HomeMy WebLinkAbout03-0243
PETITION FOR PROBATE and GRANT OF LETTERS
J1 ~IA . No. ~)-D~....;2.Ll3
Estate of Et1'te5. n~ ~ . ':5 J e-
also known as ' To:
, DeSeased. Register of Wills fo~the A L
County of Cu/tJ e.r 'jAr:. in the
Social Security No. i7f?-2(7-(i.2 "7 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
"
Your petitioner(s), who is/are 18 years of age or o%r an the ~xecutl'J~ named
in the last will of the above decedent, dated . utJUSr J r ,~:2oa1
and codicil(s) dated
(state relevant circumstances, e.g, renunciation, death of executor, etc.)
Decendent was domiciled at death in Cuf'1 ~e.f ISi1. J
hiS last family or 'principal resid~~ at d ".... p/t C
f?,4 I (70 S I vo~ ~11
, (list street, number and muncipality)
Decendent, then 73 years of age, died J 7/[ V-u"'v' 7 , Jl1'- 200' 3,
at tP~ I
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
incom peten t:
Decendent at death owned property with estimated values as follows: 'I?; (1(7 rJ
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $ I
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows: II/OI1.e...
WHEREFORE, petitioner(s) respectfully re9fest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters estanentary
(testamentary; administration c,t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I
COUNTY OF Cumberland J SS
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and uly 1 r t e ate according to law.
en
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No. 21-2003-243
Estate of llanes .0.. 'Hiqie , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW March 20th xJ9 2003 , 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 August 1st, 2001
described therein be admitted to probate and filed of record as the last will of
Janes J.;.. Hiqie ,
and Letters Testanentary
are hereby granted to Walter S. Sheets
~ 2?tf1ir=j4~4 "
,. .ttf- / . ltJ4/k
Register of Wills
FEES lbnna M.Otta. 1st Deputy~. r
80.00
Probate, Letters, Etc. ......... $
Short Certificates(5 ) . . . . . . , . .. $ 15.00 ATTORNEY (Sup. Ct. I.D. No.)
Renunciation ,............... $
x-Pages (4) $ 12.00
JCP lU.UU ADDRESS
TOTAL _ $117 nn
Filed .. .~~. ?P~.. . ?P.Q~. . . . . . . . . . . . .
PHONE
MAILED LETI'ERS 'TO EXECU'IOR ON 3-20-2003
Glenda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court One Courthouse Square
Carlisle, Pa. 17013
Marjorie A. Wevodau
First Deputy (717) 240-6345
Kirk S. Sohonage, Esquire FAX (717) 240-7797
Solicitor OFFICES OF
l\elliS'ter of a1WiIlS' anb ([lerk of !be l!&rpbanS" ([ourt
([ountp of ([umuerlanb
June 30, 2005
Mr. Walter Sheets
3402 Canyon Creek
Mechanicsburg, P A 17055
IN RE: Estate ofJames J, Higie, File No, 21-03-0243
Dear Mr. Sheets:
It has come to my attention as solicitor for the Office of the Register of Wills and Clerk
ofthe Orphans' Court in and for Cumberland County, Pennsylvania, that the above estate
has failed to file a report of the status of administration as required by Pennsylvania
Orphans' Court Rule 6,12,
Subsection (f) of Rule 6,12 requires that the Register of Wills notifY the Court in the
event the personal representative or counsel fails to file this notice after (10) days written
notice thereof. You have already received written notice of this delinquency by the
Register.
Kindly accept this letter as written notification that unless the required 6,12 Status Report
is filed with the Register of Wills Office within ten (10) days of your receipt of this
correspondence, I will be compelled to file a Motion for Sanctions for Failure to Comply
with Orphans' Court Rule 6,12, Ifrequired to do so, I will request that the Court grant
counsel fees and court costs to be assessed against the offending party,
Sincerely,
J4Ls, ;./
Kirk S, Sohonage
Solicitor
of
ccp -
This is to certifY that the information here given is correctly copied from an original clTtificatc of death duly like! \\.th ;nc as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office f~lI' permanent rllillg,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certit!care, $2,00 ,\,'II'(~(~OFPl;~ ~JC~-~
",,"q ~<J),~,
'~~~<.c, Local Regisrrar
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H J1j:J :.u Aa~ 2.'87 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
,YPfjPRINl
IN ---- STATE FILE ~UMBER ---.------ .
PERMANENT NAME OF DECEDENT (F,rS!, MtddIe, L.;u;l SEX SOCIAL SECURITY NUMBER I
BLACK INK " 2, Male 2, 178 - 20 - 7,2003
AGE {Last BorthOay) UNDER 1 VEAR UNDER 1 DAY BlATHPLACE (c."" otnd PlACE OF DERH (CI>ecll onll' one 'iH'IlSlIUCt~Ot'ICIIhef ~)
Month. : 0.,. Hourt i Winul.. Slale 01' FCrfl'9f1 CounlIY} HOSPITAL
73 v,. . I....'.... r.J ~='IyIO
5. ..,
COUNTY OF OERH leel and numben
. Cumberland White
Ib, Ie,
DECEDENT'S USUAL OCCUPATION MARITAl STATUS. Uauled SURVIVING SPOUse
l~fV::'ri~'~~~~.u:r~~ N....... Marl*', Widowed. III """e, 1'''' rYIdIOennownel
DiYorced (Speedyl
Accountant Divorced
1h, Ub.
DECEDENT'S MAILlNG AOORESS {SltMe. Clt)'lfown, Stale, .rlpCodEtl
3402 Canyon Creek Cod .....
-
Mechanicsburg Min.
Pa Cumberland lownahip? 17d.D ::~~oI
.. 17b. Coun cllylboro
fATHER'S NAUF I.f>r<;i M"""IA 1 "OU! James Joseph Higie UOTHeR'SN,6.~E\F~~! ....itjOle, U;:l~S,,''''.vNI!
11. 11, Ann Ellen Griffith
INFORMANT'S NAME (T ype.oPnof) Barbara J, Sheets INFORMANT'S MAIliNG AOORESS ISIJ... CityI1Own, S&M.. Zip Code'
,... 3402 Canyon Creek Mechanicsburg. Pa, 17055
METHOD OF DISPOSITION DATE OF OISPOStTION PLACE ~ DISPOSITlON. Name at Cemetery, CrtmMOfy LOCATION. CilyfTown, Slate, Zip Code
Bunal 0 Cremation [i Rlln'IOvll'rom SlallI 0 (Manlh. Day, ....., Of OlhM PIKe
Other lSpecdyl rJ Conollte Crematory Schaefferstown, Pa 17088
21c, 21d.
NAwe AND AOORESS OF FACLUTY
~ FD-012662-L 22e. M ers Funeral Home Inc, 37 East Main Street Mechanicsbur ,Pa 17055
.. LtCENSE NUMBER DATE SM3NED
{Monlh, Day. Year;
2..., I'-lJ 5115~}.-L. 22<, :r ,,('oJ '1 ~OOJ
~ CAse REFERRED TO MEDICAL EXAMINER1COAONEA?
24, M 25, ~oo3 H, Yo, Jil f~oocroC ...p
27. PART I; ElU~ 'he dlssaN', inlUl'iesor comp'ica'IOOS whichcaust'd lhe dealt\ 00 rlOl*nI8, th. rnocM 01 dying, slJCh .J.sc..raiacor respiratory .."nI. shocll or h4tart ,....,.. I ApproJrimAt. PAIITII; Othef Signltlc&n4 condAion8 conlflbuting 10 ~,,'h, but
llSl only one cau:y on each line I inleIwl between no!: ruuainlll in the underlying cause ;wen in PART I
: onMl and deMh
.,~lc~nlli"'--~ (I", /; C-c;..'l(!.(' " / /-~, AtI!L I ar - /L 1.1-< ^' aI.. l.h)J~-, ; /'2 ..ty',' /(j,;: ,^
I
I/. II
DUE TO (OR AS ACONSEQUENCE OF): I 1/"", V",../I<V I /1.:rt.("(J( .-"
t: , ,... I
\.:, DUE 10(00 ASA CONSEOUENCE Of): I 4.n~'/ //1..5(( ,(l'iC'-"ll('L'
, ) :
" DUE TO (OR A$ACONSEOUENCE OF)' ! 1 /
WERE AUTOPSY FINDtNGS UANNER Of DEATH DATE OF INJURY TIWE OF INJURV INJURY IJ WORK? DESCRIBE HOW INJURY OCCURRED.
') """LA8LE PfUOR TO (Month, Day, Year)
COMPLETION OF CAUSE Ii:( 0
OF DEATH? Nalural Homicide ...0 NoD
Ac<..... 0 Pending In","dg.liOn 0
...0 ...0 0 o PLACE OF INJURY. AI home, farm, str.... 'actOrY,otNc. M,
So6c:ide Coukt not C. de'elmlned LOCA11QN (Sir.. ClyfTowo. SlaIs)
, building, 81e, ,Speotvl -,
"
\; 2", .... 21, , -, -. ,
CERTIFIER (C~edI only onel
I "CERTWYIHO PHYSICIAN (PtlYSClan Clll'tllyll'l9 calJS8 01 dealt1 wh8n atlOlher P"ySlC.an has prOllOUnced dealh ana compleled flem 231 0
, To the c.., or m., knowtedge, HMtI occurNd duela the eauH(aJ.nd menner.. .'.tH. . ' . . . . , . . , . . . , . . , .. ........
~ "PRONOUNCiNG AND CERTWYtHG PHYSICIAN (Ph'i'SlCIWl both pronounc'"Q l.1ealtl and ceftdyong 10 CalJS8 01 dealh) 0
~ To 'he bee1 ot my knowledge, death occurred a1the Ume, d.'e. .nd p1ac., and due 10 the cau..(a)..nd manner aa staled., ..."....
./'
0 "MEDICAL EXAMINER/COAONER ,:
(, On th. blil. o'eumlnatlon IndJor Investlgltloft, In my opinion, d..th occurred at the lime, dat., .nd place, and due to the CIUS.(S) and 0
~ manner.. stated. , .........",.,....., ........."......... ...........,..... ...., .....,..................... ....
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21-2003-243
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LAST WILL AND TEST AMENT
OF
JAMES J. HIGIE
I, JAMES J. HIGIE, of 3402 Canyon Creek, Mechanicsburg, Cumberland County,
Pennsylvania 17055, declare this to be my Last Will and revoke any Will previously made by me.
ITRM T' I direct that all my just debts and funeral expenses shall be paid from the assets of
my estate as soon as practicable after my decease. It is my express desire that my body be
cremated.
ITRM n. I give, devise and bequeath all of my estate, real, personal and mixed
wheresoever situated as follows:
(A) I give, devise and bequeath the sum of Six Thousand ($6,000.00) Dollars to
each of my six children: JACQUELINE A. HUBBARD, STEPHANIE M.
HIGIE, BARBARA J. SHEETS, ELIZABETH ERIN BADGER, JOSEPH
D. HIGIE and JAMES F. HIGIE, per capita.
ITEM ffi' I give, devise and bequeath all the rest, residue and remainder of my estate, real,
personal and mixed, wheresoever situated, to my daughter, BARBARA J. SHEETS, provided
that she survives me by thirty (30) days. If my daughter, Barbara, does not so survive me, I give
the residue of my Estate to be divided equally among my children surviving at my death.
ITRM TV' No interest in income or principal shall be assignable by or available to anyone
having a claim against a beneficiary before actual payment to the beneficiary.
ITEM V: All federal, state, and other death taxes payable on the property forming my
SKARlA1'l:E & liONAmrn UP LAST WILL AND TESTAMENT OF
ATTORNEYS AT LAW James J. Higie
Page 10f5
gross estate for tax purposes, whether or not it passed under this Will, shall be paid out of the
principal of my residuary estate just as if they were my debts, and none of those taxes shall be
charged against any beneficiary.
ITEM VT: I authorize my Executor:
(a) to retain and to invest in all forms of real and personal property, regardless of (i)
any limitations imposed by law on investments by executors or trustees, (ii) any principle or law
concerning delegation of investment responsibility by executors or trustees, or (iii) any principle of
law concerning investment diversification;
(b) to compromise claims and to abandon any property which, in my Executor's
opinion, is of little or no value; to borrow from, and to sell property to others, and to pledge
property as security for repayment of any funds borrowed;
(c) to sell at public or private sale, to exchange or to lease for any period of time
any real or personal property, and to give options for sales or leases;
(d) to join in any merger, reorganization, voting-trust plan or other concerted action
of security holders, and to delegate discretionary duties with respect thereto;
(e) to use administrative or other expenses of my estate as income tax or estate tax
deductions and to value my estate for tax purposes by any optional method permitted by the law in
force when I die, without requiring adjustments between income and principal for any resulting
effect on income or estate taxes; and
(f) to distribute in kind and to allocate specific assets among the beneficiaries in
such proportions as my Executor may think best, so long as the total market value of any
SKARIA1U,& ;{JJNAIRiIO-II WI' LAST WILL AND TESTAMENT OF
ATTORNEYS AT LAW James J. Higie
Page 2015
beneficiary's share is not effected by such allocation.
These authorities shall extend to all real and personal property at any time held by
my Executor and shall continue in full force until the actual distribution of all such property.
All powers, authorities, and discretion granted by this Will shall be in addition to
those granted by law and shall be exercisable without leave of court.
ITEM VTT: I appoint W ALTER S. SHEETS as Executor under this Will. Should
W ALTER S. SHEETS, fail to qualify or cease to act as Executor, I appoint my daughter,
BARBARA J. SHEETS as Executrix under this Will. I direct that any fiduciary acting hereunder
shall not be required to enter bond or other security in any Court or jurisdiction in which said
fiduciary may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last
Will and Testament, consisting of Five (5) typewritten pages, including this attestation clause and
the following Acknowledgment and Affidavit, to be executed, declared and published this
I ~ day of -A- Lt rP cJ S r ,2001, at /11J(l.r1..r.> ~ fA f2. 6 , Pennsylvania.
~~
J S J. HI
SKAI<<A1U,&7.DNARIIrn UP LAST WILL AND TESTAMENT OF
ATTORNEYS AT LAW James J. Higie
Page 3 of 5
ACKNOWT ,ROGMRNT
COMMONWEALTH OF PENNSYLVANIA )
: SS:
COUNTY OF DAUPlllN )
I, JAMES J. HIGIE, the Testator, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it willingly and that I signed it as my free and
voluntary act for the purposes therein expressed.
~
Sworn or affirmed to and acknowledged before me by JAMES J. HIGIE, the Testator,
this ,~+ () D1
;= day of ill Cfl . zoo!.
/};.
Notary Public
(SEAL) AJ )cY3
My Commission Expires: '7 ~
,-
NOTARIAl SfM.
IWIIlI. HARTMAN, MJTMY PUIIl.IC
twUlIS8URG, DAUPHIN COUN1Y
1ft' COMMISSION EXPIftES JW 5. _
gJ(ARlA1I'l.E & ZONARlIGIlIJlP LAST WILL AND TESTAMENT OF
ATTORNEYS AT LAW James J. Higie
Page 4 of5
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COMMONWEALTH OF PENNSYLVANIA )
: SS:
COUNTY OF DAUPHIN )
We, SCDftW ~ k (MCUt\ , ~0'\ <& ~O\\Q~lc.h ,
I (L Z d ~ A.. (t \ c.. *' the witnesses, whose names are signed to the
and ~J 0 k1 f0
attached or foregoing instrument, being duly qualified according to law, do depose and say that we
were present and saw JAMES J. HIGIE, sign and execute the instrument as his free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the
Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at the
time twenty-one (21) or more years of age, of sound mind and under no constraint or undue
esiding at jJm S bttd- P A- f7 /1 z...
17Ma
7MO
,
Notary Public
IIOTAIW. SEAL EAL) 1J):j/Q3
1lAIIB.1I1. tIARTMAII.IIOTMIf Y Commission Expires:
IIARRIS8IJRG. DAUPltIt
., COMMISSlOll EXPIRES W S. -
WP LAST WILL AND TESTAMENT OF
James J. Higie
Page 5 of5
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COMMONWEALTH OF PENNSYLVANIA '* I
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. Z80601 NOTICE OF INHERITANCE TAX
HARRISBURG, PA 17lZ8-0601 APPRAISEKENT ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS REv-me EX AFP lDl-Oll
DATE 02-16-2004
ESTATE OF HIGIE JAMES J
DATE OF DEATH 01-07-2003
FILE NUMBER 21 03-0243
. 0 COUNTY CUMBERLAND
.04 FEB \3 P33 SSN/DC 178-20-6279
BARBARA SHEETS ACN 03110280
3402 CANYON CREEK .. ...... .. ,. "v< I Allount Rellitted I
MECHANICSBURG PA 17Q,5511. ....,;Jv'l
Cumberland Co., PA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REfv:i5~8-E)f-AFFi-(oi-:oi)------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 02-16-2004
ESTATE OF HIGIE JAMES J DATE OF DEATH 01-07-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0243 S.S/D.C. NO. 178-20-6279 ACN 03110280
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 90440975
TYPE OF ACCOUNT: () SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 10-02-1986
Account Balance 2,530.33 NOTE: TO INSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 1,265.17 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 1,265.17 REGISTER OF WILLS AT THE
Tax Rate X .15 ABOVE ADDRESS. MAKE CHECK
Tax Due 189.78 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
INTEREST IS CHARGED THROUGH 02-24-2004 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 189.78
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 3.36
TOTAL DUE 193.14
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. Jl
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND. \
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
cP-
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Ja~(.5 J. ~i {..
Date of Death: \.Ta t'\. 1 J.OO~
I F~\~ tt
"ph f; 10(.. tt d\ ~ 03 - OJ4-3 d--003 - 00 J.l\.3
Will No. Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the orphan~ourt Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 3vt\t.. ~o3:
Name Address
S\g ct\t. 1tcl ~ '\l "It flo l'
10S 5horeb(~....- L~u~~ 1-.\j\le-\ I c.A q d.-lI17
3\o~ Cun~u", CY"e.c:L ~un\~SbvJ I 1>A nO$S
131 \)tty' \vud t>r. S"'llo~ b,,~ fit 1l?35 3
1{,.:l'l b{(ewood- Ln '* 131 O~~ o~Gt. C~~ I O~ 1 J 132-
Notice has now been given to all persons entitled thereto under Rule 5,6(a) except /tf
~ ~,,~ } Joo3
Date: ~ V~e.. Signature ~f~
Name --11JtU .\-tv .).
Address 3'\-0 b- CmtiOil C.v-e.e..L
(l\.u.~QtI i (S Iov... d---3A- 11a5?
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........ Telephone (1 ~ 1"0 - Od1'1
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0 Capacity: ~ Personal Representative
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"L,) _Counsel for personal representative
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COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of: Court File No: 212003243
JAMES J HIGIE
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DIVISION: :-1 ~ 0 ::0
':; '11
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Prooate, ~ , ,
Estates, and Fiduciaries Code, 20 PA.C.S.A. g3532(b)(2). C
I
1) Claimant's name: MBNA AMERICA --'
P.O. BOX 15137 ,l::>.
2) Claimant's address: -..-......
-.'
WILMINGTON, DE 19850--5137 , r
'.."
8777679383 0,
3) Creditor listed below is the owner and holder of a claim in the amount of
$ 12600.00
4) The facts upon which this claim is based is an account for credit evidenced by the
attached Affidavit of Account Stated.
5) Decedent's address: 3402 CANYON CRK MECHANICSBURG, PA 17055
6) Date of Death: 01/07/03
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm under the penalties of
perjury that they Information and representations made herein are true and correct
to the best of my knowledge, information and belief.
Dated: :3 ~ ~..3 "- orized Representative For MBNA America
V Kyle Frenzel/Lucille Roberts/J sica Lerbs - Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
WALTER S SHEETS
Name
3402 CANYON CREEK
Address
MECHANICBURG, PA 17055
City/State/Zip
;fylO3
Date notice m iled
INRE ESTATE OF: JAMES J HIGIE
Re,':- ('t
AFFIDAVIT OF ACCOUNT
'03 JUL 14 Pil1 56
The undersigned, being first duly sworn deposes and states the follpws:
,,_.j, .....j
Ct'I;~r.
1. Your Affiant is authorized by the Claimant as its Authorized Representative-
In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect
to the decedent. Your Affiant is familiar with these records and accounts and
reviews them as a regular part of her duties.
3. The Decedent purchased merchandise in the amo unt of $ 12600.00
evidenced by account number 5490999017601179
4. The unpaid balance does not include any post-death late payment charges,
accrued interest, collection costs or attorney's fees.
Further your affiant sayeth not
MBNA America.
o e of its thorized Representatives:
Kyle Frenzel_
Lucille Roberts
jus/~ L~Yb.1 ~
MBNA America
P. O. Box 15137
Wilmington, DE 19850-5137
Subscribed and sworn before me
This 3 day of --1/-;f:r , 2003.
8JOHN E WARD LOP
. Notory "ubMc
.. .' Minnesota
My CommiSsion Expires January 31, 2008
-~.~--"
COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 NOTICE OF INHERITANCE TAX
HARRIS8URG, PA 17128-0601 APPRAISE"ENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION J AND ASSESS"ENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (01-03)
DATE 02-16-2004
ESTATE OF HIGIE JAMES
DATE OF DEATH 01-07-2003
FILE NUMBER 21 03-0243
C.().V~ CUMBERLAND
'ot} JUi~ 2~~ SSN/ 178-20-6279
BARBARA SHEETS ACN 03110280
3402 CANYON CREEK I Amount Remitted I
MECHANICSBURG PA 17055 I"~. ~.
C:\ i /0:J./lj
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
:;-'
----- --
--
. ~~
Walter Sheets
3402 Canyon Cd" , \
J>\ecbanicsbUIg, P^ 17055~177 '
.'
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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, 2B0601
HARRISBURG, PA 17128-0601
PENNSYL VANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004087
SHEETS WALTER S
3402 CANYON CREEK
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
___h___ fold ---------- --------
03110280 I $193.14
ESTATE INFORMATION: SSN: 178-20-6279 I
FILE NUMBER: 2103-0243 I
DECEDENT NAME: HIGIE JAMES J I
DATE OF PAYMENT: 06/25/2004 I
POSTMARK DATE: 06/24/2004 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 01/07/2003 I
I
TOTAL AMOUNT PAID: $193.14
REMARKS:
CHECK# 2264
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISIDN
~~:~iS~~~~~lpA 17128-0601 INHERITANCE TAX
STATEMENT OF ACCOUNT
REY-U07 EX AFP '01-03)
DATE 08-02-2004
::s ESTATE OF HIGIE JAMES J
DATE OF DEATH 01-07-2003
FILE NUMBER 21 03-0243
. AUG 17 P 1 '1 ~UNTY CUMBERLAND
BARBARA SHEETS 04 . ACN 03110280
3402 CANYON CREEK I ....... ..."... I
MECHANICSBURG PA 1705bsr,. ,_,
C\'lnb~ii f J-".
J ! "-,,
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=i6"ifj-E3f-AFP--foY:oiY------...--iNifERiYANC'E-fAX-STAfEHENf-cfF'-AC-coUiff--...---------------------
ESTATE OF HIGIE JAMES J FILE NO.21 03-0243 ACN 03110280 DATE 08-02-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-16-2004
PR I NC I PAL TAX DUE: ..............................................................................................................................................................................,..,........................................, 189 . 78
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (_) AMOUNT PAID
06-24-2004 CD004087 3.36- 193.14
BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-25-2004 TOTAL TAX CREDIT 189.78
BALANCE OF TAX DUE .00
INTEREST AND PEN. 2.52
If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 2.52
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~,~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/01/2004
SHEETS WALTER S
3402 CANYON CREEK
MECHANICSBURG, PA 17055
RE: Estate of HIGIE JAMES J
File Number: 2003-00243
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
Jul y I, 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: 1/07/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~r
.,." .~ /!
c ... ~ ~..J Jlfi4.dv:f1t
(.j
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
Estate of HIGIE JAMES J : ORPHANS' COURT DIVISION
Late of LOWER ALLEN TOWNSHIP : COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY
Estate No. : 21-03-00243 : PENNSYLVANIA
:
Date: 2/11/2005 : NO. : 21-03-00243
SHEETS WALTER S
3402 CANYON CREEK
MECHANICSBURG PA 17055
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: SHEETS WALTER S
Personal Representative Counsel: ** NO INFORMATION FOUND **
Date of Decedent's Death: 1/31/2003
Date of Delinquency Notice: 1/07/2005
The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans'
Court, in accordance with rule 6.12, Supreme Court Orphans' Court
Rules, hereby notifies the Orphans' Court Division, Court of Common
Pleas of Cumberland County, that neither the above named personal
representative nor their counsel, have filed with the Register of
Wills or Clerk of Orphans' Court, his/her Status Report required by
Rule 6.12, Supreme Court Orphans' Court Rule, and that the
requisite notice, pursuant to Rule 6.12, Supreme Court Orhans'
Court Rules, was given by the Clerk of Orphans' Court on 2/10/2005
and that the ten (10) day notice to file the status report has
expired. Accordingly, in accordance with Rule 6.12 the Court is
hereby notified of such delinquency and the undersigned requests
that a Court conduct a hearing to determine whether sanctions
should be imposed upon the delinquent personal representative or
their counsel.
cc: File i1#JA~v.~
Personal Representative Glenda Farner Strasbaugh
Counsel Clerk of Orhans' Court
A hearing is scheduled for April 01, 2005 at 9:30 AM in
Courtroom No. 3 . If the Status Report is filed prior to the
hearing date, the hearing will automatically be cancelled.
J//
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004965
SHEETS WALTER S
3402 CANYON CREEK
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
______n fold ---------- --------
101 I $2,608.90
ESTATE INFORMATION: SSN: 178-20-6279 I
FILE NUMBER: 2103-0243 I
DECEDENT NAME: HIGIE JAMES J I
DATE OF PAYMENT: 02/17/2005 I
POSTMARK DATE: 02/17/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 01/07/2003 I
I
TOTAL AMOUNT PAID: $2,608.90
REMARKS: W SHEETS
CHECK#1039
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
l\\o~RDB~Tt fEf- bLlt: .
REV.,!l:ioEX !<>00j REV-1500
'* ~lli~
PENNSYlVANIA
.. . . DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER _ cro_11'~
DEPT. 280601 ~L-~2
HARRISBURG, PA 11128-0601 RESIDENT DECEDENT
COUNTY CODE YEAR NUMBER
DECEOENrS NAME (LAST, FIRST, AND MlDOlE INITIAl) SOCIAl. SECURITY NUMBER
I- Higie. James J. i 178-20-6279
Z --'----------------------r:::~'---.-~--.-.,-.---..-..-.~---.-~-_._....__._..,....1.
W
Q DATE OF DEATH (MM.DIJ..YEAR) I DATE OF BIRTH (MM-DD-YEAR) : THIS RETURN MUST BE ALED IN DUPLICATE WiTHTHE
W 01/0712003 111/11/1929 [REGISTER OF WILLS
() ...-,.,'.__..,_......__._______,-----..-..-....-. '._....._..-...~.,,--,-__-...--.-...-_.._..-..--_._ ..- .... .,... ...L..._..-_.... ....-._..__._.. __.__.... ..".'''.._ ...... ..." ..,.__.
W (IF APPUCABlE) SURVIVING SPOUSE'S NAME (LAST, FlRST, AND MIDDlE INITiAl) I SOClAl.. SECURITY NUMBER
C I
I
W ~ 1. Original Return o 2, Supplemental Return o 3, Remainder Return (d.le of d.ath prior tJ> 12.13-82)
~
:.:$Ul o 4, Limited Estate o 4a, Future Interest Compromise (date of death after 12.12-32) o 5, Federal Estate Tax Retum Required
olXl<:
wll.g
xg.... ~ 6, Decedent Died Testate (Attach copy 01 WI>>) o 7, Decedent Maintained a Living Trust (Attach copyofT",st) 8, Total Number of Safe Deposit Boxes
o II. III -
II. o 9, Litigation Proceeds Received o 10, Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95) o 11, Election to tax under Sec. 9113(A) (Attach Soh 0)
c(
.... -,..\11I),
z COMPLETE MAILING ADDRESS
w NAME
Q Walter S. Sheets
z 3402 Canyon Creek
0 "ARM NAME (~~l~--~---..~,------..-----..--..----
II. Mechanicsburg, PA 17055
I/)
w
II::
II:: ...fELEPlfoNENuMBEFr---..---.. .---.-........--.....-.--. ...---....---
0
0 (717) 790-0277 f'.'",,)
1. Real Estate (Schedule A) (1) 0.00
2. Stocks and Bonds (Schedule 8) (2) 0.00
3, Closely Held Corporation, Partnership or S*Proprietorship (3) 0,00
4, Mortgages & Notes Receivable (Schedule 0) (4) 0.00
5, Cash, Bank Deposits & Miscellaneous Personal Property (5) 52,783.28
Z (Schedule E)
0 6, Jointly Owned Property (Schedule F) (6) 15,839.37 -
~ o Separate Billing Requested
-I (7) 0.00
::) 7, Inter-Vivos Transfers & Miscellaneous Noo-Probale Property
I- (Schedule G or L)
a: 8, Total Gross Asse1s (total Lines 1.7) (8) 68,622.65
<(
0 9, Funeral Expenses & Administrative Costs (Schedule H) (9} 1,519.00
W
a:: 10, Debts of Deeedent, Mortgage Liabilities, & liens (Schedule I) (10) 13,236.09
11, Total Deductions (total lines 9 & 10) (11) 14,755.09
12. Net Value at Estate (line 8 minus Une 11) (12) 53,867.56
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 0.00
made (Schedule J)
14, Net Value Subject to Tax (line 12 minus line 13) (14) 53,867.56
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES
Z 15, Amount of line 14 taxable at the spousal tax
0
~ rate, or transfers under See, 9116 (a)(1.2) x ,0 (15)
16, Amount of line 14 taxable at lineal rate ..______________?~,~Q7',?6__ x ,0 4~. (16) 2,424.04
....
::)
0.. 17, Amount of Line 14 taxable at sibHng rate x ,12 (17)
:IE
0 18. Amount of Line 14 taxable at coi!ateraf rate x ,15 (18)
0
~ 19, Tax Due (19) 2,424.04
20,0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
DeCedent's Complete Address:
STRE ADDRESS
~____~~2 kan~QD Cr~~jL_"___.._..__.~~__"__ --. ~___.___.~____"_" ----~-.--"--- ----- ..-..----.-."-------------..--.---.------- -.---.----.---- -~--. --------~.-
-ClTYM;~n~b~r9--.----~ .---------------- ------~~- .---- STATEpA~----- .---- -ZIP17055----~--
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 2,424.04
2, CreditslPayments
A. Spousal Poverty Credit --~--~-,----------"~-
8, PriOf Payments --~----------~--'-------
C. DisCOUl1t
~,_._--_._.,-----.,---- Total Credits (A + B + C ) (2)
3. Interest/Penally if app6cable
D. Interest
E. Penally ---~-----_._._,_._--~--~-----_.._-_.-
Total Interest/Penally ( D + E ) (3)
4. If line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 line 20 to request a refund (4)
5, If Line 1 + Line 3 is greater than Une 2, enter the difference, This is the TAX DUE. (5) 2,424.04
A. Enter the interest on the lax due, (SA) 184.86
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 2,608.90
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 Of income of the property lransferred;.......................................................................................... 0 ~
b, retain the right to designate who shall use the property transferred Of its income; .."........................................ 0 [i]
c. retain a reversionary interest; Of............................................................................................,..,.......................... 0 [i}
d. receive the promise for life of either payments, benefits Of care? ...................................................................,.. 0 [il
2. If death OCCUlTed after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ,...,.........".....................,....."",.........."...............,........,........,................ 0 [i}
3, Did decedent own an "in trust for" Of payable upon death bank account or securily at his or her death? .............. 0 ~
4. Did decedent own an Individual Retirement Account, annuily, Of other non-probate property which
contains a beneficiary designation? .........,.,.....,................."".,.,...........,...,',............,.,'..........,'.......,..,,'.......... '..'...' 0 ~
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 penaIIies of perjuty, I dedaIe \hall have examined lhis relum, induding accompanying schedules and statemenls, and to the best ar my Io1clvkdge and belief, n is true, cooect and complete.
DecIII8lion r:I. PftIIlJl1II' dher lI8l tie pIII1lOIIIII '''I''_1lIIMl is baed an all inRlIml\kllI 0( wftdI pnlp8Illr ha." kncYMedge,
~ DATE
02114105
-0- SS --- --~ - - - - -. ----- --- - ~-----_._.__._._---_...- - -. -----,.--_..---------. ----.--.,---.----....---- -..----.-,.-'--- -.--
~~~_9_~~y~ ~~_~._~!~!I!t_~~~_%_f=t~. .1_r~~~___... .'"-.----- --..,.--"--'" "-- . - _', .__,___..n__.._'._
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
For dates of death on Of after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to orfor the use of the surviving spouse is 3%
[72 P.S, ~9116 (a) (1.1) 0)}.
For dates of death on Of after January 1, 1995, the tax rate imposed on the net value of transfers to Of fOf the use of the surviving spouse is D% [72 P,S. ~9116 (a) (1.1) (ii)I,
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 retum are still applicable even if
the surviving spouse is the only beneficiary,
For dates of death on Of after July 1, 2000:
The lax rate imposed on the net value of transfers from a deceased child twenly-one years of age Of younger at death to or for the use of a natural parent, an adoptive paren~
or a stepparent ofthe child is 0% [72 P,S. ~9116(a)(1.2)J.
The tax rale imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P.S, ~9116(1.2) [72 P,S, ~9116(a)(1)},
The tax. rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3ll. 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.
REV-1508 EX+ (6-98) .- SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
James J. Higie
Include the proceeds of rJtigation and the date the proceeds were received by the estate.
All property joInt1y~ wIItt right of lurvlvorahlp IIIVIt be cIIIcIoHcI on Schedule F.
ITEM VAlUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 92 Chrysler 5th Ave 975.00
2 Clothing 100.00
3 Household Items 75.00
4 Furniture 200,00
5 Belco Bank Account #838584 10,824,91
6 Schwab Roth IRA #4342-8477 13,304.12
7 Schwab IRA #4342-8474 27,304.25
TOTAL (Also enter on line 5, Recapitulation) $ 52,783.28
(If more space is needed, insert additional sheets of the same size}
CoI1!~gon fI STATEMENT OF ACCOUNT Page
1
L getting you there
MAIN OmCE:
403 N. 2nd S1net
P.O. Box B2
HarrisIug. PA 171 DB
JOINT OWNERS
THE ESTATE OF JAMES J HIGIE WALTER S. SHEETS EXECUTOR
3402 CANYON CREEK
MECHANICSBURG PA 17055
0401 PREVIOUS BALANCE SI-SAVINGS 00
0407 PAYMENT VIA OFFICE/MAIL 500
0430 NEW BALANCE 500
0401 PREVIOUS BALANCE S4-CHECKING 00
0407 PAYMENT VIA OFFICE/MAIL 1081635
0430 DIVIDEND 1081991
THE ANNUAL PERCENTAGE RATE IS 0.50
THE ANNUAL PERCENTAGE YIELD IS 0.50
THE ANNUAL PERCENTAGE YIELD EARNED IS 0.50
0430 NEW BALANCE 1081991
TOTAL DIVIDEND YEAR- TO-DATE 3.56 TOTAL RNANCE CHARGE YEAR-TO-DATE 0.00
far . savings except IRA. far . loans.
DIvidends shawn. if $10 ar llYW. wi be
~ to the In1lmal RIMIIl.. Service NOTICE: Set I'1MII'SII side far inportant information.
far 1Iis caltndlr YIW'. 0702381
.INDICATES EFFECTIVE DATE
,-
'GiesSCHWAB Account Statement
Retain for Your Records
Roth Conversion IRA Statement Period: March 1,2003 to Marcb31, 2003
Ao:ount Number: 4342-8477 Last Statement: February 21, 2003
_.~ ---- '^ ---"~."-"-~-_.'----'-~'-'- --.- . "_-_'_"-~._'.~-"''''----- ..-.-
Vlalf our webslfe at: schwab.com Account Opened in: 1998
Question.? Ca'11~ Page 1
PrHtl: t..Quote., 2. Trading, 3-Account SfJnfIce8, 4-NMit Accoun", 5-Other Inqu'"
31103-CN3E1701-1lOO827 -MED-1705!l6777OO5 15925 .
JAMES J HlOlE
CHARLES SCHWAB & CO INC CUST
ROTH CONVERSION IRA
3402 CANYON CREEK
MECHANICSBURG PA 17055-6777 !Ill
ill
..
~~~ l t~InY"'~ ..
l.
Cash & Sweep Money Market Funds $ 1,665.99 Change In Value Since February 28, 2003: $ (1S1.OS) .
tn~ $ 11,638.13 Chahge'ln Value SinCe January 1. 2003: $118.08 _
1btaI Aceount v.du. $ 13,304.121 -
I. R_SUmmary -
,-
&:hnb MMF 0.62% _
..
II
..
.~o.taH Quantity j-
1:.-t
pi.c,;otJon Svmbol tontpShort Price Marlcet Value
,~ and"'" M8rk8t Funds (SWeep) SWMXX 1,865.9900 l $1 $ 1,665.99 ,;;
,SCHWAB MONEY MARKET FUND I
InYestmem
US TREAS BD 7.25%8115122 4,000 L $ 130.2500 $ 5,210.00
DUE 08115/22
CUAAENT YIElD 5.56621%
US J1:lEAS BONo 7.25%0&16 5,000 L 128.5625 6,42.8.13 C:J
DUE 06115116
CURRENT YIELD 5.83928%
I Total Account Val. $13,304.121
transac$R Oetaft I
Settle Trade
Date Dale Transaction DescriDtion Quantity Price T 0l8/
Cash Activity SCHWAB MONEY MARKET FUND
00117 03117 Dividend $0.81
..",~+...""", ......L..,~,}.._ ~,..L _I... It ~_ '-__ Afl ~_...4.-._~__".....l ~I....-.~..,. eu:Jf""t.Il..l........,.""""\..., ,0;:;::""""'-4 J:....-""h-.b'lc~ r-D~f11t)'1nt0fV\1..t\~M.\ ~,.p."'nA'1QR-'.()C)(AAJM\
- ....
narles SCHWAB Account Statement
ReTain for Your Records
onov.r IRA StatMlerlt P......: ........, 1,2003 to........, 11, 2003
ccount Number: 4342-8474 _,_~~ ~~~_~be!~1'~_m
Vl8If our ....... af: MIM8.00m Aooount 0peMIf m: 111I
QllMIIoM? Cd 1..1Jt1O-4J6 ft1DI1 ""1
",...: t Qt1I J.... .l-TtacMJa s..AocatatIs. ~lolIM, u....lkJ:C .,. 6<JIIttJI.....
~0181e"0 _ Il-"\I_~'-"" .
JAlES J HlGIE
OHAN..a.IQtfWAB a 00 INO OUST
fRA AOU.OVER -
3Mt2 CANYON ORES< .
MtOHANlC88URG PA 11fJ1!!i&.6771 -
..
..
~... .:.~ I~...'iiii
..''' . ......., , . _ . _...._.... _,~,.b, . ~., .. ... "".' ....'. .. .. .. ,11 . . . .
. ',' ~. .,.." "_'_~,' "'"'' " ",," _'-~<'-~';""':~'~~J_-;':;"S:"_ '. ... _,_~.__,I,,_ ," '''. ' .' ~. ,'...:St_:""._" ".' -..~
......... . 25,583.75 otNInge In v.... an. J......, 1, 2003: . (234.83)
tltARlluDt VIM $11.....1 "
~"
I
.. _L _--a. ...... ,-
,.......
auaniJIy
~ $yn*JI LofDf:SIJon Prif:>> MatIret YaW
III .. ail., ..............(thiMep) .
aH $1,110.10
........
,1lEA8 so 1.21no11t&121 10,000 L . 121,0S25 . 12,t01.25
DUE oertll22
~Y\S.D5.117~
TREM 8OND1.25%01!1M 10,000 L 128.1150 12,.'.50
DUE OMSI'll .
CURReHT YJELD 5.11'"
-- ~ nil r ,,- --" r [i!I '---!!r'" ~ ttt,tD4.lsf..
troll~ --lWi' ..... ."-.' .-" .... ....-.. ..... .... . ..
-' .. -Hit . ~~~;..,'-_.~'-'~=- . .... - "~. -..-,......,---...............-,.
tn..C1IOII .... I
'r. Tr" ...
, DaIII T,.~ ~iDfon ~ PtitJfI TofJIJ
It AIl__ J1NORMAL TOf3.ot28470 . (8.80)
11 01/31 JoumaJed fundi
REV-1509 8<+ (6-98* SCHEDULI F
COMMONINEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Jq/teS \r /-11'3 I .~ FILE NUMBER
If an us.t WIS made Joint wItIIln on. year of tII. dec.d.nt's date of d.ath, It mUlt b. repol1tcl on Schedule G.
SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Barbara J. Sheets 3402 Canyon Creek Daughter
Mechanicsburg, Pa 17055
B.
C,
JOINTLY-OWNED PROPERTY;
lETTER DATE DESCRIPTION OF PROPERTY ""'OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUOE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DArE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAl ESTATE. VAlUE OF ASSET INTEREST DECEDENT S INTEREST
1. A. 1010211986 WaypoInt Bank Checking Account #90440975 2,530.33 50 1,265.17
2 A 07~112OO1 Schwab One Brokerage Account #4342-8470 29,148.40 50 14,574.20
TOTAL (Also enter on fine 6, Recapitulation) $ 15,839,37
(If more space is needed, insert additional sheets of the same size}
"1,,, j j 1,),." SCHWAB Account Statement
J lUt u;:....)
Retain for Your Records
Schwab Ot'lee Account Statement Period: December 1, 2003 to December 31, 2003
Account Number: 4342-8470 Last Statement: November 30, 2003
.---~._._~-- .. -AccolJntOpen8d In: .1988 -
Visit our webslte .t: schwab.com
Questions? Call1-tJtJO.435.4(J( Page 1
p,...: 1-Quote., 2-T",dlng, 3-Account Serv/~, 4-New Accoun", 5-Other Inqulrle.
31/12.cNCFl704-002211-MEO-170556777l105 204206 .
JAMES J HtGtE &
BARBARA SHEETS JT TEN
3402 CANYON CREEK II
MECHANICSBURG PA 1i055-6777
-
.
.
Account Value Summary I t Change In Value SUmmary II
Cash & Sweep Money Market Funds $ 312.01 Change in Value Since November 30, 2003: $ 610.78 .
Investments $ 28;836.39 Change In Value Since January 1, 2003: $ 5,849.89 .
Tot. Account Value $ 29,148.40 I .
I 1 Rate . SUmmary -
MaralnAccount It."" .hMton l.
Matgin Account Equity $ 28,046.00 Margin Loan Rate 4.50% to 7.50% _
Funds Available Margin $ 20,119.00 .
-
.
Investment Detail 1-
Quantity
Descriotion Svmbol Lona/Short Price Market Value
Caeh and Money .....t Funds (Sweep) .
CASH $ 312.01 I
Investments
US TAEAS 80 7.25%8115/22 (M) 2,000 L $ 126.2188 $ 2,524.38 ...
-
DUE 08115/22 ~
CURRENT YIELD 5.74399%
US TREAS BONO 7 ~l6 (M) 2,000 L 124.7500 2.495.00
DUE 05115116 .
CURRENT YIELD 5.81162%
AGERE SYSTEMS INC CL A (M) AGRA 1 L 3.0500 3.05
ODD LOT OFFER
EXP: 02!06104
AGERE SYSTEMS INC Cl B (M) AGRB 26 L 2.9000 75.40
ODD LOT OFFER
EXP; 02106,'U4
ARMSTRONG HOlDINGS INC (M) ACKHQ 100 L 1.0900 109.00
HEAL THSOUTH CORP (M) HlSH I)I\l\ l 4.5900 918.00
~""
HUGHES ELECTRONICS CORP (M) Q HS 82 L 16.5500 1,357.10
LUCENT TECHNOLOGIES lNC (M) Q LU 100.4229 l 2.8400 285.20
NATIONAL CITY CORP (M) NCC 124 l 33.9400 4,208.56
Please see "Footnotes for Your Account" sBCtion for an explanation of the footnote codes and symbols on this statement.
')f\tV) ("'hp..\p<:; ~F..........",h A.. r.. ~,~'-r- ~!~ -,,-.:'-'..e- ....""'~.tH.""'...-I ),.....~l>-_""'..-. ~\p.r J"'}~'''' '.,I,...A- ~"'-'-'\.' c'...-.....l-,.....,....... ro~ '1111""'" fl",r,f"'o. ;/..v'JOP.... (""T'r.../"'oAr'tr.,.... t r,r./.-,., .'r.F,'"
COMMONWEALTH OF PENNSYLVANIA *'
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21
BUREAU OF INDIVIDUAL TAXES AND
DEPT. 280601 ACN 03110280
HARRISBURG, PA 17128-0601 TAXPAYER RESPONSE
DATE 03-17-2003
REV-1S45 EX In (19-111
TYPE OF ACCOUNT
EST. OF JAMES J HIGIE o SAVINGS
S.S. NO. 178-20-6279 [iJ CHECKING
DATE OF DEATH 01-07-2003 o TRUST
COUNTY CUMBERLAND o CERTIF.
RE"IT PA,,"ENT AND FORttS TO:
BARBARA SHEETS REGISTER OF WILLS
3402 CANYON CREEK CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE. PA 17013
WAYPOINT BANK has provided tha o.part..nt with tha info~ation listed balow which has b..n used in
calculating the potential tax dua. Their records indicata that at the death of the abova decedant, you wara a joint ownar/banaficiary of
this account. If yOU faal this inforntion is incorrect, plaasa obtain writtan corraction frOll the financial institution, attach a copy
to this fo~ and raturn it to tha &bova addrass. This account is tax&bla in accordanca with the Inhadtanca Tax Laws of the COB_nwaalth
of Pannsylvania. lNastions ny ba answarad by calli ng (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING ANn PAYMENT INSTRUCTIONS
Account No. 90440975 o.t. 10-02-1986 To insura propar cradi t to your acCOlrlt, two
EsbbllsMd (2) copias of this notica BUst accoapany your
Account B.l_. 2.530.33 pal/llant to the RlIlIister of Wills. Maka chack
payabla to: "RlIlIistar of WUls, Aslant'".
P.rcent TlIXabl. X 50.000
AIIount SubjltCt to TIIX 1.265.17 NOTE: If tax PBl/IIants ara Bada within thraa
(3) IIOI1thS of the clacedent's data of death,
TIIX R.t. X .15 yoU Bay deduct. 5% discount of tha tax dua.
Potentl.l TIIX au. 189.78 Any inharitanca tax due wUl becOlle clalinquent
nine (9) IIOnths aftar the dllta of claath.
PART TAXPAYER RESPONSE
[!] *jf-oc'f'l~-3f;=-f~t"I-";"~,:,,:~-::~-c'1Flf~1--i-:-f--~~4~(--~i{~"r'~I1J~r_~-;--r--'---~~-I;'-~~-::-tr.lr~-~'ii--l~::~ifa;ii
i-~~~--"~ --*-""".;;;'*Jf-"----~ -~-~:#'C~~~-;l!!i~-~"-~ .&..",.=.Jl!,,_,=~ iifu" =~".&.~=- ~l!:-A~-_= ,uw-- !!!!mU-"'--~--'i!
~..:.tU ~* :::::r. ..,....-iHl ,..~:::;-::--,..:r. m.-.rn..:-.t'..~_-:.'1:" !R-nr.n-.=- --=".r.."lr.C::..~ ~ ..':.'U",..:.:::::_,...._-..-_"t: :EEE;:-..-,.."';r_~~":I:...:::._*:?t-:.:' :__-!:-w.r_:t
A. 0 The above inforntion and tax dUB is correct.
1. You Bay chaosa to rMit pay_nt to the RlIlIister of WUls with two copies of this notice to obtain
[ CHECK ] a discolrlt or avoid interest, or you ny check box RAR and ~tum this notice to the Register of
ONE WUls and an official assasRant wUl be lssuad by the PA DapartJIant of Revanue.
BlOCK B. 0 The above asset has baan or wUI be raported and tax paid with the Pannsylvania Inharitanca Tax return
ONLY to ba filed by the decadent's raprasantative.
C. 0 The above inforntion is incorrect and/or dabts and deductions wara paid by you.
You BUst cOlIPlata PART ~ and/or PART @J below.
PART If you indic.t. . different tax r.t.. pl..s. st.te your
~ r.l.tlonship to ~~t:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. o.te Established 1
2. Account Balance 2
3. P.rcent T.x8ble 3 X
4. A.ount Subject to T.x 4
5. DBbts and D8ductions 5 -
6. A~t Taxable 6
7. TIIX R.t. 7 X
8. TIIX DuB 8
PART
[!]
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
I I I
TOTAL (Enter on Li~ 5 of Tax C~t.tion) .
UncMr pen.lti.s of .,.rjury, I decl.r. that tha facts I mav. raport8d above .r. tru.. corrltCt IU'Id
co~l.t. to the best of .y knowledge and b.lief. HOME ( )
WORK ( )
T.4YP.4V~'" ~Tr.:".4TII"'~ TI= I i:'DLlnNi: NIIMIlI:D nATE:'
REV-1511 EX+ (12.99)W leHIDULI H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
James J. Higie
0ebtI of decedent mat be reported on Schedule L
rreM
NUMBER DESCRIPTION AMOUNT
"- FUNERAL EXPENSES:
1. Cremation Service 1,519,00
B. ADMINISTRATIVE COSTS:
1. PllflOnll Representative'. Commissions
Name of Personal Represenlalive(.)
Social Sec;urity Numbelt.)IEIN Number of Personal Reprl88l\talive(.) -
Street~
City Slate Zip
Year(s) Commission Paid:
2. AItomey Fees
3. Family Exemplicn; (If dec:edent's address is not lhe same as claimant's, aIIach explanation)
Claimant
Street Address
C1Iy State . Zip
ReIationshlp of Claimant to Decedent
4. Probate Fees
5. Aa:ounlanfs Fees
6. Tax Relum Preparer'. Fees
7.
TOTAL (Also enter on fine 9, Recapitulation) $ 1,519.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03) *'
SCHEDULE I
DEBTS OF DECEDENT,
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN MORTGAGE UABIU'nES, & UENS
RESIDENT DECEDalf
ESTATE OF FILE NUMBER
James J. Higie
Report debIs inc:umd by the decedent prior to deeth whicb remained unpaid as of the date of death, including unreimbursed mecllcal expenses.
ITEM VAlUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Pinnacle Health Hospital BUI #223435462 92,95
2 Pinnacle Health Hospital Bill #223367774 414.80
3 Chase Visa #4032-1400-3005-8678 128.34
4 MaNA Visa #5490999017601179 12,600,00
TOTAL (Also enter on line 10, Recapitulation) $ 13,236.09
(if more space is needed, insert additional sheets of the same size)
,D~cro~AGRIB'r..'.'. ,
3607 Rosemont Avenue, Suite 502
PO Box 8875
Camp Hill, PAl 7001-8&75
Telephone: 1-717-214-3017 Toll free: ] -800-599-0423 Monday - Thursday 8:30 - &:30 (EST) Friday 8:30 - 5:00 (EST)
March 24, 2003
- In Re: Pinnacle Health Hospitals
- James J Higie Amount Due : $414.80
3402 Canyan Crk Account # : 16785649
Mechanicsburg, P A ] 7055-6777 Client Ref. # : 223367774
- Date .of Service : 09-] 6-02
James J Higie :
We sent you a first notice, which included yaur rights under theF,air Debt CoUection Practices Act Your acco_unt
remains unpaid and we have not heard fiom~;ou conc:erniDI ,oot'ri"'. .
This past-due account needs to be paid in full. If yau have any questions call our office using the accaunt # as a
reference to your file.
Remember that your account may be reported to the credit bureaus,
Yaur payments should be made directly to this .office f.or prompt credit to your account A twenty-doHar service
charge will be added to all checks returned to us by our bank Should you desire a receipt, a self-addressed., stamped
envelape is required
This is an attempt to collect a debt by a debt collector and any information .obtained will be used far that purpose.
Bureau Of Account Management
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Detach and Return with Pa}'lIlent - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
To pay by credit card, please complete the information below:
PO Box 8875 Check .one: o Visa o MasterCard
Camp HiD. PA 17001-3375
Retmn Service Requested Card Number:
----------------
Expiration Date: i / Payment Amount
Signature:
Amount Due: 5414.80 Account # : 16785649
Client Ref. # : 223367774 Date of Service: 09-16-02
PERSONAL & CONFIDENTIAL Amount Enclosed : $
James J Higie 16785649
3402 Canyon Crk
Mechanicsburg, PAl 7055-6777 Bureau of Account Management
I... I If ... m.... I. I.. 1.1.. n.. I... n... nil. m.. ...,. I.. n. I PO Bo.l 8875
Camp Hill, PA 17001-8875
I II .11I.. . IIIttt IIttt. 11m.. 1.1.. I. I... I. 1.1.1.11 1.1 .1. It. III
h":..\:,::'~:.~"~~:;~7~t~;,:;ft:~;;;g~:r;:::!~~~~J{:~~!i'~:"t';i!,!~~~~~,~~.<~~~!~>>I.I~.J~~~;'~[~^r~I;,:",:~
Pinnacle Health HoseJtals
'> _...._.._~ ' _ - _ _ ~lll ,~,_,__,_"",,,,,,,,,,,"_"~_JIIlIl:!l.~_~_~ __ _~<::'__~~.k~J~. jl_ilI;_~,_,.",u~__.,"J,.-\.~~~'.~~;;,<'''t~~''''"''''''C'~'!lIl!~-,._,,-g
P.O. BOX 2353 i:il~~~~ll:~llii:l'!'i':::l::ji:'l:'<l:':~t~i/o~l::
HARRISBURG1 PA 17105
-
(717) 23~3717 i,Ei1~1~tI~,}~~~~;~~~:i..
12/01/02
12/01/&2
,((,12/811",.. .",.,
t..,.U..;'~'(" .t!.~' ;;C/'f-;{.---' ....;
12/01/02 00
12/01/02 15.00
12/01/02 >!~'y~i%~~';::
12/01/02
12/01/02
12/01/02 . ii, J4.. 00
12101102 ,_ .tOo
12/01/02 .1... 8.00
12/01/02 86.01 1'.00
12/01/02 82&03 203.00
12/01/02 1,1020 147.00
12/01/02 10450 879.00
12/01/02 &8000 6.00
12/01/02 00000 3.00
12/01/02 J1200 7.00
12/01/02 00000 3.00
Estimated Insurance Due: .00 Total Patient Credits: Account Balance: 92.95
YOUR ACCOUNT IS SERIOUSLY DELlNQUENTl
PLEASE CALL OR PAY IMMEDIATELY.
CUSTOMER SERVICE HOURS
MON-WED-FRl 7:00AM TO 4:00PM
TUES-THUR 7:00AM TO 6:00PM
CALL 717-230-3717 LOCAL OR 1-8QC)..803..808 OUT OF ARiA
'_4 ..........._____________________________...___.._...___..._~L4!..- detK!'~~_~~ ~th your payment --- -,. --...--...---- ---~
For HOIpl1a/ U.. Only Account Number: 1,,::;I',:'t~!G~..-..'
ADM DT: 120102 223435462
PINNACLE HEALTH HOSPITAlS DSH DT: 010103 Patient Name: Due By:
P.O. BOX 2353 HIGtE ..lAMES
HARRISBURG. PA 17105 HOSP SVC: H23 o ViA o M.utereard o Dftcowot o American ~
Card Number: I!llp. DaIa:
ADDRESS SERVICE REQUESTED
OX CD: 292.81 SiClUlture: Amount PaId:
Make Check Payable To PINNACLE HEALTH HOSPITALS
'...11I,"11I. ...1.1.. f.'.. II II f 11I11 III II ... m 11...',',,11 "
00010829 1 MB 0.309 03 PINNACLE HEALTH HOSPITALS
223435462
JAMES J HIGIE P.O. BOX 2353
3402 CANYON CRK HARRISBURG. PA 17105-2353
MECHANICS BURG PA 17055-6777
;;"cr.:..~"""""iliiiii"".'<f''';;~~~-''''-'f'
Phoenix. AZ 86072-2188 . ." ~
J
,
- I
iiiii I
Ii i
\
=-
=- I
,
JAMES J HIGIE 013659 FEBRUARV 28, 2003 == i
3402 CANYON CREEK -
:III f
KECHAHICSIURG, FA 17055-6711 ==
IuJlI.JILuJ................n.............JJ.JI.I ;;;;;;
-
IZ
.... 0>',!,'."'A~~,;,;..:..<.!~
.' -.-.- . ^
Account No: 4031-:f.too~-8678 __.'. ';~J __~-=.:++-~;;~:,~*':'~~:!.~4~:';~y_~
- ,
- ,
Dear James J Higie ,
This letter is ill lepnltD YfJIII'ChaR credit....... UMNnced above.
Our records indicate that.';tJUs acmullt is past due.
Your charging privileges may be suspended if the $20.00 remains unpaid. Please call
us today, Chase RepreshtatiWs can accept your payment by phone allowing you to
avoid mall delays. If you do choose to mail your payment, a payment coupon is
attached for your convenience.
We value your bus.lnes.s with Chase. Should you have any questions or need further
assistance, please contact a Chase Representative at 800-444-9370, between the hours
of 8:00 AM to l1~OO PM, Mond~ through Thursday, Friday. 8:00AM to 9:00 PM,
Saturday 8:00 AM to 5:00 PM, an Sunday, Noon to 9:00 PM EST.
If you have already mailed your payment, thank you.
Regards,
'{j~ !f~
~~$l(~~2~~~~+
ACCOUNT IS OWNED BY CHASE MANHA TTAN BANK USA, N,A, ANO MAY BE SERVICED BY ITS AFFILIATES,
.CAllS IlAY lIE MOHITOFIED AHOIOR RECORDED TO ENSURE. THE HIGHEST LEVEl. OF QIJAUTY SERVICE,
j.CHASE----Plrue.DitA5i'OOAEltRN THiS~;ONwiTH~~A=:::=::::::~~._----..9sG1i38.--.-
BALANCE I MlMIIIUM DUE I Enter Amoulll EncloMd in 801<.. Below
$128.34 $20.00 $ CJCJrJO!JLJ,D
-~ ---
ctIaf9t Of C1t_ YfMlt
add&.-
and
telephone
~',~~.1 } SUI..l }
JAMES J HHUE
3402 CANYON CREEK CHASE HANHATTAN BANK USA, M.A.
HECHANICSBURG, PA 11055-6117 PO BOX 15583
WILMINGTON. DE 19886-1194
'11I11'...111....1.1..1.'..1111'11."...1111.111... ..1.1..11.1 11I.1I1.11I11I..I..IIIII.....II...IU.....I..ILdt.........
4234 CHR9813 JPI.4f::lJl7'~
.-,--....
~ MIINA AIIIerIa
PA _1!I1S7
....,..., DI 1....5137
877-7.7-9313
07/02103
WALTER. S SHEETS
3402 CANYON CREEK
:MECHANICBURG, PA 17055
Re: In the Estate of JAMES J HIOIE
Probate Case No. 212003243
Social Security No: 178206279
Last known~: 3402 CA.l>fYON CRK MEC.rlAL~CSB{j"RG, PA 11055
Our Client MBNA AMERICA
Account :r-.rumber. 5490999017601179
Amount of Debt $ 12600.00
Dear Sir or Madam
. , " .,.. , ,---_.,.~_._~-.....-.- -_.- -_.--.
Enclosed here\\.'ith is a ropy of the Creditor's Claim for the above-referenced Estate. The original was mailed
to CUMBERLAND COUNTY COURTHOUSE
If you have any questions or ooncems, please call our firm toll free at 1-877-767-9383.
CooliaUy,
MBNA America
EncIosmes
cc: Court
This letter is an attempt to collect a debt and any infonnation obtained will be used for that purpose. This letter
is from a debt collector.
3100 6/2612003 962413
REV.1513 EX+ (~OO) '* SCHEDULE ..
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
James J. Higie
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY Do Not List TI1IStM(s} OF ESTATE
t TAXABlE DISTRIBUTIONS rllldude outright spousal disIrlbutions, and \ralIsfers under
See. 9116 (8) (1.2)l
1 Stephanie M. Higie, 105 Shorebreaker Dr, laguna Niguet, CA 92677 Daughter 6,000.00
2 James F Higie, 7629 Lyrewood Ln#131, Oklahoma City, OK 73132 Son 6,000.00
3 Joseph P. Higie, 215 N. 17th St, Camp Hill, PA 17011 Son 6,000.00
4 Jacueline A Hubbard. 516 Gale Rd, Camp HiD, PA 17011 Daughter 6,000,00
5 Elizabeth E. Badger, RD#2 Box 2320, SayIorsburg, PA 18353 Daughter 6,000.00
6 Barbara J. Sheets, 3402 Canyon Crk, Mechanicsuburg, PA 17055 Daughter 23,861.56
ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n NON- TAXABlE DISTRIBUTIONS:
A. SPOUSAl.. D1STR/BUTJOHS UNDER SECTION 9113 FOR WHICH AA ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
.
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
---.---,...... ....~..~ .,._---_._~._,_.~
COMMONWEALTH OF PENNSYLVANIA '*'
DEPARTMENT OF REVENUE
Lf,~"r\~n r-r'''i: O~ NOTICE OF INHERITANCE TAll
BUREAU OF I1IUVlDUA . L. ~UL) ui-rlGL PPRAISEKENT, ALLOIIANCE OR DlSALLOIIANCE
llIIEllITAIItE TAX DIVISION OF DEDUCTIONS AND ASSESSIlENT OF TAll
PO lOX 21!106Gl
HARRIS8lJ1fG PA 17128-0601 REV-l54t EX AFP (03-05]
2D05 ,29 PN 12: 01 DATE 04-25-2005
ESTATE OF HIGIE JAMES J
DATE OF DEATH 01-07-2003
c\ r-cw (,\r FILE NUMBER 21 03-0243
d:ll;\ tJ;-
O~'" ,"y, r,," --~T CUMBERLAIf!l
~:,.'l--'if.\".' ". , 'j.1 H. COUNTY
1"''-''-'''''_...' ,..,....__...[1
WAL TER S ~,I1EETS ACN 101 -.J.,
3402 CANYON CREEK I _t _itt.cl I
MECHANICSBURG PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1.1.r-"t!fIl"Yf.m.'\'llY-'Il'J,.w'm.IlI!".!wm4M!'t.'IW.IWl.lTft.,~.'lft:tW4M!'t.llrr.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HIGIE JAMES J FILE NO. 21 03-0243 ACN 101 DATE 04-25-2005
TAll RETUIIN liAS. (X) ACCEPTED AS FILED I ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE i
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. _1 Est.t. IScMmll. A) (1) .00 NOTE: T", insure pro...r
2. Stack. _ Bond. (_1. B) (2) .00 creell t !to your 8C00Unt I
......it itha _r portion
3. Clo~y .-ld Stock/Part_rohi.. Int.raot ISchadul. C) (3) .00 of thl~ fora with your
'I. IIort_olNot.o _ivllbl. I_I. D) ('I) .00 tax payjlant.
S. C._ Dapo.it.lNisc. P.,._l Pr_rty ISchadul. EI IS) 52.783.28
6. Jointly _ proparty I_I. F) (6) 15,839.37
7. Tr.n.f.~. (Schedule 8) (7) .00
B. Tot.1 As.t. IB) 68,622.65
APPROVED DEDUCTIONS AND EXEMPTIONS: 1,519.00
9. Funerel E~_s.lAdlt. Costs/Hisc. Expen.s8s (Schedule HJ (9)
10. o.bto/""rtgaga Llllbllitl../Llans (Schodul. I) IIDI 13.23& 09
11. Tot.l Daductlono Ill) :'4.7';1; nQ
12. Net \1.1.. of T.x R.turn 1l2) '53,867.56
I
13. Charitllbl./llova.......t.l "_st.; Non-.lact.cl 9113 Trust. IS_dul. J) 1131 .00
1'1. .-t Valua of Eot.t. _Jact to Tax Il'l) [53,867.56
NOTE: I~ an as......nt wa. issued previously. lines 14. 15 end'or 16. 17. 18 iend 19 will
r8'flect ~i9'lres thcrt include the total of ALL returns e..eneel to dcrte.:
ASSESSMENT OF TAX: .00 x 00 .00
IS. AIIowIt of Ll_ 1'1 .t Spousal rat. Illi) =
16. _t of Ll_ 1'1 t_l. .t Unaal/Cl..s A r.t. 1161 53,867.56 X 045 = 2,424.04
17. ~t of Llna 1'1 .t Sibling rat. Iln .00 X 12 = I .00
18. _t of Ll_ 1'1 taxllbl. .t Coll.t.r.l/Cl... B r.t. (18) .00 x 15 = , .00
19. Principal Tax _ 119)= 2,424.04
.
IlUIIIEft INTEREST/PEN PAID 1-) ANDlINT PAID
CD004965 141.76- ,608.90
.
V; TOTAL TAX CREDIT 12,467.14
BALANCE OF TAX DUE 43.10CR
INTEREST AND PEN. .00
TOTAL DUE 43.10CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE I IF TOTAL DUE IS LESS THAN tl, NO PAYHENT IS REIlUJ:IlEII.
FDR CALCULA TIOII OF AIlIlITIOIlAL J:NTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU MY BE DUE
A REFUNII. SEE REVERSE SIDE OF THIS FORII FOR iNSTIlUCTIOIlS.)
L._'
(_.'1-
STATUS REPORT U1\1DER RULE 6.12
Name of Decedent: ~5, IJ JhJJ~
1- 7 .; J- a::;J 2
J 1- 03 - o2.V_g
Date of Death:
~\e_
~No.:
,A~ell11ill. No.:
Pursuant to Rule 6.12 of the Supreme Court OrphfulS' Comi 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~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 'j... No 0
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 IiXJ No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may b~filed with th Clerk of the Orphans' Court
an~may be attached to this ~ o~ -?~ ~
Date:.H.%- 2..:0.) _~
Signature
/,Atkr S 6VS
Name
()I
.,,~..l
J<to2 CfrJ'1 UuK ~4.,~s~~ tI-/7PrJ'
Address
717-77a-cJ2l7
Telephone No.
\---
t
G-
<:0
("j
Capacity: ~ersonal Representative
o Counsel for personal representative
ud