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11-15-12
1505610105 REV-1500 EX (OZ-ii) (FI) OFFICU\L USE ONLY PA Department of Revenue P~Y~ County Code Year File Number Bureau of Individual Taxes °'""°"`~°`""""°` Po Box z8o6o> INHERITANCE TAX RETURN !~ "" Harrisburg, PA i~>?8-o6oi RESIDENT DECEDENT ~ ~ ~ 02 Ul.l[ 7~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 03/18/2012 10/14/1912 Decedent's Last Name Suffix Decedent's First Name MI Mell Helen R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILE D IN DUPLICATE WRH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) m 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Michael A. Scherer, Esq. (717) 249-6873 First Line of Address Baric Scherer LLC Second Line of Address 19 West South Street City or Post Office Carlisle State ZIP Code PA 17013 REGISTER OF WILLS USE ONUF-:~ ~ `:tea -rj r--, r'1 = i -';- . ` C.j l ~_,._ , L~ ~_-. _f DATE FIEF ~,~ or Cortespondent's e-mail address: mscherer~baricscherer.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedu~s and statements, and to the best of my knowledge and belief, it is try,P, correct and complete. Declaration g( preparer othgLthan the personal representative is based on all information of which preparer has any knowledge. 397 PetersJ~(.Irg Road, Carlisle,'Pennsylvania 17015 DATE ~' ~~~~Z 19 West South Street, Carlisle, Pennsylvania 17013 PLEA8E U8E ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J -~-a ~= ~ '---~ jJJ ~_ i -ti 1 ;~ _7~~ .-`~{.., r; _- ~ J r-r-t t __ ~:f3 °n 1505610205 REV-1500 EX (FI) Decedent's Social Security Number ~eceaenYs Name: Helen R. Mell ' RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. , 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. 30,000.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 1,516.58 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 31,516.58 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 8,419.87 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 131,863.24 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. ' 140,283.11 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value SubJect to Tax (Line 12 minus Line 13) ...................... .. 14. 0.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable '~~~'"~ - r-~------.-____._...___._..._.._..._.~......_._..__.._,.. at lineal rate X .0 _ I 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 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENTS NAME Helen R. Mell STREET ADDRESS 399 Petersburg Road CITY Carlisle STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) 0.00 (3) (4) (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c. retain a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ......................................................... ^ ............................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §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 decedents lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • 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)J. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1507 EX+ (6-98) SCI~IEDVLE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen R. Mell 21-12-0670 All property JolnUy~owned with right of survlvorshlp must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-i5o8 EX+ (o8-u) jiy Pennsylvania SCHEDULE E L1J DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Helen R. Mell 21-12-0670 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) ~ Pennsylvania DEPARTMENT OP REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Helen R. Mell 21-12-0670 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Ewing Brothers Funeral Home, Inc. 5,619.69 B. 1 2 3 4. 5. 6. 7. s. s. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant None ZIP Street Address City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees; The Sentinel Cumberland Law Journal ZIP 2,500.00 67.50 157.68 75.00 TOTAL (Also enter on Line 9, Recapitulation) I ~ If more space is needed, use additional sheets of paper of the same size. 8,419.87 REV-1512 EX+ (12-08) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Helen R. Mell 21-12-0670 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. Ir more space Is needed, insert additional sheets of the same size. ~~CC~d fur ,mac Ol^ HELEN R. MELL I, HELEN R. MELL, of Cumberland County, Pennsylvania, being of sound 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. ITEM ONE: I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, in this connection, f authorize my persona! representati~re to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. ITEM TWO: I give, devise and bequeath the rest, residue and remainder of my estate of whatever nature and wherever situate as follows, per stirpes: One-third to my son, RAY MELL; 2. One-third to my daughter, POLLY THOMPSON; 3. One-third equally to each of my grandchildren, RONALD E. MELL, JR., SHERI L. MELL-MOTTER and RUSSELL D. MELL. ITEM-THREE: I direct that no executrix or other fiduciary named, nominated, or appointed by this my Last Will and Testament shall be required to post any bond or give any security of any type for any purpose whatsoever, any law or rule of the Court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. I direct that the law of the Commonwealth of Pennsylvania shall apply to any interpretation or application of the validity of this instrument. ITEM FOUR: Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to an heir, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. ITEM FIVE: I confer upon my executrix the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my executrix shalt determine, and to execute and deliver good and sufficient conveyances, assignments and transfers of the property, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments, or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so- called "legal investments;" to make distribution in cash or in kind; to allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in case or in kind, or partly in each; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. ITEM SIX: I appoint my granddaughter-in-law, SHERYL MELL, executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of four (4) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification, this `~~~ day of ~f ~U'1 G , 2007. ~~,~~-'%~, t~~% .~ ~ ~ (SEAL) Helen R. Mell Signed, sealed, published and declared by the above named Testatrix, Helen R. Mell, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ,~ ~ ~ ADDRESS --'~ ~ /~f~-~, ~,,~ ,~.,~' ,:.,; ~,.~,~~,:. , ~, 79vJa~ ~~, LH3 /~V/3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, Helen R. Mell, N~1 iGnc~~l ~-5c~'~ and ~Jznni~l~.~ ~5- t.~ l~d5a~ ,the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument of her Last Will and Testament, and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses, and that to the best of their knowledge, the testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Swom to and subscribed before me this ~ `~~~~ day of ~~~-~-~e _, 2007. ~~ COMMONWEALTH OF PENNSYLVANIA Notarial Seal Amanda L. Esher, Notary Public Carlisle Boro, Cumberland County My Commission Expires Apr. 17, 2010 Member, Pennsylvania Association of Notaries ,~ IN RE: : IN THE COURT OF COMMON PLEAS OF HELEN MELL CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION N0. 21-11-1288 DECLARATORY JUDGMENT ACTION ORDER OF COURT AND NOW, this Ig~day of 2012, upon consideration of the within Petition, it is hereby ordered and decreed that Sheryl Mell is hereby authorized, pursuant to the Power of Attorney dated March 7, 2003, to execute an Installment Sales Agreement as Agent for Helen Mell, to sell 399 Petersburg Road, Carlisle, Pennsylvania to Ronald Mell, Jr. for the sum of $30,000.00. The hearing scheduled in this matter for Monday, February 6, 2012 is hereby canceled. BY THE COURT, . L. Ebert, Jr., Michael A. Scherer, Esquire 19 West South Street Carlisle, Pennsylvania17013 Russ Mell 328 West Old York Road Carlisle, Pennsylvania 17015 Sheri Mell-Molter 251 Clay Road Carlisle, Pennsylvania 17015 Ray Mell , ~~'-' 3119 RitnerHighway NewviNe, Pennsylvania 17241 - Polly Thompson _, 505 Adams Road - ~- Carlisle, Pennsylvania 17015 ~ ' tit i esii~a~ny v~harof, 1 hereantu set my hand and the neat of sCourt at Carlisle, PA Thl tdays~t/CI/lUQ zp ~i~ ~. L~. _ t'.~t~ ^~ :tip ~;p9~a~ a f;c'~st .,, , ,: 'r IN RE: IN THE COURT OF COMMON PL~,4S OF _~: -_,, HELEN MELL CUMBERLAND COUNTY, PENNSIc`L~ANIA; , __~' ORPHANS' COURT DIVISION - '`~ ~ -= -- NO. 21-11-1288 `--' ~, - DECLARATORY JUDGMENT ACTION ~ - `~" ` ~' PETITION UNDER DECLARATORY JUDGMENT ACT FOR ORDER PERMITTING THE INSTALLMENT SALE OF REAL ESTATE BY PRINCIPAL'S AGENT AND NOW, comes Sheryl Mell, Agent for Helen Mell, by and through their attorney, Michael A. Scherer, Esquire, and respectfully represents as follows: 1. The Honorable M.L. Ebert, Jr. has been assigned to this case. 2. All interested parties are in agreement with the relief requested herein. 3. On December 1, 2011, undersigned counsel filed a Petition in this matter requesting that Sheryl Mell be permitted to sign an Installment Sales Contract to sell real estate owned by Helen Mell situate at 399 Petersburg Road, Carlisle, Pennsylvania to Ronald Mell, Jr. for the sum of $30,000.00. A copy of the Petition is attached as "Exhibit A." 4. This Honorable Court set a hearing in this matter for February 6, 2012 at 3:00 p.m. in Courtroom Number 2 of the Cumberland County Courthouse. 5. All of the heirs of Helen Mell were notified of the hearing. 6. At this time, all interested parties in the transaction, who are the heirs of Helen Mell and the Department of Public Welfare, have agreed to the transaction, as evidenced by the attached Consent forms. 7. Undersigned counsel met with Helen Mell on October 18, 2011 at Forest Park Nursing Home and despite her advanced age, undersigned counsel believes Helen Mell understands the proposed transaction and consents to the proposed transaction, because: A) Helen Mell does not believe she will return to her home at 399 Petersburg Road, Carlisle, Pennsylvania; and, B) Helen Mell believes that the Department of Public Welfare lien for medical assistance which pays for her stay at Forest Park will consume any funds in her estate generated by the sale of her only asset- namely the home at 399 Petersburg Road, Carlisle, Pennsylvania; and, C) Helen Mell prefers that her real estate be in the ultimate control of her grandson, Ronald Mell, Jr., since he owns adjacent real estate. WHEREFORE, Sheryl Mell requests that this Honorable Court issue an Order permitting her to execute an Installment Sales Contract to sell 399 Petersburg Road, Carlisle, Pennsylvania to Ronald Mell, Jr. for $30,000.00. Respectfully submitted, BARK SCHERER LLC Mi ae cherer, Esquire I.D. # 61974 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 r . ~' IN RE: IN THE COURT OF COMMON PLEAS OF HELEN NiELL CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DECLARATORY JUDGMENT ACTION CITATION AND NOW, this day of , 2011, upon consideration of the within Petition For Declaratory Judgment Pursuant To 42 Pa.C.S.a. SS 7535, it is hereby ordered and decreed that a citation is awarded, directed to: ~~ Russ Mell 328 West Old York Roady z Carlisle, Pennsylvania 17 .. `- T yid Sheri Mell-Molter -~ --. 251 Clay Road Carlisle, Pennsylvania 17015 .~, ~4 ~--, Ray Mell 3119 Ritner Highway Newville, Pennsylvania 17241 Polly Thompson 505 Adams Road Carlisle, Pennsylvania 17015 i.~3 C to appear and show cause, if any there- be, why the Court should not authorize Sheryl Mell to enter into an installment sales contract to self 399 Petersburg Road, Carlisle, Pennsylvania to Ronald Mell, Jr. for the sum of $30,000.00. CITATION returnable the lo~`day of ~-~ ~'~~'"4'"~' , 2012, at ~D~ a~/p.m. prevailing time in the Orphans' Court Division, Court Room o2., Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT, ._ __~ a' ~~~----= J. ~~~/ / , 'EXHIBIT A" `, ,; -r-i [~",'~'; ~.~ -r, ~ ' IN RE: HELEN MELL IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. _~ DECLARATORY JUDGMENT ACI .v r - .~ -~ : f t- "~:. ', PETITION FOR DECLARATORY JUDGMENT `' r~ «~' -~~. PURSUANT TO 42 PA.C.S.A. 7535 `=~=?-~-~ =r; -..1 -~ AND NOW, comes Sheryl Mell, Agent for Helen Mell, by and through~their attorney, Michael A. Scherer, Esquire, and respectfully represents as follows: 1. No judge has been assigned to this case. 2. The Orphans Court has jurisdiction to hear this matter pursuant to 20 -,~ . , ~-, -., - _ - - T' r Pa.C.S.A. Section 711, which states that "the jurisdiction of the court of common pleas over the following shall be exercised through its orphans' court division: "711(22) Agents-All matters pertaining to the exercise of powers by agents acting under powers of attorney as provided in Chapter 56 (relating to powers of attorney)." 3. Helen Mell was born October 14, 1912, and is 99 years old. 4. Helen Mell has been a resident of Forest Park Nursing Home, 700 Walnut Bottom Road, Carlisle, Pennsylvania 17013 since October, 2010. 5. On March 7, 2003, Helen Mell signed a Power of Attorney naming Sheryl Mell as her agent. A copy of the Power of Attorney is attached hereto as "Exhibit A." 6. Sheryl Mell is Helen Mell's granddaughter-in-law. 7. Sheryl Mell is married to Helen Mell's grandson, Ronald Mell, Jr. 8. The Power of Attorney mentioned above allows Sheryl Mell to engage in real property transactions on behalf of Helen Mell. 9. Helen Mell owns .real estate situate at 399 Petersburg Road, Carlisle, Pennsylvania 17015. 10. Helen Mell previously resided at 399 Petersburg Road until approximately November, 2010, when she became a resident of Forest Park. 11. Since Helen Mell became a resident of Forest Park, her home on Petersburg Road has been vacant. 12. There is no mortgage on 399 Petersburg Road, however, taxes, insurance and maintenance expenses continue to accrue on the property. 13. There is little chance Helen Mell will return to 399 Petersburg Road. 14. A recent market analysis of Helen's home indicated a suggested list price of $52,900.00. The market analysis prepared by William Ohrurn, of ReMAX. Helen Mell's indicates that the home is small and antiquated. A copy of the market Analysis is attached as "Exhibit B." 15. Due to its size, Helen Mell's home would be considered a starter home, however many upgrades are needed to the property and it is very doubtful conventional financing could be obtained for the property according to Sheri Mell-Molter, Helen's granddaughter, who is a loan officer with Sovereign Bank in Carlisle. , ., a 16. Helen's home has two small bedrooms and is in need of structural repairs, including electrical, plumbing and foundation work. 17. The cost to perform the structural repairs is approximately $25,000.00 according to the estimates from Armold and Son Excavation, P. Edward Mullin Construction and Central Penn Waterproofing, which are attached as "Exhibit C." 18. Helen Mell had three children: Raymond Mell, Polly Thompson and Ronald Mell, Sr. Raymond Mell and Polly Thompson are alive, and Ronald Mell, Sr. is deceased. 19. Ronald Mell, Sr. had three children, Russ Mell, Sheri Mell-Molter and Ronald Mell, Jr. 20. There are no other heirs of Helen Mell. 21. Ronald Mell, Jr. would like to purchase Helen Mell's house under an installment sales contract, since Ronald Mell, Jr. lives directly behind Helen's house. The sale price would be $30,000.00. 22. The only person who will not agree to the transaction is Ray Mell. A copy of his letter of objection is attached hereto as "Exhibit D." 23. Undersigned counsel wrote to the heirs of Helen Mell in an effort to obtain their consent to the transaction due to the inherent conflict of interest for Sheryl Mell to authorize the transaction on behalf of Helen Mell. A copy of undersigned counsel's letter to the heirs is attached as "Exhibit E." 24. Helen Mell's stay at Forest Park Nursing Home is funded primarily by the Department of Public Welfare. 25. DPW has a lien against Helen's estate for monies advanced to Forest Park for Helen Mell's stay. 26. DPW's lien was approximately $41,000.00 as of October 31, 2011, as set forth in "Exhibit F." 27. DPW would get the first $41,000 of Helen Mell's estate after administrative expenses were paid if DPW would not provide further assistance to Helen Mell hereafter. 28. Each month Helen Mell relies upon DPW assistance, the DPW lien grows by approximately $5,000.00. 29. Even if Helen Mell's DPW lien stopped increasing, it is likely that Helen Mell's heirs would not receive anything from Helen's estate. 30. Undersigned counsel wrote to DPW in order to get permission for the sale of Helen's home to Ronald Mell, Jr, pursuant to the proposed Installment Sales Contract. A copy of undersigned counsel's letter is attached as "Exhibit G." 31. DPW approved the transaction. DPW's approval letter is attached as "Exhibit H." 32. Undersigned counsel met with Helen Mell at Forest Park on October 18, 2011 and Helen Mell seemed to undersigned the nature of the transaction, the growing DPW lien and she consented to the transaction proposed herein. ,, 33. The Declaratory Judgment Act, 42 Pa.C.S.A. Section 7531, provides that persons interested, as through a fiduciary, may have a declaration of rights or legal relations in respect thereto to direct fiduciaries to do or abstain from doing any particular act in their fiduciary capacity. See 42 Pa.C.S.A. Section 7535. WHEREFORE, Sheryl Mell requests that this Honorable Court issue a citation to the following persons to show cause why Sheryl Mell should not be able to execute an Installment Sales Contract to sell 399 Petersburg Road, Carlisle, Pennsylvania to Ronald Mell, Jr. for $30,000.00. Ray Mell 3119 Ritner Highway Newville, Pennsylvania 17241 Russ Mell 328 West Old York Road Carlisle, Pennsylvania 17015 Polly Thompson 505 Adams Road Carlisle, Pennsylvania 17015 Sheri Mell-Molter 251 Clay Road Carlisle, Pennsylvania 17015 Respectfully submitted, BARK SCHERER LLC Gv~ Michael A. Scherer, Esquire I.D. # 61974 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CURABLE C,c.r~e.~ ...~ ~~~. SOWER OF ATTOR111EY ~tor~cE THE PURPOSE OF THIS POWER OF ATTORNEY IS T® GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE PONfERS TO SELL OR ~ OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVAAICE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, LIMIT THE DURATION OF THIS POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTIiORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS. A COURT CAN TAKE. AWAY THE POWERS OF Y®UR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA. C. S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN i11' TO YOU, - I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. MARCH 7, 2003 HELEN R. MELL "ExHIBIT A" DURABLE GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, that 1, iiELEN R. MELL, of 399 Petersburg Road, Carlisle, Pennsylvania 17013, do by these presents make, constitute and appoint SHERYL MELL (hereinafter referred to as "my agent"), my true and lawful agent under a power of attorney, for me and in my name and on my behalf generally, to do and perform alf matters and things, including, without limiting the generality of the foregoing, to transact all business, to make, execute, acknowledge, endorse and deliver al! deeds of conveyance, certificates of stock, bonds, car titles, releases of lien or satisfaction of bonds and mortgages, contracts, orders, releases, checks, notes and endorsements, transfers and assignments of any such contracts, specifically including but in no way limited to the execution in my name of checks or orders of any nature for the withdrawal of funds standing to my credit in any type of account in any bank, building and loan association or other financial institution, and also to deposit in any accounts in my name in any such institutions any money, funds, checks or drafts, payable or belonging to me; to enter my safe deposit boxes in any and all banking institutions and to establish new safe deposit boxes and to add to and to remove any of the contents thereof; to borrow money and to mortgage, pledge or hypothecate any property, real or personal, now or hereafter owned by me as security therefore; to buy, sell possess, insure, manage, maintain, improve, lease, mortgage, pledge, encumber, convey and otherwise dispose of, or take any other action with respect to, any property, real or personal, now or hereafter owned by me, on such terms and conditions as my agent may consider appropriate, and in the event of sale of any of my real estate, to execute the sales agreement and the deed in my name and to make settlement and receive the proceeds; and to prepare, execute and file any tax returns, governmental reports and other instruments of whatever kind, and likewise to execute any and all writings, assurances, instruments or documents which may be requisite or proper to effectuate any matter or thing appertaining or belonging to me. I hereby authorize my agent to contract with and arrange for my entrance to any hospital, nursing home, health center, convalescent home, residential care facility or similar institution, io authorize medical, therapeutic and surgical procedures for me and to pay all biNs in connection therewith. GIVING AND GRANTING unto my agent full authority and power to do and perform any and all other acts necessary or incident to the performance and execution of the powers herein expressly granted, with power to do and perform all acts authorized hereby as fully to all intents and purposes and with the same validity as I might or could so if personally present, hereby ratifying and confirming whatsoever all that my agent shall lawfully do or cause to be done by virtue hereof. AND, i hereby declare that any act or thing lawfully done hereunder by my agent shall be binding on myself and my heirs, legal and personal representatives and assigns. AND, if incapacity proceedings for my estate or person are hereafter commenced. l hereby nominate my agent to be appointed the guardian of my estate or person by any court having jurisdiction in accordance with the provisions of Section 5604 (c) (2) of the Probate, Estates and Fiduciaries Code. This Power of Attorney shall continue in force and maybe accepted and relied upon by anyone or any entity to whom it is presented despite my purported revocation of it or my death, until actual written notice of any such event is received by such person or entity. (n the event of my incapacity from whatever cause, this Power of Attorney shall not thereby be revoked but shall thereupon become irrevocable and may be accepted and relied upon by anyone or any entity to whom it is presented despite such incapacity, subject only to it becoming void and of no further effect only upon receipt by such person or entity either of (1 }written evidence of the appointment of a guardian for similar fiduciary} of my estate following adjudication of incapacity, or (2} written notice of my death. This Power of Attorney shat! not be affected by my subsequent disability or incapacity. This power of attorney shat! rescind and revoke any other powers of aftomey previously made by me. IN WITNESS WFIEREOF, !have hereunto set my hand and seal this 7"' day of March, 2003. WI .N SED BY: IiELEN R. MELL (SEAL) COMMONWEALTI~ ®F PEIVNSYL!/ANIA COUNTY ®F CUMBERLAN® :SS: On this, the 7T" day of March, 2003, before me, appeared FIELEN R. MELL, known to me or satisfactoril the undersigned officer, personally is subscribed to the within instrument, and acknowledged thatt she eh a uted same fora he purposes therein contained. a Notary Public NOTi~g~-'- HAilO1DS. IF~YNM,1N,1ilOTApY ~ r_ ~l' ACKNOWLEDGMENT ET AGENT I, SHERYL MELL, have read the attached Power of Attorney executed by HELEN R. MELL and am the person identified as the Agent for the PRINCIPAL. I hereby acknowledge that in the absence of a specific provision to the contrary in the Power of Attorney or in 20 PA. C. S. when I act as Agent: ! shall exercise the powers far the benefit of the PRINCIPAL. f shall keep the assets of the PRINCIPAL separate from my assets. shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the PRINCIPAL. March 7, 2003 ER L L COMMONIMEALTH OF PENNSYLVANIA :SS: C®UNTY ®F CUMBERLAND On this, the 7"' day of March, 2003, before me, the undersigned officer, personally appeared SHERYL MELL, known to me or satisfactorily proven to be the person whose name is subscribed to the within acknowledgment and acknowledged that she executed same for the purposes therein contained. WITNESS my hand and seat the day arld year aforesaid. Public N01I~iMA~.gEA1. i~AROtJD S. IRYYN. r, NORNi1f PUBEiG C111~tE OOIgl1911, OOIMR OF MY~1~~ ~- y- ' A, Seller's Estimated Proceeds Williun Ohtum, CSP, CDPE, Office: 717-432-1436 Office Far. 717-432-8187 Direct717-5U2-8929 Ce//u/ar.•717-571-94.55 Emi/.• wohrum@remax.net Each Office Independently Owned and Operated. ~, ~- "EXHIBIT B" DISCLAIMER Items and amounts presented are estimates only. „. Jul 20''r' 1 05:55p Armold & Son Excavation Armold & Son Excavation,LLC 556 Roxbury Rd. Newville. PA 17241 PA021789 Name r Address Ronald Mell P.d. # Term s Description Backhoe Pufaving Fee Backhoe Services Precast Steps With Se[co Oaors & Installation ~rrtoPd St Son Excavation,~lC 7177767749 0 , 2 Date 7!2012011 Estimate # 48 Due Date 7120/2011 Qther Qty Rate Total 1 100.00 100.00 2.5 85.00 212.50 3 2, 978.30 2, 978.30 Subtotal $3,290.80 Sales Tax (0.09b) $a.o0 Total $3,290.80 717-776-5322 717-776-7749 "EXHIBIT C" Jui 20 4~? 05:55p Armold ~ Son Excavation ,4rmoJd & San Excavation,LLC 556 Roxbury Rd. Nevwille, PA 17241 PA02f 789 77 T776 //4y p..~ Date 7/20/2011 Estimate ~ 49 iVame /Address Ronald Mell P.O.# Term s Description Service Call Excavation Labor V 100 Tank 1f2" Broiler Drain Tank Tee 1" Check vahre 1I4"X4" Bress Nipple Pressure Relief Valve Pressure Swritch Pressure Gauge dlrmtofd & Sorr Excaeiatioo,lLC Due Date 7120/2011 Other Qty Rate 1 50.00 1 50.00 1 264.59 1 fit.94 1 45.50 1 30.32 1 3.26 1 8.23 1 18.84 1 a.s7 Total 50.00 50.00 294.59 6.J4 45.50 30.32 3.26 6.23 1 B.84 4.fi7 Su btQta! Sates Tax (O.b%} Total 7i7-776-5322 71T-776-7749 Yr512.35 X0.00 Y512.35 y , i w P. Edward Mullin e: ~on~truction & Maintenance t ~°11~""'-=~~ 128 Woods Road PA075136 Newville, PA 17241 (717) 776-4085 ~~~ ~'? (717) 713-4048 cell Name ~},~ ~ ~j~!,~ Date /7"~~' ~~ Phone Quanti Descri tion Unit Price Amount ~' ~ ~ J ,- ~s~ ~' ~~ ( 1 (> li~~ l'"'y'L C. :. PF,~ f~~, ~i ;~-•'~., ..'" f" ~~ ; ~ J e /'/ P 4-' -- ; r I /:,,.i r1a..G / . rr 1 ~I'Q~IISfII Harrisburg 728-9550 Reading 372-9001 York 843-5396 Central Penn Lebanon 272-5446 Lancaster 399-0050 Williamsport 327-1994 Carlisle 243-7195 W r r fi t Sunbury 286-2878 State College 814-237-1797 Chambersburg 264-2742 p e oo ng a West Chester 610~F29-9924 Scranton 570-341-7000 Allentown 610-435-4420 800-531-6793 Pro al Submitted To Pis Phone (HOME) ~ f ~ '} 7 ~~-~' ~ ~ ~.::~ ~~ - ~ Data ald '- I! I ~,~ r 1 ,~. li Yl ~1, .~ r r Phone (wOnK) -I Street ~, ~ Job Name ~ ~; `( ~ ~L, t ~ ; 54;,1..; , ~ r is l~ `~ ~'~ ~' l ~ City, ,State and Zip ,Cgde ~ Job Location : rl ~2 ~ ( ~ Y L...G~' I s~ .. . We hereby submit specifications and estimates II Opening to Cut ~pe of Wsll Finish i Pl ,O Black Wall n a ~- i O Wood Waft ^ Paneling O Plaster Board O Other O Other __ - ~ rpe or wau ~ £ , e of Floor Finish T p Block p O Pour Concrete i k ^ B Concrete ^ Tile r c O Other O Carpeting ^ Other S stem to Dratn into M Sump Pump Obstsclss to go arour O Floor Drain ^ Soil Pipe O Sump Pump O Plaster (ta be insladed ~HOrWaterWbater by owner) O Other O Oil Tank ~] Behind' O Other Ths nonaatter's repeeanWive has tiny eePlakud the metib ~ the Prenwe Keifer ayatem. I undsafand Mtt Preeeue Relief system volt rornedy tke Problem wsh watt saapsgs Doming tram wads a below Ibar slab. l lady utdentaM tl+s wsrmnly wAtldt a aeue0 upae oompsldn d every job ~ srecePt ~'~y'~~'a ~«r~W b tdre bane twnan rot Ihs dwedon of tlw wamnry. Than will be no charge tar sarrioe cads whidt ss leaks in the PreY1Pe ReYaf syslws aoeertl under M wanalay. Arh aenioe tats whidl an cwt Nslat n aN syalam or teaks troy dnnags ar abuse veld bs chacgad S50 mininwm Nld f2S Pot man hour or anQ servios at?ddl doM not ktr~tds labor rtr Pump aarvibs.3tahP Ptenpi as ~~ ands manuktckrer's wartatllyt InehYatlen of the Preewle Reket axons will not elimirwte maigtae rJUOed by eanOstts~olt,liVaRiMy doss net Dover nstutal dlesalsts. hunfrJtltss. flobdR ek. Applytg intanor'wd ssren alone veld nd resque wsMr seepage dw to high water t~la, byd~~ Problean. It~liar dthe ayslan dbs rot include PakclYg. rniabsd alpenby. aleeMo hoekyD. or nWaoernanl d floc tik ar rapelkcg un6ps spedied. ParmeM b ~~ ~ruyns~~ereby to fprnjsh mat nal end I~Qt co ~ete g~acco5dance with above spt3cificatio~t~,~i#tt~um of: ~ ~ /~. ;w CNt a ~.sc_..L1 ¢ c: i; ~ ~,.n c+ / tLt Th , r ~c ~ ~ d~..'~f-- dollars (3 'r d~1 // ) y __ ,,;~/ All material is guaranlaed to be as specified. All work to be oompNted m a workmanlike manner according to dte standard practices. Airy alNrstfons ar dwiations from above speeifiealiens imohring erdn can will tw azeeuted only upon strikes, accidents or delays beyond our control. Authorized Signature ~~ ~- r a / ;, 1 Note: This proposal may be withdrawn by us if not accepted within days. ,acceptance of ~rapasal -The above prices, specifications and conditions Signature are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: SlgnatUft? Observations regarding Ron Mell's proposal to purchase Helen Mell's real estate: 1. DPW's approval of the proposal should be discussed in tight of the fact that DPW stands to collect all monies due for Helen Mell's Gaze through this agreement in light of Ron Mell's agreement to °obtain a •toa~n to pay aI.1 rrronres •due DPW upon •Helen bell's •death. If the real estate were to be sold on the open market DPW would have to settle for the revenue from that sale, regardless of the amount due for care at the time of Helen Mell's death. _~ extreme eoraf~a,Et o•f interest exacts r€gard~ag :Ror~ -Me[1's proposal ~aad. beryl -114e11'-s current role in making financial and health decisions for 1-Ielen i~Iell. If the proposal were approved, the longer Helen Mell lives the more Ron Mell will owe DPW. The conflict of interest exists in that Sheryl Mell would be making all health care decisions leading up to Helen Mell's death. ~. 1~To~vhere in the proposal is there arny commitment on Ron l+~gll's part to effect the improvements on Helen Mell's house. He could, in fact, purchase the home and rent or sell it as is. 4. Why is there only one set of estimates regarding real estate value? 5. Why is there only one set of estimates regazding home improvements? 6. Why should Ron Mell not be expected to pay fair market value on the home? It is understood that heirs have no reasonable expectation to inherit from Helen Mell's estate upon her death. At this time, the suggested value of the home is less than the amount owed to DPW, with no expectation that the situation will change in the near future. •Is ar a realistic expectati:or~ that •Ron. •Meld coi~[d, over ti~rx~e., profit by purcltasixag the hone at below market value, even after paying off Dl'W?~ If so, neither DPW or the heirs would receive any of the profit. Recognition of Ron and Sheryl Mell's ongoing and considerable role in the care given to Helen Mell for many.yeazs needs to be made clear. These observations are not meant to discredit their critical role. Ta prevent any suggestion of a conflict of interest the following suggestions are made: Suggestions: 1} It should be Legally ascertained as to whether or not the home is or is not sellable, as is; 2) A minimum of three estimates should be obtained for current mazket value of the home; 3) A minim~trn Qf three estimates should be obtained for critical h,~me improvements; 4) Assuming the real estate can be sold as is, bids should be accepted from the heirs to purchase the home based on a minimum appraised value; 5) If heirs aze not interested, or bid(s) do not cover minimum appraisal value, the real estate should be placed on the open market at the current maximum appraised value. "EXHIBIT D" AdZdC Attorneys at Law SCHERER I,LC David A. Baric Michael A. Scherer __ _ ~. _ Tricia D. Naylor Bret P. Shaffer 19 West South Street Carlisle, Pennsylvania 17013 (717)249-6873 (717) 2~9-5755 -Fax mschererC~baricscherer.com August 31, 2011 Polly Thompson 505 Adams Road Carlisle, Pennsylvania 17015 Russ Mell 328 West Old York Road Carlisle, Pennsylvania 17015 Ray Mell 3119 Ritner Highway Newville, Pennsylvania 17241 Sheri Mell-Motter 251 Clay Road Carlisle, Pennsylvania 17015 RE: Helen Mell Real Estate 399 Petersburg Road, Carlisle Dear Folks: Several years ago I prepared a Will for Helen wherein she divided her estate into three equal shares, one each to her son, daughter and children of her deceased child. As many of you know, Sheryl has been acting as Helen's Power of Attorney for many years. Recently Ron Mell approached me about the status of Helen's house located at 399 Petersburg Road, Carlisle, PA. Ron indicated that the house is vacant, and is concerned that it continues to accrue tax bills, upkeep and maintenance. The obvious consideration is to sell the home. Given the fact that Ron lives on a contiguous lot, Ron would be concerned about who the new owner would be. As such, Ron is interested in purchasing the home. If Ron were to purchase the home, it would be done with Sheryl executing the documents on behalf of Helen. This creates a potential conflict of interest, in that- Sheryl (and Ron) could potentially benefit from the sale of the house to the detriment of the heirs listed in Helen's Will (you folks). "EXHIBIT E" Polly Thompson ' Ray Mell Russ Mell Sheri Mell-Motter 08/31 /11 letter page 2 In fact, I do not believe that Helen's heirs will be negatively affected by a sale of the real estate to Ron. Helen's assets at this time are a very modest bank account, and the real estate. Helen is currently in Forrest Park Nursing Home and her bill is paid in part by medical assistance. She is required to spend her funds down to a minimal level to qualify for medical assistance, which she has been on since she entered the nursing home last Fall. The monies paid by medical assistance for Helen's care are required to be reimbursed from Helen's estate prior to Helen's heirs receiving any money from her estate. A sale of Helen's property would have to be approved by the Department of Public Welfare. I have obtained their approval to sell the property to Ron and I provided them the following documents in support thereof: 1. May 31, 2011 letter to Max Byers, Department of Public Welfare; 2. ReMax Real Estate Services Proposal dated March 16, 2011; 3. Estimates of repair from Arnold & Son Excavating, LLC and P. Edward Mullin Construction & Maintenance and Central Penn Waterprool:ing; 4. Installment Sales Contract between Helen and Ron. Helen's home is aged and in need of structural repairs, as detailed by item 3. above. Specifically, the foundation, crawl space, plumbing and electric are in need up upgrades/repairs. This home is small and only has two bedrooms and would be considered a starter home. Typically it would be the type of home a young couple might want. Ron has been told that it would be very difficult for someone to obtain a loan for the home in its present condition because its condition does not meet lender requirements. This would severely limit the potential buyers of this home to persons with cash. Anyone who buys the property as a "fixer-upper" would deduct from the sale price the cost to repair the property. The ReMax proposal suggests that comparable properties have sold in a range from $42,000.00 to $64,000.00. With a proposed sale price of about $52,000.00 and deducting the cost of the repairs the sale price would be about $30,000.00, which Ron is proposing to pay. I have supplied items 1. - 4. above to the Department of Public Welfare and they have approved the installment sale to Ron at $30,000.00. I enclose the August 24, 2011 DPW fax from Max Byers to me herewith. Polly Thompson Ray Mell Russ Mell Sheri Mell-Motter 08/31 /11 letter page 3 My office contacted the Department of Public Welfare to get a total for the amount of money Helen owes DPW for her care. The worker indicated that a formal statement of claim must be made to obtain that figure, and if a formal inquiry is made, DPW will have to open a file and that will result in an expectation from them for payment from Helen or her estate. In the alternative to giving us the exact total, the worker told us that we can figure the amount at $5,000.00 per month. Since we are nearing the one-year mark since Helen entered Forrest Park Nursing Home, the total she would owe at the end September would be about $60,000.00. My purpose in writing to each of you is to disclose what is taking place regarding Helen's financial situation and to apprise you of the proposed transaction between Ron and Helen; and to give you an opportunity to consent or object to the transaction. I have enclosed a form for you to sign indicating your approval or rejection of the transaction. If all of you do not approve this transaction, I will suggest to Ron that we take the matter to Court to get Court approval of the transaction so that Ron and Sheryl are protected. The long and short of this is that it appears that Helen's real estate is considerably less valuable than the amount of money it will take to repay the Department of Public Welfare to reimburse them for her care. As such, it appears Helen's estate will be insolvent, particularly if she remains in Forrest Park for any length of time. If you agree to this transaction, please sign the Consent form I have included herewith. If you object to the transaction, please call my office to notify me. I would recommend you discuss this matter with your own attorney if you have questions. I will however take your calls if you have questions. I would appreciate hearing from you on or before September 16, 2011 so that this matter can either move forward with your consent or so that we can file a Petition requesting a Court Order. Thank you for your consideration. Very truly yours, BARK SCHERER LLC ,~~~~ Michael A. Scherer MAS/jl Enc. cc: -File e11 mas.dirlestateslmell/heirs.ltr c6 m a a H a A 0 a J C E Q 0 0 ik C •C C ~ O O E Q •~ ~ ~~ ~•~N d a U ~: g ~ a ~+ ~ ~ v" ~ = O' , m `' r V A ~ U ~- N _ «. ~ r. ! 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E. .A. ~ 01 t0 t0 O ~0 N N N N l4 ca N N N O N N G1 N cE O N N o a a~ a a a a a a a n. a a~ a a s o_ a r- a s ~°. a 2 i r° ~ ;. ~ d a. ~i ~ o ~c' ~~ ~~I 7~ T W O = 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~~ = ~~ o 0 V V m O O '~, O N N N N N N N N N O N N N N N N I a :O N N N C9 ~ ~ R ~ s~L~N N I, N ~ N N N N `f of not C1 ,,'~1 N N N N ~ ~ .C N f0y C N ~O O pj ~ ~,` W O .N..N !m u1 i c%> c`n v ~n ~o ~ ~ m ~o ~ ~ co ~o ~ ~ rn V m a O In ~ T j M ~ eh3 ~al ~m~ m~ I w e 2~::~^ 'E' 0 0 0 0 0 0 0 o m 0 0 0 0 ~;o o I o 0 Qf V 0 0 V ~O N N N N N N O N N V O N N N N V `N N C a+ ~ ~ 0 w ~ I> N N ~N O I~ ~ W n R N 9 N th O O C D ZQ N y 0 N N L9 01 O A m ~; N N ~~ N t+1 N N N N N .- N N dl N N N N .- m tN N IN N o0i O I- ~ a O d c1 ~n ~'$ ~~ c%f v ~i1 cn ~ m a1 m a1 ~ ico co ~ ~ s .~ ~~ rn a'in is rn N C O "EXHIBIT F" w C L N N " '~ ~ ~ AIZIC Attorneys-at-Law SCHERER David A. Banc Michael A. Scherer Tricia D. Naylor Bref P. Shaffer 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 (717) 249-5735 -Fax May 31, 2011 Max Byers Department of Public Welfare 7591 Lake Raystown Shopping Center Huntingdon, PA 16652 RE: Helen Mell D.O.B.: October 14, 1912 Dear Mr. Byers: I write relative to Helen Mell, who is presently in Forrest Park nursing home in Carlisle, and is the recipient of medical assistance. Helen owns real estate at 399 Petersburg Road, Carlisle, Pennsylvania 17015. The real estate in question is improved with a single family dwelling that is very small and rather old. Sheryl Mell is Helen's granddaugher-in-law and Agent under a Power of Attorney. Sheryl and her husband Ron Mell live on a contiguous tract of land known as 397 Petersburg Road, Carlisle, Pennsylvania, and they would like to purchase Helen's real estate at 399 Petersburg Road under and Installment Sales Contract. I am enclosing herewith the following documents which reflect the value of the real estate in questions: 1. Real Estate Services Proposal from William Ohrum, Re-Max Broker, which indicates comparable property values ranging from $42,900 to $45,500 and a proposed selling price of $52,900 resulting in net proceeds of $48,527.00. 2. Two estimates from Armold & Son Excavating totaling $3,490.65 relative to excavation under the house to allow for foundation work to occur to stabilize the home. 3. Estimate from P. Edward Mullin totaling $3,500.00 to upgrade the electric and "EXHIBIT G" plumbing in the basement. 4. Two estimates from Central Penn Waterproofing totaling $23,865.00 to complete basement and foundation work. Ron Mell is agreeable to offering $30,000.00 to purchase the home under an Installment Safes Contract where he would pay Helen or the nursing home a monthly fee including principal and interest. At Helen's death, he would secure financing within six months of Helen's death to pay the Department of Public Welfare the then outstanding balance of the loan. The Cumberland County Tax assessment for Helen's property is $78,200.00. When this tax assessment was received by Sheryl Mell, she believe it was high and no effort was made to challenge the assessment given Helen's residence in a nursing home. Nevertheless, Ron Mell feels that the assessment is inaccurate. Please let me know if we have a basis to move forward on this transaction or if you want more information on value of condition and necessary repairs to the property. I would also like to know at this point what the total outstanding lien is against Helen's estate for medical assistance provided to her since her admission into Forrest Park Nursing Home. I would like to share this information with Helen's children when I present this proposed transaction to them for their comments. Very truly yours, BARK SCHERER }~~'UU~/ U~ Mic ael A. Scherer MAS/jl cc: Sheryl Mell Ron Mell File mas.dirlestateslmell/ronSsheryl.ltr ~O~UFIDEiVTIAL FACSIMILE MESSAGE PA ~~PAR~"N~ENT ~F PU~LlC ~1lELFA~~ fl~fic~ of ~ncor~~ ~laintanance 1~untingdort Caunty Assistance af6ce 7391 Lake Raystown Shopping Cen#er ~ian#ingdon, PA a 6652 ~a~n Phoneo (8~4~ 643-~~70 ~A~'~~ ~I2 ~ r T1~VIE r/ I I Fax: ($14) 643-~44~ .~ Total # of na es witJ't thas cover sheet =cover + ~ a es IF `!OU ~0 NOT r~FCEI~/E ,'kLL PAGES Oq IF OTHER PR03L~iVfS OCCUR, PL~SE C;LL US AT S 14-643-1170 AS SOON .4S °OSSIBLE. lF YoUIP FaX NUNt8ER IS GOING TO BE CHANGED, PLEASE NOTlrY TxE cAO,QS SOON as Poss[aLt, Ir YOU RECcIVF THIS F,~X fN ERROR, PLcASf_ CONTACT THfr SENDER [11;V1EDIATELY.aN© THEN 7E5TRC`f THE FAXED MATcRIALS. COINFIOENTIALlTY ~OT1CE: Tha inTcrma`on ccntainad in ?his iacsim12 msssage is privileged and ~onr"id~ntiai in~armaticn ntanded -0r ~:hZ U~3 O C!l~ IC1di~iidL'al •~f n:it~f n31Tcd aQOV~. r2alLh Car° IniC~",'13t10n is pErscnal anC 38nSl-i`i~3 and should only bz ~=ad by authori~sd ndivid~als_ Faifura io . ^airi:ain ccniid~riiaiiiy "s suojact t:, penalties urder;,a~~ and ~ederaf fa~,v. "EXHIBIT H" ~~~®~~ G~~~~~~5: VERIFICATION The statements in the foregoing Complaint For Declaratory Judgment Pursuant To 42 Pa.C.S.A. SS 7535 are based upon information which has been assembled by my attorney in this litigation. The language of the statements is not my own. I have read the statements; and to the extent that they are based upon information which I have given to my counsel, they are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsifications to authorities. DATE: ~ ~ - ~ (' I I ~~~ ~ ~~ eryl Mell ~,~ CERTIFICATE OF SERVICE I hereby certify that on December 1, 2011, I, Jennifer S. Lindsay, secretary at Baric Scherer LLC, did serve a copy of the Petition For Declaratory Judgment, by first class U.S. mail, postage prepaid, to the parties listed below, as follows: Ray Mell 3119 Ritner Highway Newville, Pennsylvania 17241 Russ Mell 328 West Old York Road Carlisle, Pennsylvania 17015 Polly Thompson 505 Adams Road Carlisle, Pennsylvania 17015 Sheri Mell-Motter 251 Clay Road Carlisle, Pennsylvania 17015 / ~y> J if . L~ndsay CONSENT TO SALE OF REAL ESTATE LOCATED AT 399 PETERSBURG ROAD CARLISLE PENNSYLVANIA As an heir to Helen Mell, I hereby consent to the sale of 399 Petersburg Road to Ron Mell by Sheryl Mell, Power of Attorney for Helen Mell under and Installment Sales Contract for the sum of $30,000.00. I understand my right to seek legal counsel regarding this decision. WITNESS: ~~ Date: ,, ~ ,~ CONSENT TO SALE OF REAL ESTATE LOCATED AT 399 PETERSBURG ROAD. CARLISLE. PENNSYLVANIA As an heir to Helen Mell, I hereby consent to the sale of 399 Petersburg Road to Ron Mell by Sheryl Mell, Power of Attorney for Helen Mell under and Installment Sales Contract for the sum of $30,000.00. I understand my right to seek legal counsel regarding this decision. WITNESS: ~.~L P ly Thompson, Heir Date: ~ a p. ~o<l CONSENT TO SALE OF REAL ESTATE LOCATED AT 399 PETERSBURG ROAD CARLISLE PENNSYLVANIA As an heir to Helen Mell, I hereby consent to the sale of 399 Petersburg Road to Ron Mell by Sheryl Mell, Power of Attorney for Helen Mell under and Installment Sales Contract for the sum of $30,000.00. I understand my right to seek legal counsel regarding _ this decision. WITNESS: Date: /~ ~~/ ,; . a ' CONSENT TO SALE OF REAL ESTATE LOCATED AT 399 PETERSBURG ROAD CARLISLE PENNSYLVANIA As an heir to Helen Mell, I hereby consent to the sale of 399 Petersburg Road to Ron Mell by Sheryl Mell, Power of Attorney for Helen Mell under and Installment Sales Contract for the sum of $30,000.00. I understand my right to seek legal counsel regarding this decision. WITNESS: - ;` -.~ " J " ~~ Ray Mehl, Heir ;~' -~- Date: ~~` ~J ;` CERTIFICATE OF SERVICE I hereby certify that on January 12, 2012, I, Jennifer S. Lindsay, secretary at Baric Scherer LLC, did serve a copy of the Petition Under Declaratory Judgment Act For Order Permitting The Installment Sale Of Real Estate By Principal's Agent, by first class U.S. mail, postage prepaid, to the parties listed below, as follows: Ray Mell 3119 Ritner Highway IVewville, Pennsylvania 17241 Russ Mell 328 West Old York Road Carlisle, Pennsylvania 17015 Polly Thompson 505 Adams Road Carlisle, Pennsylvania 17015 Sheri Mell-Molter 251 Clay Road Carlisle, Pennsylvania 17015 REAL ESTATE INSTALLMENT SALES CONTRACT ARTICLES OF AGREEMENT, made the 1st day of February, 2012, between Sheryl Mell, Agent for Helen Mell under a Power of Attorney dated March 7, 2003, (hereafter "Seller") and Ronald Mell, Jr., of South Middleton Township, Carlisle, ("Purchaser"). WITNESSETH: that the Seller, in consideration of the terms and conditions hereinafter mentioned and contained, agrees to sell and convey unto the said Purchaser, his heirs and assigns: 399 Petersburg Road, Carlisle, Cumberland County, Pennsylvania (hereinafter "property"), consisting of approximately .57 acres and improved with a single family dwelling; as more fully set forth in the legal description which has been attached hereto as "Exhibit A". 1. Sale Price. Terms: The Purchaser agrees to pay to Seller therefore, the sum of Thirty thousand ($30,000.00) Dollars due and payable in monthly installments of One Hundred Sixty One Dollars and 05/100 cents ($161.05) on the first day of each month beginning on March 1, 2012, to be applied first to interest at the rate of five percent per annum and thereafter to reduction of principal; All unpaid principal and interest shall be due and full on or before the earlier of six months after the death of Helen Mell or February 1, 2017. 2. Late Charge: A late charge of five (5%) percent of such monthly installment shall be paid by Purchaser for any payment received after the tenth (10th) day of any month in which the monthly installment is late for expenses incurred by Seller in sending delinquent notices and account supervision. 3. Additional Payments: In addition to the said monthly installments on account of purchase price and interest thereon, the said Purchaser agrees to pay the taxes, municipal assessments, utility charges, make all necessary repairs to the premises and to keep in force not less than One Hundred Thousand and 00/100 ($100,000.00) Dollars of fire insurance and extended coverage with a reliable insurance company approved by Seller, with loss payable to the parties as their interests appear. A copy of said policy is to be sent to Seller and Purchaser hereby authorizes any insurance agent or company with whom Purchaser transacts insurance business to release to Seller confirmation of the existence of an insurance policy satisfying the provisions of this paragraph. 4. Prepayment: The Purchaser shall have the privilege of paying as much of the required monthly installment of principal and interest as desired, and nothing contained in this Agreement shall be construed to limit reduction of principal of said amount. Interest shall be computed on the unpaid balance. 5. Place of Payment: All payments shall be made to the Seller or to Seller's designee. 6. Delivery of Possession: It is also agreed between the parties hereto that possession of the said premises shall be delivered to the Purchaser on the date of execution hereof, and that said Purchaser shall be entitled to receive rents, issues and profits from said date of delivery of possession of said property. 7. Alterations: The Purchaser may make alterations to the condition of the premises or of any buildings thereon erected without securing the written consent and approval of the Seller. 8. Real Estate Taxes: The 2011-2012 school taxes have been paid by Seller. Purchaser shall pay the 2012 county/township taxes. Presently no realty transfer tax would be paid on this transaction when legal title is taken by purchaser. However, if transfer tax is due upon the title transfer, the parties will share equally in the payment of the transfer tax. Provided, however, if this property is conveyed to a third party at the request of the Purchaser, then all transfer taxes on said conveyance shall be paid by said third party and Purchaser as they may agree and none shall be paid by Seller. 9. Seller's Right to Encumber: Seller shall have the privilege of encumbering the premises which are the subject of this agreement by a mortgage or otherwise, provided that at no time may any such encumbrance exceed the unpaid principal balance of this agreement, and if Seller should default in making any payments which may be required in connection with any such mortgage or other encumbrance, the Purchaser shall have the privilege of applying any sums payable pursuant to this agreement to such encumbrance holder, which payments shall be credited toward the obligations of Purchaser hereunder. 10. Recording of Agreement: This Agreement, or a Memorandum thereof, may be recorded at Purchaser's expense. 11. Deed Conveyance: Upon compliance with the foregoing terms and conditions and payment of the said purchase price in full by the Purchaser, the Seller will, at the expense of Seller, make, execute and deliver to the Purchaser, a good and sufficient deed for the proper conveying and assuring of the said premises, in fee simple, free from all encumbrances, dower and rights of dower, subject only to easements and restrictions, visible or of record, such conveyance to contain the usual covenants of special warranty. 12. Default by Purchaser: In the event the said Purchaser shall fail to make any monthly payment for a period of thirty (30) days after the same shall have become due and payable by the terms hereof, or if a breach of any of the foregoing conditions be made by Purchaser, then and in such case this Agreement shall, at the option of the Seller, become null and void and the Purchaser shall forfeit all monies then paid as liquidated damages, representing the fair rental value of the property during the time the same shall have been occupied by the Purchaser. Provided, however, that no such default shall occur unless Seller has given Purchaser at least fifteen (15) days written notice of such violation of the terms hereof and Purchaser shall have failed to correct such default. In order to effectuate compliance herewith, a Deed conveying the subject premises from Purchaser to Seller shall be delivered to Michael A. Scherer, Esquire, to be held in escrow to be utilized for the conveyance from Purchaser to Seller in accordance herewith in the event of default by Purchaser. Michael A. Scherer, Esquire, is authorized in his sole and total discretion to deliver said Deed to Seller thirty (30) days following written notification by Seller to Purchaser, that default in the nature of a payment being due past thirty (30) days, or otherwise has occurred. The parties release ,Michael A. Scherer, Esquire from any,liability hereunder and agree to indemnify and save him harmless from any claims with respect hereto or from any loss or damage, direct or indirect arising hereunder, including but not limited to costs and attorney's fees incurred hereby. Parties further agree not to institute or commence any action or suit whatsoever against Michael A. Scherer, Escrow Holder, but all legal actions shall be directly between the parties. Purchasers acknowledge that they have read and understand the foregoing default provisions by initialing here. 13. Escrow of Sellers' Deed. The Sellers agree that concurrent with the signing of this Agreement that they will execute and deliver to Michael A. Scherer, Esquire a deed to the subject premises to be held in escrow and delivered to Purchaser upon the compliance with the terms and conditions herein. Sellers, their heirs, successors, assigns or the survivor authorize Michael A. Scherer, Esquire, to deliver said deed upon satisfactory proof that all terms and conditions have been met and release Michael A. Scherer, Esquire, from any liability hereunder and agree to indemnify and save him harmless from any claims with respect hereto or from any loss or damage, direct or indirect arising hereunder, including but not limited to costs and attorney's fees incurred hereby. Parties further agree not to institute or commence any action or suit whatsoever against Michael A. Scherer, Escrow Holder, but all legal actions shall be directly between the parties. Acceptance by the Seller of any of the aforesaid monthly, payments after the same shall have become past due and in default, or any failure to enforce any of the rights herein reserved to the Seller, or any of the penalties, forfeitures, damages or conditions herein contained, shall not be considered a waiver of the right to enforce the same at any time without notice whatsoever, and any attempt to collect the amount due by one proceeding shall not be considered a waiver of the right to institute any of the other proceedings herein provided. 14. Modification. No modification of this Agreement shall be binding upon the parties hereto unless the same shall be in writing and duly approved by said parties. 15. Assignability. The interest of the Purchaser in this Agreement shall not be assignable, in whole or in part, without the prior written consent and approval of the Seller, and if such assignment is attempted, all rights and remedies of the Seller set forth herein or which the Seller may otherwise have, shall immediately accrue to the Seller. Transfer of title by Will, survivorship or by descent shall not be regarded as an assignment requiring the consent and approval of the Seller. 16. Binding Agreement. This Agreement is to extend to and be binding upon the heirs, successors, executors, administrators and assigns of the parties hereto. 17. Condition of Property. Purchaser acknowledges that the property requires substantial upgrades and Purchaser waives receipt of a "Seller's Disclosure Form," and the right to any and all inspections; and Purchaser accepts the property "AS IS." 18. This transaction has been approved by the Court of Common Pleas of Cumberland County by virtue of an Order dated January 18, 2012 docketed to No. 21- 11-1288. IN WITNESS WHEREOF, the parties hereto have executed this Agreement consisting of five (5) pages the day and year first above written. WITNESS: ~. SELLER: 1! '~' _~~ 1V L G ~L (Seal) Helen Mell (Seal) Helen M , by her Att ney In Fact, ryl Mell P~JRCHASER Ronald Mell, J (Seal) COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND ~ j, ~) On this, the ~~ day of `-'Q~ , 2012, before me, the undersigned ofi:lcer, personally appeared Helen Mell wn to me (or satisfactorily proven) to be the person whose name is subscribed to a within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. (Seal) M NSYLVMIIA Not#~iN SsM hnnN~ar S. lirxhay, Notary ArbNc c~rWN Sao, Cumbedaib Oounty My C.omnMa~lon Nw. 29, 2015 r+~r+ea4 vaarsnva+t~ ~ssoanimi+ aF ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. On this, the ~ day of , 2012, before me, the undersigned officer, personally appeared Sheryl M I known to me (or satisfactorily proven) to be the person whose name is subscribe to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. (Seal) coMrioNwearH of ~NNSY~vnNrA Noan« seep CeSorocWr~be,land~ P"~ Canire.an Ilav. mu r~eEa, ~+svwMan COMMONWEALTH OF PENNSYLVANIA ) :SS. COUNTY OF CUMBERLAND ) On this, the ~_ day of ~ , 2012, before me, the undersigned ofhcer, personally appeared Ronald Mell k own to me (or satisfactorily proven) to be the persons whose names are subscribe to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and ofFcial seal. (Seal) ~, d aowKv 1ww 29 21115 ~,e+er~, v °f LEGAL DESCRIPTION ALL that certain tract of ground situate in the Township of South Middleton, County of Cumberland and State of Pennsylvania, bounded and described as follows: BEGINNING at a point in the center of the Petersburg Road; thence along lands now or formerly of No V. Otto, South 88 degrees 30 minutes East, a distance of 300 feet to a stake; thence along lands now or formerly of Russell H. Mell, North 3 degrees 58 minutes 33 seconds East, a distance of 100 feet to a stake; thence along lands now or formerly of No V. Otto, North 88 degrees 30 minutes Wet, a distance of 300 feet to a point in the center of the Petersburg Road; thence by the center of the Petersburg Road, North 04 degrees 40 minutes East, a distance of 100 feet to a point, the Place of BEGINNING. BEING Lot No. 4 in that certain Plan of Lots laid out by No V. Otto and recorded in Plan Book No. 4, Page 15, in the Office of the Recorder of Deeds in and for Cumberland County. AND BEING the same tract of land as surveyed on a recorded Survey/Lot Plan for Ronald E. Mell, Jr., prepared by Larry V. Neidlinger, P.E., R.S. and dated January 18, 1992, which is tiled herewith, and attached hereto. SUBJECT, HOWEVER, to setback lines as recorded on the aforesaid Survey/Lot Plan for Ronald E. Mell, Jr.. LESS HOWEVER, the following right-of-way as recorded in Plan Book 4, Page 15, as follows: Beginning at a point in the centerline of the Petersburg Road; thence along lands now or formerly of No V. Otto, South 88 degrees 30 minutes East, a distance of 300 feet to an existing iron pin; thence along lands now or formerly of Russell H. Mell, North 03 degrees 58 minutes 33 seconds East, a distance of 15.02 feet to an iron pin; thence along Lot No. 4 of the aforesaid recorded Plan, North 88 degrees 30 minutes West, a distance of 300 feet to a point in the center of the Petersburg Road; thence by center of the Petersburg Road, North 04 degrees 40 minutes WEast, a distance of 15.02 feet, the Place of Beginning. Exhibit A" a~...,.~ Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 March 23, 2012 Sheryl L. Mell 397 Petersburg Rd. Carlisle, PA 17015 The Funeral Service for Helen R. Mell We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Basic Services of Funeral Director/Staff $1200.00 Bathing & Embalming $895.00 Dressing, Casketing, Cosmotology etc. $250.00 2. FACILITIES/SERVICES/STAFF/EQUIPMENT Basic Use of Facility , $200.00 Document Prep/Permanent Recording, $250.00 Obituary Prep/Review $30.00 Facility Usage for Viewing/Visitation , $350.00 Staff Usage for ViewingNisitation, $350.00 Facility Usage for FuneraUMemorial $350.00 Staff Usage for FuneraUMemorial , $350.00 Staff for Graveside/Interment Service , $125.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, $275.00 Hearse (Casket Coach) _ $275.00 Safety Lead/Clergy Car $125.00 Utility Car . $125.00 FUNERAL HOME SERVICE CHARGES $5150.00 SELECTED MERCHANDISE: Acknowledgement cards, $10.00 Register Book(s) $40.00 Memorial folders , $75.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $5275.00 Cash Advances Sentinel Obituary w/Photo , Certified Copies of Death Certificate , Hairdresser, , Valley Times/ShippNews , 12 Bookmarks . . TOTAL CASH ADVANCES AND SPECIAL CHARGES . Total Total Cost . $148.69 $60.00 $40.00 $60.00 $36.00 $344.69 $5619.69 v~r2 f ~ Pam -____. _-_..~ _.. P ~. SUB-TOTAL INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE The unpaid balance over 30 days is subjected to a 1.50 % service chazge per month - 18.0000 % per annum. $5619.69 0.00 $5619.69 ~~~ro. ~~ }b3.t1 i 3~Z~~~+Z Forest Park Health Center 700 Walnut Bottom Road Carlisle, PA 17013-3699 (888) 880-7090 STATEMENT Resident: Mell, Helen (23088) Location: - Statement Date: 5/1/2012 ALL TRANSACTIONS PROCESSED AFTER Apr 30, 2012 WILL APPEAR ON YOUR NEXT STATEMENT Sheryl Mell 397 Petersburg Road Carlisle, PA 17013 PLEASE DETACI-i AND RETURN WITH YOUR PAYMENT Amount Due $10,158.30 Amount Enclosed $ Forest Park Health Center Resident: Mell, Helen (23088) 700 Walnut Bottom Road Location: - Carlisle, PA 17013-3699 Statement Date: 5/1/2012 (888) 880-7090 Effective Date Description Units Unit Amount Amount BALANCE FORWARD $10,158.30 BALANCE DUE $10,158.30 WE DID NOT RECEIVE PAYMENT ON THIS ACCOUNT IN APRIL 2012. PLEASE CALL OUR OFFICE TO MAKE PAYMENT ARRANGEMENTS IF YOU CANNOT AFFORD TO PAY THE BALANCE IN FULL. GRAHAM MEDICAL CLINIC, P.C. 100 SOUTH HIGH STREET NEWVILLE, PA 17241-1409 04/02/12 I 141941 {~ f v' ~ ~,~°</,.5_~rL ~~~ ^' ~,~44~~j ITS ,u.;~ "ti'fi ~, 64.22'' 47808 HELEN R MELL 397 PETERSBURG ROAD C/0 SHERYL MELL CARLISLE PA 17013-9219 _MC _VISA Disc Card~~ _ Sign GRAHAM MEDICAL CLINIC, P.C. 100 SOUTH HIGH STREET NEWVILLE, PA 17241-1409 Security Code _ Exp _/_ MESSAGES EXPLAINED ® BELOW 'r*'ti Please Pay -Amount Due Now From Patient- See Red Box Thank You. 'ti'"` ~t~t~r PLEASE PAY UPON RECIEPT, IF BILLINGS QUESTIONS PLEASE CALL 717-776-3114 '~'~'~ *** EXT. 103 t~t~ti *'E''` YOU MAY RECEIVE 2 STATEMENTS FROM US. WE ARE CONVERTING TO A NEW SYSTEM '~'~* x~c~L•k4c~~c~c~'c~t~Y~Y~'c4c~'c~Y~c4c~':4c~':~c~'city'c~Y4c~'cdc~'cic~c4cic:c4c~'csY~Y~'c~'c~c~~F~t*~'csr4c~c~t~Y~'c9r~'c*~Y~Y~:~Y~t~'c~'c~'c~c:cic~'c~:~~x~c~c~~Y3ci;~'c~:i:~'c~:~c Insurance Charges pending to Prv: 405.00 Ins Pay/Adj against Ins pending 264.17 -37.99 102.84 09/15/11 1 1 SUB NURSING EVAL/MANAG 2 99307 681.11 55.00 09/22/11 Medicare Payment 0.00 01/30/12 Check-Personal Payment 55.00 0.00 09/29/11 1 1 SUB NURSING EVAL/MANAG 2 99307 681.11 55.00 10/10/11 Medicare Payment 0.00 11/16/11 UNITED AMERI Payment 0.00 01/30/12 Check-Personal Payment 55.00 0.00 01/17/12 1 4 E SUB NURSING CARE EVAL/MAN 99308 428.0 75.00 01/23/12 Medic DEDUCT Payment 0.00 01/23/12 Accept Assign Adj. -10.78 02/06/12 UNITE DEDUCT Payment 0.00 64.22'` E-This bill-applied against your deductible. You are responsible to pay us. SATE LAST PAID 01/30/12 AMOUNT 110.00 • 1 • 0.00 64.22 . 1 • • 1 0.00 0.00 0.00 102.84 0.00 167.06 AKE iECK GRAHAM MEDICAL CLINIC, P.C. 100 SOUTH HIGH STREET , ., , ~vaBLETO: NEWVILLE, PA 17241-1409 64.22* Ph:(717)-776-3114 PAT~~ 1-HELEN R MELL PRV~~ 1-TOWNSEND, JAY A., MD Acct~~: 141941 PRV~~ 4-HARRIS, JEFFREY H., MD Date: 04/02/12 Page 1 of 1 ~s` Pennsylvania DEPARTMENT OF PUBLIC WELFARE June 21, 2012 MICHAEL A SCHERER ESQUIRE 19 WEST SOUTH STREET CARLISLE PA 17013 Re: Helen Mell CIS # : 040218421 SSN: ###-##-4635 Date of Death: 03/18/2012 Dear Attorney Scherer: Please be advised that the Department of Public Welfare maintains a claim in the amount of $121,640.12 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 $28,018.09, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3}. The balance of the claim, namely $93,622.03, 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, Patricia Nace TPL Program Investigator 717-772-6617 717-772-6553 FAX Enclosure Bureau of Program Integrity ~ Division of Third Party Liability ~ Recovery Section PO Box 8486 ~ Harrisburg, Pennsylvania 17105-8486 COMMONWEALTH OF PENNSYLVANIA BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY RECOVERY SECTION - PO BOX 8466 HARRISBURG, PA 17105-8486 June 20, 2012 STATEMENT OF CLAIM SUMMARY NAME ' Estate of MELL, HELEN ID - 040 218 421 MEDICAL CLASS 3 CLASS 5.1 TOTAL INPATIENT .00 .00 .00 OUTPATIENT .00 26,924.86 26,924.86 LONG TERM CARE 27,971.94 86,515.64 94,487.58 DRUG 46.15 181.53 227.88 REIMBURSEMENT TO DPW 28,018.09 93,622.03 121,640.12 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE EIN- 23-60031.13. Page 1 of 14 (nv~ i ~ ~ ~j ~ ~5 ~~~~ -~