HomeMy WebLinkAbout97-00594
PKnTI(~~lOR IJROBAn: lInd GRANT OF Unn:RS
HHl/Ir' ql 4" 4"~tA 'Ji'~m / /'n'Ju: No, .:L 1- 9 7 "_S'=!_L~
III",~ ~I/(I.l'l' U;\..(~ .1, ./..M~" ro.
K4"~I:II'I"'t.,. Reglsler 01 Wills for Ihe
.. . .... ... ., /)('Cl'JI.SI'd. ('ollnly 01 .... ______.~.__ in the
Sod<ll 8.'(/Irlly No, _~i'T.""/~ .:.. ~~ '!,_... Comrnollwealth of Pennsylvania
The relilion of Ihe IIndersigned respe"lfnlly represenls Ihal:
Yom pClitioner(\). IIho b/_ IX years of ag" or older IIl1lh,' esecnlll'..__.._,..._____ named
in the IlIslwill oil h,' ahov{' decnleJlI. dlll{,d_..~,. 'tm M.c.. ..11..1 ._._......._..._.__._. 19.2L.
and ,'odldl(s) dllled Ot::f)4I,...:t~/tJ':Z_. ........ ....... __m....._....___..____._.__._
t~lall' n:IC\<Illl dr~'III1l~liH1l'l''i, l.',~ relllllldilllnn, d~'llth nt l"C~lllor, ell',)
Deeend"lIll1as dornieill'd al dealh in ..<::vm"M,.a.n.tII.....~_:r_,.- COlln!J.. Pennsylvania. with
h-C.l"__._ las! farnily 111 prineipal residence pi .~..ul"_.t"~_~"t'.l""J_#NL~ __m_
..'Z1I.9..MI/"..t:.d,,'....._.('.~..~~.IL~~~-atUL....-.-......--.m.-.-..--_~_.
(lhr \lrC:l'l, llHl1Ihcl' and llIundpalil.1,')
~"nde~, Ih~n.92._ y,'ars of age. died ___.~;Jii.---.m.-..-.m.m.--. 19..11-_.
at ;".I(.......~&-~;A.)~-r2'''-.~.Iri-IIt.L. ".If_~_~.dJJ~" Ao. I'~__,
F\:l..'l'pt (1' jplltHvo;, tlt'l'L'denl dalnolmany. was not ~livorc('d and did not have a I.:hild born or adopted
al',,'r e\e'.lIlI"n,,1 Ihe will ol'fered I'or prolnlle; was lIollhe vil'lim 01' n killing nnd was never adjudiellted
illl"lllIIK'I\.'lll: ..-.------.-.---..- _ ---------._~---~-------_.._------_.__.._--~-~-~.------- '
DC4..'l'IHklll al dealh ()wrwd p["openy with cSlIlllUICd values -as follows:
(II' dpmkiJcd in I'll,) All persollal properly
(If nol dOlilil'ilt.'d in P:\,) Pcr.'ionnl property ill Pennsylvania
(II IIOl d"lnil'lItd in 1',1.1 Persollal propcny in Connt)'
Vahll' or fcal-l'\UlIl' ill I'clln<,ylvania
SilllHll'd [I" rnlhlw.~: ~___,__.________._______________~___
$ ._Il.~ "" ,# #
$-_.~--
$ .
$
WHLKITlllU" pelitioner(s) respeclflllly requesl(s) Ihe pro bale of Ihe last will and codicll(s)
prcSI'lIl,'d hercwil hand Ihe ~ralll "I' Jcll"rs___..__ __.______._~..__.__.__.
I (ll'~laIlH.'llllll'~; adl11illiQrilliol\ l'.r.II.; adlt1ini~lratlon d,h,n,c,t,a,)
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=
OATH OF PEI{SONAL REPRESENTATIVE
~:~~~~Zll~~N~'~:A.I:r~ ~~I:.I)~~~~~~:~_~~.I.~. J ~s
SW\lll1 11.1 0.1 al.'lJ.rl1~l~~ and subsLTihcd I
. beron' II1'(j' .lhi,. . 0( ': . d~l\ "I'
I.."" I"(IZ
_..~-....t!'J..... "',k.I_ ..-- '. ,..nn ~lJ -. -- 1
'1l.} .v, .; ,.1 ,., J .I,
-11l-cUf- ,~-.(,/l..4'.~.{W _put...(.. ~._Lt----<_vi,-#f.-t-..1UJ_L.C-.,L-1J)
IS - 19 1- 6 ' 4.'<,/{ '/J R,'.~isl('''
TII,' peli\iol",r('1 abow.oallled swear(sl or arnrlll(sllhal Ihc statemel1ls inlhe foregoing petition arc
tnll' and conl','l 10 ,he hl'\1 \.II r1H' knowlt.'dge IInd helieI' of pctitioncr(s) and that as personal rcprcsenR
lal iw(,) ,,1' Ih.. "hml' dccedenl 1"'lilioner(s) will 11'1"11 "nd Inlly "dminisler Ihe eslale according to I~w,
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.. .... .... .......... __................._m ._~_
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LAST WILL AND TESTAMENT
OF
EDITH HEFP'ELFINGER
I, EDITH HEFFELFINGER, of 4027 Cherokee Avenue, Camp Hill,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory, and understanding, do hereby make, publish, and declare this
as and for my Last Will and Testament hereby revoking all the Wills
and Codioils heretofore made by me.
FIRST: I direot that my funeral arrangements be as follows:
no viewing, but I desire to be dressed as for church, with only one
spray of flowers, with the servioe from the funeral home of my choicel
that is, Myers and Hall Funeral Horne of 1903 Market Street, Camp Hill,
Pennsylvania. I further desire to be buried beside my husband in the
Prospeot Hill Cemetery, Newville, Pennsylvania.
SECOND: I give the drop-leaf cherry table to June
Heffelf inger.
THIRD: I give the grand-father clock to Edwin Heffelfinger.
FOURTH: With the exception of any specific bequests herein,
I direct that, after appraisal, my home, utility house, and their
contents, as well as my 1979 Ford Granada automobile and mink stole
shall be sold.
FIFTH: I direcf that my just debts, all inheritance taxes,
both state and federal, and funeral expenses be paid for by my
Executor as soon as possible after my death.
SIXTH: I give, devise, and bequeath my clothing in equal
shares to any of my relatives who may want them.
eEVENTH: I give, devise, and bequeath the following to
Elise Heffelfinger Sloan and Elain Heffelfinger in equal shares:
Two Japan lights, German clock, Japan dish (china), Dinner Set
(china), and Tea Silver Service.
EIGHTH: I give the silver candy dish with four raised
lids to Nikki Wood.
NINTH: I give the small drop-leaf table with two drawers
to Sara Rosenberry.
,TENTH: I return the corner shelf stand in my dining room
to Elizabeth Dougherty.
ELEVENTH: I give One Hundred Dollars ($100.00) to
Marion Beates.
TWELFTH:
my grandchildren:
John Heffelfinger
Heffelfinger.
I give Seventy-five Dollars ($75.00) each to
Elise Heffelfinger Sloan, Elain Heffelfinger,
IV, Nikki Wood, James Heffelfinger, and William
Page One of Two Pages
. 20. If lIn. 191s grloler than Un. 18, enler the diff.rence on line 20. This is Ih" OVeRPAYMENT.
IIU
21. If line 181s greal.r than Line lQ, enl'H the dUf.rence on lille 21. Thh Is the TAX DUE.
A. Enllr Ih. inltfOs' on th, bolancfl due on line 21A.
8. Enler th.'o'ol a' lIn. 21 and 21A on line 218. Thl, II Ih. BALANCE DUE,
_ Make Chock P.y._~I.t.~ Ro,I.'.r_.f_y,oll~L~~_OIIt_._.__
:-- .. . '~ .. - .iiu.. TO ANIWIR ALL QUii!i~~_S_~N RIVIRIE SIDI AND TO RICHICK MATH ~~_ '~,__
Under Plnalll.. 01 perlury, I dedar. thai I have IKomlned this rel~'rn, indudlng acc;ompant1ng schedules and stallmentl, alld 10 the bllll of my kn;';ledge and belief
:11, IruI, corrlel and comple'.. I declar. thai aU real Islale hen been reported cllrue market value. Declarotlon of pr,~porer olh.r than ,h, personal repre..ntatlve l~
bused em alllnformallon of which pr.partH has ally ~nowledge.
i'iONiffillE Of I'ER$ON RESPONSIBLE fOil fiLING jEl1TIl.N-'-'---'--;WDliEs~-'" ---.-----... ----------.---. ..--.----------~........_~--~ ~-~-.---. _h_.'
"O~~m.~OlH' lIV:_g.1{!.~h".L,l""'L'd~~".~~"'I.lI<;'M~/LL-.J,J';&,------
REV"~OO fK+ P.Q~1
l!!
..!It!
~I~
12,-I(JI-(r
~.~,Q-
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III
..
Jh,!ffelC!J\g~h .J::dHh ~\,
'~C;'~.~'~';~~~U;~" l~;'/~;:;~; ... 1~~/~1'/;;~.
I" ...",..";-,,,,,,,,,,,, '"'''' \ 'I'M' ",","" ;,,,, "''''''' """'" j""'^' \IC""" IHlM,,"
kl 1. Original R"turn II 2 SupplltmenlClI Relurn
LJ 4. Unllled Eitot. l J Au. Fuluftl Inleresl Comprrimill
llor dotlll 01 d.oth (Ihor 12.12.021
kJ 6. Oecedenl Died Tes'ole ! I 7, Oecedenl MQlnlOined Cl Uvlug Trutt
IAUach COP)- of Will) 1^"C1Ch copy of Truttl
AiL CORRIIPONDINCI ANO'CON,fDINTIALY.X'lIlPORM-ATfoN IHOULD.I DIRleTlli TO. -
NrMr'"' __~_R_"..~~ -~- ,- -.- "-~-rOMPliTflrAllING ~DDIUS5,.....,.
..!igJ~Il..~;d.wi-"..c:. Heffelfinger 2358 NW 13th IIl'lie'e, G(lin"svH1e,
TELEPHONE NUMtEll:
~k~~.LJ~16,;-~Q~)Q~_~_ - -~--=~~-' ~;-- .
None I
$n;488.00
FL 32605
~ 8. Tolal Number of 5af. Depo11t 80ltet
lill-
..lli
@i"
ui
111
(2)
(3)
14)
(5) .
z
Ii
5
~
w
..
I. R.ol Euo'.IS,h.d.l. AI
2. Stock. and 80nd, ISch.dul. 8)
3. Closely Held Stock/Partnership Interetl (Schedule q
4. Morlgaglt and Notel Recelvnble {Schedullt OJ
5. Cosh, Ban~ Depotlh & MiiCellanflout Personal Property
(Sch.dul. EI
6. Jointly Owned Properly ISchedule F)
7. !ronol... (Sch.d.l. 0) (Sth.dul. L)
8, Total Gran Anols (total lines 1.7)
9. Fun.ral El<pentel, Administratlve Coth, Miscellaneous
Expenlll ISchedule HI
10. Debit, Mortgage lIabilitlll, lien! (Schedule l)
II. Tolol D.d"lion. ('ololll,.. 9 & 10) 1111 -'2f;.i-~;~~~---'-.---.'
12. N., Volu. 01 E.,o'. (lln. 8 min.. line II) 112) .-----.....()----..-........--.
13. Charitable and Governmenlal Buquetlt ISchedulEJ J) 1131 ___~___________ ._"n~_----'
21,157.04
u. N~.'. Vol....~bl.c~.!~~,.~~. 12 ml~_~~..EL.-________~_n.____j-'-4.L.,~ ---
15. SpolJlol Tranlfen lfor dates of death alter 6.30,Q41
s.. Inll,ul:'lion. for Applicable Porcentage en Reverte 1151
Sid.. llnclude value, from Schedule K or Schedule M,)
16. Amount 01 Line 14 tOKoble 01 6% role
llnclude values from Schedule I( or Schedule M,)
17, Amounl of line 14 taxobloll 01 15% role
{Include valuet from Schedule K or Schedule M.J
18, Prlnclpallox due (Add lox Irom Un" 15, 16 and 17.1
19. (red!" Spousal Poverty Credit Prior Payments
'-.1
None
None
$5,2ZS;5j"
"
$11,873,41
None----~ ,m_U"'__'
161
( 7)
18) ,._U~~l!!;l, 94 _________
$6 503 55 .
19) _um.._L.L....o._._____
(101_83 9 ~~~------------..-
. .....__~__________)(,_.. ..S1
(161 ._$L2,563,OL______" .06 .____J5.3.,}~._______
(17)
11159It.00 m. .___" .15 .____1..1119.J..Q__....._______
z
Ii
.-
c
f
.
..
u
S
Discount
Interetl
Less (lgh ---2(~~~;}~r--m-----
(19) _.,_.______ u _._______
1201 __u___, _,,__ __.u______
+
+
CfU'{k h"1I 11 you (ut' IU(pllntHl!] U Icfvnd 01 YOIlI ovelpuymt'fll,
1,940.74
121)
121A)
(218)
_!'!.?p!!Z.'l'l__
o"u
Act .41 of 1994 provld.. for the r.ductlon of the tall r~t.. Impo..d on the n.t volu. of trond.r. to or for
the u.. of the .pou... Th. rot.. o. pr..crlb.d by the .totut. will b.1
'. 3~ (.03) wlll b. oppllcobl. for..tot.. of d.c.d.nt. dying on or oft.r 711 /94 rand b.for. 1/1196
. 2~ (.02) wlll b. appllcobl. for ..tat.. of d.c.d.ntl dying on or oft.r 111196 and b.fo!l.1I1/97
" 1~ (.01) wlll b. ClIppllcabl. for ..tat.. of d.c.d.nt. dying on or aft.r 1/1197 and b.for. 111/98
. Spau.al trand.,. occurring on or aft.r 1/1198 will b. ex.mpt from Inh.rltanc. tall.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (" )IN THE APPROPRIATE BLOCKS.
c, r.taln a reverllonary Interelt; or ,,,,,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,.,,,,,,,,.,,.,,,,.,,,,,,,,"""'".'''''
VI'- N ...-
X
X
X
X
1. Old decedent make a transler and:
a. retain the ule or Income 01 the property tronllerred, """.""""""".".;""".,,,,,,,,,,,,,,,,,,,,,,
b. retain the right to dellgnute who Ihall use the property tranllerred or 11$ Income, "".",,,.,,,,
d. receive the promlle for IIle 01 either payments, benellts or care' """"""""""."""""""""
2. If death occurred on or belore December 12, 1982, did decedent within two years preceding
d.ath transler property without receiving adequate conllderotion' II death occurred alter
December 12, 1982, did decedeflt tranlfer property within one year 01 death without receiving
ad.quate conllderatlon' "",,, "'"'',''' ",., "'" ".", "'" ""'"',''''' "",' "","" ",,,,,,, ".",,,,, "'" "",,'
x
3, Old dec.d.nt own an 'In trult for' bank account at hll or her death',,,,,,,,,,,,,,,,,,,,,,.,,,,.,,.,,,,,,,
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
..
.,
,
.'
"
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,
LAST WILL AND TESTAMENT
OF
EDITH HtFPELFINGtR
I, EDITH HEFFELFINGER, of 4027 Cherokee Avenue, .Camp Hill,
Cumberland County, Pennsylvania, being of sound and disposing mind,
m~ry, and understanding, do hereby make, publish, and deolare this
a. and for my Last Will and Testament hereby reVOking all the Wills
and Codioils heretofore made by me.
PIRST: I direot that my funeral arrangements be as followsl
no viewing, but I desire to be dressed as for ohuroh, with only one
spray of flowers, with the servioe from the funeral home of my ohoioe,
that is, Myers and Hall Funeral Home of 1903 Market Street, Camp Hill,
Pennsylvania. I further desire to be buried beside my husband in the
Prospect Hill Cemetery, Newville, Pennsylvania.
SECOND: I give the drop-leaf oherry table to June
HeffelUnget'.
THIRD: I give the grand-father olook to Edwin Heffelfinger.
FOURTH: With the exception of any speoifio bequests herein,
I direct that, after appraisal, my home, utility house, and their
oontents, as well as my 1979 Ford Granada automobile and mink etole
shall be sold.
FIFTH: I direct that my just debts, all inheritanoe taxes,
,
both state and federal, and funeral expenses be paid for by my
Executor as soon as possible after my death.
SIXTH: I give, devise, and bequeath my olothing in equal
shares to any of my relatives who may want them.
SEVENTH: I give, devise, and bequeath the following to
Elise Heffelfinger Sloan and Elain Heffelfinger in equal shares:
TWo Japan lights, German clook, Japan dish (ohina), Dinner Set
(ohina), and Tea Silver Service.
EIGHTH: I give the silver candy dish with four raised
lids to Nikki Wood.
NINTH: I give the small drop-leaf table with two drawers
to Sara Rosenberry.
TENTH: I return the corner shelf stand in my dining room
to Elizabeth Dougherty.
ELEVEN~H: 1 give One Hundred Dollars ($100.00) to
Marion neates.
TWELFTH:
my grandohildren:
John Heffelfinger
Heffelfinger.
I give Seventy-five Dollars ($75.00) eaoh to
Elise Heffelfinger Sloan, Elain Heffelfinger,
IV, Nikki Wood, James Heffelfinger, and WiUiam
Page Qa! of Two Pages
,
~[V. ~S03EKt 1.tI.861
1
u.;.=~.=:.~_::::..=.:::=....~=.='
flU NUMliR
1997-00594
~___ __.__~.___.__~___w.__-,-.._._~~.._._~----'------'
VALUE AT OATE
Of DEATH
~k
COMMONWEALTH Of 'ENNSVLVANIA
INHf~I'~HCf TAX R!TU.N
RUID!NT DlC!D!NT
ISTATi O' .0: --~
SCHEDULE B
STOCKS AND BONDS
Edith M. Heffelfinger
---~-~-~~- .-...-,.,-,.......------------
(All pro""v 1.lntlv:."~no" ~~~ RighI of Su~l~o!!""'_mu., 100 "I.c!!!~..!n_ Sch!~.u!o '.1
ITEM
NUMBeR
DESCRIPTION
1, 200 Shares, Common Stock, Houghton Mifflin Company,
CUSIP 441560 109; Par Value $1.00 per share,
Selling Price on May 6,1997 (Date of Death):
JUGH LOW AVERAGE OF THE MEAN
57 7/8
57 7/16
57
. $11,488.00
TOTAL (AI.o ontor on IIno 2, Rocaltulatlon
(1/ moro .paco /. no.dod, In..'' addlllonal .h..,. 0/ .am. .1..,)
S 11,488.00
...a... 5CH.DULI H
~ FUNERAL EXPENSES,
COMMQ"W..,1H Qf """SllVANI' ADMINISTRATIVE COSTS AND
ISTtfr"'T-'''~:~:1~~~~'''c!~:m'N ... .~~S~I~LANE.()~S EXPE~SES___. . ..~....Jl,.!.. Prl!'.I..orTtp. _._ -
___'::~. .Edith.M:.. 11~~~elf_iO!~e:' .____--~--.--------=r[I~~:.~~~0S.9~--...-~-.....-~----
. llfVI~I" .., 1""1
ITEM
NUMBER
~-------~...
A.
1.
2,
B,
"
DESCRII'TION
AMOUNT
._-..----,..~~~~.~--,---+ ~----,------"~~.~-,.,~
fu""ol bp."....
Myers/llarner Funeral IIQme, Cllmp l\Jll, I'a. (Itemlv,lItlon AttAched)
(Enclosure 4)
Purchase Qf a Marker, Engraving of II Monument, etc.
Eby Granite Works, 1'. 0, Ilox 187, Newvilla, Pa. 17241
(Enclosures 5 & 6)
$5,093.00
1.383;00
Adml"III,ollv. COlli I
Personal R.pr.sontatl.. Commllllons
Social Security Numb.. of P.roonal R.prOlonlatlv.: --.
V.ar Camml..ion. paid .-~.. ..-......"'---.
.....~-
2, Allorn.y F.OI
3, Family F.x.mption
Claimanl .. _.,~.. ..__._._._....___ R.I~llonlhlp
Addro.. of Claimant 01 d.c.d.nt', d.ath
Stro.t Add.... ....._.~..._.___._____.
City _......_.___.____..___....__Stal. -_~ Zip Cad.
4,
C.
},
2,
3,
4,
5,
6,
7,
8.
~----"
Probate F...
87,50
Mlle.lIo".oul Exp,,,,,,,
Postage involved in administering estate (Enclosure 7)
Fee for filing Inheritance Tax Return (Check .Enclosed)
15.05
15,00
.........-----.-_......,-T~~__'~~_."'..,._~_'
S 6;593,55
TOTAl. (Allo .nl.r on IIn. 9, R.c~pitulatlon)
(If more Ipae. I. "..d.d, 1".,,1 oddlllo"ollh..I. 0110"" .1...1
IIV.ISU".l"I"1
ISTAU 0'
"1M
NUMI.R
6,
7.
, 8.
9.
10.
.11,
12.
13.
14.
15,
16.
17.
18.
19.
20.
21.
22,
23.
24,
25,
*'
COMMONW'AlfH CIf ,INNnWANIA
l......ttANCIIA. .I1UIH
I,"',",*"'HI
5CH.DULI J J
~~~~FICI~RI15 _
PILI NUMI.R
1997-00594
Edith M. Heffelfillger
....._"--~~~_..-_.--_._-_.,-~-------~---_..._.-+~--'-~
NAM' AND ADIIR.SS 0' IINIPlCIARY
IILATlONSHIP
_._----_.__..__.~*-_."
1.
A. Ta.abl. "qu..",
Nikki Weoda, 5915 Colwyn Dr.. Harriaburg, I'a.
17109
John Hill 1/110169, Turney Center Annex, Rt. 1,
Only, Tenn, 37140
William Heffelfinger
Kieraten Heffelfinger
203 Fetrow Lane, New Cumberland, Pa. 17070
James Heffelfinger, P. O. !lox A CX2283,
Creason, Pa. 16699
Elise Sloan
Mara Sloan
304 Valley Rd.. F'ayetteville, N. C. 28205
KIllin Heffelfinger.
Kal1 Murphy
.randdaughter
.,reat Grand
Daughter
randdaughter
reat Grand
Daughter
,reat Grandaon
:randdaughter
2.
randflon
3,
4.
rand eon
'rea t Grand
!laughter
lrandson
5.
Maxwell Murphy
924 Rugby Rd., Charlottesville,
Donald Woods Sr.
Donald Woods Jr.
Va. 22903
Grandson
reat Great
Grandson
reat Great
Granddaughter
reat Great
Granddaughter
reat Great
Grandson
reat Grand
Daughte.r
rea t Grand
Daughter
,reat Great
Granddaughter
.reat Great
Granddaughter
reat Grand
Daughter
Kelly Heffelfinger Great Grand
106 American Legion Blvd., Pine Grove, Pa. 17693 Daughter
Candace Sue Heffelfinger, 459 Shuler Rd., Etters Great Grand
Pa., 17135 Daughter
Marlon Beates, 515 Terrace Dr., New Cumberland,
Pa" 17070
June L, Heffelfinger,62l South 23rd St.
Harrisburg, Pa. 11104
EdwIn HeffelfInger, 2358 NW 13th Place
Gainesville, l'l. 32605
Ca1tl1n Woods
JennIfer Woods
304 S. Front St., Wormleysburg, Pa. 17043
Michael K. Woods, Lot 178, 7073 Carlisle Pike,
Carlisle, Pa, 17013
Dawn Snyder, 334 East Locust, York, Pa. 17403
Richelle Hoyt
Harlee Sue Hoyt
Makenzie Hoyt
940 Pleasant Grove Rd..
Mercedes Heffelfinger
York Haven, Pa. 17370
Daughter-In-law
Daughter-in-law
Son
TOTALS
Ilf moro .po.. I. ...d.d, I..." oddltlo.al .h..,. of .amo .In)
-
AMOUNT OR
SHAll O' ISTATI
$150.00
150.00
150.00
100.00
150.00
150.00
100.00
150.00
100,00
100.00
100.00
50.00
50.00
50.00
50.00
100.00
100.00
50.00
50.00
100.00
100.00
100.00
200.00
8,39/,.00
8,394.00
$19,188.00
. '"
Mycrs.HUI'nc." Func.-al Homc, Inc.
1903 MARKET STREET . P.O. BOX 291
CAMP Hill, PENNSYLVANIA 17011
Robmlll. Harnor, Sup.rvlsor PIlOn.: (717) 737.9961
STATEMBNT OF FUNI!RAL GOOI>S ANI> SBRVI.CES SELI!CTI!l>
, t:hiffll'5 arc unly (or dUls{' Ilems Ihal YUlI sdl'l'll'd or thill arc rC(lulrl'd, H Wl' arc rl'llulrl'd hy 1:Iw ur h)' iI nUll'IN)' III nCl11.lIury In u~c any lIelllS, wc will
"1.1,10 10 wrllloR below.
II you 1I<1.,I.d, rUnmllb., OI,y r'qulr, ,ruh.lmlllR, ,ueb". funcr..' witb vlewlllM, YOII may.'"'' III I"Y ror embablllllM. You do lUll 1....10 P'Y fo,oOlb.IOIlo.
~ou did ~:I'~PIllV.lfYD.! I'C~ ar""R.m,nl! ,o,b... ~I~I "om'llo. '" Imm.dlate bllrlaL II we ,harRed Cor .mb.lml'R. w. WIII"P~/bY.IH:IO",
f.'" Ih.:... c. 01...... . ~.~.-~.f""~~~8d"".a.,*..!!I"..--.-~.)1:r oC 1J..~jhr~ ~ :.?--~. .
(.h....IO. ~_Ld.,=~,,':'L1~"~.14A<-~7d---.&-.!:.--~.._-~.~-~--.. (f I' ~
N.me AddreS! Clly ,lale J>.;J, t:,~
A. (;IIARGR fIIR SRRVU:f.S SRI,I'.Cnll,
I. l'ko1.IiSSIONAI, S1iRVICI!S
Servlcc5 uf 11uneral Hlm:tur/Sutr '
ROIb.lmlIlR .
Olher 1"""""1111 or IlIoly
. ,---..-...
..,-
()llll'r i..'llllllhllt __.__~____.._ .. _._..._~_______..._
--,----_._._-~..-------~_. .-..--
.._---_.._.~~_._----,-
Cre:l11allunurll...... ,. ......"", ,__
(llcserll.IIo",) ---~-----
OTlllill ___
1_.
,--
,-
.../,ZL
,............. ..,--~
SUH.l'OIAL Of PROfRSSIONAI,. SRRVIl:FS. . . . . . . .. A I ,~__
2. 1Al:IU1'IIiS ANll SIiRVICIiS
Une or ["11111,, and ,mlm fo,
vl,wIIlR(VI'"atlonIW.kl'). .....,__
Use of r.dllll.. .lId .ml",
for funeral ceremony, ' , ,... .~~
Use of bellll"" .nd servlm ror
Me",o,I.1 Service .. ,__
lJ5e VI equlpnu.'nt and servin's
for Kravesldc scrvlu: . . . . . . , , f __._~
Olher \ISt~ of facilllles
.1'0UI. MRRl:IIANDlSR SRLf.URIJ. .
I:, SPECIAL CIIARGRS.
Ilurwardlng of rel11111115 In
~-_._-~---,--
(I'unmlllom,)
Rl'cclvhlR uf rl'lI1itlns frum
------.___.__1-
(I'unmllll,",')
11IIIl1cdl:lte Ouri:ll ,
Ulrn:t Cremallul1. ,
...-.....-
..1-
,~
...,--
SUH:I'OTAI. Of fA<:Il.Il'IRS/RQUlPMtiNl' .
.1. AlITOMOTlVIi I!QIJlI'MIiNT
Vdlldc 10 trim~fcr rCl11:1ins In 1lUllcnlllolllc:
I.ocal. ...,_
IkarSl' (C:l~kl'l (;(1:1('11)
I.oeal.. . . .
I.lm(luslnc
1.0,,1.
I'.mlly car
1.0clII"."" .
Flower car or fluullllsposhlon
I.oeal." . . . ..,...,..
I,cad car/e1ergy ca,
I.neal.". .
C.. 10' p.llbearers
l.oe.I.."...,.
QUI of lown uanspurlatlon . .
....A2'_
SU8:I'\ll'AI. Of SI'f.C1A1, CIIARGRS
Il, l:ASII A1lV ANl:W
()lltlll1IK GrOl\'l'
Cemctc:r)' l:quipmt'nl .
t.ot' ;lnd ()c('d.
Ncwspllpe:r Nlltlcl'S-ttll:1l1 .
Ncwsp:lp4.'r Nlllit.'CS-()UI.uf.luwn.
Telcphonl' & Tcll')triulIs
Airl'arc ,
Ck'RrlMass Of[erlnR .
I'allhcarcrs.
Ccrttrled Copies uf Ihe ()ciuh
l:rrllfleat' ...
Pollee: Escorl '
1;lowcrs
V:i\llt ,cnil'e Chargc
....>>.C,_
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,----
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SUB-l'OIAL Of AU...OMO....VR RQUIPMEN....
TOTAl, Of PROfESSIONAL SRRVIl:!iS,
fACILll'IRS ANII AUl'OMOl'lVR
EQl/IPMENT ..........,..
SIJ8:Wl'A1. Of ADVANCES.
..AlI_
\l'e charge yuu fur Ollr Sl'f\'kt'!i In ubt:tlninK:
(,(Pt't"!)' mslJ cul""""es Ibfll fm' ml"lled.llp)
(hllN hurl;ll wllullnn
(l)eM:rip,lun) __.___
. 1
A ~~2t-'
SUMMARY Of l:IIARGRS
^, ()rufesslun:tl Scrvices, facilities and
l:qulpmcl\l, and AUltJllluth'e
EljllllllllCIlI ..
II, Ml.rl'handlse....
C. Slll'dill Chilf~l'S .
(). Cash Allvilm:cli .
TO...AI. Of Al.1. Sf.Cl'IONS . .
PAIII AT TIMI, Of OR PRIOR ...0
ARRANI;liMliN.rS. . .
BALANCR IlUE . . . . . . . .
REASON fOR I.MING
..:22i:r C/O
.... V--.7~ ~
..,~
..'~r..P'"
...,-
D. CIIARGE fOR MERl:IIANDISE SELECTED.
l:..kCl,.,....,....,.............I~.o#'.:-
(1"",,11'110') ____________
Olher Re:l'l'Iuadc ..
(UC!C'lplloo) ______
.~-~lr_r.2'-. -'()
----~_..._--,,-.-"_._-~-_...__._.
AcknowlcdKc:nwnt cards
Re.I"" book(.)
Melllory rold,rs ..
Ilraye:r card~ , ..
TcmllOrar}' grave 1IliUkcr . .
Uurlal dOlhh1K '
'~-'-
...f_
f_
....1___-
.,.f__
1_-
,.;,
If any law I cl~mctcry, ur erl'1 awry re(lulremenls hay required the purchase
uf any of lhe Items lislcd abuve the law or rC(lulrcmcnlls explained below,
../~..,.,. r-
.
I aRrct thai I have uamlnc:d Ihe item, of Kouds and SCf\'lt'C5 selerted ahove and found lhem In hl' (Ollert and :Jewrdlng 10 lhe arrangements I han requ~51ed. I aeknowledRc
"celplor. copy or Ihl. SIII"",nlo[ fllneral Guod, .nd ~f.l:~j:i.\o:Iw.d. I "p".' Ihat I h.ve !ufflclenl fllnd, avall.hle [0' p.ym'nl of Ih. ea.b price for lb. anod!
.nd ..,vice! ..'ee"d. 1.1", 'Rr.. 1~~'fm'"1 o[ '.l.L~r: ....,;Wllhlll d'f'. I'R'ce III be lulnlly .nd ..",.lIy lI.bl. wllh .nYQJ)t J!I' who
.IRn. belllw. A III' ,harR' IIr _ pe' month .moonllnR 10 , .......... pc' y.ar will be 'l'pll,d IlIlh. ollr,.ld b.l.nce beRlnolnR ~ d.ys
from lhe date of Ihls aRrccm nl. I will als(J pay to the Funtrall)ltwor all reasonahle l'Osts (laid hy lht' Iluneral Director 10 col ('el amounts I owe under Ihis Igrttmenl.
"hose emls may Includr allorneys' "CC5, court co5l!\. Ind olhcr COlts, .",n)' additional JUVIct'll or merchandise urderc:d or requested aflcr the dale of thl. IRreemeDI will
be ,00.lder II DC Ihl. 'R,,,m I d Ih, 011 Ihq.ul will be "flect,d d' Ih, fll1.1 bill Of '''Ielllenr.
(Se.I)
(s..l)
~r';"'"'/
......:J
.'" ,
(1urchl!"1
..,.,',)~~.~~.--".-,.=, ,.,. f.. ~,."..," ..r" . .... ...,~~lndofGranlle_ Parr.a
Bevel kl_OxP-1 OxO-7 I H!:.r1. () r.O.E..J.n961~ ..,. ...'" " . .c;~~t~~'._';~.~;;~~r ...,
Grass Marker Name on back
IYQLIlNQD
. >,
,
'l
,
,.
G
Eby Granite Works
P.O. Box 187, Newville, Pa. .17241-0187
Phone: (717) 776-5118
Name l':C1win c. HE1r:f'olflnqer
Add -TI'l1lN:W:-l ~th -Pfiice, Gainesville
ress __~__...____.__..__________...
Phone 3~~-37~-O~30
Monument
Slant
Fi.
Corner Post 0
Flower Vases 0
.._._--_._~--_.-._-----~-,--~---
Design, 1l0ne,rU(ldi~(J Included, to matcl:1
other all lot.
SDRY,
( ,
--.
EDYTH DOUGHERTY
1904:'19~7
HF.FFEI.FINGER
.." ' '
, ',~;,\ \
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...., .... /' /"., . ,/ .
I ')( ..r".., (. " /', \;/.<' 'f,.,u
oi'i'h~"~b~~;'~?;iirnii~' ~~d'd;ir~:""'" ,. .,.,
o Check How to Letter
"
take lull responsibility lor the accuracy ,
Letter this way - opposite
Unit Price $
-$
~33
Flower Vase $___ Corner Post $
Total $ 533 Deposit $ 267
~
Date ..!fa. ~...0_99~
Zip 32605
~----~
"'.~',r
FOUNDA liON
WARRANTY
ORO.
P.O.lt
POS
GRA
vMi'
POSTS
GARS
COM
B&J
Misc. $
Balance $ 266
I agree that eald memorial, with 1Ille therato and right of poseesslon thereol, shall remain your personal property until I have paid lor It In
l'-' full. In delault of any payment hereunder, I license you 10 repossess and remove !he said memorial, wlthoul gulll or trespass or othor wrong,
land aulhorlze and empower you. In my namll and on my behalf, 10 apply to the menagement 01 said cemelery or other premleae lor e permit
J for I\s removal and to lake any other elepe you may deem neoessary or expedient and further agree to save you harmless from any entry,
rapoeeesslon and removal; you may retain eald memorial or dlsposo 011\ al your own dlscrellon wllhout being answerable to me lor It or any
proceeds therefrom,
Ordere eubJect to cancellalloll. All contracts conllngent upon elrlkes, accldepts, and other causes beyond our conlrol,
, .1 understand thllt 30 day~ alter placetnellt of the memorial a FINANCE CHARGE will b8'8ntered on the billing dat~, It Is oomputed by e periodic
rate of 1 Y, % per month which Is an annual percentage rate of 18 % epplled 10 the previous balance before deducllng credits, payments or adding
purchaees appearing on this elatement. To avoid FINANCE CHARGE pay the 'New balance' belore the billing dale nexl monlh,
I AGREE THAT ALL LETTERING AND DATES GIVEN ON ABOVE ORDER ARE CORRECT.
I ALSO HAVE BEEN INFORMED AND UNDERSTAND THATTHERE WILL BE A CHARGE FOR ANY LETTERING DONE AFTER THB
MEMORIAL HAS BEEN ERECTED IN THE CEMETERY,
I ALSO ACKNOWLEDGE THAT I HAVE BEEN GIVEN MY FOUNDATION QUARANTEE,IF APPLICABLE.
M.. Heffelfinger,
Please check spelling and dates. Sign at
Malte clleck payable to Eby GrallU~1l "OaRI,
copias, keep gresn one for your records.
'I'hank you.
x cC;;'A1!'..,(~:',ra-"/ .
tl:1e 2 X' a''''''/.'<'~~~i::~}~;;;~''''''''''''''''''
return yellow and whi te SJ9
Per
Arlene t;berly
^. E//t/' / ~;-
"I
.1
1'1
Grave Marked
# of Grave
Cremation
<,I '"
10,
! .
I;
Eby Granite Works
P,O. Box 187, Newville, Pa, 17241-0187
Phone: (717) 776-5118
~
Edwin e. II",rrl?lrtnqol' mBy29,199"
~~. D~
Addres-;:r~!lll'lf;'W:~T~lJl:-I;ri;.o(~ ;-ooTi1i'8 vTITo , J1' 1. 32 () O"!i'--'-- m. .._~- ~~~_.--- .--
----~,__.__...._~._.~.___.__..__~....,_~_~._,___._.___.__._.~_.__,__ Zip .._._..........__.".......,...__
Phone 31)2-nfi-()<j:W Corner Post 0
..........~-_._~------.----~-~~-~"-"_.~------_.~- ~~_.~~_.~..____...u______~_~-----<__~_~
Monument ____,_____._._,____._________ Flower Vases 0 .. ""_"'_"..._m___...__.__._
Slant
..~ ,,,. ".f' ..
Base '.', . ..........."... I
__'_"_~___'_._"___~~_'~_'O'"'_'_~__"'--'_
f" .-'...-t..,.....- r " . \ ,'" l<ind of. Granite _m____..__.._____.._._..
'. ~..-_:..~l',I, It:' " .,.,/ 1_. J
Bevel ___ CemeterY _~!'_2.!!.pec.!?~._.~__,:,:~.......:.,
Grass Marker Name on back FOUNDATION
Design PleiHll! add tl1" FollowIng to I,ho bllelt ~I(eslhol ~ WARRANTY
HeFfelflnger: fllml.ly mon\lmen.t~, (Note t.he d!QlJge of the f!lml1.Y....fu1!ill'c.t ['ronl, ot'
monument. ~t is spel.led HEI'I'T,Jo:I'INGJ;:R, on the back it will be spelled HE~'f'ELFING
Tlle.....J:..y.p.. "r l"'thH'ln~~ r"llil"'~ Oat lIi.\;tlU/iI ant' I/i..l..l-!nollllle familr Il-ailIt"
2 incHvi<lu1l1 amNl 1 (1 .. . front.. '
Monumen~ viii bo sent. to main of rice for t.he wOlk t.o, b, done,We will
CI.\PlaCe the monument /.\110 reselll it when the 1'1orl( is comp e. d.
We will be aoding the rOllowlno,
I ~~", ;'
1H~F'F'F.l.FTNGER
JOHN A. HJo:FFELF'INGRR JR.
1901-1962
EDITH DOUGHERTY
HIS IUFE
1904-1997
'I.,
"" ". ',',.:.
. .. . ,.,' . I' __ .~:. ; I '.
ORD.
P.O, #
POS
GRA
VAS
POSTS
GARS
COM
B &J
19)
take full responsibility lor the accuracy
o Check How to Leiter
Leiter this way. opposite
Unit Price $
-$
flSO
Flower Vase $___ Corner Post $
Total $~~_ Deposil $ 425
Misc. $
Balance $ 425
I agreo thataald memorial, with title thereto and right of possession Ihereol, shall remain your personal property until I have paid lor II In
c..... lull. In delaull 01 any payment hereunder, I license you 10 repossess and remove the said memorial, wllhoul gulll or Irespass or other wrong.
~nd authorize and empower you, In my namq and on my behalf, to appll' 10 the management of said carnetary or olher premises lor a permll
lor Its removal and to take any other sleps you may deem neoessary or expedient and lurther agree to save you harmless Irom any enlry.
repossession and removal; you may retain said memorial or dispose 01 II at your own discretion wlfhoul being answerable to me lor II or any.
prooeeds therafrom.
Orders subject to canoellatlon, All contracta contlngenl upon atrlkes. accidents. and o,her caus,es ,beyo~d I'U! control... ..
I undqr918n~ that 30 days aller placement of the memOrial a FINANeE CHARG E wlllbe entered on the billing dale, Ills computed by a periodic
rate of 1 Va % per month which Is an annual percentage rale 0118 % applied to the previous balance before daductlng credits. payments or adding
purchaaes appaarlng on this stalemenl. To avoid FINANCE CHARGE pay Iha 'New balance' belore Ihe billing date nexl month.
I AGREE THAT ALL LETTERING AND DATES GIVEN ON ABOVE ORDER ARE CORRECT.
I ALSO HAVE BEEN INFORMED AND UNDERSTAND THAT THERE WILL BE A CHARGE FOR ANY LETTERING DONE AFTER THE
MEMORIAL HAS BEEN ERECTED IN THE CEMETERY.
I ALSO ACKNOWLEDGE THAT I HAVE BEEN GIVEN MY FOUNDATION GUARANTEE, IF APPLICABl.E.
~lr. Heffelfinge,r, 2 x's x ,6~.~ (""...e/,-/.'.....-. .
Please sign aJ: the X, cheCk spelling and dotes. ..........Af...."dr7{{jlf..,;:J/f,rfj";f.?........,....,....,.. \
Make check payable t.o Eby Grani t.e Works, Customer}!l s~n'ature
Return .yellow and white copies ,the green one i 1!>> for your records.
Work w111 be done this summer or early fall. er ^ 1 -"b 1
r ene '" er y
Thanlt you
,.f-~l'/ #c;;.
Grave Marked
# 01 Grave
Cremation
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l)F::Ul1 1::11 L 1 NO DEF'T ,"::::00 NOJ'n'H THlf~() ~;:THt::ET
~.* ACT! V FOR H.:H"EI. 'INGER, EDl rH FF'-.A
04/18/5'7 ~~62'O;:~1:.: 1 Fi :;:0 AUC1MENTIN 2:~50 -,,\ ,~:5 .00
04/21/97 ~~t.:.~::O ;,"::: 9 60 10 HUI~UL I I~ R tOO lJ/C ..00
04/2,,:19.7 PAYMENT-THANK YOU 2;:';:..,'!:9 .00
04/26197 f.5t~,;2(1~~r:: 1 r::i ::~O AU(,MENT I N 250-,125 01 7.0n .00
04/:~(I/~"7 f56.~~O:;::7'7f5 ;:10 GEN FOR LASIX 40M 01 4.2:5 ..(I(J
04/30/97 66Z0:37'7 t;. :30 GEN f'OR TRANSDERM 01 7.00 .00
04/3(1/97 5~:',()()',~ 1 ~?~S) 10 MORF'H I NE 10MG/ML. 01 7.0n .00
.rf#/
(;fl ?If' ')5
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I I ---1 I [ 32 . 25 I I 7 . 00 1
LE:GE:ND NON-LE6ENO
FOf~ MONTH FOH MONTH
~+~+~=~._~
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Pres6yterlan 9lotnu, Int,
For..t Park H..lth Center
UIIIT
17~-12-4S7B
I,D, MIIIR
4B
BILL TO
,
EDWIN HEFFEl.FINQER
23~B NW 13TH PLACE
QAINESVILLE
FL 3:.1605-
MlI__
OS/31/~7
OS/31/~7
OS/31/~7
OS/05/~T
OS/05/~T
05/0S/~7
Unit Discharge Cr.
Room 80 Board
LAUNDRV 1 WK
OXVQEN KIT W/HUMID
MIN DIABETIC KIT
MIN DIABETIC KIT
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c.~ .Jf! .,
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PIIIVIaUIIN.NlI:I
MYIIlm, CMIIII
IIIC111PTlOII Of _1Ma
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5 DA VB
1 UNITS
1 UNITS
1 UNITS
1 UNITS
IIIW CllAIIOllI
11.. ^^
EDITH HEFFELFINGER
AM_DAft
.WMI am
DATI
05/31/.,7
SEND ~~ITTANCE TO;
PRE5BVTERIAN HOMES INC
FOREST PARK HEALTH CENTER
BUX 631023
BALTIMORE MD 21263-1023
PHONE 717-243-1032
AIIDUIlT
FP
FP
FP
FP
FP
FP
3.844.00-
620.00
B.OO
17 .00
B.OO
B.OO
I1II_CllAAII
IIIW _AD
IV,
'" . 1!:;
CO""OHWr.AI HI or f1f.NNSVI VANIA
Df,PAW1Hf:HT Of RtvfNUE
BUWflAU OF INDIVIDUAl IA)I[5
OlCP1"la060l
tlARMI SI\lRO, ftA 111<'''-0601
.:!~.!d. { .
''tfJNJ.fI
let.,
FlLENO.21 -'I1'-':;"'f
ACN 971336~2
DATE 08-09-91
INFORMATION NOTICE
AND
TAX PAVER RnSPONSE
-~"'-.......'_.._....._,--
TVPE
EST. OF EDITH M HEFFELEFINGER
S,S, NO, 179'.12-4518
DATE OF DEATH 05-06-97
COUNTY CUMBERLAND
(;F ACCOUNT
[J SAVINGS
[ii CHECK INO
r~~\
L_..I TRUST
r; CERTlF,
PNC lANK hili provided the Oepllrtlllent wl.th thG Inforlllfttlon listed hulow which 11'*' bun lIsed In cltjculattny,th.
poUntlll1 tftlil du.. Th.ir recordl Indicate th!llt lit the d81lth 0' the Dhove d.(lIul.nt, you W"rtl a Jolllt IIwner/h"n.flc:lMY 0' tllli !lceD'mt,
If YOu hal thls Info'rlll.tlon i. Incnrrect, l,hHIU obtflln written correction 'rom \I'e flmtnclnl Institution, 'lthch It cOpy to this for~1
Imd return Itto the above addr.... Thill I'wQount Is taMable In BCcol'danc. with the Inhorltnnce Till( Inw. of the COllllllonw.alth 0' f1.nn,.,lvnnt",
(,ru..i..iyu. "loll \10' ell~loj",,"'" I., C;ll!.IIIIW \il/) ;i.,.oS;:i,
4(.'.11.111 H~ IItl.l
-
EDWIN C HEFFELFINGER
2358 NW 13TH PL
GAINESVILLE FL 32605
REHIT PAYHENT AND FURH5 TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
D.t.
E.tabU.hod
REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
04-0t-62
COMPLETE PART 1 BELOW
Account No, 5140027734
. . . SEE
Account aala"c.
Parl'..nt Tlueable
AMount Subject to T.x
Tax Rat.
Pot~nti.l Tlx Du.
K
K
15,397.97
50,000
7.698,99
,15
1,154,8:;
fa Inlur. prop.,. cr.dlt til 'Jour dOCOtmt, two
(ll cop I", of this notlc, l'lust IU:CUIllPlll1\/ 'leur
pAYl'l.nt te the ~.olshr of Wills. HGt.;, check
pl'lYAble tOI "RlIglster of Willi. Aiont",
NOTE: If tal< l1i!1'Jlllentl "ro "'lIde within thr..
(5) "'onths of the d.e.d.nt's tlat. of dnth,
you may dedue t a !)% d I scaun to' the tIIM du..
Any IrlherltllnCle tal( due will b.ClO.. dllllnquent
nln. (~) ~onths after thll date o~ d.ath,
PART
[!]
TAXPAVER RESPONSE
FAILURI TO RISPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASID ON THIS NOTICI
A. 0 Th. tl~OVe Inforlllation and tllM due II cnr,..ct.
1. You 11I8\1 choou to rllllllt ""\I",.nt to the Reltht.,. of Wills wIth two cop Ie. of thl. notice to obtain
III discount or avoid Inter..t. tlr ~ou nllIY check bOl( "A" IlInd r.turn this notice to the R.glster of
Will. and an official llUlllalllent will b. Iuu.d by the PA Oepartlll."t of R.v.nu.,
8. ~ The lIbov. auet has b..n~. 111 I.. repo,.hd and tal( pald with th. P.nns\llV<lnla Inherltanc. hl( r.turn
to be filed by the d.e.d.nt', repr.,entatlv..
C. 0 1h. above Inforlllltlon iWncorr.ct Indlor debtl and deduetlonl w.re paid by \lOll.
You IlIUlt eo.plete PART l!J Indlor PART 0 b.low.
[ C~~~K ]
BLOCK
- ONL V
If ~ou indicate I diffar.nt t.x r.t., pl.... .tat. your
rel.tion.hip to dlc.dentl~
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
TAX ON JOINT/TRUST ACCOUNTS
PART
[!]
TIIX UTIlRN . r.nMPUTATTON
LINE I. Dot. E.tobll.hod
2. Account IIllanc.
J. ~.rclnt Ta~abla
4. AMount Subj.ct to Tax
I. Debt. Ind Deduotions
.. A~ount Taxable
7, To. Rob
e. r.x Du.
OF
I
2
5 K
4
'-..:.....
.
7 K
.
PAn
1
2
3
4 _
5
6
7
8
CLAIMED
DEBTS AND DEDUCTIONS
PART
[3-
DATE
PAID
I
PAVEE
DESCR I PTI ON
AMOUNT PAID
GENERAL INFORMATION
1. fAILURE TO flESPOND WILL RESULT IN AN OFFICIAL TAK ASSESSHENT with ftp,llltablu Int.r..t haud on In'orllft'lon
lubl'lllUld b" Ih. f!llIlnoJal 1".Ututlon.
2. Inh.rllttncl tll( bICON.. clltln1lulnt filII' lIIonths Itlt..' the dleuelent',," dl'l" of deAth,
). Ai Jnlt1t !tocuu"' I, hMlbl_ 1\1'" though th. dlcldlnt', nil"''' WI" .:added n. 1I1~l\lt.r of (lonl/lnlone..
it. AenDunh Ilnoludlnll tho.. hald hlllofl.tn hUlhnnd lInd w\lal wlllr,h the (1IUI'ln, jlut In joint 11.'l""1I within one V'ltr 'Irlor to
d..th sr. fulh hl(IIbl1 '" 1'''lllf.rl,
S. Aceaunl, "labll,hld Jolnttv betw..n hUIlulI11! tlnd wi', 1111I,. thft" one .....,. prior to de,,'h ar. no, t.Ulllbl..
6. AccounU held by a dlG.dlnt IIln trll.t for" !'I/loth'r or oth.r, art 'a>cab" fullv.
REPORTING INSTRUCTIONS. PART
TAXPAVER RESPONSE
1. BlOCI( A . If U... I"for",.tlon and MlIIPutetjon In tile notlu .,r. correct !Ind tJ.duc:tlon, Itra ""t bllnG claludl place an "It"
In block "A" of Part 1 of thl "'lllcpaver "..pon.e" sactlon. SIGn two tOp'" nnd 8\1blll1t tha.. with your cheClIo: for \h. 1I11l0unt of
talll tll the Raght.r of Wllh (tf the c:oullty 'ndlcAt.d, Tha PA n."llrt",."t of Ravanue will luu. Arl offlclltl f1UU'Ment
(f'orlll REV"lljlf8 [It) upon racalpt of th.return frolll tha R.ghter of WIlIt.
Z. ILOCK I . If the ",...t .p.clfled on thil n(<tlce hu hun or wlil bl reportad IJnd tnl( paid ~dth the p,,"".yIVAnla Inh.rltance
lalll Return fll.d by the d.eed.nt'. repr...ntntllle, plllce nn "It" In block "II" nf Pan I of the "Tlucpav.r "I,pons." seotion, Sign one
e~py and r.turn to the PA D.part"'l"t at RevI"'"1 "u,~.au of IndlvJd\JlIl fallll, OlUpt 280601, tlllrrlsburll, PA I7lza~ObOI In the
anyelope provided.
J. IlOCI( C ~ If the notlCI Intor",.tlon I. Incor,.ct andlor d.dtJoUon. are b.lng r.lahlld, (lheck block "c" find cQlllplete Parts Z llnd !
aceorGlng to lna in.truction. balow. ~Iun two caple. lInd IUllllllt tn.~ with 'o'our I.:flUCII ,or thu dlrlUuni. uf till( ,.IlYdl.ol* to Un" ~.Iit1:;,i..,
of Will' 0' thl county Indlc8tad. Thl PA D.parhllnt of R'v."uv will IIIUI an offlcl.l au.ulIIant (ForM R[\I-1548 ElU upon recltpt
of tha return frOM thl R".hter 0' wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
I. Ent.,
NOTE I
the dlta Uti Ic;count orlglnlllY Will ..tabllshed or titled In the IIIl1nn,r oxhtlng at date of d'l!.lh.
For a d.udent dying afhr IU1UaZl ACClol.mts loIhlch the decedent put In joint Mill.. within on" ) (i)...aar of d.ath llr.
tlll.bl. fully as tran.'er.. Howev.r, th.r. is 8n a!Cclu.lon not to allc.ed '131000 per tran.f.r.. ,..gardl... of the vl!I,lUfl' 0'
the account or the nUMb., of I!IClcount, held.
If. doubl. a.tlrlllo: (1111) appa.r. b.forl your flrsll1ll"a In thl add,.a.. portion of this noUc., the n,o~o .xclu,lon
alra.dy ha. bIen d.cluet.d 'rOil thl llceount balanc. a. reported by thl fln.mclal Institution. ~
l.I
t. Enter the totel behnel of thl account lncludlno Int.,..t Iccruad to th. date of dleth.
1. fhe Plreant ofthl account that II talllabl. for .ach survlvQr I. dttl,.",ln.d a. follow. I
A. Thl Plrc.nt telllbll for joint Aneta utllblhhad /PIore than anI ye.r prior to the d.ca~flnt'lI delth:
i',l
DIVIDED IV TOTAL NUNIER Of'
JOINT OWNERS
Ella.~l*l A Joint ....t rlgllltlrad
DIVIDED IV TOTAl NU"IER OF X
SURVIVINO JOINT miNERS
In the nallll of thl dtCled.nt find two other
100 PEACENT TAXAILE
p.rsons.
1 DIVIDED BV 5 (JOINT OWNERS) DIYIDED BV Z (SU~VIVORS) II .167 X 100 II 16.7'1. ITAMUlE fOR EACtI SURVI\lORT'
a. Thl percent tlIClbla for ....t, cre.ted within ani ~..r of the deudlnt., death or llccounh owned bv the dlced_nt but ,h.ld
in trult tor lnoth.r IndhdduIH.) (tru.t b.nIUclariU)1
I DIVIDED BV :rOTAL NUHIIEA Of SURIJIVING ,JOINT
OWNERS OR TAUST BENEFICIAAIEi
X 100 . PERCENT TAMABLE
EMuplal Joint aCCClunt rlghterad in tt!e na.. of the dlc.dent and two other per lien. Ind ..tlbl hhad within on. VI., of dllth bv
the deeedlnt.
1 DIVID€D IV 2 (SURYIYDAS) .. .s,O I( 100 . SOZ ITAMAILE FDA EACH SURYIVOR)
ft. The allount .ubj.et to tlIC Clln. 4) Is dlhr.lned by .ultlphln. thl ICCOunt b.lanee (lIn. 2) oy the percent tnlbl. Ulna SJ.
l. Entar thl totllof the debt. end deduction. llstld In Part \.
.. Thl .ltt.Iunt tOIl.bII Clln. 61 II deterllllned by lubtrllCtlng thl debt. 'nd d'duction. (1(ne SI fro. ~h. '.ount ,ubject to hll (lIn, 4).
1. Enter thf\ approprllt. taM rata (l1n. 7l II dlterlllln.d below.
A. for dat.. of d..th occurring after 6/30/94, the t811 rat.. for trln,far. to .pouse. .r. u follo...:
1. D",te. 0; dllth on or Iftlr 111/'4 and bltore 1/1/95 the rat. 11 3%.
Z. Dlte. of de.th on or .fhr I/I/~S, trlln.fer. to .pou.., w111 b. tlllld at OX t.1Il rat..
Notll' For d.t,. of de.th prior to 7/1/'4 tr,,".flr. to ,pou.e, Irt tallabll It 6X.
I. Tr.n.flrl to Ilne.l de.clndlnt. including f.ther, .othlr, .on, daughtlr, grandchlldr.n. .on.ln.llW,
d.utlht.r~ln.hw, .tIPChJ!d Ind their IlIu. are taubl. at .111 pareant (6XI.
C. Tren'f.rl to all other. Includln, broth.r, .Ister. uncle, aunt. nephlW; Ilnd nilca ar. tall.bl.at flft.en plreent OSXI.
D. If vou chlnga thl talC r.t., pl.... .pet,lfy vour rlhUonl"lp to the d.cad."t In the IIr.. prollidllld.
..' Th. ..ount of till due (l'nl al I. dlter.lned by ..ultlplYlnglhe llIIount t'lI.bl_ (lln. "I by the tall rete (1In. 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allo~ebla debt. Ind deduction. arl .1et.r.lned .. follow.:
A. You l..elh .ra rIlPon.lbl. for p.y..nt. or thl ..tet. 'UbJect to edtllnhtratlon by a par'on.1 reprl..nt.tlv. II in,ufflclent
to p.y the d.ductible It....
I. You letuI.IlY paid the dabt. .fter deeth of the dae.dlnt .nd un furni.h proof of ply...nt.
C. Dabt, bllng el.l.ld .u.t b. It..hed fullY In Pert 1. It IddJtlonll ,pice II ne.dlel, ule plain pap.r . 111." III 11". Proof 0'
Ply.tnt .IY bl r.que.ted by the PA D.p.rt..nt of RIlI&nuI.
_,......-......'...~".., ,",,-0-
,
I-I!,!
!"-
-'If
-) I',,: II
~'~.
~
, '
NO. AA 2115 81 """'2 EX i""
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OFREV~NI'E
BUREAU Of INOIVIOUAV',AXES
DEPT ~8060' Clll
HAAAI~BUAG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
"
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
BRIG.BEN.EDWIN C.HEFFELFINGER
,--J..o.J.-
"1,01..0 74
235B NW 13TH PLACE
GAINESVILLE. FL 32605
fOi.OHERE
.--.Z1.- 1 997,.~4
NAME OF DECEDENT (LAST!
-1:IEf-EELf'" INGER
DATE OF PAYMENT
SaN- 1 79-12-..!t.52B
(FIRST)
ED U..I:L
(Mil
._2129/97
POSTMARK DATE
7/25/97
COUNTY
TOTAL AMOUNT PAID ,.
.1,940,74
Rl.AND
DATE OF DEATH
!'i IOb.i!l7
REMARKS BRIG GEN EDWIN C HEFFELFINGER
SEAlCHECK!I 7467
V,;, FA,'(. H
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COMMONWEAL TH OF PENNSYI.VANIA
DIPARTMENT OF REVENUE
"--
IUAEAU Uf INDIVIDUAL TAM.S
'l....RIUlICl UM PIYIIIOM
PEP," ""01
HAR.I..UROI PA "1l'~O'Ol
NOTICE Of INHEAIT_NeE TAM
_ppR_ISEHENT, _LLOWANCE OR DISALLOW_NCE
Of DEDUCTIONS AND ASSESSHENT Of TAM
.".1'4/11"'""'"
1I-03-97
HEFFEI.FINOER
05-06-97
21 91-0594
CUMBERLAND
101
E=~~~.~t~.ltt.d --I
MAKE CHECK PAYAILE AND REMIT PAYMENT TOI
REOISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINI .. RITAIN LOWER PORTXON FOR YOUR RICORDS ~
iiB'; = iifif-ii{ -AFi>. - i 09 =97"i -NoTi Ci--OF. INHiRi f ANci-YA'x - APPRA-j s iMINr; -.miiWANCi ''OR -.. - - -- - on - - . _.-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTAT! OF tlEFFELFINOER EDITH M FILE NO. 21 97-0594 ACN 101 DAT! 11-03-97
UM RETURN WAS' ( ) ACCEPTED AS FILED ( XI CH_NOED SEE ATTACHED NOTICE
EDWIN C HEFFELFINOER
235B NW 13TH PL
OAINESVILLE
DAT!
EBTAn OF
DAT! OF DIATH
FILE NUMIIR
COUNTY
ACN
EDITH
FL 32605
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN lASED ONI ORIGINAL RETURN
1. A..l E.t.t. (Sch.dul. -)
2. St.ck. end lond. (Schedul. I)
S. .Cl...ly H.ld st.ck/p.rtn.r.hlp Int.r..t (Sch.dul. CI
4. H.rt...../Not.. A.c.l.obl. (S.h.dul. D)
I, C..h/IPnM D.p..lt./HI.c. p.r.on.l pr.p.rty (Sch.dul. E)
.. J.lntly own.d prop.rty CSch.dul. f)
7. Tron.f.r. CSch.dul. 0)
I, T.t.l A...t.
(1)_- .00.
(2) 11.488.00
Cst .00
(4) .......ll.Q..
(SI 5.228,53
(6) 11.873.41
cn .00
(II
NOTE I ,To 1nluro. prop.,..
oredit to your account,
lub.it the upper portion
.f thl. f.r. with y.ur
to. ".y.."t,
28,589.94
APPROVED DEDUCTIONS AND EXEMPTIONS I
'0 Fun.ral E~p.n.../Ao., Co.tl/Mlle. EMp.n... (Schedul. HJ (9)
10. D.bh/Hort._ Llobllltl../LI.n. (Sch.dul. II UO) 839.35
11, T.t.l D.duotl.n. Clll
12, Not V.lue .f T.. R.turn U21
IS. Ch.rltobl./O...rno.nt.l I.qu..t.) Non-.l.ct.d 9llS Tru.t. (Soh.dul. JI CIS)
14. Not V.l... .f Eltol. Subjoot t. T.. U41
NOTII If.n ........nt w.. i..u.d pr.viou.ly. lin.. 14, 15 .nd/or 1'. 17 .nd 11 will
r.fl.ot figur.. th.t includ. the tot.l of 6kk r.~urn. .......d to d.t..
ASSIS8MINT OF TAXI
IS. _oount .f lln. 14 .t S".u..l r.t. (III
16. AIIO...,t .f Line 14 t..obl. .1 L1n..l/Cl... A r.to (hI
17. Aoount .f Line l~ t..obl. .t C.ll.t.r.l/Cl... . r.t. C171
11. prlnclp.l T.. Duo
TAX CRIDITSI
P~YHENT
DATE
07-25-9
6,593.55
7.C1l' 40
21,157.04
.00
21.157.04
.00 M .00.
21,157.04 M.06,_
,00 M ,15.
uel
.00
1.269.42
.00
1.269,42
RECEIPT
NUHIEM
AA21158
DISCOUNT C + I
INTEREST/PEN pAlO C-I
63.47
1. 940.74
AItClUNT PAID
TOTAL TAX CREDIT
IALANCI OF TAX DUI
INTIREST AND PIN.
TOTAL DUI
2,004.21
734. 79CR
.00
734.79CR
. IF pAID AFTER OATI INDICATED, SEE REVEASI
FPA CALCULATION OF ADDITIONAL INTEREST,
If TOTAL DUE IS LESS TH_N '1, NO pAYHENT IS REQUIAED.
n TOUL DUE IS AEflECTED AS A "CREDIT" ltAl, YDU HAY IE DUE
A AEfUND. SEE REVEASE SIDE Of THIS fOAN FDA INSTRUCTIONS. I
M
IS. ;q/., ~
'U~EAU Of INDIVlOUAL uxea
IHltERII~~tE ,~. DIVISIOfI
DEPl, llO60 l
HARMIS.ORO, PA 111ZI-0601
COMMONWIALTH OF PENNSYLVANIA
DIPARTMENT OF REVENUE
INHERXTANCE TAl<
STATEMENT OF ACCOUNT
(2
*'
..~.u., U IH UHIl
EDWIN C HEFFELFINGER
2358 NW 13TH PL
GAINESVILLE FL 32605
DATE 12-15-91
ESTATE OF HEFFELFINGER EDITH M
DATI OF DIATH 05-06-91
FILE NUMBER 21 97-0594
COUNTY CUMBERLAND
ACM 101
~unt ~..lttod =:!
L."__:==-=---~
MAKE CHECK PAYABLE AND REMIT PAYMENT TOl
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
MOTEl To in.ur. proper oradit to your Iccount, lubMit the upper portion of thil for~ with ~our t.. ply..nt.
CUT ALONG THIS LINE .. RITAIN LOWER PORTION FOR YOUR RECORDS ....
REV: u,'lif" i'X oAF-;- i 03: 97Y" 0_0 0 o. itiioiNHiii ii'ANcl"f Aii 0 STATiHENf - OF 0 AcciiiiifT - - iili. - - 0 - - - 0 0 - - .om 0.00.0
ESTATI OF HEFFELFINGER EDITH M FILE NO.21 97-0594 ACN 101 DATI 12-15-91
THIS STATENENT IS PROVIDED TO ADVISE Of THE CU~~ENT STATUS Of THE STATED ACN IN THE NANED ESTATE. SHOWN B!LON
IS A SUHHA~Y Of THE P~INCIPAL TAM DUE, APPLICATION Df ALL PAYNENTS, THE CUR~ENT BALANCE, AND. If APPLICABLE,
A P~OJECTED INTE~EST fIGU~E,
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 10-21-91
PRINCIPAL TAX DUE I. 1. 269.42
PAYMENTS (TAX CREDITS),
PAYMENT
DATE
01-25-91
11-25-91
RECEIPT
NUMBER
AA2115Bl
REFUND
01 SCOUNT (+)
INTEREST/PEN PAID (0)
63,41
,00
AMOUNT PAID
1.940,14
134.19-
:1
i'
"
,.'
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1 .269,42
,00
.00
,00
'. IF PAID AfTF.R THIS DATE, SEE REVERSE
SIDE fOR CALCULATION Of ADDITIONAL IHTEREST,
. ( If TOTAL DUE IS LESS TNAN U.
NO PAYNENT IS ~EqUI~ED,
If TOTAL OUE IS REflECTED AS A "C~EDIT" ICU.
YOU NAY BE DUE A ~EfUNO, SEE ~EVE~SE SIDE Df THIS fO~N fOR INST~UCTIDNS. I
..
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STATUS REPORT UNDER RULE 6,12
Name bf Decedent: Edith M, H;ffelfinger
Date of Death: May 6, 1997
Will No, 1997~00594
Admin. No. PA No. 21.97-0594
Pursuant to Rule 6,12 of the Supreme Court Orphans' Court
Rules, I report the following with t'espect to completion of the
administration of the above captioned estate:
1.
complete:
State whether the administration of the estate is
Yes X
--
2.
If the answer to No. 1 is Yes, state the following:
a. Did the personsl representative fIle a fInal account
with the Court? Yes, it is attached.
h. The separate Orphans' Court No. (if any) for the
personal representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? Yes--!L
d. Copies of receipts, releases, joinders and approvsls
of formal or informal accounts may be filed with the Clerk of the
Orphans' Court and may be attached to this report.
Date: 25 July 1997
,
~~e-?(~~
Edwin C. Heffel f ge .
2358 NW 13th Place .
Gainesville, FL 32605
(352) 376-0530
Executor
Personal Representative
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