HomeMy WebLinkAbout01-0481
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Thomas Valle
also known as
No.
21-01-481
, Deceased
Social Security No. 095-58-7550
ldelisa Polidura
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
D A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut_ named in the last Will of
the Decedent, dated and codicil(s) dated
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
[]] 8. Grant of Letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name
Relationship
Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at 724 Cumberland Point Circle, Mechanicsburg
(list street, number, and municipality)
Decedent, then ~years of age, died 04/26/2001 at Roadway, Barr isburg, PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(It not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
$
$
$
$
50.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the a pro riate form to the undersi ned:
Si nature Typed or rinted name and residence
ldelisa Polidura, 168 Bleecker Street
A artment 1, Brookl n, NY 11221
/7-7"- g'
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems,lnc.
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumber land
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
~~ PcO-L~
ldelisa Polidura
before me this ~ day of
MAY
7001
~''1~~rZs~'/ /JV/~
C~ th0 egister
No
21-01-481
Estate of Thomas Valle
Deceased
Social Security No: 095 - 58 - 7550
Date of Death: 04/26/2001
AND NOW,
OCTOBER 19,
, 2001 ,in consideration
of the Petition on the reverse side hereon. satisfactory proof having been presented before me,
IT IS DECREED that Letters D Testamentary [R] Of Administration
(c.t.a.: d.b.n.c.t.a.: pendente lite; durante absentia: durante minoritate)
are hereby granted to
ldelisa Po1idura
in the above estate and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters. $
Short Certificate( s) . $
Renunciation. $
Affidavits ( $
Extra Pages ( ) . $
Codicil. $
JCP Fee. $
Inventory. $
Other (BOND) $
TOTAL. $
18.00
~'r ?f'<~/!~'~ /k~ A<", 't'
R gister of Wills
9.00
Attorney:
John DeLorenzo, Esquire
1.0. No:
72190
Goldberg, Katzman & Shipman
320 Market Street
P.O. Box 1268
Harrisburg, PA 17108-1268
Address:
5.00
Telephone: 717/234-4161
15.00
47.00
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
: h t', IS to certitY that the information here (riven is correcrlv copied from an original certificate of dearh duly tiled with me as
I . f' The orig. inal certifIcate willl)e forwarded ((; the Srate Viral Records Office for permanent fIling.
.lh:.[ ,egisrrar.
WARNING: It is illegal to duplicate this copy by photostat or photograph,
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Loul Regisrra r
Fee for this certificate, ~2,OO
P 7297232
n; In 2 7 20Ul
No,
Date
21-01-481
144 Rev, 1191
COMMONWEALTH OF PENNSYLVANIA a DEPARTMENT OF HEALTH a VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
sex
2,m
STAfE fiLE NUMBER
SOCIAL SECURITY NUMBER
3. () , S- - S g- "15"50
ORE OF DERH (Month, Day, Year)
4. April 26, 2001
WAS DECEDENT EVER IN
U,S, ARMED FORCES?
Vas 0 NO~
1.
?e#1"'~:tl v.4~~w..
(,u,......, h~ L....... J
MARITAL STI'J'US. Married
Nevar Married. Widowed,
, Divorced (Specify)
14. fJh"N'J't!J
17c.O Vas, IMcadant lived In
~:ify)~
RACE. Arn.rlcan Indian, Black. Whita, ale
(Specify) I /J
"'i1 ~~tD 1\,''-14""
10. r I
SURVIVING SPOUSE
(If w~e, give maiden name)
1711. Coun
Old
~nt
live In a
10WIlIh1p?
2211.
10 !he beat 01 my knowledge, death occurred at the lime, date and place allied,
(Signature ana Tnle)
c"y/t
23a.
TIME OF DERH ORE PRONOUNCED DEAD (Monlh, Day, ,"r)
. _ 24. 7:45 a.m. M, 25. April 26, '2001 21.
- D. PIART I: E_!he ~. injurlea or complications which caused the death, 00 not enter !he mode 01 dying. IUCh as cardiac or rasplrmory arrast, shock or hearllallura. I Approxlmata
~ Ualon1yonacausaonaachllna, :intarvalbelwean
lonaal and death
I
i
NoD
PART!I:
OIher signillcanl conditions contributing to death,. bul .
not resulting In the undarlying cause given In PART I.
..-oIATE CAUSE (fonal
diaaa88 01 condilion
-= r-.ling in deaIh)-
~ SaquandaIy Mal condilions
.=.' any.1MdIng 10 mn.dIala
__. e- UNDEJILYINO
-.- ~ (Oiaaaa or Injury
-tIlII iniIiIIIad__
o.iiiiiirading in dIalh) LAST
b,
Multi Ie traumatic in'uries
DUE 10 (OR AS A cONstauENCE OF):
MVA
DUE 10 (OR AS A CONSEQUENCE OF):
c,
DUE 10 (OR AS A CONSEQUENCE OF):
=WUl AN AUroPSY
~__PERFORMED?
---
d
WEAE AUroPSY FINDINGS
~l.A8lE PRIOR 10
COMPLETION OF CAUSE
Of OEI'J'H?
MANNER Of DEATH
Natural
~
o
Homicide
ORE OF INJURY
(Monlh, Day, 'l8at)
Apr. 26, '01
TIME Of INJURY
INJURV RWORK?
_'Na
[2g No 0
YaaQi.
NoD
AccIdent
Pandlng Investigation
7:45 a.m.
Yes xx No 0
DESCRIBE HOW INJURV OCCURRED,
Ejected from vehicle
IlL 2111.
CIflTMIIIR p-* only 0lIl)
'cefl'nIYINQ I'ttYSlClAN (PhytiClan cer1IIyIng cauae 01 death when another phYlicien has pronounced death and completed Item 23)
1l>>...lIaatoflllY~,""'~cluatolhaC--Ca)and_'.ataWd............................... ......................
SuIclde
21.
Could not be dal8rrnlnad
'PRONOUNCING AND CEllTII'YING PHYSICIAN (Physician bolh pronouncing deeIh and certiIying to cause of -l
To Iha beat of IllY lulcMIacIge, ..... occurNd.. thelllM, dB", and ~, and due to the Clluaa(a) ancI_. atMacI.. . . . . . . . . . . . . . . , . . . . . . . . .
~
'MEDICAL lEXAIIIHERICX)R()NER
On tile..... of _1nIIIlon endIor InVMllg8tIon. In my opinion, dMtIl occurred at the t1_. dat.,lIIlcI fIIKe,lIIlcI clue 10 the cauM(a)lIIlcI
__atatacI................................................................................................. .
a1L
REGISTRAR'S S1GNArURE AND NUMBER
,..J-- 10l1.l1' I I
33. /It ~ 4.A....
PA 17111
IN RE: ESTATE OF
THOMAS VALLE,
Deceased
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: No. 2001-00481
CERTIFICA TION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.
Thomas Valle. deceased
April 26. 2001
Admin. No.
2001-00481
To the Register:
I certify that notice of estate administration required by Rule 5. 6( a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on October 23. 2001:
Ashley Valle, a minor
c/o Idelisa Polidura, 168 Blecker Street 1R
Brooklyn, NY 11221
Thomas Valle, Jr., a minor
c/o ldelisa Polidura, 168 Blecker Street 1R
Brooklyn, NY 11221
Date
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/A.
i~I2J/~1 ~::ture -anD~~
Address Goldberg. Katzman & Shipman. P.C.
P.O. Box 1268
Harrisburg_ P A 17108-1268
Telephone (717) 234-4161
Capacity:
_ Personal Representative
~ Counsel for personal
representative
GOLDBERG, KATZMAN & SlllPMAN, P.C.
John DeLorenzo, Esquire - I.D. #72190
Counsel for the Estate
320 Marlcet Street
p, 0, Box 1268
Harrisburg, PA 17108-1268
(717) 234-4161
~ 1-01- ~RI
In Re:
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS COURT DIVISION
ESTATE OF THOMAS VALLE,
Deceased
O.C. No.
SUPPLEMENT TO THE PETITION FOR LETTERS
1. Petition for Grant of Letters was filed with the Cumberland County Register
'........
of Wills on May 17, 2001.
2. Such Petition asked that the mother of the Decedent, Thomas Valle, be
appointed Administrator of the estate.
3. Thomas Valley died intestate on April 26, 2001.
4. Thomas Valle is survived by his two children, who are the sole issues, both
being minors. The net estate will be distributed to these children.
5. Pursuant to Pennsylvania case law, the mother of the decedent is more
appropriately appointed Administrator of the estate than ex-spouse.
6. Bond is included as required (see attached).
~
WHEREFORE, we supplement our Petition, asking that Idelisa Polidura be appointed
Administrator of the Estate of Thomas Valle.
Respectfully submitted,
GOLDBERG, KATZMAN & SHIPMAN, P.C.
t'\ c_.,__)
/
~ t--L::~ .?---~
J ~hn DeLorenzo~ Esquire
I.D. No. 72190
320 Market Street
P.O. Box 1268
Harrisburg, P A 17108-1268
Telephone: (717) 234-4161
Attorney for the Estate
Date: ( (
Ie (L VI
65291.1
~ ~~~~~-_._~_.~~~
..""..~~..~.~............~ ~
~y@
Western Surety Company
Bond No. 69226503
r----
Know all Persons by these Presents:
THAT WE, Idelisa Polidura
and WESTERN SURETY COMPANY, a corporation duly
business in the Commonwealth of Pennsylvania,
firmly bound unto the Commonwealth of Pennsylvania
____ , as Principal,
licensed to do
are held and
In the sum of
One Thousand and 00/100 Dollars ($~ 000. 00 ),
to be paid to the said Commonwealth, or its certain Attorney or Assigns, to which
payment Vi/ell and truly to be made, we bind ourselves jointly and severally, for
and in the whole, our heirs, executors and administrators, firmly by these
presents.
Sealed With Our Seals - Dated the 24th
day of _n~ptember ~~_,
in the year of our Lord __~__ ._nQL____________.
The Condition of This Obligation Is Such, That If The Above Bounden Principal, as Administrator of all
and singular the Goods, Chattels, and Credits of __~___________.l'homa~_Va11~_________ ________,
deceased, does make or cause to be made, a true and perfect inventory of all ancl. singular the Goods,
Chattels and Credits of the said deceased, which have come or shall come to the hande, possession or
knowledge of the Principal or into the hands or possession of any other person or persons, for the said
deceased and the same so made, do exhibit, or cause to be exhibited, into the Register's Office in the County
of______________::um}::)erlaQ9__________, within thirty days from the date hereof; and the same Goods,
Chattels and Credits, and all other the Goods, Chattels and Credits of the said deceased, at the time of
his/her death, which at any time shall come to the hands or possession of the Principal, or into the hands and
possession of any other person or persons, for the said deceased do well and truly administer according to
law, and further do make or cause to be made, a just and true account of said Administration, within six
months from the date hereof, or when thereunto required by the Orphans' Court, and all the rest and residue
of the said Goods, Chattels and Credits which shall be found remaining upon the said Administrator's
3CCO'J.!lt, the same heing fir~t examl.ned and al!oweo hy the Orphffns' Cnlll"t of thf' cOll"nty hFlving jurisdiction,
shall deliver and pay unto such person or persons at the said Orphans' Court, by their decree or sentence,
pursuant to law, shall limit and appoint, and shall well and truly comply with the laws of this
Commonwealth relating to collateral inheritances; and if it shall hereafter appear that any last will and
testament was made by the deceased, and the same shall be proved according to law, if the said Principal
being thereunto required, do surrender the said Letters of Administration into the Register's Office
aforesaid, then this obligation to be void, otherwise to remain in full force.
Principal
Principal
Form 1149-A-8-98
WESTERN SURE TY COMPANY
By ~/ -r: ~~
~ ~~~~~~~~~~~~~~
u~
Western Surety Company
J
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota,
and authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado,
Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky,
Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania,
Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia,
Wisconsin, Wyoming, and the United States of America, does hereby make, constitute and appoint
Stephen T. PaJ~ of Sioux falls
State of __ _ South Dakota , its regularly elected Executive Vice President
as Attorney-in-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for
and on its behalf as Surety and as its act and deed, all of the following classes of documents to-wit:
Indemnity, Surety and Undertakings that may be desired by contract, or may be given in any action or proceeding in any court of law or
nifying employers against loss or damage caused by the misconduct of their employees; official, bail, and surety and
. in all cases where indemnity may be lawfully given; and with full power and authority to execute consents and
or extend any bond or document executed for this Company, and to compromise and settle any and all claims
against said Company.
""
. .'. rn Surety . ~ further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety
4ny duly adopted ahd!rts?w in force, to-wit:
"it:'" "",^. '\& li:'?f
~ 1'1' 4(fl "6.( , '4J)olicies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
cor' pany by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other
officer '1-" ..... .~.,%' Irectors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may
appoint AttoffiE!\j!!f..1h\..'Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The
corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by
~xecutive Vice President with the corporate seal affixed this 24th day of September 2001
ATTEST
. .. . --ct-- ~"" nrJ -
AsSistant Secretary
WESTEI1A'! SVRETY COMPj(1\V
By ~/ -r: . ~z;:
Stephen T. Pate, Executive Vice President
STATE OF SOUTH DAKOTA }
ss
COUNTY OF MINNEHAHA
On this 24th _ day of ~tember _~, 2001___, before me, a Notary Public, personally appeared
____ ______ Stephen T. Pate and _________ L. Nelson ____
who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as_ Executive Vice President
and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be
the voluntary act and deed of said Corporation.
+~~~~~~~~~~~~~~~~~~~~~~~~+
i D. KRELL ~
~~NOTARY PUBLICc5!D~
, SOUTH DAKOTA ,
'Me .. E' 8
S Y ommlSSlOn xprres 11.30.2006 S
+~~~~~~~~~~~~~~~~~~~~~~~+
IJ) ~dl
Notary Public
{'
.~
Form F1975-4-2001
ESTATE OF
THOMAS VALLE,
Deceased
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In Re:
No. 2001-00481
~Jrlj
AND NOW, this ~ day of r
, 2003, upon
consideration of the foregoing "Petition for Distribution of Minor' s Estate as a Sequestered Deposit
Under Probate, Estates, and Fiduciaries Code 9 5103", it hereby
ORDERED AND DECREED that the final distribution to the minor beneficiaries, Thomas
V. Valle, Jr. and Ashley I. Valle (the "Minor Beneficiaries") each in the amount of Six Thousand Five
Hundred Eleven and 42/1 00 Dollars ($6,511.42) shall be distributed to Citibank in New York under
his/her respective accounts. Additionally, these deposits shall be sequestered and no withdrawals can
be made from such accounts until the Minor Beneficiary attains his/her age of majority or by further
Order of this Court.
BY THE COURT,
, Judge sitting for the
( /
'J:lll UJ
In Re:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF
THOMAS VALLE,
Deceased
No. 2001-00481
PETITION FOR DISTRIBUTION OF MINOR'S ESTATE
AS A SEOUESTERED DEPOSIT UNDER
PROBATE.. ESTATES AND FIDUCIARIES CODE ~ 5103
TO THE HONORABLE JUDGES OF SAID COURT:
AND NOW, comes Idelisa Polidura, Administratrix for the Estate of Thomas Valle (the
"Petitioner") by and through her attorney, Goldberg, Katzman & Shipman, P. C., without appointment
of guardian under provisions of ~ 5103 of the Probate, Estates and Fiduciaries Code respectfully
represents as follows:
1. Thomas Valle (the "Decedent") died intestate on April 26, 2001, late of Upper Allen
Township.
2. A Petition for Grant ofLetters of Administration was filed by Idelisa Polidura, mother
of the Decedent. On October 19, 2001, Idelisa Polidura (the "Administratrix") was appointed
Administratrix of the Estate of Thomas Valle (the "Estate"). Bond in the amount of$l,OOO.OO was
posted because the Administratrix lived out of state.
3. The Administratrix resides at 168 Blecker Street 1R, Brooklyn, New York and is the
paternal grandmother of Thomas V. Valle, Jr. (DOB: 1/8/90) and Ashley I. Valle (DOB:12/22/91),
minors and sole beneficiaries of the Estate under 20 Pa.C.S. ~ 2103 (the "Minor Beneficiaries").
4. The Minor Beneficiaries reside at 1615 Matthew Drive, Camp Hill, Pennsylvania with
their mother, Jacqueline Terry.
5. The Pennsylvania Inheritance Tax Return was filed on July 19, 2002 and was accepted
as filed by the Pennsylvania Department of Revenue on September 23,2002. A copy of the Notice
of Assessment is attached hereto as Exhibit "A".
6. The Inventory was filed on August 6, 2002. A copy of the Inventory is attached
hereto as Exhibit "B".
7. Once Estate fees and costs are paid, there will remain a balance distributable to the
Minor Beneficiaries of Thirteen Thousand Twenty-two and 84/100 Dollars ($13,022.84). Each
Minor Beneficiary will receive Six Thousand Five Hundred Eleven and 42/1 00 Dollars ($6,511.42)
as a final distribution from the Estate. A spreadsheet regarding the assets and expenses of the Estate
is attached hereto as Exhibit "C".
8. The Minor Beneficiaries each received a distribution of Three Hundred Nine and
06/100 Dollars ($309.06) from the Decedent's IRA. On November 23, 2001, the Administratrix
opened savings accounts for each Minor Beneficiary with Citibank in New York.
9. The account number for Thomas V. Valle, Jr. is 0007516712 and for Ashley I. Valle
is 0007516675. The Administratrix would use these bank accounts as the sequestered accounts.
10. Citibank is insured by a Federal government agency.
11. Preservation of the funds for the benefit of the minor beneficiaries is a tantamount
concern for the Administratrix
12. Such funds should be used exclusively for the benefit of the minor beneficiaries.
13. Establishment of the sequestered accounts would promote this goal.
14. Petitioner believes and therefore avers that the establishment of sequestered accounts
is an appropriate means to protect the funds for the Minor Beneficiaries of the Estate.
15. Appointment of a Guardian ad litem for the Minor Beneficiaries is not necessary
because Your Honorable Court maintains supervision of such accounts for Minor Beneficiaries and
under ~ 5103 of the Probate, Estates and Fiduciaries Code, no withdrawals can be made from such
accounts until the Minor Beneficiary attains his/her age of majority or by Order of Court.
WHEREFORE, Petitioner respectfully requests Your Honorable Court to sequester the
deposit of the final distributions to the Minor Beneficiaries into the savings accounts established with
Citibank and Order that no withdrawal can be made from any such account until the Minor
Beneficiary attains his/her majority.
Respectfully submitted,
GOLDBERG, KATZMAN & SHIPMAN, p.e.
Date: February 1L 2003
By:
John DeL renzo, Esquire
Attorney lD. No. 72190
320 Market Street
P.O. Box 1268
Harrisburg, P A 17108-1268
(717) 234-4161
Attorneysfor Estate oflhomas Valle
VERIFICATION
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. ~ 4904
relating to unsworn falsification to authorities.
Date: OJ/a 3/0.3
f
J2-J-,{~~~- I~~
ldelisa Polidura '
EXHIBIT ^
BUREAV OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JOHN DELORENZO ESQ
GOLDBERG ETAL
PO BOX 1268
HBG PA 17108
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-23-2002
VALLE
04-26-2001
21 01-0481
CUMBERLAND
101
I ;J"-j j-2-
'*
REY-1547 EX AFP (01-02)
THOMAS
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 ~
R"{V = i:S4-j-E3f-AFP--fO-f:02-r-NCii'-icE--OF-'rNHEifiTAifcE-"-A"X-A-PPRAisEifENT:--Ar:rOWAifcE-'i:rR"------------ - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VALLE THOMAS FILE NO. 21 01-0481 ACN 101 DATE 09-23-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
30.000.00
.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)
UO)
21.668.27
.00
(1)
(2)
(3)
(4)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
30,,000.00
21.668 27
8,,331.73
.00
8,331.73
HC'TE:
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
.00 X 00 =
8,,331.73 X 045 =
.00 X 12 =
.00 X 15 =
(9)=
(5)
(6)
(7)
(8)
.00
374.93
.00
.00
374.93
..... 'Ln, "...~....... . II (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-19-2002 CDOO1426 .00 374.93
07-19-2002 WRITEOFF .00 10.69
TOTAL TAX CREDIT 374.93
BALANCE OF TAX DUE .00
INTEREST AND PEN. .01
TOTAL DUE .01
* 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. 1
BXHIBIT B
Register of Wills of Cumberland County, Pennsylvanta
INVENTORY
, Deceased
No. 2001-00481
Date of Death April 26, 2001
Social Security No. 095-58-7550
Estate of Thomas Valle
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 Decedenfs death, and that Decedent owned no real estate outside of the Commonwealth of
Pennsylvania except that which appears in a memorandum at the end of this inventory. IMJe verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifICation
to authorities.
Name of
Attorney: John Delorenzo. ESQ.
Personal Representative:
;)JU~~~;,.~ /~~~.AA~~-
Idelisa Polidura, Administratrix
I.D. No.:
72190
Address: GoldberQ, Katzman & Shipman, P.C., 320 Market Street,
Dated 1- d;) ~ c.;2.
P.O. Box 1268. HarrisburQ, PA 17108-1268
Telephone:
717-234-4161
Description
Value
1. Settlement of civil action docketed to Cumberland County Court of Common Pleas at civil
action number 1999-02733, survival action per Court Order dated July 8, 2002
$30,000.00
(Attach Additional Sheets if necessary)
Total:
$ 30,000.00
NOTE: The Memorandum 0( real estate outside the Comrn<>rl'Nealth of Pennsylvania may, at theelediondthe personal representative, includethevaluedeach item, but such
figures should not be extended into the total of the Inventory.
BXlllBlT C
RECEIPTS OF PRINCIPAL
Settlement of civil action docketed to Cumberland
County Court of Common Pleas at civil action
number 1999-02733, survival action 30,000.00
TOTAL: 30,000.00
DISBURSEMENTS
Expenses for civil action 11,477.23
Register of Wills, Cumberland County - filing fee for
7/19/02 Return & Inventory 25.00
TOTAL: 11,502.23
TAXES:
Register of Wills, Agent - Pennsylvania Inheritance
7/19/02 Tax 374.93
TOTAL: 374.93
NET ESTATE:
18,122.84
COMPOSITION OF NET BALANCES:
Balance available in client escrow account held at
Golberg, Katzman & Shipman, P.C.
Less: Attorney fees for estate administration
Reserve for closing costs
TOTAL FOR DISTRIBUTION:
18,122.84
5,000.00
100.00
13,022.84
DISTRIBUTION TO BENEFICIARIES:
Thomas V. Valle, Jr. - 50% of residue
Ashley I. Valle - 50% of residue
TOTAL:
6,511.42
6,511.42
13,022.84
CERTIFICATE OF SERVICE
I hereby certify that on this day I served a true and correct copy of the foregoing
document upon all parties or counsel of record by depositing a copy of same in the United States
Mail at Harrisburg, Pennsylvania, with first-class postage prepaid addressed to the following:
Thomas V. Valle, Jr. and Ashley I. Valle
c/o their natural guardian and mother
Jacqueline Terry
1615 Matthew Drive
Camp Hill, PA 17011
Date: February JL, 2003
By:
DeLorenzo, Esquire
ttorney I.D. No. 72190
320 Market Street
P.O. Box 1268
Harrisburg, P A 17108-1268
(717) 234-4161
Attorneys for Estate of Thomas Valle
84463.1
JJ. j -0 I -;';'t J
COSTOPOULOS & WELCH
Attorneys
1400 North Second Street
Ha"isburg, PA 17102
Jeanne B. Costopoulos, Esquire
Allen C Welch, Esquire
Sharon 1.. Reisinger, Paralegal
Zachary D. CampbeR, Legal Assistant
Telephone: (717) 221-0900
Facsimile: (717) 221-0904
E-mail: jbclegali!J,aoL com
May 16,2001
Ralph Wright
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Informal Caveat
Estate of Thomas Valle
Date of Death: 4/26/2001
Dear Mr. Wright:
Please provide notice to me, as attorney for Leezued Rodriquez - alleged
common law wife of the deceased, before granting letters of administration to anyone
cIaiming rights to administrate Mr. Valle's estate.
Sincerely yours,
Je~osto:ulOS' E~uire
CC: File
..
--
COSTOPOULOS & WELC.H
Attorneys
1400 North Second Street
Ha"isburg, P A 17102
Jeanne B. Costopoulos, Esquire
AUen C Welch, Esquire
Sharon L Reisinger, Paralegal
Zachary D. Campbell, Legal Assiftant
Telephone: (717) 221-0900
Facsimile: (717) 221-0904
E-nudl: jbclegaJ@JloLcom
cS~
Ralph Wright
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Via facsimile no. (717) 240-7797 and regular U.S. mail
Re: Informal Caveat
Estate of Thomas Valle
Date of Death: 4/26/2001
Dear Mr. Wright:
Please be advised that my client, Leezued Rodriquez, ..is withdrawing her informal,
~t which was forwarded to your office last month. Notice to me, as attorney for
Leezued Rodriquez, is no lon~er necessary before granting letters of administration to
anyone c1airninl: riihts to administrate Mr. Valle's estate.
Sin:2erel yours,
/~
Je e B. CostoPOulos, Esquire
CC: John De Lorenzo, Esquire
ldelisa Polidura
Leezued Rodriquez
File
71 r"?;;'1::21 'JI3Cl~~
.,
05/07/2001 10:32
71 7221 0'3~14
\cJ I cJBEL'3I;.IELCH
PAGE [11
~ool-1-i g I
CO..~TOPOULOS & WELCH
Attorneys
1400 NO'I"Ilr L~oIUl StretIt
Harrisburg, PA 17101
Tt:Iep~: (717) 121..(}9O(J
F<<Si1llih: (711) 221-Htu
E-1lUliJ: ~COIII
J~ B. c~ B.,Mire
AIk. C W." bq_w
S/utrolt L. Rmi"We1'. ~td
Z~1uuy D. ~ LqtJl ~
June 6, 2001
Ralph Wright
Reglster of Wills
Cumberland CoWlty Courthouse
One Courthouse Square
Carlisle, P A 17013
Via facsimile no. (717) 240-7797 and regular U.S. mail
Re: Informal Caveat
Estate of Thomas Valle
Date of Death: 4/26f2001
Dear Mr. Wright:
Please be advised that Iny chent, Leezued Rodrique~ is withdrawing h~ informal
caveat which was forwarded to y~)ur office last month. Notice to me, as attorney for
:LeeiUed Rodriquez, is no longer necessary before granting letters of administration to
anyone claiming rights to administrate Mr. Valle's estate.
/
J' e B. Costopoulos. Esquire
cc: John De Lorenzo. Esquire
Idelisa Pohdura
Leezued Rodriquez
File
Register of Wills of Cumberland County, Pennsylvania
c
INVENTORY
Estate of Thomas Valle
also known as
I Deceased
No. 2001-00481
Date of Death April 26. 2001
Social Security No. 095-58-7550
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the follOlNing 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 Decedenfs death, and that Decedent owned no real estate outside of the Commonwealth of
Pennsylvania except that which appears in a memorandum at the end of this inventory. IMle verify that the statements made in this Inventory are true
and correct. IMle understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifICation
to authorities.
Name of
Attorney: John DeLorenzo. ESQ.
Personal Representative:
.; I' l '. i/ /" . /'
'::-;o'~/J,,-:... I ;~.&./_.~~
Idelisa Polidura, Administratrix
1.0. No.:
72190
Address: GoldberQ, Katzman & Shipman, P.C., 320 Market Street,
Dated 1 - j .;) .- D c2..
P.O. Box 1268, HarrisburQ, PA 17108-1268
Telephone:
717-234-4161
Description
Value
1. Settlement of civil action docketed to Cumberland County Court of Common Pleas at civil
action number 1999-02733, survival action per Court Order dated July 8, 2002
$30,000.00
(Attach Additional Sheets if necessary)
Total:
$ 30,000.00
NOTE: The Memorandum of real estate outside the Coml1'lOl1'Nealth of Pennsylvania may, attheeledion clthe persa1aI represenIative, incIudethevaluecl each lem. but such
ligures should not be extended into the total of the Inventory.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GOLDBERG KATZMAN & SHIPMAN PC
320 MARKET STREET
PO BOX 1268
HARRISBURG, PA 17108-1268
-------- fold
ESTATE INFORMATION: SSN: 095-58-7550
FILE NUMBER: 2101-0481
DECEDENT NAME: V ALLE THOMAS
DATE OF PAYMENT: 07/19/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/26/2001
NO. CD 001426
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $374.93
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: NEIL HENDERSHOT
C/O GOLDBERG KATZMAN ETAL
CHECK# 5756
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
$374.93
MARY C. LEWIS
REGISTER OF WILLS
'v /?-?~-R
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
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
i., COUNTY
ACN
09-23-2002
VALLE
04-26-2001
21 01-0481
CUMBERLAND
101
JOHN DELORENZO ESQ
GOLDBERG ETAL
PO BOX 1268
HBG PA 171'08
*'
REY-1547 EX AFP (DI-D21
THOMAS
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifE-Y=is"4-j-EX--AFP--foY:021--NOTICE--OF-'rNHEifITAifcE-T-AX-A-PPRAISEifENT~--Aii-oWANCE-(fR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VALLE THOMAS FILE NO. 21 01-0481 ACN 101 DATE 09-23-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
30,000.00
.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)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 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 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
NOTE:
(9)
(10)
21,668.27
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
30..000.00
21.668 27
8,331.73
.00
8,331.73
00 =
045 =
12 =
15 =
.00
374.93
.00
.00
374.93
.00
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
.00 X
8,331.73 X
.00 X
.00 X
(19)=
1"" TrIl:N I ............. . II l + J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-19-2002 CDOO1426 .00 374.93
07-19-2002 WRITEOFF .00 10.69
TOTAL TAX CREDIT 374.93
BALANCE OF TAX DUE .00
INTEREST AND PEN. .01
TOTAL DUE .01
. 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.)
"'.
r/
c
oK
~
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
THOMAS VALLE
Date of Death:
April 26. 2001
Will No.
Admin.
2001-00481
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No X
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: May 31. 2003
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 Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the
parties in interest?
Yes No
d.
Copies of receipts, releases, joinders and approvals of formal or
information accounts may be filed with the Clerk of the Orphans'
Court and may be attached t~ t . sr~.
Date:
3(l)(r, ]
John DeLorenzo. Esquire
Goldberg. Katzman & Shipman. P.C.
320 Market Street. P.O. Box 1268
Harrisburg. P A 17108-1268
(717) 234-4161
Capacity:
Personal Representative
X Counsel for personal representative
...
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (71 7) 240 - 6345
~
Date: 3/10/2003
\OLIDURA IDELISA
168 BLEECKER STREET APT 1
BROOKLYN, NY 11221
RE: Estate of VALLE THOMAS
File Number: 2001-00481
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' 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: 4/26/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc: ./ File
Counsel
Judge
(
c,
()~
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
THOMAS VALLE
Date of Death:
Aori126.2001
Will No.
Admin.
2001-00481
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
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 X
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the
parties in interest?
Yes X No
d.
Copies of receipts, releases, joinders and approvals of formal or
information accounts may be filed with the Clerk of the Orphans'
Court and may be attached to 0 r~
J.JL i!- ~-
1 ature
Date:
~ l~!CJ
John DeLorenzo. Esquire
Goldberg. Katzman & Shil'man. P. C.
320 Market Street. P.O. Box 1268
Harrisburg. P A 17108-1268
(717) 234-4161
Capacity:
Personal Representative
X Counsel for personal representative
~
/1- 70 - J"
v/
REV -1500 EX + (6-00)
CAPB
HpRL
EplO
CRAC
KOTK
ES
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
o
E
C
E
o
E
N
T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG,PA 17128-0601
DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
Valle Thomas
DATEOF DEATH (MM-DO-YEAR)
FILE.~U,MBER
0:L ()/
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
095-58-7550
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
04 26 2001
I APPLICABL URVIVING S OU
REGISTER OF WILLS
SOCIAL SE URITY NUM R
X 1. Original Return
4. limited Estate
6. Decedent Died Testate
(Attach copy of Will)
~ 9. L1t1gatron Proceeds Received
O,N,M
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a LIving Trust
(Attach copy of Trust)
o 10. Spousal Poverty Credit
(date of death between 12-31-91 and 1.1.95)
W:C,Q,lfESP:ONpitf
C P
o 0
R N
R 0
E E
S N
T
C
o
M
P
T U
A T
X A
T
I
o
N
o
o
D1~1
NUMBER
3. Remainder Return P~~J~ t"o ~l_af~_8Z)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
Copyright (c) 2000 form software only The Lackner Group, Inc.
NAME
John DeLorenzo, Es uire
FIRM NAME (If AppUcable)
Go1dber , Katzman & Shi man, P.C.
TELEPHONE NUMBER
320 Market Street
P.O. Box 1268
Harrisburg, PA 17108-1268
R
E
C
A
P
I
T
U
L
A
T
I
o
N
1. Real Es'at. (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
S. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage liabilities, & liens (Schedule 1) (10)
11. Total Deductions ('olal Lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (line 12 minus line 13)
(1)
(2)
(3)
None
None
None
i'OFFICIAL USE ONLY
(8) 30,000.00
(11) 21. 668.27
(12) 8,331. 73
(13)
(14) 8,331.73
(15)
(16)
(17)
(18)
(19)
0.00
374.93
0.00
0.00
374.93
(4)
(5)
None
30,000.00
(6)
None
None
21,668.27
None
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20.
8,331. 73
X
X
X
X
.0 0
.0 45
.12
.15
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS'
724 Cumberland Pointe Circle
CITY Mechanicsburg I STATE PA I ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line (9)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pnor Payments
C. Discount
(1)
374.93
Total Cred~s (A' B' C) (2)
(3)
(4)
(5) 374.93
0.00
(5A)
(5B) 374.93
3. InteresVPenalty if applicable
D. interest
E. Penalty .
Tolal InleresVPenalty ( 0 . E )
4. if Line 2 is greater than Line 1 . Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund
5. If Line 1 . Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the Interest on the tax due.
B. Enter the total of Line 5 . 5A. This is the BAlANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transfenred;.......................................................................................... D
b. retain the nght 10 designate who shail use the property transfenred or its inceme; ............................................ D
c. retain a reversionary interest; or.............................................................................,............................................ 0
d. receive Ihe promise for life of either payments, benefits or care? .......................,.............................................. 0
2. if death occurred afier December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in lrust fo~ or payable upon dealh bank acccunl or secunty al his or her death?.............. D
4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D
No
[iI
[iI
[iI
[iI
[iI
IjI
[j]
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 perjury, I declare that I hal/e examined this return, including accompanying schedules and slalements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of t;.\repal'e( cth9l' than \tie persCllal reprasen\ati\>& \s basecl on all infOlTTlalion of which preparer has any knowledge.
SIGNATURE PERSON RESPONSIBLE FOR FILING RETURN
. ~
ADORE S
168 Blecker Street, l-R, Brooklyn, NY 11221
SIGNATURE OF P
ADDRESS Go 1
DATE
-, Y
.;l..
DATE
101..-
& Shipman. p.e., 320 Market St, PO Box 1268, Harrisburg, PA 17108-1268
1
!M-W- llI!~~"'" - .. -. ,-
For dales of death on or afier July 1, 1994 and before January 1, 1995, the tax rate imposed en Ihe net vaiue of transfers to or forthe use of the surviving spouse is 3%
[72 P.S. 9g116 (a) (1.1) (i)).
For dales of death on or after January 1, 1995, Ihe lax rate imposed on Ihe net value of transfers to or for Ihe use of the surviving spouse is 0% [72 P.S. 99116 (al (1.1) (iill
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 relum are still applicable even if
the surviving spouse is the only beneficiary.
For dates of dealh on or afier Juiy 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)).
The lax rale imposed on Ihe net vaiue of transfers 10 or for the use of the decedent's lineal beneficianes is 4.5%, excepl as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1 II.
The lax rale imposed on Ihe net vaiue of transfers 10 or for the use of Ihe decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.150a EX +(1-97)
CO~~ONWEALTH OF PENNSVLVANIA.
INHERITA.NCETAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Thomas Valle SS# 095-58-7550 04/26/2001
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
Settlement of civil action docketed to Cumberland County Court of
Common Pleas at civil action number 1999-02733, survival action
(copies of Court Order dated July 8, 2002 and Petition for Court
Approval of Settlement, along with copies of checks received
July 19, 2002)
VALUE AT DATE
OF DEATH
30,000.00
TOTAL (Also enter on line 5, Recapitulation) S
(If more space is needed, insert additional sheets of the same sjze)
30,000.00
REV-151,l EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Thomas Valle
Debts of decedent must be reported on Schedule I,
ITEM
NUMBER
A.
B.
FILE NUMBER
55!1 095-58-7550
04/26/2001
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES,
San Juan Funeral Home - funeral services
3,500.00
2
T.S. Crough - grave marker
1,320.00
1.
ADMINISTRATIVE COSTS,
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
3.
Attorney's Fees Goldberg, Katzman & Shipman, P. C.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
5,000.00
4.
Register of Wills
47.00
Probate Fees
s. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
The Patriot News - estate notice advertisement fee
102.24
2
Cumberland Law Journal - estate notice advertisement fee
75.00
3
Vital Records - death certificate fee
9.00
4
Register of Wills, Cumberland County. short certificate fee
15.00
5
Simon Company, Inc. - surety bond fee
75.00
6
Sheriff, Cumberland County - process fee
103.48
Total of Continuation Schedule(s)
11,421. 55
TOTAL (Also enter on line 9, Recapitulation) S 21,668.27
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
Estate of: Thomas Valle
Soc See #: 095-58-7550
Date of Death: 04/26/2001
Item
#
Continuation of Schedule H-B7
(Other Administrative Costs)
Description
Amount
7
Prothonotary, Cumberland County - filing fees & subpoenas
93.00
8
Hughes, Albright. Foltz & Natale - transcript fee
247.80
9
Capitol Copy Service - copying fees
2.12
10
Myshin Prosthodnotics, PC - expert report fee
500.00
11
Periodontal Associates - expert report fee
100.00
12
Dr. Larry Pepper DMD - medical records
17.10
13
Health Information Management Services - medical records
30.15
14
Lower Allen Township - research & copy fees
10.00
15
Endodontics Associates - copy charges
25.00
16
Register of Wills, Cumberland County - filing fee for Return &
Inventory
25.00
17
Goldberg, Katzman & Shipman, P.C. - attorney fees for civil
litigation matter
10,000.00
18
Goldberg, Katzman & Shipman, P.C. - reserve for estate
administration closing fees
100.00
19
Goldberg, Katzman & Shipman, P.C. - reimbursement for out-of-
pocket expenses for civil litigation matter
271.38
11,421. 55
AEV-1S13 EX +(9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Thomas Valle
FILE NUMBER
SSIf 095-58-7550
04/2612001
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [Include outright spousal dIstrIbutions, and
transfers under Sec. 9116(a)(1.2)]
1 Thomas V. Valle, a minor
c/o Idelisa Polidura, Custodian
168 Blecker Street, loR
Brooklyn, NY 11221
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Son 1/2 of Residue
2 Ashley I. Valle, a minor
c/o Idelisa Polidura, Custodian
168 Blecker Street, loR
Brooklyn, NY 11221
Daughter 1/2 of Residue
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S
(If more space is needed, insert additional sheets of the same size)
0.00
Index to Exhibits
Pennsylvania Inheritance Tax Return
Estate of Thomas Valle, deceased
Exhibit A: Grant of Letters of Administration
Exhibit B: Copy of Court Order dated 7/8/02, along with copy of Petition for Approval of
Settlement and checks received 7/19/02
67135.1
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WHEREAS, VALLE THOMAS
(LAbl, t.LKbl,
CUMBERLAND COUNTY
and
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2001-00481 PA No. 21-01-0481
ESTATE OF VALLE THOMAS
\LAbl, ~lKbl, M1UUL~)
Late of
UPPER ALLEN TOWNSHIP
CUM~~KLill~U CUU~lY,
Deceased
Social Security No. 095-58-7550
, late of UPPER ALLEN TOWNSHIP
lVJlUUL~i
, died on the 26th day of
April
2001;
WHEREAS, the grant of letters of administration
is required for the administration of the estate.
THEREFORE, I, MARY C. LEWIS Register of wills
in and for the County of CUMBERLAND , in the
Commonwealth of Pennsylvania, have this day granted Letters of Administration
to POLIDURA IDELISA
(LAbl, tlKbl, M.LUUL~)
who has duly qualified as administrator (rix) of the estate
of the above named decedent and has agreed to administer the estate according
to law, all of which fully appears of record in my Office at CUMBERLAND
COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office on the 19th day of October 2001.
~jf/ (/ ~~ti/~'~~ ~{1er4^< ,
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
Guy H. Brooks, Esq.
J.D. #49672
GOLDBERG, KATZMAN & SHIPMAN, P.C.
320 Market Street
P. O. Box 1268
Harrisburg,PA 17108-1268
(717) 234-4161
Counsel for Plaintiff
THOMAS VALLE,
Plaintiff:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
v.
No. 1999-02733
CIVIL ACTION - LAW
WILLIAM D. BITTNER,
Defendant
JURY TRIAL DEMANDED
t;L
AND NOW, this L day of
n-
for Court Approval of Settlement, IT IS HEREBY ORDERED AND DECREED THAT:
1. In exchange for the payment of$30,000, the Administratrix ofPlaintiff's Estate will
, 2002, upon the Plaintiff s Petition
agree to sign a General Release of all claims arising from this incident.
2. From the settlement proceeds of $30,000, the payment of attorney's fees of
$10,000 to Goldberg, Katzman & Shipman, P.e. is approved.
3. The reimbursement to Goldberg, Katzman & Shipman, P. C. of costs advanced in
this case in the amount of$l,477.23 is approved.
4. From the net settlement proceeds of$18,522. 77, payment of$18,522.77 the Estate
of Thomas Valle is approved.
BY THE COURT:
TRUE <..,OPY fRROM RECORD
In T estlloony whaIeol. I hllC"& unto set my hand
11<1 tile ; 01 sa. ,ll Coof\ at Carll$la, Pa.
a ~.:ltJO;l.--
rhls dzy .01 ' . ^> '
= '1' () . p1f
. Prothonotary
J, '5/ .1:le..l.4K.- C. ll...J? P'~, I
-u- m pr-p .J.
Guy lL Brooks, Esq.
J.D. #49672
GOLDBERG, KATZMAN & SIllPMAN, P.C.
320 Market Street
P. O. Box 1268
Harrisburg, PA 17108-1268
(717) 234-4161
Counsel for Plaintiff
THOMAS VALLE,
Plaintiff:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
v.
No. 1999-02733
CIVIL ACTION - LAW
o
t=
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S~~L
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WILLIAM D. BITTNER,
Defendant
c=
JURY TRIAL DEMANDED
:;:::::~:;:;:::::.:.:.
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AND NOW COMES the Plaintiff, by his attorneys, Goldberg, Katzman & Sliipman, P.C.,
who files this Petition requesting this Honorable Court to approve a settlement based on the
following:
1. This matter arises out ofa negligence action which occurred on June 30, 1997 in
Cumberland County, Pennsylvania.
2. As a result of the alleged negligence, Plaintiff; Thomas Valle, suffered injuries.
3. On or about April 26, 2001, Plaintiff died from an unrelated accident.
4. On or about October 19, 2001, Plaintiff's mother, Idelisa Polidura
("Administratrix"), was appointed Administratrix of the Estate of Thomas Valle by grant of
Letters of Administration issued by the Register of Wills of Cumberland County. An original
Short Certificate issued by the Register of Wills of Cumberland County is attached as Exhibit
"A",
4. The Estate of Thomas Valle (the "Estate") is docketed as number 2001-00481 by
the Register of Wills of Cumberland County, Pennsylvania.
5. Accordingly, the Administratrix has the legal authority to act on behalf of the Estate
and to settle this matter.
6. Mr. VaIle's two minor children, Thomas V. VaIle (DOB: 1/8/90) and Ashley I.
VaIle (DaB: 12/22/91) are the sole heirs of the Estate. Such children are the grandchildren of the
Administratrix.
7. Plaintiff filed this civiIlawsuit against Defendant, William D. Bittner on or about
March 15,2000.
6. In June 2002, Defendant, offered the the Administratrix $30,000 to settle the
existing claim.
7. The Administratrix has carefuIly considered this offer and believes that accepting
this offer is in the best interest of the Estate.
8. In exchange for the payment of$30,000, the Administratrix on behalf of the Estate
will agree to sign a General Release of all claims arising from this incident.
9. From the settlement proceeds of$30,000, Administratrix requests this Honorable
Court to approve the payment of at tomey's fees of$10,000 to Goldberg, Katzman & Shipman,
P.C.
10. Plaintiff also requests this Honorable Court to approve the reimbursement to
Goldberg, Katzman & Shipman, P.C. of costs advanced in this case in the amount of$1,477.23.
13. Because the Plaintiff death is unrelated to this claim, all proceeds will pass through
the Estate. Therefore, no allocation between wrongful death and survival action is necessary.
12. Accordingly, from the net proceeds of$18,522.77, Administratrix requests this
Honorable Court to approve payment of$18,522.77 to the Estate of Thomas Valle.
14. The parties also request that, upon approval of this Petition, the Court direct the
Prothonotary to file both this Petition and the accompanying Order under seal.
WHEREFORE, PlaintiffrespectfuIly requests this Honorable Court to approve this Petition
for Settlement in accordance with the terms outlined in the Petition and to direct the Prothonotary
to seal both this Petition and Order approving the proposed settlement.
2
Dated: June -----> 2000
#80853 vI - Petition for Settlement
By:
RespectfuJ1y submitted,
GOLDBERG, KATZMAN & SHIPMAN, P.c.
yJ t1 J]j
Guy H. Brooks, Esquire
. Attorney LD. No. 49672
P.O. Box 1268
Harrisburg, PA 17108-1268
(717) 234-4161
Attorney for Plaintiff
CERTIFICATE OF SERVICE
I hereby certifY that I served a copy of the foregoing document upon the person(s)
indicated below by depositing a copy of the same in the United States mail, postage prepaid, at
Harrisburg, Pennsylvania and addressed as follows:
Karl R. Hildabrand, Esq.
Metzger Wickersham
3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
Attorney for Defendant
By:
GOLDBERG, KATZMAN & SHIPMAN, P.c.
~t!o,,0J,
Attorney for Plaintiff
Date: June --' 2000
~ Prudential
. Financial
Check Number:
Date:
Claim Number
12948654
Jul. 17, 2002 2469
46R08280-040 12 F0012
P.O. Box 977
Horsham, PA 19044-0977
Payee Address:
GOLDBERG,KATZMAN SHIPMAN,P.C.*
320 MARKET STREET
HARRISBURG, PA 17108-0000
"
P.O. Box 977
Horsham, PA 19044-0977
Please cut along this line and return in the enclosed envelope when necessary
..................................................................................................
RE: VALLE THOMAS
REIMBURSEMENT OF COSTS ON CASE OF THOMAS VALLE
QUESTIONS, CALL: 800-634-1523
Prudential Property and Casualty Insurance Company
Detach at perforation below
36CK12
CHECK TOTAL:
$1,477.23
"0"___._ -._.,',.' ",_,,_
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Pay ONE THOUSAND FOUR HUNDRED SEVENTY
TO THE I
ORDER OF GOLDBERG,KATZMAN SHIPMAN,P,C..
320 MARKET STREET eEA~IWt.~ 1'14At,~iii.
HARRISBURG, PA 1710B-00DO . CAWV ~~r;;~
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\8 Financial
Check Number:
Date:
Claim Number
12948655
Jul. 17. 2002 2470
46R08280-040 12 F0013
P.O. Box 977
Horsham, PA 19044-0977
Payee Address:
GOLDBERG KATZMAN AND SHIPMAN*
320 MARKET ST
POBOX 1268
HARRISBURG, PA 17108-1268
P.O. Box 977
Horsham. PA 19044-0977
Please cut along this line and return in the enclosed envelope when necessary
RE: VALLE
ATTORNEY
THOMAS
FEES ON CASE OF THOMAS VALLE
QUESTIONS. CALL: 800-634-1523
Prudential Property and Casualty Insurance Company
Detach at perforation below
36CK 12
CHECK TOTAL:
$10.000.00
TO THE t
ORDER OF
GOLDBERG KATZMAN AND SHIPMAN.
:2g ~~~KN6=T e':A~~
HARRISBURG, PA 1710B-126B ~~ )if!
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180 DAYS
Pay TEN THOUSAND DOLLARS AND 00 CENTS 'V,
<<..,
:",:,--,-",,'~~'~"'''''''''''j''
"onnl;lClLAl:.t;t;"o l~n~llnn?l:.?I~ l:.~nLI.?nLnl. 'inq"o
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~ Prudential
. Financial
Check Number:
Date:
Claim Number
12948653
Jul. 17. 2002 2468
46R08280-040 12 FOOll
P.O. Box 977
Horsham, PA 19044-0977
Payee Address:
ESTATE OF THOMAS VALLE*
C/O GUY H BROOKS.ESQUIRE
320 MA I N STRE ET
HARRISBURG. PA 17108-0000
;\
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;1 U l\L~
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JUL I 9
- -----
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P.O. Box 977
Harsham. PA 19044-0977
Please cut along this line and return in the enclosed envelope when necessary
.................................................................................................
RE: VALLE THOMAS
SETTLEMENT OF BODILY INJURY CLAIM OF THOMAS VALLE
QUESTIONS. CALL: 800-634-1523
Prudential Property and Casualty Insurance Company
Detach at perforation below
36CK12
CHECK TOTAL:
$18.522.77
O:~RT~~1 ESTATEOFntOMAS VALLE.
C/OGUY I! BROOKS,ESQUIRE
320 MAIN STREET
HARRISBURG, PA 1710B-0000~ ~~>>f~:',
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EIGHTEEN THOUSAND FIVE HUNDRED TWENTY TWO ,&LLAR$~\AND 77 'Cl;NtS
'. ",II:'
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11'00 ~ 2~I,Bb 5 ~II' 1:0 ~ ~ ~OO~!; 7': !; 'In Lt. 7n LnI.. c;nqll'