HomeMy WebLinkAbout04-26-12 (3)1505610143
REV-1500 Ex lovml ~ OFFICIAL. USE ONLY
PA Department of Revenue Pennsylvania county code rear Fne NumOer
Bureau of Individual Taxes °EP'"TMFXt°"L1°XV°
PO 80X.Z80601 INHERITANCE TAX RETURN 21 11 0 98 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Oate of Death Date of Birth
09 10 2011 07 17 1923
Decedent's Last Name Suffix Decedent's First Name MI
HOLLENBAUGH VIOLET T
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL LN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Retum ~ 2. Supplemental Return
4. Limiletl Estate ~ qa. Future Interest Compromise
(data of death after 12-12-B2J
g, Decedent Lied Testate
(Attach Copyd Will) ~ 7. (gtiach CaMaiat Trust a Living Trust
pY )
9. Litigation Proceeds Received ~ 1e~ben°veaenivl~i~~iandit(tle95~rtlealh
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA% INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number r^~>
r;-~ -~~
JAMES D HUGHES ESQ 717 2433 ~~
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REGISTEROF~IJf~3,~SEONI;gY ~,,
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First line of atldress
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354 ALEXANDER SPRING RO C-i C.
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Second line of address r'. c -?
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City or Post Office State 21P Code
CARLISLE PA 17015
correspondent'se•mailaddress: jhughes@salzmannhughes.com
Untler penalties of perjury, I declare Mat I have examined this return, including acwmpanying schedules and statements, and to the best of my knowledge and belief,
it is [rue, correct and complete. Declaration of preparer other than the personal representative Is based on all information o! which preparer has any knowledge.
1505610143 150561D143 J
PA Inheritance Tax Return
Signature of Additional Fiduciaries
EHolAlenbeugh, Violet T. (21 11-09866ER
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of
my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal rf:presentative is based on all
information of which preparer has any knowledge.
Signature #2
Name
Addressl
Addressl
City, State, Zip
Date ~ ~ot,S~da \'L
3059 Spring Rd.
J 15d561d243
REV-1500 EX
Decedent's Social Security Number
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... . 1.
2. Stocks and Bonds (Schedule B) ........................................................................... .. 2.
3. Closely lield Corporation, Partnership or Sole-Proprietorship (Schedule C)........ . 3.
4. Mortgages 8 Notes Receivable (Schedule D) ....................................................... . 4.
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) .............. . 5. 3 , 087.74
6. Jointly Chvned Property (Schedule F) ^ Separate Billing Requested........... . 6. 5 , 403.92
7. Inter-Vivos Transfers 8 Miscellaneous -Probate Property
(Schedule G) ~ Separate Billing Requested........... . 7.
8. Total Gross Assets (total Lines 1-7) ................................................................... .. 8. 8 , 491.66
9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... 9. 2 , 502.28
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule p .............................. 10. 3 9 6 . 4 6
11. Total Deductions (total Lines 9 8 10) ................................................................... 11. 2 , 8 98.74
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 5 , 592.92
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............................................... 13.
14. Net Value Subject to Tax (line 12 minus Line 13) .............................................. . 14. 5 , 592.92
TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 15 0.00
(a)(1.2) X .00
16. Amourd of Line 14 taxable 5 , 5 92.92 16. 251.68
at lineal rate X .045
17. Amounl of Line 14 taxable 0.00 17. 0.00
at siblimg rate X .12
18. Amount of Line 14 taxable 0
00 18. 0.00
.
at wllateral rate X .15
19. Tax Due ................................................................................................................. . 19. 251.68
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 15d561d243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-0986
DECEDENT'S NAME
Hollenbaugh, Violet T.
STREETADDRESS
1445 Center Road
CITY STATE
Newville PA ZIP
17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments~
A. Prior Payments
e. Discount 0.00
3. Interest
q. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
(1) 251.68
Total Credits (A + B) (2)
0.00
(3)
(4)
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 ..........................................................................._.................................. 'LrnJ~ x
d. receive the promise for life of either payments, benefts or care? ............................................................ x
2. If death occurred after December 12, 1962, did decetlent transfer property within one year of tleath without
receiving adequate consideration? .................................................................................................................... ^ 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
containsabeneficiary 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.
For dates of death an or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent (72 P.S. §9116 (a) (t.1) (i)).
Far dates of death an 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 percent
(72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from taz, and the statutory requirements for disclosure of
assets and filing a taz return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death an or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [72 P.S. §9116 (a) (1.2)].
. The tax rate imposed an the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P,S. §9116 7.2) [72 P.S. §9116 (a) (1 )].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defned under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1508 EX. (8.881
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF pENNSVLVANIA
INHERITANI:E TA% RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hollenbau h, Violet T. 21.11-0986
Indutle the proceetls of lillgatipn and the dale the prOCaeds were received by the estate.
All property joindyawrred with the fight of wrvivorahip must be dlacloaetl on schetlula F,
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Household goods taken in kind -per schedule attached
1 Antique wash stand 50.00
2 Breakfast table 25.00
3 Glider rocker 40.00
4 Jug (:rock 40.00
5 Large basket 25.00
6 Pickle Crock 40.00
7 Table 35.00
8 Tote 3.00
9 Wooden Clock 30.00
10 Wooden flower stand 15.00
11 Adams Electric Cooperative, Inc. -final lump sum payment of patronage capital 506.47
12 Cash on hand 32.00
13 Household goods - at net proceeds of sale 1,894.27
14 Red Dodge with trailer 352.00
TOTAL (Also enter on Line 5, Recapitulation) I 3.087.74
(If more space is needed, atlditional pages of the same size)
Copyright (c) 2002 Yorm software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rav~7909 EXe (9.98)
COMMONWEALTH OF PENNSYLVANIA
INNERITANf.E ip%iETURN
RESIpENT pECEOENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF (FILE NUMBER
Fiollenbaugh Violet T. 21-11-0986
M an aaaet was made joint within one year of tha tlecadent's data o! tleath, it must ba reported on achadule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Rebecca Lee Heberlig 32 SME Daughter
Shippensburg, PA 17257
B.
C.
-Ir]INTI V t7WNFn PROPERTY[
ITEM
NUMBER
LETTER
FOR JOINT
TENANT
DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF A:iSE a~O OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A 0 610 612 001 ACNE Bank, Esteem Checking Account No. 4.853.73 50.000°/a 2.476.87
119849
2 A 1113012009 Orrstown Bank, Checking Account No. 5.854.09 50.000% 2,927.05
103009014
TOTAL (Also enter on Line 6, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
5,403.92
form PA•1500 Schedule F (Rev. 6-96)
REV-1157 EX. (10.08( qJ( E
COM N~~VyEAA~N~DEC ~EN~RIN ANIA
SCHEDULE H
FUNERAL EXPENSES &
-DMINISTRATIVE COST:
ESTATE OF FILE NUMBER
Holienbaugh Violet T. 21-11-0986
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
_NUMBER
q. FUNERAL EXPENSES:
B. I ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
StreetAddress
City State Zio .
Year(s) Commission paid
2, Attorney's Fees Salzmann Hughes, P.C. 1,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 111.50
5. Accountant's Fees
6. Tax Return Preparer's Fees 375.00
7. Other Administrative Costs 515.78
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 2,502.28
Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hoilenbaugh VioletT 21-11-0988
ITEM AMOUNT
NUMBER DESCRIPTION
Other Administrative Gosts
1 Jones & Martin Auctions LLC -appraisal of household goods 200.00
2 Register of Wills -filing fees 30.00
3 Salzmann Hughes, P.C. -reimbursement for payment to Cumberland Law Journal for Legal 75.00
advertising
4 The Sentinel -reimbursement for probate expenses Legal advertising 210.78
H-67 515.78
Copyright (c) 2002 form software only The Lackner Group, Inc. Forth PA-7600 Schedule H (Rev. 6-98)
Rev-1512 EX+177-g81
COMMONWEALTH OF PENNSYLVPNIq
INHERITgNf,E TPJ( RETURN
RESIDENT OECEOENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Hollenbaugh, Violet T. _ __ 21-11-0986
Rep~oM1 tlabls incurtad by the tlecsdent prior to death that remained unpaid at the date of death, including unraimbursatl metlical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Adams Electric Coop -electric service 81.24
2 CenturyLink -phone service 199.57
3 , Cumberland County Office of Aging -home support service 34.40
4 Interstate Waste Services -refuse service 56.25
5 Rebelcca L. Heberlig -reimbursement for payment to have the tax returns prepared 25.00
TOTAL (Also enter on Line 10, Recapitulation) I 396.46
(If more space is needed additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
SCHEDULE J
BENEFICIARIES
(Part 1, Taxable Distributions)
ESTATE OF:
Violet T. Hollenbaugh .09/10/1011 513-12.4220
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
1 Rebecca Lee Heberlig Daughter Sch. F 5,430.92
32 SMEi 117th Residue
Shippensburg,PA 17257
2 Cloyd N. Hollenbaugh, Jr. Son 117th residue 27.00
3059 Spring Rd.
Carlisle, PA 17013
3 Barbara A. Severance Daughter 117th Residue 27.00
29811 Machado St.
Lake Elsinore, CA 92530
4 Robert Glenn Hollenbaugh Son 117th Residue 27.00
1465 Center Rd.
Newville, PA 17241
5 Harvey Edward Hollenbaugh Son 117th Residue 27.00
285 Pipeline Rd.
Newville, PA 17241
6 William Howard Hollenbaugh Son 117th Residue 27.00
1455 Center Rd.
Newville, PA 17241
7 Mary Ethel Hollenbaugh Daughter 117th Residue 27.00
9 E. E{ig Spring Ave.
Apt 2
Newville, PA 17241
TOta! 5.592.92
1
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LAST WILL AND TESTAMENT ~ ~`' _
s~
OF
VIOLET T. HOLLENBAUC~H
I, VIOLET T. HOLLENBAUGH, of 144 Center Road, Lower Mifflin Township,
Cumberland County, Pennsylvania, being ofsound and disposing mind, memory and understanding,
do make, publish and declare this to be my Last Will and Testament, hereby revoking and making
void all previous ~Vilis and Codicils heretofore made by me.
I order and direct my personal representative hereinafter named to pay all of my just debts,
funeral expenses and expenses involved or connected with the administration of my estate as soon
after my death as is reasonably possible. However, my personal representa.tiveneed not accelerate
and pay those utnmatured obligations which, in his, her or its opinion, it might be proper and more
advantageous to retain or renew and pay as they become due and payable. If I do not own a burial
plot or a grave marker at the time of my death, I authorize my personal representative, in his, her or
its sole discretion, to purchase a burial plot and to erect a suitable grave marker a[ my grave, and to
expend sums from my estate for this purpose.
I grant to my daughter, BARBARA A. SEVERANCE, the option to purchase all my real
estate and improvements located at 1445 Center Road, Newville, Lower Mifflin Township,
County, Pennsylvania, at a price equal to its fair market value at my death. She shall
have ninety (90) days from the date of my death to exercise this option and complete settlement.
It is my desire drat my real estate remain in my family.
1
T:
LAST WILL AND TESTA'~fENT OF VIOLET T. HOLLE~IRAUGH
3
I give, devise and bequeath the rest, residue and remainder ofmy estate, together with
all insurance proceeds thereon of whatever nature and wheresoever situate to my children,
REBECCA LEE HEBERLIG, CLOYD N. HOLLENBAUGH, JR., BARBAR4 A.
SEVERANCE, ROBERT GLENN HOLLENBAUGH, HARVEY' ED~~'ARD
HOLLENBAUGH, YVILLIAIVI HOYVARD HOLLENBAUGH AND MARY ETHEL
'~VITTLINGER, on a per stirpes distribution basis.
4
I grant my personal representative the Following powers in addition to and not in limitation
of such powers as my personal representative shall hold by law:
(a) To retain all property received including the stock of any corporate fiduciary acting
hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger, reorganization or
voting tnrst plan; Co delegate authority with respect thereto; to deposit investments
under agreements and pay assessments; and generally to exercise all rights of
investors, including but not limited to, the voting of shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate
held or owned by my estate.
(d) To operate any business that I may own at my death.
(e} To invest any funds ofmy estate in any stocks, bonds, notes or other securities or
property, real or personal, without regard to the principle of diversification or any
other statute or general rule of law in his, her or its absolate discretion, it being my
intention to give my personal representative khe broadest imrestment powers possible,
providing such investments do not unnecessarily prevent the prompt settlement of my
estate.
2
LAST WILL A>V~ TESTAMENT OF VIOLET T. HOLLENBAUGH
(f) To sell or otherwise dispose of any property-, real or personal, tangible or intangible,
at any time forming a part of my estate in any manner and on such ternrs and
conditions as my personal representative shall see fit in his, her, or its absohtte
discretion.
(g) To borrow money for the payment of taxes or for any other proper purposes in the
administration of my estate, and to mortgage or pledge estat<; assets as security.
(h) To compromise claims without court approval including, but not limited to, any
controversies with the United States of America or the Commomvealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may pass
under this my Last Will and Testament,
(i) To distribute in cash or in kind upon any division or distribution of my estate.
(j} To rmdertake any and alt acts deemed necessary and proper by my personal
representative for the proper, advantageous and prompt management of the
settlement of my estate.
(k) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his own
right, upon such terms and conditions as to him, her or :it may seem best and to
execute and deliver all instruments and to do all acts which he, she or it deems
necessary or proper to carry out the purposes of this, my Last Will and Testament.
5
No interest of any beneficiary of my estate, either itr income or in principal, shall be subject
to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have
the power in any manner to charge or encumber his interest either in income or principal, nor shall
the interest of any beneficiary be liable or subject in any manner while in the possession of my
personal representative for the liability of such beneficiary.
3
LAST WILL AND TESTAMENT OF VIOLET T. HOLLENBAUGH
6
~ I nominate, constitute and appoint REBECCA LEE HEBERLIG and CLOY'D N.
HOLLENBAliGH, JR., as Co-Executors of this my Last Will and Testament. I direct that my
personal representative shall not be required to give or post bond for the faithful performance of his,
her or its duties in this or any otherjurisdiction.
', IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament
this a ~ ~ day o€ /`? c 7 , 2001.
WITNESS:
,/ ~
~- Violet T.Hallenbau;h
i
i
cis -~ ~ u.:c..
4
LAST WILL AND TESTA'tifENT OF VIOLET T. HOLLENBAUGH
ACKNO~VLEDG?tIENT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, VIOLET T. HOLLENBAUGH, the Testatrix whose name is si;;ned to the attached or
foregoing instrument, having been duly qualified according to ]aw, do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and
that I signed it as my free and voluntary act for the purposes therein expressed.
~, L7~if~L4U~ ,
~~e6! t T. Hollenbaugh
Sworn or affirnied and acknowledged before me by VIOLET T. HOLLENBAUGH, the
cF
Testatrix, this .?~-' day of ~~~~~~t-I- ,2001.
~J
Notarial Seal
Terry E. Walker, Notary Public
South MiooletonTwp.,CumberlanaCounry
My Comm(SSlon Exp{res Mar. 31, 2003
Member, PennsVWania assxia;ion of Notaries
LAST ~GIL L AND TESTA'~IENT OF VIOLET T. HOLLENBAUGH
AFFIDAVIT
r~
Swom or affirmed and subscribed before me by ~~',c~~~~<_-~~ ~ ~`..CLJ~ 6y~y~_r' ~7 - and
a.CY"
~t~ ~ /~/'~~~ this •~ - day of ~~)~<~~: ~ , 20t)I.
r
COMitifONWEALTH OF PENNSYLVANIA
COUNTSC OF CUMBERLAND
SS.
WE, j~;r l.: -.~ L . Ln.%F ~ k~ ~~~ )-- .and ~6'> 'c l~~l ~~r°~~~L ,Che
witnesses whose names aze attached Co the foregoing document, being duly qualified according to
law, do depose and say that we were present and saw VIOLET T. HOLLENBAUGH sign and
execute the instrument as her Last Will and Testament; that she signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the VIOLET T. HOLLENBAUGH signed the Last Will and
Testament as witnesses and that to the best ofour knowledge the testvar was at the time 18 or more
years o f age, of sound mind and under no constraint or undue influence.
F'ASrr Fvldev"Fim,1)oci W Ills?n- I ~2hu'ill uMr
Notarial Seal
Terry E. Walker, Notary Public
8outn Middfatdn Twp., Cumberland Coun
My Gommlaslon Ezplres Mar. 31, Z 3
Meri?CRr.?aoln~n~.~^.•a ?ssrr;arrnn nr ninraries
6
JONES & MARTIN AUCTIONS & APPRAISALS
544 MOHAWK RD.
NEWVILLE PA 17241
717-226-0776 OR 717-477-8565
Appraisal of Household goods taken in kind for:
Violet Hollenbaugh Estate
Rebecca Lee Heberlig:
Wooden Clock $ 30.00
Tote 3.00
$ 33.00
Cloyd N. Hollenbaugh, Jr.:
Glider Rocker $ 40.00
40.00
Robert Glenn Hollenbaugh:
Pickle Crock $ 40.00
Jug Crock 40.00
Large F3asket 25.00
Table 35.00
140.00
Harvey Edward Hollenbaugh:
Breakfast Table $ 25.00
25.00
William Howard Hollenbaugh:
Antique Wash Stand $ 50.00
50.00
Mary Ethel Wittlinger:
Wooden Flower Stand $ 15.00
15.00
Total of Personal Items ~ 303.00
JONES & MARTIN AUCTIONS, LLC
Darryl Jones,
Newville, PA
SALE NAME
DATE OF SALE: ~
Neil Martin
Shippensburg, PA
I~
ADVERTISING EXPENSES:
Lancaster Farming
The Guide
News Chronicle
Valley 'l`imes
Franklin Shopper
Sentinel
Merchandiser
Other
Other
Sale Flyer Copies
Total Advertising Cost:
Total of Sa
Advertising
Auctioneer';
Tent Rental
Portable T --
Misc. Cha
Misc. Cha
Net Sale {a
Thank you for the opportunity to work with you and your family
SETTLEMENT STATEMENT
Total of Bidder Numbers ~ d~J
DEIMLER'S RECYCLING, INC.
169 Sleepy Hollow Road, New Bloomfield, PA 17065
717-5$2-3219.717-582-8902
N° -6176
~1..J~"T;Ci1 Le.L, .
.:,.~:.,
_ _,~
4
Name t `~J.L. c~-^~" ~'~" 1'Z 1.~ Fia-/~~,
Address
Driver License # ' v ~ '~
WEIGHT MATERIAL PRICE AMOUNT
IRON/CAST IRON
i CARS
MOTOR BLOCKS
~ ~ TIN ? . r ~ - r
_ APPLIANCES
BATTERIES
SMELT
TRANSMISSIONS
CATALYTIC CONVERTERS
~f`,-~~~' 7 '
Signature X
C,,reg Deimler, Jr. PA 70876 ~ Heather Smith PA 71517
Julie Deimler PA 70677 Monica Sbarar PA 73122
''-eresa Snyder PA 7067 +
Weigh Master 4"~~ `~'~v`J•~~- ~``
TOTAL
47
~`~ .
White-Wiglnal•CUStomer Copy Yellow-40W-Customer Da Not Accept Pink•YOIO•Custamer bo Nof Accept
`_
B ACNE
September e.3, 20l 1
Salzmann Hughes, PC
Attn: James D Hughes
354 Alexander Spring Rd Ste 1
Carlisle PA. 17015
RE: Estate of Violet T Hollenbaugh
Dear Mr. Hughes
The following information is being provided as per your request
Acct. Type Account No. Balance at Accrued
D.O.D. Interest to
D.O.D.
Esteem 119849 $4,953.72 $0.01
Checking
Account
Ownership
Jt w/ Rebecca L Herberlig
Date
Opened/Joint
6/6/0l
Inquiries concerning ACNE Corporation stock information should be directed to the Registrar and Transfer Company
at I-800-368-5948. If you need any additional information, please contact me a1; (717)339-5122.
Sincerely,
~ ~
~~U~C~-
Barbara J WarngF
ACNB Bank
Deposit Services
II
BUREAU OF IND IV IDWL TA%ES
PO BOX 280601
HARRI SBURL PA 271:!8-0601
~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No, 21 11•D9s6
Pennsylvania AND ACN 11165239
OEPAFTMENi DF gEVENIIE TAXPAYER RESPONSE PATE 1D-o3-2011
MEV-i5t1 EZ 1EP 105-111
REBECCA L HEBERLIG
1445 CENTER RD
NEWYILLE PA 17241-9775
TYPE OF ACCOUNT
EST. OF VIOLET T F10LLENBAUGH ^ savlNCs
SSN 513-1'1--4220 ® CHELXING
DATE OF DEATH 09-10-2011 ^ TRUSr
COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYM ENT AND FORNS T0:
REGISTER OF WILLS
1 COURTH OUSE SpUARE
CARLISLE PA 17013
ACNB HANK provided the department with the iniarmd ti on OelOw, whi cll was used in calculating the tone ri Cance tax oue.
Recur d5 indicdte that at the tleath of the above-named decetlent, you were a j07nt owner/be neH cis ry of tots account. If y0U are Che SpoUSe Of the
deceased and any amount other than ie ro is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the depa riment of your relationship to the deceased Dy checking Box C in PART 1 below and writing "spouse" in PART 2.
If You believe the information is incorrect, please able In written cor rec tr On from the fl nancial ins tl lull on, attach a cCDY to this farm and return
it to Che above adtlress. Please cats 717dg7-8327 wl to Oues ti on s.
COMPLETE PART 1 BELOW K SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUC7IONS~
At<punt No. 119849 Date 06-06-2001 To ensure proper credit to the account, two
Established copies of this notice gust acconoany
4,953.73 paynent to the Register of Will s. Make eneck
Account Balance S pav able to "Register of Wills, Agent".
p ercant Taix able X 50.000
NOTF: If tax paynents era node wi Lein three
Amount Subject to Tax $ 2,476.87 nonths of the tlecedent's date of death,
Tix Rate 3C , 1Tj deduct a 5 pa rceni tli scount on the tax due.
Any inherit an ca tax due will becone dalin@uant
potential tax Due $ 371.53 nine eonths after tna dot. of daatn.
Peer TAXPAYER RESPONSE
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A. ~ The ebova inforaati on and tax tlue is eorre ct.
Resit paywent to th@ Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or rat urn this notice to the Reg is tar of Wills and
ONE an official dS5as5nant will tla laSUed by tna PA Oepartnent of Rav@nue.
BLOC K 6. ~ Tha aaove asset has been @r will be reported and tax paid with the Pennsylvania inheri lance tax return
ONLY filed by the estate reprasenta~ive.
L. ~ Tha above infaraa ton is inc or re et antl/or debts and deductions were paid.
Lonpleta PART ~ and/ar PART ~ below.
PART If intli<ating a tlifferent tax rate, please state +`
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Q relationship to decedent: F
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TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ~
ACCOUNTS !
`t ~~d `"
LINE 3. Date EstaDlSshetl 1 ' ii
Scs ~ '11~r(ji IP~44 ~~i '1'~
.a 't
2. Acoount Balanw 2 ~ ~ .. .. -.
3.
Percant Taxable - ;
X -' - n
6. Amoumt Subject to Tax 4 $ "+' .,~+ r ~
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5. Debts and Deductions 5 y
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~~ ~ ~$'~~, "',F~~4
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6. Amount Taxable 6 ^S ~~9~R t~'i '~d~~
7. Tax Rate 7 X
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8. Tax Duo 6 $ "`~* ~ ~" ~'
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
IUTAL lEOter on Llne 5 of Tax Computation) f
Under penalties f p ur declare that She facts I reportetl above are true, correct and
complete to th be oP owledge and belSef. HOME C ) qq q
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BANK
A Tradirion ofExceAence
September 23, 2011
Salzmann Hughes, P.C.
Atorneys at Law
James D. Hughes, Esq.
354 Alexander Spring Rd., Suite 1
Carlisle, PA 17015
Fax: 249-7334
Re: Estate of Violet T. Hollenbaugh
Social Security Number 513-12-4220
Date of Death 9/10/11
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT MAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CHECKINGACCOUNT
Aca~unt No.- 103009014
Account Type- Money Mazket
Date Opened- 1 I/30/09
Date Closed- 9/16/11
Joint Account (nameldate)- Rebecca L. Heberlig, 1 ll30/09
Bal,azlce- $5,854.04
Acrrued Interest- $0.05
Into;rest Paid 1/1/11 to DOD- $2.58
Best Regards,
K•C~
J> 1 R. Worthin on
Deposit Processing Clerk
2695 Philadelphia Avenue
Chambersburg, PA 17201
1,9aS.ORRSTOWN
W W W:Oi'YS80W 11.COP1l
BUREAU OF INDIVIDUAL TAXES
Po sox zaBSOl
IURRISB URC PA 1712!1-0601
Pennsylvania
DEFAFTMEHT dF PEVENUE
RfV-1343 FX 4rP (15-111
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REBECCA L HEBERLIG
32 SHIPPENSBURG MOBILE
SHIPPENSBURG PA 17257-9528
R+~=>®` i
><.. ;
N~
FILE N 21
ACN 11163816
DATE 09-28-2011
TYPE OF
ACCOUNT
SAYINGS
® [NECKING
TRUST
CERTIF.
EST. OF VIOLET T HOLLENBAUGH
SSN 513-12-4220
DATE OF DEATH 09-10-2011
COUNTY CUMBER.LAN^
REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 170'L3
ORRSTOWN BANK provi Oetl the tlepartment with the informatt on hel Dw, which was used in cal culati nq the inheritance tax due.
Records intli Cate that: at [he death Of the above-n amed decedent. you were a point Owner/heneftCidry oT th75 account. Ii y0U are the spouse o1 Che
deceased and any amount other than zero 1s reflected below on the Potential Tax Due stns, note no tax may he due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and wrtting "spouse" in PART 2.
7f You believe the lntorma ti on is incorrect. O1 Ease ohtdin written cor re ttion Tram the financial ins ti tuts Dn, attach a copy to Ch is Corm antl return
it to the above a0dress. Please call 717-7e1-8327 with Dues ti ons.
COMPLETE PART 1 BELOW ds SEE REVERSE SIDE FOR FILING AND PAYMENT INS TRUCTIONS
Account No. 103009014
AGCpWOt Balance
Percent TaXabla
Amount Sub,iaet to Tax
Tax Rate
Potential Tax Due
Data 11-30-2009
Established
g 5,854.09
}( 50.000
$ 2,927,05
X .15
s 439.06
7o ensu r¢ proper credit to the aceourtt, two
eppi¢z pf this notice oust a¢conpanv
Day sent to tM R¢91Ster of Wills. Make check
bay able to "Reais ter of Wills, A¢ent".
NOTE: If tax Paynents are Wade within three
aonthz of the dec¢tlent's date of death.
deduct a 5 percent giscou nt on the tax due.
Any inharif:anc• tax due will bacons drl inauent
nine eo nths after the tlata of death.
A. ~ Tne abor• infonation and tex due is corn ct.
Resit pave ent to the Register of Wills with two copies of this natic¢ to obtain
a discount or avoid iota n si, pr rotors this noliea to the Resister of Wills antl
CHECK an official assesssent will b¢ issued by the PA Deoa rtnent of Revenue.
ONE
BLOCK B, y-~
lye Tho above asset has bean or will ba reported antl tax paid with the PennsY lvania inheritance tax return
ONLY F=' filed by the ast at¢ r¢arasantativa.
C. ~ Tne above inf orna San is incorr ct and/or debts and deductions were paid.
Couple to PART ~ antl/or PART ~ bel au.
PART If indioatin9 a different Sax rate, Please state
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relatSOnship to dec¢tlent: i
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TAX RE TURN - CALCULATION OF ~
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7AX ON JOINT/TRUST ACCOUNTS ~
LINE 1. Date Established 1 ~ I
~
2. Account Balance 2 .1`
S . Percent Taxable 3 X
4. Amount Sub]ect to Tax 4 S
5. Deb t.s and Deductions 5
6. Amount Taxable 6
7. Tax Rato 7 X
E. Tax Due B g
Untlar Ipenalt ies pr rjur decla ra that the facts I reported abo va are true, cprrect and
complete to the st o m souls dae and belief. HOME ( 1
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PART UEBlS ANU UEUUGIlUNS G1.A 11'IEU
a
DATE PAID PAYEE DESCRIPTION AMOUNT PAID