HomeMy WebLinkAbout04-1184PETITION FOR GRANT OF LETTERS
ADMINISTRATION
In Re: Estate of Bradford Tyson Heisey, Deceased
Social Security No. 169-44-7452
Register of Wills for the : m ~ ~ ~
Co~ of C~berl~d in the~ ~ ~.o o
Co~onwealth of Pe~sylv~ia ~ -n
The petition of the undersigned respectfully represents that:
Your petitioner, who is 18 years of age or older, applies for letters of administration on
the estate of the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last
family or principal residence at 63 South Bedford Street, Carlisle, PA 17013.
Decedent, then 44 years of age, died August 12, 2004, at Carlisle Regional Medical Ctr.
Decedent at death owned property with estimated values as follows:
All personal property $ 8076.36
Value of real estate in Pennsylvania
None
Petitioner, Mely Igay Heisey, after a proper search, has ascertained that decedent left no
will and was survived by the following heir:
Nalne
Mely I. Heisey
Mary Cale Heisey
Relationship Residence
Spouse 104 Amy Drive, Carlisle, PA 17103
Daughter (DOB 12/14/92) Same
THEREFORE, petitioner respectfully requests the grant of letters of administration in the
appropriate form to the undersigned.
Signature of Petitioner
Address
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF ~~O/~ ss
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and
beforg, me this f _~ ? ~
subscribed f- ~( ~z_ ~_~ ~/~- /~
day of I /
No. ~ I-c),4 - II ~ c] ?hug_o
GRANT OF LETTERS OF ADMINISTRATION~-
c7') C)
AND NOW ~,.~QJ~0~ ~ c~ ?tJ~ '1:~,~0_~ in consideration of the petition on
the reverse side hereof, satisfactory ~rnof having been presented before me,
IT IS DECREED that .~. ~1~/ -~_.~____ )/~Loa,4
is/are entitled to Letters of Admifiistration, oa~l in'a~cord ~ith such finding, Letters of Administration
are hereby granted to .~. ~ I~' ,~"~ ~//~'tc/~ ~/
in the estate of t~ ~' ,-~M~ '-~c¢o_ ~'"~' ~, /--/~3 ~..
FEES
Letters of Administration ..... $
Short Certificates(~) .......... $ I ~ '~-~
Renunciation ................ $
TOTAL
$Ug, oo
Register of Wills
A~I~N~ (S~p. Ct. I~D.'No.)
.~RESS
PHONE
YT, ix is ~o certify that ti~e information here given is correctly copied from an original certificate of death duly filed with me as
I.ccal Registr, The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 10589694
NO.
44
;
:
nd
Clerk
63 S. Bedford St.
Carlisle, Pa 17013
Jacob L. Heisey
Me ly
ocal Registrar
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
BRADFORD TYSON HEISEY
~ 8/11/f~60
Carlisle
~ommonwealth of P~
Male 169
bur ~,~ [] ~uo~ []
Regional Medical Center
~ Penns lvania ~
--44 --7452 August 12, 2004
' ~"~"L~r~' ~" White
Mely Igay
August 16, 2004
Ina Heller
104 .sle, Pa 17013
Mt. Zion Cemetery )iling Springs, Pa 17007
l*uneralHcme255YorkRd. Pa 17013
\ I
:28
DATE: March 30, 2005
ESTATE NO.: 21-04-11~4i:
DATE OF DEATH: AugUst, 2004
IN THE ESTATE OF BRADFORD T. HEISEY
CLAIM AGAINST DECEDENT'S ESTATE
The Claimant certifies that there is due and owing by Bradford T. Heisey, deceased, the sum
of $2,847.00 together with attorney's fees.
On behalf of the claimant, I do declare and affirm under the penalties of perjury that the
information and representations made herein are tru~ and correct to the best Of?OWledge,
information and belief ~ ' ~ ( ~
HCR ManorCare, Inc. ~ /;
c/o O'Brien, Baric & Scherer David A. Baric, Esquire
19 West South Street for Claimant,
Carlisle, Pennsylvania 17013 O'Brien, Baric & Scherer
(717) 249-6873 19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
CERTIFICATE OF SERVICE
I hereby certify that on March 30, 2005, I, David A. Baric, Esquire of O'Brien, Baric &
Scherer, did serve a copy ofthe Claim Against Decedent's Estate, by first class U.S. mail, postage
prepaid, to the party listed below, as follows:
Lindsay D. Baird, Esquire
37 South Hanover Street
C~liSle,penn~~ / Ii.
David A. Baric, Esquire
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Register of Wills of Cumberland County
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name ofDecedent: fj 1217 -p FO f2.l> 7V So rJ II E.t 'S € ~
Date ofDeath: [5 / I r!J- / 6 V
I I
Estate No.: ~OO </ - 0 I ( 8' '-f.
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
10-1.',-CiI./
iIlELy r. HD:5~
Address
/0<1 ftrn'j fll2./JE.., C!A-tt/.../SLL j/V+ 17013
Name
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
3;;lO, .(/)-
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LINUS/t'1 D. j}/tIt'2-D, <ESQ
Name
(',.1
37 S, IIl+vVOIJYL';t, Q/JkL.15I..L, Pit 1/013
Address
7/1 -aY.3-S7.3r=l
Telephone
Capacity: D Personal Representative
~ Counsel for personal representative
v-
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 03/17/2005
BAIRD LINDSAY D ESQ
37 SOUTH HANOVER ST
CARLISLE, PA 17013
RE: Estate of HEISEY BRADFORD TYSON
File Number: 2004-01184
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.6 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing is due by:
04/07/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~~
cc: File
Personal Representative(s)
Judge
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 03/17/2005
HEISEY MELY I
104 ANY DRIVE
CARLISLE, PA 17013
RE: Estate of HEISEY BRADFORD TYSON
File Number: 2004-01184
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.6 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing is due by:
04/07/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
ff::/!:!:::X
Clerk of the Orphans' Court
cc: File
Counsel
Judge
'Ilf'<-I600"'~)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Heisey, Bradford T.
DATE OF DEATH (MM-!JD..YEAR)
08/14/2004
FILE NUMBER
& 1.. - (It.i
COUNTY CODE YEAR
LLrstL_
NUMBER
DATE OF BIRTH (MM-DD- YEAR)
08/11/1960
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Heisey, Mely I.
~ t Original Return
D 4, Limited Estate
D 6. Decedent Died Testate (Attach copyafWlII)
D g, Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dal. of _ _12.12.a2j
D 7. Deoedent Maintained a Living Trust (Attach copyofT",,')
D 10. Spousal Poverty Credit (d." of death between 12-31.91 and 1.1.95)
SOCIAl. SECURITY NUMBER
169-44-7452
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
171-70-0727
D 3. Remainder Return (date of de"'" prior", 12.13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposft Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 01
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NAME
Lindsay Dare Baird, Esquire
FIRM NAME (~Ap~_.)
COMPLETE MAiLING ADDRESS
37 South Hanover Street
Carlisle, PA 17013
TELEPHONE NUMBER
(717) 243-5732
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(5)
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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 & Miscellaneous Personal Property
(Schedule E)
6. Jolntly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (lotal Lines 1-7)
9. Funeral Expenses & Adminislrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i)
lt Total Deductions (total Lines 9 & 10)
12. Nel Value of fstale (Line 8 minus Line 11)
13. Charitabie and Governmental BequeslslSec 9113 Trusts for which an eleelion to tax has not been
made (Schedule J)
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14. Net Value Subjecllo Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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x .0_ (15)
(14)
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16. Amount of Line 14 texabie at lineal rate
x .0_ (16)
,,_ x .12 (17)
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17. Amount ot Line 14 taxable at sibling nlte
18. Amount ot Line 14 taxable at collateral rate
x .15 (18)
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
f)e~e"ent's Complete Address:
STREET ADDRESS
63 South Bedford Street
CITY Carlisle I STATE PA I ZIP 17013
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. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 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;.......................................................................................... 0 ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 tRl
c. retain a reversionary interest; or.......................................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 I)(l
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 g]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 E2l-
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 B
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare tl1at I have examlnod this return. Including accompanying schedules and statemants, and 10 Ihe besl 01 my knowledge and belief, il is true, conect and complete.
OecIaration 01 prepare< _, than the personal representative is based on all information of which prepare' has any knowledge.
SIGNATURE.OF PERSON RI;.SPONS~LE FOR FILING RETURN
.~uU'kt'~.- -0' )(,tivlrl It., /1 (Ii (;, .F
ADDS If t- /
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1M Amy Drive, Carlisle, PA 17013
SIGNATURE~EPARER OTHER TH~N .~PRESENTATIVE
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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 the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)].
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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 tI
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of
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
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except a
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9911f .
individual who has at least one parent in common with the decedent, whether by blood or adoption.
ive parent,
1(1)].
1102, as an
01-24-2006
HEISEY
08-12-2004
21 04-1184
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
9Yr_~~9~~_r~}~_~}~~______~___~~!~~~_~Q~~~_~Q~!~Q~_EQ~_!QY~_~~9Q~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
BRADFORD T FILE NO. 21 04-1184 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
,,: 1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
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LINDSAY DARE BAIRD ESQ
37 S HANOVER ST
CARLISLE
PA 17013
ESTATE OF
HEISEY
REV-1547 EX AFP (06-05)
BRADFORD
T
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 01-24-2006
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. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
10.753.17
.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 Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
821.55
2.847.00
Ul)
(2)
(3)
(4)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
10,753.17
3.668 55
7,084.62
.00
7,084.62
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ~ returns assessed to date.
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:
(5) 7,084.62 X 00 = .00
(6) .00 X 045 = .00
(7) .00 X 12 = .00
(8) .00 X 15 = .00
(9)= .00
~~.... . (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
PI.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
1'--
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INRE:
ESTATE OF
BRADFORD T. HEISEY
TO THE REGISTER OF WILLS:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS COURT DIVISION
ESTATE NO. 21-04-1184
PRAECIPE TO SATISFY
Kindly mark the estate claim filed by HCR ManorCare, Inc. in above-captioned estate as
having been satisfied.
Date: 5 /:r / lJ 0
f
dab.dir/manorcare/heisey /satisfy .pra
Respectfully submitted,
Z>L)7dA\
David A. Baric, Esquire
LD. # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
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CERTIFICATE OF SERVICE
I hereby certify that on May 2, 2006, I, David A. Baric, Esquire of O'Brien, Baric & Scherer,
did serve a copy of the Praecipe To Satisfy, by first class U.S. mail, postage prepaid, to the party
listed below, as follows:
Lindsay Dare Baird, Esquire
37 South Hanover Street
Carlisle, Pennsyl nia 17013
(14
David A. Baric, Esquire
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
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Date of Death:
Will No.:
c2/- t'-'l- //fV
Admin. No.: C~(lY- //9V
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes [Rl No 0
2. lfthe answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes 0 No fg] . . .
c. S~~;:;;' d ~~~;~l;..~~id: ~: a:~~:V~1 'o~ jormal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this re
J
Date: .j'J~' C:'tJ
Sign
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Name /
37 ,...:S. i!~ntJv'O
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Address
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Telephone No.
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B<l Counsel for personal representative
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