HomeMy WebLinkAbout02-05-14 (2) J REV-1500EX(Ot-10) 1505610143
1y OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENTOFREVENUE
Po Box.2sosol INHERITANCE TAX RETURN 21 13 0 6 0 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
05 06 2013 06 19 1931
DecedenYs Last Name Su�x Decedent's First Name MI
PUTT GLENN R
(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
� 1. Original Return ❑ 2. Supplemental Return � 3.Remainder Return(date of death
priorto 12-13-82)
� 4. Limited Estate � 4a. Future Irnerest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� g Decedent Died Testate � � Decedent Maintained a Llving Trust � 8. Total Number of Safe Deposit Boxes
(Altach Copy of Wilt) (Attach Copy of Trusq
� 9. Litigation Proceeds Received � �p. Spousal Poverty Credit(date of death � 11 Election to tax under Sec.9113(A)
between 12-31-91 and i-1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
PATRICIA C ZUCKER ESQ 717 724 9821
REGISTER OF WILLS USE ONLY
First line of address � 0 � !� �
«
635 N 12TH STREET m -.��, � 4f? .�
m � c� ..., :�r
Second line of address � �'^ � t r �`t
`,�� G� �� � :�: '�?
QAT�.f I�D ';, �j .�;
City or Post Office State ZIP Code �� r> __ Fi
LEMOYNE PA 17043 `'� `�' . °"' '��='
. ;.s� r�� r_ r,�
� � ,__..
�> �
CL� � ry�
CorrespondenYse-mailaddress: pZUCker@dzmmlaw.COm
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.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RES SIBLE FOR FILING RETURN DATE
-�X John R. Putt Z ZD�
ESS
200 Park Street, Harrisbur PA 17109
ATU PAR T EPRESEN IVF OAT
Patricia C Zucker Esq 2 ZU /
ss
635 N. 12th Stre t, Le ne, PA 17043
Side 1
� 1505610143 1505610143 J
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
oeoede�rs rvar�e: P U T T� G L E N N R
RECAPITULATION
1. Real Estate(Schedule A�..................................................................................... 1.
2. Stocks and Bonds(Schedule B}.......................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)....................................................... 4.
5. Cash, Bank Deposits&Misceilaneous Personal Property(Schedule E�.............. 5. 2 6 , 1 1 8 . 4 5
6. Jointly Owned Property(Schedule F) � Separate Biliing Requested............. 6. 5 7 , 5 0 0 . 0 0
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) p Separate Billing Requested............. 7. 1 8 , 8 1 5 . 0 3
g, Total Gross Assets(total Lines 1-7).............................._.............................__..... g. 1 0 2 , 4 3 3 . 4 8
9. Funeral Expenses&Administrative Costs(Schedule H)...................................... 9. 1 6 , 7 2 rJ . 4 9
10. Debts of Decedent, Mortgage Liabilities, &Liens(Schedule I)............................... 10. 1 , 8 0 4 . 19
11. Total Deductions(total Lines 9&10).................................................................. ��. 1 H , 5 2 9 . 6 8
�2 Net Value of Estate(Line 8 minus Line 11)........................................................... 12. 8 3 , 9 0 3 . 8 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J).............................................. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)........... ................................... 14. 8 3 , 9 0 3 . 8 0
_ ___ ___ . _
TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at lineal rate X 045 8 3 , 9 0 3 . 8 0 16� 3 , 7 7 5 . 6 7
17. Amount of Line 14 taxable
at sibling rate X �2 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18
19. Tax Due............................................................................................................... 19. 3 , 7 7 5 . 6 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. a
Side 2
� 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21 - 13 - 0602
Decedent's Complete Address:
DECEDENT'S NAME
Putt, Glenn R
_ __ _ __ _
STREET ADDRESS
1 Longsdorf Way
_ _ ._ _ _ -- _ ---- --._ _ __
CITY ._ _ . . _�TATE ZIP
Carlisle �� PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 3,775.67
2. Credits/Payments
A. Prior Payments 3,0 0 0.0 0
B. Discount 157.89
__ _ _ _
Tota�Credits(A +B� (2) 3,157.89
3. I nterest (3) 0.0 0
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is theOVERPAYMENT (4)
Check box on Page 2 Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is theTAX DUE �5) 6� 7.7$
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:............................................................................. ', I x'',
b. retain the right to designate who shall use the property transferred or its income:................................ x'
--
c. retain a reversionary interest;or............................................................_.............................__................ ,__'� _X,
d. receive the promise for life of either payments, benefits or care?........................................................... '� _�, ,x_
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................................................. ' _, X'
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death'?....... ', x
4. Did decedent own an Individual Retirement Account, annuity,or other non-probate property which __
contains a beneficiary designation?................................................................................................................ ',x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR
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 January 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 re�urn 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 1.2)[72 P.S.§9116(a)(1)].
•The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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 bloo or adoption.
SCHEDULE E '
� CASH, BANK DEPOSITS, & MISC. ',
COMMONWEALTHOFPENNSYLVANIA '�. rERSONAL PROPER 1 � �'I
INHERITANCE TAX RETURN I
RESIDENT DECEDENT ', I
.____ -______.._______ . . _..____-____._ 1
_ ..:-r .. . � .. _.______. __._. . . ..._ __.__. .._ ___. . _. ___.___ . . . .
.T- - _- ____ ___
'FILE NUMBER
ESTATE OF Putt, Glenn R 21 - 13 -0602
Include the proceeds of litigation and the date the proceeds were received by the estate411 property jointly-owned with the right of
survivorship must be disclosed on schedule F.
_ _ __—------ --- _
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
- -_ _--- —
1 PNC Bank Checking Account No. 5003643581 16,528.87
2 PNC Bank Savings Account No. 5130092129 8,994.85
3 Refund 250.00
4 Refund 50.00
5 Refund 150.00
6 Refund from UGI 144.73
- --
TOTAL(Also enter on Line 5, Recapitulation) 26,118.45
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY �
INHERITANCE TAX RETURN '��
RESIDENT DECEDENT ���, . . �
. . . . .._ . __.. .__._ _. ..__.
. . . .____._.. __.._ .
� �---.. __. .._ . . . ... . _ ._----. ____.. _.__.... .
ESTATE OF FILE NUMBER
Putt, Glenn R 21 - 13 -0602
___ __
If an asset was made joint within one year of the decedenYs date of death, it must be reported on schedule G.
_ _ __ _ _ _. _
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
_ _ _ __
Lynne E. Muse (formerly Lynne E. 201 7th Street NW Ex-Wife
q Putt) Bemidji, MN 56601
_ _ _ _ _
JOINTLY OWNED PROPERTY:
LETTER DATE ESCRIPT.10�p F PROP ERTY %OF DATE OF DEATH
ITEM ,FOR JOINT MADE �nclude name o��inancial institu�ion and bank account numberDATE OF DEATH DECD'S VALUE OF
NUMBER, or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET DECEDENT'S INTEREST
TENANT JOINT 'estate.
__ INTERES ,
_
1 A 11/05/1963 Real Estate located at 9 Marshall Drive, Camp ��5,000.00 50% 57,500.00
Hill, East Pennsboro Township, Cumberland
County, Pennsylvania 17011
__ . __ _
__ _ __ __
_ __ _
TOTAL(Also enter on line 6, Recapitulation) 57,500.00
SCHEDULE G I�!
COMMONWEALTH OF PENNSYIVANIA INTER-VIVOS TRANSFERS &
INHERITANCE TAX RETURN
RESIDENTDECEDENT MISC. NON-PROBATE PROPERTY
___ _ _
__
: -._ — — -- _ _ _ _ ---- — —_ ___ ___
ESTATE OF Putt, Glenn R I FILE NUMBER
21 - 13 -0602
_ __ _-- --- __ __ _ _ --
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
._ __ _ __ --_ _ _ _ _ __ __ _ _ _ _---- _—_- _ --- _� _ _ _ __
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH ��F EXCLUSION TAXABLE VALUE
Include the name of the transferee,their relationship to decedent DECD'S (�F APPLICABLE)
NUMBER VALUE OF ASSET INTEREST
, and the date of transfer. Attach a copy of the deed for real estate.
_ _ 15,s15.o3 � 100% �__ __ _ --- 15,815.03
1 I MetLife lnvestors USA Insurance Company Contract ,
A2071181 '
I
2 Intemational Brotherhood of Electrical Workers , s,000.00 �! 100% � 3,000.00
Pension Death Benefit ' ',
, , , I
', ', !
� , � '
� ' i
; �, I
� �
I II II II
I I I
� '
�I ' i
� �
' �
I ,
� ,
'I �II
' I
I I,
' _ .__- _ --- - —_ � ----- —_ _ _
TOTAL(Also enter on line 7, Recapitulation) 18,815.03
SCFIFF�UULE H '�
' FUNERAL D(POVSES& I
COMMONWEALTH OF PENNSYLVANIA �. �'����� '.
INHERITANCE TAX RETURN � �
RESIDENT DECEDENT
__.. .__ . ._.__. .. . ._. _. .. . . _.. ._ ..... . . .. . .._ ._..._. . _I. __ . . _____... _____.. . _- _
FILE NUMBER
ESTATE OF Putt, Glenn R 21 - 13-0602
---
- -_ _ _ _ _ _ _ ___ ____ ___
Debts of decedent must be reported on Schedule I.
_- _ _ _ _ _ ___--- _ __ __ _ , .-- ----
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES: II
_ ._--- ---- - _ _- _ _ _ _ ._-_ _ _____ _ - —� -—_ _ _ _ __
A. !
I
' '�
I
�I
B. ADMINISTRATIVE COSTS: I
�. Personal Representative's Commissions '
Name of Personal Representative(s)
� John R. Putt 4,000.00
�
' street address 200 Park Street '
, city Harrisburg state PA z�p 17109
Year(s)Commission paid 2014 I
2. , attorney's Fees Daley Zucker Meilton & Miner, LLC ' 8,469.53
3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address ,
i City State Zip
' Relationship of Claimant to Decedent
a. il Probate Fees Register of Wills of Cumberland County, Pennsylvania il 358.50
5. AccountanYs Fees !
6. I Tax Retum Preparer's Fees I
7, ' Other Administrative Costs I,
1 I The Sentinel -advertising Estate Notice �� 125.82
� I
I
� I
TOTAL(Also enter on line 9, Recapitulation) 16,725.49
Schedule H '',
' Funeral E�enses&
COMMONWEALTH OF PENNSYLVANIA '., �In��+IJ�WI IY� ,
INHERITANCE TAX RETURN
RESIDENT DECEDENT __
_ _ . : _ _ _ ___ - . - - _. . __--
TFILE NUMBER
ESTATE OF Putt, Glenn R I,21 - 13-0602
- - --- -- - _ ___ _ __
1– - _– __—____ __
2 The Cumberland Law Journal-advertise Estate Notice '�i 75.00
3 PPL Electric Utilities 468.82
� '
4 � Pennsylvania American Water 111.64
5 UGI Utilities i 532.69
I '
6 ' Young J. Putt(Lawn Care) 315.00
7 ' East Pennsboro Township , 276.00
8 ' Sandra Feigley (hauling/paining at real property at 9 Marshall Drive) I 700.00
9 Debbie Lupold (real estate taxes) ' 1,292.49
I
;
�
,,
�'
'' I
I '
;
; ,
�
'� I
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE j
COMMONWEALTHOFPENNSVLVANIA LIABILITIES� aC LIENS I.
INHERITANCE TAX RETURN
RESIDENT DECEDENT �
__._ _ ._ . . _...--.- -_._ _.-___
..- �__-_._ _.._._ __. ._ . __—_ .__.
._ _. ._ .__.: __. � ._. _-_. ___ -. -- ._...__ _ . . ._- __.. _r.. -_. .—_____.
�FILE NUMBER
ESTATE OF Putt, Glenn R 21 - 13 -0602
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
-- _ _ __
ITEM DESCRIPTION AMOUNT
NUMBER
___ ___ __ __ _ _ _ _-- _ _ _ __ _ _--- _—_ ——
1 Darryl Guisiwite, DO 87.10
2 Omnicare King of Prussia 155.60
3 Diakon Lutheran Ministries ' 1,502.98
4 Mobilex Symphony Diagnostic Services 41.35
5 HealthDrive Podiatry Group 17.16
_ _ _ __ _ _._ _ _ _
. _ _ _ -- -
TOTAL(Also enter on Line 10, Recapitulation) 1,804.19
REV-1513 EX+�17-08) i
' SCHEDULE J !
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES ����
INHERITANCE TAX RETURN
RESIDENT DECEDENT ��. . . .
--- - -. _.. . . _._ . .. . ..
�-.. -__ .. _.. _ . ._ . ___ . .. . _ . . _ . . . --. --- --
ESTATE OF 'II FILE NUMBER
Putt, Glenn R 21 - 13-0602
-- ---- _ __ - _ --- _ __ _ - ___----- — __
RELATIONSHIP TO � SHARE OF ESTATE ,AMOUNT OF ESTATE
NUMBER ' NAME AND ADDRESS OF PERSON(S) , DECEDENT I (Words) ($$$)
_ _ __ _-- ._ ; __-- -1 )-- _--� _- _ . _ __ _ __
�_ _ RECEIVING PROPERTY oo Not�ist rrustee s
I� ITAXABLE DISTRIBUTIONS[include outright spousal '� �
distributions, and transfers
under Sec.9116(a)(1.2)]
1 ' Patricia Newby Daughter ' 1/3
20159 Pupsky Road NW I ',
Bemidji, MN 56601 ' '
2 ' Joanne Smith Daughter 1/3 ,
' 23365 Polaris Road NW � '
'�� Puposky, MN 56667 ' '
i
3 Thomas Putt Son �' 1/3 ',
3202 30th Avenue SE �� '
Olympia, WA 98501 '
!,
�
,� I '
'Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. ',
IL NON-TAXABLE DISTRIBUTIONS: I
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
,
�
�
' I
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I
I!
i, '
TOTAL OF PA
RT II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE1f 0.00
�� _.,
LAST WILL AND TESTAMENT
OF
GLENN R. PU7T
I, GLENN R. PUTT, of Camp Hill, Cumberland County, Pennsylvania, being of sound
mind, memory and understanding, make publish and declare this to be my Last Will and
Testament and hereby revoke all Wills and Codicils previouslymade by me.
ITEM l. I direct my Executor hereinafter named to pay all my legal debts and
funeral expenses, including the cost of my gravemarker and administration expenses of my
estate, as soon as practicable after my�death.
TTEM 2. I give,devise and bequeath the rest,residue and remainder of my estate,real,
personal or mixed,of whatever na.ture and wheresoever situate,including all lapsed legacies and
bequests including my property over which I may have a power of appointment at the time of my
death to my children,Patricia Newby,Joanne Smith and Thomas Putt,in equal shares. Should any
of my children predecease me,their share shall be divided between my surviving children.
ITEM 3. I appoint John R.Putt as the executor of this my Last Will and Testament. If
John R.Putt should predecease me,ceases or is unable to act as my executor,I appoint Young J.
Putt as my executor of this my Last Will and Testament. If Young J.Putt should predecease me,
ceases or is unable to act as my executor,I appoint Salli Merrill as my executrix of this my Last
Will and Testament.
� � ��
1 �'/ �,,,.' �/ %�G'✓
GLENN R. PUTT
ITEM 4. In addition to powers granted by law or by other parts of this Will,my
Executor hereinafter named sha11 have the following powers.
(a) To retain any and a11 assets of my estate,real,personal,or mixed,without
regard to any principle of diversification,risk,or productivity,except as may be otherwise
expressly provided herein;
(b) To sell at public or private sale,to exchange,to lease,to pledge,to
mortgage,to transfer,to convert,or otherwise dispose of,and to grant options with respect
to,any and all property,real,personal,or mixed,at any time forming part of my estate in
such manner,at such time or times,for such purposes,for such price or prices and upon
such terms,credits,and conditions as may be deemed advisable or necessary under the
circumstances;
(c) To invest and reinvest the property in stocks,bonds,mortgages,notes,
insurance policies,annuities,common trust fund participation,or other property of any
kind,real,personal,or mixed,irrespective of any statute,case,rule,or custom limiting the
investment of trust funds,except as expressly provided otherwise herein;
(d) To settle,compromise,contest,prosecute,or abandon claims in favor of or
against my estate as may be deemed advisable;
(e) To allocate receipts and disbursements to principal or income or partly to
both and to ascertain principal or income in accordance with the laws of the Commonwealth
of Pennsylvania;
e
2 -f�� ;/G%
` GLENN R. PUTT
` . ; .
(fl To make distribution or division of the esta.te in cash,in kind,or partly in
both;and to postpone distribution by agreement with a beneficiary;
(g) To exercise any law-given option to treat administration expenses either as
income tax or estate tax deductions,without regard to whether the expenses were paid from
principal or income,and'without requiring reimbursement;and
(h} To disclaim any inheritance or transfer.
ITEM 5. No bond shall be required by my Executor, but if bond is nevertheless
required,it shall be without surety.
ITEM 6. All estate, inheritance, legacy, succession or transfer taxes, including any
interest and penalties thereon, imposed by any domestic or foreign law with respect to all
property taxable under such laws by reason of my death, whether or not such property passes
under this Will, by operation of law, by contract or otherwise, shall be paid from my estate as a
part of the expenses of administration thereof without any right of reimbursement from any
recipient of any such property, without anyright of apportionment and without postponement.
-�-�h
IN WITNESS WHEREOF,I have hereunto set my hand this � S day of %�'� �2C N ,
2006.
��, /�>
����n,�.� /�� �f f//"Y
GLE�N R. PUTT v
3 �✓"J '::,,,� �/'�C`�,,�
E _ �
GLENN R. PUT'�
1 �
The preceding instrument consisting of this and three(3)other typewritten pages identified by the
signature of the Testator was on the date thereof signed,published and declared by GLENN R.
PUTT,the Testator therein named,as and for his Last Will and Testament,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.
;-�
.
i
` � ��
,���� � !-----____..___�
� ���:�,.� � U c�� �C�.- of �
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`�``,� --'"` --"'.�--� of � 1�
f
.%`�
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4 _,/ ��' �-�`�
GI..�NN R. PUTT
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF DAUPHIN �
We,GLENN R. PUTT �"�� and � � /h ,the Testator
and the witnesses,respectively,whose names are signed to the attached or foregoing instrument,
being first duly sworn,do hereby declare to the undersigned authority that the Testator signed and
executed the instrument as his last Will and that he had signed willingly(or willingly directed
another to sign for him),and that he executed it as his free and voluntary act for the purposes
therein expressed,and that each of the witnesses,in the presence and hearing of the Testa.tor,signed
the Will as witness and that to the best of our knowledge the Testa.tor was at that time eighteen
years of age or older,of sound mind and under no constraint or undue influence.
'`=-?, /' �i
��`�_,�c �r! ;
Testator �
,� _� --
�
l �� ����� �. ,- ►;� �..___� � ��
V�itness �, �
� ..r ��
t` �_�__,��j, _ _ --� -'
W1t1i�SS ��'
SWOR to or affirmed and acknowledged before me by the above named Testator and witnesses
this ��� day of NL��C h ,2006.
C�,�.-02���--�-�._.
Notary Public
COMMONWEALTH OF PENNSYLVANIA My Commission Expires:
NOTARiAL SEAL (SEAL)
CHRISTIN,A L.NICHOLAS,Notary Public
Lowe�Paxton Twp.,Dauphin County
Commission Ex ires June 20,2009
Jun. 6. 2U13 8 : 11AM NNC �ank IVo, 56�1 I', 1
4 . ' , . .
. �" , . .
�un,e 6, 2013
Courtney 7urin.a
� Attorne�At Law �
635 N 12�' St Ste 101
Z,emoyne PA 170�43
�RE: Glenn R Purt
SSN: 2U1-16-5393 �
bOD: OS/06/2013
Dear Sir/Madam:
In response to �our request�or Date of Death(D0,'�) balances .f.Q.r�the customer nated above, our
xecprds show the followin.g:
C�ecking Accoar�t
� Account# 5003643581 �:stablished: 07/15/2002
CLENN ��"UTT
DOD balance: � 16,528.�6+0.11 acerued i�terest
Sa�vuags A.ccOUnt
. Accou,n.t� S 130092129 Established: 04/O1/1978
� GLENN R�'UTT
1�OD balance: $ 8,994_62+0.23 acer�ed interest
Tnvestm�ent Account
The deezdent maintained rnvestment Acco�nt 5583308. For further informat�on,you may call the
Brokerage Department at 1-800-762-6111.
1']ease note lha�tlus off ee provides date of c�eath ba.lances for deposit a.ccounts (1R.As, CDs,Checking an.d
Savizxgs). We do not process any�t�a�cxa�t�-ahsactions or�rovide statemeets. Tf you need assis�ance'pvirh
any of these items,please eall 1-888-PNC-BANK(1-888-762-22G5) or siop by your local pNC�3ank branch
office. .
Sincezely;
Natronal�inancial Services Centez
PNC Bank,I�_A.
Member F1�TC
Page � of Z
C.Note:This form is furnished to give you a statement of actuai settletnent costs.Amounts paid to and by the sett�ement agents are snown,nen�s�u6��Cu
"(p.o.c)"were paid outside the closing;they are shown here for informational purposes and are not inc[uded in the totals.
D. Name&Address of Borrower: E. Name&Address of Selier: F. Name&Address of Lender:
Qiu Ju Wu,Ling Zhang Estate of Glenn R,Putt,Lynne E.Muse flWa Lynne E. Parke Bank
1641 E,Aibe�t Street,Philadelphia,PA 19125 Putt P.O.Box 40,601 Delsea Drive,Sewell,NJ
9 Marshall Drive,Camp Hill,PA 17011 08080
G. Property Location: H.Settlement Agent L Settlement Date:11/26/2013
9 Marshall Drive Sarristers Land Abstract Company Disbursement Date: 1'U26/2013
Camp Ni{I, PA 17091 3310 Market Street,Camp Hill,PA 17011
East Pennsboro Township
717-761-6190
Place of Settlemenr TitleExpress
3310 Market Street,Camp Hill,PA 17011 Printed 1'V22/2013 at 3:46 pm
by J E
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100. Gross Amount Dae from 8orrower 400. Gross Amount Due to Sefler �
101. Contract sales pdce
115,000.00 401.. Contractsales price 115,000.00
i02. Personal ro erf 402. Personal ro erf
103. Settlement charges to borrowe�(line 1400) 6,612.86 403.
104. 404.
•105. 405. .
Ad'ustmen(s for items paid b seller in advance Ad ustrnents for items paid b seller in advance
106. Cityltown taxes to � 406. Cityltown taxes to
107. Couniy taxes 91126/2013 to 1?J3112013 42.48 4{17. County taxes 1112612013 to 12J3112013 42.48
108. School Taxes 1112612013 to 06130l2014 784.10 408. School Taxes 1�/2612013 to 06/30I2014 784.10
109. SewedTrash 11126I2013 to 1?J31/2013 54.00 409. Sewer/1'rash 1112612013 to 12131/2013 54.00
110. 410.
��1 411.
112. 412.
�f2a• Gross Amount Due from�Sorrower 122,493.44 420. Gross Amount Due to Seller 115,880.58
200. Amounts Paid b or in Behalf of Borrower 500. Reductions fn Amount Due to Seller
201. Deposit or eamest money 10,000.00 501. Excess deposit(see instructions)
202. Principal amount of new loan(s)
69,000,00 502. Settlement charges to seller(line 1400) 8,887.31
203. Existin loan s taken sub'ect to 503. Existin loan s taken sub'ect to
204. 504. Pa off of first mort a e loan
205. 505, Pa oif of second mort a e loan
.206. 506.
207 507. Proceeds to Lynne E.Muse,flkla Lynne E.Putt 28,750.00
2os. 508. Proceeds io the Estate of Glenn R.Putt 78,243.27
I 209. 509.
Ad'astmenfs for items unpaid b setler Ad'ustments for items unpaid b seller
210. Ciryltown taxes to 510. Cityltown taxes to
211. County taxes � to 511. County taxes �
212. School Taxes to 512. School Taxes to
213. 513.
214. . 514.
215. 515.
216. 516.
217. 517.
218, 51 B,
219. ��9'
220. Total Paid bylfor Borrower 79,000.00 520. 7ofal Reducfion AmounE pue Seller 115,880.58
300. Cash at Seitlement from/to Borcower . 600.��Cash:at Settlement tolfrom Sel[er
3D1. Gross amount due from borrower(line 120) 122,493.44 gp�, Gross amount due to seller(line 420) 115,880.58
302, Less amounts paid bylfor borrower,(line 220) � 79,000.00 602. Less reductior�s in amount due seller(fine 520} 115,880.58
303. Cash QX From ❑
7o Borrower 43,493.44 603. Cash X[� To ❑ From Sel[er 0.00
�hls form,unlass Itdlipiny:o curtonllyvnlld OMB ao�rol numbor.No un�denllollty 1 DAUtIfOE�M1IS GISCIOSUfOI;�mondnlory�Thl�U Eoslpned lo provldo ha poNosto e RESPA covatod Irnneactlon wllh Infortnutlon dudnp the mp u o
sottlemonl prow�. �
300_ I�ems Pa able in Connection with Loan
3Q1. Our origination charge (Includes Origination Point 0,000%or$0.00) $2,295.00 {from GFE#1) -
from GFE#2
302. Your credit or charge(points)for the specific interest rate chosen $ t }
303. Your adjusted origination charges (from GFE A) 2,295.00
304, Appraisal fee to Petrillo Grou $450.00 P.O.C.B"' (from GFE#3) 75.00
305. Credit report � to CIS $10.52 P.O,C.B* (from GFE#3}
306. Tax service to from GFE#3
307. Flood certification to Searchtec,Inc. (from GFE#3) 10.00
308. to
d00. Items Re uired h Lender to be Paid in Advance
301. Daily interest charges from from 11126/2�13 ta 12101l2013 @$9.82201day (from GFE#10) 49.11
302. Moc�gage lns.Premium . for months to (from GFE#3)
a03. Homeowriers insurance for 12 months to Erie Insurance (from GFE#11) 445.00
304. months to from GFE#11
1000. 12eserves De osited with Lender (from GF�#9) 739.74
1001. Initial deposit for your escrow account
1002. Homeowner's insurance 3 months $ 37.081month �111.24
1003. Mortgage Insurance months $ O,OO/month �
1004.Township Properry Tax �� months $ 11.69/month $�28.59
1005.County Property Tax "�� months $ 27,78/month $305.58
10D6. School Taxes � months $ ��120.90lmonth $725•40
1007.Aggregate Adjustment $-531,07
5100. Title Cha es 1,050.01
1101. Title services and lender's title insurance from GFE#4
1102. Settlement or closing fee to $
1103. Ownet's tiUe insurance-First American'fitle Insurance Co-Hbg $ from GFE#5 245.50
11 D4. Lenders title insurance-First American Title Insurance Co-Hbg $954•50
1105. Lender's title policy limit$69,000.00 Lende�'s Poficy
1106. Owners title policy limit$195,000.00 Owners Policy
1107. Agent's portion of the total title insurance premium $1,012.50
1108. Underwriter's portion of the total title insurance prernium $187.50 25.00
1109. Escrow Fee to�Barristers Land Abstract
General-Hb 10,00
1910. Notary Fee to Linda McBeth
10.46
1111. Tax Ce�lpostage Reimbursement to Sanisters Land Abstract
Cost-Hb �
1112. Overnight Fee(proceeds) to Barristers Land Abstract 16.85
Posta e-Hb
12D0. Government Recordin and 7ransfer Char es (from GFE#7) 193,50
1201. Government recordng charges �
1202 Deed$68.50 Mort a e$85.00 Release$ �
1203. Transfertaxes $ (fromGFE#8) 1,150.00
1204. City/County tax/stamps Deed$1,150.00 Mort a e$
1205. StateTaxlstamps Deed$1,150.00 Mort a e$ 1,150.00
1206. Deed$ Mort a e$
1207. Record Assignment of Rents $40.00 -
7300.�Additionaf Set�lement Char es (from GFE#6)
1309. Required services fhat you can shop for
13�2. Suroey to
1303. Pest inspection to Ins ect A Nome $45,OQ P.O.C.B
1304. Home Inspection to Ins ect A Home $270,00 P.O.C.B"
1305. Escrow for Inheritance Taxes to Barristers Land Abstract Escrow-Hb 4,000.00
1306. Sewer Transfer Fee to East Pennsboro Townshi ' 10.00
t` . , . � - . , , - . 6,612.86 8,887.31
Paid outside of closing by(B)orrower,{S)eller,(L)ender,(I)nvestor,8ro(lner."Credt by lender shown on page 1."'`Credit by seller shown on page 1.
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Govemmentrecordng'charges ' . _# T201�:,;.::�;:::�,-::;':.:.:';=��:;':'�'. 177.00 193.50
: 804';:;:';;.,�•;_;':��,.,::,.�..::',`;:.>.�:,:� 450.00 525.00
Appraisal fee• ' - � #'•
Gredit.report:. . ' . - . , �:.#�;805" .. 10.52 10.52
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Fiood!certifcation.. � _�.� '_ ;;#:;807;r,;:,:;!:�;''�;.�i� 1500 1000
TiUe seNices:and lenders title:insurance`:�;.'•';.�'��:,<,; �.;::;':<,;'.;�!:.,_;:;�',�:_.#;;1.101..r''�,::�;`. .,:;;:"_;.'�;:.�' 1,062.00 1,OSOA1
� . 975.00 245.50
Owner;s title;insurance-Frst American Title Insurance'Co=.Hbg��.;,.: ::. .;#�1103;:�:; ,;;:::���:';`��:.' :��':',��
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� ;,. ,' ��: _ :�� 2,689.52 2,034.53
�,..� , ,. $ -654.99 or -24.3534%
CEiar es�ThatCan Cfian e . . . � . ; .. ., : : :� :': .�:.`� `,��I•Good�Faith��Estiinate:', ,: :�:, .:°�:.�;<HUDr1' ::�:;` .�,;�;,�
Initial deposit'for your escrow account'.. .: �-� � ; '#.�001',.� ,::;:,'::: :.��.:.:::��.;:`��. 2,150.32 739.74
Daily,interest charges from,::.; �' ' �� ' �
. 901�:. �.$9.822Q/da 4911 4911
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Homeowne��s.ins.urance' • .•� . � . ' ''' 903.� ;; 600.00 445.0�
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�'our:init'ial loan amount is � � �� �: ��: ', �.r��>�•. �,. � �69,000.00
i'our�loan ferm is ; , . . .. �. , : �:�- . 15.years
�(ou�.initial;;�ateresf rat@ is�' . : ; 5.1250%
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i our initial''monfhly�amount'owed for principal,,inte�est;and any;mor�tgage` $550.15 includes
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.',:���:..;..���...� � ' • � . : ..:,: ;•; ....: ,'.: ':; :. �'.:�•.' [�X No. ❑Yes,it can rise to a maximum of %. The first change
;;an:your;mterest rate nse.. `- . , ., . ._. ,',,'•,:., , ;;
� �. • � �V���= •: ��•��'��� "���•��� '- will be on ! I and can change again every years after 1 1 . Every
� . . � ' - � '� change date,your interest rate can increase or decrease by %, Over the life of
� • � , � � . � . � � -� �.� fhe loan,your interest rate is guaranteed to never be lower than %or higher
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Even;if;y,ou�make payments on time,can your�loan balance rise?,,,.:'�:; �.1�� OX No. ❑Yes,it can rise to a maximum of$ .
Even if�you make payments on.time,can.yourmonthly amourit owed.for,�;., �X No. ❑Yes,the first increase can be on I J and the monthly
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principal,�lnteresf,and mo�tgage insurance rise? ° �.'. �;: �;. ; ; amount owed can rise to$ .
'., . ;; �• ,..�:.� ' � The rnaximum it can ever ris.e to is$ .
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''` � � ' � ' � � � X ❑Yes,your maximum re a ment penalt is .
Does�your.loan have a�prepayment perialty7•:�;�.;':� �.�,: ;., �- � � :,::':� ❑No. P P Y Y $
� � ' � "•� ' X No. Yes, ou have a balloon a ment of$ due in
Does;your;loan have;a balloon payment7,.,:. „ .•.;.,�,��.,,.... •. .:. ❑ ❑ Y P Y
� . . �. . -.. years on / ! ,
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Total�mon4fily amount owed ihcluding escrow.accounf�paymenfs::,:`_:.''�.��:• ❑You do not have a monthly escrow payrnent for iterns,such as property taxes
.;: _;":;:::_".;_':.:. . . . ,..:. ': - '''"-��,:..,.�.;.=- �;�:'..�"':�':';�:';: and homeowner's insurance, You must pay these items directly yourseff.
;;:�� . . ` , : , �, � � � � . QX You have an add�tional monthly escrow payment of$197.45
� . . � �� � ,�'� - thaf results in a total initial monthly amount owed of$747.60. This includes
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�'' '��" ''� ' ' " . - .:;;;;"�. >'`��` principal,interest,any mortgage insurance and any items checked below:
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� � ��'� ' � � . � • ❑ Property taxes ❑Homeowner's insurance
:�'- ,' . . . . . . , ' � . . � Floodinsurance ❑
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lote: If yau have any questions about the Settlement Charges and Loan Terms listed on this form,pfease contact your lender.
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WNWING 171S A CRInfE 70 iQtO WINGI.Y AWCE FALSE STATEldENTS 70TFlE UNIfED 5fA7ES 0;1 T}US�RANY SII�iriAR FOW.t PENALTIES UPON '
C0;7VIC710N CAN INCLU�EA F7NE Ml�11.1PR150NMEM.FOR DETAILS SEE SIAE 18;U.S.COD�SEC710N t00i AND SEC110N fOl6, 1
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Prev ous ed tions are ob:olete Pafle 4 ot 4 HUD-i �
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's a e is furnished to ive you an itemization of the amounts shown on ����Faid`Erofn�'�;�:;;�;;Paid��;�i'oR;l';�'
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Lines 1101, 1103 and 1104 of the Settlement Statement (HUD-1). This page ,;,��;Bo`�r,o.wer`S;�r';;4�;;�Sel�er�s�`;�;�;;:;
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accompanies but is not a part of the settlement statement. If a discrepancy �`���::F.;:.uiitls''�at'::::�;?;;��:;:s;Fundsrat�:;'r;"
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exists,the information shown on the Settlement Statement(FlUD-1) applies. �;Se'ftlement::�'��.Seftlerjienf�;-�..
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1101. Title services and lender's title insurance i,050.04
a. Notary Fees $ 30.00 �
b. Wire Fee(2) 10.00
c. Ovemi ht Fee 10.51
d. Electronic Doc 7ransmittal Fee 45.00
$ 95.51
1102. Seltlement or closin fee
1103, Owner's title insurance {policy $ 245.50 245.50
1104. Lende�'s title insurance (policy) 729.50 $ 954.50
a. Endorsement 900 EPL-Residential . 50.00
b. Closin Service Letter 75.00
c. AL7A Short Form Loan 100.00
(Total 1103+1104} Q
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':1:1;08i�'i.=Und�e'twrite��sy:po�ion;of�fli'e;�otal;title�:insur.ance''"r'eml:;��i!`�r1`,��'°;��i187.50;!;;�
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1101. TiUe services and lender's title insurance � .
a. Notary Fees ko Linda McBeth 30.00 30.00
b. Wire Fee(2)to Bar�lsters Land Abstract Wire-Hbg 10.00 90,00
c. Ovemight Fee to Barristers Land Abstract Postage-Hbg 10.51 10.51 .
d, Electronic Doc Transmittal Fee to Barristers Land Abstract General-Hbg 45.00 45.00
1104. Lender's title insurance to Barristers Land Abstract Company 954.50 954.50
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Jul 19 Z013 11:38:03 MetLife -> 717+657+4996 Page 901
MetLife Invesfors USA
P.O.Box 14593 , �
Des Moines IA 50306-3593 �'
July 19, 2013
DALEY ZUCKER MEILTON & MINOR LLC Copy to:
PNCINVESTMENTS
PATRICIA CAREY ZUCKER TONY TOLENE
635 N 12T"ST STE 101 235 N ENOLA RD
LEMOYNE PA 17043 ENOLA PA 17025
717-724-9826
RE: METLIFE INVESTORS USA INSURANCE COMPANY CONTRACT A2071181
OWNER GLENN R PUTT
Dear Ms. Zucker:
Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the
date of death and the account value on that date are:
Date of Death: May 6, 2013
Account Value: $15,815.03
If you have any questions, please contact your representative or call our Customer Service Center at
1-800-284-4536 Mondaythrough Friday between 8:30 a.m. and 6:30 p.m., ET.
Sincerely,
Theisen, Elizabeth
Sr. Annuity Representative- Post Issue Processing
MetLife Annuity Operations and Setvices
Help us stay connected: Please keep us updated with respect to all who are associated with this contract,including the owner,the
annuitant,and any beneficiaries. Make sure that we have the following information for all persons or entities: name,address,
phone number,date of birth,and social securiry or tax identification num6er. Changes may 6e submitted to the address provided
above,by caliing our Customer Service Center at the phone number provided above,or by contacting your Representative.
�EP 05 2a��
,�,u.,Fnwm,...
' • ���� ``��., TRUST FOR THE
e \ rtiU M Y} s9
- INTERNATIONAL BROTHERHOOD OF ELECTRICAL WORKERS�
: , � � PENSION BENEFIT FUND
.
��`�;,�,�p��µ„�r°,�t 900 Seventh Street,NW • Washington, DC 20001 • 202.833.7000
Edwin D. Hill September 3,2013
Trustee
Sam J. Chilia
Trustee Daley Zucker Meilton&Miner,LLC
Attention: Patricia Zucker
635 N 12�' Street, Suite 101
Lemoyne,PA 17043
Re: Glenn R.Putt
Claim Number 2225948
Dear Ms. Zucker:
I am in receipt of your recent request and authorization to obtain the date of death
value of the pension that Brother Glenn R. Putt received from the IBEW Pension Benefit
Fund(PBF).
The PBF is a pension plan funded solely by member's dues payments with no
employer contributions whatsoever and is separate and autonomous from local union
pension plans. Members hold no vested interest in the plan and cannot withdraw funds
except as a pensioner receiving a monthly benefit.
Brother Putt received a gross monthly benefit of$38.01,which became effective
July 1993. This benefit continued through his lifetime and ceased upon his death on May
6, 2013. A final death benefit in the amount of$3,000.00 was paid equally to his
children JoAnne Smith,Patricia Newby, and Thomas Putt; no other benefits are due from
the PBF.
Further information regarding the PBF can be found via the Resources tab at
www.IBEW.or�, including the Summary Plan Description,Article XI of the IBEW
Constitution,Rules and Regulatiuns and Frequently Asked Questions.
Sincerely yours,
,
�
Salvatore am)J. Chilia
Trustee
SJC:kc
Copy to IBEW Local Union 143
��3 Form 972
MAY 31 2013
RECEIPT FOR PAYMENT �
GLENDA FARNER STRASBAUGH Receipt Date : 5/29/2013
Cumberland County - Register Of Wills Receipt Time : 14 : 26 : 28
One Courthouse S quare Receipt No. : 1074342
Carlisle, PA 17613
PUTT GLENN R
Estate File No. : 2013-00602
Paid By Remarks : DALEY ZUCKER ET AL
DMB
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 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# 7914 $358 . 50
Total Received. . . . . . . . . $358 . 50 (
�UL 15 �p�,�
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CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
Tele: (717)249-3166 Fax:(717)249-2663
July 12, 2013
Cumberland Law Journal is published every Friday by the Cumberland County
Bar As�ociation and is designa#ed b;� the Court of Common Pleas as the c�fficia! legal
publication for Cumberland County and the legal newspaper for publication of legal
notices.
TO: Patricia Carey Zucker, Esquire
RE: Glenn R. Putt Estate -
Legal advertisements must be received by Friday Noon. All legal advertising
must be paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on following dates:
June 28, July 5, and July 12, 2013
Advertising Cost $ 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 75.00
Total Amount Due $ 0.00
Becky H. Morgenthal, Executive Director
;
PROOF OF PUBLICATION OF NOTICE ,
IN CUMBERLAND LAW JOURNAL
(LTnder Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA :
. S5.
COUNTY OF CUMBERLAND •
Lisa Marie Coyne,Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
June 28 July 5 and July 12 2013
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time,place and character of publication are true.
`, -- }/
�-,� �� .�
L�' Maxie Coyne, Edit�
SWORN TO AND SUBSCRIBED before me this
12 dav of July, 2013
�� -
Notary
Putt,Glenn R,dec'd.
Late of C�mberland County.
Executor:John R.Putt.
Attomeys: Patricia Carey Zucker,
Esrniire, Daley Zuckes Meilton & p+OTARIAL SEAL
Miner, LLC, 635 N. 12th Street, DEEORAH A CCLLINS
Suite 101,Lemoyne,PA 17043.
IJotary Pubiic
CARLISLE BOROUGH,CU�riBERLAND COUI�TY
t�^y Commission Expires Apr 28,2014
�.
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
jackie Cox, Director of Sales,of The Sentinel,of the County and State aforesaid,being
duly sworn, deposes and says that THE SENTINEL,a newspaper of general circulation
in the Borough of Carlisle,County and State aforesaid,was established December 13�,
1881,since which date THE SENTINEL has been regularly issued in said County,and �
that the printed notice or publication attached hereto is exactly the same as was printed
and published in the regular editions and issues of
THE SENTINEL on the following day(s):
june 20,27,Tuly 4,2013
COPY OF NOTICE OF PUSLICATION -
' ESTATEINOTICE " !
; ' ` ` � r• ' :� Affiant further deposes that he/she is not
_ NOTICE IS HEREBY GIVEN that letters testamentary have been granted in �t
� the following Estate:All persons indebted to the said Estate a�e required to j ]1ltereSteC�1Tl�l2 Sllb�2Ct I11c1tteT Of LL�2
make payment,and those having claims o�demands to present the same ;
f without delay to the EzecutodAttomey named below: '.'i aforesaid notice or advertisement,and that
, . :: . , ,
� ESTATE OF GLENN R.PUTT,late of Cumberland County PA,Died May 6,` �; all allegations in the foregoing statement as
2013; Executor.John.R.Putt;Attorney_Patricia Carey Zucker;Esquire, !
f "Daley Zucker Meiiton&Miner,LLC,635 North 12th Street,Suite 101, j t0 t1ITle�place and character of publieation
i r Lemoyne,PA 17043..+
f �. __ --- - ---r_ ; e e.
Sworn to and subscribed before me this
-�h � � �
U . .
�'��.r1 c. . �i�
Not Public
. My commission expires:
C6MM6NVNEl�L��f[� ` YLV�Nr/1
Notarial Seal
Bethany M.Holtry,Notary Publlc
Carlisle Borb,Cumberiand County
My Commissfon Expires Sept.26,2015
MEMBER,PENNSYLVANIA ASSOQATION OF NOTARIES
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� STATEMENT Page: 1 ot �
' D IA 1`�O N Invoice# Account# Date
LUTHERAN SOCIAL MINISTRIES 175192 624CCNC 05/31/2013
Cumberland Crossings Retirement Community
1 Longsdorf Way
Carlisle, PA 17015-7623 Due Date Amount Due Amount Paid
Facility#(717) 245-9941
Business OfFce#(717)240-6040 6/23/2013 $1,502.98
`
Johri Putt �� Resident Name
200 Park Street Putt, Glenn R
Harrisburg, PA 17109 �/� �� '
L"��
_--- ------- ----- ------- --- ---- --------------- -- -- - -------------------------------------- ------
Please make check payable to Diakon Lutheran Social Ministries
_ __ _ __.._ . __
- -- _ __. _ _ __.
Glenn R Putt Cumberland Crossings Retirement Communiry 05/31/2013
John Putt
Date Description Units Net Balance
rom rou Char es Credits
�
04/30/2013 Bafance Forward $8,660.90
)5/01/2013 05/31/2013 Semi Private -26.00 Day -7,176.00
)5/01/2013 05/05/2013 Bed Alarm .16 Month 9.0
)5/01/2013 05/05/2013 ChairAlarm .16 Month 9.0
TOTAL BALANCE DUE ��,5o2.ss
,
DARRYL GUISTWITE,DO (717)609-2639
56 ASHTON STREET
CARLISLE,PA 17015-6914
Account Number Billine Date Pa�e Office Use Onlv
Glenn R.Putt 10147 OS/15/13 1 MED
C/O John Putt
200 Park Street ,
HARRISBURG,PA 17109
Service Date CPT4 Description Prov. Units Mes . Charze Ins.Paid Adiustment Patient Paid Balance Due
03/04/13 99308 Nursing Home Est.Patient Leve12 DG 1 80.00 13.15
Patient:Putt,Glenn R- 10147
Servicing Provider:Darryl K Guistwite DO
04/15/2013 Medicare 52.60 14.25
03/15/13 99308 Nursing Home Est.Patient Level 2 DG 1 80.00 13.15
Patient:Putt,Glenn R- 10147
Servicing Provider:Darryl K Guishvite DO
OS/07/2013 Medicare 52.60 14.25
r
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�
Comments: Please Pay—> 26.3 0
Please pay within 30 days...thank you
, Glenn R.Putt _
10147 80.00 43.55 105.20 2630
Account Number New Chuges New Payments New Ins.Pmt. Current Due Past Due Finance Charge Scheduled Amount
Since Last Bill Since Last Bill Since Last Bill /Billing Fee ,
Darryl Guistwite DO•56 Ashton Street•CARLISLE,PA 17015-6914 60
DARRYL GLTISTWITE,DO (717)609-2639
56 ASHTON STREET
CARLISLE,PA 17015-6914
Account Number Billing Date Pa�e Office Use Onlv
Glenn R.Putt 10147 06/25/13 1 MED
C/O 7ohn Putt
200 Park Street
HARRISBURG,PA 17109
Service Date CPT4 Descri�tion Prov. Units Mes�. Char�e Ins.Paid Adiustment Patient Paid Balance Due
03/22/13 99309 Nursing Home Est.Patient Leve13 DG 1 105.00 17.25
Patient:Putt,Glenn R- 10147
Servicing Provider:Darryl K Guistwite DO
- 05/31/2013 Medicare 68.98 18.77
04/22/13 99308 Nursing Home Est.Patient Level 2 DG 1 80.00 13.15
Patient:Putt,Glenn R- 10147
Servicing Provider:Darryl K Guistwite DO
06/10/2013 Medicare 51.55 1530
�
G!`�
� � ���
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PleasePay—> >0.40
Comments:
Please pay within 30 days...thank you Glenn R.Putt
10147 185.00 26.30 120.53 30.40
Account Number New Charges New Payments New Ins.Pmt. CuRent Due Past Due Finance Charge Scheduled Amount
Since Last Bil( Since Last Bill Since Last Bill /Billing Fee
Darryl Guistwite DO• 56 Ashton Street•CARLISLE,PA 17015-6914 48
DARRYL GUISTWITE,DO (717)609-2639
56 ASHTON STREET
CARLISLE,PA 17015-6914
Glenn R.Putt 10147 08/12/13 1 MED
C/O John Putt
200 Park Street
HARRISBURG,PA 17109
CPT4
OS/06/]3 99309 Nursing Home Est.Patient Level 3 DG 1 105.00 �7•25
Patient: Putt,Glenn R- 10147
Servicing Provider:Darryl K Guistwite DO
07/11/2013 Medicare 67.60 20.15
�
� �� ��
���
1�.�5
If you have sent payment in full disregard this notice -
Glenn R:Putt
10147 17.25
Darryl Guistwite DO•56 Ashton Street•CARLISLE,PA 17015-6914 53
DARRYL GUISTVJITE,DO (717)609-2639
56 ASHTON STREET
CARLISLE,PA 17015-6914
Glenn R.Putt 10147 11/20/13 1 MED
C/O Jolui Putt
200 Park Street
HARRISBURG,PA 17109
CPT4
OS/03/13 99308 Nursing Home Est.Patient Leve12 DG 1 80.00 13.15
Patient:Putt,Glenn R- 10147
Servicing Provider:Darryl K Guisrivite DO
11/13/2013 Medicare 51.55 15.30
�
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13.15
Piease pay within 30 days...thank you
Glenn R.Putt
10147 17.25 51.55 13.15
Darryl Guistwite DO•56 Ashton Street•CARLISLE,PA 17015-6914 55
� — _ __
E
STATEMENT OF ACCOUNT
��'� OMNICARE KING OF PRUSSIA
��� ALLENTOWN,PA 18R 6 _ PAGE: 1 of 3
r���`
ACCOUNT NO: 9009-29
RETURN SERVICE REQUESTED 34285 INVOICE NO: PH989262
DX NO: KOPDX
INVOICE DATE: 04/30/13
74891 0303 Phone: 877-670-6323 FACILITY: 9009 CUMBERLAND CROSSING
PATIENT NO: 29
You may also view/pay your bills at: PATIENT NAME: PUTT,GLENN
https://myomniview.omnicare.com AMOUNT DUE: 41.37
TAX: 0.00
���II�I��II���II�I�����IIII1��'I'�'ll�lll���ll��ll'�I����II��I�I� �
GLENN PUTT* UC��y'_ DUEDATE: OS�ZS�ZO13
JOHN PUTT
200 PARK STREET
HARRISBURG, PA 17109-3827 � � �� AMOUNT DUE: 41.37
� 34285*TS209SRPQ007551
3S209ZYLU:1.3
KEEP sQP PORTION FOR YOUR RECORDS-RETURN sQTSOFro STUB WITH PAYMENT IIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�III�IIIIIIIIIIIIIIIIIIIIIIIIIIII
PUTT, GLENN 9009 CUMBERLAND CROSSING
. • ��
9009-29 04/30/13
' DATE .> RX N0. TRANS._ DESCRIPTION : PHYSICIAN. NDC NO.. ' DUANT `AMOUNT -.< TYPE
04/19/13 5192 , LOCK - PAYMENT'- THANK YoU - Lockbox 20730419074505" -37:77
" 000083027 �q �ia ��"��:,
03/15/13 R2155720 CHARGE OMEPRAZOLE 20MG'CAPSULE DR Sta�te'(��'e�`�eh�{y�Dose GUISTWITE 00781-2233-10 1 8.96 RX
not covered by Thi rd Party�f3�a����`'�`s��'�'`�,'�����y�� `
' 03/26/13 R21584135 CHARGE FERROUS SULFATE 325(65>MG`a'�ABt��etl+ca�� r�.g�' ,�, GUISTWITE 00904-7591-80 1 2.99 OTC
� �+
ca�l 4� '#.� d r���`' �is . . . �
i Produet was Denied by Th,��'d�`�w����erage��.r�'���
� covered ` ���`,.�'��' r��"� �,
k
04/05/13 R21301335 CHARGE HYDROCERIN CREAM (RP:EUCERIi���'���"`� ts L��'�ak�°'�`�^�`�1���UISTWITE 54162-0600-02 113 5.14 OTC
. rry°4'Zv�'x �4�W�Cxa�'��!ltl �'�v.i . - .
related to Hospice diagn6sts ���1y�����e:i��re�;,,�;°r
�r%:? ��r� a a�^'� , �
non-covered �� `'�� "''� ����
� � �' , �`�,� �
04/08/13 R2111199 CHARGE PREDNISONE 5MG TABLET (COPAY�'� �$t �.��` �� i ��, GUISTWITE 00054-4728-31 25 0.49 RX
04/10/13 R2139350 CHARGE FUROSEMIDE 40MG TABLET (RP:LASI`�') .�Of��Y)� GUISTWITE 00172-2907-80 60 0.69 RX
Messages
Finance Charges may be assessed at a MONTHLY PERIOD RATE OF
1.50%(ANNUAL RATE OF 18.00%)based upon an unpaid 6alance
outstanding 30 days or more.
PREVIOUS BALANCE CHARGES FINANCE CHARGE TOTAL CHARGES PAYMENTS & CREDITS AMOUNT DUE
37.77 41.37 0.00 79.14 -37.77 41.37
� -
�
__.—. . ._"_ _ __._" . ___- . ._.
.. _"_ _"___ . . ."_ _.. .. . .
. _ __ . ... . . . . . __ _ ___ ..___._. .
�
�� �� STATEMENT OF ACCOUNT
f/ OMNICARE KING OF PRUSSIA
�/�1�� ALLENTO N PA 18R 6 PAGE: 1 of 1
����`
ACCOUNT NO: 9009-29
� RETURN SERVICE REQUESTED 34z85 INVOICE NO: PH1024480
DX NO: KOPDX
INVOICE DATE: 06/30/13
003753 0101 Phone: 877-670-6323 FACILITY: �9009 CUMBERLAND CROSSING
PATIENT NO: 29
You may also view/pay your bills at: PATIENT NAME: PUTT,GLENN
https://myomniview.omnicare.com AMOUNT DUE: 114.23
TAX: 0.00
I"��������I"'��1�1'I'�'��I��'I�I'�'�II'1�'�I'�I1��1�����'��III'
GLENN PUTT
JOHN PUTT*** � �uE�arE: 07/25/2013
200 PARK STREET
HARRISBURG, PA 17109-3827 �—/�} AMOUNTDUE; 114 .23
� lJ ��
��/ 34285*TTQ09TED1007437
� 3TQOA31X5:1.1
KEEP TQP PORTION FORYOUR RECORDS-RETURN eoT�vf;n STUB WITH PAYMENT IIIIIVIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
PUTT, GLENN 9009 CUMBERLAND CROSSING
. . �,
9009-29 06/30/13
DATE. •; `RX`NO:-- TRANS -` , ;. DESCRIPTION .'. r: PHYSICIAN NDC`NOr ; QUANT : AMOUNT ' " TYPE
O6/12/13 - lOCK . PAYMENT:- 7HANK YOU - Lockbox 20130612074504 -41.37
, , . 000048061 , �'� ��'� ��r'�-
05/06/13 R21665421 CHARGE LEVOFLOXACIN F/C 500MG TABLET�RP,�EyAf��I.���+ GUISTWITE 00093-7292-53 7 101.01 RX
y� � �� ���, ���b
� Resident:not enrol led in Med��t ed�t�.r��,.�p�'e����
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p assist �wa+t��,�s��,�i�k� �`�,s'�r ��s� ,�
a �. �u�,, �' _�.��' �Sv„�,
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Messages
Finance Charges may be assessed at a MONTHLY PERIOD RATE OF
1.50%(ANNUAL RATE OF 18.00%)based upon an unpaid balance
outstanding 30 days or more.
PREVI�US BALANCE CHAR6ES FINANCE CHARGE TOTAL CHARGES PAYMENTS & CREDITS AMOUNT DUE
54.59 101.01 0.00 155.60 -41.37 114.23
i ----- - - - — -- - - -
Service Dx Procedure
Date Provider Name Code Code Description Charge PaymentslAdj. Balance
88.00 88.00
02/01/2013 Marques . 43.9 11721 NAIL DEBRIDEMENT, 6 OR MORE �g34.3'� $53.69
MEDICARE PA Payment ��45.1'� �8�58
MEDICARE PA Adjustment g6.58
04/12/2013 Marques 43.9 11721 NAIL DEBRIDEMENT, 6 OR MORE $88�00 �$33.62) $62.96
MEDICARE PA Payment ($45.80) $17.16
" MEDICARE PA Adjustment
To the best of HealthDrive Podiatry Group's knowledge, this patient has no other
available insurance coverage or other liable third party coverage for the service(s)
being billed.
ALL APPROPRIATE INSURANCES HAVE BEEN BILLED. THE REMAINING
BALANCE IS DUE FROM YOU.
CURRENT 25 DAYS 50 DAYS 75 DAYS �` �� ` - �
$ 0.00 $ 17.16 $ 0.00 $ 0.00
Balance Due $17.16
Due Date 02/01/2014
Insurance Information on File:
MCDICA�E PA 20116539SA
r
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�s- �
s
� 'M E S.S A G E'S _ , �-- _. ._ -: -- --- -=--- -__
- °-- ___<<_.- .y .
(� � � � � x u 5 k Contact Cusfomer Service g
� L_� �� .� at(800) 786-8015, option 2 These char es are billed directly to the patient because a copay,
deductible is due or our claim was denied by your insurance
Sy�R,�.p�� �E���QSftC S2►YfCeS nformaton (seeeeversets de�Ponsibility to provide current insurance
payment due upnn sece:ipt of stat�ment. '
PATIENT NAME. • SERVICES PRaViDEQ AT>: STATEMENT DATE _' DATES QF SERVECE DUE UPON RECEIPT_` PAGE i
ACCOUtJT_NUMBER, _ �_ __ .-_.—_-..- . -
- _ .- - -
- -�:. _.. -----_., =
-� - CUMBERLAND CROSSINGS 01I09114
11123112-11123112 $41.35 1 of 1
4545252ihs GLENN�R PUTT
Insurance Patient Balance
Procedure Charges Payments Adjuskments Payments Due
Date Code Descripfion .00 4.49
82.50 -17.94 -60.07
11/23/12 71010 CHEST 1 VIEW
COINSURANCE AMOUN
COINSURANCE AMOUN 35.00 -16.46 -14.42 .00 4.12
11/23/12 Q0092 SET UP FEE X RAY
COINSURANCE AMOUN
COINSURANCE AMOUN 275.00 -130.96 -111.30 .00 32.74
11123112 R0070 COINSURANCEAMOUN
COINSURANCE AMOUN
�
� ` /
� �
� THIS BILL IS FOR PORTABLE XR Y SERVI ES
� .�. _- _- ;
_.-
° __ _ . �Your Payment Options .___. . .-.-= � ��j�RENT ACCOUNT BALANCE � '
' $41 35
D insurance _ ,� _ ..__ ,_ �� _ _ _- --•-, - -
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Primary: MEDICARE PA 800-786-8015 .00
TOTAL AMOUNT PENDING IN3URANCE
Secondary:SELF PAY P O Box 17452 � Y $41.35
� BALANCE DUE UPON RECEIPT
SECONDA
RY Baltimore, MD 21297-1452 �_ _��.�_ �--� ----�-----�° -
fll�'�Ill�l�'ellll 1138-MXRSTM-1982562-1595751812-P;8249983-2-1190;34050720-1; 1
PLEASE DETACH HERE AND ENCLOSE BOTTOhQ PORTION IM1�17H YpUR PROtJ�PT PAYMENT. THANK YOU!
I- _ _ _
COMMONWEALTH OF PENNSYLVANIA � REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HAflRISBURG,PA 1 7 1 2 8-0 601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017968
PUTT JOHN R
200 PARK STREET
HARRISBURG, PA 17109
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
_________' ""_"_
101 � 53,000.00
ESTATE INFORMATION: ssrv: 2o�-�s-53s3 I
FILE NUMBER: 211 3-0602 I
DECEDENT NAME: PUTT GLENN R I
DATE OF PAYMENT: 08/02/201 3 I
POSTMARK DATE: 08/01/201 3 I
couNrY: CUMBERLAND �
DATE OF DEATH: 05/06/2013 I
�
TOTAL AMOUNT PAID: 53,000.00
REMARKS: RECEIPT TO ATTY
CHECK# 114
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
�
Leaders in Justice
ParmersinReselution'=• FebT'uary 4, 2014
� Office of the Register of Wills
� Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Glenn R. Putt
File No. 2113-0602
PATRICIA CAREY ZUCKER Dear Gentleperson:
SANDRA L.MEILTON
STEVEN P.MINER Please find enclosed for filing an original and three (3) copies of an Inheritance
QUINTINA M. LAUDERMILCH Tax Return and two (2) copies of an Inventory in the above-referenced Estate.
SUSAN E.GOOD Please return the date-stamped copies to me in the enclosed self-addressed,
LAUREN E. HOKAMP Sta111peCI 211VeIOpe.
MATTHEW B.WERNER
I have enclosed a check in the amount of$617.78 made payable to the Register
PATRICIA A.PATTON of Wills, Agent for payment of the inheritance tax owed to the Pennsylvania
OFFICE ADMINISTRATOR Department of Revenue.
Thank you for your assistance with this filing. Should you have any questions,
please do not hesitate to contact me.
Very truly yours,
DALEY ZUCKER
MEILTON & MWER, LLC
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635 N. 12TH STREET, SUITE 101, LEMOYNE, PA 17043 • 717-724-9821 • 717-724-9826 Fax • DZMMLAW.COM
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