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03-28-13
REV-1500 EX (06-05) OFFICIAL USE ONLY PA.Department of Revenue — Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 1 I S Harrisburg,FA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 6 2 5 2 0 1 0 6 1 5 1 9 3 6 Decedent's Last Name Suffix Decedent's First Name MI M I N I. C H E 1, L S W O R T H G (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 FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return F] 2.Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise(date of F] 5. Federal Estate Tax Return Required death after 12-12-82) ❑X 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received F] 10.Spousal Poverty Credit(date of death n 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number W I L L I A M P D O U G L A S 7 7 2 4,--1 1`" 0.1 9 0 Firm Name(If Applicable) s '- FOE S Ua5O)&Y D O U G L A S L A W O F F I C E First line of address 4 3 W S 0 U T H S T p Second line of address > City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address:billdouq@earthlink.net Under penalties of perjury.I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRE _ate 3 SIGNATURE OF PREPAR R OTHER THAN EPRESENTATIVE DATE ADDRESS — PLEASE USE ORIGINAL FORM ONLY Side 1 15 056C I I I 5 15056041!"5 REV-1500 EX Decedent's Social Security Number Decedent's Name ���.LSWORTH G . MINICH RECAPITULATION 1_ Real estate(Schedule A) . . . . . . . . . . I c 3 8 1 3 2 1. 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 4. Mortgages& Notes Receivable(Schedule D) 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E) 5. 1 9 1 8 4 8 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . 7. 8, Total Gross Assets(total Lines 1-7) 8. 1 4 3 0 19 2 1 3 9. Funeral Expenses&Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . 9. 2 9 0 2 2 5 0 10. Debts of Decedent, Mortgage Liabilities, &Liens(Schedule 1) . . . . . I . . . . . . 10. 11. Total Deductions(total Lines 9& 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 9 0 2 2 5 0 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 1 3 c1 7 9 6 3 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. 1 1 3 9 7 9 6 3 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 - 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 1 1 3 9 7 9 6 3 16 5 1 2 9 0 8 17. Amount of Line 14 taxable at sibling rate X.12 0 0 0 17 0 0 0 18 Amount of Line 14 taxable at collateral rate X 15 0 0 0 18 0 0 0 19. Tax Due 19. 1 9 0 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15(; i_;,a ' %6 15056042126 eCC-'Caent_ , tLr �JT i L L L SWOR I F'1 C= MINILH ;TRPLT,",DDRr 6<. IL�15 Alexander Sprina Rd. - ;ITY iATF P LCarlisle _ PA 17015 Tax Payments and Credits: i- Tax Due(Page 2 Line 19) (`) $5,129.08 2 Credits/Payments — A. Spousal Poverty Credit B. Prior Payments C. Discount 3. interest/Penally if applicable Total Credits(A+B+C) (2) $0.00 D. Interest E. Penalty ) 4. If Line 2 is greater than Line 1 *Line 3,enter the difference.This is the OVERPAYMENT.Total Interest/Penalty(D+E (3) $0.00 Fill in oval on Page 2,Line 20 to request a refund. (4) $0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) $5,129.08 A.Enter the interest on the tax due. (5A) B. Enter the total of Line 5+5P..This is the BALANCE DUE. (5B) $5,129.08 Make Check Payable lo.'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; ............................... ❑ X❑ c. retain a reversionary interest;or ................................................................................................ ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. .... ❑ 3. Did decedent own an"in trust for"or payable upon death bank account or security at his or her death? ......... ❑ 0 4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which contains a beneficiary designation?........................................ ......_..............._........................... .... ❑ 0 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 January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of ine surviving spouse is three(3)percent[72 P.S.§9116(a)(1.1)(01. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero(0)percent [72 P.S.§9116(a)(1.1)(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 twenty-one years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is zero(0)percent[72 P.S.§9116(a)(1.2)]. The tax rate imposed on the net value of Iransfers to or for the use of the decedent's lineal beneficiaries is four and one-half(4.5)percent,excepi as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a1(1)]. The tax rate imposed on the net value of idransfers to or for the use of the decedent's siblings is twelve(12)percent[72 P.S.§9116(a)(1.3)] A.sihl ng is defined,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. LAST WILL, AND TESTAMENT I , Ellsworth Gernard Minich, of North Kiddleton Township, Gur��rland Coimty, Pamsylvania, bei;ag of sound and disposing hind, memory and understanding, declare the following to be my last will and testament, hereby revoking and making void any and all wills heretofore made by me. . I direct my executors to pay i(ry debts and funeral expenses II. I bequeath my coin collection to rmy son, John E. Minich., III. I bequeath my savings accounts to my daughters, Ibby E. Schwalm and. Barbara J. Punda, in equal shares. IV. I devise my ceretery lots in the Dillsburg Cemetery to ray son, John E. Minich. V. All the rest, residue and remainder of my estate I devise and bequeath in equal parts to my son, John E. Minich, and my daughters, Toby E. Schwalm and Barbara J. Punda. If any of these three of my children predecease me, their share shall go to their issue, if any, and, if they die without issue, then to my surviving children. IV. I nominate, constitute and appoint iffy wife, Diane NLnich, and iiry son, john E. Mich, as my executors. IN WITNESS WFIEREOF, I have hereunto set my hand and seal this the day of 1987. Ellsworth Gernard Minich' Signed, sealed, published and declare3 uy, the above na,-red testator as .=�nd for his last will and testame-nt, who at his request, in his presence, Ln our presence, and in the pres,--nce of each other, have hereunto subscribed our names as attestir-g witnesses: if - CC1H,X)n E!FJIPH OF PENIIIS iZUPNIA) COUNTY Off' CU'TERLAND ) I, Ellsworth Sernard Minich, whose name is signed to the attached or foregoing instrtu-e-nt, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. E lsworth Gernard Minich Sworn to and subscribe to before me this 1 li day of '�/(in ,,,w' ,1987. No Carlisle,Cumberland Co.,6 A 991 My Commission Expires May COASI"'�'vFALTH OF PENNSYLVANIA ) COLTPT^_' OF CUM13F LAm ) and —i tar < "I G2 / the witnesses whose nacres are signed to the attached or foregoina instnmient, being duly qualified according to law, do depose an say that we were present and saw testator sign and execute the instmmnt as his last will, and that he signed willingly and that he executed it as his free and voluntary act for the pur- poses therein contained; that each of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. All Sworn to and subscribed before me this / 7 day of ,ttl 1987!. Nota_m,IE N,.BIJ� C11 Carlisle,Cumberland Co.,PA My Commission Expires May 6,IN' �+ I i �.JM 1U Ahii I FF J ESE-f 4 E INHER IP,Y r E URN RE_.DI f -E--ECEVr ESTATE OF FILE NUMBER John E. Minici — 1118 _ All real property ovv r o solely or as a tenant in common must be reported at iii 1 iar st t J h e. ",it n irket value is defined as the price at which property would be exchang J between a wiliing tuyer and a willing seller,neither h.ing a inc(Ile I ,r y or ell,b�th having reasonable knowledge of the ieleva-1 facts Rea!property which is jointly-owned vvith ri;Ft )f a iv)sh p mu<.t be disclosed on Schedule F. ITEM �— VALUE AT DATE NUMBER DES(,RI'T C OF DEATH Sale of 129 Cumberland Drive, North Middle'cn TcNrship, Cumberland County, PA $123,817.32 I I ! TOTAL.(Also enter on life i. Recapitulation) I $ 123,81 7.32 Of more space is needed,insert addi!ioaal sheets cf the same size) A. Settlement Statement (HUD-1) _ _ 6 F' f umber 7 t� dumirc, S. rr as e I,.e rarce= z,er ,.� FHA �rrr�. _ !Dins L- 201.26CcJ :C,Note -'his io' i_isrn:9; d u,e,,ve Yr`U a stailemen.(of oCWai seitiernenl costs_Amour its psd tc n,b,'he seitiement aper,ts Lre_t'c,n ilEmr r..U,t, , ip .,.,s,oe the cics,nc,!hey ae si here for informEttienal r ri z n Nr,riot melded,n the lo!els ID Narne&,",ddress of c ori E.Name&Address of Se ter F.Name&Acktress of Lends_ iJesrwa L McDaniel TheEslaieoi EllsvroitiG-rCirnr.n Orrsi win Bank �1 790 P,SSna St c.el _arlia�r P:,1.10'3 2695 Philndelphia AvcnUe,Ch r b-v5b,nq,PA j 17201 G. Property Location H_Settlement Agent: I.Settlement Date:12/1272012 125 Cumberland Dri,e PA Real Estate Settlement Servic.es,LLU Disbursement Date:12/12:'2Cl2 Carlisle,PA 17012 354 Alexander Spring Road,Carlisle,'Al '17015 North Middleton Townsh p Telephone:717-249-6333 Fax:717-249 7334 Place of Settlement: TitleExpress - 354 Alexander Spring Road,Carlisle,PA 17015 Printed 1211112012 at 9''15 am by li 104. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101 Contract sales price 140,000.00 401. Conhad sales price 141 102, Personal property 402. Personal property 103. Settlement charges to borrower(line 1400) 5,865.73 403- 104 404. - 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid b seller in advance 106. Cityllown taxes _ to 406. Cilyltown taxes to 107. County taxes 1221212012 to 12131/2012 29.74 407. County taxes 1 211 2/201 2 to 1213112012 29.74 108. Assessments 12112/2012 to 06130/2013 1,201.15 408. Assessments 12112/2012 to 06130/2013 1 201.15 109. 409. 110, 410. 11r 1. 411. - 112 412. - 120. Gross Amount Due from Borrower 147,096.62 421 Gross Amount Due to Seller 141,230.89 200. Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201 Deposit or earnest money 1,000.00 501. Excess deposi!{see instructions) - 202. Principal amount of new loan(s) 130,066.00 502. Settlement charges to seller(tine 1400) 3,213.57 203. Existing loans)taken subject Io 503. Existing ioan(s)taken subject to _ 264. Appraisal Refund 25.00 504. Payoff of first mortgage loan 205. �TM 505. Payoff of second mortgage loan 206 Se lie rAssislance 4,600.00 506. Seller Assistance 4,600,00 207. - T - 507. - 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller _ 210. City/town taxes to 510. Cityllown taxes to 211. County taxes to 511. County taxes to - 212 Assessments to 512 Assessments to 213. 513. 214 _ 514. 215. 515 216. - 516. 1 217. 517. 218, 518 219, 519. _ I 220. Total Paid by/for Borrower 135,625.00 520. Total Reduction Amount Due Seller 17,813.57 300. Cash at Settlement fromito Borrower 600. Cash at Settlement tdfr'om Seller 301. Gross amount due from borrower pine 120) 147,096 62 601. Cross amount due to seller pine 4204 4?„?30.89 302. Less amounis paid byttor borrower(tine 220) 135,625.00 602. Less reductions in amount due seller((me 520) 17-A i 357 303, Cash L From To Borrower 11,471.62 603 Cash XX To From(feller 123,417.32 . ays< tw r e«m a r�.r, x�o .,, r =_aeG,nrc s=�a.we s��,r"o�s�+s.4ae g ,.a,�oarc n:,o a rev;.wur•ae,a�zow�.wa,.,romoo,�'a„m m o, .. ?revrou5 editions a.-__;f-SC"' e Pace 1 or r c—. �o - I --- ----- _. ItemsRe.lciradbyl -.che : 3rrnaire LLl:yirle Erase r.�n i r_G1� : ;Il_1 :Jt; 1 !S-i gace r u arce i i h 7 it - '_ I Icm3ow r ura r to re n .r nce 1 if > r !t rt.•. E d —_ f ='0. Reserves Den)site( vii,'i t ender - - - ---- --� I Ll. Initial deposit 6 u yoc ro, d-co -- - m F ) 4 15 53 1W)2 Homeowner's in urai n I m, 36.17/1 is r ii 4'I;E - - 1 rti3 Mortgage nsci-arca � Ih� Ie l° Blrnon i_, :4. Property(axes _. --- r in la /iron h - - ---. _----------- - ------ 1)D5 Courtly[axes ns(a ; _;,0 r7rno[t Soo 34 106.School Taxes ---- - b 1 In;(a E 161 771no[fl 5 4. 6 1 A Aggregate Adjustmer 1 ---- ---- --_--- _-----�76C 1:i ---- - --- - 1100. Title Charges 1101. Title services and len;'(:r'E lire insu_,^7-1-7- 1,359.50 102 Settlement or closing`re - --$------- - --" - -- 103. Owner's lille insurance 160.00 -G4. --- Lender's title insurance --$ 2Ti 00—----- - -= '- 1 r,5- Lender's title policy IIC)I FT 130,000.(f _anue''s Policy 106, Owner's Idle policy limit$ 4(.,C00.C: ONn l s'oliry- - - - ---- I1 U7 A.genI's portion of the:zto til e iris n�a prom um $1,176.50 — 1G8. Underwriter's portion if th?Tidal lido nsuran;e prerniurr $25fi.fi0 — 1109 -- �1200. Government RecordirgendTranslerCha'geIS i201. Government recording ;harg's .(fromCFE#7) 156.00 202. Deed$62.00 1ortlaga 994.00 Relea>_e$ 203. Transfer taxes --- $— ---- (fromCFE#8) 1,400.70 204. CilylCounrylaxlsfamps--- sed$1,400.00 Mortg3geS_- 205. State Tax7stamps -----_i'eed$1400.00 Modg3ges --- - -- 1,400.00 Mlodgage- --- ----- 300. Additional Settlement Charges - 301 Required services that yoc can shop for _ ;from GFE#6) — 302 Final WtrlSwr to North Middleton 0.uthority 63.41 303 2012 County Taxes to Robin Sollenbenler,Tax Colle:tor _ —_ 606.69 304, 2012113 Schoo!Tzxe o Robin Sollenben er,Tax Colle;tor 2,448.27 — . ---- 5 865 731 13,213.57] aid outside cf closlne by(B)oirDwe,(S.)el er,(L)ender,(I)nveslor,Bro(K)er. Cn;dil by lender shown on page 1 "`Credit by seller shown on page 1. :evious editions'7 obsolete �1ECLER �e13S REM U:;'. uF DEEDS CUMBERLAND COUNTY-PA '00 JUL 10 ff] 11 11 THIS DEED, made this day of June in the year two thousand (2000) BETWEEN ELLSWORTH G. MINICH and DIANNE W. MINICH also known as DIANE W. MINICH, and now known as DIANE W. HAIN, husband and wife, Grantors AND ELLSWORTH G. MINICH, an adult individual, Grantee The said Dianne W. Minich, also known as Diane W. Minich, has since: intermarried with one Edward M. Hain, thereby making her present. legal name "Diane W. Hain.' wiTNESSETH, that the Grantors, for and in consideration of one and no/100 ------------------------- lawful money of the United States of America, to the Grantors in hand well and truly paid by the Grantee, as or before the sealing and delivery of these presents, the receipt whereof is hereby acknowledged and the Grantors being therewith fully satisfied, do by these presents grant, bargain, sell and convey unto the Grantee forever, ALL that certain tract or parcel of land and premises, situate, lying and being in the Township of North Middleton in the County of Cumberland and Commonwealth of Pennsylvania, more particularly_ described as follows: BEING Lot No. 73B on the Resubdivision Plan of Creek view Heights, Section "C", Lots Nos. 73B and 74B, as recorded in the Office of the Recorder of Deeds for Cumberland County in Deed Book Volume 28, Page 928; containing 56.04 feet along the south along Cumberland Drive, cul-de-sac; containing 236.81 feet along the east along Lot No 72 as shown on said plan; containing 13.57 feet along the north along Lot No. 64 as shown on said plan; containing 207.40 feet along the west along Lots Nos. 61, 62 and 63 as shown on said plan; and containing 124.61 feet along the south along Lot No. 74B as shown on said plan. BEING .imcroved with a brick and aluminum house with two car garage. 40 .': atir1 r1G jjj0 BEING THE SAME PREMISES which Ellsworth G. Minich and Di.anne w. Minich also known as Diane W. Minich, husband and wife, conveyed unto Ellsworth G. Minich and Diane W. Minich, husband and wife, by deed dated December 5, 1991 and recorded December 13, 1991 in the Recorder of Deeds Office in and for Cumberland County, Pennsylvania in Record Book K, Volume 35, Page 1100. SUBJECT, nevertheless to the building and use restrictions as recorded in the Office aforesaid in Miscellaneous Book No. 197, Page 1050. This is a conveyance between former husband and former wife incident to a divorce, with the divorce decree having been granted in Dauphin County, Pennsylvania No. 3269 S 1997 on September 24, 1997. A copy of said decree is attached hereto. TOGETHER with all and singular the buildings, improvements, ways, woods, waters, watercourses, rights, liberties, privileges, hereditaments and appurtenances to the same belonging or in anywise appertaining; and the reversion and reversions, remainder and remainders, rents, issues, and profits thereof, and of every part and parcel thereof: And also all the estate, right, title, interest, use, possession, property, claim and demand whatsoever of the Grantors both in law and in equity, of, in and to the premises herein described and every part and parcel thereof with the appurtenances. To have and to hold all and singular the premises herein described together with the hereditaments and appurtenances unto the Grantee and to Grantee's proper use and benefit forever. And the Grantor will Specially Warrant said premises hereby conveyed. IN WITNESS WHEREOF, said Grantors have hereunto set their hands and seals, or if a corporation, it has caused these presents to be signed by its proper corporate officers and its corporate seal to be affixed hereto, the day and year first above written. Signed, Sealed and Delivered in the Presence of Ellsworth �7k�.h (SEAL) Ellsworth G. Minich --- SEALI ianne W. M?nich e W. Minicil � W (SEAL) e ne W. Haan ' Commonwealth of Pennsylvania • County of �tuplitr') 3S: On this � day of June, 2000, a Notary Public in and for said State and County, the undersigned officer, personally appeared ELLSWORTH G. MINICH, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. 1 is rr w.IiJlll S Ny --.nicsion expires: Nwer,W sees F., afvMisfon ExpRie Feb.21,2603 '} !';�t.1.�1 ',..�.. r.Hmwr.Pn.naw n.oa uw d+aar.. Commonwealth of Pennsylvania SS: County of Dauphin On this _ day of June, 2000, a Notary Public in and for said State and County, the undersigned officer, personally appeared DIANNE W. MINICH, also known as DIANE W. MINICH, and now known as DIANE W. HAIN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and ackno4jj. dged that she executed same for the purposes therein Cgntained. �s=;^ IN'WITNESS WHEREOF, I hereunto set my hand and official seal. :,i 8 8 r,Notary Publb .:.M�elymnopmrr�nhmdNOnMEa�Apelaaca'F�swb.2t 2oDa �— (SEAL) My COIINli tlon !1(piYete Nolan" CERTIFICATE OF RESIDENCE I do hereby certify that the precise residence and complete post office address of the within named Grantee is: 129 Cumberland Drive Carlisle, PA 17013 A-av,- or Grantee Commonwealth of Pennsylvania; :SS. County of Cumberland RECORDED in the Office for Recording of Deeds,, etc., in nd for said County, in deed Book Page/�. WITNESS m h nd and official seal this day of 2000. „ Recorderpd boos 224 e,Gd iU I��str�ziYient w . ��1U�?179 Book: ?'?,+ s` is-co rded Dt-ttc—,: ;l_ L 1U 2 Page: 1110 12:00:00 ;A1v[ Total Pages: Instrument Type: I-TED Parcel Numbers: N/A County: (-UMBERLAND Municipality: NORTH MIDDLETON TOIVNSHIP Recording Status: V'ERIhIED Notes: 1-O7° 73B; CREEKVIEAA7 HEIGHTS; SECTION C GRANTOR GRANTEE MINICH,ELLSVVORTI-I G MINICH,ELLSWORTH G MINICH,DIANNE 1\,' AKA I AIN,DIANE W 1\4INICH,DIANE VV AKA SCHEDULE E COMMONWEAL IH DFPENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHE iCE.TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ELLSWORTH G MINICH 0818 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. ITEM � VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. /I&T Checking Account Number 2678004462 $1,504.68 i 2. Cemetery Lots with Dillsburg Cemtery Assoc $500.00 I 3. Refund for overpayment of water bill from North Middleton Township Municipal Authority $139.92 4. Coin Collection Appraised by Mobile Merchants $2,884.00 5. Refund of Homeowners Insurance Policy from Penn National Insurance $185.00 6. Memberst 1st Federal Credit Union Savings Account Number 287088-00 $25.00 7. Members 1st Federal Credit Union Checking Account Number 287088-11 $1,394.45 8. Certificate of Deposit with Members 1st Federal Credit Union $10,005.04 Account Number 287088-40 9. Sale of Personal Property with Rowes Auction $1,397.25 10. Refund from Highmark for Insurance $174.47 11. 2011 State Income Tax Refund $975.00 TOTAL(Also enter on line 5,Recapitulation) $ _ 19 184.81 (If more space is needed,insert additional sheets of the same size) &T Bank Douglas Laiv Office 43 W. South Street GM-lisle- PA 17013-0261 Re- Estate of Ellsworth G. Minich Social Security 171-28-7256 Date of Death: September 24 2012 Dear Sir or Madam: Per your inquiry on October 17, 2012, please be advised that ai the time of death, the above-named decedent had on deposit with this bank the following: I T vpe oT.l ccoitrti Checking.harn(irt Accoia,i Ntarther ?6780044621 OA,ner.,hip(Names of) Ellsivorth G. Almich Openml Date 06/04/1941 Bolonco on Date of Death $1.504.68 Am Berl hliercat 01 Totol $1.504.64 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursen,�ni of funds, ple,se call the High Street Carlisle at 717-240-4536. tVf-were unable to locate any safe deposit box_for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have heen bstuvd rs Po:ver of Attorney, Custodian o !lnitonn Transfern Representative Payee,or Trustee under a Written Agreement. Snicerely- =ilall elCcT '.d,UStmePt Service Tbi5 31"bruturr n�LtDE the ,rr,ee a,iared cud , -- ,--d L Letweez,tltF DILLSBURG CEMETERY ASSOCIATION A Non-prolit Corporat,on Of the first part,and X, - .r of tlle:secanti part. IVITNESSETH, that for and in consideration of the szrm of to the said Association paid,by the said part of the second Part,the-ecez/t o DoHnrs said Dillsburg Cemetery Association,hatlz granted,bm�gained,sold and confirnzed�and by ithe�re dotht grant,dbcr gain sell,cozzfirm and convey unto and hen S,the ea-1 lusiue and entire right ,f Mezment or sepulturc- Only,777 the burial lot in the Dillsbzvg Cemetery,sitttated in Carroll Totmship,York Couutz/.mzd State of Pe-msylva- nia,-which is Marked and designated in the plan of said Cemetery as Lot No. eontaining IQ O square f eet, being Z f( {6 � h _ n Section �- feet,together whiz the right of ingress and egress to and from said lot for all purposes of sepulture: TO HAVE AND TO HOLD the said urinl Lo {zerebyt cm:- ,eyed. with the heeeditaments and appurtenances thereto belonging,zvno the said --1 and L -J`.)- =�w heirs,and such assigns as may be approved by the said Association,mzd for the pmpnse of burial orrlal- "D ED$ WgVER ❑ '� 4 I D'llsa g Cemetery Assoaal'oq a to Coo sa-d Im shall f r 6e n shill 6e , h '� 'hat the I V I'al lot,nil fhe owners the reot,osha I alPallr nmles�h ereafter 'ilnch m d nal', ci�lhe Q(tarler a Id EVLaars n[ ode al this lime or c eared hereafter.for its n sn 6oje<t lav lheruleser he oa darned c reared, nd uGOn Condil�on al.sc antl,ority. r Proper gove rnme I,znd(or nlhe c regal iio °nditions,ieslricllons nd Ey-La,vs n Inclmg of the affairs not the As.oriali°n, by its Co nsliiuled Dn�litne55 Jereof,The said Association hath her<rinto aff-d '= orpora le seal; and in -rtes to iron thereof ire sidenr and Secretary have hereunto se[their hinds and seals this �t1-rr't"jam d �e ay° �y��—� A.D. nne Ihcu sand nia e hundred and Qi:r.e„� =i1�—��_ ATTEST RE D�tT J / s ECRETTRV ahtnte'of�enn5pt6nnta � �--- Pork(countp 55' L f <m<.the su6sc rber a I Isnce w the Peace h and for sad Coonl) Persenauy c { / T I 1 0l the D'llsb am<_��,. rg Cemele As=neat-on,a nor P ott e o-p. "lo d acl.nowle dged Ih .re(1 I the seal Ihe'et No afr'_eed Ic be the corporate seal _ 9o"g meal 1 ng r. I'. act nd e might Le tcortl=d a s of sa I n;,oc-,i1,ol plaeeA Ih= t I m ,n a ce nl h ch 6;-_c., the'cor li'm the Jn Ze5ttmonp Mi ereof I set hand and seal Ine — X n — -. —All r,—vsrn_eorw�P nee- ' WAGARET L 3M TH,Ploiary P,.fhhr Dillsburg, Yortk Co., Pd. My Commission Expires luly?4,191? r� rp L �`s' C'•; c C v G', rn O rT rn w Q I i r - rn U y J i V) * i v� _ 'G 0 ((C\\\ � O al .\\ c� ] Lj i N LLJ C, b0 co aj CD 0 1 o j-� N CD a? + 1 0 o N u1 \'i C] N 'i' Cn * 16 N C rn X V -H i U i b m r71 d -x �! 0 N 4I r i RS ti O N Q n v cli rri aj oll�c r `M s (4- Zxx 7 O T o r t- v, w o zz3> o a ,Al ?� � a ao`w'oQ Zzz°wz 4 Ln o n W O Q Q, oa < � Wuj F->� in / JoQQZ J z �+ .0 L nu � � Uo a C7 CJ 1 H i N it CEO `„ _' x _ O � 'r� J i O CL r-I U N 0 u ?a i U m o p 3 rtf . C =j s Z Ln v =i rn * W m g - u r � w r w � L Ali rri 13 rD r, rri >L N `J o �A y mn-O <z- c� D - o rD Gl Q `d o O r m - -- - - - - - -------------------- ---- ---- n r � m zNd -�Q ��l IA - c ---------}- ,.j r i PO Boa 2361'Harrisburg.PA 171 Ob 236 i ,licy Di.uur,rr POSITIVE PAi DATE CHECk NUMBER 01/18/2013 00/16488 ***185 .00 'AY ONE i.iITIDKED : 'I('}I--j-:'N AND 00 100 DOLLARS RET P,N THIS CHE'::}: 7.F INCORRECT. TO THE 11'kMINICH :ELLSFTORTH** We10sFa,g.3-k,NA THIF CHECK VOID IF NOT PRESENTED ORDER " /C) JOHN .MTJvj__(.;tl 1 P PAYMENT WI'iHIN 90 DAYS OF Q 3500 ROCS CT „i ECHANI C�:BUR(� PA 17055 Authorized Signature SECURITY FEATURES INCLUDED.DETAILS ON BACK. IJ 11'0071648811' 1:0311,002251: 207995002973311' Pennsylvania National ;Mutual Casualty Insurance Company PLEASE DETACH AT PERFORATION LINE BEFORE DEPOSITING THE PAYEE: ACKNOWLEDGES THE USE OF THE ATTACHED CHECK TO BE SETTLEMENT IN FULL OF ACCOUNT AS HEREIN STATED 3759043028 00716488 INVOICE NUMBER PURCHASE ORDER DATE INVOICE AMOUNT DISCOUNT NETAMOUNT 2013/01/1413P 01/14/2013 185.00 0.00 185.00 RE ID ON ACCU= 375904 028 TOTALS 185 . 00 0 . 00 185 . 00 f r (EMBER' I' :RAI CREDIT in REGULAR SAVINGS ACCOUNT: Account Number/Suffix 287088-00 Date Account Established 06/13/2006 Principal Balance at Date of Death $25.00 Accrued Interest to Date of Death $.00 Total Principal and.Accrued Interest $25.00 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Suffix 287088-11 Date Account Established 06/13/2006 Principal Balance at Date of Death $1,394.45 Accrued Interest to Date of Death $.18 Total Principal and Accrued Interest $1,394.63 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 287088-40 Date Account Established 05/0912012' Principal Balance at Date of Death $10,005.04 Accrued Interest to Date of Death $5.26 Total Principal and Accrued Interest $10,010.30 Name of Joint Owner None VISA ACCOUNT: Account Number/Suffix 4672090000369421 Date Opened 03/18/2009 Principal Balance at Date of Death $.00 Name of Joint Cardholder None �lE kERS 1 ST FEDERAL G�REDI kJF7TON Danielle A. Kline L nding Insurance Support Specialist August 17, 2012 Estate of: ELLSWORTH MINICH Date of Death: 06/25/2012 Social Security Number: 171-28-7256 LVl11SC a31-1`vt ` r; -\,lec ni icshu, Peiii \r,l ROWE 'S -AUCTION SERVICE R -9L 2505 Ritner HigivvaN' • Carlisle. PA 17015 Bill Roti e ( AU) 1538L) 249-197 Dave Rowe (AU 2295L) ` 15-1044 574-1008 21uctioti Is Action Call "Rowe" For Satisfcr.ction --- �/ — 1 F SE LLERS NAM DATE DDRESS /%/� _�O /1 r✓i - -- ---- — PHONE ,L)THER -- AUCTIONEER / AUCTION DATE/LOCATION - - -_ -- CLE RK DESCRIPTION OF MERCHANDISE -t,c 6) S Q57--r-1-5 r l ,f vq C'c CAF S 7' 4/e qT U i y+7 trJ G { ,Si r I �T -----7 —= J f Rr►r t3 0 � ----�i 710 // �e 'c 7 /�i- U r Gi `< dr 1 Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of t merchandise,goods and or property and have good title and the right to and that they are free from all i.cuumhances.Jagree to-accelt all responsibility for providing merchantabletle and for delivery of this ao t e t aser ,agreeh�lt�harffiless the Auctioneers against a claimer the nature referred to in AUCTION SIGNATURE SELLERS , IGATURE Total Sales (Clerking 'Tickets Attached) ,$ __ r Less Sale Expense: Commission Auctioneer r ! -- Commission Clerks r r"TNER: TOTAL SAIL;E I XPEN:SE DEDUCTED SELLERS NET i Date : 97/24/2.12 This Month Oro" payment amount Net payment amount 174 . 47 174 - 47 0396430 ,ANN' fia-MA-10"Ma"Mm- HIGHM/TK, 0306430 Direst gay Central Region PrelTiium Refuna DATE AMOUNT --- ------ -- --- — 0 F7/24/201.] 17 4 t cashed w IN,1 year *ONE HUNDRED SEVENTY-FOUR AND 47/100 D01�LARS Vuld r nu FAQ THE ESTATE OF ELLSWORTH G MINICH TO THE ROn OF 129 CUMBERLAND DR nAA.t*_L'P 0T)r _ CARLISLE PA 1701 1 tvr.owzEO Sicw var i'039E43D i®� 3Eu rE 50e� 6HMO AS W, — HOL i r----_— DOCUMENT oeu. 00000 002 I ENT TO LIGHT T n O VEF I j i 8 I 05 1 9 1 2 --------� 1 'Sy�TERP�s�Rt!S z2oa 0007 CDC f -un� 945616 I 033786 5 6_ First Na ) 51 36 00126651 waRa�n National Bank �c 4 1 VERIFICATION AVAILABLE CHECK N"r''_c POSITIVE PAY"PROTECTED PAY �IEVIN ®® 07/02%2012 n NL CTS CTS - DA7E I O ORDER OF ELLSWOR T H G MINICH VOID AFTER 1 80 DAYS DIN 1170000961,68 RE',,/R SPATE ###*#iede****# 129 CUMBERLAND DR ************975.00 CARLISLE PA 1,i G13-4 628 )fill e11)�tt[ 11�f)IF Robert M McCord Of ncv 10 i i to - e, I SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ELLSWORTH G. MINICH 0818 Debts of decedent must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. Hoffman Roth Funeral $9,427.77 2. Baughman Memorial Works, Inc. $829.00 3. Cocklin Funeral Home, Inc. $235.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) JOHN E. MINICH $7,343.00 Social Security Number(s)/EIN Number of Personal Representative(s) 185381983 Street Address 3540 ROLO COURT City MECHANICSBURG State PA zip 17055 Years)Commission Paid: 2013 2. Attorney Fees Douglas Law Office $7,343.00 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) $0.00 Claimant Street Address C4 State zip 17015 Relationship of Claimant to Decedent 4. Probate Fees Grant of Letters $281.50 5 Accountant's Fees 6. Tax Return Preparers Fees 7. Advertising Cumberland Law Journal $75.00 8. Advertising The Sentinel $221.40 9. Medical Bill to Carlisle Regional Medical Center $70.58 10. Utility Bill to York Waste Disposal $85.89 11. CPI Mechanical Contractors for Air Conditioning Service $139.95 12. North Middleton Authority $209.09 13. Repairs to Real Estate to Ron Wolfe $1,410.00 14. Repairs to Garage, Doors and Deck by Al Maltman $350.00 15. ServPro $250.00 16. Medical Bill to Kenneth R. Guistwite, MD $94.29 17. Reimburse John Minich for Coin Collection Appraisal at Mobile Merchants $35.00 18. Filing Fees to Register of Wllls (Inheritance Tax Return & First& Final Account) $280.00 TOTAL(Also enter on line 9,Recapitulation) $ 29,022.50 (If more space is needed,insert additional sheets of the same size) i � 0815 F le "dumoe Schedu!e H - Funeral Expenses & Administrative Costs - B7. --— --- -- TEM i - -- -- NUMEER _---- DESCFJPTIO!,l AMOUNT 19 PPI_ :3342.03 ---------_i SUBTOTAL SCHEDULE H-87 $342.03 `�¢ �►� AAR :•1 Trrrai ;i_>>. '��_ .t°��11E�ttcf� ORRSTOWN BANK '7 East King Street Shippensburg, PA 17257 Vie.% Check Image DptJGLAS LAW OFFICE 2774 OLTA -y i. PRY TO THE t CJWJErt4F---Z- L_ t it% f j//= l/i✓+ ' 7`� 6 t /' f� a ' "�r�N�!L�� :%t.irti� ;�;-�✓- a� f I/��L, DOLL*XIS 01a&I��D 4YS y �t i y — .. ;wt-, >-:!«.n (i --- LENDER ORRSTOINN BANK 77 East King Street Shippensburg, PA 17257 Vier) Check I:rnage � ,rt J L1 L'T.zatO1t 11 L;a I7}: J ZA Z j � t:hi�pen,aYcurg. Y�4 1'253 ,3 ,� �_• i Phcna; 717-532-6114 u,x r,a=�: of/.Iof?niA i BL.tuchj:EcllcL C�003,��1t33 011'3U1:'_U13 13:1;:Zb i 1 zf k a z 5 �F '- LENDER_ e "6 i c A (.r >ekl,z, ,• ,_ flax. i 71 ,) 43'� 1 1 In PA: 780-5312 (OCKLIN FUNERAL JJONtE. INC. L)ilEsl�uz8, k�csmsFj�ariia u"'Av.cockl;nfuncralhomel com December 5, 20 i;, Mr. Pat Curry 8 Autumn Dr. Dillsburg, PA 17019 RE: Cemetery Memorial and Date of Death Cutting on existing cemetery memorial Dear Pat, dR, Please find the enclosed contract: for the cemetery memorial for Mr. Minich.The total amount due is $829.00, this check should be made payable to Baughman Memorial Works, Inc. and mailed to the Winter. G r Y ;Cif ( iclN, j C (`i'lc<<'rj Ilic',ivii4 vvili vc ii: ._ijc aft The amount of$23 S.UO is payable for the cutting date on the existing cemetery can be made payable to Cocklin Funeral Home, Inc. We will try to get'-the u date c finis winter},i puteck depending on the weather; it may not be finished until spring. If you have any hues fens ,lease feel free to contact me. Scott D. Brennernan ,L �me�ai Fianninc 23-25 Scuth %, ak-, Strc,;-t 10 First Avenue Dover, Fit\ 173 5 Red Lion, RA 17356 Telephone (71 Telephone (717) 244-11828 Fax (717) 292 79ti;6 Fax (717) 417-5263 -mal irfo(a-b, LICi E-mail Total price Date 141 For Address}: Design No. Material LINkIll, Die Base Markers Posts Vases Price Tax Deposit Balance Due Style of Letters 71 Foundation to be furnished by I Material to be best selec-ed monumental grade and to be free from imperfections afd first class in every way.Work to be finished in a workmanlike manner. This jem;ial to b-3 erected in Cemetery in or near ( during theQ;ionth of f el f-1-14, )z unless unavoidably delayed by labor troubles and other c ingencies beyond our control and then as soon as possible-Add o, nal lettering and other work on this memorial in the future is not included in the Contract Price Title and right of possession and removal of said stone,monument or appurtenances shall remain for all purposes in Baughman Memorial Works, Inc. until work and materWs ordered are fully paid by purchaser or purchasers. In consideration of the acceptance by Baughman Memorial Works, Inc, of this order,the undersigned(hereinafter known as the purchaser)agrees to pay Baughman Memorial Works,Inc. Dollars on or before the 15th day following the billing of the work or job upon completion thereof by Baughman Memorial Works,Inc.Thirty(30)days from date of invoice a 1-1/2%finance charge will be added to the unpaid balance. Said billing to be notice of completion thereof this order shall become a contract between the purchaser and Baughman Memorial Works,Inc.upon acceptance thereof in the space below by _4 duly authorized representative of said Baughman Memorial Works, Inc.It being understood tl iat this instrument upon such acceptance covers all of the aoreement between the purchaser and Baughman Memorial Works, Inc. and that no agent or representative of Baughman Memorial Works, Inc. has made any statements or agreements, verbal or written. modified or adding to the terms and conditions herein set forth. It is further understood that upon the acceptance of this order the contract so made cannot be cancelled,altered,or modified by the purchaser or by any agent of Baughman Memorial Works,Inc,in any manner except by agreement in writing between the purchaser and Baughman Memorial Works, Inc. and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers,tweniytive percent of the total original cost of the work or work ind materials ordered,as the case may be,shall be a specified correct sum as liquidated damages which purchaser shall owe Baughman fvlemoriil Wc[ks. Inc.less any payment on account made prior to such default,this specification of damages to be due regardless of removal and taking possession of stone,monument or materials from purchaser or purchasers by Baughman Memorial Works, Inc. upon following such default. —(SEAL) —-------- 20, _,_(SEAL) Baughnian Memorial Wor�s, li'c, Approval 13y (SEAL) rN,i i r E- 'Iff.(e Copv Canary Customer o p y Pnrk S,'-!I n n ,py; G o I(i Deposit C c)P RECEIPT 1-10T., F. - _'l:F'I:r GLENDA FARNE< < T RASBAUGH ,1 6 / 1 umbe-cland Cournty - Register Of Wills n�- �e!pr 40 One Square r�� �:ic . i 0 C I7 Carl isle , PA 17013 - MINICH -LLSWORTH G Estate File No . 2012-00818 -- Paid By Rema_,-ks : DOUGLAS LAW FIRM DMB - - - - - - - - - -- -- --- - - - - - - - --- Receipt Distribution - - - - - Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 210 . 00 CUMBERLAND COUNT`_- GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 28 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---- ---- ----- -- - Check# 2621 $281 . 50 Total Received. . . . . . . . . $281 . 50 ND CO 9SS00P���� CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 September 28, 2012 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: William P. Douglas, Esquire RE: Ellsworth G. Minich Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: September 14, September 21, and September 28, 2012 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by DOUGLAS LAW OFFICE PAGE NO. --- - DUMBER 43 W. SOUTH ST. OF, y 414025 -- f,'L b CARLISLE, PA 1'7013 1 of 1 - - -- - 717-243-1790 611-L DATE SALESPERSON 09/23/12 — wolfc- START DATE STOP DATE 09/08/12 09/22/12 E-41402!VVN'BI.R AD DESCRIPTION- ___ CLASS- _ ___ LPVES i EXECUTOR'S NOTICE LETTERS TESTAMEN 10 PUBLIC NOTICES 40 2 cols Publication Insertions Rate Net Amount Gross Amount 3 THE SENTIN=L-LEGAL TOTAL AD CH,URGE 3 LGL $212.40 $212.40 3 PROOF OF FUBLICA-'ION 3 MOBILE SITE 01PRF $7.00 MOB2 $2.00 Purchase Order Ellsworth Minich PAY THIS AMOUNT $221.40 $265.68* *AFTER 10/18/12 THE SENTINEL Thank you for advertising with The Sentinel! Deadline for C/o LEE NEWSPAPERS in-column legal ads is 4:00 p.m. two business days prior to PO BOX 540 date of insertion. For questions, call(717)240-7130. WATERLOO IA 50704-0540 Return this portion with yourpayment Legal THE SENTINEL ❑ Check# _ ❑Credit Card Ad Number 414025 c/o LEE NEWSPAPERS ❑ ❑ v.- ❑ ® ❑ PO BOX 540 Billing Date 09/23/12 WATERLOO IA 50704-0540 Acct#: - � -- � Amount Due $ 221.40 Exp.Date:CL —j Name on credit card -- $ Signature _ Please make checks payable to THE SENTINEL 000zaa THE SENTINEL LUE DOUGLAS LAIR!OFFICE 43 W. SOUTH ST. c/o LEE NEWSPAPERS CARLISLE, PA 17013 PO BOX 742548 CINCINNATI OH 45274-2548 11111111111111111111/11111111111111.,11111111111„111111111111 21540200000004140250000000000000002656800000221409 --T EC A O gXERVICE CPjt� SIDENTIAL 11 INSTALLA nON C CALL BACK C COMMERCIAL ❑SEA ❑WARRANTY 1 52 'East Cornirerce Avenue. Carlisle. PA 170-15 o HEATING �— ('717"t 245-2382 P"COOLING 0 REGFRIGERATION ❑OTHER C SOURCE HIC REG4 PA000555 ietOMPLETE C INCOMPLETE(explain) EQUIPMENT MAKE MODEL SERIAL NUMBER BILL TO: AIR FILTER INFO: CUSTOMER ��, OUR DATE NAME 6,;[ 7-� �a • R l ` • ADDRESS / mot i Ul I Y/STATE//ZIP HOME 1� WO (�� r VS) 77ft--n /7 (PHONE PHONE �p G j t 7 c, TECHNICIAN CONTACT / I NAME NO RISK CUSTOMER 07 74"1 FLAT RATE$ APPROVAL s s DIAGNOSTIC FEE i I — I I ---- ---- ----- -w - DOUGLAS LAW OFFICE ' IOLTA ACCOUNT 2756 (717)243-1790 €; 43 W SOUTH ST CARLISLE, PA 17013 Uv"w r e,mxtiw m�eusmes PAY January 9, 20.13 60-1503-313 TO THE ORDER OF Pat Cnrry -------- - -----DOLLARS u.Y ORRSTOWNBANK Reimbursement STraditian ofEx 1L-nce -0R for CIP / Min' - ---- l c h Est. II'00 2TS9n■ i:03 L3150361: 108 L L 2636u■ TOTAL AMOUNT DUE: C �— R � E 3�< �4 ©2006 Aptora All Rights Reserved. R R TO IN ACCOUNT WITH CL o� - I � ! c r ° t f � F OVER 30 DAYS IOVER 50 DAYS I 5 (� TOT;iaourar 116 `/3 _44 . Ct O ,cx 1 n C_i 1 -X y h t z . f 3 �y; - - Patient Name Ellsworth Minich '- Online at vmmwzndis|ennr,com Account Number 1240094 (available 24/7) Date of Service June 08 2U12 ' r1 Service Type Outpatient By phone- 717-9G -1680 Insurance Name Medicare Outpatient Name of Insured Ellsworth G K4inich 8y credit card complete section below and return Policy Number 171287256A Amount Due From You $26-82 By cheok-retunn section below with check Amount due from you is $28.82 as of 12/24/2012 for The charges listed below do not reflect the discount that Outpatient performed on June UG. 2O12. you and your insurance company received. Lob 70.58 Total Charges $78�58 TOTAL CHARGES $70.58 Diocountu/AcUuatmnentsGiven -$43.76 Insurance Payments Received MOO Amount You Paid $080 Amount Due From You $28.82 Your hospital bill has not been paid in full as of this date. Unless you remit the balance or contact the business office to establish an acceptable payment plan, we will have no alternative other than to forward your account to a national collection agency. We are sure you do not wish this action.Your immediate payment would be L greatly appreciated. Only you can protect your credit. FOR CREDIT CARD PAYMENT,PLEASE FILL OUT BELOW.- A El El DDISCOVER VISA OVISA AMEX [-t:TEMASVERCARD CARDNUMBER 361 Alexander Spring Rd. EXR Carlisle, PA 17015 SECURITY CODE 12/24/2012 UPON RECE P TI NT NAME STATEMENT DATE DATE DUE Ellsworth Mini h IPT ruucxu Financial Services: ACCOUNTNUMBER AMOUNT DUE7 AMOUNT PAYIN 1240094 $26-82 Ito 717-960-1-"6"8 0- -- Ef- ocl;-e:'tc— —1 'V ;21 0101 ELLSWORTH MINICH CARLISLE REGIONAL, MEDICAL CENTER 3540 ROLO CT PO BOX 281442 MECHANICSBURG, PA 17055-5894 ATLANTA, GA 30384-1442 i(101P10 1 _�;,- 1'altle� C�tlston;er: ur Vc,�:Ords indicate that the balance due on your account remains unpaid and past dtu( thCTV ore. our operations Tartnlent ll�ls 110t,fled us that scrVwe at yotlr location has heel) Il)terrupted. ��oUr prorllpt reI111ttailCe 11%II1 el)SUre )UI' aCC01,1iit Is relllStated and set-vice i-esumed. fisted bciov are the items that our records indicate remain open. ifyou believe there is a billing error, or if you we questions about vout account, please do not hesitate to eontIct us. Invoice Date Amount 3-0611-001031524 7/23/12 36.16 -001077544 9/15/12 3-0611 Total Amount Due 89 isit uS no,v at www.disposal.com to pay on-line with your credit card or by electronic check, or you may call ur toll-free payment line at (877) 692-9729 to pay by phone. Checks should be mailed in the enclosed envelope. hank _you for your prompt attention to this matter, and we look forward to continuing to provide exceptional °rvice to you, our Valued Customer. i�icerely. AlStomer Service Department DETACH AT PERFORATION AND RETURN BOTTOM PORI ION WITH YOUR PAYMENT PaLThis Amount $85.89 Please Return This Account Number _ 3-0611-1408431 QevuEUC Portion With Payment Date _ October 9, 2012 3730 SANDHURST DRIVE Payment Due [Fate— YORK. on Receipt YORK. PA 17406 - - ---- Tele No. (717)845-1557 LiFor Billing Add"Tess Changes, Check Box and Pc Burn Service Requested Total Enclosed Complete Reverse. I 3 -- ---�--_'_,7601-r00001-Gi12B86230d74822a0LTG2l � D , ,.cam �------�------- ------� ELLSWORTH MINICH Make Checks Payable To_ C/O JOHN MINICH 3540 ROLO CT MECHAN ICS BURG, PA 17055-5894 YORK WASTE DISPOSAL#611 PO BOX 9001099 LOUISVILLE. KY q,0290 1099 ,�0 40840�00000000000000000000000t,10008S803 "FN N;E111K <;11" I �t,;llI . '�1I� SO(_;-f I IT I _J if F ARLISLF. F . 1?n1 S 0 Payments ",th Visa, Mastercard and Discover are accepted. Please call the above numher durmL, nnnnal business boors. 1ltanl< You! ,A�.-cwjm number Rillin_ ate P:i r jff]cc I sc Gnh Ellsworth G. Minich C/o Estate Of Ellsworth Minich 679 07/16,'12 MED BPA 1?9 Cumberland Drive Carlisle, PA 1 7013 Service Date CPT-4 Des cri tion Prov. Units Mese. char,e hu-Paid Ad ustinent Patient Paid Balance Due 06/11/12 99214 Office Visit Est Patient Level4 G 1 125.00 Patient:Minich, Ellsworth G-679 94.29 06/19/2012 Medicare Applied towards deductible 0.00 29.76 06/2)1/2012 Medicare 0716/2012 Hiahmark Pa Blue Shield 0.00 0.95 0.00 onnnen[s: Please Pay;--> Please pay within 30 days...thank�ou 94.29 Ellsworth G. Minich 679 _'-70.00 19.11 account Number \ew Ch s �� 94'29 New Payments New Ms Pmt Current Due Smcc Last Bill Since Last Bill Since Last Bill Past Duc Finance Glim2e Scheduled.APtount i Billing FCC Ketineih R- C;uist�v ite MD • 5" South Pitt Street -- ° Ct;lrisle PA 1 701,-38?0 � 1 Questions?Please s Visit us online at Page 1 contact us by Oct 9. !j pplelectric.com Due i"� s. ("� 1-800-DIAL-PPL Bill Acct. :P ,1-800-342-5 775) 41555-28497 Oct 9, 2012 rrt Lledttic Ufil tles M-r: 8am to 5pm $100.20 r Your Electric Usage Profile i Billing Summary (Billing details on back) Service to: -_� Balance as of Sep 17,2012 $64.24 ELLSWORTH G MINICH Charges: 129 CUMBERLAND DR Total PPL Electric Utilities Charges $35.96 CARLISLE, PA 17013 — Meter:77065460 Total Charges _ $100.20 Your next meter reading is on or about Oct 17, 2012. Amount Due By C}ct 9 201 This section helps you understand your year-to-year Account Balance--- $100.20 electric use by month. Meter readings are actual unless PPL Electric Utilities' rice to compare for our rate is 7.907 cents per kWh otherwise noted. p p y P effective 9/1/2012 to 11/30/2012. For a list of supplier offers,visit 02011 ■2012 papowerswitch.com or www.oca.state.pa.us. 12° — --_-_-_-- Your Message Center Y loo - ---- -------- - * The$64.24 balance includes$1.54 in prior late payment charges. 75 -- __---__ _�-_—__ • With paperless billing,you can receive and pay your 50 _____-_ ___-__�_ PPL Electric Utilities bills online. The process is free, to 7S _ quick,convenient and secure.To learn more or sign up, visit pplelectric.com. o • Information about appliance energy use and tips on J r M A M 1 J A s o N o saving energy are available through the Energy Library ° Months on our Web site, pplelectric.com. + Dishwashers use about 13 gallons of hot water per Monthly Days kWh Average Averagll� load.That's less than washing dishes by hand.Always s i,nparison Billed kWh/Day Temp. use full loads on the shortest cycle. When washing Se 2012 dishes by hand,don't let the hot water run Sep 32 234 -,- - 7 71F continuously. Sep 2011 30 545 18 70F Billing Payment Methods _Sep 17 Actual 43179 /D3 Online at: By phone:1-800-342-5775 Aug 16 Actual - _..__ 42945_ U pplelectric.eom tJ or call BillMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 32 Days kWh Billed i 234 MasterCard, Discover or debit card. 1 Yearly Comparison TotalUse Avg.Monthly By Mail: Correspondence should be sent to: ..` 2 North 9th Street Customer Services Oct 2011-Sep 2012 13331 1111 CPC GcNN1 827 Hausman Road ---T________-._ -___ __ Allentown, PA 18101-1175 Allentown, PA 18104-9392 Oct 2020-Sep 2011 ( 17769 � 1481 _ Other important information on the back of this bill Questions? Please Visit us online at Page 1 � } ,t contact us by Aug S. l + pplelectric.com 1-800-DIAL-PPL Bill Acct.No. Due Date Amount ` (1-800-342-5775) 41555-28497 Aug 8, 2012 $122,88 t411 141-"�A<lv k1,u c,rw M-F:8am to 5pm /� tom' Your Electric Usage Profile _ _ Billing Summary (Billing details on back) Service to: Balance as of Jul 18, 2012 $47.34 ELLSWORTH 6 MINICH Charges: 129 CUMBERLAND DR Total PPL Electric Utilities Charges $75.54 CARLISLE, PA 17013 Meter: 77065460 Total Charges $122.88 Your next meter reading is on or about Aug 16,2012. !Arr ount Due 3y Aug'8;4O1 This section helps you understand your year-to-year Account Balance $122.88 electric use by month. Meter readings are actual unless PPL Electric Utilities'price to compare for your rate is 7.993 cents per kWh otherwise noted. effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit U2011 2012 papowerswitch.com or www.oca.state.pa.us. 154 �--�-- � X50 __ _ -____-__ _�` Your Message Center � 3 _ • This bill includes a previous balance, if you have paid soo this amount, please accept our thanks and pay only the 75 current charges. 50 ----- --- — • With paperless billing,you can receive and pay your a PPL Electric Utilities bills online.The process is free, T 25 quick, convenient and secure. To learn more or sign up, D visit pplelectric.com. J F M A M J J A s 0 N D + Information about appliance energy use and tips on Months saving energy are available through the Energy Library on our Web site,pplelectric.com. monthly Days Average Average * Close drapes, blinds and shades on the sunny side of kWh/Day�Coniparison Billed kWh your home during the hottest part of the day. It eases Jul 2012 30 584 19 78F the load on your cooling system and saves energy. Jul 2011 32 827 26 76F Period Billing Payment Methods — Jul 18 Actual 42469 Online at: By phone: 1-800-342-5775 — Jun 18 �~ Actual 41885 pplelectric.com or call BillMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 30 Days kWh Billed 584 MasterCard, Discover or debit card. . . . F { By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services Aug 2011-Jul 2012 14047 1171 CPC-GENN1 _ 827 Hausman Road //1 , Jul 2/� � 17706 _6 Allentown PA 18101-1175 Allentown,, PA 18104-9392 Aug LLt1V' Ui LV12 I li IUP 1- 1416 ! - _.. _~+� Other important information on the back of this bill 4 Questions 'Please Visit us online at Page 1 _ �„►� contact us by Nov 7. pplelectric.com Acct. ; Amount 1-800-DIAL-PPL Bill (1-800-342-5775) 41555 28497 Nov 7, 2012318. 5 Vii_Etectrtc L--*1 tlxiee M-F:Sam t 5pm Your Ffectric Usage Profile Billing Summary (Billing details an back) Service to: Balance as of Oct 17, 2012 $100.20 ELLSWOR-rH G MINICH Charges: 129 CLIMB FRLAN D DR Total PPL Electric Utilities Charges $1835 CARLISLE, PA 17©13 Meter:77065460 Total Charges _ _ $118.95 Your next meter reading is on or about Nov 1.5,2012. mciuni aide By,Nov'7,2012 _ This section helps you understand your year-to-year Account Balance $118.95 electric use by month. Meter readings are actual unless PPL Electric Utilities`price to compare for your rate is 7.907 cents per kWh otherwise noted. effective 9/1/2012 to 11/30/2012. For a list of supplier offers,visit 02011 ■ 2012 papowerswitch.com or www.ocastate.pa.us. 150 Your Message Center 125 • The$100.20 balance includes$2.34 in prior late T 1 00 payment charges- 0 75 + With paperless billing,you can receive and pay your s° ----- ------ PPL Electric Utilities bills online. The process is free, quick,convenient and secure. To learn more or sign up, < 25 visit pplelectric.com. r ° + information about appliance energy use and tips on F M A M a s o N o saving energy are available through the Energy Library Months on our Web site, pplelectric.com. • Keep light bulbs and fixtures clean. Dust and dirt absorb • +� light and can reduce light output by as much as half. comparison ' + Save postage and late charges-sign up for Automated Oct 2012 30 78 3 58F Bill Payment. Oct 2o11 32 406 , 13 60F — Period Type Reading Payment Methods — Oct 17 _ Actual 43257_ Online at: By phone: 1-800-342-5775 Sep 17 Actual 43179 pplelectric.com or call Bil[Matrix(service fee applies) at 1-800-672-2413 to pay using Visa, _ 30 Days kWh Billed 78 MasterCard, Discover or debit card. • • By Mail: Correspondence should be sent to: Oct 2012 13003 1084 2 North 9th Street Customer Services Nov 2011- _ - ---__ _ CPC-GENNI 827 Hausman Road No�2010 ~Oct 2011 1.7771 1481 Allentown, PA 18101-1175 Allentown, PA 18104-9392 — Other important information on the back of this bill 4 — i i J � _ 1 1--- ---- --- -- ---- --- ---- w � J l� � Q ---- - - - w c r � I � I o = CL 1 � v ® ZOO-uw L n Ln ~ L r. V �1 LLJ V � � � y � rq �a A pop ^ V d.! v fit-= ® $ a NORTH MIDDLETON AUTHORiT`:' _ 240 CLEARWATER DRIVE PRESORTED CARLISLE PA 17013-1100 +;T-CLASS VAIN (717)243-8269 —'���. f K) S PosraGE=Alc CARLISLE.PA f � -- I PERMIT�'% Service 1129 CUMBERLAND,Y DR TEMP-RE TURN SERVICE REQUESTED ;Bill Date 11/1/2012 _Account From 02000278 0 08/24/2012 10/17/2012) Account Number Previous Current Usage. Type n 02000278 0 213000 213000 0 Actual ° Service Address L_ Charges _ _ ° __129 CUMBERLAND DR—� Previous Balance 113.54 – Payments -117 67 , _Amount`Due .`Due Date Adjustments 0.00 83-07_.___ i 11/30/20_12 Penalty 4 13 !__ 87.23 j After Due Date Sewer Service 56.55 B Water Service 26.52 n ELLSWORTH G. MINICH 8540 ROLO CT Pay Before 11/30/12 83,07 MECHANICSBURG, PA 17055-5894 Pay After Due Date 87,23 The office will be closed on November 22 &23,2012. IIIIIIIIIIIIIIII1IIIIIIIIIIIIIILIIIIIIII JIIlIIIIIIIIIIIIIIII NORTH MIDDLETON AUTHORITY 240 CLEARWATER DRIVE RETURN THIS PRESORTED CARLISLE, PA 17013-1100 FIRST-CLASS MAn (717)243-8269 PORTION v S.POSTAGE PAD — CARLISLE,PA Se 129 CUMBERLAND DR TEMP-RETURN SERVICE REQUESTED PERMIT#2 rvice � BIII Dater 911/2012 p IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�I�IIIIIIIIIIIIIIIIIII� Account To;, 020 I Os I 018/20 08/24/2012 mbe P urre nUsage ',Type' z3 02000278 " 212000 213000 1000 Actual `-' Service Address _ Charges- ` 129 CUMBERLAND DR Previous Balance 82 30 - r— Payments , �mount:Due Date: -91.42 – Due Adjustments 35.00 ° 113.54 9/30/2012_ Penalty 5.36 117.66 After Due Date 1 Sewer Service 56.55 Water Service 25.75 C) ELLSWORTH G. MINICH 8540 ROLO CT Pay Before 09/30/12 113.54 MECHANICSBURG, PA 17055-5894 Pay After Due Date 117.66 IIIIIIIIIIIIIII 111111 Ill IIIlill II Ill II I 111 11111111111111111111 REV-1513 EX+(9-00) akt SCHEDULE COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ELLSWORTH G. MINICH 0818 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec,9116(a)(1.2)] 1. John Minich-Specific Bequest Lineal $3,384.00 ($2,884 Coin Collection & $500 Cemetery Lots In-Kind) 3540 Rolo Court, Mechanicsburg, PA 17055 2. Toby Schwalm -Specific Bequest Lineal $12.50 Savings Account($12.50) 8 Autumn Drive, Dillsburg, PA 17019 3. Barbara J. Punda Lineal $12.50 Savings Account($12.50) 100 E. Clearview Dr., Camp Hill, PA 17011 4, John Minich - rest, residue and remainder Lineal $36,856.87 3540 Rolo Court Mechanicsburg, PA 17055 5. Toby Schwalm Lineal $36,856.88 8 Autumn Drive Mechanicsburg, PA 17055 6. Barbara J. Punda Lineal $36,856.88 100 E. Clearview Dr Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE,ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (It more space is needed,insert additional sheets of the same size) M - I