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HomeMy WebLinkAbout03-0655 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Catherine T. Scott No 21-~- also known as To: R~g~ster of Wills for the County of Cumberland in the Social Security No. 201-18-8105 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the executors named in the last will of the above decedent, dated Jan. 7,1993 and codicil(s) dated N/A (state relevenat circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at Forest Park Health Center, 770 Walnut Bottom Road, Borough of Carlisle (list street, number and municipality) Decedent, then 87 years of age, died Nov. 12, 2002 at Borough of Carlisle, Cumberland County Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: No Exceptions Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ unestimated (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: Total: unestirnated WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~aes A. Scott ' ~ Theodore Thomas Scott //2/W. Penn, Apt.#208 438 N. West Street '-Carlisle PA 17013 Carlisle PA 17013 OATH O1~' PERSONAL RE}'RSENTATIVE COMMONWEATLH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent pelJtioner(s) will well and truly adminis~r t~l~ estate according to law. Sworn to or affirmed and subscribed before me this ~ :r. day of r __ ~ AUGUST, 2003 No. 21-02- ~ Estate of Catherine T. Scott , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~-~ ocz. ~:~ 200._q . in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated__ Jan. 7,1993 described therein be admitted to probate and filed of record as the last will of Catherine T. Scott and Letters Testamentary ~ are hereby granted to James A. Scott, III and Theodore Thomas Scott Probate, Letters, Etc. $ ~, a:,o Robert M. Frey #06274 Short Certificates(1 ) $ ~. ,O o ATTORNEY (Sup. Ct. I.D. No.) tion $ 5 South Hanover Street $ ~/~. t::;,~ Carlisle, Pennsylvania 17013 Total $ t .~;"~. ~5~D '- ADDRESS Filed ..... .~'..-,~...-:42~ ............... (717) 243-5838 PHONE REGISTER OF WILLS OF _CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS ROBERT M. FREY xo~i~ ., (each) a subscribing witness to the will presented herewith,.. (each) being duly qualified according to law, depose(s) and say(s) that h_._~ wa s CATHER:[NE T. SCOTT present and saw the testa rit_.~.~, sign the same and that he , signed as a witness at the request of testat_rix ._ in ~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). .' Sw°rntooraffirmedandsubscribedbefore ~f~..~4~. me this ~) re/ day of Robert M. Fre~{Name) August, 2003 ~xx 5 S. Hanover Street Carlisle PA 17013 ~-~-4~(~.~ '~~_~ ' - (Address) Register (Name) (~4ddruss) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS MARY C. WERT ~ ~ (each) a subscriber hereto, (each) being duly qualified according, to law, depose(s) and say(s) that she is " familiar with the signature of Krista Kinq testatr~-x of (one of the subscribing witnesses to) the will presented herewith and that she ' ~xx believes the signature on the will is in the handwriting of ~ Krista King to the best of her knowledge and belief.~~ ~ ' ~ Sworn to or affirmed and subscribed before me this day of Mary C. Wert (Name) August, 2003 ~ 5 S ' ~.~,.j~)~ · Hanoaver Street,Carlisle PA 17013 Register _ . (Name) (Address) H105.905M REV. 4/96 This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. Charles Hardester '" State Registrar ! ! 1 g 0 4 1 ~'~ HAY 0.5 2003 No. ~ Date /' HlOS. l~.~v. 2/87 COMMONWEALTH OF PENNSYLVANIA- DEPARTMENT OF HEALTH. VITAL RECORDS 113 4 3 ? CERTIFICATE OF DEATH TYPE/I~RtNT IN STATE FILE NUMeER e~*c~K t. Catherzne T. Scott .emale ,. 201 -- 18 ~ 8105 ~lovember 12,2002 n n_ ~ ~ ~ ~8 7 ' ' J 1" ' - ~ ~Cumberland ,Carlisle ~Forest Park Health Center ~~ Black ,. Homem~ke, ,,,~n Home I,.'='~ I~1,. "~'I. ~ - ~s~~.~) i~c~s ,?. ~ Pennsylvania ~ ,~,~~ 700 ~alnut Bottom Road }~u~ ,~Carlisle, Penna. 17013 '~ Cumberland *~' ~ Carlisle ,,. ~11z~m D. Thompson ~,,. ' ~n~e 'Thomas ~ o es A. cart,Jr. ~ ~~treet,Carlzsle,Penna. 17013 ~= ~' "1,,;: ...........' ....I,. Hemorzal Gardens I,gum6erlana County, Penna .... LAST WILL AND TESTAMENT OF CATHERINE T. SCOTT I, CATHERINE T. SCOTT, widow, of One West Penn Street, Apartment 202, in the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executors to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I direct that my funeral services be conducted by the Ewing Brothers Funeral Home 630 South Hanover Street, Carlisle, Pennsylvania, in accordance with an'angements which I have made there, and that my body be interred beside that of my husband, James A. Scott, on our burial lot located in Cumberland Valley Memorial Gardens in West Pennsboro Township near the Borough of Carlisle, Pennsylvania. I further direct that all inheritance, estate and death taxes payable on account of my death shall be paid from the residue from of my estate regardless of whether the assets upon which such taxes are based are included in my probate estate. 2. I give and bequeath the china chariot to my son, James A. Scott, Jr., provided he shall survive me by a period of ninety (90) days, but should he fail to so survive me then the same shall lapse and be included in the residue of my estate. 3. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in three (3) equal shares to my son and two grandsons, their heirs and assigns, provided each of them shall survive me by a period of ninety (90) days, but should any of them fail to so survive me then the same shall lapse and be added to the shares of the remaining person or persons. My son is James A. Scott, Jr., and his two sons who are my grandsons are James A. Scott, III, and Theodore Thomas Scott. 4. I hereby nominate, constitute and appoint my said son, James A. Scott, Jr., and my said two grandsons, James A. Scott, III, and Theodore Thomas Scott, as co-Executors of this my Last Will and Testament, and I further direct that none of them shall be required to post any bond to secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, written on one (1) page, this 7th day of January, 1993. Catherine T. Scott Signed, sealed, published and declared by CATHERINE T. SCOTT, the Testatrix above- named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. LAST WILL AND TESTAMENT OF C:ATHERINE T. SCOTT FREY & TILEY ATTO R N EYS-AT- LAW A Professional Corporation 5 South Hanover Street Carlisle, PA 17013 Telephone (717) 243-5838 FREY & TILEY A'I-I'ORN EYS-AT- LAW 5 SOUTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 ROBERT M. FREY OF COUNSEL STEPHEN D, TILEY TELEPHONE (717) 243-5838 ROBERT G. FREY FACSIMILE (717) 243-6441 August 7, 2003 Register of Wills of Cumberland County Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Catherine T. Scott Date of Death Nov. 12, 2002 Dear Sir/Madam: Catherine T. Scott died a widow on November 12, 2002, leaving a Last Will and Testament, which has been left with you for probate, in which she named her son and two grandsons as co-Executors. Her son, James A. Scott, Jr. has continuously refused to sign a renunciation or to agree to serve as a Co- Executor. He is understood to have mental health problems. The two grandsons are James A Scott, III, and Theodore Thomas Scott, who have agreed to serve. It is requested that you issue Letters Testamentary to the two grandsons, James a Scott, III, and Theodore Thomas Scott. For your information, the assets of the estate are understood to total less than $10,000 and are comprised of shares of Metropolitan Life Insurance Company common stock, and a balance in the patient account of the decedent at Forest Park Nursing Home in Carlisle. A claim against the estate has been received from the Department of Public Welfare of the Commonwealth of the Pennsylvania in the amount of $166,044.03, for restitution of m~dical assistance granted to the deceased, of which claim $24,026.97 was incurred during the last 6 months of the decedent's life. Sincerely yours, Robert M. Frey RMF/tl CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: CATHERINE T. SCOTT Date of Death: NOVEMBER 12, 2002 Will No. Admin. No. 21-03-0655 To the Register: I certify that notice of (beneficial Interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on: Name Address James A. Scott, Jr. 126 W. Willow Street, Carlisle PA 17013 James A. Scott, III 2 West Penn St.,Apt. 208, Carlisle PA 17013 Theodore Thomas Scott 438 N. West Street, Carlisle PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6)a) except NO EXCEPTIONS Date: November 26, 2003 Signature Name: Robert M. Frey Address: 5 South Hanover Street Carlisle, Pennsylvania 17013 Capacity:~Personal Representative X Counsel for Personal Representative ~EV-~0O EX (e-O0, COMMONWEALTH OF I l v-1 ....... PENNSYLVANIA DEPARTMENT OF REVENUEDEPT, 280601 INHERITANCETAX RETURN ;"E.UM.E. 21-03-0655 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT cou. cooE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) " SOCIAL SECURITY NUMBER ~- Catherine T. Scott z 201-18-8105 ¢3'" DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) III THI~ RETURN MI, J~T BE fiLED IN DUPLICATE W/TH 'I~E ~,,, 11/12/2002 11611915 REGISTER OF WILLS Q 'IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ~'~ 1. Odginal Retum ~'~ 2. Supplemental Retum [~ 3. Remainder Retum (date of death prior to 12.13.82) ~ ~--~ 4. Limitsd Estate [---] 48. Future Interest Cornpromise (date of death after 12.12.82) ~'-] 5. Federal Estate Tax Return Required O~ [~ 6. Decedent Died Testate (Attach copy of Will) J~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes < r~ 9. Litigation Proceeds Received ~---] 10. spousal Pove~ Credit (date of deal~ bergen 12.31_91 a~l 1_1.g5) ~11. Elec'don to tax under Sec. 9113(A) (Attach Sch O) ~ NAME CI COMPLETE MAILING ADDRESS z Robert M. Frey South Hanover Street O I~. FIRM NAME (If Applicable) ,,,~ Carlisle, Pennsyslvania 17013 "' Frey and Tiley O TELEPHONE NUMBER 717)243-5838 1. Real Estate (Schedule A) (1) NONE OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 1,446 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE 4. Mortgages & Notes Receivable (Schedule D) (4) NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property . (Schedule E) (5) 2,123 6.r_.__]Joinfly Owned Property (Schedule F) (6) NONE z _o Laseparate Billing Requested - < 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property ~ (Schedule G or L) I- (7) NONE a. ~ 8. TOTAL GROSS ASSETS (total Lines 1-7) ,,, (8) 3,569 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1,572 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ',10) 1,997 11. TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 3,569 12. NET VALUE OF ESTATE (Line 8 minus Line 11) (12) 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) 0 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 0 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax Z rate ,or transfers under Sec.9116 (a)(1.2) x .0 (15) -(2 - 0 I.- < 16. Amount of Line 14 taxable at lineal rate -~r- 0 x .0 45 (16) 0 ~ 17. Amount of Line 14 taxable at sibling rate OO x .12 (17) 0 < 18. Amount of Line 14 taxable at collateral rate ~- X .15 (18) 19. Tax Due 20.[~] (19) 0 Decedent's Complete Address: 700 Walnut Bottom Road CITY " ISTATE ZIP Carlisle JPA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Total Credits ( A + B + C ) (2) 0 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWI~I~ 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 trensferred; ........................ ~'~ ~-~ b. retain the dght to designate who shall use the property transferred or its income; ............. [] [] c. retain a reversionary interest; or ................................ r~ d. receive the promise for life of either payments, benefits or care? ................... ~'~ r-~ 2. if death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ............................. r~ J-~ 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? ...... [-~ 4. Did decedent own an Individual Retirement Account, annuity or other non-probate property which contains a beneficiary designation3 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 d,~c_!ere that I have examined this tatum, including ~c~,~.,~par, ying s~L.~ules and statements, and to the best of my knowledge and belief, it is true, and complete. Declaration of preparer other than the personal representative is he .,~d_ on all ;.;,.. ,,,ation of which p,-epa~, has any knowable. ~SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN - "' ~ ~,~ ~..~ DATE 5 South Hanover Street Carlisle Penns Ivania 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. Section 9116 (a)(l.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. Section 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. Section 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. Section 9116(1.2) [72 P.S. Section 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings s 12% [72 P.S. Section 9116(a)(1.3)1 .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. 217 REV-1503 EX+ (6-98} SCHEDULE B COMMO.W~LT. OF.~..SYLV*.~ STOCKS & BONDS INHERITANCE TAX RETURN .. RESIDENT DECEDENT ESTATE OF FILE NUMBER Catherine T. Scott 21-03-0655 All property jointly-owned with Hght of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MetLife(55 shams @26.29) 1,446 TOTAL (Also enter on 1,446 (If mom space is needed, insert additional sheets of the same size) Please Note: Your Sale Proceeds Check is Attached BROKER'S Nanie, Addre~. ZIP Code. Fede~l Ide,,,,ncn.on .n,nber a,,d Te,e.,,one.umber:Form 1099-B ]'roceed, From Broker and Barter COPY B FOR RECIPIENT Exchange Transactions Mellon Investor Se~lcea ' *'IMPORTANT TAX INFORMATION*.. 85 Challenger Road ~J-.~. Ridgerield Pnrk. NJ 07660 This Is Imporlanl lax Informat on a~ d s be ng rum s ~ed lo . RETURN :FOR 2004 OMB NO. : d~e lmernal Revenue Service. Ir ~ are r~qulred m Ille a .. 1545-07 22-3367522/ return, a nesllgem:e pena ). or other .~,cIIon nm)' be la DaLe orSale lb CUSIP Humber 1-800-6,19-3593 Imposed on ).ou Ir Ibis Income Is [a~ble and the IRS determlnu Ibet It Ires not been reported. 02/09/2004 59 J 56R l 0 TO WHOM PAID ;~. Stocks, Bonds. etc. 3. Bartering : $1,910.83 Theodore Thomas Scott & James A. Scott lli Ex. Uw Catherine T Scott 4. FEDERAL INCOME TAX WITHHELD C/O Robert M Frey 5 South Hanover Street $0.00 Carlisle, PA 17013 REPORTED [--1 TOIRS ~ 5. Descrl@Lim! MetLife, ~nc. 8062 0860 5433 51-6537449 · IMPORTANT TAX RETURN DOCUMENT ATTACHED · YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. Retain this number for future reference: Investor ID: 8062 0860 543:} For information concerning this statement, call MetLife, Inc.'s Transfer Agent, Mellon Investor Services toll free at 1-800-649-3593 SFULL (07-03) PLEASE DETACH ALONG THE PERFORATION ]: 021 J 0000780 :=:~ .. ~:. :~EEACFOFTHIGDOCUMENTHASA 213 ;.~;~.' ';~. ':~Order Of: Tbeodore Thom~ Scolt & James A. Payable at SCOll Ill Ex. Uw Catherine T Scoit Chase Manhattan Bank, SyracuSe:, WSJ.com Stock Charting for MET 4/22/04 1:34 PM Metlife Inc (MET) (NYSE) U.S. Dollar Date Price High Low Volume 2 Month (Daily) ~BigChart~.com 11/12/02 26.29 26.54 25.9 2,651,200 ! 28 ,...j~"V'~J 26 No Splits /4 ~, 24 Get another quote any day after 1/2/1970 No,.~ l~ec 1/2/1970 1mo 2mo 3mo 6mo lyr 3yr 5yr Sy. bo : I Date: 111!12/2002 ~ Copyright © 1998-2004 Bi.qCharts.com Inc. Historical and current end-of-day data provided by FT Interactive Data. Copyright © 2004 Dow Jones & Company, Inc. All Rights Reserved http://www~bigcharts~c~m/cust~m/wsjie/wsjbb~hist~rica~~asp?symb=m~t&sid=863~&c~~se-date=~ 1/12/2002 Page 1 of l Estate of Barbara*A Scott 60-15031313 1 12 CIO James Flower Carlisle PA 17013 PAY TO THE ' ~ ~ Orrstown Bank - :- .... ~'/~) 0 Shippensburg, PA 17257 ~o ~ MEMO ~:O ~. ~.,:1, l, 50 :t, F=~: l,O.°.O.O 58~,q,' 0 I, ], ii REV-1508 EX + ~1-97) (I) SCHEDULE E co~Mo.w~H OF.EN.S¥.VAN.^ CASH. BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN .ESlDENT DECEDE.T PERSONAL PROPERTY ESTATE OF FILE NUMBER 21-03-0655 Include the p,-~ of litigalion and the date the p~oceeds were received by the estate. ALL PROPERTY JOINTLY-OWNED WITH THE RIGHT OF SURVIVORSHIP MUST B~ DISCL(:X.RF.D ON SCHEDULE F. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Inheritance from the Estate of Barbara A. Scott 2. MetLife Dividend 2,106 17 TOTAL (Also enter on line 2,123 (If more space is needed, insert additional sheets of the same size) 217 REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES& INHERITANCE TAX RETURN RES'DENT'OECEDE.T ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Catherine T. Scott 21-03-0655 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. IVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) SEE A'I-I'ACHED SHEET Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2004 750 2. Attorney Fees 750 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 53 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills, (1) Short Certificate 3 8. Vital Records, (2) Death Certificates 6 9. Filing Fee 10 TOTAL (Also enter on line I $ 1,572 (If more space is needed, insert additional sheets of the same size) "SCHEDULE "H" ATTACHMENT" JAMES A. SCOTT, JR. 126 W. WILLOW STREET CARLISLE PA 17013 S.S. NO. AND THEODORE THOMAS SCOTT 438 NORTH WEST STREET CARLISLE PA 17013 S.S. NO. I~EV-1512' EX+ (6-98) AT SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN °' RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Catherine T. Scott 21-03-0655 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Forest Park Health Center, Nursing Home 744 2. Pennsylvania Department of Public Welfare Claim of $142,017.06 1,253 TOTAL (Also enter on line I 99/ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 March 03, 2003 FREY AND TILEY ROBERT M FREY ESQ 5 SOUTH HAi~OVER STREET CARLISLE PA 17103 Re: CATHERINE SCOTT CIS #: 110118434 SSN: 201-18-8105 Date of Death: 11/12/2002 Dear Attorney Frey: Please be advised that the Department of Public Welfare maintains a claim in the amount of $166,044.03 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $24,026.97, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $142,017.06, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth,s claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, Margaret L. Sohn Claims Investigation Agent 717-772-6609 717-705-8150 FAX Enclosure 217 REV-1513 EX + (9-00) SCHEDULE J COMMO.WE^L~. Or PENNS~,V^N~ .. BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Catherine T. Scott 21-03-0655 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBEI; NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Tr,_,~_?3~(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. JamesA. Scott, Jr. 126 W. Willow Street Carlisle, Pennsylvania 17013 .~on 1/3 of residue of residue 2. Theodore Thomas Scott 438 North West Street Carlisle, Pennsylvania 17013 Grandson 1/3 of residue of estate 3. James A. Scott, III 2 West Penn, Apt. #208 Carlisle, Pennsylvania 17013 Grandson 1/3 of residue of estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEI- I $ 0 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF CATHERINE T. SCOTT I, CATHERINE T. SCOTI', widow, of One West Penn Street, Apartment 202, in the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executors to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I direct that my funeral services be conducted by the Ewing Brothers Funeral Home 630 South Hanover Street, Car/is/e, Pennsylvania, in accordance with arrangements whi6h I have made there, and that my body be interred beside that of my husband, .lames A. Scott, on our burial lot located in Cumberland Valley Memorial Gardens in West Pennsbom Township near the Borough of Carlisle, Pennsylvania. I further direct that all inheritance, estate and death taxes payable on account of my death shall be paid from the residue from of my estate regardless of whether the assets upon which such taxes are based are included in my probate estate. 2. I give and bequeath the china chariot to my son, James A. Scott, Sr., provided he shall survive me by a period of ninety (90) days, but should he fail to so survive me then the same shall lapse and be included in the residue of my estate. 3. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in three (3) equal shares to my son and two grandsons, their heirs and assigns, provided each of them shall survive me by a period of ninety (90) days, but should any of them fail to so survive me then the same shall lapse and be added to the shares of the remaining person or persons. My son is James A. Scott, .ir., and his two sons who are my grandsons are James A. Scott, IH, and Theodore Thomas Scott. 4. I hereby nominate, constitute and appoint my said son, .lames A. Scott, .lt., and my said two grandsons, .lames A. Scott, III, and Theodore Thomas Scott, as co-Executors of this my Last Will and Testament, and I further direct that none of them shall be required to post any bond to secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, written on one (1) page, this 7th day of.lanuary, 1993. Catherine T. Scott - Signed, sealed, published and declared by CATHERINE T. SCOTF, the Testatrix above- named, as and for her Last Will and Testament, in our presence, who, in her presence, at her re.quest, and in the presence of each other, have hereunto subscribed our names as attesting WlmeSSeS. COHHONWEALTH OF PENNSYLVANZA BUREAU OF ZNDZVZDUAL TAXES DEPARTHENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRZSBURG, PA 17128-0601 NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX REV-lSd? EX AFP (DI-OS) DATE 08-16-200~ ESTATE OF SCOTT CATHERZNE T DATE OF DEATH 11-12-2002 FZLE NUHBER 21 05-0655 COUNTY CUHBERLAND ROBERT H FREY ACN 101 FREY & T/LEY 5 S HANOVER ST Aeoun~ Reei~ed CARLZSLE PA 17015 co HAKE CHECK PAYABLE AND REHZT PAYHENT TO: ~::::,? ~ RE6ZSTER OF WZLLS ~': ~ CUHBERLAND CO COURT HOUSE : ~ CARLISLE, PA 17015 CUT ALONG THzs L~I~E ii:i~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~-V-:~-7-~i~--~-~-'~-~ OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR :~ ...... D~ALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF~COTT~r ~ CATHERZNE T FZLE NO. 21 05-0655 ACN 101 DATE 08-16-200~ ~;: ' ;.,,*"1~ RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a*e (Schedule A) (1) .00 NOTE: To insure proper 2. S~ocks end Bonds (Schedule B} (2) 1~6.00 credi~ ~o your account, $. Closely Held S~ock/Par~nership In~eres* (Schedule C) ($) .00 subai~ *he upper por~ion q. Mor~gages/No~es Receivable (Schedule D) (q) .00 of ~his fora with your $. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) ($) 2;125.00 ~ex payaen~. 6. Jointly O~ned Proper~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. To,al Asse~s (8) $,569.00 APPROVED DEDUCTZONS AND EXEHPTZONS: 1,572.00 9. Funeral Expenses/Ada. Costs~Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule 1) (10) 1~997.00 11. To,al Deductions (11) ~.~9-00 12. Ne~ Value of Tax Re~urn (12) .00 15. Cheri*eble/Governaen~al Geques*s; Non-elec*ed 9115 Trusts (Schedule J) (15) .00 1~. Ne* Value of Es~a*e Sub~ec* ~o Tax (1~) .00 NOTE: Z~ an assessment ~as lssued previously, 11nes 14, 15 and/or 16, 17, 18 and 19 Nill reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Aeoun~ of Line lq e~ Spousal ra~e (15) .00 X O0 = .00 16. Aaoun~ of Line 1~ ~axable e* Lineal/Class A re~e (16). .00 X 0~5 = .00 17. Aaoun~ of L/ne 1~ a~ S/bling re~e (17) .00 X 1~ = .00 18. Aeoun~ of L/ne 1~ *axable a~ Collateral~Class B ra~e (18) .00 X 15 = .00 19. Princlpal Tax Due (19)= .00 TAX CREDITS: PAYNEN1 RECEZPT DZSCOUNT (+) DATE HUNGER 1NTEREST/PEN PA~D (-) ANOUNT PAZD TOTAL TAX CREDZT . O0 BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. I .00 TF PATD AFTER DATE TNDTCATED, SEE REVERSE ( 2F TOTAL DUE TS LESS THAN $1, NO PAYHENT TS REQUTRED. FOR CALCULATION 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 decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for 1ifa or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To RJlfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 91~0). PAYHENT: Detach the tap portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT REFUND (CR): A refund of a tax credit, which wes not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calllng the special Z~-hour answering service for forms ordering: I-BOO-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-30Z0 (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 Appaals, Dept. ZBIOZi, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADNIN- 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. ZBO601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1998, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date 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~. All 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 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .0005~6 1986-1991 llZ .000301 ~ 9Z .OOOZ~7 1983 16Z .000458 199Z 9Z .O00Z~7 ZOOZ 6Z .00016~ 1984 112 .000501 1993-1994 72 .O0019Z 2003 5X .000137 1985 13Z .000356 1995-1998 9Z .000247 2004 4Z .000110 1986 102 .000274 1999 7Z .O0019Z 1987 lOX .O0027~ ZOO0 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice) additional interest must be calculated. STATUS REPORT UNDER RUI_F 6.1P Name of Decedent: Catherine T. Scott "003 - 55'- Date of Death:November 12, 2002 03 Will No. Admin. No. 21-0~-00655 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 with the Court? Yes (X) No (). (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, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: December 8, 2004 f~~/~. ~ f~ Signature Robert M. Fre¥ Name (Please type or print) : '- 5 South Hanover Street ,- Carlisle, Pa 17013 ' Address (717) 243-5838 i'~ ' Telephone No. Cfiiiacity: ( ) Personal Representative ( X ) Counsel for personal representative Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 SCOTT JAMES A III 2 W PENN # 208 CARLISLE, PA 17013 RE: Estate of SCOTT CATHERINE T File Number: 2003-00655 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: 11/12/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, x.~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge