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DECEDEM75&OCIAL SEGURIiY pIMABER
FteruY J Nlal�
SiR�sr�oo�e�s — --- --— - - ----
142 S.30th St.
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C�►mp Hill, PA �17011'T �
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BCHSDULS '�8"
9TOCR8 AND 80ND8
Estate ot Xenry J. Malfs Fila Number 2412-01189
ITEM N[1M88R DESCRIPTION VALL7E T,�DBAT}I
J. Alden A88ociates $47,419.52
Raymontl JameB
Accaun� 35874185
(3ee attached Exhibit '�A°)
TOTAL STOCK3 $47,4I9.52
ANO BONDS
8CIi8DUL8 nga
CASB, BANK DSPOSITS ANU
rtzscs�,r�xEOUs
PER30NAL PROPERTY
Bstate o£ Henry J. Malis Fi3e Number 2412-02189
ITBM NUMBI3R DESC'RIPTI(» VALUE AT DEATH
1997 Ford F150 577.8•00
(3ee attachsd Exhibit "8" and
�����?
Ptet value
TOTAL CASH, $718.00
SANK
DEPOSITS,
MS$C.
SCHBDULE "H"
FUNERAL EXFENSSS,
ADMINISTRATIVB COSTS AND
MISCELLANEOU3 SXPBN58S
Eetate pP Henry J. Malis File Number 2fl12-01189
ITSM DE3CRIPTZON AMOUNT
1, Funeral B�cpense $6,64?.6?
2 . Peraonal Representative $5, 500.00
Commiseioa
3. Social Security Number
4 . Year Conenisaion Paid
5. Attorneys' Fees $3,250.00
6 . Family Sxeraption Claimant,
Relatianship ta Deceased
7. Address of Claimant at
Decedent�s Death
8 . Probate Fees 5138.5Q
9. Advertising eatate
10.
Obituary 597.50
Family funeral mcals $542.p0
xctel far executor $417.00
$16,552.57
SCHSDULE I
DBBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIEN3
Estate of Henry J. Malis File Numbcr 2012-01189
7'1'�N[1MBER DESCRIPTION AMOUNT
Pinnacle Health 200, 110. 06
(3ee Exhibit "D")
200110.08
SCHEDULE J
SENEFICIARIE3
Eatate of Henry J. Malis File No. 2012-01189
ITEM NUM88R NAME AND RELATION3HIP AMOUNT OR
ADDRE3S OF TO DECEDENT SHARE OF
BENBFICIARY ESTATE
A. Taxable samuel A. Malis gon 1/3
B@C�LtE8t8 200 Pennaylvania
AVO
Camp Hill, PA
17011
Jacob D. Malie son 1/3
200 Pennsylvania
Ave.
Camp Hill, PA
17011
wiiiism s. raaiie son 1/3
200 Pennaylvania
Ave.
Camp Hill, PA
17011
IT6M NUMBER NAMB AND ADDRESS OF AMOUNT OR SHARB OF
BENSFICIARY ESTATE
A. Charitable
a:ld
Governmental
Bequests
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53 b Repl Qeanfardelivey 1 OS
yl # XemfdoUS Waste RemOVel 1 3.� T
ss x aep� ne+lae carosbn vrouxuon 1 ls.ao T
56 a R�d Plena�'itive t 6.00 T
lU�fQ�ALY 3�13l.s2 21A 16.0
NO7ES
Prlar D�eya NotK
B�ADESAND RTTADUMP
�TIMAT!TOTALS
pbpory Buis nra Ooet s
P7rts 1,09232
9ody WbOr 11.4 hrs � 5 46.W/hr 984.40
Pe�t Labor 16.0 lus � S 16.00/hr 736A0
Pmdlt SuppOa 18.0 hrs � S 27AU/hr 368•00
rmoeea�eous a,so
Suhblal 4,205.22
s�s Tex S 4,205.12 � 6�0000% 25231
OINd Toml 4�437d3
DlGUdlbk 0.00
NSTOMlR PAY o.00
IN6UNANCE P11Y 4AS7.s3
2�25t1013 2:33:11 PM 033089 P�3
oaniizoia ia:is aea vi�saa»eo CL�NUI.US-HAARI9BURG �ooa
. . PrNiminary estimaEe
customer: MALiS�]iLL 7ob Nulnber.
vehide:i997 Fort�Piso ax4 wre�u93o�oNCi 8-a,6�-��aew
ANY PERSON Whb KNOWINGLY AND W1TH IMENT TO DEFRAUD ANY INSURANCE OOMPAN1f OR OTHER PERSON
FtLES MI APPLtt'ATlON FOR AVSURANCE OR SfATEMENT OF GAIM COKfAINING ANY MA7ERL4LLY FALSE
INFORMR7ION OR CONC�ALS FOR TI1E PURpOSE Of MISIPADING, INFORMRTION 00NCl0.N[NG ANY FACf
MATERTAL TMERETO COMMIfS A FRAUDULB'IT IN�JRANCE ACI', WNiCH IS A CRIME AND SU8]KfS'fHE PERSON
TO QtIMINAL AND GML PENALTIES.
THE FOLLOWING IS A LIST OF A98REVL►T[ONS OR SYMBOIS�aT MAY BE USED TO�SfRIDE WORK TO BE
DONE OR PARTS TO BE REPA[REO OR REPLACm:0�PY5CONSINUED PART AaAPPROXlM/17E PRSCE 6=BODY
LABOR D�DL4GTIOSTiC E=ELECI'RIGL F�FRAME G=GLA55 MaMECHAMCAL P=PAiNT LABOR S�SfRUCTURAL
T=�'AXED MISGEWW�US X=NON TAXED MISCELUWEOUS AD]eAp)pCENT qU(iN=ALIGN AfM=AhTERMARKET
BLI�=BL�CAPA=CER7IFiED AUfOMO'f1VE PARTS ASSOCtATlON DSR=DLSCONNECT AN6 RECOfINECi'
EST+ESTIMATE EX'f, PRIC�=UNIT PtiICE MULIIPLtED BY 7HE QUANTIfY INCL=INCLUDED MISC�MI5CELLANEOUS
NON-ADJ•I�W ADIACEI�0/H=OVERFWUL OP=OPERATION NOaLINE NUP78ER QTY=QUANRTY
RECOND=RECONDITION REFN=REPINISH REPL�REPLACE RdS=REMOVE AMD INSTALL R&RffiREMOVE AND
REPLACE RPR=REPAIR RTaRtGHT$ECT=SECRON SUBL�SZJBLET L7eLEPT W/OaWIfHOUT W/_=WITH/-
#=MANUAL LIi�BY1'RY*sOTHER [IE..MOTORS DATABASE INFORMAlION WAS CNANGED]. '�"�'�DATABASE LiNE
WITN Ah�&IMARKET N=N07ES ATTACHW TO LINE NAGS.NATlONAI AUTO GLA55 SPEG[FICATIONS.
MQVP�MANUFACTURER'S QUAL1lY AND VALIDA7ION PROGRAM.OPT OEM�ORIGINAI FQUIPMENT
MANUFACfURER PARTS EIi11ER OP'TIQNAU.Y SOURCED OR OTHERNIISE PROVtDW W!T}� SOME UNIQUE PR�QNG
OR DISCOUNT.
7HE AITACHED ESRMATE R�RESENTS AN APPRASSAL OF TME COST OF REPAIR FOR THE VISIBIE DAMAGE TO
7HE VEHI0.E NQTm AT THE T➢�7E OF INS�CrtON NC�SSARY Tt�RETURN TI1E VEFItCLE TO lT5 PREDAMAGED
C�ONDIfION. a051'S ABGME THE APPRAISEO Ah�UNT MAY BE THE RESAOIdSIBILifY OF THE VEHICLE OWNER.
THERE IS N�RBQUIRBYIINTTHATTHE VftQCLE OWNER USE ANY SPECIFiED REPAIR SHOP� INWRMATI�1
REGARDING REPAIR FAClLITIES WHICH 1NILL BE ABLE TO REPAIR 7FIE�HICLE FOR THE MPRA[SED AMOUNT IS
AVAILA&.E FROM THE INSURANCE�MPANY. 1F t15ED PARTS ARE SPECtFI�,THEY ARE REQUtRED lD BE OF
LTKE IQND AWC QUAI,TfY N THOSE BQNG REPLAC�D.INGDENTAL CNAiIGES SIJCH AS TOWWG, PROIEG�iVE
CARE� NSTODY,STURAGE, DEPREQAIION, BAIIERY AND TlRE REPIACEMENf ARE NO'TED WF�W AAPIICABLE.
AFfERMARI�T OtASH PART-A W�NORiGINAL EQUIPMENT MANUFACTURER(NON-0EM) REPLACEMENT P14RT,
E1TH6t NEIAI OR USED, FOR AfVY OF THE NONMECHMQCAL PARTS T11AT GENERALLY CONSRTUTE THE EXTERIOR
OF lNE MOTOR VEHICLE, INCLUDING TNNER AND OUTER PANELS.'ftQS APPRAISAL W!LL IND[CATE IF
AFTERMARKET d1ASH PARfS ARE SPECJFIEp. IF THE USE OF SUCH PARTS VOIDS THE WARRANTY ON THE PART
BE1NG REPLACED OR ON ANY OTHER PART,THE AF�ER MAWCEr CRASH PART SHALL HAVE A WARRAMY EQUAL
TO OR BEI'TER THAN THE REMAINDER OF THE EXISTTNG WARRAMY.
7/75/2013 2:33:f1 PM 033089 Pape�
—._ . .. .. .. . .
04/11/201� 13:Y0 FAE 717Y947780 CUlIULUS-HARRISBURC �005
PraRminary EsdmKe
C�oMer:M�LiS,�LI. Job Number.
ylhlqe:1997 FORD FLSU 4X4 SUPERIUIB 3D LONG 8i.61-FI f�1tEB7
E�ImaOe bnKd on MOTOR CRA511 P_51'LMAT[NQ GUSDE. Unlau otherwise nobed ell Items are derived hom the�uide
DE2MA97,GCC DeEe DeEe 1/71za13, and tl�e Pnrts selected are OEM-parts manufacturcd by tl�e veHdas Origtnal
EqNpment Manufedurer, OEM paRs are avst�ble at OENehkle d�lerships. OPT OEM (Optlonal OEM)or ALT OEM
(ARemetive OEM)parts are OEM parts that may be provlded tY or throuqh al0emate sourt�otlRr tl�an tlte OEM
yeMdo denitr�, ppT 0�7 or ALT OEM parts may rd11eR sana spedflc, spectal,or untque prking or dNOOUnt.
OPT OEM a uT OB�1 pmb may Mdude "BI�nKhed" parts piwtded hy oEM's thmugh oEM veMde dalerahlps.
AsOer(sk(•)or�uble AsOerisk(*") IndkaOes that tha parts andlor tabor IM�nBUOn Provlded by MO�iDR maY have
been modNled w may have aome Trom an altemate data source. llkle sign (�)iEems indicste MOTOR Not-Induded
Labor oparedons. The symbol(<>) fndiwtes tfie refinish operation W1LL NOT be peiform��a s�pa►ate proadure
fmm the othv pands tn the esNmate. NorrOriginal Equlpment Manufadurer ettermarket paMs are degaibed as AM.
Used parts nre described as LKQ RCY,or USED. Reaonditlorced Da�ls are d�oibed as t�oond. Wecored parts are
desaibed as Recore, NAG$ Pat Numbers and Bmchmerk P�loes are provided by Natbnal Auto Gless Spec�ficatbns.
Labor aperatbn Hmes UsGed on the If�x wfth the NAGS fntormaUon are MOTOR suggested labor operarJon tlmes.
WAC�S tabor opeiadon times are not induded. Pound slgn(#)I[ems indicahe manuel�101es.
Some 7Al2 vc�oa�b�n mirar d�anges fmm tlu previous yedr. For those vehicks, P►�or to reoeivfn9 �Pdabed
data from tlu vehide ma�uFacturcr, labo►snd parts dafa from the prevlous ye.ar may ba used. The CCC ONE
�naEOr has a complete itst of applkaWa vehldes. Parts numbers ane prices should be co�m�ed wlth the i�1
dealershfp.
The Foi►owu�y Is a Iist of addttlonal abbreviadons or symbols that may be�ed bo descHbc wark to be done or parts m
be repaired ar repkced:
SYMBOLS FOLLOWlNG PART PRICF:
m`MOTOR MedwNCal mmponenk. ssM01'OR Struch�ml aomponen� T�Nisoellaneous Taxed charge caEegory.
X=i�scdlerxous Non-Taxed diarqe cahegory.
SYMBOLS FOLL01NiNG LABOR:
D�Diegrrostic bbor category. E=EktUlCel 19bor categary. F�Frame labor wtegory. G�Glau labor Cabagory.
M�Mechenkel lebor ca0egory. S=Struchllal labor cat�ory. (numbers) 1 through 4=Usa D�Ined Wbor Categor�es.
O7liER SYMBOLS AND ABBREVlATIONS:
Adj.=Ac�Jaaent Algn.�Align. AW=Numtnum. NM�AIbeRnarlcet park BInd�BklM. BOR=Boron steN.
CAPA�ertlfled AuLomotive Parts Assodatton. D8(t�Disooimmt and Retonnect HSS�HIgh Sbdigth Steel.
HYD=Hydrofwmcd Steel. InclrInduded. LKQ=Lbce Klnd and QualRy� LT=Left. MAG�MagrKSlum, Non-AdJ.=Non
Ad�cEnt. NSF--N�Iirtemetlonal Cerdfled Part O/H=ove�,a�. �Quarnky. Ren,•�n�h. Rep=ReP�.
(�e1Z2T0�@ 811d T(lifi��. �s�lOV2 8�1d RlplBCl. R(1�sRl��. (�=�QIIt. $A.S�$EIIdW�Cfl@d $�68�.
Sect=Sectlon. Subl=Subld. UHS=Ultra High Strenyth S�eel. N�N�e(s)a9sOdated with the e�hnate�ine.
CCC ONE Estimatl�-A product oF CCC I�Hortnatlon ServkES Inc.
The following is a Itst of abbreviations that may be used in COC ONE Esdmatlng that are not part of the MOTOR
CRASH E57TMATING GUlDE:
8AR=8umu of Automotive Repair. EPA=Environmen�l ProteRlOn aga�cy. NHTSAr Nattonal Highway
Traroportntlon entl Safety I�mfMStratlon. POR:pntntless Derlt Repatr. VIN=Vehkle Identlffcatton Nurnber.
2/25/7A33 2:33:17 PM 033089 Pa9s 5
_01/11/PO1� 1S:Y0 FAZ 717Y947780 CUWLUS-HARRISBURG �008
. 4 1 •
Preliminary C�limaEa
CusEOmers MAI.IS,7iLL 7ob Number.
Vahlda:1997 I�dtD F150 4X�SuPEAGAB 3D LONG 8-4.6�-R GREEN
ALTERNATE PAR7S SUPPLIERS
suppltan K�ystone-CONIWeb-wlndber
Lo�tlon(s$ 320 DOB�157qFfT,WII�IOBER pA 15963 (B0�43M2430 (814)467-5531
b5 C0.0SS FARFf UWE,YORK PA 17406 (80�521-4399 (71�813-8927
tlne oasctptlon Itain�e rrice
17 A/M Mant Pend to 7J96 P01220�05 S 1xG00
20 q/M C/1PA Pintl m�er F01720233P0 S 24.00
23 A/M LT lms&h0udnp F02502112 ��85.00
25 A/M G1PA LT FOQ limp saY F02893114C ;114.00
29 A/M CAPA Hood(ALU) F017301)4C S 435.�
2/2S/2D33 2:33:11 P!4 D330H9 Page 6
MeTugqpdieas; JOHH OeLOREN2p,ESt1.
� R.O.��ifW DheclmoiLagal�Servfua
War�Itbwg,PA 1�1qS8TOtl
Lp�lipp; (717)23f-8248
408SO�dh SiqaM�81ree1 (71'n 231�f51 Eax � .
FW�1e4r�.PA t710a �
E-ma�Melaanxa�pMnadMeaBh.wg
Pi N NACLEH€ALTH
' Qecember 13,2012
� ����
VW liem L. er, Esq.
Attt�nay at law
4949 Devonshlre Road
Harti�bu+�g, PA 171�
Re: Estale of F1ersry Malis,deceaeed
NetiCe oF Claim
Dear Apomey Adler:
We have been edvised that yuu e�couns�ot rn�rd for th�Estate af Wenry Malk,dece�ed.
Pieeae be ativfeed t#r�t Mr. iNaNa d�ed ovwh!ig a de�t#o Ptrhm�cte Heeilh Npepkals in the amoWnt
af�,11Q.b$Tor m�edical care pravlded to h�Pari�he per[o+i o1 mtd-August ihrough Ms cPate of
dea3h on GkEotser 3, 20T2:
Pl�eae be adwised that we wfll be filing a NoUoe o�C!�€�w+ifi the�umaer4and Gou�aty Register
of VWiNa. Afi ym►x earf�eat corrv�en�enee, pl�se tel us kmow whether the Estate has sufi�cirnt
aesets to salisfy this debt.
If yau sharltJ have arty quea8ons, please do noY hesitate to contact rrre. Thank yau tor pour
� aEteMion ta i�is r�a[ter.
Sin�re6
�
Jahn D�lotenzo
�
__ _
NOTICE OF CLAIM
(Filal P�csuaat to 20 Pa.C.S. p 3532)
COURT OF COIrRrlON PLEAS OF
����� COUNTY,PENNSYLVAMA
ORPHANS'COURT DMSION
BS1'ATE OF H�'M� DECEASED
No. 21-12-1189
To the Cle�k of the Orphd►s'Caut Division:
Enter the claim of Pinn�ck Heelth Hospirols in thc
110.08 �
srtauM of S �+ •against the above emiUcd Fstate.
The Decedent,who rcaided at 2 t 8 North 29th S�re�,Gmp HiU,PA 17011
���
dted on 1013/12 . Written notice of
�orae�oraaV
said claim wm given to William Adler
(��a��
at 4449 Devaoshire RoQd.Hurlsbure.PA 17109
fti+w1
on 19J13/12
1u+4
Pimacie Healt6 HoapiWa
�
409 S.Second Sdroet,P.O.Box 8700
rs..�,�.�.w
HaerltMurg,PA 17104
John Dei.araozo 72190 �0'��P1
�.r.�u.�.b a�r►�..cb.naaHW
Pioa�cla HaUh,409 S.Second Sueet,Snito 2C
u�+r.al
South�te BuiWing,Htrclaburg,PA 17104
717-231-8230
ryYl�iwl
ForwOC-07 r�r.i0.11.06
WILLIAM L. ADLER
ATTORNEY AT LAW
4949 Devonshire Road
HARRISBURG, PENNSYLVANIA 17109
PHONE: (717) 652-8989
FAX: (717) 307-3343
EMAIL: BAL�u.Bi11Ad1erLaw.com
WEBSITE: Bi11Ad1erLaw.com
LEWIS F.ADLER KOHN AND ADLER
Q934_I984) (19341960)
DAVID S.KOHN KOHN, ADLER&ADLER
(1934_1985) (1960-I981)
LOUIS 1.ADLER ADLER&ADLER
(1959_1999)
(1999_2010)
CRAIG 1.ADLER
August 9, 2013
Cumberland County Courthouse
Register of Wills
One Courthouse Squaze
Carlisle, PA 17013-3387
Re: Estate of Henry Malis
Dear Register of Wills:
Enclosed please find an inheritance tax return for filing. One copy of the inventory and two copies of the
retum aze enclosed along with a check for$30.00. Please return a clocked copy to me in the envelope provided.
Thank you.
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