HomeMy WebLinkAbout03-27-14 (3) REV-1500 EX(01-10' 1505610143
PA Department of Revenue OFFICIAL USE ONLY
p Pennsylvania county toes rear File NUmher
Bureau of Individual Taxes .TM°rt°.
PO BOX.280601 INHERITANCE TAX RETURN 21 14 191
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 10 2013 10 23 1921
Decedent's Last Name Suffix Decedent's First Name MI
HALE STELLA M
(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. p o aiinder13ettu'(date of death
4. Limited Estate 4,Futwo Interest Comprohn tte 5. Federel Estate Tax Return Required
(date of death after 12-12-82)
B Decedent Died restate 7, All erlt�tntei U UNr�p inst a. Total Number of Safe Deposit Boxes
(Attach Copy of Will) Ca of T
9. Litigation Proceeds Received ❑ 10.oSg 01M ( iit{datse of death 11.Election to tax under Sec.9113(A)
end (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAN M WILEY 717 432 9666
REGISTER®F WILLS USLEDi
,;0 rn .
O rn n
First line of address p -o
r-1 (7:1 s cn
3 N BALTIMORE ST r A r rV m
rrI
Second line of address
O I
G O O r l
0ATIE-fILEO �.
City or Post Office State ZIP Code y—+ r— 41
DILLSBURG PA 17019 j s Cn C>
m
i
Correspondent's e-mail address: tanmwiley @conticast.net
Under penalties of perjury,I declare that 1 have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is ,correct and complete.Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG RE PER50 RE ONSIBLE FOR F I RETURN ' DATE
i , / r C: T' Robert L.Walker 3 ai i
DRESS
Clendenin Circle Enola PA 17025
SI ATURE OF PREPARER OTHER THAN REPRESENTATIVE DAT
At � Jan M Wiley 3 Z/
DRESS
3 N. Baltimore St., Dillsburg, PA
Side 1
1505610143 1505610143 J
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Hale, Stella M.
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&Miscellaneous Personal Property(Schedule E)............... 5. 7 , 955 . 52
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6,
7. Inter-Vivos Transfers&Miscellaneous N(oq-Probate Property
(Schedule G) u Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1-7)..................................................................... 8. 7 , 955 . 52
9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 2 , 583 . 00
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I).............................. 10. 5 , 372 . 52
11.. Total Deductions(total Lines 9&10)................................................................... 11. 7 , 955 . 52
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 0 . 00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to lax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 0 . 00
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9115 15 0 . 0 0
(a)(1.2)X.00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 00 16. 0 . 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.1 5 0 . 0 0 18. 0 . 00
19. Tax Due.................................................................................................................. 19. 0 . 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21-14-191
Decedent's Complete Address:
DECEDENT'S NAME
Hale,Stella M.
STREETADDRESS
CITY STATE ZIP
PA
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (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 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 transferred;............................ ............ .................................. ❑
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑.................................. F
AI
retain a reversionary interest;or............................................................................................................... ❑ ❑
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?.................................................................................................................. ❑ ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SC{HEDUL(EYG AND FILE IT AS PART OF THE RETURN.
h_ _�I gIl ���ILMB!,�itilFdt' Y! L,,Y.
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)(11)(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 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 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 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 1508 EX.(8-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hale, Stella M. 21-14-191
Include the proceeds of litigation and the date the proceeds were feceived by the estate
All property joindyowned with the night of survlvorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PNC Checking Account 3,575.90
2 PNC Savings Account 4,379.62
TOTAL(Also enter on Line 5, Recapitulation) 7,955.52
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.6-98)
REV-1151 EX-(10-05)
SCHEDULE H
COM INOIN 1E[DEN(1ED�EDE NYR`N ANIA ADMINISTRATIVE COSTS
ESTATE OF R IJ`4 E`f FILE NUMBER
Hale, Stella M. 21-14-191
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission paid
2. Attorney's Fees The Wiley Group, PC 2,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 83.00
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 2,583.00
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hale, Stella M. 21-14-191
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Orphans Court-Filing Fee 68.00
2 Register of Wills-Filing Fee 15.00
H-B7 83.00
Copyright(c)2002 form software only The Lackner Group, Inc. Forth PA-1500 Schedule H(Rev. 6-98)
Rev-1512 E%+(1248)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMON W E4LTH OF PENNSn VAN IA
INHERITANCE TAX RETURN
RESIDEWDECEDENT
ESTATE OF FILE NUMBER
Hale, Stella M. 21-14-191
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cocklin Funeral Home 823.82
2 Messiah Lifeways 2,271.36
3 Pennsylvania Department of Public Welfare 1,683.46
4 State Employee Retirement Fund 593.88
TOTAL(Also enter on Line 10, Recapitulation) 5,372.52
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
b
In the Matter of the Estate IN THE COURT OF COMMON PLEAS
of Stella M. Hale OF CUMBERLAND COUNTY, PA
Deceased Orphans' Court Division a
No.
Petition for Settlement of Small Estate 8
TO THE HONORABLE, THE JUDGE OF SAID COURT: cil
The petition of the undersigned respectfully represents:
(1) The name, address and relationship of your petitioner to the above decedent:
Name: Robert L. Welker (a/k/a Larry R. Welker)
Address: 5 Clendenin Circle, Enola, Pennsylvania 17025
Relationship: Son-in-law, and Executor named in Last Will & Testament
(2) The decedent died June 10, 2013, a resident of Messiah Village, 100 Mt. Allen
Drive, Mechanicsburg, Cumberland County, Pennsylvania;
(3) Said decedent died Testate, leaving a will, a copy of which is hereto attached, in
which the personal representative named therein is Larry R. Walker.
(4) The names, relationships and interests of all parties beneficially interested in the
estate are:
(A) $1,000.00 to Alan .Kauffman, grandson
(B) $1,000.00 to David Kauffman, grandson
(C) $1,000.00 to Mary Taugenbaugh, granddaughter
(D) $1,000.00 to Robert Welker, III, grandson
(E) $1,000.00 to Thomas Welker, grandson
(F) $1,000.00 to Robert Hale, grandson
(G) $1,000.00 to Brittenia Hale, granddaughter
(H) $1,000.00 to The Christian Missionary Alliance Church
(1) The remainder of the estate to be divided equally among Elsie Kauffman, Allean
Welker and Larry Hale, children.
(5) The following person is entitled to, and claims, the family exemption of$3,500.00
by virtue of being a member of the same household as the decedent:
Name: N/A
Relationship:
(6) Said decedent died owning property (exclusive of real estate and of wages, salary,
pension or vacation benefits) of a gross value not exceeding $25,000.00, which is itemized as
follows:
Item Amount
PNC Checking Account: $3,575.90
PNC Savings Account: $4,379.62
Total $ 7,955.52
(7) An itemized statement of all claims against the estate is as follows:
(a) Claims heretofore paid by The Wiley Group, P.C. to the following:
Claimant Nature Amount
Orphans Court Filing Fee $68.00
Register of Wills Filing Fee $15.00
Total $ 83.00
(b) Claims remaining unpaid:
Claimant Nature Amount
Messiah Lifeways: Nursing Home $ 2,271.36
Cocklin Funeral Home Funeral Expense $ 823.82
State Employee Retirement Refund $ 593.88
The Wiley Group: Attorney Fee: $2,500.00
Total $ 6,189.06
(8) The Petitioner will cause to be paid all Pennsylvania inheritance taxes due on all
property to be awarded.
(9) All parties beneficially interested in the estate other than the petitioner have
a. Signed the joinder in this petition which is attached hereto.
WHEREFORE, your petitioner prays that the above property of the decedent be
distributed under Section 3102 of the P-E-F Code as follows:
(a) On account of the family exemption:
Name: Amount:
N/A
(b) In reimbursement of claims against the estate heretofore paid:
Name: Amount:
The Wiley Group Filing Fee - tax return $15.00
The Wiley Group Filing Fee-Petition $68.00
Total $ 83.00
(c) For payment of claims against the estate remaining unpaid:
Name: Amount:
Messiah Lifeways: Nursing Home $ 2,27136
Cocklin Funeral Home Funeral Expense $ 823.82
State Employee Retirement Refund $ 593.88
The Wiley Group Attorney Fee: $2,500.00
Department of Revenue PA Inheritance Tax $75.76
Total $ 6,264.82
(d) In distribution in accordance with the interests in the estate:
Name: Amount:
a. Alan Kauffman: $ 211.33
b. David Kauffman: $ 211.33
C. Mary Taugenbaugh: $ 211.33
d. Robert Welker, III: $ 211.33
e. Thomas Welker: $ 211.33
f Robert Hale: $ 211.33
g. Brittenia Hale: $ 211.33
h. Christian Missionary Alliance Church $ 21.1.33
Total: $ 1690.64
Ja . Wiley, Attorney for Petitioner Robert L. Welker, Petitioner
VERIFICATION
Thisy�
day of September, 2013, the foregoing petitioner hereby verifies; subject to
the penalties of 18 Pa.C.S. 4904 (relating to unsworn falsification to authorities), that the facts set
forth in the foregoing petition which are within his knowledge are true, and as to the facts based
on information received, after diligent inquiry, he believes them to be true.
Petitioner
JOINDER
We, the undersigned, being all the parties, other than the petitioner, beneficially interested
in the estate of the foregoing decedent, do hereby certify that we have read. he f9nt;going petition
and join the prayer thereof. J ,1 L/ 11(4 17,
Alan] a ffma David Kauffrrl
i � � �
Mary genb h % �itFl;V8111tai/ Robe Welker,
J
Thomas Welker R ert Hale
Brittema Hale
e AL
� St%
4 .yE
-': M':V ti IR(-- P,�' - I-:- - - --..
- ' R - �I1�F t!-f UfJI ( i �T(\-1T v4TE _
---6051 (1---I -- _27I B — 07/,1,:21113_
B:LSIE l A411=F.11AN l'Irs. STE1_'LA IM 11A1.1'-
t528 BALTIMORE- ROAD
13I1.1 .S13U}�(;. PA 17019 j —10T/AL AkI OUNT DUE 1 '0
—271.36
DATA. %UE W- 312013
S
DATE) DESCRIPTION _ RATE 1 D-aY,y CHARGES? CREDITS BALANCE
Balance Forward - 22 96.3�IC
h'ursino, Care *`*
14/06201'3 OTHER MEDICAL EI.MNSE CREDIT (PVT -25.00 1.00 25.00 2,27136
RESIDE N7# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AM 0UN7 DUE
60510 0.00 2,271.36 0.00 0.00 0.00 52,271.36
ESIDENT NAME Mrs. STELLA M. HALE Fo,m Pe-o,
MA
=are n;ake check payable to Messiah Lifeways at Messiah VJ!Jage.
T°/ finance charge maY be assessed on accounts for.vhich payment has not been received by the one date. Thank you!
If you have any questions or concerns about Your bill;please addressthem dire(it) to Fiscal Services at 790-3220. TbankYen'
Cocklin Funeral Horne, Inc. Acct Contract # 175
MEMORANDUM OF SERVICE
1 SERVICES Of - Stella AQ- Hele _ DATE: 0C1 4i20 13
I
,._;�.ar L`Jeslern
le
I I tit I.'6_. i131
I !
i
(A) Services: j
' I i
Trad ill on al Scrvice Par'.I_gje S,JJ_.110
heulOUm Peitei crepe y2_'6i n0
'Wilder! Monarch ti1.l=15,00
Dress
� S'75 00
lOtaE (A) $8,105.00
1
(B) Cash Advance Items:
Hovers
5220.x6
Certified Copies 560.00
l _7lergy Honorarium
51 oaoa
Opening and Closinq Grave 5845.00
%ewspaper Notice-Hanisburg 5296 32
Newspaper Notice-Banner 5.'15.00
Culling Dale on Stone .5,200.00
Cemetery Equipment S200 00
Organist Honoranum 545.00
Music Honorarium 54.5 00
Total (B) $2,049.30
(D) Payments/Adjustments
Preneed AdjustmenUAllowance (5532.40)
Total (D) ($532.40)
Total Amount S9,62j .911
Less Amount Paid fS8,798.08)
rdy (200101 01v V L-I I] M 111 S I
WAP 1�ffD i'& MPLON EI S, --7
I N
A2 I L r rAiu .Hale Jnvoice
JZI-. Stella. Hale
SS >LXN XN-0659
Dead Mr. We,JeT
We have hecti rjiforduecj of the death of Slelin J-lale, a retired member of this System. We wish to
extend our condolences to -yon at this tini-,
Since Ms, 1 alu died 6;j 0/1 " and (fie June & July checks were not rcnimed to our office, this
acucluai has been overpaid in the amount of %593.88 foT the period from 6/11/13 - 7/3011 3 It
wii! therefore be necessary for out office to be reimbursed for $593.88 to liquidate this
oVcrJ)ayT1Iem'
The reimbursement should be made payable to The Stale Employees' Retirement System, and
mailed with the enclosed copy of this letter to the address sl)ovm above.
ff Yon have DOI already done so-we will Deed 2 certified copy or an original death certificate
for our file- If you cannot permanently spare the originals, please submit them with a Dole to ask
us to retni-rd them. We will Tcrund the onginals to you within 5 working days.
UPOD receipt of the reimbursement, this account will be closed. Tbere are no further benefits to
be paid from this System.
Should you have any questions concerning this matter,please do not hesitate to contact me at the
above address or by telephone at (717) 793-9065 or 1-800-633-5461.
Thank you for your cooperation.
Sincerely,
Linda Dolan, Administrative Assistant
Harrisburg Regional Counseling Center
Enclosure
'/
pennsyly nia
�e
OE}A nTME N1 0° VJEi.[C 'a Ft GAh"
l�nuai v 30, 2014
THE WILEY GROUP
)AN M WILEY ESQUIRE
3 N BALTIMORE ST
DILLSBURG PA 17019
Re. Stella Haic
CIS 7 67C195186
Date of Death: 06/10/2013
Dear Attorney:
This letter is to advise ou that acv riling to the information you provided to our
office egardinq the assets of the -above-referenced estate, the Department of Public Welfare
will accept the balance, narne!v $ ?Ei3_�_ remaining in the estate for payment of our
existing claim.
Dlease have the cheek made payable to the Department of Public Welfare and
forwareed to my attention at !n,, address listed below.
Your coopetation i , resnivinn this matter is appreciated.
Sincerely,
TPL Program Investigator
717-772-6617
717---72-6553 FAX
6n erg o`r:.-q:am Irtewit�, I D,�iso�� ur lhiro °a!Ty l2bIlly Rccovery section
c() Bn-b4" , 'an sr, j, ?enn_YDiania 17105 84 86
............. .....
. ..........
..........
.. .............. .......
i
OF
STELLA M. HALE
BE IT REMEMBERED, that 1 , STELLA M. HALE, of 103 Piq Dam
Road, Dillsburg, York C00rty, Pennsylvania, Peeing of sound
mind, memory and understanding, do make, publish and declare
this as and for my Last Will and Testament, hereby revoking
and making null and void any and all gills and Testaments and
writings in the nature thereof by me at any time heretofore
made.
ITEM 1: 1 direct that all my just debts and funeral
expenses be paid as soon after my demise as may be
convenient.
ITEM 2_ 1 give the sum of One Thousand Dollars
($1, 000.00) to each of MY GRANDCHILDREN, who survive me.
give the sum cf One _hc'usand --ollars
($1,000.00) to THE CHRISTIAN MISSIONARY ALLIANCE CHURCH, of
Dillsburg, Pennsylvania.
ITEM 9: I give unto my daughter, ELSIE M. KAUFFMAN,
the first right of refusal to purchase my home situate at 103
Big Dam Road, Dillsburg, Pennsylvania for the sum of One
Hundred Fifty Thousand Dollars ($150,000.00), provided she
does so within ninety (90) days from the date of my death.
ITEM 5: All the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate, whether
It be real, personal or mixed, including property over which
I have a power of appointment, I give, devise and bequeath
unto my three children, ELSIE M. KAUFFMAN, ALLEAN L. WELKER
and LARRY L. HALE, in equal shares, per stirpes.
�N'ITNESS: �Ja
(SEAL)
STELLA STELLA M. HALE
-1-
i
i
ITEM 6: 1 direct my hereinafter named ExecuLOr to pay
1 all inheritance, estate, succession and legacy taxes of
i
t,Ihatsoeve3 nature and kind, to which my es Cate or the
Cransfer of any property passing hereunder or otherwise
I passing by reason of my demise, may be subject and to charge
i
such taxes against my residuary estate, it being my intention
that none of the aforesaid taxes, either federal or state, on
i
t any property required to be included in my gross estate,
i
under the provisions of any state or federal law now in force
I
or hereafter enacted, shall be prorated among the persons
interested in my estate to whom such property is or may be
transferred or to whom any benefit accrues.
i
ITEM 7: 7 appoint my son-in-law, LARRY R. WELKER, as -
Executor of this my Last Will and Testament.
r
i
ITEM-R. 1 aire that Execctc:- s.,�ll '�t - ad
aqu.r
to give bond for the faithful performance of their duties in
any jurisdiction.
IN WITNESS WHEREOF, 1 have hereunto set my hand and seal
this V-6 day of /-/-//i;L/S� 2000.
TNESS:
SEAL)
/1 STELLA M. HALE
t
I
i
I
I
i
I
i
I
I
i
COMMONWEALTH 01' PENNSYLVANIA
i
: SS
COUNTY OF YORK
we, STELLA M. HALE, JAN M. WILEY, ESQUIRE and
r
I
MICHELE A. RENEKER, the Testatrix, and the si'tnesses
respectively, whose names are signed to the attached or
i
1 foregoing instrument, being first duly sworn, do hereby
i
declare to the undersigned authority that the Testatrix
I
signed and executed the instrument as her Last Will and
Testament and that she had signed willingly (or willingly
directed another to sign for her) , and that she executed
i
it as her free and voluntary act for the purposes therein
I
expressed, and that each of the witnesses, in the
presence and hearing of the 'Testatrix, signed this Last
.°Pd 'Pe=tament as witness and that to the best of
their knowledge the Testatrix was at the time eighteen
(I8) years of age or older, of sound mind and under no
constraint or undue influence.
TEL A M. HALE
Nn
ESS
`WITNESS
Sworn to and subscribed
before me this y l�b day of
57" 2000.
NOTARY P 6LIC
MY COMMISSION EXPIRES: Nolanal Seal
S.Dawn Glatllplipr Notary Public
Ddlsbura 6or,York County
Nay CommSVOn Expires May 11.200t
Mem0el, ennsy vanla Aisodalion of olmles
In the Matter of the Estate 1N THE COURT OF COMMON PLEAS
of Stella M. ]dale OF CUMBEI2L.AND COUNTY, PA
Deceased Orphans Court Division
No. '1 ,l
ORDER
AND NOW, TO WIT: This day of �Et G� 2014 upon consideration
ofthe foregoing petition and on motion of the attorney for the petitioner. it is ordered that the
Property of the decedent be distributed under Section 3102 of the P-E-F code as follows:
Name
Name:
Amount:
Messiah Lifeways: Nursing Home $ 2271 .36
Cocklin Funeral Home Funeral Expense $ 82182
State Employee Retirement Refund $ 593.88
The Wiley Group Attorney Fee: $2,500.00
Department of Revenue PA Inheritance Tax $75.76
rd,� >PartrnehIl0MMbIQ Welfare $1,683.46
fn Testimony wheroi, i hereunto
set my hand and the seal
of said Court at Carlisle, PA
ihi / - 20-Z�—,
Total $ 7,948.28
6
Cl e orEt,ans GouR
Cumberland Counttr
This decree of distribution shall constitute sufficient authority to all transfer agents,
registrars and others dealing with the property of the estate to recognize the persons named herein
as entitled io receive such property without administrztion, --nd shall in al'. respect ha the
effect as a decree of distribution after an accounting by a personal representative.
BY THE COURT,
L7
(]U? C tIF[I
r— Judge
� tiZ
ry
CD
CD
Co m r-, ltjdqe