HomeMy WebLinkAbout10-30-07
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15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes ~.
PO BOX.280601 ~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 7
File Number
0763
Date of Birth
172014189
08052007
11181909
Decedent's Last Name
Suffix
Decedent's First Name
ALLISON
HELEN
MI
B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
o 1. Original Return
o 4. Limited Estate
9. Litigation Proceeds Received
0 2. Supplemental Return 0 3. Remainder Return (date of death
prior to 12-13-82)
0 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required
(date of death after 12-12-62)
D 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
D 10 Spousal Poverty Credit ~date of death D 11. Election to tax under Sec. 9113(A)
. between 12-31-91 and -1-95) (Attach Sch. 0)
[R]
o
6. Decedent Died Testate
(Attach Copy of Will)
~ORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
HORACE J JOHNSON 7177614540
Firm Name (If Applicable)
JOHNSON DUFFIE
REGISTER QF WILLS USE"ONL Y
----J
"
First line of address
301 MARKET STREET
Second line of address
LEMOYNE
State
PA
ZIP Code
17043
DA TEFII-ED
City or Post Office
c.
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU P SON RESP E FOR FILING RETURN DATE
Jere Coxon
,
17111
Horace J Johnson
DATE
~4
rket Street, Lemoyne, PA 17043
Side 1
L
15056041147
15056041147
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15056042148
REV-1500 EX
Decedent's Name: H e I e n By I erA L LIS 0 N
RECAPITULATION
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D).......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
6. Jointly Owned Property (Schedule F) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing 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 Lines 9 & 10)......................................................................11.
12. Net Value of Estate (Line 8 minus Line 11).............................................................12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X .00
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
0.00
15.
0.00
16.
0.00
17.
18.
430,113.11
19. Tax Due.............................................................................................. ..................... ~.9.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
Decedent's Social Security Number
172014189
208,073.95
4,613.50
34,574.52
220,443.13
467,705.10
~---~-
25,421.28
2,170.71
27,591.99
440,113.11
10,000.00
430,113.11
0.00
0.00
0.00
64,516.97
64,516.97
D
15056042148
...J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Helen Byler ALLISON
STREET ADDRESS
Bethany Village
1----
File Number 21-07-0763
1----..--..
CITY
ISTATE PA-~lZIP
I 17055
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
..-
(1) 64,516.97
3,225.85
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 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.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
3,225.85
61,291.12
61,291.12
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;................................................................................[l
b. retain the right to designate who shall use the property transferred or its income;.................................... []
c. retain a reversionary interest; or............................................................................................................... 0
d. receive the promise for life of either payments, benefits or care?.............................................................D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.....................................................................................................................O
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?....................................................................................... ..... ....................... 0 [!J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
C!l
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1--1
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. 99116 (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
(0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemPB transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1503 EX+ (6-98)
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ALLISON, Helen Byler
FILE NUMBER
21-07 -0763
ESTATE OF
. All property joinlly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 264.02 shares of AIM Constellation Fund Class A 27.620 7.292.23
2 1,040 shares of AT&T Inc. 39.450 41.028.00
3 17,000 shares of Capital One Bank Medium Term - 1.00812 17.138.04
Coupon 6.7% Mature 05/15/2008
4 1,010 shares of Eaton Vance L TO Duration 16.5 16.665.00
5 10,000 shares of Ford Motor CR CO Notes - Coupon .99 9.900.00
6.75% Mature 08/15/2008
6 20,000 shares of Ford Motor Credit Corp. Notes - .96625 19,325.00
Coupon 7.375% Mature 10/28/2009
7 525 shares of Franklin Templeton L TO 12.120 6.363.00
8 154 shares of Gabelli Utilities TR 9.438 1.453.45
9 20,000 shares of General Motors Acceptance Corp. - .96419 19.283.80
Coupon 5.85% Mature 01/14/2009
10 483.42 shares of Growth Fund of America Class C 33.520 16.204.24
11 700 shares of Nuveen Multi-Strategy Income 12.210 8.547.00
12 208 shares of PP&L Corp. 47.850 9.952.80
13 352 shares of Verizon Communications 42.75 15,048.00
14 1,613.1 shares of Western Asset Global High 12.320 19.873.39
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 2, Recapitulation) 208.073.95
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-150B EX+ (6-9B)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ALLISON, Helen Byler
FILE NUMBER
21-07-0763
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 DESCRIPTION
1 3,846.28 Citi Group Smith Barney Bank Deposit Program
VALUE AT DATE
OF DEATH
3.846.28
2 Citi Group - Smith Barney Cash Account
511.76
3 High Mark Premium Refund
255.46
** A copy of the Valuation from Citi Group Smith Barney
is attached to this Return. **
TOTAL (Also enter on Line 5, Recapitulation)
4.613.50
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6-98) ..
COMMON~L TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
ALLISON, Helen Byler
FILE NUMBER
21-07 -0763
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Jere Coxon
ADDRESS
RELATIONSHIP TO DECEDENT
Friend
1633 Berkshire Lane
Harrisburg, PA 17111
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DESCRIPTION OF PROPERTY %OF DATE OF DEATH
DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTL V-HELD REAL ESTATE.
1 A 5/5/1996 Commerce Bank 50 Plus Checking 69.149.04 50.000% 34.574.52
Account No. 0512094269
TOTAL (Also enter on Line 6, Recapitulation) 34.574.52
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev-1510 EX+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ALLISON, Helen Byler
FILE NUMBER
21-07 -0763
ESTATE OF
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Midpenn Bank Individual Checking Account No. 223.443.13 100.000 3.000.00 220.443.13
31308807 - Transfer of Account to Jere Coxon,
Friend as Joint Account Holder on February 6,
2007. Copy of Date of Death Letter is attached
TOTAL (Also enter on Line 7, Recapitulation) 220.443.13
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ALLISON, Helen Byler
FILE NUMBER
21-07-0763
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 9,106.28
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Johnson Duffie 15,000.00
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 460.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 250.00
7. Other Administrative Costs 605.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 25,421.28
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ALLISON, Helen Byler
FILE NUMBER
21-07 -0763
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
West Shore County Club - Funeral Reception
1.106.28
2
Worville - Kimmell Funeral Home
8.000.00
Subtotal
9.106.28
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMON'M:ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ALLISON, Helen Byler
FILE NUMBER
21-07-0763
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register of Wills Office - Filing Fees for Inheritance Tax Return
($25.00) and Inventory ($25.00)
30.00
2
Cumberland County Register of Wills Office - Reserves for filing of formal account
350.00
3
The Cumberland Law Journal - Notice of Estate Administration
75.00
4
The Patriot News Company - Notice of Estate Administration
150.00
Subtotal
605.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ALLISON, Helen Byler
FILE NUMBER
21-07 -0763
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Bethany Village - Skilled Care Nursing
VALUE AT DATE
OF DEATH
1.747.50
2 Bethany Village - Skilled Care Nursing
134.00
3 Bonnie K. Miller - Per Capita Tax Notice - Lower Allen Township
9.80
4 Jere Coxon - Target Gift Cards for Caregivers
140.00
5 Millenium Pharmacy
139.41
TOTAL (Also enter on Line 10, Recapitulation)
2,170.71
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-00)
ESTATE OF
NUMBER
I.
1
2
3
4
5
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ALLISON, Helen Byler
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
Dean & Bette Byler Sr.
513 Boulder Court
Norman, OK 73072
Dean C. & Sharon Byler Jr.
509 Aspen Court
Arlington, TX 76013
Jere & Janet Coxon
1633 Berkshire Lane
Harrisburg, PA 17111
Bill & Joan Fertenbaugh
9 Hunter Lane
Camp Hill, PA 17011
Betty Messik
17 Hunter Lane
Camp Hill, PA 17011
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s\
Nephew/Spouse
FILE NUMBER
21-07 -0763
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Nephew/Spouse 40% of Residue
Friend/Spouse
Friend/Spouse
Friend
20% of Residue
See continuation schedule attached Continuation
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
See continuation schedule(s) attached
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
Copyright (c) 2002 form software only The Lackner Group, Inc.
5,000.00
5,000.00
14,000.00
2,000.00
2,000.00
11,000.00
39,000.00
10,000.00
Form PA-1500 Schedule J (Rev. 6-98)
10,000.00
SCHEDULE .J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Helen Byler ALLISON 172-01-4189 08/05/2007
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Fay Palmer Friend 1,000.00
Bethany Village
325 Wesley Drive, Apt. 3207
Mechanicsburg, PA 17055
7 Carol Shumaker Friend 5,000.00
324 Somerset Drive
Camp Hill, PA 17011
8 Jill Westendick Niece/Spouse 40% of Residue 5,000.00
21 Tallavana Court Deceased
Havana,FL 32333
Total 11,000.00
1
Rev-1502 EX+ (6-98)
*'
SCHEDULE J-IIB
CHARITABLE AND GOVERNMENTAL
DISTRIBUTIONS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ALLISON, Helen Byler
FILE NUMBER
21-07 -0763
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Camp Hill United Methodist Church
10.000.00
Subtotal
10.000.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J-IIS (Rev. 6-98)
EXHIBIT A
EXHIBIT B
EXHIBIT C
EXHIBIT D
:314237
ESTATE OF HELEN BYLER ALLISON
SCHEDULE OF EXHIBITS
Last Will and Testament of Helen Byler Allison signed and dated
January 22, 2004.
Citi Smith Barney Valuation of Decedent's Account No. 724-
04763-12
Commerce Bank Date of Death Account Balances
Mid Penn Bank Date of Death Account Balance
EXHIBIT A
East Will anb ~e5tament
OF
HELEN BYLER ALLISON
I, HELEN BYLER ALLISON, of East Pennsboro Township, Cumberland County, Pennsylvania, do
make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all
former Wills by me at any time heretofore made.
ITEM I: I direct that my debts and funeral expenses, including my grave marker and all expenses of my
last illness, which my estate is obligated to pay, shall be paid from my residuary estate as soon as practical after
my decease as part of the expense oJ the administration of my estate.
ITEM II: Should I place with my Will a "Memorandum To Personal Representative Pursuant to Item IT
of my Will," which disposes of specific items of tangible personal property, I direct my Personal Representative
to comply with same.
ITEM III: To the church and persons named below in this Item ill, I give the amount designated:
A. To Camp Hill United Methodist Church of 417 S. 22nd Street, Camp Hill, Pennsylvania 17011,
$10,000.00;
B. To Dean and Bette Byler, Sr., of the survivor thereof, of 513 Boulder Court, Norman, Oklahoma
73072, $5,000.00;
C. To Betty Messik of 17 Hunter Lane, Camp Hill, Pennsylvania 17011, $2,000.00;
D. To Bill and Joan Fertenbaugh, or the survivor thereof, of9 Hunter Lane, Camp Hill, Pennsylvania
17011, $2,000.00;
E. To Fay Palmer of214 Spring Drive, Aurora, North Carolina 27806, $1,000.00;
1
ITEM VI: I nominate and appoint JERE COXON, of Harrisburg, to be Executor of this my will. If
JERE COXON does not survive me or is unwilling to act in this capacity, I nominate and appoint his wife,
JANET M. COXON, to be Executrix of this my Will. If JANET M. COXON does not survive me or is unable
or unwilling to act in this capacity, I nominate and appoint CAROL SHUMAKER, of Shiremanstown,
Pennsylvania, to be the Executrix of this my Will.
ITEM VII: No fiduciary acting hereunder shall be required to post bond or enter security in any
jurisdiction.
;IN WITNESS WHEREOF, I herelmto set my hand and seal this
c J ft,V ita. it Li .~ ,2004.
j J
{~//I. !!:~i. day of
J~~~
HELEN BYLER LISON
(SEAL)
Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and
Testament in the presence of us, who, at her request, in her presence and in the presence of each other have
hereunto subscribed our names as witnesses.
~~~ ~y
3
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLV AN1A
ss.
COUNTY OF CUMBERLAND
I, HELEN BYLER ALLISON, whose name is signed to the foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and
Testament; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein
expressed.
U9~M~
HELE~YL~
((}U .. e-L
~L'/;/.{ ~7"
Sworn to or affirmed to and subscribed to before me by 1!t!6V &/(t)( l!!{/SlJV'
1 . /'. o!. 1 'Ul} . / :1,
[ \ I d' l ( 'j ,-WitE:es-ses; this,' oC -- day of L.. -li. i( li'(j,j( V , 2004.
- . t ~
and-
.J
Notarial Seal
KrlltM K Myers, NotaJy Public
L.el'OO'fM Bolo, Cumberland County
~ ~;'l>mlon Expires Dec. 2, 2006
~r. ?en~~.OlNollalies
4
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AFFIDAVIT
COMMON\VEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
- /~ ^'i.'
t/tl.C[--
.I
whose names are signed to the foregoing instrument, being duly qualified accordin to law, do depose and say
that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and
Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the
we,,--,~bld W.hfLuLt
and
, the witnesses
best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
(i
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Sworn to or affirmed to
liCit LL (: I (i' I t.t...Oj
Ji ."~
and subscribed to before me by A iL Ii' tL JIll
') 1 jUt..
, witnesses, this ()(o<- ---day of
and
,2004.
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Not
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:222352
Notarial Seal
Kristee K. Myers. Notary Public
Lemoyne Bora, Cumberland County
My Commission Exptres Dec. 2, 2006
Member, Pennsylvania Association Of Notaries
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September 14, 2007
Commerce
f:Bank
Johnson Duffie
3010 Market Street
PO Box 109
Lemoyne PA 17043-0109
RE: Estate of: Helen Byler Allison
Tax Identification Number: 172-01-4189
Date of Death: August 5, 2007
Dear Sirs:
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following:
Account Type: Checking
Account Number: 512094269
Date Opened: May 5, 1996
Primary Owner: Helen B. Allison
Secondary Owner: Jere M. Coxen
Secondary Added: May 5, 1996
Date of Death Balance: $69,149.04
Accrued Interest: $8.42
Principal Balance: $69,140.62
Please feel free to contact me at (717) 412-6134 if I may be of further assistance.
r~i.nc.. e..~eIY., i.. 1\'
\\ . ~~.. \" /
\ ~ \J~t~~,. ... ~
~i~i L. Sp att \
Levy Spec:. IisUDeposil Services
Commerce Bank
Commerce Bank / Harrisburg, N.A.
PO Box 4999
3801 Paxton Street
Harrisburg, PA 17111-0999
commercepc.com
MID PENN BANK
Making things happen for you.
September 19, 2007
Johnson, Duffie, Stewart & Weidner, P.c.
PO Box 109
Lemoyne, PA 17043-0109
Re: Estate of Helen B. Allison
SSN: 172-01-4189
Date of Death: August 5, 2007
Dear Ms. Wieseman:
In resp(:nse to your recent request for information on the accounts of Helen B. Allison, I have
researched our hIes and enclosed is the necessary data:
Account #: 103101- Checking Account
Date Opened: 2/6/2007
ACCOUJrt Name: Helen B. Allison
Balanc2 DOD: $223,443.13
Balanc~ Accrued Interest DOD: N/A
Total nOD Balance: $223,443.13
Joint Ownership Name: Helen B. Allison
Jere M. Coxon
Date Joint Ownership Established: 2/6/2007
If you h,ave any questions, please call me at 717-692-7163.
Sincerely,
c:=--:~ )').~(C\ tb.~u~
Jessica Kerwin
Deposit Processing Supervisor
Member FDIC
Corporate Headquarters: 349 Union Street, Millersburg, PA 17061 · (717) 692-2133 · www.midpennbank.com