HomeMy WebLinkAbout02-0262PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ~/.~by..* ,~. HILE~thM No.
also known as To:
Deceased.
Social Security No. ~ ~ ~ I' Izt
Register of Wills for the
County of CLt tn t~/e_z~0O
Commonwealth of Pennsylvania
in the
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/~a:g. 18 years of age or older an the execut/-;K named
in the last will of the above decedent, dated .~T~y o?o ,19~/&'
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in G t~ ~/2[F/~Lh~/> County, Pennsylva~nia, with
h~-~ last family o,r principal residence at ~,q~ ~q/~t /~/~r~ R~... ~]L_q/e; .~/g
(list street, number and muncipality)
Decendent, t~en ~:~d) years of age, died /~'~'~'~'/ ~ ,,1~)/''~dl~ ~ ,
at I~n~r La/e.
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:
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 Pennsylvania $
situated as follows:
/ OOt ooo · oo
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters te:s/ll~ttrv
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA -[- ss
COUNTY OF Cttmt~r,~.b
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 person~ represen-
tative(s) of the above decedent petitioner(s) will ~~ly ad~nis~r the estate according to law.
~f~ ~t~ affir~ and subs~ ~~~_ ~.~
~
' ,~~ ~S / R~gister~ [ ' ~
Estate of GLADYS R HILEMAN , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MARCH 15, 2002 XlqRx , 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 07-20-199~
described therein be admitted to probate and filed of record as the last will of GLADYS R HILEMAN
and Letters '£ES'_['A~:NrA~Y '
are hereby granted to LINDA L MOORE
FEES
Probate, Letters, Etc .......... $. 200.00
Short Certificates( ) .......... $ ] 2.00
l~fi]f.~-~;fix..e..xt~.r..a~.~ .j:~..~q.e.s.. $ 3.00
jc~ $ 5.00
TOTAL __ $. 220.00
03-13-2002
Filed
"if~il~;ff 'f_.6' ~f.f_.b~h'~' b'd_ ' 3-1'4-' 02
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
LAST WILL AND TESTAMENT OF OLADYS R. HII~EMAN
I, GLADYS R. HILEMAN, of the South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of ail my just debts and funerai expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, reai, personai and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my beloved husband, GEORGE B.
HILEMAN, to his own use and benefit absolutely.
3.
In the event, however, that my said husband should predecease me, or should die at about
the same time as I die, such as in a disaster common to both of us, I give, devise and bequeath my
said estate to be divided and distributed as follows:
a.) A specific bequest in the amount of $30,000.00 to my son, DEAN B.
HILEMAN. This is to be inheritance tax free to him, the said taxes to be paid from
the residue of my estate. In the event that he predeceases me, then to his daughter,
WENDY HILEMAN. In the event she aiso predeceases me and is not survived by
issue, then this gift shall lapse and become part of the ultimate residue of my estate.
b.) I give to each of my grandchildren, the sum of $10,000.00. In the event
any of said grandchildren are minors at the time of my death, this is to be invested
by their parents for the purpose of continuing education or other similar worthy
endeavor. In any event, when any of the said grandchildren reach age Twenty-one
(21), they shall be entitled to full distribution of any baiance of their gift then
remaining. In the event any of the said grandchildren has predeceased me, his/her
gift shall lapse. The inheritance and/or estate tax on the above specific bequests
shall be paid from the residue of my estate.
c.) All the rest, residue and remainder of my estate shail be divided and
distributed in equai shares to my three (3) children, to wit: DEAN B. HILEMAN,
LINDA L. MOORE and EDWARD G. HII~EMAN, per sfirpes.
4.
I nominate, constitute and appoint my husband, GEORGE B. I-III~EMAN, to be the
Executor of this my Last Will and Testament. In the event that he should predecease me or for any
reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my
daughter, LINDA L. MOORE, to be Executrix in his place and stead. I further direct that they
shall not be required to file bond or other security in the Office of the Register of Wills for the
purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ day of
~~ , A.D. 1995.
GLADYS
(SEAL)
Signed, sealed, published and declared by the above-named GLADYS R. HIIJEMAN as
and for her Last Will and Testament, in the presence of us, who at her request and in her presence,
and in the presence of each other, have hereunto subscribed our names as wimesses.
REGISTER 0~F WILLS OF COUNTY
OATH OF sUBSCRIBING WITNESS
(each) a subscribing witness to the wi)l'~'pr-e4ented herewith, (each) being dui~,~alified according to
law, delcO_and..... '"'""~say(s) that ~ ~ ~x[~ent and saw
the testat , sign the~-~e and that ~ signed asa witn~ at th~
request of testat ___inb ~ce and (in the presence o~a~h other, (in the presence o~e
~ witness(es)). ~ ~ ~
Sm~C~i~o or affi~ day o~nd subscribedbef°7 ~~ (Name)x~~~
(Name)X~
(Address)
REGISTER OF WILLS OF E a m a ~eL,¢-~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
ffeaeh-) a subscriber hereto, ~ being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of g/~d?:s ~. ,z,&~'~t,e# ,
testatrix of (one of thc ~ub~calbiug w][li~.33~3 ~to) the will presented herewith and
codicil
that ~ believes the signature on the will is in the handwriting of
to the best of her knowledge and belief.~ ~ ~.~
Sworn to or affirmed and subscribed before~~/~~q~'
me this 1 Ych day of L/~tda g. 'Oaoar~,Name)
~Y ~ ~S ~- ' '
~ ~ Register
(Name)
(Address)
REGISTER OF WILLS OF C~t~,5~_.z,4~/~ COUNTY
OATH OF SUBSCRIBING WITNESS
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that fie zog~5 present and saw
the testatt';x. , sign the same and that /4e signed as a witness at the
request of testat~,,~ in h er' presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this ] 3~h day of
~.Aa,4e$ ~=. Sh,'~da(l~ame)
~ C/ooso. ,ed. .~eet)a~-,,~'.~.,,~, ~/7oxS"
(Address)
(Name)
(Address)
REGISTER OF WILLS OF-'0"P'~ COUNTY
(each) a subscriber hereto, (each) being duly quaked according to law, depose(s)~d say(s) thal
~-'"'"'-._ familiar with the sig'~ure of codicil ~ '
testat__ of (one~cribing witnesses-to) the~iwcill presented herewith~nd
- --~*~ ~ _ . ~ codicil
that .~~ ~gnature on the ~he handwriting of
tO the best of ~and belief.
Sworn to or affirmed and subscribed bef'or, e~
day of ~
19.__
me this
Register
..(A ddress)
(Address)
OEOR(IE M~ HOUCK
CHARLES E. SHIELDS, HI
A TTORNEY-AT-LAW
6 CLOUSER ROAD
Corner of Trindl~ a~t Clouser Roads
MECHANICSBURG, PA 17055
~/,~x' jz/'~O- 77 ~ 7
TELEPHONE (717) 766-0209
FAX (717) 795-74?3
P~°'~I =esn°t;3 9
III '~(I'I:~ttS '~[ ~I'IKV-HD
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.
Gladys R. Hileman
March 6, 2002
Admin. No. 21-02-0262
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
April 3, 2001:
NalTle
Linda L. Moore
Edward G. Hileman
Dean B. Hileman
Steven P. Moore
Wendy Hileman Holler
William L. Moore
Kimberlee Deann Hileman
Address
497 Petersburg Road, Carlisle, PA 17013
608 Ledgdale Circle, Valdosta, GA 31602
4424 Carter Way, Valdosta, GA 31602
Box 241 Field Pine Drive, Brown Summit, NC 27214
R. R. 1, Box 129, Millerstown, PA 17062
1607 N. Ashley Street, Valdosta, GA 31602
c/o Dean B. Hileman, 4424 Carter Way, Valdosta, GA 31602
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: April 3, 2001
CHARLES E. SHIELDS, III
6 Clouser Road
Mechanicsburg, PA 17055
Telephone: (717) 766-0209
Counsel for Personal Representative
flR~I,I~N® Post Office Box 4284
UNIU
Glen Allen, Virginia 23058-4284
NO.333-188Ol
ACCOUNT NUMBER DESCRIPTION AMOUNT
POTAL 8 ,336. 2S
0000 544314 (250/pkg Rev 06)
Accounts carried by First Clearing Corporation, Member NYSE and SIPC
PLEASE DETACH
BEFORE DEPOSITING
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 001253
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA
17055
........ fold
ESTATE INFORMATION: SSN.' 171-14-2771
FILE NUMBER: 21 02-0262
DECEDENT NAME: HILEMAN GLAD'(S R
DATE OF PAYMENT: 06/05/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/06/2002
REMARKS:
T
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $8,336.25
CHARLES E SHIELD III ES
CHECK# 333-18801
SEAL R
DTAL AMOUNT PAID:
$8,336.25
IITIALS: DO
:_CEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
OFFICIAL USE ONLY
FILE NUMBER
RE S I D E N T D E C E D E N T oou..coDE Y~ -- ...-~E.
BECEBENTS NAME (LAST, FIRST, AND MIBDLE INITIAL) SOCIAL SECURITY NUMBER
HIZFM~N~ ~L#DY$ ~. t~/ - I~ - 277/
DATE OF D~TH (MM-DD-Y~R) DATE OF BIRTH (MM-DD-Y~R) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
03-~ - 2~o~ ~7- o~-- /721 REGISTEROFWILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER
WIA - -
IAI
[~1. Original Return [] 2. Supplemental Return
C-] 4. Limited Estate C-] 4a. Future Interest Compromise (date of death after 12-12-82)
[] 6. Decedent Died Testate (Attach copy of Wi,) ~ 7. Decedent Maintained a Living Trust (Attach copy of Trust)
J'~ 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date or death between 12-31-91 and 1-1-95)
NAME ~///.,~I~,Z ES ~ ~/;//~ZD..~ ~
FIRM NAME (IfApplicaUe)
TELEPHONE NUMBER
'7/7-
3. Remainder Return (date of death prior to 12-1~82)
C"~ 5. Federal Estate Tax Return Required
~) 8. Total Number of Safe Deposit Boxes
[--]11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
O Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11, Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
-- 0--
7.2,
OFFICIAL USE ONLY
(8)
, I[~, V/a. 3 ¥
(11)
(12)
(13)
,;7 3,.2, .~¢/, 37'
~/~', (,,cz, 7/
(14)
15.
16.
17.
18.
19.
20.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
Amount of Line 14 taxable at lineal rate
Amount of Line 14 taxable at sibling rate
Amount of Line 14 taxable at collateral rate
Tax Due
x .o o (15)
x .0 ~ (16)
x .12 (17)
x .15 (18)
(19)
Decedent's Complete Address:
STREETADDRESS /~.AJ'O,~ C~¢~' 0~' C',~,~/-./,$/
CITY
ISTATE /~?,~g
ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments ~"
C. Discount ~-
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
A. Enter the interest on the tax due.
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 1 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)
(5A)
~"~ 775'.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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 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? .............................................................................................................. [ I []
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 perjurT, I declare that I have examined this return, including accompanying schedules and statements, and to the Pest of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF~ON,RESPON IB~_R FILING RETURN
x
ADDRESS
SIGNATURE ~R ~~E~NTATIVE DATE
ADDRESS ~Z E~
For dates of death on or after July 1, 1994 and before Janua~ 1, 1995, the tax rote im~sed on the net value of transbrs to or for the use of the sullying spouse is 3%
[72 FS. {9116 (a) (1.1) (i)].
For dates of death on or after Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the su~iving spouse is 0% [72 FS. {9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a su~iving spouse from tax, and the statuto~ requirements for disclosure of assets and filing a tax return are still applicable even if
the su~iving spouse is the only beneficial.
For dates of dea~ on or a~er Ju~y 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child ~enty-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 RS. {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%, ex,pt as noted in 72 RS. ~9116(1.2) [72 P.S. {9116(a)(1)].
The tax rate imposed on the net value of transfem to or for the use of the decedent's siblings is 12% [72 FS. {9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in ~mmon with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
#
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule
ITEM
NUMBER DESCRIPTION
1.
,4 5.5oR.'7~D ~Ci, LI~I'T'IE-$
I -I I10a ~ ~'~ r~ G ~' /~e . '~ J~ ~'O ,~ ~ ~.
L
TOTAL (Also enter on line 2, Recapitulation)
(if more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
SqL/.5"
$ 153, 7~a. 'H
Securities
First Union Securities
WF3240
Harrisburg Branch
3401 North Front Street, Suite 110
Harrisburg, PA 17110
Tel 717 238-9636
800 254-8211
Fax 717 238-9789
May16,2002
Charles Shields
6 Clouser Road
Mechanicsburg, PA
17055
RE: Gladys R. Hileman date of death 3/6/2002
Dear Mr. Shields,
Listed below are the values for Mrs. Hileman's accounts on her date of
death:
Single Account
686
434.631
100
2O0
100
400
100
100
1000
300
150
8
1000
200
8000
3,513.31
Aim Blue Chip Fund B
Aim Charter Fund B
Citigroup Inc.
E1 Paso Corp.
Emerson Electric Co.
Ford Motor Co.
Harley Davidson Inc.
Johnson & Johnson
Lucent Technologies Inc.
Medtronic Inc.
Novartis AG
Syngenta AG-ADR
US Air Group Inc.
Xerox Corp.
FHMLC 2395 GW 6% 4/15/23
Money Market
Held outside her account was:
$ 8 019.34
$ 4 837.44
$ 4 870.00
$ 8 910.00
$ 6 398.00
$ 6 540.00
$ 5.29O.00
$ 6252.00
$ 6 230.00
$13,296.00
$ 5,607.00
$ 95.20
$ 6,480.00
$ 2,024.00
$ 7,846.97
$ 3,513.31
3,522.675
1,634.49
158.206
Aim Value Fund B
Aim Charter Fund A
Aim Constellation A
$35,297.20
$18,747.60
$ 3,496.35
/~57, 3'¢/./s'
First Union Securities, inc.
Member NYSE/SIPC
IRA Account
1,026.544
869.557
45,000
25,000
35,000
349.421
1,408.56
Aim Value Fund B
Goldman Sachs
FNMA 01-43 6.5% 9/25/31
GNMA 177026 9% 9/15/16
GNMA 3619 8% 1/15/04
Ft. Unit 578 Utility Growth
Money Market
If I can be of further assistance, please let me know.
SincT~
C'~Ynd la J~. Neff
Assistant to George A. Sneed
Senior Account Administrator
$10,285.97
$ 9,878.16
$44,936.91
$ 1,546.88
$ 355.87
$ 3,714.34
$ 1,408.56
/.,
SCHEDULE E
'COMMONWEALTH OF PENNSYLVANIA /CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT OECEDENT PERSONAL PROPERTY
ESTATE OF
H IL~'/~/q / ~z/h~y..~' /~. FILENUMBER
Include the
ITEM
NUMBER
~mceeds of litigation and the date the proceeds were received by the estate. All prope~'y jointly-owned with the right of survivorshi ~ must be disclosed on Schedule F.
DESCRIPTION
/~ O0ou~IT h'r'
7. o. ~. vbu~w$
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
'~do~ q 8'o7, 77
~o, qgq. 77
I~V-1510 EX * (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE N~ OF'rI.E TI~NSFEI~£ THBR ~a.A~ONa.llpm OC-CED~rr AND THE ATFACHACOPYOFTME DEED FORREXL ESTATE. DATE OF'Rm~R. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER VALUE OF ASSET INTEREST
1. ~Z'~,~ A~E~.~NT A~-r FI/~$'7- ce,v/ox/ SE'c-
L~FdI1'I~--~, ..~ol/~I. ~'~4/f ~77., ~t~t7-E' /Io,
H,'I~/s'~yO~, ~o,q /71/o, 6b"o/~6~0- ~]~.
TOT~O. (^lso ont~r on lino 7, R~ttula~on) $
III ~ en-z,a, ie nacrlcrl ine=~'t =rldltlnn=l ,=hc~h= nf th= ~="'m~, qi?A'~
EV-1511ED(* (1-9~) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
/-/ / z 6 /~ /~ ,,v' , G~ /~ z> y',s' ,~.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
..Z/- 4)2. -
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1.
DESCRIPTION
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) /--
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address z/?'7 ~' 7-~"~..T~
city CA,~z./$z,~ State
Year(s) Commission Paid:
AttomeyFees O//~-~'[E.S ~-'. .~///~7_.Z:>.~' ~
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Zip / 70
City State Zip
Relationship of Claimant to Decedent
ProbeteFees ,4~v~) z~E','6/~/.,q~
A~un~nfsF~ FLoY ~ FAHNESToCK, sec ~o~.
Tax Return Preparers Fees
TOTAL (Also enter on line 9, Recapitulation
(If more space is needed, insert additional sheets of the same size)
AMOUNT
3-00,
,,7o7o. oo
33-0.00
~"75', oo
$ /4,710.$q
REV-1512 EX * (1-90 ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE !
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
/'I ILE~A-fl, Gl~tbV£ ~. FILENUMBER
Include unreimbursed medical expenses,
ITEM
NUMBER DESCRIPTION AMOUNT
1.
/Ne. - b,q. T,~YB~/e - ,~'~¢sa,¢/,,l.I.
- ,~'/,4,, ,,¢¢_ BIZ.L/NC,-
TOTAL (Atso enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
'= g?. ¢9'
~' g-"/.
g~L 37
REV-1513 EX * (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
-~-I- OZ-
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
NUMBER
IX.
ENTER DOLOR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE,
NON-TA~BLE 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)
15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
LAST WILL AND TESTAMENT OF GLADYS R..HIIJF~MAN
I, GLADYS R. HILEMAN, of the South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my beloved husband, GEORGE B.
HILEMAN, to his own use and benefit absolutely.
3.
In the event, however, that my said husband should predecease me, or should die at about
the same time as I die, such as in a disaster common to both of us, I give, devise and bequeath my
said estate to be divided and distributed as follows:
a.) A specific bequest in the amount of $30,000.00 to my son, DEAN B.
HILEMAN. This is to be inheritance tax free to him, the said taxes to be paid from
the residue of my estate. In the event that he predeceases me, then to his daughter,
WENDY HILEMAN. In the event she also predeceases me and is not survived by
/
issue, then this gift shall lapse and become part of the ultimate residue-of my estate.
b.) I give to each of my grandchildren, the sum of $10,000.00. In the event
any of said grandchildren are minors at the time of my death, this is to be invested
by their parents for the purpose of continuing education or other similar worthy
endeavor. In any event, when any of the said grandchildren reach age Twenty-one
(21), they shall be entitled to full distribution of any balance of their gift then
remaining. In the event any of the said grandchildren has predeceased me, his/her
gift shall lapse. The inheritance and/or estate tax on the above specific bequests
shall be paid fi'om the residue of my estate.
c.) All the rest, residue and remainder of my estate shall be divided and
distributed in equal shares to my three (3) children, to wit: DEAN B. HILEMAN,
LINDA L. MOORE and EDWARD G. HILEMAN, per stirpes.
4.
I nominate, constitute and appoint my husband, GEORGE B. HILEMAN, to be the
Executor of this my Last Will and Testament. In the event that he should predecease me or for any
reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my
daughter, L1NDA L. MOORE, to be Executrix in his place and stead. I further direct that they
shall not be required to file bond or other security in the Office of the Register of Wills for the
purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ day of
~~ , A.D. 1995.
GLADYS R~4tlLEMAN - '
Signed, sealed, published and declared by the above-named GLADYS R. HII JEMAN as
and for her Last Will and Testament, in the presence of us, who at her request and in her presence,
and in the presence of each other, have hereunto subscribed our names as witnesses.
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 001718
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA
17O55
........ fold
ESTATE INFORMATION: SSN: 171-14-2771
FILE NUMBER: 21 02-0262
DECEDENT NAME: HILEMAN GLADYS R
DATE OF PAYMENT: 10/11/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/06/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $844.16
REMARKS:
TOTAL AMOUNT PAID:
LINDA L MOORE
C/O CHARLES E SHIELDS III ESQ
$844.16
SEAL
CHECK# 114
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF ZNDZVZDUAL TAXES
TNHER]'TANCE TAX DI'VTSZON
DEPT. 280601
HARRISBURG, PA 171Z8-0601
COHHONHEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEMENT] ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
CHARLES E SHIELDS
6 CLOUSER RD
HECHANZCSBURG
III
PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
iCOUNTY
ACN
REV-I5¢7 EX AFP (Ol-O~')
12-02-2002
HILEHAN GLADYS R
05-06-2002
21 02-0262
CUHBERLAND
101
Amount Remitted
HAKE CHECK PAYADLE AND REHZT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE I~ RETAIN LO#ER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-02) NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLO~/ANCE OR
DZSALLO~/ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF HILEHAN GLADYS R FZLE NO. 21 02-0262 ACM 101 DATE 12-02-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE ZN"I=KEST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
$. Closely Held Stock/Partnersh/p Interest (Schedule C)
q. Mortgages/Notes Rece/vable (Schedule D)
5. Cash/Bank Deposits/M/sc. Personal Property (Schedule E)
6. Jo/ntly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilit/es/L/ens (Schedule I)
11. Total Deduct/ohs
12. Net Value of Tax Return
15.
lq.
NOTE:
(1)
(2)
(3)
(~)
(6)
(7)
155~750.~1
.00
6/~8q.77
.00
.00 NOTE: To insure proper
credit to your account]
submit the upper port/on
.00 of this for. with your
tax payment.
7Z/126.69
(B)
232,361.87
(;) 16,710.54
(10) 1~892.37
(11}
(12)
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Net Value of Estate Sub~ect to Tax (1~)
18.60~.71
215,759.16
Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 w111
reflect figures that include the total of ALL returns assessed to date.
.00
215,759.16
(15) .00 x O0 = .00
(16) 215,759.16 x Oq5 = 9,619.16
(17) .00 X 12 = .00
(za) .00 x 15 : .00
(19)= 9,619.16
AMOUNT PAZD
ASSESSHENT OF TAX:
15. Aaount of L/ne lfi at Spousal rate
16. Amount of L/ne lq taxabZe at L/naal/Class A rate
17. Amount of Line lq at S/bl/ng rate
18. Amount of L/ne lq taxable at Collateral/Class B rate
19. Princ/pal Tax Due
TAX CREDITS:
PAYMENT J RECEzP!
BATE NUMBER
06-05-2002 CD001255
10-11-2002 CD001718
8,336.25
8qq.16
IF PAID AFTER DATE IND/CATED] SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
D/SCOUNT (+}
INTEREST/PEN PAZD (-)
q38.75
.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
9,619.16.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CA), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.)
STATUS REPORT UNDER RULE 6.17
Name of Decedent:
Date of Death:
Will No. 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. Stat~ ~ether administration of the estate is complete:
Yes_~ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes 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.
Sighature
(MAH:rmf/AM3)
Charles E. Shields, III
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
{717 ) 766-0209
Tel. No.
Capacity:
· Personal Representative
~Counsel for personal
7 representative