HomeMy WebLinkAbout06-21-12 (3)1585618148
REV-1500 Ex (°'_'°'
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
Po Box zaosot ~? 1 1 2 8 2 8 7
Harrisburg PA f712s-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Data of Death MMDDriri Date of Birth MMDDYYYY
1 9 8 2 2 9 8 5 9 0 5 0 2 2 0 1 1 0 6 2 4 1 9 2 9
Decedent's Last Name Suffix Decedent's First Name MI
L O W E C L I F F' O R D p
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
4. Limited Estate
~
4a. Future Interest Compromise (date of priorta 12-13-a2)
~ 5. Federal Estate Tax Return Required
^X
6. Decedent Died Testate
~ death after 12-12.82)
7. Decedent Maintained a Living Trust
~ B. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ t 1. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-t-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAx INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 7 4 3 5
REGISTER OF WILLS
First line of address
4 1 4 B R I D G E
Second line of address
S T R E E T
City or Post Office
N E W C U M B E R L A N D
correspondent's a-mail address: D S T O N E a S T
Untler penalties of perjury, I declare that I have examinetl Nis return, ind
it is true, coned and complete. DeGaration of preparer other than the cel
State 21P Code l
P A 1 7 p 7 0
;.
r..i
.LIiW •IYL i
accompanying schetlules and statements, and to the best of my kno
representative is based on all information of which preparer has any
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ige and belief,
alamn I u~7tPREP~~R ~THE~THAN REPRESENTATIVE DATE
414 BRIDGE STINEET NEW
PLEASE USE ORIGINAL FORM
Side 1
1505610148
1585618148
1505610240
REV-1500 EX
Decedent's Socia l Security Number
oecedenPS Name: CLIFFORD P. L O W E 1 9 8 2 2 9 0 5 9
RECAPITULATION
i. Real Estate (Schedule A) ........................................ ... 1. 5 5 0 0 0, Q Q
2. Stocks and Bonds (Schedule B) ................................... ... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3.
4. Mortgages and Notes Receivable (Schedule D) ....................... ... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous N
-Probate Property
~
(Schedule G) Separate Billing Requested .... ... 7. ,
8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8. 9 5 Q Q Q , Q Q
9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 1 6 8 4 5 . 1 5
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 4 9 3 6 5 . 9 9
11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 6 6 2 1 1 . 1 4
12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 2 8 7 8 8 . 8 6
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not bean made (Schedule J) .................... .. 13. ,
14. Net Value Subject to Tax (Line t2 minus Line 13) .................... .. 14. 2 8 7 8 8 . 8 6
TAX CALCULATION -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• Q Q Q Q 15. Q. Q Q
16. Amount of Line 14 taxable
at lineal rate x• 0 4 5 2 8 7 8 8. 8 6 1 s. 1 2 9 5. 5 0
17. Amount of Line 14 taxable
at sibling rate X .12 Q. Q Q 17. Q, Q Q
18. Amount of Line 14 taxable
at collateral rate X .15 Q Q Q 18. Q, Q Q
19. TAX DUE ..................... ............................ .... .. 79. 1 2 9 5. 5 Q
20. FILL IN THE OVAL IF YOU ARE REpUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505610240 15175610240
REV-1500 EX Page 3
Decedent's Complete Address:
Flle Number
21 12 0287
DECEDENT'S NAME
CLIFFORD P• LOWE
STREETADDRESS . -----.___ -_____. _ _-...- -_.-_---
521 4TH STREET
_ _ _
CITY -----------~-STATE -------- ZIP
NEW CUMBERLAND PA ~17070-
Tax Payments and Credits:
t. Tax Due (Page 2, Line 19) (i) 1,295.5
2. Credits/Payments
A. Pdor Payments
8. Discount
Total Credits (A + 6) (2) 0 • o D
3. Interest
4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. (3) 0 • IJ ~
Fill In oval on Page 2, Line 20 to request a refund. (4) 0 • 0 0
5. If Line 1 +Line 3 is greater than Line 2, enter fhe difference. This is the TAX DUE. (5) 1, 2 9 5 • 50
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
i. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ................................................................ ...... ~ ^X
b. retain the right to designate who shall use the property transferred or its income; ..... ...... ^ ^X
c. retain a reversionary interest; or ......................................................................................... ...... ^
d. receive the promise for life of either payments, benefts or care7 .................................................. ..... ~ Q
2. If death occurred after December 12,1982, did decedent transfer propedy within one year of death
without receiving adequate consideration? ...........................
.......................................................
....
3. Did decedent own an'in trust for' or payable-upondeath bank account or security at his or her death? .... ..... ^ XQ
4, Did decedent own an individual retirement account, annuity or other non-probate property
which
,
contains a benefciary designation? ......................................................
......................
..... ^
a
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 trannsfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 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 4.5 percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(i)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undo
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 SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
"" "" "' ' FILE NUMBER:
CLIFFORD P• LOWE 2:1 12 0287
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 between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that Is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the setllemenl sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
Property located at 521 4th Street New Cumberland
Cumberland Co, PA granted and conveyed unto Clifford
P• Lowe and Barbara A• Lowe, his wife• The said
Barbara A• Lowe having died September 16, 1992,
vesting title in Clifford P• Lowe at Comparitive
Market Analysis by Christopher Pirritano from Re/Max
Realty
TOTAL (Also enter on Line 1,
95,000.0
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
CLIFFORD P• LOWE 21 12 0287
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1• Parthemore Funeral Home-funeral expenses 2,250.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Repmsentative(s)
Sheet Address
City
Year(s) Commission Paid:
State
ZIP
2. AnomeyFees: David H• Stone, Esquire 5,000.00
3. Family Exemption: (It decedenCs address is not the same as claimant's, adach explanation.)
Claimant
Street Address
City State ZIP _
Relationship of Claimant to Decedent
4• Probate Fees: Cumberland County, Register of Wills 311.50
5 , Accountant Fees:
6 • Tax Relum Preparer Fees:
7• Leffler Energy-gas serv at prop from 5-11 to :L2-11 3,246.68
2• PPL Corp-electric serv at prop from 5-11 to 12-11 778.06
3• PAWC-water serv at prop from 5-11 to 2-12 784.95
4• Robin Gasperetti-taxes on property 2,525.13
5• New Cumberland Boro-sewer and refuse 9-11 to i'_-12 1,719.82
6• UGI-gas serv at property from 6-11 to 2-12 99.01
7• Register of Wills-filing Inh tax ret and Inv 30.00
8• Reserve for closing expenses 100.00
TOTAL (Also enter on Line 9, Recapitulation) I E 16 , 8 4 5 •
If more space is needed, use additional sheets of paperof the same size.
REV-1512 EXt (12-0e)
pennsylvania
DEPARTMENT OP REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
°'"" "" FILE NUMBER
CLIFFORD P• LOWE 21 12 0287
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• PA Dept of Public Welfare-claim 49,365.99
TOTAL (Also enter on Line 10, Recapitulation) S
If more space is needed, insert additional sheeLS of the same size.
REV-1513 EX~ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CLIFFORD P.
LOWS aT. i.a n~a~
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP i0 DECEDENT
Do Not Llst Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [IndudeouMghtspousaldistributionsandtransfersunder
Sec. 9176 (a) (1.2).J
1 JOYCE A HAMILTON Lineal 28,788.86
521 4TH STREET
NEW CUMBERLAND PA 17070-
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF RE'/-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1•
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OFPART if -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
_ _~
l
LAST WILL AND TEST]
OF
CLIFFORD P. LOWE
I, CLIFFORD P. LOWE, of the Borough of New Cumberland, Cumberland
County, Pennsylvania, declare this to be my last: will and revoke any
will previously made by me.
ITEM I: I devise and bequeath all of my estate of every nature
and wherever situate to my daughter, JOYCE A. HAMILTON, or to her
issue, per stirpes.
ITEM II: I appoint my daughter, JOYCE A. HAMILTON, Executrix of
this my last will.
ITEM III: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of her duties in
any jurisdiction.
IN WITNESS WHEREOF, I, CLIFFORD P.ML,,OWE(, have hereunto set my
hand and seal this ~_ day of f ' ~cY~cl~ 2007.
~~
~~ ~l','F_c~~.c
CLIFFORD P. LOWE
Pa~:I° _ `~ J
w ,
SIGNED, SEALED, PUBLISHED and DECLARED by CLIFFORD P. LOWS, the
Testator above named, as and for his Last Will and Testament, and in
the presence of us, who at his request, in his presence and in the
presence of each ot~er, have subscribed our name=_s as witnesses.
_919 Bridge Std New Cumberland PA
wi ess Address
~~~ /~~
4.14 Bridge Std New Cumberland PA
Witness Address
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS:
I, CLIFFORD P. LOWE, the 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 e~;ecuted this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
CLIFFORD P. LOWS
Sworn t:o or affirmed to dn~acknowi~dged before me by CLIFFORD P.
LGWE, the Testator, this ~_k ~ j ~/~,/::~~ ~ ~~ , 2007.
COMM NWEALIH OE PENNSYLVANIA I
N TA I SEAL notary Public ~
~ANIEI M, 4ARTMAN, Notary Public ~
New Cumberland Boro., Cumbadand Co.
My Commission Expires Jan. 21, 2009 =,a~~N `~ i
v
COMMONWEALTH OF PENNSYLVANIA
COCINTY OF CUMBERLAND
SS:
We, ~h (~ J ~ and \ ~~~._~ .\lal'~\~
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execc.te the instrument as
her last will; that Testatrix signed willingly and that she executed
it 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; that to the best of our knowl~=_dge, the Testatrix
was at that. time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
l~. r
Witness
Sworn to or affirmed to and ackn }edged before me by
~, I
~'~ :r ~
witnesses, this '.'/` day of i~ 2007.
e ~ -~ I
.-`_;'ArdUN4VEALfH Of PENNSYLVANIA ~~
~- N07ARIAL SEAL
6.4:r~EC ";1. ~9ARTM,AN, Notary Public
Nero Cumberland Boro., Cumberland Co.
1y Commission Expires Jan. 21, ~ppg c^- a ~ . 3 o f
b~l~
COMPARATIVE MARKET ANALYSIS
CMA presenWtlon
Prepared /br.
David stoneJBarty Hamilton
sz14m sneer
New Cumberland, PA 17070
Tuesday, May 15, 2012
Prepared By:
CHRISTOPHER
PIRRITANO
RE/MAx REALTY
AssoaarEs
3azs MARKET ST
CAMP HILL, PA 17011
PHONE: (717) 350-s118
cmpwitlvemaxOyahoo.com
rar«meaon Orwlded k weaned rtllabk drt rot quaranpttd
COMPARABLE REPORT
A~ 6
...... ........
6.._.
6
Vrlaa
.. .... .
;120,000
._ .. _..._
;13250D
Address 521 4th Sbeet 728,Hummd Ave
. ..123 7th SQeet...._
...
~' ....._ ..
LemWne ..
... _
New CLmherland ~ .. ._
Strtus Subje~POperty ___,_ .
.....
......._Sold .... .
SoW
d Bedmom7 3
.... ............ _...,._.........
.. _.
3 .......... ..............._
3
aK d Areplaas
.
....................................... _
...... ... .. ........
.....
..
.
..
.
.
._
..... ........_......, ..„......
0
0 d Rdl Batlu !
.. .
.
.
1 _
.
_. _.......
..._..__. .............. _.......__ 1._............_....._._......
t of Fis9 Betle 1
_
1 ~ .._......._
1
AGO 01700
.. __._... ..- 0.1200.
.......
. ._..._,.._,..
0.
1900
Days On t7arket
_ .
. ........_..._....._....
. 36.
. ,
._._._....._
......_.._ _.
_ ................._......_....
159
SOld Rke
......_.
_. _.,
.
............
;lzoooo .. _ .... __.
__ ...............
sao.
~
g
2,
_
Square reef Ahaue
1634
.._.
1497
.._....._.
..
.....
.......
.
~...
1544
ruade
Adjusted fD 31zo,ooo #13z,wo
Price
trdorrtrtbn prtwlded B domed reOaWe b~R m><gumanoeM.
~.. au.~,,w ~uy,wo ;124,800 ;124,800
SP: ;132,500 i ;120,000
. _..._ .. ;126,250 ~ ;126,260
CMA SUMMARY REPORT
~~~
~: ;129,700
~ ;132,500
1 ~~ 1Ma "'AVER116E'~ M!p!1 N
;119,900 ;124,800 ~ ;129,800
;120,000 j 5126,250
__ _ .. ;126,250;..._.._.
~ ~ Fr
`AOaa~s ~ Mls~ ~ sotw` aura s«itrtene ~~~ oaM ~r "~~! s~,y'A ~~et
726 Hummel Ave 10209106. SLD - 6 ~ For Sale s 1987 36 ~ ~'
,_.._
i -1.:119.900 _~..~63. ~.;12Q,000 _ X0,70 i
123 7N Street ! 10167576 SLD ' 6 ;For Sek _; i_SM ~ 159 ;, 5329,700 ~ ;8100 _ , ~ ;132,500 ~; ~;~ ~_. ~ ~
~_
7odl LYUnye ~ - _ ~ _..~ L ~ _ ... ~~.i~ Avy ~. Avp .. _. I_A~9 ! Av0
2 1 t i 512A,800 I 2.32. ~ 1 ,I
_.. ~. __.__ _. `_ ~.._...__ 97 _#0....__...~..~2i0;#Y2.20
Inlarrnalion proNded h deened MIffile but rqt yuarenpxd,
Subject properly of 5214"' street:
38R
1.SBA
Square Feet: 1634
Built: 1910
Other home information:
-Roof 15 years old
-Furnace -1.5 years old
-No Central Air
-Oil Baseboard heat
-Replacement vinyl windows
Home needs a lot of work. Inside, plaster on walls and ceilings needs significant repairs. Hardwoods
need replacing/reflnishing. Upstairs needs paint in all BRs. Outside, spouting needs a complete overhaul,
basically falling off the house. Yard is enclosed with a very old and rusty chain link fence. Major
landscaping needs.
In conclusion, with all the adjustments/replacements necessary for this home,l would recommend a
value between $90,000 and $100,000.
Tax Report Page
httpJ/cpml.parago~els.com~ParagonLS/Reports/TaxRepart.mvc?lisdn..
FuII RgpoK
GA~14~ Y `lY~
Land Ur Cade nnGAlYCry11g6 aU1LAa1`R7
101 RESIDENTIAL 1 FAA~flLY
School DIWkr 9 Land Orarlptbn LAND
PNlgbarhood 2519 lot Cando UnR ID
Gnnr Tnd 708 lattuda -78
888124
Gneue Bk Orp 6 LapRado .
-40.:tZ~42
ToW Value 5188.800.00 CIer~AM Oreu~
Wa Buit 1910 Daarlad Aar 0.24
Eff Yinr Bu! 1976 g~ya. 2
LMnq AtM SF 1834 Drtiq 7}rpe DETACH
Uvlrg Arr Faefor 90.68 Saanr lypo PUBLIC
LNNq Arr ToW 148006 Reed 7yPe. PAVED
L6nltlnp Faatare B02 Wabr 8aurp. PUBLIC
t of 1
5/15/2012 2:27 PM
~~.q.~v,w~, acigm sl hYR Addr2 NEW CU~t)EPo.APD PA 17070
CRY State 21p PEW CUMBERUNO PA 77070 BubdMNon
Lam 8W Deta CLIFFORD P 8 BARBARA A LOWE Hour Nuni6ar 521
rier Bunk 1910
LaM SaN Prix
t~~r ~w.-ar nw-a.r w
~fjis
I, ..
,::. ..}
2~.~
saws ear ~ s ~" dw e/ (a~r1,en ~ im tAa
of err Load oad t7YoawYd sir Auadtrd a lsty.ntae (1969) c:%.: ' .' ~y~1~ ~ Y
tt1J~5 YL'IA::IA
Bi'TWtCjN Pay Vaadezelice and Charles Low, Jr., Esacutors of the Last WSLI
and Testament oC eBRTDA M. LOUR, lari of tlu Borough ot.NyYl
CumberlW, county o! Cumberland mfdsriri o[ Pemuylwnta,
(iramppra ,
eed CLiPyODD P. LOU6 and HAttDABA A, fAUD, h!e a1Ce, o! the Clty
o! Harrisburg, County oC Deuphln, state o! Paneuylvanle
-°---CYrats
s~~a~w~d Sw.a~911.700.06)• ..._....
G Awd void, tM raMfjt vAawe/ 6 5w•6Y edleosbdped, t8s acid i.saCoA do 1)aNara.
amd aaaseY b ttv ssQt dreatss e, Aa~e6H pYant
"ALL 'that oerriln Parael or piaea o! load steuari la the Borough o! Ner Cumberland,
County o! CumberlanW, start o1 Pesmeylvanly beiag Lob Noe. 10. 11 and 12, Dloak
N, !n the General Plan of Oeorge U, Duttorlt ~• Addttloa b Ner CmaWrleM and
reeordad in the Cwabeelstuf County Aeoozder'• Orlin In Deed Dook N, Vol. S, Page 700,
sold Lots 6eing bounded and dasarlbed as lotions, ri riti
BBCINNiNO et • point on ch. north •lM of Houceh street aewnty-Clw (77) Get
seat oC 6urir Aveaue; thean watr.tdly along aald Pwrth street wventy-!!ve
(73) Ceet Co a polnl; tlanw northvardly slab a l1YU parallel vlth Butar Avawe
one hundred Loety (140) teat to Flrat ASlep; tlsnae eaetwrdly along sold Piret
Allen wwnty-Clue (7s) last Co tM dividing 11w Mtreen Lob Noe, 9 sad 10{.
thanes aatthWrdly alont sold dirldimg ilYS one hundred forty (140) Leer to Fourth
strwt, cM piaea o! 8aglaaing.
MVilg: thaaon ereabd • CW sad one-hal! .Cory !same dw113Yy house on the
easteta portion or a~ Lots Nos, 10 aaW 11, end beltlg i<apra ea No. 321 Pourth street,
Nw CumMrlead, Pa,
BEVY. the same premlew ubloh George C. Delrihpover, A. i:ayw smith amd Harold 1.
Troetle, Cumberland County Coanlseloners, by deed darid P•6taary 28, 1938, recorded
fn CutAhertaM Couaty Deed Duet I. Vol. 18, Page 189, greeted end aamveyed b
8erehe M. Low, TM said Bertha M. lore died on tM 1st day o[ November, 1968,
having made her Cast U111 end lnteaamt duly probated sad recorded In tls 0!llae
o! the Neglsbr oC 4111e of Cumberland County, Peawylvanle, in lilll Boot Page
and Latrin Teatansibry duly laawd to Pey Yenderallu, Chertaa Low, Jr, sad
CI1lfozd Lars, Thls deed !s eseaubd purauent to tM Order o! the Orphw Court
Division of the Coure of Casson Pieas o! Cumberland County entered on etas day
of August, 1969, to No. '
B : "' `x Wr<,.~~,,,,,.u,,,9a,d -Suomi.
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a.r. iq-a~4ry n„r,
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e..a. a aw~~ Saar
~~
.rt 0. bM. GI. Asa `a,-
mac jJ` ~3-ncl 531
_ AND Ne eaid pimttore Mreby aovaRaRt ena aprn lAat tAey aad aal o/ Nest wYl +aarraRt
g a n a r e L l y ~ 7+~aDMY AerebY oaageyed.
R'r.r:.it REm BY int
OAR OF R.W CCYR:RIAi~
M WZTND34 WH8R60F, add praRtora Nave AeNRato at thalr
the dsy and yrar fret above turitteR.
$tenab, *asW aqR ~altvpN
fq t!q btrraenrr of
_„-l~~e. -~i5`~~L~~ ) Exaoutora oC rM~Will of
.. are •, aoasa
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5!15/2012 3:14 PM
Pennsylvania
DEPARTMENT OF PUBLIC WELFARE
December 28, 2011
STONELAFAVER SHEKLETSKI
ATTORNEYS AT LAW
414 BRIDGE STREET
POST OFFICE BOX E
NEW CUMBERLAND PA 17070
Re: Clifford Lowe
CIS #: 480254976
SSN: ###-##-9059
Date of Death: 05/02/2011
Dear Attorney:
Please be advised that the Department of Public Welfare maintains a claim in the
amount of 549.365.99 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 529,593.17, 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). "fhe balance of the
claim, namely $19,772.82, 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,
1
c~
Jessica L. Strawbridge
TPL Program Investigator
717-772-6238
717-772-6553 FAX
Enclosure
Bureau of Program Integrity ~ Division of Third Party Liability ~ Recovery Section
PO Box 6486 ~ Harrisburg, Pennsylvania 17105-8486
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
TPL SECTION -CASUALTY UNIT
PO BOX 8486
HARRISBURG PA 11105-8408
December 7, 2011
STATEMENT OF CLAIM SUMMARY
NAME Estate of LOWE, CLIFFORD
ID 480 254 976
MEDICAL CLASS 3 CLASS 5.1 TOTAL"
INPATIENT .00 .00 .00
OUTPATIENT .00 80.00 80.00
LONG TERM CARE 29,588.06 19,463.72 49,051.78
DRUG 5.11 229.70 234.21
REIMBURSEMENT TO DPW 29,593.17 19,772.82 49,365.99
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
EIN- 23-6003113