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HomeMy WebLinkAbout95-0291H105.112 REV. 8-88 YJARNING: IT IS ILLEGAL TO ALTER THIS COPY OR (FEE FOR THIS ~Q bUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. CERTIFICATE $2.00) DEPARTMENT OF HEALTH V TI AL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. N0. 254~~85 -1'~-95 - atQ of issue of This Certification Name of Decedent Arthur W. W First Middle Last Sex Male Social Security No. 159-07-8958 Date of Death _ 2~1-95 Date of Birth 2-4-1913 Birthplace Duncannon PA Place of Death _ Holy Spirit Hospital ~oUCumberland E Pennsboro Twp Pennsvlvanla Faality Name City, Borough or Township Race White Occupation Mechanic Armed Forces? (Yes or No) N o Decedent's Marital Status Widower Mailing Address 208 Senate Ave Apt 15 amra Hi 7 1 PA 17011 Number Street City or Town Stete Informant Coroner's Office Funeral Director Sallv Myers Mactav; ch Name and Address of Funeral Establishment. Myers Funeral Home Newport, PA 17074 Part I: Immediate Cause Interval Between Onset and Death (a) Congestive Cardio Myopathy I (b) ' (c (d) Part II: Other Significant Conditions Manner of Death: Natural X~] Homicide ^ Accident ^ Pending Investigation ^ Suicide ^ Could not be Determined ^ Describe how injury occurred: Name and Title of Certifier Michael Norris Coroner Address 405 Fairway Drive, Mechanicsbur PA 17055 (M.D., D.O., Coroner, M.E.) This is to certify that the information here death duly filed with me as Local Registrar Vital Records Office for permanent filing. 2-13-95 Date Received by Local Registrar given is correctly copied from an original certificate of The original certificate will be forwarded to the State ' ~ 50-455 Local Registrar of Vita Records District No. 101 Barnett St ~~ew 61 nnmf; c7.~1 pQ 17068 Street Address City, Borough, To nship PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of __ARTHilR W. W. BEr mpN No. also known as ARTHUR W. B .r,mnu To' Deceased. Social Security No. x.59-07-g9~~ Register of Wills for the County of Cutnberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appt , AS for letters of administration on the estate of (d.b.n.; pendente life; durante absentia; durante minoritate) ' the above decedent. Decendent was domiciled at death in Cumberland County, Pennsylvania, with h >_s last family or principal residence at 208 Senate Ave. , Apt. 15 , East Pennsboro Twp. (list street, number and municipality) Decendent, then 81 years of age, died February 1 19~_ at-Holy Spirit Hoao;tal ' -ti--° ~'a D~1 r~ri?lyayl ~~ani a • Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ 6 r o00 _ o0 (If not domiciled in Pa.) Personal property in Pennsylvania $~/A (If not domiciled in Pa.) Personal property in County $~jA Value of real estate in Pennsylvania $~~nP situated as follows: Petitioner after a proper search ham' _ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: v _ .. ~~% - e H N ~.s °~ y Marlin R Mr(`~l ah a~ ~~ ?1~ Fac+ Main Q}rap}r p (~ R 730 ~'~ ~ Marhanir•al-+iir pann ya 4. svl ~~--= - ~ ~n55 ~~ ~ o c eo rn THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. • OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF } ss 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 representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this day of April 19 95 Register Marlin R. McCaleh a 00 No. Estate of ARTHUR W. W, BECTON, a/k/a ARTHUR W BELTO~T Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW 19 95 the reverse side hereof, satisfacto , in consideration of the petition on IT IS DECREED that Marline Rpr McCa eb been presented before me, is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Marl ; „ u nn..r~~, ,.ti. in the estate of ARTHUR W. W. BECTON a/k/a ARTHUR W BECTON Register of Wills FEES Letters of Administration . •.... $ Short Certificates( ) .......... $ Renunciation ................ $ TOTAL $ Filed ..................... A.D. 19 Marlin R. McCaleb (ID # 06353) ATTORNEY (Sup. Ct. I.D. No.) 219 East Main Street, P.O. Box 230 Mechanicsbur Pennsylvania 17055 ADDRESS PHONE Arthur W. W. Belton Heirs Name Address Renun. Submitted Ernest A. Wagner c/o Besie Care Center, R.D. 2, Grantville PA 17028 X Ruth Messimer 121 Lakeview Lane, Hidden Lake Cameron, North Carolina 28236 X Joyce Weikel 87 Appletree Drive Levittown, PA 19055 X Carla Hamilton .2651 Booser Avenue Harrisburg, PA 17103 X Sandra K. Greider 215 Erie Street, Box 178 Dauphin, PA 17018 X Paul Lester Belton 103 Cider Drive, P.O. Box 50 York Springs, PA 17372 X Phyllis J. Leiby 1163 Derry Street, 2nd Floor Harrisburg, PA 17104 X Marcelline L. Faust Box 198-F20, R.D. 1 Kempton, PA 19529 X Bertha Seibert 38 West Main Street Shiremanstown, PA 17011 X Earl Wagner 12 Walnut Street Duncannon, PA 17020 X Merlin A. Belton 443 Franklin Street Hamburg, PA 19526 X MtV346 tx Itl•92) PA DEPARTMENT OF REVENUE .r``.r,r.% ES~ATE.INF~RMA~'10f~ SHEEN' FOR REGiST~A';, OF~iC~ ~ c O:JLY IiUUC I Year I rile Numoer DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department. Name (Last) (First) BECTON (Middlei ARTHUR W. W. Decedent's Social Security Number Date of Death Date of Birth 159 07 8958 February 1, 1995 February 4, 1913 T~>'1OF F?LING: Enter check (r) mark to indicate the nature of the return to be filed with the department. Probate Return ^Joint Assets Only ^Estate Tax Onl Y ^Litigation Purposes (No Other ,4ssets) I I_- : 7'cRS GRANTErJ• Enter check (,~) mark tb indicate the nature of the proceedings at the Register of tNi11s • Office. (Attach additional sheets if explanation is necessary.) ^Testamertary ®Administration ^No Letters ^Other (Please Explain) ~-TTORNE'~/CORRESPONDENT Enter ail data concerning the attorney or other individual to receive all INFORMATION: tax information and correspondence. Name (Last) First ( ) (Middle) Supreme Court I.D. ,~ McCaleb Marlin R. 06353 Street Address 219 East Main Street, P.O. Box 230 City State Zip Code Telephone Number Mechanicsburg Pennsylvania 17055 717-691-7770 PEr~SONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate INFORMATION: authorized by the Register of Wills Executor/Administrator Name (Last) (First) Middle ( ) Social Security Number McCaleb Marlin R. 176 34 Street Address 8 7 0 7 219 East Main Street, P.O. Box 230 cicy State Zip Code Telephone Number Mechanicsburg Pennsylvania 17055 717-691-7770 Co-Executor/Administrator Name (Last) (First) Middle ( ) Social Security Number Street Address i City State Zip Code Teleonone Number Co-Executor/Administrator Name (Last) (First) Middle ( ) Social Security Number Street Address i City State Zip Code Telepnone Numoer Prepared By I i Da[e I RENUNCIATION In Re Estate of ARTHUR W. W. BECTON deceased. To the Re ister of Wills of CIIMBERLAND g County, Pennsylvania. The undersigned niece or nephew (and .next of kin) - of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Leiters of Administrat-ion be issued to Marlin R. McCaleb WITNESS my hand this ~ day of f~fG~d~, 19 95 . ~~~•. (Signature) Ernest Wagner LAddress) c/o Bes~ie Care Center, R.D. 2 Grantville, gennsylvania 17028 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON deceased. To the Register of Wills of CUMBERLAND County, Pennsylvania. The undersigned niece or nephew (and .next of kin) ~ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R . McCaleb WITNESS my hand this a ~ ~ 9 5 day of 7 , I9 `~~ ~~`~ (Signature) Ruth Messimer / ~ ~ p~ /y /lQ~P-u-~'z-X-~]" / (Address) ENE 121 Lakeview Hidden Lake. Cameron, North Carolina 28236 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON To the Register of Wills of CUMBERLAND deceased. County, Pennsylvania. The undersigned niece or nephew (and next of kin ) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R . McCaleb WITNESS my hand this ~ ~ day of 1985,__. ~=~- `mil/ J e eikliegnacure> j,U E ~ ,~~ L 87 Appletre~dt~.ve Levittown, Pennsylvania 1905 5 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON To the Register of Wills of CUMBERLAND deceased. County, Pennsylvania. The undersigned niece or nephew (and next of kin) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R. McCaleb WITNESS mY hand this day of 19 95 . ~~~a ~ ~a Carla Hamilton azure) i~ /~cU / ~/0 3 Address) 265.1 Booser venue Harrisburg, Pennsylvania 17103 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON deceased. To the Register of Wills of CUMBERLAND County, Pennsylvania The undersigned niece or nephew (and .next of kin) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R. McCaleb WITNESS my hand this j s T day of (-~ -~ . 19 95 . i / Sandra R. d~~t8~r 215 Erie Street,) Box 178 Dauphin, Pennsylvania 17018 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON deceased. To the Re inter of Wills of CUMBERLAND g County, Pennsylvania. The undersigned niece or nephew (and next of kin) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R. McCaleb WITNESS my hand this •~ ~ day of ~ ~ G ~l 19 9 5 . Paul Leste=1~e~eton (Address) 103 Cider Drive York Springs, Pennsylvania 17372 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON To the Register of Wills of CUMBERLAND deceased. County, Pennsylvania. The undersigned niece or nephew (and next of kin) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters ~f Administration be issued to Marlin R. McCaleb WITNESS mS' - hand this ~_ day of LG~,~L , 19 9 5 . U ~ ~ n lure) Phyllis J . ~ei~y (Address) 1163 Derry Street Harrisburg, Pennsylvania 17104 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W : BECTON deceased. To the Register of Wills of CUMBERLAND County, Pennsylvania. The undersigned niece or nephew (and next of kin) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R. McCaleb WITNESS mV hand this ~ day of 1.~-' , 19 95 ~, ~a~.~~ JC.~t~v~R. Signature) Marcelline iL. Faust (Address) Box 198-F20, R.D 1 Kempton, Pennsylvania 19529 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON To the Register of Wills of CUMBERLAND deceased. County, Pennsylvania. The undersigned niece or nephew (and next of kin) ~ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued tc Marlin R. McCaleb WITNESS my hand this ~ day of , 19 95 . Bertha Seib~s~ature> (Address) 38 West Main Street Shiremanstown; Pennsylvania 17011• {Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W . BECTON deceased. To the Register of Wills of CUMBERLAND County, Pennsylvania. The undersigned niece or nephew (and next of kin) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R. McCaleb my ' WITNESS hand this _~_ day of ~ 19 95 o {Signature) Earl Wagner 12 Walnut StAreet Duncannon, Pennsylvania 17020 (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of ARTHUR W . W. BECTON deceased. To the Register of Wills of CUMBERLAND County, Pennsylvania. The undersigned niece or nephew (and next 'of kin.) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Marlin R. McCaleb WITNESS mV hand this day of ~ ~' ~ ~, 19 9 5 ' /; (Signature) Merlin A. Belton (Address) 443 Franklin Street Hamburg, Pennsylvania 19526 (Signature) • (Address) (Signature) (Address) a ` CERTIFICATION OF NOTICE UNDER RULE 5.6 a LAW pFFIC ES .AARLiN R. McCALEB Name of Decedent: ARTHUR W. W. BECTON Date of Death: February 1, 1995 Admin. No. 25-6495840 To the Register: I certify that Notice of Beneficial Interest 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 April 19, 1995: Name Ernest A. Wagner Ruth Messimer ~ Joyce Weikel Carla Hamilton Sandra K. Greider Paul Lester Belton Phyllis J. Leiby Marcelline L. Faust Bertha Seibert Earl Wagner Merlin A. Belton Address c/o Besie Care Center, R.D. 2, Grantville, Pennsylvania 17028 121 Lakeview Lane, Hidden Lake Cameron, North Carolina 28236. 87 Appletree Drive, Levittown, Pennsylvania 19055 2651 Booser Avenue Harrisburg, Pennsylvania 17103 215 Erie Street, Box 178 Dauphin, Pennsylvania 17018 103 Cider Drive, P.O. Box 50 York Springs, Pennsylvania 17372 1163 Derry Street, 2nd Floor, Harrisburg, Pennsylvania 17104 Box 198-F20, R.D. 1, Kempton, Pennsylvania 19529 38 West Main Street, Shiremanstown, Pennsylvania 17011 12 Walnut Street, Duncannon, Pennsylvania 17020 443 Franklin Street, Hamburg, Pennsylvania 19526 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: April 20, 1995 ~' /'~~~Z6 Marlin R. McCa eb Attorney I.D. No. 06353 219 East Main Street P.O. BoX 230 Mechanicsburg, Pennsylvania 17055 (717) 691-7770 FAX: (717) 691-7772 Personal Representative LAW (7FFIC ES MAF2 LIN R. McCALEB -2- t") C7 c ~, =, - L.n ~=' ~. h~ ~~ '~ ~4 '..~. :~+ cs~ :~ -;ej CJ, ~.. REV,1500 EX+ 7-94 r f COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISB RG, PA 17128-0601 DECEO T'S NAME (LAST, FIRST, AND M ~ elton Arthur W. W a H Y 0 0 ~m a h ~ W yZj C p ~z og v z 0 5 a a W z 0 e_ f 0 v a f- /.~ a ~-~o INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) j~~~~3 FOR DATES DEATH AFTER 12131/91 CHECK HERE IF A SPOU AL POVERTY CREDIT IS CLAIMED ^ FILE NUMBER 21-95291 COUNTY CODE YEAR NUM 208 Senate Avenue, Apt. 15 SATE OF BIRTH Camp Hill, PA 17011 02/04/1913 c°°ory Cumberland o OCIAL S URITY NUMBER DATE OF ATH W 9-07-8958 0 01/1995 D APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND DDLE INITIAL) 5 1. Original Return ^ 4. Limited Estate ^ b. Decedent Died Testate (Attach copy of Will) lin R. McCaleb, Es ^ 3. Remainder Return (for dates of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required ._ 8. Total Number of Safe Deposit Boxes Law Offices -Marlin R. McCaleb 219 East Main Street, P.O. Box 230 1. Real Estate (Schedule A) (1) Non 2. Stocks and Bonds (Schedule B) (2) None 3. Closely Held Stock/Partnership Interest (Schedule C) (3) None 4. Mortgages and Nores Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Propert y 7, 055.42 (Schedule E) b. Jointly Owned Property (Schedule F) (b) None 7. Transfers (Schedule G) (Schedule L) (7) None 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) (~'_ 4, 509.79 10. Debts, Mortgage Liabilities, Liens (Schedule I) / (1 6.147 93 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicable Percentage on Reverse Sid I l d l (15) e. ( nc u e va ues from Schedule K or Schedule M ) . 16. Amount of Line 14 taxable at b% rate (16) (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + + _ ?0. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. !l. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A. B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. Make Check Payable to: Register of Wllls, Agent ~~" ~~ Under penalties of perjury, f declare fha it is true, correct and complete. I declare based °P all information of which preps awrvATJsI~ OF PERSON 1'~IBIE FILING (8) 7,055.42 (11) (12) 113) (14) 10, 657.72 _ (3,602 30) None (3.602 30 ) x•-= 0 00 x .Ob = 0.00 x .15 = 0.00 118) 0 00 (19) (20) (21) (21 A) (216) 0 00 ve examined this return, including occompanying schedules and statements, and to the bes all real estate has been reported at true market value. Declaration of preparer other than ~s any knowledge. 219 E. Main St., Mechanicsburg, PA 17055 ^ 2. Supplemental Return ^ 4a. Fufure Interest Compromise (for dates of death after 12-12-82) ^ 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~....v.. ~iyryi ~..-t ~ -- ~f my knowledge and belief, le personal representative is DATE r~ z-~-- DATE Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 ~ 29/0 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1 % (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98 • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (-~) IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: x 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 ................................................................................... X d. receive the promise for life of either payments, benefits or care$ ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding x death transfer property without receiving adequate consideration$ If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving X adequate consideration$ ................................................................................................... x 3. Did decedent own an 'in trust for'. bank account at his or her death$ ...................................... =1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST -COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~~, t,_V ., . "~ ~jc ~ REV-1508 EX + (Z-g~) SCHEDULE E CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNS~YpLVANIA MISCELLANEOUS IN-~F~s~a~NNS~FbT~(RET~(iN PERSONAL PROPERTY Please print or Tvoe ecr.Tr i,~ ESE FILE NUMBER Arthur W. Belton SS# 159-07-8958 02/01/1995 21-95-291 All of with RI ht of8urvlvorshl must be dl9xaosed on Schedule ITEM NUMBE DESCRIPTION VALUE AT DATE PNC Bank, N.A., Checking A OF DEATH 5,981.97 ccount No. 5140149344, 2 Coins in Decedent's possession. 11.25 3 Internists of Central PA, Ltd., check in Decedent's 70.00 possession. 4 Cash in Decedent's possession. 19.00 5 Furniture and furnishings (sold at public sale). 441.50 6 Internal Revenue Service, 1994 federal income tax 402.10 refund. 7 Commonwealth of Pennsylvania, 1994 Tax 129.60 Rebate. TOTAL (Abo enter on line 5, R Itulatbn) S 7 0 .42 (Attach additional 81/2" x 11" sheets ff mare space is needed,) Copyriyht(c)1991fcrm softwus only Csntsr Piscs 3oftwaro, Ine. Form 1500 3chsd E (Rsv. 2-8>) PNC Bank, N.A. " 4242 Carlisle Pike Camp Hill, PA 17011 May 4, 1995 Law Offices of Marlin R. McCaleb Frankeberger Place 219 East Main Street P.O. Box 230 Mechanicsburg, PA 17055 RE: Arthur R. Belton Date of Death: February 1, 1995 Social Security No. 159-07-8958 Dear Mr. McCaleb: PNC 1~~~II~ As per your request for information on accounts the above referenced decedent held with us, the information is as follows: -Checking c~coun~~~t No . 514 01.~ 4~ 4~opened 12 / 01 / 7 5 in the f Arthur Be o1~He7en ~el~n. Balance at date of deat 5 9 $ , 11.97. If I can be of any further assistance, please feel free to contact me at (717) 730-2321. Sincerely, ~~~~~ ~ Edith Tancil Miscellaneous Services Supervisor Bank Operations ET/mky r REV-1811 Ex+ (6-88) COMINHE3IDENTDT~TNT NANIA SCHEDULE H .FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND 21-95-291 Arthur W. Belton SS# 159-07-8958 02 O1 1995 ITEM NUMBER DESCRIPTION AMOUNT A Funeral Expenses: 1 David M. Myers Funeral Home, 3,089.10 funeral expense. B• Adminlstratlve Coate: 1. Personal Representative Comrnissbns Social Security Number of Personal Representative: 17 6 - 34 - 8 707 Year Commissions paid 2. Attomev Fees 3. ~ FamN)f Exemptbn Gatrnant Relatbnahip Address of Gaimant at decedenYa death Street Address ~ State 2lp Code 4. Probate Fees C. Miscellaneous Expenses; 1 Stickers Auction, expenses of public sale of furniture and furnishings. 2 Cumberland Law Journal, advertising. 3 The Patriot-News, advertising. 4 Register of Wills, filing Inventory and Appraisement. 5 Reserve for filing Account, Notices, etc. 0.00 750.00 0.00 121.00 141.50 40.00 48.19 20.00 300.00 TOTAL Also enter on Nne 9, R itulatbn S 4 5 .79 (If more space is needed, insert additbnal sheets of same size.) Copyrlyht (c)1991 form software only Csntsr Piscs Software, Inc. Form 1500 Schedule (Rw. 7-88) REV-1512E7(+ (t0-BB) SCHEDULE I COMMONWEALTHF~PE~NN$yLVANIA DEBTS OF DECEDENT INH€sITANNSS~F T T N MORTGAGE LIABILITIES AND LIENS ESTATE ~ nt IOE Nr r FILE NUMBER Arthur W. Belton SS# 159-07-8958 02/01/1995 21-95-291 ITEM NUMBER DESCRIPTION AMOUNT 1 Susquehanna View Apartments , account payable, rent. 1,107.60 2 Bell Atlantic-PA, account payable, telephone. 50.17 3 Holy Spirit Hospital, account payable, medical 2,075.00 expense for deceased wife. 4 SmithKline Beecham Clinical Laboratories, account 214.25 payable, medical expense. 5 A. Z. Ritzman Associates, Inc., account .Payable, 19.00 medical expense. 6 Holy Spirit Hospital, account payable, medical 2,681.91 expense. TOTAL Also enter on line to, llulation ; 6 1 .93 (If more space is needed, Insert additional sheets of same size.) Copyright (e)1991 form software only Csntsr Plecs 8oitwars, Inc. Form 1600 Sched I (Rev.7-88) m tt~ :~ ~- ~;. c~ 4 _-:. `si:. ifs C"1~ REV-1547 EX AFP (12-95) COMMONNEALTH OF PENNSYLVANIA • DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101 BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 02-12-96 eerere nr ~~~~• HR~nuR w FILE N0. 9 -0 9 DATE OF DEATH 02-01-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT^ REMIT PAYMENT T0: MARLIN R MCCALEB ESA 219 E MAIN ST PO BOX 230 MECHANICSBURG PA 17055 DISCOUNT (+) INTEREST (-) AMOUNT PAID Amount Remitted CUT ALONG THIS LINE - RETAIN LOaER POR_TION_ FOR YOUR RECORDS ~ ---------------------------------------------- --------------------- REV-1547 EX AFP (12-'35) NOTICE OF INHEttYTANCE TAX APPIIAYTSENtNT, ALLOWANCE OR DISALLOYIANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BECTON ARTHUR W FILE N0. 21 95-0291 ACN 101 DATE 02-12-96 TAX RETURN WAS: (X) ACCEPTED AS FILED ( )CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Daposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adn.~ Costs/Misc. Expenses f~Schadule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Nst Value of Tax Return 13. Charitable/Governmental 8egwsts (Schedule J) 14. Net Value of Estate Subject to Tax REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 (1) .00 (2) .00 (3) .00 (4) .00 (5) 7.055.42 (6) .00 (7) .00 (8) 7, 055.42 (9) 4, 509.79 (io) 6.147.93 (11) - 10.6 7 7 (13) .00 NOTE: if an assessment was issued previously, lines reflect figures that in l d 14, 15 andior 16, 17 and 18 will c u e the total of ALL ASSESSMENT OF TAX: returns assessed to date. 15. Amount of Line 14 at Spousal rate (15) • 00 X . 00_ . 00 16. Amount of Lins 14 taxable at Lineal/Class A rata (16) .00 X.06_ 00 17. Amount of Lina 14 taxable at Collateral/Class 8 rata (17) .00 X .15. . 00 18. Principal Tax Due . TAX CREDITS' (18) : 00 PAYMENT RECEIPT DATE NUMBER * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST .00 TOTAL DUE .00 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/21/1997 MC CALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 RE: Estate of BECTON ARTHUR W W File Number: 1995-00291 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. 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 will become delinquent on 2/01/1997. Your prompt attention to this matter will be appreciated. Thank You. S' cerely, MA C. LEWIS REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~ iyU~ ~ ~ ~~1~'~/V~ Date of Death: ~L~rc.~,c.~-y /_r /~ts~ Will No. Adm i n . No . v< ~` ~5~' = 0iZ ~// Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, 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: 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 Cerk of the Orphans' Court and may be aL-tached to this report.. Date : I z3 ~7 ~~~~~ Signature ~~%~~~~~ Name (Please type or print) ra '~v ~,"-~~~ ~"' ,i. alb L~': I c( bZ f~~(' 16. Address Tel. No. Capacity: Personal Representative _~Counsel for personal representative (MAH:rmf/AM3) ACCOUNT OF Marlin R. McCaleb, Administrator for ESTATE OF ARTHUR W. BECTON, Deceased Date of Death: O1-Feb-95 Date of Executor's Appointment: 18-Apr-95 Date of First Advertisement of Letters 02-May-95 Accounting for the Period: O1-Feb-95 19-Apr-96 Purpose of Account: Marlin R. McCaleb, Administrator offers this account to acquaint interested parties with the transactions that have occurred during this administration. The account also indicates the proposed distribution of the estate. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Marlin R. McCaleb, Esquire 219 East Main Street, P.0. Box 230 Mechanicsburg, PA 17055 717-691-7770 PRINCIPAL Page Receipts: Per Inventory Filed or Balance of Prior Account 0.00 This Account 8,689.82 1 Net Gain (or Loss) on Sales or Other Disposition/Principal 0.00 8,689.82 Less Disbursements: Debts of Decedent 0.00 Funeral Expenses 0.00 Administration Expenses 673.69 ~ Federal/State Taxes 0.00 Fees & Commissions 0.00 Family Exemption 0.00 673.69 --- Balance before Distributions ------------ ----------- 8,016.13 Distributions to Beneficiaries 0.00 Principal Balance on Hand -- ----------- 8,016.13 For Information: Investments Made Changes in Investment Holdings INCOME Receipts: Per Prior Account Filed 0.00 This Account 246.02 3 Net Gain (or Loss) on Sales or Other Disposition/Income 0.00 246.02 Less Disbursements 3.00 4 Balance Before Distribution __ ____243.02 Distributions to Beneficiaries 0.00 Income Balance on Hand -- ----------- 243.02 For Information; Investments Made Changes in Investment Holdings Combined Balance on Hand 8,259.15 RECEIPTS OF PRINCIPAL Description Cash: 1995-02-01 PNC Bank, N.A., Checking Account No. 5140149344. 1995-02-01 Coins in Decedent's possession. 1995-02-01 Internists of Central PA, Ltd., check in Decedent's possession. 1995-02-01 Cash in Decedent's possession. 1995-02-01 Office of Personnel Management, CSF death benefits. 1995-05-23 Federal Employees Group Life, life insurance. 1995-02-01 Internal Revenue Service, 1994 federal income tax refund. 1995-07-10 Commonwealth of Pennsylvania, 1994 Tax Rebate. 1996-02-13 Internal Revenue Service, 1995 federal income tax refund. Misc. Personal Property: 1995-02-01 Furniture and furnishings (sold at public sale). Total Receipts of Principal -1- Fiduciary Acquisition Value 5,981.97 11.25 70.00 19.00 32.40 1,500.00 402.10 129.60 102.00 8,248.32 441.50 441.50 8,689.82 DISBURSEMENTS OF PRINCIPAL Administration Expenses: 1995-04-21 Cumberland Law Journal, advertising. 1995-OS-02 Marlin R. McCaleb, reimbursement for probate expenses advanced. 1995-05-02 Marlin R. McCaleb, reimbursement for costs of death certificates advanced. 1995-05-04 Register of Wills, short certificates. 1995-05-19 The Patriot-News,- advertising. 1995-06-23 Brickers Auction, expenses of public sale of furniture and furnishings. 1995-11-02 Register of Wills, filing Inventory and Appraisement. 1995-11-02 Reserve for filing Account, Notices, etc. 1996-02-13 Marlin R. McCaleb, reimbursement for cost of short certificate. Total Disbursements of Principal 40.00 109.00 6.00 6.00 48.19 141.50 20.00 300.00 3.00 673.69 b73.69 -2- RECEIPTS OF INCOME Interest: 1995-OS-23 Federal Employees Group Life, interest on insurance proceeds. 1995-12-31 PNC Bank, 1995 interest on Certificate of Deposit. 1996-03-06 PNC Bank, 1996 interest on Certificate of Deposit. Total Receipts of Income 18.73 97.36 129.93 246.02 246.02 -3- DISBURSEMENTS OF INCOME 1996-02-14 PA Dept. of Revenue, 1995 3.00 Fiduciary income tax. 3.00 -4- AFFIDAVIT Marlin R. McCaleb, Administrator of the Estate of Arthur W. W. Belton, Deceased, hereby declares that he has fully and faithfully discharged the duties of his office; that the foregoing accounting is true, correct and complete and fully discloses all significant transactions occurring during the accounting period; that the attached list or schedule (*) contains the names, addresses and amounts due unpaid creditors having given notice of their claims; that the attached list or schedule (**) contains the names and addresses of all persons interested in the distribution of the said Estate; that all taxes presently due from the Estate have been paid; that more than four months have elapsed since the first complete advertisement of the granting of letters in the Estate; and that the facts set forth in the foregoing Account are true and correct to the best of his knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S., Section 4904, relating to unsworn falsification to authorities Date: April 19, 1996 ~ 4 v~- Marlin R. McCaleb Administrator *UNPAID CREDITORS: 1. Susquehanna View Apartments ($625.69) 208 Senate Avenue Camp Hill, Pennsylvania 17011 2. Holy Spirit Hospital ($1,172.18) 503 North 21st Street Camp Hill, Pennsylvania 17011 3. A. Z. Ritzman Associates, Inc. ($127.67) P.O. Box 655 Camp Hill, Pennsylvania 17011 4. Bell Atlantic-PA ($28.34) Philadelphia SSG 2000 South Broad Street Philadelphia, Pennsylvania 19145-2305 **PERSONS INTERESTED IN ESTATE• 1. Ernest A. Wagner 10180 Allentown Blvd., Grantville, Pennsylvania 17028 2. Ruth Messimer 121 Lakeview Lane, Hidden Lake Cameron, North Carolina 28236 3. Joyce Weikel 87 Appletree Drive Levittown, Pennsylvania 19055 4. Carla Hamilton 2651 Booser Avenue Harrisburg, Pennsylvania 17103 5. Sandra K. Greider 215 Erie Street, Box 178 Dauphin, Pennsylvania 17018 6. Paul Lester Belton 103 Cider Drive, P.O. Box 50 York Springs, Pennsylvania 17372 7. Phyllis J. Leiby 1163 Derry Street, 2nd Floor Harrisburg, Pennsylvania 17104 8. Marcelline L. Faust Box 198-F20, R.D. 1 Kempton, Pennsylvania 19529 9. Bertha Seibert 38 West Main Street Shiremanstown, Pennsylvania 17011 10. Earl Wagner 12 Walnut Street Duncannon, Pennsylvania 17020 11. Teresa Masters 213 Palermo Drive Fort Walton Beach, Florida 32547 12. Ronald Osborne General Delivery P.O. Box 28 Swengel, Pennsylvania 17880 13. Elaine May 17 South Market Street Duncannon, Pennsylvania. 17020 14. Betty Jean Burd 546 Fishing Creek Road Lewisberry, Pennsylvania 17339 -2- 15. Sharon Drayer 4616 Crooked Hill Road Harrisburg, Pennsylvania 17110 16. Arthur Freeman, Jr. 67 Camber's Corner Duncannon, Pennsylvania 17020 17. Merlin A. Belton 443 Franklin Street Hamburg, Pennsylvania 19526 18. Dale K. Wagner 2641 Grand Street Williamsport, Pennsylvania 17701 19. Ronald Wagner 35 Reed Avenue Marysville, Pennsylvania 17053 20. Robert Peters c/o William Peters 1035 State Road Duncannon, Pennsylvania 17020 21. William Peters, II c/o William Peters 1035 State Road Duncannon, Pennsylvania 17020 22. Larry Peters c/o William Peters 1035 State Road Duncannon, Pennsylvania 17020 23. Russel Kiner, Jr. 112 Roseglen Road Duncannon, Pennsylvania 17020 24. Kenneth Kiner 20 North Enola Drive Enola, Pennsylvania 17025 25. Edward Kiner -120 Ann Street Duncannon, Pennsylvania 17020 26. Jane Engle Bunker Hill 1404 Yorktown Road Mechanicsburg, Pennsylvania 17055 -3- 27. SmithKline Beecham Clinical Laboratories P.O. Box 13858 Philadelphia, Pennsylvania 19101-3858 28. David M. Myers Funeral Home Second & Walnut Streets Newport, Pennsylvania 17074 -4- S . STATEMENT OF PROPOSED DISTRIBUTION BY MARLIN R.McCALEB, ADMINISTRATOR OF THE ESTATE OF ARTHUR W. W. BECTON, LATE OF EAST PENNSBORO TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED MARLIN R. McCALEB, Administrator of the Estate of Arthur W. W. Belton, Deceased, proposes to distribute the balance of said Estate in his hand, to wit: $8,259.15, in accordance with Section 3392 of the Probate, Estates and Fiduciaries Code of Pennsylvania, as follows: The Costs of Administration (Section 3392 (1)): TO: Marlin R. McCaleb, Esquire, attorney's fee: 750.00 750.00 The Family. Exemption (Section 3392 (2)): No eligible claimant The Costs of Decedents Funeral and Burial and Medical and Hospital Services Furnished Within Six Months of Death (Section 3392 (3)): TO: 1. David M. Myers Funeral Home, funeral expense: 2. Holy Spirit Hospital, medical services rendered 1/31/95-2/1/95: 3. A. Z. Ritzman Associates, medical services rendered 1/31/95: 4. SmithKline Beecham Clinical Laboratories, medical services rendered 10/25/94: The Cost of a Gravemarker (Section 3392 (4)): No eligible claimant None 3,089.10 2,681.91 19.00 214.25 6,004.26 None Rents for Six Months Prior to Death (Section 3392 (5)): LAW OFFICES MARLIN R. McCALEB No eligible claimant None All Other Claims (Section 3392 (6)): (Claimants paid at 43.51% of original claim. Amount of original claim stated in parentheses) TO: 1. Susquehanna View Apartments, rent and late charges, 2/1/95 - 3/31/95 ($1,107.60): 481.91 2. Bell Atlantic - PA, account payable, telephone ($50.17): 21.83 3. Holy Spirit Hospital, account payable, medical services provided in 1987 ($2,075.00): 902.82 4. A. Z. Ritzman Associates, account payable, medical services provided 7/19/94 - 7/20/94 ($226.00): 98.33 1,504.89 TOTAL TO BE DISTRIBUTED: $ 8,259.15 Marlin R. McCaleb Administrator LAW OFFICES II MARLIN R. MCCALEB -2- AFFIDAVIT MARLIN R. McCALEB, hereby certifies and says: that he is the Administrator of the Estate of Arthur W. W. Belton, Deceased; and that the facts set forth in the foregoing Statement of Proposed Distribution are true and correct to the best of his knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S., Section 4904, relating to unsworn falsification to authorities. Date: April 19, 1996 ~~~~w[c-L Marlin R. McCaleb Administrator LAW OFFICES MARLIN R. McCALEB -3- COMMONWEALTH OF PENNSYLVANIA ' COUNTY OF CUMBERLAND S5 JUNE 18 19 96 I, Mary C. Lewis, Register for Probate of Wills and granting Letters of Administration for the County of Cumberland, in the Commonwealth of Pennsylvania, do hereby certify the foregoing to be true and accurate copies of the FIRST AND FINAL ACCOUNT OF MARLIN R.MCCALEB ADMINISTRATOR O THE ESTATE OF ARTHUR W W B T TON ATF O , F___AyT PENNSBORO TnWNNTP r ,_ CUMBERLAND COUNTY. PENNSvLVANTA DFC ASFn as the same were passed and advertised and remain on file and of record in this office. IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal the date above. C Mary C. Lewi ,Register of Wills NOW TO WIT, JUNE 1819 9 6 ,came into Court MARLIN R. MCCALEB , ADMINISTRATOR and presented an account and statement of proposed distrubution, which were examined, passed, approved, and confirmed with a balance in his hands of $ * . (~ ~ (. ! ~ and the. accountant was directed to distribute said balance in accordance with the statement of distribution filed. i M C. is, Clerk oft Orphans Court COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ~ ss I, Mary C. Lewis, Clerk of the Orphans' Court, in and for said County, do hereby certify the foregoing to be a true copy of the account and statement of proposed distribution of MARLIN R. MCCALEB ADMINISTRATOR as full and entire as the same remain on file and record in this office. IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal at Carlisle, this 18th day of _ JUNE 1991i- ,~ Mary ewis, Clerk oft Orphans Court `''•`~- ~ ~' ~ ~Y'~ 4;:ceunt Gonfiir!~na~ci ~absolutaly and dish?'~~±?!on decr~~;r; in accord:~rica wits er~Ycszd selad uie Af ~i;tri~azj~,~ n~rr~mriti~. ~~ ?fiar-. m 3 ~ ~Q ~~~ o ~ ,'~ ~O' _~~ ~a m~ ~oC~ ~ T ~.o Der q0 (7f~°~ W ~ e u~ ~ H O mo ~ ~ y ~ . d ~ ~ ~ C ~ ~ z ~ ~~ ~ ~ p ~ z t~-'oy C H ~ y O ~ ~ Ca c N ~ C ? d H ~~ nro''~z ~ ~ ~ ~ ~ z z ~ a, 4 --~ H~ ro zY o ~' G o ~ ~ e~ ~ o ~~ d t77 ~ ~ ` ('~ H ~ O ~ Hz H~ °z ~O H O