HomeMy WebLinkAbout06-30-11 (2)1505610145
-' REV-1500 ~"°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
oevum~ert oFn~wue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~ I ~r-I
PO BOX 280801 n
Harrisbum. PA 17128-0601 RESIDENT DECEDENT !~[~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
208-42-3761 10152010 12201916
Decedent's Last Name Suffix Decedents First Name MI
Lindsay Marie B
(If Applicable) Enter Surviving Spouae's Information Below
Spouse's last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTE R OF WILLS
FILL IN APPROPRIATE BOXES BELOW
® t. Original Return 0 2. Supplemental Return ~ 3. Remainder Return (date of death
pdorto 12-13.62)
4. Limited Estate 0 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death akerl2-12-82)
® 8. Decedent Died Testate ~ 7. DeeadeM A,laimafned a Uving Trust ~ 8. Total Number of Safe Deposk Boxes
(Attach Copy of WIII) (Attach Copy of Trust) ,
0 9. Utlgatbn Proceeds Received 0 10. Spousal Poverty Credk (date of death 0 11. Electbn to tax under Sec. 9113(A)
between 121-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Robert G. Frey 7172435838
REGISTER ILLS USE 0~' ' -'1"
~ ~-'
First Iine of address _ rn
~
Cis
5 South Hanover Street ~rfi o ~-1'T
t~
Second line of address Q r7 ~ ,~~
~
n ~ '~"t
City Or Post Offlce State ZIP Code FILED
fU
Carlisle PA 17013
correspondent's e-maH address: rf rey~ f reyt i l ey . c om
Under penalties of perjury, I declare that I have examkled this return, including mpanying schedules and statements, and to the best o my knowledge and belief, k is
true coned and corn . Dedaretion of rer other than the nal ntative is ed on all infomtation ich re rer has an kn e.
SIGNATURE OF PERSON RESPONSIBLE FOR FlLING RETURN
ADDRESS
SIGMA F P P R O R T E RESENTATIVE ~y Z 7
ADDRESS `
5 South Hanover Stree Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610145 1505610145 ~ ~~
J
1505610245
REV-1500 EX
DecedenPs Social Security Number
DecedenPsName: Marie B Lindsay 208-42-3761
RECAPITULATION
1. Real Estate (Schedule A> ........................................... 1. 7 7 0 0 0.0 0
2. Stocks and Bonds (Schedule B) ...................................... 2. NONE
3. Closely Hekf Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. NONE
4. Mortgages and Notes Receivable (Schedule D) .......................... 4. NONE
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ..... . 5. 10 5 9 6 . 0 0
6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ........ 6. NONE
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested ........ 7 0 . 0 0
8. Total Gross Assets (total Lines 1 through 7) .......................... . 8. 8 7 5 9 6. 0 0
9. Funeral Expenses and Administrative Costs (Schedule H) ................. . 9. 5 4 21.0 0
10. Debts of Decedent, Mortgage.Liabilities, and Liens (Schedule I) ............. 10. 3 6 4 8 . 0 0
11. Total Deductions (total Lines 9 and 10) .............................. . 11. 9 0 6 9 . 0 0
12. Net Value of Estate (Line 8 minus Line 11) ............................ . 12. 7 8 5 2 7 . 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ....................... 13. 0 . 0 0
14. Net Valor Subkct to Tax (Line 12 minus Llne 13) ....................... 14. 7 8 5 2 7 . 0 0
TAX CALCULATION - 8EE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sec. 9116
(aX1.2)X.0 ~ 15. 0.00
18. Amount of line 14 taxable
at linealratex.o 45 78527.00 ib. 3533.72
17. Amount of Llne 14
taxable at sibling rate X • 12
17.
0 . 0 0
16. Amount of Line 14 taxable
at collateral rate x . 15 1 s. 0 . 0 0
19. TAX DUE ....................................................... 19.
y0, FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
3533.72
L 1505610245 15.05610245 J
Rl1/-1500 FJ( Page 3
Decedent's Complete Address:
File Number
2082-3761
2110-1277
DECEDENTS NAME
Marie B Lindsa
STREET ADDRESS
CITY
Carlisle STATE.
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credib/Payments
A. Prior Payments
B. Discount
3. Interest
(1) 3533.72
Total Credits (A + g) (2) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Llne 20 to roquest a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE
(3)
(4) 0.00
(5) 3533.72
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:
ro
ert
transferred
in
me of the
i
th
o
t Yes
0 No
^
: ............................................................................
r
p
p
y
n
e use
co
a. re
a .
b. retain the right to designate who shall use the property transferred or its income : ............................... . ^
c. retafn a reversionary interest; or .......................................................................................................... .. ^
d. receive the promise for life of ekherpayments, benefits or care7 ........................................................ .. ^ ^X
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate wnsideration7 ................................................................................................ . ^ ^X
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .. .. ^ ^X
4. Did decedent own an individual retirement account, annuity or other non-probate properly, 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.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent [72 P.S. §9118 (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 percent
p2 P.S. §911 B (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 tiling 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 ch11d 21 years of age or younger at death to or far the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9118(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 decedents siblings is 12 percent [72 P.S. §9118(a)(1.3)J. 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-1502 EX+ (01-10)
Pennsylvania SCH~t~ULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
FILE NUMBER:
Marie B Lindsay 21-10-1277
All real property owned solely or ~ a bnattt in common must he sported at fair market value. Fair market value is defined as the prtce at which property
would be exchanged between a willing buyer and a willing seller, netther being compelled to buy or sell, both having roasonable knowledge of the relevant facts.
Real property that la jolnty-owned with right of survNOrship moat bs disclosed on schedule F.
Attach a copy of the settlement sheet if the properly has been sold.
ITEM InGude a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
OUSE AND LOT OF GROUND. DECEDENT OWNED 40% INTEREST BUT RETAIN 77,000
IGHT TO LIVE IN HOUSE AFTER TRANSFER (QUESTION 1 REV1500. SETTLEME
HEET ATTACHED.
TOTAL (Also enter on Line 1, Recapitulation.) ~ S
If more space is needed, use additional sheets of paper of fhe same size.
REV-1508 EX+(6-98) SCHEDULE E
CASH, BANK D~I~t~SITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Marie B Lindsay 21-10-1277
Include the proceeds of litigation and the date the proceeds were received by the estate.
(If more space is needed, insert additional sheets of the same size)
Rtl/-1511 IX ~ (10-09)
Pennsylvania
" DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATNE COSTS
ESTATE OF FILE NUMBER
Marie B Lindsay
Decedent's debts must be reported on Schedule I.
ITEM
A. I FUNERAL EXPENSES:
1.
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative Commisslans:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State ZIP
2. ~ Attorney Fees:
3. I Family F~cemptlon: (If decedent's address Is not the same as claimants, attach explanation J
Claimant __
Street Address _
4.
5.
8.
7.
8.
City State
Relationship of Claimant to Decedent _ _ _
ZIP
Probate Fees:
Axountant Fees:
Tax Return Preparer Fees:
ELEMENT COSTS FROM HUD-1 SETTLEMENT STATEMENT
TIONEER EXPENSES
2,000
1,100
2,321
TOTAL (Also enter on Line 9, Re
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES 8~ LIENS
ESTATE OF FILE NUMBER ~7
Marie B Lindsay 2 ~ ~ ~ ~ ~ ' ~'
Repoli rbbts Incurred by the decedent prior b death that remained unpaid at the dab of death, including unrolmburoed medkal expenses.
REV-1513 EX+ (01-10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: If FILE NUMBER: (~/y "/~/
RELATIONSHIP TO DECEDENT AMOUNT OR SHAR
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Truetsa(a) OF ESTATE
TAXABLE DISTRIBUTIONS pnclude outriyM spousal distributions and transfers under
Sec. 9116 (a) (t.2).]
SEE ATTACHED LIST
~
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SH EET, 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 DISTR1Bll1lONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-t 500 COVER SHEET. s .
0
ti more space is needed, use additional sheets of paper of ti~ same size.
NAME AND ADDRESS RELATIONSHIP SHARE
JENNIFER R. ARBUCKLE GRANDDAUGHTER 1/6 OF RESIDUE ANC
2092 JARVIS ROAD 10% INTEREST IN
VIRGINIA BEACH, VA 23456 REAL ESTATE
JOHN LINDSAY, JR. SON 1/6 OF RESIDUE AN[
18 NAUGLE ROAD 10% INTEREST IN
SHIPPENSBURG,PA 17257 REAL ESTATE
DOROTHY L. BUSH DAUGHTER 116 OF RESIDUE ANC
137 FRYTOWN ROAD 10% INTEREST IN
CARLISLE, PA 17015 REAL ESTATE
JAMES E. LINDSAY SON 116 OF RESIDUE ANC
2168 NEWVILLE ROAD 10% INTEREST IN
CARLISLE, PA 17013 REAL ESTATE
BETTY J. JOHNSON DAUGHTER 116 OF RESIDUE ANC
13690 MONGUL HILL ROAD 10% INTEREST IN
SHIPPENSBURG,PA 17257 REAL ESTATE
HARRY D. LINDSAY SON 1/6 OF RESIDUE ANC
ONE EAST MAIN ST. 10°h INTEREST IN
PO BOX 101 REAL ESTATE
PLAINFIELD, PA 17081
~ ~
~tt~Y ~i11 ttn~ C~lP~Y~ttu~
~.
r
I, MARIE B, LINDSAY, of Cazlisle, Cumberland County, Pennsylvania, being of
sound and disposing mind, memory and understanding, do make, publish, and declare this
to be my Last Will and Testament, hereby revoking and making void all previous Wills and
Codicils heretofore made by me.
F/RST
I order and direct my Executor hereinafter named to pay all of my just debts,
funeral expenses and expenses involved or connected with the administration of my estate
as soon after my death as is reasonably possible. However, my Executor need not
accelerate and pay those unmatured obligations which, in his, her or its opinion, it might
be proper and more advantageous to retain or renew and pay as they become due and
payable.
SECOND
I give, devise and bequeath the rest, residue and remainder of my estate together
with all insurance proceeds thereon of whatsoever nature and wheresoever situate in equal
shares to my children, HARRY D. LINDSAY, DOROTHY L BUSH, JAMES E
LWDSAY, BETTY J. JOHNSON, and H. JOHN LINDSAY and my granddaughter,
JENNIFER R ARBUCKLE, daughter of my deceased child, Fred Lindsay, provided
they survive me by sixty (60) days. In the event any of my children predecease me or dies
within sixty (60) days following my death, I give, devise, and bequeath the share of my
estate to which he or she would otherwise have been entitled in equal shazes to their
children, per stirpes. In the event that my granddaughter, JENNIFER R ARBUCKLE,
predeceases me or dies within sixty (60) days following my death, I give, devise, and
bequeath the share of my estate to which she would have been entitled in equal shares to
my surviving children.
GRIFFIE & ASSOCIATES
ATTORNEYS AT LAW
200 NORTH HANOVER STREET
CARLISLE. PA 17013
14 NORTH MAIN STREET
SUITE 307
PAGE ~ OF Q CHAMBERSBURG, PA 17201
I direct my Executor to divide among such beneficiaries all personal property of
1
sentimental or family nature (exclusive of cash, stock, bonds, and the like), including but
not limited to jewelry, household goods, antiques, furniture and memorabilia, in
accordance with a separate memorandum which I may place with my will or deposit with
my attorney. In the absence of such disposition by memorandum, I direct that the said
tangible personal property be divided between my residual .beneficiaries with due regard
for their personal preferences in as nearly equal shares as practical, with the value of such
dispositions being credited to the share of each respective recipient. If the said
beneficiaries do not agree to the division of the personal property provided for hereunder,
the decision of my Executor, including the decision to sell the property at public or private
sale and distribute the proceeds therefrom as provided hereinafter, shall be final and
conclusive on all parties.
THIRD
I grant my Executor the following powers in addition to and not in limitation of
such powers as my personal representative shall hold by law:
(a) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger, reorganization
or voting trust plan; to delegate authority with respect thereto; to deposit
investments under agreements and pay assessments; and generally to exercise
all rights of investors, including but not limited to, the voting of shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
(d) To operate any business that I may own at my death.
(e) To invest any funds of my estate in any stocks, bonds, notes or other securities
or property, real or personal, without regard to the principle of diversification
or any other statute or general rule of law in his, her or its absolute discretion,
it being my intention to give my personal representative the broadest
investment powers .possible, providing such investments do not unnecessarily
prevent the prompt settlement of my estate.
GRIFFIE & ASSOCIATES
ATTORNEYS AT LAW
14 NORTH MAIN STREET
SUITE 550 200 NORTH HANOVER STREET
CHAMBERSBURG, PA 17201 CARLISLE, PA 17013
PAGE 2 OF 4
(f) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my personal representative shall see fit in his, her or its
absolute discretion.
(g) To borrow money for the payment of taxes or for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
security.
B
(h) To compromise claims without approval including, but not limited to, any
controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will 'and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my estate.
(j) To undertake any and all acts deemed necessary and proper by my personal
representative for the proper, advantageous and prompt management of the
settlement of my estate.
(k) In general, to exercise all powers in the management of my estate, which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and
Testament.
FOURTH
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any
beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my Executor for the liability of such beneficiary.
GRIFFIE & ASSOCIATES
ATTORNEYS AT LAW
14 NORTH MAIN STREET
SUITE S50
CHAMBERSBURG, PA 17201
200 NORTH HANOVER STREET
CARLISLE, PA 17013
PAGE 3 OF 4
.:............
F/FTH
I nominate, wnstitute and appoint my son and daughter, JAMES E LINDSAY
aged DOROTHYL. BUSH, or the survivor of them, as Executors of this my Last Will and
Testament. I direct that my Executors shall not be required to give or post bond for the
faithful performance of his or her duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and
Testament this ~~ day of ~~ ~-n (rjeJ , 1997.
WITNESS:
'~'~ GIl-.~.Q. /3
MARIE S LINDSAY
GRIFFIE & ASSaC1ATES
ATTORNEYS AT LAW
14 NORTH MAIN STREET
SUITE SSO
CHAMBERSBURG, PA 17201
200 NORTH HANOVER STREET
PAGE 4 OF 4 CARLISLE, PA 17013
ACKNOR'LEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I, MARIE S LINDSAY, the Testatrix, 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.
~ ~ Y3 r~,
MARIE B. LINDSAY
Sworn or affirmed and acknowledged~b~effore me, MARIE B. LINDSAY, the
Testatrix, this Q~ day of ,~/'~~'6T~/» , 1997.
+ Notarial Seal
lt/ah A. Miller, Notary Publie
Carlit+la Boro, Cumberland County
My Commission Expires April 17, 2000
GRIFFIE & ASSOCIATES
ATTORNEYS AT LAW
14 NORTH MAIN STREET
SUITE 330 200 NORTH HANOVER STREET
CHAMBERSBURG, PA 17201 CARLISLE, PA 17013
A1C'F~AVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
We, YY1 ~ c.~ e 11 e ~.. ~~ treJ ~- and V~ ~1 m ~ ~ ` Il .~ tr ,
the witnesses whose names are attached to the foregoing document, being duly qualified
according to taw, do depose and say that we were present and saw the Testatrix sign and
execute the instrument as her Last Will and Testament; that she signed willingly and that
she executed it as his free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testatrix signed the Last Will and
Testament as witnesses and that to the best of our knowledge the Testatrix was at the time
18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn,or affi~rjmed and/~su/bscribed`tS
and ~GG~L1 " ~ ~ `-~ Q~~'
~~ , 1997.
me by ~/~~~~~ /t . L~~~~
this ~f-~''~:~ day of
ti _~+
Notarial Seal
Carilsle 6oro,IlCumberaia d County
My Commission Expires Aprri 17, 2000
GRIFFIE & ASSOCIATES
ATTORNEYS AT LAW
14 NORTH MAIN STREET
SUITE S50 200 NORTH HANOVER STREET
CHAMBERSBURG, PA 17201 CARLISLE, PA 17013
A. Settlement Statement THUD-11
( ) 1. FHA d Mou ' and Ufban Da+elo Fam US HUD -1 P No. 1
( 1 2. FmHA 9. FIN Number 7. Laen NumMr B. N Insurance
X 3. Conv. Unins. Casa Number
( ) ~. vA RE3381 COMMITMENT #14068431
s. Cony. Ins. ABST;M6663
C. This Nnn is Nmishad ro prva you a statemam d ocWel ssltlrnam msts. Amovib paid m and by Ma sNtlamem spent are shown. IWns markad'(p.o.c.)'vnrepeid mNida a
dla ; tl1 an shown haN for imormaticnal rpMes and sle na altludad in tlN toWa.
D. Name and Adtllus d Boyar E. Name and Address d SNIT. F. Name and Atltlms a Lantlar:
KENNETH C. HAIR ESTATE OF MARIE B. LINDSAY MBrT BANK
MARY T. HAIR ISAOA ATIMA
2172 NEWVILLE ROAD 2170 NEWVILLE ROAD ONE FOUNTAIN PLAZA
CARLISLE, PA 17015 CARLISLE, PA 17015 BUFFALO, NY 14203
G. Propsny LceaGOn H. SsdNmam ApanC Saltlamam Dab:
2170 NEWVILLE ROAD, CARLISLE, PA 17015 F & Tile Lsw Offius 92011
WEST PENNSBORO TOWNSHIP Fnaca dSattlamarn 11:30 A.M.
CUMBERLAND COUNTY 5 South Hanover Street
PARCEL NO. 46-18-1400-022 Cadiala PA 17013
Irisals papa 1 d4 Initlals
therein, and understand that proretions were based on figures for the preceding year, or gtimates for the current year, and in the event of any change for the current
year, all necessary adjustments must ba made tgelvveen Setler and Bonower direct; likewise any DEFICIT in delinquent taxes will be reimbursed to Frey 8 Tiley by Seller.
1 have carefulty re ' , the HUD-1 Settlement State ent and to the best of my knoMrledge and belief, ft is a true and accurete statement of all receipts and
disburse n de on my mount ar by me' is nsactlon. 1 further certlfy that I have received y of the HU~ettleme lament.
~.
K .HAIR J E. LINDSAY, EXE/.~^ ' INDI (DUALLY
MA T. IR DO OTHY .BUSH, EXEC AND INDNIDUALLY
Ta the beat of knowledge, the HUD-1 Settlement Statement which 1 have prepared is a true and accurate account of the funds which were received and have been
or will be di reed by he undersi net as part of the settlement of this transaction.
_[JA May 9, 2011
F d~ Tfley, Settlement Age Peg. z or a Date
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DMSION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8466
HARRISBURG, PA 17105-8486
January 11, 2011
FREY & TILEY
ROBERT G FREY ESQUIRE
5 SOUTH HANOVER STREET
CARLISLE PA 17013
Re: Marie Lindsay
CIS #: 120262243
SSN: ###-##-3761
Date of Death: 10/15/2010
Dear Mr. Frey:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $3,648.37 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $3,648.37, was incurred during
the last six months of the decedent's life; therefore, it is a Class 3 claim
pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20
Pa. C.S.A. 3392(3). The balance. of the claim, namely $.00, is to be entered
as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely, /I~ ~~ J~(fJ
~~~~',,yy~71t~. ~~ - rL @_~
I~• Q.
1 ,'r• ~ r• ~ 4~
Jessica L. Strawbridge iI
TPL Program Investigator
717-772-6238 '
717-772-6553 FAX
Enclosure
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCVLL OPERATIONS
TPL SECTION - CASUALTY UNIT
PO BOX 8466
H1{RRISBURG PA 17105486
January 11, 201T
STATEMENT OF CLAIM SUMMARY
~,_~ ,4_
NAM,E,`,~,' Estate of LINDSAY, MARIE
D ~~' °:"'"`~' 120 262 243
Y e..:. u:~,jy-i
,-,z y H: q r "... ~ k -w
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INPATIENT .00 .00 .00
OUTPATIENT .00 .00 .00
LONG TERM CARE 2,654.73 .00 2,654.73
DRUG 993.64 .00 993.64
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' REIMBURS~IT~Tt7 DPW,;. 3,648:37 .00 3,648.37
COMMONWEALTF~FOF PENNSYLVANIA
6EPARrTMENT OF PUBLIC WELFAR„E,
EIN '~,rt23 604311.;3, t
...~
ACNB
BANK
January 20, 1011
Frey & Tiley
Attn: Robert G Frey
5 S Hanover St
Carilsle PA 17013
RE: Estate of Marie B Lindsay
Dear Mr. Frey:
The following information is being provided as per your request:
Acct. Type Account No. Balance at Accrued Ownership Date
D.O.D. Interest to Opened
D.O.D.
Super NOW 221473 $1,555.39 $0.03 Individual 2/5/88
Account
Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company
at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5122.
Sincerely,
Barbara J W
ACNB Ban
Deposit Se es Representative II
PO Box 3129, GErrvssuac, PA 17325 I FeoeE 717.334.3161 I rou FREE 1.888.334.2262 I acnb.com I acnbbusiness.com
p ~s~
499 Mitchen Road, Millsboro, DE 19966 Adjustment Services
Phone 888-502-4349
F az (302)934-2955
January 19, 2011
Frey and Tiley
Attorneys at Law
5 South Hanover Street
Carlisle, PA 17013
Re: Estate of Marie B Lindsay
Social Security: 208-42-3761
Date of Death: October 15, 2010
Dear Sir or Madam:
Per your inquiry on January 10, 2011, please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
Type of Account
Account Number
Ownership (Names ofJ
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
1362410
Marie B Lindsay
04i07i97
$3,826.03
$ .00
__
.$3,826.03
For fUrtber account h~tormation, doaures and/or reimburxmmt of funds please cell the Stonehedge l)Qice at N717-240.4524.
We were unable to locate any safe deposit boz for the above-mentioned decedent
This letter does not indude my aocamts in which the demacd may ~K been Hated as Powa~ of Attorney, (,lastodian of Uniform Tran~ers,
Repreaeritlve Payee, or'IYvatee tender a Wrlttm Ag[e®mt
Sincerely,
!J_ 0~
Tammy Spencer
Adjustment Services
-t u I ~.>U i ~. ~ ~ 5, ~ ~ ~, c~ ~ FINAL
SETTLEMENT
r
SELLER NAME t ~i (9-I ~' d~, IG~1(~ (i t_° ~~.j F' (h~c`~ L 1 n ~ ~->("t V DATE OF SALE ~ o~
ADDRESS ~ ~ r ~ ~ ~ P I J~ V) ~ I. ~ F R ~•1 PHC)NE ~ ~~~
ZIP
LOCATION OF SALE .`2_Q (Yl P (~ ` ~a U DnJ ~.
AUCTIONEER ~ t? ~ 1 ~ rl I' V r . ~ t C ~~C (L( CX PHONE ~ )' ` c~ ~ ~ ' fJ ~J `"~ 1
PROFESSIONAL FEES - o-~ ,
AUCTIONEER $~ ~ ..'
LERK t 1~- ~/O $
CASHIER ! $
OTHER EXPENSES
CASH $ - 5
CHECKS $ F- ~ ~~~ -;
OTHER RECEIPTS
TOTAL RECEIPTS
LESS TOTAL EXPENSES
$
$ `~ .~
I
.-, f ,
$ :~
o,
ia~4`E 10 '~ a s{„ Its R v ~ k:t . ~~ ..
~, ~ ~r,~~.~ ,,"
I (or we), the seller, accept this settlement and acknowledge receipt of the above speciFied net proceeds
from the auction of my goods and property sold on the above date. I accept all respponsibility For providing
merchantable title to a l goods, and property sold, and for delivery of tide to the pur,EAaser.
r
j ~, ~'
~~~~A ti~n~~or C~ hiers Si nature ~ V~
g ,. (Seller's ignature)
y- ~-?~:/ Date
Date
(Sellers Signature)
~°~ -s'~ ~" t ~ *~""' k y/~/~ SELLER'S COPY
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