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Home My WebLink About05-25-10--~ REV-1500 150560712^ EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes councycode Year File Number Po Box.zaosot INHERITANCE TAX RETURN 2 1 1 0 Harrisburg, PA 17128-0601 - RESIDENT DECEDENT 0 0 0 1 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201185986 11292009 02031925 Decedent's Last Name Suffix Decedent's First Name HOLTRY ROBERT nnl E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^. 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. limited Estate ^ qa Future Interest Compromise (date of death after t2-12-s2) ^ 5. Federal Estate Tax Return Required ® g. Decedent Died Testate ~ Decedent Maintained a Living Trust 0 (Attach Copy of Will) ^ (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 Q Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 11.Edection to tax under Sec. 9113(A) (Attach Sch. O) Name CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: WILLIAM R . BUNT , ESQ . Daytime Telephone Number 7175828195 Firm Name (If Applicable) LAW OFFICE OF WILLIAM R. BUNT First line of address 109 SOUTH CARLISLE STREET Second line of address P.O. BOX 336 City or Post Office State NEW BLOOMFIELD ZIP Code PA 17068 Correspondent'se-mail address: Wrb@pa.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my kno it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any SIGNATURE OF PERSON RESPOySIB f,OR FILING RETURN Wayne E. Holtry 226 North Locus Point Road, Mechani A 17050 SIGNATURE OF PREPARE TN Tueni oooovc~ ~ ~.,~ ~ !/ William R. Bunt, Esq. ADDRESS REGISTER OF WILLS USE ONLY rv O ,___y -~ ~_~ ~ ~~ , i.i rv u7 -, DAT1=~fL~D ~ - ~~ W... ~ ____ 3 .. ~---,~ ~-., ~~~c.'> ,.,r , ~ Nledge and belief, knowledge. ~l 109 South Carlisle Street, New Bloomfield, PA 17068 Side 1 1505607120 150560712^ __.J 1505607220 REV-1500 EX Decedent's Social Security Number _ oe~edelll~5 Name: H O L T R Y, R O B E R T E 2 0 118 5 9 8 6 RECAPITULATION 1. Real Estate (Schedule A) ....................... .................................................................. . 1. 2. Stocks and Bonds (Schedule B) .............................................................................. . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... . 3, 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 5 , 8 7 1 5 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) .................... ................................................... 8. 5 8 7 1 5 4 Funeral Expenses 8 Administrative Costs (Schedule H) ......................................... g, ---- 3 , 19 6 2 8 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ............... ................. 10. 12 $ , 9 4 2 2 1 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11 • 1 3 2 , 13 8 4 9 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12 - 1 2 6 , 2 6 6 9 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which . an election to tax has not been made (Schedule J) ....................... .......................... 13. 14. - Net Value Subject to Tax (Line 12 minus Line 13)........ - ...................... - 12 ( 2 6 6 9 5 14 ........... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES , ........ . --- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 1 ~ 18. Amount of Line 14 taxable at collateral rate X .15 18 19. Tax Due ............. .................................................................................................. ...... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: _ Holtry, Robert E STREET ADDRESS - 210 Big Spring Road clrv Newville Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 3. InteresUPenalty ifapplicable Total Credits (A + g + C) (2) 0.00 D. Interest --- E. Penalty Total Interest/Penalty (D + E) (3) __ 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 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. --- (5B) ~.00 Make Check Payable to: REGISTER OF W/LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :............................................................................... Yes No b. retain the right to designate who shall use the property transferred or its income :.................................... ~ O 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 roe 0 receiving adequate consideration?............ p p rtY within one year of death without .................................. .. .. .. ^ 0 .............................. . 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. 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 three (3) percent [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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. File Number 21 - 10 - 00016 STATE ZIP PA 17241 The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [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 - CASH, BANK DEPOSITS, ~ MISC. COMMONWEALTH OE PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Holtry, RObert E FILE NUMBER 21 - 10 - 00016 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 VALUE AT DATE OF 1 Citizens Bank account no. 6100705803 -__- DEATH See attached exhibit 5,871.54 TOTAL (Also enter on Line 5, Recapitulation) 5,871.54 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA ~• -`r ~. E/V~E~S INHERITANCE TAX RETURN ~I~~~ RESIDENT DECEDENT ESTATE OF Holtry, Roben` E FILE NUMBER 71 _ 1n _ nnn~c vents of decedent must be reported on Schedule I. ITEM j NUMBERiFUNERALEXPENSES: A• 1 Hoffman-Roth Funeral Home B• ' ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Wayne E. Holtry Street Address 226 North Locust Point Road city Mechanicsburg state PA zi p 17050 Year(s) Commission paid 2010 2. j Attorneys Fees William R. Bunt 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Str eetAddress City State Zip Relationship of Claimant to Decedent 4. Probate Fees William R. Bunt-reimbursement 5. Accountant's Fees i 6. I Tax Return Preparer's Fees i i 7. Other Administrative Costs i 1 ;Green Ridge Village-nursing home final bill ' AMOUNT 428.00 150.00 1,250.00 376.28 977.00 --- TOTAL (Also enter on line 9, Recapitulation) 3,196.28 DESCRIPTION Schedule H COMMONWEALTH OF PENNSYLVANIA c ~e17SeS - INHERITANCE TAX RETURN A.J..,.:n;~,~,,,,,,~y „~ ~.~,~y„ ~n~ RESIDENT DECEDENT ~'~.Y~11 ti7u~1YVC~+WIa ESTATE OF Holtry, Robert E 2 FILE NUMBER 21 - 10 - 00016 ~~~~~~~~,a.'U ~~u~I~y Register or wuis-tile inheritance tax return 15.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OE PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Holtry, Robert E FILE NUMBER 21 - 10 - 00016 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Commonwealth of Pennsylvania Department of Public Welfare -- 128,942.21 TOTAL (Also enter on Line 10, Recapitulation) 128 942.21 REV-1513 EX+ (11-08) COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDE NT ESTATE OF Holtry, Robert E NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ :TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 !Kenneth Holtry 7223 Wood Brook Drive Tampa, FL 33625 FILE NUMBER ~ 21 - 10 - 00016 RELATIONSHIP TO SHARE OF ESTATE I AMOUNT OF ESTATE DECEDENT (Words) ($$$) Do Not List Trustee(s) Son I estate insolvent 2 ' Wayne Holtry I Son 226 N. Locust Point Road estate insolvent Mechanicsburg, PA 17050 3 ~ Ray Holtry ~ Son 2290 Pine Road estate insolvent Newville, PA 17241 I i i i i '.:Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II, ~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET - 0.00 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES continued ~-.~ ~ f+~ ~ yr Holtry, Robert E NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, ;TAXABLE DISTRIBUTIONS [include outright S ousal distributions, and transfers under Sec. 9116 (a) (1.2)] 4 Bethany (Holtry) Fitzpatrick 807 Fiarview Road Carlisle, PA 17013 5 I Cara Holtry 171 Faith Circle , Carlisle, PA 17013 6 Jason Ball 5802 Idle Forest Place Tampa, FL 33614 7 Matthew Holtry 102 Pearl Drive Chaple Hill, NC 27517 8 Nicole (Holtry) Frazer 806 Carved Oak Drive ; Durham, NC 27707 9 ~ Stephany (Holtry) Wisler 260 Airport Road Shippensburg, PA 17257 10 ;Clinton Holtry 220 Jumper Road Newburg, PA 17240 11 Jesston Holtry 15599 Cumberland Hwy. : Newburg, PA 17240 12 ' Deloris Kidd 698 Shermans Valley Road New Bloomfield, PA 17068 13 !Barbara Singleton 466 Pine Hill Road Landisburg, PA 17040 FILE NUMBER 21 - 10 - 00016 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) __ Do Not List Trustee(s) Granddaughter I estate insolvent Granddaughter I estate insolvent Stepgrandson I estate insolvent Grandson I estate insolvent Granddaughter I estate insolvent Granddaughter I estate insolvent Grandson I estate insolvent Grandson I estate insolvent Stepdaughter I estate insolvent Stepdaughter estate insolvent Page 2 of Schedule J REV-1513 EX+ (9-0O) COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF Holtry, Robert E NUMBER ! NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, ,,,!TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 14 ;Jerry Frederick 124 Claire Lane, Apt. 208 Mooresville, NC 28117 FILE NUMBER ~ 21 - 10 - 00016 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Do Not List Trustee(s) Stepson I estate insolvent 15 ;Jennifer (Butch) Landis 250 W. 75th Street, Apt. 3A New York, NY 10023 16 Elizabeth (Butch) Nace 418C West Main Street New Bloomfield, PA 17068 17 Thomas Kidd 698 Shermans Valley Road New Bloomfield, PA 17068 Stepgranddaughter I estate insolvent Stepgranddaughter I estate insolvent Stepgrandson estate insolvent Page 3 of Schedule J LAST WILL ~NT~ T ~T7-MFNT ROBERT E• HO_ LTRY WILLIAM R. BUNT ATTORNEY AT LAW TOY 8. CARLrfaLf BT. Ntw B~oowr~rrcLC, PA. t~oee TE~• +~+~+ aat-~taa I, ROBERT E. HOLTRY, of Carroll Township, perry County, Pennsylvania, being of sound mind, memory and understanding, do hereby declare this to be my Last Will and Testament, revoking all former wills or writings in the nature thereof and any codicils thereto made. FIRST: I direct my hereinafter named Executor or alternate Executor, as the case may be, to pay all of my just debts, funeral expenses, costs of administration and inheritance taxes out of the corpus of my estate as soon after my decease as is practicable to do so. SECOND: A.) I give and bequeath unto my wife, Doris M. Holtry, all of my push and riding mowers. B.) I give and bequeath unto my granddaughter, Bethany C. Holtry, the display cupboard which was given to my parents for their 60th wedding anniversary by their children. C•) I give and bequeath unto my granddaughter, Nicole Holtry, the display cupboard which my former wife and I had at our farmhouse. D•) I give and bequeath unto my Page 1 of 6 pages granddaughter, stephany Holtry, my black miniature chair. E•) I give and bequeath unto my granddaughter, Cara L. Holtry, my set of dishes with blue flowers received by my former wife and me on our 25th wedding anniversary. F.) I give and bequeath unto my grandson, Jesston Holtry, my set of draft horses given to me by my parents. G.) I give and bequeath unto my grandson, Matthew Holtry, my painted circular saw. H.) I give and bequeath unto my grandson, Clinton Holtry, my painted milk stool. I.) I give and bequeath unto my son, Kenneth R. Holtry, the Civil War discharge papers of Solomon Holtry with the admonition that it is to remain in the Holtry name forever. J•) I give and bequeath the sum of One Hundred ($100.00) Dollars unto my grandson, Matthew Holtry. K.) I give and bequeath the sum of one Hundred ($100.00) Dollars unto my granddaughter, Nicole Holtry. L.) I give and bequeath the sum of One Hundred ($ioo.oo) Dollars unto my granddaughter, Bethany C. H l o try. M.) I give and be eath t ~ he sum of One Hundred ($100.00) Dollars unto my granddaughter, Cara Holtry. N.) I give and bequeath the sum of One waLUwwA R. 6UNT A Hundred ($100.00) Dollars unto my granddaughter, Stephany Holtry. TrORN[Y AT LAW IO>a d. CARL1l LS 8T. "`W g`°°"F"`°' ~"~ »oes Page 2 of 6 pages IT F [L. (7171 sez-spas tx. 1717) 6s2-7621 O•) I give and bequeath the sum of One Hundred (5100.00) Dollars unto my grandson, Clinton Holtry. P.) I give and bequeath the sum of One Hundred ($100.00) Dollars unto my grandson, Jesston Holtry. 4•) I give and bequeath the sum of One Hundred ($100.00) Dollars unto my stepgrandson, Jason J. Ball. R•) I give and bequeath the sum of One Hundred ($100.00) Dollars unto my stepgranddaughter, Elizabeth A. Sutch. S•) I give and bequeath the sum of One Hundred ($100.00) Dollars unto my stepgranddaughter, Jenny Sutch. T•) I give and bequeath the sum of One Hundred ($100.00) Dollars unto my stepgrandson, Thomas D. Kidd. THIRD: In the event that my wife, Doris M. Holtry, survives my decease, then and in that event, I give, bequeath and devise all of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever situate as set forth below: A.} I give, bequeath and devise six-ninths (6/9} of my residuary estate unto my wife, Doris M. Holtry. B•) I give, bequeath and devise one-ninth (1/9) of my residuary estate unto my son, Kenneth R. Holtry. C•) I give, bequeath and devise one-ninth (1/9) of my residuary estate unto my son, Wayne E. Holtry. D•) I give, bequeath and devise one-ninth WILLIAM R. BUNT ATfORN[Y At LAw Page 3 of 6 pages tC6 ,. CA11LIf LS >n, NLW BLOO MFIlLD~ rA. »oss r~L. <~1~- sst-alga iAli. Ir1T> aas-~szl (1/9) of my residuary estate unto my son, Ray E. Holtry. In the event that any of my three (3) sons named in Paragraph THIRD predecease my decease, then and in that event, I give, bequeath and devise the share of said deceased son's share of my estate unto my remaining sons above named surviving my decease, in equal shares, share and share alike. FOURTH: In the event that my wife, Doris M. Holtry, predecease my decease, then and in that event, I give, bequeath and devise all of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever situate as set forth below: A.) I give, bequeath and devise one-sixth (1/6) of my residuary estate unto my son, Kenneth R. Holtry. B.) I give, bequeath and devise one-sixth (1/6} of my residuary estate unto my son, Wayne E. Holtry. C.) I give, bequeath and devise one-sixth (1/b) of my residuary estate unto my son, Ray E. Holtry. D.} I give, bequeath and devise one-sixth (1/6) of my residuary estate unto my stepdaughter, Deloris E. Kidd. E.} I give, bequeath and devise one-sixth ~ (1/6) of my residuary estate unto my stepdaughter, Barbara J. Singleton. F.) I give, bequeath and devise one-sixth WILLIAM R. RUNT (1/6) of my residuary estate unto my stepson, Jerry L. Frederick. At7cRN[Y AT LAW 108 8. CARLIiL[ 8T. Page 4 of 6 pages N[W BLDDMTI[LD~ PA. 1>ose raL. (>171 as2•elea iAJ[. (717) 682-7521 i In the event that any of the beneficiaries above named in Paragraph FOURTH predecease my decease, then and in that event, I give, bequeath and devise the share of said deceased beneficiary~s share of my estate unto the remaining • beneficiaries above named surviving my decease, in equal shares, share and share alike. .FIFTH: Any person who shall have died within thirty (30) days of my death, or under such circumstances that the order • of our deaths cannot be established by proof, shall be deemed to have predeceased me. SIXTH: I name, constitute and appoint my son, Wayne E. Holtry, as the Executor of this my Last Will and Testament. In the event of the renunciation, death, resignation or inability of my son, Wayne E. Holtry, to act for any reason whatsoever, as the Executor of my estate, then and in that event, I name, constitute and appoint my son., Ray E. Holtry, as the alternate Executor of this my Last Will and Testament. My Executor or alternate Executor, as the case may be, is hereby excused from the posting of any bond or security, notwithstanding any provisions of the law to the ~ contrary. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this 20th day of December, 1994. P WILLIAM R. PUNT G` (S~~ ATTOR}!tY AT LI1W loo s. cARLr.I.s ,,, Page 5 of 6 pages N[w H~ooM~lao, PA. boss TRH. c717) sez-slos FAx. (717) 6D2-7621 Signed, sealed, published and declared by the above wlLUwM a. suNr ATTORN;y AT LAW ZOO a. CARLI~Lt >aT. N;M/ 9LOOMPI;I,D, TA. ~~oes rAx. IT17i as:-~a2r named Testator, as and for his Last Will and Testament, in our presence, who, in his presence, at his request and in the presence or each other, have hereunto sett our names as attesting witrse~ses . _ ., _ / Page 6 of 6 pages ~~ ~~~~~~~ tY ~~ Account Account xoL rnuclpat tsatance A5 of I)O)r Interest tom Last Posting to Account Balance as of D4D f COA~IONWEALTH OF PENNSYLVANW DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCULL OPERATIONS DMSION OF THIRD PARTY LIABIL1Ty ESTATE RECOVERY PROGRAM Po Box a+es HARRISBURG, PA 1710586 January 19, 2010 WILLIAM R BUNT ESQUIRE 109 S CARLISLE ST PO BOX 336 NEW BLOOMFIELD PA 17068 Dear Mr. Bunt: Re: ROBERT HOLTRY CIS #: 570178897 SSN: 201-18-5986 Date of Death: 11/29/2009 Please be advised that the Department of Public Welfare maintains a claim in the amount of $128,942.21 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August I5, 1994, as amended by Act 20-95, effective June 30; 1995. Enclosed is the Department's itemized statement of claim. i A portion of this medical expense „ namely $30,707.59, was incurred during the last six months of the decedent's life; claim pursuant to Section 3392 of the Decedents, Estatesfoand Fiduciariesss 3 Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely _$98_ 2~,62~ is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this;Ietter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the doed, the latest tax assessment, and a current appraisal, if available. Sincerely, ~~- ~y~ . t~~ Tina M. Wise TPL Program Investigator 717-219-1209 717-772--6553 FAX Enclosure WILLIAM R. BUNT ATTORNEY AT LAW 109 SOUTH CARLISLE STREET P. O. Box 336 NEW BLOOMFIELD, PA 17068-0336 TEL (717) 582-8195 FAx (717) 582-7521 May 21, 2010 Ms. Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Robert E. Holtry No. 21-2010-00016 Dear Ms. Farner Strasbaugh: WILLIAM R. BUNT, ESQ. CHRYSTAL L. PROSSER, ESQ. I am enclosing herein two (2) copies of the Pennsylvania Inheritance Tax Return with regard to the above referenced estate. I am also enclosing herein a check made payable to the Register of Wills in the amount of $15.00 for the filing fee for said Inheritance Tax Return. If you have any questions with regard thereto, please contact me. Enc. Cc: Mr. Wayne Holtry WRB/as Very tr y yours, William R. Bunt ra -~ cJ _. ~ .-~ --,~ - -~ i -l~_ C-? ~,. -.t - - ". i "T'i f „~'~ ~' _~ ~ v . ~ ...s r- ~~. ~~'_+ O .ice hT ~ '` ~ C,L Ci ~ O fn ~.~ a aC V p ~ ~ ` ~ / ~ . t".~ Cry lr., , V (B ~ ~ N . ~•-- U ~ ~ ~ ~ ~T, ' ~ ~ ~ ch C ~ ~ O O U ~ ~ LL ~ ~ ~ ~ __ - (LS C ` ~ ~ ~ O ~ _ ~ ~ U ~ f - ~ C ~ - j vi ~ ~ U ~ U f ' ~ .... i p ~ ~ O ~ ~ a'cn ~ ~ j a~ R. ^ _ -. ~ ^ ~ 7 ~ ~ W U M ~ X ~ i ~ ~ v i CG1 ~ O O ~ . _ ,~ ~ L1. Z