HomeMy WebLinkAbout03-25-15 r11 t
1505610101
REV-1500 EX iO3-10'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
OEFARTM-OF REVENUE County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ,— -
PO BOX 28o6o1 F�JA
I ` �i- ��Harrisburg,PA 17128-0601 RESIDENT DECEDENT dj LIJt�� JU1—iiAl _'IJ_
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
, 50 �WMJ_ �00JJJI
Decedent's Last Name Suffix Decedent's First Name MI
A 1,01 1 jr �61 1: 6'4L
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
100ALIOU11o[10DIOUJ7jl UJOLILLLLIUa 0
Spouse's Social Security Number
II�� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
I[1JLHJ�I_..IU❑ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
C=D 4. Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
® 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime TelephoneNlumber
REIGISTER OOF)WILCO USE OONLY
First line of address ~'
I � n
[L�l�I 3411_ !� � .1-11_5J_
-�J�-SLI JL�U U�I�U_UU�_��._�i !_z3
Second line of address
JiJJJUI_ JUU❑CJiJUJC�JI�J
City or Post Office State ZIP Code DATE Fk�gb
[ a1nLJ'1 �JU i�l�'�'J!�':_I'J,_j i7 io_r
Correspondent's e-mail address: ('I G IC - ( CQ n m •e--D N'Y1
Under penalties of pe6ury,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.
SIGNATU OF PER ON RESRONS1111 E FOR FILIN ET N DATE
AD ES
SIGNATURE OF PREPARER OTHER THAN REPRESENTA IVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
i
Side 1
L 1505610101 1505610101
1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: �Q LQ IE �f�b C:...C_.f� [
RECAPITULATION ++Ill
1. Real Estate Schedule A. ............................... ............. 1. Li
2. Stocks and Bonds(Schedule B) ....................................... 2. !uu u �l-t �vl'•'��,��
3. Closely Held Corporation, Partnership or Sole=Proprietorship(Schedule C) ..... 3. I01�
( )..... ...................... I. _
4. Mortgages and Notes Receivable Schedule D 4. u'uU�uElm uEDJ
P Pity( ) I J
5. Cash,Bank Deposits and Miscellaneous Personal Property Schedule E .. ..... 5. 1�]LOD ' •f�-1
6. Jointly Owned Property(Schedule F) p Separate Billing Requested ....... 6.
uLu. .b..
•uj� 1. luu
7 (Schedule
s )ansfers&Miscellaneous NPProperty - �
(Shdu eGNon-Probate
Requested.. .. .... 7. J�� I i{ �.�10{.l_llI
( 9 ).. .... ........ ..
• . 8. Total Gross Assets total Lines 1 through 7 . ........ ... 8.
9. Funeral Expenses and Administrative Costs(Schedule H).. .. ...... ...... ... 9.
LJ �� � 'y o� '371
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ... ...... .... . 10. uuL
11. Total Deductions(total Lines 9 and 10).... ..... .... .... .. .......... .... 11.
�u� a �` I
12. Net Value of Estate(Line 8 minus Line 11) . ... .. ...... . . .... .... .... ... . 12. �
j ,
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which uu�lul �I�i�•, "
an election to tax has not been made(Schedule J) 13 4L,}- 1
14. Net Value Subject to Tax(Line 12 minus Line 13) ... .... .... .... ... . ..... 14. .{]�
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 i n
(a)(1.2)X.0_ uu! uuuuu•�u 15.
16. Amount of Line 14 taxable II
at lineal rate X.0_ J� J;ID 16
17. Amount of Line 14 taxable
at sibling rate X.12 LlLlIx[AX 0. uu 17.
18. Amount of Line 14 taxable
at collateral rate X.15L] 18.
u 18. '
19. TAX DUE . . ... .... .... .... ... ......... .. ..... ... . . .. . ... ..... .... . 19. L_JJ�r
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610105 1505610105
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
NCO
�
STREET ADDRESS
MeG o, 'G,� b1.t,-
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1)
2. Credits/Payments
A.Prior Payments _
B.Discount
Total Credits(A+B) (2)
3. Interest
(3) d
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) 4
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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;or.......................................................................................................................... ❑
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 death
without receiving adequate consideration?.............................................................................................................. ID19
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 9
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑
169
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S.§9116(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+(1-97)
4& SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RESIDENT DECEDENT RN PERSONAL PROPERTY
ESTATE OF ,., FILE NUMBER
Ufa -1. E-
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Cod 7, 5-z
TOTAL(Also enter on line 5,Recapitulation) $
(If more space is needed,insert additional sheets of the same size)
` AEV-1511 EX+(10-06)
4b- SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
0o rrbt,�1 :
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
8 ')J6-nce, on ftwerr&jCprcpa�6)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) chW-J
Street Address A q gn SPS" Drive,
City Eli I ii State—& Zip
Year(s)Commission Paid: 4161
2. Attorney Fees 7
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) T
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL(Also enter on line 9, Recapitulation)
(If more space is needed,insert additional sheets of the same size)
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF130
FILE NUMBER
Report debts incurred by4he decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
C�Mru Ga.(e,
P�escriP+ic3n,� . �3
0 LU f
TOTAL(Also enter on Line 10, Recapitulation) $ I o
If more space is needed,insert additional sheets of the same size.
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
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No. 2013- 00234 PA No. 21- 13- 0234
Estate Of: DOROTHY E STORBECK
(First,Middle,Last)
Late Of: LOWER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
0 Social Security No:
WHEREAS, on the 26th day of February 2013 an instrument dated
July 22nd 1996 was admitted to probate as the last will of
DOROTHY E STORBECK
(First,Middle,Lastl
late of LOWER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 13th day of February 2013 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
RICHARD J STORBECK
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYL VANIA,
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 26th day of February 2013.
Register ofM71s
e ty
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
METTE, EVANS &•WOODSIDE -
ATTORNEYS AT LAW
HARRISBURG, PENNSYLVANIA 17108-0729
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Lass 'NVill and Tesiam � 0?_ rn
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DOROTHY E. STORBECK
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1, DOROTHY E. STORBECK, of East Pennsboro Tnship, "� o
Cumberland County, Pennsylvania, do make, publish and declare this to be my
Last Will and Testament, hereby revoking all Wills and Codicils by me at any
time made.
F
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ITEM. 1: 1 direct that all inheritance and estate
taxes becoming due by reason of my death, whether payable by my estate or by
any recipient of any property, shall be paid by the Executor out of the residue of
my estate, as an expense and cost of administration of my estate. The Executor
shall have no duty or obligation to obtain reimbursement for any such tax so paid,
even though on proceeds of insurance or other property not passing under this
Will.
ITEM 11: 1 direct the Executor to pay the expenses
of my last illness and funeral expenses from the residue of my estate as an
expense and cost of administration of my estate.
3
ITEM III: I may leave a written list in my safe
deposit box or elsewhere disposing of certain items of my tangible personal
property. The Executor shall dispose of items of my personal property as specified
in the written list. If no written list is found in my safe deposit box or elsewhere
and properly identified by the Executor within thirty (30) days after the probate of
my Will, it shall be presumed that there is no other statement or list. Any
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subsequent discovered. list shall be ignored. I give and bequeath my household
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furniture and furnishings, books, pictures,jewelry, silverware, automobiles,
wearing apparel and all other articles of household or personal use or adornment
not mentioned in the written list and all policies of insurance thereon to any
children living at the time of my death, to be divided among them as they shall
agree.
I
ITEM IV: I give the residue of my estate, not disposed of
in the preceding portions of this Will, to my children, RICHARD J. STORBECK,
SUSAN L. STORBECK AND RONALD M. STORBECK, in equal shares. If any
of my children is not living at the time of my death, his or her share shall be paid
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to his or her then living issue, per stirpes. If, however, any issue of a deceased
child has not attained the age of twenty-five (25) years at the time of my death,
his or her share shall be held in trust by the living parent of such issue, as
Trustee, IN TRUST NEVERTHELESS, and shall be administered and distributed �
as follows:
(a) The Trustee shall pay to or for his or her benefit, in
convenient, at least annual, installments, all of the.net income. The F
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Trustee shall. also pay to or for the benefit of that issue (the
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"Beneficiary") so much of the principal of this Trust as the Trustee, in
the sole discretion of the Trustee, considers necessary to maintain the
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Beneficiary in the proper station in life, including proper support,
maintenance, medical care and college or higher education.
(b) Upon the attainment of the age of twenty-five (25) years
a by the Beneficiary, the Trust shall terminate, and the Trustee shall
distribute to the Beneficiary all the assets of the Trust.
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(c) If the Beneficiary dies before final distribution of the
assets of the Trust, but is survived by then living issue, the Trustee
shall quarterly pay the net income from this Trust; to or for the benefit
of the Beneficiary's issue, per stirpes, living at each time of quarterly
distribution. As soon as any one of the Beneficiary's issue attains the
age of twenty-one (21) years, but in no event later than twenty (20)
years following the death of the Beneficiary, the Trustee shall pay over
all of the assets in the Trust to the then living issue of the Beneficiary,
per stupes. Should such Beneficiary die before final distribution of
this Trust and not be survived by issue, the provisions of
subparagraph (d) shall apply.
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(d) If, before final distribution of the assets of any Trust
established f'or the issue of a deceased child, there is no living
beneficiary of that Trust, it shall terminate. The principal of the Trust
shall be added to the other Trusts created under this Will for the
benefit of the other issue of my deceased child. A per stirpital share
shall be allocated for each Trust. If any Trust created for issue of a
deceased child had previously been terminated, the beneficiary who
received payment of the principal of that Trust shall be considered a
"Trust" for the purpose of this paragraph, and one share shall be paid
directly to that beneficiary. If that beneficiary is deceased, his or her
share shall be paid to his or her then living issue, per stirpes.
ITEM V: No part of the income or principal of any Trust
created by this Will shall be subject to attachment, levy or seizure by any creditor,
i
spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior to
his or her actual receipt of income or principal distributed.. The Trustee shall pay
the net income and the principal to the beneficiaries specified by :me, as their j
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interests may appear, without regard to any attempted anticipation, pledging or
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assignment, and without regard to any claim or attempted levy, attachment,
seizure or other process against the beneficiary.
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ITEM VI: The Executor and the Trustee shall each
possess the following powers, each of which may be exercised in a fiduciary
capacity only:
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(a) To retain any investments I have at my death, including j
specifically those consisting of stock of any bank even if i have named j
that bank as the Executor or Trustee.
(b) To vary investments, and to invest in bonds, stocks, notes,
real estate mortgages or other securities or in other property, real or
personal, without being restricted to so-called "legal investments", and l
without being limited by any statute or rule of law regarding
investments by fiduciaries.
(c) In order to divide the principal of a Trust or for any other
purpose, including final distributions, the Executor and Trustee are j
authorized to divide and distribute personal property and real
property, partly or wholly in kind, and to allocate specific assets
i
among beneficiaries and Trusts so long as the total market value of
each share is not affected by the division, distribution or allocation in
kind. The Executor and Trustee are each authorized to make,join in
and consummate partitions of lands, voluntarily or involuntarily,
including giving of mutual deeds, or other obligations, with as wide
powers as an individual owner in fee simple.
Page 4
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(d) To sell either at public or private sale real and personal
property severally or in, conjunction with other persons, and to
consummate sale(s) by deed(s) or other instrument(s) to the
purchaser(s), conveying a fee simple title. No purchaser shall be
obligated to see to the application of the purchase money or to make
inquiry into the validity of any sale(s). The Executor and Trustee are
authorized to execute, acknowledge and deliver deeds, assignments,
options or other writings as necessary or convenient to any of the
power conferred upon the Executor and Trustee.
(e) To mortgage real estate, and to make leases of real estate.
(D To borrow money from any person, including the Executor
or Trustee, to pay indebtedness of mine or of my estate, expenses of
administration or inheritance, legacy, estate and other taxes, and to
assign and pledge assets of my estate or any Trust established by this
Will.
(g) To pay all costs, taxes, expenses and charges in connection
with the administration of my estate or any Trust established under
this Will.
(h) To make distributions of income and of principal to the
proper beneficiaries, during the administration of my estate, with or
without court order, in. such manner and in such amounts as the
Executor deems prudent and appropriate.
Page 5
(i) To vote shares of stock which form a part of my estate or
1
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any Trust established under this Will, and to exercise all the powers
incident to the ownership of stock.
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(j) To unite with other owners of property similar to property
in my estate to carry out plans for the reorganization of any company
whose securities harm a part of my estate.
(k) To disclaim any interest in property which would devolve
to me or nay estate by whatever means, including but not limited to
I
the following means: as beneficiary under a will, as an appointee
under the exercise of a power of appointment, as a person entitled to
take by intestacy, as a donee of an inter vivos transfer, and as a donee
under a third-party beneficiary contract.
(1) To prepare, execute and file tax returns of any type
required by applicable law, and to make all tax elections authorized by
law.
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(m) To employ custodians of property, investment or business
advisors, accountants and attorneys as the Executor or Trustee deems
appropriate, and to compensate these persons from assets of my estate
or trust, without affecting the compensation to which the Executor and
Trustee are entitled.
(n) To do all other acts in their judgment necessary or
desirable for the proper and advantageous management, investment s
and distribution of the estate and Trusts established under this Will.
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ITEM VII: The Trustee is authorized to distribute
principal and/or income in any one or more of the following ways if the Trustee, in
the sole discretion of the Trustee, considers the beneficiary unable to apply f
distributions to the beneficiary's ow.nbest interests, or if the beneficiary is under a
legal disability:
1
(a) Directly to the beneficiary;
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2
(b) To the Trustee, or to another person selected by the
Trustee, as custodian under the Pennsylvania Uniform Transfers to
Minors Act as to a beneficiary under the age of twenty-one (21) years;
(c) To a relative of the beneficiary, to be expended by that
relative for the benefit of the beneficiary; or
(d) By directly applying distributions for the benefit of the
beneficiary.
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ITEM VIII: Any person who has died within thirty (30)
days of my death, or under such circumstances that the order of our deaths cannot
be established by proof, shall be deemed to have predeceased me. Any person
(other than myself) who has died at the same time as any beneficiary under this
Will, or in a common disaster with that beneficiary, or under such circumstances
t
that the order of deaths cannot be established by proof, shall be deemed to have
predeceased that beneficiary.
ITEM I hereby nominate, constitute and appoint m i
y �
children, RICHARD J. STORBECK, SUSAN L. STORBECK AND RONALD M.
STORBECK, or the sur�,rvors of them, to be the Executors, collectively referred to
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as "Executor". The Executor and Trustee are specifically relieved from the
obligation of filing bond or entering security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my
Last Will and Testament, consisting of this and the preceding seven (7) pages, at
the end of each page of which .1 have also set my initials for greater security and
better identification this day of
(SEAL}SE,
DOROTHYE. STORBECK
We, the undersigned, hereby certify that the foregoing Will. was
signed, sealed, published and declared by the above-named Testatrix as and for
her Last Will and Testament, in the presence of us, who, at her request and in her
presence and in the presence of each other, have hereunto set our hands and seals
the day and year first above written, and we certify that at the time of the
execution thereof, the said Testatrix was of sound and disposing mind and
memory.
- ,�. ,�--dSEAL) Residing at
SEAL) Residing at
V''
(SEAL) Residing,at
b.
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ILI,
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF
1, DOROTHY E. STORBECK, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed and executed the instrument as my Last Will
and Testament; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
(SEAL)
DOROTHY'l. STORIBECK
Sworn to and subscribed before
A
me this day of
19
Notary Public
My Commission Expires: NOTAAR AL
MAR EAL
GARET L Boyj)
...... 0 PublicCity of H rjsb Dauphin County(SEAL) n.
uno
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
/0 SS:
ff)
COUNTY OF
We, All, f and
2- L� the Witnesses whose names are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose
and say that we were present and saw Testatrix, DOROTHY E. STORBECK, sign
and execute the instrument as her Last Will and Testament; that Testatrix signed
willingly and that she executed said Will as her free and voluntary act for the
purposes therein expressed; that each. of us in the hearing and sight of the
Testatrix signed the Will as Witnesses; and that to the best of our knowledge the
Testatrix was at that time eighteen (18) or more years of age, of sound mind and
under no constraint or undue influence.
bu,;Z:t J d...'z"
Witness i X Witness
Witness
Sworn to and subscribed before
qday of
me this
19 •
Notary Public
My Commission Expires: NOTARIAL SEAL
:;t,,RET!_BOYD,Notary Public
(SEAL) :,—i-,,�rrisburg.Dauphin County
Expims June 27,2WO
Z21 1
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Law Offices of
SAIDIS, SULLIVAN & ROGERS
A PROFESSIONAL CORPORATION
635 NORTH 12TH STREET,SUITE 400 CARLISLE OFFICE:
ROBERT C.SAIDIS LEMOYNE,PENNSYLVANIA 17043 26 WEST HIGH STREET
DANIEL L.SULLIVAN TELEPHONE:(717)612-5800-FACSIMILIE(717)612-5805 CARLISLE,PA 17013
ELYSE E.ROGERS EMAIL:attorney@ssr-attorneys.com TELEPHONE:(717)243-6222
JOHN A.FEICHTEL www.ssr-attornas.com FACSIMILE:(717)243-6486
DEAN E.REYNOSA
TODD F.TRUNTZ Of Counsel
MARYLOU MATAS
JOHN E.
SEAN M.SHULTZ
STEPHEN L..GRO GROSS
ROBERT B.HAMILTON
HANNAH WHITE-GIBSON June 28, 2013 REPLY TO LEMOYNE
717-612-5801
erogers@ssr-attorneys.com
Jennifer Hartman
TPL Program Investigator
Pennsylvania Department of Public Welfare
Division of Third Party Liability Recovery Section
P.O. Box 8486
Harrisburg, PA 17105-8486
Re: Dorothy Storbeck
CIS #: 380359720
SSN: ###-##-2942
Date of Death: 02/13/2013
Dear Ms. Hartman:
Thank you for your letter of April 12, 2013, advising that the Department of
Public Welfare has a claim in the amount of$7,331.65 against the above-mentioned
estate.
Your letter indicates that the entirety of this claim is a Class 3 claim pursuant to
Section 3392 of the PEF Code.
The only asset in Mrs. Storbeck's estate at the time of her death was a small
cash balance remaining in PNC Bank account 50-0321-7726.
As you can see from the statement, a number of checks cleared shortly after Mrs.
Storbeck's death; all of these checks had been written prior to date of death. The
account was closed on February 26 with the remaining balance of$3,690.20. This is
the only asset in Mrs. Storbeck's estate.
I am enclosing a number of invoices for your information. There are a number of
Class 1 claims. In addition to the Department of Public Welfare's Class 3 claim, there
are also a number of other Class 3 claims.
Pennsylvania Department of Public Welfare
June 28, 2013
Page 2
The Class 1 claims include the following:
Funck's Restaurant, funeral luncheon $ 178.13
Register of Wills, probate fee (advanced by
Personal Representative) 123.50
Saidis, Sullivan & Rogers, reimbursement
for legal advertising (Cumberland Law
Journal and the Carlisle Sentinel) 243.30
Saidis, Sullivan & Rogers, legal fees 500.00
Richard Storbeck, Personal Representative's
fees 500.00
Myers Funeral Home, balance remaining for
funeral service 11.00
Total $1,555.93
When subtracted from the estate assets on hand, that leaves $2,134.27 for the
payment of Class 3 claims. If that amount is distributed pro-rata among the creditors,
each will receive the following:
Amount of
Outstanding Proposed
Claim Payment
Bethany Village $1,711.61 $ 362.83
Highmark 249.11 64.02
Omnicare 609.66 128.06
Department of Public Welfare 7,331.65 1,579.36
Total $9,902.03 $2,134.27
The executor is holding the funds pending approval of the Department of Public
Welfare to this proposed distribution of the limited funds on hand.
Please let us hear from you at your convenience.
Sincerely yours,
Elyse E. Rogers
cjr
Enclosures
cc: Richard J. Storbeck
Rick Storbeck
From: '
Sent: Wednesday, July 31, 2013 9:44 AM
To: Rick@FalconMtg.00m
Cc: Elyse Rogers
Subject: Estate of Dorothy Storbeck
Attachments: 2U13O73ORStorbeck.odtAsset-Claim Reconciliation.odf
Rick:
Attached is a letter from Elyse along with a revised spreadsheet re the payment of the Class 3 claims for your mother's
estate.
Cindy Rule
Legal Secretary to Elyse E. Rogers
Saidis, Sullivan & Rogers
635 North 12 th Street,Suite 4OO
Lemoyne, PA 17043
717-901-7781(phone)
717-612-5805(fax)
This e-mail may contain privileged,confidential,copyrighted,or other legally protected information. |fyou are not the
intended recipient(even if the e-mail address above isyours\,you may not use, copy orretransmit this e-mail. if you
have received this by mistake please notify us by return e-mail,then delete. Thank you.
Saidis,Sullivan&RoQers'xvebsi1eis
To comply with IRS regulations,we advise you that any discussion of federal tax issues in this e-mail is not to be used,
and cannot be relied upon by you (i)toavoid any penalty imposed under the Internal Revenue Code,or(ii)to promote,
market or recommend to another party any transaction or matter addressed in this e-mail.
1
Law Offices of
SAIDIS, SULLIVAN & ROGERS
A PROFESSIONAL CORPORATION
635 NORTH 12TH STREET,SUITE 400 CARLISLE OFFICE:
ROBERT C.SAIDIS LEMOYNE,PENNSYLVANIA 17043 26 WEST HIGH STREET
DANIEL L.SULLIVAN TELEPHONE:(717)612-5800-FACSIMILIE(717)612-5805 CARLISLE,PA 17013
ELYSE E.ROGERS EMAIL attorney
Ossr-attorneys.c TELEPHONE:(717)243-6222
JOHN A.FEICHTEL Www4sr-attorneys.corn FACSIMILE-(717)243-W6
DEAN E.REYNOSA
TODD F.TRUNITZ Of Counsel
MARYLOU MATAS JOHN E.SLIKE
SEAN M.SHULTZ STEPHEN L.GRC)SE
HANNAH WHITE-GIBSON
July 30, 2013 REPLY TO LEMOYNE
717-612-5801
erogery?,ssr-attorneys.corn
VIA E-MAIL
Richard J. Storbeck
2830 Sunset Drive
Camp Hill, PA 17011
Re: Estate of Dorothy E. Storbeck
Dear Rick:
We have updated the spreadsheet and I am attaching a copy of it.
I suggest that you send the checks for the Department of Public Welfare and
for us to me. The balance of the checks you should feel free to submit directly.
If you have any questions, please do not hesitate to contact me.
Sincerely yours,
Elyse--jE. Rogers
cjr
Attachment
Estate of Dorothy Storbeck
Date of Death: 02/13/2013
Assets:
PNC Bank checking account $ 3,690.20
Highmark refund $ 687.56
Total Estate Assets $ 4,377.76
{Balance as of 7/24 $4,379.83} per R. Storbeck
Class I Claims
Funck's Restaurant -funeral lunched n 178.13
Register of Wills - probate fee t/ -$ 123.50
Saidis, Sullivan & Rogers - reimbursement for
legal advertising / hA-/5 256 $ 243.30
Saidis, Sullivan & Rogers - legal fees v/d/6,01 $ 500.00
Richard Storbeck- personal representative's feesk $ 500.00
Myers Funeral Hon)e - balance remaining for
funeral service V' �6D5 $ 11.00
Total Class 1 Claims $ 1,555.93_
Balance for payment of Class 3 Claims $ 2,821.83
Payment of Class 3 Claims
Outstanding Amount of
Claim Proposed Claim
Bethany Village v1 4, $ 1,711.61 $ 517.50
Highmark v," 40-/5,p,7 A 1 $ 249.11 $ 75.31
Omnicare (negotiated down from $609.66) *15 j $ 40.81 $ 12.34
Department of Public Welfare Z 54-2. $ 7,331.65 $ 2,216.68
ITotal Class 3 Claims $ 9,333.18 $ 2,821.83
Ccr.�
,3 4
Richard J Storbeck
2830 Sunset Drive
Camp Hill,PA 17011
717-761-4824
September 24, 2013
Saidis, Sullivan&Rogers
Elyse E Rogers
635 North 12`h Street, Suite 400
Lemoyne,PA 17043
043
RE: Estate of Dorothy E Storbeck
Dear Elyse:
I have enclosed three checks. Two checks to Saidis, Sullivan&Rogers for Legal
Advertising and Legal Fees. The third check is to Department of Public Welfare. I have
included this per your instructions.
Sorry for the delay,we just received the last of the reissued Highmark checks. I didn't
want to disburse in case there was a problem with the reissued checks. As of this date, I
have paid all the bills in the amount included in your pro-rated spreadsheet.
If you have any questions,please feel free to call me at the number above.
Sincerely,
Rick Storbeck
Law Offices of
SAIDIS, SULLIVAN & ROGERS
A PROFESSIONAL CORPORATION
635 NORTH 12TH STREET,SUITE 400 CARLISLE OFFICE:
ROBERT C.SAIDIS LEMOYNE,PENNSYLVANIA 17043 26 WEST HIGH STREET
DANIEL L.SULLIVAN TELEPHONE:(717)612-5800-FACSIMILIE(717)612-5805 CARLISLE,PA 17013
ELYSE E.ROGERS EMAIL:attorna@ssr-attorneys.com TELEPHONE:(717)243-6222
JOHN A.FEICHTEL www.ssr-A!jqrngy&M FACSIMILE:(717)243-6486
DEAN E.REYNOSA
TODD F.TRUNTZ Of Counsel
MARYLOU MATHS JOHN E.SLIKE
SEAN M.SHULTZ STEPHEN L.GROSE
ROBERT B.HAMILTON
HANNAH WHITE-GIBSON September 9, 2013 REPLY TO LEMOYNE
717-612-5801
erogers@ssr-attorneys.com
Richard J. Storbeck
2830 Sunset Drive
Camp Hill, PA 17011
Re: Estate of Dorothy E. Storbeck
Dear Rick:
I am enclosing an invoice for our work in connection with your mother's
estate. Our time was $689, but since DPW approved $500, the invoice is for that.
Please notice that our prior invoice, for out-of-pocket expenses we incurred on behalf
of the estate also remains unpaid.
Kindly pay the total amount due of$743.30 at your earliest convenience. If
you have any questions, please do not hesitate to contact me.
Sincerely yours,
r
Elyse Rogers
cjr
Enclosure
Law Offices of
Saidis, Sullivan & Rogers
A PROFESSIONAL CORPORATION
635 NORTH 12TH STREET, SUITE 400
CARLISLE OFFICE LEMOYNE, PA 17043
26 NVEST HIGH STREET TELEPHONE: (717) 612-5800- FACSIMILE: (717) 612-5805
CARLISLE, PA 17013 EMAIL: attorney@ssr-attorneys.com
TELEPHONE: (717) 243-6222 www.ssr-attomeys.com
FACSIMILE: (717) 243-6486 REPLY TO LEMME
September 3, 2013
Richard J. Storbeck Our file# 12323 132239
2830 Sunset Drive Invoice# 13104
Camp Hill, PA 17011
EIN: 27-2700453
RE: Estate of Dorothy E. Storbeck
Balance forward as of invoice dated May 2, 2013 $243.30
Payments received since last invoice $0.00
Accounts receivable balance carried forward $243.30
DATE DESCRIPTION LAWYER
02/25/2013 Telephone conference with R. Storbeck re mother's estate EER
03/11/2013 Email from and to client; Instructions re legal advertising,notices of EER
beneficial interest, certification of notice, and letters to DPW and
Unclaimed Property
03/13/2013 Prepare legal advertising; Letters to DPW and Unclaimed Property; CR
Prepare Notices of Estate Administration and Certification of Notice
03/14/2013 Legal advertising, letters to DPW and Unclaimed Property,Notices of EER
Beneficial Interest and Certification of Notice
03/24/2013 Docketed estate deadlines CS
04/18/2013 Review notice from DPW; Email client EER
06/19/2013 Office conference with C. Cairo re analysis for insolvent estate; Dictate EER
letter to DPW and to client; Finalize letter to client
06/24/2013 Email from and to client EER
06/28/2013 Finalize letter to DPW EER
07/22/2013 Notice from PA Department of Public Welfare; Dictate letter to client EER
07/23/2013 Revise list of estate assets and recalculate payment amounts for Class 3 CR
claims
07/26/2013 Various emails EER
07/30/2013 Review spreadsheet; Letter to client EER
TOTALS $689.00
132239 Storbeck, Estate of Dorothy E. Invoice# 13104 Page 2
Billing Summary
Total professional services $689.00
Discount ($189.00)
Total of new charges for this invoice $500.00
Plus net balance forward $243.30
Total balance now due $743.30
** Trust account remaining balance is $0.00
PRIVACY POLICY: During this firms representation of you,we may receive nonpublic,personal information from you or
from sources about you. It is our policy and practice that our attorneys and staff do not at any time reveal information relating
to our representation of you unless you consent after consultation,except for disclosures that are impliedly authorized to carry
out the representation,and except for disclosures required or authorized by the Pennsylvania Rules of Professional Conduct.
Interest at 1 1/2%per month on unpaid balance after 30 days.
Law Offices of
Saidis, Sullivan & Rogers
A PROFESSIONAL CORPORATION
635 NORTH 12TH STREET, SUITE 400
CARLISLE,OFFICE LEMOYNE, PA 17043
26 WEST HIGH STREET TELEPHONE: (717) 612-5800 - FACSIMILE: (717) 612-5805
CARLISLE,PA 1,7013 EMAIL: attorney@ssr-attomeys.com
TELEPHONE: (717)243-6222 www.ssr-attorneys.com
FACSIMILE: (717) 243-6486 REPLY TO LEMOYNE
May 2, 2013
Richard J. Storbeck Our file# 12323 132239
2830 Sunset Drive Invoice# 11741
Camp Hill, PA 17011
EIN: 27-2700453
RE: Estate of Dorothy E. Storbeck
Payments received since last invoice $0.00
Accounts receivable balance carried forward $0.00
TOTALS $0.00
EXPENSES
03/14/2013 Cumberland Law Journal; Estate Notice $75.00
04/15/2013 The Sentinel;Advertising Fee $168.30
TOTAL EXPENSES $243.30
132239 Storbeck,Estate of Dorothy E. Invoice# 11741 Page 2
Billing Summary
Total expenses incurred $243.30
Total of new charges for this invoice $243.30
Total balance now due $243.30
** Trust account remaining balance is $0.00
PRIVACY POLICY: During this firms representation of you,we may receive nonpublic,personal information from you or
from sources about you. It is our policy and practice that our attorneys and staff do not at any time reveal information relating
to our representation of you unless you consent after consultation,except for disclosures that are impliedly authorized to carry
out the representation,and except for disclosures required or authorized by the Pennsylvania Rules of Professional Conduct.
Interest at 1 1/2%per month on unpaid balance after 30 days.
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH Receipt Date : 2/26/2013
Cumberland County - Register of Wills Receipt Time: 15 : 09 :01
One Courthouse Square Receipt No. : 1073211
Carlisle, PA 17913
STORBCEK DOROTHY E
Estate File No. : 2013-00234
Paid By Remarks : RICHARD J STORBECK
DMB
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 30 . 00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION 10 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 10 . 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# 553123 . 50
Total Received. . . . . . . . . P23 . 50
MYERS-H.ARNER FUNERAL HOME, INC.
1903 MARKET STREET
*Iii ui T � Tt X� "� �.; CAMP HILL, PENNSYLVANIA 17011
�r ROBERT H.HARNER
"V.
SUPERVISOR
717-737-9961 717-737-4618
PHONE FAJX.. DUSTIN R.BAKER
FUNERAL DIRECTOR
LOCALLY OWNED.AND OPERATED www.myets-hamencom ♦ myers-harner(<r)comcast.net
March 8, 2013
Mr. Rick Storbeck
2930 Sunset Drive
Camp Hill PA 17011
Services for Dorothy E. Storbeck
February 18, 2013
Charges for Services Selected $ 51290.00
Professional Services
Use of Facilities
Automotive Equipment $ 52290.00
Charges for Merchandise Selected
Casket $ 22865.00
Vault 11465,00
$ 4,330.00
Cash Advanced
Newspaper Notice/Local $ 338.00
Clergy 150.00
Flowers 159.00
Certified Copies 18.00
Hair Dresser 45..00
$ 710.00
Total: $102730-lou
Received from the Insurance Company: - 9718.00
�
Total: $ 12:00
(2)
Non-guaranteed items:
Obituary (Increase) $ 188.00
Clergy (Increase) 25.00
Certified Copies (Addition) 18.00
$ 2M_.M
Organist (Refund) - 125.00
Soloist (Refund) - 75.00
Altar Servers (Refund) - 20.00
Balance Due: $ 11.00
EUNCK 'S RESTAURANT
ANNVILLE
Date: 2/19/2013 Time: 2:33:24 PM
Status: Approved
Card Type: Visa
Card Number: XXXXXXXXXXXX0483
Swipe/Manual: Swipe
Server Name: 68 - Jolene
Check Number: 218087
Tab Number: 1
Profit Center: 3 - Funck's
Persons: I
Card Owner: STORBECK/RICHARD J
AMOUNT 152.27
GRATUITY 25.86
TIP 2
TOTALt—L,—el
r/
Approval: 055820
Customer Copy
Richard J Storbeck
2830 Sunset Drive
Camp Hill, PA 17011
717-761-4824
September 24, 2013
Bethany Village
Accounts Receivable
325 Wesley Drive
Mechanicsburg, PA 17055
RE: Dorothy E Storbeck
Account#23409
Please accept the enclosed check 41506 in the amount of$517.50 as payment in full for
this account. At the time of her death, Dorothy had minimal assets remaining. This
amount represents the pro-rated portion of her assets at the time of her death.
If you have any questions,please feel free to call me at the number above.
Sincerely,
e
Richard J Storbec
Executor
Richard J Storbeck
2830 Sunset Drive
Camp Hill, PA 17011
717-761-4824
September 24, 2013
Highmark Inc.
P.O. Box 1068
Pittsburgh, PA 15230-1068
RE: Dorothy E Storbeck
PRN0004811214
Please accept the enclosed check#1507 in the amount of$75.31 as payment in full for
this account. At the time of her death, Dorothy had minimal assets remaining. This
amount represents the pro-rated portion of her assets at the time of her death.
If you have any questions,please feel free to call me at the number above.
Sincerely,
Richard J Storbeck
Executor
Richard J Storbeck
2830 Sunset Drive
Camp Hill, PA 17011
717-761-4824
September 24, 2013
CCRX of Bethany Village
P.O. Box 740391
Cincinnati, OH 45274-0391
RE: Dorothy E Storbeck
Account#7002-371
Please accept the enclosed check#1510 in the amount of$7.53 as payment in fall for this
account. At the time of her death, Dorothy had minimal assets remaining. This amount
represents the pro-rated portion of her assets at the time of her death.
If you have any questions,please feel free to call me at the number above.
Sincerely,
Richard J Stor;eck
Executor
Richard J Storbeck
2830 Sunset Drive
Camp Hill, PA 17011
717-761-4824
September 24, 2013
Omnicare King of Prussia
P.O. Box 740391
Cincinnati, OH 45274-0391
RE: Dorothy E Storbeck
Account#7003-44
Please accept the enclosed check#1509 in the amount of$4.81 as payment in full for this
account. At the time of her death, Dorothy had minimal assets remaining. This amount
represents the pro-rated portion of her assets at the time of her death.
If you have any questions,please feel free to call me at the number above.
Sincerely,
Richard J Storbeck
Executor