HomeMy WebLinkAbout01-0323
PETITION FOR PROBATE and GRANT OF LETTERS
,;L 1- 6 (- 3;1,,3
Estate of MARY 'T', M~G~BO
also known as
No.
To:
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. I q J - 'f 2 - ., S- 8. q Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execu1Qr
in the last will of the above decedent, dated March 7,
and codicil(s) dated
Po IJ.r.If I'v.. C f2.() Ci-f'l ft t- & I ~ t::/J-C' P P
named
, 19--9.5.-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~l1mhprl;:ln(l County, Pennsylvania, with
last family or principal residence at 72 3 Shaffer Street, Enol a l PA
~
(list street, number and muncipality)
Decendent, then q 3 years of age, died March 12 ,21.~ 2001,
at 'iTi 1 ] a Teresa Nursing Hom@ .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
7' '..9-
$ ~ 10 Ot<. 0_ :-----
$ ,/
$
$
5 s;, 6o~ po-
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
theron.
(testamentary; administration c.La.; administration d.b.n.c.t.a.)
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389 Quail Hollow Road
Harrisburq, PA 17112
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ss
COUNTY OF l!;/m~r'r/tZ Ild J
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 represen-
tative(s) of the above decedent petitioner(s) will we nd truly administer the estate according to law.
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affirm. ed ~ncl subscribed
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No. 21-01-323
Estate of
MARY T. MAGARO
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MARCH 26, 2001 2HZ 7- 0 0 ~ 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 Ma r c h 7. 1 9 95
described therein be admitted to probate and filed of record as the last will of Mary T. Mag-aro
and Letters Testamentary
are hereby granted to . Andrew S. Merlina, Jr.
7J)a~ L~ :;<;~ ~1(, . t! a. ~.L;.-u; 11,.:I~
Register of Wills
FEES
Probate, Letters, Etc. ......... $ 115.00
Short Certificates(6 ) . .. . . . . . .. $ 18.00
~ .F;~rM.:r9.S..).. $ 9.00
JCP $ 5.00
TOTAL _ $ 147.00
Filed M!RCE .26... .400.1.... ......... .....
WilliRm J. PAtArs, Esql1irA
ATTORNEY (Sup. Ct. I.D. No.) 09983
2931 North Front Street
ADDRESS Harrisburg, PA 17110
(717) 238-7555
PHONE
MAILED LETTERS TO ATTORNEY MARCH 26, 2001
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H1f)C;.:::l0C; R..FV ql.Q,(..
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul): filed with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
HEM #
Si-IOULD READ AS FQLLOWS:
,4. ( 91..1~' ~
.61.1./1') ,4~ k? .
No.
a-,~~
Local eglstrar .
Fee for this certificate, $2.00
p
7294930
\~iM'\ 2 3 200\
Date
a-v~~
"- ~ov. 2/87
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
NAME OF DECEDENT (F'" ..idtte, lOll)
..Mary T. Magaro
AGE (l.. BWlhday! UNOEA . YEAR
_ o.p
UNDER. OIl\'
-llotlnul.
SEX
Ifemale
STAfE FILE NUM8EA
SOCIAL seCURITY NUMBER
..191 42 9583
IlIRTHPLACE (City _ Pl.<CE OF OER'H IChecl< only """ _ _uct..,.,. on _ ~
SloJe or Foreogn Counuy) HOSPITAl.; OTHER:
7.owellspX~lle 1,:,...0 ::::;:OCQI
FACIUTV NAME (II no! .nstiIuIion. QlVtI.1eI and nomber)
Dauphin
DECEDENT'8 USUAl.. OCCUIWlON
~..=:~~.:::~.,.
"..Houseduties 11b.
DECEDENT'S MMJNG _ss (SIr"', c....li>wn, _, lIpC_1
Villa Teresa Nursing Ho.
105 I Avilla Rd.
...Lowe r Pax t on
KINO OF IUSlNESS/lNDUSTAY
DECEDENT'S
ACTUAl
RESIDENCE
(See II\Ib'UCbClfW
on om8f SlOe)
'1.
17.._
Pa.
1Wp.
'lb. Ccu
'TO.o :... ""::"::: of
MOTHER.S NAME IF.., MNldlo, M8KlonSurI1llme)
...Josephine Magnelli
INFORMANT"S MAlUNO ADDRESS (Soreet, CjtyI!Own, _, 2'", C_I
.1389 Quayle Hollow Rd. Harrisburg, Pa.
PlACE OF DISPOSITION. N....of Como'Oty, c,_ lOCAnON. C~. Stol.. Zip ~
Of Other PIac.
Holy Cross Cemetery Lower Paxton Twp.
ate. Ztcl,
cilylboro.
171 12
] 5,
2001
Pa.
PART II: 0Ih0r",-, _COlOrlbulfngIO_....
not NIUIting in tM undIrtying C8UH g;.. in PART I.
lb.
c.
.
DUE TO (OR AS A CONSEOUENCE Of):
DUE TO (OR AS A CONSEQUENCE Of):
WERE AUTOPSY fINDINGS MANNER OF DEATH
_LAlllE PAIOR TO ~
COMPlETION CE CAUSE D
OF DEATH? ........ Homicide
-- D Pending __Ion D
...0 NoD - D Could not be determined D
DATE OF INJURY
(Month, Qey, 'lItar)
TIME OF INJURY
INJURY II.f WORK? DESCRIBE HOW INJURY OCCURRED.
..... D NoD
.....
~ER ICheck only one)
-C8I1'IFYINQ PHYSICIAN (PhytlClan C8f1lfy~ cause 01 death wheo anoth8f phVSlCian has prOf1OlJnced death and ccmpleted Item 23)
To.......o..ny knowIedge.....OCCurred due 10 Ihe QUH(.).nd manner a 1ItMed. .... .......,.. ...."...",....................
D.
. ....
PlACE Of INJURV . At home. farm, II"", factory. otftce
bWldlng. .... ISpecoIy)
_.
'MEIIlCAI. EXAMINER/CORONER
On.... buIa ot..aminatton anellOI' lnv.ltlgatton, In my opinion, d.ath occurred It the time. da'" and place, and due to the cau"(I) and
mann.,....ltecI..........,.",.....,............,..,.........................,....,.....,.,............... _......
31..
REGISTRAR'S SIGNATURE AND NUMBER
I~/I~//I
(!t
I'll tJ '1
-ttfIONOUNClNG N40 CERTIFYING PHYSICIAN (PhVSlClan boIh prooouoclI"Ig death ana clK1if'y!nQ 10 cause 01 dealhl
To the........, knowledge, .... occurred II the........ ate. and pIKe. and.,. 10 the CMIM(I) and manner _ alated., . . . . . . . . . . . . . . . . . . . . , . . .
...
\
21-01-323
LAST WILL AND TESTAMENT
OF
MARY T. MAGARO
I, MARY T. MAGARO, of East Pennsboro
Township, Cumberland COlmty, Pennsylvania, declare this
to be my last will and revoke any will previously made
by me.
ITEM I. I direct that all my just debts and
funeral expenses, including my gravemarker and all
expenses of my last illness, shall be paid from my
resid11ary estate as soon as practicable after my
decease as a part of the expense of the administration
of my estate.
ITEM II. I devise and bequeath all of my
estate, of every nature and wherever situate to my
daughter, Norma M. Crognale, providing she shall
survive me by thirty (30) days.
ITEM II. Should my daughter, Norma M.
Crognale, predecease me or die on or before the
thirtieth day following my death, I devise and beq11eath
all of my estate of every nature and wherever siblate
to my issue per stirpes living on the thirty-first day
following my death.
ITEM III. I appoint Andrew S. Merlina, Jr.,
gllardian of any property which passes either under this
will or otherwise to a minor and with respect to which
I am authorized to appoint a gnardian and have not
otherwise specifically done so, provided that this
appointment of a guardian shall not supersede the right
of any fiduciary in its discretion to distribute a
share where possible to the minor or to another for the
minor's benefit. Such guardian shall have the power to
llse principal as well as income from time to time for
the minor's support and education (including college
education, both graduate and undergraduate) without
regard to his or her parent's ability to provide for
such support and education, or to make payment for
these purposes, without further responsibility, to the
minor or to the minor's parent or to any person taking
care of the minor.
Should Andrew S. Merlina, Jr., predecease me
or cease to act as guardian, I appoint Joseph F.
Merlina, guardian of this my Last Will and Testament.
ITEM V. I direct that all taxes that may be
assessed in consequence of my death, of whateve nature
and by whatever j11risdiction imposed, shall be paid
from my residuary estate as a part of the expense of
the administration of my estate.
-2-
ITEM VI. I appoint my daughter, Norma M.
Crognale, executrix of this my last will. Should my
da1lghter, Norma M. Crognale, fail to qualify or cease
to act as executrix, I appoint Andrew S. Merlina, Jr.,
executor of this my last will.
ITEM VII. I direct that my executrix or
gllardian or their Sllccessors shall not be required to
give bond for the faithful performance of their duties
in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my
hand this I ~ day of .~ , 1995.
~4jjfl!a~~~vU ~
ary_ agaro
The preceding instrument, consisting of this
and two other typewritten pages, identified by the
signat1lre of the testatrix, was on the day and date
thereof signed, published and declared by Mary T.
Magaro, the testatrix therein named, as and for her
last will, in the presence of us, who, at her request,
in her presence and in the presence of each other, have
subscribed our names as wit~ hereto.
U~ _ -~ ~
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-3-
. .
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'. .
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
)
We, Mary T. Magaro, (j); Ihw(h ,1. Mic- v:::'
and LQ::\'" T (:A:f..(>J~ 'f
respectively, whose names are signed to the
, the testatrix
3MY1~ A. Lu"'J
and the witnesses,
attached or foregoing instrument, being first duly sworn, do
hereby declare to the undersigned authority that the testatrix
signed and executed the instrument as her last will: that she had
signed willingly: that she executed it as her free and voluntary
act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testatrix, signed
the Will as witness and that to the best of their knowledge the
testatrix was at that time eighteen (18) years of age or older,
. /<.
Testatr1x,
of sound mind and under no constraint or undue influence. .
residing at 7-:( 3 J~/1/JJ~/ ~ I
~~~I p:r-fj 7/JdS--
residing at
residing at ~ /A
residing at ~'l~ g
Witness,
Witness,
Witness,
Subscribed, sworn to and acknowledged before me by
Mary T. Magaro, the testatrix, and subscribed and sworn to before
me by (2). II id.J{Y) J: -U--k:.v "') {AMnO.:"3 ~4. lo..JII\q and
J
1\ ncL. .T (<)(V(Y\ b{/t witnesses, this -;IT;;" day of 7JlA )},/,JLI
i
1995.
!). L'
, . . 1 ,:
t ti-J 11. A ,y ~ ' U3-J{;
Notary Pub ic
,
NOTARIAL SEAL
P. KATHRYN SWARTZ, Notary Public
Harrisburg, Dauphin County
M Commission Ex ires March 30 1995
!
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--
CERTIFICATE OF MOTICE UMDER RULE 5.6(a)
NAMe Oil DECEDENT: Mary T. Magaro ESTATE I 21-01-0323
DATE OF DEATH: March 12, 2001 WILL or ADMINISTRATION will
To the Register:
I certify that notice of benefici~l interest required by Rule 5.6(a)
of the Orphans' Court Rules was served on or .ailed to the following
beneficiaries of the above captioned estate. on April 3, 2001
Na.e Address
Robin Sheriff
10 Vir.tnr Drive. Mechanicsburq, PA 17055-2914
Robert Croanale
Rqht:\ 'R"";~'JOf'"'''''f"'\C'c nr;'t7~r lTRr!k~(')n't;"p, FT. 32244
Notice has been given to all persons entitled thereto under Rule 5.6(a}
except
N/A
Date:
It - Lr -' 61
( . \.A 1. I - 'dJ. e. )
Slgnrlure." ~
Na..William J. Peters, Esquire
Address 2931 North Front Street
Harrisburg, PA 17110-1280
Telephone
(717 )238-7555
.
Capacity:
Personal Representative
Counsel for Personal Representati
- -'
". ;.'
x
PETERS & WASILEFSKI
ATTORNEYS AND COUNSELORS AT LAw
2931 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17110-1280
WilLIAM J. PETERS
CHARLES E. WASllEFSKI
DENNIS J. BONETTI
JOSEPH C. PHilliPS
MICHAEL R. BONSHOCK
THOMAS A. lANG
STEPHEN F. MOORE
SCOTT M. SCHWARTZ
TELEPHONE (717) 238-7555
FAX (717) 238-7750
E-Mail Addresses:
pwlaw@pwlegal.com
WEB SITE: www.pwlegal.com
January 18, 2002
Mary C. Lewis, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, Pennsylvania 17013-3387
Re: Estate of Mary Mae:aro
Our File No: 31-34
Dear Ms. Lewis:
Please find enclosed a check in the amount of $25.00 for ftling of the Inventory and
Inheritance Tax Return in the above-captioned matter. I am enclosing an extra copy of the
Inventory and Inheritance Tax Return. Please time stamp each document and return them to me in
the self-addressed, stamped envelope provided.
Thank you for your time and attention to this matter. If any additional information. is
needed, please do not hesitate to contact me.
f ~:~~~~~
...~.v ~
William J. Peters "
WJP/mmk
Enclosure
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Register of Wills of Cumberland County, Pennsylvania
~'
INVENTORY
Estate of Mary T. Maqaro
No. 2001-
00323
, Deceased
Date of Death March 12, 2001
Social Security No. 191-42-9583
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe
verify that the statements made in this inventory are true and correct. INVe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities.
Personal Representative:
Name of
Attorney: William J. Peters, Esquire
1.0. No.: 09983
Address: 2931 North Front Street
Harrisburq
Telephone: 717-238-7555
Andrew S. Merlina, Jr.
Dated
.I
~
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I
PA 17110
Description
Real Estate located at Lot 13, Plan of No. 1 Gatesway Townhouses, Plan
Book 38, Page 144, Cumberland Cty. known and numbered as 723 Shaffer
Street, Enola, Cumberland, County, Pennsylvania
AIIFirst Bank, Harrisburg, Pennsylvania
Checking Account No. 5966-5475-99
Value
60,433.70
6,895.90
Metlife - Life Insurance
Policy No. 806509421472
1,283.08
Metlife - Life Insurance
Policy No. 611263837MS
5,058.40
Reimbursement of Utility Bill
19.64
Total
(Attach Additional Sheets if necessary)
73,690.72
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG, PA 171Z8-D6Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
.02 liAY -3
",11 :20
WILLIAM J PETERS ESQ
PETERS S WASILEFSKI
2931 N FRONT ST
HBG
Cc;
PA 1~~i1'ij:"0300
04-29-2002
MAGARO
03-12-2001
21 01-0323
CUMBERLAND
101
Allount Rellitted
'*
REV-1547 EX iFP 101-021
MARY
T
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 ~
REV=is'4i-EX--AFP-foY':oZY-NcfficE--OF-YNHEifiTANCE-TAsrjrpPRAisEMiNT~--Ar:rOWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX I
ESTATE OF MAGARO MARY T FILE NO. 21 01-0323 ACN 101 DATE 04-29-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
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)
~. 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
( ) CHANGED
U)
(2)
(3)
(~)
(5)
(6)
(7)
60.433.70
.00
.00
.00
13.257.02
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
l~. Net Value of Estate Subject to Tax
(9)
UO)
13,234.63
100.738.20
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
73,690.72
(11)
(12)
(13)
(1~)
113.972 83
40,282.11-
.00
40,282.11-
NOTE: I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line l~ at Spousal rate
16. Allount of Line l~ taxable at Lineal/Class A rate
17. Allount of Line l~ at Sibling rate
18. Allount of Line l~ taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(5) .00 X 00 = .00
(6) .00 X 045 = .00
(7) .00 X 12 = .00
(18) .00 X 15 = .00
(19)= .00
AMOUNT PAID
DATE
n..........
NUMBER
(+)
INTEREST/PEN PAID (-)
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.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.)
FIRST AND FINAL ACCOUNT OF
Andrew S. Merlina, Jr., Executor
For
ESTATE OF Mary T. Ma2aro. Deceased
Estate File Number
Date of Death
Place of Death
Date of Advertisement of Estate Letters
Cumberland Law Journal
The Evening Sentinel
Date of Executors Appointment
Principal of Personal Estate
Principal of Converted Real Estate
Total Principal Receipts
2001-00323
March 12,2001
East Pennsboro Township, Cumberland County
April 13,20,27,2001
April 7, 14,21,2001
March 26,2001
$13,257.02
$60,433.70
$73,690.72
Purpose of Account, Andrew S. Merlina, Jr., Executor, offers this account to acquaint interested
parties with the transactions that have occurred during his administration.
The account also indicates the proposed distribution of the estate.
It is important that the account be carefully examined. Requests for additional information or
questions or objections can be discussed with:
Andrew S. Merlina, Jr., Executor
1389 Quail Hollow Road
Harrisburg, Pennsylvania 17112
OR
William J. Peters, Esquire
2931 North Front Street
Harrisburg, Pennsylvania 17110
717-238-7555
STATEMENT OF ACCOUNT
ANDREW S. MERUNA, JR.
.EXECUTOR OF THE
ESTATE OF MARY T. MAGARO
Personal ProDertv
Allfirst Checking Account
Met-Life Life Insurance
Met-Life Life Insurance
Reimbursement of Utility Bill
Total Income
Real ProDertv
Real Estate located at 723 Shaffer Street
Encla, Cumberland County, Pennsylvania
Total PrinciDal ReceiDts
Disbursements
Richardson Funeral Home
Our Lady of Lourdes
Administrative Costs (Andrew S. Merlina, Jr.)
Attorney's Fees (Peters & Wasilefski)
Reimbursement to Andrew Merlina
Cumberland County Law Journal
The Sentinal
Pennsylvania Water Company
PPL -Electric
Villa Theresa - Hospital Bill
Pennsylvania American Water Company
PPL -Electric
Jane Biddle - County Tax 2001
East Pennsboro Township Sewer
Remax Realty - Realtor Commission
Notary for Sale of Real Estate
1 % Transfer Tax for sale of Real Estate
Total Disbursements
ProDosed Distribution to Beneficiaries
02/28/95
04/09/01
04/06/01
04/06/01
04/06/01
04/16/01
05/03/01
05/09/01
04/06/01
04/16/01
6,895.90
$1,283.08
$5,058.40
$19.64
$13,257.02
$60,433.70
$73,690.72
$3,384.00
$257.00
$4,401.00
$4,893.00
$147.00
$75.00
$77.63
$9.86
$60.32
$906.31
$15.60
$35.54
$197.55
$87.75
$1,800.00
$5.00
$600.00
$16,952.56
$0.00
ProDosed Distribution for Administrative EXDenses
Executor's Commission - Andrew S. Merlina, Jr.
Attorney's Fees (Peters & Waslefski)
$4,401.00
$4,893.00
$60,122.60
ProDosed Distribution to the DeDartment of Public Welfare
(See Department of Welfare Notice of Claim attached as Exhibit nAn
and acceptance of proposed sum by the Department of Public
Welfare attached as Exhibit B
Insolvent Estate:
All monies in excess of funeral expenses and Administrative
Costs to be paid to the Pennsylvania Department of
Public Welfare for Restitution for Medical Assistance
granted on behalf of Decedent.
EXHIBIT A
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG. PA 17105-8486
April 23, 2001
PETERS & WASILEFSKI
WILLIAM J PETERS ESQUIRE
2931 NORTH FRONT ST
HARRISBURG PA 17110-1280
Re: MARY MAGARO
CIS #: 680141633
Co/Rec: 22/0219066
Date of Birth: 09/03/1907
SSN: 191-42-9583
Dear Attorney Peters:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $97.020.27 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 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $19.240.96 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 $77.779.31 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. If the estate contains
real estate, please provide copies of the deed and the latest tax assessment.
Sincerely,
'-A~ ~.L
Linda C. Price
Claims Investigation Agent
717-772-6741
717-705-8150 FAX
Enclosure
EXHIBIT B
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
TPL SECTION CASUAL TV UNIT
PO BOX 8486
HARRISBURG, PA 17105-8486
October 10, 2001
PETERS & WASILEFSKI
WILLIAM J PETERS ESQUIRE
2931 NORTH FRONT ST
HARRISBURG PA 17110-1280
Re: MARY MAGARO
CIS #: 680141633
Incident Date: 03/12/2001
Dear Attorney Peters:
Thank you for your correspondence dated October 5, 2001. I have
reviewed the information and everything appears to be in order. The
Department of Public Welfare will accept $60,122.60 as payment in full for
its medical assistance lien as long as no other assets are found in the
future.
Sincerely,
~~~.L
Linda C. Price
Claims Investigation Agent
717-772-6741
717-705-8150 FAX
~
FIRST AND PiNAL ACCOUNT
AND SCHEDULE OF PROPOSED DISTRIBUTION
OF
ANDREW S. MERLINA, JR., EXECUTOR
IN THE ESTATE OF
MARY T. MAGARO, DECEASED
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LATE OF EAST PENNSBORO TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLANIA
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ESTATE FILE NO: 2001-00323
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William J. Peters, Esquire
Attorney of Record
I hereby certify that written notico of the filing of I n~ieby cortify tMl wrlt10n not!'Xl of the flUng of this
this Aocount. and of the date, time and place " Swerr~ of Proposed OIsttIbution. and ~ the data,
Nnen the same wiU be preeentecl to ~ Court time and place when the same will be ",see. IMd kl
'or oonikmatton and of ~ last day to file written the Court for cou.fmelion en:! of Ile I8It ~ to tie
vOjectlonS to said Aocount. has been given \0 written objecticlI'lI to IlIid Sill t Ml~ ~ Propoeed
t1very unpaid cI8knent and \0 evefy ot~ perlOO DiWI:lulIor" h8I been gNen to ..., unpeId cteimant
l<nown to the aooountant to have Of cI8tm an and to 8Y8fY 0Iher pnon known to the acoouneent to
---Altoi' ....~ heYI!t or eIalm an inlil!Jr8St In the estaI8 as c:MlItor
interest In ~ estate as \;ItnJ ,L1<"I"""~1'
f kin ~. h9lr Of' (Y.l.)it of Idn. . heir or next 0 . A COfjy of ~aid Statement was lnduded with the notlce
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STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WillS, COUNTY OF Cumberland , PENNSYLVANIA
Name of Decedent: Mary T. Magaro
Date of Death:
3/12/01
2001-00323\
File No.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to the completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
YES X
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~ NO_
b. The separate Orphan's 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?
YES_ NO_
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may
be filed with the Clerk of the Orphans' Court and may be attached to this report.
Date:
2 - J'i-O}
W-o: ~
Signature
William J. Peters. Esquire
Name (Please type or print)
2931 North Front Street
Address
Harrisburg
-
PA 17110
717-238-7555
Tel. No.
Capacity: _ Personal Representative
--L Counsel for personal representative
..
Cumberland County - Register Of wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/07/2003
ANDREW S MERLINA JR
1389 QUAIL HOLLOW ROAD
HARRISBURG, PA 17112
RE: Estate of MAGARO MARY T
File Number: 2001-00323
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS I COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 3/12/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc: j File
Counsel
Judge
REV-1500 EX+ (S-OO)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 260601
HARRISBURG. PA 17126-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDlE INITIAL)
DATE DF BIRTH \MM-oo.Vear)
[R) 1. Original Retum
o 4. Limited Estate
[R) 6. DecedentDied Testate 1_'"'''''''')
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise {daleddealh after 12-12-&2)
o 7. Decedent Maintained a Living Trust (Attacll copy of Trust)
o 10, Spousal Poverty Credn (dale ofdeatll between 12-31-91 and1-1..gs)
OFFICIAL USE ONLY
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03 12 2001 09 03 1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INiTIAl)
NA
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FIlE NUMBER
.el' -...a.L _~~l6...~
COUN~ YEAR NUMBER
SOCIAL SECURJTY NUMBER
191-42-9583
TIllS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURJTY NUMBER
o 3. Remainder Retum (daleofcleathpriorkl12-13-82J
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Depos~ Boxes
o 11.ElectiontotaxunderSee.9113{A)_',",0)
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COMPLETE MAILING ADDRESS
2931 North Front 5treet
NAME
William J. Peters E uire
FIRM NAME (If Applicable)
Peters & Wasilefski
TELEPHONE NUMBER
717-238-7555
Harrisbur
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X .12 (17)
X .15 (16)
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
60.433.70
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PA 17110
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortyages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Scheduie E)
6. Joint~ Owned Properly (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
6. Total Gro.. As.... (total Lines1-?)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Deceden~ Mortyage Liabilities, & Uens (Schedu~ I)
11. Total Deduction. (lotalUnes 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts forwhk:h an eleclion to lax has not been
made (Schedule J)
(6)
(7)
(9)
(10)
14. Net Value Subject \0 Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal lax
rate, ortransiers under See. 9116 (a}(1.2)
16. Amount ot Line 14 taxab~ at lineal rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
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73.690.72
13.234.63
100.738.20
(11)
(12)
(13)
113.972.83
-40.282.11
(14)
-40.282.11
Decedent's omplete Address:
STREET ADDRESS
723 Shaffer Street
CITY I STA1E I ZIP
Enola PA 17025
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Tax Payments and Credits:
1. TaxDue(PagelUneI9) (I)
2. Credils/Payments
A. Spousal Poverty Credit
6. Pnor Payments
C. Discount
Tolal Credits (A +6+C) (2)
3. InteresVPenalty W applicable
D.lnteresl
E. Penally
T otallnleresVPenally ( 0 + E ) (3)
4. If Line 2 is greater than Une 1 + Une 3, enlerthe difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is grealer than Une 2, enler Ihe diffOfOnce. This Is the TAX DUE. (5)
A. Enter the interesl on the tax due. (5A)
6. Enler the total of Line 5 + 5A This is the BALANCE DUE. (56)
Make Check Payable to: REGISTER OF WILLS, AGENT
illlillliM.I_iMI_. liilllillll.iII-~lIillllllllrlllFiHr'l.illlllll illl'~" i ..111111111..111.
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 lransferred; ........................................................................... 0 ~
b. retain the nghl to deslgnalewho shall use the property transferred or its income; ........................................ 0 ~
c. retain a reversionary interest; or ...................................................................................................... 0 1Zl
d. receive the promise for life of eilher payments, benefits or care? ............................................................. 0 ~
2. If death occurred after December 12, 1962, did deceda11t transfer property within one year of death
without receiving adequale consideralion?............. ....................................... .......... .... .................. .......... 0 IE]
3. Did decedenl own an 'in trustfo~ or payable upon death bank account or secunly at his or herdealh? ................. 0 ~
4. Did decedent own an Individual Retiremenl Accounl, annuily, or other non-probate property which
conlains a beneficiary designation? ....................................................................................................... 0 IE]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjU'Y, I declare thai I have examined this return, includi~ ~ying schedules and statements, and to the best of my knowledge and belief, it is !rue, correct and complete.
Declorcmn of prepanl!r other thal the personal representative is based on all Information of which preparer has any knowledge.
SIGNATURE OF R N RESPONSIBLE FOR FILING RE RN DATE
ADDRESS ndrew S. Merlina
1389 Ouail Hollow Road. HarrisburQ.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
PA 17112
DATE
ADDRESS William J. Peters, Esquire
2931 North Front Street. Harrisburq PA 17110
_~_~__~_,__"IfJ.L.J". .,.,."'...d,~.,'__,,_~~,a;;Jlc .___1 ill ..LI-'" llil:l.
For dates of death on or after July 1, 1964 and before January 1, 1995, Ihe lax rale imposed on the net value of transfers 10 or for the use of Ihe surviving spouse is 3%
(72 P.S. ~9116 <a) (1.1) (i)].
For dales of death on or after January 1, 1995, the tax rate imposed on the nel value of transfers to or for the use oflhe surviving spouse is 0% (72 P.S. ~9116 (a) (1.1) (iill.
The statule does nol exemot a transfer 10 a surviving spouse from lax, and the slatulory requiremenls for disclosure of assets and filing a tax retum are still applicable even if
Ihe surviving spouse is the only beneficiary.
For dates of dealh on Dr after July 1, 2000:
The lax rale imposed on the net value of Iransfers from a deceased child twenty-<lne years of age or younger at death to Of for the use of a natural parent, an adoptive parent,
or a slepparent 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 beneficianes is 4.5%, excepl as noled in 72 P.S. ~9116(1.2) (72 P.S. ~9116(a)(1)].
The lax rale imposed on the net value of Iransfers 10 or for the use of the decedenl's siblings is 12% (72 P.S. ~9116{a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has alleasl one parenl in common with Ihe decedent, whether by blood or adoption.
~'~~'I"" '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETlRN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Maaaro MaN T
Indude the proceeds 01 litigation and the date the proceeds were received by the eslate. All property jolntly-owned with the right.' survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Allfirst Bank, Harrisburg, Pennsylvania 6,895.90
Checking Account No. 031300834-5966-5475-99
2 Metlife - Life Insurance 1,283.08
Policy No. 806509421472
3 Metlife - Life Insurance 5,058.40
Policy No. 611263837MS
4 Reimbursement of Utility Bill 19.64
TOTAL (Also enter on line 5, Recapitulation) $
(if more space is needed, insert additional sheets of the same size)
13 257.02
~""EX..I'~I.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Manaro MaN T
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Richardson Funeral Home, Inc. 3,384.00
2 Our Lady of Lourdes - Luncheon and Service 257.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Andrew 5. Merlina. Jr. 4,401.00
Sodal Security Numbeljs) I EIN Number of Personal Represenlative(s)
Street Address 1389 Quail Hollow Road
City Harrisburq Slate PA Zip 17112
Year(s) Commission Paid: 4,401.00
2. Attorney Fees 4,893.00
3. Family Exemption: (If decedents address is not the same as daimanfs. attach explanation)
Claimant
Streel Address
City Slate Zip
Relationship of Claimant to Decedenl
4. Probate Fees
5. Accountants Fees Reimbursement to Andrew 5. Merlina for advancement of Probate fees 147.00
6. Tax Return Prepare~s Fees
7. Cumberland County Law Journal 75.00
The Sentinel - Legal 77.63
TOTAL (Also enler on line 9, Recapitulation) $ 13 234.63
(If more space IS needed, Insert additional sheets of the same size)
. ~l"m~I:$1 .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE 1AX RE1URN
RESIOENT DECEDENT
ESTATE OF
Maaaro Marv T
Include unrelmbursed medica' expenses.
ITEM
NUMBER
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
DESCRIPTION
AMOUNT
1.
Pennsylvania Water Company
9.86
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
PPL - Electric
60.32
Villa Theresa - Hospital Bill
906.31
Pennsylvania American Water Company
15.60
PPL Electric
35.54
Jane Biddle, Treasurer
County Tax 2001
197.55
East Pennsboro Township Sewer
87.75
Remax Realty Professionals, Inc.
Realtor Commission
Sale of 723 Shaffer Street, Enola, Pennsylvania 17025
Notary for Sale of Real Estate
1,800.00
5.00
1% Transfer Tax
Sale of Real Estate
600.00
Department of Public Welfare
Medical Assistance Class 3
19,240.96
Department of Public Welfare
Medical Assistance Class 6
77,779.31
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
100 738.20
'~'''''':''.n .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
"~n,T
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (Include outright spousal distributions)
1. Insolvent Estate 60,122.60
Balance of Funds to be paid to the Commonwealth of
Pennsylvania Department of Public Welfare
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL OISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
S. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
, .
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.
LAST WILL AND TESTAMENT
OF
MARY T. MAGARO
I, MARY T. MAGARO, of East pennsboro
Township, Cnmberland COlmty, Pennsylvania, declare this
to be my last will and revoke any will previo1lsly made
by me.
ITEM I. I direct that all my just debts and
funeral expenses, including my gravemarker and all
expenses of my last illness, shall be paid from my
resid11ary estate as soon as practicable after my
decease as a part of the expense of the administration
of my estate.
ITEM II. I devise and bequeath all of my
estate, of every nature and wherever situate to my
daughter, Norma M. Crognale, providing she shall
sllrvive me by thirty (30) days.
ITEM II. Should my daughter, Norma M.
Crognale, predecease me or die on or before the
thirtieth day following my death, I devise and beq1leath
all of my estate of every nature and wherever situate
to my issue per stirpes living on the thirty-first day
following my death.
t
~
ITEM III. I appoint Andrew S. Merlina, Jr.,
gnardian of any property which passes either ,mder this
will or otherwise to a minor and with respect to which
I am a11thorized to appoint a gnardian and have not
otherwise specifically done so, provided that this
appointment of a guardian shall not supersede the right
of any fidnciary in its discretion to distribute a
share where possible to the minor or to another for the
minor's benefit. Such guardian shall have the power to
l1se principal as well as income from time to time for
the minor's s11pport and edncation (incl11ding college
education, both gradnate and undergradnate) withont
regard to his or her parent's ability to provide for
such support and eduoation, or to make payment for
these pnrposes, without fnrther responsibility, to the
minor or to the minor's parent or to any person taking
care of the minor.
Should Andrew S. Merlina, Jr., predecease me
or cease to act as guardian, I appoint Joseph F.
Merlina, guardian of this my Last Will and Testament.
ITEM V. I direct that all taxes that may be
assessed in consequence of my death, of whateve natnre
and by whatever j11risdiction imposed, shall be paid
from my residnary estate as a part of the expense of
the administration of my estate.
-2-
ITEM VI. I appoint my daughter, Norma M.
Crognale, executrix of this my last will. Shollld my
dallghter, Norma M. Crognale, fail to qualify or cease
to act as executrix, I appoint Andrew S. Merlina, Jr.,
execlltor of this my last will.
ITEM VII. I direct that my executrix or
~Iardian or their successors shall not be reqllired to
give bond for the faithful performance of their d'lties
in any jurisdiction.
hand this
IN WITNESS
----, Lr
I day
WHEREOF, I have hereunto set my
of .~.c
, 1995.
t;::, <1j}1:o ~-Ekl~vU -
ary L agaro
The preceding instr1lment, consisting of this
and two other typewritten pages, identified by the
signa~lre of the testatrix, was on the day and date
thereof signed, published and declared by Mary T.
Magaro, the testatrix therein named, as and for her
last will, in the presence of lIS, who, at her req1lest,
in her presence and in the presence of each other, have
subscribed our names as witness hereto.
u
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COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
We, Mary
--IT-Anlru~> II" [-ijf../kCl
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and the witnesses,
r,
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T. Magaro, VJ' ......ufY) ,-. ti:..-fc~/~
and ,1((,,,[,,,, T ["'(frY] hi)
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respect~vely, whose names are s~gned to the
,
, the testatrix
attached or foregoing instr1lment, being first duly sworn, do
hereby declare to the undersigned authority that the testatrix
signed and executed the instrument as her last will; that she had
signed willingly; that she executed it as her free and voluntary
act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testatrix, signed
the Will as witness and that to the best of their knowledge the
testatrix was at that time eighteen (18) years of age or older,
Testatrix,
'/7u ~
residing at
residing at
residing at
residing at
influence. '
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c>'n~"#.-f p= I TPdS -
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5:::kf: h. ~
LA,L)fd'.-'-~ cL
before me by
of sound mind and under no constraint or undue
Witness,
Witness,
Witness,
Subscribed, sworn to and acknowledged
Mary T. Magaro, the testatrix,
me by UX 1111.1/01 IR)-k~\( ::,
! '",,1,,- ,T (")e""rnt"l, witnesses, this
I
and subscribed and sworn to before
tI:/ffYJOfJ A,
-~)
!'.-.t'
Lcfi_N\q
J
day of
and
IJ: 1
.1,1 j)/>,f!..-;
1995.
NOTARIAL SEAL
p, KATHRYN SWARTZ. Notary Public
Hanlsburg. DauphIn County
Mv Commission Exoires March 30 1995
*'
~J"I.; ,;" '7(,1)1
~~' ','
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
April 23, 2001
PETERS & WASILEFSKI
WILLIAM J PETERS ESQUIRE
2931 NORTH FRONT ST
HARRISBURG PA 17110-1280
Re: MARY MAGARO
CIS #: 680141633
Co/Rec: 22/0219066
Date of Birth: 09/03/1907
SSN: 191-42-9583
Dear Attorney Peters:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $97,020.27 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 30, 1995. Enclosed is the Department IS
itemized statement of claim.
A portion of this medical expense, namely $19,240~96 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 $77.779.31 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. Xf the estate contains
real estate, please provide copies of the deed and the latest tax assessment.
Sincerely,
~~Q..L
Linda C. Price
Claims Investigation Agent
717-772-6741
717-705-8150 FAX
Enclosure
*'
'" lMlt
(, "U\t~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
TPL SECTION CASUAL TV UNIT
PO BOX 8486
HARRISBURG, PA 17105-8486
October 10, 2001
PETERS & WASILEFSKI
WILLIAM J PETERS ESQUIRE
2931 NORTH FRONT ST
HARRISBURG PA 17110-1280
Re: MARY MAGARO
CIS #: 680141633
Incident Date: 03/12/2001
Dear Attorney Peters:
Thank you for your correspondence dated October 5, 2001. I have
reviewed the information and everything appears to be in order. The
Department of Public Welfare will accept $60,122.60 as payment in full for
its medical assistance lien as long as no other assets are found in the
future.
Sincerely,
~l-'v'<.a....l!...L
Linda C. Price
Claims Investigation Agent
717-772 -6741
717-705-8150 FAX
A. ::.eUjemenl.Slalemenl
U.S. Department of Housing
.nd UrlNin Development
OMB No. 2502-0265
~
1r
B. Type 01 Loan
6. File Number
7. loan NumbeJ
8. Mortgage Insul1Ince Case Number
1.0 FHA
4.0 VA
C. NOTE:
2. 0 FmHA 3. D COny. Unins.
5. 0 COny. Ins.
This form is furnished 10 give you a sl",,,,,,,, I of aclual settlemenl costs. Amounts paid to and by the
settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown
here for informational purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER: RONALD G. GATES and DONNA L. GATES
E. NAME AND ADDRESS OF SELLER: ANDREW S. MERLINA, JR.
EXECUTOR OF THE ESTATE OF MARY T. MAGARO
G. PROPERTY
LOCATION:
723 SHAFFER STREET
ENOLA EAST PENNSBORO TOWNSHIP
CUMBERLAND COUNTY
H. SETTLEMENT AGENT: A-1 ABSTRACT .ASSOCIATES INC.
PLACE OF SETTLEMENT: 1aOO Ling1estown Road, Suite
COYNE & COYNE, PC, Attorneys
102 Harrieburg, PA
at Law
17HO (717) 257-5400
I. SETTLEMENT DATE:
J. SUMMARY OF BORROW R'S RANSACTlON
::jddi:LG.a.osl,fAMQijijt;b.us::f'aoM:,a6,AAOWeatW:::t>:J::::'::: :::':'::::::'",::::;::,;,::;;,:::;,;;:.::::',:::::::;::::::::;:;:::~
101. Contract sales price
102. Personal property
:103; Settlement charges, t6J)()rrowar:
(Iromline14oo) 1,219.25
K. SUMMARY OF SELLER'S TRANSACTION
AOO;GRQSs AMDUNT.DuEtoselLER:.:..... ." ."
401. Contract sales price
402. Personel property
403.
60,000.00
~
404.
405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
406. Clty/town taxes 10
143.43 407. County taxes 04/11/01to 12/31/01
408. Assessments 10
409. School tax 04/11/01-06/30/01
410. SEWER/TRAS 04/11/01-06/30/01
411.
412.
420. GROSS AMOUNT
61,652.95 DUE TO SELLER:
.,: :/t".<.Aioo; ..AEDOeTIONSIN AM6uNT.OUETO SELLEii: .......
5, 000 . 00 501. Excess deposit (see/nstructions)
502. Settlement charges 10 seller (lIne 1400)
503. Existing loan(s) taken subject to
504. Payoff of first mortgaga loan
505. Payotl of second mortgage loan
506. 2001 CO/'t'WP TAX
507. SEWER/TR 2ND QTR
508.
509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
143.43
104.
105.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
106. Clty/town taxes to
.107. County taxes 04/11/0110 12/31/01
108", Assessments to
109. School tax 04/11/01-06/30/01
110. SEWER/TRAS 04/11/01-06/30/01
111.
112.
120. GROSS AMOUNT DUE
FROM BORROWER:
,2oo.iiMOUNTSpilw.IlYORII!iBEHALF.OF.BOIlROWElli',
212.38
77.89
212.38
77.89
~
60,433.70
201 \. Oepos,it or ~arnest money
202. Principal amount of new loan(.)
203., Existing ,lq_lln{s) taken, subject to
204.
205.
206.
207.
208.
209.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. Cltyltown taxes to
21 f county taxes to
212. Assessments to
213. School Taxes
214.
215.
216.
217.
218.
219.
220. TOTAL PAID BY/FOR
BORROWER:
;l00.. C:/lSH At SE'rt"EI.1EN:r~1'I9M/T(j .!lDIl!i9W.ER~ .
301. Gross amount due from ~rrower (line, 1_20)
30~, _ Less, amo\Jnt paid byJlor_bortowet (Iihe 220) ;
2,405.00
197.55
87.75
510. ,Clty/town taxes
511. County taxe.
512. Assessments
513.
514.
515.
516.
517.
518.
519.
520. TOTAL REDUCTIONS
5,000.00 IN AMOUNT DUE SELLER:
.. ..,\ ...i.',' ,,<.lIll11, .eMIl. 4l Sm~EMEI'Ir'r9~IlDMSE~~I!!i(' .'. .
61, 652 . 95 601. Gross amount due to seller (Iin,s 420)
5,,' O.o,:O.-:~- q 0) 602, Lesa total reductions in amount due sellet.
to
to
. . to
~
2,690.30
(fine 520)
60,433.70
2,690.30
303. CASH ~ FROM 0 TO BORROWER:
~
56,652.95 603. CASH ~ TO 0 FROM SELLER: ~
57,743.40
~~501 (8811).01
'"
VMP MORTGAGE FORMS. (313)293-8100. (800)521-7291
HUD-l (3-66)
RESPA, HB 4305.2
HU()... 'Rev~3186
rUWJ@b'.W~.?1t'4~~ll:t~>~~~:;:~f:ffl '~t; ~it.t*P*~*i~U!~f~~it~!t.8:~~W~~:~t1:~::::f*-~W:i:'.""
700.
TO~AL S!,Le.s / "ROKER'S COMMISSION:
.. BASED ON PRICE
to
$
60,000.00@
%-
1,800.00
PAID FROM
BORROWER'S
FUNDS
AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS
AT
SETTLEMENT
1,800.00
~M:':.'~i
: i\1!lilliiiC IF'"
$ 1,800.00
$
.:u. "jf4MWMV@@M
701,
702.
703.
704.
....... ....~
".
REALTY PROFESSIONALS INC
to
601.
802.
603.
804.
805.
Loan- 6flginatiOn ,fee
Loan ,(:tiscount
Apprtilsa\..fee:.(o,
Credit ,report ,to:
Lender's inspection fee
Mortgage Insurance application le;e 10
ASsumptiOn fee
606.
607.
606.
809.
610.
811.
IJlllllii1WIfi1M$Ml!l!)iJIM~'lf;;j;mllr ..'
901. Inleres,lrom 04/11/01'0
902. Mortgage insurance premium for
903. Hazard insurance prem,ium lor
>l1ll!l'litAlb.'INt. .6.\!J\Ne~P\%YW
04/30/01 @ $
Iday
904.
Flood Insurance Premium for
mas. 10
ynt to
yrs.lo
1001. monlhs,@ S
1002. Mortgage insurance months @$
1003, City. property taxes monthS @ $
1004. Co:unly property _t,~.xes months @ $
100s. Annuai assessments monthS '@,$
1006, Road insuranc9 montt:'s_ @ $
1007. School property taxes monlh. @$
100B. Aggregate Adjustment months@
rar: "\Wfr;"::,'. 'r.]!jiJiJr.":-:~~m 'A:~~P*lr~%~~:~F~*!}~~Hlt.M~~t~;~':l\#@~:M~:~W@w..
pet monlh
per month
pel' month
per ,month
petli1Cirlth
per ,~onth
pel' mOnth
er month
1101. Se:ttlementorclos,ing,feeto
11b2. Abstract ot title search to
1103. Title examinatlon to
1104. Title in~uriit1te binder to
~ 1 05. Dqcurnent prep,afation to,
t1OO. Notary,fees t6
1107. Attorneys' lees to
A-1 Al3STRACT ASSOCIATES tNC
75,00
1108.
A-1 ABSTRACT ASSOCIATES INC
5.00
A-1 ABSTRACT ASSOCIATES, INC
(lffclUdeS above irimls Numbers:
1109. Lender's coverage $
1110. OWner's coVerage $
1111. PA End. 300, 100,
1112. APPROVED ATTOlWEY
1113.
M~%l!~!iiiji'lM~ilfj1' ............. ."
60,000,00
8.1
FEE COYNE & COYNE, PC
291.25
1301. SurVey to
1302. Pest inspection to
1303. FED-EX
1304.
1305.
1306.
13 7.
;' Releases $
'201; ReCOrding fees: beed ,$
1202. City/county ,tax 'stamps: .
1203. Stale tax / stamps
1204.
1205.
'\1@ll' M;llfjfftlil~All\f
Deed $
Deed $
: Mortgage $
; Mortgage $
1400. TOTAL SETTLEMENT CHARGES (Enter on line 103, Section J-and./ine 502, Section K)
1,219.25
2,405.00
I have carefully reviewed Ihe HUO.1 Seltlement Slatement and to the besl 01 my knowledge and belief, it Is a lrue and accurate statement of all receipts and disbursemants made
on m, .~~o.;'a'by me In ~I':'"'!i' lI.rt.: .rt;r, ."hovo "",~,,<lo "'o,art"o HUO.' SOlllom,"~ ~.
eana_, . /"7; 0010' 04/11 /01 Sollo. j_.s~. /... fx'i.... --D.4/11/01
RONALD G. GATES . REW S. LINA R or ecutor
Borrower:
'11{>~ .J.
LJUNNA L. (jAl~~
~
Date:
04/11/01
Seller:
Dale:
The HUD.1 Settlement Statement which I have prepared is a true and accurate
in accordance with this statement.
account 01 this transacllon. I have caused or will cause the lunds to be
A-1 ABST~T ASSOC INC.
Dale: 04 / 11 / 0 1 Selllemen! Agent '
WARNING: II Is It crime to knowingly make fBlse statements to the United States on this or any other similar fonn. Penallles upon convl
Ford9lails see: Title 18 U.S. Code Secllon 1001 and Section 1010.
G>m-502 (8811).02
disbursed
04 11 01
VMP MORTGAGE FORMS (313)293.8100 - (800)521-7291
PAGE 2