HomeMy WebLinkAbout03-0332PETITION
also known as
Social Security No. ! '-I (z~ -
FOR PROBATE and GRANT OF LETTERS
To:
Register of Wills for the
Deceased. County of ~m/Oe-4-'~O '/xa/ .in the
43 - CIqT~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an tire execut o O, s
in the last will of the above decedent, dated ~'ot n, a r-/ lo,. / O~ Q 9'
and codicil(s) dated
named
,19__
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent ,,'as domiciled at death in ('?~ (..¢ n,q ~e t,/~'rltx~', _ County,.Penn~ylvania, wil-} tt
hz lastfa.miiyor~12.rincipal, resi. denc~-at ~c~O:5' ~3--~-~.lqho~,O,~d. (~O.~3m,~0 /,~-'LL~
(list street, number and muncipality)
Decen~dent then ' 7 ~ years of age, died ~ ~-t r~ -~ [ ,O~'CO '~ ,
at 3c]o~~ -~ -/--/oC /~otr~ ~. ~.&~'~9,/--J-t'/~. /9,4
· -' ~ - ' ' ~' ' ' ' V
Except as tollows, decedent did dot marry, was not divorced and d~d not ha e a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent 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,
situated as follows: ,~ q}O.5- (~z-eM-d~ ~? Rd. ~a D'z~./~
WHEREFORE, petitioner(s) respectfully re.quest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; admi~stration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3> ss
COUNTY OF CumberianO
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 truly administer the estate according to law.
Sworn to or affirmed and subscribed c ~~-"~]~'-'-~'~ff-~ ~
~fore me this mTth day of [ F ., ~
~ / ~¢~i~ k L/~ /~ ~ 2003 J ~/~ ~,. ~t4.1~, ,~
~ ~ ' ~-- / -- /~~ - ' ' ~
mnna M Otto, 1st mputy ~&~r [ ~ te~* ~./~r ~/6~-~ ~
'
NO. 21-2003-332
Estate Of
Mildred J. Hulbert
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW April 15th, :~ 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 January_ 6th. 1997
described therein be admitted to probate and filed of record as the last will of
Mildred J. Hulbert .
and Letters
are hereby granted to
Testa~entaz7
Nicholas Ray Hulbert and Diana J. Hulbert
FEES
Probate, Letters, Etc .......... $ 235.00
Short Certificates(4) .......... $ 12.00
Renunciation ................ $.
x-Pages (5) $ 15.00
JCP 10.00
TOTAL ~ $.
Filed April. 15.tl~, 20.0.3 ...... $. 2.72.00..
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
Letters will be picked up o n 4-15-03.
105 112-' RE"/ 8,88
IFEE FOR THiS
CERTIFIC, ATE ,32
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 5374382
April 5, 2003
Date of ~ssue of This Certification
Name of Decedent Mildred J.
Hulbert
FilSt Middle
Sex Female Social Security No. 176-34-9475
Date of Birth Sept. 20, 1926 Birthplace Milford Twp.,
Place of Death Residence Cumberland
Last
Date of Death
Juniata Co., PA
3-31-2003
Lower Allen Twp. Pennsylvania
Facility Name County City Borough or Township
Race White Occupation Insurance Clerk Armed Forces? (Yes or No)
Decedent's
Marital Status Widow Mailing Address 3905 Old Gettysburg Rd. Camp
Number Street City or Town
Informant Diana Hulbert Funeral Director Sally A. Myers
Name and Address of
Funeral Establishment David Myers Funeral Home, Newport, PA 17074
No
PA
Hill 17011
Part I:
Immediate Cause
(a) Poorly Diff. Adeno Carcinoma Esophagus
(b) Gastric Junction
(c)
(d)
Interval Between
Onset and Death
Part I1:
Other Significant Conditions
Manner of Death
Natural
Accident
Suicide
Homicide []
Pending Investigation []
Could not be Determined []
Describe how injury occurred:
Name and Title of Certfier
Shashikant Patel
MoD.
Address
3912 Trindle Road, Camp Hill, PA 17011
(M.D., D.C., Coroner, M.E.)
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. The original certificate will be forwarded to the
State Vital Records Office for permanent filing,~ ..~ ~ ,~]~j.~
(../ fC2/~/////~L/ ~Z~., 50-455
% .... ocaI-Re~istr~r of Vital Records
April 5, 2003 Z1 B~;nett St., New Bloomfiel~ty~N°PA 17068
Dat( H~, (i,ed by L:sca} Registrar Street Address City Borough, Township
21-2003-332
LAST WILL AND TESTAMENT
OF
MILDRED J. HULBERT
I, Mildred J. Hulbert, of 3905 Gettysburg Road, Camp Hill, Cumberland
County, Pennsylvania, do make, publish and declare this to be my Last Will and
Testament, hereby revoking all Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate taxes becoming due by reason
of my death, whether such taxes may be payable by my estate or by any recipient of any
properly, shall be paid by the Executor out of the property passing under ITEM IV of
this Will, as an expense and cost of administration of my estate. The Executor shall
have no duty or obligation to obtain reimbursement for any such tax so paid, even
though on proceeds of insurance or other property not passing under this Will.
ITEM II: I direct the Executor to pay my just debts and the expenses of my
last illness and funeral expenses from the property passing under this Will as an
expense and cost of administration of my estate.
ITEM III: I make the following special bequests:
a. To my daughter, LINDA J. REISINGER, my grandmother's
watch.
b. To my son, NICHOLAS RAY HIfLBERT, my Noritake
china;
follows:
a.
To my daughter, DI4NA J. It[ffJRERI', my grandfather
clock and silverware and chest;
To my daughter, MARILYN K. REI$1NG~ my antique
cradle and all Princess House items; and
All shares of Mid Penn Bank owned by me at the time of my
death shall be divided equally, in kind, between my surviving
children.
All the rest, residue and remainder of my estate shall be divided as
One-fourth (1/4) to my daughter, LINDA J. ItEISINGER,
or her issue, per stirpes.
b. One-fourth (1/4) to my son, NICHOLAS RAY HULBERT,
or his issue, per stirpes;
c.One-fourth (1/4) to my daughter, DIANA J. HI]LBERT, or
her issue, per stirpes;
d. One-fourth (1/4) to my daughter, MARIL YN K.
REISINGER, or her issue, per stirpes; and
In the event any of said beneficiaries shall predecease me and die without issue, I
devise and bequeath his or her share to be divided equally between my surviving issue.
ITEM ¥: In the settlement of my estate, my Executor shall possess, among
others, the following powers:
(a) To retain any investments I may have at my death, as long as the
Executor may deem it advisable to my estate to do so;
(b) To sell either at private or public sale and upon such terms and
conditions as the Executor may deem advantageous to the estate, any or all real or
personal property or interest therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
(e) To do all other acts in the Executor's judgment deemed necessary
or desirable for the proper and advantageous management, investment and distribution
of the estate.
ITEM Viz Any person who shall have died at the same time as I shall have,
or in a common disaster with me, or under circumstance that the order of deaths
cannot be established by proof, or within thirty (30) days of my death, shall be deemed
to have predeceased me.
ITEM ViI: I appoint my children, NICHOLAS RAY HULBERT and DIANA
J. HULBERT, to be the Co-Executors of my Estate. The Co-Executors are specifically
relieved from the duty or obligation of filing any bond or other security.
IN WITNESS WtIE~OF, I have hereunto set my hand and seal to this, my
Last Will and Testament, consisting of this and the preceding3 pages, at the end of
each page of which I have also set my initials for greater security and better
identification this ~4x. day of ,,Jolluata . 1997.
(SEAL)
We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and
Testament, in the presence of each other, have hereunto set our hands and seals the
day and year first above written, and we certify that at the time of the execution
thereof, the said Testatrix was of sound mind and memory.
Residing at:
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
I, MILDRED J. HULBERT, 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 and Testament; that I signed it
willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
(SEAL)
Sworn to and subscribed
before_~m/~is &~ day
of ~~, /2., 1997.
NOTARY PUBLIC
.... J NOTARIAL SEAL
My Commtsston z~xptres'
· ] arbara ~umple-Sullivan, Notary Public
(SEAL)
Now Curnbor and Boro Cumberland Co.
L My Commissior~ Expires Nov. 15. 1999
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, ~ ~.-~0~ ~b~ and ~.~ L. ~i$~e~c4, the witnesses whose names
are signed to the attached or foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw Testatrix, MILDRED J.
HULBERT, sign and execute the instrument as her Last Will and Testament; that
Testatrix signed willingly and she executed said Will as her free and voluntary act for
the purposes therein expressed; that each of us in the hearing and sight of the Testatrix
signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at
that time eighteen (18) or more years of age, of sound mind and under no constraint
or undue influence.
Sworn to and subscribed
before me thi~_lz4k' day
N. .OT~R Y PUBLIC - hO-r^FU^t_
My Commission Expires: Barbara Sumplo-Sullivan, Notary Public;
(SEAL) Now Cumberland Bore, Cumberland Co.
My Commission Expires Nov, 15, 1999
6
MILDRED J. HULBERT
LAW OFFICES
BARBARA SUMPLE-SULLIVAN
549 BRIDGE STREET
NEW CUMBERLAND, PENNSYLVANIA 17070-1931
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
,I,
Date of Death:
'03 JUL 23 ?n:%7
WillNo. '2_OO~ ~o '~ ~ Admin. No. ~/~I~ 0 "~7_..
To the Register: r', ,~-
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 7-/ -ocs' :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Telephone (,~[~) S 7 !
Capacity: t~ Personal Representative
Counsel for personal representative
July 21, 2003
As of July 1 2003, my new mailing address is:
2360 Verity Pkwy
Middletown, Oh 45042
Sincerly / .- ~"
Nicholas R. Hulbert
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIBENT BECEBENT
DI~C~,I~ENT'S NAME (LAST, FIRST, AND MIDDLE
INITIAL)
SOCIAL
SECURI~
NUMBER
I-- H~)ert,~ Mildred J.
UJ
~1~) DATE OF BIRTH (MM-DD-YEAR)
~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
(.)I'Ll03/31/2003 0912011926 REGISTER OF WILLS
I.LI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
J~l. Odgins/Retain
[~4. Limited Estate
[~]6. Decedent Died Testate (Auac~ ~
E~]9. Litigation Proceeds Received
NAME
Betsy Albright, CPA
FIRM NAME (if .~pl~)
Betsy Albright & Associates
TELEPHONE NUMBER
(717) 789-3995
r~2. Supplemental Return
[~4a. Future Interest Compromise (date of death after 12-1282)
[~7, Decedent Maintained a LNing Trust p~ch copy of Tr~st)
~]10. Spousal Pove~ Credit (~te of death be~,~en 12-31-91 and 1-1~5}
COMPLETE MAILING ADDRESS
PO BOX 912
Loysvifle, PA 17047
---] 5. Federal Eslate Tax Return Required
__ 8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (AEach Cch O)
1. Real Estate (ScheduleA) (1)
2. Stocks and Boeds (Schedule B) (2)
3. Closely Held Coq)oration, Partnership or Sole-Propdetorship (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-Pmbafo Property (7)
(Schedule G or L)
8, Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Adminie~tive Costs (Schedule H) (9)
10. Debts of D~cedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & ~0)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
93,000.00
7,490.73~; '
14,000.00
(e)
7,808.21
3,612.20
(11)
(12)
(13)
(14)
136,441.98
11,420.'14
125,021.84
t25,021.84
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICASLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15)
16. Amount of Line 14 taxabfe at lineal rate __ 125,021.84_ x .0 4~5 (16)
17. Amount of Line 14 taxable at sibling rata x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Oue (19)
5,625.98
5,625.98
Decedent's Complete Address:
STREET ADDRESS
3905 Gettysburg Road
CiTYcamp Hill I STATE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Paymenta
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
225.03
Total Credits ( A + B + C ) (2)
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 t Line 20 to request a refund (4)
(5)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
5,625.98
225.03
5,851.01
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 5,851.01
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 or income of the property transferred; .......................................................................................... [] []
b. retain the fight to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a revemionary 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 properly within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decadent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Regrament Acccunt, annuity, or other non-prebate preperty which
contains a beneficiary designation? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of pajury, I declare that I have examlaed this return, including acc~npanytn§ schedules and statements, and ta the best of my knOwludge and belief, It ts true, correc~ and complete.
Declaration of pmpaer other than the ~'~onal representative is based o~ all ioformatim~ of which preparer has any knowledge.
SIGNATURE OF PERSON RESEON~BLF~OR FILING RETURN
PO Box 701, Springboro, OH 45066
DATE
09/27/04
, SIGNATUI~OF P~?~P-N~ OT.W~ TI-L~I R~E~-I~'SENTATIVE DATE
~DEESS ~J ( ~ -
PO Box 912, Lw~lie, PA 17047 ~
For dates of death on or a~r July 1, 1994 and before Janua~ 1, 1995, the ~x rote imposed on the net value of transom to or ~r the use of the su~iving spouse is 3%
[72 P.S. {9116 (a)(1.1) (i)].
For da~s of dea~ on or after Janua~ 1, 1995, the tax rote imposed on the net value o~ transom to or for the use of the sullying spou~ is 0% [72 RS. {9116 (a) (1.1) (ii)].
The ~tu~ d~s not exempt a transfer taa su~iving spouse from ~x, and the s~tuto~ ~uimments for disclosure of as~ts and filing a tax tatum am st[l~ appli~b~e even if
the suwiving spouse is the only beneficial.
For dates of death on or a~r July 1,2000:
The ~x ra~ imposed on ~e net value of tmnsfem from a d~eased child ~en~ne yearn of age or younger at death te or for the use of a natural parent, an adoptive parent,
or a steppamnt of the child is 0% [72 P.S. ~9116(a)(1.2)].
The ~x rate imposed on the net value of transom to or for the u~ of the de~enfis ~inea~ beneficiaries is 4.5%, ex.pt as not~ in 72 ES. ~9116(1,2) ~2 RS. ~9116(a)(1)].
The t~ rate im~sad on ~e net value of transom to or for the use of the decadenffs siblings is 12% ~2 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in ~mmon with the de.dent, whether by blood or adoption.
REV-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mildred J. Hulbert
SCHEDULE A
REAL ESTATE
FILE NUMBER
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the pdce at which property would be
exchanged behveen a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts,
Real prope~7 which is jointly-owned with rt§ht of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Pdmary Residence: 3905 Gettysburg Road, Camp Hill, PA 17011
93,000.00
TOTAL (Also enter on line 1, Recapitulation) $ 93,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX+ (6-9S)
COMMONWT~ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mildred J. Hulbert
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property jointly-owned with rigM of survivorship must be discloeed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Mid-Penn Stocks, 1033 @ 21.25 per share
21,951.25
TOTAL (Also enter on line 2
(If mom space is needed, insert additional sheets of the same size)
$ 21,951.25
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mildred J. Hulbert
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with right of survivomhlp must be dlsclceed on Schedule F.
ITEM
NUMBER DESCRIPTION
1991 Chevy Geo Pdsm
Citizen Bank Checking Account ~f6200273158
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
2,10000
5,390.73
7,490.73
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
REStDENT DECEDENT
ESTATE OF
Mildred J. Hulbert
SCHEDULE G
INTER-VIVOS TRANSFER! &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV*1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE~IJENAMEOF'PdE3RANSFEREE, THEIRRELATE3NSHIPmDECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBEF ~HE DA~ OF ~ANSFER. AT~ACH A COPY OF TH~ DEED FOR REAL ESTATE, VALUE OF ASSET INTEREST {IF APPLIC~BLEI VALUE
1, Cash transferred to children, Nicholas R, Hulbert and Diana J, Hulbert to pay 20,000.00 0 6,000,00 14,000,C
anticipated expenses 2/28/03
TOTAL (Also enter on line 7 Recapitulation) $ 14,000.0(
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mildred J. Hulbert
Debts of decedent must be repo~ted on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
5.
7.
FUNERAL EXPENSES:
David U. Uyem Funeral Home (see attached)
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Secudly Number(s)/EIN Number of Personal Representative(s)
Street Address
City . State Zip
Year(s) Commission Paid:
A~tomey Fees
Family Exemption: (Jr decebent's address is not the same as claimant's, atiach explanation)
Claimant
Street Address
City State . Zip
Relationship of Claimant to Decedent
Probate Fees
Tax Return Preparer's Fees
Property Appraisal
7,080.21
278.00
175.00
275.00
7,808.21
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVAN~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mildred J. Hulbert
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, &UENS
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Nationwide Insurance
PP&L
PA Water
UGI
Comcast
Verizon
UGI
Nationwide Insurance
Lower Allen Township Seware & Refuse
Property Maintenance
Intemal Revenue Service
Postage
206.50
80.00
51.72
300.00
79.27
55.00
53.00
439.00
161.38
359.57
1,817.00
9.76
TOTAL (Also enter on line 10, Recapitulation) $ 3,612.20
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mildred J. Hulbert
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1.
2.
3.
4,
TAXABLE DISTRIBUTIONS [include out~ght spousal distributions, and transfers under
Sec. 9116 (a)(1
Linda J. Reisinger, 937 Eppley Road, Mechanicsburg, PA 17055
Nicholas R. Hulbert, PO Box 701, Springbom, OH 45066
Diana J. Hulbert, 3905 Gettysburg Road, Camp Hill, PA 17011
Marilyn K. Reisinger, 940 Windy Hill Road, Shermans Dale, PA 17090
.3hild
Child
Child
Child
31,255.46
31,255.46
31,255.46
31,255.46
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
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 $ 0.00
(If more space is needed, ineer~ additional sheets of the same size)
Ewing Residential Appraisals
A Summa~ Report
F~e No. SF30701
Estate of Mildred J Hulbert
File Number: SF30701
In accordance with your request, I have personally inspected and appraised the real property at:
3905 Gett~burg Road
Camp HI!l, PA 17011
The purpose of this appraisal is to estimate the market value of the subject property, as improved.
The property rights appraised are the fee simple interest in the site and improvements.
In my opinion, ~he estimated market value of the property as of July 2, 2003 is:
$93,000
Ninety-Three Thousand Dollacs
The attached report contains the description, analysis and supportive data for the conclusions,
final estimate qf value, descriptive photographs, limiling conditions and appropriate certifications.
Ew~ng Residential Apprasals
A Summary Report
F~N~. SF3070t
File Number: SF30701
In accordance ~vith your request, I have personally inspected and appraised the real property at:
3905 Ge~sburg Read
Camp Hi~l, PA 17011
The purpose of this appraisal is to estimale the market value of the subject property, as improved,
The property rights appraised are the fee simple interest in the site and improvements.
In my opinion, the estimated market valus of Ihs property as of July2,2003 is:
$93,000
Ninety-Three Thousand Dollars
The attached report contains the description, analysis and supportive data for the conclusions,
final estimate qf value, descriptive photographs, limiting conditions and appropriate certifications.
GIT[gENS BANK
CLOSING DEBIT - CHECKING
is amount has been charged to your account. Please adjust your records.
For:
^ccT. boa 373/5¢
CITIZENS BANK
Transaction Date
Description Account Number
Customer Receipt
Please be sure to enter this
transaction in your records.
SEE REVERSE FOR CREDITING OF DEPOSITS AND PAYMENTS
Established in 1895
By Samuel D. Myers
April 18, 2003
Diana Hulbert
~ACCOUNTWlTH
Dasd M. Mygs
Jack & S~ly
DAVID M. MYERS FUNERAL HOME
SECOND AND WALNUT STREETS
NEWPORT, PENNSYLVANIA 17074
PHONE (717) 567-3138
31
March
2003
Complete funeral expenses for:
Mildred J. Hulbert
Tradi.~ional funeral with Yorktowne 18 gauge
casket, protective, with crepe interior
W~lbert Monarch Burial Vault, grave casket
placer, grass and tent
Grave opening- Newport Cemetery
Clergy honorarium
Mt. Gilead Church Women
(12) Death Certificates
Obituary Notice- Patriot News
Lana's Flower Boutique
Marker- Rice Memorials
$ 4,890i00
840.00
400.00
150.00
150.00
24.00
92.50
162.71
371.00
$ 7,080.21
Bill of Sale
Mildred J. Hulbert Estate hereby agrees to sell to Susan B. Ester, 1991 Chev Geo
Prism, 1Y1SK546nMZ079782 VIN, with//~_Smiles, for $2100. Cash at time of title
transfer.
Diana J. Hulbert, Executor
Linda J. Reisinger, POA for Nlcholas Ray Hulbert, Executor
Register of Wills of CUMBERLAND County, Pennsylvania
Certfficate of Grant of Letters
No. 2003-00332 PA No.
ESTATE OF HULBERT MILDRED J
(~A~'I', P'l~'f, MIDDLE)
21-03-0332
Late of LOWER ALLEN TOWNSHIP
Deceased
Social Security No. 176-34-9475
WHEREAS, on the 15th day of April 200--3 an instrument
dated January 6th 1997
was admitted to probate as the last will of HULBERT MILDRED J
late of LOWER ALLEN TOWNSHIP , CUMBERLAND County, who died on the
31st day of March 2003 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, DONNA M. OTTO , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to HULBERT DIANA J and HULBERT NICHOLAS P~AY
who have duly qualified as Executor(rix)
and have agreed to administer the estate according to
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLV/LNIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
of my Office the 15th day of April 2003.
law, all of which fully
seal
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
LAST WILL AND TESTAil4~NT
OF
MILDRED J. HULBERT
I, Mildred J. Hulbert, of 3905 Gettysburg Road, Camp Hill, Cumberland
County, Pennsylvania, do make, publish and declare this to be my Last Will and
Testament, hereby revoking all Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate taxes becoming due by reason
of my death, whether such taxes may be payable by my estate or by any recipient of any
property, shall be paid by the Executor out of the property passing under ITEM IV of
this Will, as an expense and cost of administration of my estate. The Executor shall
have no du~y or obligation to obtain reimbursement for any such tax so paid, even
though on proceeds of insurance or other property not passing under this Will.
ITEM II: I direct the Executor to pay my just debts and the expenses of my
last illness and funeral expenses from the property passing under this Will as an
expense and cost of administration of my estate.
ITEM IH: I make the following special bequests:
a. To my daughter, LINDA J. J~tSINGER, my grandmother's
watch.
b. To my son, NICHOLAS RAY HIJLBERE my Noritake
china;
c. To my daughter, DIANA J. HI]LBERT, my grandfather
clock and silverware and chest;
d. To my daughter, MARILYN K. REISI~GER, my antique
cradle and all Princess House items; and
e. All shares of Mid Penn Bank owned by me at the timq of my
death shall be divided equally, in kind, between my 6~rviving
chRdren.
ITEM IV: All the rest, residue and remainder of my estate shall be divided as
follows:
a.
One-fourth (1/4) to my daughter, I. INDA J. RFJSINGER,
or her issue, per stirpes.
b. One-fourth (1/4) to my son, NICHOLAS RAY HULBERT,
or his issue, per stirpes;
c.One-fourth (1/4) to my daughter, DIANA J. HULBERT, or
her issue, per stirpes;
d. One-fourth (1/4) to my daughter, MARIL~ lC
REISINGER, or her issue, per stirpes; and
In the event any of said beneficiaries shall predecease me and die without issue, I
devise and bequeath his or her share to be divided equally between my surviving issue.
ITEM V: In the settlement of my estate, my Executor shah possess, among
others, the following powers:
(a) To retain any investments I may have at my death, as long as the
Executor may deem it advisable to my estate to do so;
(b) To sell either at private or public sale and upon such terms and
conditions as the Executor may deem advantageous to the estate, any or aH real or
personal proper~y or interest therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
(e) To do aH other acts in the Executor's judgment deemed necessary
or desirable for the proper and advantageous management, investment and distribution
of the estate.
ITEM FI: Any person who shah have died at the same time as I shah have,
or in a common disaster with me, or under circumstance that the order of deaths
cannot be established by proof, or within thirty (30) days of my death, shall be deemed
to have predeceased me.
ITEM FII: I appoint my children, NICHOLAS RAY HULBERT and DIANA
J. HULBERT, to be the Co-Executors of my Estate. The Co-Executors are specifically
relieved from the duty or obligation of filing any bond or other security.
IN I~rlTNESS [YItEREOF,, I have hereunto set my hand and seal to this, my
Last Will and Testament, consisting of this and the preceding3 pages, at the end of
each page of which I have also set my initials for greater securi(y and better
identification this ~o41~ day of ' ~J'OllU~xt~ . 1997.
MILDRED J. HULBERT
We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and
Testament, in the presence of each other, have hereunto set our hands and seals the
day and year first above written, and we certify that at the time of the execution
thereof, the said Testatrix was of sound mind and memory.
Residing at:
4
A CKNOWLF~DGEMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
I, M1-LDRED J. HULBERT, 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 and Testament; that I signed it
willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
M .gV ma Efr
(SEAL)
Sworn to and subscribed
befqre m~his &4n day
of ~C--~ lq, 1997.
NO~'ARY PUBLIC
MY(sEAL)Commission Expires: ,
NOTARIAL SEAL
Barbara Sumple-Sullivan, Notary Public
Now Cumbarland Boro, Cumberland Co.
My Commission Expires Nov. 15, 1999
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, ~k~ ~.~0 ~ ~ and [~fO~ £. ,~i~¥~_~3r; the witnesses whose names
are signed to the attached or foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw Testatrix, MILDRED J.
HUI, BERT, sign and execute the instrument as her Last Will and Testament; that
Testatrix signed wilh'ngly and she executed said Will as her free and voluntary act for
the purposes therein expressed; that each of us in the hearing and sight of the Testatrix
signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at
that time eighteen (18) or more years of age, of sound mind and under no constraint
or undue influence.
Sworn to and subscribed
· k.
before me this~_~o~ day
...... ] NOTARIAL SEAL
1¥1y [.~ommlsslon ~x~r~.~ Barbara Sumple-oullivan, Notary Public
(SEAL) I NOw Oumborland Boro, Cumborland Co.
[ My Commission Exp,ros Nov. ~5, ~999
6
tt/ /1,, zI.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2806O1
HARRISBURG, PA 17128-0801
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD OO4432
HULBERT NICHOLAS RAY
2836 BURBANK AVENUE
MIDDLETOWN, OH 45066
........ fold
ESTATE INFORMATION: SSN: 176-34-9475
FILE NUMBER: 2103-0332
DECEDENT NAME: HULBERT MILDRED J
DATE OF PAYMENT: 09/28/2004
POSTMARK DATE: 09/28/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 03/31/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 t~5,851.01
TOTAL AMOUNT PAID:
t~5,851.01
REMARKS:
SEAL
CHECK# 133
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Inventon/of the real and personal estate of
Mildred J. Hulbert deceased
S,9- - o3- 53 _
Primary Resideece: 3905 Gettysburg Road, Camp Hill, PA 17011
Mid -Penn Stocks, 1033 ~21.25 per share
1991 Chevy Geo Prism
Citizens Bank Checking aec. ount//6200273158
Cash mmsfcrred to children, Nicholas R. Hulbert and Diana J. Hulb~rt
to pay anticipated expenses 2/28/03
TOTAL
m
93,000.0(
21,951.25
2,100.0(
5,390.7.~
14,000.0{
36,441.9[
COMMONWEALTH OF I~NNSYLVANIA
COUNTY OF CUMIERLANO
Nicholas Ray Huibcrt & Diana .]1. Hulbcrt
.~ ~:~ ~1~, desjgl~al~d a¢cord;ng to law. dPposes ~nd says the+ he EXeCUtors_
of the E~tete of h/lildrcd J~HulboL'~
;~,, o; 390:5 Gettysburg Road, Camp Hill,. c,,,~,,d,~ co,,q. P,.. a,,,,,ci ,~ t~,t th,
-.-. ......... +o~, ~.aa.. by Nicholas Ray Hulbert & Di=~ J. HulberL. th, ~o;ci Executors
Lemo~e ~To. Cu~I~o~/ ~" ~/~
My Commi~ion ~ir~ dom m,
31 st March 2003
~*~ c; Death _
INSTRUCTIONS
rn~t be ~:;[~d within fhr~e monfhs 4[fer appo;ntmen+ of personal repre~ntetive.
;~ntory must be filed wDhln fh~rfy days of d~scovery of eddltionel esseh.
may be attached as fo personaJty or realty
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX D/VTS/OH
PO BOX 180601
HARRTSBURG, PA 17128-0601
CONHONHEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
REV-1547 EX I~FP (Og-Fi)
BETSY ALBRIGHT
B ALBRIGHT 8 ASSOCS
PO BOX 912
LOYSVILLE
PA 170R7
DATE 11-22-200~
ESTATE OF HULBERT HZLDRED
DATE OF DEATH 03-31-2003
FILE NUHBER 21 Q.~T0332
COUNTY CUH]~]-':R LAND
ACN ! 01 * :~
A.ouni
HAKE CHECK PAYABLE AND REHIT PAYHENT TO.-
REGISTER OF WILLS
CUHBERLAND CO COURT ~USE
CARLISLE, PA 17013
J
CUT ALONG THIS LINE ~"- RETAIN LOWER PORTION FOR YOUR RECORDS ~
m m m m m m mm m mm m m m m m m m m m m m m mm m m mm m mN m m m m. m m m m m m m mm m mm m m m m m m m m m mm m m m m m m m m m m m m m m m mm m m m m m m m m m m m m mm m m m m m m mm m m m m m Nm m m m m m-
REV-1547 EX AFP (01'03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF HULBERT HILDRED J FILE NO. 21 03-0332 ACN 101 DATE 11-22-200q
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks end Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
q. Nortgages/Notes Receivable (Schedule D) (~)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXENPTIONS:
9. Funeral Expensas/Adm. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule Z) (10)
11. Total Deductions
12. Net Value of Tax Return
93~000.00
21~951.25
.00
.0O
7z~90.73
.00
NOTE: To insure proper
credit to your account,
subeit the upper portion
of this fore with your
tax payeent.
7,808.21
3,612.20
(11) II .420.14
(12) 125,021.8~
ASSESSNENT OF TAX:
15. Amount of Line li at Spousal rate
16. Amount of Line 1~ taxable at Lineal/Class A rate
17. Amount of Line 1~ et Sibling rate
18. Amount of Line 1R taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS=
PAYHENT RECEIPT DISCOUNT (+)
DATE NUNDER INTEREST/PEN PAID (-)
09-28-200~ CDO0~3Z
1F PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
13.
NOTE:
168.33-
5,851.01
TOTAL TAX CREDIT I 5,681.68
BALANCE OF TAX DUEl 56.70CR
INTEREST AND PEN. .00
TOTAL DUE 56.70CR
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT- (CR), YOU NAY DE DUE
A REFUND. SEE REVERSE S/DE OF THIS FORN FOR INSTRUCTIONS.) ~
(15) .00 X O0 = .00
(16) 125,021.8~ X 0~5 = 5,625.98
(17) .00 X 1Z = .00
(18) .00 x 15 = .00
(19)= 5,625.98
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) . O0
Net Value of Estate Subject to Tax (1~) 125,021.8~
If an assessment ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ,111
reflect flgures that include the total of ALL returns assessed to date.
AHOUNT PAID
l~zO00.O0
(8) 136,~1.98
RESERVATION:
Estates of decadents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, tho Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CA):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DZSCOUNT:
PENALTY:
INTEREST:
To ~ulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act g$ of 2000. (TI P.S.
Section 91q0).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed an the reverse side.
--Make check or money order payable to: REGISTER OF NILLS, AGENT
A refund of a tax credit, mhJch was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available
online at wwa.revenue.state.pa.us, any Register of Hills or Revenue Oistrict Office, or from the Department's
Zq-hour ansaering service for forms orders: 1-BOO-56Z-Z050~ services for taxpayers with special hearing and/or
speaking needs: 1-800-~q7-30ZO (TT only).
Any party in interest not satisfied aith the apprais~ant, alloaanca or disallowance of deductions or assessment of tax
(including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice
by filing one of the following:
A) Protest to the PA Department of Revenue, Board of Appeals. You may obSect by filing a protest online at
www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for
an electronic protest to bo valid, you must receive a confirmation number and processed date from the
Board of Appeals website. You may also send a written protest to PA Department of Revenue, Board of Appeals
P.O. Box ZBIOZ1, Harrisburg, PA 171ZB-lOZ1. Petitions may not be foxed.
B) Election to have the matter determined at the audit of the account of the personal representative.
C) Appeal to tho Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Pest Assessment Review Unit, P.O. Box gB060I, Harrisburg, PA 171ZB-060l
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (RE¥-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decadant's death, a five percent (SZ) discount of
the tax paid is allowed.
The 15Z 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 with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 19BI bear interest at the rate of
six (BZ) percent par annum caZculated at a daily rate of .00016q. All taxes which became delinquent on and after
January l, 19aZ will bear interest at a rate which will vary from calendar year to calendar year with that rata
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ 2OZ .OOOSq8 1988-1991 llX .000501 20G'[ 9X .OOOZfi7
1983 X6Z .00045B 1992 9Z .0002~7 ZOOZ 6Z .00016~
2003 5Z .000137
1984 11Z .000501 1995-1994 7Z .O0019Z
1985 13Z .000356 1995-1998 9Z .000247 2004 qZ .000110
1986 lOX .000274 1999 7Z .O0019Z
1987 IOZ .O00Z7q ZOO0 7Z .00019Z
--/nterest is calculated as follows:
ZNTEREST = BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/06/2006
HULBERT DIANA J
175 RIDGE ROAD
ETTERS, PA 17319
RE: Estate of HULBERT MILDRED J
File Number: 2003-00332
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
3/31/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~=~f:&
Clerk of the Orphans' Court
cc: File
Counsel
~~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/06/2006
HULBERT NICHOLAS RAY
2836 BURBANK AVENUE
MIDDLETOWN, OH 45066
RE: Estate of HULBERT MILDRED J
File Number: 2003-00332
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July 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 is due by:
3/31/2006
please feel free to contact this office with any questions you may
have. If you have already filed your Status Report! please disregard
this notice.
Sincerely!
'~d~~~h
Clerk of the Orphans' Court
cc: File
Counsel
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Law Offices of
Craig A. Diehl
3464 Trindle Road
Camp Hill, Pennsylvania) 70 I ) - 4436
Telephone (717) 763-7613
Fax (717) 763-8293
Craig A. Diehl, Esquire, CPA
Shelly 1. Kunkel, Esquire
In Spring Grove, Pennsylvania
119 West Hanover Street
Spring Grove, PA 17362
Telephone: (717) 225-1929
March 28, 2006
Cumberland County Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
He: Estate of Mildred J. Hulbert 0"3 ,- O?> ~ 2-
Dear Register:
Please find enclosed the Family Settlement and Final Release regarding the ahove-
referenced Estate and requisite recording fees. We ask that you record this document and
return the extra time-stamped copies to our office in the attached envelope.
Should you have any questions or concerns regarding same, please feel free to contact
our office. Your time and cooperation is truly appreciated.
Very truly yours,
~~~~
Lacy A. Jay
Legal Assistant
Ilaj
Enclosures
1'-",)
.
""-..ei
FAMILY SETTLEMENT AND FINAL RELEASE
IN THE
ESTATE OF MILDRED J. HULBERT
KNOW ALL MEN BY THESE PRESENTS, THAT WHEREAS, Mildred J. Hulbert,
late of Lower Allen Township, Cumberland County, Pennsylvania, deceased, died on March 31,
2003, having first made her Last Will and Testament, which was duly executed on January 6,
1997, and is duly recorded in Cumberland County, Pennsylvania, Estate No. 21-03-00332.
WHEREAS, the said Mildred J. Hulbert, by the aforesaid Last Will and Testament,
named Nicholas Ray Hulbert and Diana J. Hulbert as the Co-Executors of said Last Will and
Testament; and
WHEREAS, Nicholas Ray Hulbert and Diana J. Hulbert, were duly appointed by the
Cumberland County Register of Wills as the Co-Executors of the Estate of Mildred J. Hulbert on
April 15,2003; and
WHEREAS, the said Co-Executors have gathered the assets of the estate of the said
decedent and the assets consist of real and personal property to a total value of $213,007.33, as
set forth in Exhibit "A", which is attached hereto and made a part hereof; and
WHEREAS, the debts and deductions, including the payment of inheritance tax in the
said estate, amount to $39,717.79, leaving a gross balance for distribution of $173,289.54, also
as set forth in the statement of the said Co-Executors, which is attached hereto and made a part
hereof, and marked Exhibits "B" and "C"; and
WHEREAS, a portion of the aforementioned balance for distribution was comprised of
1033 shares of Mid Penn Bank common stock and an American General Life Company annuity
previously distributed in equal shares to the heirs of Mildred J. Hulbert, and reimbursements to
Nicholas Ray Hulbert and Diana Hulbert for loans contributed to the decedent's estate thereby
further reducing the balance for distribution to $ 94,386.51 as set forth on Exhibit "C"; and
WHEREAS, the following specific bequests of personalty to the beneficiaries of the
Estate of Mildred J. Hulbert have previously been made:
Linda J. Reisinger Grandmother's watch
Nicholas Ray Hulbert N oritake china
Diana J. Hulbert Grandfather clock,
silverware, chest
Marilyn K. Reisinger Antique cradle, Princess
House items
1
NOW THEREFORE, KNOW YE, that we, Linda J. Reisinger, Nicholas Ray Hulbert,
Diana J. Hulbert and Marilyn K. Reisinger, being all of the heirs under the Last Will and
Testament of the said decedent, and being the persons entitled to inherit under said Last Will and
Testament, do hereby acknowledge that we have this day had and received from the aforesaid
Co-Executors, in full satisfaction and payment of all sum or sums of money, legacies, bequests,
and devises as are given, devised and bequeathed to us by the said Last Will and Testament,
which amount we have received this day, and which is the amount set opposite our names in the
table and schedule of proposed distribution in said statement attached hereto and marked Exhibit
"D" ;
AND, we do hereby stipulate that in order to avoid the expense and time involved in the
filing of a formal account and schedule of distribution, we agree that no account is necessary and
we hereby agree and consent to distribution being made without the filing of an account and
schedule of distribution, the same to be with the same force and effect as if it had been filed and
confirmed by the Orphans' Court Division of the Court of Common Pleas of Cumberland
County.
THEREFORE, we do hereby remise, release, quitclaim and forever discharge the said
Co- Executors, their heirs, executors, administrators and assigns, of and from the said estate and
from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever,
touching upon the estate of said decedent, and we do further hereby covenant and agree that we
will contribute our share of the estate to satisfy any and all claims, demands, suits, or causes of
action which may be successfully prosecuted against the said estate or the aforesaid Co-
Executors after the signing, sealing and delivery of this family settlement agreement and final
release.
FURTHER, we, the beneficiaries, do hereby release, forever discharge and hold
harmless Counsel, and its predecessors, successors, affiliates, assigns, either in the course of their
employment or as individuals outside the course and scope of their employment or in any other
capacity, as and from any and all actions, and causes of action, claims, demands, damages,
attorneys' fees, costs, loss of services, expenses, compensation, suits, debts, documents, bonds,
covenants, contracts, agreements and judgments of whatsoever kind, at law or in equity, on
account of, or in any way growing out of Counsel's representation of the Co-Executors and the
Estate of the Decedent. Each Beneficiary further agrees and covenants that, neither she, nor any
other person, organization or other entity on her behalf will file, charge, claim, sue or cause to
permit to be filed, charged or claimed any action for damages, injunctive, declaratory, monetary
relief, equitable relief, or otherwise against Counsel, and its predecessors, successors, affiliates,
parents, subsidiaries, assigns, agents, directors, officers, partners, attorneys, employees and
insurers involving any matter arising from Counsel's representation of Co-Executors and the
Estate of the Decedent.
2
IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~ "day of
March, 2006.
WITNESS:
dt~~
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t/~4Zr r-' ';{:U,up!-
Linda J. Reisinger
COMMONWEAL TH OF PENNSYL VANIA
SSe
COUNTY OF CUMBERLAND
On this ~ day of March, 2006, before me, the undersigned officer, personally appeared
LINDA J. REISINGER, known to me (or satisfactorily proven) to be the individual whose
name is subscribed to the foregoing instrument, and acknowledged that she executed the same
for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
d~~
Notary Public
Notarial Seal
Marlin R. McCaleb, Notary Public
Mechanicsburg Boro, Cumberland County
My Commission Expires Dec. 14, 2006
Member, Pennsylvania Association Of Notaries
3
IN WITNESS WHEREOF, we have hereunto set our hands and seals this JtJ f' day of
December, 2005.
WITNESS:
~
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Nicholas Ray Hu ert
COMMONWEAL TH OF PENNSYL VANIA
SSe
COUNTY OF CUMBERLAND
On this 20th day of December, 2005, before me, the undersigned officer, personally
appeared NICHOLAS RAY HULBERT, known to me (or satisfactorily proven) to be the
individual whose name is subscribed to the foregoing instrument, and acknowledged that he
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~
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....
WI, .1h/U
COMMONWEAL. TH OF PENNSYL. V AN'A
NOT ARfAL SEAL
STEPHANIE M. RIDER, Notary Public
Camp Hill Boro., Cumberland County
My Commission Expires October 31, 2009
4
IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~ day of
December, 2005.
WITNESS:
~
d./
Diana J. Hulbert
COMMONWEAL TH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
On this 20th day of December, 2005, before me, the undersigned officer, personally
appeared DIANA J. HULBERT, known to me (or satisfactorily proven) to be the individual
whose name is subscribed to the foregoing instrument, and acknowledged that she executed the
same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~~. Wl- ~
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
STEPHANIE M. RIDER, Notary Public
Camp Hill Boro.. Cumberland County
My Commission Exp-ires October 31, 2.0g9
5
IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~ day of
~c@mber, ~ +-
J~ 2~b
WITNESS:
~
~~/J/~>'~~
Marilyn K. eisinger 0
COMMONWEAL TH OF PENNSYL VANIA
SSe
COUNTY OF CUMBERLAND
'~
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On this ~ay Of9c.CCIU ,-z.ee5, before me, the undersigned officer, personally
appeared MARILYN K. REISINGER, known to me (or satisfactorily proven) to be the
individual whose name is subscribed to the foregoing instrument, and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
-2
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NIA
COMMONW
Notarial s.at .
Helen E. Rasmussen, Notary Public
Camp Hill Boro, CU!llberland County
My Commission Expires Aug. 2, 2007
Member, Permsylvania Association of Notaries
6
DEBITS:
CO-EXECUTORS' ACCOUNT OF THE
ESTATE OF MILDRED J. HULBERT
LATE OF LOWER ALLEN TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA
DATE OF DEATH: MARCH 31, 2003
PRINCIPAL ACCOUNT
Your Accountants charge themselves with the following:
Real Property
3905 Gettysburg Road, Camp Hill, PA
Personal Property
1991 Chevrolet Geo Prism - sale price
1033 Shares Mid Penn Bank common stock
Citizen's Bank Checking Account #6200273158
2005 School real estate tax pro-ration from sale of residence
American General Life Companies - Annuity # Al 0096313F
MidPenn Bank - Stock dividends
Contribution to Estate by Nick Hulbert
Contribution to Estate by Diana Hulbert
Nationwide Insurance - Refund of homeowner's premium
Refund of overpayment on real estate taxes
Liberty Mutual Insurance - Refund of automobile insurance
Insurance Refund
Citizens Bank - Interest earned on estate checking account
TOTAL PRINCIPAL DEBITS
EXHIBIT A
Value
$122,000.00
Value
$2,100.00
$21,951.25
$5,390.73
$549.92
$54,951. 78
$2,456.60
$1,400.00
$723.82
$200.50
$59.95
$81.66
$263.30
$877.82
$213,007.33
CREDITS
Your Accountants ask credit for payments made from Principal Account as follows:
Description
Nick Hulbert - Reimbursement for funeral expenses to David M. Myers F.H.
Betsy Albright - Tax return preparation fees
Cumberland County Register of Wills - Probate expense
The Sentinel - Estate advertisement for Mildred 1. Hulbert
Law Offices of Craig A. Diehl- Estate ad reimbursement (Cumb. Law Jouma
Property Appraisal
Law Offices of Craig A. Diehl - Retainer
Law Offices of Craig A. Diehl - Certified mail reimbursement
Cumberland County Register of Wills - Initial inheritance tax payment
Nationwide Insurance - Homowner's insurance 2003-2005
PPL - Electric utilities during administration
American Water - Water bills during administration
UGI - Gas bills during administration
Comcast Cable - Final cable bill
Verizon - Final telephone bill
Lower Allen Township - Delinquent trash bill paid at settlement
Lower Allen Township - Delinquent sewer bill paid at settlement
Cumberland County Tax Claim Bureau - '03-'04 street light tax
David Nulton - Tree branch removal after storm damage
Subtotal
EXHIBIT B
Amount
$7,080.21
$175.00
$278.00
$144.29
$ 75.00
$275.00
$1,300.00
$4.42
$5,851.01
$894.40
$134.21
$125.90
$621.88
$79.27
$55.00
$287.73
$257.88
$145.05
$45.00
$17,829.25
CREDITS continued
Cumberland County Register of Wills - Short certificates
Tim Hoffman - Lawn mowing and snow removal
Kmart - Paint for Gettysburg Road
Home Depot - Paint and supplies for clean up of Gettysburg Road
Sears - 1 gallon paint and dehumidifier purchase
Jeffrey Norford - Replacement of inside sewer line at Gettysburg Road
Scott Hill Plumbing - Replacement of hot water heater
Big Lots - Paint and painting supplies for Gettysburg Road
Diana Hulbert - Reimbursement for paint, cleaners, light, toilet seat
Cumberland County Tax Claim Bureau - Est. payment on delinquent RE taxe:
Heather Marshall - Labor charge for clean up and scrubbing at home
Balance of settlement charges per HUD-l settlement sheet
Citizens Bank - Fee for estate checks
Citizens Bank - Insufficient funds surcharge
Citizens Bank - Research fee
Shelly J. Kunkel, Esquire - Reimbursement for tax return filing fee
Cumberland County Register of Wills - Additional inheritance taxes
Register of Wills, Agent - Balance due PA inheritance taxes
Law Offices of Craig A. Diehl - Balance attorney fees
Diana 1. Hulbert and Nicholas R. Hulbert - Executors' fee
Law Offices of Craig A. Diehl- Final tax preparation (1040,1041)
Subtotal
TOTAL PRINCIPAL CREDITS
EXHIBIT B
$9.00
$150.00
$64.57
$120.61
$161.08
$820.00
$495.00
$27.31
$123.82
$2,000.00
$100.00
$8,543.61
$8.28
$35.00
$10.00
$40.00
$3,060.00
$50.26
$1,400.00
$4,420.00
$250.00
$21,888.54
$39,717.79
RECAPITULATION
Principal Debits - Estate of Mildred J. Hulbert
Principal Credits - Estate of Mildred 1. Hulbert
Subtotal- Estate of Mildred J. Hulbert
Less Prior In-Kind Distribution of Mid-Penn Stock
Less Prior Distribution of American General Annuity
Less Reimbursement to Nicholas Ray Hulbert:
Cash contributions to Estate by Nicholas Hulbert
Less Reimbursement to Diana 1. Hulbert:
Cash contribution to Estate by Diana J. Hulbert
COMBINED BALANCE FOR DISTRIBUTION PURSUANT
TO LAST WILL AND TESTAMENT OF
MILDREDJ.HULBERT
EXHIBIT C
$213,007.33
$39,717.79
$173,289.54
($21,951.25)
($54,951.78)
($1,400.00)
($600.00)
($78,903.03)
$94,386.51
SCHEDULE OF PROPOSED DISTRIBUTION
The Co-Executors propose distribution of the Total Balance for Distribution
to the following heirs as described:
Balance Available per Account:
Linda J. Reisinger
937 Eppley Road
Mechanicsburg, P A 17055
Nicholas Ray Hulbert
P.O. Box 701
Springboro, OH 45066
Diana J. Hulbert
117 BLane
Harrisburg, P A 17111
Marilyn K. Reisinger
940 Windy Hill Road
Shermans Dale, P A 17090
Residuary Bequest per Item IV of Last Will
and Testament of Mildred J. Hulbert
1/4 Estate Residue
Plus adjustment for 1/3 utility expenses
Residuary Bequest per Item IV of Last Will
and Testament of Mildred J. Hulbert
1/4 Estate Residue
Plus adjustment for 1/3 utility expenses
Residuary Bequest per Item IV of Last Will
and Testament of Mildred J. Hulbert
1/4 Estate Residue
(Less debit for utility miscellaneous utilities:
$159.86 water, $161.38 trash)
Residuary Bequest per Item IV of Last Will
and Testament of Mildred J. Hulbert
1/4 Estate Residue
Plus adjustment for 1/3 utility expenses
BALANCE FOR DISTRIBUTION PURSUANT
TO LAST WILL AND TESTAMENT OF MILDRED J. HULBERT
EXHIBIT D
$94,386.51
$23,596.63
$107.08
$23,703.71
$23,596.63
$107.08
$23,703.71
$23,596.63
($321.24)
$23,275.39
$23,596.63
$107.08
$23,703.71
$94,386.51
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WillS, COUNTY OF Cumberland_~~_, PENNSYLVANIA
Name of Decedent: Mildred J. Hulbert
Date of Death:
3/31/2003
File No.
21-03-00332
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 ~ _
NO ___
2. If the answer is "No", state when the personal representative reasonably believes that the
administration will be complete: _~______
3 If the answer to NO.1 is "Yes", state the following:
a. Did the personal representative file a final account with the Court?
YES__ NO ~
b. The separate Orphan's 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 ~__ NO ____
d.
Copies of receipts, releases, joinders and approvals of formal or informal accounts may
be filed with the Clerk of the Orphans' Court and may be attached to this report.
-- ~~~--- ..--
Signature.
Date: 4/19/2006
Shelly J. Kunkel___u___~ _______~__
Name (Please type or print)
3464 Trindle Road
Address
'Vd . 'OJ Gr~'~"-ldJ8i^1n6
18noo SJNHdHO
30 >lH310
, C :" WV 0 Z ~dV 9DDZ
Camp Hill.
PA 17011
(I17)763-76J~___
Tel. No.
:l] j~)IJjO O:JCt!O:J:JU
Capacity: __ Personal Representative
~~ Counsel for personal representative
(#
IN RE: ESTATE OF
HULBERT MILDRED J
RECEIVED
APR 0 4 2006
BY:
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
~~
NO. 2003-00332
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: HULBERT DIANA J
Counsel for Personal Representative:
Date of Decedent's Death: 3/31/2003
Date of Delinquency Notice: 4/3/2006
The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' 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 the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules was given on the above date 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 counsel for the delinquent personal representative.
Date:
4/4/2006
~~uJ&~.t~
Glenda Farner Strasbaugh ~
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled June 26.. 2006 at 11 a.m.
in Courtroom No.3. If the Status Report is filed prior
automatically be cancelled.
ring will
Edgar B. Bayley, J.
o.'1\;~
,
-.
,e"..
In Re: Estate of
HULBERT MILDRED J
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2003-00332
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: HULBERT DIANA J
Counsel for Personal Representative:
Date of Decedent's Death: 3/31/2003
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
~~~
Date:
4/3/2006
..
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
.
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