Loading...
HomeMy WebLinkAbout04-06-111505610140 ~I~ REV 1500 ~` ~"-"' - OFFICIAL USE ONLY PA Department Of Revenue Bureau of Individual Taxes INHERITANCE TAx RETURN County Code Year File Number Po Box 2,3vso1 2 1 1 0 1 2 2 8 Hartisbu PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death MMODYYYY Date of Birth MMDDYYYY 165 2fi 5477 11,232010 12221923 Decedent's Last Name Suffer Deo>3dent's First Name M{ Baer Mary ~, E (If Applit:able) Entier Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/ A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER t'3F WILLS FILL IN APPROPRIATE OVALS BELOW © 1.Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of de th prior tv 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Re uired death after 12-12-82) 0 ® 6. Deoedent Died Testate a 7. Decedent Maintained a Living Trust 8. Total Nuunber of Safe Deposit oxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 911 (A) between 12-31-91 and 1-1-95) (Attach Sch. 4) CORRESPONDENT - THIS SEGTION MUST BE COMPLETED. ALL CORRESPONDENGE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRE TED TO Name Daytime Telephone Number Scot t W. Mor r i son, Esq 717 582 23 0 REGISTER O ~;LLS U3E ONt.~ ;, ~- _. First line of address ° -* } ~~ -I . ~C~7 '` 6 West Mai n S t r e e t ~' ~-~~ ~~ -ry-, l = -= -;~ ~. Second line of address ' ~ ~ 1.; ; P ~ Box 2 3 2 _- ~rf ~-~ ... ~ DATE r~ED ~~ City or Post Uffice State ZIP Code ~~~ .. New B I o o mf i e 1 d PA 1 7 0 6 8 ~ ~~ ~.~~ Correspondent's e-mail address: I' Under penalties Of perjury, I declare that I have examined this return, indudlnp aocomparrylnq schedules and statements, and to the beat of my lcnaMedge a belief, R is true, coned and complete. Dedaraation of preparer other then the personal representative is based on all lntormetfon of which prepanar has array knowledg . ~S/IG TU PERSO RESPO BLE FOR FILING RETURN pA ADDRESS Mechani bu PA 17050 and Hilton Head SC 29928 SIGNATUR OTHER THAN REPRESENTATIVE OrgTE ADORES fi We sin Street New Bloomfield PA 17068 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 150561014() t -.~- ; .._~ ,: 7 r_ ~- -) r, ~~ ~~d L/~ J 1505610290 REV-1500 EX Decedent's Social Security Numbe oeoedent's Name: Ma E. Baer 1 6 5 2 6 5 4 7 7 RECAPITULATION 1. Real Estate (Schedu[e A} ........................................... 1. • 2. Stocks and Bonds (Schedule B) ............................... . . . .... 2. • 3. Closely Held Corporation, Partnership or Sale-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes Receivable (Schedule D) ....... ......... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ 2 3 () 7 0 • 4 ~ 8. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 8. 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property • (Schedule G} ~ Separate Billing Requested ....... 7. 'I i3. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 Z 3 0 7 0. 4 1 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. ~ 1 8 0 0 . 3 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. ~ ~ 1 9 • 5 0 1 i . Total Deductions (total Lines 9 and 10) ............ ................... 11. 1 3 i' 1 9. 8 4 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. ~ 0 9 ~ 5 0 . 5 17 13. Charitable and Governmental BequestslSec 9113 Trusts for which ~ ~, an election to tax has not been made (Schedule J} . . .................... 13. 14. Net Valus SubJect to Tax (Line 12 minus Line 13) ...................... 14. 1 ~ g ~ 5 0 . 5 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (a)(1.2) X .0 15. 16. Amount of Line 14 taxable at lineal rate X .045 1 0 4 9 7 6. 5 5 16. 17. Amount of Line 14 taxable at sibling rate X .12 4 3 7 4. 0 2 17. 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 1 S. 19. TAX DUE ......................... ...................... ....... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 o. o 47'23.9 5 2 4. 8 Q.0 5248.8 1505610240 0 4 8 O 2 REV-15o0 EX Page ~ Decedent's Complete Address: Fits Number 21 10 1228 aECEDENrs roAME Ma E. Ba®r _ __ STREET ADDRESS 1211 Hi hiander Wa CfTY Mechanicsbur STATE PA ZIP .17050 Tax Payments and Credits: ~ • Tax Due (Page 2, line 19) 2. CreditsnPayments 5, 000.00 A. Prior Payments B. Discount 262.44 3. Interest 4. tf Line 2 is greater than line 1 + Line 3, enter the disenence. This Is the OVERPAYMENT, Fill in oval on Page T, Llne 2Q fA raque:t a refund. {i) 5,248.82 Total Credits { A + B } (2) 5,282.44 (3) (4) 13.62 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is fine TAX DUE. (~) a.oo Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN'~C" IN THE APPROPRIATE BLOGKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ............... ....................................................... b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c. retain a retrersionary irrter~est; or ................................................................................................ ^ d. receive the promise for Nfe of either payments, benefits or care? ....................................................... ^ 2. If death oocuned after Deoemt~er 12,1382, did decedent transfer property within one year of death without receiving adequate oonsideration? ....................................................................................... ^ 3. Did decedent own an "m trust for' or payable~pon-death bank aa;ount or seauity at his or her death? ......... ^ d. Did decedent own an individual retirement account, annuity or od~er non-probate property, which contains a beneficiary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE AB01tE QUESTIONS IS YES, YOU MUST COMPLETE 8CHEDULE G AND FILE IT AS PART OF THE RETURN Far dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers th or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i~]. For dates of death on or after Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 peroent [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 disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefidary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased ohikl 21 years of age or younger at death to or for the use of a natural parent, an adaptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a}(1.2~]. • The tax rate imposed an the net value of transfers to or for the use of the dec~denYs lineal benefiaarieg is 4.5 percent. 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 percent [72 P.S. §9116(a)(1.3~]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + ~&98) S~HEDUI.E E ' CASN, BANK DEPOSITS, 8~ MISC. ti OF PENNSYLVANIA coluaNONwEALI INHERITANCE TAX RETURN PERSONAL PRQPERTY RESIDENT DECEDENT ESTATE OF FILE HUMBER Marv E. Baer, 21 10 1226 Include the roceeds of rdigatlon and the date the proceeds were received hY the estak. Ali pro erly ~Imly-owned w~h Fight of sunrirra~st-ip ~r+ust be dlsdosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Carolina First Certificate of Deposit #9105042760 fi,397.98 2. Carolina First Certificate of Deposit #9105042782 5,437.27 3. Ally Certificate of Deposit #3012814061 21,888.fi1 4. Ally Certificate of Deposit #3092829721 5,290.07 5. Ally Cetificate of Deposit #3012829739 5,489.48 6. Ally Certificate of Deposit #30'12829747 10,978.96 7. Sun Trust Banks Certiftcate of Deposit #17540787643-400000011 5,952.89 8. Sun Trust Banks Certificate of Deposit #17540787643-2000000010 5,952.89 9. Metro Bank Checking Account #513140806 63.53 10. Metro Bank Swings Account #616102900 2,228.92 11. NBSC Bank -Certificate of Deposit #8310287717 20,000.00 12. NBSC Bank -Certificate of Deposit #8310269237 20,000.00 13. NBSC Bank -Certificate of Deposit #8310526749 12,879.80 14. Sold Lift chair 250.00 15. Cash 13.72 16. Country Meadows -refund 147.33 TOTAL (Also enter on line 5, Recapitulation) ` S 123,070.41 .~ - - {Ifmore space is needed, in9ert additional sheets of the same size) Continuation of REV-1500 inf~eritalnce Tax Return Resident Decedent Mary E. Baer 21 10 1228 Decedents Name Page 9 Eile Number Schedule E -Cash Bank Deposits 8 Misc. Personal Property ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATM 17, 18. Alert Pharmacy -refund IRS -income tax refund 48.96 450.00 SUBTOTAL SCHEDULE E 498.96 GRAND TOTAL SCHEDULE E ~ 123,070.41 REV-15'f 1 ~C+ (10-09) pennsylvania DEPARTMENT OF REVENUE MIHERITANCE TAX RETURN f~SIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINlSTRATIYE COSTS Mary E. Baer 21 10 1228 Qecedent's debts must be rapoRed an Schedule I. {TEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: ~. Personal Representative Commissions: Name(s) of Persona! Represerrtative(s) Leonard W. Baer 3,07fi.76 streetAddrea 1211 Highlander Way cry Mechanicsburg state P~ ztP 17050 Year(s) Commissior- Paid: 2011 y, Attorney Fees: Scott W. Morrison - 4,922.82 3. Family Exemption: (If deoadeMs address is not the same as claimanCs, attach explanation.) Claimant Stn3et Address Cilyy State ZIP Relationship of Claimam b Decedent a. Prorate Fees: Glenda Farner Strasbaugh, Register of Wills 376.50 ~ Aocourrtant Fees: 6. Tax Return Pn3paaer Fees: 7. Cumberland Law Journal -estate advertising 75.00 8. The Sentinel -estate advertising ~ 272.50 TaTAL (Also enter our Line 9, Recapitulation), i 11.800.34 If more space is needed, use additlonal sheets of paper of the same size. Continuation of REV-15001nheritancs Tax Return Resident Decedent Mary E. Baer Decedent's Name Page 2 21 10 1228 Ffle Number Schedule H - Funeral Expenses 8i Administrative Costs - 61 REV-1512 E}(+ (12-08) Pennsylvania SCHEDULE i DEPARTMENT of REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MQRTGAC7E LIABILITIES, & LIENS RI_SIDENT nECEOENT ESTATE OF f=ILE NUMBER Marv E. Baer 21 10 1228 Report debts Mcurred by the decxd~t prbr to death that rsmatned unpaitf at the date of death, including m'treimburaed medtca! expenses. ITEM VALUE AT GATE NUMBER DESGRIPTION OE DEATH 1. Leonard Baer -reimbursement for funeral expenses, pastor, etc. 200.00 Z. Belco Credit Union -checks 13.25 3. Dr. Barbacci -medical account 30.00 4. Country Meadows Nursing Home -account 1,368.00 5. Dennis Baer -Reimbursement for church ffuneral reception 250.00 6. LISPS -mailing costs 30.13 7. Federal Express -shipping costs 28.12 TOTAL {Also enter on Line 10, Recapitulaiieon) , ~ ~ , 919. If more space is needed, insert additlonal stwE~s of the same Size. REV-1513 EX+ (01-10) . , pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES L ESTATE OF: FILE NUMBER: Ma E. Baer 21 10 1228 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under I Sec. 9116 (a) (1.2).] 1. Robert H. Rhoades Sibling 1822 New Bloomfield Road 4% New Bloomfield, PA 17068 2. Leonard W. Baer Lineal 1211 Highlander Way one-third rest and Mechanicsburg, PA 17050 residue 3. Dennis A. Baer Lineal 2 Low Water one-third rest and Hilton Head Island, SC 29928 residue 4. Ronald E. Baer Lineal 160 Camp Strauss Road one-third rest and Bethel, PA 17507 residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1, B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. CODICIL TO LAST WILL AND TESTAMENT I, MARY E. BAER of 1806 New Bloomfield Road, New Bloomfield, Perry County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this to be a Codicil to my Last Will and Testament dated March 31, 1994. I hereby add the following two paragraphs to my Last Will and Testament: "I hereby give and bequeath four (4%) percent of my distributive estate to my brother, Robert H. Rhoades, if he survives me." "I hereby give and bequeath four (4%) percent of my distributive estate to my sister- in-law, Anne J. Rhoades, if she survives me." IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27t" day of June, 2007. x MARY E I;SEAL) ., , 2 n G d c~ ~` ,. p -~ rT'1 ' - ~ "3 _~ ---# ~Y ~-. ~ f^~ tV _~:, ~t? N C7 A © _ "". :Z+ ~-*-c •, ~ ~~ Q rT~,.` ;. ~7 f"" n C'f'~; E ..... ' `r-~ '"1'11 I> O ::'. r ? _"~ ~ . ~._ .'TI • ~ ;~ LAST WILL AND TESTAMENT OF MARY E . BA.:~2 I, MARY E. BAER of R. D. #1, New Bloomfield, 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 wr:i.tings 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, 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 ma~- own at the time of my death, or to which I may be entitled or of .~rlich I ~<<ay have the right to uispOSC at tiie ti.if-e of ~-iy deati~, to my Husband, Harold E. Baer if he is living at the time of my death. FOURTH: In the event that my Husband is not living at: the time of my death, or in the event that he and I shall die simultaneously, ~-~` ~~ ~J~. ( SEAL ) MARY E. B ER Page one of two then I give, bequeath and devise all my property to my three Sons, Leonard W. Baer, Dennis A. Baer and Ronald E. Baer :in equal shares. FIFTH: I hereby appoint my Husband, Harold E. Baer as Executor of this, my Last Will and Testament, but in the event that he is unable or unwilling to serve, I then appoint my two Baer as Executors ur_i7~.s S17r15 , 1~Clillal d bJ . Baer Gilt ~Eilti~lS A . '- , 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 31st day of MarcY~, 1994. WIT S: /~ ~~~ ( SEAL ) ~- ~ MARY E . B ER ~. ~~ ' ~- n 2 / . Page two of two 'METRO BANK 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 December 24, 2010 Law Offices of Scott W. Morrison PO Box 232 New Bloomfield PA 17068 RE: Estate of: Mary E. Baer Tax Identification Number: 165-26-5477 Date of Death: November 23, 2010 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 513140806 Date Opened: 11/30/2000 Date Closed: 12/15/2010 Primary Owner: Mary E. Baer Date of Death Balance: $63.53 Account Type: Savings Account Number: 616102900 Date Opened: 11/30/2000 Jate Closed: 1~j15/~010 Primary Owner: Mary E. Baer Date of Death Balance: $2228.92 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, Diana Reynolds ~_ Metro Bank Research Associate JDeposit Services ~~ ~,~` {, .~ f ~;. .''~ 210 Central Avenue • Hilton Head Island, SC 29926.843,681.2800 Member FDIC ~ ~ Equal Housing lender March 17, 2011 Law Offices Crexald Morrison Scott Morrison. 6 West Main Street New Bloomfield, PA- 17068 To Whom Yt May Concern: Listed below are the balances of the accounts for Mary Baez aS of 11-23-2010. No interest was posted to the accounts till later in the year. Account Numbex Balance 8310269237 $20,000.00 8310257717 X20,000.00 5310526749 $12,579.80 Plcasc feel frze to contact me at S43 6S 1 SS 13 or ~rauTeraedisch ,,,baxiknbsc.eoxx~ should you have any questions or nod additional information. Thank you, Sin~rcly, .~~' Trautz R,acdisch Brnnch Manager Hilton Head Island Z!Z d OZZ~i Zg5 L ~1 « ~08Z 489£~i8 ZX3~ ~Z ~ 60 1 ~ -£0- ~ ~OZ SunTrust Banks Mail Code GA-ATL-5134 Post Office Box 4418 Atlanta, GA 30302-4418 u~ID~/ SU11fI~tUST Verification of Deposit/Loans LAW OFFICES SCOTT W MORRISON CENTER SQUARE P O BOX 232 NEW BLOOMFIELD, PA 17068 As requested account balances as of the Date of Death. CD account 17540787643 - 400000011 contained $5,952.89 Titled as: Mary Elizabeth Baer Sole Ownership CD account 17540787643 - 2000000010 contained $5,952.89 Titled as: Mary Elizabeth Baer Sole Ownership Both accounts closed 1220/2010. NO other accounts located. Applicant ESTATE OF MARY E BAER Signature of De~sitory Official Title Date O erations Mana Jer 12/29/20 l 0 An ela Cainion Please direct inquires ~ SLJl~1'~2UST Cr Credit Verification Department GA-ATLANTA-5134 /Post Office Box 441.8 Atlanta, GA 30302-4418 Request Number Contact Number: 1-800-786-8787 This letter is confidential and written without prejudice as a matter of business courtesy with the understanding that its~s©e and contents will not be divulged and that no responsibility is to attach to this Bank or any of its officers or agents for information herein. Ibtains information solely as to transactions or experience between the designated customer and this Bank. ~~. ~~ t~ ~~~ ~"~ ~. ~ ~' ~ ~, r r CAROLINA FIRST December 29, 2010 Law Offices of Scott W Morrison Attn: Scott W Morrison, Esquire Center Square, P O Box 232 New Bloomfield PA 17068 Re: the Estate of Mary E Baer Case Number: Dear Mr. Morrison: i'; :~ k3o; ! ~~ 4~, Columba, SC 292 I 1 Carolina First Bank hereby advises that we are in receipt of the request for information concerning the estate matter reference above. Our records indicate the late Ms. Mary E Baer held two Certificate of Deposit accounts with our institution at the time of her passing. Details on these accounts are listed below for your review: CD #9105042760 Titled: Mary Elizabeth Baer Dennis ABaer-POA Opening date: 07/07/2010 Balance, as of 11/23/2010: $6,350.65 Accrued interest, as of 11/23/2010: $47.33 Current status: Closed, 12/20/2010 CD #9105042782 Titled: Mary Elizabeth Baer Dennis ABaer-POA Opening date: 07/07/2010 Balance, as of 11/23/2010: $5,000.00 Accrued interest, as of 11/23/2010: $37.27 Current status: Closed, 12/20/2010 If you have questions or need additional assistance in this matter, please feel free to contact me at the number listed below. Sincerely, Andrea S . Jenkins Operations Associate Phone: 803-996-7743 Fax: 803-358-6020 Carolina First Bank is a trade name of TD Bank, N.A P.O. Box 951 Horsham, PA 19044 December 24, 2010 Scott W Morrison Center Square P.O. Box 232 New Bloomfield Pa. 17068 RE: Estate of Mary E Baer: Dear Scott P~!c?rrison: In response to your inquiry, the above-named decedent had the following account(s) with Ally Bank: See Attached Questions? We're here to help, anytime. Just call 877-247-ALLY (2559) 24 hours a day, 7 days a week. You can press "0" to reach a Customer Care Associate immediately. Or go to allybank.com. Sincerely, ~: ~ ,~ ~ y ~. , 7} Michael P. DiComo Senior Vice President Customer Care 1225/FW Encl: Member FDIC any Type of Account Account Title Account Number(s) Balance oln ~1l23/2010 Mary E Baer Raise Your Rate CD Mr. Dennis Albert Baer 3012814061 Principal $21673.51 Int $215.10 POA Mary E Baer High Yield CD 6- Mr. Dennis Month Albert Baer 3012829721 Principal $5262.0;~ I nt $28.00, 301 POA Mary F, Baer 60M CD Mr. Dennis Albert Baer 3012829739 Principal $5423.61) Int $65.88 POA Mary E Baer 60M CD Mr. Dennis Albert Baer 3012829747 Principal $10847.21 POA Int $131.75 r ~ ~ • ~ a ~' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO SOX 8486 HARRISBURG, PA 1 7 1 05-8486 February 9, 2011 SCOTT W MORRISON ESQUIRE CENTER SQUARE P 0 BOX 232 NEW BLOOMFIELD PA 17068 Re: Mary Baer SSN: ###-##-5477 Dear Sir: Pursuant to your letter dated December 16, 2010, 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 your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. If you have any questions, please feel free to contact me. Sincerely, ~~ ~ ~'r~ Vince A. Porter Recovery sect ion iylanager (717)772-6604 ~__----- ~. ~~ t ~~ ~ ~ •-- ,~ ~ 1 ~ .} 8 I ~ 5 5 ~~ ~ ~~_ ~ ~~;~ ::. ~C~ Z ~ ~ m 1./ / Y.' `c~ ~ '~ ~ ^ ~-° ~ ~ vii ~. l ~ '~ C.:l ~' . ,,. t ~ ~ ~ ~ p Q ~,, ~ ~ ei: ~ l.,J ~ ..., y ~ ,. l l ~4 ^~" .~.+' 1 s ..~,,,~, c. ~ b +I ~..»~ .rte ~ .~....~ K ~.~.~..~ .,...~.. ...M+~ I w.+w .«..~.. ;1 w+ I 1 .~ F y_,~~ __~. ~]