HomeMy WebLinkAbout04-0136 Cumberland
Register of Wills of ~x~:County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Olqa A. Heverly
also known as
O~= C~m? ;4~ 11 Rorc~uqh
, Deceased
Social Security No. 196-14-2475
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated 8-30-79 and codicil(s) dated
named in the Last Will of the
Sta~e r~eva~t d cumstences, e.g.. ~enundaTio~, death of executo¢, etc
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence J
(COMPLETE IN ALL CASES:) Attach additional ~heets if necessary.
Oecedent was domiciled at death in Cumberlarld
residence at 906 Wertzville Road r Enola,
Decedent, then 78 years of age, died 1-26
County, Pennsylvania, with his/her last family or principal
PA, 17025
,2004,at Camp Hill, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property .............................. $ 2 , 000.00
(If not domiciled in PA) Personal property in Pennsylvania ...................... $
(If not domiciled in PA) Personal property in County .......................... $
Value of real estate in Pennsylvania ............................................... $1 ] 5 , 000 . 00
Total . . .
Real Estate situated as fol;~:' ' ' 96~ W~'~Ji'ie' 'Eb'a'~',' '~6i'~;' '~A .............. $~ ~ '7_ nnn qO
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature Typed or printed name and resdence I
-~,, ' Francis M. He,_verly
73 Sharon Road
Enola, PA 17025
RW-7
REGISTER OF WI.~LS OF '\ COUNTY
~ OATH OF'SUBSCRIBING WITNESS
(each) a subscribing 'tness to the~ll presented herewith~g duly qualified'~ccording to
~se(s) andsay{s)that..~ ~ - - prese~aw,
the testat ~sign the sme ~d th~ ~gn~d as a witness a~e
request of t~t~~ h prese~nd (in ~esence of each other~ the presence of th~
°ther subscriblng withes~ ~ ~ ~
Sworn to ~ affixed ~~~r~ ~ ~
me this - ~ ~ (Name) ~
(Address) ~
~ ' Register
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(~) and sayO0 that
[~-~e~ ~ r~,~ familiar with the signature of ~, ~,4. ~/-r/~,~e ,
testat,qr~c, of ~ne of '~. ..... :ubgcribing ~";....~oo~o ......... ~' the will presented herewith and
codicil
that ~e,~ / believe~ the signature on the will is in the handwriting of
to the best ofQ~e, ~t '
Sworn to or affirmed an6 subscribed before ~
me this I t ~ day of -~t /NamO ~ ~
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 9 9 6:1. 8 5 4
No. ~ Date
~5.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (Fl~t, Middle Lest) STATE F~.E NUMBER
' I SEX I SOCIAL SECURITY NUMBER I DATE OF DEATH (Mon~, Day, Yea0
t Ol~a A. Heverly 12Female la. 196 -- 14 --2475 14. January 26, 2004
AGE (Last ~,~;;,~.y) I UNDER 1 YEAR ~ UNDEI~ 1 [~.'~Y I DATE OF B RTH I BIRTHPLACE (City and ~PLACE OF DEATH fCheck oniv mm - see instmctiofls o~ other
I Mo.th, I Dey, I Noom I M~ I (uo~th, Day. Year) I sma or Foreign Coun~/) I HOSPITAl.: ,
,. 78 Y"'II I I.-IE7-26-1925 I,.e. Orleans, ooAm ~ ~ n
COUNTY OF DEATH CITY ' ' I ' . . ~ . 'lee' I ~ t.;J '~: ::ti S~<e/) U
] , ~I~IJi~...~NP OF DEATH I FACILITY NAME (If not msUtoUo~, give street end number) IWAS DECEDENT OF HISPANIC ORIGIN? IRACE- Ame~can Indian, Slack, Whim, et
Cumb e No ee If yes, abedfy Cuban, (Spe~)
,. r,and I'e, Camp .i,l I'd..anor Care . :sin ome I
DECEDENTS USUAL OCCUPATION KIND OF BUSINESS / INDUSTRY I ~1, It0.
I [WAS DE~u=r~'NT EVER 'N ' DECEDENT'S EDUCATION MARITAL STATUS ' ~.~. c'-~. I ~URVlVlNG SPOUSE
Cctv. ktad ~ worn d.~. au,'.,lO mo.~ IU'S' ARMED FORCES? I ( se~tv amy htgh~qFad~ '~'mP~)
~'""~,:~,~,,dl I-b.C°mm°nwealth of PA --/ Yeel-'l NolO" 1%3.~'"'""~/'s'~'~/11 ~o-~2) I
Is;* I ~ s4. ~tdowed ss.
~le. Clerical
DECEDENT'S MAttING ADDRESS (Street, C#y/Town. State, Zip Code) I DECEDENT'S
' I ACTUAL
906 Wertzville Road IRESIDENCE
lc. Enola, PA 17025
I F
ATHER'S .~.~MF (First, I~,'lale. Last)
1~. Leslie McEnany
I ~NFOR~CrS ~ME fry~Pr~t)
~20e. Francis M. Heverly
t21a. othor (Spedf./)
state p~ O~
decedent
llve in a
co~n~ Cumberland towns~?
17G. [] Yea, decedentlivedin
17d. r""] No, deeedent lived
Wfthin actoat limits of
Enola
I DATE OF DISPOSITION
I (Monlh, DiV. Yeart__
Ol,,~. I-~q-09'
JMOTHER'S NAME (First, Middle, Maiden Sumama)
it Annie. Rooney
INFOR~ ~M~N~S~ MAILING ADDRESS (Street, City/Town, Stale, ZIp Code)
2Ob. /..,1 ~naro[l Road, Enola, PA 17025
~1=. PA Crematory ~21d Harrisburg, PA
physician is riot av~.~ et time of death to
cedi~y cause of death.
IMMEDIATE CAUSE (Final
dieeeee or Cortdi~3~
reeultklg irt
Sequandaly ~t ccmdlUo4~
if any. leading to Imi'nadleto
Entel' UNDERLYING
LICENSE NUMBER '
22b.
beat of my know'mdge, death occulted et Ule time date end place stated
(Signature a~d
TIME OF DEATH DATE PRONOUNCED DEAD (Month, Day, Year)
pm'ion who IxonouncBE death.
..
d.
CAUSE (Disease o~ injury
reeulUng o~ death ) ~T
WAS ~ AUTOPSY ~ ~RE A~OPSY FINDINGS I ~NER ~ D~TH
PERFUMED? ~ AVAI~LE PRIOR TO
I
I COMPLETI~ OF CAUSE
__J OF D~TH? INaIu~ ~
28a. / 28b. .
Homicide
Pending Inves~stkm
Could not be detarmim~d
CERTIFIER (Check mY~y one)
'~o~l~l~l~tGo?HmYv~_ _.lA~l. (?h~.ce~Zy~g ~p. m' ..death when.apoth~- physician has pronounced death and completed item 23)
*PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronounck~g death and cerUfyblG to cause of deaU1)
lo the belt Of my knowledOe, death occurred et the time, date. and place, and due to the r.&uaee(i) end manner am Italed ...................... []
*MEDICAL EXAMINER/CORONER
,,,,,,,,,,.-ted ............................................................................................... ... . '. . ( ) 1-'
33.
17109
INAMEANDADDRESSOFFAClLITYCremation Society of PA
22~100 Jonestown Road~ Harrisburg~pA
! LICENSE NUMBER IDATE SIGNED
~ . ~ . . _ I(Month, Dey, Yeaq
WAS ~E R~E~ED TO A MEDI~ E~INER ~ER?
, intewal betv.'ee f
: onset end deeU'
J DATE OF INJURY J TIME OF INJURY J
LICENSE ~MBE~ J ' DATE SI~ED (~m. Day, Ye~)
DATE F~D (~n~, Day. Ye~)
PART H:OUm¢ Mgnlf,~ca~ conditions cm'ddl~uti~g to death, but
not resulting in the undedythg ceuee Bi,mn in PART I.
LAST WILL AND TESTAMENT
OF
OLGA A. HEVERLY
I, OLGA A. HEVERLY, of 906 Wertzville Road, Enola,
Cumberland County, Pennsylvania, being of sound mind, memory and
understanding, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking and making void any and
all Wills or testamentary writings by me at any time heretofore
made.
ITEM 1. I direct that all my debts, funeral expenses
and inheritance taxes be paid by my personal representative, here-
inafter named, as soon after my death as may be practicable.
ITEM 2. Ail the rest, residue and remainder of my
estate, be it real, personal or mixed, of whatsoever nature or
kind, and wheresoever the same shall be at the time of my death,
to my husband, WILDON M. HEVERLY, providing he shall survive me
by a period of sixty (60) days.
ITEM 3. In the event that my husband, WILDON M.
HEVERLY, should predecease me, or if he and I should die as the
result of a corrosion disaster, or under such circumstances as make
it impossible to determine who died first, then and in that event,
I give, devise and bequeath all the rest, residue and remainder of
my estate, real, personal or mixed, of whatsoever nature or kind
and wheresoever the same may be situate, to my son, FRANCIS M.
HEVERLY, of 73 Sharon Road, Enola, Cumberland County, Pennsylvania
ITEM 4. I hereby authorize, empower and direct my
Executor, hereinafter named, to sell and to convert into cash any
or all property, both real and personal, without order of court,
and without bond, and for such price or prices as my said Executor
shall deem appropriate.
ITEM 5. I also hereby direct that my Executor herein-
after named, shall not be required to give bond for the faithful
performance of his duties in any jurisdiction.
ITEM 6. I hereby nominate, constitute and appoint my
husband, WILDON M. HEVERLY, to serve as Executor of this my Last
Will and Testament; and in the alternative, if my husband is
unable or unwilling to serve, then in that event, I nominate and
appoint my son, FRANCIS M. HEVERLY, to be the Executor of this my
Last Will and Testament.
I WITNES WHEREOF, I, OLGA A. HEVERLY, have signed,
sealed, published and declared this to be my Last Will and Testa-
ment on the ~6
day of ~ , 1979.
· HEVERLY ~
~/ OLGA A.
(SEAL)
SIGNED, SEALED, PUBLISHED and DECLARED by the said
Testatrix, OLGA A. HEVERLY, to be her Last Will and Testament, in
our presence, who, at her request, in her presence, and in the
presence of each other, we, believing her to be of sound and dis-
posing mind, memory and understanding, have hereunto subscribed
our names as witnesses.
- 2 -
REVal 5C.0 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
COUNTY CODE YEAR NUMBER
I-
Z
LU
C]
Z
0
0
0
0
(J
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Heverly, Olga A.
-DAT~ O~ DEATH (MM-DD-YEAR) ...... DATE OF BIRTH (MM-DD.YEAR
01/26/2004 07/26/1925
'iIF'~,PPLi~B[~i'S~/'i~i-N'~ ~P'(~O',~;§ N-,~E~ST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
196-14-2475
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
r~l. Odginal Return
[-'-~ 4. Limited Estate
~-~6. Decedent Died Testate (Attach copy
~--~9. Litigation Proceeds Received
~-]2. Supplemental Return
--"] 4a. Future interest Compromise (date ~ death alter 12-12-82)
[~7. Decedent Maintained a Living Trust (A,ach copy o~ Trust)
r--] 10. Spousal Poverty Credit (date of death belween 12-31-gl snd 1-1-95)
[-'-~ 3. Remainder Return (date of death prior to 12-13-82)
[~ 5. Federal Estate Tax I~etum Required
8. Total Number of Safe Deposit Boxes
--]11. Election to tax under Sec. 9113(A) tAt~ch Sch O)
NAME
Jerome J. McDonald
FIRM NAME (IfApplicable)
TELEPHONE NU-~iBER
(717) 566-2127
COMPLETE MAILING ADDRESS
439 Walton Avenue
Hummelstown, PA 17036
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Padnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Daposits & Miscellaneous Personal Properly (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[--~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
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)
112 000.0~ ::':
2,805.15
25,599.33
(8)
7,842.47
144.78
(11)
(12)
(13)
140,404.48
7,992.25
132,412.23
132,412.23
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
.................... x .0 (15)
___132,412.2~3__ x .0 45 (16) 5,958.55
..................... x .12 (17)
x .15 (18)
(19) 5,958.55
AND,.
REV-1502 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
'ESTATE OF
Olga A. Heverly
SCHEDULE A
REAL ESTATE
FILE NUMBER
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
ITEM
NUMBER
exchanged between a willihg buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
Residence - 906 Wertzville Road, Enola, PA, 17025
VALUE AT DATE
OF DEATH
112000.00
TOTAL (Also enter on line 1, Recapitulation) $ '1'12,000.00
(If more space is needed, insert additional sheets of the same size)
r A. B. TYPE OF LOAN: OMB NO. 2502-0265 ~1'~
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.["]FHA 2.E]FmHA 3. J"~CONV. UNINS. 4. E]VA 5. E]CONV. INS.
6. FILE NUMBER: J 7. LOAN NUMBER:
SETTLEMENT STATEMENT ,2004020,109
8. MORTGAGE INs'CAsE NUMBER:
C. NOTE: This form is furnished to give you a statement Of actual seffiement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC]" were paid outside the closing; they are shown here for informational puq:~oses and are not included in the totals.
1.0 3~8 120040201 {~9. PFD/2004020109/211
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Scott D. King and The Estate of OIga A. ~leverly CASH TRANSACTION
Michelle L. King Francis M. Heverly, Executor
34 Shenvood Circle
Enola, PA 17025
G. PROPERTY LOCATION: H. SETTLEMENTAGENT:
906 Wertzville Road . I. SETTLEMENT DATE:
Chelsea Settlement Services
Enola, PA 17025
February 20, 2004
Cumberland County, Pennsylvania PLACE OF SE3-rLEMENT
3800 Market Street
Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
t00. GROSS AMOUNT DUE FROM BORROWIER: 400 GROSS AMOUNT DUE TO S[=I ~=R:
101. Contract Sales Price I 112,000.00 401. Contract SalesPrice 112,000.00
102. Personal Property I 402. Personal Property
103. Settlement Charges to Borrower (Line 1400) 1,728.54 403.
104. Payoff Mortgage 404.
105. Payoff Mort~la¢le 405.
Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance
106. 04 Locel/Cnty Tax to i 406. 04 Local/Cnty Tax to
107. 03 School Taxes 02/21/04 to 07/01/04 I 426.4'-'~ 407. 03 School Taxes 02/21/04 to 07/01/04 426.48
108. Assessments to 408. Assessments to
109. 1st Qtr Sewer/Trash 02/21/04 to 04101104 42.20 409. 1st Qtr Sewer/Trash 02/21/04 to 04/01/04 42.20
110. 410.
111. 411.
112. I 412.
120. GROSS AMOUNT DUE FROM BORROWER I 114,197.22 420. GROSS AMOUNT DUE TO SELLER
~ ! 112,468.68
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:' 600. REDUCTIONS IN AMOUNT DUE TO S~I ~ ~=R:
201. Deposit or earnest money I 501. Excess Deposit (See Instruct/ons)
202. Principal Amount of New Loan(s) r 502. Settlement Charges to Seller (Line 1400) 1,164.53
203. Existing loan(s) taken subject to 503. Existin.q oan(s) taken sublect to r
204. I 504. Payoff of first Mortgage
205.
206. I 505. Payoff of secoi~d Mort.(~a~e
207. I 506.
507.
208. 508.
209. , 509.
Adjustments For Items Unpaid By Seller Adjustments FOr Items Unpaid Bi/Seller
210. 04 Locel/CntyTax to I 510. 04 Locel/CntyTax to
211. 03 School Taxes to I 511.03 School Taxes to
212. Assessments to I 512. Assessments to
213. I 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. j 518. J
220. TOTAL PAID BY/FOR BORROWER I 520. TOTAL REDUCTION AMOUNT DUE SELLER 1 1,164.53
300. CASH AT Si= I ~ [.EMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM Sm ~ ~=R:
301. Gross Amount Due From Borrower (Line 120) r 114,197.22 601. Gross Amount Due To Seller (Line 420) I 112,468.6E
302. Less Amount Paid B},/For Borrower (Line 2201 I( 602. Less Reductions Due Seller (Line 5201 I( 1r164.5t~
303. CASH( X FROM)( TO)BORROWER I 114,197.22 603. CASH( X TO)( FROM)SELLER I 111,304.15
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
Borrower
Scott D. K]'ng ~
ich6lie L. King-'-
Seller
The Estate of Olga A. Heverly Fj'ancis M. Hevedy,
B
Page 2
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Baaed on Price $ ~ % P,~o F~OM PASO FROM
Division of Commission (line 700) as Follows: BORROWER'S SELLER*S
701~ $ to FUNDS AT FUNDS AT
702. $ to SE'rTLEMEN? SE'r'rLEMENT
703. Commission Paid at Settlement
704. to
800. I'tI=MS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to CASH TRANSACTION
802. Loan Discount % to CASH TRANSACTION
803.. to
804.. to
805.. to
806.. to
807.. to
808.
809.
810.
811. ·
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to ~ $ /da)/ ( days
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance ~,, ~ per
;1002. Mortgagelnsurance ~,, $ per
1003. 04 Local/CntyTax ~ $ per
1004. 03 SchoolTaxes ~, ~ per
1005. Assessments ~ $ per
1006. ~ $ per
1007. ~ $ per
1008. Aaare,cjate Adiustment ~ ~ per
1100. TITLE CHARGES
1101. Settlement Fee to Chelsea Settlement Services 100.00
1102. Title Search Fee to Chelsea Settlement Sewices 150.00
1103. Disbursement Fee to Chelsea Settlement Services 35.00
1104. Title Insurance Binder to
1105. Document Preparation to Chelsea Settlement Services Deed Prep.
1106. Notan/Fees to
1107. Attorney's Fees to
(includes above item numbers: )
1108. Titlelnsurance to Chelsea Settler'n~rlf[~ervi~e~
(includes above item numbers:
1109. Lender's Coverage $
1110. Owner's Coverage $
1111. ALTA Endorsements
1112.
1113.
1114. Express Overnight Fee Chelsea Settlement Services
1115. Wire Fee
1116. Closin~l Protection Letter Fee
1117. Tax Cert Fee Chelsea Settlement Services
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortga~le $ ; Releases $ 38.50
1202. City/County Tax/Stamps: Deed 1,120.00; Mortgage Conveyance Fee 560.00 560.00
1203. State Tax/Stamps: Revenue Stamps 1 ~120.00; Mortgage 560.0C 560.00
1204. Assignment Recording Fee Chelsea Recordino
1205. Recordin~l Service Fee to Chelsea Settlement Services 10.0~
1300. ADDITIONAL SE'I-FLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303. 04 Locel/CntyTax to Alicia Stine, Treasurer 09-14-0836-134A 275.04 44.53
1304.
13O5.
t400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103~ Section J and $02r Section K~
. ~ / 'l 1,728.54 1,164.53
~e~o.~} / // /'/
By ~lgnlng page I of Ibis staternenl, Ihe slgnalo~les acknowledge receipt of a cornlfleted copy of page 2 of ~1~ twopageage statTn//(~/.///4,.~ Aj ~/[/// ///~,//~.~_.~.,/~..~/~.~ j)stat ~
: tt,;men ,rv,ce
Certified to be a true copy. Settlement Agent/J //
( 200402010g 12004020109121 )
REV-1508 EX+ (6-g8) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Olga A. Heverly
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ITEM
NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate,
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
Personal property
IRS - tax refund
Refund of real estate tax and sewer bill
TOTAL (Also enter on line 5, Recapitulation
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
2338.00
43.00
424.15
2,805.15
REV-1509 EX+ (6-98~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
'ESTATE OF
Olga A. Heverly
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
If an asset was made Joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Francis U. Heverly 73 Sharon Road, Enola, PA, 17025 son
JOINTLY-OWNED PROPERTY
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 2/1/70 PNC Bank Checking A/C No. 5140109326 9368.39 .50 4684.2(
2. A. 2/19/97 PNC SavingA/C No. 5000718883 41830.27 .50 20915.1:
TOTAL (Also enter on line 6, Recapitulation)$ 25,599.3,3
(If more space is needed, insed additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONV~A,2'H Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Olga A. Heverly
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1.
5,
6.
7.
8.
FUNERAL EXPENSES:
Cremation Society of PA
ADMINISTRATIVE COSTS:
Pemonal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City __ State __ Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
PNC Bank Check fee
Realty transfer tax
94.48
6,342.00
275.00
15.99
1120.00
TOTAL (Also enter on tine 9, Recapitulation) $ 7,847.47
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Olga A. Heverly
SCHEDULE I
DEBTS OF DECEDENT,
MOI~TGAGE LIABILITIES, & LIENS
FILE NUMBER
Include unrelmbursed medical expenses.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4.
5.
Internists of Central PA
Central Pa Hematalogy
Lifeline Services
Verizon
AT&T
53.59
46.41
35.00
1.41
8.37
TOTAL (Also enter on line 10, Recapitulation) $ 144.78
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Olga A. Heverly
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Francis M. Heverly
73 Sharon Road
Enola, PA 17025
Son
1 OO%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
OLGA A. HEVERLY
I, 0LGA A. HEVERLY, of 906 Wertzville Road, Enola,
Cumberland County, Pennsylvania, being of sound mind, and
memory
understanding, do hereby make publish and declare this to be my
Last Will and Testament, hereby revoking and making void any and
all Wills or ~estamentary writings by me at any time heretofore
made-
ITEM 1. I direct that all my debts, funeral expenses
and inheritance taxes be paid by my personal representative, here-
inafter named, as soon after my death as may be practicable.
ITEM 2. All the rest, residue and remainder of my
estate, be it real, personal or mixed, of whatsoever nature or
kind, and wheresoever the same shall be at the time of my death,
to my husband, WILDON M. HEVERLY, providing he sha].l survive me
by a period of sixty (60) days.
ITEM 3. In the event that my husband, WILDON M.
HEVERLY, should predecease me, or if he and I should die as the
result of a common disaster, or under such circumstances as make
it impossible to determine who died first, then and in that event,
I give, devise and bequeath all the rest, residue and remainder of
my estate, real, personal or mixed, of whatsoever nature or kind
and wheresoever the same may be situate, to my son, FRANCIS M.
HEVERLY, of 73 Sharon Road, Enola, Cumberland County, Pennsylvania.
ITEM 4. I hereby authorize, empower and direct my
Executor, hereinafter named, to sell and to convert into cash any
or all property, both real and personal, without order of court,
and without bond, and for such price or prices as my said Executor
shall deem appropriate.
ITEM 5. I also hereby direct that my Executor herein-
after named, shall~ not .be required to give bond for the faithful
performance of his duties in any jurisdiction.
ITEM 6. I hereby nominate, constitute and appoint my
husband, WILDON M. HEVERLY, to serve as Executor of this my Last
Will and Testament; and in the alternative, if my husband is
unable or unwilling to serve, then in that event, I nominate and
appoint my son, FRANCIS M. HEVERLY, to be the Executor of this my
Last Will and Testament.
I WITNES WHEREOF, I, OLGA A. HEVERLY, have signed,
sealed, published and declared this to be my Last Will and Testa-
ment on the~6 day of ~ , 1979.
~_. (SEAL)
,../ OLGA A. HEVERLY J
SIGNED, SEALED, PUBLISHED and DECLARED by the said
Testatrix, OLGA A. HEYERLY, to be her Last Will and Testament, in
our presence, who, at her request, in her presence, and in the
presence of each other, we, believing her to be of sound and dis-
posing mind, memory and understanding, have hereunto subscribed
our names as witnesses.
- 2 -
JEROME J. McDONALD
Attorney at Law
439 Walton Avenue
Hummelstown, PA 17036
Phone(717) 566-2127
Fax(717) 566-7199
April 19, 2004
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
RE: Estate of Olga A. Heverly
Estate No.: 2004-00136
Dear Register of Wills:
Enclosed you will find the original and two copies of the Inheritance Tax Return
for the above referenced estate. Please time-stamp the enclosed tax returns and return
one copy to me in the enclosed self-addressed envelope.
Additionally, I have enclosed a $15.00 check in payment of the filing fee and a
second check in the amount of $5,660.62, which represents the payment of the
inheritance tax.
If you have any questions, please do not hesitate to contact me.
Very truly yours,
JJM/slh
Enclosures
cc: Francis Heverly
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 003852
MCDONALD JEROME J
439 WALTON AVENUE
HUMMELSTOWN, PA 17036
........ fold
ESTATE INFORMATION: SSN: 196-14-2475
FILE NUMBER: 2104-01 36
DECEDENT NAME: HEVERLY OLGA A
DATE OF PAYMENT: 04/21/2004
POSTMARK DATE: 04/21/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 01/26/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $5,660.62
REMARKS:
TOTAL AMOUNT PAID:
$5,660.62
" SEAL
CHECK//106
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
JEROME J. McDONALD
Attorney at Law
439 Walton Avenue
Hummelstown, PA 17036
7003 1680 0004 8042 6843__ __
0000
17013
U.S. POSTAGE
PAID
HUMMELSTONN,PR
17036
APR 20,'04
AMOUNT
$5.80
00087990-08
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM .YEARLY
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Estate No.: ,,2
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to completion of the administration of the above-captioned estate:
State whether administration of the estate is complete:
Yes .~" No
Date:
If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
If the answer to No. 1 is yes, state the following:
A. Did the personal representative file a final account with the court?
Yes No .~/
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
C. Did the personal representative state an account informally to the parties in
interest? Yes ,)~ No
D. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
(MAH:rmt/AM3)
to this report.
Name (Please type or. print),
_e tVa
Address
Telephone No.
R.W. - ,5~5
Capacity:
Personal Representative
Counsel for Personal Representative
BUREAU OF ZNDTVIDUAL TAXES
INHERZTANCE TAX DZVISXON
DEPTo Z80601
HARRZSBURG, PA 17128-0601
COHNONWEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOT/CE OF /NHER/TANCE TAX
APPRAZSEHENT, ALLOWANCE OR DZSALLONANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
REV-i$~i7 EX AFP (01-05)
JEROHE J HCDONALD
459 WALTON AVE
HUHHELSTOWN
'04 JU;,~-7
PA 17056
DATE 06-08-2004
ESTATE OF HEVERLY
DATE OF DEATH 01-26-2004
FZLE NUH]~ER 21 04-0156
I AC~c~U~NTY , CUHBERLAND 101
Amoun't Remi't'ted
OLGA A
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LOWER PORT]:ON FOR YOUR RECORDS '~
REV-15&7 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF HEVERLY OLGA A FZLE NO. 21 04-0156 ACH 101 DATE 06-08-2004
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATZON CONCERNING FUTURE ]:NTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGZNAL RETURN
1. Real Estate (Schedule A} (1)
2. S~ocks and Bonds (Schedule B) (2)
$. Closely Held S~ock/Par~nership Zn~eres~ (Schedule C) ($)
¢. War,gages/No,es Receivable (Schedule D)
E. Cash/Bank Deposi~s/Hisc. Personal Propar~y (Schedule E)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTZONS AND EXENPTIONS:
9. Funeral Expenses/Adm. Cos~s/Nisc. Expenses (Schedule H) (9)
10. Dab~s/Nor~gege Liabilities/Liens (Schedule 1) (10)
11. To'al Deductions
12. Ne~ Value of Tax Re~urn
112~000.00
.00
.00
.00
2~805.15
Z5~599.~
.00
(8)
7,842.47
144.78
NOTE: To insure proper
cradi~ ~o your account,
submi~ the upper por~ion
of ~his form wi~h your
~ax payment.
15.
NOTE:
ASSESSHENT OF TAX: 15. Amoun~ of Line 1¢ e~ Spousal ra~e
16. Amoun~ of Line 1¢ ~:exable e~ Lineal/Class A re'ce
17. Amoun~c of Line 1¢ e4: Sibling ra~e
16. Amoun~ of Line 1~ ~axable at CoZla~eral/Class B ra~e
19. Principal Tax Duo
140,404.48
(15) .00 X O0 : .00
(t6) 152,417.25 X 045= 5,958.55
(Z7) .00 x 12 = .00
(z8) .00 x 15 = .00
(19)= 5,958.55
TAX CRED'rTS:
PAYMENT
DATE
04-21-2004
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
RECE/PT
NUNBER
CDOO$85Z
DZSCOUNT (+)
ZNTEREST/PEN PAZD (-)
297.95
ANOUNT PAZD
5,660.62
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
5,958.55
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDZT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.)
Charitable/Governmental Bequests; Non-elec*ed 9115 Trusts (Schedule J) (1:5) . O0
Ne~ Value of Es~a~e Subjec~ ~o Tax (1¢) 152,417.25
Zf an assessment ,as issued previously, 11nas 1¢, 15 and/or 16, 17, 18 and 19 ,111
reflect figures that lnclude the total of ALL returns assessed to date.
(11) 7,987.25
(~2) 1:52,417.25
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADNZN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on ar before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collataral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coamonaaalth hereby expressly reserves the rlght to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To ~ulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of NiI1s printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #ILLS, AGENT
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-1313). Applications ara available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
ansaering service for forms ordering: 1-800-562-2050; services for taxpayers aith special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
Any party in interest not satisfied aith the appraisement, allowance, or disalloaance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object aithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 171ZB-1OZ1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Raviea Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the dacadant's death, a five percent (SI) discount of
the tax paid is alloaed.
The 15Z tax amnesty nan-participation penalty is computed on the total of tho tax and interest assessed, and not
paid before January 18, 1996, the first day after the end 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 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 1, 198Z bear interest at the rata of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes mhich became delinquent on and after
January 1, 1982 will bear interest at a rate ahich will vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1952 through 2004 ara:
Interest Daily Interest Dally Interest
Year Rate Factor Year Rate Factor Year Rate
~ 20Z .000548 ~T~'8-1991 11z .00030! ~ 9z
1983 16Z .000438 199Z 9Z .000247 200Z 6Z
1984 llZ .000301 1993-1994 7Z .00019Z ZOO3 5Z
1985 137. .000356 1995-1996 9Z .000247 2004 4Z
1986 lOX .OOOZ74 1999 7Z .00019Z
1987 IOZ .000274 ZOO0 7Z .00019Z
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DBLZNQUENT X DALLY INTEREST FACTOR
Daily
Factor
,000Z47
.000164
.000137
.000110
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. Xf payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.