The URL can be used to link to this page

Home My WebLink About12-09-11Pa. O.C. Rul~je.',6_^.-12 STATUS REPORT REGISTER OF WILLS OF (.l~~l l ~ COUNTY, PENNSYLVANIA Name of Decedent: ~~~~ r - _. Date of Death: (~ o~~ ~(~~ ~ File Number: a ~-(~~ "U~a'~~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... "`Yes ^ No 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 Orphans' Court No. (if any) for the personal representative's account is: ~ oag - o i aa~ 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 maybe tiled with the Clerk of the Orp1-ia1;s' Court as;d may be attached to this repot. Date 6 ~ . v . :._ ~. ~ ~, ~, ~, ~ . i -'~ Li..l --~ .:.a_ Ll. L.) ~- 1 '- ,k ' t[ u , ~ _ ~ . _ . i_~ - C..~ c -.. FormRW-/0 rev. /0./3.06 ~I~VI C~ Signature ojPerso ing this Form Capacity: Personal Representative ^Counsel Nnme ojPersor~.f` to this Form Addre C`~ ~~) G~~ _ t ~a'~ Telephone ±-.U IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHAN'S COURT DIVISION In Re: No. 2008-01228 ESTATE OF DAVID C. 3UMPER DECEASED ORDER AND NOW, this 2 "~' day of .f,j , 2011, this Court approves the payment of alI proper charges and claims against the estate as set forth in the foregoing Petition For Distribution of Insolvent Estate Under 20 Pa. Cons. Stat. Ann. Section 3392. BY THE COURT: ~; c~ ~~ ,, -r-~~ , L7~ . rn ~ _ ~ ._J ~~ O - ' ~, . . - ' ) J'T7 C ,~ ~7 --z; r -r - ,, ". ~ ~ a ~ ~,~ ~ C: Distribution List: James J. McCarthy, Jr., Esq. 2041 Herr Street, Harrisburg, PA 17103 Dianna L. Stoneroad, TPL Investigator, Dept. of Public Welfare, P.O. Box 8486, Harrisburg, PA 17105-848b ~, McCarthy Weisberg Cummings, P.C. James J. McCarthy, Jr., Esquire Attorney I.D. No. $2266 2041 Herr Street Harrisburg, PA 17103-1624 717-238-5707 717-233-8133 (fax) jmccarthy(~mwcfirm.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHAN'S COURT DIVISION In Re: No. 2008-01228 ESTATE OF DAVID C. JUMPER DECEASED PETITION FOR DISTRIBUTION OF INSOLVENT ESTATE UNDER 20 PA. CONS. STAT. ANN. SECTION 3392 TO THE HONORABLE JUDGES OF SAID COURT: AND NOW COMES, Petitioner, Tracey S. Barrick, by and through her counsel, McCarthy Weisberg Cummings, P.C., attorney of record in the Estate of David C. Jumper, Deceased, to petition the Court to settle an insolvent estate at the above number and term and in support thereof avers as follows: 1. David C. Jumper ("Decedent"), sixty-eight years of age, who resided at 121 Walnut Bottom Road, Shippensburg, Cumberland County, Pennsylvania died testate on November 24, 2008. His Last Will and Testament, dated March 13, 2004 ("Will"}, was admitted to probate on December 9, 2008 by the Register of Wills of Cumberland County, Pennsylvania at the above number and term. A copy of the Will is attached hereto and made a part hereof as Exhibit I. 2. The Decedent was not survived by a spouse. 3. The Decedent was survived by his daughter, Tracey S. Barrick of East Berlin, Pennsylvania. 4. On December 9, 2008, Letters Testamentary were duly granted to Tracey S. Barrick. 5. The probate estate of which Decedent died consisted of the following property valued as of the Decedent's date of death: a. Orrstown Bank Account # 570465 $ 6,475.07 b. Auction of personal items -Dan Hershey Auction 1,264.08 c. Electric and medical reimbursements 233.55 Total $ 7,972.70 The Decedent did not own and interest in real estate. 6. The family exemption has not been claimed since there are no heirs who were members of the Decedent's household at the time of death. 7. Administration expenses, debts and claims against the estate as set forth in Exhibit II, are summarized as follows: a. The costs of administration - 20 Pa.C.S. § 3392 (1) $2,863.00 b. The family exemption - 20 Pa.C.S. § 3392(2) NONE c. The cost of Decedent's funeral and burial, etc. - 20 Pa.C.S. § 3392(3) $5,926.59 d. The cost of a gravemarker - 20 Pa.C.S. § 3392(4) NONE e. Rents for occupany - 20 Pa.C.S. § 3392(5) NONE f. All other claims - 20 Pa.C.S. § 3392(6) 52.90 Total all Claims $8,842.49 8. Petitioner is not aware of any claims against the estate which are not admitted. 9. The assets totaling $7,759.28, as set forth in Paragraph 5, are insufficient to pay all proper charges and claims against the estate which total $8,842.49. 2 10. Pursuant to 20 Pa.C.S. Ann § 3392, payment should be made as listed on EXHIBIT II attached and presented as "Requested Payments." 11. Petitioner is requesting that all parties in interest are paid, except as noted in EXHIBIT II. 12. the Agent for the Commonwealth of Pennsylvania -Estate Recovery Program maintains a claim in the amount of $7,997.50. However, a letter requesting payment of $5,205.78 from the Estate is attached to this Petition, and made part hereof and marked as Exhibits III and IV. 13. In exchange for the consideration of the Agent for the Commonwealth of Pennsylvania -Estate Recovery Program consenting to the grant of this Petition, the Executrix and Attorney for the Estate have consented to reduce their claims as shown on the attached Exhibit II. WHEREFORE, the Petitioner pray your Honorable Court to approve payment of all proper chazges and claims against the estate as set forth in the foregoing Petition, and discharge Tracey S. Barrick from her duties as Executrix. Date: ~- ~ `l Z ~ ~ t By: ~ r1 ames J. cCarthy, Jr. qui Supreme Court ID # 822 McCarthy Weisberg Cummings, PC 2041 Herr Street Harrisburg, PA 17103 Phone: 717-238-5707 Attorney of Record for the Estate of David C. Jumper 3 VERIFICATION The undersigned, Tracey S. Barrick, hereby verifies that she is the Executrix of the above-named Estate and that the facts set forth in the foregoing PETTI'ION FOR DISTRIBUTION OF INSOLVENT ESTATE UNDER 20 PA. CONS. STAT. ANN. SECTION 3392 which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. § 49Q4 relating to unsworn falsification to authorities. ~:.~; ~ I J Date Tracey S. 'ck, Executrix 4 LAST WILL AND TESTAMENT OF DAVID C. JUMPER I, DAVID C. JUMPER, of 40 Colonial Court, Cumberland CowZty, Shippensburg, Pe2u~sylvania, being of sound and disposing mind, memory and understanding, do hereby make, - publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. ~RS'r= I direct that all my just debts and funzral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath the residue of my estate, of every rature and wherever situate, to my Daughter, Tracey S. Wit,'~jac%, providing she shall survive me by thirty (30) days. ~~ Z'>EIIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature aad by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my Daughter, ~ racey S. W ithjack, Executrix of this my Last Will and Testament. FI)H"I'H: I direct my Executrix and her successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. /--~,- IN WITNESS WHEREOF, I have hereunto set my hand and seat to Ibis, my Last Witt and Testament, consisting of two S2) typewritten pages, each identified by my signature, this /,,~~- day of ~~}~. C~-r~.- , ~~~. (SEAL) Davi C. Jumper . ..- Signed, seated, published and declared by the above-named Testator, David C. Jumper, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. Wr ess ~oQ.hnRwt.~- i!'kL..t ~L~ W1tneSs Date: 3_ i~~-~_ Daroe:~ -13 ~ o+~ COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND ) I, David C. Jumper, Testator, whose name is signed to the attached or foregoing instrument; having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by David C. Jumper, the Testator, this --~-r~'~y of ,21.4-.e-Llt. , ~- (SEAL) -Notary Pu c ~~~ tJ~d.AwptiN~rPabt~ C7A~doR0la~1~d~- IMyOonwYlon Eapi~s.ly-~ 2006 ~,~„~e,~~a~arw COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND ) We,~~~~_~ _ and ~ ~ ~ ~ the witnesses whose names are si J~attached or foregoing instrument, being d y qualified 8n according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that signed willingly and that he executed it as his free and voluntary act for the purpose therein expresse;ci; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knov~•Iedge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. / Sworn or affirmed to and subscribed to before me by ~ ~ - and ~_~/~.-~~ ` witnesses, this ~ fit day of _ 2004. ,.. (SEAL) ~R,,M,~f1A,~TR `~~9j~__, Witness (SEAL) ' ` Witness .- i t ,^ .. 'L No Pub ~~ ~~~ '~~-~ ~~~'~ ~~ar'°t~renar~~rs Estate of David C. Jumper, Deceased For the period November 24, 2008 through August 31, 2011 File Number 2008-1228 Total Estate Assets Claims against the estate: Class 1 - 20 Pa.C.S. § 3392(1) Attorney Fees Executrix Fees Probate fees -Cumberland County Register of Wills Register of Wills -fees for inventory and Inh Tax Total Class 1 -20 Pa.C.S. § 3392(1) Class 2 - 20 Pa.C.S. § 3392(2) Class 3 - 20 Pa.C.S. § 3392(3) PA Department of Public Welfare Carlisle Regional Medical Center Fisher Florist -Flowers for Funeral Shippensburg Health Care Center -Cable Bill First Weslyan Church -funeral costs Total Class 3 - 20 Pa.C.S. § 3392(3} Class 4 - 20 Pa.C.S. § 3392(4) Class 5 - 20 Pa.C.S. § 3392(5) Class 6 - 20 Pa.C.S. § 3392(6) Embarq -last phone bill Kinetic Imaging Total Class 6 - 20 Pa.C.S. § 3392(6) Total all claims $ 7,972.70 $ 2,100.00 650.00 83.00 30.00 $ 2,863.00 NONE $ 5,205.78 11.81 399.00 10.00 300.00 $ 5,926.59 NONE NONE $ 47.47 5.43 $ 52.90 $ 8,842.49 Requested Payments $ 7,972.70 $ 1,800.00 500.00 83.00 30.00 $ 2,413.00 NONE $ 4,785.99 11.81 399.00 10.00 300.00 $ 5,506.80 NONE NONE $ 47.47 5.43 $ 52.90 $ 7,972.70 EXHIBIT II COIrBtAON1NEALTH OF PENNSYLVANIA DEPARTNB:NT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DMSION OF THIRD PARTY LWBILITY ESTATE RECOVERY PROGRAM PO BOX 8186 HARRISBURG, PA 17105-8486 April 26, 2010 MCCARTHY WEISBERG CUMMINGS JAMES J MCCARTHY JR 2091 HERR STREET HARRISBURG PA 17110-1624 Re: David Jumper CZS #: 710205017 SSN: ###-##-2595 Date of Death: 11/24/2008 Dear Attorney McCarthy Jr: Please be advised that the Department of Public Welfare maintains a claim in the amount of $7,997.50 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. 1912, 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 $7,997.50, 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. 339213). The balance of the claim, namely $, 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, ~~~u~ Dianna L. Stoneroad TPL Program Investigator 717-265-7688 717-772-6553 FAX Enclosure COMMONWEALTH of PENNSYLVANW DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DMSION OF THIRD PARTY LIABILRY CASUALTY UNR P.O.BOX 8486 HARRISBURG, PA 17105-8486 January 26, 2011 MCCARTHY WEISBERG CUNNINGS JAMES J MCCARTHY JR 2041 HERR STREET HARRISBURG PA 17110-1624 Re: David Jumper CIS #: 710205017 Incident Date: 11/24/2008 Dear Attorney McCarthy Jr: This letter is in response to your voice mail on January 26, 2010. In regards to a 5500.00 gift allowed by the CAO. The Department has already calculated this into its agreed recovery amount of $5,205.78. Since 52,500.00 was gifted, it caused an over payment of $2,034.00. The Department has already agreed to recover only 51,279.70 rather than the full 52,034.00 overpayment. Also, a gift amount of 5500.00 would have needed to occur before the dated of death. If the Office of Inspector General would collect on this over payment they will seek to recover the full $2,034.00. The Department has already reduced this portion of the recovery by $754.30. Another $500.00 cannot be deducted. The amount due to the Department remains at $5,205.78. If you have any questions please contact me. Sincerely, Diar_na L.- Stoneroad TPL Program Investigator 717-265-7688 717-772-6553 FAX x 1 REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } TRACEY S. BARRICK File Number 21 - 08 - 01228 Personal Representative(s) of the Estate of JUMPER, DAVID C _ _ _ __ __ _ _ deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and alt of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state-} TRACEY S. BARRICK ~~ ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unswom falsification to } _ __ authorities. ~-`---`~ -- -` ~- ---~-- Attorney - (Name) (Firm) (Address) Jame_s_J. M_c_Carthy, Jr., Esq. McCarthy Weisberg Cummings, P.C. 2041 Herr Street Harrisburg, PA 17103-1624 (Supreme Court I.D. No.) PA 82266 (Te%phone) 7171233-5974 DATE OF DEATH LAST RESIDENCE 121 WALNUT BOTTOM ROAD DECEDENTS SOC. SEC. NO. 11124/2008 SHIPPENSBURG, PA 17257 214-34-2595 FIGURES MUST BE TOTALED Personal Pro rt ORRSTOWN BANK -ACCOUNT NUMBER 570465 6,475.07 AUCTION OF PERSONAL ITEMS -DAN HERSHEY AUCTION SERVICE, LLC 1,264.08 ADAMS ELECTRIC -REFUND 8.32 CARLISLE REGIONAL MEDICAL CENTER -REIMBURSEMENT 11.81 Total Personal Property 7,759.28 INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA (Attach additional sheets if necessary) Total Personal Property and Real Estate $7,759.28 J REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county cone Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 8 0 12 2 8 PO 80X.280601 Harrisburg, PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Deatft Date of Birth 214342595 11242008 05151940 Deterdent's Last Name JUMPER Suffix Decedent's First Name DAVID (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Mt C M! Spouse's Social Security Number ~--- TNlS RETURN MUST BE FILED IN DUPLICATE W17H THE REGISTER OF WILLS FILL tN APPROPRIATE OVALS BELOW ® 1- Original Return ^ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limitt'd Estate ^ Aa. Future Interest Compromise (~ 5. Federal Estate Tax Return Required (date of death after 12-12-B2) 0 ® g Decedent Died Testate 7_ Decedent Maintained a Living Trust _ 8. Total Number of Safe Oe sd Boxes (Attach Copy of Will) ^ lAftach Copy ar Trust) ~ ^ 9. Litigation Prot:eeds Received ^ 10. Spousal poverty Credit Itlate of death ^ t 1-Election to tax under Sec. 9113(A) between 121-91 and •1-95) (Attach SCh, O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES J. MCCARTHY, JR., ESQ. 7172335974 Firm Name (If Applicable) MCCARTHY T^1EISBERG CUMMINGS, P.C. First line of address 2041 HERR STREET Second line of address City or Post Office HARRISBURG State ZIP Code RE6iSTE~F WILLS li ONLY;. "-ti ; _~~ ~ ~; :~^ n _ _ ` tv -~7 '_ ;J . ~ _~ ~ --- _ _ , ....- DLED ~. ''_ PA 17103-1624 Correspondent'se-mailaddress: Jamesjmccarthy@comcast.net Under penalties of perjury, i declare that 1 have exarrrrted this return, irrcwding accompanying sctredules and statements, and to the best of my knowledge and belief, a is true, coned and complete. Declaration of preparet other than the personnaall representative [s based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE,FC)R'F1tiNGl>;EETq, ~ ~ DATE - ;, TRACEY S. BARRICK ADDRESS 328 LAKE MEADE DRIVE, EAST BERLIN, PA 17316 SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE DATE James J. McCarthy, Jr., Esq. AOORESS 2041 Herr Street, Harrisburg, PA 17103-1624 Side 1 ~, 1505607120 1505607120 J 1505607220 REV-1500 EX Decedent's Social Security Number oecE.wenrs ntame: J U All P E R. D A V I D C 2 14 3 4 2 5 9 5 RECAPITULATION 1. Real Estate (Schedule A} ............................._...................................................... 1. 2. Stocks and Bonds (Schedule 8) ............................._............................__............. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ....................................................... 4. 7,759.28 5• Cash, Bank Deposits & Miscellaneous Persona! Property (Schedule E.} .............. 5. 6. Jointly Owned Property (Schedule F) Q Separate Billing Requested...-........ 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0 (Schedule G) ® Separate Billing Requested............ 7, . 8. _ . ................................. Total Gross Assets (total Lines 1-7) ................................ 8. 7, 7 5 9. 2 8 6,182.00 9. Funeral Expenses & Administrative Costs (Schedule H} .............................__....... 9. 8,741.04 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... 10. 1 4, 9 2 3. 0 4 11. .........................__.... Total Deductions {total Lines 9& 10} .................................. 11. ' 7.16 3 . 7 6 12. Net Value of Estate (Line 8 minus Line 11). ......... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. 13. ' 7 , 16 3 . 7 6 14. ............ Net Value Subject to 7ax(Line 12 minus Line 13} .............................._... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X •045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..........................................................................................__................... 19. 0.00 Z0. FILL tN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT, a Side 2 1505607220 1505607220 i.. _ REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 08 - 01228 JUMPER, DAVID C 'STREET ADDRESS ~ ~ ~~ 121 WALNUT BOTTOM ROAD Y - --- __ ---- - --------- -- SHIPPENSBURG --._- - -- - - - -`- -- - ^STATE ~ ZIP PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19j (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit _ _ _ _, _ _~__ B. Prior Payments __ _ _ _ _ _ ___ _ C. Discount -- ^ - - - _ Total Credits (A + B + C) (2) 0.0 0 3. InteresUPenalry if applicable --- -------- D- Interest E. Penalty _-,_ -_____ Total InteresUPenatty (D + Ej {3) 0.00 `~ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is th~VERPAYMEN7. (4) Check box on Page 2 Line 20 to request arefund --- - _-~ 5. !f Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 0.00 A. Enter the interest on the tax due. (5Aj _ B. Enter the total of Line 5 + 5A. This is the9ALANCE DUE (SBj Q , 0 Q 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 .. ..........................__................ ~x: 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 :................................ ~_ x c. retain a reversionary interest; oc ....................................................•--....._............................__................ ~' ~ x''; - =s ==, d. receive the promise for life of either payments, benefits or care? ........................................................... _ _x 2. It death occurred after December 12, 1982, did decedent transfer properly within one year of death without -, -- receiving adequate consideraUon? ........................................................................•---..............._..................... '. x 3. Did decedent own an "in trust for" or payable 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 property which -, -. contains a beneficiary designation? ............................................................................................ _ ; ~_ _ ................... ', ~ ~xi, IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR "s t a : , For dates of death on or after July 1, 1994 and before January 1, 1995,-the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 {a) (1.1) (i)j. For dates of death an or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero {0) percent (72 P.S. §9116 (a) (1.1) (i!)]. The statutedoes not exempla transfer to a surviving spouse from tax, and the statutory requin?ments for disclosure of assets and filing a tax return are stll! applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (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 decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §91 i6 (aj {1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12j 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH DF PENNSYLVANIA ~ PERSONAL PROPERTY INHERITANCE TAX RETURN - RESIDENT DECEDENT FILE NUMBER ESTATE OF JUMPER, DAVID C 21 - 08 - 01228 Include the proceeds of litigation and the date the proceeds were received by the estate~ll property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 ORRSTOWN BANK -ACCOUNT NUMBER 570465 6,475.07 2 AUCTION OF PERSONAL ITEMS -DAN HERSHEY AUCTION SERVICE, LLC 1,264.08 3 ADAMS ELECTRIC -REFUND 8.32 4 CARLISLE REGIONAL MEDICAL CENTER -REIMBURSEMENT 11.81 TOTAL (Also enter on Line 5, Recapitulation) ' __ _ 7,7§g,2$ CH DU1.E COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERRANCE 7AX RETURN RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF JUMPER, DAVID C !FILE N2MB08 - 01228 This schedule must tie completed and filed if the answer to any o! questions 1 through 4 on page 2 is yes. ITEM OESCRIPiION OF PROPERTY DATE OF DEATH % OF EXCLUSION NUMBER InGude the name of the transferee, their relationship to tlecedent VALUE OF ASSET ' DECD'S pF APPLICABLE) ' TAXABLE VALUE and the date of transfer. Attach a wpy of the deed far rent estate. INTEREST -~ _ T ---- ---- - - «. _^ 1 ~ CASH -PAID TO FRIEND (NO RELATION) OF 2,500.00 ' 100% 2,500.00 ' 0.00 DECEDENT ON NOV. 5, 2008. BRIDGETTE GETTLE 1642 RITNER HWY SHIPPENSBURG, PA 17257 TOTAL (Also enter on tine 7, Recapitulation) 0.00 ~UI.E H R~p-L. DAISES 8~ COMMONWEALTH OF PENNSYLVANIA ~ ~~ INHERITANCE TAX RETURN RESIDENT DECEDENT ' - - - --- - ---------------- ---------- -.- --FILE NUMBER -- EsTATE OF JUMPER, DAVID C ~ 21 - 08 - 01228 Debts of decedent must be reported on Schedule 1. _ _ _ _ _ _- ^ __ `_-__ ITEM .- -. DESCRIPTION AMOUNT NUMBER FUN_ER_AL_EX_PENSES_ _ _. __ `_ - __~___ _- __ _. __ .. - . _. ._ A. 1 FISHER FLORIST -FLOWERS FOR FUNERAL 399.00 2 FIRST WESLEYAN CHURCH 300.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions TRACEY S. BARRICK 3,000.00 Social Security Number(s) / EIN Number of Personal Representative(s): 161-60-2469 street Address 328 LAKE MEADE DRIVE City EAST BERLIN State PA Zip 17316 Year{s) Commission paid 2. Attorney's Fees MCCARTHY WEISBERG CUMMINGS, P.C. 2,100.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 83.00 5. Accountant's Fees MCCARTHY SHEA, P.C. 300.00 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 - --- - -- -- ------ (--- -- - P ) _ TOTAL Also enter on line 9, Reca itulation 6,182,00 SCHEDULE! . DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, ~ LIENS INHERITANCE TAX RETURN RESIOEN7 DECEDENT FILE NUMBER ~i ESTATE OF JUMPER, DAVID C 21 - 08 - 01228 Include unreimbursed medical expenses. ITEM ~ ~ DESCRIPTION NUMBER _ 1 EMBARQ -LAST PHONE BILL~_ ~_`____.._ .-,__ __ _ 2 CARLISLE REGIONAL MEDICAL CENTER 3 KINETIC IMAGING 4 SHIPPENSBURG HEALTH CENTER -CABLE BILL 5 LEWIN & NADAR ASSOC, MD 6 PA DEPARTMENT OF PUBLIC WELFARE -CLASS 3 CLAIM 7 TRACEY BARRICK -MEDICAL SERVICES - REIMBURESED TRAVEL - 6 MONTHS @ 2 TRIPS PER MONTH; 50 MILES ONE WAY = 1,200 MILES @ .55 PER MILE TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 47.47 11.81 12.63 10.00 1.63 7,997.50 660.00 8,741.04 RcV-1513 EX+ (9.p0) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BCNEF~`+~ A ~~E~+ INHERITANCE TAX RETURN GG1,G ~trr /~1 ~7 RESIDENT DECEDENT ESTATE OF JUMPER, DAVID C ,FILE NUMBER __ __ __ _ _ _ __ _ _ 21 - 08 - 01228 RELATIONSHIP TO SHARE OF ESTATE i AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) I DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS[nclude outright spousal dlstributtons, and transfers under Sec. 9116 (a) (1.2)j 1 TRACEY WITHJACK BARRICK Daughter ENTIRE ESTATE 328 LAKE MEADE DR EAST BERLIN, PA 17316 'Enter dollar amounts for distributions shown above on tines 15 through 18, as appropriate, on Rev 1500 cover sheet ~~ ~ NON-TAXABLE DISTRBUTIONS: !A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS 'NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00