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Home My WebLink About01-0179 PETITION FOR PROBATE & GRANT OF LETTERS Social Security No. 204-01-3426 No. 21-01- LJ!'1 To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania Estate of VIOLET MINICH also known as MARY VIOLET MINICH , deceased. The Petition of the undersigned respectfully represents that: Your Petitioners, who islare 18 years of age or older and the Executor/rix named in the Last Will of the above decedent dated April 9 , 1979, and codicils dated none . 19---.: The Executor named William L. Minich died July 12. 1987 . Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at One LonQsdorf Way. Carlisle. South Middleton Township Decedent, then ~ years of age, died November 2 . 2000, at CumberlaQd CrossinQs Retirement Center, Carlisle. PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the V\lH! offered for probate; was not the victim of a killing and was never adjudicated i ncom petent: Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled In PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: 502 North Walnut Street, Mt. Holly SprinQs BorouQh. Cumberland County $2.000.00 $ $ $60.000.00 WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of letters testamentary thereon. Signature ) and Residence(s) of Petitioner(s): J. zanne I. Cornman 3 Yates Street Rear Mt. Holly Sprinqs, PA 17065 717 -486-3429 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND The Petitioner(s) above named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that as personal representative of the above decedent, petitioner(s) will well and truly administer the estate according to law. ~J~ SU nne I. 'Cornman ; (;~- ~JC' - lP AND NOW, February b..r:sTtt-- . 2001, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated April 9, 1979 described therein be admitted to probate and filed of record as the Last Will of Violet Minich a/kJa Mary Violet Minich ; and Letters Testamentarv are hereby granted to Suzanne I. Cornman No. 21-01-' .' 'I <1 Estate of VOILET MINICH a/k/a MARY VIOLET MINICH deceased. DECREE OF PROBATE & GRANT OF LETTERS .A,lAJ/ nlJ;1-w - . I .:../ IRWIN McKNIGHT & HUGHES FEES Probate, Letters, Etc. . . . . . . . $ 115.00 Short Certificates( -1- ) . . . . $ 3.00 Renunciation(s) .. . . . . . . . . . $ JCP . . . . . . . . . . . . . . . . . . . . $ 5.00 Other . . . . $ TOTAL: .... $ 123.00 Filed. . . ... ... ... . . . . .. ... . ... ... James D. HUQhes. Esquire (58884) ATTORNEY (Sup. Ct. 1.0. No.) 60 West Pomfret S1.. Carlisle, PA 17013 ADDRESS 717 -249-2353 PHONE , .. I L 'J I I I hl.d vvirh me as Thi~ i~ to l.t'nit~. tk\t rhe infornnlillll here given IS LOiTCLr!:' l.opicd trOl1l an ongllla cl~l~rillc:\te OJ ueat 1 (U}' l ()i"j,,'li1,'11 ,"'rt'lf'I",'lr,J will he forwarded to rhe Surl' Viral Records Ofhce tor pertLlllent lding. LOLal Registrar. The ::- ~'- '- '- WARNING: It is illegal to duplicate this copy by photostat or photograph. /(1,{'~G"'otp~~ ""\'~"/' .---.---<(4' ~--;.::- ?~/ '~~\ p~1 ..~\~~ i{ ~:i~. ~ll \~*~. .;.*{' \~ 0. ....~) \- <:'~, . ,'-}J ~ ~'_ ..... ~"v\'1 ~~------,?liiE-Ni \\\ ~,~III\\ ,~ ",,- '/'//'/I01111IJJ~ .=-- ~~. ~'eu-~~~ [()L.d RcTISt!~lI .' Fcc t(l! [his l.cnit'c.',lk. S2.(l{) P 5837049 :\ P. ~Q 1._ :~ _ j~!LL-_ I l,lfe H \ 05.743 Rev VB7 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 'lINT ,ENT INK NA~E OF DECEDENT IF"". M,",lIe LOSlI SEX STATE FILE ~UMBEA SOCIAL SECUR'TY NUMBER DATE OF DEATH iMcntl'l. Oa'1. 'fear) ~ \ . ~onths HOUtS ~ Min~" BIRTHPLACE (City and Pt..ACE OF DeATH (C~eck Of'ty f){le -- -;.ee ,nSlruct~ on Olh<e, ,tde) Stale Of FcrR.qn Cououy) HOSPITAL: Mt.H oLf.y SpJr..{ngf.JP npah.n. D ERlO"""'h.n, [J 7. ... FACIlCu",;b~kla;;r E1 o~~1ng~" Oher " iSpeedy) U 1. z. F ema.f. e 3.204 - 07 -3426 4. No v. 2, 2 0 0 0 83 Y" 5. COUNTY OF DE.lJ'H Cumbvl..f.and I". RACE. Amenea.n Indian. Black, White. &tc (~dy) Wh'..tt.e Ie. DECEDENT'S USUAL OCCUP,uION C t'iilF"~~ ~e~':~r:)' KIND OF BUSINESSIINDUSTRY 10. PhaJr.mac.y CO. 11.. 11b. DECEDENT'S MAILING ADDRESS (SI'e... CdylTown. State. Zop COdel 7 Longf.JdoJr.n Way CaJr..f.'{f.J.f.e, Pa. 77073 SURVIVING SPOUSE (II .....1.. ~ ma.oen namfll DECEDENT'S ACTUAL RESIDENCE (S~ InstructIOnS on other S!O.1 on ~ 17b.County CumbeJr..f.and 17d.D :;,;:e':''''~=Of MOTHER'fan~"I~<l~~~'<li<~nrr 1.. INFO~Av(n1!.l.fl ~f:ES~1f,fdyAft"; Sia" fjr;f,f'!t S pJr..{n 9 f.J , 201>. PLACE Of DISPOSrTlON . Name of Cemetery, Crematory or Other Place Cf!ylboro Pa. 77065 DATE OF DISPOSITION (Monlh. Dey. .....,) 77/6/2000 lICENb7~~~ L LOCATION. CityfTown. St.,.. rop Code 21e, Mt. Ho.f..f.y SpJr..{ngf.J Cem. Z1d0t. Ho.f..f.y SpJr..{ngf.J,PA 77065 N~!$~o~~~rl~~geJr. Mt.. Ho.f..f.y SpJr..{ngf.J, Pa. 77065 22c. LICENSE NUMBER DATE SIGNED 23b. (,f\J J Z i q 9 J - 1- ~:t!\n_") - 2 coO WAS CASE REFERRED TO MEDICAL EXA~INEAiCORONER? v.. D ! : {\ L-'~ (Y-..70c.r__.\....S DUE TO (OR AS A CONSEOUENCE OF): \:) ... ~ '-. a. L.-..., """ e ( l. .h- . DUf \0 (OR AS A CONSEOUENCE OF): \-\ ...., r'-\-- DUE TO (OR AS A CONSEOUENCE OF)' .J... c.v. ~ ^ t. T <...-' z.. I ApprOXimate : interval berween : onset and death : ~ PART II: Other s9'1irtcanl conditions contributing to death. but nor ntSUfting in the undertyingcauM oMen in PART I WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEnH? MANNER OF DEATH Natural ~ o D DATE OF 'NJURY (Monltl. Day. Yeal) TIME OF INJURY INJURY ,u WORK? DESCRIBE HOW INJURY OCCURRED ...... D NO~ YnU Z... Z8b. CERTIFIER lCt-eck 0"""., one} .CERTIFYING PHYSICIAN IPhyslC.an cefllfYlng cause of dealh wh9f'" anOlhet' otwStCJan has pt'Onollnced dealh ana completed Item 231 To the be.t o' my know~~. death occurred due to the cauM(s) and m."ner a. st.tiKI. . . . . . . . . . . . . . , . . . . . , . Pendinq Invesh9alion o o D ~~CE OF INJURY. AI nomo. tar~.o:,;eol. lactory. offic. building, .tc. (Specd,,) 30.. Yn D NoD Homfc~ NoD SuK;;<le Could not be determined M. 3Oc:. 3Od. LOCATION ($,,_. C...,fTown. StalO) . PRONOUNCING AND CERTIFYING PHYSICIAN (P'"'YSlCaan hoth t>I::>flQu('l(;inQ cealh and c@rtlfYlnglocauseol dealh1 To Ihe Mst of my knowl~9" death occurred at the time, date, and plac., and due to Ih. cause(s) and manner u, stated {:\. ~~ ~~~ ~I I I~I \ 1<:> I 34. ~: t - ( i - (' I ! I REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that Sworn to or affirmed and subscribed before me this day of 19_ the testat , sign the same and that signed as request of testat_ in h presence and (in the presence of each other) (in other subscribing witness(es)). / //' /' Regisl!}.V/ ...--/ // ~/-/~ // /~ (Name) (Address) (Name) (Address) / REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS James D. Hughes and Suzanne I. Cornman (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Mary Violet Minich codicil testat rix of (one of the subscribing witnesses to) the will presented herewith and codicil that each believes the signature on the will is in the handwriting of Mary Violet Minich to the best of the ir knowledge and belief. ~ Sworn to or affirmed and subscribed before me this ,~ rl-t-- ~~C'~~ Holly Springs, PA 17065 (Address) jEnsllUill nub Qipstament I, VIOLET MINICH, also known as MARY VIOLET MINICH, of the Borough of Mt. Holly Springs, Cumberland County, Pennsylvania, declare this to be my last will and testament and revoke all wills which I have previously made. I I give, devise and bequeath my entire estate, to my husband, William L. Minich, if living, otherwise to my daughter, Suzanne I. Cornman, if living, otherwise to her surviving issue per stirpes. II If neither my husband nor my daughter nor any issue shall survive me, I give, devise and bequeath my entire estate, one- half to my son-in-law Delmar W. Cornman if living, and the residue to Salem United Methodist Church, Mt. Holly Springs, Pennsylvania. III Any share of my estate which may become distri- butable to a minor beneficiary may be held in a savings account in the name of the minor, or in trust by Farmers Trust Company until the minor attains the age of 18 years. IV I appoint as executor of this will, my husband, William L. Minich, and if for any reason he shall fail to qualify or cease to act as such during the administration of my estate, I appoint as alternate executrix my daughter, Suzanne I. Cornman, and if for any reason she shall fail to qualify or cease to act as such, I appoint as alternate executor, Farmers Trust Company of Carlisle, Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal if I.) i? ( l..- day 0 f 1\,{ r I 1 h , 19 79 . I / r 1'-\ I , t."- 1.<-/ / J I ',/ . - ,I",. I <( L (SEAL) tis . I ~JJ) i'"1 <<: { t j)!i ",; t (SEAL) , J Signed, sealed, published and declared by Violet Minich, also known as Mary Violet Minich, testatrix above named, as and for her last will and testament, written on one sheet of paper, in our presence, who, in her presence, at her 'I request, and in the presence of each other have hereunto subscribed our names as attesting witnesses: Crmj]~f RJ?Ji~. : /lL~ ~.db---J --.l f~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MARY VIOLET MINICH Date of Death: NOVEMBE 2. 2000 Estate No.: 21-01-0179 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March 14. 2001 Name Address Suzanne 1. Cornman 3 Yates Street Rear, Mt. Holly Springs. PA 17065 Notice has now been given to all persons entitled thereto unde Date: 03/14/0 1 James D. Hughes, Esquire CarIisle,PA 17013 Telephone (717) 249-2353 Capacity: Personal Representative x Counsel for Personal Representative \, / {, - c2/(": ~. (-; COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT Of TAX JAMES D HUGHES ESQ IRWIN ETAL 60 W POMFRET ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-27-2001 MINICH 11-02-2000 21 01-0179 CUMBERLAND 101 REV-1547 EX AFP <l2-DDJ MARY v Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ifE"v =is4i-Ex--AFP-ri"2:oIff-No'ficE--oF-'ftiHEifiTANcE-TAX-APPRAisEMEN~--Aii-oWAtiCE-(fi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MINICH MARY V FILE NO. 21 01-0179 ACN 101 DATE 08-27-2001 T AX RETURN WAS: (X) ACCEPTED AS fILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 67,000.00 .00 .00 .00 1,894.81 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 3,705.07 127.836.26 (11) (12) (13) (14) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 68,894.81 131.'i4133 62,646.52- .00 62,646.52- 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = (19)= .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN._ .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) /" STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARY V. MINICH Date of Death: November 2. 2000 No. 21-01-0179 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: ....L Yes _ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes .....L No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ..L Yes No d. Copies of receipts, releases, joinders and accounts may be filed with the CI of attached to this report. vals of formal or informal han's Court and may be Date: 9/14/01 , McKNIGHT & HUGHES James D. Hughes. Esauire Name (please type or print) 60 West Pomfret Street Address Carlisle. P A 17013 City, State, Zip (717) 249-2353 Telephone Number x Personal Representative Counsel for Personal Representative Capacity: OFFICIAL USE ONLY REV-1500 EX +(6.00) REV-1500 f(P --210 - {[I INHERITANCE TAX RETURN FILE NUMBER COMMONWEALTH OF PENNSYLVANIA 21-01-0179 DEPARTMENT OF REVENUE RESIDENT DECEDENT DEPT,280601 COUNTY CODE YEAR NUMBER HARRISaURG, PA 17128.0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE IN!TI~L) SOCIAL SECURITY NUMBER 0 Minich Marv Violet 204-01-3425 E C OArEOF DEATH (MM-DD~YEAR) DATE OF BIRTH (MM-DD-YEAFl) THIS RETURN MUST BE FilED IN DUPLICATE WITH THE E 0 11/02/2000 07/04/1917 REGISTER OF WILLS E (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, ANLJ"MI[')'[J[E INITIAL) SOCIAL SECUAl1Y NUMBER N T ~ 1. Original Return 2. Supplemen'" Re'um tJ 3. . 1 L~ate of death r- Remainder Return prior to 12-13~82) CAPB ~ 4. limited Estate r- 4a. Future Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required HpRL 6. 7. 8. EplO Decedent Died Te<state '--- Decedent Maintained a Living Trust Total Number of Safe Deposit Boxes L..:.: - CRAC (AttaCh copy of Will) (AttaCh copy of Trust) KOTK 0 9. 010. 0 11. Election to tax under Sec. 9113(A) ES litigation Proceeds Received Spousal Poverty Credit (date of death between 12-31~91 and 1-1-95) (Attach Sch 0) ;'tilI$jlgCl"I(l.~!.I$j'!lI;jft:PMP~~li,'''ti...j(:QI'I~~J:jEm:..~iJ:jEli!TIA~'''MfNFClflMA''fPN1lHQllLDBEOII'IE(:TEPl'Qf' P NAME COMPLETE MAILING ADDRESS C 0 0 James D. Hughes Esa. 60 West Pomfret Street R N FIRM NAME (If Applicable) West Pomfret Professional Bldg. R 0 E E IRWIN McKNIGHT & HUGHES Car lisle, PA 17013 S N T TELEPHONE NUMBER 717/?49-?353 1. Real Estate (Schedule A) (1) 67,000.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) None .. 3. Crosery Held Corporation, Partnership or (3) None Sale-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) None R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1,894.81 -..- E (Schedule E) C A 6. Jointly Owned Property (Schedule F) (6) None P 0 I Separate Billlng Requested T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None U L (Schedule G or L) A T 8. Total Gross Assets (total lines 1-7) (8) 68,894.81 I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 3,705.07 0 N 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) (10) 127,836.26 11. Total Deductions (total Lines 9 & 10) (11) 131,541. 33 12. Net Value of Estate (Line 8 minus Line 11) (12) (62,646.52) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject 10 Tax (Line 12 minus Line 13) (14) (62,646.52) C SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0 M T P 15. Amount of Une 14 taxable at the spousal tax U A T rate, or transfers under Sec. 9116(a)(1.2) X ,0 0 (15) 0.00 X A 16. (62,646.52) 45 (16) 0.00 T Amount of line 14 taxable at lineal rate X ,0 I 17. Amount of line 14 taxable at sibling rate X ,12 (17) 0.00 0 N 18. Amount of Line 14 taxable at collateral rate X ,15 (18) 0.00 19. Tax Due (19) 0.00 20. 'Ff 1!<:tfg~KHgl'lg!!I'i:t(c:!IiIAIlE!!\$Ql.Ig$1'I"!l!~'1I11I1llHPP~;AH!q~!iMAYlolliHt;;;I > > BE SURE TO ANSWER ALL QUESTIONS ON REVEIlSE SIDE AND TO RECHECK MATH < < Copyright (c) 2000 form software only The Lackner Group,lnc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS One Lon~sdorf Wav CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Cred.s ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WillS, AGENT ':':'~:t!~~'~'!~~~!~~:'+~~':~:~tt~!i~~m~u~~+i~,~~m~~~t~~I~~!~~!'~,~"m~~!+~~!!~~~:~~~~I!~+~~t~:~:k!~i 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ~ ~~x 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 December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . 0 ITl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 ITl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? 0 [!l IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. 0.00 0.00 0.00 0.00 0.00 Under penalties of perjury, t 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. DATE SIGNATURE OF P?SON RESPON:I'a;:~ _ _~~y;;;;_ _~~o~_;~y_:;o_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 'x:/.tt 0 0 Mount Holl S rin s, PA 17065 SIGNATUREOFP THAN REPRESENTATIVE IRWIN McKNIGHT & HUGHES 60 West Pomfret Street - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- Carlisle, PA 17013 1-/?--O1 7J9 lot For dates of death or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sur 'ving spouse' 3% [72 PS 9116 (a) (1.1) (in For da eath 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% (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 twenty-one 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% [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%, except as noted in 72 P.S. 9116(1.2) [72 PS 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% [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. Copyright (c) 2000 form software only The LaCKner Group, Inc. Form REV-1500 EX (Rev. 6-00) , REV.1502EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST ATE OF FILE NUMBER Mary Violet Minich SS# 204-01-3425 11/02/2000 21-01-0179 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledde of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 502 North Walnut Street, Mt. Holly Springs Borough - Cumberland 67,000.00 County (settlement sheet attached) SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recap"ulation) S 67,000.00 (If more space is needed, insert additional sheets of the same size) Copyrfght(c) 1996 form software onfy CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) ,REV-1508 EX t (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Mary Violet Minich SS# 204-01-3425 11/02/2000 21-01-0179 lndude 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 NUMBER 1 Cash on hand DESCRIPTION VALUE AT DATE OF DEATH 5.00 2 M&T Bank - checking account 1,325.59 3 Personal property sold 564.22 TOTAL (Also enter on line 5, Recapitulation) $ 1,894.81 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) ,REV.1511 l;:x t (1.97) COMMOMWEAL TH OF P\:.MNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mary Violet Minich SSI! 204-01-3425 11/02/2000 FILE NUMBER 21-01-0179 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES, B. DESCRIPTION AMOUNT 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees IRWIN McKNIGfIT & HUGHES Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 3,400.00 City Relationship of Claimant to Decedent State Zip 4. Register of Wills 123.00 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal - estate notice publication 75.00 2 Register of Wills - filing fee 10.00 3 The Sentinel - Legal - estate notice publication 97.07 TOTAL (Also enter on line 9, Recapitulation) $ 3,705.07 (If more space is needed, insert additional sheets of the same size 1 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) AEV- 151:2 EX" (1-97) COMMONWEAL. TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Violet Minich SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS!I 204-01-3425 11/02/2000 FILE NUMBER 21-01-0179 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Cornm. of PA; Dept. of Public Welfare - restitution AMOUNT 117,590.73 2 Cumberland Crossings 834.60 3 Irwin McKnight & Hughes - POA/Nursing Care matters 1,032.50 4 Promissory Note dated July 10, 1994 - to Delmar & Suzanne Cornman 8,326.00 5 Triangle Traveling Store, medical supplies 52.43 TOTAL (Also enter on line 10, Recapitulation) $ 127,836.26 (If more space is needed, insert additional sheets of the same size) CopyrIght (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) ,REV-l!i13"EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Marv Violet Minich SSII 204-01-3425 11/02/2000 FILE NUMBER 21-01-0179 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS jlnclude outright spousal distributions, and transfers under Sec:. 9116{a)(1.2)] Suzanne I. Cornman 3 Yates Street Rear Mount Holly Springs, PA 17065 Daughter remainder NUMBER I. ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) -- 3lIastlllIill anb (!fCShUlt~llt I, VIOLET MINICH, also known as MARY VIOLET MINICH, of the Borough of Mt. Holly Springs, Cumberland County, Pennsylvania, declare this to be my last will and testament and revoke all wills which I have previously made. r I give, devise and bequeath my entire estate, to my husband, William L. l\1inich, if living, otherwise to my daughter, Suzanne I. Cornman, if living, otherwise to her surviving issue per stirpes. II If neither my husband nor my daughter nor any issue shall survive me, I give, devise and bequeath my entire estate, CHCr half to my son-in-law Delmar W. Cornman if living, and the residue to Salem United Methodist Church, ~lt. 1I011y Springs, Pennsylvania. III Any share of my estate which JJlay becoJlle distri- butable to a minor beneficiary lIlay be held in a savings account in the name of the minor, 01' ill trust by Farmers Trust Company until the minor attains the age of 18 years. IV I appoint as executor of this will, lilY husband, William L. Minich, and if for any reason he shall fail to qualify or cease to act as such during the administration of my estate, I appoint as alternate executrix my daughter, Suzanne I. Cornman, and if for any reason she shall fail to qualify or cease to act as such, I appolllt as alternate executor, F~rnlers Trust Company of Carlisle, Pennsylvania. ~jd d Lf ay IN WITNESS WHEREOF, I1PRIL of w..-h, 1979. I have hereunto set IllY hand and seal tis UAc'-Lf J7h,c'~1.! (SEAL) Signed, sealed, published and declared by Violet Minich, also known as Mary Violet Minich, testatrix above named, as and for her last will and testament, written on one sheet of paper, in our presence, who, in her presence, at her request, and in the presence of each other have hereunto subscribed our names as attesting witnesses: ~J7; P I? ,51/ IfUj A-..P:-CJ.I:. 0.1 7lJ eve., (j . ) , L)~,~111)){7";/!' (SEAL) A. Settlement Statement U.S. Departmenl 0' Houalng andUJbanDevelopment~ ,r OMS No. 2502-0265 B. Type of loan 1. 0 FHA 2.0 FmHA 3. D Conv. Umns File Number BARBER Loan Number Mortgage Insurance Case Number 4. D VA 5.@: (onv. Ins. C. NOTE: This form IS furnished to gIVe you a statement of actual settlement costs. Amounts paId to and by the seutement agent are shown. lIems marked ~p.o.c.~ were paId outside of closing; they are shown here for informational purposes and are not included in the 101als. D. NAME AND ADDRESS OF aORROWER, ~~N~~;i:~~ ~TRE~T. ~T:'HOL~yiSPRINGS. PENNSYLVANIA 17065 E. NAME AND ADDRESS OF SELLER: ESTATE OF MARY VIOLET MINICH (Seller TIN - 25-6727551) 60 WEST POMFRET STREET. CARLISLE. PENNSYLVANIA 17013 F. NAME; _ AND APORESS OF.: tENPER;_ 'mRAJP~~:(~IA_~~?::::)::\:;:i:():: i ::>:::i;:r<::;<:;::~)i,::;:6/~-~ 427 STONEHEDGE DRIVE.' CARLISLE. PA 17013 502 NORTH WALNUT STREET LOCATION: MT HOLLY SPRINGS, PA 17065 H. SETI1.EMENT AGENT, IRWIN. McKNIGHT.& H~HES.. .... .' P~ri ~3~~~NT: 60 WEST P(l'1i'RH Sl1lEET; cAAL~LE. PA. I. SETTl.EMENT DATE: February 22, 2001 J. SUMMARY OF BORROWER'S TRANSACTI 100;- GROSS"AMOUN1f'OUE::FROlvl'-'BORROWSAW~~t~iWH~:~WMX- G. PROPERTY 17013' ' , .. K. UMMARY OF SELLER'S TRANSACTION /GROSS'AMOUN'l' OUE'TO SELlER: ' . ...... ...., 10f. ConlraCl Uln'j)riCe 102,PeJSOnilproperly 103. SatlJemenl'Cllatgu_ lQ-l>otJ<lw.r~ (I'D," """1400' 7,000.00 104. 105. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE; 10&:-CllJItl>w"taJ<u 101. County lax.. t08. Auenment. " " " 407. County laxn Aaillll~m.nl' " " ~1l 109. 110. 111. 112. 41tl: 120. GROSS AMOUNT DUE FROM BORROWER: 68,809.00. 420. GROSS AMOUNT DUE TO SELLER: 200. AMOUNTS'-PAID'--BY OR -IN' BEHALF,:OF:::SOAROWEA: '~:::'",=':::n::~m::::*Hm~~:!:@ '5Doti:~'A80UCtiONS:::IN\AMOUNT"DUE:::trO';SELLEA: 67,000.00 :2<l1. Cepoelt or Ulnnt money :<0:<. PrincIpal .mouni-"';;ne.. loln(e) 203. E~;allnll loan(a) laken eubJeC! 10 ,... 205. 7 1000.00 lI01. Exee.. depoell (en Inetruollonej 5'3 ,- 6-0:0;V:O 0 !~~.,::8,1;iI~jini~::(.~.tr~.~,::ib' '~'oil.;\II~ir 14M) 03.Exl.tlnllloan(l)taken."bjeCllO iil4::::Pay~iti:~t': ilr~'lj,iJ,t~a:c. :~C:an 7,000.00 1,672.00 505. Parol! of ucond mortgage loan PRINCIPAL CREDIT PER-SALES AGR 834.18"." PRINCIPAL CREDn PER SALES AGR 834.18 206. m 20!. 201/. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER; 507. 508. 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210, CltY/lown l;xes 211. Colln')'la,... 212_ AOI...menla " 510, 01y!town axe. 511."CCUrllylaxll' " " " 512. A.....m.nla " " "a 214. 21S. $13}; 216. 21'.' 218. 21\1. 220. TOTAL PAID BYJFOR BORROWER: aoo>CASH AT:;SETTtEMENT'-FRQMtrO:: BOAAOWEfI,"-}"'- 301. Gross amount due from borrower 1 i ne 120 302.-less- amount a1d'::b' !for tiorr.awer":'O:fne-::~20-r; 303. CASH (0"ROM) (0 TO) BORROWER: 514. ':'::'5~~?::'- 518.' ~11P.' 518.' -. '1~~ 61,434.18 9,506.18 , w:";t:#:nWN:~:i::::W\'k*, 67,000.00 9 506.18 57,493.82 HUD-l (3-86) - RESPA, HB 4305.2 PAGE 1 OMS No. 2502-0265 HUD-\ fRIY. 3/861 L. 700. TOTAL SALESfBROKER'S COMMISSION SETTLEMENT CHARGES BASED ON PRICE @ %- PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FROM SELLER'S FUNDS AT SETTLEMENT DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: " 702. 703.'COmml In al.:! at ..Ill, 70~. 800. ITEMS PAYABLE IN CONNECTI N WITH LOAN: .. .. BANK 801. LoanorJinltIOnr" 602. Loan dlacoUM '"' , rlntl, , RR T 604, Oedltrlo"to: 805. n(lllr','irla ,lln1e 806. Mort a elnsu,anoe a IIcallonleelo 250.00 . o , 608. APPLICATION FEE TO ORRSTOWN BANK 809. NDE~\.slJnoo:,' ~?:!t RRSlO\\W':aANt;:, 810. DOCUMENT/PREP FEE TO QRRSTOWN 611. FL I)' CER >---fE O"'-Of<RSJOWN, 900. ITEMS RE UIRED BY LENDER TO BE PAID IN ADVANCE: 1l01.lnl,r..t'froll'1' j':::::,~: : 902. Morl 1 e Insurance rlmlum lor iio~ Hanrd'-I~IUTlnC" r.mrum :10' 1104. Flood In uranee femlvm lor 905. 1000. RESERVES DEPO ITED WITH LENDER: HIOI.HUvdlil.ll,aii " 1002. Morl 1,ln8vrlncIl HI03 ell 08.10 re~ la r8.Io 15 nn 1008. Flood InlurlnCI 1007. 1008 " monlh,:',@" monlhl@$ nionlhl:'~II'-$ monthl@$ 'lil!l;lIltili'-:(lj)li monlhl@$ lY\oJrthli::~,'. monlhe@$ lJ$tment 1If:"mOllUl,. per month pe"mollth per monlh ';1Il'::,~M11h per month ;~:'~th per monlh 1004. Counl fO Ifl lun r te' Accouiiti{1 Escrow 1100. TITLE HAAGE: 1101.Settllmenl 01 clolln Into tlo. AbllrlClor llle:"narth to 1103. Title Ulmlnallonlo 1104 nUll euranceblnder ti> 1105 Documenl fe araUon to nOlI. Not 'I" 0 ARY PUB Ie 1107. Anorn,n len 10 IRWIN, McKNIGHT & HUGHES Includu aboye Items Numbers: fricllidee-abov&' IIOll.lender'l coyea I " < 1111. 1112. Ill:!. 4.00 400.00 2.00 1 000.00 110a.nUt_lne\lrtinC.1II 1200. G VERNMENT REC RDING AND TRANSFER CHARGES: 12111. Recordln teu' De 25 ~'5:0 ."Moi1 ,I. :-2. 50 ':'~lleh" 1202. ClI counl 11 a 11'1 s: DI 670.00. Mor I' 1203. 81atel4 .tam 8' Dud 670".00 lin 'a 1 1204. 1:l05, 1300. ADDITIONAL SETTLEMENT HAR ES: l~\,"'SU( 10,'''' 1302,Pnllnaection'o 1M3. 1304. 1305 130B. 1307. 55.00 670.00 670.00 Borrower: Dale' 1,B09.00 1,672.00 14 . TOTAL SETTLEMENT CHARGES nd accurate 1!llement 01 all receipts and disbursemenrl made allmenl. I haye carelully revllwed the HUD-l Selllemenl Slltemllnt end to Ihe bnl 01 my knowl,dge and blllel, It 18 on my account or by me In Ihls Ir;oneaction Ilurlher certlly Ihat I haYI "celnd 1 copy ollhe HUO-l 8e ,,,,ow,,~(J~)/j ),,,. 2/22/01:""~ DaIt: 2/22/01 Oale: The HUD-I Selllernenl Slalemenr which I haye prepared 10 a l,ue and accu'ale accounl oT lhla nansacllon. ..Ilh Ihls stalemenl. ausethelunds10 be dlabu,ud In acco,dancl Dale' Sonlemanl A!lenl: Date" 2/22/01 J Penalllu upon conviOllon can Include a line and Imp,i.on' WARNING: It II a Crlmll to knowln!lly makll lain .Ialemenll 10 Ihe United SlaIn on Ihla or any othe, 7Imll..! rn. menl. For dlllll. lse: Tille 18 U.S. Code Section 1001 end Section '010. " , I. . '~M&rBank March 15,2001 RE: Estate Search The Estate of: Date of Death (D.O. D.) MARY VIOLET MINICH 1112/2000 To Whom It May Concern: Identified below is the account information requested. 1. M&T Bank accounts in which the decedent's name appears: Account Type Account Number Account Title Opening Branch CHK 1189875 VIOLET MINICH 4331 SUZANNE I Co.RMAN Po.A D.O.D. Accrued Interest Balances (Includes Accr. Int.) $1325.59 $.00 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount o.wed Account Description NO. Safe Deposit Box titled in the Decedent's name existed at our office. If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK Co.RPORA nON BY: 'G(), A~:v..Q Authorized Signature ~J</24.-.. u DATE: ~ - / .;,--{)) Manufacturers and Traders Trust Company. 1100 Wehrle Drive, Po. Box 767, Buffalo, NY 14240-0767 . . ~~~~uw~~ CEC 05 2000 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBlIC WElFAAE BUREAU OF FINANCIAL OPERATIONS EST ATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-6466 December 01, 2000 IRWIN MCKNIGHT & HUGHES JAMES D HUGHES WEST POMFRET PROF BLDG 600 WEST POMFRET STREET CARLISLE PA 17013-3222 !RWIN, McKNIGHT &. HUGHES Re: MARY MINICH CIS #: 970123927 Co/Rec: 21/0071797 Date of Birth: 07/04/1907 SSN: 204-01-3426 Dear Attorney Hughes: Please be advised that the Department of Public Welfare maintains a claim in the amount of 5117.590.73 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 3D, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely 518.211.97 was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.B.A. 3392(3). The balance of the claim, namely $99.378.76 is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. Sincerely, ~Q7~~ Elaine Andrews Claims Investigation Agent 717-772-6608 717-705-8150 FAX Enclosure