HomeMy WebLinkAbout03-1048 PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Register of Wills for the
· Deceased. County of Cumberland in the
Social Security No. 180-26-6107 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an tl3.e~execut~rs named
in the last will of the above decedent, dated e~ay z9 ,1986
and codicil(s) dated N/A
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h er last family or principal residence at 390 Wh±skey Run Road. Upper M~ffl~n Townsh±p
(list street, number and muncipality)
Decendent, then 83 years of age, died November 14 ,X_~ ?003 ,
at Shippensburg Health Caro~ Centor: .qn~t'h~mr~enn T~; C,,mb~'!and County~ PA
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: Decedent was married to Carl U. Clevenger. He died on April 7, 2001.
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 $ 40,000.00
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ 175, OOO. 00
situated as follows: Real Estate. together with 'imp'roxromon~ thereon, situate
in Upper Mifflin Tnxo~h-lp: n,,mh-r!end County. Pennsylvania
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Testamentary
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
'~ .~/Janet L Whisler /-
~ g · John E. Cieveng~z
= [~ 655 N. Middle Road Newv~lle, PA172&] /,27 Whq~koy R,,n Rn~d Mor.nrqllo, PA 17241
~o Dale E. Clev~figer Connie A, Clevenger, now Connie A, Bryfnesser
g 35 Lay Road 400 Whiskey Run Road
Newville, PA 17241 Newville, PA 17241
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF CUMBERLAND~ SS
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 affirm, and subscribed ~?~e~ ~- ~Z~~ ~
..bef.~r. e me this /~r'/'' day of [~~ ', ~ O~-~,~g~ ,,t,',~-,q ~.~
No. ~2/-tg,~-
Estate Of Helen I. Clevenger , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~__~ff~~e-~ '~ 1Lg[ 2003, 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 May 29, 1986
described therein be admitted to probate and filed of record as the last will of.
;
and Letters Testamentary
are hereby granted to Janet L. Whisler, Dale E. Clevenger. John E. Clevenger and
Connie A. Clevenger, now Connie A. Brymesser
FEES Richard ~J.'Webber,'J~r., Esquire ,,49634
Probate, Letters, Etc. SCrimP. O~
~.~5~----~ ......... ~ .~e~ ATTORNEY (Sup. Ct. I.D. No.)
Short Certificates( ) .......... $~9~-~-~--
126 East King Street Sh±ppensburg, PA 17257
(~tion ................ $
/ $ ~.~2~ ADDRESS
TOTAL . $~j;1~7~,o (717) 532-7388
Filed .~'~.-. · .~. .... ~r.~. P.oN~
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00 ~{~&~. ~ ~. ~'~%.¢~le~~Local Registrar
P 9 7 5 0 3 9 2 NOV Z 6 2003
No. '~ Date
H~0$.~ ~,. ~e? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
,,.T CERTIFICATE OF DEATH
ENT NAME OF OECEOENT (F,~s;. M~Ie, La~I STATE F~LE NU~E~
"~ '¢emale ,.180 -- 26 --6107 ~ov. 14, 2003
Cumberland S. ~am~n Shippensbur~ Health Care L..._.~.~,.,,.
__ o.~s*, I,~idowed
,~,.~,,,, n~ ~ ,~.~m.~ Lower Mifflin
390 ~iskey Run Rd ,~s,~
Newville PA 17241
,~.~ Cumberland ~, ,,.~ ~.~
George Chestnut ,,. Irene S. Gutshall
Con: ]~.400 Whiskev Run Rd
~~ "~"'~ [~rland Valley Mem. ICarlisle PA 17013
~ ~ ~ ,,~1/18/2003 ~ ~'m-~ ........ c .......
~er ~'uner~I Nome lno 15 Bi~ 8~rln Ave
,~.FD 13895 T. ,~. ~ ....... ~,,~ ~ ~, _ _ g
E~.~~-- ::: ~.
,--~.,,,~__l,.~ C~cE~'~u ~,,.~'c"~'~ .... .......... ~'-- 1, ~ ~''.~.S--.)L~'.
,,,.[~-OOfO(~- ~ I,,.. ~'/1~1o~ '
LAST WILL AND TESTAMENT
I, HELEN I. CLEVENGER, of Upper Mifflin Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any
will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decease as a part of the
administration of my estate.
ITEM II: I bequeath those articles of my household furniture and
furnishings and those articles of my personal effects and personal property
as set forth in a separate memorandum, which I shall place with my will or
~osit with my attorney, to the persons therein designated.
ITEM III: I devise and bequeath the residue of my estate of every
nature and wherever situate to my husband, CARL U. CLEVENGER, providing he
shall survive me by thirty days.
ITEM IV: Should my husband, CARL U. CLEVENGER, predecease me or die on
or before the thirtieth day following my death, I devise and bequeath all of
the residue of my estate of every nature and wherever situate to my four
children, JANET L. WHISLER, DALE E. CLEVENGER, JOHN E. CLEVENGER, and CONNIE
A. CLEVENGER, in equal shares, per stirpes.
ITEM V: I direct that all taxes that may be assessed in consequence of
my death, of whatever nature and by whatever jurisdiction imposed, shall be
laid from my residuary estate as part of the expenses of the administration
HAMILTDN C. DAVIS
ATTDRN£¥ATLAW if my estate.
NEWVILLE & ~HiPPENSBURB
PENNA.
ITEM VI: I appoint my husband, CARL U. CLEVENGER, executor of this my
last will. Should he fail to qualify or cease to act as executor, I appoint
my four children, JANET L. WHISLER, DALE E. CLEVENGER, JOHN E. CLEVENGER, and
CONNIE A. CLEVENGER, executors of this my last will.
ITEM VII: I direct that my executors or guardian or their successors
shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on three (3) sheets of paper, dated this ~qT~ day of
,
Helen I. Clevenger
The preceding instrument, consisting of this and two (2) other
typewritten pages, 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 at her
request, in her presence, and in the presence of each other have subscribed
our names as witnesse~hereto.
~~)/~ residing at /[//~a./~/~////~.
HAMILTON ~. DAVIS
ATTDRN£Y AT LAW
N£WVILLE & ~HIPPENSMURG
PENNA.
ZOMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
I, Helen I. Clevenger, the testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the instrument as my
Last Will; and that I signed it willingly and as my free and voluntary act
for the purposes therein expressed.
Helen I. Cl~venge~ ~
Sworn to or affirmed and~acknowledged
b.efore me by~.~-~. -~<Z~-V~-Z~. ~ ,
t~e testatrix, this ~{~ dayw of
~>,~;,~,Jz , 1986. VELDA M. SEASE, Notary Public
My Commi~siari Expires April 16, 1990
Notary Public
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We (or I), ~/,~ ~. ~ %7I~ and ~-Z~'~6'/~ ~T~ , the
witness(es) whose name(s) are (is) signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say that we
were (I was) present and saw the testatrix sign and execute the instrument as
her Last Will; that the testatrix signed willingly and executed it as her
free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the testatrix signed the Will
as a witness; and that to the best of our (my) knowledge the testatrix was at
that time eighteen (18) or more years of age and of sound mini and under no
constraint or undue influence. . ~// , / ~
before .me by ~x~ ~i.~.~
and ~e-~ ~.~-~ . witness(es).
, zest.
HA~ILTBN C. DAVIS '
U[ww~L[ ~ SH,~,~.s~u.~ Ship~nsburg, Cumberland Co., Pa.
~ota~ ~ubllc ~y Commission ~pires April 16, 1990
IN RE: HELEN I. CLEVENGER, LATE : IN THE COURT OF COMMON PLEAS OF
OF TOWNSHIP OF UPPER MIFFLIN, : CUMBERLAND COUNTY, PENNSYLVANIA
CUMBERLAND COUNTY, PENNSYLVANIA, : ORPHANS' COURT DIVISION
DECEASED : ESTATE NUMBER 2003-01048
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Helen I. Clevenger
Date of Death: November 14, 2003
Will No. 2003-01048
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-captioned
estate on June 13, 2004:
Janet L. Whisler John E. Clevenger
655 N. Middle Road 432 Whiskey Run Road
Newville, PA 17241 Newville, PA 17241
Dale E. Clevenger Connie A. Clevenger Brymesser
35 Lay Road 400 Whiskey Run Road
Newville, PA 17241 Newville, PA 17241
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
Date: / /[ ~/crt/'
Signature ,----~ ~/
Name: Richard L. Webber, Jr., Esquire
Address: Weigle & Associates, P.C.
126 East King Street
Shippensburg, PA 17257
Telephone: (717) 532-7388
Capacity: Personal Representative
X Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE REV-1162 EX(11-96)
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003554
WEBBER RICHARD L JR
126 EAST KING STREET
SHIPPENSBURG, PA 17257
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $7,750.00
ESTATE INFORMATION: SSN: 180-26-6107
FILE NUMBER: 2103- 1048
'DECEDENT NAME: CLEVENGER HELEN I
DATE OF PAYMENT: 02/12/2004
POSTMARK DATE: 02/11/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 11/14/2003
TOTAL AMOUNT PAID: $7,750.00
REMARKS:
r~ CHECK//8
?~. INITIALS: JA
' SEAL RECEIVED BY' GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
C UMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE REV ] 162 EX(11 96)
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128 0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004166
CLEVENGER CONNIEA NKA
400 WHISKEY RUN ROAD
NEWVILLE, PA 17241
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 $374.40
ESTATE INFORMATION: SSN: 18026-6107
FILE NUMBER: 2103- 1 048
DECEDENT NAME: CLEVENGER HELEN I
DATE OF PAYMENT: 07/16/2004
POSTMARK DATE: 07/16/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 11 / 14/2003
TOTAL AMOUNT PAID: $374.40
REMARKS: CONNIEA BRYMESSER
CHECK# 23
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF
PENNSYLVANIA
FILE NUMBER
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN
DEPT 280601 2~ 0 3 01 0 4 8
HARRISBURG, PA 17128-0601 , RESIDENT DECEDENT cou,~cooE
Clevenger, Helen I 180-26-6107
11-14-2003 i 12-27-1919 REGISTER OF WILLS
~x 1. Original Return iX 2 Supplemental Return __ 3 Remainder Retum (date of death p~or to 12 13 82)
X]6 Decedent Died Testate (Atiach ~ 7 DecedentMaintainedaLivingT~ust(Atlach 0 8 fotalNumberofSafeDepositBoxes
i ~ 10 S ousalPOW,lrb~Credit dateofdeath~t~veen 11 Election to tax under Sec 9113(A)(A~achSchO)
lAME ~COM PLETE MAILING ADDR ESS
Richard L Webber, Jr.., Esquire
IRUNAME(Ifepplicable) iWeigle & Associates, P.C.
,
i 126 East King Street
ELEPHONENUMBER Shippensburg, PA 17257
I Real Estate (Schedule A) (1) 14 0,0 0 0.0 0 OFtFIf~' [~.L [JSE ON LY
2. Stocks and Bonds (Schedule B) (2) N 0 Ile
3. C osely Held Corporation, Padnership or Sole-Proprietorship (3) N 0 n e
4. Modgages & Notes Receivable (Schedule D) (4) N 0 n e
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 59,8 3 6.6 7
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) N 0 n e
I J Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate (7) N
Property
O
n
e
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8) 1 99,8 3 6.6 7
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 6,7 50.5 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 3,479.6 8
11. Total Deductions (total Lines 9 & 10) (11) 10,230 .t 8
12. Net Value of Estate (Line 8 minus Line 11) (12) 189,606.49
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has (13) 0.0 0
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1 89,6 0 6.4 9
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 0.0 0 x .00 (15) 0.0 0
or transfers under Sec. 9116(a)(1.2)
16 Amount of Line14 taxable at lineal rate 189,606.49 x .045 (16) 8,532.29
17, Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 0.00
18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) 0.00
19. Tax Due (19) 8,532.29
Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev 6-00',
Decedent's Complete Address:
STREET ADDRESS
390 Whiskey Run Road
CITY Newville ISTATE PA ZIP 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 8,532.29
2. Credits/Payments
A. Spousal Poverty Credit
B Prior Payments 7,750.00
C. Discount 407.89
Total Credits (A +B+C) (2) 8,157.89
3. Interesl/Penalty if applicable
D. Interest
E. Penalty
Total Interesl/Penalty (D + E) (3)
4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE (5) 374.40
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3 7 4.4 0
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1 Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................
b. retain the right to designate who shall use the property transferred or ils income; .....................
c relain a reversionary interest; or ............................................................................................................
d. receive the promise for life of either payments, benefits or care? ............................................. ] [x~
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? I Ex]
3 Did decedent own an "in trust for' or payable upon death bank account or security at h s or her death? ...... :~J ! x J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
con ains a beneficiary designat on? ...............
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 1T AS PART OF THE RETURN.
Under penalties of pedury, I dec/are that I have examined this return, including accompanying sChedules and statements, and to the test of my k~oc4edge and belief, it is tcae, co~ect and
complete DeCJaration of preparer other than the personal representative is based on ail infermatioa of which preparer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
C~,~nie A. Brymesser n 400 Whiskey Run Road
~,4~ · : ~.~.~ ~ Newville, PA 17241
SIGNATURE OF PERSON RESPONSIBLE F~;~F LiNG RETURN ADDRESS DATE
Janet L Whisler 655 N. Middle Road
[' %/' , .
~(~..~_¢/L_ ~.~ 14.~J~[.~.~_.- Newville, PA 17241
S ATURE OF PREPARER OTHER THAN EEPRESENTA~VE ADDRESS
';~:hard b Webber, Jr., Esquire 126 East King Street
Shippensburg, PA 17257 "~
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 PS. §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 §9115 (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 b, venty-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 PS. §9116 (a) (1 2)]
The lax raid imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4 5%, excepl as noted in 72 P.S.
§9116 1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the aet 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
SIGNATURE OF PERSON(s) RESPONSIBLE FOR FILING RETURN
~J~ohn E. Clevenger
423 Whiskey Run Road
Newville, PA 17241
Dale E. Clevenger
35 Lay Road
Newville, PA 17241
Rev '1502 EX+ {6-98)
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Clevenger, Helen I 21-03-01048
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real - Estate, together with improvements thereon, situate in Upper Mifflin 140,000.00
Township Cumberland County Pa, containing '1.607 acres, known as 390 Whiskey
Run Road, Newville, PA 17241
TOTAL (Also enter on Line 1, Recapitulation) 140,000.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule A (Rev. 6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
oo..o.~.~., o~ ~..~,~,~ PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Clevenger, Helen I 21-03-01048
VALUE AT DATE
ITEM DESCRIPTI ON OF DEATH
NUMBER
1 Adams Electric Cooperative - Patronage Dividend 93.61
2 Farmers National Bank of Newville - Checking Account #22-012-4 35,767.11
Accrued income on Item 2 through date of death 11.06
3 Gross proceeds from Public Sale of Personal Property 23,741.25
4 Refund School Tax - Portion of 2003-04 School Real Estate Tax 223.64
TOTAL (Also enter on Line 5, Recapitulation) 59,836.67
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form sofbNare only The Lackner Group, Inc Form PA-1500 Schedule E (Rev 6-98)
~"'~×+~"'"~ ~ SCHEDULE H
OOMMONWE^LT"~'~OF ~N~¥LV^~^ FUNERAL EXPENSES &
~N,E,,T^,CE TM RETUR, ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clevenger, Helen I 2t-03-01048
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
None
B. ADMINISTRATIVE COSTS:
1. Persona[ Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees
See continuation schedule(s) attached * 2,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
See continuation schedule(s) attached * 295.00
5 Accountant's Fees
6 Tax Return Preparer's Fees
7 Other Administrative Costs
See continuation schedule(s) attached * 3.955.50
TOTAL (Also enter on line 9, Recapitulation) i 6,750.50
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-B2
ATTORNEY'S FEES
continued
ESTATE OF FILE NUMBER
Clevenger, Helen I 21-03-0~1048
ITEM
NUMBER DESCRIPTION AMOUNT
1 Weigle & Associates, P.C. 2,500.00
Subtotal 2,500.00
Copyright (c) 2002 form sofiware only The Lackner Group, Inc. Form PA-1560 Schedule H-B2 (Rev 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-B4
PROBATE FEES
continued
ESTATE OF FILE NUMBER
Clevenger, Helen I 21-03-01048
ITEM
NUMBER DESCRIPTION AMOUNT
1 Cumberland County Register of Wills 295.00
Subtotal 295.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B4 (Rev. 6 98)
Rev-1502 EX*- (6 98)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
~N~E~,.~OET~,ETU,N continued
ESTATE OF FILE NUMBER
Clevenger, Helen I 21-03-0t048
ITEM DESCRIPTION AMOUNT
NUMBER
1 Cumberland Law Journal - Legal advertisement 75.00
2 Cumberland Register of Wills - Filing fee for Inheritance Tax Return '15.00
3 D.E.W. & Sons rental fee for Porta-John 35.00
4 Dan Hershey Auctioneer Service - fee for public sale 2,594.50
5 Doubling Gap Church - Rental fee for tables for public sale 50.00
6 Realty transfer tax for sale of real Estate 1,050.00
7 South Central Home Settlements, Inc. abstract fee for real estate matters. 39.50
8 The Valley Times-Star - legal advertisement 96.50
Subtotal 3,955.50
Copyright (c) 2002 form software only The Lackner Group, I nc Form PA-1500 Schedule H-B7 (Rev 6-98)
Rev-1512 EX+ ($-98)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Clevenger, Helen I 2t-03-01048
VALUE AT DATE
ITEM DESCRIPTION
NUMBER OF DEATH
1 Shippensburg Health Care Center 2,123.58
2 Pharmacare 655.61
3 Chambersburg ALS - West Shore 448.55
4 Adams Elect. Coop., Inc 94.51
5 Adams Electric Coop., Inc. 71.34
6 Adams Electric Coop., Inc 66.57
7 Adams Electric Coop, Inc. 19.52
TOTAL (Aisc enter on Line 10, Recapitulation) 3,479.68
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev 6-98)
oo~o,wE^~, o, ,,,,s¥,v.~,~^
~N,ER~T^.OE T~< R,~,,, BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clevenger, Helen I 21-03-01048
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY' DECEDENT OF ESTATE
Do Not List Trustee(s)
TAXABLE I')ISTRIB[JTIC)NS [include outright spousal distributions, and
][- --- - transfers under Sec. 9116(a)(1 2)]
1 Janet L Whisler Daughter 47401.62
655 N. Middle Road
Newville, PA '17241
2 John E Clevenger Son 47401.62
432 Whiskey Run Road
Newville, PA '17241
3 Dale E Clevenger Son 4740'1.62
35 Lay Road
Newville, PA '17241
4 Connie A Clevenger, Brymesser Daughter 4740'1.62
400 Whiskey Run Road
Newville, PA '17241
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LiNE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND TESTAMENT
I, HELEN I. CLEVENGER, of Upper Mifflin Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any
will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
esiduary estate as soon as practicable after my decease as a part of the
~tion of my estate.
ITEM II: I bequeath those articles of my household furniture and
urnishings and those articles of my personal effects and personal property
as set forth in a separate memorandum, which I shall place with my will or
~sit with my attorney, to the persons therein designated.
ITEM III: I devise and bequeath the residue of my estate of every
nature and wherever situate to my husband, CARL U. CLEVENGER, providing he
shall survive me by thirty days.
ITE~ IV: Should my husband, CARL U. CLEVENGER, predecease me or die on
~ or before the thirtieth day following my death, I devise and bequeath all of
the residue of my estate of every nature and wherever situate to my four
chi2dren, JANET L. WHISLER, DALE E. CLEVENGER, JOHN E. CLEVENGER, and CONNIE
A. CLEVENGER, in equal shares, per stirpes.
ITEM V: I direct that all taxes that may be assessed in consequence of
my death, of whatever nature and by whatever jurisdiction imposed, shall be
~aid from my residuary estate as part of the expenses of the administration
HAMILTBN C. DAVIS
AT%BRNEY AT LAW )f my estate.
ITEM VI: I appoint my husband, CARL U. CLEVENGER, executor of this my
last will. Should he fail to qualify or cease to act as executor, I appoint
my four children, JAfqET L. WHISLER, DALE E. CLEVENGER, JOHN E. CLEVENGER, and
~ONNIE A. CLEVENGER, executors of this my last will.
ITEM VII: I direct that my executors or guardian or their successors
~hall not be required to give bond for the faithful performance of their
iuties in any jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on three (3) sheets of paper, dated this ~q~-O- day of
Helen I. Clevenger
The preceding instrument, consisting of this and two (2) other
typewritten pages, 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 at her
request, in her presence, and in the presence of each other have subscribed
our names as witnesse~ hereto.
residing at ~¢~J~ ~,
residing atXi7~/~
HAMILTUN C. DAVIS
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND :
I, Helen I. Clevenger, the testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the instrument as my
Last Will; and that I signed it willingly and as my free and voluntary act
for the purposes therein expressed.
/~ ~. p. ~~ .(SEAL)
Helen I. Cl[venger ~
Sworn to or affirmed an~acknowledged
before me ,
the te~tatrix,~------this ~ da~of
VELDA M. SEASE, Notary pijbli¢
/~ ~/~. ~ Shippensburg, CumberlandCo.,?a.
My Commission Expire~ Apri~ i 6, ] 990
Notary Public
]OMMONWEALTH OF PENNSYLVANIA :
iOUNTY OF CUMBERLAND :
We (or l), , I Z ~f-¢~} ~ and ~d~ , the
witness(es) whose name(s) are (is) signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say that we
were (I was) present and saw the testatrix sign and execute the instrument as
her Last Will; that the testatrix signed willingly and executed it as her
free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the testatrix signed the Will
as a witness; and that to the best of our (my) knowledge the testatrix was at
constraint or undue influence.that time eighteen (18)or more years of ager/ ~/'/~--and of sound min~ and under~ no
Sworn to or affirmed and ~,~ibsl2ribed to ('
Notary Public ' My Commission Expires April 16, 1990
LOCATION OF SALE ~ ~'r ~6/4/5~' (~ ,~
( SEER'S EXPENSES ) ( RECEIPTS
AUCTIONEER $ / ~ fica., ~v ~ CASH
CLERK $ CHECKS
CASHIER $ OTHER RECEIPTS
OTHER EXPENSES
$
$
$
$
$ LESS TOTAL EXPENSES
I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds
from the auction of my goods and properly sold on the above date. I accept all responsibility for providing
merchantable title to all goods, and property sold, and for delivery of title to the purchaser.
'.--~ ~- ' Date
Au~tionee~or Cashier s Signature (SelJer's~gnature)
~----~/Z/ ~ ~' Date Date
//
(Seller's Signature)
FARMERS NATIONAL BANK
~?~
December 30, 2003
Richard L. Webber Jr., Esquire
Weigle & Associates, P. C.
126 East King Street
Shippensburg, PA 17257
RE: Estate of Helen I. Clevenger
Dear Mr. Webber:
Mrs. Clevenger had a checking account with this bank which was in her
name alone. The account number was #22-012-4 and had a balance as of her
date of death, November 14, 2003, of $35,767.11 and $11.06 accrued interest.
There are no other accounts and no safe deposit box.
Sincerely yours,
~/'~' Carolyn ~. Kough ! '~
Executive Vice President
MADE THE ~'2 day of -J .... ~ , in the year of our Lord two thousand
and four (2004).
BETWEEN Janet L. Whisler, Dale E. Clevenger, John E. Clevenger, and
Connie A. Clevenger n/k/a/ Connie A. Brymesser, as Co-Executors of
the ESTATE OF HELEN L CLEVENGER, late of Upper Mifflin
Township, Cumberland County, Pennsylvania, hereinafter referred to
as Grantors,
AND Connie A. Brymesser, presently of 400 Whiskey Run Road, Newville,
Pennsylvania 17241, hereinafter referred to as Grantee,
WHEREAS, the said Helen I. Clevenger, was vested in her lifetime with title to real
estate hereinafter described, situate in the Upper Mifflin Township, Cumberland County,
Commonwealth of Pennsylvania; and,
WHEREAS, the said Helen I. Clevenger died testate on November 14, 2003; and her
Last Will and Testament was duly probated in the Register of Wills Office in the County of
Cumberland; and,
WHEREAS, the said real estate hereinafter described was not specifically devised, and
the said Janet L. Whisler, Dale E. Clevenger, John E. Clevenger, and Connie A. Clevenger
Brymesser subsequently qualified as Co-Executors of the Estate of Helen I. Clevenger.
NOW THEREFORE, This Indenture Witncsscth that the said Janet L. Whisler, Dale E.
Clevenger, John E. Clevenger, and Connie A. Clevenger Brymesser as Co-Executors aforesaid,
for and in consideration of the sum of ONE DOLLAR ($1.00), lawful money of the United
States of America to them and hand paid by the said Grantees, at and before the sealing and
delivery hereof, the receipt whereof is hereby acknowledged, has granted, bargained, sold,
aliened, released and confirmed, and by these presents, by virtue of the power and authority in
the said Co-Executors vested by the Probate, Estates and Fiduciaries Code of the Commonwealth
of Pennsylvania, does grant, bargain, sell, alien, release and confirm unto the said Grantee, her
heirs and assigns,
ALL THAT CERTAIN lot or parcel of land together with the improvements erected
thereon situate in Upper Mifflin Township, Cumberland County, Pennsylvania, designated as Lot
2 on a plan entitled "Final Subdivision Plan for Carl U. Clevenger,' dated Novembcr 16, 1989,
prepared by Larry V. Neidlinger, P.E.R.S., approved by the appropriate municipal authorities,
and plan is recorded in the Office of the Recorder of Deeds in and for Cumberland County,
Pennsylvania, in Plan Book 59, Page 134, more fully bounded and described as tbllows:
BEGINNING at a point in the intersection in PA Traffic Route 997 and
L.R. 21040 (SR 4013); thence along centerline of SR 4013 (L.R. 21040), South
fifty-four (54) degrees twenty-three (23) minutes East, two hundred and
zero hundredths (200.00) feet to a point; thence along lands formerly of Carl U.
Clevenger and Helen I. Clevenger, South thirty-five (35) degrees thirty-seven (37)
minutes zero (00) seconds West, three hundred fifty-six and zero hundredths
(356.00) feet to an iron pin; thence continuing along the same, North fifty-one
(51) degrees thirty (30) minutes twenty-two (22) seconds West, one hundred
ninety-nine and twenty-four hundredths (199.24) feet to a point in the centerline
of PA Traffic Route 997; thence along centerline of PA Traffic Route 997, North
thirty-five (35) degrees twenty-seven (27) minutes zero (00) seconds East, three
hundred forty-six and zero hundredths (346.00) feet to the point and place of
BEGINNING. CONTAINING 1.607 acres.
UNDER AND SUBJECT to dedicated right-of-way lines, building setback lines
and other notations as shown on the aforesaid plan.
BEING THE RESIDUE of real estate that J. Elton Clevenger, Executor of the Estate of
Margaret A. Clevenger, by his deed dated May 2, 1957 and recorded in the Office of the
Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book U, Volume 17 at
Page 98 conveyed to Carl U. Clevenger and Helen I. Cleventer, his wife. The said Carl U.
Clevenger died April 7, 2001, thereby vesting full title in Helen I. Clevenger. The said Helen 1.
Clevenger, died November 14, 2003. The Last Will and Testament of Helen I. Clevenger,
dated May 29, 1986, was entered for Probate in the Office of the Register of Wills in and
for Cumberland County, Pennsylvania. On December 23, 2003 Letters Testamentary at
Estate Number 2003-01048 were granted to Janet L. Whisler, Dale E. Clevenger, John E.
Clevenger, and Connie A. Clevenger n/k/a/Connie A. Brymesser, Co-Executors of the Estate of
Helen I. Clevenger.
AND THE SAID Grantors, Co-Executors as aforesaid, their heirs, executors and
administrators, do covenant, promise and agree to and with the said Grantee, her heirs and
assigns, by these presents, that the Grantors have not done, committed any act, matter or thing
whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be
impeached, charged or encumbered in title, or otherwise howsoever.
THE GRANTEE HEREIN HAS RECEIVED A ONE-FOURTH INTEREST IN THE
PREMISES CONVEYED HEREIN BY TESTATE SUCCESSION. GRANTEE'S ONE-
FOURTH INTEREST IS THEREFORE EXEMPT FROM REALTY TRANSFER TAX.
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
On this, the ~ / ~' day of "'~ ~ ., ,2004, before me, a Notary Public
in and for said County and State, the undersigned officer, personally appeared Janet L. YVhisler,
Dale E. Clevenger, John Clevenger, and Connie A. Clevenger n/k/a/Connie A. Brymesser, as the
Co-Executors of the Estate of Helen I. Clevenger, known to me (or satisfactorily proven) to be
the persons whose names are subscribed to the within instrument, and acknowledged that they
executed the same in the capacity therein stated and for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
RICHARD L. ~WEBBER JR, NOTARY PUBLIO Notary Public
SH PPENSBUR* BORO, CUMBERLAND COUNTY '
MYCOMM[SS~ON FD(PIRESJ'JLY 5,2006
I do hereby certify that the complete post office address of the within named Grantee is:
400 Whiskey Run Road, Newville, Pennsylvania 17241
Attorney for Grantees Z'...
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
RECORDED on this day of ., A.D. 2004, in the
Recorder's Office of said County, in Deed Book at Page
Recorder
IN WITNESS WHEREOF, the said Co-Executors of the Estate of Helen I. Clevenger,
deceased, Grantors herein, have hereunto set their hands and seals the day and year first
above written.
Signed, Sealed and Delivered
in the Presence of
/J~,,n~t L. Whisler
Co-Executor of the Estate
of Helen I. Clevenger
Dale E. Clevenger
Co-Executor of the Estate
of Helen I. Clevenger
'~o~ E. Clevenger
Co-Executor of the Estate
of Helen i. Clevenger
Co~ie A. Clevenger
Co-Executor of the Estate
of Helen I. Clevenger
~ Co~ie A. B~messer
Co-Executor of the Estate
of Helen I, Clevenger
.~..~.~/~ s,o,~ Tax Fo~d
REALTY TRANSFER TAX ~o~k nu,~b~, --
COMMONWEALTH OF PENNSYLYANIA STATEMENT OF VALUE
Complete each section and file in duplicate with Recorder of Deeds when (1) th e full value/consideration is not set forth in the deed, (2) when the deed
based on: (1) family relationship or (2} public utility easement. If more space is needed, attach additional sheet(s).
A CORRESPONDENT - All inquiries may be directed to the following person:
Richard L. Webber. Jr.. Esq,,ire AreaCode( 717 ) 532-7388
126 East King Street Shippens~urg PA 17257
B TRANSFER DATA
Grantor (s)/Lessor(s) Grantee (s)/Lessee(s)
Helen I. Cleven~er Estate onnie A. Brymesser
c/o Richard L. Webber, Jr. Esq. 17257 400 Whiskey Run Road
cnY126 East King Street Newville PA 17241
C -PROPERTY LOCATION
390 Whiskey Run Road: ~wville. U~er M~ff]in Tnwn~hio
County School District 44-06-0037-013
Cumberland
D VALUATION DATA
$ 140,000.00 + 0.00 _-- $140,000.00
E EXEMPTION DATA
$700.00 (one-quarter interest 100%
is succession by Will)
[] Will or intestate succession Helen I. Clevenger, deceased 21-03-1048
(If condemnation or in lieu of condemnation, attach copy of resolution.)
[] Corrective or confirmatory deed. (Attach complete copy of the prior deed being corrected or confirmed.)
[] Statutory corporate consolidation, merger or division. (Attach copy of articles.)
[] Other (Please explain exemption claimed, [f other than listed above.)
Under penalties of law, I declare that I have examined this Statement, including accompanying information, and to the best of my knowledge
and belief, it is true, correct and complete.
Signature of Correspondent{.._.~/.-'~°r Responsible~.._.~Party j ±/Date(~- !/'>!'..'~. ~' ~J
PA~LURE ~O CO~P~TE TInS ~ORM PROPERLY O. AnACH AP.UCA~E DOCUMENtAtiON MAY R£SU~T ~N T.E RECORD~R'S REPUSA~
TO RECORD THE DEED.
A. Settlement Statement U.S. DepartmentofHousingandUrbanDevelopment
B. Type of Loan OMB No. 2502-0265 REV. HUD-1 (3/86)
1. I~FHA 2. [~FmHA 3. [~Conv. Unins. [ 6. FileNumber [ 7. LoanNumber 8. Mortg'a;eln;uranceCaseNumber
4. [~VA n~,~', ~onv. Ins. I 04t092BRYMESSER l
N ' / o s Turn,she(3 to g~ve you a stalement o/actual sememenl c~sts Amounts pale to an~3 oy me settlement agenl are Sl~wn TitteExpress Settlement System
C. o[e~" ~tems marked ~'(p.~ c )" were pa~d ~u~side the c~sing~ they are sh~w~ hem f~r inf~rmaedn pu~ses and are n~t inc~uded in the t~ta~s
¢- WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form Penalties upon
conviction can include a fine and imprisonment For details see Title 18 LIS Ccde Section 1 OO1 and Section 1 O10 Pr nted 05/05/2004 at 15:35 ASF
D. NAME OF BORROWER: Steve F. Brymesser and Connie A. Brymesser
ADDRESS: 400 Whiskey Run Road~ Newville~ PA 17241
E. NAME OF SELLER: Estate of Helen I. Clevenger
ADDRESS: CIO Richard L. Webber, Jr. Esq, 126 E. King Street, Shil~pensburg, PA 17257
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 390 Whiskey Run Road, Newville, PA 17241
H. SETTLEMENT AGENT: Weigle & Associates, P.C., Telephone: 717-532-7388 Fax: 717-532-6552
PLACE OF SETTLEMENT: 126 East King Street, Shippensburg, PA 17257
I. SETTLEMENT DATE: 05~05~2004
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales price 140~000.00 401. Contract sales price 140,000.00
102. Personal Property 402. Personal Property
103. Settlement charges oborrower( ne1400) 1~385.00 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/towntaxes 05105104to12131104 196.80 406. City/towntaxes 05105104tot2131104 196.80
108. School Taxes 05105104to09/30/04 223.64 408. School Taxes 05105/04to06130104 223.64
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 141,805.44 420. GROSS AMOUNT DUE TO SELLER 140,420.44
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO gFI I FR
201. Depesitoreamestmoney 501. Excess Depesit (see instructions)
202. Principal amount of new loans 502. Settlement charges o se er ( ne 1400) 1~089,50
203. Existing loan(s) taken subject o 503. Existing loan(s) taken subject to
204. 504. Payoff of First Modgage Loan
205. 505.
206. 506.
207. 507.
208. 508.
209. 509,
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 520. TOTAL REDUCTION AMOUNT DUE SELLER 1~089.50
300, CASH AT SETTLEMENT FROM ORTO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gmss amount due from borrower (line120) t41,805.44 601. Grossamountduetoseller(line420) 140,420.44
302. Less amounts paid by/for borrower (line 220) 602. Lessreductionamountdueseller(line520) 1~089.50
303. CASH FROM BORROWER 141,805.44, 603. CASH TO SELLER 139~330.94
SUBSTITUT~ FORM 1099 SELLER STATEMENT: The information contained herein is important ta~ information and is being furnished to the Internal Revenue Service If you a e equ ed to file a return
a negligence penedy or other sanction w}ll be imposed on ~ou ~f this item is required to be reported and the IRS determines that it has not been reported The Contract Sales Price described on
!ine ,~o1 above constitutes the Gross Proceeds of this [ransacti~
SELLERINSTRUCT]ONS: Ifthiscealestate~asy~urpr~nclpalresidence f~leForm2~19, Saler,rExchangeo Pnncpa Resdence, fo¢anygaJn withyourlncometaxretum;forother ansactons
, STATEMENT REV. HUD-1 (3/86) TitleExpress Settlement System Pdnted 05/05/2004 at 15:35 ASF
JHARGES PAID FROM PAID FROM
.S/BROKER'S COMMISSION based on price $140~000.00 ~ 0.000 = BORROWER'S SELLER'S
,ommissice (line 700) as follows: FUNDS AT FUNDS AT
to SETTLEMENT SETTLEMENT
to
,nission paid at Settlement
.~IS PAYABLE IN CONNECTION WITH LOAN
,_can Origination Fee %
. Loan Discount %
J3. Appraisal Fee
804. Credit Report
805. Lender's Inspection Fee
806. Mortf:!afle Application Fee
807. Assumption Fee
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to ~,,$ /day
902. Modgagelnsurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. ~,, $ /mo
1002. Mortgage Insurance mo. ~,, $ /mo
1003. City Property Tax mo, ~,, $ 24.84/mo
1004. County Proper~y Tax mo. ~,, $ /mo
1005. School Taxes mo. @ $ 119.34/mo
1009. Agqregate Analysis Adiustment
1100. TITLE CHARGES
1101. Settlement or closinq fee
1102. Abstract or title search to South Central Home Settlements, Inc. 39.50
1103. Title examination
1104. Title insurance binder
1105. Document Preparation
1106. Notary Fees
1107. Attorney's fees to Weigle & Associates, P.C. 250.00
(includes above items No:
1108. Title Insurance
(includes above items No:
1109. Lender's Coverage $
1 10 Owner's Coverage $ 140~000.00 -
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees Deed $ 85.00 ; Uort,qape $ ; Release $ 85.00
1202. City/County tax/stamps Deed $1~050.00 ; Mor[ga.qe $ 1~050.00
1203. State Tax/stamps Deed $1~050.00 ; Mortgage $ t,050.00
1204.
1205.
1300, ADDITIONAL SETTLEMENT CHARGES
1301. Survey
1302. Pest Inspection
1303.
1304.
1305.
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K} 1,385.00 t,089.5(]
HUD CERTIFICATION OF BUYER AND SELLER
[ have carefully reviewed the HUD-1 aettlemef~t Statement and to the best of my knOwledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me
in this transaction I fudhe¢ ce riify that I have received a copy of the HUD I Settlement Statement
WARNING IT IS A CRIME TO KNOWINGLY fCC, K E FALSE STATEMENTS TO THE The HUD 1 Settlement Statement which I have prepared is a tr~e and accurate account of this ~ansactJon
UNITED STATES ON THiS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION I have caused or will cause the funds to be disbursed in accord~ce with this statement.
CAN INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE TITLE
US CODE SECTION 1001 AND SECTION 1010By:
COHHONNEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTHENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX REV-~S47£XAFP~O~-OS~
DATE 09-06-2004
ESTATE OF CLEVENGER HELEN
DATE OF DEATH 11-14-2005
FILE NUMBER 21 05-1048
COUNTY CU,H~.£AND
RICHARD L NE~BER JR ESQ ACN 10~i? ~
WEIGLE & ASSOCS A.oun~* R'm***ed :ii!
126 E KING ST m'~:'l~ ~
SHIPPENSBURG PA 17257 :
HAKE CHECK PAYADLE~AND R~ZT PAYMENT
TO:
REGISTER OF WILLS '
CO!
CUHBERLAND COURT ~USE
CARLISLE, PA ~17015 ;~
CUT ALONG THZS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS
DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF CLEVENGER HELEN I FILE NO. 21 05-1048 ACN 101 DATE 09-06-2004
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I Real Es~a~e (Schedule A) (1) ~40~000 O0 NOTE: To /nsure proper
2 S*ocks and Bonds (Schedule B) (2) O0 credi~ ~o your account,
$ Closely Held S~ock/Par~nership Zn~eres* (Schedule C) (3) O0 subai* *he upper portion
~ Hor~gages/No~es Receivable (Schedule D) (~) O0 of ~his form wi~h your
5 Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) (5) 59~856 67 ~ax payment.
6 Jointly Owned Proper~y (Schedule F) (6) O0
7. Transfers (Schedule G) (7) O0
8. To~al Asse~s (8) 199,856.67
APPROVED DEDUCTIONS AND EXEHPTZONS: 6,750.50
9. Funeral Expenses/Adm. Cos~s/Nisc. Expenses (Schedule H) (9)
10. Deb*s/Hor~gage Liabili~ies/Liens (Schedule 1) (10) ~,479.68
11. Total Deductions (11)
12. Ne~ Value of Tax Re~urn (12) 189,606.49
15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00
1~. Ne~ Value of Es*a~e Sub~ec* ~o Tax (1~) 189,606.49
NOTE: Z~ an assessment ~as issued previously, 11nes 1~, 15 and/or 16, 17, 18 and 19
reflect flgures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amoun~ of L/ne 1~ a~ Spousal ra~e (15) .00 X O0 = .00
16. Amoun~ of L/nB 1~ ~axeble a~ Lineal/Class A ra~e (16) 189,606.49 x 045 = 8,552.29
17. Aaoun~ of L/ne 1~ e* Sibl/ng rata (17) .00 x 12 = .00
18. Aaoun~ of Line 1~ ~axable e* Collateral/Class B ra~e (18) .00 X 15 = .00
19. Principal Tax Due (19)= 8,552.29
TAX CREDITS:
PAYHENT RECE/PT DISCOUNT (+) ANOUNT PA/D
DATE NUHBER INTEREST/PEN PAZD (-)
02-11-Z004 CD00~554 407.89 7,750.00
07-16-2004 CD004166 .00
TOTAL TAX CREDIT 8,552.29
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00 ~_
TOTAL DUE .00
TF pATD AFTER DATE /ND/CATED, SEE REVERSE ( 1F TOTAL DUE TS LESS THAN $1, NO PAYNENT TS RE~U/RED.
FOR CALCULAT/ON OF ADDZTTONAL TNTEREST. ZF TOTAL DUE TS REFLECTED AS A "CRED/T" (CH), YOU NAY BE D~
A REFUND. SEE REVERSE S[DE OF THIS FORH FOR INSTRUCTTONS.) ~l
RESERVATION= Estates of decedents dying an or before December 1Z, lgBZ -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years) the Commonmaalth 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: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S.
Section 9140).
PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGXSTER OF NILLS, AGENT
REFUND (CR): 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 [nheritanca and Estate Tax" (REV-ISiS). Applications are available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-BO0-56Z-Z050; services for taxpayers aith special hearing and / or
speaking needs: 1-800-447-50Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allomance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals) Dept. Z81021, Harrisburg, PA 171Z&-10Z1) OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADNIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 171Z6-0601
Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (EX) discount of
the tax paid is allowed.
PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 16, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate af .000164. AIl taxes which became delinquent on and after
January 1~ 198Z 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 19BI through ZOO4 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ 20Z .000546 ~)-8-6-1991 llZ .000501 ~ 9Z .O00Z~7
1983 16X .000438 199Z 9Z .000247 ZOOZ 6Z .000164
1984 11Z .000301 1993-1994 ?Z .O0019Z ZOO3 5Z .000137
1985 13Z .000356 1995-1998 92 .000247 ZOO4 42 .000110
1986 lOX .000Z74 1999 7Z .O0019Z
1987 102 .000274 ZOO0 7Z .00019Z
--Interest is calculatad as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (lB) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Helen I. Clevenger
Date of Death: November 14, 2003
Will No. 2003-01048 Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: N/A
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is: N/A
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
Cerk of the Orphans' Court and may be attached to this report.
Date: ,,/ )-- / ~') ~l~/'~ ':/'
.-- - .'.- SignaDure .~ ..~-----~/-
Richard L. Webber, Jr., ~ES4u~r~
Name (Please type. Or print)
126 East King Street, Shippensburg, PA 17257
Address
.L~t ~0.3 ,.,l,~vt4d~ (717) 532-7388
It :Oi~ 0t33~0~Z Capacity: __Personal Representative
h~,,',' ~:~0~ X Counsel for personal
~'~ ~% [.l~(.?~O0~~ representstive
(~H:rmf/
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Helen I. Clevenger
Date of Death: November 14, 2003
Will No. 2003-01048 Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: N/A
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
N/A
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
Cerk of the Orphans' Court and may be attached to this report.
Richard L. Webber, Jr.,
Name (Please type~or print)
126 East King Street, Shippensburg, PA 17257
Address
~Jt tU.J °~,['iVtu, d~0 I 717) 532-7388
JO >:.~]~0 Tel. No.
~ :01~ 0~03~~i~z Capacity: ~Personal Representative
~, ~.~. ~?j ~ ~:~.O:,L~ X Counsel for personal
'( ~H: rmf/~%~ ~% Q~],~]00~. representa t ive