HomeMy WebLinkAbout11-26-13 IN THE COURT OF COMMON PLEAS RECORi1E0 OFFICE 0
OF CUMBERLAND COUNTY, PENNSYLVANIA R E C 1 S T E R OF W i L LS
IN RE: : Orphans Court Division I6i3 NO"d 26 Fn
Estate of Michael William Walter, Deceased : No. 13-00581 CLER;\ OF
ORPHANS' COURT
PETITION FOR SETTLEMENT OF SMALL ESTATE CUMBERLAND G4., P,
AND NOW COMES, Ronald L. Walter, by and through his counsel, Law Offices of Peter J.
Russo, P. C. and it avers the following in support of her petition for settlement of small estate:
I. The petitioner Ronald L. Walter, who is the brother of Michael William Walter., the
decedent.
2. The petitioner has an interest in the estate of Michael William Walter.
3. The above named decedent died intestate and letters of administration were issued on
May 22, 2013.
4. The names, addresses, and relationships of all persons having interest in the estate of the
decedent as heirs or next of kin are as follows:
Name Address Relationshi
Ronald L. Walter 920 Sunrise Lane Brother
Wrightsville, PA 17368
Carlyn L. Williams 11014 Shadowood Drive Sister
Newberry, OH 44065
5. The total value of the decedent's personal estate is less than $25,000 and consists of the
following assets that have the following values:
Asset Value
Members 1 st Estate Checking Account $9,481.96
Dividends .01
Comcast $122.29
PNC $80.48
Total $9,684.74
�2J
6. The following is a list of all known, unpaid creditors and the amount of their claims,
which claims are proposed to be paid from the assets of the decedent.
Name Amount
EChase k $15,916.23
ore EMS $157.74
ank $31,104.14
$48,209.11
7. A proposed Pennsylvania Inheritance Tax Return shall be filed in the amount of tax due
upon the decedent estate will be paid as set forth therein. A true and correct copy of the
inheritance tax return is attached hereto as Exhibit A.
8. It is proposed that the following distribution of the decedent estate be made to the
following creditors, heirs, or next of kin:
Name Distribution
Ronald Walter(Reimbursement of Funeral) $846.44
Carlyn L. Williams (Reimbursement of $846.44
Funeral)
Ronald L. Walter (Reimbursement of $108.50
Probation Fees)
Law Office of Peter J. Russo (Attorney $925.00
Fee)
Ronald L. Walter(Administrator Fee) $533.78
West Shore EMS $157.74
US Bank $1,977.20
Chase Bank $4,289.64
Total $9,684.74
9. Ten days written notice of intention to present this petition has been given to the
beneficiaries and creditors in accordance with Cumberland County Orphans' Court Local
Rule 5.3, Time for Notice.
WHEREFORE, your petitioner respectfully requests your honorable court to decree the
distribution of the decedent's personal estate to the persons entitled thereto as set forth in
paragraph 9 above.
Date: IL a )-
Peter J. Russo, squir
Attorney I.D. No. 72897
Attorneys for Petitioner
5006 E. Trindle Road, Suite 203
Mechanicsburg, PA 17050
Telephone: (717) 591-1755
Facsimile: (717) 591-1756
VERIFICATION
I, Ronald L. Walter, verify that the statements made in the forgoing document are true
and correct to the best of my knowledge and belief. I understand that false statements herein are
made subject to the penalties of 18 Pa. C. S. § 4904 relating to unsworn falsification to
authorities.
Dated:
/0 — �� I2 '^
Ronald L. Walter
REV-1500 EXtez.rr)lrt a
1505610105
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Count Code Year File Number
28o6
Bureau Individual Taxes INHERITANCE TAX RETURN Y -- _-- -
PO BOX 806ot -
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number _ Date of Death MMDDYYYY Date of Birth MMDDYYYY
187-30-1372 . 01/11/2013 ' 11/13/1939
Decedent's Last Name Suffix Decedent's First Name MI
Walter
Michael W
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number - -----
-- -- -- - -- - "- --- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
_. . REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CID 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest date Compromise of
P ( O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Wilt) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO
Name Daytime Telephone Number
Peter J. Russo (717) 591-1755
REGISTER OF WILLS USE ONLY
First Line of Address
5006 E. Trindle Road
Second Line of Address
Suite 203
City or Post Office Stale ZIP Code DATE FILED
Mechanicsburg PA 17050
Correspondent's e-mail address: ru_ 5 P)r18W.ODf1T
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Dectaralion of preparer other than the personal representative is based on all information of which preparer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY -
Side 1
L 1505610105 1505610105
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedem':Name: Michael William Walter 187-30-1372
RECAPITULATION
1. Real Estate(Schedule A). .... .. _ ........ ............. .... 1.
2. Stocks and Bonds Schedule B ...... . ..................... .......... .
( 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship Schedule C
4. Mortgages and Notes Receivable(Schedule D). ...
. .... ..... ............
5. Cash, Bank Deposits and Miscellaneous Personal Property Schedule E ... .... 5. 10,675.59
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property •---'" --- "-""- "---""" - ----' '�'---- -------
(Schedule G) O Separate Billing Requested...... .. 7. 1 ,
8. Total Gross Assets(total Lines 1 through 7)..... . .....
e. ! 10,675.59
9. Funeral Expenses and Administrative Costs(Schedule H). ................. . 9. 14,155.28 i
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. ! 48,178.11
11, Total Deductions(total Lines 9 and 10). .... .. .. 62,333.39
12. Net Value of Estate(Line 8 minus Line 11) .. .. ...... ... ..... .. 12. -51,657.80 j
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which -------`-
an election to tax has not been made(Schedule J) .. . ..... . .. ..... . ..... . 13. j
14, Net Value Subject to Tax(Line 12 minus Line 13) .......... .. ... ... ... ... 14. -51,657.80 ,
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ I
16. Amount of Line 14 taxable
at lineal rate X.0_. 16
17. Amount of Line 14 taxable , .__.__...."__.___.___..._.__.__.._.,
at sibling rate X,12 -51,657.80 . 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X.15 t8
19. TAX DUE . ... .. .. . ....... ....... ... ........ .. .............. ....... 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205
REV-1500 EX(Fl) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Michael William Walter
STREET ADDRESS
528 Hummel Avenue,Apt 1A
CITY STATE ZIP
Lemoyne PA 17043
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
3. Interest Total Credits(A+B) (2) 0.00
4. If Line 2 is greater than Line i +Line 3,enter the difference. This is the OVERPAYMENT. (3) 0.00
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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 transf erred ................._......................................_..._._..................... ❑
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑
c. retain a reversionary interest .....................................,...................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑
2. If death occurred after Dec. 12,1982,did decedent transfer properly within one year of death
without receiving adequate consideration?............_..........................................................................................._. ❑ 0
3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ N
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent(72 P.S.§9116(a)(1.1)(i)].
For dates 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.§9116(a)(1.1)(ii)).The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still 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 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(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 percent,except as noted in[72 P.S.§9116(a)(1)1.
o The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-iSOS EX+(v-10)
Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS St MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Michael William Walter 2013-00581
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
1. Members 1SI Savings Acct-Acct No.42379-00 25.12
2, Members 1st Savings Acct-Acct No.42379-11 10,447.69
3. Comcast
122.29
4, Cumberland County Ret 80.48
5. Members 1st Dividends
0.01
6.
7.
8
TOTAL(Also enter on Line 5, Recapitulation) $ 10,675.59
If more space is needed,use additional sheets of paper of the same size.
st
m
MEMBERS 1"
FEDERALCREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 42379-00
D-ate Account Established 10/0311984
Principal Balance at Date of Death $25.12
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest $25.12
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/Suffix 42379-11
D-ate Account Established 09/1911990
Principal Balance at Date of Death $10,447.54
Accrued Interest to Date of Death $.15
Total Principal and Accrued Interest $10,447.69
Name of Joint Owner None
M ERS 1ST FEDE AL,Cf,��IT UNION
�,�
Danie le A. Kline
Lending Insurance Support Specialist
July 17, 2013
Estate of: MICHAEL W WALTER
Date of Death: 01/1112013
Social Security Number: 187-30-1372
5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • www.memberslst.org
COMCAST
1555 SUZY STREET
ATM: LEBANON SUPPORT SERVICES
LEBANON, PA 17046 (j�� ,p��^
it�r®m'^lvast,
MICHAEL WALTER. 17563 0052-31-47-3DG
150 ORE BANK RD
— DILISBURG, PA 17019-9334
I�Ilid•111111'II��I1�„�I•IIIILI�IIIIIIIdI�JI���lhllll,�JII
PAYMENT S UALWARY
CHECK NO: 0010333894
ACCOUNTNO: '09547-18067304 CHECK DATE: 02/06/13
Dear MICHAEL WALTER,
The attached check represents a refund for account number 09547-18067304 in the amount of
$122.29.
If you are a Comcast $FINITY customer and have questions regarding your refund check, you
can write us at the address above, call Comeast's toll free customer service number at
1-888-COMCAST (1-888-266-2278) or chat with us at www.comoast.com/chat. Our
representatives are available to assist you 24 hours a day, 7 days a week.
If you are a COm"ast Spotlight client or agency, please contact your local Spotlight
office.
DETACH AND RETAIN THIS STATEMENT
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE,
IF NOT CORRECT,PLEASE NOTIFY US PROMPTLY NO RECEIPT DESIRED.
1:7 5115i T
COMCAST FINANCIALAGENCY CORPORATION
ACOIVICASTCABLECOMMUNICATIONSGROUPCOMPANY 60-160/433
; , I
. . - ACCOUNTNUMUER - CHECK DATE OHECKNUMBER
09547-18067304 02/06/2013- 0010333894
1 1 ' 1 1 ti j
VALID FOR 180 DAYS
To MICHAEL WALTER $ •++**�12z.29
THE 1'50 ORES BANK RD
oRDeR 'DILLSBURG, PA 1701:9=9334 -
THE BANK 'OF NEW YORK MELLON
PITTSBURGH, PENNSYLVANIA I
11.001033389411° 1:0433016011: 1 i3t11783110
CUMBERLAND CTY RET - OPERATE ACC
STATEMENT OF DISTRIBUTION - TAX YEAR 2013
-----------------------------------------
DISTRIBUTION DETAIL TAX DETAIL
-------------------
TOTAL VALUE OF PAYMENT S 100.60 GROSS AMOUNT S 100.60
ROLLOVER AMOUNT S 0.00 TAXABLE AMOUNT S 100.60
FED TAX $ 20.12 NON TAXABLE S 0.00
EMP AFTER TAX CONTRIB S 0.00
NET UNREALIZED APPREC $ 0.00
TOTAL ROLLOVER AMOUNT S 0.00
VALUE OF SHARES DISTRIB $ 0.00
NET PAYMENT AMOUNT S 80.48 COST OF SHARES DISTRIB $ 0.00
IRS FORM 1099-R IS ISSUED BY JANUARY 31ST OF THE YEAR FOLLOWING THE DISTRIBUTION,
OR IN THE CASE OF A REISSUED CHECK, IN THE YEAR FOLLOWING THE ORIGINAL DISTRIBUTION.
THE DISTRIBUTION CODE THAT WILL APPEAR IN BOX 7 IS 4 -DEATH
QUESTIONS REGARDING THE TAXABILITY OF THIS DISTRIBUTION SHOULD BE DIRECTED TO YOUR
TAX ADVISOR. PLEASE NOTIFY YOUR PLAN SPONSOR OF ANY CHANGES IN YOUR ADDRESS.
IF YOU DECIDE TO ROLL OVER THE ELIGIBLE PORTION OF YOUR DISTRIBUTION, FEDERAL TAX
LAW REQUIRES THAT YOU MAKE THE DEPOSIT WITHIN 60 DAYS AFTER YOU RECEIVE THIS
PAYMENT.
ROTH CONTRIB. DATE:
ESTATE OF MICHAEL W WALTER DATE: 04/29/2013
528 HUMMEL AVE PAY GRP: 353840271L
1ST FL CHECK B: 0011201961
LEMOYNE PA 17243
i
0091.201961
DATE: 04/29/2013
..,FOR.;THE 353840271E .:.. ..
AccouNi of CUMBERLANDCTY-RET"- OPERATE ACC
EIGHTY DOLLARS 8 48/100 PNC Bank,National Association
VOID AFTER 1 YR
PAY TO THE
ORDER OF
ESTATE ;OF MICHAEL W WALTER ,
Bank 1ST FL
528 HUMMEL AVE
PNC B ar.
Pt1uLt¢pp,PA LEMOYNE PA 17243 -
AUTHORIZED SIGNATURE
11°00 L 1 20 1 9 6 111• 1:0430000961° 0011173011110
REV-1511 EX+(10-09)
pennsytvania SCHEDULE H
yl DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
URN
EREM CE ADMINISTRATIVE COSTS
INHERITANCE
ESTATE OF
Michael William Walter FILE NUMBER
2013-00581
REM Decedent's debts must be reported on Schedule I.
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Myers Buhrig Funeral Home
12,313.00
B. ADMINISTRATIVE COSTS:
t. Personal Representative Commissions:
Name(s)of Personal Representative(s) 533.78
Street Address
City State—ZIP
YEar(s)Commission Paid:
Z. Attorney Fees: 925.00
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State_ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 383.50
S. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 14,155.28
If more space is needed,use additional sheets of paper of the same size.
..."•<' -4"sSt4�%.:2. 5.ik'sx 4R: -•ts^°U,�,..�s.�15. iiN:.
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2:'[r.•rNCYILU'w Ot7�lGiilh ° ) (�iV�fft,-r. 1 2 /�
W 'rJ ffy9~^^'.nJ.J1 '� �i�l a„ �'4 tlC�ll d•�I�
January 30,2013
Gary Reihart �
150 Ore Bank Road
Dillsburg,PA 17019
Dear Gary:
Thank you for allowing us the privilege of serving you and your family. We appreciate your payment
of$1,700.00 using check#5323;however,the check was retuned to us by Members 1"Federal
Credit Union. The reason for its return is that the bank account the check was written from has been
frozen by the credit union. You can save$858.00 with our terms discount if the discounted balance
of$1,744.87 is paid in full by no later than February 12,2013. If paid after February 12,2013,the
balance due is$2,602.87,as the Terms Discount will have expired. Below is an accounting for your
records:
Statement of Goods&Services $ 12,31100
Plus: Limousine 217.00
Plus: Casket Personalization 65.00
Less:Adjustment to Newspaper Obituaries (115.00)
Less:Payment from NGL Insurance Company 8,544.13
Less:Payment from family (1,700.00
Less:Preneed Guarantee Savings (1,383.00
Plus: Returned Check#5323 1,700.00
Plus: Returned Check Fee 50.00
Balance. $2,602.87
Less:Terms Discount,if paid by February 12,2013 (858.00)
Balance Due,if paid by February 12,2013 $ 1,744.87
Please call us at anytime that we may be of service-
With Warm Regards,
Michell
Walking with Those in Grief
Robert"Bob"1,.Bubrig,Jr.,FA,supermurc•William"Bi1P'L.Christopher,ro
Phone: prq 7663421 • Fax: (m)795.7291 • 37 East Main Street • Mechanicsburg,PA 17055 • wtvw.Myem-Buhrig.conn Direclors@Myen;-Buhri&conn
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date: 5/22/2013
Cumberland County - Register Of Wills Receipt Time: 12 : 01 :32
One Courthouse Square Receipt No. : 1074262
Carlisle, PA 17613
WALTER MICHAEL WILLIAM
Estate File No. : 2013-00581
Paid By Remarks : GARY REIHART
DMB
--------------- --------- Receipt Distribution ----------------- -------
Fee/Tax Description Payment Amount Payee Name
RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN
PETITION LTRS ADM 20 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 528 $108 . 50
Total Received. . . . . . . . . $108 . 50
COMMISSIONS: PERSONAL REPRESENTATIVE
$ 00.01 to $ 100,000.00 5% $ 5,000.00 ($ 5,000.00)
$ 100,000.01 to $ 200,000.00 4% $ 4,000.00 ($ 9,000.00)
$ 200,000.01 to $1,000,000.00 3% $24,000.00 ($33,000.00)
$1,000,000.01 to $2,000,000.00 2% $20,000.00 ($53,000.00)
$2,000,000.01 to $3,000,000.00 1%z% $15,000.00 ($68,000.00)
$3,000,000.01 to $4,000,000.00 1% $10,000.00 ($78,000.00)
$4,000,000.01 to $5,000,000.00 /2% $ 5,000.00 ($83,000.00)
1%Joint accounts
1%P.O.D.Bond
1%Trust funds
I%Real Estate svecific devise
3%Real Estate converted with the aid of a broker
5%Real Estate: non-converted
$ 00.01 to $ 25,000.00 7% $ 1,750.00 ($ 1,750.00)
$ 25,000.01 to $ 50,000.00 6% $ 1,500.00 ($ 3,250.00)
$ 50,000.01 to $ 100,000.00 5% $ 2,500.00 ($ 5,750.00)
$ 100,000.01 to $ 200,000.00 4% $ 4,000.00 ($ 9,750.00)
$ 200,000.01 to $1,000,000.00 3% $24,000.00 ($33,750.00)
$1,000,000.01 to $2,000,000.00 2% $20,000.00 ($53,750.00)
$2,000,000.01 to $3,000,000.00 1%z% $15,000.00 ($68,750.00)
$3,000,000.01 to $4,000,000.00 1% $10,000.00 ($78,750.00)
$4,000,000.01 to $5,000,000.00 %z% $ 5,000.00 ($83,750.00)
':JP]RLaw 3/2012®
REV-1512 E%+(12-06)
1 '
pennsytvania SCHEDULE I
DEPARTMENT OF REVENVE DEBTS OF DECEDENT,
INHERITANCE DECEDENT URN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Michael William Walter 2013-00581
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. US Bank-Loan 0000-0513-036-278 15,916.23
2. West Shore EMS 157.74
3. Chase Bank Acct 3108(DCM Services) 31,104.14
4. Harrisburg Brethren in Church in Christ(Deposited After Date of Dealth) 1,000.00
5.
6.
7.
8.
9.
10.
11.
12.
TOTAL(Also enter on Line 10, Recapitulation) $ 48,178.11
If more space is needed,insert additional sheets of the same size.
LOAN STATEMENT
Page 1 of 2
U.S. BANK 0300
PITTSBURGH INDIRECT ..ACCOUi?tt Sun711]af A r 11 2013..
— PO BOX 790179 .y_.....::P
ST. LOUIS MO 63179-0179 Account Number: 0000-0513-036-278
Maturity Date: Oct. 01, 2016
Principal Balance:' $15,916.23
Total Minimum Amt. Due: $2,189.72
�rI�1�IIlIl��rt�lrilr�ll�lq�l'1111i1Ii��'lir�l�lnll�lrllrl�r�l Payment Due Date: May 1, 2013
�— If you do not pay.the Total Minimum Amount Due by the
000066656 1 AB 0.384 106481090400980 P Payment Due Date,you may be subject to late charges
MICHAEL W WALTER which win appear on your next statement.
528 HUMMEL" FUR 1 y
Contact.20PNour Banking of 1-800-USBANKS for payai
amount.
LEMOYNE PA 17043-1826
V TO CQNTACT U:S
If you have questions concerning your account please contact U.S. Bank 24 Hour Banking toll free at 1-800 USBANKS
(1-800-872-2657). For TDD access,call 1-800.68$-5065. -
For billing Inquiries write to us at U.S.Bank P.O. Box 2188,Oshkosh WI 54903-2188. Please note that calling us will not preserve
your billing rights.to prohibit us from shor ng Information about you with our affiliates, please send a written notice with your
name,address, and lost four digits of your social security number to U.S. Bank, P.O. Box 1800,St. Paul MN 55101.
IMPQRTAN.T MESSAGES
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t+i e!
uate you pap • t tt Free!nli a state e! 4
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Interest paid in 2012 $460.07
The Interest and taxes paid amounts on the statement Is provided only as a courtesy. If your account qualifies for 1098
reporting you should have received an official 1098 form In January.Year-end Interest adjustments could result in a variance
in the amount shown above and the actual amount on the 1098. The amount listed above should only be considered an
estimate of Interest and taxes paid.
Please use the coupon at the bottom of the first page when making your payment.Your payment will satisfy the current
minimum payment amount due- Each time you or anyone who pays your bill sends a personal check with this payment
coupon,you authorize us to process that payment by electronic debit to your account.Your checking account will be debited
In the amount on the check and that check will be destroyed. If you wish to make any additional payments you may do so at
www.usbank.com.U.S. Bank checking account customers may also make payments by calling the number listed above.
Payments received before 5:00 p.m.Central Time at our Payment Processing Center will be appplied to your account effective
the same business day.Payments received after the cutoff time,or on weekends or legal hall days,will be applied to your
Statement Continues on Next Page 12r Equal Housing Lender
�� y Please detach coupon and send with payment Account Nbr.0000.0513-036-278
Statement Date:Apr. 11,2013
MICHAEL W WALTER
Address Change?Visit your branch,call 24-Hour
Banking at 1-800-USBANKS,of visit www.usbank.com Payment Due Date May 1,2013
Send payment to address below: MINIMUM AMOUNT DUE $2,189.72
U.S. BANK 0300 Amount Enclosed $
PITTSBURGH INDIRECT
PO BOX 790179 To make additional payments or principal payments.please read the
ST. LOUIS MO 63179.0179 Important Messages section for lnshadiohs.
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000000 580580574000005130362 7845100002189721
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WEST SHORE
EMERGENCY MEDICAL SERVICES 205 Grandview Ave.,Suite 211 Camp Mill,RA 17011-1703 (777 763-2102
ESTATE OF: MICHAEL WALTER
CALL NUMBER: 236955W
To Whom it May Concern:
Please accept our condolences on your recent loss. We realize that this is a difficult time for you,
and we will do our best to help you with this procedure.
To assist with the processing of the above claim,please complete the following steps:
2. Estate is being handled by:
(Please include full
3. There is no estate(circle)
Thank you for your attention to this matter. Please contact our office if you have any questions.
Billing Office
West Shore EMS
i
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WEST SHORE EMS - BLS y/S' DISCOVER os,e1Ca,a.
205 GRANDVIEW AVE SUITE 211
CAMP HILL, PA 17011-1708 ON REVERSE SIDE
V=SHORE EMS Phone#: (800) 367-0512 Federal Tax ID: 23-2463002
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PATIENT NAME: MICHAEL WALTER INSURANCE: NOVITAS SOLUTIONS, INC. ESTATE
A
CALL NUMBER: 2369555W DATE OF CALL: 01/05/2013
FROM: GOLDEN LIVING
TO: 115 MUMPER LN
ACCOUNT SUMMARY
MICHAEL WALTER
C/O ATTORNEY PETER RUSSO TOTAL CHARGES: 188.74
5006 E TRINDLE RD SUITE 203 PAYMENTS/ADJUSTMENTS: 0.00
MECHANICSBURG, PA 17050.3651 PLEASE PAY THIS AMOUNT: 188.74
DETACH ALONG PERFORATION AND RETURN STUB WITH PAYMENT _
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
STRETCHER VAN-1 Way Transport T2005 1.0 108.75 108.75
Transport Van Mileage S0209 13.1 - 3.74 48.99
BAD CHECK CHARGE 1.0 31.00 31.00
Total Charges - 188.74
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
Private Payment/Check 5324 02/02/2013 -157.74
Private Payment/Check 5324 01/23/2013 157.74
Total Credits 0.00
PLEASE PAY THIS AMOUNT–INVOICE DUE UPON RECEIPT —0- $188.74
RETURNED CHECK FEE–$31.00
i
PATIENT NAME: WALTER, MICHAEL CALL NUMBER: 236955W AMOUNT PAID:
06/28/2013
IMPORTANT MESSAGES: WE ARE AWARE THAT THE PATIENT IS DECEASED AND YOUR OFFICE IS
HANDLING THE ESTATE. PLEASE FORWARD PAYMENT TO ABOVE
ADDRESS AS SOON AS POSSIBLE.
WEST SHORE EMS - BLS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011-1708
i
I
May 07 2013 3:17PM Dcm Services 6122438490 page 3
*IMPORTANT INFORMATION* Page 2 of 2
Under the law we are required to notify you of the following information. This list does not include a
complete list of rights consumers have under State and Federal Laws.
NOTICE ABOUT ELECTRONIC CHECK CONVERSION
When you provide a check as payment, you authorize us either to use information from your check
to make a one-time electronic fund transfer from your account or to process the payment as a
check transaction. When we use Information from your check to make an electronic fund transfer,
funds may be withdrawn from your account as soon as the same day we receive your payment,
and you will not receive your check back from your financial institution.
FOR COLORADO
Colorado Office Information: Colorado Manager Inc. 80 Garden Center, Suite 3, Broomfield, CO
80020, (303) 920-4763.
FOR MASSACHUSETTS RESIDENTS
NOTICE OF IMPORTANT RIGHTS
YOU HAVE THE RIGHT TO MAKE A WRITTEN OR ORAL REQUEST THAT TELEPHONE CALLS
REGARDING YOUR DEBT NOT BE MADE TO YOU AT YOUR PLACE OF EMPLOYMENT, ANY
SUCH ORAL REQUEST WILL BE VALID FOR ONLY TEN DAYS UNLESS YOU PROVIDE
WRITTEN CONFIRMATION OF THE REQUEST POSTMARKED OR DELIVERED WITHIN SEVEN
DAYS OF SUCH REQUEST, YOU MAY TERMINATE THIS REQUEST BY WRITING TO THE DEBT
COLLECTOR,
FOR This Collection Agency is licensed by tthetMinnesota Department of Commerce.
New York City Department of ConOsumer Affairs License Number: 1239504
To discuss this account, please call our toll free number to speak with Amanda Kodelka. A
representative will be able to assist you during our normal business hours.
FOR NORTH CAROLINA RESIDENTS
North Carolina Permit Number: 4440
FOR This Collection Agency is licensed by he Collection RESIDENTS
on Servi e Board of the Department of
Commerce and Insurance.
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DPA.SeUIRG� PA 1-7019 zy
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9% ,-M MEMBEIRS V
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REV-1513 EX+(01-10)
N o - pennsylvania SCHEDULE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
Michael William Walter FILE NUMBER:
2013-00581
NUMBER NAME AND ADDRESS OF PERSON(,)RECEIVING PROPERTY RELATIONSHIP TruDDECED)NT ---AMOUMT
ESTATE
sec. ARE Do I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Ronald L.Walter ',Brother - 50
2 Carlyn L.Williams Sister — 50
! i
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
it NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
I
!
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: - - -
1. _.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $:
If more space is needed,use additional sheets of paper of the same size.
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: : Orphans Court Division
Estate of Michael William Walter, Deceased : No. 13-00581
CERTIFICATE OF SERVICE
I hereby certify that on KW I have served a true and correct copy of
the foregoing document upon the following persons, in the manner indicated:
FIRST CLASS MAIL
Ronald L. Walter US Bank
920 Sunrise Lane Pittsburgh Indirect
Wrightsville, PA 17368 PO Box 790179
St. Louis, MO 63179-0179
Carlyn L. Williams
11014 Shadowood Drive DCM Services/Chase
Newberry, OH 44065 PO Box 1473
Minneapolis, MN 55440-1473
THE LAW OFFICES OF PETER J. RUSSO, P.C.
BY: b
Ashley R. Mal olm, Paralegal