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Home My WebLink About03-22-06 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION In the Matter of the Estate of No. '"l.,.. c:: '-..I --- "-', C-, (;\". , '., \ J...... RAY W. WINGARD, deceased PETITION FOR SETTLEMENT OF SMALL ESTATE PURSUANT TO SECTION 3102 OF THE PROBATE, ESTATES AND FIDUCIARIES CODE TO THE HONORABLE, THE JUDGE OF SAID COURT: The Petition of the Undersigned respectfully represents: 1. The name, address and relationship of your Petitioner to the above decedent are: Name: Robert R. Schuster, Esquire Address: 1204 Maple Street, Bethlehem, PA 18018-2925 Relationship: Pa. DPW Estate Recovery Program (A copy of the letter from the Conunonwealth of Pennsylvania is attached, labeled EXHIBIT 1. 2. The above decedent died on December 25, 2005, a resident of Carlisle, Cumberland County, Pennsylvania. A copy of the death certificate is attached, labeled EXHIBIT 2. 3. Said decedent died intestate. 4. The names, relationships and interests of all parties interested in the estate are: NAME RELATIONSHIP INTEREST SUI JURIS Maryann Wingard wife SA Richland Ln Apt 101 Camp Hill, PA 17011 first $30,000.00 Plus 50% of balance of estate no Raeann Wittle daughter 14 North Enola Drive Enola, PA 17025 1/5 of balance pt Maryann Ulrich 101 Pepper Avenue Enola, PA 17025 daughter 1/5 of balance Brenda Killian Wellsville, PA daughter 1/5 of balance Ray Wingard, Jr. son 301 North 71st Street Harrisburg, PA 17111 1/5 of balance Davis Wingard son SA Richland Lane Camp Hill, PA 17011 1/5 of balance 5. The following person is entitled to, and claims, the family exemption by virtue of being a member of the same household as the decedent: No one 6. Said decedent died owning property (exclusive of real estate and of wages, salary, pension or vacation benefits) of a gross value not exceeding $25,000.00, which is itemized as follows: ITEM AMOUNT M&T Bank (Account 9838897248 $4008.30 $5257.00 $9265.30 Sullivan Funeral Home (prepaid funeral) 7. An itemized statement of all claims against the estate is as follows: a. Claims heretofore paid by to the following: CLAIMANT NATURE AMOUNT Sullivan Funeral Home Funeral Services 51 North Enola Drive Enola, PA 17025 $5257.00 (Funeral was prepaid) A copy of funeral bill is attached, labeled EXHIBIT 3. b. Claims remaining unpaid: CLAIMANT NATURE AMOUNT Commonwealth of Pennsylvania long term care $48,782.12 A copy of DPW's Statement of Claim is attached hereto, labeled EXHIBIT 4. Robert R. Schuster Petitioner's fee $1000.00 # Robert R. Schuster filing fee (petition) $ 30.00 George H. Harhigh, D.O. medical $ 62 . 97 West Shore EMS ambulance $ 110.06 Holy Spirit Hospital medical $ 930.90 Robert R. Schuster inheritance tax return $ 15.00 TOTAL $50,931.05 # Fee set pursuant to 31 Pa. Bulletin 258.11(d) 8 . The Petitioner will cause to be paid all Pennsylvania Inheritance taxes due on all property to be awarded. A copy of the Inheritance Tax Return is attached hereto, labeled EXHIBIT 5. 9. All parties beneficially interested in the estate other than the Petitioner have been mailed a written notice of the date when this Petition will be presented. A copy of the notice mailed is attached hereto, and labeled Exhibit 6. WHEREFORE, your Petitioner prays that the above property of the decedent be distributed under Section 3102 of the P.E.F. Code as follows: a. On account of the family exemption: Not applicable b. In reimbursement of claims against the estate heretofore paid: Not applicable. Ii I c. For payment of claims against the estate remaining unpaid: AMOUNT NAME Robert R. Schuster Petitioner's fee $1000.00 # Robert R. Schuster filing fee (petition) $ 30.00 George H. Harhigh, D.O. medical $ 62.97 West Shore EMS ambulance $ 110.06 Holy Spirit Hospital medical $ 930.90 Robert R. Schuster inheritance tax return $ 15.00 Commonwealth of Pennsylvania $1859.37 d. In distribution in accordance with the interests in the estate: None il4~ Petitio er PA Bar 10 Number: 23774 1204 Maple Street Bethlehem, PA 18018-2925 610-691-0200 Fax: 610-866-8661 VERIFICATION This 9th day of March, 2006, the foregoing Petitioner hereby verifies, subject to the penalties of 18 Pa. C.S. 4994 (relating to unsworn falsification to authorities) that the facts set forth in the foregoing Petition which are within his knowledge are true, and as to the facts based on information received, after diligent inquiry, he believes them to be true. etitioner . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBUC WELFARE BUREAU OF FINANCIAL OPERATIONS DMSION OF1lI1RD PARTY UABIUIY PO BOX 8486 HARRISBURG, PA 17105 Date: February 13, 2006 ROBERT R SCHUSTER, ESQ. 1204 MAPLE STREET BETHLEHEM PA 18018 RE: RAY WINGARD CIS: 320160678 SSN: 201-16-6417 000: 12/25/2005 Dear Mr. Schuster: The Department of Public Welfare is responsible for the implementation and operation of Pennsylvania's Medical Assistance Estate Recovery Program. (62 P.S. 1412.) The Medical Assistance Estate Recovery program is a Federally-mandated program requiring recovery of medical assistance from the estates of deceased individuals age 55 and older who received nursing home care, home and community-based services or related hospital and prescription drug services on or after August 15, 1994. In operating the program, we must dispose of estates that remain unadministered throughout the Commonwealth. The Department's new regulations authorize referral of these cases for administration to the probate and estates sections of local county bar associations. In previous conversation with you, you have agreed to handle the cases for Cumberland County. We are now forwarding to you the unadministered estate cases; with all the attached information we have in our file. A reasonable administrator's commission and attorney's fee may be charged to the estate as expenses of administration, but may not exceed a combined fee of $1,000, or 6% of the gross assets of the estate, whichever is greater. (Other administrative costs associated with filing for administration will be dealt with on a case-by-case basis.) Thank you for your willingness to cooperate with the Department in this matter. You may receive referrals at a later date as they are identified. If you have any questions, do not hesitate to contact Carol Beery at (717) 772- 6245. s3-~c~rely, /1 {/Ia~tJ.(j '" -" Charles .Jones ~V-G TPL Administrator Enclosure EXHIBIT 1 This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~. filed with me as Local Registrar. The driginal certificate will be forwarded to the State VItal Records Office for pern:anent fIlIng. WARNING: It is illegal to duplicate this copy by photostat or photograph. U193468C) . No. .... /) .tyj ~~ ~~< t:7~ Local Registrar Fee for this certificate, $6.00 DEe 2 7 2005 Date Rev. 2187 COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF HEALTH - VITAL RECORDS NAME OF DECEDENT (First, Middle. Lut) .TATE..J!IU!NU~ SOCIAL SECURITVNUMBER 3. 20 1 1 6 6 4 1 7 DATE OF DEATH (Month, Day, Year) 12/25/05 1. AGE (Lut BIr1hday) 4. Cumberland ::'ty) 0 RACE. Amencan Indian. Black, While, el . (S~)Whi te 10. 5. 7 3 Vrs. COUNTY OF DEATH Ib. DECEDENT'S USUAL OCCUPATION 'r:r-=:~~~ MARITAL STATUS. t..taI'Md. N.~~~. 14. Married 17~ 0 Va.. deeedentllved In SURVIVING SPOUSE (W wM, ~ maiden name) r ann McQuaid lWp :\1b. CountY Cumb~rland 11d.I~1~=ot MOTHER'S NAME(Fnl, MlddIe.~ Surname) 1.. Mrtle Dunn INFORMANTS MAILING ADDRESS. J She.. to Ct. ty. frawn, Stata. Zlp Code) ~~ SA Richlantt Lane A t#101 Carn Hill ~~o:Ie~SPOSITION. N.me ~c.m.tfiY. Crematory LOCA nON - CltylTown. Stat.. Zip Code JJ.ldiantownGapNat I 1 C d. Lebanon, Pa NAME ANQ.^OD~ESS OF FACILITY 22c.SUJ.llvan FH, 51 N. Enola Dr, ENola,Pa LICENSE NUMBER DATE SIGNED . f l (Month, Day, Year) 23b. 23c. 5-: WM CASE REF~ED TO A MEDICAL EXAMINER /CORONER? V.. 0 PART U: Other Ilgnlfic:anl conditions contributing to death, but not resulting In the underiylng caUH given in PART I Carlisle dtylboro. Pa IUMEDlATE CAUSE (FInal dbuse or condIticn ~ It dNlh)---" .. SequantIaIy III CXlrlCIIIIonI {..b' it trr'I. INdI'lg to mm.dIa&. alUM. Enter UNDERl YlHG CAUSE (DiMaM or injury c. lNl i1iliNd ~ r8IIJIIWlQ on deaIh ) lAST d. WAS AN AUTOPSV WERE AUTOPSV FINDINGS PERFORMED? AVAlLA8lE PRIOR TO COMPlETION OF CAUSE OF DEATH? y..D =E:::~ ~. .0. El TIME Of INJURV INJURV AT WORK? OESCRIBE HOW INJURY OCCURRED. DATE OF INJURV lNoftlh. Day. v....) ~.. D....... ~~IIg.lIon 0: Y.. 0 No 0 O 30..30b. t.C. 30c. ..CouId nOt tladatannlnad ~~_~,~=y. Athoma. lamI. .treel, I.<:toty. otnca 28L 2Ib. 28. 30.. CCRnFIER (Check only one) ... . .. .,..... ./..... . .,. ... ...... .. SIGNATURE AN '~~tGJ~t~Js~lh~J:::g:~~:r=.r,rr~~.~~.~.~~~.I~.~~).................. o 31b: . "- "PRONOUNCING AND CERTJFYlNG PHYSlCWI(PhwIcIan both prclnOUIlclr,g_th and~.~ caUM~ death). ..ICEN~E U~"EOR To the beat of "'Y.knclwtedg.!d..lh occurred.t the time, ~ and pla.,JlPd dU'~tJM~u...(a)~d ~.. .tat.d...................... 31c. ~U 31d. 7..' "1i.tl- "MEDICAL EXAMINI:RJCORONER . . .. ~~~f~2f}.~~F PE~spN ~ COMPlETED CAUSE OF DEATH On the bula of aumlnatlon and/or Inv..Ug.tJon. In my opinion, de.th occurred at the tlm., deta, and place, and due to the GMl...(a) and m \)a~ of\.. \ vJ ~ rif" bV manner u stat.d.......... ........................... ............................................................. ......... ......................".......................... 0 . 31.. . 32. " DATE FILED (Month. Day, y..,.) 1~ /1ol1/1 , v.. 0 No NoD Sulcida 33. RE~?~rMBER .. 1~)(JJ I {3 (I d2 34. l""lIRllI,l~~lJ1!.I~~'''1<;~,~~.",,'''f'''~'' Sullivan Funeral: tj';::J!ne 51 N. Enola Driv~ Enola, Pa 17025 732-5400 OF FUNERAL GOODS AND SERVICES SElECI1ID :'.r those items that you Selected or that are required If we are required by law or by a cemetely or crematory to use any items, we will ; ~ writing below. . em1.that may require embalming, such as a funern1 viewing, you may have to pay for embalming. You do not have to pay for embalm- . '. . 'e if you selecredsudusdirectcrematiofl or ~buriai If we charged foc'embalming, we will.~. why belo.)Y. jm: Id. . . . .' . . Date>.of Deatb./J ~ 3. S4 "'" 0 . Other clothing State 1 <Description) I.(J ornER . $ . .,.-' ---- ~q/~ tQ.- TOTALMFltOfANDlSESEI.EGI'F.D.. .~~.... .B .11.f1- .....AI $~ C. SPEOAL CHARGES: ~'of remains.to ~ HClI1le) Receivin8.of remains. from (FoneralH~ lmIDed.iate Burlal .............. DiRctCremation c. . . . . . . . . . ~ . . . . .. .. .C $--,-"- D. asHADVANCED Opening Gave ......... ,. . . . .. ... $.' . Cemelery'Equipment. .. . .c.., . . . . . $""'-- . ~nee:~~;.::: ::: ::: :::;~ \;':~.,i .:::::~; 7\~. ,.~~~,_, .~ t:26fr~g :... ~.::~:,f~~'r'J~ PaU~:.. ... ......... .......... $~ ~~pf~\Pt!1 ..~.. _..$ . c:ertific2te. to. .~,,,.,.~..,. $~ Police Escort ...... """". .......... $~... ....... . . ..' ....... Flowers;lH .'. :.1", ... .. ..- .. .$~v ~..:.....~:.:/....~.~;fR . . ..... ....... .........~...:<~1jf/) .1lJJ'AI.0Jl..mvAl'lCES .. .:u... .....:. .' . . 0..0.$ . ......; Wecll:.u8e'YJ)11 fOfl)Ursemcesin~ ,F (i/!t!!dh}:IISb~.;II!Pt~~) cards ..... ....... $_____: "/ .................$~~ :Ii:: ~:: ::..:::;:1~ .... .......:... $----- . ~OFCBAIlGES. A..'~ Senices, FadIiies and ~and Automotive . . .,' J~ (fJ i~:: ;221;.;:~:,.:.J~;" ~OR ..-;'~fi/:::::::::::~~ IIM$oNFOIt .~ If--.,.Iaw, cemetery, Of~ . .';. required the purtbase dc.anydthe irfms liStedabOYe. rhe]aw or ~.~ ~ below. to- be ~ and acalII'diDgto the ~ IiIave requested. I acknowIedge ,- I tme~ fuods :lVlIilallIe far ~ '* tile cash price fQr the goods mi~liabte wilhanyone.~ who EXHIBIT 3 . COMMONWEAl. TH OF PENNSYLVANIA DEPARTMENT OF PU8UC WElFARE BUREAU OF ANANClAl. OPERATIONS TPL SECTION - CASUAlTY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 January 17,2006 STATEMENT OF CLAIM SUMMARY NAME 10 Estate of WINGARD, RAY 320 160 678 MEDICAL CLASS 3 ..CLASS 6 TOTAL INPATIENT .00 .00 .00 OUTPATIENT .00 .00 .00 LONG TERM CARE 19,132.56 23,928.60 43,061.16 DRUG 2,002.87 3,718.09 5,720.96 REfMBURSEMENTTOOPW 21,135.43 27,646.69 48.782.12 COMMONWEALTH. OF PENNSYLVANIA DepARTMeNT OF PUBUC WELFARE EIN - 23-6003113 EXHIBIT 4 -I 15056051058 REV-1500 EX (06-05) PA Oepartment of Revenue . Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0001 ENTER DECEDENT INFORMATION BELOW Social SeaJrity Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Nwnber Date of Birth 201-16-6417 12/2512005 05/17/1932 Wingard (If Applicable) Enter SUrviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Wingard Ray MI W Decedenfs Last Name Suffix Decedent's First Name Spouse's First Name Maryann MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Retum 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13--82) 5. Federal Estate Tax Return Required 48. Future Interest Compromise (date of death after 12-12--82) 7. Decedent Maintained a LMng Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 11. electJon to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. AU CORRESPONDENCE AND CONFIDENTIAL TAX IN'ORMAnON SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4. Umited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Utigation Proceeds Received 8. Total Number of Safe Deposit Boxes Robert R. Schuster, Esq Firm Name (If Applicable) (610) 691-0200 REGISTER OF WILLS USE ONLY First line of address 1204 Maple Street Second line of address City or Post Office Bethlehem State PA ZIP Code 18018-2925 DAfE FILED Correspondenfs &-mail address: shoey@netscape.com Under penaltfes of pefjUtY, I dedare that I haYe examined this return. lnctudlng accompanying schedules and statements, and to the best of my knowledge and belief It Is true, correct and complete. OecIaration of Pf8peter other than the personel representative II based on aN Information of which prepa,.,. has any knowledge. · ~' ~ :ru ON RESPONSIBLE FOR FILING ReTURN . ~TE" -- ----- 3 Jq Lb ADDRESS I ' 1204 Maple Street, Bethlehem, PA 18018-2925 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 .....I EXHIBIT 5 -.J 15056052059 REV.1500 EX Oecedenfs Name: RECAPITULATION Ray W Wingard 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or SokrProprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash. Bank Deposits & MIscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. JoinUy Owned Property (Schedule F) Separate BlUing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Prob8te Property (Schedule G) Separate BHHng Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Unes 9 & 10). . . . . . .. . . . . . . . . . . . . . . . .. . . ... . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which an etection to tax has not been made (Schedule J) . .. . .. . . .. . . .. . .. .. . .. . . 13. 14. Net Value Subject to Tax (Une 12 minus Line 13) ... . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Une 14 taxable at lineal rate X.O _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Une 14 taxable at collateral rate X .15 18. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 201-16-6417 Decedent's SocIal Security Number 15056052059 9,265.30 9,265.30 6,302.00 49,885.99 56,187.99 -46,922.69 0.00 0.00 ....J REV-1500 EX Page 3 Decedent's Complete Address: File Number Ray STREET ADDRESS 16 West W \Ningard -~-....._-~---_._._,-", OECEOENT'S SOCIAl SECURITY NUMBER ~______'________n________~_01-:!~~~_!~ Street crrv-"- Carlisle ." - - -----n------.---..--r--.---.--..--...-----..-....--- I STATE PA ZlP17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) 0.00 ------.- TotaIlnterestIPenatty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the dift'erence. This is 1he OVERPAYMENT. FBI in oval on Page 2, Une 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) 0.00 0.00 A. Enter the interest on the tax due. B. Enter the totaf of Line 5 + SA. This is the BALANCE DUE. (SA) (58) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN IIXIIIN THE APPROPRIATE BLOCKS 1. Did dec:edent make a transfer and: Yes No a retain the use or income of the property 1ransferred;.......................................................................................... 0 [i] b. retain the right 10 designate who shaI use the property transferred or its income; ............................................ 0 Ii] c. retain a reversionary interest; 01".......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 (iJ 2. If death occurred after December 12, 1982, did deaKfent transfer property within one year of death without receiving adequate COIlSideration? .................................................. ..................... ... ......... .......... ................. 0 [i] 3. Did decedent own an 'n trust fof or payable upon death bank account or security at his or her death? .............. D ~ 4. Did deaKfent own an Individual Retirement Aa:ount. annuity, or other non-probate property which contains a beneficiary designation? ................. ........ .................. .............................. ........................................... .... 0 [iI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1 t 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse Is three (3) percent (72 P.S. 59116 (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 zero (O) percent [72 P.S. 19116 (8) (1.1) OQl. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For 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 paren~ an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. S9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percent, except 8S noted in 72 P.S. ~9116(1.2) [72 ~S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs sibHngs is twelve (12) percent [72 P.S. S9116(a){1.3)].Asibllng is defined. under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. i RE\l.1SOIl ex+(6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OeCEDENT seMIDULI I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Ray W. Wingard FILE NUMBER Include the proceeds of ligation .-ad the date the proceeds were received by the estate. An propeIty joIntIy-owrted with right of IUl'YIvorahlp MUtt be dIIcIoItd on Schedule F. ITEM NUMBER 1. MaT Bank (Account # 9838897248) 2. SUllivan Funeral Home (pre-paid Funeral) DESCRIPTION VAlUE AT DATE OF DEATH 4,008.30 5,257.00 TOTAL (Also enter on line 5, Recapitulation) . (If more space Is needed, insert additional sheets of the same size) 9,265.30 f REV-151l EX+ (12-9&>W COMMONWEALTH OF PENNSYlVANIA 'NHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI H fUNERAL EXPENSES & ADMINIStRATIVE COSTS ESTATE OF Ray W. Wingard FILE NUMBER Debta of dIcedInt must be reported on ScheduIt I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Sunivan Funeral Home, 51 North EnoIa Drive, EnoIa, PA 17025 5,257.00 B. ADMINISTRATIVE COSTS: 1. Personal Representattve's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: . State Zip 2. Attorney Fees 1,000.00 3. FamIty Exemption: (If decedent's address is not the same as cI8lmant's, attach explanation) CIalm8nt Street Address CIty Retationship of Claimant to Decedent State . Zip 4. Probate Fees 45.00 5. AcaM1tBnt's Fees 8. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, RecapitulatiOn) $ (If more space Is needed, insert additional sheets of the same me) 6,302.00 REV.1512 EX+ (12..()3) .. SCNEDULI I DEBTS OF DECEDENT, MORTGAGE UABlunES, & UENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIlENT DECEDENT ESTATE OF Ray W. Wingard Report debts inca.ned by the decedent prior to death wbfctt rwnained unpaid as of the date of death, including unrefmbursed medlcllexpenses. VALUE AT DATE OF DEATH FILE NUMBER ITEM NUMBER 1. DESCRIPTION Commonwealth of Pennsylvania Estate Recovery Program 48,782.12 110.00 62.97 930.90 2. West Shore EMS 3. George H. Harhigh, M.D. Holy Spirit Hospital 4. TOTAL (Also enter on line 10. Recapitulation) $ (If IIQ8 space is needed. i1sert additional sheets of the same size) 49,885.99 . .J REV-1513 ex+ (!f.OO} '* SCHEDULI J BENEFICIARIES COMMONWEAL 1M OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DEceOENT ESTATE OF Ray W. Wingard FILE NUMBER RElAnONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LIst Truattl(1) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright IpOUSII disbibutIons, end transfers under Sec. 9116 (8) (1.2)] 1. Mary Wmgard, SA Richland Lane, Apt 101, Camp HiM, PA 17011 wife 50,000.00 2. Raeann WIttIe, 14 North EnoIa Dr., EnoIa. PA 17025 daughter 20.00 3. Maryann Ulrich, 101 Pepper Ave., enoIa, PA 17025 daughter 20.00 4. Brenda Killian. WeIIsviHe. PA daughter 20.00 5. Ray Wingard, Jr., 301 N. 71st St., Harrisburg, PA 17111 son 20.00 6. David Wingard, 5')1Richland Lane, Apt 101, Camp HI, PA 17011 son 20.00 ENTER OOUAR AMOUNTS FOR DlSTRI8U1lONS SHOWN ABOVE ON UNES 15 THROUGH 18, AS APPROPRIATE. ON REV..1500 COVER SHEET n NON-TAXABLE DlSTRIBUnONS: A. SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN aecnoN TO TAX IS NOT BEtNG MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART U - ENTER TOTAL NON-TAXABLE DISTRIBUnONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, Insert additional sheets of the same size) I IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION In the Matter of the Estate of } } } } No. RAY W. WINGARD, deceased NOTICE OF INTENTION TO REQUEST ENTRY OF ORDER OF COURT FOR SETTLEMENT OF SMALL ESTATE TO: Mary Wingard David wingard 5A Richland Lane Apt. 1 Camp Hill, PA 17011 Raeann Wittle 14 N. Enola Dr. Enola, PA 17025 Maryann Ulrich 101 Pepper Ave. Enola, PA 17025 Brenda Killian Wellsville, PA Ray Wingard, Jr. 301 N. 71st Street Harrisburg, PA 17111 Please be advised that Robert R. Schuster, Esquire, intends to file with the Court a Petition for the Settlement of a Small estate in the matter of the Estate of RAY W. WINGARD, on or after March 20, 2006, requesting that an Order of Court be entered confirming the Petition, and ordering the distribution of the assets of the estate in accordance thereto. If you have any objections, they must be raised with the Court at that time. ROBERT R. SCHUSTER Petitioner PA Bar ID # 23774 1204 Maple Street Bethlehem, PA 18018 610-691-0200 Fax (610) 866-8661 mailed: 3/9/2006 EXHIBIT 6