HomeMy WebLinkAbout03-0698 PETITION FOR PROBATE and
also known as To:
GRANT OF LETTERS
Deceased.
Social Security No. -L(.~_ '~f~?_ ~'~-.~"'{~
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or ol. der an the executo&~
in the last will of the above de_.~cedent, dated t~ ~ t ~
and codicil(s) dated ~
Register of Wills for the
County of~?~,,-~M-[e~ in the
Commonwealth of Pennsylvania
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~ ~-,~,~ ~-&~- ~ ..........
- -..~-- ~uun~, rennsy~vama, with
h ~ lasLfamily ,o .r principal Lesidence at ~t.l-
(list street, number and muncipality)
D~endent, then
at ~,~.G..~Z~'~{.x, ~s.?..~, died _
Except as follows, decedent did n~t 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: L ~
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsyl. kvania -- ~,, ~ .
situated as follows:
$ OO0. oO
$
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
reqqest(s), the probate of the. last will and codicil(s)
(testamentary; administration c~t.~.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C~-x~-..-.)~,~,_~
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 affirmed and subscribed y ~_~3 ~ ~_~~_ ~
befo~ me this _ r~ ~ day of
_ C~,~-L 02003 la/
I-t- uo.- q
Estate of
BECKY L HEBERLIG ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW AUGUST 26, 2003 Xl~ , 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 10-16-~ 996
described therein be admitted to probate and filed of record as the last will of
BECKY L HEBERLIG ;
and Letters TESTAMENTARY
are hereby granted to HELEN M HEBERLIG
FEES
Probate, Letters, Etc .......... Sa;tO0 .c-'~
Short Certificates( ) .......... $
TOTAL $~q~ .(iX3
Filed 8-25-2003 ...........
PHONE
tJ Becky L. Heberlig of 2145 Newville Road, Carlisle, Cumberland County, Pennsylvania, declare this
to be my last will and revoke any will previously made by me.
3item ~e: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from
my residuary estate as soon as practicable after my decease as a part of the expense of the administration
of my estate.
3item [t~0: I give, devise, and bequeath my entire estate of whatever nature to my parents Helen M.
Heberlig and Glenn E. Heberlig or to the survivor. In the event that both my parents predecease me,
then I give, devise and bequeath my entire estate to my sister Donna H. Crist. In the event that both
my parents predecease me and my sister Donna H. Crist predeceases me, then I give, devise, and
bequeath my entire estate to my Trustee hereinafter named to be held, administered, and disposed of in
the following manner:
A. Trustee shall hold, manage, and invest trust property and income and shall pay to my sister Judy
L. Stine all of the net income of the trust estate for the support, maintenance, comfort and welfare of
my sister Judy L. Stine for and during her natural life in her accustomed manner of living and shall pay
such portions of principal as Trustee in Trustee's absolute discretion may deem advisable to provide for
medical, health, and institutional care required. Payments shall be made quarterly or by any other period
as Trustee deems advisable in Trustee's absolute discretion.
B. In the event that my sister Judy L. Stine predeceases me or deceases during the administration
of the trust, I direct that my entire estate or the then remaining principal and any accumulated income
shall be distributed equally, share and share alike, among my nieces and nephews, per stirpes.
3item [~ree: I appoint my mother Helen M. Heberlig of Carlisle, Pennsylvania, Executrix of this my last
will. Should she fail to qualify or cease to act as Executrix, I appoint my father Glenn E. Heberlig, to
act as Executor with the same rights, powers, and duties. Should he fail to qualify or cease to act as
Executor, then I appoint my sister Donna H. Crist to act as Executrix with the same rights, powers, and
duties.
~tem ~our: I nominate and appoint Farmers Trust Company of Carlisle, Pennsylvania, Trustee of the
trust created herein.
3item 2ffil~e: All estate, inheritance, succession, and other taxes, imposed or payable by reason of my
death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax
purposes, whether or not such property passes under this will, shall be paid out of the principal of my
residuary estate, without apportionment or right of reimbursement.
3item ~bix: I direct that my personal representative or guardian shall not be required to give bond for the
faithful performance of his duties in any jurisdiction.
JJtem ~be~en: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this
will, I give to my Executrix and Trustee during the full time necessary and for the administration of my
estate and trust herein the following rights and powers to be exercised in his or her sole discretion.
To retain any real or personal property which may at any time form a part of my estate so long
as he or she deems it advisable.
B. To invest in any real or personal property without restrictions to legal investments.
To repair, alter, improve or lease for any period of time any real or personal property and to give
options for leases.
Do
To sell at public or private sale, for cash or credit, with or without security, to exchange or to
partition, to mortgage or pledge real or personal property, and to give options for leases.
E. To make distribution in kind.
F. To compromise claims.
G. To expend directly any income or principal which it is authorized in this instrument to use for
the benefit of any person. Trustee shall not be required to obtain authority or approval of any court in
the exercise of any power permitted under this instrument. Trustee shall not be required to file
accountings with any court. No person dealing with Trustee shall be obligated to inquire into the
Trustee's power or authority or into the validity of any act of the Trustee or be liable for the application
of any money paid to the Trustee in the management of the trust fund.
IN WITNESS WHEREOF, I have hereunto set my hand this /~' d'~ay of October, 1996.
Becky L. H'eberlig {-,/
The preceding instrument, consisting of this and one other typewritten page each identified by the signature
of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein
named as and for her last will, in the presence of us, who~herrr-~uest,~'e~presence and in the presence
of each other have subscribed our names.
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
We John H. Broujos and ~, cfl~9,,,.,/-/~Codcd/'6,c~itnesses whose names are signed to the attached or
foregoing instrument being duly ~lualified according to law, do depose and say that we were present and saw
the Testatrix sign and execute the instrument as her last will; that she signed willingly and executed it as her
free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the
Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time
18 or more years of age, of sound mind and under no c°~xtrain~'~xrl~~uence'
Sworn and subscribed to before
me this ~, ~lay of October, 1996.
~ c.. c/ 0herfl L. Murphy, Notary Puolic
Carlisle Bom, Cumberland County
"- Notary Public "- ..2 My Commission Expires Jan. 4, 1997
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
I, Becky L. Heberlig, whose name is signed to the attached document, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as
my free and voluntary act for the purposes therein expressed.
Sworn and affirmed to and acknowledged
before me this/b ¢~-day of October, 1996.
Notary Pubh'c
Notarial Seal
~ L. Murphy, Notary PuOlic
Carlisle Boro, Cumberland County
My Commission Expires Jan. 4, 1999
'O3
of
Becky L. Heberlig
BROUJOS, GILROY ~ HOUSTON,
ATTO R.I',I EY$ AT LAW
4 NORTH HANOVER STREET
CARLI.SLE, PE]xI'IXISYLVAi~IIA 17013
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.
Becky L. Heberlig
August 11, 2003
2003 - 0698
Administration No.
21-03-00698
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the Orphan's
Court Rules was served on or mailed to the following beneficiaries for the above captioned
estate on August 29, 2003:
Helen M. Heberlig
1044 South Pitt Street
Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
Date: August 29, 2003
Helen M. Heberlig
1044 South Pitt Street
Carlisle, PA 17013
Capacity: Personal Representative
Estate Recoveries, Inc.
Over 15 Years of Service to the Financial Industry
Register Of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
November 21. 2003
Estate Of Becky L
Heberlig, deceased.
Our File#: HFL-44040
Estate #: 2103698
Dear Sir/Madam:
Enclosed please find our claim regarding the above captioned estate which is being
filed on behalf of Fleet Credit Card Services, L.P., creditor.
A copy of this claim is being forwarded to Helen M. Heberlig, Representative for the
estate.
If you have any questions concerning the attached claim, please do not hesitate to
contact this office.
Robin J. Bortner, Ext. 133
RJB
Enclosure
See Reverse Side For Special State Disclosures.
This communication is from a debt collector.
This is an attempt to collect a debt and any information obtained will be used for that purpose.
P.O. Box 24566, Baltimore, Maryland 21214 · 5543 Harford Road, Baltimore, Maryland 21214
Monday - Friday 8:00 am- 6:00 pm Eastern Time ° Telephone: 410-444-8022 · 800-229-8472 · Fax: 410-426-4051
Special State Disclosures
Colorado
FOR INFORMATION ABOUT THE COLORAI)O FAIR DEBT COLLECTION PRACTICES ACT, SEE
V~ ~VV~.AGO.STATE.CO.US/CAB.HT .
Maine
The business hours fur Estate Recoveries, Inc. are Monday - Friday 8:t11} a.m. - 6:0tt p.m. Eastern Time. This
agency ma3 be contacted using the fi~llowing numbers: 800-229-8472 or 410-444-8022, Fax: 41tt-426-4t}5 !
Massachusetts
Notice of hnportant Rights: You have the right to make a written or oral request that telephune calls regarding
your debt rmt be made to you at yuur place of employment. Any such oral request will be valid for onl~ ten days
unless you provide written confirmation of the request postmarked or delivered within seven days of such
quest. You may terminate this request by writing to Estate Recoveries, Inc. at 15 Uuion Street, I,awrence, MA
t}1841}. Hours tbr Massachusetts are: Momtay ~ Thursday: 8:00 a.m~ ~ 8:00 p.m., Friday: 8:00 a.m. ~ 5:00 p.m..
Saturday: 8:00 a.m. - 12:00 p.m. Eastern Time.
Minnesota
Estate Recoveries~ Inc. is licensed hy the Minnesota Department of Commerce.
Ne~ York
The license number ~i~r Estate Recoveries. Inc. in New York City is as fi}ilows: 0976707
North Caroliua
The per[nit number for Estate Recoveries, Iuc. in North Carolina is as [~lluws: 3523
rlkmnessee
This collection agency' is licensed by the Collection Service Board, State l)epartment of Commerce and
Insurance, 500 James Robertson Parkway, Nashville, l~nnessec 37243.
IN THE MATTER OF
ESTATE OF:
BECKY L ItEBERLIG
STATE OF PENNSYLVANIA
IN THE ORPHAN'S COURT
OF CUMBERLAND COUNTY
ESTATE#: 2103698
DATE OF DEATH: 08/11/03
STATEMENT OF CLAIM
1. The creditor, Fleet Credit Card Services, L.P., certifies that there is due and owing by BECKY L HEBERLIG,
deceased, the sum of SIX THOUSAND NINE HUNDRED SEVENTEEN DOLLARS AND EIGHTY NINE CENTS ($
6,917.89).
2. The nature of the claim is a VISA account 4305500066133938, which was established in 06/03/01.
3. The name and address of the claimant is: Fleet Credit Card Services, L.P., 550 Blair Mill Road, Horsham,
Pennsylvania 19044.
4. The name and address of the claimant's agent is: Robin J. Bortner, Estate Recoveries, Inc., P. O. Box 24566,
Baltimore, Maryland 21214.
5. This claim is not contingent and is not secured by any liens or judgrnents.
6. This claim is not based on any one instrument. Said balance has accrued since the account was established.
My Commission Expires:
On behalf of Fleet Credit Card Services, L.P., creditor, I do solemnly declare and affirm under the penalties of perjury
that the information in the foregoing claim is true and correct to the best of my knowledge, information and belief. I have
made diligent inquiry and examination, and I believe the claim is just and all legal offsets, payments, and credits made
known to the affiant have been allowed.
Estate Recoveries, Inc.
P.O. Box 24566
Baltimore, Maryland 21214
(410) 444-8022
County of Baltimore, Maryland:
IN WITNESS WHEREOF, I hereunto set my hand and Notarial Seal this November 21, 2003.
~,,,~[~?...L; ~,,,, J IFER L. STREHLEIN, Notary Public
August 8, 2004.~O~..;' *' '~'~ "~
~- :'--~O'-----~: g
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 003930
BROUJOS JOHN ESQ
4 N HANOVER ST
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 206-36-8378
FILE NUMBER: 2103-0698
DECEDENT NAME: HEBERLIG BECKY L
DATE OF PAYMENT: 05/11/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 08/1 1/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $82.50
REMARKS:
TOTAL AMOUNT PAID:
$82.50
SEAL
CHECK# 110
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
INVENTORY OF THE REAL AND PERSONAL ESTATE OF Becky L. Heberlig, i ,d. eceased ·
File No.: 21-03-0698
Date of Death: August 11, 2003
'04 t'ifiY 11 P4:12
1. Condominium, 14 Courtyard Drive, Carlisle C $ 45,330.00
2. M&T Bank checking acct #3740987908 95.89
3. Household property (sold at yard sale) 328.00
4. M&T Mortgage Corp. - refund after payoff was made 14.63
5. MBNA Visa card - credit refunded 14.21
6. IRS - 2003 federal income tax refund 219.00
7. PA Dept. of Revenue - 2003 state income tax refund .51.00
SUBTOTAL $ 46,085.73
Jointly-owed property:
Members 1 st FCU checking
and savings acct #25937
_DOD value
$ 780.26
% of Decd's
Interest
DOD Value of
Decd's Interest
5O% $ 390.13
TOTAL
$ 46,475.86
I, Helen M. Heberlig, Executrix of the Estate of Becky L. Heberlig, late of Carlisle, Cumberland
County, Pennsylvania, have made an inventory of the entire estate of decedent, consisting of all
the personal property and real estate, except real estate outside the Commonwealth of
Pennsylvania, and the figures opposite each item of the Inventory represent the fair value as of
the date of decedent's death.
May 11, 2004
Helen M. Heberlig, Execut(r/ix
REV-I,~i;'' EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
z
HEBERLIG, BECKY L.
DATE OF DEATH (MM-DD-Year}
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH (MM-DD-Year)
08/11/2003 08/21/1952
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
r'~2. Supplemental Return
[~4a. Future Interest Compromise (date of death after 12-12-82)
[--17. Decedent Maintained a Living Trust (Attach copyofTrust)
["~10. Spousal Poverty Credit (d~ of death ~tween 12-31-91 and 1-1-95)
[-~1. Odginal Retum
E~]4. Limited Estate
J~-'~ 6. Decedent Died Testata (Attachcop¥ofWill)
~]9. Litigation Proceeds Received
JOHN H. BROUJOS, ESQUIRE
FIRM NAME (If Applicable)
BROUJOS & GILROY, P.C.
TELEPHONE NUMBER
717-243-4574
1. Reap 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 )
OFRCIAL USE ONLY
FILE NUMBER
2 1 -0 3
SOCIAL SECURITY NUMBER
0 6 9 8
2 0 6-3 6-8 3 7 8
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
['~3, RemainderRetum (date of death pdor to 12-13-82)
-'15. Federal Estate Tax Return Required
0__ 8. Total Number of Safe Deposit Boxes
~']11. Election to tax under Sec. 9113(A) (A~ch Sch O)
4 NORTH HANOVER STREET
CARLISLE ....
45~,330.00 ~ LY
0.00
755.73 '~
t..,j
390.13
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
(8) 46,475.86
14~570.95
30,071.49
44~642.44
1,833.42
(11)
(12)
(13)
1,833.42
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
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
20. []
x .. (15)
1,833.42 x .:045 (16)
x .12 (17)
x .15 (18)
(19)
82.50
82.50
Decedent's Complete Address: ' r ,
ISTREET ADDRESS 14 Courtyard Drive
I IZ,.
C~TY carliSle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty Total Interest/Penalty ( D + E ) (3)
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. (EA)
B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (EB)
Make Check Payable to: REGISTER OF WILLS, AGENT
82.50 '
0.00
82.50
82.50
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, dec are that I have examined this return, including accompany?g sc.hedules an.d statem.ents, an.d 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 informat on or wh cn preparer nas any Knowledge.
DATE
o,-/'
SIGNATURE OF PEI~SON RESPONSIBLE FOR FILING RETURN
ADDRESS Helen M. Heberh'g, Executri~ 1044 S. Pitt Street
Carlisle
PA 17013
SIGNATURE OF I~PARER OTHER THAN REPRESENTATIVE
ADDRESS z~. Hanover Street
Carlisle
DATE
PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use Of thbld~e'.n'['{ Siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is d~'n~i t~'hd~i:Secti°n 9102, as an
individual WhO has at least One Pa~-er{t in common With the decedent, wheihet bY~lood Or adoPtion.,' , "' :' ' '
REV-1502EX + (I-97) ~ ~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT D[q;I=DENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
HEBERLIG. BECKY L, 21 03 0698
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 pdce at which property would be exchanged
between a willing buyer and a witling seller, neither being compelled to buy or sell, beth having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 45,330.00
14 Courtyard Drive, Carlisle, PA
frame condominium
HUD-1 attached.
TOTAL (Also enter on line 1, Recapitulation)
$ 45~330.00
(If more space is needed, insert additional sheets of the same size)
, ,~.. U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT
SETTLEMENT STATEMENT
SECURED LAND
TRANSFERS, INC.
5006 East Trindle Road
Suite 203
Mechanicsburg, PA 17055
Phone: (717) 591-8500 FAX: (717) 591-8506
OMB No. 2502-0265
TITLEPRO
Lasetprinl
B. TYPE OF LOAN
1. [ ] FHA 2. I 1 FMHA 3..~ ] CONV. UNINS.
4. [ ] VA 5. [ ] CONV. INS.
6. FILE NUMBER: I 7 LOAN NUMBER:
505815 I 23-00523
8~ MORT. INS. CASE NO.:
C. NOTE: This form is furnished to give you a statemenl of aclual setllemenl costs. Amounts paid to and by the settlement agenl are shown. Items marked
'(po.c.)' were paid outside the closing: they are shown here for informational purposes and are not included in Ihe totals.
D NAME AND ADDRESS OF BORROWER:
John P. Giampietro
Ann Marie Niebergall
G. PROPERTY LOCATION:
14 Courtyard Drive
Carlisle BOROUGH
CUMBERLAND County
E NAME AND ADDRESS OF SELLER:
Becky L. Heberlig ESTATE
F NAME AND ADDRESS OF LENDER:
Waypoint Bank
101 S. GEORGE STREET
YORK PA 17401
H. SE~LEMENT AGENT:
Secured Land Transfers, Inc.
PLACE OF SE~LEMENT:
1068 Harrisburg Pike, Carlisle, PA 17012
I SE~LEMENT DATE:
10/24/03
J, SUMMARY OF BORROWER'S TRANSACTION: K, SUMMARY OF SELLER'S TRANSACTION:
1 oo. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
94900.00
~0~ Contract sales price
to2. Personal propedy
to3. Settlement charges to borrower (line 1400)
104.
3773.68
40~ Contract sales price
402.Personal property
403
404
105. 405
Adiustments for items paid by seller in advance
106 Ci~/Town tax to
,07 County lax 10/24/03to 12/31/
108. Assessments tO
,09 Schoo! 10/24/03,o06/30/04
81.58
701.00
16.26
,10 HOADs:$72.02/m ~nd 10/31
Adjustments for items paid by seller in advance
4o~ CitTfTown lax to
407 Counl¥ tax 10/24/03to 12/31/03
408 Assessmenls to
409 School 10/24/03to06/30/04
410 HOADs:$72.02/m ~nd 10/3
411.
94900.00
81.58
701.00
16.26
112 412.
120. GROSS AMOUNT DUE FROM BORROWER 99472.52 42o GROSS AMOUNT DUE TO SELLER 95698.84
2oo. AMOUNTS PAID BY OR IN BEHALF OF BORROWER so0. REDUCTIONS IN AMOUNT DUE TO SELLER
1000.00
93000.00
501.Excess deposit (see instruclions)
502 Settlemen! charges to seller (line 1400)
503 Existing loan(s) taken subject to
504~Payoff of First Mortgage Loan
M&T Mortgage
5o$ Payoff of Second Mortgage Loan
s06. S to B Closing Costs
507.
3000.00
20t. Deposit or earnest money
202. Principal amount of new loan{s)
203. Existin,q loan(s) taken subject to
204.
Cumberland County Grant
2o5
206 S to B Closing Costs
207.
3000.00
208. 508
209 50g
Adjuslmenls for items unpaid by seller
to
210 City/Town tax
Adjustments for items unpaid by seller
to
21 I. Count'/tax to
51o CityfTown lax
511.County tax
7608.35
39760.49
3000.00
212 Assessments to 512 Assessments to
213 School to 513 School tO
214. 514.
215 515.
216 516.
217. 517.
218. 5t8
219 519.
220. TOTAL PAID BY/FOR BORROWER 1 0 0 0 0 0 . 0 0 520. TOTAL REDUCTION AMOUNT DUE SELLER 5 0 3 6 8. 8 4 !
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600 CASH AT SEI'FLEMENT TO OR FROM SELLER
30,, 99472 . 52 95698 . 84
Gross amount due from borrower (line 120)
302. Less amount paid by/for borrower {line 220)
3o3. CASH ([ ] FROM) ([ ]~O) BORROWER
100000.00
so~.Gross amount due to selle'r (line 420) ': "
6o2.Less reduction amount due seller (line 520)
603 CASH ([ ZTO) ([ ] FROM) SELLER
527.48
50368.84
45330.00
Buyer or Borrower's Signature
Seller's Signature
HUD-t Rev 5186
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT OMB No 2502-0265
SETTLEMENT STATEMENT Page 2
L. SE'n'LEMENT CHARG~ 5 0 5 8 1 5
700. TOTAL SALES/BROKER'S COMMISSION based on price $
94900.00
DivisionofCommission(line700)asfollows: Total: $5,054.50
?01.$ 2502.25 to ERA-NRT, Inc.
?o2.$ 2552.25 to Coldwell Banker HSG
?O;~, Commission paid at Settlement
7o4. Trans Fee
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
ERA-NRT, Inc.
PAID FROM
BORROWER'S
FUNDS AT
SET'rt~:U~=NT
100.00
PAiD FROM
SELLER'S
FUNDS AT
SETI'~
, ~,~ ~:~
5054.50
801. Loan Origination Fee %
802, Loan Discount
803. Appraisal Fee to
804. Credit Report to
806.
807.
808. Doc prep
809. Tax serv
805. Lenders Inspection Fee
Mortgage Insurance Application Fee to
Assumption Fee
290.00
sis. Underwrite
8t~.Flood cart
900. ITEMS REQUIRED DY LENDER TO DE PAID IN ADVANCE
Waypoint Bank
Way-point Bank
Waypoint Bank
Waypoint Bank
91.00
115.00 I
14.00 I
901. Interest from 10/24/03 to10/31/03 @$
902. Mortgage Insurance Premium for mo, to
16.47/da¥
903. Hazard Insurance Premium for yrs. to
9o4, yrs. to
905. Appl fee
10oo. RESERVES DEPOSITED WITH LENDER FOR
Waypoint($350.POC)
131.76
100t. Hazard Insurance mo. e $ /mo.
1002. Mortgage Insurance mo. e $ /mo.
1003, City/Town tax
~004, County tax
mo. e $ /mo,
9 mo. eS 36.49 /mo. 328.41
~005, Assessments mo. e $ /mo.
o0GSchool tax 5 mo.e$ 85.52 /mo. 427.60
007. mo. e $ /mo. '
ese. AqqrAdj us t mo. e S /mo. - 145.90
100. TITLE CHARGES
1101. Settlement or closinq fee to
1102. Abstract or title search to
~ 103. Title examination to
1104. Title insurance binder to
1105. Document preparation to
1106. Notary fees to Cash
ll07, A/torney'sfees to Broujos & Gilro¥, PC
10.00
{includes above items No.:) 1105, 1106
lO8. Title Insurance Io
Secured Land Transfers
353.50
1028.75
(includes above items No.:)
Lender's coverage $
Owner's coverage $
ICPLtr
end. 100,
93,000
94,900
300, 900, 810
109.
.:~$~..:¢~'"?:$ .::~: :~; :~:. ~:~:~ ~:
~::~ ~:::~ ~:::- :::~:~ .::;:~ .A ~.'
,H~. First ~erican Title Ins.~ 35.00~
,,~2. Mail Fee Secured Land Transfers 15.00~ 15.00
1~3. Trans Fee Coldwell Banker HSG 195.00
111
120t, Recording fees: Deeds 38.50 Mort,qage$ 72 . 50 Misc. $
1202. City/counlytaxlstamps: Deeds 949.00Mortgages
1203. State tax/stamps: Deeds 949.00 Mortga[~e $
~o4, RecGrant Recorder of Deeds
~2os. '03 School Darlene Meyer, Tax Coil.
949.00
949.00
17.
1026.27
300. ADDITIONAL SETTLEMENT CHARGES
301. Survey to
302, Pest Inspection to Pen~ Pest 40.00
3o3. FinalSewer 15,08
Carlisle Boroqh Office
3o~.HOA Init COC Unit Owners Assoc. 144.04
.~8. HOADsll/03 COC Unit Owners Assoc. 72.02
14~. TOTAL SET'rLEME~ CHARGES (enter on lines 103 and 602, Sections J and K) 3 7 7 3. 6 8 7 6 0 8.3 5
Phdies agree Ihaf no liabilily is m~surned by Setllemenl Agent lot Ih· accuracy of information furnished by olhers as shown on Ih· HUD- I Setllement Statement. Selflement Ag·hi hereby expressl
re·er~el the right Io del~3sil any amounls ceE·clad for disbufsemenl in an ante;esl bearing account iff · Fader·Ih/insured instilulio n and lo credit any inter·si so earned to its own accounl i~l ·ddilional
compensation lot ils services in this Ir·nS·clash.
HUD CERTIFICATION OF DUYERS AND SELLERS
I have carelully reviewed the HUD* t Settlement Statement and to the best o! my knowledge and belier, it is a true and accurale slalemonl el all receipts and disbursements
made o~ my account by me in this transaction. I further cattily that I have received a copy el the HUD- 1 Settlement Stalemenl
Buyer's Address & Phone: Seller's New Address & Phone
REV-1508 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
HEBERLIG, BECKY L. 21 03 Q69~
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
NUMBER DESCRIPTION
1. M&T Bank checking acct # 3740987908
Household property (sold at yard sale)
M&T Mortgage Corp. - refund after payoff was made
MBNA Visa card - credit refunded
IRS - 2003 federal income tax refund
PA Department of Revenue - 2003 state income tax refund
TOTAL (Also enter on line 5, Recapitulation
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
95.89
328.00
14.63
47.21
219.00
51.00
755.73
REV-1509 EX + I1-97) ' ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
HEBERLIG, BECKY L. 21
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
03 0~98
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Helen M. Heberlig 1044 S. Pitt Street Mother
Carlisle, PA 17013
JOINTLY-OWNED PROPERTY:
L~-I I ~-A DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Inctude 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 INTERE~
1 A. 1/6/81 Members 1st FCU, checking and savings acct # 25937 780.26 50. 390.1~
TOTAL (Also enter on line 6, Recapitulation) $
390.13
(If more space is needed, insert additional sheets of the same size)
REV-1511~ +(1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
HEBERLIG, BECKY L.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 03
O698
ITEM
NUMBER
1.
2.
3.
4.
8.
9.
10.
DESCRIPTION AMOUNT
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home
Helen Heberlig - reimbursement for grave opening
Donna Crist - reimbursement for funeral meal
Cumberland Valley Memorial - gravemarker
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Helen M. Heberlig
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address 1044 S. Pitt Street
City Carlisle Sta~ PA
Year(s) Commission Paid: 2004
AttomeyFees Broujos & Gilroy, P.C.; EIN 23-2267691
Family Exemption: (If decedent's address is not the same as daimanfs, attach explanation)
Claimant
Zip 17013
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills
State Zip
Accountants Fees
Tax Return Preparer's Fees
Register of Wills - Inventory filing fee
Register of Wills - Inheritance Tax Return filing fee
Register of Wills - Family Settlement Agreement filing fee
printing of checks for estate account
6,362.00
945.00
200.00
1,784.00
2,500.00
2,500.00
228.00
10.00
15.00
17.00
9.95
TOTAL (Also enter on line 9, Recapitulation) $ 14,570.95
(If more space is needed, insert additional sheets of the same size)
RB~1512 ~ + (1-97), ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAX RETURN
RES{DENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
HEBERLIG, BECKY L.
Include unreimbursed medical expenses.
FILE NUMBER
21 03 0698
ITEM
NUMBER DESCRIPTION AMOUNT
1. P P L - electricity 44.80
10.
11.
12.
13.
UGI - gas
iBroujos & Gilroy, P.C. - legal fees from 2001 case & during hospital stay
Cumberland Goodwill Fire Company ~ ambulance service
West Shore EMS - ambulance service
Masland Associates - medical services
Andorra Radiology Associates - x-rays
Fleet Credit Card Services
Helen Heberlig-reimbursement for payment of bills preparing 14 Courtyard Drive for sale:
G.Fair - removed mattress 35.00; Robert Stine - painting, repaired floor 137.50;
Kay Herrin - paint and painting 416.70; Hilton Key Service 68.00
Capital Tax Collection Bureau - local 2003 income tax
Helen Heberlig - reimb, for payment of bills after DOD: condo fees 275.38; PPL 69.38;
UGI 30.02; water 45.24; MBNA 107.00; Fleet 422.00; Goodville-homeowners 49.00;
Darlene Moyer-personal tax 10.00; Blue Cross premium 113.67; M&T Mortgage 797.79
Helen Heberlig - reimbursement for payment of Becky's 2003 household bills while Becky
was unable to work and had no income (see attached January-July, 2003 lists)
Helen Heberlig - reimbursement for payment of Becky's 2002 household bills while Becky
was unable to work and had no income (see attached January-December 2002 lists)
TOTAL (Also enter on line 10, Recapitulation)
33.49
437.50
847.65
810.68
50.00
320.00
6,917.89
657.20
10.91
1,919.48
6,531.31
11,490.58
30~071.49
(If more space is needed, insert additional sheets of the same size)
. , i J
l o g. '-Io 'i
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE81DENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
HEBER G, BECKY L.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
[. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Helen M. Heberlig
1044 S. Pitt Street
Carlisle, PA 17013
II.
FILE NUMBER
21 03
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
100%
Mother
0698
AMOUNT ORSHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
tl Becky L. Heberlig of 2145 Newville Road, Carlisle, Cumberland County, Pennsylvania, declare this
to be my last will and revoke any will previously made by me.
~ltem ®ne: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from
my residuary estate as soon as practicable after my decease as a part of the expense of the administration
of my estate.
~ttra Igt~o: I give, devise, and bequeath my entire estate of whatever nature to my parents Helen M.
Heberlig and Glenn E. Heberlig or to the survivor. In the event that both my parents predecease me,
then I give, devise and bequeath my entire estate to my sister Donna H. Crist. In the event that both
my parents predecease me and my sister Donna H. Crist predeceases me, then I give, devise, and
bequeath my entire estate to my Trustee hereinafter named to be held, administered, and disposed of in
the following manner:
A. Trustee shall hold, manage, and invest trust property and income and shall pay to my sister Judy
L. Stine all of the net income of the trust estate for the support, maintenance, comfort and welfare of
my sister Judy L. Stine for and during her natural life in her accustomed manner of living and shall pay
such portions of principal as Trustee in Trustee's absolute discretion may deem advisable to provide for
medical, health, and institutional care required. Payments shall be made quarterly or by any other period
as Trustee deems advisable in Trustee's absolute discretion.
B. In the event that my sister Judy L. Stine predeceases me or deceases during the administration
of the trust, I direct that my entire estate or the then remaining principal and any accumulated income
shall be distributed equally, share and share alike, among my nieces and nephews, per stirpes.
~Jtem ~ree: I appoint my mother Helen M. Heberlig of Carlisle, Pennsylvania, Executrix of this my last
will. Should she fail to qualify or cease to act as Executrix, I appoint my father Glenn E. Heberlig, to
act as Executor with the same rights, powers, and duties. Should he fail to qualify or cease to act as
Executor, then I appoint my sister Donna H. Crist to act as Executrix with the same rights, powers, and
duties.
~tem ~our: I nominate and appoint Farmers Trust Company of Carlisle, Pennsylvania, Trustee of the
trust created herein.
~tem .~it~t: All estate, inheritance, succession, and other taxes, imposed or payable by reason of my
death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax
purposes, whether or not such property passes under this will, shall be paid out of the principal of my
residuary estate, without apportionment or right of reimbursement.
]Item ~/x: I direct that my personal representative or guardian shall not be required to give bond for the
faithful performance of his duties in any jurisdiction.
~tem ~el~en: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this
will, I give to my Executrix and Trustee during the full time necessary and for the administration of my
estate and trust herein the following .fights and powers to be exercised in his or her sole discretion.
To retain any real or personal property which may at any time form a part of my estate so long
as he or she deems it advisable.
B. To invest in any real or personal property without restrictions to legal investments.
To repair, alter, improve or lease for any period of time any real or personal property and to give
options for leases.
To sell at public or private sale, for cash or credit, with or without security, to exchange or to
partition, to mortgage or pledge real or personal property, and to give options for leases.
To make distribution in kind.
F. To compromise claims.
G. To expend directly any income or principal which it is authorized in this instrument to use for
the benefit of any person. Trustee shall not be required to obtain authority or approval of any court in
the exercise of any power permitted under this instrument. Trustee shall not be required to file
accountings with any court. No person dealing with Trustee shall be obligated to inquire into the
Trustee's power or authority or into the validity of any act of the Trustee or be liable for the application
of any money paid to the Trustee in the management of the trust fund.
IN WITNESS WHEREOF, I have hereunto set my hand this ./___~% of October, 1996.
Becky L. ltfeberlig {_/
The preceding instrument, consisting of this and one other typewritten page each identified by the signature
of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein
named as and for her last will, in the presence of us, who~'l~e~/u?ti~"~presence and in the presence
of each other have subscribed our names.
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
We John H. Broujos and ~f, dD~,,J~/~ Co,,'c0 f(~,vitnesses whose names are signed to the attached or
foregoing instrument being duly 4ualified according to law, do depose and say that we were present and saw
the Testatrix sign and execute the instrument as her last will; that she signed willingly and executed it as her
free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the
Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time
18 or more years of age, of sound mind and under no co~ra~r~nfluence.
Sworn and subscribed to before ~LZ]' ~
me this '?___~ay of October, 1996.
~- Sh~ L. Murphy, No ar,/Puolic
'" Notary Public'"- ' J Cadisle Bom, Cumberland County
My Corem ssion Expires Jan. 4, 1
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
I, Becky L. Heberlig, whose name is signed to the attached document, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as
my free and voluntary act for the purposes therein expressed.
before me this/b ¢~-day of October, 1996. ~// '
" Notary Publ~ '
Notarial Seal
Sberd L. Murphy Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Jan. 4, 1999
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-060!
COMNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JOHN H BROUJOS ESQ
BROUJOS & GILROY
4 N HANOVER ST
CARL[SLE
PA 17015
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-28-2004
HEBERL[G
08-11-2005
21 05-0698
CUMBERLAND
101
Amount Remitted
BECKY L
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF NILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~* RETAIN LONER PORTION FOR YOUR RECORDS *~
REV-1547 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF HEBERLIG BECKY L FILE NO. 21 05-0698 ACN 101 DATE 06-28-2004
TAX RETURN WAS: C X} ACCEPTED AS FILED C ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate (Schedule A)
2. Stocks and Bonds (Schedule
S. Closely Held Stock/Partnership Interest (Schedule C) CS)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
&. Jointly Owned Property (Schedule
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXENPTIONS:
9. Funeral Expenses/Adm. Costs/M/sc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10}
11. Total Deductions
12. Net Value of Tax Return
45r550.00
.00
.00
.00
755.75
:590.15
.00
14,570.95
50r071.49
CII)
C12}
13.
14.
NOTE:
ASSESSMENT OF TAX:
15. Amount of L/ne 14 at Spousal rate C15}
16. Amount of Line 14 taxable at Lineal/Class A rate Cl6)
17. Amount of Line 1~ at Sibling rate C17).
18. Amount of Line 14 taxable at Collateral/Class B rate C18)
19. Principal Tax Due
TAX CREDITS:
NOTE: To insure proper
credit to your account,
submit the upper port/on
of this form with your
tax payment.
46,475.86
PAYMENT
DATE
05-11-2004
1,833.42
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C1S)
Net Value of Estate Subject to Tax C14)
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and
reflect flgures that include the total of ALL returns assessed to date.
RECEIPT
NUMBER
DISCOUNT
INTEREST/PEN PAID
.00
· O0 x O0 =
1,855.42 x 045 =
LDO x
C19>=
.00
1,85:3.42
82.50
.00
CD005950
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
19 will
.00
82.50
.00
.00
82.50
.00
.00
( IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA), YOU HAY BE DUE.~/L
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION=
Estates of decedents dying on or before December I2, 1982 -- if anY future interest in the estate is transferred
in possession or enjoyment to Ciass B (coiiateral) 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
NOTICE=
PAYMENT=
REFUND CCR):
OBJECTIONS=
ADflIN-
ISTRATIVE
CORRECTIONS
DISCOUNT=
PENALTY=
INTEREST=
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S.
Section 91403.
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse s/de.
--Make check or money order payabZe to: REGIS~I~R OF NILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" CREV-l$15). Applications are available at the Office
of the Register of Nills, anY of the 25 Revenue District 0fftces, or by calling the special 2~-hour
answering service for forms ordering= 1-800-$62-2050; services for taxpayers with special hearing and / or
speaking needs= 1-800-~7-$020 (TT only).
AnY party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sho~n on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenuq, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individua! Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-060I
Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" CREV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three CS) calendar months after the decedent's death, a five percent CSX) discount of
the tax paid is allo~ed.
The 15X 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 from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
s/x (&Y,) percent per annum calculated at a daily rate of .0001&4. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced bY the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are=
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ 20X .000548 ~'~'8-1991 11~ .000501 2001 9~ .000247
1983 16~ .000458 1992 9~ .000247 2002 &X .0001&4
1984 11~ .000501 1993-1994 7X .000192 2003 5X .000157
1985 13X .000556 1995-1998 9X .000247 2004 4X .000110
198& lOX .000274 1999 7X .000192
1987 1DX .000274 2000 7X .000192
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTI~REST 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 sho~n on the
Notice, additional interest must be calculated.
Final Settlement Statement
File No. 21-03-00698
THIS is a statement made this ~ff'~day of July, 2004, by Helen M. Heberlig, 1044 South Pitt
Street, Carlisle, PA 17013, sole beneficiary and Executrix of the Estate of Becky L. Heberlig,
Decedent, and whose name is set forth as signatory at the end of this Statement.
WITNESSETH:
A. Becky L. Heberlig of 14 Courtyard Drive, Carlisle, Cumberland County, Pennsylvania,
died on August 11, 2003.
B. On August 26, 2003, Letters Testamentary were granted to Helen M. Heberlig at File No.
21-03-00698 in the Register of Wills Office for Cumberland County, Pennsylvania.
C. Executrix has administered the estate until the present time and has paid all debts of the
estate, including inheritance tax owed.
D. Decedent died testate, providing for the residue of decedent's estate to pass to her mother
and father. Her father died November 26, 2000.
E. The assets of the estate are set forth in Exhibit A attached hereto and made a part hereof.
F. Executrix has paid the debts of the estate as set forth in Exhibit B attached hereto and
made a part hereof.
G. There remains to be distributed to the beneficiary the assets set forth in the Schedule of
Distribution in Exhibit C attached hereto and made a part hereof.
H. The party desires to forego a formal account and schedule of distribution and desires to
conclude the estate by virtue of filing of this Statement.
NOW, THEREFORE, the said party intending to be legally bound sets forth the following:
1.
distribution.
o
Executrix of the estate of deceased will not file a formal accountin~?,~che e
:ri ~::.~ of
Inheritance Tax was paid.
The party will distribute the assets in accordance with Exhibit C.
4. The beneficiary designates this Statement as a "satisfaction of award" and hereby
authorizes and directs the Clerk of Orphans' Court to mark satisfied of record any award which
may subsequently be made by the Court with respect to the distribution made to the distributee in
this Statement.
5. The beneficiary acknowledges that this Final Settlement Statement shall be filed with the
Clerk of Orphans' Court in final settlement of the estate of decedent Becky L. Heberlig.
IN WITNESS WHEREOF, the Executrix/Beneficiary, intending to be legally bound hereby, sets
her hand and seal the day and year first above written.
WITNEI~
Helen M. Heberlig, Executrix & ~eneficiary
1044 South Pitt Street
Carlisle, PA 17013
ITEM
NUMBER
EXHIBIT A - ASSETS & INCOME
DESCRIPTION
VALUE AT
DATE OF DEATH
2.
3.
4.
5.
6.
7.
Frame condominium, 14 Courtyard Drive, Carlisle, PA
M&T Bank Checking Account #3740987908
Household items
M&T Mortgage Corp. - refund after payoff was made
MBNA Visa card - credit refunded
IRS - 2003 federal income tax refund
PA Department of Revenue - 2003 state income tax refund
SUBTOTAL
Jointly-owned property:
Members 1 st FCU checking
and savings acct #25937
DOD value
$ 78O.26
% of Decd's
_Interest
50%
TOTAL ASSETS
INCOME
Interest earned on estate checking account
$ 45,330.00
95.89
328.00
14.63
47.21
219.00
51.00
$ 46,085.73
DOD Value of
Decd's Interest
390.13
$ 46,475.86
$ 53.82
TOTAL ASSETS AND INCOME $ 46,529.68
ITEM
NUMBER
EXHIBIT B - DEBTS AND DEDUCTIONS
DESCRIPTION
AMOUNT
FUNERAL EXPENSES
1. Hoffman-Roth Funeral Home
2. Helen Heberlig - reimbursement for grave opening
3. Donna Crist - reimbursement for funeral meal
4. Cumberland Valley Memorial - gravemarker
ADMINISTRATIVE COSTS
1. Personal Representative Commissions - Helen M. Heberlig
2. Attorney Fees - Broujos & Gilroy, P.C.; EIN 23-2267691
3. Register of Wills - Probate Fees
MISCELLANEOUS EXPENSES
1. Register of Wills - Inventory
2. Register of Wills - Inheritance Tax Return
3. Register of Wills - Final Settlement Statement
4. printing of checks for estate account
MISCELLANEOUS DEBTS
1. PP&L - electricity
2. UGI - gas
3. Broujos & Gilroy, P.C. - legal fees from 2001 case &
during hospital stay
4. Cumberland Goodwill Fire Company - ambulance service
5. West Shore EMS - ambulance service
6. Masland Associates - medical services
7. Andorra Radiology Associates - x-rays
8. Fleet Credit Card Services
9. Capital Tax Collection - local 2003 income tax
10. Helen Heberlig - reimbursement for payment of bills preparing
14 Courtyard Drive for sale
11. Helen Heberlig - reimbursement for payment of bills after DOD:
condo fees 275.38, PPL 69.38, UGI 30.02, water 45.24, MBNA 107
Fleet 422.00, Goodville-homeowners 49.00, Darlene Moyer-personal
Tax 10, BC premium 113.67, M&T Mortgage 797.79
12. Helen Heberlig - reimbursement for payment of Becky's 2003
household bills while Becky was unable to work
13. Helen Heberlig - reimbursement for payment of Becky's 2002
household bills while Becky was unable to work
Inheritance Tax
SUBTOTAL
$ 6,362.00
945.00
200.00
1,784.00
2,500.00
2,500.00
228.00
10.00
15.00
17.00
9.95
44.80
33.49
437.50
847.65
810.68
50.00
320.00
6,917.89
10.91
657.20
1,919.48
6,531.31
J1,490.58
44,642.44
82.50
TOTAL DEBTS AND DEDUCTIONS $44,724.94
Assets
Income
Debts and Deductions
Balance for Distribution
EXHIBIT C - DISTRIBUTION
$ 46,475.86
53.82
46,529.68
- _44,724.94
1,804.74
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Becky L. Heberlig
Date of Death:
Augustll, 2003
Will No. Admin. No. 21-03-0698
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 X No
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:
ao
Did the personal representative file a final account/statement with the
Court? Yes No X
bo
The separate Orphans' Court No. (if any) for the personal representative's
account is:
Co
Did the personal representative state an account informally to the parties
in interest? Yes X No
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be
attached to this report.
Capacity:
Signature
Helen M. Heberlig
1044 S. Pitt St., Carlisle, PA 17013
717-243-3865
Personal Representative