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Home My WebLink About03-0638PETITION FOR PROBATE and GRANT OF LETTERS Estate of Evelyn M. Hackenberg also known as Social Security No. Deceased. 181-03-99~0 To: Register of Wills for the County of Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who i~/are 18 years of age or older an the execut rices in the last will of the above decedent, dated June 1 in the named ,19 70 spouse, Russell S. Hackenberg, died 12/28/00. (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at Sarah A. Todd Memorial Home. 1000 West South Street, Carlisle: Carlisle Borough, Cumberlmnd an,m~-y: Ponn~ylv~n~ (list street, number and muncipality) Dece~de,t, then 91 years of age, died July 3 , I~, at_Sarah A. Todd Memorial Home, 100 W. South St., Carlisle, Pennsylvania . Except a.s 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: spouse, Russell S. Hackenberg, died 12/28/00. Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 8,000.00 (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(s) respectfully presented herewith and the grant of letters theron. request(s) the probate of the last will a~txx~.ki~6~r testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~nlriey~ac~en~erg. O~chalc cz/fa ~. ~z~z~r Shirley L. Do~ha"R ' 0earn Hac~en~erg-Orne~ a/k/a Jfi~n H.' Orner 215 Franklin Street P.O. Box 247 Fairfield, PA 17320 Arendtsville, PA 17303 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss 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. Sworn to or affirmd and subscribed ~r ..... ,h~ ~ ~ .... r ~ Shirley ~ac~enberg Oonchak a/~ ~- / / ~ ~ t~i ~2003 ' O Jean H. Orner No..Jt-o - b3 Estate of Evelyn M. Hackenberg , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof,' satisfactory p~f having been presented before me, IT IS DECREED that the instrument(s) dated June 1. 1970 described therein be admitted to probate and filed of record as the last will of Evelyn M. Hackenberg and Letters Testamentary are herebygrantedto Shirley Hackenberg Donchak a/k/a Shirley L. Donchak and Jean Hackenberg Orner a/k/a Jean H. Orner ~ (~LtxO~t,%~-~ ~ 1~2003 , in consideration of the petition on FEES Probate, Letters, Etc .......... $ Short Certificates(3) .......... $ ' _I~.~_.M~J.C~. F.e.e. ........ $ Extra pages of Will $' Filed 40.00 9.00 10.00 3.00 TOTAL __ $ 62.00 ....'~:.~. :~.cx>.3 ................... - k RcgisterotWilO'O- U ~ Gregory L. Kiersz 21928 ATTORNEY (Sup. Ct. I.D. No.) 239-B East Main Street, Waynesboro, PA 17268 ADDRESS 717-762-3170 PHONE REGISTER,OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS codic~~~~..~ ' (each) a subscribing ~ to the will ~erewith, (each)'b~,~uly qualified according to law, depose(s)and say(s)th~~,~,~ ~resent and saw, th~__, s~at ~ signed as]t~ess at the request of tes-t~rt~ in h_~ presence and ~he presence of each other) (in the presen of the other subscribing ~ ~ Sworn to or affirmed and subs'br, ibed before '~x me this,~ day of "~Name) ,9__ 'x. ~ __ (Addre Register ! (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OAT I OF NON-SUBSCRImNG WITNESS qt- t>_a- Shirley L. Donchak and Jean H. Orner , (each). a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Evelyn M. Hackenberg , testatrix of ~a:ffx~l~rx~qa~m, ilMalgxaM~x/~) the will presented herewith and that they believes the signature on the will is in the handwriting of testatr J.x - _ I_l to the best of ~ knowledge and belief. Sworn to or affirmed and subscribed before me this L~q% day of Jn~l~C~~ 31312003 ~.n~O~ ~ ~~egister Shirley L~ Doncbgk . 215 Franklin St{~e~ Fairfield, PA 17320 (Address) dea~ H. Or~er -- P.O. Box 247 (Name) Arendtsville, PA 17303 (Address) 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. Fee for this certificate, $2.00 ,, Local Registrar P 4 4 s 1 o g No. ~ Date H 105.~43 Rev 2/87 lINT {iNT COMMONWEALTH OF PENNSYLVANIA · DEPARTMEN'I' OF~ HEALTH · VIRAL RECORDS CERTIFICATE OF DEA'I]H ,. Evelyn M. Hackenbe_rg ,. fcmate[,. 181 _05 _9940! ~u~ ~,~0~ ' s. : : /23/1912 Peach G~e~, PA .... Laborer .... Fruit Processor I,,- p -- I ('"~'+' I,, widowed ACTU~ l/a. aa~e ennsylvanra ~ ,t..~ m.~ I Car~iste, PA 17013 (~ ,... ~. J~an h. Orn~r ~.Box 247 Ar~ndtsvZ~ PA 17303 ~s~s,,~. I°~s~'~ I~C~S~T~"'"--~ ~ ........ ........ It~.-C~ ~.,. ~ B~M~ Cr~at~ R~f~a~l~ (M~.Oay.~) ~ , · ~'~' /(', v I~, _ ~ ~o ~ · .Z . ,Z~ I ~ ~ ~/1~-~ I(~.~.~, m I~- I~. u. I~. I~, of Evelyn M. Hackenberg KNOW ALL MEN BY THESE PRESENTS, that I, Evelyn M. Hackenberg, R.D.#2, Gardners, Pennsylvania, being of sound and disposing mind and memory do hereby make this my last Will and Testament, revoking all Wills and Codicils by me at any time heretofore made. First: I direct that all my just debts, funeral expenses, and testamentary expenses, including headstone expenses, be paid, as soon after my death as may reasonably be done. Second: If my husband survives me by thirty (30) or more days. I give, devise and bequeath unto him all of my estate of whatever nature and wheresoever situate~ Third: If my husband predeceases me or dies within thirty days of my death, I give, devise and bequeath all of my estate of whatever nature and wheresoever situate, in equal shares, unto my daughters, Shirley Hackenberg Donchak and Jean Hackenberg Orner or to their issue per stirpes. Forth: If my husband and I die under circumstances from which it does not appear otherwise than that we died simultaneous] I shall presumed to have predeceased my husband. Fifth: I name, constitute and appoint as guardian of all beneficiaries, under this my last Will and Testament, who may not be sui juris by reason of infancy or otherwise, my daughters Shirley Hackenberg Donchak and Jean Hackenberg Orner or the survivor of them, I authorize said guardian or guardians to receive and retain assets in kind, whether income producing or not, and to invest and reinvest the corpus of any beneficiary's share, plus accumlated income, if any, in such investment as they or the survivor of them deem advisable, and to expend corpus and income in such portions, amounts and at such times as they or the survivor of them, deem advisable for the welfare, maintenence, comfort, education and support of said beneficiary. Sixth: I name, constitute and appoint as co-executrices under this my last Will and Testament, my daughters Shirley Hackenberg Donchak and Jean Hackenberg Orner or the survivor of them with full power and authority to sell, lease, mortgage, pledge, encumber and otherwise deal in or with all property, real, personal or mixed, which may be a part of my estate, at whatever terms and conditions as they or the survivor of them deem advisable. IN WITNESS THEREOF, I hereunto set my hand and seal this day of , 'I9~. elyn' M.' ~ackenberq~ Signed, sealed, published and declared by Evelyn M. Hackenberg, the above named Testatrix, as and for her last Will and Testament, in our presence, and we, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses this~~-~ day of~_~ in the year of our Lord, 1~? U VI NVA-IA$ N N':lcl ' ~)~:1 ri S SA.L.L:~ ~> ~!u~AI~SUU~d 'S~aup~ ~0 ~aqu~o~H '~ UfilaAH ~0 '~- 0~'~: fO. 239-B East Main Street Waynesboro, PA 17268-1681 (717) 762-3170 Telefax (717) 762-0988 TTERSON & KIERSZ, P.C. ATTORNEYS AT LAW Toil Free 800-261-1194 E-mail: pklaw~pattersonandkiersz, com 20 West Baltimore Street Greencastle, PA 17225-1408 (717) 597-3180 Telefax (717) 597-5121 Stephen E. Patterson Gregory L. Kiersz R. Thomas Murphy March 31, 2004 Attn: Register of Wills Office Cumberland County Court House Hanover and High Street Carlisle, PA 17013 Re~ Evelyn M. Hackenberg Estate 21-03-0638 Dear Sir or Madam: Please find enclosed herewith two original copies of the Pennsylvania inheritance tax return, original Inventory, check in the sum of $25.00 representing filing and probate charges, check in the sum of $291.00 representing inheritance tax due, and status report. Would you please file the enclosed and return the receipts back to our office in the enclosed self-addressed, stamped envelope. Thank you for your assistance in this matter. Sincerely, PATTERSON & KIERSZ, P.C. GLK/bah Enclosures 60: Id t-8d~/ ~. 0648 1 04 7268 ~ '-'- ~B~?00~ ~'00-60° ~A~ ~0 0~ 3 I 02 ~NA~ESBORO. PA 17268 First Class Mail & KIERSZ, RC. -:YS AT LAW MAIN STREET ), PA 17268-1681 'LS OFFICE ~ COURT[lOUSE 0~3 REV-1500 EX (1~-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0001 REV-1 500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Z -=rg Evelyn M ~1'i'1 DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) oud 7/3/2003 I 4/23/1912 LU IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 21 -- 03 0638______ _ COUNTY CODE YEAR NUMBER ~-J 1. Original Return r~4. Limited Estate ~ §. Decedent Died Testate (Attach copy of Will) SOCIAL SECURITY NUMBER 181-03-9940 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER J I 2, Supplemental Return ~]4a. Future Interest Compromise (date of death after 12-12-82) ~] 7. Decedent Maintained a Living Trust (Attach copyof Trust) I 3. Remainder Return (data of death prior to 12.13.8 ~ 5. Federal Estate Tax Return Required n 8. Total Number of Safe Deposit Boxes (~ ~ 9. Litigation Proceeds Received ~ 10. Spousal PoverW Credit (date of death b ..... 12-31-9, .nd 1-1-95) ~'] 11. Election to tax under Sec. 9113(A) (Att.ch S,'h t- 3 N MUS~:BE: C~MPr~E~E Di :AL~ C0R RF~P ON DEN ~E AN D: C~N~iD~ Ni~i~:i~A~:ij NFb RMA¥i~ ~ ~ h b b ~ B E: Dl R E ~E D ~bi :i: ::: :: Z O 0 NAME ~ COMPLETE MAILING ADDRESS L. Kiersz 239-B East Main Street FIRM NAME (If Applicable) Waynesboro, PA 17268-1681 & Kiersz, P.C. TELEPHONE NUMBER -3170 Z 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) §. Jointly Owned Property (Schedule F) (§) ~'~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 0 7,336 0 78,500 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) 3. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (8) 1,587 (11) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) OFFICIAL USE ONLY 85,836 1,587 84,249 0 84,249 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 5. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 911§ (a)(1.2) 1§. 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 20. 0 x.o 0.0,,(15)n 84,239 x.O 45 (16) 0 x .12 (17) 0 x .15 (18) (19) 0 3,791 0 0 3,791 HASPXXNUMBER Decedent's Complete Address: STREET ADDRESS Sarah A. Todd Memorial Home Cumberland CITY ] STATE ZIP Carlisle I PA 17013- Tax Payments and Credits: 1. TaxDue (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 0 3,325 175 0 0 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) (1) 3,791 3,500 0 0 291 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 0 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 291 Make Check Payable to: REG/STER OF W/LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... [----] ~-~ b. retain the right to designate who shall use the property transferred or its income; ......... [----} c. retain a reversionary interest; or ................................ m~ m~ d. receive the promise for life of either payments, benefits or care7 ................. ~ m-~ 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration7 ............................ ~--~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. /,ON RESPONSlBJ~ FOR FILING [~ETURN DATE ADDRESS ~- U 215 Franklin St., Fairfield, PA 17320 P.O. Box 247, Arendtsville, PA 17303 SIG~ DATE March .~/, 2004 239-B East Main Street /~ Waynesboro, PA 17268-1681 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on tho net value of transfers to or for the use of the surviving spouse is 3% [72 P.S.§ 9916 {a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 911 § (a) ( 1.1 ) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 911§(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.596, except as noted in 72 P,S. § 9116( 1.2) [72 P.S. § 911 §(a)( 1 )]. 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. § 911 §(a)( 1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. HASPXXNUMBER REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANI( DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Evelyn M. Hackenberg 21 03 0638 Include the Proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi must be disclosed on Schedule ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Adams County National Bank Checking Account No: 604496 iHighmark Blue Shield, refund 7,100 236 7,336 TOTAL(AIsc enter on line 5, Recapitulation) HASPXXNUMBER (If more space is needed, insert additional sheets of the same size) REV-1510 EX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Evelyn M. Hackenberg 21 03 0638 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 SHEEI is yes. DESCRIPTION OF PROPEHiY % OF ITEM INCLUOE THE NAME OF THE TRANSFEREE. THEIR RE~TIONSHIP TO DATE OF DEATH DECD'S EXCLUSION NUMBER DECEDENT AND THE DATE OF TRANSFER, ATTACH A COPY OF THE TAXABLE VALUE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST CF APPLICABLE) 1. Cash gift check no: 2588, dated 7/19/02 to daughter, Shirley Donchak, attached 10,500 100.000 3,000 7,500 2 Cash gift check no: 2611, dated 1/10/03 to grandson, Jim Orner, attached 20,000 100.000 3,000 17,000 3 Cash gift check no: 2612, dated 1/10/03 to daughter, Jean H. Orner, attached 10,000 100.000 3,000 7,000 4 Cash gift check no: 2613, dated 1/10/03 to daughter, Shirley L. Donchak, attached 10,000 100.000 3,000 7,000 5 Cash gift check no: 2619, dated 3/13/03 to grandson, Jim Orner, attached 20,000 100.000 0 20,000 6 Cash gift check no: 2620, dated 3/13/03 to daughter, Jean H. Orner, attached 10,000 100.000 0 10,000 7 Cash gift check no: 2621, dated 3/13/03 to daughter, Shirley L. Donchak, attached 10,000 100.000 0 10,000 TOTAL(Alsoenteronline7, Recapitulation) $ 78,500 (If more spaceis needed, insertadditionalsheets ofsame size.) HASPXXNUMBER REV-'1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Evelyn M. Hackenberg 21 03 0638 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: 5. 6. 7. DESCRIPTION ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Patterson & Kiersz ~ P.C. 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 Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) HASPXXNUMBER (If more space is needed, insert additional sheets of same size) AMOUNT 1,500 87 REV-1513 EX+ (9-O0) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Evelyn M. Hackenberg 21 03 0638 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLEDISTRIBUTIONS[includeoutrightspousaldistributions, andtrans~rs underSec. 9116(a)(1.2)] Shirley H. Donchak 215 Franklin Street Fairfield, PA 17320 Jean H. Orner P.O. Box 247 Arendtsville, PA 17303 Daughter Daughter 1/2 Residue Per Item THIRD of LW&T 1/2 Residue Per Item THIRD of LW&T ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ HASPXXNUMBER (If more space is needed, insert additional sheets of the same size) of Evelyn M. Hackenberg KNOW ALL'MEN BY THESE PRESENTS, that. I, Evelyn M.. Hackenbe~g, R.D.#2, Gardners, Pennsylvania, being of sound and disposing, mind and memory do hereby make this my last Will and Testament, revoking all Wills and Codicils by me at any time heretofore made. First: I direct that all my just debts, funeral expenses and testamentary expenses, including he.ads,one expenses, be paid, as soon after my death as may reasonably be done. Second: If my husband survives me by thirty (30) or more days. I give, devise and bequeath unto him all of my estate of Whatever nature and wheresoever situate Third: If my~ husband predeceases me or dies within thirty days of my death, I give, devise and bequeath all of my estate of whatever nature and wheresoever situate, in equal shares, unto my daughters, Shirley Hackenberg Donchak and Jean Hackenberg Orner or to their issue per .stirpes. Forth: If my husband and I die under circumstances from which it does ~ot appear otherwise than that we died simultaneousl I shall presumed to have predeceased my husband. Fifth: I name, constitute and appoint as guardian of all beneficiaries, under this my last Will and Testament, who may not be sui juris by reason of infancy or otherwise, my daughters Shirley Hackenberg Donchak and Jean Hackenberg Orner or the survivor of them, I authorize said guardian or. guardians to receive and retain assets in kind, whether income producing or not, and to invest and reinvest the corpus of any beneficiary's share, plus accumlated income, if any, in such investment as they or the survivor of them deem advisable, and to expend corpus and income in .such portions, amounts and at such times as they or the survivor of themr deem advisable for the welfare, maintenence, comfort, education and support of said beneficiary. Sixth; I name, constitute and appoint as co-executrices under this my last Will and Testament, my daughters Shirley Hackenberg Donchak and Jean Hackenberg Orner or the survivor of them with full power and authority to sell, lease, mortgage, pledge, encumber and otherwise deal in or with all property, real, personal or mixed, which may be a part of my estate, at whatever terms and conditions as they or the survivor of them~ deem advisable. I~WITNESS THEREOF, I hereunto set my hand and seal this day ' ~',J~'~ - · (SEAL) Signed, sealed,.published and declared by Evelyn M. Hackenberg, the above named Testatrix· as and for her last Will and Testament, 'in our presence, and we, at her request, in her presence and in the presence of each other, have hereunt6_ subscribed our names as witnesses this~ _ day o~--~ in the year of our Lord, 19~? EVELYN HACKENBERG P. O. BOX 247 149 FOHL STREET ARENDTSVILLE, PA 17303 ORDER OF ~ NATIONAL BANK GE'FI~SBURG, PENNb~YLVANIA 2588 0 r= o,,, t, L, q,,, r=,, ~S88 EVELYN HACKENBERG 261 1 P. O. BOX 247 149 FOHL STREET 60-994/313 ARENDTSVILLE, PA 17303 ~,/~"~;~ ~'-'~ DAI~ BRANCH3 ORDER OF ~ ADAMS COUNIY - NATIONAL BANK EVELYN HACKENBERG P. o. Box 247 2612 ' 149 FOHL STREET 60-994/313 ARENDTSVILLE, PA 17303 '/"~'~/~:~ ~3 DATE BRANCH0 PAY TO TI-IB ORDER OF ADAMS COUNIY NATIONAL BANK GE'I'FYSBURG, PENNSYLVANIA DOLLARS ~-'O~. ],~.Dqq[.S~-' OP.O..,ht.q,,,P,,' PF= ], P EVELYN HACKENBERG 2613 P. O. BOX 247 149 FOHL STREET ARENDTSVILLE, PA 17303 60-994/313 ADAMS COUNTY DOLLARS oo,,,,, 0. NATIONAL BANK GETr'YSBURG, PENNSYLVANIA ~-'O:~l,=,OqqhS'-' OP.O,,,hhq,,,F.,' ~F= ~:~ p.EVo.ELYN HACKENBERG ........ ' ........... -~ · . BOX 247 2620 149 FOHL STREET ARENDTSVILLE, PA 17303 -- 60-994/313 NATI~ B~K EVELYN HACKENBERG P. O. BOx 247 149 FOHL STREET ARENDTSVILLE, PA 17303 2621 60-994/313 BRANCH 3 NATIONAL BANK GEFFYSBURG, PENNSYLVANIA m:OS~SOqq~Sm: O ~0,,, h h q,,, ~mm' Register of Wills of County, Pennsylvania INVENTORY Estateof Evelyn M. Hackenberg No. 21-03-0638 also known as Date of Death July 3 ~ 2003 , Deceased Social Securi~7 No. 181-03-9940 Jean Hackenberg Orner a/k/a Jean H. Orner and Shirley Hackenberg Donchak a/k/a Shirley L? Donchak Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate end all of the real estate in the Commonwealth of PennSylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no mai estate outside of the Commonwealth of Pennsylvenia except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understend that false statements herein are made subject to the penalties of 18 P-~ C.S. Section 4904 relating to unswom falsification to authorities. ARomey . Gregory L. Kiersz Jea~ H~ Orner Y · o~nchak Address: 239-B East Main Street Dated Marc~ I. 2004 Waynesboro, PA 17268-1681 ~lephone: 717-762-3170 Description Adams County National Bank Checking Account No: 604496 Highmark Blue Shield, refund TOTAL INVENTORY AND APPRAISEMENT OL: £~ L-~TdT/ 170. (Attach additional sheets ff necessary) Total: 7,100.00 236.00 $7,336.00 NOTE: The Memorandum of real estate outside the Commonweaith~of Pennsylvania may, at the election of personal rep- resentative, include the value of each Item, but such figures should not be extended into the total of the Inventory. ,COMM(~NWEALTH 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 003748 KIERSZ GREGORY L ESQUIRE 239-B EAST MAIN STREET WAAYANESBORO, PA 17268 ........ fold ESTATE INFORMATION: SSN.' 181-03-9940 FILE NUMBER: 2103-0638 DECEDENT NAME: HACKENBERG EVELYN M DATE OF PAYMENT: 04/01/2004 POSTMARK DATE: 03/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $291.00 REMARKS: SEAL CHECK# 000995 TOTAL AMOUNT PAID' $291.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No. Evelyn M. Hackenberg July 3, 2003 Admin. No. 21-03-0638 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of tile administration of the above-captioned estate: State whether administration of the estate is compleke: 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. 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: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of ~eceipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date:March ~, 2004 fgn'~ture Gregory L. Kiersz Name (Please type or print) 239-B East Main Street, Waynesboro, PA 17268 Address 60: L d L-8d'd (MAH: rmf/AM3) ;:' ,( 717 ) 762-3170 Tel. No. Capacity: __Personal Representative X __Counsel for personal representative BUREAU OF ZNDZVZDUAL TAXES /NHERZTANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17128-0601 GREGORY L KIERSZ PATTERSON & KIERSZ Z$9-B E MAIN ST WAYNESBORO COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX pA 17268 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REV-1547 EX AFP (01-OS) 05-17-200q HACKENBERG EVELYN M 07-03-2005 21 05-0658 CUMBERLAND 101 Amount Remitted I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THiS LZNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HACKENBERG EVELYN MFILE NO. 21 05-0658 ACN 101 DATE 05-17-200q TAX RETURN WAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE iNTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Ram1 Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits~Misc. Personal Property (Schodula E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTZONS: 9. Funeral Expensos/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Dmbts/Mortgagm Liabilitims/Limns (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) Not Value of Estate Subject to Tax 7/336.00 .00 NOTE: To insure proper .00 credit to your account, .00 submit tho upper portion .00 of this form with your tax payment. .00 78/500.00 (8) 1,587.00 .00 NOTE: 85,836.00 (11) 1 .~87. (1o (12) 8q,Zq9. O0 (13) . O0 (lq) 8q,Zqg. O0 Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. 18 and 19 will (15) .00 x O0 = .00 (16) 8q,Zq9.00 x Oq5= 3,791.00 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (lg)= ~,791.00 ASSESSMENT OF TAX: 15. Amount of Line lq at Spousal rata 16. Amount of Line lq taxable at Lineal/Class A rata 17. Amount of Line lq at Sibling rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT U1$COUNT (+) BATE NUMBER INTEREST/PEN PAID (-) 08-22-2005 CDOO29ql 175.00 0~;-$0-200q CD0057~8 .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID 3,325.00 291.00 TOTAL TAX CREDIT [ BALANCE OF TAX DUE iNTEREST AND PEN. TOTAL DUE 5,791.00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOT[CE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S. Section 91q0). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT REFUND (CR): A refund of a tax credit, which mas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available et the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special 2fi-hour answering service for forms ordering: 1-B00-562-Z050; services for taxpayers with special hearing end / or speaking needs: 1-800-~7-30Z0 (TT only). OBJECT[OHS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171za-10Z1, DR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADNZN- [STRAT[VE CORRECTIONS: DXSCOUNT: PENALTY: INTEREST: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 17126-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. Xf any tax due is paid within three (3) calendar months after the decedent's death, a five percent (Si) discount of the tax paid is allowed. The 1Si tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time 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 free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .00016q. A11 taxes which became delinquent on and after January 1, 1982 wiX1 bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: Interest Daily Interest OaiXy Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor. /'~ 20X .O00Sq~ ~)'~'8-1991 11Z .000301' ~ 9Z .OOOgq7 1983 16Z .000q38 1992 9Z .0002~7 200Z 6Z .00016~ 198q 11Z .000301 1993-199~ 7Z .OOO19Z ZOO3 51 .000137 1985 132 .000356 1995-1998 9Z .0002fi7 200~ qZ .000110 1986 102 ,oooz7q 1999 72 .oooxez 1987 lOX .o00zTq ZOO0 7X .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. 239-B East Main Street Waynesboro, PA 17268-1681 (717) 762-3170 Telefax (717) 762-0988 PA TTERSON & KIERSZ, p.C. .4 TTORNEYS /1T L.4 W Toll Free 800-261-1194 E-mall: pMaw~pattersonandMersz, com 20 West Baltimore Street Greencastle, P.4 17225-1408 (717) 597-3180 Telefax (717) 597-5121 Stephen E. Patterson Gregory L. Kiersz R. Thomas Murphy July 24, 2003 LETTER OF INTRODUCTION Register of Wills Office Cumberland County Courthouse Hanover & High Streets Carlisle, PA 17013 Re: Evelyn M. Hackenberg Estate Dear Sir or Madam: This letter of introduction is on behalf of Shirley L. Donchak and Jean H. Orner who desire to be sworn in as the executrices of their mother's estate. ' They have with them an original Will, Death Certificate, an original Petition and Non- Subscribing Witness Statement, Estate Information Sheet, together with the attached check in the amount of $62.00 representing the required fees based on $8,000.00 in assets. After both Shirley L. Donchak and Jean H. Orner have been sworn in as the executrices of the Hackenberg estate, would you please issue me 3 short certificates of administration and mail them to the above Waynesboro office address. Thank you for your assistance in this matter. Sincerely, GLK/bah Enclosures PAI-FERSON & KIERSZ, P.C. 239-B East Main Street AI-I'ORNEYS AT LAW 2.0 West Baltimore Street Waynesboro, PA 17268 Greencastle, PA 17225 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Administration No: Evelyn M. Hackenberg July 3, 2003 21-03-0638 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on August 7, 2003. Name and Address: Jean H. Omer P. O. Box 247 Arendtsville, PA 17303 Shirley L. Donchak 215 Franklin Street Fairfield, PA 17320 Notice has now been given to all persons entitled thereto under Rule 5.6(a) without exceptions. Dated: August 7, 2003 239-B East Main Street Waynesboro, PA 17268-1681 717-762-3170 239-B East Main Street Waynesboro, PA 17268-1681 (717) 762-3170 Telefax (717) 762-0988 PA TTERSON & KIERSZ, P.C. ATTORNEYS AT LAW Toll Free 800-261-1194 E-mail: pklaw~pattersonandkiersz, com 20 West Baltimore Street Greencastle, PA 17225-1407 (717) $97-3180 Telefax (717) 597-5121 Stephen E. Patterson Gregory L. Kiersz R. Thomas Murphy August 20, 2003 Attn: Register of Wills Office Cumberland County Court House Hanover and High Street Carlisle, PA 17013 Re~ Evelyn M. Hackenberg Estate 21-03-0638 Dear Sir or Madam: Please find enclosed herewith a check in the sum of $3,325.00, which represents prepayment of inheritance tax on the Hackenberg Estate. Please mail back to me in the enclosed self-addressed, stamped envelope, receipt of payment. Thank you for your assistance in this matter. Sincerely, PATTERSON & KIERSZ, P.C. EnclosUres cc: Jean H. Orner Shirley L. Donchak W:\XW~DOCS~Estate~Hackenberg, Evelyn IVI~R&R Cumberland County ltr..do~ PATTERSON ~/; I~IERSZ~ P.C. ATTORNEYS AT LAW 239-B East Main Street Waynesboro, PA 17268-1681 Attn: Register of Wills Office Cumberland County Courthouse Hanover & High Street Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0801 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002941 PATTERSON & KIERSZ PC 239-B EAST MAIN STREET WAYNESBORO, PA 17268-1681 ........ fold ESTATE INFORMATION: SSN: 181-03-9940 FILE NUMBER: 2103-0638 DECEDENT NAME: HACKENBERG EVELYN M DATE OF PAYMENT: 08/25/2003 POSTMARK DATE: 08/22/2003 CUMBERLAND COUNTY: DATE OF DEATH: 07/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 93,325.00 TOTAL AMOUNT PAID: $3,325.00 REMARKS: PATTERSON & KIERSZ PC SEAL CHECK# 000703 INITIALS: DO RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS