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.
RE:.V_1500 EX: (6-00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 06 00556
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Heberlig, Betty I
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
06/02/2006
07/10/1930
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IRM NAME (If applicable)
Griffie & Associates
ElEPHONE NUMBER
717/243-5551
1. Real Estate (Schedule A)
2, Stocks and Bonds (Schedule B)
3, Closely Held Corporation, Partnership or Sole-Proprietorship
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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
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:s 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
~ (Schedule G or L) . f'C
5 8. Total Gross Assets (\~tal Lines 1-7)
~ 9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (L"ine 8 minus Line 11)
OFFICIAL USE OI'LY
170-24-2151
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-B2)
o
1
5, Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
200 North Hanover Street
Carlisle, PA 17013
(1 ) 62,000.00
(2) None
(3) None
(4) None ,
:; ,
(5) 10,466.86
.r;-
(6) None c.n
(7) 10,461.29
(8) 82,928,15
(9) 5,479.02
(10) 696.56
(11)
6,175.58
76,752.57
(12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J) .
14. Net Value Subjectto Tax (Line 12 minus Line 13)
(13)
(14)
76,752.57
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec,9116(a)(1.2)
z 76,551.31 .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
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c. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
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0
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S 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
3,444.81
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
3,444.81
-,.,. BE SURETOANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH<<
Copyright 2000 form software only T~e Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
STREET ADDRESS
703 Sandbank Road
CITY
Mt. Holly Springs
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Inlerest
E. Penalty
(3) 0.00
(4)
(5) 76.39
(SA)
(58) 76.39
, Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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 totaf Of Line 5 + 5A. This is the BALANCE DUE.
, ~.!
Make Check Payable to: REGISTER OF WILLS, AGENT
;~ ' ii~~~i;;j~~t1~ti }",: 1", ~ ;;rn; :.~~,:.e:,....~ ..'if
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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:;~t,.,1. ~'ci!'"",,l'i '~tE.l'~l:~.Jt~ '
1. Did decedent make,a transfer and:
a. retain the use 9r income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or........................................ ................ ..................................... .....................
d. receive the promise for life of either payments, benefits or care?.............................................................
2.. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequ ate consideration?........................... ........................................... .................... ............................
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?............................................... .................. no............... ......................... .........
Yes No
D r&I
8 ~
o ~
o ~
D ~
~ 0
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and behef, 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.
ADDRESS DATE
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
5563 Philadelphia Avenue cp/67
Chambersburg, PA 17201
ETURN ADDRESS DATE
1162 Centerville Road ) d.0/o.?
Newville PA 17241
ADDRESS DATE
200 North Hanover Street I j.J.bl 67
Carlisle, PA 17013
on or aft 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
is 3% [7 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after Janu~ry 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. 119116 (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 vafue 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. 119116
1.2) [72 P.S. !l9116 (a) (1)]. .
The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individ~~1 who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Heberlig, Betty I
FILE NUMBER
21 - 06 - 00556
. '
All re.al 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 wilnng seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM VALUE AT DATE 0
NUMBER DESCRIPTION DEATH
1 703 Sandbank Road 62,000.00
Mt. Holly Springs, PA 17065
(see attached settlement sheet)
(net costs of sale deducted at schedule H)
,.
TOTAL (Also enter on Line 1, Recapitulation) 62,OOO.O{
F
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Heberlig, Betty I
FILE NUMBER
21 - 06 - 00556
Irfclu?e the proceeds of li.tigation 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 VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 Checking Account # 5140185548 8,405.49
PNC Bank
(attached statement)
2 Auto insurance refund 55.00
Allstate
3 Comcast Refund 47.81
;
4 Comcast Refund 33.49
5 Pension payment .:, 35.20
,
6 The Sentinel newspaper subscription refund 91.50
7 1989 Olds Cutlass Ciera 500.00
VIN 1G3AM51N9KG356814
(attached appraisal)
8 Personal property appraisal 430.00
(attached appraisal)
9 Three Springs Family Practice 110.37
(Refund of overpayment)
10 Embarq Refund 0.09
11 Chapel Pointe - Refund of prepayment 119.00
12 Chapel Pointe - Supplemental insurance payment 119.00
13 Aflac insurance premium refund 13.21:
TOTAL (Also enter on Line 5, Recapitulation) lO,466.8(
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Heberlig, Betty I
FILE NUMBER
21 - 06 - 00556
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
14 Personal property sale
DESCRIPTION
VALUE AT DATE OF
DEATH
125.48
15
Aero Oil credit refund
179.89
16
Foremost Insurance Refund (Homeowners)
34.25
17
Personal Property sold (Statements attached)
167.01
Page 2 of Schedule E
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Heberlig, Betty I
FILE NUMBER
21 - 06 - 00556
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee, their relationship to decadent VALUE OF ASSET DECO'S (IF APPLICABLE) TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. INTEREST
1 Erie Family Life Insurance Company 10,461.29 100% 10,461.29
Annuity # 560-267
(attached statement)
TOTAL (Also enter on line 7, Recapitulation) 10,461.29
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSlS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Heberlig, Betty I
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 - 06 - 00556
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
A. 1 Aver Memorial Home and Cremation Services, Inc. 229.60
2 Carlisle Memorial Services, Inc. 170.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security NUm~er(s) / EIN Number of Personal Representative(s):
Street Address
City ,." State Zip
I
-
Year(s) Commission paid
2. Attorney's Fees Griffie & Associates 3,450.00
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 220.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
I
7. Other Administrative Costs I
I
I
1 The Sentinel - Advertising 173.15
"
Total of Continuation Schedule(s) 1,236.27
TOTAL (Also enter on line 9, Recapitulation)
5,479.02
Schedule H
Funeral Expenses &
Administrative Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Heberlig, Betty I
FILE NUMBER
21 - 06 - 00556
2 Cumberland Law Journal
3 Net costs of real estate sale
4 Bank fees
5 Met Ed (electric)
6 The Sentinel (ad to sell home)
7 South Middleton Township (sewer)
8 Foremost Insurance Company (homeowners)
9 Borough of Mt. Holly Springs (water)
10 Met Ed (electric)
11 Met Ed (electric)
12 Morrison Auto Sales (auto appraisal)
75.00
821.01
10.00
18.33
80.36
66.00
89.25
5.00
30.21
21.11
20.00
Page 2 of Schedule H
'.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Heberlig, Betty I
FILE NUMBER
21 - 06 - 00556
Illclude unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Direct Pay from checking (post death) 4.00
(Health insurance)
2 Direct Pay from checking (post death) 9.00
3 Embarq (final bill) 7.80
4 Three Springs Familt Practice 110.37
5 Com cast Direct Pay from checking (post death) 47.81
6 First energy OpcoDirect Pay from checking (post death) 28.51
7 Direct Pay from checking (post death) 4.00
(Health insurance)
8 Comcast Direct Pay from checking (post death) 47.81
9 South Middleton Township Direct Pay from checking (post death) 66.00
10 First energy Opco Direct Pay from checking (post death) 23.23
11 Met Ed 20.28
12 Borough of Mt. Holly Springs (water bill) 22.00
13 Chapel Pointe (Nursing home care) 305.75
14 * CHECKS / WITHDRAWALS PROCESSED POST-DEATH
TOTAL (Also enter on Line 10, Recapitulation) 696.5t
REV-1513 EX+ (9-00)
'.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Heberlig, Betty I
I FILE NUMBER
21 - 06 - 00556
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Geraldine E. Garner daughter one-fourth
1162 Centerville Road
Newville, PA 17241
2 Barry L. Sanno son one-fourth
640 Highland Avenue
Mt. Holly Springs, PA 17065
3 Dana L. Heberlig step-son one-fourth
5563 Philadelphia Avenue
Chambersburg, PA 17201
See Continuation Schedule(s) attached
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART \1_ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Heberlig, Betty I
I FILE NUMBER
21 - 06 - 00556
, RELATIONSHIP TO
, AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
Do Not List Trustee(s)
I. AXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116(a)(1.2)]
4 Gary R. Heberlig step-son one-fourth
32 Shippensburg Mobile Home Estate
Shippensburg, PA 17257
I
I
Page 2 of Schedule J
ATTACHMENT TO SCHEDULE A
A; Settlement Statement
U.S. Department of Housing
and Urban Development
*
1r
OMS No. 2502-0265 (Page I)
B. Type of Luan
I. FHA 2. FmHA 3.
4. VA 5. Cony. [ns.
Cony. Unins. 6. File Number
7. Loan Number
8. MOltgage Insurance Case Number
C. Note:
Thi~ form is furulsheo 10 8h'i! rou II statement of acwal seUlcmen( costs. Amounts paid to llllJ uy tile seUlcl1Icnlllgeut lire shown. Hems mllrked "(p.o. c.}" were paid outside the c105hl~; they lire shown hei'e for
infiJrmalionlll purposes 1IlH.lllre not Included In tbe lOhl.ls.
o Name and Address of B'llTower E. Name, Address, and Taxpayer idenlltication # of Seller
Herbw D. l11ld Bonnie L. Coyle Estate of Betty I. Heberlig
321 North Baltimore Avenue c/o Bradley L. Griffie, Esq.
I\lt Holly Springs, PA \ 7065 200 North Hanover Street
Carlisle, P A 170 I 3
F. Name and Address of Lender
N/A
703 Sandbank Road (South lvliddleton Township)
tvl E. Holly Springs; P A 17065
1-1. Settlement Agent Name, Address and Taxpayer Identification Number
Dale F. Shughart, Jr., Esq.-
10 West High Street
Carlisle, PA 17013 25-180-2515
G Prllperty L,)cation
Adjustments for items paid by seller in advance
106. CIty/town taxes 11110/06 to 12/31/06
107. County taxes to
Ill8. Assessments to
109. School Tax 11/10/06 to 06/30/07
110. Garbage Fee
III.
112.
Place uf Settlement
10 West High Street, Carlisle, PA
K. Summary uf Seller's Transaction
400. Gross Amount Due To Seller
62,000.00 40 I. Contract sales price
402. Personal Property
658.50 403.
404.
405.
Adjustments for items paid by seller in advance
11.63 406. City/town taxes 11110/06 to 12/31/06
407. County taxes to
408. Assessments to
234.89 409. School Tax 11/10/06 to 06/30/07
410. Garbage Fee
411.
412.
I. Settlement Date
II/l 0/2006
,I. Summary of Borrower's Transactions
lOO. Gross Amount Due From Borrower
101. Contract sales price
102. Personal Property
103. Settlement charges to bOlTo\.Ver (line 1400)
104.
105.
62,000.00
1\.63
234.89
110. Gross Amount Due From Borrower
62,905.02 420. Gross Amount Due To Seller
62,246.52
213. School Tax
214.
215
216.
217.
218.
219.
to
50tl. Reductions in Amount Due To Seller
1,000.00 50 I. Excess deposit (see instructions)
502. Settlement charges to seller (line 1400)
503. Existing loan(s) taken subject to
504. Payoff of t1rst mortgage loan
50S. Payoff of second mortgage loan
50b.
507.
508.
509.
Ad.iustments for items unpaid by seller
510. City/town taxes to
5 II. County taxes to
512. Assessments to
513. School Tax to
514,
515.
516.
517.
518.
519.
1,067.53
200. Amounts Paid By Or in Behalf Of Borrower
20 I. Deposits or earnest money
202. Principal amount of new loan(s)
203. Existing 10an(s) taken subject to
204.
205.
206.
207.
208
209.
AdJustments for items unpaid by seller
210. Ctty/town taxes to
211. County taxes to
212. Assessments to
220. Total Paid By/For Borrower 1,000.00 520. Total Reduction Amonnt Due Seller 1,067.53
JOO. Cash At Settlement From/To BOlTOIVer 600. Cash At Settlement To/From Seller
JOI. Gros~ Amount due from bOlTower (line 120) 62,905.02 60 I. Gross Amollnt due to seller (line 420) 62,246.52
J02. Les:; amounts paid by/for bOlTower (line 220) 1,000,00 602. Less reductions in amt. due seller (line 520) 1,067.53 )
.10.1. Cash X From To Borrower $ 61,905.02 603. Cash X To From Seller '\; 61,178.99
I hil\ ~ l.:Mcfully reviewed the HUD-l SdtlelHent Sl~llcnH::nt and 10 the best of Ill}' knowkdgc and belid', jt is a [rue alld uccurate statement of nil receipts ulld disbursements made: on my
;h':l:OllH! or b} llle i~~[r."71'al.:[iOIl' ']'lI her cfl'~ifY tha~l.:ci\lcJ. a cOlllpktt:d copy ofpagc$ I and 1 of thi$ HUD-I St:ulcment Statelllelll.
")1 Iii TLld / L/) /"'\, ......iJ II'
L. Sdtleli1",nt Charges
700. Total Sales/Broker's Commission based on $
Division ofCOIll1nission (line 7(0) as follows:
7t1l. ~ to
7U2. $ to
7m. Commission paid at SC[tlement
7U4.
800, Items Payable in COllnection With Loan
SO I. Loan Origination Fee
802. Lllall Discount
~03. Appraisal Fee
~04. Credit Report
80S. Lemler's Inspecticm Fee
SOo. rvlongage In,urance Application Fee
807. A,sumpticm Fee
SOS. Flood Certitication Fee to:
~(() ')
Sill.
@
Paid From
BOlTower's
Funds at
Settlement
Page 2
Paid From
Seller's
Funds at
Settlement
01 _
/0-
0'
10
O.
/0
to
to
to
to
811.
900, Items Required By Lender To Be Paid In Advance
90 I . Interest ti'om to (gl $
902. f\longage Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000.
IOUI.
1002.
1003.
IUD-I.
1005.
1000.
I U07.
100S.
1100.
1101
1102.
IIOJ.
1104.
I I OS.
1\06.
1107.
11119
1110.
I I II.
1112.
III J.
1200,
120 I.
1202.
120J.
12114.
1205.
DOO.
IJOI
1302.
13uJ
IJU-l.
I JU5.
IJlic,
I.W7
I J1I8.
I JCl'J
1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 658.50
Jnitial Fsrrol\' ACCollnt Statement ReUllired h\' Sertinn 1Il (e) (I) of the Real Estate Settlement Procedures Act (RESPA)
IIOS.
/day
months to
I years to Lititz Mutual
Reserves Deposited With Lender
Hazard Insurance s@ $ per
MOl1gage Insurance s@ $ per
City property ta.,es s@ $ per
County property taxes s@ $ per
Annual assessments s@ $ per
School Taxes s@ $ per
s@ $ per
Aggregate Reserve Adjustment
Title Charges
Settlement or closing fee to
Abstract nr title search to
Title examination to
Title insurance bl11der to
DclCumellt preparation to
NcHnry's fees to
Attorney's fees to
(Includes nbo\e Items numbers:
Title insurance to
(includes nbove items numbers:
Lender', coverage $
Owner's coverage $
Goverument Recording and Transfer Charges
Recordl11g fees: Deed $ 38.50; Mortgage $
Clty/couney tax/stamps: Deed $ 620.00 ; Mortgage $
State tax/stamps: Deed $ 620.00 ; MOl1gage $
; Releases $
38.50
620.00
0.00
0.00
620.00
Additional Settlement Charges
Survey te)
Pest Illsp"ction to:
l3e,mugh e,f I\ll HGlly Springs, water bill #00001116
Se,uth rvliddletcHI Township. ,"wer #500790
ludy Camphell, fax CL1lltctor, 2006-07 school district tax
5.00
29.93
412.60
1,067.53
ATTACH~vlENT TO SCHEDULE E
. ':'UG-22-2i3aS ['9:31 From:PH: Brlf~K
7174855767
To: 7172.q35BS3
~ PNC Erica L
~ . Schlllgel/Con:ilurner/PGH/PN
C
08/07/2000 12:06 PM
To Judy Yaw/CollsumarISCP/PNC@PNC
cc
bee
Subject Date of death balances
Estatt llf Belly I Hcbcl'lig (Deceased)
SSff 1.70-24-2151
DOD 06-02- 200()
ACCOUNT NUMBER It: DATE OF DEATH BALANCE -+- ACCRUED INTEREST
DDA #5 140185548
$~,405.49
$0.66
+
Safe depusit box #479Ioci:ltcd allhc Mount Holly Branch.
lfyou selected the bali:lIlces to be senlLO the "Bnmch" lhey will only be sent to
The requestor by lJ)tus N(ltes.
Ha vc i1 great Day !!! :-)
~ '?Kj. &~ "- ~.- tk~ ..~....:-.
F'. 1 1
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~
MORRISONS AUTO SALES
1560 Holly Pike
Carlisle, PA 17013
(717) 249-6262
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No+~
ialion of Notaries
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Date: 08-24-2005 22:05:39
t\!
KaseY~5 Auction Service
408 N. Baltimore St.
Mt.Holly Springs, PA 17065
717-258-5858
bring Buyers and Sellers together~
"v,je
Settlement
Selley': 738
BETTY HEBERLIG ESTATE
Page:
71Zi3 S~~NDBANK RD
MT. HOLLY SPRINGS PA 17065
---------------------------.---------------------------------------.-----------
It em
Descr-.i pt ion
Pl"'ice
Qty
Tot .:d.
.-J'-'
c.(.-:.
1 fJ u ill Q.i
1 -:;- !ZUll
....J.
1 .-, 012:1
c.
~.~..*.
1 2. 12HZ!
. 1- 0lZ!
.l.
1 1.. QUZt
:_1 2~ 0111
-fi.**
1 L illiZi
1 1. 121 JZi
1 1. lZHZI
1 2. lZHZI
1 -:! 0iZt
....J.
1 17.50
**-ll'
1 5a lZIlZl
1 3.00
1 1 .. tZlJZ\
1 -:! III 0
....J.
1 20.. IZIIZl
1 1- lZl0
75.50
KEROSENE HEATER
2 un FIGURES
SHELF
2 GLASS-4 PLASTIC BOWLS
"~.** Not sold
CLOC~{
tvl I Be B01ALS LC:-r
TRAY LOT
ANGEL FIGURE CHOICE
PANS/COOKIE CUTTER ETC
GLASS/PICTURE
CAT TRAY LOT
PANS LOT
COOKIE JAR
STAINLESS POT
TABLE-4 CHAIRS
2 LAlVlPS
RECLINER
LIFT CHAIR
STEP STOOL
VANITY CHAIR
DRESSER
trlICROWAVE STAND
1 >> QliZl
..H,'* "..jot sold
,*.** Not sold
Items:
~lmount :
~ /).1>: AS" 1 b
1? . G\)
Jr.- )'
~~-\)~ - ID f\. --
Thank you for your business~
Date: 09-21-2006 20:17:37
Settlement
Se 11 ey".:: -738
It em
Kasey's Auction Service
408 N. B21timore St.
Mt.Holly Springs, PA 17065
71 -"/-258--5858
U i.,,; e by' i n g E. u Y E'l'-' S a. n d Sell E\ '(' S t c get h e t-. II
BETTY HEBERLIG ESTATE
7iZi3 S;:;fhlr}B~1hlt{ F~D
MT. HOLLY SPRINGS PA 17065
DesC:t-.j, pt: i on
i=t)--. i c' e
G~t: Y
No
~121.g e ~
-rot.;:~l
------------------------------------------.----------------------.-------.--------.
[,. ILliZI
2 C~-ir:.l I t.+~s
OIL CANS/TOOLBOX LOT
COOKIE SHEETS/PANS ETC
PI TCHEi=( AND Bm-JL U::ir'1PS
STAINLESS BOWLS ETC
SEl.,) I NG tvlACH I WE
COLOR TV
SHELF
1
i
1
l
1
1
i
1
Items: 8 Amount:
L~h" ((?rom. C- 451>t'6
Thank you ftH'
YOUl""\ bu.siness!
~ ~~'. tt
1 " QUll
3"iZI0
1. 12HZI
6.12HZl
7. IZIlZl
3. IZlIZI
2. lZIlLt
29. IZl0
. ~6
\? //
IS", ;!
Date: 09-07-2006 21:01~42
Settlement
Se 11 et...: 738
Item
" ~"Je
Kasey's Auction Service
408 N. Baltimore st.
Mt.Holly Springs, PA 17065
717--258-5858
bl'-'in~1 Buyel"s and SE.ller's togethEl"'"
f\~o
t:-' cq;i e :
To b:d
------------------------------------~------------------------------------------
BETTY HEBERLIG ESTATE
703 S~INDBAl\lt{ RD
MT. HOLLY SPRINGS PA 17065
Desct-'iption
Pt-'ice
G!ty
GLUCOSE METERS/BANDAGES
BASKETS/WALL HANGERS
MISC AUTO SUPPLIES
WALL HANGERS/VASE
LIGHT BULBS/EXTENSION CORDS
KITCHEN UTENSILS
NEBULIZER MACHINE
KITCHEN UTENSILS
Yf:iRD STIChS
BA!-{ING TINS
P8TS f:lND PANE;
TOOLS TF:~iV LOT
4 PUnES/3 CUPS
TOOU; TRAY L.OT
KITCHEN FLATWARE
TABLECLOTHES/PHOTO ALBUM
COma30[Jt{S LOT
TOOLS TRA"r' L.OT
TOOLS TRAY LOT
B?"{SF,ETS/BOX LOT
SWEEPER
CAR RAtTlPS
TOOL BOX
t"lET~IL CAB I NET
BLUE WILLOW DISH SET
DISH SET
PYREX DISHES
POPCORN POPPER
SUhlBEAM POT
COOKIE CUTTERS LOT
JUICER/SHELF
TABLE CLOTHES
ROASTER
APPLESAUCER
1
.j.~.*oj;;. l\iot so 1 d ~+*
i
1
1
1
~dHi. t"~ot sCild *'**
1
i
.l.
.L
j,
1.
i
1
:I.
1
1
*** Not sold *7..,*.
1
1
1
1
1
1
1
~.** !\lot sol d -1,"**
1
1
1
1
1
1
1 . lZI1Z1
1.. IZHZ!
1. iZHZl
1 . ILI0
3.00
2. 0~?i
1 . IZIO
i.:::" 0iZi
1 II !2:.0
.y.. ILl ill
1 " 12uZ!
2.. ioiZl
1 . i21iZ!
111 ILIQi
12. 12021
2. iZHZi
5. ILlIZi
2. 1210
2. iZ11Z1
45. illIZI
S. ILlIZI
1 E:. 50
1. 12l1l1
1 . ~?l0
1 . iZi0
1. 00
1 . IZl0
2.00
3.00
1. 00
It ems: 34
L.'Z1>-]\". (omm. <2 4 ~ lilt;
Amount: 119.5~
~1. !)
l-l~ ~.~: j , ). !2
Thank you for your business!
t."!.
Date: 09-14-2005 21:14:25
IIL.)e
Kasev's Auction Service
40~ N. Baltimore St.
Mt.Holly Springs, PA 17065
717-258-5858
bring Buyers and Sellers together"
BETTY HEBERLIG ESTATE
Settlement
Selle,": 738
703 SANDBANh RD
MT. HOLLY SPRINGS PA 17055
Item
Desct~ipt ion
1=~r-~ i c. e
G!t y
NI
P2\ge~
--------.----------------------------------.------------.---------------------------
Total
it.
f. S.
--1. ~~
----.-------
1.~1J
41. ~
41. ~
SEWING MACH/SPOOLS OF
THRE?=lD
CRUTCHES
PAINT BY NUMBER SET
2 LIGHT GLOBES
r'lISC trlATERIAL
BED F RAIYlE
~H~"* Not sold *~"*
*** Not sold ***
1
1
*"j<"* t'-.lot so 10 ***
i
Items:
s
?=Uil 0 l.J.ilt ;:
Commission at +,.00QIY-
1. ~f
Less
adjustments:
Net due to seller~
A~J:
Thank you 'Fat' Ylll.J.\""' business! T-6~{ ~UR: .~.
fI lD.~:sL D I (\. /If 0..(- Tc:~,,- 'r
0. I.sPClS,,- \ ~
W\Scld. ~~S,
1. iZi0
1 . 1L10
1.00
3.00
fOi1>tO{fiCQ rntf-9.fl q.. \Y\lh-h.\<.e. o{ -\hR mOW~~( ,^-l'/IUV-Itt ~J(Q..J
6t 1T::> 4--0 @ 1h.z~ tf\qJq rtt ~ 17 4-1. (!) 'vJ~;ch \.,-) ~ \11~
"
i\TTACHMENT TO SCHEDULE G
lit- LJ'~ .zca.16 if' 4.0 ;:.~~ &2..~57i->4..':::'U:3
~P: 32~~:ITIES - ~~:X ~
.!.?I (!Ul
\ .
\ .~ FRIE FAJ\~jL Y LfFF= INSURANCE CC~fV1PAhrY
f:."PlE
.....-.. Cil
l~~~!TY STATEMENT FOR PERIOD E~DING OG!OS!Z006
BI:TTY I BEBEI:..LIG
703 SAND~ANK :RD
!IT HOLLY S!'F..INGS P A 17065-1140
A'NNUrrANT: BETT!
1:J'mt1I:r1' NUHEa:
ANNUITY DJ..'!'E:;
OWNER'S TAX In:
I HE55P..1.!G
560-261
10-24-2002:
170-24-2151
TYPE:
FLEXIBLE PREM!UM - R.EGULkR NON-QUALIFIED ANNlUT!'
'!'EAlt-TG-DAn: IIiiFORKil.TION:
SIJRmIDBll !NFOm'il..'!'ION:
AN]fuITY VALUE AS OF 01-01-06
CONTP~IRUTIONS.____..........
ROLLOVER/Tr~.N5FERil035 EXCH.
~~EREST EARNED...__........
p~JD'STMEtI;TS . . . . . . . . . . . . . . . . .
ADMiNISTRATIVE FEES.........
iIJ.PJV:;R llENEFIT PR.~IUM...,...
GROSS DISBur~SE.~NTS.........
J.RNUrrr V ALut t.S OF 06-C5-06
S10,264.25
$0.00
1;;0.00
5197.04
$0.00
$0.00
$0.00
$0.00
$lO.46L29
SURR.ENDER VALUE AS OF 06/05120D6 IS
$10,461.29.
Th"TEFJ:ST t.1.I'E INFOrJiLTIm.J:
ERn:: FP.MIl.Y LIFE COMPOUNDS INTER.EST DAILY TO 'fIELD THE P.l\,'NUAL EFFECTIVE :RATE (5) SHOWN
BELOW~ THE NEW CO~~!BUTrON INI~fJEST r~TE IS IN EFFECT FOR EACH CONTRIBUTION FOR. A
PERIOD OF ONE YE1\.F. :FROM TRE .DATE wE RECEIVE THE CONTRIBUTION. THE EX.ISTH1G FLlJIDS
Th"'TEREST RA'!E IS ill EPHeT FOR FUNDS ON DEPOSI! OIfE'R ONE rLAR.
IETEREST RArE mSTOF..T SINCE 01./01/06
:rmw ~:rtmS
!;!,~::t;cnn un:
01/'01/06 4.:5%
EXI.STING FUmlS
EFFEc:rnrE un;
Ol/Ol!06 4.55~
FOUR GREAT REASONS TO RAVE AN ldiHU'!TY WITH ERIE FAKILY LIFE:
PEACE OF !illID: AN "AU EXCELLENT RATING FItOM A.M:. BEST CO. IS YODR ASSURANCE.
.!lOBE :i.ftl.O!IE: YOER 'RETIREMENT WILL BE HORE EN.TOYABLE WITH ADDIT:rONAL INCOME.
TAX-IlEFElm:EIl EAlUiDJGS: THE EARNINGS ON YOUR PREMIU1'1 DEPOSITS AltE TAK-DEPEF.JtEtl.
SlJI"EltI01l. SEll.VICE~WE PROUDLY UPHOLD A TRADITION OF SUPERIOR SERVICE SINCE 1967.
FOR INQUIRIES CGNTACT AN ANNrrlTY smVICE REPRESE1HATIn: AT 1-S00-458-0811.
EXT. 3302 OR YOER AGENT, CARL L. CRAMER INSURANCE LtC, AT 1-717-530-8600.
llll1lllll3
Member. 6';c 'l'lWrlm~ Group _ 110me Offil;:<; . 1QO Erie 1"""'8<= f'l,Jo.;e . Eri6. p.,"""yMulla 16530 . (614) 670--2000 . Toll >'rae 1~n
DP"511 (EFL-:>e)
~
ATTACHMENTTOSCHEDULEJ
. .
:::_:\..:.85 :.X - ,:~-3.J.)
.
SAFE DEPOSii BOX
INVENTo.RY
::JMMO~jWEALiH wF PENNSYlVANIA
DE?ARiMENi OF REVENUE
BUREAU OF EXAMINATION
P.O. BOX 8327
HARRISBURG, P." 17105
MUST BE COMPL.:TED BY R:PRESENTAiIYE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT 30X 15 LOCATED AND RETURNED TO:..aOYE ADDRESS
L2J COUNTY CODE I2J FILE NUMBER . 3 SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
i i
14
(CITY]
'> . Ie \ o--d /h-/ j{ JI "l
NAME AND ADDRESS OF PERSON 'REQUESTING THE OPENING OF THE SAr,:E
(NAME)
(~;ET~~E~I) L.
).. Db tl /) r -rk
H-
(STREET)
,-
~ DATE OF DEATH
I
(SiAiE]
A
Ji
(ZIP CODE)
,-
0r ,r}G ~
(CITY)
Hv...1\.6-.rc.r ~jycV(-. (1.c-'l~) 1<-
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO ECEDENT, OF PERSON(S) PRESENT AT THE aox OPENING
a. (NAME) (RELATlONSHIPI
1ST ATE)
h/-f
:ZI P CODE)
170/ J
8
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
b. (NAME)
(RELATIONSHIP)
(STREET ADDRESS)
(CITY)
(STAiE)
(ZIP C:JDE)
c. (NAMEI
(RELATIONSHIP]
(SiREET ADDRESS)
(CITY]
(STATE]
(",IP CODE)
9 NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT aox IS LOCATED.
(NAME]
fi0L S'kcv'/
(CITY)
!ZIP CODE)
I /[)fos~
10
I
~ TITLE UNDER WHICH BOX IS REGISTERED.
i c..l~e.s [. cI-<3c
(2c/
('A (?Jb
fA {7~~(
Hcloe,l;
c Gc;...((\ (
NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY
.JuDY L, YPrLD
l3:R f1 tJC.H ~t M fIJ A (h GR
W AS A Will IN THE BOX?
o YES ~ NO
If yes. c. date of will:
b. name and address of personal repre~entativet if named in the wHI
(NAME)
(STREET ADDRESS I
(CITYI
57;. TEl
(liP (::;DE)
c. name and address af attorney, if any
(NAME)
IST;;'::ET ..ODRESS)
(CliYj
STATEl
Ill? ::C:DEI
J!
Page
SAFE DEPOSIT BOX INVENTORY
~NSTRUCTIONS
or
..
(i 1 Cash: Report rOTal only.
(2) Stocks: list in detail every common or prererred certiricate, warrant or other rights Found in box. Stocks are
to be designared by name of company, certificate number, date or certificate, name in which srock is registered,
and number or shares and class or stock.
(3) Obligations or U. S. Government: Number or items, date ar issue, race value, names in which registered.
(4) Bonds: Designate by nome, amount, serial number, or other designation.
(5) Bank and Savings and Loan Passbooks: State name or depositor, number or book, last date appearing in
book, name or bank and branch, and balance.
(6) Je_elry I Coins, Stamps, Manuscripts, etc: List and describe as Fully as possible.
(7) Deeds, Mortgages, Current Insurance Polides or other evidences of indebtedness: List and describe as
fully os possible.
(8) All other contents.
ITEM
I NO.
ITEM DESCRIPTION
i
()eLd +r:, rc.-!/hPr E J1ef,""r}~('
.s 0
'auf), ('\ ~ 0\11 \<.- -hl"- J:."
(),...e...c;( G:, no ) ( .J ~ V ~ \
fJ7 6 ,h ,( ) ~ H/\ m f' 7<--t I~ f S .n) LP<.
1', -rk 1t bOO 73 J J '1;)c
.510 Ac..rc.... '^
~--, f 1.1& 'If" " .....
I
~
:h. ' J (c..5"'G-ST
I certify under penalty or perjury that the above record is correct and complete to the best or my knowledge
a e
oj
Dote
f'~
NOTE: Use .seporote sheets jf nece.:5sory.