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Home My WebLink About04-1117CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Susan Herlt a/k/a Susan E. Herlt Date of Death: November 14, 2004 Will No. 2004-1117 Admin. No. 21-04-1117 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 9, 2004. Name Ad&ess Daniel A. Herlt 448 Clover Road, Etters, PA 17319 Donnell A. Herlt 1136 Brockton Circle, New Cumberland, PA. 17070 Susanne E. H erlt 512 Terrace Drive, New Cumberland, p/0/47070 Notice has now been given to all persons entitled theretg~finder R~e 5.6(a)/~'cept: NONE Date December 9, 2004 Murrel R. Walters, III, Esquire 54 East Main Street Mechanicsburg, PA 17055 (717) 697-4650 Capacity: __ Personal Representative __X_ Counsel for personal representative PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of SUSAN HERLT No. also known as SUSAN E. HERLT To: Social Security No. 194-36-4961 Register of Wills for the Deceased. County of CUMBERLAND in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl¥ for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with h er last family or principal residence at 512 Terrace DriveI Boroullh of New CumberlandI PA (list street, number, Twp. or Boro.) Decedent, then 59 years of age, died 11/14/2004 at West Shore Health & Rehab~ Camp HillI E. Pennsboro Twp.~ PA Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: 3711 ROSEMONT AVENUE, CAMP HILL, LOWER ALLEN TOWNSHIP, PA 501000.00 Petitioner a after a proper search ha ye the following spouse (if any) and heirs: Name ascertained that decedent left no will and was survived by Residence 448 CLOVER ROAD DANIEL A. HERLT SON ETTERS PA t7319 1136 BROCKTON CIRCLE DONNELL J. HERLT SON NEW CUMBERLa_ND PA 17070 Relationship THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned.. ~ DANIEL A~. I~ b/'~LT~ /~ / ~ DONNELL A. HERLT 448 CLOVER ROAD ETTERS PA 17319 1136 BROCKTON CIRCLE NEW CUMBERLAND PA 17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF CUMBERLAND) SS The petitioner(s) above-named swear(s) or afffirm(s) that the statements in the foregoing petition are tree and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed, amd subscribed before me this --C]'z'~'~ . ~ ~ aay ot <X eg,ste, ' NNELL A. HERLT~ Estate of SUSAN HERLT , Deceased GRANT OF LETTERS OF ADMINISTRATION ANDNOW ~~ .v~ ~,~o.,%t:3k.k ,~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that DANIEL A. HERLT and DONNELL A. HERLT 'ia/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to in the estate of SUSAN NERLT FEES Letters of Administration ...... $ Short Certificates ( -~'~ ) ...... $ Renunciation ............ $ TOTAL $ Filed . . . x.~.7 ?.~.-. ~.~.. A.D. c~ister .of Wills MURREL R, WALTERS III 24849 ATTORNEY (Sup. Ct. I.D. No.) 54 EAST MAIN STREET MECHANICSBURG PA ¶ 7055 ADDRESS 717-697-4650 PHONE RENUNCIATION In Re Estate of SUSAN HERLT a/k/a SUSAN E. HERLT, deceased. To the Register of Wills of Cumberland County, Pennsylvania I The undersigned, SUSANNE E. HERLT, daughter of the above .decedent, hereby renounces the right to administer the estate and respectfully as~',that Letters of Administration be issued to DANIEL A. HERLT and DONNELL A. HERLT. WITNESS her hand this Ist day of December, 2004. SySANNE E. HERLT 512 Terrace Drive New Cumberland, PA 17070 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: AND NOW, this 1st day of December, 2004, before me, the undersigned officer, personally appeared Susanne E. Herlt, known to me (or satisfactorily proven) to be the person whose name is subscribed to the instrument, and acknowledged that she executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. DEBORAH L. RYAN, NOTARY PUBLIC CITY OF MEOHANICSBURG, CUMBERLAND COUNTY! MY COMMISSION EXPIRES JUNE 11,2006 fi. is o certify that the inf(~rmation here given is correctly copied i'rom an original certificate of death duly filed with me as l., ,t,t Registrar. The original ccHificale will bt; for,~xardcd k> Ibc %late Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee lbr this certificate, $2.00 ' L~l-~egist tar - y H105 143 Rev 1/87 YPFJPRJNT :RMANENT 7 cS COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ~,~. ~rzand I~. C~p Hzl~ T~.I,. West Shore Health & Retmb ~ ..... ~o~,~.~ [,o ~ite ~ New C~rland, PA 17070 I(s""'~' " '~ Wi 11 ~ nm Donnell I". Esther 2o,. Daniel A. Herlt b~. 448 Clover Rd. ~S ~ _ _ u q ,,bJ1/18/2004 ~ .... Bm Cre~tory 2~d. Grantville, PA 17028 SIG~TORE OF FU~L~ICENSE~R PERSON~~ j LICENSE NUMBER I ~E AND ADORESS OF FACILITY t125 WnlBut ,,,. ~~ ~,, /~ ' J~ 011370-L J~2,. Hetrick Funeral Home, ~r~is~ro P~ ~7[09 I I ST~R S S~ TURE AND NUMBER ~ ~ ~ ] OAT~ FILE0 (M~. ~y. Y~) FORM 93 - O. C. DIVISION IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA. ORPHANS' COURT DIVISION OF } } } } } } . ::. INRE: ESTATE No. 21-04-1117 Qt:;2oo4 SUSAN E HERL T (Deceased) CLAIM To the Clerk of Orphans court Division: Index and make proper entry in your official records of the claim of OMNIUM WORLDWIDE, INC. for HOUSEHOLD CREDIT SERVICES (Claimant), account # 5215077338594458/ 194364961, in the amount of $10,274.73 against the estate of the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended. The said decedent, who resided at 3711 ROSEMONT AVE, CAMP HILL, P A 17011-6935, died on November 14, 2004. Written notice of this claim was given to MURREL WALTERS, 64 E MAIN, MECHANICSBURG, P A 17055 (Personal representative if any, or counsel). February 17 , 2005 z:: (Clai OMNIUM WORLDWID , INC. 7171 MERCY RD, SUITE 400 PO BOX6618 OMAHA, NE 68106 800-999- 3778 (Claimant's Address) .,)-. "'~ B ~ .\:1. ~ ~~ \ ~ ~u;l ~ ~:e 'Q I'l'" .... .... Bt:i ~ .,. r- ~~% .. a ~ ~ ..... S '0 ..... ~ \.U ~ ..... ~u'8 ~ ~ I'" ~~ ~ QP~ '" . ~5 t ~ (f)~ ..... '" ?, <3 ~~ ~ ~ z ~~ Q;:C ~ ~ ~ ARS-ARRC 25 CLIENT: HOUSEHOLD BANK (SB) , N. A. STATUS: ACTIVE STATUS RECOVERY MAINTENANCE RECDSP 7:16:23 2/17/2005 CLI REF#: 5215077]]8594458 REASON: 42-CLAIM FILED ACCOUNT: 104884141 PACKET: I CONTACT TYPE: PRMCON PREFIX: FIRST NOO: SUSAN MIDDLE NOO: E LAST NOO: IIERLT EXTENDED: SUFFIX: More... PHONE INFORMATION I PHONE TYPE: HOMPHN AREA CODE: ~ PREFIX: 761 NUMBER: m! EXTENSION: 00000 ANSWER CODE: CALL CODE: CALL CONTACT INFORMATION I LANGUAGE: RESP: PRMRSP I ADDRESS INFORMATION I ADDRESS TYPE: PRMROM STREET: 3711 ROSEMONT AVE SSN: 194364961 CITY: CAMP HILL STATE: PA ZIP CODE: 17011 6935 COUNTRY: us-- ~IL CODE: MAIL BALANCES I I ADJUSTMENTS I I ADJUSTED BALANCE: 0.00000 PRINCIPAL PAYMENTS: 0.00000 I EVENTS I I CURRENT EALANCE: 10274.7]000 PROMISED PAYMENTS: 0.00000 PAYMENTS I I ACCOUNT STATISTICS I LISTING BALANCE: 10274.7]000 LOCAL LISTING BAL: 0.00000 More... ACTIVITY: S42 eLM CLM CLAIM FILED PRBCRT-FILE CLAIM WITH PROBATE:PROBATE CLAIM FORM INDATY - FILE CLAIM WITH PROBATE: PROBATE CLAIM FORM FOLLOW UP ACTIVITY: REVIEW FOLLOW UP DATE: 2/18/2005 FOLLOW UP TIME: 102749 02/17/2005 07:16:20 102749 02/17/2005 07:16:06 102749 02/17/2005 07:15:]1 More... I ACCOUNT ATTRIBUTES I F2=CONTINUE SEARCH F3=EXIT F4=PROMPT F6=ADD CONTACT F?=PREVIOUS CONTACT F8=NEXT CONTACT F9=HISTORY F24=MORE KEYS STAtE; OF PENNSYLVANIA IN THE MATTER OF ESTATE OF: SUSAN HERLT 11(:: 'j i: 19 IN THE ORPHANS' COURT OF CUMBERLAND COUNTY ESTATE#:2120041117 DATE OF DEATH: 11/14/04 r-,:: OPI'~"";\;' ;'0 eVo' , 'R' T 1; i [, \, \ \J 1 0'1 r.-',.'" STATEMENT OF CLAIM 1. The creditor, American Express, certifies that there is due and owing by SUSAN HERL T, deceased, the sum of SIX THOUSAND TWO HUNDRED THIRTY THREE DOLLARS AND FIFTY NINE CENTS ($ 6,233.59). 2. The nature of the claim is a Optima Card, account number 372534125791002, . 3. The name and address ofthe claimant is: American Express, 200 Vesey Street, New York, NY 10285-3830. 4. The name and address ofthe claimant's agent is: Kate Schalizki, Estate Recoveries, Inc., P. O. Box 24566, Baltimore, Maryland 21214. 5. This claim is not contingent and is not secured by any liens or judgments. 6. This claim is not based on anyone instrument. Said balance has accrued since the account was established. On behalf of American Express, creditor, I do solemnly declare and affirm under the penalties of perjury that the information in the foregoing claim is true and correct to the best of my knowledge, information and belief. I have made diligent inquiry and examination, and I believe the claim is just and all legal offsets, payments, and credits made known to the affiant have been allowed. /1.t~, Estate Recoveries, Inc. P.O. Box 24566 Baltimore, Maryland 21214 (410) 444-8022 County of Baltimore, Maryland: IN WITNESS WHEREOF, I hereunto set my hand and Notarial Seal this May 12,2005. My Commission Expires: September I, 2 " . STATE OF PENNSYLVANIA STATEMENT AND PROOF OF FILE NO: 21041117 PROBATE COURT CLAIM CUMBERLAND COUNTY Estate of Susan E Herlt I, NATIONAL CITY CORPORATION of ONE NATIONAL CITY PARKWAY, KALAMAZOO MI 49009 submit the following claim against the estate for the sum set forth. . DESCRIPTION OF CLAIM AMOUNT Type of Account: CREDIT CARD Account Number: 4311966298060870 $3923.16 Date Opened: 5/7/2003 There is now due on the claim, above all legal set-offs, the sum of: $3923.16 [ ] Notice to interested persons: This- is a claim by a personal representative for an obligation that €I rose before the death of the decedent. A hearing will be held to determine whether to allow the claim. You may object to the claim before or at the hearing. I declare under penalties of perjury that this statement and proof of claim has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Date 7/ Z 1-/(0 .5 Attorney Sianature Name (type or print) Claimant si~~K:ina ~~~OSs8-9350 EXT 50248 PO BOX 500 Address Address PORTAGE MI 49081 City, State, Zip City, State, Zip . 1. Describe nature of claim or attach statement. Attach copy of receipt or other evidence of payment if submitted by assignee. 2. Claims must be presented either personally or by mail to the fiduciary on or before the last day for presentment of claims. This claim may also be filed with the probate court (see reverse side for proof of service). PLEASE SEE OTHER SIDE Do not write below this line - For court use only , ) f-,.o' .) ~~,.;~ f''-) C:.J ) ~, J -n ("~) v-- (::1 " c..> alBa aJnlBu6!s .pa6paIMOu}pB S! W!BP JO JOOJd pUB luawalBlS paLl:JBnB aLIi JO a:Jli\Jas 3~1^~3S.:l0 lN311\1~a31MON}I~'o' JOlBU!PJOo:J alBqOJd 'Jal>tU!M BUpB)i 'aJnlBu6!s S{J/-rzt -V;; r L7 ~ :3.L'v'a "ja!laq pUB 'a6paIMOU>t 'UO!lBWJOJU! ^W JO lsaq aLIi Ol anJl aJB SlUaluo:J SlllBLll pUB aw ^q paU!WBXa uaaq SBLI a:Jli\Jas JO JOOJd S!L111BLll AJnfJad JO samBuad aLIi Japun aJBI:Jap I 900Z 'zz Alnr ~ 'apJ!:J uaABLI>t:JoJ8 98 ~ ~ 'l1 p~ JaAol:J 91717 Olll'v'l/IJ sn A~'v'Nla~O ^q , UO W!BI:J JO JOOJd pUB luawalBlS S!L11 JO ^do:J B '~B!::lnp!J waH laUUoa 'l1la!UBa uodn pai\Jas I 1l\l1'o'1~ .:10 3~1^~3S .:10 .:IOO~d I Page~ 1 Document Name: karina winkler BS 4311966298060870 HERLT,SUSAN E**512 TERRACE CUR BAL CRDT LIMIT AVLB CRDT LS BAL PRV H BAL LST PMT AM AM DUE DSP AM DLQ # DAYS DELINQUENT # TIMES 1 CYCLE # TIMES 2 CYCLES # TIMES 3 CYCLES RECOURSE FLAG CASH OUT YTD INT I CROSS REFERENCE 1 DR**NEW CUMBERLND*PA*17070-1562*4311966298060870*0 CRCD 840 07/22/05 13:14 HOME PHONE 000-0023 WORK PHONE SOC SEC # 194-36-4961 CHECKING 0007509607 SAVINGS ANNUAL CHARGE CREDIT LINE 3,923.16 3,000 923- 3,923.16 3,923 30 2,190 STTS CD INT/EX X/Z CYCLE CODE 2Y OPEN DATE 05-03 EXP DATE 05-06 PLST# 00 TYPE 11 LST PMT DT 10-02-03 LST MON 04-30-04 Y 00-00 05-03 o o 0 LST NM 07-19-05 028 FX PY AM 2,091 AUTH FLG PIN TR 0 RENEWAL CODE 6 586 OVERLIMIT HIST 26 USER FLAGS o TERMS LEVEL 1 SPECIAL FLAGS 1 HIST 7777 7777 7777 MISC F ELIT 20 REAGE COUNTER 00 MONTHS GROSS ACTIVE 28 N STS CD CHG 04-30-04 DELQ SCENARIO 0002 o AUTO PAYMNT FLAG 0 SCORE: BH 005 CR 000 0.00 CRDT BUREAU FLAG 1 CREDIT LIFE 0 / DUALITY 1 \ . 0000000000000000 2 0000000000000000 3 0000000000000000 Date: 7/22/2005 Time: 2:15:02 PM o 0.00 CONTROL 0 V REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z w c w () w c W I- lo:: :$Ul ull::lo:: wa..u :J:OO "II::...J ~a..Cll a.. < DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) HERLT DATE OF DEATH (MM-DD-Year) SUSAN E. DATE OF BIRTH (MM-DD-Year) [X] 1. Original Retum o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death afler 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrusij o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) OFFICIAL USE Oi'lLY FILE NUMBER 21 -0 4 1 1 1 7 -----~--- COUNTY CODE YEAR ,NUMBER SOCIAL SECURITY NUMBER 1 9 4 - 3 6 - 4 19 6 1 THIS RETURN MUST BE FILED IN PLICATE WITH THE REGISTER OFI WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (d~ofdeathpriorto12.1J.82) o 5. Federal Estate Tax Retilim Required ! _ 8. Total Number of Safe t)bposit Boxes I o 11. Election to tax under'~ec. 9113(A) (Attach Sch 0) 85,000.00 11/14/2004 11/09/1945 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) , ':1'0: ;:!1i'HIS:seCnmn.Q'$1:j:s1:.:cQliiPJ.;-e~D~fAa CeRRESJt:O~CE!:ANO!bONfJ8EriiAtiT.~ORilA:RON SHOOm:SE; NAME COMPLETE MAILING ADDRESS MURREL R. WALTERS III, ESQUIRE 54 EAST MAIN STREET FIRM NAME (If Applicable) z o i= <II( ...J ::) ~ n: <II( () W 0::: z o i= <C ~ ::) D.. :iE o () ~ ~ I- Z W C Z o a.. Ul w II:: II:: o U TELEPHONE NUMBER 717-697-4650 MECHANICSBURG 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Misoellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due X _(15) X _(16) X .12 (17) X .15 (18) (19) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 17055 950.00 -) 'V cl:::l L+_J iii? 1'< (8) -"1- I '"1 85,950.00 22,726.69 86,939.57 (11) (12) (13) 109,666.26 -23,716.26 (14) -23,716.26 ! , I I I ! Decedent's Com lete Address: STREET ADDRESS 512 TERRACE DRIVE NEW CUMBERLAND STATE PA ZIP 17070 CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 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; ........................................................................... D 1EJ ~: ;::::~ :h~e:;~i:~~~s:~~~::;~~ ~.~~I~.~~~.~~~.~~~~~:..t~~~~~~~~~.~~.i.t~.i~~~.~~.:::::::::::::::::::::::::::::::::::::::: B ~ d. receive the promise for life of either payments, benefits or care? ............................................................. D 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................... D IEl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D lEI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... D lEI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF lrHE RETURN. ao.s- " ADDRESS MURREL R. WALTERS III, Q. 54 EAST MAIN STREET, MECHANICSBURG PA 17055 For dates of death on or after July 1, 1994 anc" '- -- I--,,~", 1 100l\ thA t::lX rate imoosed on the net value of transfers to or for the use of the survivinm Ispouse is 3% [72P.S.~9116(a)(1.1)(i)]. \'-"1('-> ...--., ,""'I, ,~,;:--.. u~ '_ .L- -.J _-' J For dates of death on or after January 1, 199[ D \ r: msfers to or for the use of the surviving spouse is 0% [72 P.S. ~~116 (a) (1.1) (ii)], The statute does not exempt a transfer to a Sl\ (\ f::)() O~ 3quirements for disclosure of assets and filing a tax retum are stili applicable even if the surviving spouse is the only beneficiary, C,"" 0 D' - \- \J \ dO ,00 For dates of death on or after July 1, 2000: The tax rate imposed on the net value of trar r" ,/) -+- or a stepparent of the child is 0% [72 p.s. ~S 'Y!.( ),j..U0 LJ The tax rate imposed on the net value of tral al beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) rr2 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use or me CJe{,=IU, "lUIings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. is of age or younger at death to or for the use of a natural parent,1 an adoptive parent, REV-1502.EX + (6-98) '* SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HERL T SUSAN E. 21 04 1117 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real ro which is' in -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM NUMBER 1. 3711 ROSEMONT AVENUE CAMP HILL, PA 17011 GROSS SALE PRICE DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) IJ'ALUEAT DATE i OF DEATH 85,000.00 85,000.00 REV-150B EX + (6-9B) "w SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HERL T FILE NUMBER SUSAN E. 21 04 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. 1117 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE . OF DEATH -,- 950.00 CHUCK BRICKER AUCTIONEER NET SALE OF PERSONAL PROPERTY AND HOUSEHOLD GOODS TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 950.00 REV-151 , EX .1'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HERL T SUSAN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS E. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 04 1117 ITEM 1 NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HETRICK FUNERAL HOME 2,000.00 2 GINGERICH MEMORIALS GRAVESTONE 1,985.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. Name of Personal Representative (s) DANIEL A. HERL T 2,150.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 448 CLOVER ROAD City ETTERS State PA Zip 17319 Year(s) Commission Paid: 2005 2. Attorney Fees MURREL R. WALTERS III, ESQUIRE 4,300.00 3. Family Exemption: (If decedenfs address is not the same as c1aimanfs. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 139.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. POSTAGE 35.00 8 REAL ESTATE SALE SETTLEMENT CHARGES 9,467.69 9 REAL ESTATE SALE CREDIT TO BUYER FOR TRASH REMOVAL 500.00 TOTAL (Also enter on line 9, Recapitulation) $ 22,726.69 (If more space is needed. insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent HERL T Decedent's Name SUSAN E. Page 1 21 04 1117 File Number Schedule H - Funeral Expenses & Administrative Costs - B1 ITEM NUMBER DESCRIPTION I AMOUNT B. ADMINISTRATIVE COSTS: I Personal Representative's Commissions 2. Name of Personal Representative (s) DONNELL A. HERL T 2,150.00 Social Security Number(s)IEIN Number of Personal Representative(s) 173-58-9728 Street Address 500 ROSS AVE., #B City NEW CUMBERLAND State PA Zip 17070 Year(s) Commission Paid: 2005 SUBTOTAL SCHEDULE H-B1 2,150.00 REV-1512-EX + (6-98) ESTATE OF HERL T *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SUSAN E. Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. PENNSYLVANIA DEPARTMENT OF WELFARE MEDICAID REIMBURSEMENT 2. SUSQUEHANNA SURGEONS MEDICAL 3. ANDREWS & PATEL ASSOCIATES, P.C. MEDICAL 4. QUANTUM IMAGING & THERAPEUTIC (NATIONAL RECOVERY) MEDICAL 5. RITE AID CORP 3 BAD CHECKS 6. VERIZON (OMNIUM) TELEPHONE 7. HUDSON UNITED BANK (GOLDMAN & ) AUTOMOBILE REPOSSESSION 8. 9. 10. 11. 12. 13. 14. 15. AMERICAN EXPRESS (CENTURION BANK) ESTATE RECOVERIES CREDIT CARD COMCAST CABLE TELEVISION VERIZON (CBCS) TELEPHONE PENNSYLVANIA AMERICAN WATER WATER PPL (POWELL) ELECTRIC AT&T WIRELESS (SUPERIOR) PHONE COLLECT AMERICA (PHILLIPS) CREDIT CARD AT&T WIRELESS (BUREAU) PHONE FILE NUMBER 21 04 1117 VALuE AT DATE OF DEATH i TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 34,733.02 30.00 178.00 1,901.35 323.14 15.45 3,837.87 6,233.59 247.92 368.62 236.12 381.66 344.63 3,382.56 384.02 86,939.57 HERL T Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent SUSAN E. Page 2 Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER 16. 17. 18. 19. 20. 21 22 23 24 25. 26. DESCRIPTION WEST SHORE SCHOOL DISTRICT (STATEWIDE) 2004 PER CAPITA TAX HOLY SPIRIT HOSPITAL (HBCS) MEDICAL HOLY SPIRIT HOSPITAL (PENN CREDIT) MEDICAL HOUSEHOLD BANK (OMNIUM WORLDWIDE, INC.) CREDIT CARD COUNTY I TOWNSHIP TAX 2004 (PENN CREDIT) SEARS (ACADEMY) CREDIT CARD NATIONAL CITY CREDIT CARD CUMBERLAND COUNTY TAX CLAIM BUREAU INTERNAL REVENUE SERVICE 2003 INCOME TAX 21 04 1117 file Number , AMOUNT 52.00 11,964.73 3,070.00 10,274.73 28.50 1,171.77 3,923.16 2,709.36 787.43 LOWER ALLEN TOWNSHIP EMS (POWELL ROGERS & SPEAKS) 109.94 INTERNAL REVENUE SERVICE 2004 INCOME TAX 250.00 , SUBTOTAL SCHEDULE I , , 34,341.62 GRAND TOTAL SCHEDULE I $ 86,939.57 ~':''''' ex' ". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER HERL T SUSAN E. 21 04 1117 i RELATIONSHIP TO DECEDENT AM~UNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under I Sec. 9116 (a) (1.2)] 1. DANIEL A. HERL T SON 1/3 448 CLOVER ROAD ETTERS, PA 17319 2. DONNELL A. HERL T SON 1/3 500 ROSS AVE, #B NEW CUMBERLAND, PA 17070 3. SUSANNE E. HERL T DAUGHTER 1/3 512 TERRACE DRIVE NEW CUMBERLAND, PA 17070 i ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 CbVER SHEET II. 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ! (If more space is needed, insert additional sheets of the same size) STATE OF PENNSYLVANIA PROBATE COURT CUMBERLAND COUNTY STATEMENT AND PROOF OF CLAIM Estate of, SUSAN HERLT FILE NO: 21041117 I, Howard A. Enders, Esq. on behalf of COLLECT AMERICA located at 1999 BROADWAY SUITE 2180: DENVER, CO 80202-5744 submit the following claim against the estate for the sum set forth. DECSRIPTION COLLECT AMERICA ACCOUNT #: 5458001246265528 ORIGINAL CREDITOR: AMOUNT DUE: FILE #: 4021539 There is now due on the claim, above all legal set-offs, the sum of: VALUE $3,382.56 $3,382.56 Notice to interested persons: This is a claim by a personal representative. This claim will be allowed unless notice of an objection by an interested person is delivered or mailed t~..pe.rsoaaH not later than _~.~~~ ._.___" 0" .~r;;:: .~~ t't , I \ ) i' I ~ .1..<:- , , t I declare that this claim has been exam ed by me and that its contents are true to the best ~fmy ~n'm.f:~,w'Jbe, f. t7 ~ !: Authorized signature Howard A. Enders. F'IQ...OiR@f8l-eem ~'-.-'N'3m;TtYp~ or print) The Creditor's Rights & Bankruptcy Group A Division of Phillips & Cohen Associates, Ltd. 695 Rancocas Road Address Westampton. NJ 08060 609-518-9000 City, State, Zip Telephone ; -.,) :;-:..J '-~'-, r-..) h) --;""1 "'.J ~.- -r;- PI- PROOF OF SERVICE OF CLAIM I served upon A TTY -MURREL W ALTERS Name fiduciary, a copy of this claim on November 14, 2005.. by REGULAR MAIL Date State manner and address of service 54 E MAIN ST MECHANICS BURG, P A 17055 r-' ...........-..-....----..... -~_._-._-- I declare that this proof of service has bee 5(xamined by me and that its contents are true to the best of my information, knowledge, If1d belielt ./7. -1 I{ ./(/-05 '. ~ /71 / ~J. c.:J'J l,.<;. Date ~ ~ature -....~_r.~.~""q'"r ACCEPTANCE OF SERVICE Service of the attached claim is accepted. Date Signature (j -- -J r~.) r.,.) ---l ...~:~.- .... << j" C ~ INRE: ESTATE OF: SUSANHERLT ESTATE NO. 2120041117 DECEASED. SATISFACTION AND RELEASE OF CLAIM The undersigned, Kathy M Peyton, Agent for AMERICAN EXPRESS, has received a pro-rata distribution of $1573 .98 equal to 25%, satisfying the claim filed in this proceeding on behalf of the Creditor to the extent of insolvency of the estate. This satisfaction and Release of Claim is executed to acknowledge discharge of the claim and to release the estate and personal representative from all further liability in respect to the date of death liability on account number 372534125791002. Executed this December 16,2005. AMERICAN EXPRESS ::Un~t kc ~ Kathy M Pe on, Agent Estate Recoveries, Inc. P.O. Box 24566 Baltimore, MD 21214 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX 'APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-24-2006 HERLT 11-14-2004 21 04-1117 CUMBERLAND 101 APPEAL DATE: 03-25-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~~!_~~9~9_!~!~_~!~~------~___~~!!!~_~9~~~_~9~!!9~_E9~_Y9Y~_~~~9~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX SUSAN FILE NO. 21 04-1117 ACN 101 BUREAU OF INDIVIDUAL TAXes INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 r'l ! l n -' MURREL R WALTERS 54 E MAIN ST MECHANICS BURG III ESQ PA 17055 ESTATE OF HERLT TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets CHANGED (1) (2) (3) (4) (5) (6) (7) 85,000.00 .00 .00 .00 950.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: 22,726.69 86.939.57 (11) (12) (13) (14) (9) (10) REV-1547 EX AFP (06-05) SUSAN DATE 01-24-2006 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 85,950.00 ]09.666 26 23,716.26- .00 23,716.26- 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. (15) (16) (17) (18) .00 X 00 = .00 X 045= .00 X 12 = .00 X 15 = (19)= .00 .00 .00 .00 .00 KI:~I:~"I (+T AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 f\V j(A · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)