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HomeMy WebLinkAbout09-08-14 DECEDENT'S ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF CAROLYN G.HUMPHREYS DECEASER x c m rn No, 2013 -00711 2 C y, r mrn r rt Co C, cn 72 o r': O tJ CJ -n PETITION FOR ADJUDICATION/ ca -,� � � -^ STATEMENT OF PROPOSED DISTRIBUTION " co ;" rn PURSUANT TO Pa.O.C.Rule 6.9 r r � cn This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers required under items 8-19 inclusive;and any instrument pertinent to the adjudication. INCL UDE A TTA CHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Ann E.Rhoads,Esquire Supreme Court I.D.No.:49631 Name of Law Firm: Address: 244 West Main Street,Hummelstown,PA 17036 Telephone: 717-482-8392 Fax: 717-482-8394 Form O(7-01 Ym 10.1106 Page I of 10 Estate of CAROLYN G.HUMPHREYS Deceased L Name(s)and address(es)of Petitioner(s): Name. Patricia A.Hoesch Address.- 3609 Kohler Pl.,Apt. 17 i Camp Hill,PA 17011 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: none Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . . . ®Yes © No If not, identify prior accountings,the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on May 19, 2013 ®Letters Testamentary or®Letters of Administration were granted to Petitioner(s)on June 27. 2013 Date of Will (if applicable): December 14,2001 Date(s) ofCodicil(s) (f applicable): none Date of probate (f different from date Letters granted): same Was a bond required?[3Yes ®No If yes,state amount: Are proofs of advertising of the grant of Letters attached? . . . . . . . . . 0 Yes E3 No Dates of advertising of the grant of Letters:The Patriot News:7/23; 7/30;&8/6/13 Cumberland Law Journal: 7/19; 7/26; & $/2/13 Form oC-01 rev.10.13.06 Page 2 of 10 Estate of CAROLYN G. HUMPHREYS Deceased 3. Was decedent survived by a spouse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ®Yes ONO If yes, name of the surviving spouse: 4. Has the surviving spouse filed to take an elective share? . . . . . . . . . . . . . []Yes O No (See Section 2201 et sue. of the Probate, Estates and Fiduciaries Code) If yes, date of election: 5. In the case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (if none, so state): 6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . . . []Yes 0 No Were any children born to decedent after execution of Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ®Yes ® No If yes, give names and dates of birth: Name: Date of Birth: 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. § 1412, was a request for a statement of claim sent to the Department of Public Welfare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes ® No Form oC-01 rev. 10.13.06 Page 3 of 10 Estate of CAROLYN G. HUMPHREYS , Deceased 8. Written notice of the Audit as required by Pa.O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given,attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not suijw•is(e.g., minors or incapacitated persons),Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest is involved,Notice of the Audit has been or will also be given to the Attorney General as required under Pa.O.C.Rule 5.5. In addition,the Attorney General's clearance certificate(or proof of service of Notice and a copy of such Notice) must be submitted herewith'or at the Audit. 9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s)or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest(s): Name and Address of Each Pp in Interest Relommkir and Comments.tam* Interest Patricia A. Hoesch Daughter 1/3 estate 3609 Kohler Pi.,Apt. 17 Camp Hill, PA 17011 Carolyn G. Mozlack Daughter 1/3 estate 320 Ft. Duquesne Blvd. Pittsburgh,PA 15222 Farm OC-01 rev.to.13.06 Page 4 of 10 Estate of CAROLYN G.HUMPHREYS Deceased Name and Address o F,ach Party in Interest Relationship and Comments ifany Interest Nancy Humphreys Step-daughter 113 estate 600 Humboldt St. Richmond, CA B. Identify each party who is not sui juris(e.g.,minors or incapacitated persons). For each such party,give date of birth,the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. N/A C. State why a Petition for Guardian/Trustec Ad Litem has or has not been filed for this Audit(see Ila. O.C. Rule 12.4). D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. FormoC-01 rte.Io.IS.oe Page 5 of 10 Estate of CAROLYN G.HUMPHREYS Deceased 10. Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Address of Each Claimant Amount of Claim Claim Will Claim Admitted? Be Paid In Fulls none ®Yes Yes nNo E]No [3Yes ®Yes []No No OYes 0Yes []No [I No E]Yes QYes EjNo ®No If the estate is insolvent,attach a schedule setting forth the order of preference under 20 Pa.C.S. § 3392 and the proposed payments. 11. Was family exemption claimed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OYes ®No Was family exemption allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OYes ONo Family exemption claimant's name and relationship: Name:Patricia A.Hoesch Relationship:Daughter Farm 0C-o1 rev.10.13.06 Page 6 of 10 Estate of CAROLYN G. HUMPHREYS , Deceased 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s)of payment(s), and the interest(s)upon which paid, are as follows: Date Payment Interest 08/02/2013 728.64 0.00 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond of a fiduciary? . . . . . . . . . . . . . . . . . . . []Yes ®No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: None B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . . . . . . [:]Yes ®No 15. If Petitioner(s) has/have knowledge that a share has been assigned, renounced, disclaimed or attached,provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation. Form OC-01 rev. 10.13.06 Page 7 of 10 Estate of CAROLYN G. HUMPHREYS Deceased 16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . ® Yes E] No If yes, attach a copy of the Order if available; otherwise state the Court, term,number, date, and name of Hearing Judge. 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. None B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . ®Yes ®No 18. If a reserve is requested, state amount and purpose. Amount 280.00 "'Po": Filing Fee: First and Final Account and Certified Mail for Notices of Account If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes ®No If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . []Yes ONo As to real estate only? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ®Yes [Z]No FormOC-01 rev. 10.13.06 Page 8 of 10 Estate of CAROLYN G. HUMPHREYS Deceased Wherefore, your Petitioner(s) ask(s)that distribution be awarded to the parties entitled and suggest(s)that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Distributee(s) Amamt/Proponion None B. Principal: Proposed Distributee(s) AmountlProportion Carolyn G. Mozlack $4,459.17 Patricia A. Hoesch $4,459.16 Nancy Humphreys $4,459.17 Submitted By: (All petitioners must sign. Add additional lines if necessary): Name of Petitioner:PATRICIA A. HOESCH Name of Petitioner: Form OC-01 rev. 10.13.06 Page 9 of 10 Estate of CAROLYN G. HUMPHREYS Deceased Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * [that heAhe is title of the above-named name ofcorporation and] that the facts set forth in the foregoing Petition for Adjudication/Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others,the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relating to unswom falsification to authorities). �o�6-00b Signature of Petitioner *Corporate petitioners must complete bracketed information. Certification of Counsel The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/ Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Court, and that no changes to the form have been made beyond the responses herein. (� Signature of Counsel for Petitioner Form OC-01 rev. to.13.06 Page 10 of 10 Ann E. Rhoads, Attorney at Law 244 West Main Street Hummelstown,Pennsylvania 17436 Telephone: 717-482-8392 Facsimile: 717-482-8394 Email: rhoadsann*hotmaiLcom September 8,2014 VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED Ms.Nancy Humphreys 600 Humboldt Street Richmond, CA 94805 RE: Estate of Carolyn G. Humphreys No. 21-2103-0071 Dear Ms. Humphreys: The First and Final Account of Patricia A. Hoesch,Executrix of the Estate of Carolyn G. Humphreys,Deceased, will be presented by the Clerk of the Orphans' Court Division for audit and confirmation at the Cumberland County Courthouse, One Courthouse Square, Carlisle,Pennsylvania 17013, at 9:00 am on October 14,2014. I enclose a copy of the First and Final Account and Petition. You will note that the Account includes a$280.00 reserve for the filing fee and postage. If you wish to object to the Account,you must file a written objection with the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania by no later than 9:00 a.m. on Tuesday, October 14,2014, Otherwise, any objection will be deemed to have been waived. Please contact me if you need further information or have any questions regarding the Account. Best wishes,as always. Very truly yours, Ann E. Rhoads Enclosures Ann E. Rhoads, Attorney at Law 244 West Main Street Hummelstown,Pennsylvania 17036 Telephone: 717-482-8392 Facsimile: 717-482-8394 Email: rhoadsann@hotmail.com September 8, 2014 VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED Ms. Patricia A. Hoesch 3609 Kohler Place, Apt. 17 Camp Hill,PA 17011 RE: Estate of Carolyn G. Humphreys No. 21-2103-0071 Dear Pat: The First and Final Account of Patricia A. Hoesch, Executrix of the Estate of Carolyn G. Humphreys, Deceased,will be presented by the Clerk of the Orphans' Court Division for audit and confirmation at the Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013, at 9:00 am on October 14, 2014. I enclose a copy of the First and Final Account and Petition. You will note that the Account includes a$280.00 reserve for the filing fee and postage. If you wish to object to the Account, you must file a written objection with the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania by no later than 9:00 a.m. on Tuesday, October.14, 2014. Otherwise, any objection will be deemed to have been waived. Please contact me if you need further information or have any questions regarding the Account. Best wishes, as always. Very truly yours, Ann E. Rhoads Enclosures Ann E. Rhoads, Attorney at Law 244 West Main Street Hummelstown,Pennsylvania 17036 Telephone: 717-482-8392 Facsimile: 717482-8394 Email: rhondsann @hotmail.com September 8, 2014 VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED Ms. Carolyn G. Mozlack 320 Ft. Duquesne Blvd. Pittsburgh, PA 15222 RE: .Estate of Carolyn G. Humphreys No. 21-2103-0071 Dear Ms. Mozlack: The First and Final Account of Patricia A. Hoesch, Executrix of the Estate of Carolyn G. Humphreys, Deceased, will be presented by the Clerk of the Orphans' Court Division for audit and confirmation at the Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013, at 9:00 am on October 14, 2014. I enclose a copy of the First and Final Account and Petition. You will note that the Account includes a$280.00 reserve for the filing fee and postage. If you wish to object to the Account, you must file a written objection with the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania by no later than 9:00 a.m. on Tuesday, October 14, 2014. Otherwise, any objection will be deemed to have been waived. Please contact me if you need further information or have any questions regarding the Account. Best wishes, as always. Very truly yours, Ann E. Rhoads Enclosures FIRST AND FINAL ACCOUNT OF PATRICIA A. HOESCH For ESTATE OF CAROLYN G. HUMPHREYS, Deceased LATE OF CAMP HILL BOROUGH CUMBERLAND COUNTY, PENNSYLVANIA NO. 2013 — 00711 l Date of Death: May 19,2013 z s m Date of Executrix's Appointment: June 27,2013 w N M � rn Co rnm Dates of Advertisement of the Grant of Letters: �� Cl < o T n v - The Patriot News—July 23,30 and August 6,2013 c, o -- -" s Cumberland Law Journal—July 19,26 and August 2, 2013 `'' ::u CD m N C Accounting for the Period: r -a June 27, 2013 to August 31,2014 Purpose of Account: Patricia A. Hoesch, Executrix, offers this Account to acquaint interested parties with the transactions that have occurred during her administration. This Account also indicates the proposed distribution of the Estate. It is important that the Account be carefully examined. Requests for additional information or objections can be discussed with: Ann E. Rhoads, Esquire Pa. Supreme Court ID No. 49631 244 West Main Street Hummelstown, PA 17036 717-482-8392 SUMMARY OF ACCOUNT Proposed Distributions to Beneficiaries: $13.377.50 Principal Receipts $27,287.48 Net Gain or Loss on Sales or Dispositions $ 0.00 Less Disbursements: Debts of Decedent $ 74.84 Funeral Expenses $6,505.00 Administration Expenses $ 720.56 Federal and State Taxes $ 728.64 Fees and Commissions $2,650.00 Family Allowance $3,500.00 $14,179.04 Balance Before Distributions $13,108.44 Distributions to Beneficiaries $ 0.00 Principal Balance on Hand $13,108.44 Adjustment to Principal Balance 4 269.06 Adjusted Principal Balance $13,377.50 Income Receipts 0.00 Less Disbursements 0.00 Income Balance on Hand 0.00 Combined Adjusted Balance on Hand $13,377.50 -1- RECEIPTS OF PRINCIPAL Fiduciary Assets Listed in Inventory Acquisition (Valued as of Date of Death) Value Cash Country Meadows Refund $ 440.02 Citizens Bank Checking Account #6225118393 22,060.60 Citizens Bank 9-month CD #6230512126 4,007.86 2013 Federal Income Tax Refund 679.00 $27,187.48 TOTAL INVENTORY $27,187.48 Assets Not Listed in Inventory (Valued as of Date of Receipt) Cash Cumberland County VA Benefit $ 100.00 100.00 TOTAL RECEIPTS OF PRINCIPAL $27,287.48 -2- DISBURSEMENTS OF PRINCIPAL Debts of Decedent: 05/23/2013 Alpha Diagnostics, LLC $ 74.84 $ 74.84 Funeral Expenses: 05/22/2103 American Memorial Life $6,355.00 07/29/2013 Pastor Martin Romaine $ 75.00 07/29/2013 Reverend Dennis E. Fulk $ 75.00 $6,505.00 Administration Expenses: 06/25/2013 Register of Wills, Probate Fee $ 173.50 06/25/2013 Register of Wills, Oath Fee $ 20.00 07/31/2013 Citizens Bank, Service Fee $ 10.03 09/09/2013 Cumberland Law Journal, (legal advertising) $ 75.00 09/09/2013 The Patriot News (legal advertising) $ 162.03 RESERVE Register of Wills, Filing Fee $ 250.00 RESERVE Certified Mail,Notice of Account $ 30.00 $ 720.56 Family Allowance: 08/14/13 Patricia A. Hoesch, Daughter $3,500.00 $3.500.00 Federal and State Taxes: 08/02/2013 Pennsylvania Inheritance Tax $ 728.64 $ 728.64 -3- Fees and Commissions: 09/09/2013 Cleckner and Fearen, Partial Legal Fees $ 625.00 01/26/2014 Karen Selzer, Preparation of Income Tax Return $ 150.00 02/05/2014 Ann E. Rhoads, Esquire, Partial Legal Fees $1,250.00 08/14/2014 Ann E. Rhoads, Esquire, Balance of Legal Fees $ 625.00 $2,650.00 TOTAL DISBURSEMENTS OF PRINCIPAL $14, 179.04 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES NONE. PRINCIPAL BALANCE ON HAND Cash $13,108.44 Adjustment + 269.06 ADJUSTED PRINCIPAL BALANCE ON HAND $13,377.50 RECEIPTS OF INCOME NONE TOTAL RECEIPTS OF INCOME $ 0.00 DISBURSEMENTS OF INCOME NONE -4- TOTAL DISBURSEMENTS OF INCOME $ 0.00 ADJUSTED COMBINED BALANCE ON HAND $13,377.50 PROPOSED DISTRIBUTIONS TO BENEFICIARIES TO: Carolyn G. Mozlack, in satisfaction of gift of one-third(1/3) of net estate: Cash: $4,459.17 $ 4,459.17 TO: Patricia A. Hoesch, in satisfaction of gift of one-third (1/3) of net estate: Cash: $4,459.16 $ 4,459.16 TO: Nancy Humphreys, in satisfaction of gift of one-third (1/3) of net estate: Cash: $4,459.17 $ 4,459.17 TOTAL PROPOSED DISTRIBUTIONS TO BENEFICIARIES $13,377.50 -5- IN RE:ESTATE OF CAROLYN G. HUMPHREYS, NO. 2013 —00711 Deceased STATEMENT OF PROPOSED DISTRIBUTION Pursuant to Local Rule 6.9-1 of the Orphans' Court of the Ninth Judicial District, Cumberland County, Pennsylvania, and the foregoing First and Final Account of Patricia A. Hoesch, Executrix of the Estate of Carolyn G. Humphreys, deceased, said Executrix proposes the following distribution of said estate: TO: Carolyn G. Mozlack, in satisfaction of gift of one-third(1/3) of net estate: Cash: $4,459.17 $ 4,459.17 TO: Patricia A. Hoesch, in satisfaction of gift of one-third(1/3) of net estate: Cash: $4,459.16 $ 4,459.16 TO: Nancy Humphreys, in satisfaction of gift of one-third (1/3) of net estate: Cash: $4,459.17 $ 4,459.17 TOTAL PROPOSED DISTRIBUTIONS TO BENEFICIARIES $13,377.50 NOTICE OF INHERITANCE TAX pennsylvania APPRAISEMENT, ALLOWANCE OR DISALLOWANCE BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-1547 EX AFP (08-13) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 07-07-2014 ESTATE OF HUMPHREYS CAROLYN G DATE OF DEATH 05-19-2013 FILE NUMBER 21 13-0711 R COUNTY CUMBERLAND HOADS ESQ ANN E ACN 244 W MAIN ST APPEAL DATE: 09-05-2014 HUMMELSTOWN PA 17036-1422 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ____ RETAIN LOWER PORTION FOR YOUR RECORDS 4--REV-1547 EX AFP C08-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: HUMPHREYS CAROLYN GFILE NO. :21 13-0711 ACN: 101 DATE: 07-07-2014 TAX RETURN WAS: ( X) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 00 submit the upper portion S. Closely Held Stock/Partnership Interest (Schedule C) (3) . of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 27, 187.48 6. Jointly Owned Property (Schedule F) (6) 2, 186.99 7. Transfers (Schedule G) (7) 840. 15 8. Total Assets (e) 30.214.62 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 13.095.56 10. Debts/Mortgage Liabilities/Liens (Schedule I) (30) 74.84 11. Total Deductions (11) 13,170.40 12. Net Value of Tax Return (12) 17,044.22 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 17,044.22 NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will reflect figures that include the total of all returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at spousal rate C15) .00 X 00 = .00 16-. Amount of Line 14 taxable at lineal rate (16) 17.044=99 X 045 = 766.99 17. Amount of Line 14 at sibling rate (17) -nn X 12 ' . DO 18. Amount of Line 14 taxable at collateral rate C18) .00 X 15 = .00 19. Principal Tax Due (19)= 766.99 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-02-2013 CDC17976 38.35 11000.00 TOTAL TAX PAYMENT 1 ,038.35 BALANCE OF TAX DUE 271 .36CR INTEREST AND PEN. .00 TOTAL DUE 271 .36CR IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS. RESERVATION: Estates of decedents dying on or before Dec. 12, 1982-if any future interest in the estate is transferred in possession or enjoyment to collateral beneficiaries of the decedent after the expiration of any estate for life or years;the commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest. PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills indicated on the front of the notice. Make check or money order payable to:REGISTER OF WILLS,AGENT. REFUND(CR): A refund of a tax credit not requested on the tax return may be requested by completing an Application for Refund of Pennsylvania Inheritance and Estate Tax(REV-1313). Applications are available from the department's website at www revenue state pa.us,any Register of Wills or Revenue District Office,or from the department's 24-hour forms ordering service: 1-800-362-2050;services for taxpayers with special hearing and/or speaking needs:1-800-447-3020(TT only). Please allow 4-6 weeks from the date a refund was granted to receive the check. OBJECTIONS: Any party interest not satisfied with the appraisement,allowance or disallowance of deductions,or assessment of tax (including discount or interest)as shown on this notice may object within 60 days of the date of receipt of this notice by: A) Filing an appeal online at A"Jb.pardofaoogals.state_pa.M on or before the appeal date identified on the front of this notice. Or sending a written protest to:PA Department of Revenue, Board of Appeals,PO BOX 281021,Harrisburg PA 17128-1021; B) Having the matter determined at audit of the account of the personal representative;or C) Appealing to the Orphans'Court. ADMINISTRATIVE Errors discovered on this assessment should be addressed in writing to:PA Department of Revenue,Bureau of Individual CORRECTIONS: Taxes,ATTN:Post Assessment Review Unit,PO BOX 280601,Harrisburg PA, 17128-0601,Phone(717)787-6505. See page 4 Instructions for Inheritance Tax Return for a Resident Decedent(REV-1501)for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death,a five percent discount of the tax paid is allowable. INTEREST: Interest is charged beginning with first day of delinquency,or nine months and one day from date of death,to the date of payment. Annual interest rates are available on Form REV-1611,available at www.revenue.state.oa.us,or upon request by calling 1-888-728-2937. Interest is calculated as follows: INTEREST=BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest calculation date show on the notice,additional interest must be calculated. The Patriot-News Co. µ"�O`~ �W� 2020 Technology Pkwy Suite 300 Mechanicsburg, PA 17050 Now you know Inquiries - 717-255-8213 CLECKNER AND FEAREN ATTN: ANN E. RHOADS 119 LOCUST STREET P.O. BOX 11847 HARRISBURG PA 17108 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin) ss Marianne Miller, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the Township of Hampden, County of Cumberland, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/Community Weekly editions which appeared on the date(s) indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book"M", Volume 14, Page 317. PUBLICATION COPY This ad# 0002267234 ran on the dates shown below: July 23, 2013 July 30, 2013 August 06, 2013 n I i ESTATE NOTICE NOTICE IS HEREBY GIVEN thOt 4 Letters Testamentary In tht Estate of Carolyn G.HumahreYs,late of Came Hill Borough,Cumberland County, Sw to and subscribed befor a this. 6 day of August, 2013 A.D. Pennsylvanlo,deceased,(died May 19, 2013),have been granted to the undersigned,and all persons IfMebted to ) sold estott are rtaulred to fnnke Immtdlate Payment Md these haying clolms will Present them for settlement � to. ry Public Pa Hoesch,Executrix 7609 09 Kan Kohler Place,Apt.17 Came Hill,PA 17011 I 0 y Ann E.Rhoads, nd Esauln CleP.O.Box li;.17 ` � 0 P.O.Box 1181] COMMONWEALTH OF PENNSYLVANIA Morrlsburg,PA 1]10&180 Attorneys Notarial Seal Holly Lynn Warfel,Notary Public Washington Twp.,Dauphin County My Cornmtssion Expires Dec.12,2016 MEMBER,PENNSYLVANIA ASMATION OF NOTARIES PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA : SS. 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: July 19, July 26, and August 2, 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. f Lis Marie Coyne, Editor SWO TO AND SUBSCRIBED before me this 2 day of August, 2013 tom Notary Humphreys,Carolyn 6.,deed. Late of Camp Hill Borough. Executrix:Patricia A.Hoesch,3609 Kohler Place, Apt. 17, Camp Hill, PA 17011. Attomcys:Ann E.Rhoads,Esquire, Cleclmer and Fearen, P.O. Box NOTARIAL SEAL 11847, Harrisburg, PA 17108- DEBORAH A COLLINS 1847. Notary Public CARLISLE BOROUGH,CUMBERLAND COUNTY My Commission Expires Apr 28,2014 p® pennsylvania DEPARTMENT OF PUBLIC WELFARE RECEIVED July 11, 2013 JUL 1 8 2013 ANNE CLECKNER AND ESQUIRE & FEAREN ANN E RHOADS ESQUIRE PO BOX 11847 HARRISBURG PA 17108-1847 Re: Carolyn Humphreys SSN: ###-##-4764 Dear Attorney Rhoads: Pursuant to your letter dated July 08, 2013, the Department's, Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. Thank you for your cooperation in this matter. If you have any questions, please contact me. Sincerely ;� �? � Yd� Vince A. Porter Recovery Section Manager (717)772-6604 Bureau of Program Integrity Division of Third Party Liability Recovery Section PO Box 8486 1 Harrisburg, Pennsylvania 17105-8486 PATRICIA A. HOESCH, Executrix of the Estate of Carolyn G. Humphreys, deceased, being duly sworn according to law, hereby declares and says that the foregoing account is just and true and that the grant of letters and first complete advertisement thereof occurred more than four months prior to the filing of this account. PATRICIA A. HOESCH Sworn and subscribed to before me, this ao'aday of Auawl t 2014 v _ r. 'J, Notary Public My Commission Expires: /o2. 0A7 COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Lauien E.Snavely,Notary Public Hununelstown Horo,Dauphin County M commission expires Daember 10,2017 . . , , . :,•.. � tt