HomeMy WebLinkAbout01-0434
IN RE: THE ESTATE OF
MARY J. MUMMA
deceased
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. o4J'f
2001
ORDER OF THE COURT
AND NOW, to wit, this ~~ day of
2001, upon due consideration of the foregoing
hereby ordered, that the Petitioner, Ella M. Holtzman, through
her counsel, John J. Krafsig, Jr., Esquire, having represented
to the Court, that all known debts, fees, taxes which are due,
have been paid with the exception of the claim of the Pa. Dept.
of Welfare which far exceeds the assets of the Estate; and that
said Estate being insolvent, there is no Inheritance Tax; that
from the sum of $3,222.67, the requested costs of administration
payments are hereby approved, as set forth in the Petition, to
wit:
$18.00 Register of Wills, filing Petition; $15.00 Register
of Wills, filing Inheritance Tax Return; $225.57 7% fee allowed
for the Executrix by the Dept. of Welfare; $500.00 John J. Krafsig,
Jr., Esquire, attorney's fee for preparation of Petition and In-
heritance Tax Return.
That after payment of the costs of administration,
there is a balance of $2,464.10, which pursuant to the priority
,
,
claim of the Commonwealth of pennsylvania shall be paid to the
pennsylvania Department of Welfare to exhaust the said asset.
This Order is predicated upon the provisions of
Section 3102 of the Probate, Estate and Fiduciary Code of the
Commonwealth of Pennsylvania.
The Petitioner is further authorized to settle this
estate without the necessity to apply for Letters Testamentary
or to make legal advertisement or to conduct formal administra-
tion of the said Estate.
Judge
~
IN RE: THE ESTATE OF
MARY J. MUMMA
deceased
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. i6~
2001
SMALL ESTATE PETITION,
PURSUANT TO RULE 6.11-2
TO THE HONORABLE, THE JUDGES OF CUMBERLAND COUNTY:
AND NOW, comes Ella M. Holtzman, named Executrix of the
above mentioned decedent's estate, by her lawful counsel, John
J. Krafsig, Jr., Esquire, who respectfully petitions as follows:
1. The name of the Petitioner is Ella M. Holtzman,
who resides at 501 Water Street, New Cumberland, York County,
Pennsylvania, but was not related to the decedent.
2. The name of the decedent, Mary J. Mumma, whose
full name was Mary Jane Mumma, who resided at her death, at the
Camp Hill Center, East Pennsboro Township, Cumberland County,
Pennsylvania, who died December 25, 2000.
3. The decedent died testate, for which the
original of the said will is attached hereto, marked as Exhibit
"A" and made a part hereof; and no Letters have been granted and
no bond requested or required.
4. The name and the relationship of all bene-
- 1 -
ficiaries entitled to any part of the Estate, under her Will,
are as follows: Thelma E. Snyder; Jean I. Morris; Ella M.
Holtzman; Nathan Cole; Patricia Cole; and Allison Holtzman. All
have received their respective interest at least, in excess of
two (2) years before date of death.
5. There are no person or persons entitled to
the family exemption.
6. There was no real estate and the personal
Estate of the Decedent, which consisted of the following with a
value ascribed to wit:
(a) A checking account in the amount of
$4,602.50 with the AIIFirst; a copy of said bank statement is
attached hereto, marked Exhibit "B" and made a part hereof,
less the deduction of three monthly payments of $464.41, $451.48
and $463.88 from a trust set up by her late husband with the
Mellon Bank, which were erroneously paid to the decedent's account
after her death; leaving a balance of $3222.67.
7. The preference of the unpaid claimants
against the said Estate, which claim is admitted; is a claim for
$44,592.93, of which attached is the official notice from the
Department of Public Welfare, Estate Recovery Program, marked as
Exhibit "C", asserting the same.
8. To the best of the knowledge of the Petitioner,
there are no other unknown, unpaid claimants that have claims
- 2 -
against the said Estate.
9. As previously noted, there is no unpaid bene-
ficiary or claimant, other than the Commonwealth of Pennsylvania,
Department of Public Welfare and the residuary beneficiary,
Allison Holtzman,
for which there are no assets to pay any
residuary benefits. The Executrix, the Petitioner, is the mother
of the said Allison Holtzman, who has been given notice of the
intent to present this Petition and acknowledges notice of the
same in her behalf, Exhibit "E."
10. There has been no disbursement made, prior to the
filing of this Petition.
11 . Attached hereto a true and correct copy of the
Inheritance Return filed, marked Exhibit "D." The Estate being
insolvent, there is no Certificate from the Register of Wills,
showing the payment of any Inheritance Tax.
12. Distribution of the sole personal property, to
those entitled, is as follows:
$ 18.00 - Cost of filing Petition
$ 15.00 - Cost of filing Inheritance Tax Return
$ 225.57 - 7% fee allowed for the Executrix
of Estate by the Dept. of Welfare
$ 500.00 - Attorney's fee allowed for preparation
of Petition and Inheritance Tax Return
- John J. Krafsig, Jr., Esquire
$ 2,464.10 - Balance to be paid to the Pa. Dept.
Public Welfare
WHEREFORE, your Honorable Court is requested to approve
payment of the costs of administration, as set forth in the fore-
- 3 -
going Petition, and to order and direct that the balance of
$ 2,464.10 , shall be paid to the Pa. Dept. of Public Welfare
and said proceedings terminated.
Respectfully submitted,
17110
Dated: April 4o,J~, 2001
- 4 -
WILL AND TESTAMENT
I,
MARY J. MUMMA,
of Lemoyne,
in the County of
Cumberland and state of Pennsylvania, being of sound mind, memory
and understanding, do make and publish this my last will and
testament, hereby revoking and making void all former wills by me
at any time heretofore made.
And first,
I direct that my funeral be conducted in
manner corresponding with my estate and situation in life and that
all my just debts and funeral expenses be fully paid and satisfied
as soon as conveniently may be after my decease.
As to such estate as it hath pleased God to intrust
me with, I dispose of the same as follows, viz:
I .
I hereby make the following
special specific bequests
of
personal property, as follows:
(a) To Thelma E. Snyder, of Lemoyne, Pa.: 1 recliner,
I rocking chair, wi padded ottoman, Thelma's bedroom furniture
w/linens, walnut corner cupboard, white wltan top
particleboard cupboard, cat plates (except as otherwise
noted), table, combined brass lamp and stand, TV, magazine
rack, everyday cat dish set, cat carrier, small breakfast
- Page 1 -
J1t j,)y;
EXHIBIT "A"
table & 2 chairs, 2 ceramic Angora cat statues, vacuum cleaner
and padded rocking chair.
(b) To Jean I. Morris, of Shermansdale, Pa.: 2 Siamese
Cat plates, adjustable electric bed, 2 night stands w/bookcase
in back and coffee table.
(c) To Ella M. Holtzman, of New Cumberland, Pa.: Oak
hutch w/white stain, cherry curio cabinet, green satin chair,
lace doilies & table covers, candles and other holiday
decorations (except Christmas items), sea shells, black
ceramic lady lead w/earrings and jewelry.
(d) To Nathan Cole, of Shermansdale, Pa.: Ceramic deer
head, I recliner chair, eagle statute, couch, Christmas tree
and decorations.
(e) To patricia Cole, of New Cumberland, Pa.: Wicker
& glass Dining room set w/2 chairs, maple hutch, tiger plates,
chime wall clock, wicker 3 shelve table and nicknacks.
(f) To Allison Holtzman: White bedroom furniture
II. As to my remaining personal property, consisting primarily
of ki tchen utensi Is, pots & pans and the like, I authorize
and empower my Executrix, Ella M. Holtzman, to have sole dis-
cretion and authority to divide those items in kind: as she
deems appropriate in her sole judgment.
I direct that my clothing shall be donated to charity, except
for my winter coats, which shall be divided as previously
stated in the sole judgment and discretion of my Executrix.
III. As to the rest, residue and remainder of my estate, in which
there is no real estate presently, real, personal or mixed,
wheresoever situate,
I bequeath and devise to Allison
- Page 2 -
J11 (L l;;.
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Holtzman, provided she has attained at least 18 years of age;
and if she has not, then I hereby appoint her mother, Ella
M. Holtzman, as Trustee-Guardian, to serve without the
necessi ty posting bond and wi thout prior court approval, to
maintain the same for her until she attains 18 years of age;
at which time, she shall be entitled to the same.
III. I further directed that the Inheri tance Tax shall be borne
by each beneficiary and shall not paid and shall not be paid
out of my residuary estate.
IV. I further direct that my funeral shall be by means of
cremation and shall be handled by the Neill Funeral Home and
that the arrangements shall be carried by my Executrix Ella
M. Holtzman.
V. I hereby nominate and appoint John J. Krafsig, Jr., Esquire,
to serve as the attorney for my estate.
And I hereby nominate, consti tute and appoint ELLA M.
HOLTZMAN, my Executrix, of this last Will and Testament, without
the necessity of posting bond.
IN WITNESS WHEREOF, I, MARY J. MUMMA, the Testatrix,
- Page 3 -
fr}. jJ1J,
have to this, my Will, written on four (4) sheets of paper, set my
hand and seal this fRd~5- day of August, A. D. One Thousand Nine
Hundred and Ninety-eight (1998).
moM J. !J1 LVn1/WUL.-
MARY J.~U A
(SEAL)
Signed, sealed,
published and declared by the above
named Testatrix,
as and for my last Will and Testament,
in the
presence of us,
who have hereunto subscribed our names at her
request as witnesses thereto, in the presence of the said Testatrix
and of each other.
- Page 4 -
'~I . 1': ,,\ r 'I Ir, 111\'
ft-. . COMMONWE^LTH OF
~ 1R ~ PENNSYLVANIA
I r (~Jl~~ ,OEP^R1MENT OF REVENUE
~nlJ OEPT. 280t301
. :~W:t.. HARRISBURG, PA 17128-0601
REV-1500
INSOLVENT
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENts NAME (LAST, FIRST"AND MIDDLE INIlIAL)
MUMMA MARY J.
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~^'. E or OfMH.(MM.D. O-YE^. "I D^lE. OF 8l.RlIl (MM-DD-YEAR)
12/25/2000 04/05/1923
~r ^rriic'\rn.E) StmvlviNG srOUSE'SNAME (LASr:- FIRST. AND"iioOlE INITIAL)
N/ A
IXI 1. Origin;J1 Relum
[J <i limiter! E~'a'e
L~J fj Decedenl Died Teslate (AIl",h ropy "' WillI
I_I 9 lilig;'llion Proceeds Received
o 2. S'lpplemenlal Relurn
o ~~l Fulure I"Ieresl Compromise Id~190Ide~lh~ner.t2.12.821
o 7. Decedent M<1lnl<1lned a living Trusll^"~cI1 copy 01 Trus',
[J to. Spousal Poverty Credit (dnle 01 dealh betwel!n 12.31-9t And 1.'-9!i~
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01 FlelM. USE ONLY
FILE NUMBER
COUNTY cooe
YE^R
NUMBER
SOCIAL SECURITY NUMBER
191 - 18 4563
THtS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
SOCIAL SECURITY NUMBER
o 3. RemClinder ReltJrn (dllle 01 death prIof 10 12.IJ.Jl2)
o 5. I=ederal Estate T:lx Relurn Required
8. Tolal Number 01 Sale Deposit Boxes
o ii. Election to tax under Sec. 9113(1\) t~lIachStt1O)
NMv'E
_.__.____JqJ!N J. KRAFSIG, JR., ESQUIRE
~~~~~h~_~~~r'::1 r a f s~ , Jr., In c .
TElEPHONE NUMBER
717-236-2109
I to: .
COMPLETE MAILING ADDRESS
2921 N. Front Street
Harrisburg, Pennsylvania
x.o_ (15) None
x.O_ (16) NOne
x .12 (17) None
x .15 (18) ~'Q tl9
(19) None
1. Real Es(nle (Schedule ^)
2. Sloc~s and Bonds (Schedule B)
(1) None
(2) Nbne
(3) None
(4) None
(5) $3,222.67
(6) None
(7) None
(8)
(9) $45,351.50
(10) None
3. Clos!!ly Held Corporation, Partnership or Sole-Proprietorship
<1 Morlg(lges & Noles Receivable (Schedule D)
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5 C;lsh. B~m~ Deposils 8. Miscellaneous Personal PlOperty
(Schedule E)
6 Jointly Owned Ploperty (Schedule F)
[J Sep:lrale Billing Requested
7 Inler.Vivos Translers & Miscellaneous Non-Probale Properly
(Schedule G or L)
8. Total GIOS!! Assets (101;11 LInes 1-7)
9. rUnPr;1! Expenses 8. Admlnlslrallve Cosls (Schedule H)
10. Debls 01 Decedent, Morlgage liabilities, 8. liens (Schedule I)
11. T olal Oeductlons (101<11 LInes 9 & 10)
12 Net Value of Estate (Line 8 minus line 11)
13. Chmil"ble .md Governmental BeQuests/Sec 9113 Trusls lor which an elecllon 10 tax hClS not been
made (Schedule J)
I" Net Value Subject to Tax (Line 12 minus line 13)
SEe INSTRUCTIONS ON REVERSE SlOE tOR APPLICABLE RATES
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15 ^mounl 01 line 14 t;lx;lble nl the spousf/llax
r;lle. or h;1nslers under Sec. 9116 (a)(1.2)
16 Arnounl 01 Line 14 l;Jxable at Iinenl rale
17. ^molllll ot Une 1~ laxnble nl sibling rale
18 ^mollnt 01 line 14 laxable at collateral rale
19 Tax Dlle
2n []
tHECK Hl:~~ IF yoU A~~ ~~OUl:stIN~ A ttEr=UNU O~ AN OVE~tiAYMl:Nt
JtJj',
17110
OFFiciAL USE ONLy
.
$3,222.67
(11)
(12)
(13)
$45.351.50
None-Insolvent
None
(14)
None-Insolvent
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W1LL AND TESTAMENT
I,
MARY J. MUMMA ,
of Lemoyne;
in
the
,
County
of
cumberland and state of Pennsylvania, being of sound mind, memory
and understanding, do make and publish this my last will and
testament, hereby revoking and making void all former wills by me
at any time heretofore made.
And first,
I direct that my funeral be conducted in
manner corresponding wi~h my estate and situation in life and that
all my just debts and funeral expenses be fully paid and satisfied
as soon as conveniently may be after my decease.
As to such estate as it:. hath pleased God to intrust
me with, I dispose of the same as follows, viz:
I .
I hereby make the following
special specif ic bequests
of
personal property, as follows:
(a) To Thelma E. Snyder, of Lemoyne, Pa.: 1 recliner,
I rocking chair, wi padded ottoman, Thelma's bedroom furni~ure
w/linens, walnut corner cupboard, white w/tan top
particleboard cupboard, cat plates (except as otherwise
noted), table, combined brass lamp and st:.and, TV, magazine
rack, everyday cat:. dish set, cat carrier~ small breakfast:.
- Page l' -
>>1 J l JJ;.
1
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table & 2 chairs. 2 ceramic Angora cat statUes, vacuum cleaner
and padded rocking chair.
(b) To Jean I. Morris. of Shetmansdale. Pa.: 2 siamese
Cat plates, adjustable electric bed. 2 night stands w/bookcase
in back and coffee table.
(c) To Ella M. Holtzman, of New cumberland, Pa.~ Oak
hutch w/white stain, cherry cutlo cabinet, green satin chair,
lace doilies & table covers, candles and other holiday
decorations (except Christmas items), sea shells, black
ceramic lady lead w/earrings and jewelry.
(d) To Nathan Cole, of Shermansdale, Pa.: Ceramic deer
head, 1 recliner chair. eagle statute, couch, Christmas tree
and decorations.
(e) To patricia cole, of New Cumberland, Pa.: Wicker
& glass Dining room set w/2 chairs, maple hutch, tiger plates,
chime wall clock, wicker 3 shelve table and nicknacks.
(f) To Allison Holtzman: White bedroom furniture
I I . As t.o my remaining personal property t consisting primarily
of ki tchen utensl Is, pots & pans and the like, I aUthorize
and empower my Execut.rix, Ella M. Holtzman, to have sole dis-
cretion and authori ty t.o divide those i t.ems in kind: as she
deems appropriat.e in her sole judgment.
I direct that my clothing shall be donated to charity, except
for my wihter coats, which shall be divided as previously
stated in t.he sole judgment and discretion of my ExeCUtrix.
III. As to the rest, residue and remainder of my estate, in which
t.here is no real estate presently, real, personal or mixed,
wheresoever situate, I bequeath and devise t.o Allison
- Page 2 -
JI1 (L J/t.
O(]
Italtzmant ptovided she has attaihed at least 18 years of aget
and if she has not; t:hen t hereby appoint: her mothet t E11el
M. Holtzmat1~ CiS Trustee-Guardian; to serve without the
necessity posting bond and without ptiot court approval. to
maintain the same for her until she attains 18 years of age:
at which time. she shall be entitled to the same.
I I I. 1 further directed that the tnheri tance Tax shall be borne
by each beneficiary and shall not paid and shall not be paid
out af my residuary estate.
IV. I further direct that my funeral shall be by means of
cremation and shall be handled by the Neill Funeral Home and
that the arrangements shall be carried by my Executrix Ella
M. Holtzman.
V. I hereby nominate and appoint John J. Krafsig; Jr., Esquire,
to serve as the attorney for my estate.
l\nd I hereby nominate, cansti tute and appoint ELLA M.
1I0l.TZM1\N, my Executrix, of this last Will and Testament, without
the necessity of posting bond.
IN WITNESS WHEREOF, I, M1\RY J. MUMMA, the Testatrix,
.
- Page 3 -
)fJ. J1r1'
have to this, my Will. writlen dn lour (4) sh~e~s of paper, set my
hand and seal lhis ~d~day of AUgUst.. A.b. One 'l'hoUsat1d Nine "~:'.i i
Hundred and Ninely-eight (1998).
Jtl()~A' 1rl~A#./L
(SEAL)
Signed, sealed,
published and declared by the above
named Testatrix. as and for my last Will and Testamen~, in t.he
presence of Us, who have hereunto subsctibed our names at her
request as witnesses thereto; in the presence of the said Testatrix
and of each other.
- J?age 4 -
REV 1508 EX. (1.97)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
MARY J. MUMMA
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
NUMBER
1.
DESCRIPTION
Checking account #00618-3685-0 with AIIFirst Bank
VALUE AT DATE
OF DEATH
$3,222.67
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert :3dditional sheets of the same size)
3,222.67
Il allflrst
MARY J MUMMA
501 WATER ST.
NEW CUMBERLAND PA 17070-2632
111111 1111111",1...111111111.11111111111111.11111111111.11111
Page 1 of 3
Relationship With I~terest
February 76. 2001 fhru March ,e, roo,
Mary J Mumma
Acct No 00618-3685-0
Q allflrst.com 0 24-hour
customer Service
1-800-533-4630
Activity Summary
Annual percentage yield earned
Avg. daily ledger balance
Avg. daily collected balance
Interest earned this statement
Interest paid this statement
Interest paid this year
Days covered by this statement
0.90:'.
$4,167.73
$4,167.63
$2.98
$2.98
$9.73
29
Balance on 02/15
Deposits and additions
Balance on 03/16
$14,135.614
1466.86
$14,602.50
Deposits and additions
Dale Descriplion
Amount
03/15 ACH CREDIT
MELLON PAM TRANSFER 10171156BN1
3250659306MARY J MUMMA 20010734592137
03/16 INTEREST PAID
$1463.88
2.98
~q';6_8('
End of Day Ledger Balance
Account balances are updated In the section below on days when transactions posted
to this account.
Dale
Balance
Dille
Balance Dale
Balance
02/15
$4,135.64
03/15
$4,599.52 03116
$4,602.50
The annual percentage yield earned reflects the amount of Interest earned on the account
during the statement period and the average dally balance In the account for that period.
The interest rate paid will fluctuate according to money market conditions.
001655
0009.90317487312 050
REV-1511EX + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERIT ANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
MARY J. MUMMA
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Prepaid
None
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions (7 % 0 f tot ale s tat e, asp e r We 1 far e
a~fm~~rt.Se<fsJ-n~t Representative (s) Ell aM. Ho 1 t zman
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 5 0 1 W t=1 t p r S t r p p t
City Npw rllmhp r 1 rl nn State P-"'l
$225.57
B.
Zip
17070
Year(s) Commission Paid:
2001
2.
3.
AttomeyFees - John J. Krafsig, Jr., ES'luire
(Per Dept. of Welfare approval)
Family. Exemption: (If decedent's address is not the same"aS'"c1aimant's, attach explanation)
Claimant Non p
Street Address
$500.00
None
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
None
5.
Accountant's Fees
None
6.
Tax Retum Preparer's Fees - Filing Return
$15.00
7.
Register of Wills - Filing Small Estate Petition,
pursuant to Rule 6.11-2
$18.00
Dept. of Welfare - Bill of decedent for reimbursement
for decedent's nursing home care $44,592.93
TOTAL (Also enter on line 9, Recapitulation) $ 4 5 , 3 5 1 . 5 0
(If more space is needed, insert additional sheets of the same size)
*'
COMMONWEAlTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG. PA 17105.8486
February 09, 2001
JOHN J KRAFSIG JR INC
ATTORNEY AT LAW
2921 NORTH FRONT ST
HARRISBURG PA 17110-1281
Re: MARY MUMMA
CIS ft: 570144539
Co/Rec: 21/0085154
Date of Birth: 04/05/1923
SSN: 191-18-4563
Dear Attorney Krafsig:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $44.592.93 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 $13.099.90 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 $31.493.03 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,
)1{~~ L&,h..,..
Margaret L. Sohn
Claims Investigation Agent
717-772-6609
717-705-8150 FAX
Enclosure - Statement of Claim
REV-15!3 EX. (2-87)
'*
COMMONWEALTH Of P~NNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
MARY J. MUMMA
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
1.
NONE DUE TO THE INSOLVENCY OF THE ESTATE
N/A
N/A
N.B.
Specific bequests of personal property
in Paragraph I (a), (b), (c), (d), (e) and (f)
were disposed of prior to the decedent's death
With regard to paragraph III of decedent's Will, the
bequest and devise to Allison Holtzman, fresently a
minor, cannot be made, due to the insolvency of
the estate, and has been so advise3.
None
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
None
None
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
s
None
(If more space is needed, insert additional sheets of same size)
Il allfirst
MARY J MUMMA
501 WATER ST.
NEW CUMBERLAND PA 17070-2632
I, ,,111...1111111111111111111.1.11111111'111.11111111111111111
Page f of 3
Relationship With Interest
FebrulJry '6, 2001 thru MlIrch 16, 2001
Mary J Mumma
Acct No 00618-3685-0
Q allflrst.com 0 24-hour
Customer Service
1-800-533-4630
Activity Summary
Annual percentage yield earned
Avg. daily ledger balance
Avg. daily collected balance
Interest earned this statement
Interest paid this statement
Interest paid this year
Days covered by this statement
0.90%
$4,167.73
$4,167.63
$2.98
$2.98
$9.73
29
Balance on 02/15
Deposits and additions
Balance on 03/16
$4,135.64
466.86
$4,602.50
D@po~lt~ and additions
Date Descriplion
Amount
03/15 ACH CREDIT
MELLON PAM TRANSFER 10171156BN1
3250659306MARY J MUMMA 20010734592137
03/16 INTEREST PAID
$463.88
2.98
~4';6.R';
End of Day Ledger Balance
Account balances are updated In the section below on days when transactions posted
to this account.
Date
Balance
Dale
Balitnce DiJle
Bali1nce
02/15
$4,135.64
03/15
$4,599.52 03/16
$4,602.50
The annual percentage yield earned reflects the amount of Interest earned on the account
during the statement period and the average dally balance In the account for that period.
The interest rate paid will fluctuate according to money market conditions.
EXHIBIT "B"
001655
0009-98317487312 050
*
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG. PA 17105-8486
February 09, 2001
JOHN J KRAFSIG JR INC
ATTORNEY AT LAW
2921 NORTH FRONT ST
HARRISBURG PA 17110-1281
Re: MARY MUMMA
CIS #: 570144539
Co/Rec: 21/0085154
Date of Birth: 04/05/1923
SSN: 191-18-4563
Dear Attorney Krafsig:
please be advised that the Department of Public Welfare maintains a
claim in the amount of $44.592.93 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 $13.099.90 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 $31.493.03 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,
YK~OA.gi- L&>'v-
Margaret L. Sohn
Claims Investigation Agent
717-772-6609
717-705-8150 FAX
Enclosure - Statement of Claim
EXHIBIT "e"
JOHN J. KRAFSIG, JR., INC.
ATTORNEY-AT-LAW
HARRISBURG, PENNSYLVANIA
171 10- 1 28 1
2921 N. FRONT STREET
TEL: 717-236-2109
FAX: 717-236-0100
MEMBER
PENNSVLVANIA BAR
DISTRICT OF' COLUMBIA BAR
April 2, 2001
In Re: Estate of
MARY J. MUMMA
TO: Allison Holtzman
c/o Ella M. Holtzman, her mother and legal guardian
501 Water Street
New Cumberland, Pennsylvania 17070
You are notified that a Small Estate Petition will be
filed with the Cumberland County Court of Common Pleas, Office
of Register of wills, in which you are an unpaid beneficiary, by
reason of the insolvency of the Estate of Mary J. Mumma, deceased,
and which will be presented on or about April 23, 2001.
Notice of the same had been previously given to your
Mother and legal guadian, and acknowledgement is set forth in the
foregoing Petition.
John J. Krafsig, Jr., Esquire
Attorney for the Estate of
Mary J. Mumma, deceased
EXHIBIT "E"
.
VERIFICATION
c2~
/
I, Ella M. Holtzman, the within Executrix of the Estate of Mary
AND NOW, to wit, this
day of April, 2001,
J. Mumma, do hereby certify and state the facts as set forth in
the foregoing Petition, are true and correct to the best of my
information, knowledge and belief.
I understand that false statements herein are made
subject to the penalties of
18 Pa. C.B.A. ~4904 relating to
unsworn verification to authorities.
/ ~ I
{IX/;': 7X 1; Uvxau
Ella M. Holtzman, Executrix
--
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVlDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128r0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JOHN J KRAFSIG JR ESQ
2921 N FRONT ST
HBG PA 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-05-2001
MUMMA
12-25-2000
21 01-0434
CUMBERLAND
101
~t*
REY-1547 EX AFP el2-00)
MARY
J
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-\j=is4-j-E"X-AFP--ciz':oIff-NCif"icE"-OF-'rtiHEifiTANCE-TASrAppRAisEMENT-,--ALi-oWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MUMMA MARY J FILE NO. 21 01-0434 ACN 101 DATE 06-05-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of Ahh returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
3.222.67
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
45,351.50
.00
(1)
(2)
(3)
(14)
NOTE:
.00 X
.00 X
.00 X
.00 X
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
3,222.67
45.3lil liO
42,128.83-
.00
42,128.83-
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
(19)=
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
/
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Oi.J-~~YI'i"OFXIr,(jOl .
Y" *" COMMONWEALTH OF
r ' PENNSYLVANIA
'i1lli.. DEPARTMENT OF REVENUE
, DEPT. 280601
," . HARRISBURG, PA 17128.0601
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REV-1500
INSOLVENT
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
___.._.:. j (eg Jtr - 1.3
FILE NUMBER 0
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
MUMMA MARY J.
DATE OF DEATH (MM-DD.YEAR) DATE OF BIRTH (MM-DD.YEAR)
12/25/2000 04/05/1923
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
N/ A
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
191 - 18
4563
00 1. Original Return
o 4. Limited Estate
[K] 6. Decedent Died Testate (Mach copy of Will)
D g. litigation Proceeds Received
D 2. Supplemental Return
D 48. Future Interest Compromise (date ofdealh after,12-12-.82)
o 7. Decedent Maintained a living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (dale ofdealh between 12.3\.91 and 1-1-95)
o 3. Remainder Return (dale of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Tolal Number of Safe Deposit Boxes
o 11. Election 10 tax under Sec. 9113(A) (AlIachSch0)
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TI-IIS SECTIoN
NAME
I
COMPLETE MAILING ADDRESS
2921 N. Front Street
Harrisburg, Pennsylvania
17110
ilL I);
CORRES
N
JOHN J. KRAFSIG, JR., ESQUIRE
FIRM NAME (1IAjp'icab,ek
John J. rafsi, Jr., Inc.
TELEPHONE NUMBER
717-236-2109
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1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. InterNivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
(I) None
(2) None
,'-- .
(3) None
(4) None
(5) $3,222.67
(6) None
(7) None
(6)
(9) $45,351.50
(10) None
OFFICIAL USE ONLY
$3,222.67
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental BequeslsfSec 9113 Trusts for which an election to tax has nol been
made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus Une 13)
(II)
(12)
(13)
$45.351.50
None-Insolvent
None
(14)
None-Insolvent
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Une 14 taxable at Ihe spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
'.0_ (15)
None
16. Amount of Une 14 taxable allineal rate
'.0_ (16)
NOne
17. Amount of Une 14 taxable at sibling rate
, .12 (17)
None
18. Amount of Line 14 laxable at collaleral rate
, .15 (16)
l\lQ~Q
19. Tax Due
(19)
None
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > liE SURE TO ANSWER ALL QUEtlflClIiII1Nrt!\II!1t11! IllrlE ANllItEI:Hl!(l1t MATI-I ~ <' ;1<1f!!tf,i~ff~~'!lj'~>r~1
Decedent's Complete Address:
STREET ADDRESS Camn Hi 11
Care Center
Erford Road
CITY Camp Hill I STATE Pa. I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
N~jle-Inso1vent
Total Credits (A + 8 + C) (2)
None
3. InteresUPenalty if applicable
D.lnlerest
E. Penally
TotallnteresUPenally ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
N/A
N/A
5. If Line 1 + Line 3 is grealer than Line 2, enter the difference. This is the TAX DUE. (5)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
N/A
N/A
N/A
A. Enter the interest on the lax due.
Make Check Payable to: REGISTER OF WILLS, AGENT.
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'~~,f~,,}f"{"'fIII\'~ P",_ .~r.~~_~
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 Ihe property transferred;..... ................................. ..... [J rn
b. retain the right to designate who shall use the property transferred or its income; ....... ......................... D rn
c. retain a reversionary interest; or... .............................. .......................,.......... ................................ D {]I
d. receive the promise for life of either payments, benefits or care? ............ .................................. ... D []I
2. If dealh occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ...... .............................................................. 0 []I
3. Did decedenl own an 'in trust fo~' or payable upon death bank account or security al his or her death?............. D D
4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which
conlains a beneficiary designation? .......... ................................... ................................................................. ....... D rn
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 pe~ury, I declare thai! have examined this return, inCluding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all informatioll of which preparer has any knowledge.
SIGNATURE OF PERS DATE
4
2001
ADDRESS
Pa. 17070
DATE
4
/2001
ADDRESS
.,
Esquire
19?1 1\1 l<'r...n.... ~....rAAt- H.r:lrri~hlirg Pi"I. 17110
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For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
172 PS. 39116 (a) (1.1) (i)l.
For daies of dealh on or after January 1, 1995, the tax rate imposed on the net value of transfers 10 or for the use ofthe surviving spouse is 0% [72 P.S. 39116 (a) (1.1) (ii)l.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dales of dealh on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty.one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a slepparenl of the child is 0% [72 P.S. 39116(a)(1.2)1.
The lax rale imposed on the net value of translers to or for the use of Ihe decedent's lineal beneficiaries is 4.5%, except as noled in 72 P.S. 39116(1.2) (72 P.S. 39116(a)(l)1.
The lax rate imposed on the net value of Iransfers 10 or for Ihe use of the decedent's siblings is 12% (72 P.S. 39116(a)(1.3)1. A sibling is defined, under Seclion 9102, as an
individual who has at least one parent in common with Ihe decedent, whelher by biood or adoption.
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WItt AND TESTAMENT
I .
MARY J. MUMMA,
of Lemoyne,
in the County of
Cumberland and state of Pennsylvania. being of sound mind. memory
and understanding. do make and publish this my last will and
testament, hereby revoking and making void all former wills by me
at any time heretofore made.
I\nd first,
I direct that my funeral be conducted in
manner corresponding with my estate and situation in life and that
all my just debts and funeral expenses be fully paid and satisfied
as soon as conveniently may be after my decease.
I\s to such estate as it hath pleased God to intrust
me with. I dispose of the same as follows, viz,
1.
I hereby make the following
special specif ie bequests
of
personal property. as follows:
(a) To Thelma E. Snyder. of temoyne. Pa.: 1 recliner,
I rocking chair. wi padded ottoman, Thelma's bedroom furniture
w/linens, walnut corner cupboard, white wltan top
particleboard cupboard, cat plates (except as otherwise
noted). table, combined brass lamp and stand. TV, magazine
rack. everyday cat dish set. cat carrier, small breakfast
- Page l' -
J1t J. JJ;.
table & 2 chairs, 2 ceramic nngora cat statUes, vacuum cleaner
and padded rocking chair.
(b) To Jean I. Morris, of shetmansdale, Pa.' 2 Siamese
Cat plates, adjustabie electric bed, 2 night stands w/bookcase
in back and coffee table.
(c) 'fo El1a M. Holtzman, of New cumberland, Pa.! oak
hutch w/white stain, cherry curio cabinet, green satin chair,
lace doilies & table covers, candles and other holiday
decorations (except christmas items), sea shells, black
ceramic lady lead w/earrings and jewelry.
(d) To Nathan Cole, of Shermansdale, Pa., Ceramic deer
head, I recliner chair, eagle statute, couch, Christmas tree
and decorations.
(e) To Patricia Cole, of New Cumberland, Pa.'
& glass Dining room set w/2 chairs, maple hutch, tiger
chime wall clock, wicker 3 shelve table and nicknacks.
Wicker
plates,
(f) To nllison Holtzman, White bedroom furniture
II. ns to my remaining personal property, consisting primarily
of kitchen utensils, pots & pans and the like, I authorize
and empower my Executrix, Ella M. Holtzman, to have sole dis-
cretlon and authority to divide those items in kind: as she
deems appropriate in her sole judgment.
I direct that my clothing shall be donated to charity, except
for my winter coats, which shall be divided as previously
stated in the sole judgment and discretion of my Executrix.
III. ns to the rest, residue and remainder of my estate, in which
there is no real estate presently, real, l>ersonal or mixed,
wheresoever situate,
I bequeath and devise to Allison
- Page 2 -
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Hol\:zman, provided she has al:l:aitted at lea!!\: 18 ye1lrs of a<:lel
and If she has nab thett I hereby 1IpPdirtt her mo\:her, Ella
M. ~oltzmant 1IS Trustee-Guardiatl, to serve without the
necessity posting bond and without pdor court approval, to
maintain the same for her until she attains 18 years of a<:le;
at which time, she sh1ll1 be entitled to the same.
III. I further directed that the Inheritance Tax shall be bortle
by each beneficiary and sh1ll1 not paid and shall not be p1lid
out of my residuary estate.
IV. I further direct that my funeral shall be by means of
cremation and shall be handled by the Neill Funeral Home and
that the arrangements shall be carried by my Executrix Ella
M. Holtzman.
V. I hereby nominate and appoint John J. Krafsig, Jr., Esquire,
to serve as the attorney for my estate.
^nd I hereby nominate, constitute and appoint ELLA M.
HO(.TZ~N, my Executrix, of this last Will and Testament, without
the necessity of posting bond.
IN WI'l'NESS WHEREOF, I, ~RY J. MUMMA, the Testatrix,
.
- Page 3 -
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\
I
have t.o t.his, my Wilb wri t.ten on foUr (41 sheets of paper, set my
hand and seal t.his f5?c9~day of AugUst. A.b. One ThoUsatld Nine
Hundred and Ninety-eight \1998).
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MAR J :-~Ui@A
Signed,
pUblished and declared by the above
sealed.
named Test.atrix. as and for my last. Will and Testament, in the
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presence of Us, who have hereunt.o SUbscribed our names at. het
request. as wit.nesses theret.o, in the presence of the said Test.atrix
and of each ot.her.
- Fage 4 -
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
EST ATE OF
FILE NUMBER
MARY J. MUMMA
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on SChedule F.
ITEM
NUMBER
1.
DESCRIPTION
Checking account #00618-3685-0 with A11First Bank
VALUE AT DATE
OF DEATH
$3,222.67
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert addilional sheels of the same size)
3,222.67
Il allftrst
MARY J MUMMA
501 WATER ST.
NEW CUMBERLAND PA 17070-2632
1",111...111...1...111... ,,1.1. n.. ..11..,1.111.... ..II. ..111
Page 1 of 3
Relationship With Interest
February 16, 2001 rhrll March '8, 2001
g allflrsl.com " 24.haur
Cuslomer Service
1-800-533-4630
Mary J Mumma
Accl No 00618-3685-0
Activity Summary
Annual percentage yield earned
Avg. daily ledger balance
Avg. daily collected balance
Interest earned this statement
Interest paid this statement
Interest paid this year
Days covered by this slatement
0.90%
$'1,167.73
$'1,167.63
$2.98
$2.98
$9.73
29
Balance on 02115
Deposits and addlllons
Balance on 03118
$'1,135.6'1
'166.86
$'1,602.50
Deposits and additions
D.ale
Descriplio"
Amount
03115
ACH CREDIT
MELLON PAM TRANSFER
3250659306MARY J MUMMA
INTEREST PAID
$'163.88
10171156BNl
20010734592137
03116
2.98
$u~6_8~
End 01 Day Ledger Balance
Account balances are updated In the secllon below on days when transactions posted
to this account.
Dale
Balance
Dale
Balance Dale
a"/ance
02115
$'1,135.6'1
03115
$'1,599.52 03118
$'1,602.50
The annual percentage yield earned reflects the amount of Interest earned on the account
during the statement period and the average dally balance In the account lor that period.
The Interest rate paid will fluctuate according to money market condlllons.
001655
oom'!.9BJ174B7312 050
""'''''''''''''.
COMMQNWEAUH OF PENNSYl\lANlA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
MARY J. MUMMA
Debts 01 decedenl must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT .
A. FUNERAL EXPENSES:
1 Prepaid None
B. ADMINISTRATIVE COSTS: $225.57
1. Personal Representative's Commissions (7 % of total estate, as per Welfare
a~ro1ial) . Ella M. Holtzman
me of ersonal Replesentative (s)
Social Security Numbe~s) I EIN Number of Personal Representative(.)
Street Address 50] Wr:ltpr Strppt
City Npw rnmhprl.=lnn State p~ Zip 17n70
Year{s) Commission Paid: 2001
2. AttomeyFees - John J. Krafsig, Jr., ESo'luire $500.00
(Per Dept. of Welfare a~Rroval)
3. Family. Exemplion: (If decedenfs eddress ~ nollhe same Iaimant's, attach explanalion)
Claimant None:> None
Street Address
City Stale Zip
Relationship of Claimant to Decedent
4. Probate Fees None
5. Accountant's Fees None
6. Tall. Return Preparer's Fees - Filing Return $15.00
7. Register of Wi 11 s - Filing Sma 11 Estate Petition, $18.00
pursuant to Rule 6.11-2
Dept. of Welfare - Bill of ciecedent for reimbursement
for decedent's nursing hom.e care $44,592.93
TOTAL (Also enler on line 9, Recapitulation) $ 45,351.50
(If more space is needed, Insert additional sheels of the same size)
I.
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANClAt OPEflAT10NS
ESTATE RECOVERY PROGRAM
POBO)(84B6
HARRISBURG. PA 17105.8488
February 09, 2001
JOHN J KRAFSIG JR INC
ATTORNEY AT LAW
2921 NORTH FRONT ST
HARRISBURG PA 17110-1281
Re: MARY MUMMA
CIS *: 570144539
Co/Rec: 21/0085154
Date of Birth: 04/05/1923
SSN: 191-18-4563
Dear Attorney Krafsig:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $44.592.93 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 $13.099.90 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 $31.493.03 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,
YK~~ L&>hp-
Margaret L. Sohn
Claims Investigation Agent
717 -772-6609
717-705-8150 FAX
Enclosure - Statement of Claim
.
.
;
~{V-15l) fK+ pll7J
.
COMMQ\".lWt"\lH Of rh>lNSYl'VJI.r>llA
INlllRITA,NCf tAl( RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
~lARY J. MUMMA
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
1.
A. Taxable Bequests:
NONE DUE TO THE INSOLVENCY OF THE ESTA1E
N/A
N/A
N.B. Specific bequests of personal property
in Paragraph I (a), (b), (c), (d), (e) and (f)
were disposed of prior to the decedent's death
With regard to paragraph III of decedent's Will, the
bequest and devise to Allison Holtzman, t resently a
minor, cannot be made, due to the insolvency of
the estate, and has been so advise'!.
None
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMoUNT OR
SHARE OF ESTATE
B. Charitable and Go....ernmenlal Bequests:
1.
None
None
TOT At CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recopitulallanl
III more space I. ne.d.d, Ins.rt additional sh..ts of lame .Ize)
s
None