HomeMy WebLinkAbout03-0184Estate of Mary S. Reich
also known as
PETITION FOR GRANT OF LETTERS
, Deceased Social Security No. 182385854
Petitioner(s), who is/are 18 years of age or older, apply)les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix
I~ Decedent, dated 12/16/1991 and codicil(s) dated None
*See Renunciation Q~ Richard B. Hyser. Jr.
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(ct.a.d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at Forest Park Health Center, 700 Walnut Bottom Road, Carlisle, PA 17013 ~'~-~ -~ ~
(list street, number and municipality)
Decedent, then 86 years of age, died January 26 ,2003 , at Forest Park Health Center, Carlisle, PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property ......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
30,000.00
30,000.00
Real Estate situated as follows: None
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Signature Typed or printed name and residence
Wendy S. Wolf, 40 Winchester Gardens, Carlisle, PA 17013
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed Wendy S. Wo~ - '~ ':-
before me this X.//7"/{ __ day of
DECREE OF REGISTER
Estate of Mary S. Reich
Deceased
also known as
Social Security No: 1 $2:~,~854 Date of Death: 01/26/2003
AND NOW, /'2"~ /, ,o~z::z2..~ , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters I~ Testamentary I~ of Administration
((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate)
are hereby granted to Wendy S. Wolf
in the above estate and that the instrument(s), if any, dated December 16, 1991
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters ....................................
Short Certificates(s) ...............
Renunciation .......................... $
Extra Pages ( ) ............... $
I.T.R ....................................... $
JCP Fee ................................. $
Inventory ................................ $
Other ...................................... $
TOTAL ............................. $
Register of Wills /
Signature
Attorney: Scott W. Morrison
I.D. No: 83943
Address: P.O. Box 232
New Bloomfield PA 17068
TeLephone: (717) 582-2300
DATE FILED: 03/04/2003
OATH OF SUBSCRIBING WITNESS
Estate of Mar~ S. Reich
also known as Mar~ Susan Reich
, Deceased
No.
Gerald K. Morrison
Tamatha R. Dobbs~ n/b/m Tamatha R. Kauffman
(each) a subscribing witness to the ~ codicil(s) ~ will(s) presented herewith, (each) duly qualified according to
law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and
that she/he/they signed as a witness at the request of the Testator(rix) in her/his/their presence and~ in the
presence of each other I~ in the presence of the ot er~:~scribing witness(es).
" ~,/ (Signature)
Gerald K. Morrison
R.R. #2 Box 315, Landisburg, PA 17040
(Address)
Tamatha R. Dobbs, n/b/m Tamatha R. Kauffman
Dobbs Road~ Ickesburg, PA
(Address)
Sworn to or affirmed and subscribed
before me this ~, ~t
day of
Notar~ublic '
INOTARIAL SEAL
My Commission Expires: SCOTT W. MORRISON, NOTARY PUBLIC
BLOOMFIELD BORO., PERRY COUNTY
MY COMMISSION EXPIRES MAY 3, 2004,
(Signature and seal of Notary or other
official qualified to administer oaths. Show
date of expiration of Notary's commission.)
NOTE:
To be taken by officer authorized to administer oaths. Please have
present the original or copy of instrument(s) at time of notarization.
RW-2
RENUNCIATION
Estate of Mary S. Reich
also known as
, Deceased
NO.
The undersigned,Richard B. Hyser, Jr.~ ,grandson
(Relationship)
(Capaci~)
of
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters Testamentary be issued to Wend)/S. Wolf
Witness my
handthis q+~ dayof F~c~,.~ , ~¢~z.-.
-/ -'/ (Sign§ture)
Richard B. Hyser, Jr.
808 West 27th Street~ Lowrance~ KS 66046
(Address)
(Signature)
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before me this day of
Notary Public
My Commission Expires:
(Signature and seal of Notary or other
official qualified to administer oaths. Show
date of expiration of Notary's commission.)
NOTE:
Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
RW-3
LAST WILL AND TESTAMENT
OF
MARY S. REICH
I, MARY S. REICH of R. D. #1, Shermans Dale, Carroll Township,
Perry County, Pennsylvania, being of sound and disposing mind,
memory, and understanding, do hereby make, publish, and declare
this my Last Will and Testament, hereby expressly revoking all
other writings in nature testamentary by me at any time heretofore
made.
FIRST: I direct that all my debts and funeral expenses
be paid as soon after my decease as may be practicable.
SECOND: I direct that inheritance tax on property disposed
of herein, shall be paid from my residuary estate.
THIRD: I hereby give and bequeath the sum of FIVE HUNDRED
DOLLARS ($500.00) to each of my Greatgrandchildren who are living
at the time of my death.
FOURTH: I hereby give and bequeath my new typewriter,
Elgin tape player~ Motorola radio and Emerson radio to my
Grandson, Richard B. Hyser, Jr.
FIFTH: I hereby give and bequeath all my jewelry to my
Granddaughter, Wendy S. Wolf.
MARY ~. REICH
(SEAL)
Page one of two
SIXTH: I hereby give, bequeath and devise all the rest
and residue of my estate and property, real, personal and mixed,
of whatsoever nature and wheresoever situated, of which I may
own at the time of my death, or to which I may be entitled or
of which I may have the right to dispose at the time of my death,
to my two Grandchildren, Richard B. Hyser, Jr. and Wendy S.
Wolf in equal shares.
SEVENTH: I hereby appoint my two Grandchildren, Richard B.
Hyser, Jr. and Wendy S. Wolf as Executors of this my Last Will
and Testament, and I further appoint Wendy S. Wolf as Guardian
for any minor children that shall be entitled to receive property
under this, my Last Will and Testament, and I direct that they
shall not be required to give bond or other security in any
jurisdiction wherein proceedings may be held in connection with
my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this 16 day of December, 1991.
WI~S:
I
MARY ~. REICH
(SEAL}
Page two of two
LAST WILL AND TESTAMENT
OF
~V~ARY S. REICH
LAW OFFICES
GERALD K. MORRISON
P.O. Box 232
CENTER SQUARE
NEW BLOOMFIELD, PA. 17068
CLAIM
No. 21-2003-184
ESTATE OF
Deceased
MARY REICH
Notice of claim by CONTINUING CARE RX
In the amount of $ 502.64 , filed
pursuant to Section 3384, Probate, Estates and Fiduciaries Code
Laws of 1972, Act No. 164 effective July 1, 1972, as amended.
Name and address of Attorney:
ATTORNEY SCOTT MORRISON
P.O. BOX 232
NEW BLOOMFIELD, PA 17068
CLAIM
ESTATE OF
MARY REICH
No. 21-2003-184
Notice of claim by CONTINUING CARE RX in the amount
of $ 502.64 Filed pursuant to section 3384, Probate, Estates
and Fiduciaries Code Laws of 1972, Act. No. 164, effective July 1, 1972,
as amended:
Date 3-21-2003
TO THE CLERK OFTHE
COURT DIVISION:
Enter the claim of CONTINUING CARE RX - 5775 ALLENTOWN BLVD
(claimant)
SUITE 202, HARRISBURG, PA 17112 in the amount of $ FIVE HLrNDRED TWO DOLLARS
AND SIXTY FOUR CENTS.
against the above entitled Estate. The decedent, who resided at FOREST PARK HEALTH CENTER
(address)
700 WALNUT BOTTOM ROAD, CARLISLE, PA 17013.
died on JANUARY 26, 2003
(date)
Written notice of said claim was given to WENDY S. WOLF
(personal representative or his counsel)
at 40 WINCHESTER GARDENS, CARLISLE, PA 17013, on
(address)
The basis of aforesaid claim is as follows:
(Itemize fully to enable personal representative to make proper investigation).
WE SUPPLIED MEDICATIONS TO MARY REICH WHILE SHE WAS A RESIDENT OF
FOREST PARK HEALTH CENTER. COMPLETE BILL IS ATTACHED.
MARCH 21, 2003
(date)
Claimant's counsel
Richard V. Costa Jr.
(name) Continuing Care RX
(claimant)
5775 Allentown Blvd. Suite 202, Harrisburg, PA 17112
(address) 5775 Allentown Blvd. Suite 202, Harrisburg, PA 17112
(address)
CONTINUING CARE RX
28 S 2ND ST /PO BOX 355
NEWPORT PA 17074
Statement date: 3/01/03
Account #: 100010262 FPC
Name: M~Y REICH
WENDY WOLF
40 WINDCHESTER GARDENS
Ci~RLISLE, PA 17013
* *STATEMENT* *
Statement Date: 3/01/03 Page:
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
3/14/02 RX# 1146552 SORBITOL 70% SOLUTION 480 6.25
3/25/02 HF 1146552 SORBITOL 70% SOLUTION 480 6.25
3/25/02 RX# 1157564 DIOCTO-C 60-30/15 SYRUP 480 5.55
3/15/02 RF 1141223 COUMADIN 1MG TABLET UD 4 6.36
3/22/02 RF 1141223 COUM/%DIN 1MG TABLET UD 4 6.36
3/29/02 RF 1141223 COUMADIN 1MG TABLET UD 4 6.36
4/02/02 RX# 1166868 DUONEB INq~ SOLN 90 58.00
4/02/02 RX# 1166872 ROCEPHIN 1GM VIAL 7 326.00
4/02/02 RX# 1166874 LIDOCAINE 1% 20ML VIAL 1 8.90
4/02/02 RX# 1166876 ZITHROM~( 250MG T~BLET 6 42.78
4/06/02 RF 1052272 LANOXIN 0.125MG TAB 30 8.60
4/06/02 RF 1052273 FUROSEMIDE 40MG TAB 60 12.61
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 2
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
4/06/02 RF 1052274 DETROL 2MG TAB 30 44.96
4/06/02 RF 1052277 CARB/LEVO 25/100MG TAB 45 36.41
4/06/02 RF 1052281 FERROUS SULF 325MG/5GR TA 60 1.55
4/06/02 RF 1052283 ASPIRIN 325MG TAB 30 1.55
4/06/02 RF 1083064 CEROVITE (CERTAVITE) TAB 30 1.65
4/06/02 RF 1139322 MEGESTROL AC 40MG TAB 60 70.42
4/06/02 RF 1139324 ZOLOFT 100MG TAB 30 72.06
4/08/02 RX# 1132902 ACETAMINOPHEN 650MG SUPP 12 4.85
4/08/02 RF 1141223 COL~{ADIN 1MG TABLET UD 4 6.36
4/09/02 RF 1146552 SORBITOL 70% SOLUTION 480 6.25
4/09/02 RF 1166868 DUONEB INH SOLN 90 58.00
4/13/02 RF 1141223 COUM3%DIN 1MG TABLET UD 4 6.36
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 3
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date
4/17/02 DOC#224
4/18/02 RX# 1186546
4/18/02 RX# 1186548
4/20/02 RX# 1188971
4/20/02 RX# 1188973
4/22/02 RX# 1190640
4/22/02 RX# 1190650
4/25/02 RX# 1194138
4/27/02 RF 1166870
4/27/02 RF 1190650
4/02/02 RX# 1166870
5/06/02 RF 1083064
Description Qty Amount
PAYMENT - THANK YOU 37.13-
MIRALAX POWDER 255 17.05
COUMADIN 1MG TABLET UD 19 15.19
MAGNESIUM CITP. ATE SOLN 10 300 1.55
LACTULOSE 10GM/15ML (ENUL 480 18.50
DUONEB INH SOLN 90 58.00
MAGNESIUM CITRATE SOLN 10 300 1.55
MIRALAX POWDER 255 17.05
ADVAIR DISKUS 500/50MCG 60 178.64
MAGNESIUM CITRATE SOLN 10 300 1.95
ADVAIR DISKUS 500/50MCG 60 178.64
CEROVITE (CERTAVITE) TAB 30 1.95
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 4
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GAAIDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
5/06/02 RF 1139322 MEGESTROL AC 40MG TAB 60 70.42
5/06/02 RF 1186548 COUM/kDIN 1MG TABLET UD 30 21.66
5/06/02 RF 1194138 MIP~ALAX POWDER 255 17.05
5/06/02 RX# 1199310 LANOXIN 0.125MG TAB 30 8.60
5/06/02 RX# 1199311 FUROSEMIDE 40MG TAB 60 12.61
5/06/02 RX# 1199312 DETROL 2MG TAB 30 48.03
5/06/02 RX# 1199313 CARB/LEVO 25/100MG TAB 45 36.41
5/06/02 RX# 1199314 FERROUS SULF 325MG/SGR TA 60 1.95
5/06/02 RX# 1199315 ASPIRIN 325MG TAB 30 1.95
5/06/02 RX# 1207773 ZOLOFT 50MG TAB 31 74.33
5/10/02 DOC#225 PAYMENT - THA/~K YOU 1,255.43-
5/13/02 RF 1157564 DIOCTO-C 60-30/15 SYRUP 480 5.55
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 5
Account #: 100010262 FPC
MJ~RY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
5/15/02 RF 1194138 MIR/LLAX POWDER 255 17.05
5/20/02 RF 1113990 CALMOSEPTINE OINT l13G 113 4.80
5/25/02 RF 1194138 MIRALAX POWDER 255 17.05
6/05/02 RF 1139322 MEGESTROL AC 40MG TAB 60 70.42
6/05/02 RF 1199310 LANOXIN 0.125MG TAB 30 8.60
6/05/02 RF 1199311 FUROSEMIDE 40MG TAB 60 12.61
6/05/02 RF 1199312 DETROL 2MG TAB 30 48.03
6/05/02 RF 1199313 CARB/LEVO 25/100MG TDJB 45 36.41
6/05/02 RF 1199314 FERROUS SULF 325MG/5GR TA 60 1.95
6/05/02 RF 1199315 ASPIRIN 325MG TAB 30 1.95
6/05/02 RF 1207773 ZOLOFT 50MG TAB 30 72.06
6/05/02 RX# 1233015 CEROVITE (CERTAVITE) TAB 30 1.95
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 6
Account 0: 100010262 FPC
MARY REICH
WEN]DY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
6/07/02 RF 1194138
6/19/02 DOC#228
6/20/02 RX# 1260287
6/25/02 RX# 1264013
6/27/02 RX# 1268168
7/02/02 RF 1157564
7/04/02 RF 1268168
7/05/02 RF 1199310
7/05/02 RF 1199311
7/05/02 RF 1199312
7/05/02 RF 1199313
7/05/02 RF 1199314
MIRALAX POWDER 255 17.05
PAYMENT - THANK YOU 339.41-
CILOXAN 0.3% 5ML EYE DROP 5 40.29
MIRALAX POWDER 255 17.05
MEGESTROL ORAL 40MG/ML SU 240 133.55
DIOCTO-C 60-30/15 SYRUP 480 5.55
MEGESTROL OP~AL 40MG/ML SU 240 133.55
LANOXIN 0.125MG TAB 30 8.60
FUROSEMIDE 40MG TAB 60 12.61
DETROL 2MG TAB 30 48.03
CARB/LEVO 25/100MG TAB 45 36.41
FERROUS SULF 325MG/5GR TA 60 1.95
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 7
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
7/05/02 RF 1199315 ASPIRIN 325MG TAB 30 1.95
7/05/02 RF 1207773 ZOLOFT 50MG TAB 30 72.06
7/05/02 RF 1233015 CEROVITE (CERTAVITE) TAB 30 1.95
7/10/02 RX# 1281581 AUGMENTIN 875MG TAB 20 105.03
7/16/02 DOC#233 PAYMENT - THANK YOU 461.92-
7/18/02 RX# 1289706 DUONEB INH SOLN 90 58.00
7/18/02 RX# 1290310 BENZONATATE 100MG CAP 60 52.98
7/18/02 RX# 1290314 PULMICORT RESPULES 0.5MG 60 127.44
7/22/02 RF 1264013 MIRALAX POWDER 255 17.80
7/25/02 RX# 1299949 ZOLOFT 25MG TAB 7 19.88
7/29/02 RF 1290314 PULMICORT RESPULES 0.5MG 60 127.44
7/31/02 RF 1289706 DUONEB INH SOLN 90 58.00
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 8
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
8/01/02 RF 1264013 MIRALAX POWDER 255 17.85
8/04/02 RF 1199310 L~NOXIN 0.125MG TAB 30 8.60
8/04/02 RF 1199311 FUROSEMIDE 40MG TA~ 60 12.61
8/04/02 RF 1199312 DETROL 2MG TAB 30 48.03
8/04/02 RF 1199313 CARB/LEVO 25/100MG TAB 45 36.41
8/04/02 RF 1199314 FERROUS SULF 325MG/5GR TA 60 1.95
8/04/02 RF 1199315 ASPIRIN 325MG TAB 30 1.95
8/04/02 RF 1233015 CEROVITE (CERTAVITE) TAB 30 1.95
8/09/02 RX# 1316706 EAR WAX DR0PS(CARBAMOXIDE 15 2.00
8/12/02 RF 1264013 MIP~ALAX POWDER 255 17.85
8/12/02 RX# 1319892 DUONEB INH SOLN 90 58.00
8/12/02 RX# 1319904 DOCUSATE 100MG/10ML 473ML 473 15.40
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 9
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
8/22/02 RX# 1333137 ZOLOFT 50MG TAB 13 33.49
8/23/02 RX# 1333837 MIRALA~ POWDER 255 17.85
8/27/02 DOC#241 PAYMENT - THANK YOU 889.23-
8/29/02 RX# 1340676 MEGESTROL AC 40MG TAB 6 10.64
9/03/02 RF 1199310 LANOXIN 0.125MG TAB 30 8.99
9/03/02 RF 1199311 FUROSEMIDE 40MG TAB 60 12.61
9/03/02 RF 1199312 DETROL 2MG TAB 30 48.03
9/03/02 RF 1199313 CARB/LEVO 25/100MG TAB 45 36.41
9/03/02 RF 1199314 FERROUS SULF 325MG/5GR TA 60 1.95
9/03/02 RF 1199315 ASPIRIN 325MG TAB 30 1.95
9/03/02 RF 1233015 CEROVITE (CERTAVITE) TAB 30 1.95
9/03/02 RF 1333137 ZOLOFT 50MG TAB 30 72.06
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 10
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
9/03/02 RF 1340676 MEGESTROL AC 40MG TAB 30 37.21
9/04/02 RF 1333837 MIP. ALAX POWDER 255 17.85
9/18/02 RF 1319904 DOCUSATE 100MG/10ML 473ML 473 15.40
9/18/02 RF 1333837 MIRALAX POWDER 255 17.85
9/30/02 RF 1333837 MIP~ALAX POWDER 255 17.85
9/30/02 DOC#243 PAYMENT - THANK YOU 284.58-
10/03/02 RF 1233015 CEROVITE (CERTAVITE) TAB 30 1.95
10/03/02 RF 1333137 ZOLOFT 50MG TAB 30 72.06
10/03/02 RF 1340676 MEGESTROL AC 40MG TAB 30 37.21
10/03/02 RX# 1371896 LANOXIN 0o125MG TAB 30 8.99
10/03/02 RX# 1371897 FUROSEMIDE 40MG TAB 60 12.61
10/03/02 RX# 1371898 DETROL 2MG TAB 30 50.63
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 11
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
10/03/02 RX# 1371899 CARB/LEVO 25/100MG TAB 45 36.41
10/03/02 RX# 1371900 FERROUS SULF 325MG/5GR TA 60 1.95
10/03/02 RX# 1371901 ASPIRIN 325MG TAB 30 1.95
10/10/02 RF 1333837 MIRALA~ POWDER 255 17.85
10/11/02 DOC#248 PAYMENT - THANK YOU 290.11-
10/25/02 RX# 1410828 MIR3%LAX POWDER 255 17.85
11/02/02 RF 1333137 ZOLOFT 50MG TAB 30 72.06
11/02/02 RF 1340676 MEGESTROL AC 40MG TAB 30 37.21
11/02/02 RF 1371896 LANOXIN 0.125MG TAB 30 8.99
11/02/02 RF 1371897 FUROSEMIDE 40MG TAB 60 12.61
11/02/02 RF 1371898 DETROL 2MG TAB 30 50.63
11/02/02 RF 1371899 CARB/LEVO 25/100MG TAB 45 36.41
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 12
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CD~RLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
11/02/02 RF 1371900 FERROUS SULF 325MG/5GR TA 60 1.95
11/02/02 RF 1371901 ASPIRIN 325MG TAB 30 1.95
11/02/02 RX# 1410169 CEROVITE (CERTAVITE) TAB 30 1.95
11/09/02 RF 1410828 MIRALAX POWDER 255 17.85
11/14/02 RX# 1436647 KCL ER 10MEQ TAB (KLOR-CO 19 8.77
11/15/02 RF 1410828 MIRALAX POWDER 255 17.85
11/21/02 DOC#252 PAYMENT - THANK YOU 259.46-
11/25/02 RF 1410828 MIRALAX POWDER 255 17.85
12/02/02 RF 1333137 ZOLOFT 50MG TAB 30 72.06
12/02/02 RF 1340676 MEGESTROL AC 40MG TAR 30 37.21
12/02/02 RF 1371896 LANOXIN 0.125MG TAR 30 8.99
12/02/02 RF 1371897 FUROSEMIDE 40MG TAB 80 13.66
continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 13
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regardinG your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
..............................................................
12/02/02 RF 1371898 DETROL 2MG TAB 30 50.63
12/02/02 RF 1371899 CARB/LEVO 25/100MG TAB 45 36.41
12/02/02 RF 1371900 FERROUS SULF 325MG/5GR TA 60 1.95
12/02/02 RF 1371901 ASPIRIN 325MG TAB 30 1.95
12/02/02 RF 1410169 CEROVITE (CERTAVITE) TAB 30 1.95
12/02/02 RF 1436647 KCL ER 10MEQ TAB (KLOR-CO 30 11.53
12/16/02 RF 1410828 MIRALA.X POWDER 255 17.85
12/20/02 RX# 1480109 MIRALAX POWDER 255 17.85
12/23/02 RX# 1482832 BACITRACIN ZINC OINT 30G 1 2.05
12/24/02 DOC#257 PAYMENT - THANK YOU 286.08-
1/01/03 RF 1371896 LANOXIN 0.125MG TAB 30 8.99
1/01/03 RF 1371897 FUROSEMIDE 40MG TAB 60 13.66
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 14
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date
1/01/03 RF 1371898
1/01/03 RF 1371899
1/01/03 RF 1371900
1/01/03 RF 1371901
1/01/03 RF 1410169
1/01/03 RF 1436647
1/01/03 RX# 1486227
1/01/03 RX# 1486228
1/06/03 RX# 1497756
1/07/03 RF 1480109
1/10/03 RX# 1504784
1/13/03 RX# 1508045
Description Qty Amount
DETROL 2MG TAB 30 50.63
CARB/LEVO 25/100MG TAB 45 36.41
FERROUS SULF 325MG/5GR TA 60 1.95
ASPIRIN 325MG TAB 30 1.95
CEROVITE (CERTAVITE) TAB 30 1.95
KCL ER 10MEQ TAB (KLOR-CO 30 11.53
ZOLOFT 50MG TAB 30 72.06
MEGESTROL AC 40MG TAB 30 37.21
CILOXAN 0.3% 5ML EYE DROP 5 41.18
MIRALAX POWDER 255 17.85
ERYTHROMYCIN EYE OINT 3.5 4 8.69
AUGMENTIN XR 1000-62.5MG 40 102.61
** continued on next page **
**STATEMENT**
Statement Date: 3/01/03 Page: 15
Account #: 100010262 FPC
MARY REICH
WENDY WOLF
40 WINDCHESTER GARDENS
CARLISLE, PA 17013
If you have any questions regarding your bill please call
(717) 567-2147 or 1-800-675-2279. Thank you!
Date Description Qty Amount
1/13/03 RX# 1508050
1/13/03 RX# 1508101
1/15/03 RX# 1511688
1/16/03 DOC#259
1/17/03 RF 1480109
1/23/03 RX# 1521414
1/25/03 RX# 1524984
1/26/03 RX# 1527654
EAR WAD( DROPS(CARBAMOXIDE 15
FUROSEMIDE 80MG TAB 19
MORPHINE SULF 20MG/ML SOL 30
PAYMENT - THANK YOU
MIRALA~X POWDER 255
DIOV~LN 80MG TAB 9
MORPHINE SULF 20MG/ML SOL 30
ROXA~NOL 5MG SYR-PYXIS-UD 1
2 00
11 31
20 76
274 09-
17 85
16 59
20 76
6.70
Ending balance - Pay this amount ......... > 502.64
Past Due Past Due Past Due
Current 31-60 days 61-90 days 90+ days
502.64 .00 .00 .00
Please cut here and remit this portion with payment
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mary S. Reich
Date of Death: 01/26/2003
Estate No. 2003-00184
SSN: 182-38-5854 File No.
Date Letters Granted: 03/04/2003 Will No.
Adm. No.
To the Register:
I certify that Notice of 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 04/03/2003 ·
Name
Wendy S. Wolf
Richard B. Hyser, Jr.
Seth T. Hyser
Chase C. Hyser
Avery L. Hyser
Danielle L. Hyser
Address
40 Winchester Gardens, Carlisle, PA 17013
808 West 27th Street, Lawrence, KS 66046
1603 North Bensington Court, Normal, IL 61761
1603 North Bensin,qton Court, Normal, IL 61761
19 East Main Street, Plainfield, PA 17081
808 West 27th Street, Lawrence, KS 66046
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Gary LeFever and David LeFever~ addresses currently unknown
Date: 06/11/2003
Capacity:
Personal Representative
X
Counsel
for
Pers°nal~l
Representative
!q: Olb' £! N I? £0.
(Signature)
Scott W. Morrison
Name (Please type or print)
Address
P.O. Box 232
New Bloomfield PA 17068
Telephone No. (717) 582-2300
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mary S. Reich
Date of Death: 01/26/2003
SSN: 182-38-5854
Date Letters Granted: 03/04/2003
To the Register:
Estate No. 2003-00184
File No.
Will No. Adm. No.
I certify that Notice of 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 07/09/2003 :
Name Address
Gary LeFever P.O. Box 384, Keystone, FL 32656
David LeFever P.O. Box 1764, Keystone, FL 32656
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 07/09/2003
Capacity:
Repre~tative
Personal ,? c':~
X Counsel for Pers'~al
RepreSentative ,--
Scott W. Morrison
Name (Please type or print)
P.O. Box 232
Address
Center Square
New Bloomfield PA 17068
Telephone No. ('717) 582-2300
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003037
MORRISON SCOTT W ESQ
P O BOX 232
NEW BLOOMFIELD, PA 17068
........ fold
ESTATE INFORMATION: SSN: 182-38-5854
FILE NUMBER: 2103-0184
DECEDENT NAME: REICH MARY S
DATE OF PAYMENT: 09/19/2003
POSTMARK DATE: 09/1 9/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 01/26/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $1,469.50
TOTAL AMOUNT PAID:
$1,469.50
REMARKS: WENDY SUSAN WOLF C/O SCOTT W
MORRISON-TAX PAYMT SAME DAY
SEAL
CHECK//269
INITIALS: SK
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX + (6-~0)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA t7128-0601
I-.
Z
LU
ILl
~oo
n
Z
Z
DECEDENT'$ NAME (LAST, FIRST, AND MIDDLE INITIAL
/ i -/g ,.'>----
RE{/-I$00
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Reich, Mar7 S.
DATE OF DEATH (MM-DD-Year)
01/26/2003
DATE OF BIRTH (MM-DD-Year)
09/05/1916
OFFICIAL USE ONLY
1 8 4
FILE NUMBER
2003-
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
1 8 2-3 8-5 8
NUMBER
5 4
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
]'~1. Odginal Retum
r--] 4. Limited Estate
E~6. Decedent Died Testate (A~t~ch copy Of Will)
---] 9. Litigation Proceeds Received
E~2. Supplemental Return
E~ 4a. Future Interest Compromise(dateofdea~after12.12-82)
r'~7. Becedent Maintained a Living Trust (Att~h copy of Trust)
] 10. Spousal Poverty Credit (dateof death bel~een 12-31-91 and 1-1-95)
NAME
Scott W. Morrison, Esquire
FIRM NAME (If Applicable)
TELEPHONE NUMBER
(717) 582-2300
] 3. Remainder Return (dateofdeathpdorto12-13-82)
r-j5. Federal Estate Tax Return Required
0__ 8. Total Number of Safe Deposit Boxes
E~I 1. Election to tax under Sec. 9113(A) (A~h Sch O)
COMPLETE MAILING ADDRESS
P.O. BOX 232
New Bloomfield PA 17068
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses 8, Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11 )
13.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
- OFFICIAL USE ONLY
39,207.34
(8)
3,990.00
2,561.84
(11)
(12)
(13)
(14)
39,207.34
6,551.84
32,655.50
32,655.50
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17, Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
x (15)
32,655.50 x .045 (16)
x .12 (17)
x .15 (18)
(19)
1,469.50
1,469.50
Decedent's Complete Address:
ISTREET ADDRESS
CITY Carlisle
Forest Park Health Center
700 Walnut Bottom Road
I STATE PA I Z,~' 17013
Tax Payments and Credits:
1. Tax Due(Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B, Prior Payments
C. Discount
Total Credits ( A + B + C )
(1)
(2)
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
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)
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 ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; ........................................................................... []
b. retain the right to designate who shall use the property transferred or its income; ........................................[]
c. retain a reversionary interest; or ...................................................................................................... []
d. receive the promise for life of either payments, benefits or care? ............................................................. []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... []
1,469.50
1,469.50
1,469.50
No
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE~OF PERSON RESPONSIBLE FOR FILING RETU~RN
SIGNATUR~ PREPARE~ ~THER THAN REPR~ENTATIVE
DATE
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at teast one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (1-9T)* j~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Reich. Mary. S. ~Q03 104
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F,
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. The Bank of Landisburg Checking Account #3602885 32,829.22
Holman & Roth--refund
Presbyterian Homes--refund
Bankers Life--refund of coinsurance
Forest Park Health Center-refund
358.61
785.50
1,783.01
3,451.00
TOTAL (Also enter on line 5, Recapitulation) $ 39,207.34
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Reich. Mary_ S.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
2003
194
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1,
5.
6,
7,
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Wendy S. Wolf
Social Secudty Number(s) 1EIN Number of Personal Representative(s)
Street Address 40 Winchester Gardens
City Carlisle State PA
Year(s) Commission Paid: 2003
Attorney Fees Scott W. Morrison, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip 17013
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Donna M. Otto
Accountant's Fees
Tax Retum Preparer's Fees
State Zip
1,950.00
1,950.00
90.00
TOTAL (Also enter on line 9, Recapitulation) $ 3,990.00
(If more space is needed, insert additional sheets of the same size)
RE¥-1512 EX +{1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Reich, Mary $.
Include unreimbursed medical expenses.
FILE NUMBER
2003
184
ITEM
NUMBER DESCRIPTION AMOUNT
1. Carlisle Memorial Service, Inc.--headstone 1,797.00
Paul J. Creedon--medical account
Continuing Care--medical bill
Cumberland Law Journal--estate advertising
Sentinel--estate advertising
Forest Park Health Center--medical bill
Quantum Imaging Therapeutics
20.00
502.64
75.00
95.27
62.16
9.77
TOTAL (Also enter on line 10, Recapitulation) $ 2,561.64
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX ~: (9~nnl
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Reich. M;iry $,
NUMBER
I.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
Wendy S. Wolf, 40 Winchester Gardens, Carlisle, PA 17013
Richard B. Hyser, Jr., 808 West 27th Street, Lawrence, KS 66046
Sean T. Hyser, 1603 North Bensington Court, Normal, IL 61761
Chase C. Hyser, 1603 North Bensington Court, Normal, IL 61761
Avery L. Hyser, 19 East Main Street, Plainfield, PA 17081
Danielle L. Hyser, 808 West 27th Street, Lawrence, KS 66046
Gary LeFever, P.O. Box 384, Keystone, FL 32656
David LeFever, P.O. Box 1764, Keystone, FL 32656
FILE NUMBER
2003
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Granddaughter
Grandson
Greatgrandson
Greatgrandson
Greatgranddaughter
Greatgranddaughter
Greatgrandson
Greatgrandson
184
AMOUNT OR SHARE
OF ESTATE
/2 residue
/2 residue
;500.00
;500.00
;500.00
;500.00
;500.00
;500.00
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
B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
L The l ankol: Landisbu
P.O. BOX 179 * LANDISBURG, PA 17040 ~1~
ESTABLISHED 1903
March 20,2003
Scott W. Morrison
Law Offices
Center Square, New Bloomfield
Pa. 17024
Re: Estate of Mary S. Reich
To Whom It May Concern:
The information you requested regarding Estate of Mary S. Reich,
is as follows:
Now Checking Account No. 3602885, opened 4/4/79, sole owner,
balance as of date of death-S32,799.33, interest rate-l.10%,
accrued interest-S29.89.
Thank you/
Joan Smoker, Customer Service
LANDISBURG - 717-789-3213
· BLAIN - 536-3118 ·
SHERMANS DALE - 582-8511
SCOTT W MORRISON
SCOTT W MORRISON ESQUIRE
CENTER SQUARE
P O BOX 232
NEW BLOOMFIELD PA 17068
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
March 24, 2003
Re: MARY REICH
SSN: 182-38-5854
Dear Attorney Morrison:
Pursuant to your letter dated March 12, 2003, the Department of Public
Welfare (DPW), Estate Recovery Program, has reviewed the information you
provided regarding the above-referenced individual.
It has been determined that this individual did not receive any type of
assistance during the questioned period.
Therefore, according to the information you provided, the Department's
Estate Recovery Program will not seek any recovery from this estate.
If you have any questions, please feel free to contact me.
Sincerely,
Ronald D. Hill, Manager
TPL - Casualty Unit
(717)772-6604
(717)772-6553 FA~
LAST WILL AND TESTAMENT
OF
MARY S. REICH
I, MARY S. REICH of R. D. #1, Shermans Dale, Carroll Township,
Perry County, Pennsylvania, being of sound and disposing mind,
memory, and understanding, do hereby make, publish, an~ declare
this my Last Will and Testament, hereby expressly revoking all
other writings in nature testamentary by me at any time heretofore
made.
FIRST: I direct that all my debts and funeral expenses
be paid as soon after my decease as may be practicable.
SECOND: I direct that inheritance tax on property disposed
of herein, shall be paid from my residuary estate.
THIRD: I hereby give and bequeath the sum of FIVE HUNDRED
DOLLARS ($500.00) to each of my Greatgrandchildren who are living
at the time of my death.
FOURTH: I hereby give and bequeath my new typewriter,
Elgin tape playeri Motorola radio and Emerson radio to my
Grandson, Richard B. Hyser, Jr.
FIFTH: I hereby give and bequeath all my jewelry to my
Granddaughter, Wendy S. Wolf.
MARY ~. REICH
(SEAL)
Page one of two
SIXTH: I hereby give, bequeath and devise all the res~
and residue of my estate and property, real, personal and mixed,
of whatsoever nature and wheresoever situated, of which I may
own at the time' of my death, or to which I may be entitled or
of which I may have the right to dispose at the time of my death,
to my two Grandchildren, Richard B. Hyser, Jr. and Wendy S.
Wolf in equal shares. /
SEVENTH: I hereby appoint my two Grandchildren, Richard B.
Hyser, Jr. and Wendy S. Wolf as Executors of this my Last Will
and Testament, and I further appoint Wendy S. Wolf as Guardian
for any minor children that shall be entitled to receive property
under this, my Last Will and Testament, and I direct that they
shall not be requi~ed to give bond or other security in any
jurisdiction wherein proceedings may be held in connection with
my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal .
this 16 day of December, 1991.
WI~S:
MARY ~. REICH
Page two of two
BUREAU OF TNDTVZDUAL TAXES
TNHER/TANCE TAX DTVTSTON
DEPT. 18060!
HARRTSBURG, PA 17118-0601
COHHON#EALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-lSd? EX AFP (Gl-DS)
SCOTT N NORRISON ESQ
PO BOX 232
NEN BLOOHFIELD PA 17068.-
DATE 11-03-2003
ESTATE OF REICH
DATE OF DEATH 01-26-2003
FILE NUHBER 21 05-0184
COUNTY CUHBERLAND
ACN 101
Amoun~ Remi~ed
HARY S
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF N'rLLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~'~ RETAIN LONER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF RETCH HARY S FILE NO. 21 03-0184 ACN 101 DATE 11-03-2003
TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Es~e~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. CZosely HeZd S~ock/Par~nershLp Zn~eres~ (Schedule C)
~. Hor~gages/No~es Rece/vable (Schedule D) (~)
$, Cash/Bank DeposL~s/Hisc. Personal Proper~y (Schedule E) (5)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Ada. Cos~s/Nisc. Expenses (Schedule H) (9)
10. Deb~s/Nor~gege LiabLli~/es/LLens (Schedule Z) (10)
11. To~el Deduc~/ons
12. Ne~ Value of Tax RB~urn
39,,207.34
.00
.00 NOTE: To insure proper
.00 cred/~ ~o your account,
.00 submL~ ~he upper portion
.00 of ~his form wi~h your
~ax payment.
.00
(8)
3,990.00
15.
1~.
NOTE:
2,561.84
(11)
(12)
Char/~able/GovBrneen~al Beques'~s; Non-elected 9115 TrusSes (Schedule J:) (13)
Ne~ Value of Es~a~e Sub.~Bc* ~:o Tax (lq)
Zf an assessment vas issued previously, 11nes 14, 15 and/or 16, 17,
reflect figures that /nclude the total of ALL returns assessed to date.
39,207.34
ASSESSNENT OF TAX:
15. Amoun~ of L/ne lq a~ Spouse1 re~e
16. Aeoun~ of Line lq ~axable e~ Lineal/Class A re~e
17. Aeoun~ of L/ne lq a~ Sibling re~e
18. Amoun~ of L/ne lq ~axable a~ Collateral/Class B ra~e
19. Pr/nc/pal Tax Dus
TAX CREDITS:
PAYHENT RECEZPT DZSCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-)
09-19-Z005 CD003057 .00
32,655.50
ZF PAZD AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADD/TIONAL INTEREST.
.00
32,655.50
18 and 19 #ill
(15) .00 x O0 = .00
(16) 32,655.50 x 045= 1,469.50
(~7) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= 1,469.50
AHOUNT PAID
1,469.50
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1,469.50
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN 01, NO PAYNENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THZS FORH FOR ZNSTRUCTZONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on er before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class D (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collatara1) rate on any such future interest.
To ~ulfill the requirements of Section ZlqO of tho Inheritance and Estate Tax Act, Act Z5 of ZOO0. (?Z P.S.
Section 9140).
Detach the top portion of this Notice and submit mith your payment to tho Register of Hills printed on the reverse side.
--Hake check ar money order payable to: REGISTER OF #ILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-362-Z050; services for taxpayers #ith special hearing end ! or
speaking needs: 1-800-447-3020 (TT only).
Any party in interest not satisfied mith the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) es shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZ1, 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.
Factual errors discovered on this assessment should be addressed in ariting to: PA Daparfd~ant of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (5Z) discount of
the tax paid is alloaed.
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning eith first day of delinquency, ar nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes ahich became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. A11 taxes ahich became delinquent on and after
January 1, 198Z will bear interest at a rate which mill vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. Tho applicable interest rates for 1982 through ZOOS ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOZ .000548 1987 91 .000247 1999 71 .O00lgZ
1983 i6Z .0004S8 1988-1991 I1Z .OOOSO1 ZOO0 82 .000219
1984 IIZ .000301 1991 91 .000247 ZOOX 91 .000147
1985 131 .000356 1995-1994 71 .000191 ZOOZ 61 .000164
1986 lOZ .000274 1995-1998 91 .000147 ZOOS SZ .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is aada after the interest computation date shown on the
Notice, additional interest must be calculated.
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA
Name of Decedent: Mary S. Reich
Date of Death: 01/26/2003
File No. 21-03-0184
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to the 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:
If the answer to No. 1 is "Yes", state the following:
a. Did the personal representative file a final account with the Court? YES __
b. The separate Orphan's Court No. (if any) for the personal representative's account is:
NO X
Date:
06/08/2004
Did the personal representative state an account informally to the parties in interest?
YES X NO
New Bloomfield PA 17068
(717)582-2300
Tel. No.
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.
:-7. · ' , squire
~.. Name (Please type or print)
4 West Main Street
Address
Capacity: __ Personal Representative
X Counsel for personal representative