HomeMy WebLinkAbout01-0762
Estate of Shirley lEe.~nes
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
:1.../-0/- "'''A,
No.
To:
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 210- 2 0-1 d 9 9 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut nrs
in the last will of the above decedent, dated 18 September 1997
and codicil(s) dated n / a
named
, 19_
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h er last family or principal residence at 355 Sporting Hill Rd.. Mechanicsburg.
FA Hampden Township
(list street, number and muncipality)
Decendent, then ~~ y~ars of age, <;lied 8 Jun e ~ ~ ~ 1
at HOTY Splrlt Hospltal, Camp Hl , PA
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
, 19
None
$ 16,000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters tes tamen tarv
theron.
(testamentary; administration c.La.; administration d.b.n.c.t.a.)
~L
Bruce A. Barnes
900 Indiana Avenue
Lemoyne, PA 17043
~(1~
'"
'ti'
~
;:;
~3
0.....
0::: v
c
-00
c'=
cu.=:
.....0
",0..
'ti'.....
~ 0
~
c
OIl
i:i5
1700 Appletree Road
Harrisburq, PA 17110
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ s"
COUNTY OF /!U/nAer-/4Ad J ~
The petitioner(s) above-n~med swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to ~r affirme ...and subscribed ~ ~O ~ ~
before e tillS day of ~ ~ ~
})If. /l1JIJ I /J. ~
s:::
~
~
! "~I - \ - \
No. 21-01-762
Estate of
Shirley ~ Barnes
~
DECREE OF PROBATE AND GRANT OF LETTERS
, Deceased
AND NOW AUGUST 17th ~ 200~ in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 18 September 1997
described therein be admitt~1:9 probate and filed of record as the last will of
Shirley ~~arnes
and Letters Testamentary
are hereby granted to Bruce' A. Barnes and Lee D. Barnes
'"hJ2-"1 t! ~ DtA . ~4. u,.C~~ O~~
' ,
Reg:ster of Wills .
FEES
Probate, Letters, Etc. ......... $ 50.00
Short Certificates~O) . . . . . . . . .. $ 30.00
~.r:X~~..p.G$.~.. $ 6.00
JCP $ 5.00
TOTAL _ $ 91.00
Filed .. AV<;P.S:~. ~7.,. .~99.1. ..............
Samuel L. Andes, 17225
ATTORNEY (Sup. Ct. LD. No.)
525 N. 12th Street, Lemoyne, PA 17043
ADDRESS
717-761-5361
PHONE
MAILED LETTERS TO ATTORNEY AUGUST 17, 2001
!10'.RO'i R;~)i:6 is to certifY that the information here given is correctly copied fro~ an original certificate of death dul~ filed with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg,
WARNING: It is illegal to duplicate this copy by photostat or photograph,
Fee for this certificate, $2.00
p
7429756
No.
me as
~L~e~
JUN 0 9 2001
Date
.'
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
. R.v 2/81
NAME OF DECEDENT IflrS!. MocldIe. L_I
.. Shirley L. Barnes
/IDE lL-1liIlNIaYl UNDER I YEAR
~ Daya
SEX
.female
lIlRJtR.ACE CColy W1d
s...... fQ'eogR Counlryt
P\JlCE 01 OERH CC'-lo 0I1Iy",.. .. __ .....'uc:IIOnS on 0IIler _I
HOSPITAl;
.......M.... ~O
~10
17..0 :"'-=:':::01
YOTHER/'S HAUl! ,fOIl. ModclIe. w-. Suonamel
t n a
T'S MAIlf<<i AOOflESS ~.... ~ .... roq~CodeI
00 Appletree Ra.,.l:iarrl.sourg,PA 1717110
OF OlSPOSlT1OH -.... oI~ C.-y lOCArlOH . CilyIlbwn, StIle. Z1peoc.
orOlMr PIKe
Con-O-Lite crematory haefferstown,PA17088
2tc. 21 .
~ & Cran. Sr:v. 324 H.mrel
DECEOENT'S USUAl OCCUMION
lGive IUnCl III work 00ne durong _
oI~"'; lID _ use ...., I
".. receptionist .
DECEDENT'S MAIl.ING AOOAESS lSlr...~. a.. ZIp CoWl
355 Sporting Hill Rd.
... Mechanicsburg, PA 1 7055
I'RttEA'S NAME IFirll. MocldIe. Lasll
Robert
Cumberland
I lb.
11
II,
INFClRMANT'S NAME (T ypelPronll
Lee D. Barnes
..... 24-ft _ 1M c:ornplel'" by
::::.-- wIlo.............- dUlIl
001
~ICAUIIIFonal
..... f1I concIIlJOn
_ -.Iing"-l-
::~liIl""-"
,;;: I...,. ......10...........
=_.~~
- CAUIIE co-ue.. ....y
="'nliIIId_
='...."'CIMIlIUST
I D.
c.
II.
DUE 1IOCOA AS A CONSEOUENCE OF):
-llINSANAUroPSY
~f'ERFOfIMED?
WERE AtJ1DPSY FINDINGS
-.....alE PRIOR 10
COMPlETION 01 CAUSE
01 OERH?
UANHER Of DEATH
DATE OIlNJtJRV
1Mon". Day. \\tar)
,... ~
AccideIll 0
SUlcICle n
Homicide D
Pendong ~"'" 0
CoIlld _ 1M ....""ned 0
..0 No
v.. 0
NoD
STAtE '11.1 NIl_R
SOCIAL SECURITY NUMBER
1210 -20
RACE - A___Indien.lll8cIo. WlIile. lfIC.
lSpeQIyJwhi te
,..
MARITAl STRtJS. .......
He.- ......iecI. WIdDwelI.
wi~
1.,
1fe1l- ".lIecedIflllioed'
SUfMY1NG SPOUSE
111-. \IIYe"--1
lWp.
dy/bolo.
LICENSE NUMeER
\WI CASE REFERRED TO MEDICAL IX
2t. 'M ~ D'f r:: D.
I=:-":'" PARTI: C:-":"~=.~::m~
.__dMlIl
I
.
I
NoD
TIMe OF INJURY
IN.IURY III' WORK? DESCRIIIE HOW IN.IURV OCCURRED.
.. 0 NoD
... Z.... a.
C8Wr1FlER ICIleck onI~ onel
'C8n'lI'YlNG PHVSICIAN IPhys.coan cerlllyong cause ~ dealh wh." anolher phVSICoan has IlI'QnOunced dealh ana Camplered"em 231
To'" ..... 01 "'llu1owleclge. de.1Il OCCurred due..... c.uM(.1 and m....... .. ..._. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.i; . PRONOUNCING AHD CERTIFYiNG PHYSICIAN (Physaan boItl plOIlQlloctOg oedl and cet1tfytng to causa 01 dea1hl
i To 1IIe..... of "'Y know~... de,,1Il occur,'" a.......... d.... and plac.. and clu.lo I'" cauMlaI.nlI m.nner.. ...t...
;;
~ 'MEDICAl. EXAMINER/CORONER .
On.... b..i. of ...min.tion .nd/or inv..tigalioft, in ml opinion, cI..lh occUl,ed .llIle tlm., d.te, and p1i1ce. iIRd due to the Cau..(.).nd
menner.. .I.t..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31..
REGISTRAR'S SIGNATURE AND NUMSER
33
~.~"'-~~
1,,/,~/t II
JOt.
S1GNATU AND TITLe OF CERTIFIER
o :U . 4', 7-1.du..
LICE ORE SIGHED (Montto. Day. _I
o 'c. I'\,V 0 l{ I ')q;, (. JIll cr;,.~ f lol' (
NAME AND ADDRESS OF. PERSON WHO~ETEDCAUSE 01 DEATH
(hem27)rypeIllP'inlJos~h ft. TOrc.h;(I,
o >>?-o' l-lofA.Se Aue., Cam, ,,",ill, Pit 170fC
:EFIL,~~;'I
"
WILL
OF
SHIRLEY LEE BARNES
21-01-762
I, SHIRLEY LEE BARNES, of Lower Allen Township, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my
gravemarker and all expenses of my last illness, and any and all taxes and assessments
imposed by any governmental body as a result of my death, whether on property passing
under this will or otherwise, shall be paid from my residuary estate as soon as practicable
after my decease as a part of the expense of the administration of my estate.
ITEM II. I give and bequeath my antique music box to rny grandson, JACK BARNES,
provided he survives my death by sixty (60) days.
ITEM III. I give, devise, and bequeath all the rest, residue and remainder of my
possessions and estate of every nature and wherever situate in equal shares to those of my
issue, per stirpes, who survive my death by sixty (60) days.
ITEM IV. I appoint my sons, BRUCE A. BARNES and LEE D. BARNES, co-executors
of this my last will. Should either of my sons predecease me or otherwise fall to qualify or
cease to serve hereunder, I appoint the survivor to serve as executor of this my last will.
ITEM V. In addition to the other powers and authorities granted to my personal
representative by Pennsylvania Law and by the other terms and provisions of this will, I
hereby give to my personal representative the following powers and authorities effective
without court approval and until actual distribution of all property: to compromise any claim
or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind,
and in such manner as my personal representative may determine and at valuations finally
to be fixed by them; to invest in all forms of property, including any stock or other
securities in any corporate fiduciary or its successor without restriction to investments
authorized for Pennsylvania fiduciaries, as my personal representative deems proper,
without regard to any principle of risk or diversification; to retain any or all assets of my
Page 1 of 3
!I
estate, real or personal, without regard to any principle of risk or diversification; to sell at
public or private sale, to exchange, or to lease for any period of time, any real or personal
property and to give options for sales, exchanges, or leases, for such prices and upon such
terms or conditions as my personal representative deems proper; and to allocate receipts
and expenses to principal or income or partly to each as my personal representatives deem
proper in their sole discretion.
ITEM VI. I direct that my personal representatives and fiduciaries shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
/f-d day of
IN WITNESS WHEREOF, I have hereunto set my hand this
L~
, 1 997.
~~,.~~
SHIRLEY L E BARNES
The preceding instrument, consisting of this and one other typewritten page, each
identified by the signature of the testatrix was on the date thereof signed, published, and
declared by SHIRLEY LEE BARNES, the testatrix therein named, as and for her last will, in
the presence of us, who at her request, in her presence, and in the presence of each other,
have subscribed our names as witnesses hereto.
&-~
uel L. Andes
OJ17"Jr ytl/kY U-
Amy Ro II
Page 2 of 3
COUNTY OF CUMBERLAND
)
( 55.:
)
COMMONWEALTH OF PENNSYLVANIA
The undersigned, being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
~ i~~/J-<<A"u",
SHIRLEY LEE ARNES
Sworn or affirmed to and acknowledged
I before nle by the testatrix named above
'I this I g-tl- day of ~~ ' 1997.
I
I
L~
NotarvPublic
COUNTY OF CUMBERLAND
)
( 55.:
)
COMMONWEALTH OF PENNSYLVANIA
WE, SAMUEL L. ANDES and AMY ROSELLI, the witnesses whose names are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose and say that we
were present and saw the testatrix sign and execute the instrument as her last will; that she signed
it willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and
that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound
mind, and under no constraint or undue influence.
o _,~_ ~
~ Andes
Sworn or affirmed to and
acknowledged before me this
fg-<<-- day of ~, 1997.
0. m ~~&DR Q ,G.
Amy R el i
3
~
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decendent:
SHIRLEY LEE BARNES
Date of Death:
8 JUNE 2001
Will No.
Admin. No. ~1-Ol-l~;;J
To the Register:
I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
LEE E. BARNES
1700 APPLETREE ROAD
HARRISBURG, PA 17110
BRUCE A. BARNES
900 INDIANA AVENUE
LEMOYNE, PA 17043
GLEN H. BARNES
358 EAST CHERRY LANE
DALLASTOWN, PA 17313
DEAN L. BARNES
23 CHESTNUT DRIVE
CARLISLE, PA 17013
THOMAS F. BARNES
2416 ARCONA ROAD
MECHANICSBURG, PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except NONE.
Date: 27 August 2001
8~And~
525 North 12th Street
Lemoyne, PA 17043
(717) 761-5361
Counsel for Personal Representative
...
NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of SHIRLEY LEE BARNES, deceased,
No.
of 2001
TO:
(Beneficiary)
(Address)
Please take notice of the death of decedent and the grant of letters to the personal representative(s) named
below. You may have a beneficial interest in the estate as follows:
(A) 1/5 of the residue of the estate
Name of decedent
SHIRLEY LEE BARNES
Last known address 355 SPORTING HILL ROAD IN MECHANCISBURG, PA 17055 of decendent SHIRLEY
LEE BARNES
Date of death 8 JUNE 2001
Place of death EAST PENNSBORO TOWNSHIP
County of grant of original letters CUMBERLAND
Decedent died TESTATE.
A copy of the will IS attached.
Name(s), address(es) and telephone number(s) of all personal representatives appointed:
Name
Address
Telephone
BRUCE A. BARNES
900 INDIANA AVENUE
LEMOYNE, PA 17043
(717) 763-9019
LEE E. BARNES
1700 APPLETREE ROAD
HARRISBURG, PA 17110
(717) 238-7079
Name(s), address(es) and telephone number(s) of all counsel
Name
Address
Telephone
SAMUEL L. ANDES
525 NORTH 12TH STREET
LEMOYNE, PA 17043
(717) 761-5361
Additional information may be obtained from the undersigned.
Date: 27 August 2001
S~And~.~
525 North 12th Street
Lemoyne, PA 17043
(717) 761-5361
Counsel for personal representative
"
WILL
OF
SHIRLEY LEE BARNES
I, SHIRLEY LEE BARNES, of Lower Allen Township, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my
gravemarker and all expenses of my last illness, and any and all taxes and assessments
imposed by any governmental body as a result of my death, whether on property passing
under this will or otherwise, shall be paid from my residuary estate as soon as practicable
after my decease as a part of the expense of the administration of my estate.
ITEM II. I give and bequeath my antique music box to rny grandson, JACK BARNES,
provided he survives my death by sixty (60) days.
ITEM III. I give, devise, and bequeath all the rest, residue and remainder of my
possessions and estate of every nature and wherever situate in equal shares to those of my
issue, per stirpes, who survive my death by sixty (60) days.
ITEM IV. I appoint my sons, BRUCE A. BARNES and LEE D. BARNES, co-executors
of this my last will. Should either of my sons predecease me or otherwise fall to qualify or
cease to serve hereunder, I appoint the survivor to serve as executor of this my last will.
ITEM V. In addition to the other powers and authorities granted to my personal
representative by Pennsylvania Law and by the other terms and provisions of this will, I
hereby give to my personal representative the following powers and authorities effective
without court approval and until actual distribution of all property: to compromise any claim
or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind,
and in such manner as my personal representative may determine and at valuations finally
to be fixed by them; to invest in all forms of property, including any stock or other
securities in any corporate fiduciary or its successor without restriction to investments
authorized for Pennsylvania fiduciaries, as my personal representative deems proper,
without regard to any principle of risk or diversification; to retain any or all assets of my
Page 1 of 3
estate, real or personal, without regard to any principle of risk or diversification; to sell at
public or private sale, to exchange, or to lease for any period of time, any real or personal
property and to give options for sales, exchanges, or leases, for such prices and upon such
terms or conditions as my personal representative deems proper; and to allocate receipts
and expenses to principal or income or partly to each as my personal representatives deem
proper in their sole discretion.
ITEM VI. I direct that my personal representatives and fiduciaries shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
/ f;rt, day of
IN WITNESS WHEREOF, I have hereunto set my hand this
~()~~ .1997.
~ ~
j;;t~_ (~
SHIRLEY L E BARNES
The preceding instrument, consisting of this and one other typewritten page, each
identified by the signature of the testatrix was on the date thereof signed, published, and
declared by SHIRLEY LEE BARNES, the testatrix therein named, as and for her last will, in
the presence of us, v"ho at her request, in her presence, and in the presence of each other,
have subscribed our names as witnesses hereto.
~~
uel L. Andes
Om..lJ WtklIU
Amy Ro ~fIi
Page 2 of 3
.
COUNTY OF CUMBERLAND
)
( 55.:
)
COMMONWEALTH OF PENNSYLVANIA
The undersigned, being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
~-&-; die. - LL,~ ~/
SHIRLEY LEE ARNES
Sworn or affirmed to and acknowledged
before me by the testatrix named above
'I this I g-i'l- day of <;;('f~ · 1997.
I
I
L~_c~
Notar{Public
COMMONWEALTH OF PENNSYLVANIA
)
( 55.:
)
COUNTY OF CUMBERLAND
WE, SAMUEL L. ANDES and AMY ROSELLI, the witnesses whose names are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose and say that we
were present and saw the testatrix sign and execute the instrument as her last will; that she signed
it willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and
that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound
mind, and under no constraint or undue influence.
o ~~. ~
~ Andes
Sworn or affirmed to and
acknowledged before me this
IS'ff,.. day of Sepk~"" 1997.
Om~'-Rl9()D Q G-
Amy R .s-el i
3
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
ANDES SAMUEL L
525 N 12TH ST
LEMOYNE, PA 17043
_n_____ fold
ESTATE INFORMATION: SSN: 210-20-1099
FILE NUMBER: 2101-0762
DECEDENT NAME: BARNES SHIRLEY LEE
DA TE OF PAYMENT: 06/05/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/08/2001
NO. CD 001251
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $10,496.24
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$10,496.24
REMARKS: BRUCE A BARNES
C/O SAMUEL L ANDES ESQUIRE
CHECK# 309
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
~.~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
(,,' ~;/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
.. HARR~S;BURGI PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-15-2002
BARNES
06-08-2001
21 01-0762
CUMBERLAND
101
Allount R.llitt.d
'UZ
-.7
"
SAMUEL LANDES
525 N 12TH ST
LEMOVNE
PA,17043-1129
f ., ~.
\. ,'\ :
;*
v
IlEY-I&47 EX AFP (11-02)
SHIRLEV
L
I S .5, 2.;:>
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-Y:is4j-ix--AFP--foi-:oii--NoTICEOF-.rNHiifiTANci-YA)rAPPRA-isiiiENT~--Ai.i-oWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BARNES SHIRLEV L FILE NO. 21 01-0762 ACN 101 DATE 07-15-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
I~ an assessMent was issued previously, lines 14, 15 and/or 16, 17, 18 and
re~lect ~igures that inclUde the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. AMOunt of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount 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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
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/Governmental Bequestsj Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
NOTE:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
153,195.79
.00
89,756.22
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax pay.ent.
242,952.01
9.702 27
233,249.74
.00
233,249.74
19 will
(19)=
.00
10,496.24
.00
.00
10,496.24
(9)
(10)
7,056.61
rAY"I:"r KI:l;I:U' I l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-05-2002 CDOO1251 .00 10,496.24
BALANCE OF UNPAID INTEREST/PENALTV AS OF 06-06-2002 TOTAL TAX CREDIT 10,496.24
BALANCE OF TAX DUE .00
INTEREST AND PEN. 153.20
TOTAL DUE 153.20
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
2.645.66
(11)
(12)
(13)
(14)
(Schedule J)
.00 X 00 =
233,249.74 X 045 =
.00 X 12 =
.00 X 15 =
( 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 R~FUNO. SF~ RFV~RSF SIDE OF THIS FOR" FOR INSTRUCTIONS.)
.40NWEALTH OF PENNSYLVANIA
~TMENT OF REVENUE
A.U OF INDIVIDUAL TAXES
280601
ISBURG, PA 17128-0601
REV-1162 EX( 11-96)
D FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
iDES SAMUEL L
5 N 12TH ST
vlOYNE, PA 17043
fE INFORMATION: SSN: 210-20-1099
-UMBER: 2101-0762
-
JENT NAME: BARNES SHIRLEY LEE
-
OF PAYMENT: 08/07/2002
'/lARK DATE: 08/06/2002
ITY: CUMBERLAND
OF DEATH: 06/08/2001
NO. CD 001485
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $153.20
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$153.20
\RKS: BRUCE A BARNES
C/O SAMUEL L ANDES ESQUIRE
CHECK# 311
L
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
/'?-/-/
BUREAU OF INDIVIDUAL TAXES
'" INHERITANCE TAX DIVISION
DEPT. Z806Dl
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-1U7 EX AFP (01-02)
.02
SAMUEL LANDES
525 N 12TH ST
LEMOYNE i..
/'.~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-26-2002
BARNES
06-08-2001
21 01-0762
CUMBERLAND
101
SHIRLEY
L
Allount Rellitted
PA 17043
\. I' ~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=i6oj-i3fAFP--fol-:oz.r------...--iNHEiiTANc"E-fAx-STA-fEM"ENf-OF-Accouii'f--.-i.---------------------
ESTATE OF BARNES SHIRLEY L FILE NO. 21 01-0762 ACN 101 DATE 08-26-2002
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-15-2002
P R I NC I PAL TAX DU E : ...........................................................................................................................................................................................................................
10,496.24
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-05-2002 CDOO1251 .00 10,496.24
08-07-2002 CDOO1485 153.20- 153.20
TOTAL TAX CREDIT 10,496.24
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE 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. )
/ '}.- / - /
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I 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
COUNTY
ACN
07-15-2002
BARNES
06-08-2001
21 01-0762
CUMBERLAND
101
SAMUEL LANDES
525 N 12TH ST
LEMOVNE
'02 JuL L~ 3
:15
~A 17043-1129
C:l';
*
REY-1541 EX AFP [01-021
SHIRLEY
L
Allount Rellitted
) CHANGED
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
153~195.79
.00
89~756.22
(8)
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-Y=is'4;-Eif-AFP--loi-':oz'r-NoT"icE--ciF-'rtitiEifiTANci-TAx-AppRA-isEMENT-;-Aii.-ciwAifci-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BARNES SHIRLEY L FILE NO. 21 01-0762 ACN 101 DATE 07-15-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
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. Tot91 Assets
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 Bequestsj 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 (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CR D TS:
NOTE:
+
INTEREST/PEN PAID (-)
.00
DATE
06-05-2002
NUMBER
CD001251
7,056.61
2.645.66
Ul)
(2)
(3)
(4)
(9)
UO)
.00 X 00 =
233,249.74 X 045 =
.00 X 12 =
.00 X 15 =
AMOUNT PAID
10,496.24
BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-06-2002 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
(9)=
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
242,952.01
9.702 27
233,249.74
.00
233,249.74
.00
10,496.24
.00
.00
10,496.24
10,496.24
.00
153.20
153.20
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
...
'"
'.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~1;h1 L. 15a.rAleJ
Date of Death: ,/g/o J
, ,
C,;V
otl
Will No.:
Admin. No.: 2 J.. 0 I.... c> 1 ',,2.
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 0
2. If the answer is No, state when the personal representative reasonably beiieves
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal ~resentative file a final account with the Court?
Yes _ No l2S.l
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 181 No 0
....-
E:
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
~~
. Dat~>~
. ~ ..,;
1..,.....
~
;--;'
;D
a:
t.n
I
z
:::J
-"J
~A-IV\L(GL-- L... ~vtJ€J
Name
SZ~ #. {2:-/t1 5+~
LeMOrl'e P A- J70YJ
Address
p
,'i-
JJ
o
::: s::
:;> ==
.50
It7 "1b( ss~,
Telephone No.
Capacity: 0 Personal Representative
D(l Counsel for personal representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
~- .
..
Date: 5/07/2003
BARNES BRUCE A
900 INDIANA AVENUE
LEMOYNE, PA 17043
RE: Estate of BARNES SHIRLEY LEE
File Number: 2001-00762
Dear Sir/Madam:
It has corne 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: 6/08/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc:
JFile
Counsel
Judge
~~ '
REV- 'i 500 EX (6-00.'
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
w
.....
lI:::!!;rn
uO::lI::
wc..u
zoo
uO::..J
c..al
c..
<:
~
I '7 - J- I
.'__"_"_~M._W_'" ,'~~-,,,,,"'."- '_.' ,-,-"-' -,,' -- ',-
FILE NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
....
Z
W
C
W
U
W
o
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Barnes, Shirle L.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
02/08/2001 04/30/1927
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
2L-DL
COUNTY CODE YEAR
-O.-!lfL"Z...-
NUMBER
SOCIAL SECURITY NUMBER _ I D q()
<1fO - 110 r VI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1 Original Return
D 4. Limited Estate
D 6. Decedent Died Testate IAtlach copy of Will)
D 9. Lit'lgation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death after 12-12-82)
o 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)
o 3. Remainder Return Idate of dealh prior to 12-13-821
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
Samuel L. Andes
FIRM NAME (If Applicable)
THIS SECTlON'MUSTBECOMflLETEO; ALL 'CORRESf'ONDENCE AND C;ONFIt)ENfrIAL TAX INFORMATIoN SHOULD BE DI RECTEO'.TO:
NAME COMPLETE MAILING ADDRESS
.....
Z
W
C
Z
o
c..
rn
w
0::
0::
o
U
525 North 12th Street
Lemoyne, PA 17043
TELEPHONE NUMBER
(717) 761-5361
OFFiCIAL USE Of.1LY
..-'_, ,S'.
c~,
f"--,__I
I
I r-'
r.
(8) 242,952. Or
(11) 9/702.27
(12) 233,249.74
(13)
(14) 233,249.74
x.O_ (15)
x.O~ (16) $10,496.24
x .12 (17)
x .15 (18)
(19) /O('I'f'.2'i
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
z
o
~
~
::)
Q.
::!iE
o
u
><
~
20.0
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
z
o
~
..J
::)
!:::
Q.
<(
U
W
c:::
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Soie-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8 . Total Gross Assets (total Lines 1-7)
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)
(1)
(2)
(3)
(4)
(5) 153,195.79
(6)
(7) 89/756.22
(9) 7 ,056.61
(10) 2.645.66
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
$233,249.74
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at coiiaterai rate
REV.15Il3 Ex. (t91;,
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
All pr~~JiMIp-otn~j1J~ li~ht of liulV~Jo~S~I~ must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
None. See Schedule E
TOTAL (Also enter on line 2. Recapitulation) $ O. 00
(If more space is needed, insert additional sheets of the same size)
~EV-1508 EX. (1-971
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE ~state of Shirley L. Barnes
FILE NUMBE
1.
DESCRIPTION
Certificate of Deposit issued by DN Trust Company in face amount
of $25,000.00, with interest paid monthly
VALUE AT DATE
OF DEATH
$25,000.00
2009.2050 shares in Lord Abbett Affiliated Mutual Fund (at
$15.38/share) $30,901.57
458.644 units in Mercury U.S. cap Growth Fund (Class C) at
$11.01/unit $5,049.67
1146.154 units of Merrill Lynch Fundamental Growth Fund C
at $18.88/unit $21,639.39
831.4680 units of Merrill Lynch Global Growth Fund at
$10.75/ unit $8,938.28
255.1830 units of Merrill Lynch Global Technology Fund
at $11.43/ unit $2,916.74
2108.3270 units of Pimco Renaissance Fund at $19.05/unit $41,112.38
450.65 units in Merrill Lynch Banking Advantage Money Market $450.65
(SEE LETTER FROM MERRILL LYNCH ATTACHED HERETO)
Checking Account No.1 000035384 with Waypoint Bank
(see statement attached) $9,422.79
Savings Account No.1 050006407 with Waypoint Bank
(see statement attached) $17.69
Certificate of Deposit No. 1091288346 with Waypoint Bank
(see statement attached) $5,046.63
1981 Buick Regal custom automobile in fair condition $1,500.00
Miscellaneous items of furnishings, clothing, and other
personal effects $1,200.00
TOTAL (Also enter on line 5, Recapitulation) $ 153,195.79
(If more space is needed, insert additional sheets of the same size)
REV-1510 Ex.. (1-97)
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE Of .
I:state of Shirley L. Barnes
FILE NUMBE~ 1 -01 -0762
This schedule must be completed and filed if the answer to any oi Questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF t
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT ANO THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATlACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST IIF APPLICABLE)
1. I
Individual retirement account (Account No.523007480)
with Waypoint Bank (see statement attached) $4,696.01 100% None $4,696.01
Decedent's account within the Stackpole, Inc., 401 (k)
retirement plan (see statement attached) I $33,055.42 100% None $33,055.42
I Annuity contract with Hartford Life Insurance
I (contract No. 710021855) (see statement attached) $52,004.79 100% None I $52,004.79
I
I I
I I I
I
1
I
I
f
I
I
I
I
I
I
I
I
I
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
89 756.22
. ,
REV-1511 EX+ (12-99) \~,
~i"'~'
- "I. )'
"..,1'0 '._
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Estate of Shirley L. Barnes .
Debts of decedent must be reported on Schedule I.
21-01-0762
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Musselman Funeral Home, Lemoyne, PA $2,791.50
Evans Cemetary Memorials (headstone) $500.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Numberls)/EIN Number of Personal Representative(s)
Street Address
City State _ Zip
Year(s) Commission Paid:
2. Attorney Fees Samuel L. Andes $3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, aUach explanation)
Claimant
Street Address
City State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills $ 91. 0
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Estate Advertising:
The Sentinel $84.1
Cumberland Law Journal $75.0
Vital Records (death certificates) $15.0
7,056.61
TOTAL (Also enter on line 9, Recapitulation) $
o
1
o
o
(If more space is needed, insert additional sheets of the same size)
REV-'511 EX. (1-97;
~~
'5c(tfIlJ~':'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-01-0762
ESTATE OF
Estate of Shirley L. Barnes
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
Country Meadows Home (final month's rent and fees) $2,146.04
West Shore Emergency Medical Service (transportation fee) $39.60
Kilmore Eye Associates (optical fee) $20.00
Comcast (final cable bill) $14.87
Citgo (gas credit card balance) $61.55
Verizon (final phone bill) $87.98
Holy Spirit Hospital (medical bill) $28.62
payment of final taxes owed to IRS for decedent's federal income tax
for 2000 (net of refund) $247.00
TOTAL (Also enter on line 10, Recapitulation) $ 2,645.66
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX. (t-97)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21 01 0762
=state of Shirlev L. Barnes - -
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) OF EST ATE
I. TAXABLE DISTRIBUTIONS (include outright spousal dislributions)
1.
Lee D. Barnes, 1700 Appletree Road, Harrisburg, PA 17110 Son 20%
Bruce A. Barnes, 900 Indiana Avenue, Lemoyne, PA 17043 Son 20%
Glenn H. Barnes, 358 E. Cherry Lane, Dallastown, PA 1731 3 Son 20%
Thomas F. Barnes, 2416 Arcana Road. Mechanicsburg, PA
17055 Son 20%
Dean L. Barnes, 23 Chestnut Drive, Carlisle, PA 17013 Son 20%
ENTER DOLLAR AMOUNTS fOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17. AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
NONE
B. CHAR IT ABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTA.L OF PA.RT II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Private Client Group
t!~~~~!~~ Lynch
214 Senate Avenue
Suite 501
P.O. Box 0810
Camp Hill, PA 17001-0810
717 975 4600
8009370735
Mr. Samuel L. Andes, Esquire
525 North Twelfth Street
P. O. Box 168
Lemoyne, P A 17043
Re: Estate of Shirley Lee Barnes
Dear Mr. Andes:
Per your letter of August 27, 2001, listed below is information that you requested
regarding the Merrill Lynch account number 872-54057 (previously numbered 807-
35418) titled Shirley L. Barnes. The account, which was originally opened on September
27, 1995, held the following assets at the time of Mrs. Barnes' death on June 8, 2001.
Quantity
Description
25,000
2,009.2050
458.6440
1,146.1540
831.4680
255.1830
2,108.3270
ON Bankers Trust Co.
Lord Abbett Affiliated F d CL C
Mercury US Small Cap Growth Fund Class C
ML Fundamental Growth C
ML Global Growth CL C
ML Global Tech FD CL C
PIMCO Renaissance FD Class B
$450.65
Merrill Lynch Banking Advantage Money Market
and cash
I have enclosed historical pricing for the date of death, June 8, 2001. Please see
the attached June 2001 account statement for information on DN Bankers Trust Co.
which is not included on the historical pricing list.
I am sorry for the delay in getting this information to you. If you have any
questions or need further information, please contact me at 975-4675.
relY,
Sue Pritchard
Client Associate
HIstorical Pricing inquiry
Page I of 1
Historical Pricing Inquiry
LAFCX - LORD ABBETI AFFILIATED fD Cusip: 544001308
Date Bid Price Offer Price
06/08/2001 15.380 15.380
MCFGX - MERRILL LYNCH FUNDMNTL GRWTH Cusip: 589958305
Date Bid Price Offer Price
06/08/2001 18.880 18.880
MCGGX - MERRILL LYNCH GBL GRWTH FD I Cusip: 59020J308
Date Bid Price Offer Price
06/08/2001 10.750 10.750
MCGTX - MERRILL LYNCH GLBAL TCHNLGY Cusip: 589983303
Date Bid Price Offer Price
06/08/2001 11.430 11.430
MSSCX - MERCURY ASSET MGMT FDS INC Cusip: 589358662
Date Bid Price Offer Price
06/08/2001 11.010 11.010
PQNBX - PIMCO FDS MULTI MANAGER SER Cusip: 693389231
Date Bid Price Offer Price
06/08/2001 19.050 19.050
H4A10 --> Historical Pricing data not available for this symbol.
The information has been obtained from sources we believe to be reliable but we do not guarantee its accuracy. Past
performance is not indicative of future performance.
http://hpi.worldnet.ml.com/loginlhpiIHPITable.asp?SearchType= 1 &StartDate=200 1 0608&EndD3/12/02
iI.
FULTON FINANCIAL ADVISORS
Making Success Personal.
(717) 291-2445
January 22,2002
Samuel L. Andes
Attorney at Law
525 North 1 ih Street
P. O. Box 168
Lemoyne, PA 17043
RE: Shirley Lee Barnes
Dear Attorney Andes:
Since I do not have access to all of Mrs. Barnes accounts with us, I had to wait
until I received back information from the commercial side of our bank.
It looks like the only account she had with us was a checking account, which now
has a balance of $2025.00. The account number is 1370-22749.
Mrs. Barnes was receiving a pension check monthly from the Stackpole, Inc.
401 (k) Retirement Plan. When she passed away on June 8, there was a balance of
$33,055.42 left in the account in her name. This amount, less federal withholding, was
distributed to her beneficiary, Bruce A. Barnes, on October 4, 2001.
If you should need any further information, please do not hesitate to contact me
at the number listed above.
Sincerely,
/')
-I- 0 ( (~1 Oi L/ 0-1 C::{
Patricia F. Crawford
Administrative Assistant
/pfc
One Penn Square, Lancastel~ PA 17602 . www.fultonfinancialadvisors.com
Investments · Wealth Management. Corporate and Retirement Services · Private Banking · Insurance
08/29/2001
SAMUEL ANDES
525 N TWELFTH ST
LEMOYNE PA 17043
~/Way~qi!lJ
LOOK FOR US. WE'LL GET YOU THERE.
The information which you requested on the account(s) of SHIRLEY BARNES ESTATE
(Social Security Number 210-20-1099) is/are as follows:
Account Number
Class of Account
1000035384
CHECKING
07/14/99
9422.33
Date Opened
Principal Balance
Accrued Interest
.46
Balance at Date of 9422.79
Death
Account Ownership SOLE
Name of Joint
Owner, if any
Date Ownership
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
Information
Requested
1050006407
SA VINGS
10/14/97
17.69
1091288346
CERTIFICATE
04/23/96
5042.37
4.26
5046.63
523007480
IRA
04/12/86
4684.39
11.62
4696.01
17.69
SOLE
SOLE
SOLE
PLEASE COMPLETE W-9
S}7:e;e1'! JJ~
(Yl5Jt;' d ? (VI-1/j
KATIiW YO G 0
SENIOR SERVICES REP.
P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711
Toll Free 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com
08/29/2001
SAMUEL ANDES
525 N TWELFTH ST
LEMOYNE PA 17043
VI Way Rqi!'J
LOOK FOR US. WE'LL GET YOU THERE.
The infoTIl1ation which you requested on the account(s) of SHIRLEY BARNES EST ATE
(Social Security Number 210-20-1099) is/are as follows:
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
1000035384
CHECKING
07/14/99
9422.33
.46
Balance at Date of 9422.79
Death
Account Ownership SOLE
Name of Joint
I Owner, if any
Date Ownership
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
1050006407
SAVINGS
1 0/14/97
17.69
1091288346
CERTIFICATE
04/23/96
5042.37
4.26
5046.63
523007480
IRA
04/12/86
4684.39
11.62
4696.01
17.69
SOLE
SOLE
SOLE
S/~cerely, ~~
(yUtJ;}/ d Z 1'Vl-11j
KAT:ijW YO G U
SENIOR SERVICES REP.
PLEASE COMPLETE W-9
Additional
Information
Requested
ROo Box 1711. HARRISBURG, PeNNSYLVANIA 17105-1711
Toll Free I-B66-WAYPOINT (1-866-929-7646) . www.waypointbank.com
August 29, 2001
Samuel Andes
525 North Twelfth St
P.O. Box 168
Lemoyne, PA 17043
Hartford Life
Re: Hartford Annuity Contract Number: 710021855
Decedent: Shirley L Barnes
Dear Mr. Andes:
Thank you for your correspondence regarding the above Annuity contract.
The death benefit payable under this contract is not considered "life insurance" reportable on IRS
Form 712, (Life Insurance Statement). Please find below information in response to your request:
Contract Number: 710021855
Owner:
Deceased:
Owner's SSN:
Date of Death:
Date of Death Value:
Account Type
Contract Effective Date
Tax Cost Basis, (if applicable):
Shirley L Barn~s
Shirley L Barnes
210-20-1099
June 8, 2001
$52,004.79
Non Qualified Annuity
11/29/1996
40,007.78
Neither Hartford Life nor its agents or employees provide tax or legal advice. We strongly recommend
that you speak with your tax advisor.
Should you haw>, !'lny question" regarding this information, please contract Annuity Client Services at
1-800-862-6668, Monday through Thursday, from 8 a.m. to 7 p.m., Friday from 8 a.m. to 6 p.m., or
Saturday from 9 a.m. to 2 p.m., Eastern time.
Sinc9relY)
{ 1/
JI. .
/j l ,t "..-
// tveetc
S.Riccio
Investment Product Services
Contract Management (Technical) Team
Hartford Life Insurance Co.
Hartford Life Insurance Companies
200 Hopmeadow Street
Simshury, CT 06089
Toll Free 1 800 862 6668
Investment Product Services
Mailing Address: P.O. Box 5085
Hartford, CT 06102-5085
online.hartfordlife.com