HomeMy WebLinkAbout10-21-05
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Barrick Lester E.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 7 5 9
coUNh"COOE -ye~ - - NUMeER- -
SOCIAL SECURITY NUMBER
1 87- 1 6 - 5 2 0 7
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of dealh priorto 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)
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NAME COMPLETE MAILING ADDRESS
Ro er B. Irwin Es uire 60 West Pomfret Street
FIRM NAME (If Applicable)
Irwin & McKni ht
TELEPHONE NUMBER
717 249-2353 Carlisle r-~PA 17013
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07/27/2005 09/09/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of daalh after 12.12-82)
D 7. Decedent Maintained a Living Trust (Altaeh copy 01 Trust)
D 10. Spousal Poverty Credit (date of daalh between 12-31.91 and 1.1.95)
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _(15)
0.00 X _(16)
0.00 X .12 (17)
57,344.30 X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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(8)
'24 {390.33
33,570.39
150,475.64
(11)
(12)
(13)
184,046.03
57,344.30
(14)
57,344.30
0.00
0.00
0.00
8,601.65
8,601.65
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\lTOANSWERAlL QUESTIONS'ON:RSVERSES.OEANOBECHECKMAtff '.. '-t< '. .'
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Decedent's Complete Address:
STREET ADDRESS
213 Steelstown Road
CITY I STATE I ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
8,601.65
430.08
Total Credits ( A + B + C )
(2)
430.08
3. Interest/Penalty if applicable
D.lnterest
E. Penalty
0.00
T otallnterest/Penalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
8,171.57
8,171.57
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; ........................................................................... 0 \Xl
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 \Xl
c. retain a reversionary interest; or ...................................................................................................... 0 \Xl
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 \Xl
2. If death occurred alter December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?.... ..... ....... .,. ....................... ....... .... ..... ... ......... .......... ....... ... .... 0 \Xl
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 \Xl
4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 \Xl
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare that I have examined this retum, includinQ 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
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41 S. pri Garden Street
Carlisle
SIGNATURE OF PREPARER OTHER THAN REPRESEN}f.TIVE
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ADDRESS Irwin & Me . igh , 60 West Pomfret Street
Carlisle
ADDRESS
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. ~9116 (a) (1.1) (i)].
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. ~9116 (a) (1.1) (ii)].
The statute does not exempt 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. ~9116(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.S. ~9116(1.2) [72 P .S. ~9116(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.S. ~9116(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.
PA 17013
DATE
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PA 17013
REV -1502 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Barrick. Lester E. 21 05 0759
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
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge 01 the relevant lacts.
Real property which is iointlv-owned with riaht 01 survivorshiD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
213 Steelstown Road, North Newton Township, Newville, PA - SOLD
Settlement Sheet Attached
VALUE AT DATE
OF DEATH
220,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(II more space is needed, insert additional sheets 01 the same size)
220 000.00
REV-1508 EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0759
Barrick. Lester E.
ITEM
NUMBER
1.
DESCRIPTION
Personal Property - Settlement Sheet Attached
VALUE AT DATE
OF DEATH
21,359.95
2.
Members 1 st Federal Credit Union - Savings Account
25.41
3.
Members 1 st Federal Credit Union - Checking Account
4.97
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
21 390.33
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Barrick. Lester E.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
05
0759
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ronan Funeral Home 7,337.35
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Irwin & McKnight 10,900.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 294.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 350.00
7. Cumberland Law Journal - Estate Notice 75.00
8. The Sentinel - Estate Notice 129.77
9. Register of Wills - Filing Fee 30.00
10. Gary W. Honard - Reimbursement of Expenses for Sale of Property 459.73
11. Roy D. Gottshall - Appraisal on Personal Property 65.00
12. Steven W. Barrett - Appraisal on Real Estate 275.00
13. Rick Foreman, Auctioneer - Public Sale 10,742.75
14. Closing Costs 2,911.79
TOTAL (Also enter on line 9, Recapitulation) $ 33 570.39
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Barrick. Lester E.
FILE NUMBER
21
05
0759
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Department of Public Welfare Claim
VALUE AT DATE
OF DEATH
148,228.86
2. PP&L, Electric
18.52
3. Forest Park Health Center, Nursing
2,138.26
4. Department of Vetrans Affairs, Reimbursement of Pension Payment
90.00
TOTAL (Also enter on line 10, Recapitulation) $
150,475.64
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
BMrick_ I p.~tp.r F. ?1 Ol'\ 07!,)~
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outritt spousal distributions, and transfers under
Sec. 9116 (a (1.2)]
1. Mary E. Barrick Collateral 1,500.00
41 S. Spring Garden Street
Carlisle, PA 17013
2. Erika Nicole Honard Collateral 1,000.00
3114 Brett Road
Denton, TX 76210
3. Oscar R. Barrick, Jr. Collateral 1,000.00
4476 Enola Road
Newville, PA 17241
4. Richard Lee Barrick Collateral 1,000.00
340 Doubling Gap Road
Newville, PA 17241
5. John E. Barrick Collateral 1,000.00
400 North Mountain Road
Newville, PA 17241
6. Carl Jay Barrick Collateral 1,000.00
414 North Mountain Road
Newville, PA 17241
Ronald E. Barrick Collateral 1,000.00
26 Lonesome Road
Newville, PA 17241-9732
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 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)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Barrick, Lester E.
Decedent's Name
Page 1
21 05 0759
File Number
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s} OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
8. Gary W. Honard Collateral Remainder
3114 Brett Road
Denton, TX 76210
LAST WILL AND TESTAMENT
I, LESTER E. BARRICK, of Carlisle Borough, Cumberland County, Pennsylvania,
declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills
and Codicils heretofore made by me.
1. I direct my personal representative to have my funeral conducted in accordance
with the arrangements made at Ronan Funeral Home and my burial in the Garden of Benediction
at the Westminster Cemetery, Carlisle, Pennsylvania.
2. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as may be done conveniently after my decease.
3. I authorize and empower my personal representative to sell any realty owned by
me at my death, and not specifically devised herein, at either public or private sale, and to give
good and sufficient deeds therefor, in fee simple, as I could do ifliving.
4. I give, devise and bequeath all of my estate of every nature and wherever situate
as follows:
A. $1,5000.00 to MARY E. BARRICK;
B. $1,000.00 to ERIKA NICOLE HONARD;
C. $1,000.00 to OSCAR R. BARRICK JR.;
D. $1,000.00 to RICHARD LEE BARRICK;
E. $1,000.00 to JOHN E. BARRICK;
F. $1,000.00 to CARL 1. BARRICK;
G. $1,000.00 to RONALD E. BARRICK; and
H. All the rest, residue and remainder to GARY W. HONARD.
I have made no provision in this my Last \Vill and Testament for any of my other
relatives, not from lack of affection for them but because they are already provided for.
5. I nominate and appoint MARY E. BARRICK to be the Executrix of this my Last
Will and Testament; she is to serve as such without bond. Should she die before my death,
renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I !
nominate and appoint GARY W. HONARD, as substitute Executor, also to serve as such
without bond, with the same powers as are given herein to my original Executrix. I hereby
suggest that my personal representative retain the services of Irwin, McKnight & Hughes, as
attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 2t~t day of
April, 2002.
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LESTER E. BARRICK
(SEAL)
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Signed, sealed, published and declared by the above-named person as and for a Last Will
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, LESTER E. BARRICK, JACQUELINE L. DRAWBAUGH and"l\IARTHA L.
NOEL, the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as his Last Will, and that he had signed willingly,
and that he 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 testator, signed the Will as a witness and
that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of
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COl\IMON\VEAL TH OF PENNSYLVANIA
ss
COUNTY OF CUl\tIBERLAND
Subscribed, sworn to and acknowledged before me by LESTER E. BARRICK, the
testator herein, and subscribed and sworn to before me by JACQUELINE L. DRA \VBAUGH
and l\tIARTHA L. NOEL, witnesses, this 2--~"" day of April, 2002.
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'"" Not~ry Public
/ I
.' otarial Seal
~~ger B. Invin, Notary Public
Car.lsle Bora, Cumberla.nd C
My Commission Expires Ocr. 3~u~~
Member, P8OI1sylVanl8Aesoc1attonor NotaJ1es
A. Settlement Statelnent
U.S. Department of Housing and Urban Development
S. Tvoe of Loan OMS No. 2502-0265 REV. HUD-1 (3/86)
1. 0 FHA 2. OFmHA 3. OCony. Unins. I 6. File Number I 7. Loan Number I B. Mortgage Insurance Case Number
4. OVA 5. DCony. Ins. 051616KOUGH
C. Note: I nlS fOrm IS fur",s eo 10 give you a s a emem 0 ac ua selllemem cos s. Amoun s palo 10 ana oy me settlement agem are snown. I. TitleExpress Settlement System
Items marked "(p.o.c.)" were paid outside the closing; they are shown here for infonnation purposes and are not included in the totals.
WARNING: It is a crime to knowingly make false statements to the United States on this or an~ other similar form. Penalties upon Printed 10/14/2005 at 12:18 ASF
conviction can include a fine and imorisonment. For details see: Title 18 U. S. Code Section 1 01 and Section 1010.
D. NAME OF BORROWER: Jeffrey A. Kough
ADDRESS: 235 Steelstown Road Newville. PA 17241
E. NAME OF SELLER: Estate of Lester E. Barrick
ADDRESS: c/o Roaer B. Irwin Esauire 60 W. Pomfret Street Carlisle PA 17013
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 213 Steelstown Road, Newville, PAS 17241
North Newton TownshiD
H. SETTLEMENT AGENT: South Central Home Settlements, Inc., Telephone: 717-532.7387 Fax: 717-532-6552
PLACE OF SETTLEMENT: 126 East Kina Street ShiDDensbura. PA 17257
I. SETTLEMENT DATE: 10/14/2005
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales Drice 220 000.00 401. Contract sales Drice 220 000.00
102. Personal Pronertv 402. Personal Prooertv
103. Settlement charaes to borrower Cline 140m 2 863.50 403.
104. 404.
105. 405.
Adiustments for items paid by seller in advance Adjustments for items oaid by seller in advance
107. County taxes 10/14105 to 12/31/05 28.54 407. County taxes 10/14/05 to 12/31/05 28.54
108. School Taxes 10/14/05 to 06/30/06 499.90 408. School Taxes 10/14/05 to 06/30106 499.90
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 223 391.94 420. GROSS AMOUNT DUE TO SELLER 220.528.44
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Denosit or earnest money 25.000.00 501. Excess Deoosit (see instructions) 25.000.00
202. Princioal amount of new loans 502. Settlement charaes to seller Cline 140m 2.911.79
203. Existina loan(s) taken subiect to 503. Existina loan(s) taken subiect to
204. 504. Payoff of First Mortaaae Loan
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adiustments for items unoaid bv seller Adiustments for items unDaid bv seller
213. 513.
214. 514.
215, 515.
"..c l:H'
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
'5ETTLEMENT STATEMENT
File Number: 051616KOUGH
PAGE 2
REV. HUD-1 (3/B6) TitleExoress Settlement System Printed 10/14/2005 at 12:1B ASF
C -C-SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $220.000.00 lID. 0.000 = BORROWER'S SELLER'S
Division of commission (line 70m as follows: FUNDS AT FUNDS AT
701. $ to SETTLEMENT SETTLEMENT
702. $ to
703. Commission paid at Settlement
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
B01. Loan OriQination Fee %
B02. Loan Discount %
B03. Appraisal Fee
B04. Credit Report
B05. Lender's Inspection Fee
B06. Mortaaae Apolication Fee
B07. Assumption Fee
B08.
B09.
B10.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @$ /dav
902. Mortaaae Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. (a) $ /mo
1002. Mortaaae Insurance mO.@$ /mo
1003. City Prooertv Tax mo.@$ /mo
1004. County Property Tax mo. (a) $ /mo
1005. School Taxes mO.@$ /mo
1009. Aaareaate Analvsis Adiustment
1100. TITLE CHARGES
1101. Settlement or closina fee to South Central Home Settlements. Inc. 125.00
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Preoaration to Irwin & McKnight P.O.C.
1106. Notary Fees to Irwin & McKniaht 10.00
1107. Attornev's fees to Weiale & Associates 500.00
(includes above items No: )
110B. Title Insurance
(includes above items No: )
1109. Lender's Coveraae $
1110. Owner's Coveraqe $ 220.000.00 .
1111.
111 ?
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MEMBERS 1st
FEDERAL CREDIT UNION
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/05 to Date of Death
~Jame of Joint O'-".'ner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/05 to Date of Death
Name of Joint Owner
MONEY MANAGEMENT ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/05 to Date of Death
Name of Joint Owner
Estate of: LESTER E. BARRICK
Date of Death: 07/27/2005
Social Security Number: 187-16-5207
~~<SfEUW~~
SEP - 1 2005
.I.Hen ~' & M KrNT'-"'Lfl
p.j'i '., ~C t lU.r~:.
16631 -00
10/07/1974
$25.41
$.00
$25.41
$.00
None
16631 -11
01/29/1981
$4.97
$.00
$4.97
$.00
None
16631 -05
04/04/1997
$.00
$.00
$.00
$.00
None
~..:. B.~. RS 1~EDERAL CREDIT UNION
/V~~u dMd-
Denise A. Wolfe /
Insurance Services Supervisor
August 30, 2005
5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www:members1st.org
Rick Foreman Auctioneer
386 Springfield Rd.
Shippensburg Pa 17257
SETTLEMENT FOR LESTER BARRICK ESTATE SALE
OCT. 1 ,2005
Sale total not including real estate
21,359.95
Adv. Cost
1,400.00
Sale help -- set up & sale day
5,547.75
Auctioneer fee 1 % real estate 7% all other
3,695.00
All other costs -- signs , port -a-pot, ect.
100.00
Total all sale expenses
10,742.75
Balance due estate
10,617.20
li~cL ;P ~d'-it/YXt'11<..J ~c-~ ?1~(/J/..31,
'7/7- 77t..~6.?;J.
./J.
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
August 9, 2005
~~~!aWfK~
AUG 1 0 2005
IRWIN & MCKNIGHT LAW OFFICES
ROGER B IRWIN ESQ
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE PA 17013-3222
IR V\/IN
:\:- 1\!1 ,--. k' i'J 1 ("'; PT
--- ~\_........._- '.'-i.~
Re: LESTER BARRICK
CIS #: 190215362
SSN: 187-16-5207
Date of Death: 07/27/2005
Dear Attorney Irwin:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $148,228.86 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $22,205.39, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $126,023.47,
is to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
kL~~
Sandi L. Sral
TPL Program Investigator
717-772-6238
717-772-6553 FAX
Enclosure
~._'
Lynn A. Ronan, F.D.
717.258.9863
717.241.4041 (fax)
www.ronanfh.com
Our Family Serving Your Family
Monday, August 1,2005
Ms. Mary Barrick
41 S. Spring Garden Street
Carlisle, Pennsylvania 17013
Dear Ms. Barrick,
Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that YOu
found our services, so far, to be of the highest standards that we always try to achieve. The following is a summary of the
service charges as previously explained and provided in written form on the services for:
LESTER E. BARRICK
1. Professional Services
Basic Service Of Funeral Director & Staff
Embalming
Dressing, CasketingJ Cosmetics, Details
Other Preparation 01 Deceased
2. Use Of Facilities, Staff And Equipment
Use Of Staff And Facilities For Viewing / Visitation
Use Of Staff And Facilities For Funeral Ceremony
Equipment & Staff For Graveside Service
3. Automotive Equipment
Transfer Remains To Funeral Home
Hearse
Flower Car
Lead Car For Funeral Procession
TOTAL OF PROFESSIONAL SERVICES,
FACILITIES AND AUTOMOTIVE EQUIPMENT
Merchandise
Casket: DARLINGTON
From Cemetery
Acknowledgement
Register Book
Memorial Folders
Burial Clothing: Blue suit/shirt
C~
~ ewsJla er Notice
Churc
Certified Copies of Death Certificate
TOTAL FUNERAL CONTRACT
LESS: Credits granted
Cumberland County V A
$100.00
BALANCE DUE
$ 3995.00
Inel
Inel
Inel
$3,995.00
Inel
Inel
Incl
Inel
Inel
Inel
Inel
$3,995.00
$2,995.00
Incl
Inel
Inel
$ 150.00
$3,145.00
Inel
$ 111.35 --'j
$~
$ 36
$297.35
$7,437.35
$100.00
$7,337.35
If there are any questions or concerns that remain unanswered, please call me. BALANCE DUE Sep 1, 2005
A late charge of 1.5% per month on the outstanding balance
(annual rate of 18%) will be added to the balance.
. Smo"e1y, ~
~&Ln
Funeral Director
255 York Road .. Carlisle, Pennsylvania 17103 .. 717.258.9863 .. 717.241.4041 (fax) ,. www.ronanfh.com