HomeMy WebLinkAbout11-04-14 � 1505610105
REV-1500 EX�oz_��,��, �
PA Department of Revenue pennsylvania OFFICIAL USE ONLY
Bureau of Individuat Taxes �EP�pT�E�'�Fp�NHERITANCE TAX RETURN County Code Year File Number
PO BOX 28o6oi �I �� 3��
Harrisburq,PA i'7128-o6oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
03/18/2011 11/16/1919
DecedenYs Last Name Suffix DecedenYs First Name MI
Nevius Ruth E
(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 O 2.Supplemental Return p 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate p 4a.Future interest Compromise(date of p 5. Federai Estate Tax Return Required
death after 12-12-82)
� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Pove!ty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedui ) �
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD D TED T0:"� ,� �l
Name Daytime Telephone�'}�nb� � rd7 �
�.-=, ca h
William S. Daniels (717)243-3831r�-`' �� r�-�-� `' r.%; :�
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REGISTER OF,WIlLS USE ONLY ':, �,y
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--� '3 ''d
First Line of Address `r`t
1 West High Street -� � �''r�7
Second Line of Address "V' �
"�
Suite 205
City or Post Office State ZIP Code DATE FILED
Carlisle PA 17013
Correspondent°s e-maii adaress: humeranddaniels@outlook.com
Under penalties of perjury,I declare that 1 have examined this retum,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.
SI QN RESPONSIBLE FOR FILI G RETURNp DATE.
k � � �aC Q�f.c�C.i�. /�Q.0 l/� ��'�����
ADORESS
Clark C Dunkle III, 66 E Willo . a d Cheryl L Key, 70 Mead Dr., both of Carlisle, PA 17013
IGNATUR P�EPARER OTH H EP ESENTATIVE� �TE�'� �/
/ V �ADDRESS
Humer& Daniels Law Office, 1 W. High St., Suite 205, Carlisle PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 J
�
�
� 15�561�2�5
REV-1500 EX(FI}
DecedenYs Social Security Number
�ecedent's Name: Ruth E. Nevius
RECAPITULATION
1. Real Estate(Schedule A). .. . .................... . . . .. ... . ............ 1. 0.00
2. Stocks and Bonds(Schedule B) 2. 0.00
...... . . ................. .. . ......... . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .... 3. 0.00
4. Mortgages and Notes Receivable(Schedule D). ....... . . . . . ...... . . . .... . 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .... 5. 6,51524
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . .. .. 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . . . . . . 7. 0.00
8. Total Gross Assets(total Lines 1 through 7). . . . . ...... . . ....... . . . . ..... 8. 6,515.24
9. Funeral Expenses and Administrative Costs(Schedule H)..... . . ............ 9. 4,345.50
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). .. . . . ... . . .... 10. 97,24227
11. Total Deductions(total Lines 9 and 10)..... . . . . ........................ 11. 101,587.77
12. Net Value of Estate(Line 8 minus Line 11) .......... . . . ..... .. . .. . . . . . .. 12. 0.00
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ................ . . . ..... 13. 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) . .. ..................... 14. 0.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 0 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X.0 45 0.00 16, 0.00
17. Amount of Line 14 taxable
at sibling rate X.12 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X.15 18. 0.00
19. TAX DUE . ...... ..... . . ........ .. .......... . .. ... . . . . . . . ....... . . . 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� ],505610205 15056102�5 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Ruth E. Nevius
STREETADDRESS
770 S. Hanover Street
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. if death occurred after Dec.12,1982,did decedent transfer property within one year of tleath
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payabie-upon-death bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a){1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For tlates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers from a deceasetl 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 decetlenYs lineal beneficiaries is 4.5 percent,except as noted in[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,
untler Section 9102,as an indivitlual who has at least one parent in common with the decedent,whether by blood or adoption.
•
, � , ,
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTER�
PENNSYLVANIA
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No. 2011- 0039 7 PA No. 21- 11- 039 7
Es ta te Of: RUTH E NEVIUS
(Fi�st,Middle,Last1
La te Of: CARLISLE BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No:
WHEREAS, on the 28th day of March 2011 instruments dated:
November 12th 1996 January 25th 2001 were admi tted
to probate as the last will and codicil of RUTHENEV/US
(First,Middle,Lastl
la te of CARL/SLE BOROUGH, CUMBERLAND County,
who died on the 18th day of March 2011 and,
WHEREAS, a true copy of the will &codicil as probated is annexed hereto
THEREFORE, I, GLENDA FARNER STRASBAUGH , Regi s ter of Wi 11 s in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, here.by
certify that I have this day granted Letters TESTAMENTARY to:
CLARK C DUNKLE lll and CHERYL L KEY
who have duly qualified as EXECUTOR(R/X)
and have agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 28th day of March 2011.
�.���i <�x�y��.�urg c h
Regis r of s �
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**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
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��nc����-:fe� i.ri a���csru�nc� w�th x�re�7_.:�z�c_tem�nts w�:i.r..'r� T ��av� m�c��
�ait:�: th� {;i��s�n-T-iollir�g��- ��;.ne�al. Hc�m� ,
_ of Mn�nt Holly Springs ,
Curr�k��rland C:�aunt�v, Pe�n:_,ylva�-:iG e
II . I bequ�ath all af thF tangi.blp persc�al �ropgr�y
ownecl }�y me and founc� �t my d�utrz in rn� hc�mE ta rriy ste�--son,
r�2AYMORI� D. l�T�:VIU�, JF�.
III . I devise and bequea�th al l tn� res;t , r�sidue, a�ac�
remainder of my estate of every nature and wherever situate i,r�.
eq�i�al shares to such of. my adult children, THEQS �� Zr�RQ�, �����
C. DUIYKLE, BEVERLY A. RIEE, and CHERYL L. BRETT, �s shail surviv�:
m� bY thirty days . Should any of mv sai�' childr:�n �red�cease me
or di� or� ur bc�for� the thirtieth day follawirg my �leath, I
r-��-'ti•is� and bequeat�z the share of such chil.d oz children to his c�r
her issu� pAr at.L��JFtiS ls.vi.n� c�n tr��. t3-iirty-�first da� fol ] c�wing nzy
death; anc� in default of at�.y such then livin i.ssua �
g , such shar� ' �
shall be added to th� shar� or �hares for my nther chaldren. �
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Z�1. I appoint the PM� �ANK of Mc�unt �Ioll� Springs or
its suceessar in busine�s, guardian of ar� �
y pro�erty which passes
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th� minor's s,�P:ar� ant� t�{1=ar�tin.:. (i..:+.C11.3.C�7.T?y c;�i : :�,g� ed,�zc�t.ion,
bc�t� gra�uat� az-�cr unc�er���duate) wit�-ic�u�t r.zgar�F� to �:i � ��n c�,_
parent 's ability to provid� for such :�izppait �r1c� �c�ucatic�n , or tc
m��e �aym�nt f�r
t_h�>>�: �.�r�,o��s , withuu�t f.�rther r�s�orssi�aility
,
.o th� minri or to the minGr ' �� �ar�n� ,�.� �-
• -- � o �ry �Qrson takinr,
Cr'�Y'E.' G� ��7E'. T117.h�aY`.
�. I direct that all taxes that m�y b� asse:�sea in.
cansequence af my death, of whatever natur� and k�y whatever
jurisc�iction impasecl, shall �� �aid fx�c,m my rEsi.duary �state ��; ��
part of the expens� of tha admi.nistr�tion of my estate.
�II . I appoint my �ons , �'I�EOS E. VERO'F� and CI,�,RK C.
DUNKLE, co-executorsp or t�e survivor of th�m exec�utor of thzs mv
Iast will , �
VI� . I direc:t that my executors ar�cx cru�rc�3 an er t�l�_ir
successoY-s �ha31 not be raquir2c� �o exive bond for the faithful
��erforman�.� of. their duties i.n anY 7Lxri��icc�,:;r.�.
IN WITIYESS WHERE�F, I have hereunto set my hand thi.s
/ ��
/ � -'day of November, 1996 .
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7
_.__ � ��,L,C.�i..' i °if C.:�1�''LC�C...�
RUTH E. EVIUS
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SOLE CODICIL TO LAST WILL NOVEMBER 12 1996
RUTH E. NEVIUS, MOUNT HOLLY SPRINGS
I, RUTH E. NEVIUS, of Mount Holly Springs, Cumberland
County, Pennsylvania, declare this to be the sole codicil to my
last will dated November 12, 1996 .
I . I hereby revoke Article II of my Last Will and in
lieu thereof provide as follows :
I bequeath such items of tangible personal
property belonging to me and found upon my death
in my home to my adult children, RAYMOND D. NEVIIIS,
JR. , THEOS E. VEROW, CLARK C. DUNKLE, III, BEVERLY
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A. RIFE, and CHERYL L. -B���, as they shall so
select and amicably agree among themselves without
strict regard to equality in value. I direct that
the remainder of said tangible personal property „��
. �
shall be sold at public or private sale, with the �'
�;�
proceeds therefrom being applied to my residuary `��;
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estate.
��,�
II . I hereby revoke Article VI of my Last Will and in �,�
,�
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lieu thereof provide as follows : {�-:.�=�'
�
I appoint my son, CLARK C. DUNKLE, III, and
'h r ���.'-/-'
my daughter, CHERYL L. , co-executors, or
, ,..._ ,�
the survivor of them executor of this my Last
Will .
III . In all other respects, I hereby ratify, confirm and
republish my Last Will dated November 12, 1996, together with
this Sole Codicil, as and for my Last Will .
IN WITNESS WHEREOF, I have hereunto set my hand this
��' _'"_ c .f:, ->;: �
�y"" � i�;`p j
,�j � day o f A�, �-�9-9�. °
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''�C c.��`°� � ,�t:- �''�.'1�.-:...=' (S EAL)
RUTH Ec�: NEVIUS
Signed, published and declared on the date thereof by
the above named RUTH E. NEVIUS as and for the sole codicil to her
last will dated 11/12/96, in the presence of us, who, at her
request, in her presence, and in the presence of each other, have
subscribed our name�a� witnesses hereto.
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C.7.11i:�'L��:'.TF�Ci S.T�1 3r;°.'.'L;I'�ct.i1C: W:iL?� T"L�cj'.:c�.:i:l�E'TT1E'.S7-�:S [�7T21.C:�'! � iIa';� :::r.Zt"'t�
urit�. ti:� ;;ib:,or.-Ho� iina�� r^��nera.? Ha�n� o� �I�t,nt �olly Springs ,
��r�l��rlan� C:ount;�, P��.�nsyi�,�zAia .
II . I be�u�;ath all of the tan�i�;1_�: ;��y�sol�al ��a��rtv
owrieci bv m� and io�;ncZ at my d��th in rr�_� 1-iame to ?�1 ste�--4,n�n.., -
�1����Oi�1D I?. l�Et7IU�, 4F;.
III . I devise and '�equeath all ti�� rest , r�esidu�, �r;r'
remainder of my Pstate of evary natur� and wherever situate i.��.
e���zal shares to such of. my adult cnildren, TI3ECrS ,�� tl�;g�,�, ��,A�i�
C. DUNKLE, BEVERLY A. RIFE; and CHERy�, �,� BRE�T, �� shail �urvi.vr
me by thirty days . Should any of mv sai�� chil�r�n x�red�c�ase me
or �iE �r� ��r �->�fc,r� thU thirtieth cl�v f.ol i c,tair_g m� �1ra�th. �
`=��3�',�"��" and b`�uea4h the share cf such chil.d or children to his �r
h�r issu� �r:•r sti r��s li.t�in� o?� tr�r tlsir�y--fi�s�L c�at� fol l atai�ia n;=r �
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dPath; and in c��fault of az�y such then living issue, such shara ' �
sh�l l be aclded to �riv ��are oz :h.arF, Y ; t ';'}
s fo� n� r,+h�r �.rsi� d.�en. • �
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IV. I appoint th� �1�C BAA1K af �l�+�un�t ��c�ll� Springs o�� s
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its successor in �usiness, guardian of ar�y pror�ert1 which passes
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ca're of thQ min�z:-,
��. � dir�ct that al l taYes that malr �ic �.ssE�sec� in.
consequericP of my d�ath, of Frhat�ver nature and by f�rhatever
jiz:c.-isc'iccicn impased, shall k,a paid from my resi.duarl e.state �� :.�
part of �ne expense of the ac��;��,�,i�fi��tian �f my estate ,
!II . I app�in�t my son�, ��EOS E. VERO'[a ��d CLd�FtX C.
DUNIi�E, co-executors r �r th� survivor of th�m ex_ecLito.r of t�-�a.s rn�
la.�t will .
VLI . i. direc:t that mv exEcutors a.:.t� cii.�ar.r.':.�.an cr tiic:i�
�uccessoLs shai 1 not be rP4uir2�� ta �ive bond �o� ti�e f3z.thful
_=�rf��rmar:ce of their duties i.n ar�y juri��ic���vr.
I1V G7ITi�ESS WHEREOF I �iave hEreuntp set mt
�f.� ' 1 har_d thi.s
�� �day of Novzrrber, 199e .
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RUTH E. EVIUS
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i SOLE CODICIS,_iU Lr�ST i+VZLL, �{JVE'�IBSR 12 , 19:b
RUTH E._ _IGEVIUS, MOUNT Ht�LLY SPQINGS
I, RUTH E. NEVIUS, of Mount Holly Springs, Cumberland
County, Pennsylvania, declare this to be the sole codicil to my
last will dated November 12, 1996.
I . I hereby revoke Article II of my Last Will and in
lieu thereof provide as follows:
I bequeath such items of tangible personal
property belonging to me and found upon my death
in my home to my adult children, RAYMOND D. NEVIIIS,
JR. , THEOS E. VEROW, CLARK C. DUNKLE, III, BEVERLY
f��- r,� � ��;` ' �,
A. RIFE, and CHERYL L. -8�-�, as they shall so !�J Y y
�`-
select and amicably agree among themselves without
strict regard to equality in value.- I direct that
the remainder of said tangible personal property ..;i
. �
shall be sold at public or private sale, with the ,�.�'j
proceeds therefrom being applied to my residuary t:"=�;
l R`�
estate.
�'-�
II . I hereby revoke Article VI of my Last Will and in °�
:�
lieu thereof provide as follows : �` ��
;
I appoint my son, CLARK C. DUNRLE, III, and
%� - , .
my daughter, CHERYL L. �BR�, co-executors, or �`�`���,
_� ---"�
the survivor of them executor of this my Last
Will .
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iIII _ Ir all other respe�ts, I hereb�,r raLifl, corlrir-r� �nd
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i repu�lish my Last r�Till dat��� �dovem'r�er 12, 199� , tog��Y'E'l �.vit�n
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this Sol� Codicil, as and for my Last wili .
IN VJITNESS WHEREOF, I have hereunto set my hand this
7 '�•;' �if:�';"::.-:f:Z -; _ •= � ,
,�; � day o f Ma�;-�9-9-3.
r"
'i�2. �` `Lrl�'� �r�. � �
._ �T�' ... �_;�L�..�. . S EAL
RUTH E�: NEVIUS
Signed, published and declared on the date thereof by
the above named RUTH E. NEVIUS as and for the sole codicil to her
last will dated 11/12/96, in the presence of us, who, at her
request, in her presence, and in the presence of each other, have
subscribed our nam��as witnesses hereto.
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REV-i5o8 EX+(o8-iz)
�� ` pennsylvania SCI�IEDt�LE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX REfURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ruth E. Nevius 21-11-0397
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC Bank,Checking account#5140189012 4,473.56
2. PNC Bank,Savings account#5000806429 1,741.68
TOTAL(Also enter on Line 5, Recapitulation) $ 6,215.24
If more space is needed,use additional sheets of paper of the same size.
Total Banking Statement
For q�e por�od BS/O3/4d11 to 6AJO7/2011
�For 24-hour information,sign on to PNC BankOnline Banldng RUTH E NEVIUS DECD
on pnc.com. Primary ac�ount number.51-4018-9012
Page 2 of 4
Account number:51-401$-9012-continued
/�ctlyity Detail
There was 1 Deposit or Other Addition
Deposits and Olh� Additions tota�ing 52os.13.
pate Amount Descriptfon
p��l¢ 209.1� Deposit Reference No 521062972
Checks and Substitute Chedcs
Check Date Reference
number Amourrt paid number
q4� 1,118.75 03/08 08596571i
There is 1 check listed tota{ing $1,118J5.
Q�� �e�luCtions There were 2 Other Deductions totaling
$4,473.56.
Date Amourrt Description
03/30 .00 . Outstanding Item Close
03/31 4,473.56 Debit Memo Reference No 52�794026
Daily Balance Detai!
Date Balance Date Balance Date Balance Date Balance
03/OS 4,269.43 03/14 4,473.56 03/90 4,473.56 0�/31 •40
Savings �ccount Su�nmarY Cheryi L Key
Account number:50-0080-6429
Overdraft Protection Provided By: Coutaot PNC to�stabNsh OrKdraft Protsction
galance Summary
Begfnnin9 Deposks and Checks and other Ending
bafance other additions deductions ��a�
1,741.68 .00 1,741.68 •�
Average mo�thiy Charges
balance andfees
1,292.21 •�
Interest Summa�y As of 04107,a total of S.Z2 in interest was
paid this year.
Annual PerceMa9e Number of days Average collected Interest Paid
Yield Eamed(APYE) in interest period balance forAPYE this period _
p,ppy 22 1,741.68 .�
A�ct�gity D�taii -
Ather Deductions There were 2 Other Deductions totaling
Date AmouM Description �'�741�8
0�/30 .00 Outstanding Itern Close
U3/31 1,741.68 Debit�rlemo Reference No 523794025
Daily Balance Detail
Date Balance Date Balance Date ��a�
03/08 1,741.68 OS/30 1,741.68 09/31
���.r�c�. ��i C.,f1��k i�=��-` �- S�i t�;���s� Gl.�.f
�i�')'t�..- o -�' C'c�� ��.�
FURP�n'f soFE
REV-15ll EX+ (08-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ruth E. Nevius 21-11-0397
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Westminster Cemetary,Grave marker 1,513.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 1,000.00
Name(s)of Personal Representative(s) Clark C. Dunkle III and Cheryl L. Key
street Address 66 Willow Street and 70 Mead Dr.
city Carlisle _ state PA ZIP 17013
Year(s)Commission Paid:
2• Attorney Fees:
3• Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation.)
1,000.00
Claimant N!A
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: 82.50
5. Accountant Fees: 0.00
6. Tax Return Preparer Fees: 0.00
�• The Sentinel-Legal,Advertising 300.00
s. Cumberland Law Journal,Advertising 75.00
s. Register of Wills,Filing Fees 50.00
�o. Additional Probate 25.00
��. Reserve 300.00
TOTAL(Also enter on Line 9, Recapitulation) $ 4,345.50
If more space is needed,use additional sheets of paper of the same size.
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RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH Receipt Date : 3/25/2011
Cumberland County - Register Of Wills Receipt Time : 16 : 14 : 11
One Courthouse S quare Receipt No. : 1064938
Carlisle, PA 17613
NEVIUS RUTH E
Estate File No. : 2011-00397
Paid By Remarks : CLARK DUNKLE
DB
------------------------ Receipt Distribution - -----------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 20 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
CODICIL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 4 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Cash $82 . 50
Total Received. . . . . . . . . $82 . 50
REV-1512 EX+ (12-12)
� pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OP FILE NUMBER
Ruth E. Nevius 21-11-0397
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• Commonwealth of PA,Department of Pubiic Weifare,Medical Costs 97,242.27
TOTAL(Also enter on Line 10, Recapitulation) $ 97,24227
If more space is needed,insert additional sheets of the same size.
CQMMONWEALTH OF PENNSYLVANIA
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABIIITY
RECOVERY SECTION
PO BOX 8486
HARRISBURG,PA 17105-8486
May 2T,2014
STATEMENT OF CLAIM SUMMARY
NAME Estate of NEVIUS,RUTH
ID 940 232 452
MEDICAL CLASS 3 CLASS 5.1 TOTAL
INPA7IEIVT .00 .00 .00
OUTPATIENT .00 .00 .00
LONG TERM CARE 22,921.72 74,374_51 97,296.23
DRUG 62.23 65.81 128.04
REIMBURSEMENT TO DPW 22,983.95 74,440.32 97,424.27
COMMONWEALTH OF PENNSYIVANtA
DEPARTMENT OF PUBLIC WELFARE
EIN- 23-6003113
Page 1 of 12
REV-1513 EX+ (O1-10)
<'� pennsylvania SCHEDULE �
�� DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ruth E. Nevius 21-11-0397
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1• Raymond D.Nevius,Jr., 1024 JuniperAve, Niceville,FL 32578-2119 Stepson 1/5
2. Theos E.Verow,97A Partridge Circle,Carlisle, PA 17013 Son 1/5
3. Clark C.Dunkle III,66.East Willow St.,Carlisle,PA 17013 Son 1/5
4. Beverly A.Rife,54 Country View Estates,Newville,PA 17241 Daughter 1/5
5. Cheryl L.Key,70 Meade Dr.,Carlisle,PA 17013 Daughter 1/5
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.