3. Penn State Medical Plan A - reimbursement for medicine 250.03
4. Forest Park Health Center - refund on nursing care 242.44
5. PSERS Retirement Benefit 38.69
6. Pa SERS Surviving Spouse Benefit 29.33
7. Central PA Medical Group - reimbursement of 12/02 overpayment 26.74
TOTAL ASSETS 19,732.35
INCOME
Interest earned on estate checking account 28.61
TOTAL ASSETS AND INCOME $19,760.96
EXHIBIT B - EXPENSES
1. Terry L. Hardy - reimbursement for funeral luncheon $ 250.00
2. Terry L. Hardy - personal representative fee 1,000.00
3. Broujos & Gilroy, P.C. - attorney fees 1,000.00
4. Register of Wills - probate fees 93.00
5. Register of Wills - Inventory filing fee 10.00
6. Register of Wills - Inheritance Tax Return 10.00
7. Register of Wills - Family Settlement Statement 17.00
8. Terry L. Hardy - reimbursement for mileage 141.84
9. Terry L. Hardy - reimbursement for postage stamps 7.40
10. Continuing Care RX - medicine 230.21
11. Forest Park Health Center - nursing home care Oct-Dec not covered by ins. 8,120.00
12. Central PA Medical Group - emergency services 28.02
Subtotal 10,907.47
Inheritance Tax -0-
TOTAL EXPENSES $10,907.47
EXHIBIT C - DISTRIBUTION
Assets $19,732.35
Income 28.61
Total Assets and Income 19,760.96
Expenditures - 10,907.47
Balance $ 8,853.49
Checkbook Balance 9,370.49
Final Bills
Register of Wills - filing fee for Family Settlement Agreement $ 17.00
Terry L. Hardy -balance of personal representative fee 250.00
Broujos & Gilroy, P.C. - legal fees 250.00
Total -517.00
Balance for final distribution $ 8,853.49
Payment to Department of Public Welfare to settle claim of $40,517.35 8,853.49
Checkbook Balance - 0 -
'/~-//"~'~-~:'~'~ COMMONNEALTH OF PENNSYLVANZA
BUREAU OF ZNDZVTDUAL TAXES DEPARTMENT OF REVENUE
XNHERITANCE TAX DIVISION
DEPT. 180601
HARRISBURG, PA X?IZB-0601 NOTICE OF INHERITANCE TAX
APPRATSENENT, ALLO#ANCE OR DTSALLONANCE
OF DEDUCTTONS AND ASSESSMENT OF TAX REV-1647EXAFP(DI-O$)
DATE 11-24-2003
ESTATE OF HARDY MARY J
DATE OF DEATH 01-06-2003
FILE NUMBER 21 03-0043
- '~ COUNTY CUMBERLAND
JOHN H BROUJOS ESQ ACN 101
BROUJOS & GILROY Amount
4 N HANOVER ST
CARLISLE PA 17013'
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS
DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HARDY MARY J FILE NO. 11 03-0043 ACN 101 DATE 11-14-2003
TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2 Stocks and Bonds (Schedule B) (2) .00 credit to your account,
$ Closely Held Stock/Partnership Tnterest (Schedule C) ($) .00 submit the upper port/on
q Hortgages/Notes Receivable (Schedule D) (4} .00 of this form with your
$ Cash/Bank Daposits/Hisc. Personal Property (Schedule E) (5) 19~732.35 tax payment.
6 Jointly Owned Property (Schedule F) (6) .00
7 Transfers (Schedule G) (7) .00
B Total Assets (B) 19,732.35
APPROVED DEDUCTIONS AND EXEMPTIONS: 2,529.24
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule T) (10) 48~895.58
11. Total Deductions (11)
12. Net Value of Tax Return (12) 31,692.47-
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 31,692.47-
NOTE: If an assessment ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .00 X O0 = .§0
16. Amount of Line 14 taxable at LAneal/Cless A rate (16), .00 X 045 = .00
17. Amount of Line 14 et Sibling rate (17), .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18), .00 X 15 = .00
19. Principal Tax Due (19)= .00
TAX CREDITS:
PAYMENT RECEIPT D/~COUNT (+)
AMOUNT PAID
DATE NUHBER TNTEREST/PEN PAID (-)
TOTAL TAX CREDIT I .00
BALANCE OF TAX DUEl .00
INTEREST AND PEN. . O0
TOTAL DUE . O0
ZF PAID AFTER DATE ZNDTCATED, SEE REVERSE ( TF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS REI~UIRED.
FOR CALCULAT/ON OF ADDTTTONAL TNTEREST. TF TOTAL DUE TS REFLECTED AS A 'CREDTT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCTTONS.)
RESERVATION: Estates of decadents dying on or before December 11, 1981 -- if any future interest in the estate is transferred
Jn possession or enjoyment to Class D (collateral) beneficiaries of tha decedent after the expiration of any estate For
lifo or for years, the Coaaonmaalth hereby expressZy reserves the right to appraise and assess transfer Inheritance Taxes
at the lamful Class B (collataral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section ZI40 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S.
Section 9140).
PAYMENT: Detach the top portion cf this Notice and submit mith your payment to the Register of Rills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NZLLB, AGENT
REFUND (CR): A refund of a tax credit, ahich ems not requested on the Tax Return, say ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of tha Register of Hills, any of the 13 Revenue District Offices, or by calling the special 2~-hour
answering service for forms ordering: 1-800-361-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-4~7-3010 (TT only).
OBJECTIONS: 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. 281021j Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the persona! representative, OR
--appeal to the Orphans' Court.
ADHIN-
ISTRATIVE
CORRECTIONS: 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 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-ISOi) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) colander months after the dacedent's death, a five percent (SX) discount of
the tax paid is allowed.
PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, ar nine (9) months and one (1) day from the date of
death, to the data of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .00016~. A11 taxes which became delinquent on 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 198Z through 2003 are:
Interest Daily Interest Daily Interest gaily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20X .0005~8 1987 9X .0001~7 1999 7~ .000192
1983 X6X .OOOq38 1988-1991 llX ,O00~O1 2000 8Z .000219
1984 IIX .000301 1992 9~ .0002~7 2001 91 .0002~7
1985 13X .000356 199~-199~ 7X .000192 2002 6~ .00016~
1986 lOX .00D174 1995-1998 9X .0001~7 Z003 5~ .000137
--Interest is calculated as follows:
ZNTERE~? = BALANCE OF TAX UNPAID X NUNBER OF DA¥~ DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax b~coaas delinquent will reflect an interest calculation to fifteen (15) days
beyond the data of the assessment. If payment is aade after the interest computation data shown on the
Notice, additional interest must be celculmted.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Mary Jane Hardy
Date of Death: January 6, 2003
Will No. Admin. No. 21-03-0043
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account/statement with the
Court? Yes No X
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes X No
d. Copies of receipts, releases, j oinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be
attached to this report.
Date:
~ Signature
~:~' Terry L. Hardy
~ 2205 N. Pewter Drive
cc Macungie, PA 18062
~ ~: 610 395 6583
.:2 ~ Capacity: X Personal Representative
Counsel for Personal
Representative
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/01/2004
BROUJOS JOHN ESQ
4 N HANOVER ST
CARLISLE, PA 17013
RE: Estate of HARDY MARY JANE
File Number: 2003-00043
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 1/06/2005
Your prompt attention to this matter will be appreciated.
Thank You.
S~hcerel~, ~ ~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative (s)
Judge
Pursuant to Rule 6.12 of the Supreme Court O~hans' Court Rules, I report the
following with respect to completion of the admin/stration of the above-captioned estate:
1. State whether administration o£the estate is complete:
2. If the answer is No, state when the persona/representative reasonably bel/eves
that the adm/_rfistrat/on ~dll be complete:
3. If the answer to No. I is Yes, state the fo/lowing:
a. Did the persona/representative ffle a final account with the Court?
Yes _ No ~-~ '
b. The separate Orphans' Court No. (if'any) for the personal representative's
account is:
c. Did the personal r._~presentative state an account informally to the parties
in/nterest¢ Yes ~ No /~.
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts
c'n acity: ~ers0n_*l Representative
~ :l 1~ 91 ;2~0'~ L--I Counsel £or personal representative