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Home My WebLink About04-0285PETITION FOR PROBATE and GRANT OF LETTERS Estate of Romaine I. Heller No abo known as To Deceased. SoctalSecurttyNo I fiP-22-7R7R The petttlon of the undersigned respectfully represents that Your pettttoner(s), who Is/are 18 years of ag~ or older an the execut, r~.x tn the last will of the above decedent, dated e'ebruar¥ 14 and codtctl(s) dated Regtster of Wills for the County of Commonwealth of Pennsylvama tn the named ,~ 2001 (state relevant c~rcumstances, e g renunc~anon, death of executor, etc ) Decendent was domtcfled at death in Cumberland County, Pennsylvanta, wtth er D3_ckinson Townshxp ~last famdyorprlnctpalresldenceat 4269 Carlisle Road. Gardners. PA (hst street, number and munctpabty) Decendent, then 82 years of age, died February 22 ~,J~,_, at Oh~mhor~hl~rg gn~nn tn 1 Except as follows, decedent .did not marry, was not divorced and did not have a chtld born or adopted after execuuon of the will olfered for probate, was not the victim of a ktlhng and was never adjudtcated incompetent None Decendent at death o~ned~property with esttmated values as follows (If domtctled*ln Pa~)-. ...... ,All personal property in excess of $ (If not domtclled in Pa )~ - Personal property tn Pennsylvama $ (If not domtctled ~ff Pa ) ' Personal property tn County $ Value of r.e.al estate in P/,enn.sylvanta, $ sttuated as follows !0,000.00 WHEREFORE, pettttoner(s) respectfully request(s) the probate of th~last wlll:xand c~,)c~(s) presented herewith and the grant of letters Testamentarv ~-r ' ::= ~' ~ theron Bonnie L. Blocher 4269 Carlisle Road Gardners~ PA 17324 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF The pettttoner~s)~above-y~amed swear(s) or affirm(s) that the statements tn the foregotng petmon are true and correc0t~ the best'$f the knowledge and behef of pettttoner(s) and that as personal represen- tattve(s) of th(above decedent pettttoner(s) will well and truly admtnlster the estate accordtng to law Sworn to~'or affirmed and subscribed before me this ~%~/77/ day of Estate of ~- ,'~,,vT~/~--~ ~7- //~//~, , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse s~de hereof, sansfacto~ proof having been presented before me, IT IS DECREED that the instrument(s} dated /~'~ /~ ~-,~('P/ described therein be admitted to probate and Hied of record as the last will of are hereby ~'anted to J~'~(, m consideration of the petition on FEES Probate, Letters, Etc. ). TOTAL $ ATTORN~:¥ (Sup Ct ! D No ) PHONE CAMPBELL & WHITE ~.0 uu ~U LAST WILL AND TESTAMENT OF ROMAINE I. HELLER I, ROMAINE I. HELLER, of 261 Cllnes Church Road, Aspers, Adams County, Pennsylvania, do make and publish th~s my Last W~ll, hereby revoking and making void all former W~lls heretofore made by me. FIRST: I direct that my Executrix or Successor Executor hereinafter named shall first pay out of my general estate, as soon as possible after my death, all of my 3ust and legally collect~ble debts, funeral expenses, expenses of administration of my estate, and all estate, inheritance and l~ke taxes becoming due w~th respect to any and all property required to be included in my gross estate for tax purposes, regardless of whether such property passes by the terms of the Will, the transfer of all such property shall be free and clear of such taxes. SECOND: I gxve, devise and bequeath all of the rest, residue and remaznder of my property of every kind and nature, real, personal or mixed, and wheresoever smtuated, unto my daughter, Bonnie L Blocher. If my daughter predeceases me I give, devise and bequeath One-half (1/2) of my estate unto my grandson, M~chael L. O'Donnell and ~e-half (1/2) unto my son-xn-law, Fred A. Blocher THIRD: I nominate, constmtute and appoint my daughter, Bonnie L. Blocher, as Executrzx of this my Last [1 and Testament, provided that she survmves me and Page 1 of Will dated CAMPBELL & WHITE ATTORNEYS AT LAW qualifmes as Executrmx w~th~n Szxty (60) days after my death I expressly dmrect that she not be requmred to post bond for the fazthful performance of her dutmes as my personal representatmve mn this or mn any other 3urmsdxctlon. FOURTH: In the event that my daughter, Bonnme L Blocher, does not survmve me, or mn the event that she falls to qualmfy as Executrix wathmn Saxty (60) days after my death, I nomanate, law, Fred A. Blocher, Wmll and Testament. constatute, and appomnt my son-an- as Successor Executor of this my Last I expressly direct that my Successor Executor not be requmred to post bond for the faathful performance of has dutaes an thas or mn any jurmsdmctaon FIFTH: I confer upon Executrix or Successor Executor full power and authority to sell, transfer and convey any property, of whatever nature and wherever satuate, whach I may own or have the raght to d~spose of at the tmme of my death, at publac or prmvate sale, and at such tame and place, and upon such terms and condatmons, as my Executrzx or Successor Executor may determane. I further gave my personal representataves named the power'to make dastrabutaons in cash or mn kand, or partly mn cash and partly an kand, and an such manner as my personal representataves may determine, and at the valuatmons fmnally to be faxed by sa~d personal representatmves. Page 2 of Will dated 2l,¥/o,~Oa~L~ S' ~- CAMPBLLL & WHITE ATTORNEYS AT LAW IN WITNESS WHEREOF, Testatrzx, have to thms my Last will hand,and seal this /~ day of Two Thousand One (2001). I, ROMAINE I. HELLER, the and Testament set my Romaine I. Heller Signed, sealed, published and declared by the Testatrix, Romaine I. Heller, 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 CAMPBELL & WHITE ATTORNEYS AT LAW COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF ADAMS We, Romaine I. Helle r, ~--~o.~ ~ ~'~~ and f , the Testatrxx and Witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the ~nstrument as her Last W~ll and she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the Witnesses, in the presence and hearing of the Testatrix signed the W~ll as Witnesses and that to the best of their knowledge the Testatrix was at that time Eighteen (18) years of age or older, no constraint or undue influence. of sound mind and under ~:>~.~T.~,/7t.~24~ (SEAL) Romaine I Heller Subscribed, sworn to and acknowledged before me by Romaine I. Heller, Testatrix, and subscrlbed~and sworn to before, me by ~ ~. ~~ and_~ ~.~ , ' Wltnes~es this //~ day of , ~ Notary Public My commission expires Page 4 of Will dated CERTIFICATION OF NOTICE UNDER RULE 5.6{a) Name of Decedent: Date of Death: Romaine I. Heller February 22, 2004 Will No. 2o 04-00285 To the Register: Admin. No. I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Bonnie L. Blocher Address 4269 Carlisle Road, Gardners, PA 17324 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Robert E. Campbell Campbell & White Address 112 Baltimore Street Gettysburg, PA 17325 Telephone (717) 334-9278 Capacity;. X Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO3918 CAMPBELL ROBERT E 112 BALTIMORE STREET GETTYSBURG, PA 17325 ........ fold ESTATE INFORMATION: SSN: 162-22-7878 FILE NUMBER: 2104-0285 DECEDENT NAME: HELLER ROMAINE I DATE OF PAYMENT: 05/07/2004 POSTMARK DATE: 05/06/2004 COUNTY: CUMBERLAND DATE OF DEATH: 02/22/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT lOl I ~5,ooo.oo REMARKS: CHECK# 16 SEAL TOTAL AMOUNT PAID: $5,000.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ROBERT E. CAMPBELL JOHN R. WHITE THOMAS R. CAMPBELL* ALSO ADMITTED MD BAR* CAMPBELL & WHITE, P.C. ATTORNEYS AT LAW 112 BALTIMORE STREET GETI'YSBURG, PENNSYLVANIA 17325 TELEPHONE 717-334-9278 FACSIMILE 717-334-1371 Direct Dial: (717) 334-9278, Voicemailbox 14 E-mail: rcampbell @pa.net May 6, 2004 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Re: Payment on Account of Inheritance Tax Estate of Romaine I. Heller No. 20 04-00285 Dear Ms. Strasbaugh: I have enclosed herewith a check payable to the Register of Wills, Agent, in the amount of $5,000.00 representing a payment on account of the Romaine I. Heller Estate. This payment is within the three (3) month time period and will qualify for a tax discount. Please send me a Certificate of Payment in the enclosed self-addressed stamped envelope. Sincerely, REC/slg Enclosure CAMPBELL & WH.I~T~E, p.C. Robert E. Can~Pbell ~ GA3iPBELL & WHITE, P.C. ATTORNEys; AT LAW 11~ BALTIMORE STREET GETTYSBURG, PENNSYLVANIA 17S2S GLENDA FA~qER STtASBAUGH REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE CARLISLE PA 170!3-33g7 ROBERT E. CAMPBELL JOHN R. WHITE THOMAS R. CAMPBELL* ALSO ADMITTED MD BAR* CAMPBELL & WHITE, P.C. ATTORNEYS AT LAW 112 BALTIMORE STREET GETI'YSBURG, PENNSYLVANIA 17325 Direct Dial: (717)334-9278, Voicemailbox 14 E-mail: rcampbell @pa.net TELEPHONE 717-334-9278 FACSIMILE 717-334-1371 May 18, 2004 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: Estate of Romaine I. Heller No. 21-04-285 Dear Ms. Strasbaugh: I have enclosed herewith the Inventory, two copies of the Inheritance Tax Return with one copy of the Will attached in the Estate of Romaine I. Heller. I have also enclosed a check payable to Glenda Farrier Strasbaugh, Register of Wills for $100.00 representing my calculation of the underestimate on fees plus the cost of filing the Inventory and Inheritance Tax Return. A check payable to Register of Wills, Agent in the amount of $638.64 is also enclosed. Kindly send me a copy of the receipt for the additional inheritance tax payment. Sincerely, C~~L~ P.C. Robert E. Ca~npbell REC/slg Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003953 CAMPBELL ROBERT E 112 BALTIMORE STREET GETTYSBURG, PA 17325 ........ fold ESTATE INFORMATION: SSN: 162-22-7878 FILE NUMBER: 2104-0285 DECEDENT NAME: HELLER ROMAINE I DATE OF PAYMENT: 05/19/2004 POSTMARK DATE: 05/1 8/2004 COUNTY: CUMBERLAND DATE OF DEATH: 02/22/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $638.64 REMARKS: TOTAL AMOUNT PAID: $638.64 SEAL CHECK# 19 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 i_ oF ,0, ,L INHERITANCE TAX RETURN .LE.U..E. 2] RESIDENT DECEDENT / 04 00285 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER : Heller, Romaine I 162-22-7878 DATE OF DEATH (MM-DD-YEAR) DATE Of BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE WITH THE 02/22/2004 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER =o~ 10. 11. 12. 13. 14. [] 1. Original Return [] 4. Limited Estate [] 6. Decedent Died Testate (Attach copy of wi,) [] 9. Litigation Proceeds Received 4AME Robert E Campbell :IRM NAME (If applicable) Campbell & White,P.e. F'ELEPHONE NUMBER 717/334-9278 ] 2. Supplemental Return [] 3. Remainder Return (date of death pdor to 12-13-82) [] 4a. Future Interest Compromise (date of death after [] 5. Federal Estate Tax Return Required 12-12-82) [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes copy of Trust) [] 10. Spousal Poverty Credit (date of death between [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 112 Baltimore Street Gettysburg, PA 17325 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Non~' NoneF: None None 63,059.46 None 72,698.08 3,305.51 1,301.02 Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (8) 135,757.54 4,606.53 131,151.01 131,151.01 (11) (12) (13) (14) 131,151.01 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) 16. Amount of Line 14 taxable at lineal rate x .045 (16) 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 5,901.80 5,901.80 20. [] >~ BE 8UR~ TO AI~WER ALL QU~~:~RE~ERSE ~1~ ~ ~REC~ MAT~ << i';:'~'~' Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS CITY Gardners STATE Pa ZIP 17324 4269 Carlisle Road Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 5,000.00 263.16 Total Credits (A + B + C) (2) (1) 5,901.80 5,263.16 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 638.64 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 638,64 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .................................................................................. [] [] 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 adequate 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? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of 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 and complete. Declaration of preparer other than the personal raprasentative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Be"~ C~, ~ 4269 Carlisle Road Gardners, PA 17324 SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE SlGNATI~E 9F PREPARER OTHER THAN t~PRESENTATIVE ADDRESS DATE Robe~_ ~.11 112 Baltimore Street ~ Gettysburg, Pa 17325 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116 1.2) [72 P.S. {}9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. {}9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Heller, Romaine I 21 - 04 - 00285 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 VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 2 3 4 5 6 Checking Account #0604828 at ACNB CD#31800237830 at PNC Bank Checking Account #5004274036 at PNC Bank Savings Account #5004436269 at PNC Bank Uncashed check from Glenbrook Life Village of Laurel Run - refund 8,781.60 20,002.61 500.00 30,848.85 258.40 2,668.00 TOTAL (Also enter on Line 5, Recapitulation) 63,059.46 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Heller, Romaine I 21 - 04 - 00285 This schedule must be completed and filed if the answer to any of questions 1 througt 4 on page 2 Is yes. DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE VALUE ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET INTEREST NUMBER Attach a copy of the deed for real estate. (IF APPLICABLE) 1 Annuity Contract #A2072638 with MetLife Investors 54,947.64 54,947.64 decedent annuitant; Bonnie Blocher beneficiary 2 Glenbrook Life & Annuity Co. -contract #ga2077170 17,750.44 17,750.44 daughter Bonnie Blocher - beneficiary TOTAL (Also enter on line 7, Recapitulation) 72,698.08 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Heller, Romaine I 21 - 04 - 00285 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT Ao FUNERAL EXPENSES: Codori Memorials - inscription on tombstone ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Campbell & White,P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Register of Wills of Cumberland County __ Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Postmaster - stamps & envelopes TOTAL (Also enter on line 9, Recapitulation) 125.00 0.00 3,000.00 171.00 9.51 3,305.51 COI~MONV~=ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Heller, Romaine I 21 - 04 - 00285 Include unreimbumed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 8 9 l0 Gettysburg Opthamology Assoc. Wellspan Medical Group Diamond Pharmacy - medicines Fayetteville Volunteer Fire Co - ambulance transportation Keystone Podiatry Medical Services Chambersburg Imaging Assoc. Fairifield Medical Center- doctor visit Chambersburg Hospital - balance services Wellspan Medical Group - balance Keystone Podiatry Med Services - final bill TOTAL (Also enter on Line 10, Recapitulation) 60.69 57.34 114.24 84.84 26.00 4.01 20.07 919.16 7.19 7.48 1,301.02 REV-lE13 EX+ (9.~0) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Heller, Romaine I SCHEDULE J BENEFICIARIES FILE NUMBER 21 - 04 - 00285 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outrigM spousal distributions) Bonnie L. Blocher 4269 Carlisle Road Gardners, Pa. 17324 RELATIONSHIP TO DECEDENT r~ ~ [~, T,. · Daughter Enter dollar amounts for distn'butions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheel NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE AMOUNT OR SHARE OF ESTATE 131,151.01 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Register of Wills of Cumberland County, INVENTORY Estate of Hailer, Romaine I also known as , Deceased ,, Bonnie L. Blocher Pennsylvania No. 21 -04- 00285 Date of Death 2/22/2004 Social Security No. 162-22-7878 The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: Robert E Campbell I.D. No.: 07332 Address: 112 Baltimore Street Gettysburg, Pa 17325 Personal Represent.~_~3, ~, ,, J~' ,_ ~ Signature: ~~-~.~, Bonnie L. Blocher Signature: Signature: Address: 4269 Carlisle Road Gardners, PA 17324 Telephone: 717/334-9278 Personal Property Checking Account #0604828 at ACNB CD#31800237830 at PNC Bank Checking Account #5004274036 at PNC Bank Savings Account #5004436269 at PNC Bank Uncashed check from Glenbrook Life Village of Laurel Run - refund Telephone: 717-334-9278 Dated: Total Personal Property 8,781.60 20,002.61 500.00 30,848.85 258.40 . ~:~,i: ' 2,668.00 $63,059.46 (Attach additional sheets if necessary) Total Personal Property and Real Estate $63,059.46 5171,01.060 i:'B850807 Z MAY 18 04 3 4 8 6 GETTYSBURG. PA I 7325 TO: First Class Mail CAMPBELL & WHITE 112 BALTIMORE STREET GETTYSBURG, PENNSYLVANIA 17325 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 BUREAU OF ZNDZVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17118-0601 ROBERT E CAHPBELL CAHPBELL & WHITE 112 BALTIHORE ST GETTYSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX PA 27325 DATE ESTATE OF DATE OF DEATH FZLE NUMBER COUNTY ACN RE¥-ZS~i? El( AFP (01-05) 07-05-200q HELLER ROHAINE I 02-22-200q 21 0~-0285 CUHBERLAND 101 Amount ReBit~ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOW~ OR ESTATE OF HELLER DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAx ROMAINE !FZLE NO. 21 0~-0285 ACN 101 DATE 07-05-200R TAX RETURN HAS: (X) ACCEPTED AS FTLED RESERVATTON CONCERNING FUTURE INTEREST - SEE REVERSE ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .Qo 2. Stocks end Bonds (Schedule B) (2) .QO $. Closely Held Stock/Partnership Interest (Schedule C) ($) .OiO q. Mortgages/Notes Rece/veble (Schedule D) (q) .0!0 S. Cash/Bank Depos/ts/Misc. Personal Property (Schedule E) ($) 63;059.~i6 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 71;698.08 B. Total Assets (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage L/ab/1/t/es/Liens (Schedule Z) (10) 11. Total Deduct/ohs 3,305.51 1~301.02 (11) NOTE: To insure proper credit to your account, submit ~he upper port/on of this form with your tax payment. ASSESSMENT OF TAX: 15. Amount of L/ne 1~ at Spousal rate 16. Amount of L/ne 1~ taxable at Lineal/Class A rate 17. Amount of L/ne 1~ et Sibling re~e 18. Amount of L/ne 1~ taxable at Collateral/Class B rate 19. Pr/nc/pal Tax Due TAX CREDITS: REC~:ZPT DISCOUNT NUMBER INTEREST/PEN PAID (-) CD005918 265.16 CD003953 31.93 135,757.5q ~ .606.53 131,151.01 (is) .00 x O0 = .00 (16). 131,151.01 x 0~5= 5,901.80 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 AMOUNT PAID 5,000.00 638.6q~ TOTAL TAX CREDIT ZNTEREST AND PEN. TOTAL DUE 5,933.75 31.93CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED. ZF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRUCTTONS. (19)= 5,901.80 ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. PAYMENT DATE 05- 06-::'00q 05-18-200q 12. Net Value of Tax Return (12) 13. Char/table/governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . O0 lq. Net Value of Estate Sub~act *o Tax (lq) 131,151.01 NOTE: If an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill reflect flgures that include the total of ALL returns assessed to date. RESERVATION: Estates of decedents dying on or before December 1Z, 1982 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class D (collateral) rate on any such futura interest. PURPOSE OF NOTICE: To ~ulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act~ Act Z5 of ZOO0. (TI P.S. Section 91~0). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13153. Applications are available at the Office of the Register of Mills, any of the Z3 Revenue District Offices, or by calling the special Z~-hour answering service for fores ordering: 1-800-56Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-qq7-SO20 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must abject within sixty [60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-IOZI, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-15Ol) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacedant's death, a five percent (BI) discount of the tax paid is allowed. PENALTY: The 15g tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor. ~-~ ~ ,O005q& ~'B-1991 llZ .000301' ~ 9X .O00Z~7 1983 16X .000~58 199Z 9X .O00Zq7 ZOOZ 6Z .00016~ 198fi llZ .000301 1993-199q 7Z .000192 2003 52 .00D137 1985 132 .000356 1995-1998 92 .O00gq7 ZOOq qZ .000110 1986 lOX .OOOZ7fi 1999 7Z .O0019Z 1987 IOZ ,00027q ZOOO 72 .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG,, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERT'I'ANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP ROBERT E CAMPBELL 112 BALTIMORE ST GETTYSBURG PA 17525 DATE 08-02-2004 ESTATE OF HELLER DATE OF DEATH 02-II-ZOO4 FILE NUMBER Z1 04-0285 COUNTY CUMBER LAND ACN 101 I Amoun~ Rein i'l:'l:ed ROMAINE I HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit: ~o your account, submit: ~:he upper por~:ion of ~hLs fore wi~h your ~ex payment:. CUT ALONG THIS LINE ~ RETA'rN LOWER PORTZON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~## TNHERITANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF HELLER ROMAINE T F'rLE NO. 21 04-0285 ACN 101 DATE 08-02-2004 THTS STATEMENT TS PROV'rDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHO#N BELOW TS A SUNHARY OF THE PR/NC/PAL TAX DUE, APPL/CATTON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, 'rF APPLTCABLE, A PROJECTED TNTEREST FTGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-05-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 5,901.80 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID 263.16 05-06-2004 05-18-Z004 07-19-Z004 CD003918 CD003953 REFUND 31.93 .00 5,000.00 638.64 TOTAL TAX CREDIT 5,901.80 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT- (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~.,..U'lr,., !:';'/ ,~,,,,;\,, I~! ~ ,..\ 1.:;),.... "";>\ ~~ ~J ~ ":!"":)_~_."_:-__~. _,J't'"":^T'.2illl_ _Er.'\-----T:---...-.ii---2 .0_..........--.~- li:~':J'C~.!L~!t)cJr (U1Ji "rj'f/ lL.lULBj OJ!. ~IUL!Lll.1l1U)~1i".!l.aL1Ll!.U vUU.!i1il.l.y Name of Decedent: STATuS REPORT Ul\lTJER RULE 6.12 t< 0 \'V'. <X ; '" <<- ;t. I~ Q..II ~ {""- Date of Death: 2. . :J.J... 0 'f Estate No.: ;}. OD Y .- cp;2. ~.s . Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes J8f No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lithe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the CoUrt? . Yes 0 No!81 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. ~id the personal repr:sentative state fu"1 account inforrna~ to the parties in mterest?Yes 0 No ~ .s~ w~ ..sole.1~"Ie~~c...~....y c. Copies of receipts, releases, joinders and approval of formal or h"1iormal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~." SiJP-tr ~ Qn~+ f. Ca.~f kit Name 1/:2- B~tl;~ ~'k C~bQI732S- Address Date: I /t7/0~ 1/7- 33Y- 9:J.?f- TelephQ11e }.Jo. 1 L ; J~ ~ ~ j Ca.paciti: LJ Pe2:"sonal f,"epresenI2:'Cl~le fV! (',.,..-,,-1 .(:-- "'e----.-1 ..-~-e---t-"':vo .:pi ,--".J!..l..:..l,,-,~-_ .!..Ul }-i 1. ;:::'Ul..!.C-_ ..!. C}-'.!. ~c:..!..!. a.1..l ,........ \H::: Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 . Phone: (717) 240-6345 Date: 1/13/2006 CAMPBELL ROBERT E 112 BALTIMORE STREET GETTYSBURG, PA 17325 RE: Estate of HELLER ROMAINE I File Number: 2004-00285 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 2/22/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~-~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge