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Home My WebLink About04-02-15 Pennsylvania 1505618403 �!�' DEPaRTNENT OF REVENUEEX(03-14) REV-15010 OFFICIAL USE ONLY County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2sosol Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 14 0458 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 04 07 2014 12 15 1920 Decedent's Last Name Suffix Decedent's First Name MI JAMISON MARY 0 (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(date of death prior to 12-13-82) ❑ 4. Agricultural Exemption(date of ❑ 5. Future Interest Compromise(date of ❑ 8. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) ® 7 Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) ❑ 10. Litigation Proceeds Received ❑ 11• Non-Probate Transferee Return ❑ 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) ❑ 13. Business Assets ❑ 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GERALD J BRINSER 717 838 6348 First Line of Address 6 E MAIN STREET Second Line of Address PO BOX 323 City or Post Office State ZIP Code PALMYRA PA 17078 Correspondent's email address: gjbrin@aol.com REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY �v C ^ M DAIFFI_qD STAMP-n C7' r I r7 f V f'r't t'ri Side 1 e, cit 1505618403 1505618403 W �...1 1505618411 REV-1500 EX Decedent's Social Security Number Decedent!s Name: JAMISON, MARY O R R RECAPITULATION 1. Real Estate(Schedule A)..................................11........... ......................-1................. I 2. Stocks and Bonds(Schedule 8)................................ .......................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).............. 3- 4. Mortgages and Notes Receivable(Schedule D)......................................................... 4, 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)................ 5. 1 462 . 10 6. Jointly Owned Property(Schedule F) 0 Separate Billing Requested.............. 6. 998 . 62 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested........ 7. & Total Gross Assets(total Lines 1 through 7).......... ........ ....... 2 , 460 . 72 9. Funeral Expenses and Administrative Costs(Schedule H)...................:.................... 9. 1 , 491 - 12 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)................................ 10. 334 , 791 - 36 11. Total Deductions(total Lines 9 and 10)............................................................... 11. 336 , 282 - 48 111 Net Value of Estate(Line 8 minus Line 11)............... .......... ........ 12, -333 , 821 - 76 13. Charitable and Governmental Bequests/Sec 9113 Trusts.for which an election to tax has not been made(Schedule J)........................................._....... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)...._........................................... 14. -333 , 821 - 76 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 .00 is. 16. Amount of Line 14 taxable at lineal rate X .045 998 . 62 16. 44 - 94 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE...-.........__..................................... ............ .............................._...... 19. 44 - 94 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has any knowledge. R SIGNATURE OF PERSON �=SPONSIELE FOR FILING RETURN Sandra L.Jamison DATE ADD ESS 6/ 823 Oak Oval., Mechanicsburg, PA 17055 SIGNATURE 0 PARER OTHIE=NREPRESENTATIVE Gerald J Brinser ATE ADDRESS 19rinser,WagrieH&Zimmerman 6 E.Main St'reet,Palmyra,PA 17078 Side 2 1505618411 1505618411 REV-1500 EX Page 3 File Number 21 - 14 - 0458 Decedent's Complete Address: DECEDENT'S NAME Jamison, Mary Orr STREET ADDRESS Messiah Lifeways, 100 Mount Allen Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2;Line 19) (1) 44.94 2. Credits/Payments A. Prior Payments 44.94 B. Discount 2.25 Total Credits(A +B) (2) 47.19 3. Interest (3) 0.00 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 2.25 Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) Make Check Payable to: REGISTER OF WILLS, AGENT. .......... ....„_:..._.................;;; .,......�,..;......,;..;,..--nn _...v : ST'.�w x "4:v r.-.....�.p rx.x"r u a:.#'"2.Css'C. i, ""'AxYr'xTfi'x'x:. 'd'az453H'<""i:9REt x.: :e. x"4�ti?t` s`xxF':t'�ux .' r5x; r .,xx...°::^ --k:.x:mak ^.:sre,.x '' S,xx xn ps ,�,,:.x� xx. xxx :x�. . .xa. s.x s.:. "wv .:x,,,..x., �,��^x�,:: ,,.: _ cx.lkxx .:. a_...,x: ,,x ,.xx xars. xx ...,: ee�� ..xxxx-x.<.a c^ xxx.x,s c. , ., ,x.. e..x..x �, ... ..s... .�x Pix x, w 5.. ec wsss:e a a Fa 9.. ?as s::t �F.a d€:s:nsua: esaaa!�`s`eL'C ..s E01110111»�xea03e�a��es��s�RIMIM RM..: ."M 019%e i,'` Emr^. �s w44.�.._ ._?:.: Leh" `.:� 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;.................................................................................... Ix 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 adequateconsideration?......................................................................................................................................... ❑ x❑ 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?............... ❑ x❑ 4. Did decedent own an individual retirement account,annuity,or other non-probate property which containsa beneficiary designation?........................................................................................................................ ❑ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. . .x.,.>x.€.. FEer ...c.A..xxx.m:x^�x;.x.axx�'u,a`<,�e.C�.xIx�axx,.x.:�..,�..q�.�.z.nnsxx;.a . _x:se:•;•:•cx^xx.c:.xx�r,c.x_oi...:fi.:<d.xx,xxxs1y: 111 1-1 � xxxS� H =. w- 111101101 01"N's txsv For dates of death on or after July 1,1994 and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent 72.P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and fling 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 step-parent 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(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. pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF Jamison, Mary Orr 21 - 14-0458 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 OF NUMBER DESCRIPTION DEATH 1 Miscellaneous Jewelry and Silverware From Safe Deposit Box-Appraised Value 1,462.10 TOTAL(Also enter on Line 5,Recapitulation) 1,462.10 REV-1509 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE SCHEDULE F RESIDENT EDEN TURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF I FILE NUMBER Jamison, Mary Orr 21 - 14-0458 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT Stephen B. Jamison 14 Fuller Farms Road Son A Topsfield, MA 01983 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY o ITEM LETTER DATE DATE OF DEATH OF DATE OUE DEATH NUMBER FOR JOINT MADE Include name of financial institution and bank account number VALUEE OF ASSET DECD'S VALOF TENANT JOINT similar identifying number.Attach deed for jointly-held real estat . INTEREST DECEDENTS INTEREST 1 A 02/10/1993 PNC Bank-Checking Account#5070074809 1,997.24 50% 998.62 TOTAL(Also enter on line 6, Recapitulation) 998.62 REV-1511 EX+(08-13) SCHEDULE H k pennsylDEPARTMENT OREVENUE vanI FUN0ALD(PENSESAND INHERITANCE TAX RETURN D SADMINISTRATIVE INIS��COSTS RESIDENT DECEDENT /�V' ESTATE OF Jamison, Mary Orr FILE NUMBER21 - 14-0458 Decedent's debts must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Auer Cremation Services of Pennsylvania, Inc. - Balance Due 180.62 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Sandra L. Jamison 300.00 Street Address 823 Oak Oval City Mechanicsburg State PA Zip 17055 Year(s)Commission Paid 2015 2. Attorney's Fees Brinser,Wagner&Zimmerman--Gerald J. Brinser 875.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills (Ltrs. Pd. $45.00 =$5,000-$10,000) 135.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 TOTAL(Also enter on line 9, Recapitulation) 1,491.12 pennsylvania SCHEDULE 1 DEPARTMENT OFDEBTS OF DECEDENT MORTGAGE EVENUE RET INHERITANCE TAXAX RETURRNN f RESIDENT DECEDENT LIABILITIES & LIENS ESTATE OF Jamison, Mary Orr FILE NUMBER21 - 14-0458 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 PA Department of Revenue, Department of Public Welfare-Class 3 Claim 23,522.30 2 PA Department of Revenue, Department of Public Welfare-Class 5.1 Claim 311,184.26 3 Miscellaneous Expense 84.80 TOTAL(Also enter on Line 10, Recapitulation) 334,791.36 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF I FILE NUMBER Jamison, Mary Orr 21 - 14-0458 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) _ RECEIVING PROPERTY Do Not ListTrustee(s) ITAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 W. Glenn Jamison, M.D. Son 1/4 Residue 0.00 460 Parrish Road Honeoye Falls, NY 14472-9746 2 Stephen B.Jamison Son 1/4 Residue 0.00 14 Fuller Farms Road Topsfield, MA 01983 3 Deborah Von Zinkernagel Daughter 1/4 Residue 0.00 Chemin Henri-Schmitt 14 1218 Grand Saconnex Geneva, Switzerland Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Jamison, Mary Orr 21 - 14-0458 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not ListTrustee(s) I. TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 4 Sandra L. Jamison Daughter 1/4 Residue 0.00 823 Oak Oval Mechanicsburg, PA 17055 Page 2 of Schedule J t _-,ate x - JOSEPh JAMES ,EWEAERS TO WHOM IT MAY CONCERN: This is to certify that we are engaged in the jewelry business,appraising diamonds,watches,jewelry and precious stones of all descriptions. We herewith certify that we have this day carefully examined the following listed and described articles,the property of. NAME: Estate of Mary O.Jamison ADDRESS: 823 Oak Oval Mechanicsburg,PA 17055 We estimate the value as listed for insurance or other purposes at the current retail value,excluding Federal and other taxes. In making this Appraisal we DO NOT agree to purchase or replace the articles. The following items are evaluated for estate purposes. 1 Lot of 2 18K Rose Gold Gents Rings. 1 includes a Synthetic Corundum and the other a Scarab,weighing 22.2dwt. Value: $964.00 1 Lot of 2 18K Rose Gold Lady's Rings. 1 includes a Synthetic Corundum and the other a Scarab,weighing 4.7dwt. Value: $206.00 1 Gents Synthetic Corundum tie tack,weighing 1.8dwt Value: $79.20 Lady's 14K Old Mine Cut Diamond Ring set. Approx.38ct,weighing 1.5dwt. Value:$100.00 » . 1 pair Silver&Bronze Ancient Constantine Era Coin ' Cuff Links Value: $60.00 1 Buffalo Nickel in poor condition. Value: $.10 2 Silver 40mm Egyptian Coins,weighing 32,Odwt. Value: $ 12.80 4 Silver Ancient Constantine Era Coins. Value:$10.001 each Boston University lapel pin. Value: $0 no value January 29 2015 aures D avis P.G. The foregoing Appraisal is made with the understanding that the Appraiser assumes no liability with respect to any action that may be taken on the basis of this Appraisal. 301 East Main Street • Mechanicsburg, PA 17055 • (717)795-9224 Jan. 20. 2015 10: 02AM PNC Bank No. 2655 P, 1/1 January 20, 2015 Gerald J Brisner Esq. Brisner Wagner &Zimmerman PC 6 E Main St 2 Floor Palmyra PA 17078 RE: Mary O Jamison SSN: DOD: 04-07-2014 Dear Mr. Brisner: In response to your request for bate of Death(DOD)balances for the customer noted above', our records show the following: Checking Account Account#5070074809 Established: 02-10-1993 MARY 0 JAMISON STEPHEN B JAMISON DOD balance: $ 1,997.24 non-interest bearing Please note that this office provides date of death balances for deposit accounts(IRAs,CDs,Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. 1f the reader of this message is not the intended recipient or the employee or agent responsible for delivering chis message ro the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 1 of 1 � 1NATION SgR y cs s 1�� AUER CREMATION SERVICES OF PENNSYLVANIA, INC. 4100 Jonestown Road • Harrisburg,PA 17109 • 1-800-720-8221 • Fax 717-541-9943 • Shawn E.Carper,Supervisor p�'NNsnvnN�� 140349 MO-5 Apr 7 , 2014 Ms . Sandra L. Jamison 823 Oak Oval Mechanicsburg, PA 17055 Mary Martha Orr Jamison - Deceased SPECIAL CHARGES X Direct Cremation $1 , 795 . 00 X Nationwide Guarantee Program $350 . 00 Worldwide Travel Protection TOTAL SPECIAL CHARGES $2 , 145 .00 PROFESSIONAL SERVICES X Services of Funeral Director & Staff Included Other Preparation of the Body Facilities & Staff for Memorial Service Staff & Equipment for Memorial Service Witnessing the Cremation Private Family Viewing/Witnessing Cremation X Packaging And Forwarding Cremated Remains $65 . 00 Personal Delivery of Cremated Remains Scattering of Cremated Remains Medical Documents/Courier Fee TOTAL PROFESSIONAL SERVICES $65. 00 AUTOMOTIVE EQUIPMENT X Removal Vehicle Included Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT 5@ . 00 MERCHANDISE Register Book Memorial Cards Thank You Cards $0 . 00 X Remembrance Package $155 . 00 6% Tax $9 . 30 $164. 30 Arrange For Burial X Solid Sheet Bronze Urn with Satin Finish $125 . 00 Urn Burial Vault Veterans Flag Case Grave/Memorial Marker TOTAL MERCHANDISE $289 . 30 CASH ADVANCED ITEMS Grave Opening Cemetery Equipment X Harrisburg Patriot $265 . 62 Newspaper Vault Service Charge . Clergy Church/Organist/Soloist Flowers X Crematory Charge Included X Cumberland County Coroner Fee $30 .00 X 10 Certified Copies of Death Certificate $60 . 00 TOTAL CASH ADVANCED ITEMS $355 .62 SUMMARY OF CHARGES Special Charges $2 , 145 . 00 Professional Services $65 . 00 Automotive Equipment $0 . 00 Merchandise $289 . 30 Cash Advanced items $355 . 62 SUB TOTAL $2 , 854. 92 CREDITS -$1 ,426. 30 AMOUNT PREPAID Date Mar 23 , 1996 -$1 , 248. 00 TOTAL $180. 62 AMOUNT PAID Date Apr 21 , 2014 -$180.62 BALANCE DUE $0 .00 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES RECEIPT FOR PAYMENT ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 12/23/2014 Cumberland County - Register Of Wills Receipt Time : 15 : 39 : 16 One Courthouse Square Receipt No. : 1080002 Carlisle, PA 17613 JAMISON MARY O Estate File No . : 2014-00458 Paid By Remarks : BRINSER WAGNER & ZIMMERMAN CJ ------------------ ------ Receipt Distribution - ----------------------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 45 . 00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 4971 $135 . 50 Total Received. . . . . . . . . $135 . 50 NOTICE OF BOX INVENTORY Please be advised That a box inventory will be conducted for the following: Name of Estate: Mary O. Jamison Number of Box: 134 Name of Person(s) doing.Inventory: Gerald J. Brinser, Attorney Sandra L. Jamison 6 E. Main Street, P.O. Box 323 823 Oak Oval Palmyra, PA" 17078 Mechanicsburg, PA 17055 (717)838-6348 Date and Time of Entry: January 6, 2015 @ 11:00 am r t • This Notice is being supplied,to: PA Dept of Revenue PNC Bank Safe Deposit Box Unit 939 Oak Oval P.O. Box 280601- , ; Mechariicsbur`g, PA.170.55 Harrisburg, PA 17128-0601 PALMYRA POST OFFICE r'' PALMYRA, Pennsylvania, i U S' E 170789998 -4134870078 -0096 ., Un - Postage $ 12%30/2414 (800)275-8777 10:53.:38 AM r a' ve3ti 07 Certified Fee Sales Receipt Return Receipt Fee } 7sl Postmark Product Sale Unit Final d (Endorsement Required) Here Description Oty Price Price C3 r C3 (Endorsement Delivery Required $t �,i}IJ HARRISBURG PA 17128 Zone-1 $0.49 0 First-Class Mail Letterj, C3 Total Postage&Fees $ #6049 12/30/2@14 0.40 oz: Expected Delivery: Wed 12/31/14 ;33• sent o. Return Rcpt (Green.Card) $2 70 l`ri' _ �.__ X01 .,-z l_.._ N Certified $3.30 r•-a s;fim_et�r.No.; USPS Certified ,Mai 1 4: p or PO Bax No. /tr1 C> _✓ ? s�.................... 70130600000019504718 cr stare,zrP+a"' "'" Issue Passage: _-=; _ - 't=�` Sri✓� �� ', � l %/ - fir' $8.49 pennsylvania DEPARTMENT OF PUBLIC WELFARE Your Responsibility to Provide Information to the Department Please acknowledge receipt of this letter and advise whether the Department's claim is admitted and when payment may be expected. When the estate accounting is complete, please provide a copy. The Department audits all estate recovery claims and therefore we require documentation to substantiate all deductions from the gross estate. The regulations governing how the Department computes its estate recovery claim are found in 55 Pa. Code Chapter 258. These regulations are readily available on the Internet, in addition to being carried in most local law libraries. In order to accurately compute the amount due the Department, the following items should be submitted to the address below: 1. For real estate: a. Copy of the deed b. Copy of the latest tax assessment c. Copy of a current appraisal, if available 2. Copy of the funeral bill 3. Copy of the statement of the burial account if one existed 4. Copy of the statement of the personal care account balance at date of death, if the decedent was in a nursing home 5. Copies of original and updated life insurance policy forms naming beneficiaries 6. Copies of any and all stocks and bonds 7. Copies of bank statements showing balances on the date of death 8. Copies of signature cards or other proof of when accounts were made joint 9. A list of any gifts or other transfers for less than fair market value made by the decedent (personally or under a power of attorney) V-,� —k-a� P-,- Your Responsibilities to the Department Under State law, executors or administrators may be personally liable to pay the Department's estate recovery claim if they transfer estate property without the Department's claim being paid. Persons who receive that property without paying valuable and adequate consideration to the estate may also be personally liable. The responsibilities of the primary next of kin/administrator/executor, is to advise the Department of any assets in the estate and to ensure that the remaining money, after all funeral and administrative costs are deducted, is sent to the Department. Accordingly, you must ensure the Department's claim is satisfied before making distribution of assets to heirs. Bureau of Program Integrity i Division of Third Party Liability i Recovery Section PO Box 8486 1 Harrisburg, Pennsylvania 17105-8486 ��K�� ^�� n~~~~^^^~�� ~~~~^^^~~ DEPARTMENT orPUBLIC weLp^ns Insolvent Estates and the Fiduciary Responsibility to Creditors If there are not enough estate assets to pay the dainnm of all creditors in full,, then the executor oradministrator has a duty to act in the best interest of creditors when administering the estate. If you must spend the estate's money to administer it, you must act prudently and make purchases as if the money were conning out of your own pocket. The Department's approval is required if you expect the legal fees to exceed more than the greaie of 6% of the estate assets or $1,000. Contingent fees for estate administration will generally not beapproved. Ifyou donot obtain approval, the Department may consider the excessive fees to be a transfer for less than valuable and adequate consideration. Sincerely, / - Karen H. Paterson Claims Investigation Agent 717-772-6615 717-772-6553 FAX Enclosure Bureau of Program Division of Third Party Liability Recovery Section LAW OFFICES BRINSER,WAGNER&ZIMMERMAN 6 EAST MAIN STREET-SECOND FLOOR (EAST MAIN&SOUTH RAILROAD STREETS) P.O.BOX 323 PALMYRA,PA 17078 PHONE:(717)838-6348 FAX:(717)838-6912 MECHANICSBURG OFFICE MESSIAH VILLAGE GERALD J.BRINSER 100 MT.ALLEN DRIVE KEITH D.WAGNER MECHANICSBURG,PA 17055 JOHN M.ZIMMERMAN PHONE/FAX(717)697-4666 CALEB J.ZIMMERMAN w March 31, 2015 'cam . s M f" }n N :�7 Glenda Famer Strasbaugh, Register of Wills Cumberland County Courthouse c= 1 Courthouse Square Carlisle, PA 17013 N In Re: Mary O. Jamison Estate Estate No. 21-14-0458 Dear Register of Wills, Enclosed you will find two (2) copies of the PA Inheritance Tax Return for the above- captioned estate. If you have any questions, please feel free to contact me. Thank you. Very truly yours, BRINSER,WAGNER& ZIMMERMAN . „ Gerald J. Brinser GJB/wlc Enclosures c: file m rn � m a � m A � mo � Z* 7' o @ m 0 ' x n 4 W (D N � O O W -n 0 3 , z y, c m c� 3 n roar ► .-�cmN r rn D %� C:) Z C Q � � N � n rn O N �+ r• o C-1 ,s d r C) C N x C1 . C N m i O 0 0 i V a D b N zo°DD y m