HomeMy WebLinkAbout05-15-14 J 1505610105
REV-1500 a(02-31"R'
enn5 Ivania
Bu County Code Year File Number
OFFICIAL USE ONLY
Department of Revenue P m..Y
Bureau of Individual Taxes INHERITANCE TAX RETURN "
PO BOX 28o6o1 ^1
fL+ -..:
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW -
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
.............. _._..._. .................
. 11!24/2013 02/13/1921
........ ....._..............
Decedent's Last Name Suffix Decedent's First Name MI
.-.__ ............. ...-........... -.-.-_ _......-..... ....-.......-
Hornberger Jane H
_._-.. ......... _.___.
(If Applicable) Enter Surviving Spouses Information Below
Spouses Last Name Suffix Spouses First Name _ _— MI
___..._-.. . ............_....... __._-.. _...... ____.....
None
Spouse's Social Security Number
_ _ ----- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
--- -- . _
-------- -----__....... .__._.. --
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
OD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
of 6. Decedent Died Testate i=t 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.) _
C=D 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death C7 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Michael Cherewka, Esquire (717) 232-4701
x
REGISTER OtPVS USE O (?
First Line of Address
624 North Front Street
CTi;;c c_n-1
Second Line of Address " ^'
co O
_..---_-.. _-_._...._ ............... ........__. .-._..____.._.. . ......_._... . ..._.. DATE BLED O
City or Post Office State ZIP Code
................. .-.-.-.-.-.... -___ __
Wormleysburg PA 17043
Correspondent's e-mail address: mcherewka @cherewkalaw.com
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAi O P N RF,.SPNSr�BLE FR FILING RETURN DATE
�/`t7a 5 /3//Y
ADDRESS
1749 North Union Street, Middletown, PA 17057
SAIG pTHF�R THAN REPRESENTATIVE /yfE
624 North Front Street, Wormleysburg, PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1SD5610105 1505610105 J
1 1505610205
�1 REV-1500 EX(Fl) Decedent's Social Security Number
Decedents Name: Jane H. Horriberger
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1, 0.00
i
2. Stocks and Bonds(Schedule B) ....................................... 2.: 0.00
1 Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ..... 1 0.00
{
4, Mortgages and Notes Receivable(Schedule D)....._.:.......__...... 4.I 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5, 158,228.03
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00
7 eeransfers&Miscellaneous NSeparate ril/(Sched
(Schedule O Blng Requested........ 7. - 39,563.46
j
8. Total Grass Assets(total Lines 1 through 7)............................. 8. 197,891.49 }
9. Funeral Expenses and Administrative Costs(Schedule H)........... ....... 9. 20,046.78 C
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 679.01 1
11. Total Deductions(total Lines 9 and 10).. ... ........................... 11. 20,725.79
12. Net Value of Estate(Line 8 minus Line 11)................_...,.......,12.! 177,085.70 I
,
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which + i
an election to tax has not been made(Schedule J) ........................ 13. 0.00
14, Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 177,085.70
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(11.2)x.o_ 0.00 ; 15 j 0.00
16. Amount of Line 14 taxable
at lineal rate X.045
177,065.70 i 16,i 7,968.86 7
17. Amount of Line 14 taxable 3 i
at sibling rate X.12 17.
18. Amount of Line 14 taxable i
at collateral rate X,15 !. 18,j
.....,.. _._._-----------.__„_......
.__.__........_._._�
19. TAX DUE._..___.............................................. 19.I 7,96$.$$
20, FILL IN THE OVAL IF YOU ARE REOUFSTING A REFUND OF AN OVERPAYMENT Q
Side 2
1505610205 1505610205
REV-IWO EX(Pi) Page 3 Ere Number
Decedents Complete Address:
DECEDENTS NAME
Jane H..Hornberger
STREETADDRESS
4837 East Trindle Road
CRY STATE ZIP
Mechanicsburg I PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 7,968.86
2. CreditslPayments
A.Prior Payments 0.00
S.Discount 0.00
Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5, If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 7,965.86
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.......................................................................................... ❑ E
b.retain the right to designate who shall use the property transferred or its income...._............._.._................... ❑ E
c. retain a reversionary interest...................__....................................................................................................... ❑ ■
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑
2 if death occurred after Dec.12,1982,did decedent transfer property within one year of death
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?.............. ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ....................................................._...........__.._.................._.....................__. E ❑
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 on 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)(1.1) (i)].
For dates of death on or after Jan. 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)(11)(ii)].The statute does riot 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 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 on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in F2 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 defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-iScS EX+(o&z2)
pennsylvania SCHEDULE E
T" DEPARTMEMOFREVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX W" " PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: . FILE NUMBER:
Jane H. Homberger 21-13.1274
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed an Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.. _PNC Checking A=unt#5004416444 _ 17,851.16
2, .PNC Savings Account#5004417754 ,772 58tl'
_T
_ ,772.58
- , -
3, PNC Certificate of Deposit Account#31600279219 ,
13330.46
13,33..-_-.
4, PNC Certificate of Deposit Account#31900319561 17,941.92
5, _PNC Certificate of Deposit Account#31200296651 13,1107.23;.
6, :PNC Certificate of Deposit Account#31000324186YYywwpMr � 10,972.461
T. PNC Certificate of Deposit Account#31400353553 _14,324.62
g .PNC Investment Account#044-813435 67,431.60';
T9,! Clothing and Personal Items 500 40
r
-
:-Z
4
TOTAL(Also enter on line 5, Recapitulation) $ 158,228.43
If more space is needed,use additional sheets of paper of the same size.
REV-1S10 EX+(08-09)
Tiffpennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
MMEPJT94CE TAX RERIRN MISC. NON—PROBATE PROPERTY
RESIDENT DECEDENT -
ESTATE OF FILE NUMBER
Jane H. Homberger 21-13-1274
This schedule must be completed and[led if the answer to any of questions f through 4 on page three of the REV-1500 is yes. '
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECOS EXCLUSION TAXABLE
INC7lAE TIE MAINE WINE rMWEREE,THEIR A MIOFSV TO DECEDENT AM
NUMBER THE wTE OrTaNaPEx AmnHAmPrarnE OEm ra RFAI ESrAre VALUE OF ASSET .INTEREST OF VALUE
26270.431- 100; OAO.
1. PNCIRA-Accoank#75600026120 ` — 26,270.43? .
n.,..,-� �Y+:'+-L+Y�N�u`.N.WM:MnsV-w':IN.Y•-�':rN'tLMCfa�ex-�TV.butw-aoCMvimeweKaR i 'C�n '.�i' � .YM16Yt?-�2T-i MHf,A-,Yi:W� � vury�"7""X.
2 PNC IRA Account 375900026447
f3,373.031 1007 000 13,31303.
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.......__.._,„.tea,,...,.«-.-....:. :......_ _a ....m.,t
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:..vm:L vwr.0-._,ee a.v-au,r-r�.•�-m.n.,w-a,e.._-.- enume:.:•...vr.x�.-..e.�z+w,asrun<nw,w.r.:.�: .--^.gf:..,._...._. :�+-av-_,.n,-,� ..ur......: ^ss•k,-..,�.,,.._^:r'..� .
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TOTAL(Also enter on Une 7, Recapitulation} # ra 35,583.46
- If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
pennsytvania SCHEDULE H
_v"__
f DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane H. Homberger 21-13-1274
Decedent's debts must be reported on schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
i' Funeral Expenses 4,712.40;.
2.; ,Funeral Luncheon at St.Paul's t r 250;04
} i :Flowers 392.20::
4;
,
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
4,000.00¥
Name(s)of personal Representative(s) Richard L Hombergef ''"""'
Street Address 1749 N. Union Street
city Middletown state P— ZIP 17057
Years)Commission Paid:
;_�
Z Attorney Fees: - ?'i;6.
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City state—up
Relationship of Claimant to Decedent
4. Probate Fees: 363,50
S. Accountant Fees: 5 s
.�3 rr�i�ii:Y.!_'Yl".%TIB�LALFA
b. Tax Return Preparer Fees: .; 229.00
7• i Legal Notice-Cumberland Law Journals x 75,00 y
! e.?
Legal Advertising-Sentinel 158.68
3.
rx
TOTAL.(Also enter on line 9, Recapitulation) .¢3 20,046.78
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12) -
�ys\� pennsytvania SCHEDULE I
10 DEPARTMENTOFAMNUE DEBTS OF DECEDENT, -
INHOUTMCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT oECEOerr
ESTATE OF - - FILE NUMBER
Jane H Homberger 21-13-1274
.Report debts incurred by the decedent prior to death that remained unpaid at the date of death,induding unreimbursed medical expenses.
ITEM - VALUE AT DATE
NUMBER DESCRIPTION - OF DEATH
Personal Property Moving Expenses ? 40804
2; ;Diamond Pharmacy 7 1.97
3L—
3.j 'PA State Income Tax 41.00 aA
4.'.,:.ut 1:�..-:��:-=-:�r:s�.._�_.*���r_=.--:� � _- ---'- �,-c.�-.'_�or'�u z'•y`-�.,r+me�-�•_..-'.m,e�s3i
4.: Federal Income Tax 226.00°
_ r ymx:.::-_.,_:a..s:.s.--,-.__•�.-_. �-____.__.,.--__W.-_.-..__.._:,�a:.'-=.--i jez-<z-.wc:al.�er..a:•m�r�
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�._. _�__._._.....____.�.._._.�..-..r..__._....»_._....,...._.�.....__._...._.._.__,..._....._._.....-..�..... . �r«_exam=.a•.iar+cr..--.Sl
ir��� i�.._._.»....____._s:.^a:�_-_.^...�._z-�_---=.—c-�-���:=_::_�-�-�v::_._.r=:=ri �rave��a�'°✓�s=�'s'�•ciamr
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kr-.n... �:..�..«.x�.rwa..+rv- mee+c=-•�m�.-.r:r. .:Asa-�r_:umx--ae+veiaxv.oa.-mrx_mu=.'�..i! �''r...<u�w,Y.h.: •a+�!Y'e
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TOTAL(Also enter on line 10, Recapitulation) $ TM M» 679,0;
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsytvania SCHEDULE J.
OVARTMENT OF REVENUE I I
INHERITANCE TAX RUM BENEFICIARIES
RESIDENT
ESTATE OF: FILE NUMBER:
Jane H. Homberger 21-13-1274
RELATIONSHIP TO DECEDENT -AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under
Sec.9116(a)(1.2)]
1. ;Richard L.Hornberger 1749 North Union Street,Middletown,PA 17057 .•on 20%
2.i Miller 134 Oakwood Drive,State College,PA 16801 Daughter i 20%
L—j
7 3.j 'Janis Daron 111 Fieldstone Drive,Carlisle,PA 17015 20%
4.j
Steven Homberger P.O.Box 1548, 103 Pat St.,Athens,AL 35612 i Son 20%
5. 'Eric McKinsey 38 Averty Drive,Fort Mitchell,AL 36856 :Grandson 10%
!Grandson
6.1 :Michael McKinsey 4273 Cary Drive,Snellville,GA 30039 10%
Fd
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IS OF REV-1500 COVER SHEET,AS APPROPRIATE,
SI NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
.......... .......
TOTAL OF PART n -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
GP NC
December 9, 2013
Law Office of Michael Cherewka
624 N Front St
Wormleysburg, PA 17043
RE: Name:Jane H Hornberger
SSN:
DOD: 11-24-2013
Dear Mr. Cherewka:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Certificate of Deposit
Account#31600279219 Established: 12-07-2005
JANE H HORNBERGER
DOD balance: $13,329.28 + 1.18 accrued interest
Account#31900319561 Established: 09-20-2007
JANE H HORNBERGER
DOD balance: $17,941.04+0.88 accrued interest
Account #31200296651 Established: 07-19-2006
JANE HORNBERGER
DOD balance: $13,106.42+0.81 accrued interest
Account#31000324186 Established: 05-06-2008
JANE H HORNBERGER
DOD balance: $10.970.01 + 2.45 accrued interest
Account#31400353553 Established: 09-07-2010
JANE HORNBERGER
DOD balance: $10,318.45 + 2.17 accrued interest
Page 1 of 2
Checking Account
Account#5004416444 Established: 03-08-2004
JANE H HORNBERGER
DOD balance: $17,851.15 + 0.01 accrued interest
Savings Account
Account#5004417754 Established: 06-07-2005
JANE H HORNBERGER
DOD balance: $6,772.56 + 0.02 accrued interest
IRA Account
Account#75800026120 Established: 03-25-2004
JANE H HORNBERGER
DOD balance: $26,216.58+ 53.85 accrued interest
Account#75900026447 Established: 03-29-2004
JANE H HORNBERGER
DOD balance: $13,285.74+27.29 accrued interest
For beneficiary information, please call 1-888-762-4727.
Investment Account
The decedent maintained Investment Account#4813435. For further information, you may call the
Brokerage Department at 1-800-762-6111.
Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items, please call 1-888-PNC-BANK(1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank, N.A.
Member FDIC
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient, you are hereby notified that any dissemination,
distribution or copying of this communications is strictly prohibited. If you have received this
communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and
immediately destroy this faxed document.
Page 2 of 2
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��ii,, Department of the Treasury
0015 Form 1040-V K0 Internal Revenue Service
Detach coupon Below
Before Mailing
Make your check payable to the 'United States Treasury' . our SSN.
Include in the check' s memo section 2013 FORM 1040A and y
INTERNAL REVENUE SERVICE
p. O. BOX 37008 I
HARTFORD, CT 06176-7008 Sv D
KBA Form 1040-V(2013)
' ♦ Detach Here and Mail With Your Payment and Return
Department of the Treasury
2013 Form 1040-V Internal Revenue Service
Detach Coupon Below
Before Mailing
Make your check payable to the 'United States Treasury' .
Include in the check' s memo section 12013 FORM 1040X' and your SSN.
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE CENTER
KANSAS CITY, MO 64999
J
v Detach Here and Mail With Your . KBA Form 9D40-Vj2013}
Faymentandi2etum 'f
Statement Date: 12116/13 Diamond Pharmacy
Customer Number: 111766 645 KDl, P Drive
Indiana,
Facility ID: CMWS4 15
{SdO}682-6-6337 phone
Customer Group: P152 (724)349-1111 toll-free
Balance Forward
$2.43
:Payments
Check Date Check Number Amount
12102/43 8922 ($2.43)
.New Activity
Date Rx No Drug Name Qty Price ins.Pay Amt Pat Pay Amt
Invoice-IN00040897 - ..
HORNBERGER,JAP E
10727113 411902 OTC-VITAMIN D TAB 400ONIT -90 ($2.43) - $0,00 - ($243)
11/02/13 420328 RX-WARFARIN TAB 2MG 30 $4-40 $0.00 coney $4.40
IN000408974 Totals -- --
Total Legend-INOg(1408374 $4.40 UWE) $4.43
Total OTC-IN000MS974 ($2.43) $0.00 ($2.43)
Total-IN000408974 $1.97 $0.00 ,$1.97
Statement Totals —
Total Legend-Statement $4.40 $0.00 $4.40
Total OTC-Statement ($243) $0.00 ($2.43)
Total-Statement - $1.97 $0.00 $1.97
Page 1 Balance Due: $1.97
1-30 Days O/Due 31-60 Days O/Due 61-90 Days OIDue Over 90 Days O/Due
$1.97 $0.00 $0.00 $0.00
Payment Due Upon Receipt Please pay Balance Due. To pay using your MasterCard or Visa, please colt
(800)882-6337.Pharmacy Hours:Monday-Friday 9 a.m.-5 p.m.8 Saturday 9 a.m.-2 D rn.
JANE H HORNBERGER
1749 N UNION ST 5005
MIDDLETOWN,PA 170575051 - W12MI3
J&A 17120 /4 183
Daft
Par to the ,;7 1�
&affAq -Iw e Order of
_ $22
Dollars a'
�PNCBANK
PBnk.NA. X040
For �6 Cy-ly';
1:0313127381: 50044j6444u• 5005
2013 PA-V PA PAYMENT VOUCHER
r �
HO 1300912076
PAYMENT AMOUNT
HORNBERGER
JANE H 256-278-4060
$ 32 . 00
1749 N UNION ST
M I D D L E T O W N Make check or money order
PA DEPARTMENT USE ONLY payable to the Pennsytvanfa
17057 Department of Revenue
L
THIS SHIPPING ORDER must be legibly filled In,In ink,to indelible v � Agents must detach and retain this Shipping Order
pencII or In carbon and retained by the Agent and must sign the Original Bill of Lading
HARRISBURG STORAGE COMPANY
-. GEO.W.WEAVER&SON,INC. 16S LAMONT ST. Shipper's No. 38898 'H
PENN HERSHEY TRANSFER
NEW CUMBERLAND,PA 17070
717-774-7835 Nbvv227,20M Agent's No.
PA P.U.C.NO.A-00I 13647 ace.
Received ppursuant to Order for Services(if any)and subject to the classifications and tariffs,rules and regulations in effect on the date of
the issue of this1 ill of ladingg. '
The propertyry described baian'(contents and canditons of centents of packages unknown))consigned and destined ss shown below,which said company{the word
company beingg understood throughout this contract as meaning any person or corpOra8oa.in possession of the roperty under the contract)agrees to carry to
desnnahon indicated below,it within Ota scope of its lawful operatlons,otherwdse[a deliver to anothar carrier to deliver to said destination,it is mutually egreod
as to each carrier or all or any of acid property over eB or.enyy portions oC route to dostioatioa,and to each party at any time interested to all or any o7 sairi
property,that ovary service to ba performed heraander shall be subject to all conditions noL prattibited by law£wether printed or wriften,herein contained
m udmg the coadtb"on back hereof,which are bereby agreed to y shipper and accepted or himself and his assigns.
Rick Horn erger Ob Rick Hbrnberger
From Consigned to
Address 4837 E Trindle Rd. Bldg•_4 Rm 220 _ Address !': 3812 Couestoaa Rd '
Address' ?.S Ianicsbura. PA 17050 -city Camp Hill-,PA 17011
sm
?'Date Time Van- ( {�C - Clew ,,gyp Ca.FL wise. FR'EIGH'T BILL
hg.to C
DETAILS OF TPAE-BASIS CHARGE $°les Cc,
Due as amount
-
Travel and Man Travel '' stony„ Vault
Aa Hours First Hr. Pur ur:After -
c ' Cbatge First Hr.... _ S {. Open
.`a Van and Driver ' Warehouse Labor Helpers,each ARGCB Insurance '
m Supervisors,each._.. P� ,
eHOURLY CHARGE applies from time of arrival at ........._.»........................._.......:.__:r., - . TRANSPORTATION
until completion of loading and/or unloading and dismissal of vanities and men $96.00
c
D at......................... ,•Fractions of 1/2 hour considered 12 hour.
. ...................:.:...............:..•..................
Hs0
lMaly
Dismissal A. rrival ••�" LL_ .JJ Hxsua yoCbg..
_ . . ..... .. ...........................-
»_ Fva)k,U 7 . M Hr
SYLLLAL INSTRUCTIONS WEIGHT BASIS f AftrFnst
Sc .,
Basis
z. .... . Gross Weight . Extras Change-
t , Tire WeighT"`" _ �
V .. .
a C7 V r Net Weight
v •. (Smweighthtl¢aataidud)
K
mks,-. Rate .
Exclusive use of vehicle ardsmil i
by Shglpec Shipment moving at fuel surcharge 24.04
ra weight of [�
pounds.Aetna)weight Total
g Paid on a/c
n° A AM WAREHOUSE Balance
-RECEIPT TO J x CODs:-* '
Sul)jeut•to action o conditions, this shipment Is to be DESCRIPTION OF PROPERTY
delivered to the consignee without recourse on the consignor, (Sub.to corns bard RATE CHARGE
the consignor shall sign the following statement:
Thu carrier shall not make delivery of this shipment without used hhd goods Tariff 50T Sec E1 1g 45
payment of transportation and all other lawful charges. ............:................................»..................................... ........_:.............__:...........„.................
... .................._......
Signami'e of consignor ....:..........__............_...............................
......................................................................................................................... ..........................
Class
Received S...........-.................... to apply in prepayment .
of the charges on the property'described herein. Shippers are Required to Declare in Writing the Released Value of the Property
declared value the property is hereby specifically stated by the shipper' .
The agreed or des a of p
.....................................................................................................
I �to be not exceedin
The signature here acknowledges onty the amount prepaid) g.............._6. ..:...:..............cents per pound,Per article.
e s op
be y. ec ares va uahons to excess 'd a e.tm t set forth SPACE BELOW S-NOT PART O IFORM BILL OF LADING
above on the following specific articles. - DELIVERY RECEIPT
c- f�Tri`T, Excess Value Drivers and helpers have completed work in a satisfactory manner.
...............:....:................................................................._......:.....:..........................:..... All property has been-bandied in satisfactory manner and received in
good condition,except as noted below
....................._................._»..._..............,..._,..._................................»....._..............._..._ _ ...
....._......._........:.:.......................... Dollars . Cents
Carrier: HARRISBURG STORAGE COMPANY ',.,...
...................:..................•.........................•....................
Per ......................:.............................................................................. ..
. �
Per .:................:.....:...............RJ.�k:.L7of1 11...............:............ (Sigaed) .'...... ..................................................................:....::.:,
MIBURN PRINTING •¢0-999-6640-www.mAbumpdntGg.nom S09375e2
T/,- O mo w' 511711`! THE FLOWERSHOP KOONS FLORIST
� /: � 46 PRINCE ST.
C 3 �O Z LITTLESTOWN, PA 17340
SALES DRAFT (717)359-4624
flowershopkoons@yahoo.com
H&R Block 01473 www.flowershopkoons.cam
WAL MART 'SHOPPING CENTER Recipient:Jane Homberger
ATHENS, AL
Li.DISC
(256)232-1896 NO ITEM NAME OTY PRICE °b L.TOTAL
7 sympathy 1 t1611.60-696 S750.00
03/02/2014 14:25:07 2 sgmpz by . 1--- -5150.00 0% $150.00
. 3 .sympahy Y,... 535.00 0^.6 510.00
DEBITCARD ---------------------------------- ------------------------
SUBTOTAL $370.00
VS XXXXXXXXXXXX2247 DELNERY: $0.00
MERCHANT ID 904201473991 NET TOTAL: $370.00
TERMINAL ID 0001 6.90%TAX: $2220
RECEIPT 98559
INVOICE 06173496 Grand Total: $392.20
AUTH. CODE 032559 ORDER DATE: 1213(2013 1141:37AM
ENTRY METHOD SWIPED
DEBIT .k 155840 Cash Cheei Creditcardl Account
SALE TOTAL $429,00 $9.00 $0.00 $392.20 so.00
Store Credit Credit Card Donation
Signature not required $0.1 $9.99 $0.00
HORNBERGER, STEVEN E ORDER TAKEN AT STATION: 2
CUSTOMER COPY Approved amount
XXXX-XXXX-XXXX-1577 $392.20
This transaction has been approved.
Auth.Code:00579Z
Trans.ID:5742281884
x
Customer Signature
Welcome to The Flowershop Koons
cI.,�Icr.Your advertisement could go here.
•e this message go to control
defaults.(Default Address
tab)
Little's Funeral Home
PO BOX 155 oA
34 MAPLE AVENUE 12rreaoz3
LITTLESTOWN PA 17340
Phone, 717-359-4224 Fax: 717-359-5237
Mr. Richard L. Homberger
1749 N. Union St.
Middletown, PA 17057
DESCRIPTION AMOUNT
Direct Cremation Services for Mrs. Jane H. Homberger 2,495.00
Memorial Service w/Visitiation @ Funeral Home 500.00
H.S. Fabricated Bronze Um w/cross 250.00
Cemetery Opening @ Mt. Carmel 650.00
Minister 125.00
12 Death Certificates @ $6 72.00
Cumberland County Coroner Services 30.00
Memorial folders, Reg book &Ack.cards 75.00
Chambersburg Paper Publication 177.40
Hanover Evening Sun Publication 108.00
Gettysburg Times Publication 20.00
$4,502.46
CREDITS: Homesteaders 12/16 (3298.10
Little' s F.H. _(755.90
TENT _ _210.00___
BALANCE —TF59
JANE H HORN13ERGER 4999
1749 N UNION ST 661273!313
MIDDLEFOWN,PA 17057-3051 163
Pay to the /""C��c.G�+e-C • I - ° �^""
_ Order of
Q PNCBANK
For ei lx72�!
6:031312.7386: 50044,16444u' 4999
Deceased
Richard A.Little hirley H Little,F.D.
LITTLE'S FUNERAL HOME (717)359-4224
LITTf ESTOWN,PA 17 40
Lee Ann(Little)Study,F.D.,Owner
we win
F.D. a cemetery' or crematory to use any items,
John D.Study, OF FLTNE GOODS AND SERVICES SELECTED
STATEMENT you selected or that ace required.If we are required by law or b for embalming.You do not have to pay for embalming
Charges are only for those items that Y with viewing,you may have tc pay d for embalming,we will N O V 2 4 2O 13
explain in writing below. such as a funeral ediate burial.If we charge may requff
ements such as a direct cremation or imm Date of Death��
if you selected afunerayooselectedarrangbM�sS ha Hornber er
you did not app Mrs- Jane State
For the Service of City
Charge to: Address
Name Other clothing S
A.CHARGE FOR SERVICES SELECTED: - f-2–S-0-00 CrOSS
1. PROFESSIONAL SERVICES . ........... .
Cremation urn....... prnnze
Embalming Funeral.... ....I.. .... $ (Description)
Embalming ... ....... ....... f
Other preparation of body OTHER S
f Bf 325.00
S ISE SELECTED....... ......
..... . ..
Al S TOTAL MERCHAND
SUB-TOTAL OF PROFESSIONAL SERVICES..•..... C.SPECIAL CHARGES:
2. FACILITIES AND SERVICES Forwarding of remains to f
Use of facilities and services for
(Funeral Home)
viewing(VisitauonlWake).... f services
Receiving of remains from
S
Use of facilities and sery S
for funeral ceremony
Use of facilities and services for 500•00 Immediate Burial. .•• .''' '' • 00
..... . $ 5'2D-0•
Memorial Service Direct Cremation. ..... ... f 2200.0
Use of equipment and services .•••... C f
f _
for graveside service... .SUB-TOTAL OF SPECIAL CHARGE "'+tea oo 310
Other use of facdtoes D.CASH ADVANCED
Opening Grave . .... ..... .... ... .
500.00 Cemetery Equipment.. ......... ... s TOg .00 E.Still
. .. ... .... . ... ......... .. S ..... A2 f Lot and Deed... ... ..... ..... .... S
SUB-TOTAL OF FAC[LITIESIEQIHPMENT ...... Newspaper Notices—Local .���" "'
—2�00 G–burg
3.AUTOMOTIVE EQUIPMENT Newspaper Notices—Out-of-town.... $
Telephone&Telegrams 00 ,�rJ
Vehicle to transfer remains to Funeral Home. Airfare .... .. . .. .. '' 8 12 5
f
Local....... .... ... ....... ClergylMass Offering...... . .......
Hearse(Casket Coach)
... . S pallbearers ... . ..... ............ . O�
Local...... . .... .. ..... .... Certified Copies of the Death
Limousine f 12 '@,,$6
3�2
., ., Certificate -.
Local . . . .... Police Escort ..... ..... .... .....
. . .
. ....... ....
Family car
Local...... ......... .......... .. 5
o cOGti'�.
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
Tele: (717)2493166 Fax:(717)249-2663
March 7, 2014
Cumberland Law Journal is published every Friday by the Cumberland County
Bar Association and is designated by the Court of Common Pleas as the official legal
publication for Cumberland County and the legal newspaper for publication of legal
notices.
TO: Michael Cherewka, Esquire
RE: Jane H. Hornberger Estate
Legal advertisements must be received by Friday Noon. All legal advertising
must be paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on following dates:
February 21, February 28, and March 7, 2014
Advertising Cost $ 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 75.00
Total Amount Due $ 0.00
Becky H. Morgenthal, Executive Director
RECEIPT FOR PAYMENT
-------------------
GLENDA FARNER STRASBAUGH Receipt Date : 12/04/2013
Cumberland County - Register Of Wills Receipt Time : 11 : 03 : 59
One Courthouse Square Receipt No. : 1076392
Carlisle, PA 17013
HORNBERGER JANE H
Estate File No. : 2013-01274
Paid By Remarks : RICHARD L HORNBERGER
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 30 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 8923 $363 . 50
Total Received. . . . . . . . . $363 . 50
LAST WILL AND TESTAMENT
OF
JANE H. HORNBERGER
I, JANE H. HORNBERGER, Social Security Number 168-14-3343, of the
state of Pennsylvania, declare that this is my LAST WILL AND TESTAMENT
and I revoke all other wills and codicils previously made by me.
•FIRST: I appoint my Husband, _GEORGE E. HORNBERGER; as my Personal
Representative concerning this Will. If he is unable or fails to
serve, I then appoint my son, RICHARD L. HORNBERGER, to serve as my
Personal Representative.
a. I request that my Personal Representative be permitted to
serve without bond or surety thereon and without the intervention of
any court, except as required by law. I direct that my Personal
Representative act in unsupervised administration so as to administer
my estate with a minimum of court supervision. If it becomes necessary
to have ancillary administration of my estate in any jurisdiction where
my Personal Representative is unable or does not desire to qualify as
ancillary legal representative, I appoint as such ancillary legal
representative such individual or corporation as my Personal
Representative shall designate, in writing.
b. I direct my Personal Representative to pay the expenses
of my last illness, the expenses of a funeral appropriate to my station
in ,life and custom of living (including a suitable monument or marker
for my grave) , and written charitable pledges which I have made. I
grant my Personal Representative the power to extend or renew any debt
for such time as my Personal Representative shall deem appropriate.
C. All estate, ' inheritance, succession and other death taxes
with respect to all property passing under this my Will shall be paid
from and borne by the principal of my residuary estate, without regard
to reimbursement, as if such taxes were administration expenses. My
Personal Representative may pay such taxes at any time deemed
advisable, whether or not then due and payable.
d. My Personal Representative is requested to settle my
estate as soon after my death as may be practicable, and to pay or
deliver every legacy or bequest to my beneficiaries without waiting any
time that may be believed to be customary in probate matters.
blorcrnGen_ yz
PAGE
OF 4 PAGES
e. My husband has served in the Armed Forces of the United
States. Therefore, I direct my Personal Representative to consult with
a Legal Assistance Attorney at the nearest military installation and
with the Department of Veterans Affairs and the Social Security
Administration to ascertain if there are any benefits to which my
family members are entitled by virtue of his military service.
f. I may leave a letter of intent with the executed copy of
this Will for the purpose of giving guidance to my Personal
Representative concerning the distribution or sale of certain items of
my property. I request, but do not require, that my Personal
Representative honor my wishes therein expressed.
SECOND: I give, devise and bequeath, absolutely and forever, all
of my estate and property of which I may be seized or possessed, or to
which I may be entitled, at the time of my death, wherever situated or
of whatever nature, be it real, personal, or mixed, to my Husband,
GEORGE E. HORNBERGER, as his sole and absolute property if he shall
survive me.
THIRD: In the event that my Husband, GEORGE E. HORNBERGER shall
not survive me, I give, devise and bequeath, absolutely and forever,
all of my estate and property of which I may be seized or possessed, or
to which I may be entitled, at the time of my death, wherever situated
or of whatever nature, be it real, personal, or mixed, to to my
daughter, JEAN M. MILLER, to my daughter, JANIS L. DARON, to
my daughter, JULIE MCRINSEY, to my son, RICHARD L. HORNBERGER, and to
my son, STEVEN E. HORNBERGER, and to any child or children that have
been or may be born to or adopted by me, in shares of substantially
equal value to be divided as they may agree.
a. If any of my children shall not survive me, then the
share of that deceased child shall go to the descendants of that child,
who are to take per stirpes and not per capita. If any of my children
shall not survive me and shall not be survived by any descendants, then
the share of that deceased child shall be distributed to my surviving
children and the descendants of any of my other children who fail to
survive me, in the manner set forth above.
b. If they are unable to agree, the division among my
children and the descendants of any of my children who fail to survive
me shall be made by my Personal Representative, in that person's sole
and absolute discretion. I empower my Personal Representative to sell
any or all of such property, if such property is not distributed in
kind hereunder, and to distribute the proceeds among my said children
in substantially equal shares. Any determination of my Personal
Representative as to what should pass or be sold under this paragraph
and to whom it should pass or be delivered or at what price it should
be sold shall be conclusive.
r PAGE 2
OF 4 PAGES
FOURTH: Except as otherwise provided in this Will, I have
intentionally failed to provide for any other relatives or other
persons, whether claiming to be an heir of mine or not. Insofar as I
have failed to provide in this Will for any of my issue now living or
later born or adopted, such failure is intentional and not occasioned
by accident or mistake.
FIFTH: Any beneficiary who fails to survive until one hundred
twenty (120) hours after my death shall be deemed to have predeceased
me, and the gift to that beneficiary shall be disposed of accordingly.
SIXTH: Definitions:
a. The term "children" as used in this Will includes adopted
and afterborn persons. The term "children" as used in this Will shall
also include step-children, the natural born or adopted children of a
person's spouse who are not the natural born or adopted children of the
person. A relationship by or through legal adoption shall be treated
the same as a relationship by or through blood for purpose of
succession to property under this Will.
b. The term "descendants" as used in this Will means the
immediate and remote lawful, lineal descendants by blood or adoption of
the person referred to who are in being at the time they must be
ascertained in order to give effect to the reference to them.
c. The term "Personal Representative" as used in this Will
means Executor, Executrix, Independent Executor, or any other title of
like import which is used to describe such a fiduciary.
d. The term "per stirpes" as used in this Will means that
whenever a distribution is to be made to the descendants of any person,
the property to be distributed shall be divided into as many shares as
there are (1) living children of the person, and (2) deceased children,
who left descendants who are then living, of the person. Each living
child (if any) shall take one share and the share of each deceased
child shall be divided among his then living descendants in the same
manner.
SEVENTH: In addition to any powers granted by the laws of the
state in which this Will is probated,, I hereby authorize and empower
the fiduciaries named in this Will, to the extent of the discretion
herein granted, to sell, exchange, convey, transfer, assign, mortgage,
pledge, lease or rent the whole or any part of my real or personal
estate, to invest, reinvest, or retain investments of my estate, to
perform all acts and to execute all documents which my fiduciaries may
deem necessary or proper in regard to my property. If any of my
fiduciaries elect to receive compensation for services, such
compensation will be that allowed by law.
PAGE 3
OF 4 PAGES
EIGHTH: If any part of this Will shall be invalid, illegal, or
inoperative for any reason, it is my intention that the remaining
parts, so far as possible and reasonable, shall be effective and fully
operative. My Personal Representative may seek and obtain court
instructions for the purpose of carrying out as nearly as may be
possible the intention of this Will as shown by the terms hereof,
including any terms held invalid, illegal, or inoperative.
IN WITNESS WHEREOF, I have at
this day of iT�� r , 19 , set my hand and seal to
this my LAST WILL AND TESTAMENT, consisting of 4 typewritten pages,
each page bearing my handwritten signature.
This document was prepared under the authority of 10 U.S.C,
section 1/044, and implementing military regulations and instructions,
by TM n 7 v �- . Slur , , who is licensed to practice law in
(�, HDS7�y�Lw�4.r (SEAL)
JANE H. HORNBERGER
The foregoing instrument was, at ,
this j1`k� day of "-Ma'C_N— , 19 (A7�-, signed, sealed, published
and declared by JANE H. HORNBERGER, the testatrix, to be her LAST WILL
AND TESTAMENT in the presence of all of us at one time, and at the same
time we, at her request and in her presence and in the presence of each
other, have hereunto subscribed our names as attesting witnesses, and
we do so verily believe that the said testatrix is of sound and
disposing mind and memory at the date hereof.
�i .+1o��Y V7'at('/"1 �le✓!'v�( G.o GG A„" 66S
Soc.Sec.No. i65-53-jiff Soc.Sec.No. Soc.�S/ec.N/o�. NP-3 `f-104a
OF OF R fcl e + /VJ 67 OF T� / •-� �, /71 /l
\VJnn� OFPA4EPAGES ��G
State of
County of
ACKNOWLEDGMENT
I, JANE H. HORNBERGER, 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; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed.
`f� Y� Ohm�anCe?z (SEAL)
JANE H. HORNBERGER
JJ�r ,C I
AFFIDAVIT
We, f woo ThY ' vTur r. , r �^ cz5 N and
1
—30-rb csg-a- LP, G Un C c - , the witnesses, sign our names to this
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testatrix sign and execute the
instrument as her Last Will; that 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
knowledge the testatrix was at that time 18 or more years of age, of
sound end 21 �e no cons aint u ue influence.
L
Witne Wi ness Witness
Zscribed, sworn to and acknowledged before me by JANE H.
HORNBERGER, the testatrix, and subscribed and sworn to before me by
L and
ar 6a r c� + r , the witnesses, this day of
�ar-Ck , 19 93
NOTARY PUBLI My Commission Expires:
i