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Home My WebLink About06-28-13 IN RE ESTATE OF : IN THE COURT OF COMMON PLEAS MEDA J. STINE, Deceased : OF CUMBERLAND COUNTY : PENNSYLVANIA : No. <� I" l� - �71�1 �' � - ::� PETITION FOR SETTLEMENT OF SMALL ESTA� �`' �ry� `"�' ;;; �-�, [_; c=- �� __ C: --_ ,.i :F � ��. r J .. g � ,:,- �_;` C� �.,� To the Honorable , the Jud e of said Cc�ar�;, ::: - . , , �,; ,; _ �- -� 1. Your petitioner is Robert C. Stine, Jr. who is the st� bf Meda-�. - -�= �--� :-:� Stine, deceased, and has the following interest in the assets tha�,would comprise;..� `' � =,-, the estate of Meda J. Stine. 2. Meda J. Stine died intestate on the 4th day of March, 2013, at 8:56 o'clock a.m., and at the time of death the decedent's last principal residence was 770 South Hanover Street, Carlisle, Cumberland County, Pennsylvania. 3. The above-named decedent died intestate and no letters of administration have been issued. � 4. The names, addresses, and relationships of all persons having an interest in the estate of the decedent as heirs or next of kin are as follows: NAME ADDRESS RELATIONSHIP Robert C. Stine, Jr. 746 W. Louther St., Carlisle, PA Son James T. Stine 221 Cornman Road, Carlisle, PA Son 5. The decedent was not survived by any persons entitled to claim the family exemption under 20 Pa. C.S.A. Section 3121. 6. The total value of the decedent's personal estate is less than $10,000 and consists of the following assets which have the following values: ASSET VALUE M&T Bank Acct. 9861431113 $4,275.18 7. The following is a list of all known, unpaid creditors and the amount of their claims, which claims are proposed to be paid from the assets of the decedent. NAME AMOUNT Robert C. Stine, Jr. to reimburse expenses $2,304.43 Paid on behalf of the Decedent/Estate 8. A Pennsylvania lnheritance Tax Return is being filed simultaneously with this petition and inheritance tax in the nominal amount of $13.23 is due. In the event that additional tax is deemed due, petitioner shall insure that such tax is promptly paid. A copy of the Inheritance Tax Return is attached hereto and made a part hereof. 9. It is proposed that the following distribution of the decedent's estate be made to the following creditors, heirs or next of kin. NAME DISTRIBUTION Robert C. Stine, Jr. (Expense Reimbursement) $ 2,304.43 James T. Stine (Distribution) 985.38 Robert C. Stine, Jr. (Distribution) 985.37 WHEREFORE, your petition respectfully requests your Honorable Court to decree the distribution of the decedent's personal estate to the persons entif(e thereto as set forth in Paragraph 9 above obert C. tine, Jr., itioner � , ,/�.c,,,d �,c.-L.f...�f.�c. Ja e M. Robins n, Esq. Att r ey for Petif ner Supreme Court I 84133 129 South Pitt Street Carlisle, PA 17013 (717) 245-9688 �„� K-,�.��-�� w�. � �.� � �,� . �� .�. � „ :r. �.��,�-..- �,.��..�,.� � _ . H705.805 REV(9/11) � LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ,,,��"'��--.. This is to certify that the information here given is �' �ZHOFp"' ,��,n�'��,P __ E�j%y�: correctly copied from an original Certificate of Death ��'py` - _ �; duly filed with me as Local Registrar. The original ��_ �` = z� certificate will be forwarded to the State Vital '°- � Records Office for permanent filing. . '� � a; �* _ i *Q P 19 4 3 4 611 =__°�,,q = P��,,�� . --�_ � / 9lMENT 0E�'�'� �,u�e �.'��.��c�r�ox- WI 5 ZO�� ,,, Certi�cation Number "'°��"""'"�� _ Local Registrar Date Issued Type/P�Ini In COMMONWEALTH OF PENNSVLVANIA�DEPARTMENT OF HEALTH�VITAL RECORDS ) PefTa"e"` CERTfFKATE OF UEATH Black Ink 5[ate File N�mber: � 1.Dccedeni's Legal Name(Firsf,Middle,Last,Suffix) 2.Sex 3.Social Se<urity Number 4.�ate of DeatM1(MO/Oay/Yr)(Spell Mo) Meda Jane Stine F�1 '184-12-3572 March 4, 20'13 Sa.Ag¢-Last Birthday(Yrs) Sb.Under 1 Vear Sc.Under 1�a 6.Date of Birth(MO/Day/Vear)(Spell Month) �a.BirtM1place(City antl Stace or Foreig Co�ntry) Months Oays Hours Min�ies MeCt]3T71CSr7L1Y' pH 1 89 All S't ��♦ 1 923 �b.Birthplace(COUnty) r].c'�yd 8a.Residence(SCate or Foreign Co�ntry) 86.Residence(Street and Number-Inctude Apt No.) Sc.�id Decedent Live in a Townshlp7 ad.a PA..�e(co�.,ov) 770 S. H�iOVar St_ 0 re:,ae�eae.,c u..ea i� owP. Cisnt�rland g¢,Resldence(Zip Code) �No,decedent lived within Iimifs of C'�r11S1e clSy/bo�o. 9.Ever in US Armed ForcesT SO.Marital Status at Time of�eath � Married Widowed 11.Surviving Spouse's Name(If wife,give name prior to Flrsi marriage) �Yes '�NO �Unknown � Divorced � Never Marrled � �Unknow - 12.Father's Name(Firsi,Midtlle,Last,Suffix) 13.Mother's Name Prlor io First Marriage(Firsi,Middle,Last) Ro er O_ Waise Catherine =_ Cramer 14a.Informant's Name 14b.Relationship to Decedent 14c.Informant's Mailing Atldress(SYreet and N�mber,City,State,2ip Code) o Robert C_ Stine Jr_ Son 746 W_ Louther St_ , Carlisle, PA '170'13 G _ _ _ _ _ _ _ _ _ _ _ _ 15a.P ace of Death C ec on�one If Death Occurred in a Hospital: ['] Inpa[lent �If Death Occurretl Somewhere Other Than a Hospital [7 Hospice Facllify �]Decedeni's Hom� ° O Emergency Room/OU(pa[ient � Dead on Arrival � �$]CNUrsing Home/LOng-Term Care Facility O Other(Specify) � 15b.Facility Name(If not institutlon,give street and mber) 15c.City or Town,Staie tl Zip tl 15d.CounTy of Death � Cl�apel Pointe at Carlisle Carlisle, �A "�7�13 Gtimtbarland 16a.Method of pisposition Burial � Cremation 166.Date of DlsposlSion 16c.Place of Disposi[io�(Name of cemetery,crematory,or other place) � � Hamoval f�om State 0 Donation OOther(Specify) 3 7 2013 Westm�r+st2r CBt12t2 � 16d.LocaHOn of Disposition(City or Town,State,and Zip) 17a.Signature of F��ense n iry�ha�ge of InYerment l�b.license Number � Carlisle, PA '1 70'I 3 ¢r C � FD 01 2633 L E 17c.Name and Complete Address of Funeral Facility � ° ' = S_ H over St_ Carlisle PA 170'13 r� 18.Decedeni s Ed�catfon-Check the box thaf bes[describes the 19.�ecetlent of Hispanic Origin-Check the 20.Decedent's Race-Check ONE OR MORE races to Indicate whaf � highesC degree or level of school complet¢d at the time of death. box that best tlescribes wheiher the decetlenc cM1e decedent considered himself or herseif to be. � 8in grade or less is Spanish/Hispanic/La(ino. Check the"NO" �Nhite Q Kor¢an � No diploma,9th-12th grade bo If decedent K not Spanish/Hispa�ic/Latino. � 61ack or African American O Vietnamese j� High school graduaie o�GE�complefed �NO not Spanish/Hispanic%Latlno � Amerlcan Indian or Alaska Native � Othe�Asian � So coliege retlii,but no degree O Yes,Mexican,Mexican American,Chicano O Aslan Indian � Native Hawailan O As ociate tleg ee(e.g.AA,AS) O Ves,Puerto Rlcan O Chinese � Gvamanian or Chamorro 0 Baclielor's tlegree(e.g.BA,AB,BS) �Ves,C�ban � Fillpino O Samoan O Mascer's degree(e.g.MA,M5,MEng,MEd,MSW,MBA) 0 Ves,othe�Spanish/Hispanic/Latino �Japanese � Other Pacific Islander � Doctorate(e.g.PhD,EdD)or Professlonal degree (Specify) � Other 5 if ( pec y) .MD 005,OVM,LLB JD 21.Oecedent's Single Race Seif-Designafion-Check ONIY ONE to indicate what the decetle�t considered himself or herseif to be. 22a.Decedent's Vsual Occ�pat(on-Indicate type of work White O Japanese O Samoan done tluring most of working Iife. DO NOT USE 0.ETIftED. Black or African American � Korean � Other Pacific Islander p �Amerlcan Indlan o�Alaska Native � Vietnamese � Don'i Know/NOt Sure H�.7c.er j �Aslan Indian �Other Asian � Refused 226.Kind of B�siness/Industry .� 0 Chinese � NaHVe Hawaiian � Other(Specify) � � Filipino � Guamanian or Chamorro HeY OWIZ hCHSle ITEMS 23a-23d MUS 9E COM LETED 23a.Date Pro � d d(MO Oay/Vr) 23b. f Pers Prono�ncing Deat�yfOnly when applicable) 23c.License Num er BV PERSON WHO PRONOVNCES OR �j (� �j /A/ /J // CERTIFIES DEATH O J � • /�Q�� /� e��S/J�=_ �N RN 2Z�l.5��L 23d.Daie 5 d(M /Day/V�) 24.Time of t �� /- °�'��'r� 3 0� Q�3 e� �/✓1 25.Was Medtcal Examiner or Coroner Con[actedT 0 Ves No CAUSE OF UEATH � � Approxima�e 26.Part I. Enter She chain of events--diseases,Injuries,or complicaHOns--that dlrectiy caused the tleath. DO NOT enter terminai events such as cardiac arrest, � Interval: re5piratory arrest,or ventrlcular fibrlllatlo\n w`ith\out showing the etlology. DO NOqT A`BBREVIATE. Ente'r�only one cause on a Iine. Add additlonal Iines If necessary. � Onset to Deaih IMME�IATECAUSE a. ��'1t'^�-�fl Sc�Q-p�� `y��(�� \ ]\SQc � ____'"""__'_'> � (Final disease o nd�fion Due�o(o�as a consequence of): resuicina�n aeacn7 � b. Sequenilally Ilst corid(tb�s, Due to(or as a consequence of): � 1 If any,leading to the cause � � Iisted on line a. Enter She c � UNOERLYING CAUSE pue co(or as a consequenca ofJ: (disease or Injury that � F initiated the events resuliing d. 1 In death)LAST. D�e to(o as a consequence of): � 1 � 26.Part 11. Enter oiher si¢nificant conditions c tribuSina co death but not resultfng in tFie underlying cause given in Part 1. 27.Was an autopsy perfoyr �edi O Yes _�No � . � 28.Were autopsy fintlings avallable m' to complete the caus of deathT O Ves �No ^_r+ 29.If�Fe�m�ale: 30.Ditl Tobacco Use Contribute to Death? 31.� er of Death � o ,�.yT�.c.�pregnant withln pasC year � Yes O Probably j[f Natural Q Pregnant at time of deafh �,_P1� � Unknown � Homtcide � Not pregnant,bu[pregnant within 42 days of death � Accident O �'endin olnvastigatlon m p 5uicide p Could t be determined � � Noi pregnant,but pregnant 43 days to 1 year befo�e tleaCh 32.Date of InJury(Mo/Day/Vr)(Spell Mon<li) - � � Unknown if pregnant within the past year 33.Time of Injury (, 34.Place of Injury(e.g.home;consfructlon site;farm;school) 35.Location of InJury(Street and Number,City,County,State,Zip Cotle) V) 36.InJury ai Wa�k 37.If Transportation Inj�ry,Specify: 38.Describe How Injury Occurretl: � Ye5 � �river/OperaTOr � P¢desirlan ` � No O Passenger � Other(Specify) d 39a.Certifler-physician,�certified n e practitioner,metlical examiner/coro r(Check only one): � Certifying only-To the best of my knowledge,death occurred due fo the cause(s)antl manner stated. _\ � Pronouncing 8.Gertifying-To the best of my knowledge,death occurred at the tlme,tlate,and place,antl tlue to the ca�se(s)and manner stafed. �� O nnedical Examine/C er-�e►��sis of exa ination and/or inves[Igaiion,in my opinio�,tleath occurred ac[he time,date,and place,and due to the cause(s)and mann r s2ated. Signatura of certifler k!'^�'•� Tltie of certlfier: �� Llcense N�mber� ��OZ-cl�e�,� 39b.Name,Atldress tl 2ip Cotle of Person Compl¢ting Caiase of qpa h(I�em 26) � �`,e�� _ _�P��JC 3g ti� 5-iOg�ed/MO/Day/Yr) zZa V .�S•T-� ST c�.�r�,)L. I��/4 I Z J\ � � ZJ� y�Gj 40.RegiSCrar's Disirici N�mber 41.Registrar's S�ignate�are � ./� ]� 42.Registrar File Oafte(MO Day/Vr) 6 � L�K#"�.�,\��" Q�- J O � 43.Ameridments � Otsposition Permit No. O�Q[„J\� H105-143 REV 07/2012 --� REV-'1500� �505610143 EX(01-10) ' •_ OFFIGIAL USE OWLY PA Department af Revenue penn�ylvania County Code Year File Numbe� Bureau of Individual Ta7ces d�AR7MENTOFREVENU6 �o Boxzsoso� INHERITANCE TAX RETURN ��, 13 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT lNFORMATIQN BE�QW Socia(Security Number Dafe of Death Dafe of BiRh 184 12 3572 03 04 2013 08 10 1923 - Decedent's Last Name Suffix Decedent's First Name Mt STSNL MEDA J �If Applicable)Enter Surviving Spouse's Inforrnation Below Spouse's Last Name Suffuc Spouse's First Name MI 5pouse`s Social Securi#y Number TWIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WIL�S FILL IN APPROPRIATE OVALS BELOW � 1.Originat Re#um ❑ 2. SupplementaC Retum � 3.Remainder Retum{date af deattr pnorto 12-13-82} � 4. 4imited Estate � 4a.Futuru�ntenest compromise � 5. Federal Estate T�a�c Retum itequired {date a�death sfter 92-12-82} � s. Decedent Died Testate � 7, Decedent Mefntained a living Trust � g, 7'otal Number oP Safe Deposit Boxes (Attach Gopy of Wili} (Altach Copy of T�usq � � 9. Litigation Proceeds Received � �p,spausat Povert�Credit(d8te of deattr 1�,EfecGon to tax under Sec.91 t 3(A} � belween 1231- 1 and T-1-95) � (AttaCh SCh.O) i CORRESPONDENT-THIS SECTIQN MUST BE COMPIETEq.ALL CORRESPONDENGE AND CONFIDENTIAL tAX INFORNIATiON SH8U4D Bf DtRECTEQ TO: Name Daykime Tslephone Number JAMES M ROBINSON 71T 245 96$$ REGISTER OF WI�LS USE QNLY First tine of address 129 SOUTH PITT STREET Second line of address DATE WI.ED City or Past Offiee State ZIP Code CARLISLE PA 17013 Correspondent's e-mail address: )C013 f i18011 Q�t U�018 W.C O Ct1 �,U�n�der penat�'hes��peg�u�ry�,t�d�ecia�re��e examined this retum,inciuding accompanying schedules ar�d atatements,and to the best of my knowledge and belief, preparer afher than the�'sonal regre.ser�Natlue is based on at!infortnafion af wrhidt preparer has arry knowiedge. $IG TURE OF PE SP SIBLE FOR FILINO RETURN DATE Robert C.Stine,JC, �,, ,�g . 3 ADDRESS T46 W.louther Street,Carliste,PA 97013 SIGNAT E OF PREPAR�qT` R A R ENTATIVE OATE :�� „�� ,,� James M Rabinson C��-Z��J.� A DR S South Pitt tree#,Carlisle,PA 97013 Side 1 � 15056'10143 1505610143 � � 95Q5610243 REV-15Q0 EX t}ecedent's Social Security Number os�a�,rsrvgme: STtNE, MEDA J 1$4 12 35?2 RECAPITULAl'ION 1. Real Estafe{Schedu(e A).......................................................................................... 1. 2. Stacks and Bonds(Schedule B)............................................................................... 2. 3. Closety Hetd Carpara#ion,Pa�tnership or Sale-Proprie#arship(Schedule C).......... 3. 4. Mortgages&Notes Receivabie(Schedule D).......................................................... 4. 5• Cash,Sank De osits&MisceOaneous Personat Pro e 4 r 2 7 5 • 3 8 P P �Y(Scfiedule E}................ 5. B. Jaintly Owr�ed PropeRy{Scheduis F) ❑ Separate Billing Requesfed............. 6. 7. Inter-Vivos Transfers 8�Miscellaneous Nnn-Probate Properly (Schedute G} [j Separate Billing Requested............. 7„ 8. Total Cross Assets(totai Lines 1-7}....................................................................... $. +� , 2 7 5 . 18 9. Funeral Expenses&Administrative Costs(Schedule M}......................................... 9. � � ��7 • 7 4 i0. Debfs of Decedent,Moctgage�iabitities,&�iens(Scheduie i)................................ 1�. 713 . 4 6 11. Tatal Deductions(to#al Lines 9&90)...................................................................... 1 L 3 , 9�1 . 2 0 ' 12. Net Value of Estate(Line 8 minus Line 11}............................................................. i2. 2 9 3 , 9 8 13. Charitabte and Govemrr�antal BequesMtSec 9113 Trusts for which an election to tax has not been made{Schedule J)................�................................ 13. i4. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. ��3 � �� TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amounf of Line 14 taxabte at ttre spousai tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 18. Amount of Line 14 tauable a#iinea!rate X .045 2 9 3 . 9$ �s. 13 . 2 3 17. Amaun#of Line 14 t�able at sibling rate X .�2 ��• 18. Amount of Line 1A taxabie at collaterai rate X .15 18. 19. Tax Due..................................................................................................................... 19. 1� . 2� 20. Fi�L iN THE OVAL iF Y8U AtRE REQUESTtNG A REFUND OF AN OVERPAYMENT. ❑ Side 2 � 15056'i0243 1505610243 � REV-15Q0 EX Page 3 ' Fite Numt�r 21 - 13 Decedent's Campiete Address: D CE ENT' A Stine, Meda J STREET ADDRESS 770 S. Hanaver $treet C1TY STATE ZIP Carlisle PA 17Q13 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19} (1} 13.23 2. Credits/Payments A. Priar Paymenfs 8. Discount Tota!CredEts{A+B} (2} 0.04 3. fnterest (3) 0.00 4. !f Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check Box on Page 2 Line 2d to request a refund 5. !f Line 9+Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. t5f '��.7 3 Make Check Payable ta: REGISTER{}F WI�LS, AGENT. ..;-�` � ,-w, -Y-�-�, -r�._.. �*�^C�"°"� -"�-��- �'�`,.�.�-� ,��„.¢."�. �'.x� +-�-m--�.�.... :�-,�-sc� �-, . c� f'�'� . . �..._...�,:a,_'z.�i.b!�ze..�ae:,.:.:_..ia_as.s4i'�"'y.'��a't.�..,5.ti:::a.:...��.a�:��Yy.�..s;,y�`�'..m�.��,+�, a�ir��i"�,�-��`.�,s.z��,,.g .�%�a--r r �, x� �iw + r ... �:.;��'s.�.'$"'�.�.h,,�,"��."� .�.::...,c.,...v:��x;s��.=.�c:r.._cr--'_'_„t.,,.y��.fi:...&.:n�.,�w�c�..�,.vi.�3:"w'..,.��..a:=.-•.'r..a�«... PLEASE ANSWER TNE FOLLC�WING 4UESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes Ma a. retain the use or income af the prapert}r transferred:.................................................................................. � b. retain the right fo designate who shali use the praperty transfer�ed ot its incame:.................................... x c. retain a reversionary inferest;or.................................................................................................................. x d. receive the pramise for life of either payments,benefits or care?.............................................................. x 2. tf death occurred after Clecember 12, 1982,did decedent transfer property within one year of death without receivingadequate cansideration?....................................................................................................................... ❑ � 3. Did decedent awn an"in frust far" or payabte upon death bank account ar security at his or her death?......... � 0 4. Did decedent awn an Endividual Retiremeni Account,annuity,or other non-prabate property which con#ains a beneficiary designatian?...................................................................................................................... ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G ANd FILH IT AS PART OF THE RETUi2N. r. . � Z'�,i, - .a ,.,♦ sN „�.,�s:,;� c, ��,�,z.� -rt.y.�, s rt -�i 5.�'�. ��e..4`^'� ' �3�'ft ,.x�. �t c i ;. s ��„ �"�. S C�w^ ,,.u�.a _,...�ri�;,....a:,.y��:...xs.ez.e:,s:4z�:.... .s,.i.-:L;,_.;",.„;;,,,,;.1"y;;e, _,�,4^�.t �i AF � i 2�,.� ��..:��..•�:......!.,:j...:....�:�.�.t�._:.':�._.....,_ M...`.;..+,�.:i.a�._?r.t'��.�.•R%�':z� For dates of death on or after Jul 1,1994 and befare Jan.1,1995,the tax rate imposed on the net value of transfers fo or for the`use of the surviving spouse is 3 percent[72 P.S,§91�6(a}(1.1)(ij�. For dates of death on or after Janua 1,1995,the tax rate imposed on the net value of transfers to or for the use af the suroiving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The sta�ute does nof exempt a transfer to a surviving spouse from tax,and the sta#utory requirements for disciosure of assets and filing a tax refum are stit!appiicabie even if the sunriving spouse is the only beneficiary. For dates af death an ar after Juty 1,2000: •The tax rate imposed on the nef value of transfers from a deceased child 29 years of age ar younger at death to or for the use af a naturat parenf,an adaptive parent,or a stepparent of the chitd is Q percent j72 P.S.§9116(a}{1,2)]. •The tax rate imposed on the net vatue of transfers to ar for the use of the decedent's tineal l�neficiaries 9s 4.�percent,except as natad in 72 P.S.§9116 1.2)[72 P.S.§9116(a)(1)]• !The tau�ate imposed an the net vaiue of transfers ta or for the use of the decedenYs siblings is 12 percent(72 P.S.§9116(a)(1.3). A sibling is defined under Section 9102,as an individuai wha has at least one parent in common with the decedenf,wfiether by bioa�or adoption. SCHEDULE E CASH, BANK DEPOSlTS, & MISC. COMMONWE/LLTHOFPENNSYLVANIA PERSONAL PROPERTY WHERITANCE TAX RETURN RESIDENT DECEDEN7' ESTATE OF Stine, Meda J FI�E t�UMBER 2'i -13 !nclude the proceeds af litiga#ion and the date the praceeds were received by#he estate.A!I praperty jointly-owned with the right of survivorship must be disciosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 9 M &T Bank-Checking Acct. No. 9861436663 4,275.18 TOTAL(Alsa enter on Line 5,Recaqitulatian) 4,275.18 SCt�EDl1LE H COMM6NWEA{.TH 8F PENNSYLVAPttA ��E�� INHERITANCE TAX RETURN ��{�JC f'Y'1�T� RESIDENT DECEUEN7 ■w��v'��nr r.N�.N 1\7 FILE NUMBER ESTATE OF Stine, Meda J 21 _ 13 Debts of decedent must be reported on Schedule L ITEM - NUMBER pUNERAL EXPENSES: d��}�T�� AMOl1lVT A. 1 Westminster Cemetery LLC 1,720.Q0 2 Eby Granite Works 1,046.00 3 Gearge's Flowers 136.74 4 Faith Chapel - 115.00 5 B. ADMINISTI2ATIVE Ct�STS: �. Personal Represenfa#ive's Commiss"sons Name of Parsonat Representative(s} Street Rddress City State Zip Year{s}Cammission paid 2. attomeyrs�ees Turo Robinson Attomeys at Law 250.00 3. Family Exempfion: (If decedent's address is nof the same as claimattf's,attach e�slanafion} Claimant Sfreet Address City State Zip Relationship of Ciaimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 TOTAL{Alsa enter on line 9,Recapitulatian) 3,267.74 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTHdFPENNSriVAN1A LtABILITIES & LIENS MRiEF21TANCE TA}C RETURN ! RESIDENTOECEDENT FIi.E NUMBER ESTATE OF Stine, Meda J �� - �� _ Report debts incurred by the decedent prior ta death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM . DESCRIPTION AMOUNT NUMBER 1 Chapel Pointe at Carlisie 708.56 2 Carfisle Barough Tax Coilector 4.90 TOTAt.{Also en#er on Line 90,RecapitulaYsan) 713.46 E1/•1573 EX+(11-063 SCHEDULEJ COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stine, Meda J FILE NUMBER 21 - 13 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) (�$$) - RECEIVING PROPERTY Do Not ust Trustee(s) I� TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 James T. Stine Son One-Half 221 Cornman Road Carlisle, PA 17013 2 Robert C. Stine, Jr. Son One-Half 746 Louther Street Carlisle, PA 17013 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 6 B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00