HomeMy WebLinkAbout09-25-13 (2) � 15osbza�4a
REV��5�0 ex (ai-+oy
PA Department at Revenue �F����tY
Bureau of Indivitlua4 Ta�ce� County Code Year FAe Num6er
Po eax zaoso� INHERITANGE TAX RETURN 2 1 1 3 0 ? � 4
Harrisbur�,PA t7128�0601 RESIDEPiT DECED8N1'
ENTER DECEDEMT tNFORMATlON BEIOW
Sociel Secunty Number Date of Death MMDDrYYr Date of Birth MMDDYYYY
1 2 1 6 2 � � 8 0 1 0 3 Z 9 1 tl
DecedenPs last Name Suffx GecedenYs First Name MI
M U R G A N I S A 8 E L M
(It Applicable)Enter Survtving Spause's InformaUen 8elow
Spouse's Last Neme Su�x Spouse's First Name MI
Spouse's Sociai Security Number
THIS RETURM MUST$E FIIED IN QUPLlCATE WiTH TNE
REGISTER OF WILLS
FILL IN APPROPRIATE OYALS BELOW
Q 1.Original Retum � 2.Supplemental Retum � 3.Remainder Return{date of death
prforto 72-1���-82)
� 4.�imded Estate � 4a.Future interest Compromise(date of � 5.Fadera�Estate Tax Return Required
death after f 2-i 2-92}
� 6.pec�dent Died Testate � 7.Decedent Maintained a Living Trust _ 8.Total Number of Safe Deposit 8oues
(Attach Copy of Will) (Attach Cqpy of Trust)
� 9.Lftigation Proceeds Received � 10.Spousa�Poverty Credd idete of death � i i.Election to tax under Sec.97 i3(A)
bebreen 12-31-37 and t-i-95) (Attach Sch.O}
CORRESPONDENT-THIS SECTK)N�IttST BE COMPLE.7ED.Atl CORftES�1DEtICE AHO COliFIDENTtA4 TAX M7FORMATION SNpULD 8E DFRECTfD T4:
Name Daytime Telephone Number
R 4 G E R B - I R W I N , E S Q U I R E ? � 7 2 4 9 2 3 5 3
� r'
� C8Efd1$TER OF WlLLS USE Of7t.Y 1
�� �. , �
�
!_'
First line of address �� - .
' c,.
I R W I N & M c K td I G H T , P . { .
Second line of address �
6 0 W E S T P 0 M F R E T S T R E E T � �� :
City or PtlSt pffiCH State ZIP CodE � __. pATE-�tZED
C A R l I S l E P A 1 7 0 1 3
Correspa�enYS e-maii addrsss:
Under penatties of peryury,t tlaGare that�have examineA ihis return,inciuding acmmpanying schedules and statements,antl ro the Eest of my knowletlge and belief,
it is true.corcect antl cwnplete.Oer,laration c�P�Perer�er than the personai tapr85entative is based on afl k�tprma�oFwhich preparar tas arry knowietly�e.
SIGNATURE PERSON RESPpNSIHLE F R FILING RETURN !?ATE
i ./) �./1 J �
AOpRE S
60 WEST P FRET STREET CkRLISLE PA 17013_
S{�,NqTU OPPREPAREROTHERT REPRESENTATIVE DA/TE � �� ���
+ytLSf�3
AD RESS
60 WESTr MFRET STREET CARLISLE PA 17013
PlEASE USE ORIGINAL PORM ONLY
Side i
� 1505610140 150561014U � �
�
� 150561024Q
REV-1560 EX
DacedenPs Sociat Security Number
oecaeeoest+ame: I$k$EL i"I• MORGAN
RECAPITUlAT10N
1. Real Estate(Schedul�A) .. . _ . .. . . . .. .. . . . . .. ..... . . . . . _ .. ... .. .,. t. -
2. Stocksand Bands(SaAedWe 8) . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 2. •
3. Closely Held Corporation,Partnership or Sa�-Proprietorship(SChedule C} .. . . . 3. �
4. Mprtgages and Nates Receiveble(SChedule D) . . . .. . . . . . . . . . .. . .. . . . .. . . 4. �
5. Cash,Bank De ostts end Miscellaneous Persanat Pr e } y � b 5 4 • 9 7
P op rty(Scheduie E . . . . . . . 5.
6. Jointry Owned Propedy(Schedule F) ❑ Separete Billing Requested . .. . .. . 6. •
7. inter-Vivos Transfers&Misceilaneous N -Probete Property
{Schedule Gj � Separate Biiling Requesled .. . .. . . 7. .
8. Total Gross Assets(totel Lines 1 through 7) . . . .. . . .. . . . .. . .. .. . .. . .. . . &. 1 Q 6 5 4 . 9 7
9. Funerai Expenses and Administratrve Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 8 6 5 . 5 �
70. Dehts of pecedent,Martgage Liabilities,and Liens{Schedale i) .. . . . . . .. . . . . 10. 3 L 3 Q � 4 . 5 9
�i. Tatai Deductions(totet Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 1 3 9 3 0 . d 9
12. Net Value of Estate(Li�8 minus Line t 1} . . .. .. . . . .. . . .. . ... . . . . . . . . . i 2. � 3 � 3 2 7 5 . 1 2
7 3. Chantable and Govemmental BequestslSec 91 f 3 Tcusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . .. 13. .
14. Net Yalue Subject M Tax(line 12 minus line 13} � . . . . . . . . . . . . . . . . . . . . . 14. - 3 � 3 2 7 5 . 1 2 �
TAX CAICULAT70N-SEE tNSTRUC110NS FOR APPGGABLE RATES
15. AmuvM of�ine 14 taxable
at the spousal tax rete,or
hansfere under Sec.9116
{a)(�.2}X.0 _ , 15. ,
i6. Amount of li(ee 14 taYabte
at lineal reke X �0` + ig, ,
17. Amount of Line 14 taxable
at sibiing rete X.i2 . 17. .
18. Amoant of Lirre 14 taxable
atcollateralrate X.t5 • t$. .
1$. TA7C DUE . . . . . . . . . . . . .. . .. . . . . .. . . . . .. . .. . .. . . . . . . . . . . . . . .. . . .. 19. •
2p. FlLL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15�561Q240 1505610240 �
RFV-'SC^Ex Fage."� FiteNOmber
UecedenYsCompleteAddre�s: z� �3 o7Qa
DECEC EN75 NAME
IS"ABEL M. MQRGAN
--- — ----___----_.._-----___...___— — —.—._.
9TRFF.TApDRESS � �� � �
210 BIG SPRING RQAD
—------—---------—--------— --
CITY STATE ZIP� �
NEWVILLE PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) {i}
2. Credits/Payments —
A Prior Payments
8.Discaunt
Total Credits(A+g} (2)
3. Interest `
(3}
d. If Llne 2 is greaferthan I.ine 1 +Line 3,enter the difference.Thls is the OVERPAYMENL —
F�i in ovai an Page 2,l.ine 20 to request a eefund. (dj
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAl(DUE. (5)
Make check payable to: REGI5TER OF W1LLS, AGENT
PLEASE ANSWER THE FOLLOWIN�QUESTIQNS BY PIACING AN "X" fN THE APPROPRIATE BLdCKS
i. Did decedent make a fransfer and: Yes No
a. retain the use or incrome of the prqpedy iransferred: ...................................................................... ❑ �
b. retain the right to designate wlw shai(use the property fransferred or its income; ❑ XQ
c. retain a reversionary interest:or ........_..................................................................................... ❑ � �
d. receivelhe prwnise fa life of either paymenGS,benefits a care7 ....................................................... ❑ �
2. If death occurred after December 12,f 982,did decedent transfer praperty wiihin a�e year flf deaitr
withoutreceivingadequateconsideration? ...._............._........._..._.__................_....__.._.._.............. ❑ Q
3. Did decedent own an"in trust for"or payeble-upon-death bank axount or secunty at his or her death7 .._..._ ❑ 0
4. Did decedenl own an individual retirement account,annuity or other non-pro6ate propedy,which
coMainsabeneficiarydesignation?..............................._.................._._.._.........._..._...._................. ❑ X[�
!F THE ANSWER TO AMY 4F TNE ABOVE QUESTIdNS IS YES,YOU MUST COMFLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on w after July 1, 1994,end before Jan, t, 1995,the tax rate imposed on ihe net vaiue of transfers to or for the use of the surviving spouse is
3 percent[72 PS.§9718(a)(t.i}(i}].
for daies of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
(72 P.S.§9716{a)(1.1)(ii)).The statute does not exempt a transfer fo a surviving spouse hom tax,and the statutory requireme�rts for disciosure of assets and
filing a tax return are s611 applicable even ii the surviving spouse is tfte oniy beneFiciary.
For dates of death on or after July t,2Q04:
• The t�rate imposed on the net value of transfers from a deceased chiki 21 years of age or yqunger at death to or for the use ot a natural parent,an
adoptive parent or a stepparent of the child is�peroent(72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for ihe use of fhe decsdenfs fineal benefiaaries is 9.5 percen#,excep#as noted in
�z P.s. §stis(�2�p2 P.s.�ei�s(a)(�ll�
• The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12 percent j72 P.S.§9116(a)(i.3}].A sibiing is defined,under
Section 9102, as an individual who has at least one parent in common with the decedenl,whether hy blood or adnption.
�Fy_i5na cx.inc.+7�
pennsylvania SCHEDULE E
oe=aRreaeNroFaeveNUe CASH, BANK DEPOSITS & MISC.
1NNERI�RNCE TAX RETURN
RF;oFNrnECeoENT PER$ONAL PROPERTY
ESTATE C+F: FlLE NUMBER:
ISABELM. MdRGAN 21 13 4704
Include the proceeds of lidgation and the date the R��eds were received 6y the estafe.
AII property jointiy owned with right of survlvorship must be disclosed on Sehedule F.
ITEM VALUE AT pATE
NUMBER DESCRlPTION qF DEATH
t AVlVA LlFE AND ANNUI'TY G4MPANY-POLICY#10GA333992 9,829.1$
2. ACNB BANK-CHECKING ACCOUNT 225.78
3. UNCCAIMED PRdPERTY 600.00
� I
TOTAL{Nso enter on Line 5,Recapitulation) $ �p gr� g�
!f more space is needed,use additional sheeis of paper of the same siza.
REV-^F•. cx.Mn nm
pennsylvania SCHEDU�E H
°��`""`"�"T oF aE"E""E FUNERAL EXPENSES AND
INHERI7ANCETAXRETURN ADMINISTRATNE COSTS
RkSiDLNT pECE0EN7
ESTATE OF FttE NUMBER
ISABEL M. MORGAN 21 13 0744
Decedenfs debts muet be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMQUNT
A. FUNER4L,EXPENSES:
1.
B ADMlNISTRATIVE CQSTS:
;. Person�Representative Commissions:
Neme(s)of Personal Representative(sj
Streei Address
Cfij State ZIP
Yeer{s)Gommission Paid:
2, nnomeyFees: IRWIN & MCKNIGHT, P.C. 750.d0
3. Family Exemp6on�.{!t decedenYs address is rrot Ure same as ciaimants,attach explanation)
G�anaM
S12ef AddtBSs
City Staie 21P
Ralationship of Ciaimant to Decedent
4. ProbateFees�
r� AcrAVnTarn F�s:
6. Tax ReWm Preparer Pees:
7. REGlSTEI2 OF WIL�S-FI�iNG FEES 58.50
8. REGIS7ER OF W1LLS-GERTIFIEQ COURT ORQERS 10.00
9. EGGER FUNERAL HOME- QEATH CERTIFICATES 37.60
10. NpTARY FEES 10.40
TOTAL(Alsa enter on Line 9,Recapituiation) $ g�5.54
ii more space is needed,use addiM1Onal SheetS oF paper of ihe same Size.
REV.�512 isX+(�z-�2)
p�nngy�y���� SCHEDULE 1
DEPARTMFNTOFREVENVE DEBTS OF AECEQENT�
�NNER�FAN�E�AxRETURN MORTC,AGE LIABILITiES& LIENS
RESIDENT OECEDFNT
ESTATE OF FIIE NUMBER
ISABEI M. MORGAN 21 13 07p�4
Report debts incurred by the decedeot prior to death that remained unpaid at the date of death,inciuding unreimbw�sed medical expenses.
ITEM VALUE AT DA7E
NUMBER DESCRIPTIQN OF DEATH
i. DEPARTMENT OF PUBLIC WELFARE - OUTSTANDING CLAIM 393,064.59
CIS#27p153427
TOTAL(Also qnter on Line 10,RecepitulationJ $ 3�3 064.59
�
If more space is needed,insert additionai sheets of the same size.
qEV-.t+p�x.rn.:�i
pennsylvania SCHEDULE J
DE�kRTMEPIT#REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESI�ENT RECEDENT
ESTA7E OF: FiLE NUMBER:
lSABEL M. MQRGAN 21 13 0704
RELATlONSHlP TO DECEDENT AMflUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON{S)RECEIVING PR�PERTY Da I�t List Trustee{s} OF ESTATE
� TAXABLEDISTRIBUTIONS [Includeouhiqhtspousaidistnbutionsandhensfersu�dar
Sec.91 f6(a}(t.z}.j
t, DEPARTMENT OF PUBLIC WELFARE
C�AIM
ENTER DOLLAR AMOUNTB FOR DISTRIBUTIONS SHOWN A@pVE ON LINES 15 TNROUGN 16 4F REV-5500 GOVER SHEET,AS APPR4PRIATE. I
Il. NON-1AXABLE DISTRIBUTIONS:
A.SPpUSAL pISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTIpN TO TAX IS NOT TAKEN:
1.
B.GHARITABLE AND�,OVERNMENTAL DISTRIBUTI4NS:
f.
T4T/U.OF PART it-ENTER TOTAL NON-TAXABLE 61S7RIBUTIONS ON LlNE 13 OF REV4500 CdVER SHEET. $
If mae space is needed,use additional sheets of pspsr of the same size.
i nis is to cemfy cha[ thu is a t[ue copy ot che record whcch. is on hte m che Yenn.ryivama Uepartmen� oY �-ieaJrn, in accoraance with
C'�e V?ca' Stari;*�cs i.a�u Qr t953, as amended.
WARNtNG: R is i0egai to duplicate this copy by photastai or photoe�raph.
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ESTATE UF : IN THE COURT 4F COMMON PLEAS
ISABEL iVi. MORGAN : CLiMBERLAND COUNTY,PENNSYZYANIA
: ORPHANS' COURT DIVISIQN
. 1VCl.�/ � j� _ '/"7
AMENDED
FETITION UNbER SECTTON 3t42 OF THE PROBAT� :,
ESTATES AND FIDUCIARIES CQDE FQR � 3 `"' =� �;:�
SETTLEMENT QF SMALL ESTATE � `= ,,, C � �
r-. *• ��
� � fr,
TO THE HQNORABLE JtIDGBS QF SAID COURT: '� "' =" �^
�., - , ._ ,
�-, .� c�
Rager B. Irwin, Esquire, your Petitioner, files t(ris Pet'rtion foc Setttememt c�f'a Smatl
Estate under the provisions of Sectian 3102 af the Probate, Estates and F.iduc�aries Coile ancl in
support thereof avers that: �:. _ ; ,'
'r
(1} Your Petitianer, Itoger B. Irwin is a competent adutt residing a# 233 Avon Drive,
Caziisle, PennsyFvania 170 T 3, and is the attarney of the abave decedent.
(2} Isabe] M. Margan, died on December Ib, 20d8 at the age af 98 years, but prior
thereto was last domiciled at Green Ridge Village, 2I0 Big Spring Raad,
Newville, Pennsylvania, Cumberland County, Pennsylvania. A copy of
DecedenYs Death Certificate is attached hereto as Exhibit"A."
(3} Isabet M. Morgan died without a Witl.
(4) Isabel M. Margan had na probate estate when she died ather than the following:
Annuity Policy lOGA333492 with Avtva Life and Azuiuity
Company with a value of$4,829.18. Correspondence from Aviva
Life and Annuity Compazay is attachad hereto as Exhibit"B."
Checking accaunt with ACNB Bank with a value of $22'�.79.
Carrespondence from ACNS Bank is attached hereto as E�ibit
«C ,>
Unclaimed Praperty with an approxirnate value of$604.d4. A list
of assets with Unelairned Property is attached hereto as Exhibit
«D >,
(5} The sole heirs at�d retatianship to the L}ecedent are as foltows:
The L?eeedent has no living family members.
(b) The Pennsylvania Department of Public Welfare maintains a cl:um against the
Decedent ia the amaunt of$313,064.59. A copy af tt�e Pennsylvania Department
of Public Welfare Ctaim is attached hereto as Fxhibit"E."
{7} Attomay fees in the amount of$754.00 will be chazged to the estate:.
(8) All assets in the name of the Decedent will be closed and the funds, less estate
amuristration costs, wiIi be forwarded to the Pennsylvania Deparhnent of Public
Welfare.
WHEREFqRE, your Petitioner respect£ully requests that an C)rder t7e made authorizing
Roger B. Irwin, Fsquire ta act as Fiduciary and claim the proceeds with Aviva Lifa and Annuity
Cornpany, ACNB Bantc and Unclaimed Properry and pay to the Pannsylvania L7epartrnent af
Public Walfare Claim, pursuant to Section 3162 of ttte Probate,Estates and Fiduciaxies Code.
By � �
Roger . Irwin,Esquire
Supreme Court I.D.No. b282
IRWIN&McKMGHT,P.C.
60 West Pomfret Street
Cazlisle, PA 1'7d13
(717}249-2353
COMMQNWEALTH OF PENNSYLVANIA .
COUNTY OF CLTMBERLAND .
Roger B. Irwin, Esquire, being duly swom according to law, depases and says zhat the
facts cantained in the foregaing Petition aze true and correct to the best of his knowledge,
information and belie£.
Sw��L--- subscribed befare me �q � �
thi day of June,2013. ��
Kazdi s.Pbtl,PbbtY P�
Ca6�la tlao,Gwnbalend CewM,Y
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Aviva Life and Mnuity Company
January 28,2p13
ESTA'i'E O lSABEL
G14 65 E MAIN ST
NEWVILLE,PA 77247
�ear ESTATE O ISABEL:
We are hoidi�g anciaimed praperty in ttse amcwnt of�5,829.18 from�5/201201d due to the persan or
business listed above.A review of o�r recards indicates that you may be the owner of or have a�in#erest in
the properly.
For q�estians regarding this Praperty piease contact cuskomer service at(800}800-9B82.
You muet respond to this letter or tha funds will be submittsd to tha PENN$Y4VANIA State
TreasursPs Office in accordanca witfi its abandoned property Iaws.At that point,the funds wilt na
longsr be paFd hy AvFva Life and AnnutYy Company and a cl�m mast be flFed wtth#he approprlate
authority in PENNSYlYAN1A.
Sineerety,
Aviva Lite and Annuity Compeay
PLEASE SIGN BELOW TO ACKNOWLEDGE OWNERSNIP OF THIS PROPERTY
Last four digits of your SSN or Ta�c ID for veritkatfun pur(sases: ��C:%_ (REQUIREDii
Signahire: "3 ��--�^— �� pate: ✓T 1� z3 wj 3
if the address ebove is i ct please provide your carreded address helow:
1` � � �Y1c, t . P c .
S��
� G A ! c�t
Please allow up to 8 weeks for orocessin9 and nots that addiGanal information mav be roauirew�!to
grocess vour ciaim 6efore the funds can be released if additional informaUon is reauired or chanaes
ate reaueated#o be made reQardin9 ths abavs name andlor address then the time needed ta orocess
the clafm wH!be e�ctended.
Re:Properry: DC 10GA333992 and Policy: 10GA333992
Please f�c or mail the completed furm to:
Fax:977-381-2$81 w
Aviva life and Mnuity Comparay
Att:Anthony McDowe/1-Eschealment 3C-1 DE
PO Box f 555
Des A9anes, fA 5Q306-99$5
�� 4 '
� t�l�t„
Page i of 1
Pam Yarlets
From: Pam Yorlets
Sent: Tuesday, February O5, 2013 9:12 AM
To: jpyorlets@COmcast.neY
Subject: FW:ACNB ear�k account dormant
from: Lindsay, poug [mailto:dlindsay@acnb.com]
SenC:Tuesday, February O5, 2023 9:12 AM
To: Pam YorleYs
Subject: ACNB 8ank account dormant
Hi Pamela, �..�
e��';..
We have an account for Isabe! Morgan that is in dormant status. You are listed as PdA on this account.
Can yo� update me on Yha status of this account to your knowiedge7 Thanks.
-----_,
_�.�_ __...____._. _.__._
�_,� e
��-y� �g
�?au� �'. .L�u�d�y ___--
Retaii Office Manager NMts#631851
Newvii(e Office
ACNB BANK
1-866-683-5413
d(indsay@acnb.com
� CONFIDENTIALTTY NOTICE: This ernail and any attachments may contain informatian that
is privileged, confidential, or otherwise protected from disclosure. If you are not the intended
recipient of Yhis email,piease natify the sender immediateIy by retum emaiI and delete this
message. Further, if this email was received in error, any disclasure, dissemination, distributian,
copying or other use of this message or any attachments is strictly prohibited.
_._..;... i
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215J2013
t'ennsylvania Treasury- 8ureau af Uraciaimed Property- http;�/www.patreaswy.gov/UnclaimedlSeazchResults.asp
Back New Searcf� Search Resuits � ■ �oq In
Accounts appearing on this page will remain visible and claimable sven after a claim has bee�initiated.The property
will be removed from the Web site once Treasury has received sufficient documentation to prawe entitlement.
To learn more about an account and how to claim it,check the box next to the name and then press'Request Ciaim
Fortn'.The rows are color coded to ass)st in your claim inquiry as sirfgte and Joint owner properties may not be
combined on a claim inquiry form.
Green raws show propeRies wFiere you must contact the office to determine e�igibility.
White rows show single owner propeRy records,click on those that you are entitled to claim.
Gray rows shrnv joint owner propeRy records,dick on those that you are entitled to c�aim.
k22s8t Seareh Resutts for: MORGAM,iSABEI Request Claim Farrn�
Ciaim last First MJ. City — St�T.ip �Hoider �� � i Amount
Name Neme
�(— MORGAN ISi ABEL _ Newville PR 17241-0044 Harleysville Mutuai ktsurance Gort�any Under$i00
�r' �MORGAN ISABEL �i Lansdaie PA 19448 (Prudential Insurance Company i_ Over$100
� MORGAN l5ABEl ��M — Newviite PA 17241- �PAony Life{nsurance Company _ Under$1 p0
�Q� MORGAN (�IS�ABEL �M (�Newwlle� PA 17241-OO4Q Mony Life Insurance Cort�any Under$100
I__— � i �_ — — -- ---------
r�� MORGAN ISABEL M Newviiie PA 17241- � Chubb Life insurance Company Of Under$100
� r ' �__ � � _America _____------ —
��'r MORGAN ISABEI �M �Newville PA 17241 Millville Mutu� I�surance Company Under$100
�" MORGRN tSABEL �M ^�Newville PA 17241-0093 Metlife inc _�__ �Under$1p0
MORGAN ISABEL PA Nemrilte PA 17241-Q093 MetMe inc Over$10d
� � ��v�,_
�(�' �MORGAN ISABEL M�LLER Newville PA 17241-0000 Chubb Life Insurance Co Of America Under$1�
�� ----------
� MQRGAN ISABEI�IA Philadelphia PA 19140-4320 John Hancock Financiai Svcs Demute Over$10q
� � � � �— �Gash ^----------
r MORGAN ISABELLA � �thlehem PAT78015 � Colonial Penn Life Insurance Gc�rnpany (Over$100
RBSet Searoh Resuits for: MORGAN,ISABEL Request Claim Form�
I of 1 615/24?3 t0;29 AM
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date� : 6/25/2013
Cumberland County - Orphans Court
One Courthouse Square Receipt Time� : 10 : 31 :59
Carlisle, PA 17613-3387 Receipt No. :: 1052273
MORGAN ISABEL M
File Number : 2013-00704 ---
Paid By Remarks : IRWIN & MCKNIGHT PC
HMW
-- - �-- -- - -- - - Receipt Distribution -- - -
- - -- - ---- ---- -
Fee/Tax Description Payment Amount Payee Name
ZZ PET SETL SM EST 15 . 00 CUMBERLAND COUNT'Y GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIP'PS & CNTR M.D
AUTOMATION r^EE 5_00 CUMBERLAND COUNT't GENERAL FUN
Check# 34033 $43 . 50
Total Received. . . . . . . . . $43 . 50
RECEIPT FOR PAYMENT
Cumberla dNCountyASBOrphans Court Receipt Date : 7/09/2013
One Courthouse Square Receipt Tim� ; 15 :26 : 16
Carlisle, PA 17613-3387 Receipt No. : 1052396
MORGAN ISABEL M
File Number: 2013-00704 -- -
Paid By Remarks : IRWIN & MCKNIGHT
WZ
- -- - --"--- — --- - Receipt Distribution -----
--- - - ----------
Fee/Tax Description Payment Amount Payee Name
PETITION 15_00 CUMBERLAND COUNTY GENERAL FUN
Check# 034168 $15 . 00
Total Received. . . . . . . . . $15 . 00
RECEIPT FOR PAYMENT
CumberlandNCountyASBOrphans Court Receipt Date : 9/09/2013
One Courthouse Square Receipt Tim�=_ : 15 :37 :40
Carlisle, PA 17613-3387 Receipt No. : 1052964
MORGAN ISABEL M
File Number: 2013-00704 ---
Paid By Remarks : IRWIN & MCKNIGHT
CJ
- - - - ------- ----— Receipt Distribution - -- - —
- - - - --- - - --
Fee/Tax Description Payment Amount Payee Name
CERTIFIED COPIES 5_00 CUMBERLAND COUNTY GENERAL FUN
Check# 34558 $5 . 00
Total Received. . . . . . . . . $5 . 00
" (�a�� �J'tr:�1,r�.it,�G��� �az�
15 Big 5pring Avenue
NEWVILlE, PENN5YLYANIA 172di
F. CHARLES EGGER, Supervisor 717-776-3414 FRANK C. EGGER, Funeral 6irector
May 34, 2013
Death Certificate order far Isabel Morgan
3 Certificates $9.60 a piece $27.00
Processing fee by state $lO.OQ
Totai $37.40
��������
MAY 31 ?f:+;�3
uRWIN Y�iWcKNIGNt'
i.HW DfFiCES
pennsyLvania
DEPARFMENT OF PUBLAC Wf.i.FAftE
t� �
,�Uti..i:�_�tr � A"Ijj.
L f` ! C? �'`J'j�
February 8, 2013 0 �� � � L; :.x
=RU1'i+'a k Mr,}t�JlGlit
;aE{�r^,:_�;�[ti
IRWIN & MCKNIGHT LAW OFFICES
ROGER B IRWIN E5QUIRE
WEST FOMFRET PROFESSIONAL BUILDING
64 WEST PC}MFRET STREET
CARLISLE PA 17013-3222
Re: Isabel Morgan
CIS #: 270153427
SSN: ###-##-8836
Date of Deakh: 12/16/2008
Dear ROGER B IRWIN:
Please be advised that the Department of Public Welfare maintains a ctaim in the
amount of ffi3i3,d64.59 against the abqve-menkioned estate. This claim is for restitutfon
of inedical assistance granted on behalf of the decedent for which the Prabate Estate is now
responsibie ko reimburse the Department according to Act 49, 62 P.S. 1412, effec:tive
August 15, 1994, as emended by Ack 20-95, effective )une 30, 1995. Eneiosed is the
DepartmenY's itemrzed statement of claim.
A portion of this medical expense, namely $23.d86.d9, was incurred during the last
six months of the decedent's life; therePare, it is a C4ass 3 ctaim pursuant ta Sectian 3392 of
the Decedents, Estates, and Fiduciaries Code, 2Q Pa. C.S.A. 3392(3). The balance af the
claim, namely 5289,998.50, is to be entered as a priority Class 5.1 claim against the
estate.
Please acknowfedge receipt of this letter and advise whether the Commonuveaitfi's
claim is admitted ar�d when payment may be expected. Ff the estate accounting is
complete, please provide a copy. Tf tha estate contains reai estate, please pravede
capies of the deed, the latest tax assessment, and a current appralsat, if avaitable.
Sincerely,
�--�.r..n.�:t�`.2e,�'.��,
Marianne Meckley
TPL Program Investigator
72?-772-6246
727-772-6553 FAX
Enclosure
8ureau of Program Integri[y � Division of Third Party liability f Recovery Sec[ion
PO 6ox 84&6 � Harrisburg, Pennsylvania 17105-8486