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Home My WebLink About01-0108 L REV -1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 16 :QL1 /- g - DEPARTMENT OF REVENUE L. ~ ~ - DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER leg HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 02/ () / COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Rhone Kenneth L 204-03-6354 DECE- DATE OF DEATH (MM-DD-VEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 12/27/2000 08/05/1919 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER - - 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required ~ate of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. acadon! Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) ~ttach a copy of TrUS~ BLOCKS 9. Litigation Proceeds Received 10. pousal Poverty Credi (date of death between 0 11. Election 10 tax under Sec. 9113(A) 12-31-91and 1-1-95) (Attach 8ch OJ jHI$B'liIll!NMU$itj;j$!;!:lli!l!ij~jliti~ijij~~i!:li$l~ijjl!m!'Ni!tAl!IM"l:l!lMlljl!!llil~UlijilejjIR~.tQi NAME COMPLETE MAILING ADDRESS COR- Jered L. Hock, Esquire 3211 N. Front St. ; PO BOx 5300 RE- FIRM NAME (If Applicable) Harrisburg, PA 17110-0300 SPON DENT Metzger Wickersham TELEPHONE NUMBER 717-238-8187 ,,-',r_ .....~, .. c:5lFFICIAL}J~ ONLY ~ lJ 1. Real Estate (Schedule A) (1) ::; ~" 2. Stocks and Bonds (Schedule B) (2) 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) .. 0 .....l';. ;;:c.- 4. Mongages & Notes Receivable (Schedule D) (4) 0 ;J~_I 5. Cash, Bank Deposits & Miscellaneous Personal t'-l \.51 Property (Schedule E) (5) 5,683 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) 0 ~ RECA- ----', PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 0 8. Total Gross Assets (total Lines 1-7) (8) 5,683 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 3,996 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 32,457 11. Total Deductions (total Lines 9 & 10) (11) 36,452 12. Net Value of Estate (Line 8 minus Line 11) (12) (30,769) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 0 has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) (30,769) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taKable at the spousal taK rate, or transfers under Sec. 9116 (aX1.2) 0 X.O 00 (15) 0 TAX 16. Amount of Line 14 taxable at lineal rate 0 X.O 0.045 (16) 0 - COMPU- 17. Amount of Line 14 taKable at sibling rate 0 X .12 (17) 0 TATION 18. Amount of Line 14 taKable at collateral rate 0 X .15 (18) 0 19. Tax Due (19) 0 20. 0 1~~Hl!!ll!lfYOU4811~miN~Aij~i\lPOF)W~~AYMIWtI iijilai!($Qi!e[QA!ii$Wea;AQ;lllOJ;$tiQ!ii$O!lM$~~A!iiPm;;CAeCKMAtAi* o PA 15001 NTF 29755 Copyright 2000 Greatland/Nelco LP - Forms Software Only Estate of Name Address Tax ID 204-03-6354 Executors (Page 1) Dana L. Heberlig 5563 Philadelphia Avenue Charnbersburg, PA 17201- 161-34-0875 PA REV-15oo EX (6-00) Page 2 Decedent's Comclete Address: STREET ADDRESS 101 North Prince Street Apt. 111 Cumberland County CITY I STATE I ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o o o o Total Credits (A + B + C) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty o o Total Interest/Penalty (D + E) (3) 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 A. Enter the interest on the tax due. (SA) 0 B. Enter the total of Une 5 + SA. This is the BAlANCE DUE. (5B) 0 .................................................... ..................... ........................... .... .t;1.ake.Sh~.~~.:~~~.b.I.~::~:..~:.~!:~TER O..F...:.:....w............1 LLS, A9ENT .. .... .. . ...... ...... .. ... .... .. , . ..... ,. ,.. ... .. ::::::::::::::.::::.:.:.:.:::;:::::::::::::::.:~::::::.:.:...... ',". .............................. .:.. ............ ...................... . ................................. .., ;:;:::::;::::;:;~,t~:' ;:;:;:::3;:,:;:::':: ... :;,;:,:,:,;,~,,;,:;:~, .,.,,::.,.;.;.,........ ~E~~~~ ANS.;;~!~'iHEFOLLOwiNG J~~gffo~S~y~ctciNGAN;;X"INfHEAPPROPRiATEBi:OcKs...... 1. Did decedent make a transfer and: 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 withoutreceiving 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 o~ preparer other than the personal representative is based on information of which re arer has an knowled e. SIG RE OF PERS RE 51 LE.F FILING RETURN DATE . 3- -0; Yes No ~ ; B ~ D i9 ADDRESS 5563 Philadel hia Avenue SIG PRE PARER OTtjER T~ REP~1TATIVE 7 ~__-,__,A_---t:.__'\.../ u C_~ Chambersbur , PA 17201 DATI' '321(0 L. 5300 Harrisburg, PA 17110-0300 ':::::::~:::~::::::?.. ....,... . ???????::;:??:::f:::.:::.: ::::.: ... ,':':':':':':':':':>:::::':':':':':':':':':':':':'~". '::::?:::::':';':':::':;:':'?????? ?iJ::,:?,:::::;;~t ?:::::':::::;:::':: :':::::'::;':::';':::::::::::::';':::::':'::? ::::. ::::::::::::. ::::::. .'?:::;:':::=?l?:'~? :::::. .::':':::~:5:~:..::':':::':':'~~:'. .:::::::::,dh;::::::':'~:;",::<':::r:,:::::":':"""" For dates of death on or after July 1,1994and 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. 19116 (a) (1.1) (I)]. For dates of death on or after January 1, 19515, the tax rate Is Imposed on the net value of transfers to or for the use of the surviving Spouse is 0% [72 P.S. 19116 (a) (1.1) (ii)). The statute dn.... nnt .."..mnta transfer toa surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are sllll 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.IS1 16(a)(1.2)J. 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.19116(1.2) [72 P.S.191 16(aX1)]. The tax rate Imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. 1191 16(aX1.3)J. A sibling Is defined, under Section 9102, asan Individual who hasat least one parent In common with the decedent, whether by blood or adoption. o PA 15002 NTF 29756 Copyright 2000 Greatland/Nelco LP - Forms Software Only 'REV-1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone 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 exchanged between a willing buyer and a willing selJer, 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. SCHEDULE A REAL ESTATE FILE NUMBER ITEM NO. 1. DESCRIPTION VALUE AT DATE OF DEATH 9 PA 15021 NTF 10871 Copyright 1999 Greatland/Nelco LP - Forms Software Only TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insen additional sheets of the same size) o 'REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. 1. DESCRI PTION VALUE AT DATE OF DEATH 9 PA15031 NTF 10872 Copyright 1999 Grealland/Nelco LP - Forms Software Only TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insen additional sheets of the same size) o 'REV-1504EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-propiertorship. See instructions for the supporting information to be submitted for sole-proprietorships. SCHEDULE C CLOSELY-HELD CORPORATION PARTNERSHIP or SOLE-PROPRIETORSHIP FILE NUMBER ITEM NO. 1. DESCRI PTION VALUE AT DATE OF DEATH 9 PA 15041 NTF 10873 Copyright 1999 Greatland/Nefco LP - Forms Software Only TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) o REV-1S07EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER Kenneth L. Rhone All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION 1. VALUE AT DATE OF DEATH TOTAL (.Also enter on line 4, Recapitulation) $ (If more space is needed, insen additional sheets of the same size) o 9 PA 15071 NTF 10874 Copyright 1999 Greatland/Nelco LP - Forms Software Only REV -1508 EX + (1-97) SCHEDULE E CASH. BANK DEPOSITS. & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone Inelude proceeds of Iltlgatlon & date proeeeds were received by the estate All prop. jointly-owned with right of survivorship must be disclosed on Sch. F. FILE NUMBER ITEM NO. 11. 2001 Income Tax Refund DESCRIPTION VALUE AT DATE OF DEATH 300 2 Card Services - rebate check 12 3 Episcopal Square Apartments - security deposit refund 291 4 Monumental Life - life insurance premium refund Policy #MM2159783 40 5 Monumental Life - life insurance premium refund Policy #MM2225007 20 6 Monumental Life - life insurance premium refund Policy #MM786065 21 7 Orrstown Bank Checking Account NOTE: The balance Orrstown Bank reported may have differed from the $4,999 figure herein, but this is accounted for by the fact that there were several checks which were written within days of decedent!s death and which, it is believed, remained uncleared at death. The balance set forth herein of $4,999 accords precisely with the actual balance available at date of death. 4,999 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,683 9 PA 15081 NTF 10875 Copyright 1999 Greatland/Nelco LP - Forms Software Only REV-1S09 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone SCHEDULE F JOINTLY-OWNED PROPERTY FI LE 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. B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH Include name of financial institution and bank ITEM FDA MADE account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF JOINT NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ 0 9 PA 15091 NTF 10876 (If more space is needed, insert additional sheets of the same size) Copyright 1999 GreatlandfNelco LP - Forms Software Only REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FI LE NUMBER 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. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER NO. ATTACH COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLlCABUE) 1. TOTAL (Also enter on line 7, Recapitulation) $ 0 9 PA 15101 NTF 10877 (If more space is needed, insert additional sheets of the same size) Copyright 1999 Greatland/Ne\co LP - Forms Software Only REV-1511EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NO. A. 1. 1 DESCRIPTION AMOUNT FUNERAL EXPENSES: Fogelsanger Bricker Funeral Home 1,405 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Dana L. Heberlig Social Security Number(s)/E1N No. of Personal Representative(s) S1reetAddress 5563 Philadelphia Avenue CityChambersburg State PA Zip 1720] 300 Year(s) Commission Paid: 2002 2. J. AttorneyFees Metzger, Wickersham, Knauss & Erb, P. C. (estimated) 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 1,700 4. Probate Fees 42 5. Accountant's Fees 6. Tax Return Preparer's Fees S & S Tax Services 75 7. 1 Catherine E. Heberlig - necessary cleaning/clearing out of decedent's apartment, so that security deposit refund would be available 200 2 Cumberland Law Journal - estate advertisement 75 Total from continuation cages 199 9 PA 15111 NTF 10878 Copyrighl1999 Greatland/Nelco LP - Forms Software Only TOTAL (Also enter on line 9, Recapitulation) S (If more space is needed, insert additional sheets of the same size) 3,996 Schedule H part 2 (Page 2) Estate of: Kenneth L. Rhone Item No. Description Amount 3 News Chronicle Co. - estate advertisement 4 Reserve for Small Estate Petition and closing expenses 5 Reserve for payment of postage and certified return receipt notices to creditors and photocopy Total (Carry forward to main schedule) 56 75 67 199 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER DESCRIPTION AMOUNT 1. 1 Advantage Recoverable Solutions - credit collection service Account #719M00128428 384 2 Allfirst Bank Card Services - credit card debt of decedent Account #5406292160427387 260 3 AT&T Universal Card Services Corporate Acct #5491-1300-4592-3504 4,701 4 Bank Services - payment uncleared at date of death 260 5 Episcopal Towers - check uncleared at death 215 6 First USA Bank - credit card debt of decedent 7,741 7 First USA Bank - check uncleared at death 160 8 First USA Bank - credit card debt of decedent Account #4366 1630 5010 8402 7,434 9 GPU - check uncleared at death 21 10 GPU Energy - debt of decedent Account #100112221642 50 11 Household Consumer Services - debt of decedent 578 12 IRS - income tax debt of decedent 421 13 MBNA America - credit card debt of decedent Account #5490996252007898 552 Total from continuation pages 9,680 9 PA 15121 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 32,457 NTF 10874 Copyright 1999 Greatland/Nelco LP - Forms Software Only Estate of: Kenneth L. Rhone Item No. Description 14 Orrstown Bank - fee, payment uncleared at death 15 PA Department of Public Welfare - medical assistance 16 Pearl Harbor Association - check uncleared at death 17 Universal Card Services - credit card debt of decedent Account #5491130095923504 Schedule I (Page 2) Amount Total (Carry forward to main schedule) 5 4,847 6 4,822 9,680 REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Kenneth L Rhone No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 1. Dana L. Heberlig 5563 Philadelphia Avenue Chambersburg, PA 17201 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Stepson AMOUNT OR SHARE OF ESTATE Entire Estate Zero Balance ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 9 PA 15131 NTF 10880 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) Copyright 1999 Greatland/Nelco LP - Forms Software Only o "REV -1514 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN ESTATE OF Kenneth L. Rhone This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will 0 Intervivos Deed of Trust D Other UeeeS'llATE.llilltEAES'llGAFGlJIlATlONt (Check Box 4 on Rev-1500 Cover Sheet) FILE NUMBER NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE n Ufe or D Term of Years n Life or n Term of Years n Life or 0 Term of Years o Life or n Term of Years 1. Value of fund from which life estate is payable $ 0 2. Actuarial factor per approriate table 0 Interest table rate -- 3 1/2% 06% 010% o Variable Rate % 3. Value of life estate (Line 1 multiplied by line 2) $ 0 iIANN!lllntll'il'llEAESl!~IllIlATlON NAME (5) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE Term of Years Term of Years Life or 0 Term of Years Life or 0 Term of Years 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corre[Onding (nUmbeB Frequency of payout -- 0 Weekly (52) BI-weekly (26) Monthly (12) o Quarterly (4) 0 Semi-annually (2) Annually (1) Other ( ) 3. Amount of payout per period o o $ o 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate 0 3 1/2% 0 6% 0 10% o o Variable Rate % o 6. Adjustment Factor (see instructions) 7. Value of annuity -- If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x line 5 x Line 6 If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + line 3 o $ o $ o NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) 9 PA15141 NTF 10881 Copyright 1999 Greatland/Nelco LP - Forms Software Only COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE REV-1847 EX + (1-97)(1) ESTATE OF Kenneth L. Rhone This schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. (Check Box 4a on Rev-1500 Cover Sheet) FILE NUMBER nWiII n Trust n Other I. Beneficiaries NAME OF AGE TO BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. n Limited right of withdrawal n Unlimited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest $ 0 2. Value of Une 1 exempt from tax as amount passing to charities, etc. (also include as pan of total shown on Une 13 of Cover Sheet) $ 0 3. Value of Une 1 passing to spouse at appropriate tax rate Check One D 6% D 3% D 0% (also include as part of total shown on Une 15 of Cover Sheet) $ 0 4. Value of Une 1 Taxable at 6% Rate (also include as part of total shown on Line 16 of Cover Sheet) $ 0 5. Value of Line 1 Taxable at 15% Rate (also include as part of total shown on Line 17 of Cover Sheet) $ 0 6. Total value of Future Interest (sum of Lines 2 thru 5 must equal Line 1) $ 0 (If more space is needed, insert additional sheets of the same size) 9 PA16471 NTF 26890 Copyright 1999 Greatland/Nelco LP - Forms Software Only REV-1649 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kenneth L. Rhone Do not complete this schedule unless estate is making election to tax assets under Section 9113(A) of Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust(marltal, residual A, S, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) FI LE NUMBER PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION VALUE Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE 9 PA 16491 NTF 10882 Part B Total $ (If more space is needed, insert additional sheets of the same size) o Copyright 1999 Greatland/Nelco LP - Forms Software Only LAST WILL AND TESTAMENT --- It Kenneth L. Rhone, of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I give, devise and bequeath all of my estate of every nature and wheresoever situate to Dana Heberlig, his heirs and assigns. ITEM III: I appoint Dana Heberlig executor of this my Last Will and Testament. ITEM IV: I direct that my executor or his successors shall not be required to give bond for the faithful performance of his duties in any jurisdiction. and Testament, written on IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will sheets of paper, dated this 13 day of fyu~ 1990. ~ d! d?L~- Kenneth L. Rhone ( SEAL) The preceding instrument, consisting of this and one other typewritten page, each identified by the signature of the testator, Kenneth L. Rhone, was on the day and date thereof signed, published and declared by Kenneth L. Rhone, the testator herein named, as and for his Last Will, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. 2ilto J UJ 14^'d M ~~Mc ~~ residing at 1/~jjp jJ A . ... residing at tv~ rA- ! COMMONWEALTH OF PENNSYLVANIA: SS COUNTY OF CUMBERLAND "'-.L/Vt (IlL ~~ the testator and the witnesses, res ectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another person to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as witnesses and that to the best of our knowledge, the testator was at that time eighteen years or older, of sound mind and under no constraint or undue influence. We, Kenneth L. Rhone, '-SoJ rJ, LJlndcrand ~d -L~ Kenneth L, Rhone a~ J{iJM~ ~L lk:1L--t~ ~ Subscribed, sworn to and acknowledged, by Kenneth L. Rhone, the testator and sworn to before me bY\~l~. uJ,rule.- and ~/V1 M~~, witness s, this 13 day of fJeeerdxr, 1990. " ,'..,'. -1 :',,".,," Prw1~ (VL, !lw1 1 " Notary Public NOTARIAL SEAL . PAUlA M. REED, Notary Public Sh'pp~n:bu.-g Twp., Cumberland (0., Pa. My Commission Expires Dec. 13, 1993 IN RE: Estate of Kenneth L. Rhone, · IN THE COURT OF COMMON PLEAS deceased · CUMBERLAND COUNTY, PENNSYLVANIA · ORPHANS' COURT DIVISION No. 2001-00108 PETITION FOR DISTRIBUTION Dana L. Heberlig, Personal Representative For ESTATE OF Kenneth L. Rhone, Deceased Date of Death: 12/27/00 Domicile: Shippensburg Borough, Cumberland County Testate Date of Probate of Will: January 25, 2001 Date of Grant of Letters: January 25, 2001, No Bond Required Beneficiaries Under Will: Entire estate to Dana L. Heberlig, but no residuary estate available because of insolvency Persons Entitled to Family Exemption: None· Inventory: Filed with Register List of Unpaid Claimants: See below Notice of Intent to present this Petition has been given as required by Rules Prayer for Distribution: Payment to Heir, Dana Heberlig, under Item II of Will $ 0.00 Payment to Priority 1 Creditors in full. Metzger, Wickersham, Knauss & Erb, P.C. $ 1,940.39 Dana L. Heberlig $ 300.00 Catherine E. Heberlig ~ $ 2,440.39 Payment to Priority 3 Creditors in full· ' :~ i~ Fogelsanger Bricker Funeral Home 7~: ~ c! 9E ~1 ~. $ 505.00 $ 505·00 282787-1 Payment to Priority 6 Creditors on prorated basis at approx. 4.4% Advantage Recoverable Solutions $ 15.77 Allfirst Bank Card Services $ 10.68 AT&T Universal Card Services $ 193.17 First USA Bank, Account $ 623.54 GPU Energy $ 2.05 Household Consumer Services $ 23.75 MBNA America Bank $ 19.68 Orrstown Bank $ 0.22 Pennsylvania Department of Public Welfare $ 199.18 Universal Card Services $ 198_ 14 $ 1,286.19 Please see Account, incorporated herein by reference, for claimants paid and disbursements made prior to filing of Petition. Respectfully submitted, METZGER, WICKERSHAM, KNA~A~_SS & ERB, P.C. David H. Martineau, Esquire Attorney I.D. No. 84127 Jered L. Hock, Esquire Attorney I.D. No. 19211 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attomeys for Petitioner Date: ,J/~/0~ 282787-1 AFFIDAVIT Dana L. Heberlig, Executor under the Last Will and Testament of Kenneth L. Rhone, deceased, hereby declares under oath that he has fully and faithfully discharged the duties of his office; that the foregoing Petition for Distribution is true and correct and has fully and adequately disclosed all those entitled to payment of less than claimed amounts, being Priority 6 Creditors; and that all known claimants against the Estate who have not been paid in full are listed herein; that, to his knowledge, there are no other claims now outstanding against the Estate; that all taxes presently due from the Estate have been paid; and that more than four months have elapsed since the first complete advertisement of the granting of Letters in this Estate. Dana L. Heberlig, Executor Subscribed and sworn to before me this ~S/kday of ~ cc~ , ~2-00~3. Notary 0ublic ' -- My Commission Expires: (SEAL) t~otaria~ sea~ Angela M. Miller, Notary Public City_ of Harrisburg, Dauphin County My C. ommission Expires Oct. 15, 2006 282787-1 SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg, Pennsylvania 17110-0300 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION FIRST AND FINAL .ACCOUNTING OF Dana L. Heberlig, Executor For Estate of Kenneth L. Rhone Date of Death: December 27, 2000 Date of Appointment: January 25, 2001 Accounting for the Period: December 27, 2000 to January 15, 2004 Purpose of Account: The above fiduciary offers this account to acquaint interested parties with the transactions that have occurred during his/her administration. It is important that the account be carefully examined. Requests for additional information, or questions, or objections, can be discussed with: Metzger, Wickersham, Knauss & Erb, P.C. 3211 North Front Street, P.O. Box 5300 Harrisburg, PA 17110-0300 (717)238-8187 Signatures: Estate of Kenneth L. Rhone Summary of Account Principal Page Receipts 2 $ 5,586.40 Net Gain on Sales or Other Dispositions 3 0.00 $ 5,586.40 Less Disbursements: 4 Debts of Decedent $ 427.00 Administrative Expenses 736.79 1,163.79 Balance Before Distributions $ 4,422.61 Less Distributions to Beneficiaries 7 0.00 Principal Balance On Hand 8 $ 4,422.61 For Information: Investments Made 9 Unpaid Expenses 10 Unrealized Gains and Losses 14 Income Receipts 15 $ 1,738.87 Net Gain on Sales or Other Dispositions 16 0.00 $ 1,738.87 Less Disbursements: 17 Administrative Expenses $ 1,687.91 1,687.91 Balance Before Distributions $ 50.96 Less Distributions to Beneficiaries 18 0.00 Income Balance on Hand 19 $ 50.96 For Information: Investments Made 20 Unpaid Expenses 20 Unrealized Gains and Losses 20 Combined Balance on Hand $ 4,473.57 Page I (1) Estate of Kenneth L. Rhone Receipts of Principal Inventory Value Cash and Cash Equivalents 12/27/2000 Orrstown Bank Checking Account Account No. 103000194 $ 4,983.15 Total Cash and Cash Equivalents $ 4,983.15 Inventory Value Miscellaneous 12/27/2000 2001 Income Tax Refund $ 300.00 Card Services - rebate check J2.04 Episcopal Square Apartments security deposit refund 291.21 Total Miscellaneous 603.25 Total Receipts of Principal $ 5,586.40 Page I (2) Estate of Kenneth L. Rhone Gains and Losses on Sales or Other Dispositions of Principal Net Gain Net Loss 02/20/2001 Collection Card Services - rebate check Net Proceeds $ 12.04 Carried at 12.04 03/02/2001 Collection Episcopal Square Apartments - security deposit refund Net Proceeds $ 291.21 Carried at 291.21 12/31/2001 Collection 2001 Income Tax Refund Actual Date of Collection Unknown Net Proceeds $ 300.00 Carried at 300.00 Total Gains and Losses $ o.oo $ o.oo No Gain or Loss $ o.oo Page I (3) Estate of Kenneth L. Rhone Disbursements of Principal Date Paid Amount Paid Claims presented, allowed, paid, credited and appearing in the Summary Statement United States of America Internal Revenue Service 04/11/2001 2000 Personal Income Tax $ 421 00 of decedent ' Total United States of America Internal Revenue Service $ 421.00 Pearl Harbor Association 12/31/2000 Check written by $ 6.00 decendent prior to death. Total Pearl Harbor Association $ 6.00 Total Claims presented, allowed, paid, $ 427.00 credited and appearing in the Summary Statement Administration Expenses Bankcard Services 01/02/2001 Check written by decedent $ 260.00 but not deducted from account prior to DOD. Check Number 722 Total Bankcard Services $ 260.00 Episcopal Towers 01/16/2001 Check written by decedent $ 215 00 but not cleared prior to ' DOD. Check Number 727 Total Episcopal Towers $ 215.00 Page I (4) Disbursements of Principal (Continued) Date Paid Amount Paid Administration Expenses First USA Bank 01/02/2001 Check written by $ 160.00 decendent but not deducted from account prior to DOD. Check Number 724 Total First USA Bank $ 16o.0o GPU Energy 01/05/2001 Check written by decedent $ 20 79 but not deducted from ' account prior to DOD. Check Number 725 Total GPU Energy $ 20.79 Monumental Life - Insurance Premium 01/16/2001 Policy MM1786065 $ 20 18 (Premium Refunded ' 2/20/2001 01/16/2001 Policy MM2159783 (Premium Refunded 40.32 2/20/2001 01/16/2001 Policy MM2225007 (Premium Refunded 21.68 2/20/2001 02/20/2001 Return of premium overpayment ( 20.18 ) Policy no. MM1786065 02/20/2001 Return of premium overpayment (40.32 ) Policy no. MM2159783 Page 2 (5) Disbursements of Principal (Continued) Date Paid Amount Paid Administration Expenses 02/20/2001 Return of premium overpayment $ ( 21.68 ) Policy no. MM2225007 Total Monumental Life - Insurance Premium $ 0.00 Orrstown Bank 01/10/2001 Account Service Fee $ 3.00 02/09/2001 Account Service Fee 3.00 Total Orrstown Bank $ 6.00 S&S Tax Services 04/15/2001 Preparation of 2000 1040 $ 75.00 Total S&S Tax Services ~ 7s.oo Total Administration Expenses $ 736.79 Total Disbursements of Principal $ 1,163.79 Page 3 (6) Estate of Kenneth L. Rhone Distributions of Principal to Beneficiaries Distribution Value Total Distributions of Principal $ 0.00 Page 1 (7) Estate of Kenneth L. Rhone Principal Balance On Hand Valued as of March 25, 2004 Inventory Value Cash and Cash Equivalents Estate Checking Account Orrstown Bank Account No. $ 4,422.61 Total Cash and Cash Equivalents $ 4,422.61 Total Balance on Hand $ 4,422.61 Page 1 (8) Estate of Kenneth L. Rhone Information Schedules - Principal Exchanges and Stock Distributions Inventory Value 2001 Income Tax Refund 12/27/2000 Received $ 300.00 12/31/2001 Collected Actual Date of Collection (300.00) Unknown Card Services - rebate check 12/27/2000 Received $ 12.04 02/20/2001 Collected (12.04) Episcopal Square Apartments - security deposit refund 12/27/2000 Received $ 291.21 03/02/2001 Collected (291.21) Page 1 (9) Estate of Kenneth L. Rhone Unpaid Principal Expenses Debts of Decedent Advantage Recoverable Solutions Account no. 719M00128428 $ 383.86 Total Advantage Recoverable $ 383.86 Solutions Allfirst Bank Card Services Account no. 5406292160427387 $ 260.00 Total Allfirst Bank Card $ 260.00 Services AT&T Universal Card Services Account no. 491130045923504 $ 4,701.00 Total AT&T Universal Card $ 4~701.00 Services First USA Bank Account No. Unknown $ 7,741.00 Account No. 4366163050108402 7,433.65 Total First USA Bank $ 15~174.65 GPU Energy Account no. 100112221642 $ 49.96 Total GPU Energy $ 49.96 Household Consumer Services $ 578.10 Total Household Consumer $ 578.10 Services Page I (10) Unpaid Principal Expenses (Continued) Debts of Decedent MBNA America - credit card Account no. 5490996252007898 $ 478.96 Total MBNA America - credit $ 478.96 card Orrstown Bank Account Fees $ 5.30 Total Orrstown Bank $ 5.30 PA Department of Public Welfare Medical Assistance $ 4,847.19 Total PA Department of Public $ 4~847.19 Welfare Universal Card Services Account no. 5491130095923504 $ 4,821.85 Total Universal Card Services $ 4,821.85 Total Debts of Decedent $ 31,300.87 Funeral Expenses Fogelsanger Bricker Funeral Home Original debt - $1,255 $750 paid by VA on 3/26/01 $ 505.00 Total Fogelsanger Bricker $ 505.00 Funeral Home Total Funeral Expenses $ 505.00 Page 2 (11) Unpaid Principal Expenses (Continued) Administration Expenses Catherine E. Heberlig Cleaning decedent ' s apartment to obtain refund of security deposit $ 200.00 Total Catherine E. Heberlig $ 200.00 Dana L. Heberlig Executor, s Commission $ 300.00 Total Dana L. Heberlig $ 300.00 Metzger, Wickersham, Knauss & Erb, P.C. Probate Fees $ 42.00 Filing Fee - PA Inheritance Tax Return 15.00 Cumberland County Law Journal Publication of estate notice 75.00 The News-Chronical Co. Publication of Estate Notice 56.39 Long Distance Phone 7.77 Postage 19.79 Fax 5.00 Photocopies 19.44 Attorney Fees 1,700.00 Total Metzger, Wickersham, $ 1,940.39 Knauss & Erb, P.C. Page 3 (12) Unpaid Principal Expenses (Continued) Administration Expenses Reserve for payment of Administrative Expenses Postage and certified return receipt notices to creditors and photocopy $ 77.99 Reserve for filing Accounting 164.00 Total Reserve for payment of $ 241.99 Administrative Expenses Total Administration Expenses $ 2,682.38 Total Unpaid Expenses $ 34,488.25 Page 4 (13) Estate of Kenneth L. Rhone Principal Unrealized Gains and Losses Market Value Inventory Value Gain or (Loss) Total Unrealized $ 0.00 $ 0.00 $ 0.00 Page 1 (14) Estate of Kenneth L. Rhone Receipts of Income Income Collected Benefit Payments 12/29/2000 Miscellaneous Income $ 427 00 Payment. · Improperly paid to estate. Payment refunded to VA on 4/10/2001. 01/02/2001 Miscellaneous Income Benefit. 1,260.91 Improperly paid to estate. Refunded to Civil Service on 2/13/2001. $ 1,687.91 Estate Checking Account Orrstown Bank Account No, 01/15/2004 Interest through 1/15/04 $ 40.49 40.49 Orrstown Bank Checking Account Account No. 103000194 01/10/2001 Interest $ 4.86 02/11/2001 Interest 5.14 02/20/2001 Interest 0.47 10.47 Total Income Received $ 1,738.87 Page 1 (15) Estate of Kenneth L. Rhone Gains and Losses on Sales or Other Dispositions of Income Net Gain Net Loss No Gain or Loss $ 0.o0 Page 1 (16) Estate of Kenneth L. Rhone Disbursements of Income Date Paid Amount Paid Administration Expenses Benefit Payments 02/13/2001 Retirn of improperly paid Civil Service Benefit $ 1,260.91 04/10/2001 Return of improperly paid VA Benefit 427.00 Total Benefit Payments $ 1,687.91 Total Administration Expenses $ 1,687.91 Total Disbursements of Income $ 1,687.91 Page 1 (17) Estate of Kenneth L. Rhone Distributions of Income to Beneficiaries Distribution Value Total Distributions of Income $ 0.00 Page 1 (18) Estate of Kenneth L. Rhone Income Balance On Hand Valued as of March 25, 2004 Inventory Value Cash and Cash Equivalents Estate Checking Account Orrstown Bank Account No. $ 50.96 Total Cash and Cash Equivalents $ 50.96 Total Balance on Hand $ 50.96 Page 1 (19) Estate of Kenneth L. Rhone Income Unrealized Gains and Losses Market Value Inventory Value Gain or (Loss) Page 1 (20) e ul osqe 321'1 North Front Street P.O. Box 5300 Harrisburg, Pennsylvania 1711,0-0300 Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/10/2004 HOCK JERED L ESQ P O BOX 5300 3211 NORTH FRONT STREET HARRISBURG, PA 17110 RE: Estate of RHONE KENNETH L File Number: 2001-00108 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. 1, for decedents dying on or after July 1, 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 will become delinquent on: 12/27/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STP~ASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge Lt._ C) U.J STATUS REPORT UNDER RULE 6.12 Name of Decedent: Kenneth L. Rhone Date of Death: 12/27/2000 Will No. 21-01-0108 Admin. No. 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 X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes X No b . The separate Orphans' Court No. (if any) for the personal representative's account is: c . Did the personal representative state an X' 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 to this report. ~ Date: ~ 2-01 0 s I Jered L. Hock. Esauire Name (Please type or print) 3211 N. Front St., PO Box 5300 Harrisbura PA Address C1'\ (717) 238- 8187 Tel. No. (:.'. c:, :.~i U._ () Capacity : Personal Representative ...0 '" >:<(1": CC=----, . l_: - d~~:.~: 0"" u X Counsel for personal representative .,'~ -, "" =, = c~.-.: , 17110-0300 ) ", : Proof of Publication of Notice in TIlE NEWS-CHRONICLE COUNTY OF CUMBERLAND COMMONWEALTIf OF PENNSYL VANIA NMWK Barbara C. Thompson, being duly sworn according to law, deposes and says that she is the editor of "The News-Chronicle", which is a bi-weeldy newspaper of general circulation published in Shippensburg Township, Cumberland County, Pennsylvania, by The News-Chronicle Company, a corporation duly organized and existing under the laws of the Commonwealth of Pennsylvania having it's principle place of business at 1011 Ritner Highway [P.O.Box 100], Shippensburg, Pennsylvania; that she is authorized to and does make this affidavit on it's behalf, that the printed notice, advertisement or publication attached hereto is the same as was printed in the regular editions & issues of "The News- Chronicle" on the following date(s): FEBRUARY 9,2001 FEBRUARY 16, 2001 FEBRUARY 23, 2001 CODY of Notice of Publication Affiant further deposes that neither she nor "The News-Chronicle" and The News- Chronicle Company have any interest in the subject matters of the aforesaid notice or advertisement, and that the filets set forth in the foregoing affidavit are true and correct. '\()IH'I Sworn and subscribed before me this 0~ day of -tift<<.. ZCv / I $lrJl:l' Letten Te'..ID,ntary m I the Eatate . of ,Ke,DJ;letb .L Rhone, late or Boro'ulh' )of ! , Shippensbufl', "Cumberlancl 'County~ PenD~rlvBllia:." de- : ceased. havi~ t*8n granted to ' . ~e, "UJidenigDed; all p8uana: I Lmde~ to said ..ta~,.re _re- : t,quested to ,make 'immecWlte' ,;payment .and ,thOle" ,hnina I :;~~~ present th~w~tbout . . ! Dad L. Heber1iI. Executor 5S63 _adelpbieA_ue " I ChambOnibu'll;PA 17201 '/-5AAJlUbL C\ )lJvnytd~L w or A.' ,'\ f Je"" '1. Hod!. E8qWre IMMzGBR; 'Rlcllft." SIIAM, KNAUSS .t ERB, P,C, . ,'P,O, IIpdsOO , ' ,[ ~211 North Frou.I!lNOt, ''', ':' -wi!, PA 17i\J.1J,03OO I,; .., ',',',." I "",. '<IlJ} :Adv. NO Feb. 9,16.,23: . I ---.-:--- ~ -,- lit, 'j .I!tl\'~,,- +. 'Na$rfa;1 s.;al Clayton L .Jahllslcin'll, Nolai)' Public 19~ Shippenshurg Twp. O.umberland CounfY' My Commission Expires Aug, 30, 2004 To: "THE NEWS-CHRONICLE" Shippensburg, PA 17257 For publishing the notice attached hereto: On the stated daters] ..,.. $ ')4 ,q Affidavit ........,.....$ 2 00 Total ................. $ 56 _ 39 ~'l "") i PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16,1929), P. L.1784 STATEOFPENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2,1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, V1Z: FEBRUARY 16, 23, MARCH 2, 2001 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. RhODe. K.euneth L.t dec'd. Late of the Borough of Shippens. burg. Executor: Dana L. Heberlig. 5563 PWladelphia Avenue, Chambers~ burg. PA 17201. Attomeys: Jered L. Hock. EsquJre. Metzger, Wickersham, Knauss & Erb. P.C" P.O. Box 5300. 3211 North Front Street, Harrisburg, PA 17110.0300. r ~ Rog.!r M. Morgenthal, Editor - SWORN TO AND SUBSCRIBED before me this 2 day of MARCH. 2001 SEAl LOIS E. SNYDER. Notary P.Jblk " Cariitl. 8oro. Comboriond eoo.ty. PA My CommiMioo Ex.piNK March 5, 2091; JRD/June30, 1992/17858 JAN 1 22005f In Re: Estate of Kenneth L. Rhone Late of Shipp ens burg Borough ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-01-0108 NO. 21-01-0108 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Dana Heberlig Counsel for Personal Representative: Jered Hock, Esquire Date of Decedent's Death: 12/27/2000 Date of Delinquency Notice: 01/10/2005 The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk ofthe Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk ofthe Orphans' Court on November 10, 2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 01/13/2005 ~~~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File "^'~ 4-] ;;LooS' q: ~ 0 11IM A hearing is scheduled for at in Courtroom No.3. If the Status Re ort is filed prior to the hearing date, the hearing will automatically be cancelled. ~ PETITION FOR PROBATE and GRANT OF LETTERS Register of Wills for the . Deceased. County of Cumberland in the Social Security No. 204-03-6354 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner~), who is/lire 18 years of age or older an the execut or in the last will of the above decedent, dated December 13 and codicil(s) dated N / A No. To: 21-01-108 Estate of Kenneth L. Rhone also known as named ,19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland h is last family. or priJipal residence at 101 North Prince Shippensburg l~~ (list street, number and muncipality) County, Pennsylvania, with Street, Apartment Ill; Decendent, then 81 years of age, died December 27 ,:If' 2000 , at VA Medical Center~artinsburg: Berkeley County; WeRt VirginiR Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Fa.) All personal property $ 5,000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioner(3) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters tes tamentary (testamentary; administration c. La.; administration d. b.n.c. La.) theron. 'Vw~ ~ ~ u u = u -.:I~ .- '" '" '-' u.... c.::~ -.:10 r::";:: t';S"= 3~ u'- EO OJ = 00 en ~~ Dana fl. Heberl g 5563 'Philadelphia Chambersburg, PA Avenue 17201 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } S8 COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~1~ Sworn to or a,ffirm ed and SUbS,Cribedi before me this 24th' day of ~NUARY ti:~ U1/(J~; I u<-j~>n(//2l -/ . I R~~W /6 -cJClQ< c? nIJN/) HE15l:(?LICd ~ liej' ;:s !::l .... $:: ill :s: ~o. 21-01-108 Estate of Kenneth L. Rhone , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JANUARY 25 ~~ 2001, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated December 13, 1990 described therein be admitted to probate and filed of record as the last will of Kenne th L. Rhone and Letters Testamentary VJf are hereby granted to Dana 1U. Heberlig Will Book # Page , (C;7 i ~/~;nl/a~ .. #AL)~~7 { ytg.ister of ills FEES Probate, Letters, Etc. ......... Short Certificates( ).......... x-pag~s. RenunCiatIOn ................ JCP $ $ $ $ 5.00 TOTAL _ $ 42.00 ... .-!~~~~~f. .~~? .~qQ.1............ 25.00 9.00 J.UU Jered L. Hock, Esquire (#19211) ATTORNEY (Sup. Ct. I.D. No.) 3211 N. Front St.; PO Box 5300 Harrisburg, PA 17110-0300 ADDRESS Filed (717) 238-8187 PHONE >...1 LAST WILL AND TESTAMENT 21-01-108 I, Kenneth L. Rhone, of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I give, devise and bequeath all of my estate of every nature and wheresoever situate to Dana Heber1ig, his heirs and assigns. ITEM III: I appoint Dana Heber1ig executor of this my Last Will and Testament. ITEM IV: I direct that my executor or his successors shall not be required to give bond for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on I sheets of paper, dated this 13 day of tt(Y~ ,1990. ~ ri d(,L~ Kenneth L. Rhone (SEAL) The preceding instrument, consisting of this and one other typewritten page, each identified by the signature of the testator, Kenneth L. Rhone, was on the day and date thereof signed, published and declared by Kenneth L. Rhone, the testator herein named, as and for his Last Will, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. &/to J W 4-'J J-, residing at l)~j/{ fA , ~ ~Jf- Me ~~ residing at fV.~ Pil- f !- L,_ ,,--... U.l- STATUS REPORT UNDER RULE 6.12 Name of Decedent: Kenneth L. Rhone Date of Death: 12/27/2000 Will No. 21-01-0108 Admin. No. Pursuant to Rule 6. 12 of the Supreme Court Orphans I Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 0 State whether administration of the estate IS complete: Yes X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 0 If the answer to No 0 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes X No b 0 The separate Orphans I Court No 0 (if any) for the personal representative I s account is : c . Did the personal representative state an X account informally to the parties in interest? Yes No d 0 Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans I Court and may be attached to this report 0 ~ Date. -1/2-0l 05 I Jered L. Hock. Esauire Name (Please type or print) 3211 N. Front St., PO Box 5300 Harrisbura PA Address en C::l (717) 238-8187 Tel. No 0 ..J.: L~~ (::) . Capacity : Personal Representative u.") (''o"j ,.- /: ~.. ~;: 6~~~ u X Counsel for personal representative _0-) U":) => = e,J ------ 17110-0300 ) > c ' -, \ Proof of Publication of Notice in THE NEWS-CHRONICLE COUNTY OF CUMBERLAND COMMONWEALlH OF PENNSYL VANIA NMWK Barbara C. Thompson, being duly sworn according to law, deposes and says that she is the editor of "The News-Chronicle", which is a bi-weekly newspaper of general circulation published in Shippensburg Township, Cumberland County, Pennsylvania, by The News-Chronicle Company, a corporation duly organized and existing under the laws of the Commonwealth of Pennsylvania having it's principle place of business at lOll Ritner Highway [p.O.Box 100], Shippensburg, Pennsylvania; that she is authorized to and does make this affidavit on it's behalf; that the printed notice, advertisement or publication attached hereto is the same as was printed in the regular editions & issues of "The News- Chronicle" on the following date(s): FEBRUARY 9,2001 FEBRUARY 16, 2001 FEBRUARY 23, 2001 Copy of Notice of Publication Affiant further deposes that neither she nor "The News-Chronicle" and The News- Chronicle Company have any interest in the subject matters of the aforesaid notice or advertisement, and that the fiu:ts set forth in the foregoing affidavit are true and correct. NOTICE " "/i.A/jlU",- ("-.,\)It~rL NOTICE Letters Testamentary in the Estate of Kenneth L Rhone, late of Borough of i ,Shippensburg, Cumberland County, Pennsylvania, de- . ceased, having been granted to the undersigned, all perllons . indebted to said estate are re- ,quested to make immediate 'payment and those having claims.to present them without ;d81ay to: ' Sworn and subscribed before me this 0~ day of -ti!44 ZOv / I Dana L, Heberlig, Executor 5563 Philadelphia Avenue Chambersburg, PA 17201 or Jered L. Hock, Esquire METZGER, WICKER- SHAM. KNAUSS & ERB, P.C. P.O. Box 5300 3211 North Front ~reet Harrisburg, PA 172110.0300 Notarial Seal Clayton l. ,Johnston/t, Notary Public J 9~ Shippensburg Twp. Cumberland County My Commission Expires Aug. 30, 2004 To: "THE NEWS-CHRONICLE" Shippensburg, P A 17257 For publishing the notice attached hereto: On the stated daters] ..... $ 54 _ 19 Affidavit ..... . . . . . . . . . $ 2 _ 0 0 Total ................. $ 56. 39 I ..... 4 .,.., 't. .. ~. f' " ;' / PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATEOFPENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: FEBRUARY 16,23, MARCH 2,2001 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true, Rhone. Kenneth L.. dec'd. Late of the Borough of Shippens- burg. Executor: Dana L. Heberlig. 5563 Philadelphia Avenue, Chambers- burg, PA 17201. . Attorneys: Jered L. Hock, EsqUIre. Metzger, Wickersham, Knauss & Erb, P.C.. P.O. Box 5300. 3211 North Front Street, Harrisburg. PA 17110-0300. ~ f Rogc!r M. Morgenthal, Editor - SWORN TO AND SUBSCRIBED before me this 2 day of MARCH, 2001 " SEAL LOIS E. SNYDeR, Notary Public Carlitl. Boro, Cumb4M1and County, PA My Commiaion fxpires March 5. 2001 .... .. /~-p(1(}5-? COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 sf.. c... September 27, 2001 Telephone (717) 787-3930 FAX (717) 772-0412 Law Offices of Metzger & Wickersham 3211 N. Front St. P.O. Box 5300 Harrisburg, Pa.1711 0-0300 Re: Estate of Kenneth L. Rhone File Number 2101-0108 Dear Mr Martineau: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before March 27,2002. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. _/ "- <~'"'- Sincerely, /'// /::...' /./.<7 .~ /.I'.,.,.....':..,I~' 1./ . . " ',', "",' _l . I oj ...}".'-~,i;;. "::...(/.//j/ }; -, ,i' . ]!........;.; ,.A:/, \.~ 1/ V ~,'"' Jeffrey D. Hollenbush, Supervisor Document Processing Unit Inheritance Tax Division STATUS REPORT UNDER RULE 6.12 r\ . tJv o~ .. .. Name of Decedent Date of Death Will No. 2001-00108 Kenneth L. Rhone December 27,2000 Admin No. 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 No. X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: March I, 2003 3. 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 X b. The separate Orphans' Court No. (if any) for the personal representative's account is: in interest? c. Did the personal representative state an account informally to the parties Yes No not vet d. Copies of receipts, releases, joinders and approvals of formal or informal :::unl' :::::'l~~ ~:o:e Clerk of ilie ~tt~hed 00 tlri, re~rt Name Jered L. Hock, Esquire Address 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 Telephone : I (717) 238-8187 Capacity: Personal Representative X Counsel for Personal Representative Document #: 247074.] ~ Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/05/2002 DANA HEBERLIG 5563 PHILADELPHIA AVENUE CHAMBERS BURG , PA 17201 RE: Estate of RHONE KENNETH L File Number: 2001-00108 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 will become delinquent on: 12/27/2002 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, MARY C. LEWIS REGISTER OF WILLS cc: JFile Counsel Judge STATE OF PENNSYL VANIA IN RE: ESTATE OF KENNETH L. RHONE IN THE PROBATE COURT: CUMBERLAND COUNTY ESTATE NO. 21-01-108 STATEMENT OF CLAIM 1. MBNA America hereby presents for filing against the above estate this statement of claim in the amount of $ 478.96. 2. The basis for the claim is MBNA account number 5490996252007898 which was opened on 11-6-92. 3. The tax identification number of the claimant is 510331454. 4. The name and address of the claimant is MBNA America, 1000 Samoset Drive, Wilmington, DE 19884. 5. This claim IS NOT contingent. 6. This claim IS NOT secured. 7. The last payment made on the account was $ 200.00 on 12-11-00. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. <} Executed this ~ day OfciJpA _ ,2001 NlCOL~~ Jvffi~ Claimant State Of Delaware, County of Kent IN WITNESS WHEREOF, I have set my hand and notarial seal this ,. 0!5 daYOf~ ,2001 DAWN M PEUGH NOTARY PUBLIC STATE OF DELAWARE MY COMMISSION EXPIRES ON 12112/02 My Commission Expires: \'d..\ \ d.. \ 0 d-- , X165-1 CUSTOMER INFORMATION SYSTEM 04/23/01 * 5490996252007898 * 11:09:33 KENNETH L*RHONE CURBAL: 560.24 CYCLE: 23 N 0000000000000000 C/O VANA*HEBERLIG CR LIN: 10600.00 STATUS: 5 CHANGED: 02/27/01 ***************************** DECEMBER STATEMENT ***************************** POST -------REFERENCE------- TRAN --------DESCRIPTION------- BC ---AMOUNT--- PAYMENTS AND CREDITS 1211 12110058112936 1210 PAYMENT - THANK YOU 200.00CR ***************************** DECEMBER STATEMENT ***************************** PREV BAL - $670.75 PAY + $200.00 SALE + $0.00 CASH + $0.00 F/C $8.21 = NEW BAL $478.96 PF10=PAGE FORWARD PF11=TRANSACTION SUMMARY ----- --- 4-@ 1 MBNAIS PF09=JANUARY STMT PF18=NOVEMBER STMT - - - --- ---- 192.168.14.20 PA1=BEGIN AGAIN 1 PA2=SYSTEM MENU IAD5 -- ---- --- ---- ----- 2/31 ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent Date of Death Will No.: 2001-00108 Kenneth L. Rhone December 27, 2000 Admin. No.: To the Register: I hereby 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 January 25, 2001 Name Address Dana L. Heberlig 5563 Philadelphia Avenue: Chambersburg, PA 17201 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: February S ,2001 { /-;- . -" A . __ LAJ~-/ I--v__.AJ-e ~.-( "SIgnature Name Jered L. Hock, Esquire Address 3211 North Front Street P.O. Box 5300 Harrisburg, P A 17110-0300 Telephone (717) 238-8187 Capacity: Personal Representative X Counsel for Personal Representati ve Document #: 196727.1 TYPE /PAlNT IN PE RMANENT BLACK INK WI:.::iT VIRGINIA DEPARTMENT OF HEALTH & HUMAN RESOURCES BUREAU FOR PUBLIC HEALTH - VITAL REGISTRATION PHYSICIANS I MEDICAL EXAMINER'S CERTIFICATE OF DEATH ROOM 165, 350 CAPITOL STREET, CHARLESTON, WV 25301 2-01-108 STATE FILE NUMBER 10 MARITAL STATUS Marned NeYer Maned. W'Idovo.oed. Di""ced (Speoly) DIVORCED I I SURVIVING SPOuSE (" wile. gtlfle meiden rane) LOCATION Of DEATH Martinsburg. 12a DECEDENT"S USUAl. OCCUPATION (Give '(Jncl 01 WOOf c1ale c1tIing mosl of 'IlI()rlUflg Iile Do '12! we retired.' 5c UNDER' DAY Hours MInutes I DECEDENT"SNAMElFiIst. Middle, Las1) Kenneth L. Rhone 4 SOCIAL SECURI1Y NUMBER 5b UNDER 1 YEAR Monlhs Days 204-03-6354 6 WAS DECEDENT EVlER IN U S ARMED FORCES? (Yes 01 no) o Inpatlen' o {R/Outpatoenl o Nutsmg Home o ReS<dence 9b FACILITY NAME (fI not lnsIilUtm, gtYe street and /'ltnIbe") VA Medical Center 133 RESIDENCE STATE 13b COUNTY LIFT OPERATOR 13c CITY. TOWN. OR LOCATION MECHANICS BURG NAVAL DEPOT 13d STREET AND NUMBER PA CUMBERLAND SHIPPENSBURG 101 N. PRINCE ST. APT. 111 13e INSIDE CITY LIMITS? (Yes or no) 13' liP CODE YES 17257 14 lNAS DECEDENT OF HISPANIC ORIGIN? (Specify No Of Yes-II yes.. speedy Cuban t..4e...l(an, Puerto RICan elc 1)P No 0 Yes Spec,,., Eleme!'"llar'1 iSecOnda1Y \0- '2\ l6A 11 18 MOTHERS NAME (Firs!, Middle, MalC1en SumWtJe) 15 RACE AmerICan Indian 81ac~ WhIle etc (Speedy) WHITE ~6 DECEOEN1" S EDUCATION (Speedy (X1/y "KJhest grade conf)leted I Col'iege (1.4 015.) 168 j7 FATHE::R'SNAME (FirS'. MldcJle. Last) ., . ROY H. RHONE ALVA J. MUMMERT 193 INFORMANTS NAME (Type/Print) DANA L. HEBERLIG 19b MAILING ADDRESS (SUffet ancJ Nlfl'bef Of Rural Roure N/fllber, City Of Town State Z/fJ Code) 5563 PHILADELPHIA AVE. CHAMBERSBURG PA 17201 20b PlACE OF DISPOSITION (Narne 01 cemere,y, CfM1iJtOfY. Of Olher place) ~U" lOCAnON ell, \)1 Tow" S',11f" o Buraal 0 CrematIOn 0 Removal from Slate IXl lX>na'oon 0 Of"'" {Spec,fy} 21 SIGNATURE OF FUNERAL SERVICE LICENSEE OR ~ PER~~ /n.~ HUMANITY GIFTS REGIS?ERY PHILADELPHIA, PA 8:00 p.. 22 NAME AND ADDRESS OF FACILITy FOGELSANGER-BRICKER F.H.112 W.KING ST. .0. BOX 336, SHIPPENSBURG, PA 17257 23b DATE SIGNED (Monfh, Day 'Yeil/l 12 27 2000 24 TIME Of DEATH 27 PART I Entel' the dtseas.es. 1000fles. Of c.omplicatlons that caused the dealh Do not enf€'+' the mode 01 dyIng, such as ca,dlac 01 respIratory arrest shock. or heart failure ust only one cause on each line Applo..male Interval 1 Belween Onsel and ,Death IMMEDIATE CAUSE (FIIlaI dISease or condfllon resulting ., death) ~ CARDIOPULMONARY ARREST $equenlialty lIst conditions. ~ any, leadinrJ to Imrneaale cause Enter UNDERLYING CAUSE Co.sease Of If'4Ury fhat Initiated eo.ents reSUltirq In death) LAST DUE TO (OR AS A CONSEQUENCE OF) CONGESTIVE HEART FAILURE DUE TO lOR IoS A CONSEQUENCE OFI DUE TO lOR IoS ~ CONSEOUENCE OFI d PART II ~ slOnilicanl CondltlOOS contrlbullng 10 death but not reSUltIng In the underlyll"'9 cause given In Pari I 2& WAS AN AUTOPSY PERfORMEO" (Yes Of no) 2Bb WERE AUTOPSY FINDINGS AVA.IL ABLE PRIOR TO COMPlE TION OF CAUSE OF OEAlt-\"'l fYes 01 no, NO 29 MANNER OF DEA.TH 3Ja DATE Of INJURY (Mortth, Day, Yew J 3)b TIME OF INJURY :n: INJURY AT WORK? (Yes or No) Xld DESCRIBE HOW INJURY OCCURRED }l[ HatUlal o Aceoden' 050"',"" o Hom"''''' 313 CERT\FIER 100ed< only one} o Pend'"!l lrweshgallQ(l .. .:))e. PlACE OF INJURY At home. larm streel. laclOl"V. office bullding_ etc (Speafy J :xJ1 LOCATION (Streel and Number Of P Jr,;Ji Route Number City I)r Town Slalel o .Could not be Determined CERTIFYING PHYSICIAN (PflysiciWl cetTifyrng cause 01 death ~ N'IOlhe, phy.sJc.an has plCYI(XI1Ced dearh and cOfT'pIe'eClltem 23) To the best of rtf'I k.now'eO;)e death occuned due 10 the ca~~s) and manner as slated o PRONOUNCING AND CERTIFY\NG PHY$tClAN (PhysK;.i.:wl bofh iXOf"IOtI'CIflg c1ealh and certtfYIflf) to C./IUSe of death) To lhe best of my knowtedge, death occurred at the lime. date, and place. and due 10 the cause{sl and manner as slated o MEDICAL E XMAINER/CORONER On the basis 01 examU1ahon and/(l( In~shgallQfl_ In my OpinIOn death occurred at the lime date. and place ar'\d due 10 lhe causelsJ and manr'ler <itS sl.dted JIb SIGNATURE AND TITLE OF CERTIFIER M.D. CfrJ !~ 'ffb '100(; 'A.rnmrnf JO ABP lIlX~S s~lIlIB;:)s pUB PUBlI Aill SS;:)Ul~A\ 'B~U~Zll~A lS;:)A\ 'uols;:)pmD 'lIlIB;:)H ~nqnd 10J nB;:)Jng ';:)~mo UO~lBllS~Zl;:)lI IBl!A ;:)llllll!M. P;:)lY plO~;:)l B JO Ado~ ~!l{dBlZlOlOl{d ;:)nll B S! ;:)AOqB ;:)l{llBlIl ~!ll;:)~ Aq;:)l;:)lI I i,dO:) 31 Y 1,-; ,__"""".~~,..,~.,_.......__.-____"""""'1""""_";~"""_'_ v FORM 93 - O. C. DIVISION IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION OF } } } } } } . 'I" IN RE: ESTATE No. 21-01-108 of 01 KENNETH L RHONE (Deceased) CLAIM To the Clerk of Orphans court Division: Index and make proper entry in your official records of the claim of ADV ANT AGE RECEIV ABLE SOLUTIONS for HOUSEHOLD FINANCE CORPORATION (Claimant), account # 71911100128428/ 00000, in the amount of $383.86 against the estate of the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended. The said decedent, who resided at 101 N PRINCE ST APT 111, SHIPPENSBURG, P A 17257, died on January 1, 01. Written notice of this claim was given to JEROD L HOCK, POBOX 5300/3211 N FRONT ST, HARRISBURG, PA 17110 (Personal representative, if any, orcounseI). March 14 , 2001 (Claimant) \ ADV AGE RECEIVABLE SOLUTIONS 1941 SOUTH 42ND STREET SUITE 380-25 PO BOX 6618 OMAHA, NE 68106-0618 800-999-3778 (Claimant's Address) \~ ..;-:::-: ~ \~\r~ 2 r.n6 'tV 6b Ii'o ~ g~ \ - 5~ 0 0 - ~8c ~ 0 ~ ~ ;;e ~ ~ ~~= = a ... Q,l u = ~ ,...1 1d - ~~.~ ... ~ 1 0 ';t. ~ - .0( ~ ~ 0 ~e . ~reB $ - c--l ~ ~ <3 ~ ~ ~ w9 Ii'o z ~g ~ ~~ g "i Q~ - .~ Ii'o ,. . STATE OF PENNSYLVANIA IN RE: EST ATE OF KENNETH L. RHONE IN THE REGISTER OF WILLS COURT: CUMBERLAND COUNTY EST ATE NO. 21-01-108 STATEMENT OF CLAIM 1. MBNA America hereby presents for filing against the above estate this statement of claim in the amount of $ 486.34. 2. The basis for the claim is MBNA account number 5490 9962 5200 7898 which was opened on 11/06/1992. 3. The tax identification number of the claimant is 510331454. 4. The name and address of the claimant is MBNA America. 655 Paper Mill Road. Newark. DE 19713. 5. This claim IS NOT contingent. 6. This claim IS NOT secured. 7. The last payment made on the account was $ 200.00 on 12/11/2000. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. ~ ,2001_ Claimant State Of Delaware, County of KENT IN WITNESS WHEREOF, I have set my hand and notarial seal this d \.ociay of ~ ' 2001_ DAWN M PEUGH NOTARY PUBLIC STATE OF DELAWARE MY COMMISSION EXPIRES ON 12 0J~ot~pu?~ih My Commission Expires: \ d.-\ \ 2. ~ \ 0 L .... , X165-1 CUSTOMER INFORMATION SYSTEM 04/26/01 * 5490996252007898 * 09:55:59 KENNETH L*RHONE CURBAL: 560.24 CYCLE: 23 N 0000000000000000 C/O VANA*HEBERLIG CR LIN: 10600.00 STATUS: 5 CHANGED: 02/27/01 ***************************** JANUARY STATEMENT ***************************** POST -------REFERENCE------- TRAN --------DESCRIPTION------- BC ---AMOUNT--- PURCHASES AND ADJUSTMENTS 0127 00000000000000 0127 LATE CHARGE FOR PMT DU A REMINDER: IF YOU MISS TH DATE, YOU WILL LOSE THE PR RATE ON CATEGORY A. AS A COURTESY WE DID NOT CHANGE TIME. C 29.00 .00 .00 .00 .00 .00 ***************************** JANUARY STATEMENT ***************************** PREV BAL - PAY + SALE + CASH~~ M- LATE $478.96 $0.00 $0.00 $0.00 $7.38 $29.00 PFIO=PAGE FORWARD PFll=TRANSACTION SUMMARY 4 -(e) 1 MBNAI S PF06=FEBRUARY STMT PF15=DECEMBER STMT 192.168.16.20 PA1=BEGIN AGAIN 1 PA2=SYSTEM MENU HA3L WDA43T13 2/31 - \ J / _ 10C"1 L,-_ P /~ ~~____ c' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN JERED L HOCK ESQ METZGER WICKERSHAM PO BOX 5300 HBG '02 :'::4 !'\i,'{ 1 {] \" Pf\;t.l~UO 05-06-2002 RHONE 12-27-2000 21 01-0108 CUMBERLAND 101 '* REY-1547 EX AFP <01-021 KENNETH L Allount Rellitted ) CHANGED ll) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 5.683.00 .00 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is4j-ix--AFP--foY=02Y-No'Tici--OF-YNHiififANcr'TAstA"PPRAIsiMiNT~--Ai:.LowANcE-ori----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RHONE KENNETH L FILE NO. 21 01-0108 ACN 101 DATE 05-06-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due X CR TS: NOTE: DATE + INTEREST/PEN PAID (-) NUMBER . IF PAID AfTER DATE INDICATED, SEE REVERSE FOR CALCULATION Of ADDITIONAL INTEREST. (9) 1l0) 3,996.00 32.457.00 NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax paYllent. 5,683.00 (11) (12) (13) (14) 36.452.00 30,769.00- .00 30,769.00- .00 X .00 X .00 X .00 X AI10UNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 (19)= .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)