HomeMy WebLinkAbout06-02-15 (2) ,..
? Pennsylvania 1505618403
DEPARTMENT OF REVEMEX(03-14)
REV-150110 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 13 0741
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
06 27 2013 08 28 1948
Decedent's Last Name Suffix Decedent's First Name MI
RETTBERG RALPH M
(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
❑X 1. Original Return 2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
F] 4. Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
❑X 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 1 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
GEORGE F DOUGLAS III ESQ 717 249 6333
First Line of Address
354 ALEXANDER SPRING RO
Second Line of Address
City or Post Office State ZIP Code
CARLISLE PA 17015
C-.3
Correspondent's email address: gdouglas salzmannhughes.conn
rT1
REGtSTE%OF WILL VSE dN[ Y"
REGISTER OF WILLS USE ONLY CD
DATE FILED MMDDYYYY
rn
DATE,FILED STAMP t-
CID
Side 1
IIIIIIIILIIVIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
1505618403 1505618403
1505618411
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Rettberg, Ralph M.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Heid 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. 2671380-86
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............ 7. 618 - 89
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 267-,999- 75
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 16-,358. 92
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 2 5,3 0 8- 5 7
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 41-1667- 49
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 226-1332- 2 6
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. 226,332-26
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 15. 0-00
16. Amount of Line 14 taxable
at lineal rate x .045 226,332 .26 16. 101184.95
17. Amount of Line 14 taxable
at sibling rate X.12 0 .110 17• 11-00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 11-110
19. TAX DUE................................................................................................................ 19. 10,184 .95
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.
SIGNATURE Qk PERSON REgPONSIBLE FO FI N RETURN�aVid J.11 A.Rettberg DATE 2 7 �y
P[u frac
ADDRESS
2640 Britany Circle,Bedford,TX 76022
SIGNAT,URE OF PREPARER OTHE AN REPRESE ATIVE eorge F Douglas,III Esq. DATE
ADDRESS U �d 7-
354 Alexander Spring Road, Suite 1,Carlisle,PA
Side 2
4, 1 f n r n -1 n A -1 1 4-
1505618411 1505618411
REV-1500 EX Page 3 File Number 21-13-0741
Decedent's Complete Address:
DECEDENT'S NAME
Rettberg, Ralph M.
STREET ADDRESS
99 Regency Woods North
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 10,184.95
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3) 361.63
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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) 10,546.58
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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ ❑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
contains a beneficiary designation?.................................................................................................................. ❑ ❑x
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 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
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
y 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.
REV-485 EX(05-04) 4850004104k
SAFE DEPOSIT t*.
BOX INVENTORY
PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY
Social Security or Death Certificate Number Date of Death
--------- County Code Year File Number
06/27/2013 21 1 13 0741
.......... ............. ...............................
............................. ............
Decedent's Last Name ........... ..............
................ ------- ------------- .......... Suffix- First Name MI
.......------------ ............ ........................
Rettberg M
Ralph
........... ............... ....... .....................
............................................. .....................
... ..........
ADDRESS OF DECEDENT STREET: --------
CITY: STATE: ZIP CODE:
99 Regent .Woods North Carlisle PA 17015 i
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
NAME:
David J. M. Rettberg, Executor
STREET ADDRESS: CITY.
STATE: ZIP CODE:
2640 Britany Circle Bedford TX 76022 1
NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX 6-P--ENING
a. NAME:
RELATIONSHIP:
George F. Douglas, III
Attorney for the estate
STREET ADDRESS:
CITY: STATE:
ZIP CODE:
354 Alexander Spring Road, Suite 1 Carlisle PA 17015
b. NAME:
RELATIONSHIP:
STREETADDRESS:
CITY:
STATE:
ZIP CODE:
c. NAME: RELATIONSHIP:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
NAME:
Wells Fargo
STREET ADDRESS: CITY: STATE: ZIP CODE:
604 East High Street Carlisle PA 17013
13 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY
DATE OF CONTRACT TO RENT BOX NUMBER OF BOX
TITLE UNDER WHICH BOX IS REQUESTED
24 o r— 9,ALPR M R C-2-1 T C, R G-
U1 NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX
a. NAME:
b. NAME:
Ralph M. Rettberg
STREET ADDRESS: STREET-ADDRESS:
99 Regency Woods North
CITY:
STATE: ZIP CODE: CITY: STATE: ZIP CODE:
Carlisle PA 17013
NAME AND TITLE OF�MPLOYEE TAKING THE INVENTORY
WAS A WILL IN THE BOX? ❑ YES NO If yes, a. Date of will:
b. Name and address of personal representative,if named in the will
NAME:
David J. M. Rettberg
STREET ADDRESS:
CITY:
STATE: ZIP CODE:
2640 Britany Circle Bedford TX 76022 1
c. Name and address of attorney,if any
NAME:
George F. Douglas Ili Esquire
STREET ADDRESS: CITY: STATE: ZIP CODE:
354 Alexander Spring...Rqqo, Suite 1 Carlisle _. .. .
PA 17015
....................... .......
4850004104L 4850004104L
REV-485 EX SAFE DEPOSIT BOX INVENTORY Page 2 Of 2
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by
name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock.
(3) Obligations of U.S.Government: Number of items,date of issue, face value, names in which registered and type of ownership,
i.e.,jointly held,payable on death,etc.
(4) Bonds: Designate by name,amount,serial number,or other designation.(Bearer Bonds)
(5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book,name of bank
and branch,and balance.
(6) Jewelry, Coins,Stamps,Manuscripts,etc: List and describe as fully as possible.
(7) Deeds, Mortgages,Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible.
(8) All other contents.
(9) Return completed form to: DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT.280601
HARRISBURG,PA 17128-0601
ITEM ITEM DESCRIPTION
NO.
"Bo Lo" ew -�
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATUFJE
T SIGNATURE
PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
Geor e F. Douglas, III George F. Douglas, III
PRINT TITLE DATE / CHECK APPROPRIATE BOX:
Attorney ❑Executor(trix) n Adrninistrator(trix)
J 111 ®Estate Representative ElJoint owner of safe deposit box
NOTE:Attach additional 8'/Z„x 11" sheet(s) if necessary or use duplicates of this page of form.
The Department is authorized by law,42 U.S,C.§405(c)(2)(C)(1),to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the
Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of tax information agreements
with Federal and local taxing authorities.The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes.
Rev-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Rehberg, Ralph M. 21-13-0741
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
1 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 2,000.00
Metropolitan Life Insurance Company
2 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 5,000.15
Certain Teed Corporation
3 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 10,000.00
Cummins, Inc.
4 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 3,333.92
Genuine Parts Company
5 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 57,553.19
Georgia-Pacific Corporation
6 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 49,990.15
Honeywell International, Inc.
7 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 7,821.87
Union Carbide Corporation
8 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 37,454.22
DAP, Inc.
9 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 23,100.00
Armstrong World Industries
10 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 5,790.80
Celotex
11 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 900.00
Federal Mogul
Total of Continuation Schedules See attached
pages
TOTAL(Also enter on Line 5, Recapitulation) 267,380.86
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
Rev-1508 EX+(08.12)
SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE p�+ p p �/
INHERITANCE TAX RETURN PERSONAL. PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Rettberg, Ralph M. 21-13-0741
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
12 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 29,126.64
Harbison Walker
13 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 630.00
Raytech
14 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against 840.00
US Mineral Products Company "
15 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against A. 3,514.17
P.Green
16 Bailey Perrin Bailey PLLC Asbestos IOLTA-net settlement proceeds from lawsuit against H. 360.00
K. Porter Asbestos Trust
17 Cash on hand 70.74
18 Unum Life Insurance Company of America-long term disability benefits 6,869.47
19 Unum Life Insurance Company of America-long term disability benefits 813.00
20 Woodforest National Bank,Account No. 1332338381 5.716.29
Accrued interest on Item 20 through date of death 0.08
21 Household furnishings at net proceeds of sale 1,774.18
22 Household furnishings at net proceeds of sale 8,982.34
23 Household furnishings at net proceeds of sale 2,532.73
24 Household furnishings at net proceeds of sale 3,153.81
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
Rev-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Rettberg, Ralph M. 21-13-0741
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
25 Optum Bank-refund 7.05
26 State Farm -refund due to cancellation of automobile insurance 0.13
27 State Farm -refund due to cancellation of automobile insurance 7.12
28 State Farm -refund due to cancellation of automobile insurance 38.81
TOTAL(Also enter on Line 5, Recapitulation) 267,380.86
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12)
} Bailey Peirin Bailey PLLC Asbestos IOLTA WESTBOUND BANK f 2339
440 Louisiana,Suite 2100 Westbound Bank.Katy
Houston,TX.77002 Katy,TX 77492
(713)425-7100 88-2548/1130
. 11/7/2013
° PAY TO THE Estate of Ralph Rettberg **2,000.00
ORDER OF ( -
v
a
Two Thousand and
DOLLARS
ATAMPER RESISTANTTONER AREAA
Estate of Ralph Rettberg
C/O George F. Douglas, ill
Salzmann Hughes' P.C.
354 ALEXANDER SPRING RD STE 1 ✓r
CARLISLE PA 17015-7451 f r
Metropolitian Life Insurance Company Settlement Pr
11'00233911' 1: 1130 2 5 4801: 00779911'
4"v.'�y'y-:.a•-s.:.:-�rd'a..t1:w.'+.i.:u=ate ii,JL...�+`.w:ii.r...vc.��.:s.�a<-vim_.lin:y.a'>.�%.n.:<6�-�ss..ti.+ts_-rsua'x�vlc..rv.W4;.rL.v��a�u:..4_:._ ..1.2'.x......wx ".amu_ .r5�ti...-�a.N�asrs-c_vll.'+...+4-���.:av:��v..�.a1"•'ta....ub�J'-:.�r�ia.:i.+_
Bailey Perrin Bailey Asbestos IOLTA 2339
Estate of Ralph Rettberg 11/7/2013
Metropolitian Life Insurance Company Settlement Pr 2,000.00
Westbound IOLTA-7 Metropolitian Life Insurance Company Settlemen 2,400.00
Bailey Perrin Bailey PLLC Asbestos IOLTA WESTBOUND BANK - 2340
440 Louisiana,Suite 2100 . Westbound Bank-Katy
Houston,TX 77002 Katy,TX 77492
(713)425-7100 68.2549/1130
11/7/2013
. Y
PAY TO THE Estate of Ralph Rettberg **5,000.15 °
:1. ORDER OF
0
_ Five Thousand and
DOLLARS (�
A TAMPER RESISTANT TONER AREA,,A � Y
Z Estate of Ralph Rettberg
z C/O Geoige F. Douglas, III J.
z Salzmann Hughes, P.C.
354 ALEXANDER SPRING RD STE 1 ' ---�''
CARLISLE PA 17015-7451 ��'
CU .,
MEMO CertainTeed Corporation Settlement Proceeds -- ` NP
DO 23400 1: 113 0 2 54801: 007 ?99119
�7
Bailey Perrin Bailey Asbestos IOLTA 2340
Estate of Ralph Rettberg 11/7/2013
CertainTeed Corporation Settlement Proceeds 5,000,15
Westbound IOLTA-7 CertainTeed Corporation Settlement Proceeds 5.000.15
s
BaileyRd
Perrin BaileyPLLC Asbestos IOLTA WESTBOUND BANK ~2448 `
440 Louisina,Suite 2100 westbound Bank-Katy _
Houston,TX 77002 Katy,TX 77492 ;
(713)425-7100 88.254811130
.11/26/2013
-c
PAY TO THE Estate of Ralph Rettberg $ *'10,000.00 v
ORDER OF I a
C
Ten Thousand and 00/100* .«.x,«.*........... ..**,.«........,.. *.,........*«.. , *.* ** .«*x.**,..,��,.*...**.*..�*.* **
DOLLARS e
ra Estate of Ralph Rettberg ATAMPER RESISTANT TONER AREA
s
C/O George F. Douglas, III
Salzmann Hughes, P.C. -" 3
354•ALEXANDER SPRING RD STE 1
s'.
CARLISLE PA 17015-7451 tv
nnMoNP
Cummins, Inc. Settlement Proceeds
t:
00 21,4130 I: L L 30 254801: 007799ii'
--_ci- _-S� _vei+.uM....�aeao-:....iV-.......��.uu-;vs.+.:..ti.....lx�y...t.....4:�f-sasa_`....fa.�.4aw...rxs.. :e-a:dw.:r.-..e:s`�.:a�+'+"v:e.��..ver--is..K•..S�F-.er-�+u.�_>.��-�aa��-1s.i.✓'�ed-�1..��...u�:au�.�.�.._ __
Bailey Perrin Bailey Asbestos IOLTA 2448
Estate of Ralph Rettberg 11/26/2013
Cummins, Inc. Settlement Proceeds 10,000.00
Westbound IOLTA-7 Cummins, Inc. Settlement Proceeds 10,000.00
? Bailey Perrin Baiiey.PLLC Asbestos IOLTA WESTBOUND BANK v' 2449
440 Louisiana;Suite 2100 Westbound Bank.
Katy
-Houston,TX 77002 Katy,TX 77432
t (713)425-7100 88-254811130
r 11/26/2013'
PAY TO THE Estate of Ralph Rettberg ( **3,333.92
} _ ORDER OF
Three Thousand Three Hundred Thirty-Three and 921100
I DOLLARS 1�
- - A TAMPER RESISTANT TONER AREA A
Estate of Ralph Rettberg t
C/O George F. Douglas, Il!
Salzmann Hughes, P.C.
Y
354 ALEXANDER SPRING RD STE 1 -� . 1 ♦ ., .
N. CARLISLE PA 17015-7451 ' ' ,✓` o
'_6.MEMO,. .. Genuine Parts Company Settlement Proceeds , • "�,' . �"' A°
u•00244911• 1: 1 L302St.60i: 00779911'
Bailey Perrin Bailey Asbestos IOLTA 2449
Estate of Ralph Rettberg 11/26/2013
Genuine Parts Company Settlement Proceeds 3,333.92
Westbound IOLTA- 7 Genuine Parts Company Settlement Proceeds 3,333.92
l
n.--.�.-._ ._�swwen.--.
...... .-. _.. ..
IVA
a
Bailey Perrin Bailey PLLCAsbestos IOLTA WESTBOUND BANK 2450 ~
440 Louisiana,Suite 2100 westbound Bank-Katy y
a' Houston,TX 77002 Katy,TX 77492
` (713)425-7100 88-254811130 J -
1126/2013'
,.
_ V,
ORDTO THE ER OF Estate of Ralph Rettberg **57,553.19 a
0
Fifty-Seven Thousand Five Hundred Fifty-Three and 19/100************************************************************
µ{ms
DOLLARS
- Estate of Ralph Rettberg A TAMPER RESISTANT TONER AREA A
v
c
C/O George F. Douglas, III
�= Salzmann Hughes, P.C.
Z - - 354 ALEXANDER SPRING RD STE 1
CARLISLE PA 17015-7451 JJ s
:_�,. MEnnoGeorgia-Pacific Corporation Settlement Proceeds --
11'00245011' 1: 1130 254801: 00779911•
Bailey Perrin Bailey Asbestos IOLTA 2450
Estate of Ralph Rettberg 11/26/2013
Georgia-Pacific Corporation Settlement Proceeds 57,553.19
Westbound IOLTA- 7 Georgia-Pacific Corporation Settlement Proceed 57,553.19
�r
WESTBOUND BANK N`25508
Bailey Peavy Bailey PLLC Asbestos IOLTA westbound Bank-Katy
444 Louisiana,Suite 2140 Katy,TX 77492 j
I Houston,TX 77002 88-2548/1134. - {
(713)425-7100 12/12/2013 }
PAY TO THE Estate of Ralph Rettberg **
ORDER OF 49,990.15
I ci
Forty-Nine Thousand Nine Hundred Ninety and
DOLLARS
i ' A,TAMPER RESISTANT TONER AREA A,
Estate of Ralph Rettberg
4 C/O George F. Douglas, III
A ,
Salzmann Hughes, P.C.
354 ALEXANDER SPRING RD STE 1
a CARLISLE PA 17015-7451 '" E
MEMO Honeywell International, Inc. Settlement Proceeds
}}•00250811' 1: 1L3025I-,801: 00779911'
;..N:...K.- -G_�-v... .,,«4�A+.:il>.'�za.�..w.._+ti�xw.._is%.ai«'41�w�'v.:or-ay..4.z —�'.:iA�..-...w-...N+:<. .ref r..v.�3u:�i?Li/+" :+'+>w_+--_.+.?=V�^.«0.s+a'.o:*Y-i m-�-,w<Siw'•^�_.e4..v.rv>�f_ua:�.✓a+:`vii:a::G.a.4isi...+.a,.-�_Y.a.k-t.
Bailey Peavy Bailey Asbestos IOLTA 2508
Estate of Ralph Rettberg 12/12/2013
Honeywell International, Inc. Settlement Proceeds 49,990.15
Westbound IOLTA- 7 Honeywell International, Inc. Settlement Proceed 49,990.15
t
WESTBOUND BANK 2539
Batley Peavy Bailey PLLC Asbestos IOLTA Westbound Bank-Katy
440 Louisiana,Suite 2100 Katy,TX 77492 t
Houston,TX 77002 88-2548/1130
(713}425-7100 12/27/2013 ...
PAY TO THE Estate of Ralph Rettberg -x7,$21.87
95' ORDER OF
mo
Seven Thousand Eight Hundred Twenty-One and 87/100***
DOLLARS 8
Estateof'Ralph,Rettberg ATAMPER RESISTANT TONER AREA,A, - Y
-C/O George,F. Douglas, Ill
Salzmann Hughes, P.C.
354 ALEXANDER SPRING RD STE 1 �-M
CARLISLE PA 17015-7451.
i MEMO . Union Carbide Corporation Settlement Proceeds
! 1,1'00 25390 1: 1130 254801: 00779911'
Bailey Peavy Bailey Asbestos IOLTA 2539
Estate of Ralph Rettberg 12/27/2013
Union Carbide Corporation Settlement Proceeds 7,821.87
Westbound IOLTA-7 Union Carbide Corporation Settlement Proceeds 7,821.87
NUTT
-tom.-';;.`
Bailey Peavy Bailey PLLC WESTBOUND BANK .4267
y Asbestos IOLTA Westbound Bank-Katy
440 Louisiana,Suite 2100 Katy,TX 77492 "
Houston,TX 77002 88-254911130 11/24/2014
(713)425-7100
PAY TO THE Estate of Ralph Rettberg **37,454.22
ORDER OF
Thirty-Seven Thousand Four Hundred Fifty-Four and 22/100««****************"**"**************************«***«*******
DOLLARS
` Estate of Ralph Rettberg ATAMPER RESISTANT TONER AREA ;
w
G C/O George F. Douglas, III
Salzmann Hughes, P.C. ;
354 ALEXANDER SPRING RD STE 1 � {r ,.
- CARLISLE PA 17015-7451 '"
MEIv!C? DAP, Inc. Settlement Proceeds
0001, 2C3W9 1: 1 1 30 2 5 4801: 0077990
Bailey Peavy Bailey Asbestos IOLTA 4267
Estate of Ralph Rettberg 11/24/2014
DAP, Inc. Settlement Proceeds 37,454.22
Westbound IOLTA-7 DAP, Inc. Settlement Proceeds 37,454.22
. ..._-------- ---------------------Asb --. . .. .
Bailey Peavy Bailey Asbestos IOLTA 4267
Estate of Ralph Rettberg 11/24/2014
DAP, Inc. Settlement Proceeds 37,454.22
Westbound IOLTA-7 DAP, Inc. Settlement Proceeds 37'454'22
Bailey Peavy Bailey Asbestos IOLTA 44U/
Estate of Ralph Rettberg 12/15/2014
Armstrong World Industries Settlement Proceeds 23,100.00
Westbound IOLTA-7 Armstrong World Industries Settlement Proceed 23,100.00
• . . - -- -
Bailey Peavy Bailey PLLCWESTBOUND BANK 4407
Asbestos IOLTA Westbound Bank-Katy
440 Louisiana,Suite 2100 Katy,TX 77492 _
Houston,TX 77002 88-2548/1130 12/15/2014.
(713)425-7100
X TO THE Estate of Ralph Rettberg $ --23,100.00
3DER OF
Twenty-Three Thousand One Hundred and
DOLLARS
Estate of Ralph Rettberg A TAMPER RESISTANT TONER AREA
C/O George F. Douglas, III t
Salzmann Hughes, P.C.
354 ALEXANDER SPRING RD STE 1 F
CARLISLE PA 17015-7451
=rtcO Armstrong World Industries Settlement Proceeds
_ t
11000 4 40 ?"1 11: 1 1 30 2 5 4801: 00 7 7 9 9ii'
Bailey Peavy Bailey Asbestos IOLTA 4407
Estate of Ralph Rettberg 12/15/2014
Armstrong World Industries Settlement Proceeds 23,100.00
Westbound IOLTA-7 Armstrong World Industries Settlement Proceed 23,100.00
Bailey Peavy Bailey Asbestos IOLTA 4408
/--Estate of Ralph Rettberg 12/15/2014
Celotex Settlement Proceeds 5,790.80
Westbound IOLTA-7 Celotex Settlement Proceeds 5,790.80
-- _ -----------
Bailey
-Bailey Peavy Bailey PLLC WESTBOUND BANK 4408 • '
Asbestos IOLTA Westbound Bank-Katy
Katy,TX
440 Louisiana,Suite 2100 77492
Houston,TX 77002 es-z5488-2548/1130 12/15/2014 -
(713)425-7100
% PAY TO THE Estate of Ralph Rettberg I **5,790.80
ORDER OF
' Five Thousand Seven Hundred Ninety and 801100********************************«««««**.«*****«*«««*«***«*«*««****«««*«
r
DOLLARS
Estate of Ralph Rettberg A TAMPER RESISTANT TONER AREA A
ff TA
} C/O George F' Douglas, III
Salzmann Hughes, P.C. -
354 ALEXANDER SPRING RD STE 1 , -'
CARLISLE PA 17015-7451
> M,EV~, Celotex Settlement Proceeds -t f �� ""
11'00440811' 1: 1130 2 S4601: 007799ii'
Bailey Peavy Bailey Asbestos IOLTA 4408
Estate of Ralph Rettberg 12/15/2014
Celotex Settlement Proceeds 5,790.80
\A
ti
Westbound IOLTA-7 Celotex Settlement Proceeds 5,790.80
Bailey Peavy Bailey Asbestos IOLTA 44UU
Estate of Ralph Rettberg 12/15/2014
�.--�- Federal Mogul Settlement Proceeds 900.00
Westbound IOLTA-7 Federal Mogul Settlement Proceeds 900.00
j Bailey Peavy Bailey PLLC WESTBOUND BANK 4409
Asbestos IOLTA Westbound Bank-Katy -
440 Louisiana,Suite 2100 Katy.TX 77462
Houston,Tx 77002 88-2548/1130 12/15/2014
(713)425-7100
? PAY TO THE Estate of Ralph Rettberg I **900.00
` ORDER OF
Nine Hundred and
DOLLARS
Estate of Ralph Rettberg A TAMPER RESISTANT TONER AREA
f C/O George F. Douglas, III
Salzmann Hughes, P.C. ;
354 ALEXANDER SPRING RD STE 1 -
CARLISLE PA 17015-7451
44EVO,,-• Federal Mogul Settlement Proceeds
11'00440911' 1: b X30 254801: 007799ne
------------
Bailey
Bailey Peavy Bailey Asbestos IOLTA 4409
Estate of Ralph Rettberg 12/15/2014
Federal Mogul Settlement Proceeds 900.00
K
Westbound IOLTA-7 Federal Mogul Settlement Proceeds 900.00
Bailey Peavy Bailey Asbestos IOLTA 4410
Estate of Ralph Rettberg 12/15!2014
Harbison Walker Settlement Proceeds 29,126.64
Westbound IOLTA-7 Harbison Walker Settlement Proceeds 29,126.64
MOM 111 v qff.1'mTq3Ar,
.•
Bailey Peavy Bailey PLLC WESTBOUND BANK 4410
Asbestos IOLTA Westbound Bank-Katy
440 Louisiana,Suite 2100 Katy,TX 77492
Houston,TX 77002 88-2548/1130 ;12/15/2014
(713)425-7100
PAY TO THE Estate of Ralph Rettberg "29,126.64
ORDER OF
Twenty-Nine Thousand One Hundred Twenty-Six and
DOLLARS
A TAMPER RESISTANT TONER AREA A
Estate of Ralph Rettberg -
C/O George F. Douglas, III
Salzmann Hughes, P.C. ._
354 ALEXANDER SPRING RD STE 1 - -
CARLISLE PA 17015-7451 p
Harbison Walker Settlement Proceeds
1180044 L0111 1: 1130 254800: 00779911'
Bailey Peavy Bailey Asbestos IOLTA 4410
Estate of Ralph Rettberg 12/15/2014
Harbison Walker Settlement Proceeds 29.126.64
Westbound IOLTA- 7 Harbison Walker Settlement Proceeds 29,126.64
Bailey Peavy Bailey Asbestos IOLTA 4411
Estate of Ralph Rettberg 12/15/2014
-�" Raytech Settlement Proceeds 630.00
Westbound IOLTA-7 Raytech Settlement Proceeds 630.00
Bailey Peavy Bailey PLLC WESTBOUND BANK 4411
Asbestos IOLTA Westbound Bank-Katy
440 Louisiana,Suite 2100 Katy,TX 77492
Houston,TX 77002 88-2548/1130 12/15/2014 .. -
(713)425-7100
! PRYER of Estate of Ralph Rettberg $ **630.00
Six Hundred Thirty and 00/100+wwwwwwwwwww+ww+wwwwwwwwwwwwwwwwwww+wwwwwwwwwwwwww+++ww+www+wwwwwwwwwwww+++wwwwwwwwwwww«wwwwww
DOLLARS
A TAMPER RESISTANT TONER AREA A
Estate of Ralph Rettberg
C/O George F. Douglas, III
Salzmann Hughes, P.C.
354 ALEXANDER SPRING RD STE 1 — i
CARLISLE PA 17015-7451
; �rsa Raytech Settlement Proceeds -.-- !1 " —_ _pip
1100044 111" 1: l L 30 254801: 00? ?99ii'
__ � _ _ �_. i-.wa -- �.�:-- +....•.+.:...vas,✓...r..K.;..s�x-•_,._ ....+:- -2rsd,:.vaswa:v:.
Bailey Peavy Bailey Asbestos IOLTA 4411
Estate of Ralph Rettberg 12/15/2014
Raytech Settlement Proceeds 630.00
till
L
Westbound IOLTA-7 Raytech Settlement Proceeds 630.00
Bailey Peavy Bailey Asbestos IOLTA 4412
Estate of Ralph Rettberg 12/15/2014
US Mineral Products Company Settlement Proceeds 840.00
Westbound IOLTA-7 US Mineral Products Company Settlement Proce 840.00
/,Jut, - - -
Bailey Peavy Bailey PLLC WESTBOUND BANK 4412:
Asbestos IOLTA Westbound Bank-Katy
440 Louisiana,Suite 2100 Katy,TX 77492
88-2548/1130
Houston,TX 77002 12/15/2014
(713)425-7100
PAY TO THE Estate of Ralph Rettberg **840.00
ORDER OF
Eight Hundred Forty and
DOLLARS
Estate Of Ralph Rettberg A TAMPER RESISTANT TONER AREA A -
C/O George F. Douglas, III
..Salzmann Hughes, P.C. ?
354-ALEXANDER SPRING RD STE 1 !�
f
CARLISLE PA,17015-7451
'a*tiro US Mineral Products Company Settlement Proceeds
11'00441 be 1: 1 130 2 5 4801: 007799n,
-"rz��' -i -'iY�--- ___ —�:-Jv-av`�->c'�`.ae:%%os6G'.�rsa��.:-✓%+v`.Gi�Fa�i.:ra-�Yr'tiL'^ _ - _ _��
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Bailey Peavy Bailey Asbestos IOLTA 4412
Estate of Ralph Rettberg 12/15/2014
US Mineral Products Company Settlement Proceeds 840.00
'c
ti
Westbound IOLTA-7 US Mineral Products Company Settlement Proce 840.00
� c
WESTBOUND
BANK 5051
Bailey Peavy Bailey PLLC Westbound BaKy
Asbestos IOLTA Katy,TX 77492
440 Lou4Lana-Suite 2100 88-254811130
Houston,TX 77002 4/13/2015
(713)425-7100 --- --_--— —_. I
PAY TO THE Estate of Ralph Rettberg V� $ "3,514.17
ORDER OF —_ — --- ---- —
n
Three Thousand Five Hundred Fourteen and
DOLLARS
Estate of Ralph Rettberg '
C/O George F. Douglas, III
Salzmann Hughes, P.C.
354 ALEXANDER SPRING RD STE 1
CARLISLE PA 17015-7451.
MEMO A.P. Green Settlement Proceeds
11'00505 LII' 1: 1 130 2 54801: 00779911'
Bailey Peavy Bailey Asbestos IOLTA 5051
Estate of Ralph Rettberg 4/13/201.5-
A.P. Green Settlement Proceeds 3,514.17
Westbound IOLTA- 7 A.P. Green Settlement Proceeds 3,514.17
----F---1 ------i-------�---i-r------'
Q II I r I 1 � I 60-1503-313
E�m �I1oi I j I�1 �I S I I
LJy I i j I I TOTAL 101J-1
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0 0PA INT ON LAWYER TRUST ACCOUNT
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0 354 ALEXANDER SPRING ROAD, STE. 1
a CARLISLE,PA 17015
I: 500 1111 13 201: 108 1 10 3 201"
i'I!i1:!-�.l:��i��i 1111.11I:�I.,•.<'iI(t1-flVfll l�Jl:l�tl•'i:.li>1:11L111�!fall.l'H.II�/l�'�e", 1�f iNl ;11{1)1'.r.1 ,i,�;r,111:1!,\i 1:11CAL 111,A— N1 I'll,A11;.t. + 1f�111--:•!',Hli,':
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BaileyPeav BaileyPLLC WESTBOUND BANK 5052
y Westbound Bank-Katy
Asbestos IOLTA Katy,TX 77492
440 LoLIJ iana.R[[ite 2100 85-2548/1130
Houston,TX 77002 4/13/2015 I
(713)425-7100
PAY TO THE Estate of Ralph Rettberg $ *"360.00
ORDER OF ---
�7 Three Hundred Sixty and 00/100****„****,.**"*„*..*..*,,"*"*.***"*.******.,..*.*.,*."..**,****.**"*„**"**.**,*********."***,
DOLLARS
Estate of Ralph Rettberg
C/O George F: Douglas, III
L
Salzmann Hughes, P.C.
354 ALEXANDER SPRING RD STE 1
v CARLISLE PA 17015-7451
HAEMO H. K. Porter Asbestos Trust Settlement Proceeds —
11'00505 211' 1: 1 130 2 54801: 0077991"
r
Bailey Peavy Bailey Asbestos IOLTA 5052
Estate of Ralph Rettberg . 4/13/20.15
H. K. Porter Asbestos Trust Settlement Proceeds 360.00
Westbound IOLTA-7 H. K. Porter Asbestos Trust Settlement Proceed 360.00
--- ------------_
W 11 I j 1
60-1503-313
uJ i o Mj 5 j n I M TOTAL 1
-- �.I—'.- I— ! -------�----i----1---J"—i.----�--�-- PLEASE BESURE ALL ITEMS
--1----—'-- ----;- - l
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p PA INT ON LAWYER TRUST ACCOUNT
LL IOLTA ACCOUNT
0 354 ALEXANDER SPRING ROAD,STE. 1
a CARLISLE,PA 17015
1: 500 Lill 13 201: 1,08 1 10 3 2011'
1:11EI;1� A.:,II!IIII I+!"I",I, ,.I:I:LIAI11.11[.1,f.f 1".,S!f_.I-.Vit, t.l'I: Or ill[1::11 I'1'.nl1�1.A.-:.!"I,I ,11.1.i -r.il l E.r'ill —KI 1:.,1'�!
0 0 0 EXPLANATION OF LONG TERM DISABILITY BENEFITS
unum, If you have any questions, please call:
Angelea Errington-Cyr at 1.800.633.7479
Unum,is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
CLAIMANT Ralph M. Rettberg PAYMENT PERIOD
POLICY NUMBER 00069129-0001 PAYMENT DATE 09/05/2013
CLAIM NUMBER 0102749637 PAYMENT NUMBER 13141693
BEGIN DATE END DATE DESCRIPTION AMOUNT NOTES
06/01/2013 07/18/2013 Primary Social Security S 2,080-00
06/27/2013 06/27/2013 Survivor Income Benefit S 6,339.00
NET BENEFIT S 8,419.00
06/01/2013 07/18/2013 Overpayment Reduction -1 ,549-53
PAYMENT AMOUNT S 6,869.47
NOTES
1249-03 SAVE FOR YOUR RECORDS
::i**"—**'**'—"'****"****"*"**"*,*,*,,*",**,*"""**"*"***l,"*"","**"***""**"*,**"*",**'*"*""'*'***""""*"*'**"***...**"****.......**...*****.....*'*"**'**...*'***....**......*-**---
-44
0 1314169
Unum Life Insurance Company,of America 1'l 19
unum, Portland, Maine
Group Account Claimant *6,869 . 47**
.LAZER SPOT, INC. Ralph M. Rettbergs Amount
ay This
of
Valid After 90 Days
Bank of Claim Number Policy Number Date
`America 0102749637 — September 05.1, .2013
Pay; Six thousand eight hundred sixty nine dollars and 47 *cents,
Ralph Rettberg Estate IIII
Pay To
George F.Douglas III Esq
The Order
Of Salzmann Hughes PC
354 Alexander Spring Road
Ste 1
Carlisle, PA 17015,
SECURITY FEATURES INCLUDED.DETAILS ON BACK
110 13 11, 16 q 110 1:0 1 180044 51:00000006 7 7 3 7
AVOODFOREST
Sanking your way.. EVER'Y D.AY AND NIGHT!;'
Member FDIC
August 27,2013
Salzmann Hughes,P.C. Attorneys at Law
139 Carlisle St
Gettysburg, PA 17325
Re: Estate of Ralph M. Rettberg, Deceased
Date of Death:June 27, 2013
To Whom It May Concern:
Per your request dated July 16, 2013,Woodforest National Bank has researched our database
for any information regarding the Decedent. The following has been located and documentation
as requested is attached:
1. Accounts listed under Decedent:
a. Demand Deposit Account
i. Account number 1332338381("the Account")
ii. Balance as of 6/27/2013:$5,716.29
iii. Accrued interest as of 6/27/2013:$0.08
iv. Signatory(s): Ralph M. Rettberg
v. Date Account opened: 12/21/2011
vi. Payable on Death (POD) Beneficiary(s): None
b. .Demand Deposit Account
i. Account number 1332801701("the Account")
ii. Balance as of 6/27/2013:$618.74
iii. Accrued interest as of 6/27/2013:$0.15
iv. Signatory(s): Ralph M. Rettberg
v. Date Account opened:8/28/2012
vi. Payable on Death (POD) Beneficiary(s): David Rettberg
On July 21,2013,the Bank issued a cashier's check for$618.81 to the POD beneficiary for
Account XXX1701 and$6,278.01 to the Estate of Ralph M. Rettberg,Deceased for Account
XXX8381. The cashier's check was released to Mr. David Rettberg, Administrator of the Estate,
and the Accounts were closed. There will be no charge for this research.
If you need further assistance, please feel free to contact us at 832-375-2898.
Sincerely,
Woodforest National Bank
Legal Department
25231 Grogan's Mill Road,Suite 100•The Woodlands,Texas 77390•832-375-2898 Phone•832-375-3071 Fax
ROWE'S AUCTION SERVICE (RH 79L)
2505 Ritner Highway • Carlisle,PA 17015
Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L)
Auction Is Action Call "Rowe" For Satisfaction
SELLERS NAME h L P"t Nit. 2y'� DATE
ADDRESS F o c cj, =. -9SA,.canrz PHONE DL, 01 — (P-'5-575,
OTHER "'S r) d1 AUCTIONEER % 3 s
AUCTION DATE/LOCATION CC�U3 cft P4-- i-7 0 t S� CLERK %
DESCRIPTION OF MERCHANDISE
JL
I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise,goods and or property and have good title and the right to sell and that they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
title to the purchaser. I agr a to hold harmless the Auctioneers against any claims of the nature referred to in
this agreement.
AUCTION SIGNATURE SELLERS SIGNATURE
Total Sales (Clerking Tickets Attached) $ -I
Less Sale Expense:
3,� %Commission Auctioneer $
% Commission Clerks $
OTHER:
TOTAL SALE EXPENSE DEDUCTED $
t�
SELLERS NET $ �'� `�`4
Rowe's Auction Service
2505 Ritner Highway
Carlisle,Pa. 17015
717-215-1044 574-1008 249-1978
Oct. 21, 2013
To: George F. Douglas 111, Esquire
Salzmann Hughes PC
354 Alexander Spring Rd
Carlisle, Pa. 17015
From: Rowe's Auction Service
2505 Ritner Highway
Carlisle,Pa. 17015
Re: Ralph M. Rettberg Estate
Auction Total to Date $16,774.00
Less 35% Commission -5860.40
Less Hauling Personal Property from Trailer -250.00
Less Hauling Personal Property from Storage Unit -200.00
Less Clean Up Charge @ No. 99 Regency Ct. -150.00
Less Hauling Fee for Storage Shed -200.00
Less Hauling Fee for(8)Vehicles -480.00
Less Title Transfers from Sollenbergers -207.00
Less taxes for House Trailer -37.16
Less Trash Disposal Fee for Trailer, Storage Unit&Vehicles -350.00
Total Due to Date8982.34
*** We still have approximately 4 Auctions remaining for Personal Property
I
William G. Rowe
ROWE'S AUCTION SERVICE (R 11 7 9 1
Bill Row-e (AU 1538L) 2505Ritnerlfighway o Carlisle,PA 17015 Dave Rcmve (AU 2295L)
249-1978 215-1044 574-1008
Auction Is Action Call- "Rowe" For Satisfaction
SELLERS NAME !;!,,_—i DATE t Ael
ADDRESS eA, L i - t C'7 CIr Y
PHONE
OTHER AUCTIONEER
AUCTION DATEILOCATION CLERK %
DESCRIPTION OF MERCHANDISE
I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & grouped as necessary to obtain bids. I certify that I am the oiwner or authorized represen-
tative of the merchandise,goods and or property and have good title and the right to sell and that they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in
this agreement,
AUCTION' SIGNATURE SELLERS SIGNATURE
Total Sales (Clerking Tickets Attached) S 3 e q (9
Less Sale Expense:
5_5r T-o Commission Auctioneer $ t 3
%Commission Clerks
OTHER:
TOTAL SALE EXPENSE DEDUCTED S
SELLERS NET -S
Rowe's Auction Service
2505 Ritner Highway
Carlisle,PA 17015
717-215-1044 574-1008 249-1978
February 25, 2014
To: George F. Douglas 111, Esquire
Salzmann Hughes PC
354 Alexander Spring Rd
Carlisle, PA 17015
From: Rowe's Auction Service
2505 Ritner Highway
Carlisle, PA 17015
Re: Ralph M. Rettberg Estate
Enclosed,please find proceeds from the final two auctions for the Ralph M. Rettberg
Estate. Rowe's Auction appreciates your decision to use our services and to allow us to
sell the estate over a period of tim-.
Auction Totals $4852.00
Less 35% Commission -
Total Due $3153.81
William G. Rowe
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Rettberg, Ralph M. 21-13-0741
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE DA E ODE F^TRANSERSATTACH A COPY OFEREE THEIR F THE DEED FOR HIP TO REAL ESENTTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Woodforest National Bank, Demand Deposit Account 618.89 618.89
No. 1332801701 -POD to David Rettberg,son
TOTAL(Also enter on Line 7, Recapitulation) 618.89
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 EX+(08-13) SCHEDULE H
Pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Rettberg, Ralph M. 21-13-0741
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 3,730.26
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
David I M. Rettberg
Street Address 2640 Britany Circle
City Bedford State TX ZiD 76022
Year(s)Commission Paid Waived
2. Attorney's Fees Salzmann Hughes, P.C. 9,850.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 458.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 2,320.16
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 16,358.92
Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Rettberg, Ralph M. 21-13-0741
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Baughman Memorial Works, Inc.-lettering of monument 303.00
2 Hoffman-Roth Funeral Home&Crematory, Inc.-funeral services 3,427.26
H-A 3,730.26
Other Administrative Costs
3 George F. Douglas, III -reimbursement for filing fees 30.00
4 Regency Parks-August rent plus late fee 340.00
5 Reserve-closing costs to necessary to administer the estate including postage,tax 1,500.00
preparation fees and other miscellaneous expenses
6 Salzmann Hughes, P.C.-reimbursement for legal advertising in the Cumberland Law Journal 75.00
7 The Sentinel -legal advertising 200.16
8 Wells Fargo-safe deposit box drilling fee due to lost keys 175.00
H-B7 2,320.16
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE 1
n pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OFMORTGAGE LIABILITIES AND LIENS
RET
INHERITANCE TAXAXRETURRNN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Rettberg, Ralph M. 21-13-0741
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Carlisle Family Care-balance due on Account#937266 for medical services rendered prior 246.32
to death -paid to Apex Asset Management
2 Carlisle HMA Physicians Mgmt-medical services rendered prior to death 11.86
3 Carlisle Regional Medical Center-balance due for medical services ;Account No. 1342647 21.00
4 Carlisle Regional Medical Center-balance due for medical services payable to Paragon 445.51
Revenue Group; Reference#15613318
5 Colavecchi&Colavecchi -balance due on JMMMPC Company XXXVI Account 850.06
#418586416316; #15663
6 Consolidated Collection Service, Inc. -balance due on Account for Andrews and Patel 111.56
Associates,Account#56053
7 Cumberland Goodwill Fire Rescue EMS-ambulance services rendered prior to death-paid 1,570.68
to Commercial Acceptance Company
8 David Rettburg -reimbursement for payment to Capital Self Storage Mechanicsburg for 181.61
Units 01-00036,01-00037 and 01-00038
9 David Rettburg -reimbursement for payment to Frank Roberto,Tax Collector, 2013/14 real 25.62
estate taxes
10 Department of Public Welfare-last six months medical expense,Class 3 claim pursuant to 17,285.99
Section 3392 of the Decedents, Estates,and Fiduciaries Code,20Pa.C.S.A.3392(3)
11 Hospitalists of Central Pennsylvania-medical services rendered prior to death 134.35
12 Letort Warehouse-back rent owed for June 2013,check written prior to death cleared after 251.50
death
13 Letort Warehouses Inc. -July storage rent 75.00
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 10, Recapitulation) 25,308.57
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12)
pennsyLvarna
DEPARTMENT OF PUBLIC WELFARE
October 15, 2013
SALZMANN HUGHES PC
GEORGE F DOUGLAS III ESQ
STE 1
354 ALEXANDER SPRING RD
CARLISLE PA 17015
Re: Ralph Rettberg
CIS #: 530188957
SSN: ###-##-
- Date of Death: 06/27/2013
ESTATE RECOVERY STATEMENT OF CLAIM
Dear Attorney Douglas:
Under State and Federal law, the Department of Public Welfare (the Department) is
required to recover medical assistance (MA) reimbursement from the probate estates of
deceased individuals who were over age 55 when such assistance was received. 42 U.S.C.
§1396p(b)(1). 62 P.S. § 1412. This letter sets forth the amount of the Department's claim
against the estate of the above referenced individual and explains the obligations of
executors, administrators, and persons receiving estate property.
Although the amount in the estate may be considerably less than that which
is owed to the Department, our claim is against the estate, no one else.
Statement of Claim Amount
The Department maintains a claim in the amount of $17,285.99 against the
above-mentioned estate. This claim is for repayment of MA granted on behalf of the
decedent. Enclosed is the Department's itemized statement of claim.
A portion of this medical expense, namely $17.285.99, 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.S.A. 3392(3). The balance of the
claim, namely .00, is to be entered as a priority Class 5.1 claim against the estate. You
should refer to Section 3392 for a more complete explanation of the priority rules.
If a lawsuit is filed for injuries sustained by the decedent prior to death, then the
Department may also have a lien against the personal injury action. A statement of claim
for that injury-related lien must be requested separately.
Bureau of Program Integrity i Division of Third Party Liability I Recovery Section
PO Box 8486 1 Harrisburg, Pennsylvania 17105-8486
7 61
SALZMANN HUGHES PC URxS'TOWNBANKPmMcWn tr ksh=
ESTATE TRUST ACCOUNT A Tradition ofFrctaa
354 ALEXANDER SPRING ROAD,STE. 1 60-1503-313
CARLISLE,PA 17015
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4Y TO THE o
RDER OF DEPARTMENT OF PUBLIC WELFARE $ '-'17,285.99
Seventeen Thousand Two Hundred Eighty-Five and 99/100****** DOLLARS
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BUREAU OF PROGRAM INTEGRITY 8
DIV THIRD PARTY LIAB/REC SECT ' S#6101 6345 t
ATTN:ANGELA D. CARTER o
P.O.BOX 8486 ;'
MEMO HARRISBURG, PA 17105-8486 AUTHORIZEDSIGNATURE ➢11
LPHRETTBERG ESTATE/CIS#530188957-final pay
11'00 7 76 LI18 1:0 3 b 3 L 50 36e: LOS L LO 3 2011'
SALZMANN HUGHES PC/ESTATE TRUST ACCOUNT
7761
DEPARTMENT OF PUBLIC WELFARE 2/5/2015
Misc/RETTBERG, RALPH M. 17,285.99
1
Estate Trust Account RALPH RETTBERG ESTATE/CIS#530188957-final 17,285.99
SALZMANN HUGHES PC/ESTATE TRUST ACCOUNT
7761
DEPARTMENT OF PUBLIC WELFARE 2/5/2015
Misc/RETTBERG, RALPH M. 17,285.99
I
Estate Trust Account RALPH RETTBERG ESTATE/CIS#530188957-final 17,285.99
RODUCT SSLT104 USE WITH 91663 ENVELOPE
Rev-1512 EX+(12.12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Rettberg, Ralph M. 21-13-0741
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
14 Manor Care Health Services LLC-medical services rendered prior to death 1,412.99
15 Pinnacle Cardiology-medical services rendered prior to death-paid to Peerless Credit 152.95
Services, Inc.
16 PPL-balance due on account-paid to Penn Credit 282.02
17 Quantum Imaging and Therapeutic Associates-medical services rendered prior to death 7.60
18 Regency Parks -July rent 315.00
19 Salzmann Hughes, P.C.-preparation of Will, Living Will and POA on June 4,2013 400.00
20 The Hetrick Center-medical services rendered prior to death 56.00
21 Wells Fargo-safe deposit box overdue fee 125.00
22 West Shore Emergency Medical Services-medical services rendered prior to death 1,345.95
TOTAL(Also enter on Line 10, Recapitulation) 25,308.57
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1513 EX+(01.10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Rettber , Ralph M. 21-13-0741
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do o is tee s
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
David J.M. Rettberg Son 1/3rd Residue
2640 Britany Circle Per Item FOUR of
Bedford,TX 76022 the Will
Ivan W. Rettberg Brother Disclaimed
548 Miller Fork Lane interest in Tools
La Follette,TN 37766 as per Item
THREE of Will
Rachel M. Rettberg Daughter 1/3rd Residue
2805 S. 300 E. Per Item FOUR of
Salt Lake City, UT 84115 the Will
Ryan P. Rettberg Son 1/3rd Residue
506 E. Elm#5 Per Item FOUR of
Urbana, IL 61802 the Will
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
C:
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LAST WILL AND TEST� T y, `p
1, RALPH M. RETTBERG, of Carlisle, Cumberland County, k-erinsylvftia, bei - of
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sound mind, disposing memory and full legal age do hereby make, punish' are,
-Uish and de Ai�&to be
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my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me.
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ONE. I direct my Executor or Executrix, as the case may be, to pay all of my
debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore,
I direct that all state, inheritance, succession and other death taxes imposed or payable by reason
of my death and interest and penalties thereon with respect to all property composing of my gross
estate for death tax purposes, whether or not such property passes under this Will, shall be paid
by the Executor or Executrix of my estate. Further, to the extent that sufficient assets exist in my
estate, any and all inheritance or other estate taxes, whether to non-charitable or charitable
beneficiaries, shall be paid by my Executor or Executrix from the residuary of my estate prior to
distribution and no part of the taxes paid shall be prorated or apportioned among the persons or
beneficiaries receiving the taxable property regardless of tax rate applicable by law to each such
persons or beneficiaries.
TWO. My Executor or Executrix may, at his or her discretion, compromise
claims, borrow money, retain property for such length of time as he or she may deem proper;
lease and sell property for such prices, on such terms, at public or private sales, as be or she may
deem proper; and invest estate property and income without restriction to legal investments
unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell
any realty and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to good good and sufficient deeds and/or bills of sale
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therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and
empowered to engage in any business in which I may be engaged at my death, for such period of
time after my death as seerns,expedient to said Executor or Executrix.
THREE. I give, devise and bequeath all of my tools to my brother, IVAN W.
RETTBERG.
FOUR. I give, devise and bequeath the rest, residue and remainder of my estate to
be divided equally between my three children, DAVID J. M. RETTBERG, RYAN P.
RETTBERG and RACHAEL M. RETTBERG, per stirpes.
FIVE. If, tinder any of the provisions of this Will, any principal becomes vested
in a minor, my Executor or Executrix, as the case may be, including any administrator c.t.a., shall
have the discretion either to pay over such principal or any part thereof to any parent of such
minor, any guardian of the person or estate of such minor, or any person with whom such minor
resides, or to retain the same as trustee of a power in trust for the benefit of such minor during his
or her minority. Any of the principal thus retained, and any of the income therefrom, including
the whole thereof, may be paid to or applied for the benefit of such minor from time to time in
the discretion of the trustee of such power, Vvqieji such minor reaches majority, the hinds so held
shall be paid over to such person, or, if lie or she shall sooner die, to his or her legal
representatives. In so holding any principal or income for any minor, the trustee of such power
shall have all the rights, powers, duties and discretions conferred or imposed upon my fiduciaries
acting under this Will. I further direct that no bond shall be required from any person receiving a
payment hereunder and receipt from such person shall be a full discharge to the trustee of such
power who shall not be bound to see to the application or use of such payment. The trustee of
such power shall be entitled to cojiiinissions at the rates and in the manner payable to a
testamentary trustee.
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SIX. I nominate and appoint my son, DAVID J. M. RETTBERG, to be the
Executor of this my Last Will and Testament. In the event he has predeceased me, failed to
qualify or is not able or does not serve for whatever reason, I then appoint my son, RYAN P.
RETTBERG„ to be the substitute Executor of this my Last Will and Testament, whereby the said
substitute personal representatives shall have the same powers as are given to the original
Executor hereunder.
SEVEN. No person(s) shall benefit hereunder unless such beneficiary shall survive
me by sixty(60) days.
EIGHT. No Executrix, Executor, Guardian or Trustee acting hereunder shall be
required to post bond or enter security in this or any other jurisdiction.
NINE. No beneficiary may assign, anticipate or pledge his or her interest in any
income or principal held or distributable hereunder, and no beneficiary's creditors may levy,
attach or otherwise reach any such interest.
TEN. If any person or institution entitled to share in any distribution under the
terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest
the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its
entire interest inherited hereunder and all provisions in favor of such person or institution shall
be declared void and of no effect. The share of such person or institution so forfeited shall be
distributed as part of the residue hereof except that if such person or institution is entitled to
share in the said residue, that interest shall be distributed proportionately to the other residuary
distributees.
TH
IN WITNESS WHEREOF, I have hereunto set my hand and seal this C f day of
2013.
J , 6;4kkl �(SEAL)
RAL H M. RETTBERG
Signed, sealed, published and declared by the above-named person as and for a Last Will
and Testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
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ACKNOWLEDGMENT AND AFFIDAVIT
WE, RALPH M. RETTBERG, GEORGE F. DOUGLAS, 111, and
the testator and witnesses respectively, whose
names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testator signed and executed the instrument as his Last Will, and
that he had signed willingly, and that he executed it as his free and voluntary act for the purpose
herein expressed, and that each of the witnesses, in the presence and healing of the testator,
signed the Will as a witness and that to the best of their knowledge the testator was, at that time,
eighteen years of age or older, of sound mind and under no constraint or undue influence.
RACPH M. RETTBERG—
dEORGE F. DOUGLAS, III
WITNOf-
T
COMMONWEALTH OF PENNSYLVANIA
: SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by RALPH M. RETTBERG, the
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testator herein, and subscribed and sworn to before me by GEORGE F. DOUGLAS, 111, and
, witnesses, this day of 2013.
4
Notary Public
COMMONWMTH OF PENNSYMN
Nota"seal
rarnera S.siegrist,Notary PutAic
South Middleton Twp-,curnt>eriand county
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