Loading...
HomeMy WebLinkAbout02-0388PETITION FOR PROBATE and GRANT OF LETTERS 'tate of Irvin M. Welty No. ~o known as To: Deceased. ,cial Security No. 2 0 7 - 0 7 - 9 ~13 Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ri× the last will of the above decedent, dated d codicil(s) dated n/a in the named December 13, 1999 , (state relevant circumstances, e.g. renunciation, death of executor, etc.) .Decendent was domiciled at death in Cumberland County, Pennsylvania, with xs last family or principal.residence.at 256 Walton street Lemoyne, l~ennsy±vania f~-~--~ rJ-~ (list street, number and muncipality) ~'~ ! ' ~ Decendent, then $6 years of age, died March 17, 2002 , lq~ , Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted ter execution of the will offered for probate; w_as not the victim of a killing and was never adjudicated :ompetent: widow,.. Olive Welty ~cendent at death owned property with estimated values as follows: · domiciled in Pa.) All personal property $ · not domiciled in Pa.) Personal property in Pennsylvania $ · not domiciled in Pa.) Personal property in County $ due of real estate in Pennsylvania___ $ uated as follows: WHEREFORE, petitioner(s) respectfully esented herewith and the grant of letters :ron. request(s) the probate of the last will and codicil(s) testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) Arlene H. ~a~bell 301 East Emaus Street Middletown, PA 17057 /7-57. OATH OF' PERSONAL REPRESENTATIVE DMMONWEALTH OF PENNSYLVANIA ~ ss DUNTY OF Cumberland rhe petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are te and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- ive(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. tore me this _ 12th day of [ __ c~ / ~. April.~ [ ~/' , >[R__21)_fl2J ~ t. ~ No. 21-2002-388 Estate of Irvin M. Welty , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW April 15th ........ 2~_x__ 2003 cor~sideration c ' o< !:.t.:itio~,. on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 13 December 1999 described therein be admitted to probate and filed of record as the last will of I rvin M. Welty and Letters Testamentary are hereby granted to Arlene H. Campbell FEES Probate, Letters, Etc .......... $ 25.00 Short Certificates( 4) .......... $ 12.00 Renunciation ................ $ x-Pages (3) $ 9.00 JCP TOTAL __ $ 5.00 Filed .A.p.r..i.1...1.5. kb., .2.09.2...$.5.1. :.0.0... Register of Wills l~ary C. Lewis '~' Samuel L. Andes (17225) A~ORNEY (Sup. Ct. I.D. No.) 525 N. 12th Street, ADDRESS PA (717) 761-5361 PHONE Lemoyne 17043 MAILED LETTERS TO ATTORNEY ON April 15th,2002 his is tc Local Ret tify that the information here given is correctly copied from an original certificate of death duly filed with me as tr. 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. Local Registrar iviAR g 0 2002 Date NAME OFOECEDENT( 86 COUNTY OF DEATH Cutaberla D~CEDENT'S U (Give kind o/we DECEDENT'S MAILING 256 Wa] FATHER'S NAME (First t iNFORMANT'S NAME (3 METHOD OF DISPOSI?~ physician i~ not available certify cause of death. CAU~ ~se o~ mlury WAS AN AUTOPSY PERFORMED? To ~he bel~ of my kn 'MEDICAL E~AMIN On the hims of em mL"mir iii M~ted. REGISTRAR'S SIGt ER 1 YEAR Days DS (Slreet, City/Town, Stale, Zip Code) St.. A 17043 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) STATE F~E NUMaER ISEX SOCIAL SECURITY NUMBER JDATE OF DEATH (Month. Day, Year) M Welty a. Male 13.207-07-9513 ,. March 17, 2002 Hours Minutes(Mo~lh, Day, Yea0 J Slste o~ Fc~e,gn Counb'y) IHOSPITAL: JOTNER: I~- I~. I'. ' ' ,3.12 (~,z) (,-,~ s+) ,~ri~ re,s0live D~CE~NT'S P~sylv~ia MOTHER'S NAME {First M.~ite, Ma<lan Surname ~') Worden Welty ,~ebecca Myers ) A~le.ne H. Ca~l 1 INFORMANT'S MAILING ADDRESS S~'eet. Cit}~/Town, Slate Zip Code) ~01 E. ~naus St. ,Middletown,PA 17057 DATE OF DISPOS,T,ON {(MO~th, Day, ~ar) IP~ACE OF DISPOSITION - Name of Cemetery, Crematory I LOCATION- City/Town, Slate, Zip Code '"~"~ ~'"~""[] %?rch 20, 2002 ,~ndiantown Gap Nat. Cern. st Hanover Twp.,PA17003 'E. UCENSEE OR P,~mSON ACT{NG AS SUCH tK~ENSE NUMBER [~ME ARD AD[X~ESS OF FACm{TY { ~?. ~n~. ~.~ he beS~ of ~ knowtedge,~curred at the ~ime, date and plac® slated ~ LICENSE NUMBER { DATE SIGNED DUE TO (OR AS A CONSEQUENCE OF): DUE TO (OR AS A CONSEQUENCE OF): DUE TO (OR AS A CONSEQUENCE OF): Hypertensive Cardiovascular Disease JTOPSY FINDINGS I M ;)L%'E R OF DEATH .E PRIOR TO TK)N OF CAUSE H? Natural L~A Homick~ [] No [] Accident[] Pem~ng Investigation S9u. i¢ ids [] Could no{ be delarmim~d ~y~can car i~ f./Ing cause of death ~ snot he~' physcian has pron~Jnced dealh and completed Item 23) ,, dealh occun'ed due to the c&u~l) end manner ii elated ..................................................... [] FYING PNY$1CIAN (Phy~cian bo~h I~ono~ncing cleath eno car titylng Io cause el death) ,, ~eath OCCUlTed &t lhl time, date, and place, lind ~ue to the cau~e(~) ind meaner ~ ~lalad .......................... [] lONER m and/o~ Inveatlgatlofl, In my oplnlml, death occurred at the time, date, and place, and due tm the cause(e) and ~ [] J 3~1. J 30~. M. LOCATION (Slmel, ~ily/Town. Slale) [] ,,c. Coroner 3,,,. -----,,- -~--~;~ --- ~/ ~- s,~. I,,d. March 18, 2002 (he~?)~me~P,,t Michael L. Norris. Coroner 6375 Basehore Road, Suite MechanicsburE, Pa. 17050 21-2002-388 WILL OF IRVIN M. WELTY 21-2002-388 I, IRVIN M. WELTY, of the Borough of Lemoyne, Cumberland County, Pennsylvania, (~,declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I give, devise, and bequeath all of my possessions and estate of every nature and wherever situate as follows: A. One-half thereof to my brother, ROBERT N. WELTY, provided he _~.,,~ survive my death by sixty (60) days; and  B. One-half thereof to my sister, ARLENE H. CAMPBELL, provided she survive my death by sixty (60) days. Should either my said brother or sister predecease me or be deceased on the sixty-first day following death, I direct that their share hereunder to the survivor of them. my go ITEM III. I appoint my sister, ARLENE H. CAMPBELL, executrix of this my last will. ITEM IV. In addition to the other powers and authorities granted to my personal representative by Pennsylvania Law and by the other terms and provisions of this will, I hereby give to my personal representative the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representative may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representative deems proper, Page 1 of 4 without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representative deems proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM V. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this / ~ day of Pa~e 2 of 4 The preceding instrument, consisting of this and TWO other typewritten pages, each identified by the signature of the testator was on the date thereof signed, published, and declared by IRVIN M. WELTY, the testator therein named, as and for his last will, in the presence of us, who at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. Amy Pa~e 3 of 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ) ( SS.: ) The undersigned, being the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. /I VIN M. WELTY Sworn or affirmed to and acknowledged before me by the testator named above this ~+~' day of J~ce~:~eA. , Iq~l. Notary ~ublic COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ) ( SS.: ) WE, SAMUEL L. ANDES and AMY HARKINS, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his last will; that he signed it willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. Amy Har~ins Sworn or affirmed to and acknowledged before me this ~ ~ ¢- day of ,Oeo,.,,.,~l:,~.~ , Notary ' u~blic CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Irvin H. Welty Date of Death: 17 March 2002 Will No. Admin. No. 2002-00388 To the Register: I certify ~ha~ notice of beneficial interest' 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 21 May 2002. TO: Robert N. Welty 590 Pleasant View Road Hummelstown, PA 17036 Arlene H. Campbell 301 East Emaus Street Middletown, PA 17057 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: ~'//~ (////O ~ Attorney-at-Law 525 North 1 2th Street Lemoyne, PA 17043 (717) 761-5361 Counsel for personal representative ["'~ ,,_z~__ ,~¢'1~ PENNSYLVANIA ~~~ DEPARTME~ OF REVENUE INHERITANCE TAX RETURN 21 _ 02 0388 HARRISBURG, PA 1712 0601 RESIDENT DECEDENT DECEDENTS ~ME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL $ECUR~ NUMBER Welty, I~in M. 202 - 07 - 9513 DA~ OF D~TH (MM-D~Y~R) J DATE OF BIR~ (MM-DD-Y~R THIS R~URN MUST BE FILED IN DUPUCATE WITH THE 03-17-2002 J 12=27-1915 REGISTER OF WILLS {IF APPLIC~LE) SU~qVING S~USE'S NAME (~ST, FIRST, AND MIDD~ INITJ~ SOCIAL SECURI~ NUMBER Welty, Olive M. 211 - 36 - 9033 NAME Samuel II J" COMPL~ ~LING g Andes FtRMNmE(nAp~) J 525 North 12th Street ~LEPHONENUMBER J L~oyne, PA 17043 (717) 761-5361 J 1. Real ~mte (Sm~uleA) (1) *' ~FtCIAL USE ONLY Z. Stocks and Bonds (Schedule B) (2) 3, Closely Held ~mfion, PaF~emhip m Sol~opdetomhip (3) 4. M~gages & Notes Remivable (S~ule D) (4) 5. Ca~, Bank Deposi~ & Mism~an~s Pe~nal P~ (5) 20,982.95 (~ule E) 6. Joi~ O~ed Prope~ (S~ule F) (6) *. 8epa~te Billi~ R~u~ed 7. Inter-~s Tran~ & Mis~llaneous Non-Pro,re Prope~ (S~edule G or L) ~, To~, ~,~,s Ass~ (~o~, u,~ ~-7) (~) 20,982.95 9. Funeral ~pen~ & Adminimative ~sm (Schedule H) (9) 9,288.37 10, Deb~ of De~dem, ~Agage Liabili~es, & Liens (Sch~ule I) (10) 1,217.57 11. Total Dedu~ons {~1 Lines 9 & 10) (11) 10,505.94 12. N~ Value of Eslme (Uno 8 minus Line 11) (12) 10,477.01 i 3, C~d~e and Govemmentai Bequ~Sec 91~ 3 T~s~ for whid~ an ele:io~ to ~x has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Uno 12 minus Line 13) (14) 10,477.01 SEE INS~UCTIONS ON ~RSE SIDE FOR APPLICAB~ ~TES 15, Amount el Line 14 ~xable at the spou~i ~x ~te, ortransfe~ under Sec. 9116 (a)(1.2) x.O__ (:5) 16, ~ounl of Line i4 taxable at lin~l rote 10,477.01 x .0~ (16 471.46 17, Amount of Dne 14 t~ble at sibling Bte x .12 (17) 18, ~ount of Line 14 ~ble at ~llat~l rate x ,15 (18) 19, T~ Due (19) Decedent's Complete Address: "' STREET ADDRESS CITY 256 Walton Street Lemoyne STATE PA ZiP 17011 Tax Payments and Credits: i, Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount (1) 471.46 3, Interest/Penalty if applicable Total Credits (A + B + C ) D. Interest E. Penalty Total Interest/Penalty ( D + E ) 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 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (2) (3) (4) (5) 471.46 (SA} 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 ffansfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......... ................................................................................................................ [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2, ff death occurred after December 12, 1982, did decedent transtar property, within one year of death without receiving adequate consideration? .............................................................................................................. [] ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ~ ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefidary designation? ........................................................................................................................ [] [] 1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under ~..',~ies of perjury, I declare thai J have examine0 this mlum. i,'~uding acc~,~ ~ing Schedules and statemem% and to the best of my kn, owle~§e and belief, it is true, correct and c~mpiete. Declaration of preparer etha' ~,n Ihe personal represenlalive is based on a~l in[urination of which ~'epater has any k~ow[ed§e. SIGNATt~E (~ PERSON RESPONSIBLE FOR FILING RETURN Arlene H. Campbell ADDRESS 301 East Emaus Street, Middletown, PA 17057 SIGNATURE O PREPARER eT E'R H REP CSENT, IVE ~a.,muel L. Andes '~DDRES _~,.~¢/~,frS 525 North 12th Street, L~:Arne, PA 17043 DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rata imposed on the net value of transfers to or for the use of the surviving spouse is [72 P.S. §9116 (a) (1 .t) (i)]. 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 the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii)]. The statute d~es not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stili applicable even if 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 to or tot the use of a natural parent, an adoptive parent, or a stapparent of the child is 0% [72 RS. §9116(a)(1.2)]. The tax rate imposed on the net value cf transfers to or for the ,Jse of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value cf transfers to or for the use of the decedents siblings is 12% [72 P.S. §9116(a'~(1.3)]. A siblin~ is defined, under Section 9102. as an individual who has at ieast one parent in common with the decedent, whether by blood or adoption, ' ~ ' COMMONWEALTH OF PENNSYLVANIA iNHERiTANCE 'fAX RETURN RESIDENT DECEDE~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ESTATE OF Irvin M. Welty 21-02-0388 Include the proceeds of litigation and the date lfle proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Checking Account No. 5140067752 with PNC Bank (date of death value, see attached letter) Investment account No. 86718888 with PNC Brokerage Corp. (date of death value, see statement attached). 1996 Pontiac Grand Prix 4-door sedan (see Kelly Blue Book valuation attached). Miscellaneous items of household furniture and appliances and personal effects. Sold at public sale, see auctionneer's statement attached). IRS refund for tax year 2001 Final Pension payment for month of March, 2002, paid after decedent's death (Bethlehem Steel Pension Trust, see check stub attached). $8,023.32 $6,333.87 $4,795.00 $653.00 $184.00 $993.76 TOTAL (Also enter on line 5. Recapitulation) $ 20,982.95 (If more space is needed, insert additional sheets of the same size) PNCBAN( June 7, 2002 Samuel L. Andes 525 North 12~h Street P.O. Box 168 Lemoyne, PA 17043 Estate of Irvin M. Welty, deceased SSN: 20%07-9513 DOD: 3/17/2002 Dear Mr. Andes: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Accoum #5140067752 IRVIN M WELTY DOD balance: $8,022.72 * $0.62 accrued interest Established 08/07/1993 For Brokerage information, you may call 1-800-762-6111. INV #86718888 Please note that this office only provides date of death balances for deposit accoums (IRAs, CDs, Checking and Savings accoums). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Si/merely, Rachelle Wells 1-800-762-1775 P7-PFSC-04-F 500 first Ave. Pittsburgh PA 15219 Member FDIC TOTRL P.01 Illlllllllllllllllllllllllllllllll 0 0 0 0 I~o~o~ /omomo~ ~o~o~ ~ m m 0 [ .! Date of Death: 03/17/2002 Valuatlon Date: 03/17/2002 ProcessingDate: 05/30/2002 Estate Valuation Shares Security or Par Description High/Ask Low/Bid i) 2) 95 PNC FINL b'VCS GROUP INC (693475105) NYSE o3/15/2oo2 o3/10/~oo~ 466.91 MONEY MA~Y FUND 03/17/2002 62.12000 61.16000 H/L 62.19000 61.56000 H/L 1.00000 1.00000 H/L Eetate of: IRVIN #BLTY Account: 86718888 Report Type: Date o! Death Number of Securities: 2 File ID: WELTY,IRVIN Mean and/or Div and Int Secu:ity Adjustments Accruals Value 61.757500 5,866.96 1.000000 466.91 Total Value: Total Accrual: Total: $6,333.87 $0.00 $6,333.87 Page 1 This report was produced with ~etateVal, a product of Estate Valuations & Prlcin~ Systems, Inc. please cautact ~Vp Systenm at (818) 313-6300. (Revision 6.4.0) If you have queetiou~, K~lley Blue Book Used Car Values Page 1 of 1 Kell Blue Book The Trusted Resource New Car Pricing Build a Car Incentives My Car's Value Used Car Retail Buy a New Car i1~ a Used Car Sell Your Car Motorcycles Financing Insurance Lemon Check Wa rranti es Accessories Car Reviews Car Previews Decision Guides Advice Home Blue Book Private Party Report Pennsylvania · May 21. 2002 1996 Pontiac Grand Prix SE Sedan 4D Engine: V6 3.1 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 73,000 Equipment Air Conditioning Power Steering Power Windows Power Door Locks Buy a New Car Buy a Used Car List Your Car For Sale Online Financing Quote Insurance Quote Warranty Quote. Payment Calculator Tilt Wheel AM/FM Stereo Dual Front Air Bags Consumer Rated Condition: Fair "Fair" condition means that the vehicle probably has some mechanical or cosmetic defects, but is still in safe running condition. The paint, body and/or interior need work to be performed by a professional in order to be sold. The tires need to be replaced. There may be some repairable rust damage. The value of cars in this category may vary widely. A clean title history is assumed. Even after significant reconditioning this vehicle may not qualify for the Blue Book Suggested Retail value. Private Party Value $4,795 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. :~,~ .~ ~? .:., ~ ::. ~ L::~° Get a Used Car Trade-In Value Get Invoice & N1SRP on New Cars Click to vi,, You gre ' Get i Locate Ne~ S~ ¢ 3rd Pa Copyright © 2002 by Kelley Blue Book Co., All Rights Reserved. May-3un 2002 Edition. The information in this report was printed from the Kelley Blue Book Web site (www.kbb.com) and is intended for the personal use of the customer only and may not be sold or transmitted to another party. We assume no responsibility for errors or omissions.(v.02050) http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb;547016&;p&723 ;Pontiac; 1996%20Grand%20... 5/21/2002 BRICKERS AUCTION Complete Auction Service Auction - Wednesday Evenings 766-5785 Chuck Bricker, Auctioneer TOTAL SALE COMM. CLEAR. PENSToN TRUST OF' BE"I'HLF'HEg STEEL CORPORAT1'ON ' '+"' EHPLOYEE HAHE TR -- PENSZON M.Z.T. F.Z .C.A. S~I.T AHOUHT · z~oo DEDUCTZONS 8~6 I / HEDZCAL TOTAL DEDUCTIONS 99?+6__ 99~76 P F.Z.T. H'~ REMOVE DOCUMENT ALONG THIS PERFORATION ~,. Z.T. N'~ STATUS REV. 15t1 EX+ (12-99) COMMONWEALTH OF PF-NNSYLVANiA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Irvin M. Welty 21-02-0388 Debts of decedent must be reported on Schedule [. DESCRIPTION AMOUNT ITEM NUMBER A. 1. FUNERAL EXPENSES: Musselman Funeral Home ADMINISTRATIVE COSTS: Personal Representatk, e's Commissions Name of Personal Representative(a) N/A Social Security f',Jumber(s)/EIN Number of Personal Representative(s) Street Address City ................................................................. State Year(s) Commission Paid: Attorney Fees Samuel L. Andes Family Exemption: (If decedenCs address is not the same as claimant's, attach explanation) Claimant N/A Zip Street Address City State_____Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees The Sentinel (advertising) Cumberland Law Journal Bricker's Auction (sale of personal property) $5,368.50 $3,500.00 $51.00 $80.87 $75.OO $213.00 TOTAL (Also enter on line 9, Recapitulation) $ 9,288.37 (if more space is needed, insert addit one sheets ot the same size) ~.0 INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIEN..S_.j ESTATE OF Irvin M. Welty FILE NUMBER 21-02-0388 Include unreimbursed medical expenses. !TEM NUMBER DESCRIPTION AMOLiNT 2. 3. 4. 5. 6. 7. 8. 9. Dr. Bream (medical expense) Connor Rich Associates (medical expense) Carlos R. Leffler Inc. (fuel oil bill) Comcast (cable television bill) Pa. Water Company (water bill) Borough of Lemoyne (trash/sewer bill) Verizon (telephone bill) PPL (electric bill) Arlene H. Campbell (reimbursement of varoius miscellaneous expenses incurred in administering estate) $35.25 $48.03 $180.36 $72.84 $23.02 $56.7O $56.60 $54.73 $690.04 . 1,217.57 TOTAL (Also enter on iin¢ 10. R(capi u ation) ,~ (if more sp~ce is needed, ir~ser~ additiona! sheets of ~he same size) REV-1513 EX+ (9-00~ ~.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE 'tAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Irvin M. Welty FILE NUMBER 21-02--388 NUMBER l II 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outfight spousal distributions, and transters under Sec, 9116 (a) Arlene H. Campbell 301 East Emaus Street Middletown, PA 17057 Robert N. Welty 590 Pleasantview Road Hummelstown, PA 17036 RELATIONSHIP TO DECEDENT Do Not ListTrustee(s) sister brother AMOUNT OR SHARE OF ESTATE 50 percent 50 percent ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV~1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE Not applicable B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I. TOTAL OF PART I! - 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) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001898 ANDES SAMUEL L 525 N 12TH ST LEMOYNE, PA 17043 ........ fold ESTATE INFORMATION: SSN: 207-07-9513 FILE NUMBER: 2102-0388 DECEDENT NAME: WELTY IRVIN M DATE OF PAYMENT: 12/02/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/17/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $471.46 TOTAL AMOUNT PAID: $471.46 REMARKS: SAMUEL LANDES ESQUIRE SEAL CHECK//4402 INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHER/TANCE TAX DTV/STON DEPT. 280601 HARRTSBURG, PA 17128-0601 CONNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT) ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-15q7 EX &FP (01-05) SAHUEL L ANDES 525 N 1ZTH ST LEHOYNE PA 170q$ DATE 02-05-2005 ESTATE OF WELTY IRVIN DATE OF DEATH 05-17-2002 FILE NUNBER 21 02-0588 COUNTY CUHBERLAND ACN 101 HAKE CHECK PAYABLE AND RENIT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 M CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF WELTY TRVIN HFZLE NO. 21 02-0588 ACN 101 DATE 02-03-2003 TAX RETURN NAS: { ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN I Real Estate (Schedule A) 2 Stocks and Bends (Schedule B) $ Closely Held S~ock/Par~nership /n~eres~ (Schedule C) Mortgages/No,es Receivable (Schedule D) $ Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) 6 Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. To~el Asse~s APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expenses/Ado. Costs/Misc. Expenses (Schedule H) 10. Deb~s/Mor~gegm Liabillt/es/L/ons (Schodule I) 11. To~el Deduc~/ons Ne* Value of Tax Ro~urn (1) (2) (3) (5) 20z982.95 (b) .00 .00 NOTE: To insuro proper .00 crod/~ ~o your account, .00 sube/~ *he upper por~1on .00 of ~hls form with your ~ex peyeen~. (7) .00 (8) 9,288.37 (9) 20,982.95 REVERSE SIDE OF THIS FORH ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 19. Principel Tax Due TAX CREDITS: PAYMENT RECETpT 15. 1~. NOTE: ASSESSNENT OF TAX: 15. Aeount of L/ne lfi e~ Spousal ra~e 16. Amount of Line 1~ ~axablo a~ Lineal/Class A re~e 17. Aeoun* of L/nm 1~ a~ S/bllng re~e ~8. Amount of Line lq taxable e~ Collateral/Class B ra~e (16) .00 X O0 = .00 (16) .00 X Oq5= .00 (17) 10,~77.01 X 12 = 1,257.2~ (18) .00 x 15 = .00 (19)= 1,257.2~ Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schodulo J) (13) . O0 Nm~ Value of Es~a*e Sub~ec~ ~o Tax (1~) 10,fi77.01 Zf an assessment ~as issued previously, 11nos 14, 15 and/or 16, 17, 18 and 19 ~ill reflect ~:lgures that include the total of ALL returns assessed to date. DATE 12-02-2002 NUMBER CD001898 DISCOUNT (+) /NTEREST/PEN PAID (-) .00 INTEREST IS CHARGED THROUGH 02-18-Z003 AT THE RATES APPLICABLE AS OUTLINED ON THE AMOUNT PAID q71.q6 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE q71.q6 785.78 7.08 792.86 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) (10) 1,217.57 (11) (12) 10,q77.01 ~EV-1470 EX (6-88) ' ~ INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDEN'I"S NAME FILE NUMBER In/in M. Welty 2102-0388 F~EVIE'VVED BY ACN John Kuchinski 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES J 1,2 Changed tax rate from 4.$ percent to 12 percent, the sibling tax rate for dates of death on or after ?-1-2000. ROW Page 1 BURE~ OF INDIVIDUAL TAXES INHERTTANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17118-0601 / ¢-O .O.WEALT. oF PE..SYLVA.,A DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLONANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-/5~i? EX AFP (01-03) SAMUEL L ANDES 525 N 12TH ST LEMOYNE PA 170q$ DATE OZ-O$-ZO0$ ESTATE OF WELTY DATE OF DEATH 03-17-2002 FILE NUMBER 21 02-0588 COUNTY CUMBERLAND ACN 101 Amount Remitted IRVIN HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF WELTY IRVIN MFZLE NO. 21 02-0388 ACN 101 DATE 02-03-2003 TAX RETURN HAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE ~NTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Sohedula A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnarsh/p Tnterest (Schedule C) ($) q. Hortgages/Notes Rece/vabla (Schedule D) E. Cash/Bank Depos/ts/N/sc. Personal Property (Schedule E) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/H/sc. Expenses (Schedule H) (9) 10. Dabts/Hortgage Liab/1/t/es/Liens (Schedule T) (10) 11. Total Deductions 12. Net Value of Tax Return .O0 .00 .00 .00 20~982.95 .00 .00 (8) 9,288.37 1~217.57 (11) (12) 15. lq. NOTE: ASSESSMENT OF TAX: 15. Amount of L/nm lq at Spousal rate 16. Amount of L/nm lq taxable at Lineal/Class A rate 17. Amount of Line lq at Sibling rate 18. Amount of L/ne lq taxable at Collateral~Class B rate Charitable~governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (lq) Zf an assessment Has issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. 19. Print/pal Tax Due TAX CREDITS: PAYffENT RECEJ. P m NOTE: To insure proper crad/t to your account, subm/t the upper port/on of this form w/th your tax payment. DATE 12-02-1001 NUHBER CD001898 DISCOUNT INTEREST/PEN PAID (-) .0O INTEREST IS CHARGED THROUGH 02-18-2003 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM IF PAZD AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL /NTEREST. 20,982.95 ]o.5os.qq lO,q77.ol .00 10,q77.01 18 and 19 #ill q71.q6 785.78 7.08 792.86 ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ~S REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE q71.q6 AHOUNT PAID (15), .00 x O0 = .00 (16) .00 x Oq5= .00 (17) 10,q77.01 x 12 = 1,257.2q (18) .00 x 15 = .00 (19): 1,257.2q REV-1470 EX (6-88)  INHERITANCE TAX EXPLANATION COMMONVVEALT. OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURGi PA 17128-0601 DECEDENTS NAME FILE NUMBER Irvin M. Welty 2102-0388 REVIEWED BY ACN John Kuchinski 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES J 1,2 Changed tax rate from 4.5 percent to 12 percent, the sibling tax rate for dates of death on or after 7-1-2000. ORIGINAL Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002222 ANDES SAMUEL L ESQUIRE 525 N 12TH STREET LEMOYNE, PA 17043 ........ fold ESTATE INFORMATION: SSN: 207-07-9513 FILE NUMBER: 2102- 0388 DECEDENT NAME: WELTY IRVIN M DATE OF PAYMENT: 02/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/17/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $792.86 TOTAL AMOUNT PAID: $792.86 REMARKS: JOHN E CAMPBELLSR C/O SAMUEL L ANDES ESQUIRE SEAL CHECK# 8292 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DZVZSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COMNONNEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP (01-95) SAMUEL L ANDES 525 N 12TH ST LEMOYNE PA 17045 DATE 0:5-17-2005 ESTATE OF NELTY DATE OF DEATH 0:5-17-200Z FILE NUMBER Z1 02-0:588 ~NTY CUMBERLAND ACM 101 Amoun~ Rmni'l:'~ed ZRVZN M MAKE CHECK PAYABLE AND REM/T PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper cred/~ ~:o your account, subei~ ~he upper portion of ~his form wi~h your ~ax payment. CUT ALONG THIS L/NE l~* RETAIN LONER PORT/ON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ### INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF WELTY IRVIN M FILE NO. 21 02-0388 ACM 101 DATE 03-17-200:5 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM IN THE NAMED ESTATE. SHO#N BELO# IS A SUHNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE.. AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-0:5-200:5 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 1,257.24 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 12-02-2002 02-26-200:5 CD001898 .00 7.08- 471.46 792.86 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQU/RED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 1,257.24 BALANCE OF TAX DUE .00 INTEREST AND PEN. .86 TOTAL DUE .86 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: :r~VI'" W fi....T'I Date of Death: \., Mo<^-c-k 2..o0~ Estate No.: 7 tJn/- 003'8'8 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: . Yes ~ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 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 ~ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: frO> ~~~ Signa e C"' ("oj SA-MIA'CL- t... p.,>lJ)E's Name SZS N, I '2-1"- s~ec..+ l..e,Vlo '((>Ie fA 17 o'f 3 Address c.:) , '7)7 '7 ~ 1- or; 3(, ( Telephone No. Capacity: 0 Personal Representative l29. Counsel for personal representative J Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2005 ANDES SAMUEL L 525 N 12TH ST LEMOYNE, PA 17043 RE: Estate of WELTY IRVIN M File Number: 2002-00388 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) 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 two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 3/17/2005 Your prompt attention to this matter will be appreciated. Thank You. ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~