HomeMy WebLinkAbout01-0848
.1
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ':]JtJlrofh y f.. ~eL]a J ~ No. 21-01-848
also known as To:
Register of Wills for the
. Deceased. County of CUMBERLAND in the
Social Security No. J 9 0 / % ,2 J / / 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 gecut
in the last will of the above decedent, dated ~ / 30 I 9 ~
and codicil(s) dated ' ,
named
,19_
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
(list street, number and muncipality)
Decendent, then 7 9 years of age, died
at 5.' 00 A M III I-IlJme
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: ..., j,j / A
. ,
Decendent at death owned p;operty with estimated values as follows: c..t 000. 0 ()
(If domiciled in Pa.) All personal property $ ..1' ~ . !?.. e f? <'
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in PennsYUrania I J . ;l\A _ /'. L L ~ 3:.000. 0 c>
situated as follows: i~'=3 PI n@ t1:. i (J A De. I "\~~ ) ~ . _ 7 (J :5 6
q /7
.
,T'ir ~ooJ,
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
theron.
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
,-.,
V>
II cq,J;~~:~~E:~~L9
3~
cu'-
50
CiS
s::
tlIl
i:i5
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1 ss
COUNTY OF CUMBERLAND J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will we d truly administer the estate according to law.
~
QQ'
;::s
E:l
.....
$;;:
~
~
Sworn to or affirmed and subscribed {.
before me this , 14 th day of
~PTEMB~ ~
~.(7/f:; "M~~ILU jOl....~:t
RegIS er
/-?--?-O"
No. 21-01-848
Estate of
DOROTHY E DEWALD
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW SEPTEMBER 17 ~ 200 l, 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 MARCH 30. 1995
described therein be admitted to probate and filed of record as the last will of
DOROTHY E DEWALD
and Letters TESTAMENTARY
are hereby granted to JOYCE J ROVERTER
~/1~~<</.P'''J ~; / .q....,7"
egIster of Wills
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
x-pages
RenuncIation ................
JCP
$ 70.00
$ 6.00
Y.oo
$
$ 5.00
TOTAL _ $ 90.00
. S.eptemher .1.4.,. .20fil......... .,.
A TIORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE
105.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local ~e.gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
p
7556057
tM~-'L<.~ ;(~v<).M
Local Registrar .
Fee for this certificate, $2.00
No.
.LtK;..Lh) € ,idCJ
Date
21-01-848
H 1 0). t 4J Aev 2187
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT Qf. H.EALTH · VITAL RECORDS ,
CERTIFICATE OF DEATH
PtPEiPRtNT
IN
PEAM"NENT
BLACKIN"
SEX
Female
STAll FILE NUMIIfR
SOCIAl. SECURITY NUMBER
3. 190 _ 18_
I,
79
v,.
PLACE OF OfAJHIC""". ....,,,,,..- _,nsr,uc""""",,OlI\eI St<MI
HOSPITAl:
'-ienl 0 ER/OuIoMienl 0
5.
COUNTY OF DEArH
Cumberland
to 1IlC,
..
DECEDENT'S USUAl 0CClJPlIllI0H
\~~~.'io~~:f
I~ I~
DECEDENT'S loWLlNG ADOAESS (SIr- ~,SIa. ZIpCOdeI
. 13 Pine Hill Ave
Mechanicsburg, Pennsylvania 170
SUAVIVING SI'OUSE
11""',_--
wp,
-
Cumberland
17...0 :....~.:.::oI
WOTHER'SNAMfjfcll_,lota_Surname) Alma Campbell
It.
1Hf00000T'S~um~m~lrs')JfQ.'TJa. 17019
, ClIy/bon>
...
FAJHER'S NAME (f'lI, loflCldle. lalll
1'Ill.
...
1Nf00000TS_ (T~
Joyce J, Hoverter
~
fa
l;l
o
~
w
~
Z
_.
I.lETMOO OF DISPOSITION
. 0 _0 c,_IT'*-_sa...o
~ 0lIler (SpeUy1
II..
SIGNATURE
PlACE OF 0lSP0SlTJ0N. ~ ofC-..y. Ct--.y
OIOlhttPlKe Conolite Crematory
11",
NAUEANO~~~::~rat Home, Inc, 37 East Main Street Mechanicsburg, p~ 1705
UC,
lICENSE NUMBER OAJE SIGNED
c-,!lay, -.
LOCAnON . c~ _,C.-COde
Schaefferstownl Pennsylv~nia
1ME000EAJg:OO A.M DAJEPRONOUNCEDOfS~~r:~b~~1. 2001
24. lot 25,
27, MAT I: En..,",- ....us. Wti"'... or compIIcaf:1OM 'IIlhich CIIused lhe deAth 00 IlOI .1W....me modi 01 ay~, such as C&f<Nc Of le~a'Of't aunt. shock Of haan tau.
lISt 0I*t one cause on each line
I .
v.MS CASE REFERRED 10 r.lE0tCAt. EXAMINERICORONER?
......1)lI Y ,0 , NoD
[ :
L L........~ ~)I..-../y..
DUE 10 lOA AS A CONSEOUENCE Of):
t..- ,A- \)
DUE 10 lOA AS A CONSEOUENCE Of):
, Approximat.
'--
:---
I
I
PART .: 0lIla< 1igttiIIc.... ___ CDnIIIIluIlng 10 ....". lIUl
_..-;ng..II1a~_gMAiIl_1.
DUE 10 COR AS A CONSEOUENCE Of)'
\-\ '\ tJ
~V'\
.0 <:>~~
~
:\;
NoD
Ac_
Sulctdo
~
o
o
OAJE OF III.JUAV
tl.lonll1 Day,_'
TIWE OF INJURY
INJURY AJ WOfII('7
DESCRIBE HClWINJUAY~D.
,~
Wl:RE AUlOPSY FINDINGS
_U\8lE 1'RIOfI1O
COIa'LET1ON OF CAUSE
OF DEATH?
IotANNER OF DEAJH
Hal"'''
Homoctdo
o
o
o PUlCE OF 'NJURV . AI_, larm. ......, 'acl"'V, _ M.
bu;IdIng, at.. ,Spec'vl
300.
... 0 NoD
P.ndIr>g In_lQalion
Could not be dele,mtned
~,
1:.-4 lid] II~
J4.~
21-01-848
LAST WILL AND TESTAMENT
I, DOROTHY E. DEWALD, of Mechanicsburg, Cumberland County, Pennsylvania,
being of sound mind, disposing memory and full legal age, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by
me.
ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts,
funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct
that all state, inheritance, succession and other death taxes imposed or payable by reason of my
death and interest and penalties thereon with respect to all property composing of my gross estate
for death tax purposes, whether or not such property passes under this will, shall be paid by the
Executor or Executrix of my estate.
TWO. My Executor or Executrix may, at his or her discretion, compromise claims,
borrow money, retain property for such length of time as he or she may deem proper; lease and
sell property for such prices, on such terms, at public or private sales, as he or she may deem
proper; and invest estate property and income without restriction to legal investments unless
otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any
realty and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale
therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and
, '
"
empowered to engage in any business in which I may be engaged at my death, for such period of
time after my death as seems expedient to said Executor or Executrix.
THREE. I give, devise and bequeath all of my estate of whatever nature and wherever
situate to my spouse, Henry L. Dewald.
FOUR. Ifmy spouse, Henry L. Dewald, does not survive me by a period of at least sixty
(60) days, then my estate I give, devise and bequeath to my son, George H. Dewald, a life estate
in my home located at 13 Pine Hill Avenue, Mechanicsburg, Cumberland County, Pennsylvania,
with the remainder to my daughter, Joyce 1. Hoverter, per stirpes. George H. Dewald shall be
responsible for all taxes, insurance and assessments levied against the property during his lifetime.
FIVE. I hereby give, devise and bequeath all of my personal property to my children,
share and share alike.
SIX. The rest, remainder and residue of my estate I hereby give, devise and bequeath to
my daughter, Joyce 1. Hoverter, per stirpes.
SEVEN. I nominate and appoint my spouse, Henry L. Dewald, to be the Executor of
this my Last Will and Testament. If my spouse has predeceased me, failed to qualify or is not able
or does not serve for whatever reason, then I appoint Joyce 1. Hoverter to be the Substitute
Executrix of my estate. In the event that Joyce 1. Hoverter predeceased me, failed to qualify or is
unable to serve for whatever reason, then I appoint Kim Marie Emanuel as the Substitute
Executrix.
t'
EIGHT, No person(s) shall benefit hereunder unless such beneficiary shall survive me by
sixty (60) days.
NINE. No Executrix, Executor, Trustee or Guardian acting hereunder shall be required
to post bond or enter security in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30TH day of March,
1995.
lJ-0'l-~1l~
DOROTHY E. DEWALD
(SEAL)
Signed, sealed, published and declared by the above-named person as and for a Last Will
and Testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
~tU/X ;/?~dnv
e#~/~w
,"
ACKNOWLEDGMENT AND AFFIDAVIT
WE, DOROTHY E. DEWALD, SHARON L. SCHWALM and CHERYL L.
CLELAND, the testatrix and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testatrix signed and executed the instrument as her last will and that she had signed willingly, and
that she executed it as his free and voluntary act for the purpose herein expressed, and that each
of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that
to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
J9m6',G~
DOROTHY E. D W ALD
~~~fJ~
S ONL. SC ALM
~~//e/k /
CHER L. CLELAND ~
COMMONWEALTH OF PENNSYLVANIA
: SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by DOROTHY E. DEWALD, the
testatrix herein, and subscribed and sworn ~ before me by SHARON L. SCHWALM and
CHERYL L. CLELAND, witnesses, thia:> day of March, 1995.
B~~~
~ta~Pu Ie - _ __
Notarial Seal
Betzi A Mooison, Notaly Public
Carlisle Boro, Cumber1and County
M;l (;ollvn:2$ion Expires Dee. 15, 1996,
MemEer:-Pet1nsyMnaAssociaiKii of ~ '
~
~
Name of Decedent:
CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
E. -=newo-,d
--noro-\-h y
_)t{J t) /. /})
,
1Do I
Admin No.: f,' J e .t:+- c::2. 00 1-00 If(j ~
Date of Death:
Will No.:
To the Register:
I certify that notice of (beneficial interest) 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
Name
Address
Jove.e J l-Iollu1er
1(, Jv..n('r,' on Rd. 12ilJ.s bk'rj ; R, 170/9
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ~I, )0 I
fip~~
Si tu
Jt>yu
Name
9, ~Ai;;J
J. )./{) lie:I+~r
/& , ) UJ1(1T",'o. n f! rI . I ]); j).s b(r... YQ ) fl. J 70 IS
Address .J
'0
-
. .
.::.(
r"
......\.~
71'7 l./-32-;l/Pf'l
Telephone
Capacity: GYPersonal Representative
D Counsel for personal representative
r-
-
:a:
r-
N
t..:)
o
~..:~
~u
~~
0;=
5U
.." ~'
8r;
ob~
r.)CD
~a:
-
p
~
---
CERTIFICATION OF NOTICE UNDER RULE 5.6la)
Name 0 f Deceden t: Dorothy E. Dewald
Date of Death:
September 7. 2001
Will No. 21-01-0848
Admin. No.
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' (o'Jrt Rules was served on or mailed to
the following beneficiaries of the above-captioned estate on
Name
Address
George H. Dew~ld
11 Pi n~ Hi 11 Aut:> , Mt:>('ha1"\it"c;b'1rg, PA
Notice has now been given to all persons entitled thereto under
Rule 5.6 (a) except None
Date: November 10. 2001
~Yr1a
Signatu
Name John M. Eakin
Address Market Square Buildin~
N
Mechanicsburg, PA 17055
"~"
r.
'---
Telephone(717) 766-3172
W)
N
Capacity:
Personal Representative
F~
a:
x
Counsel for personal
representative
('-1
P
jr-
J -:-:::
. -
" " f '.
...... 'I....--
I
...
IN THE COURT OF CO~ON PLEAS, ~"Y"\lm":'(ord COCNTY
PENNSYLVAN:r.A
ORPHANS' COURX.DI~SION
ESTATE OF
[k--r~-\dt(-\ hh'>::d\0\
)
) Reg i 5 t err s # .. ') \ l'f?-,L\ '\
Deceased )
CLAIM
To the Clerk of the Orphans r Court Oi vision:
~
Index and make proper entry in your official records'of the
clai~ of CmCORP CREDIT SERVICES. INC. in the amount of
.11 ~"'~~4__G~-) against the estate of the above-named decedent. . This
claim is .filed u~ Section 3532 (b) .(2) PEF Code, 20 Fa. C.S.
s s. 3532 (b) (2) .-t-<~ ~\ VULt C~ Ck~ S-+Cf i 1~3cO-=t :ac;~
The said decedent, whose last known residence was at i3 .. .
J~ Vl~42 \-\--1. 1 l p..V\2 ,. (y)~('hl [\1 (,~"'t'l c t~( r J .H:). ,+oS~~. i (~.:}l ~,
~ritten notice of this claim was given to ~) f(~~). ,~'\Pro-h-),~ GVt>c ~
i(" ~.u..i7 cn~} 1),))c~~rqfl:lI'::tr)lq
Qn \., YluaJ-l t ~, ,J-r, I
;d;/Xf~~~
(Claimant '-----'
Tammy Anzelone Manager for ClTICORP CREDIT
SERVICES, INC.
7930 NW 11 0 Stree~
-~--
Kan~~Ci~,..MO, ...Q4j~;\ Ill:)
(Cla"Jirnan t 's Addrt:!~li)
. .
L 17: lid (2: N~r ZOo
-;; r~'et:J
'~'. (ijO:)8H
I
'0
(:t ".., ;"~
:;. 0)
ala:
0:
Your A1&T Universal Card Statement
September 7 - October 5, 2001
. -1iENRY~
/ DOROTHY E DEWALD
Account 5491 1300 8270 3537
Calling Card 8461078491 + PIN
No Annual Fee/Platinum Card
.------.----..---.......-........--..
. Q~id{R~t~l"enre
Minimum Payment Due .................. .......................... S948.6S
Due Date" .................................................. October 30, 2001
.Psyment must be received by 1:00 pm loc.1 time on the PiIYment due dllte.
Amount Past Due .......................... ............................ $314.00
Amount OVer Limit ................................................... S458.6S
Credit Line ........ .................. ................ ......... ............ $8,000 .00
Available Credit ............................................................. $0.00
Cash Advance Limit ...............................................$7,000.00
Available Cash Advance Limit ..................................... $0.00
...-.................-...-.-.............................
r A~untSu~.n~.;y> ...
Previous Balance
Payments and Adjustments
MasterCardl!> Activity
Total AT&T Services
New Balance
Note: Detailed activity starts on page 2.
$8,229.66
0.00
228.99
0.00
$8,458.65
r-
~
N
EL
.'.':!'
.~ a.. Payment Record
Amount Paid:
Date Paid:
~~
~=\ '~ATiaT
~~
Page 1 of 2
How to Reach {js
Account Online: www.universalcard.com
Account OnCall: 1 800 636-8330
(For Automated Service Only)
Customer Service: 1 800423-4343 or write
Universal Card Services Corp., PO Box 441 t
Jacksonville, FL 32231-4167
Your account is two months past due and your
credit privileges have been suspended. If you
have already sent us this payment, thank you.
PLEASE SEE THE ENCLOSED
CHANGE IN TERMS NOTICE
FOR IMPORTANT INFORMATION ABOUT
THE BINDING ARBITRATION PROVISION
WE ARE ADDING TO YOUR CARDMEMBER
AGREEMENT.
~~45<6 .(;5
35 .co Lr-
-- 2<1.ooocl
CM(L t C63Or4:G5
S,kv
Check Number:
f"rl
N
Please follow payment instructions in the "'Important Instructions for Making Payments'" section of the original statement.
Account Number Pa ment Due New Balance Minimum Pa ment Enter Amount. ncloseL
5491 1300 9270 3537
10/30/01
z
c::x::
-,
..5
-;;:s::
~=
Go
Make changes to address and phone number below:
Address Apt./Suite
~
5946.65 $
City
State
Zip
Home phone
( )
Busine.. phone
(
o XX 549115 040 00 C
HENRY L DEWALD
DOROTHY E DEWALD
13 PINE HILL AVE
MECHANICSBURG PA 17055-1626
54911300927035370000946650008458651
Make check payable to:
Universal Card
PO BOX 8204
SOUTH HACKENSACK NJ 07606-8204
IN RE:
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ESTATE OF DOROTHY
E. DEWALD
ORPHANS' COURT DIVISION
NO. 21-01-00848
FAMILY AGREEMENT
Filed on Behalf of:
Jo1rce J. Hoverter
Personal Representative
Counsel of Record for
this Party:
Scott Alan Bly, Esquire
PA I.D. #71887
P.O. Box 341
Hershey, PA 17033
(717) 533-8315
FAMILY AGREEMENT
THIS AGREEMENT by and between Joyce J. Hoverter,
individually and as personal representatives of the Estate of
Dorothy E. Dewald, Deceased, of Cumberland County, Pennsylvania.
WHEREAS, Dorothy D. Dewald, who resided at 13 Pine Hill
Ave., Mechanicsburg, PA 17050 died September 7, 2001, having
left her Last Will and Testament dated March 30, 1995, which was
duly admitted to probate by the Register of Wills of Cumberland
County at the above number and term on September 17, 2001 and
WHEREAS, Joyce J. Hoverter has been duly appointed as
Personal Representatives of the Estate of Dorothy E. Dewald,
Deceased; and
WHEREAS, the parties in interest under the Last Will and
Testament of Dorothy E. Dewald, Deceased are:
1) Joyce J. Hoverter, daughter, Personal
Representative; and
2) George H. Dewald, son.
WHEREAS, Joyce J. Roverter is entitled to one hundred
percent (100%) of distributive share of the residuary estate and
George H. Dewald renounced and acquitted his life estate in 13
Pine Hill Avenue, Mechanicsburg, Pennsylvania (see Attached
Exhibit "B"); and
WHEREAS, each of the parties to this Agreement has been
furnished with a complete listing of the estate assets, receipts,
and disbursements as set forth on the Accounting as attached
hereto and marked as Exhibit "A"; and
WHEREAS, it is the desire of the parties to this Agreement
that final distribution of this estate be accomplished without a
formal accounting to the Orphans' Court Division of the Court of
Common Pleas of Cumberland, it being the desire of the parties to
avoid the expense, delay, and publicity of a formal accounting;
and
WHEREAS, Joyce J. Roverter does acknowledge to have received
from the Personal Representatives the sum of $8,668.08 as an
distribution evidenced by Receipts for Distribution which are
attached hereto.
NOW, THEREFORE, WITNESSETH, in consideration of the mutual
promises, covenants, and agreements recited herein the parties do
agree as follows:
1. Each of the parties to this Agreement does hereby
release and forever discharge Joyce J. Hoverter, Personal
Representative, from any and all liability which may from time to
time arise in connection with his service as Personal
Representative of the Estate of Dorothy E. Dewald, Deceased. The
parties to further agree to indemnify and hold harmless said
Joyce J. Hoverter, Personal Representative, from any and all
liability which may arise against the estate from creditors or
other claimants.
2. Each of the parties does hereby acknowledge receipt of
the assets described on the Memorandum of Distribution attached
hereto.
3. Each party to this Agreement acknowledges that this
Agreement shall be indexed and recorded in the estate proceedings
and that the terms hereof shall be binding upon their respective
heirs, successors, administrators, and assigns.
4. This Agreement shall be governed by the laws of the
Commonwealth of Pennsylvania.
Dated at ~J~ lAhl~LJ~ ' Pennsylvania
this 1.;a.J- day of ..:::.-;JrtfUm/wJ, 2003.
WITNESS:
~d
F
. Herter, individually
Personal Representative
of the Estate of Dorothy E.
Dewald, Deceased
~a 7?~
tf7
~"p~?-I. 0 ~
Geor e H. e aId
RECEIPTS OF DISTRIBUTION
ESTATE OF DOROTHY E. DEWALD
JOYCE J. HOVERTER
PERSONAL REPRESENTATIVE
The total value of the property distributed is:
$8'1668.08
The total value of the property to be distributed consists of cash only,
To be distributed under the terms of the Last Will and Testament of decedent as follows:
TO: Joyce 1. Hoverter, daughter
16 Junction Rd..
Dillsburg, PAl 7019
Cash
$8.668.08
TOTAL AMOUNT DISTRIBUTED
$8.668.08
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96l
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BL Y SCOTT A ESQUIRE
POBOX 341
HERSHEY, PA 17033
---.---- fold
ESTATE INFORMATION: SSN: 190-18-2111
FILE NUMBER: 2101-0848
DECEDENT NAME: DEWALD DOROTHY E
DATE OF PAYMENT: 02/25/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 09/07/2001
NO. CD 002214
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $409.24
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JOYCE L HOVERTER
C/O SCOTT A BL Y ESQUIRE
CHECK# 131
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$409.24
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
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
HOVERTER JOYCE J
16 JUNCTION ROAD
DILLSBURG, PA 17019
____h__ fold
ESTATE INFORMATION: SSN: 1 90-1 8-2111
FILE NUMBER: 2101-0848
DECEDENT NAME: DEWALD DOROTHY E
DATE OF PAYMENT: 06/02/2003
POSTMARK DATE: 05/30/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 09/07/2001
NO. CD 002630
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $17.03
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JOYCE J HOVERTER
CHECK# 200
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$17.03
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
/ /) ....., /- ----
/ - / -""../
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-UD7 Ell AFP CUI-OJ)
SCOTT ABLY
POBOX 341
HERSHEY
.03 JUN 30 A 8 :0 1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-16-2003
DEWALD
09-07-2001
21 01-0848
CUMBERLAND
101
DOROTHY
E
Amount Rellitted
PA ItJ)33:
Cwnbt;:
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 ~
ifEtj=i6ci"j-Ex-AFP--fiir=o3i-------...-iNHERITANCE--TAX-sTjffEME-NT-ifF-ACCouiff--...---------------------
ES'lATE OF DEWALD DOROTHY E FILE NO.21 01-0848 ACN 101 DATE 06-16-2003
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: 03-17-2003
PR I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
409.24
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-25-2003 CD002214 .00 409.24
05-30-2003 CD002630 17.03- 11.03
TOTAL TAX CREDIT 409.24
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 PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
I '?-~- 6-
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
Rn-U07 EX AFP 101-03)
SCOTT ABLY
POBOX 341
HERSHEY
-03 MAY -2 All:52
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-28-2003
DEWALD
09-07-2001
21 01-0848
CUMBERLAND
101
DOROTHY
E
ReCOfoed.Ofnc,E:; of
Register of \Nilts
Allount Rellitted
CleA<~1):93'3';, _ Court
Cumberland Co" PA
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 paYIIBnt'.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV =i60j-ix--AFP-foi-:03:f------...-iNHiiiTANC'E-fAX-STA-fEME-tif-OF-Accouiif--.-..---------------------
ESTATE OF DEWALD DOROTHY E FILE NO. 21 01-0848 ACN 101 DATE 04-28-20013
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-17-2003
PR I NCI PAL TAX DUE: ...........................................................................................................................................................................................................................
409.24
PAYMENTS (TAX CREDITS):
BAL
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-25-2003 CD002214 .00 409.24
ANCE OF UNPAID INTEREST/PENALTY AS OF 02-26-2003 TOTAL TAX CREDIT 409.24
BALANCE OF TAX DUE .00
INTEREST AND PEN. 17.03
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 17.03
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" (CRl,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
/"}-'1-6-
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
SCOTT ABLY
POBOX 341
HERSHEY
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
. ACN
03-17-2003
DEWALD
09-07-2001
21 01-0848
CUMBERLAND
101
'*
REV-1547 EX AFP lO1-DJl
DOROTHY
E
PA 17033
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARlISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is4j-ix--AFP--foi-:oii--No'ficE--oF-'rNHERITANci-TAi-APpiAISEiiENT~--ALtowAiici-oR-------------- ..--
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DEWALD DOROTHY E FILE NO. 21 01-0848 ACN 101 DATE 03-17-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
If an assessment was issued previously, lines 14. 15 and/or 16. 17. 18 and 19 will
reflect figures that include the total of 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
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)
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 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
NOTE:
151500.00
.00
.00
.00
3,480.95
.00
.00
(8)
71066.05
2.820.58
(II)
(12)
(13)
(14)
.00 X 00 =
91094.32 X 045=
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your aCQOuntl
subllit the upper portion
of this forll with your
tax paYllent.
181980.9~
9.886 63
91094.32
.00
.1
91094.32
(19)=
.00
409.24
.00
.00
409.24
TAX CREDITS:
'" I n..n I R...........-. t+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-25-2003 CD002214 .00 409.24
BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-26-2003 TOTAL TAX CREDIT 409.24
BALANCE OF TAX DUE .00
INTEREST AND PEN. 17.03
TOTAL DUE 17.03
. IF PAID AFTER DATE INDICATED 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
.
STATUS REPORT UNDER RULE 6.12
Name ofDecedent: >> o. rl \. t f J::k. W tL I J
Date of Death: q / 7 / 0 I
I I
Will No.: 01/- C,1 J - R-ys-? Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State wh~r administration of the estate is complete:
Yes H'" No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the ~sonal representative file a final account with the Court?
Yes...,/ No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal ~JYSentative state an account informally to the parties
in interest? Yes W No 0
Date: z.jxj 03
t~ :;
.--
.-'"'\
?
/(, ,")~nC+;~h ed
Address
"D ~ \ I s bt,,-~.!.
/7tJ Je
, {-~
-,,' ~,....
Capacity:
11 1 Lf 3 ~ - ,;2 {, ?1
Telephone No.
~onal Representative
o Counsel for personal representative
REV .1600 EX + (6.oo)
.
\\-1- 5-
o REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEAL Tli OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
OFFICIAL USE ONLY
FILE NUMBER
21
COUNTY CODE
01 8'-18
YEAR NUMBER
I-
Z
W
o
w
o
w
o
DECEDENTS NAME (lAST, FIRST, AND MIDDLE INITIAL)
Dewald, Dorothy E.
SOCIAL SECURITY NUMBER
190-18-2111
09/07/2001
01/13/2022
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
1. Original Return
DATE OF DEATH (MM.DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
I-
ll:::$Ul
OO::ll::
Wn.g
:J:~...J
On.a!
n.
<(
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death
after 12-12.82)
D 7. Decedent Maintained a Living Trust (Attach
copy of Trust)
D 10. Spousal Poverty Credit (date of death between
12.31.91 and 1-1-95
:::':ji:ii4.tl.d.it:.l@Mi..JiUI~.tijij~tiilMf.jUimlQ.fimdj.ijUl.Jiiii.f.btii::rIr::rrr:ffm:fffff':'I::r::r::
AME COMPLETE MAILING ADDRESS
Scott ABly
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
4. Limited Estate
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
'I-
Ulz
Ww
0::0
O::z
00
On.
IRM NAME (If applicable)
Scott Alan Bly, Attorney at Law
ELEPHONE NUMBER
717/533-8315
D 3. Remainder Return (date of death prior to 12-13-82)
D
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
P.O. Box 341
Hershey, PA 17033
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
z
o
;::
~
~
l-
ii:
<(
o
W
0::
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. 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)
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
OFFICIAL USE ONLY
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
15,500.00
None
None
None
3,480.95
None
None
(8)
18,980.95
(9)
(10)
7,066.05
2,820.58
(11 )
9,886.63
9,094.32
(12)
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)
(13)
(14)
9,094.32
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
409.24
409.24
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
20. D
f:::ff:rmr:rr:::f:r::r:frmm:m:ffm::::::fffffff::::f::frfi::m.HW~:19:AtiWmMj*~.@:fm:9.ijiIlWMln.MM),~K@m:girrrr:tfffffffff'rrr'fffittttr:t:r::r::::r::r::
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 9,094.32 .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
;::
<(
I-
~
n. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
:E
0
0
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
I-
19. Tax Due (19)
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
13 Pine Hill Ave.
CITY
Mechanicsburg
STATE PA
ZIP 17055
Tax Payments and Credits:
1 . Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
409.24
Total Credits (A + B + C)
(2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
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.
(3) 0.00
(4)
(5) 409.24
(5A)
(5B) 409.24
Make Check Payable to: REGISTER OF WILLS, AGENT
R::::!r~::':::H~rmriiHfj!:::[:::::::::::::::[l:I:::::\::\J\::::':::\: :t :H:ltm:H:ttImmtl:~::i:::t:::[[:::::::::I:I::::::::i[:::::I~tt:~~:i:::::i:::~f.\UJm::mm~m!:::::::::::i:]::nJ\[[::II::[[![[:[[:I
!
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;..................................................................................... R 15<1
b. retain the right to designate who shall use the property transferred or its income;......................................... 15<1
c. retain a reversionary interest; or..................................................................................................................... n 15<1
d. receive the promise for life of either payments, benefits or care?.................................................................. D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?............................................................................................................... .......... D ~
D ~
D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?...............
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.................................................................................................................. .....
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 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN URE OFCP.....LERSON RE_SPONrt:;IB E FOR Fr;J;;5IL1NG RETURN ADDRESS
16 Junction Rd.
Dillsburg, P A 17019
RESPONSIBLE FOR FILING RETURN ADDRESS
DATE
SIGN
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE
~~ ~~. ~L P.O. Box 341
.iik#~AWf#B$#';;~"~~IKM%~ W~=~f~:~~
r.:tmm 1m "':0.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)].
\ d- } 3 cfj () ~
-
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .5. 99116
1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .5. 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.
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PEr.NSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
21 - 01 -
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be excnanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knoWledge of the relevant facts. Real property which is jointly~wned with righf of survivorship must be disclosed on
schedule F.
Dewald, Dorothy E.
ITEM
NUMBER
1 15 Pine Hill Ave., Mechanicsburg, PA
DESCRIPTION
VALUE AT DATE
OF DEATH
15,500.00
TOTAL (Also enter on Line 1, Recapitulation)
15,500.00
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
It.HERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF
Dewald, Dorothy E.
I FILE NUMBER
21 - 01 -
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 DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Certificate of Deposit, PNC Bank 1,979.86
2 Checking Account, PNC Bank 1,012.09
3 Sale of 1980 Buick Electra vehicle 400.00
4 Refund from A T & T 20.00
5 Household sale 69.00
TOTAL (Also enter on Line 5, Recapitulation)
3,480.95
.
SCHEDULE H
FUNERAL EXPENSES &
ADNNSTRA11VE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF
Dewald, Dorothy E.
I FILE NUMBER
21-01-
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
1 Myers Funeral Home 2,450.00
2
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s} Commission paid
2. Attorney's Fees Scott Alan Bly, Attorney at Law -- Scott ABly 1,500.00
3. 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
4. Probate Fees Cwnberland County 100.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Settlement costs for 13 Pine Hill Ave, Mechanisburg, P A 605.83
2 P P & L. Electric bill until house was sold 2,283.42
3 Patriot News (advertisement for decedent's personal effects) 16.30
Total of Continuation Schedule(s) 110.50
TOTAL (Also enter on line 9, Recapitulation) 7,066.05
.
SchedE H
Fu1eraI ExpeIISeS &
Ad I ir 8ati>Je Costs CCI'1IiruKt
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dewald, Dorothy E.
I FILE NUMBER
21-01-
4
5
Cwnberland Law Journal (advertisement)
The Paxton Herald (advertisement)
75.00
35.50
Page 2 of Schedule H
'*
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEAllli OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dewald, Dorothy E.
I FILE NUMBER
21-01-
Include unreimbursed medical expenses.
ITEM
NUMBER
1 Comcast (cable bill)
DESCRIPTION
AMOUNT
1,366.23
2 PP & L (electric bill)
3 Allstate (mobile home insurance)
4 York Waste Disposal (trash removal)
5 AT & T (telephone bill)
6 Allstate (automobile insurance)
7 Verizon (telephone bills)
123.53
385.92
154.06
302.20
53.66
434.98
TOTAL (Also enter on Line 10, Recapitulation)
2,820.58
1401-PAGE 1 HUD.l
OMB. No. 2502.026SlExp. 12-31.66)
HUD-1 UNIFORM SETTLEMENT STATEMENT
(Ro'i. Augu6.I. \9IH)
ALL-STATE LEGAL SUPPU CO
0118 Commeu:. O,i"e. Crafllord, H_ J. 01106
A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT
- 6. File Numbar; 17 Loan "umbe"
B. TYPE OF LOAN
1 o FHA 2. 0 FmHA
3 0 CONV. UNINS. 4 OVA 5. 0 CONV. INS. O. MOllgage Insurance Csse Nwnber:
C. NOTE: This form is furnished to give you a statement of actual sel(/ement cos{s. Amounts paid to and by the settlement agent are shown. Items malked
"(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
NOTE: TIN = Taxpayer's Indenti/ication Number.
D NAME AND ADDRESS OF BORROWER: E. NAME. ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER:
Dorothy E. Dewald Es Itate
Stephen Motter Joyce J. Hoverter, E lI'ecutrix
Cheryl L. Motter 16 Junction Rd.
15 pine Hill Ave. Dillsburg, PA 17019
Mechanicsburg, PA 17050
G. PROPERT'>' LOCA liON: H. SETTLEMENT AGENT: NAME. ADDRESS AND TIN
13 pine Hill Ave. Scott Alan Bly, Esquire, P.o. Box 341 Hershey, 1
Mechanicsburg, PA PLACE OF SETTLEMENT: II. SETTLEMENT DATE:
1251 E. Chocolate Ave. November II, 2002
Hp-rshev PA 17033
A 17033
Adjustments for items paid by sefler in advance
106. Cily/lown taxes 0
107. County taxes
108. Assessments to
109.
110.
111.
112.
120. GROSS AMOUNT DUE FROM BORROWER
K. SUMMARY OF SELLER'S TRANSACTION
400. GROSS AMOUNT DUE TO SELLER:
401 . Contract sales price
402. Personal property
403.
404.
405.
J. SUMMARY OF BORROWER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
10\. Contract sales price
102. Personal property
t03. Settlement charges 10 borrower (line 1400)
104.
105.
409.
410.
411.
412.
420. GROSS AMOUNT DUE TO SELLER
200. AMOUNTS PAlO BY OR IN BEHALF OF BORROWER:
201. Deposit or earnest money 1,000.00
202. Principal amount ot new loan(s}
203. Existing loan(s} taken subject to
204.
205.
206.
207.
208.
209.
Adjustments for items unpaid by seller
210. Cilyllown taxes to
211 . County taxes to
212. Assessments to
213.
214.
2t5.
216.
217.
218.
219.
220. TOTAL PAID BY/FOR BORROWER , . (\(\(\ (\(\
500. REDUCTIONS IN AMOUNT DUE TO SELLER:
501. Excess deposit (see instructions)
502. Selltement charges to seller (line 1400) O~~.~q
503. Existing loan(s} taken subject to
504. Payoff of first mortgage loan
505. Payoff of second mortgage foan
506.
507.
508.
509.
Adjustments lor items unpaid by seller
510. Cityltown taxes to
511.. County taxes to
512. Assessments to
513.
5\4.
515.
516.
517.
518.
519.
520. TOTAL REDUCTION AMOUNT DUE SELLER 699 94
300. CASH AT SETTLEMENT FROMITO BORROWER
301. Gross amount due Irom borrower (line 120)
302. Less amounts paid by/for borrower (/il1e 220)
303. CASH ( FROM) \ TO) BORROWER
600. CASH AT SETTLEMENT TOIFROM SELLER
601. GlOSS amount due to seller (line 420)
602. Less reductions in amount due seller (line 520)
603. CASH QO TO) (0 FROM) SelLER
SUBSTITUTE FORM 1099 SELLER STATEMENT
The inlormation contained in Blocks E, G. Hand l and on line 40\ {Of, illine 401 is as\0risKed. \~e 403 and 404) is -Important tax inlormalion and is being lumished to the Internal
Revenue Sefvice. II you are lequiled 10 Ide a relurn, a negligence penalty or other sanction will be imposed on you it Ihis item is required to be 'eported and the IRS determines Ih30!
il
has not been reported. Illhis real esLale is YOUI principallesidence, hie Form 2119, Sale Of Exchange 0/ Principal Residence, lor aoy gain, with )'OUI income lax lelum: 101 olher
uansactions, com~ele the applicable parts of Form 4797, Form 6252 and/ol Schedule 0 (Form 1040). You ale lequiled 10 provide the Settlement Agent (named above) wilh your
COffeel taxpayer idenlilicalion number. If you do nol provide the SeUlement Agent with your cOHecllaxpayer idenlilK:ation.ft 81, you may be subia to civil {)I; clim. I penal\ies
imposed b'1law. UndeI penalties oi perjufY, ~ cerbiy lhallne number shown on this slatemenl is my correcllaxpayer ide ,'hcat n number.
/v
'"'
1401 --Page 2 SETTlEMENT STATEMENT
HUD-' I
All-STATr LEGAL SUPPLY CO.. Dno Commerce Oriye. Cllmlo,d. N. J. 070\6
L. SETTLEMENT CHARGES
700. TOTAL SALES/BROKER'S COMMISSION based on price $
@
%=
PAID FROM
BORROWER'S
FUNDS AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS AT
SETTLEMENT
Division of Commission (line 700) as follows:
-.-2Ql.~~--~~-~-~_._----------_..
_Z.Q:?_~______. ____H_ to ._ _ ____ ___
~~. Comm~s~n paid at Settlement
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
1-----_802. Loan Discount %
803. Appraisal Fee to
f-- 804. ~':':.dit_R.epor!..______ to
.-.805. !:-!,''..der's Inspection Fee
_ 806c_rv1'?!t~aJl.e~~~r~n.c'<:_-:-I:!,lication Fee to _.__"_~.____ _____
_ ?Q.7. .~~surnpti()n.J'_~_______ __________________
8OB.
~--------_._-~.-
809.
~O.
81l.
900. ITEMS REOUIRED BY LENDER TO BE PAID IN ADVANCE
_~Q.1.:__~"ter"_stJrom________ ~t~__ @$____. J day
f-~02:_f\.1o!t~~geJn.2':!~"c_"~.r"~LJm f<)!..___~QIl!'~to.....___ .___
903. f1.az~!<llns~anc" !,re..rniLJ."'_for___ __ __ __y'e~r~ ~~__ ___ _ ___"
_~Q<I.:.___._ years to I
905.
1'000. RESERVES DEPOSITED WITH LENDER
JQ!lJ. !:!a_z~n:UD~lI!.a!!~e_______.____~"lQD!hs @J;______ pe'--':Tl.o')~t,-
..l902 .-i'to_r~9."Jl.,,~~urallce m().':'.t,=,E.~______ per month__
1003. City property taxes months@ $ per month
~~o.~ty-p.r.'?p.".r.!.y--~a~_--------~ollt~~~ L__"_ _._ per month
_.!9.Q~._ _A_n"-lJal_~~s"..s'_'!:',,".!.s____________.__'!'~Il.tt's _~~__H"__' __E."!_'Il~nttJ_______.___.
.!006.____________~..______._..Il:'~'2!hs @L...._._____~_'__'!'.onth___
....lQ~_______.______"'2':'.ths ~.!__.__.P~!_'Tl.2!'tb_
lOOB. months @ $ Der month
1100. TITLE CHARGES
1101.Settlementorclosinllfee to __
~102. ~_b~tra_c;t~itle search ___to -.-
~!Q~:...Ii!!"-examinati().n_____~ --.J.,and Tr(!nsf.er ' :;;1./ j. UO __.______
1104. Title insurance binder to ~.
J.!Q5~'D~~~~;~~;Pa~;;;'~__ t~pee<;1.L "Bc_6tCAIa~;-"Esquire--= _____~ -":_'I,?-LJ:J.-oO __
-+}~t-~t~;~;;~f~_s_~-~:-==~=~.:sCOtl:-1U~m t;IY=-~~=--=-~=_=--=___ $20e~ - 1$208: gg - -
____ ___ (in(~!Y~~~_f!boveJ!-':!!!E!7!:!mb~!--~____~__~______ ) :~~~~~~~<~~~~~~~~'~'~~:\~:<:~2:'>~:\"'\:."~_~
..!.!2?..:.. Titl!,_i.!'~-,,~~~__ to 11-'.'. eel. ,.,' .'
(includes above items numbers; ).
1109. Lender's coverage $ ::,\\:.:" .. ,,\\':':::'S. '
-11l9=9iN~ii=~~;age:==-$--___----- ____un"~ :,<>,<,'
,.!J.lL------.------ ..------------ -----...-
1112.
--- --------.----.-.--.-------.-- ---------
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
.11Q.!.:...B.e~o-,tlinjl..!."lJ.s.o__.__ __~<!!..3l......~~'!.':!Jl.a9~-~- __..;.fleleases $
~202. City/S:<>..un!Y~.)(/sta'llP~_Deed L...._____;..I\llortgag~ $ Transfer'"""""Tax
.1103. State t""Jstamps: ._Deed $ ; Mortgage $ Transfer Tax
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
_!~___~urvey to
",!;3Q?.i'"..s!J.n2P~.tion to
J1Q~. TomL..T.ax__
,...!1Q~:...S~hool Tax
1305.
..-..- -.--..-- ---
--
-----
T
,.,. .:.-
.,.::
<
"\~:.:a:::>
1;"';:\" : .':
---
31.50
-1.jj.VV
--l~()-
.-----
----
---sI. 31
....------ -.--.---~------------.--.- .---- - -r~.6:3-..-
-.---.-.-
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K)
565.50
699.94
CERTIFICATION
I have carelully reviewed the HUQ.l Settlement Statement and to the best of my knowledge and beliel, it is a true and accurate slalemenl of
::~~3:'r"n;zx:,,:: '0 ,"" ".O""~ji;;.,.=;.'O~'O''":o~::,~
;:I~en~~~t:I;~~.~~~~;~~~~.;~~n~.~~.;m~.~tl;~~.~~;~;~::~nt which I have.~~~It~:~:~~;::E:~~.f~n~:':::~
~.~~:s~v.:l\~a~~~~.:'~.~.r..~'n..~.:..~i.Sb:~~I~:m:n:7g~~~erSigned as pa~:.:'.~~~..:~.:':.~~.r..\1~11t~~~:I'~~:..n... ............ Dale
WARNING: It is a crime to knowingly make false statemenls to the United States on this or any other similar torm. Penallies upon conviction
can include a tine and imprisonment. For details see: Tille 18 U.S. Code Section 1001 and Seclion 1010.
*'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
October 24, 2002
SCOTT ALAN BLY ESQUIRE
POBOX 341
HERSHEY PA 17033
Re: DOROTHY DEWALD
SSN: 190-18-2111
Dear Attorney Bly:
Pursuant to your letter dated October 15, 2002, the Department of Public
Welfare (DPW), Estate Recovery Program, has reviewed the information you
provided regarding the above-referenced individual.
It has been determined that this individual did not receive any type of
assistance during the questioned period.
Therefore, according to the information you provided, the Department's
Estate Recovery Program will not seek any recovery from this estate.
If you have any questions, please feel free to contact me.
Sincerely,
~.~
Ronald D. Hill, Manager
TPL - Casualty Unit
(717)772-6604
(717)772-6553 FAX