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Home My WebLink About02-0338Mar 19 02 02:37p Brinser Wa~ner &Zimmerman (?171838-6912 p. 1 M/~R'r' "' LEWrS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS Esta,',e o? ORPHA H. KIBLER No. 21 also known as , Deceased ROBERT R ECKERT AND JANET E. BLACK Petitioner(s), who is/are 18 years of age or older apl~y)ies', for: Social Security No. 179-07-3529 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ~ named in the Last Will of the [~] Decedent, dated 11/10/92 and codicil(s) dated N/A RUTH E. ENGLE IS RENOUNCING IN FAVOR OF JANET E. BLACK. Except as follows, Decedent did not marry, was not divorced and did not have a child borl or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (ct.a., db.n.c.t.a: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets If necessary. Decedent was domiciled at death in CUMBERLAND Cou~)ty, Pennsylvania, with his/her last family or principal residence at MESSIAH VILLAGE~ 100 MT. ALLEN DR., UPPER ALLEN TWP., MECHANICSBURG, PA (list street, number and muni;ipelity) Decedent, then 89.~._~ years of age, died MARCH 5 ,2002 _, at MESSIAH VILLAGE, MECHANICSBURG, PA Decedent at death owned property with estimated values as follows: (Location) (if domiciled in PA All personal property ....................................... $ ../.~ ~'~ ~) ~ ~ (if not domiciled in PA Personal property in Penr.$ylvanla .................... $... '"'~'--' (if not domiciled in PA Personal property in Cour,ty ........................ $ ------- Value of real estate in Pennsylvania Total Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: i. Signature Typed or printed name and residence Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and 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 representative(s) of the Decedent, Petitioner(s)will well and truly administer the ~t~.. Sworn to and affirmed and subscribed · ' ROBERT R. ECKERT before me this 19TH day of ~ MARCH, 2002,,n ' ' ~ ~-~J.~,~'~ c'(~ MARY C__ ~EWIS Y ~, DECREE Of REGISTER Estate of ORPHA H. KIBLER Deceased No. ?,1 02 also known as F.K.A. ORPFLA H HEIS~qYr Social Security No: 179-07-3529 Date of Death: AND NOW, APRIL~ 2002 , , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 1~ Testamentary 1~ of Administration Ar)MTNISTRA?ION C.?.A. ((c.I a., (LQn.c.t.; pende~l~b; durante~sentla; d'd~a~ minoriate) are hereby granted to gOBERT R ECKERT AND JANET E BLACK ~ in the above estate and that the instrument(s), if any, dated NOV-EMBDR 10, 1992 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ 295.00 Short Certificates(s) ............... $ 15.00 ' ~__~ Register ,, Wills - ~jf ~/ Renunciation .......................... $ __5.00 Extra Pages ( ) ...............$ 6.00 I.T.R ....................................... $ JCP Fee ................................. $ Inventory ................................ $ Other ...................................... $ 5.00 TOTAL ............................. $. 266.00 mailed to attorney 4-3-02 Signature Attorney: GERALD J. BRINSER I.D. No: 09655 Address: 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Telephone: .(717)838-6348 DATE FILED: APRIL 3, 2002 Mar 19 02 02:38p Brinser Wa~ner &Zimmerman (?17)B38-6912 p.~ MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION Estate of ORPHA H, KIBLER also known as Deceased No. 21 o2 The undersigned, RUTH E. ENGLE AND RICHARD R, ECKERT~ CHILDREN (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters TESTAMENTARY be issued to JANET E. BLACK, A DAUGHTER OF DECEASED. Witness OUR hand this day of MARCH 2002 (~,/gnature) ELIZABETHTOWN PA 17022 (Address) (Signature) 1923 S. FORGE ROAD PALMYRA PA 17078 (Address) (Signature) (Address) Sworn to or affirmed an¢ subscribed before me this i Q4~ day or ' ' - ~mis~on Expfl~iaI Seal / Jennifer R. Freeland, Notaw Public / Upper Allen Twp., Cumberland ~un~ ~ My Commission Expires D~. 13, 2~ Mem~r, ~nnsylvania Ass~ation ct Notaries (Signature ~nd seal of Nota~ or other o~cial qu~iif~ed ;o administer oaths. Show d~t~e 0¢ 9x~:mtion of Nota~'s commission.) NOTE: Renunciation.'; executed outside the Office of Register of Wills are required in some counties to be notarized. of RW*3 21-02-338 t .a t i tli[I[ i estament I, the undersigned, ORPHA H. HEISEY, presently of the Township of Upper Allen, County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and disposing memory, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, Who died for my sins upon the cross and rose again to redeem me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses, including the cost of a headstone and the inscription thereon, be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate, inheritance and succession taxes that may be assessed in conse- quence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administra- tion and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. IlL All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, including property over which I hold a power of appointment, I hereby give, devise and be- queath as follows: A. All of the tangible personal property equally unto my surviving children. B. Five (5%) percent of the remaining balance unto the CONOY BRETHREN IN CHRIST CHURCH, of Elizabethtown, Pennsylvania, to be used for capital indebtedness reduction. If said Church is free of capital indebtedness, this bequest may be used as it sees best. C. All the rest, remainder and residue equally unto my children, RUTH E. ENGLE, JANET E. BLACK, ROBERT J. ECKERT and RICHARD R. ECKERT. If any child predeceases me or dies be- fore distribution is made pursuant to this subsection, his or her share shall pass unto his or her issue per stirpes. If said child leaves no issue, his or her share shall lapse and be added to the shares pass- ing to my other children or their issue per stirpes. IV. I hereby nominate, constitute and appoint my daughter, RUTH E. ENGLE, and my son, ROBERT R. ECKERT, Co-Executors, or the survivor of them as sole Executor, of this my Will. V. I hereby order and direct that no bond shall be required by my fiduciaries for the faithful performance of their duties in any court or jurisdiction. IN WITNESS WHEREOF, I, ORPHA H. HEISEY, herewith set my hand to this my Last Will and Testament, typewritten on two (2) sheets of paper, including the attestation clause and signatures of witnesses, this IO'i-14 day of ~o~e_~nt~:R-~ ,1992. O~PH~-I-I~ H~ISEY Signed by ORPHA H. HEISEY, by her declared to be her Last Will and Testament in our pres- ence, who have hereunto subscribed our names as witnesses in her presence and at her request, this /~'~ ~/ day of ~/o~, ~ ~ ~ g-- ,1992. residing at 2 · ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA - SS: We, ORPHAH. HEISEY, ~Oovedn //l McC£efl~d St/~RwoatvlP t//~LL,-thetesta- tflx and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed it willingly (or willingly directed another to sign for her), and that she executed it as her free and vol- untary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the tes- tatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ORPI-I~ HfI-IEISEY WITNESS ~ITNESS SUBSCRIBED, sworn or affirmed and acknowledged before me, by ORPHA H. HEISEY, the testatrix, /TriM,dm ,tr.4 //It (~e.~q~.Y and G~,e. coo-oo A/~'.i~cz~.witnesses, this IO7-t-t day of ]~/o ~.4,e ~.~ ,1992· NOTARY P~BLIC -3- Mary L Kun'~,weiler, Notary Public. J Upger Allen Twp., Cumberland County I My Commission Expires Jaja. 13, 1994 J Member, Pennsylvania As$oca'don o! Notarie~ GERALD J. BRINSER KEITH D. WAGNER JOHN M. ZIMMERMAN Attn: Jackie Register of Wills Office LAW OFFICES BRINSER, WAGNER & ZIMMERMAN 6 EAST MAIN STREET - SECOND FLOOR (EAST MAIN & SOUTH RAILROAD STREETS) P. O. BOX 323 PALMYRA, PA 17078 PHONE: (717) 838-6348 FAX: (717) 838-6912 ) Cumberland County Court House S. Hanover Street Carlisle, PA 17013 MECHANICSBURG OFFICE MESSIAH VILLAGE 100 MT. ALLEN DRIVE MECHANICSBURG, PA 17055 PHONE/FAX (717) 795-1737 In Re: Orpha H. Kibler Estate Dear Jackie, Pursuant to our phone conversation with your office, I do hereby give you authorization to change the probate documents for the above-captioned estate to "Orpha H. Kibler, a/k/a Orpha H. Heisey". Also, please add to the Petition that Decedent married John S. Kibler on or about April 29, 1995. If you need anything else, feel free to give me a call. Thank you for your assistance in this matter. Very truly yours, BRINSER, WAGNER & ZIMMERMAN Gerald J. Brinser GJB/wlc MESSAGE CONF I RMAT I ON 03,.~22/02 09:11 IDcREGISTER OF WILLS DATE 03/22 S,R-TIME DISTANT STATION ID MODE PAGES 00~27" ?17 761 3015 CALLING 01 RESULT OK 0000 FAX # FAX TRANSMITTAL FR()M- T() CAI.L (7 17) 2..q0...~'~.ot~:Ol,~ ANY INQU[R[E:S FROM: One Courthouse Square Carlisle, PA 17013-3387 FAX # (717) . 240--"/'/97 I'A(;E (}NI': ()1-' ~ M,a~r !~ 02 02:37p · MARY C LEWIS, REGISTER OF WILLS CUMB'-c-P, LAND COUNTY, PENNSYLVANIA Bpinsep Wa~nep &Zimmepman (?171838-~812 PETITION FOR GRANT OF LETTERS Esta,:e of ORPHA H.___KIBLER No. 21 also known as 02 p.1 Deceased Per~tio.._~.~,,,~,, ~ ............ ROBERT R. ECKERT AND JANET E. BLACK Petitbner(s), who is/are 18 years of age or older, app~)i"~') ~ (COMPLETE "A" OR "B" BELOW:) Social Security No. 179-07-3529 A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut _ Decedent, dated 11/10/92 and codicil(s) dated N/A RUTH E. ENGLE IS RENOUNCING IN FAVOR_.,?F JANET E. BLACK. named in the Last Will of the Slate relevant circumstances, e.g., renunciation, death of executor, etc Except as t~o lows, Decedent did not marry, was not divorced and did not have a child bor ~ or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (ct.a.d.b.n.c.t.a.: pendente lite. durante al~sentia; durante minoritate,) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence J (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at MESSIAH VILLAGE~ 100 MT. ALLEN DR.,UPPER ALLEN TWP., MECHANICSBURG, PA (list street, number end muni:i~alib/) Decedent, then 89._.~_._. years of age, died MARCH 5 _, ..2002_, at MESSIAH VILLAGE, MECHANICSBURG, PA Decedent at death owned property with estimated values as follows: (Location,~ (if domiciled in PA All personal property (if not domiciled in PA .................................... S~,'/,"~ ~ E2 o o Personal property in Pent,sylvania .................... $. ~ (if not domiciled in PA Personal property in Cour, ty ....................... $ _---- Value of real estate in Pennsylvania ............. Total .................................................................... $ ~ Real Estate situated as follow~: ................................................................................................................... $~"~,-~ ~,'~ ~.2 ~ Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and CodicJl(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence ECKERT -:W~OURT. DOVER PA 17315 .ACK ~ 6Z1. FRANC~--_S DRIVE, HARRISBURG, PA 17109 t ast i litt anl i estament I, the undersigned, ORPHA H. HEISEY, presently of the Township of Upper Allen, County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and disposing memory, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, Who died for my sins upon the cross and rose again to redeem me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses, including the cost of a headstone and the inscription thereon, be paid fi.om the assets of my estate as soon as practicable after my demise. II. I direct that all estate, inheritance and succession taxes that may be assessed in conse- quence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administra- tion and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, including property over which I hold a power of appointment, I hereby give, devise and be- queath as follows: A. All of the tangible personal property equally unto my surviving children. I[' B. Five (5%) percent of the remaining balance unto the CONOY BRETHREN IN CHRIST CHURCH, of Elizabethtown, Pennsylvania, to be used for capital indebtedness reduction. If said Church is free of capital indebtedness, this bequest may be used as it sees best. E.B C. All the rest, remainder and residue equally unto my children, RUTH E. ENGLE, JANET LACK, ROBERT J. ECKERT and RICHARD R. ECKERT. If any child predeceases me or dies be- fore distribution is made pursuant to this subsection, his or her share shall pass unto his or her issue per stirpes. If said child leaves no issue, his or her share shall lapse and be added to the shares pass- ing to my other children or their issue per stirpes. IV. I hereby nominate, constitute and appoint my daughter, RUTH E. ENGLE, and my son, B__E_RT R. ECKERT, Co-Executors, or the survivor of them as sole Executor, of this my Will. V. I hereby order and direct that no bond shall be required by my fiduciaries for the faithful performance of their duties in any court or jurisdiction. · egi~ter ~f ~ills an~ Clerk of the ®rPban~' C~urt ~unt~ a! MARY C. LEWIS COURTHOUSE. CARLISLE. PA 17013 R~gister of Wills & Clerk of th~ Orphans' Courl JERRY IL DUgFIE. ESQ. Solicitor TO: CHERYL A. WINTERS PER RALPH WRIGHT, ESQUIRE Date: 04-03-2002 PER: RALPH WRIGHT, LETTERS OF ADMINISTRATION C.T.A. CAN BE ISSUED ON THE ORPHA HEISEY A/K/A ORPHA KIBBLER. MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE $.6(a) Name of Decedent: ORPHA H. KIBLER, a/k/a ORPHA H. HE SEY Date of Death: 3/5/02 Estate No. 2002-0338 SSN: 179-07-3529 File No. 21-02-0338 Date Letters Granted: 4/3/02 Will or Administration No. To the Register: I certify that Notice of Estate Administration 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 4/11/02 Name RICHARD R. ECKERT RUTH E. ENGLE CONOYBRETHRENINCHRISTCHuRcH Address 1923 S. FORGE ROAD PALMYRA 431 SUNRISE BLVD. ELIZABETHTOW_N_ 1722 BAINBRIDGE ROAD ELIZABETHTOWN PA 17078 PA 17022 PA 17022 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ROBERT R. ECKERT AND JANET E. BLACK, EXECUTORS, WHO MET IN OUR OFFICE. Date: 4/11/02 Capacity: Personal Representative X Counsel for Personal Representative GERALD J. BRINSER, ESQUIRE Name (Please type or print) 6 E. MAIN STREET Address P.O. BOX 323 PALMYRA PA 17078 Telephone No. (717)838-6348 BRINSEI~, '~TAGNEP, ~ ZIMMERMAN Law C)f~ice 6 E. Main Street, 2na Floor P.O. Box 323 Palmyra, PA 17078-0323 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE S HANOVER ST CARLISLE PA 17013 h,,llh,,llh,,,,,Ih,lh,,li,,,Ihli,,,,,,llhh,hh,,,ihi GERALD J. BRINSER KEITH D. WAGNER JOHN M. ZIMMERMAN LAW OFFICES BRINSER, WAGNER & ZIMMERMAN 6 EAST MAIN STREET - SECOND FLOOR (EAST MAIN & SOUTH RAILROAD STREETS) P. O. BOX 323 PALMYRA, PA 17078 PHONE: (717) 838-6348 FAX: (717) 838-6912 May 31, 2002 MECHANICSBURG OFFICE MESSIAH VILLAGE 100 MT. ALLEN DRIVE MECHANICSBURG, PA 17055 PHONE/FAX (717) 795-1737 Mary C. Lewis, Register of Wills Cumberland County Court House S. Hanover Street Carlisle, PA 17013 In Re: Orpha H. Kibler Estate No. 21-02-0338 Dear Register of Wills: Enclosed you will find a check in the amount of $3,800.00 in payment of a deposit towards inheritance taxes for the above-captioned estate. If you have any questions, please feel free to give me a call. Thank you. Very truly yours, BRINSER, WAGNER & ZIMMERMAN W end~y '~ Estate Secretary wlc Enclosure COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001 243 BRINSER GERALD J 6 E MAIN STREET, 2ND FLOOR P O BOX 323 PALMYRA, PA 17078 ........ fold ESTATE INFORMATION: SSN: 179-07-3529 FILE NUMBER: 2102-0338 DECEDENT NAME: KIBLER ORPHA H DATE OF PAYMENT: 06/03/2002 POSTMARK DATE: 05/31/2002 COUNTY: CUM BERLAN D DATE OF DEATH: 03/05/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,800.00 TOTAL AMOUNT PAID: $3,800.00 REMARKS: SEAL CHECK# 10 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001790 BRINSER GERALD J 6 E MAIN STREET,2ND FLOOR P O BOX 323 PALMYRA, PA 17078 ........ foJd ESTATE INFORMATION: SSN: 179-07-3529 FILE NUMBER: 2102-0338 DECEDENT NAME: KIBLER ORPHA H DATE OF PAYMENT: 10/31/2002 POSTMARK DATE: 1 0/30/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/05/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,751.51 TOTAL AMOUNT PAID: $3,751.51 REMARKS: SEAL INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DI~/ISION DEPT. 280601 HARRISBURG, PA 17118-0601 COHHONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-/;dI7 EX AFP C01-OZ) GERALD J BRINSER ESG BRINSER ETAL PO BOX PALHYRA PA 17078~5266 DATE 12-16-2002 ESTATE OF KIBLER DATE OF DEATH 05-05-2002 FZLE NUHBER 21 02-0558 ~OUNTY CUHBERLAND ACN 101 Amount Rem/fred ORPHA H HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAZN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF KIBLER ORPHA H FILE NO. 11 02-0338 ACN 101 DATE 12-16-Z001 TAX RETURN NAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORTGTNAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) q. Hortgegas/Notes Reca/vable (Schedule D) (q) 5. Cash/Bank Depos/ts/H/sc. Personal Property (Schedule E) ($) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule O) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/N/sc. Expenses (Schedule H) (9) 10. Dmbts/Nortgagm L/ab/lit/es/Liens (Schedule T) (10) 11. Total Deduct ions 12. Nat Value of Tax Return 102/358.15 .00 22~$76.09 6q~178.60 .00 .00 NOTE: To insure proper credit to your account, submit the upper portion .00 of th/s form w/th your tax payment. (8) 15,582.05 15. lq. NOTE: 1~075.07 (11) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (1:5) Net Value of Estate Subject to Tax If an assessment ~as issued previously, lines 14, 15 and/or 16, 17, reflect f/gures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rata 16. Amount of Line lq taxable at L/heal/Class A rata 17. Amount of L/ne lq at S/bl/ng rata 18. Amount of L/nm lq taxable at Collateral/Class B rate 19. Princ/pal Tax Due /AX CREDITS: PAYH~NT REC[ZPT DISCOUNT (+J DATE NUNBER INTEREST/PEN PAID (-) 05-$1-2002 CDOO12R~ ZO0.O0 IO-~O-ZOOZ CD001790 .00 188,91Z.8~ 1&.657.12 171,255.71 5,$88.86 166,866.86 18 and 19 wi11 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL ~NTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORH FOR INSTRUCTIONS.) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE $,800.00 $,751.51 AHOUNT PAID 7,751.51 2¢Z.50CR .00 2~2.50CR (15) .00 X O0 = .00 (16) 166,866.86 X 0~5= 7,509.01 (17) .00 x 1Z = .00 (18) .00 x 15 : .00 (29)= 7,509.01 s~ INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME Kibler, Orpha H. FILE NUMBER 2102-0338 REVIEWED BY Daniel Heck ACN 101 ITEM EXPLANATION OF CHANGES SCHEDULE NO. The distribution of the estate has been adjusted to show the 5% that goes to the Conoy Brethren in Christ per Will article 3 item b. Row Page 1 ~REV-I'500 EX '~(6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY 'FILE NUMBER 2 1 -0 2 0 3 3 HARRISBURG, PA 17128-0601 8 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL SOCIAL SECURITY NUMBER Z KIBLER, ORPHAH.,a/k/aORPHAH. HEISEY 1 7 9- 0 7- 3 5 2 9 t't DATE OF DEATH (MM~DD-Year) DATE OF BIRTH (MM-DD*Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE U.I REGISTER OF WILLS ~ 03/05/2002 01/26/1913 III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER JOHN S. KIBLER _ _ U.I Z IAI Z 0 0 ,/ ['~1. Original Retum [~]4. Limited Estate r~6. Decedent Died Testate (Attach copy of Will) [] 9. Litigation Proceeds Received [--~ 2. Supplemental Return ~---~ 4a. Future Interest Compromise (date ofdeath alter 12-12-82) [---~ 7. Decedent Maintained a Living Trust (A~ch co~y of Tr~st) r"-~ 10. Spousal Povel'~ Credit (d~ of deah be~v~en 12-31-91 and 1-1-95) [--'~ 3. RemainderRetum (dateofdeathp~orto12-13-82) ---]5. Federal Estate Tax Return Required 1__ 8. Total Number of Safe Deposit Boxes [--~11. Election to tax under Sec. 9113(A) (Atach Sch O) THtS ~C~ON MUST U C~E~Oi ALL CORRES~NDENCE AND ~NFiDEN~AL TAX INFORMATION SHOULD:BE D!UCT~ TO: NAME COMPLETE MAILING ADDRESS GERALD J. BRINSER, ESQUIRE 6 E. MAIN STREET FIRM NAME (If Applicable) BRINSER, WAGNER & ZIMMERMAN P.O. BOX 323 TELEPHONE NUMBER (717)838-6348 PALMYRA PA 17078 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 (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13, Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14, Net Value Subject to Tax (Line 12 minus Line 13) 102,.358.15 22,376.09 64,178.60 OFFICIAL USE ONLY (8) 15,582.05 1,075.07 188,912.84 (11) 16,657.12 (12) 172,255.72 (13) (14) 172,255.72 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec, 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19, Tax Due 0.00 X .00 (15) 172,255.72 X .04.5 (16) 7,751.51 O.00 X .12 (17) 0.00 X .15 (18) (19) 7,751.51 > MATH Decedent's Complete Address: STREET ADDRESS 754 ALLEGHENY cl'r~ MESSIAH VILLAGE MECHANICSBURG ISTATE PA I ZiP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount 3,800.00 200.00 Interest/Penalty if applicable D. Interest E. Penalty (1) 7,751.51 Total Credits ( A + B + C ) (2) 4,000.00 (3) 4. If Une 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 Une 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. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISrER OF WILLS, AGEN}' 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 dght to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the premise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... [] [] 3. Did decedent own an 'in trust for" or payable upon death bank account or secudty at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................ (.Jo.-i.n.t.'J.y..~.h e.'l.d.) ............................................... [] [] Total InterestJPenalty ( D + E ) 0.00 3,751.51 3,751.51 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 tha! 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 a information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ,/~t~ FRANCES DRIVE - /'/HARRIS, BURG SIGNATURE OF PR~~~_~REPR~ ADDRESS 6~E. I~AIN STREE~I~,~P~.0. BOX 323 PALMYRA DATE PA 17109 DATE PA 17078 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (iii. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~/-1503 EX + (1-~7) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF KIBLER. ORPHA H.. a/k/a ORPHA H. HEISEY All prope~y jointly-o~med with right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER DESCRIPTION 1. BRYN MAWR SECURITIES, INC. - VARIOUS SECURITIES (SEE ATTACHED) TOTAL (Also enter on line 2, Recapitulation) VALUEAT DATE OF DEATH 102,358.15 102~358.15 (If more space is needed, insert additional sheets of the same size) DATE-OF-DEATH VALUE MUTUAL FUND PORTFOLIO ORPHA H. KIBLER 754 MESSIAH VILLAGE, P.O. BOX 2015 MECHANICSBURG, PA 17055-2015 TELEPHONE: (717) 691-1412 MARCH 5, 2002 JOHN HANCOCK LARGE CAP EQUITY (VALUE) FUND (A) A/C #50-777107797 / (800) 257-3336 DISTRIBUTIONS OF $125/NONTH Invested Shares Price VaLue Gain Purchase (10/01/92) ....................... Purchase (01/26/93) ....................... WithdrawaLs in 1999 ....................... Converted (7/20/00) ....................... Converted (7/20/00) ....................... Redeemed (11/21/00) ....................... Redeemed (11/22/00) ....................... WithdrawaLs in 2000 ....................... ~ithdrawaLs in 2001 ....................... ~ithdrawaLs in 2002 ....................... Total $ 10,000.00 20,000.00 -1,500.00 -20,060.05 -10,909.76 -20,000.00 -33,000.00 -2,236.00 -1,500.00 -250.00 -59,455.81 PIONEER FUND (B) A/C #801-6208318411 / (800) 622-3265 Purchase (12/04/00) ....................... $ 20,000.00 AIM BASIC VALUE FUND (B)* A/C #663-3810218325 / (800) 457-0630 Purchase (12/04/00) ....................... $ 20,000.00 PIMCO RENAISSANCE FUND (B)** A/C #122-1001541836 / (800) 426-0107 DISTRIBUTIONS OF $125/MONTH Purchase (12/04/00) ....................... $ WithdrawaLs in 2001 ....................... WithdrawaLs in 2002 ....................... Total $ 20,000.00 -1,500.00 -250.00 18,250.00 SUNAMERICA GROI4TH OPPORTUNITIES FUND (B) A/C #571-9235236-8 / (800) 858-8850 Purchase (12/04/00) ....................... $ 15,000.00 VAN KAMPEN COMSTOCK FUND (B)*** A/C #113'672119598 / (800) 421-5666 Purchase (12/04/00) ....................... $ 15,000.00 lNG (PILGRIM) MIDCAP GROWTH FUND (B) A/C #1622-9911045651 / (800) 992-0180 856.307 463.609 558.863 665.051 615.503 660.602 $ 17.83 39.36 $ $ 27.83 $ $ 20.63 $ $ 16.08 $ $ 16.11 $ 15,267.95 18,247.65 15,553.16 13,720.00 9,897.29 10,642.30 -8.8% -22.2% -24.8% -34.0% -29.1~ Purchase (12/04/00) ....................... $ FRANKLIN CALIFORNIA GROWTH FUND (B) A/C ~380-258475 / (800) 524-4040 Purchase (12/04/00) ....................... $ GRAND TOTAL 15,000.00_ 12,000.00 55,794.19 683.132 302.158 S 14.26 S 30.74 $ 9,741.46 $ 9,288.34 $ 102,358.15 -35.1~ -22.6% 83.5% * Exchanged from AIM Blue Chip Fund (B) on December 28, 2001. ** Exchanged from P[MCO Target Fund (B) on December 28, 2001. *** Exchanged from Van Kampen Emerging Growth Fund (B) on December 28, 2001. Orpha. Cat 01-26-13 / 179-07-3529 Prepared by: Carl E. Keefer, CLU, ChFC c/o THE KEEFER GROUP P.O. Box 4213 Harrisburg, PA 17111 Telephone: (717) 939-8962 e-mai l: cart@thekeefergroup.com Registered Representative #PA1-321 BRYN MAWR SECURITIES, INC. 1122 Bilt Smith Btvd. P.O. Box 62387 King of Prussia, PA 19406 ~etephone: (610) 337-3090 COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER KIBLER. ORPHA H.. a/k/a ORPHA H. HEISEY 21 02 033{I Include the proceeds of litigation and the date the proceeds were received by the estate. All pmpmly jointly-owned with the right of survivomhip must be disclosed on Schedule F. ITEM NUMBER 10. 11. 12. 13. DESCRIPTION MISCELLANEOUS PERSONALTY CASH ON HAND PNC BANK - CHECKING ACCOUNT #5070071958 BRETHREN IN CHRIST FOUNDATION - TAP ACCOUNT BLAIR - REFUND STATE EMPLOYEE'S RETIREMENT SYSTEM MILLER FUNERAL HOME - REFUND FEDERAL TAX REFUND NATIONWIDE INSURANCE - CAR INSURANCE REFUND PA DEPT. OF REVENUE - TAX REFUND PIONEER LIFE INSURANCE - MEDICAL REIMBURSEMENTS WASHINGTON NATIONAL INSURANCE - REFUND MESSIAH VILLAGE - APARTMENT EQUITY REFUND TOTAL (Also enter on line 5, Recapitulation) VALUEAT DATE OF DEATH 300.00 58.00 4,283.17 61,000.00 69.97 26.23 105.53 1,200.00 78.20 184.00 603.59 17.40 15,450.00 83,376.09 (Ifmorespa~isneed~,inse~additionalsheetsofthesamesize) ,REV-1508 EX + (I-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER KIBLER. ORPHA H.. a/k/a ORPHA H. HEI$1~Y 21 02 0338 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MISCELLANEOUS PERSONALTY 300.00 8 10. 11. 12. CASH ON HAND PNC BANK - CHECKING ACCOUNT #5070071958 BLAIR - REFUND STATE EMPLOYEE'S RETIREMENT SYSTEM MILLER FUNERAL HOME - REFUND FEDERAL TAX REFUND NATIONWIDEINSURANCE-CARINSURANCE REFUND PA DEPT. OF REVENUE-TAXREFUND PIONEER LIFE INSURANCE - MEDICAL REIMBURSEMENTS WASHINGTON NATIONALINSURANCE-REFUND MESSIAH VILLAGE - APARTMENT EQUITY REFUND TOTAL (Also enter on line 5, Recapitulation) 58.00 4,283.17 69.97 26.23 105.53 1,200.00 78.20 184.00 603.59 17.40 15,450.00 22~376.09 (If more space is needed, insert additional sheets of the same size) ,REV-1509 EX* (~-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER KIBLER. ORPHA H.. a/kJa ORPHA H. HEI~[~Y 21 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 02 0338 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. RUTH E. ENGLE DAUGHTER B C 431 SUNRISE BLVD. ELIZABETHTOWN, PA 17022 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. 11/1997 BIC FOUNDATION - MINISTRY THRIFT ACCUMULA- 61,000.00 50. 30,500.0£ TION PLAN ACCOUNT 2. A. 4~30~96 BIC FOUNDATION - CERTIFICATE OF DEPOSIT 5,002.19 50. 2,501.1£ #2596-11535 (INCLUDES ACC. INT. OF $2.19) 3. A. 8~2~93 BIC FOUNDATION - CERTIFICATE OF DEPOSIT 10,004.38 50. 5,002.1c. #2596-12461 (INCLUDES ACC. INT. OF $4.38) 4. A. 8~20~93 ~BIC FOUNDATION - CERTIFICATE OF DEPOSIT 10,004.38 50. 5,002.1~c #2596-12476 (INCLUDES ACC. INT. OF $4.38) 5. A. 1211993 BIC FOUNDATION - CERTIFICATE OF DEPOSIT 20,008.77 50. 10,004.3§ #2596-12534 (INCLUDES ACC. INT. OF $8.77) 6. A. 3~2000 BIC FOUNDATION - CERTIFICATE OF DEPOSIT 22,337.46 50. 11,168.73 #2596-12722 (INCLUDES ACC. INT. OF $153.16) TOTAL (Aisc enter on line 6, Recapitulation) $ 64~ 178.60 (If more space is needed, insert additional sheets of the same size) Brethren bt Christ FOUNDATION POST OFFICE BOX 290 431 GRANTHAM ROAD GRANTHAM, PA 17027 April 18, 2002 Mr. Gerald J. Brinser Brinser, Wagner & Zimmerman P.O. Box 323 Palmyra, PA 17078 RE: Estate of Orpha H. Kibler SS//179-07-3529 Dear Mr. Brinser: Mrs. Kibler had six different investments with the Brethren in Christ Foundation as of the date of her death, March 5,2002. One account is a Ministry Thrift Accumulatiol~lan (TAP) Acc~fl~ the 'mount of $61,000.00.t~ This account earns 'no interest' The fOrfeited~nterest has gone~e-~::'': Br6thren in Christ World Missions. From its inception on November 25, 1997, the joint owner has~' beth"Ruth E. Engle? ~ '' ':': The five other investments are Stewards)ip Investment Certificates. Below is a chart that shows the ~nformatton that you requested. The joiiit'owner for each of the certificates~i~ Riith E. Englefland she has been joint owner since the beginning date of each certificate. Beginning Date-of-Death Accrued Total Account// Date Balance Interest Date-of-Death Value 2596-11535 4/30/1996 $5,000.00 $2.19 $5,002.19 2596-12461 8/02/1993 ~ $10,000.00 $4.38 $10,004.38 2596-12476 8/20/1993 , $10,000.00 $4.38 $10,004.38 2596-12534 12/06/1993 $20,000.00 $8.77 $20,008.77 2596-12722 3/06/2000 " $22,184.30 $153.16 $22,337.46 OVER PLEASE Phone: (717) 697-2634 · Fax: (717) 697-7714 · E-mail: bicf@messiah.edu REV-IS11F_.X + (~-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF KIBLER. ORPHA H.. a/k/a ORPHA H. HEISEy Debts of decedent must be reported on Schedule I. FILE NUBBER 21 02 ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: MESSIAH VILLAGE - FUNERAL LUNCHEON ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) JANET E. BLACK/ROBERT R. ECKERT Social Security Number(s) / EIN Number of Personal Representative(s) Street Address C/O 671 FRANCES DRIVE City HARRISBURG State PA Year(s) Commission Paid: 2002/2003 AttomeyFees BRINSER, WAGNER & ZIMMERMAN Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip 17109 Street Address City State Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS Accountant's Fees Tax Retum Preparer's Fees THE SENTINEL - LEGAL ADVERTISING CUMBERLAND LAW JOURNAL - LEGAL ADVERTISING Zip TOTAL (Also enter on line 9, Recapitulation) O338 AMOUNT 1,137.50 8,000.00 6,000.00 266.00 103.55 75.OO 15~582.05 (Ifmorespaceisne~,insedadditionalsh~tsofthesamesize) ' REV-1512 EX + (1-97) j~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS ESTATE OF KIBLER. ORPHA H.. a/k/a ORPHA H. HEISEY Include unreimbursed medical expenses. FILE NUMBER 21 02 0338 ITEM NUMBER DESCRIPTION 1. P P & L - ELECTRIC BILL VERIZON - PHONE BILL RETINA & ACULOPLASTIC CONSULTANTS MESSIAH VILLAGE - ROOM, NURSE CALL AND TRANSPORT TOTAL (Also enter on line 10, Recapitulation) AMOUNT 25.37 20.65 100.00 929.05 1,075.07 (Ifmorespa~isneed~,insedadditionalsheetsofthesamesize) · REV-;513EX+~(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF KIBLER. NUMBER ::)RPHA H.. a/k/a ORPHA H. HEISEy NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) ROBERT R. ECKERT 3022 ENGLEWOOD COURT, DOVER, PA 17315 RICHARD R. ECKERT 1923 S. FORGE ROAD, PALMYRA, PA 17078 RUTH E. ENGLE 431 SUNRISE BLVD., ELIZABETHTOWN, PA 17022 JANET E. BLACK 671 FRANCES DRIVE, HARRISBURG, PA 17109 FILE NUMBER 21 02 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SON SON DAUGHTER DAUGHTER AMOUNT OR SHARE OF ESTATE 1/4 RESIDUE 1/4 RESIDUE 1/4 RESIDUE 1/4 RESIDUE 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) B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET lil[ anl iEe tament I, the undersigned, ORPHA H. HEISEY, presently of the Township of Upper Allen, County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and disposing memory, realizing the uncertainty of this life, but with confidence in (;od and trust in His Son, my Lord and Savior, Jesus Christ, Who died for my sins upon the cross and rose again to redeem me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses, including the cost of a headstone and the inscription thereon, be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate, inheritance and succession taxes that may be assessed in conse- quence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administra- tion and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, including property over which I hold a power of appointment, I hereby give, devise and be- queath as follows: A. All of the tangible personal property equally unto my surviving children. B. Five (5%) percent of the remaining balance unto the CONOY BRETHREN IN CHRIST CHURCHi of Elizabethtown, Pennsylvania, to be used for capital indebtedness reduction. If said Church is free of capital indebtedness, this bequest may be used as it sees best. C. All the rest, remainder and residue equally unto my children, RUTH E. ENGLE, JANET E. BLACK, ROBERT J. ECKERT and RICHARD R. ECKERT. If any child predeceases me or dies be- fore distribution is made pursuant to this subsection, his or her share shall pass unto his or her issue per stirpes. If said child leaves no issue, his or her share shall lapse and be added to the shares pass- ing to my other children or their issue per stirpes. IV. I hereby nominate, constitute and appoint my daughter, RUTH E. ENGLE, and my son, ROBERT R. ECKERT, Co-Executors, or the survivor of them as sole Executor, of this my Will. ¥. I hereby order and direct that no bond shall be required by my fiduciaries for the faithful performance of their duties in any court or jurisdiction. IN WITNESS WHEREOF, I, ORPHA H. HEISEY, herewith set my hand to this my Last Will and Testament, typewritten on two (2) sheets of paper, including the attestation clause and signatures of witnesses, this IO~-14 day of AIo,~,~n~R_~ ., 1992. 0 ~P-I-L~ ~H~ HEISEY Signed by ORPHA H. HEISEY, by her declared to be her Last Will and Testament in our pres- ence, who have hereunto subscribed our names as witnesses in her presence and at her request, this /£~-tff day of /~/o~,~ ~ ~ ~ ,1992. residing at -2- · ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF ~ ~5 e. ~ ~ ~ ~' z~ : SS: We, ORPHAH. HEISEY, ~Co~,~'./~q /d/'4cCa~Y~d ~ft aRWaaf~fbI Ma~.c,-thetesta- trix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed it willingly (or willingly directed another to sign for her), and that she executed it as her free and vol- untary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the tes- tatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ORPH~ H~-HEISEY ,3 WITNESS WITNESS SUBSCRIBED, sworn or affirmed and acknowledged before me, by ORPHA H. HEISEY, the testatrix, tT~Zn t~ ].,'~r, ~-.~q.~Y and '~Ha.f.~'~cJoo tJ~w/~_z~.witnesses, this lO~t¥ day of /~/o a~,.~,,~ ~_,e~ ,1992. MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of ORPHA H. KIBLER also known as ORPHA H. HEISEY , Deceased No..21 02 0338 Date of Death 03/05/2002 Social Security No. 179073529 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate 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 real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: GERALD J. BRINSER, ESQUIRE ,~/~_.~ ~-~, //~ LD. No.: 09655 5'ANET E. BLACK Address: 6 E. MAIN STREET PALMYRA PA 17078 Dated OCTOBER 29~ 2002 Telephone: (717)838-6348 Stocks & Bonds Description BRYN MAWR SECURITIES, INC. - VARIOUS SECURITIES Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property MISCELLANEOUS PERSONALTY (Attach Additional Sheets if necessary) Total Value 102,358.15 300.00 124,734.24 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW--4 Continuation of Inventory ORPHA H. KIBLER Description of Inventory CASH ON HAND Description PNC BANK - CHECKING ACCOUNT #5070071958 Paqe 1 BLAIR - REFUND STATE EMPLOYEE'S RETIREMENT SYSTEM MILLER FUNERAL HOME - REFUND FEDERAL TAX REFUND NATIONWIDEINSURANCE-CARINSURANCE REFUND PA DEPT. OF REVENUE-TAXREFUND 21 02 0338 Value 58.00 4,283.17 69.97 26.23 105.53 1,200.00 78.20 PIONEER LIFE INSURANCE - MEDICAL REIMBURSEMENTS 184.00 WASHINGTON NATIONALINSURANCE-REFUND MESSIAH VILLAGE -APARTMENT EQUITY REFUND Real Estate 603.59 17.40 15,450. O0 Subtotal $ 22,076.09 Grand Total $ 124,734.24 ! I 2002 I ~ HARriSBURG ~ ~ IIIIIi IIiiiii,~ 'qARY C LEWIS REGISTER OF CUMBERLAND CO COURT HOUSE S HANOVER ST CARLISLE PA 17013 WILLS BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DIV/SZDN DEPT. 280601 HARR/SDURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-I&07 EX AFP (01-05) GERALD J BRINSER ESQ BRINSER ETAL PO BOX $25 PALMYRA PA 17078 DATE 01-27-2005 ESTATE OF KIBLER DATE OF DEATH O$-05-ZOOZ FILE NUMBER 21 0Z-0558 COUNTY CUMBERLAND ACN 101 Amount Remitted ORPHA H MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credAt to your account, submit the upper portion of thLs fore with your tax payment. CUT ALONG THIS L'rNE ~ RETAZN LONER PORT/ON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ### 'rNHERZTANCE TAX STATEMENT OF ACCOUNT ESTATE OF KIBLER ORPHA H FILE NO. Z1 02-0558 ACN 101 DATE 01-IT-ZOO5 THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHONN BELON ZSA SUHNARY OF THE PRINCIPAL TAX DUE;, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-09-2002 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 7,509.01 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-51-2002 10-50-Z00Z 01-06-2005 CDOO1245 CD001790 REFUND ZO0.O0 .00 .00 5,800.00 5,751.51 242.50- ZF PA/D AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADD/TZONAL /NTEREST. ( IF TOTAL DUE 1S LESS THAN $1~ NO PAYMENT 1S REQUIRED. ZF TOTAL DUE 1S REFLECTED AS A "CRED/T' (CR), TOTAL TAX CREDIT 7,509.01 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) JRD/June30, 1992/17858 Date: February 03, 2005 ORPHANS' COURT DIVISION Gerald Brinser, Esquire 6 East Main Street, 2nd Floor P.O. Box 323 Palmyra, P A 17078 RE: Estate of Orpha H Kibler File Number: 21-02-0338 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: 03/05/2005 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, ~~~ GLENDAFARNERSTRASBAUGH REGISTER OF WILLS cc: File Judge cI STATUS REPORT UNDER RULE 6.12 Name of Decedent · ORPHA H. KIBLER ESTATE Date of Death' 3/5/03 Will No. 2002-00338 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' State whether administration of the estate is complete' Yes ~ No X 2. If the answer is No, state when the personal representative regsonably believes tha~t the admin, istration will be complete: t;tJ/~ ~ _ '~/7~,x/P c/F1¢/3 ~c/'h ('~/:~tO. 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 ~C~ b. The separate Orphans' Court No. (if ai~' for the personal representative's account is' c. Did the personal representative state an account informally to the parties in interest ? Yes ~ No d. Copies of receipts, releases, joinders approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date' 3/22/04 Signature GERALD J. BRINSER Name (Please type or print ) 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Address ( 717 ) 838-6348 Tel. No. Capacity' Personal Representative Counsel for personal representative STATUS REPORT UNDER RULE 6.12 Name of Decedent: ORPHA H. KIBLER Date of Death: 3/5/2002 Will No. 21-02-0338 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: I . 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. I is Yes, state the following: a. account with the Court? Did the personal representative file a final 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 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: 2/8/2005 -~~.~'tliMd Signature GERALD J. BRINSER Name (Please type or print) 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Address i' ( 717 ) 838- 6348 Tel.No. Capacity : Personal Representative X Counsel for personal representative J