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Home My WebLink About02-0573PETITION FOR PROBATE and GRANT OF LETTERS Estate of _ also known a Hubertha A. Heather Deceased. Social Security No. 154-18-0691 No. 21-02• ~.5~3 To: ' Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(), who is/ 18 years of age or older an the execut rix named in the last will of the above decedent, dated October 12 . 1995 , 19 and codicil(s) dated (state relevant circnmstanccs, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 1 Lon~sdorff Way, Carlisle, South Middleton Townshiy, Pennsylvania (Gst street, number and muncipality) Decendent, then 81 .years of age, died June 7 , 2002 , 19 , at Ct~mherland Crossings Retirement Center, Carlisle, Pennsylvania 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: 166,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. u ` V 1 v ti - t•(.. y~ ~ ~~ Catherine H. Dembowski o r'"G86 Spring Lane ya Boiling S rings PA 17()0] u ._ ~ ~ R C e0 N OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF Cumberland ~ 5s The petitioner( above-named swear(s) or affirm(s) [hat the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and t my administer the estate according to law. Sworn to or affirmed and subscribed r I ~ c., before me this 19th day of I t~ ~" a~-l ~-~~ MARY C (]4EWIS Register 1~--~o~-1c~ No. 21- Oz - 573 Estate of Hubertha A. Heatherly ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUNE 19. 2002 , in consideration of the petition on the reverse side hereof, satisfactory proof having been ppresented before me, IT IS DECREED that the instrument(s) dated 10-12-1995 described therein be admitted to probate and filed of record as the last will of ~UBE'IRTHA A HEATHERLY and Letters TE are hereby granted to CATHERINE H DEMBOWSKI ~ ~• L~I~tegister of Wills FEES Probate, Letters, Etc.......... $ 235.00 Short Certificates( ) .......... $ ~_ . .) X'•1'IiA • PAGES$ 3... 0I1 -icp $ 5.00 TOTAL - S 24~ X10 Filed 6-19-2002 put ' iri prbtYi 'box' csn' 6='Y9=fl2• - ' ~. ~J ~_ l Hubert X. Gilroy, Esquire (29943) ATTORNEY (Sup. Ct. I.D. No.) Broujos & Gilroy, P.C. 4 N. Hanover St., Carlisle, PA 17013 ADDRESS (717) 243-4574 PHONE f\: -. i~ " _ ~ ~~ IOS.ROS REV 9JRC This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for, permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 831991.6 No. M,DS.1 U Rar. 7187 .~ ti11T NK ~~ e=7a+.~c ~1. Local Registrar _ ~uN 1 o z~az Date COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALIH • VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENiIF•a. MiddN.trl SE% SCCIAL SECURITY NUMBER OA7E Of OERNrMaM.D.y.'!r) ,. Hubertha A. Heatherly a. Fenale a. 154 - 18 - 0691 .. June 7, 2002 AOE lLaa B+aaay, UNOER,YEAR WIDER,DA' OATE Of BIRTH BtRTNPUCE ICa/aa PIACE OF OERNICIecMaWav-aa marucsa~•manw awl ~,a = Data ,~ ( M„w,w 1M,OMh. OaT,Nrt StwayapnCaaaN 9/3/1920 cheveningen, 81 Y HOSPILLL: OTHER I,IpaNrKO ER10umaiaK^ Da^ „~ ® ,,.,a„aa^ ,^ ,,, .. T. H • COUNTY OF DERH CffY, BDRO, TWPOF DEATH FACRRY NAME Ia nd .9n+area arq r%ana•ri NMS OECEDEM OF NISPA111C ORNiltlt RACE.Amarkan M,dlw.BMCM. WNA•. at. ND ® N• ^ a y.., apacay,ae.n. ISn•I'1Tl • Cumberland „South Middleton Ctanberland Crossings Ret. Cntr. ;"w'°^^a^°"'~•^••"' 10. White DECEDENT'S U8UAl OCCUPAgN KIND Of BUS,NES811NWSTRY WAS DECEDENT EVERNI DECEDENT'SEOI1CI010N MARITALSWUS•MarrYa SURVMNO SPDUSE ARMEDFORCESt NawManwd.Wlm.ad. In.r.pn.naor,wma, S U . . p;i•.MadawrMdorad~aaqaaa ^ ~® ,ary/Sacaaary ew•o. Dla,rwaROae•,L aaaM.,Ya;d,,,,,uNrW.dJ Connecticut Natio 1 Y w • ,,.Assistant Branch Bank , . „ 12'°'n "~aa" ,. Widowed , - Sou eton ,w oECEOENT'S MAK,%aT A0011ESS ISbwl L3M~. saa.Iq C•d•, ~ B PA ,h eae.eaK tti.d aL ® N. ~ c U ~ . . , _ oa ,7a. sw. A c T a . 1 Longsdorf Way ~ ~ °; K ~ .a. ,a ,~ Carlisle, PA 17013 °"°'""°" ,,., Cimiberland '°""a"°' ,T..O ~a:r,~wa f/e11ER'S NAME (Fire. Midda, Laa1 MOTHER'S NAME (Pita. Mad•. Matl•n sawral Peter - Hardenber ,,, Klazina - DenDulk INFOIWANT'S I•NaE (Typ•IPgy BIFORMANT•B MAIt1Nfi ADOREBSdtgaLCaww•.r.sar.,z>pcad•1 S PA 17007 rin s L Boilin ne i 586 S Catherine H. Danbowski p g , g ; pr ng a IAETttoooFDlBVOeITaN EaFasPOSIraN aFUSposrrloN•N.aaaca,aary.Ganaay LOCRION• Swa.74Cwa rr ^ R 8,a 0 [~ C ~~~ a~earo+.w ~~ rl d CO' 7 T L} y .aaY an . BaW wmadw ^ ~~++ ^ 6j11J2002 Mt. Zion Cemetery ' " ~ jr t 4lonroe~ap• 7 `•' .~ ,,,• ,~a t SKINRURE OFf RVICE LICE PE IND A8.IL,CN LICENSE NUMBER NAME ANDAODRESSOF FACILRY „a•FD 012633 L ,xBwin Brothers Funeral Hone, Carlisle, PA 17013 CaruplMw lar,a 7aae aaywnw o•nafMq aNt,aanl.naaxrY.raa.aa.,ma Maas .4am axunwa,M,aa,daaaw acad. LICENSE NUMBER DATE SKLNED N 3 "~""°~ ~ ~ ~ ~ nr,ay oauw aaaall. ~ oz ~ 4o So ~ -~ ~ Z• R a 7Nr,ataas~arta carp,aada OF DEATH DIOE NCEO DEAD(MOM.DaK »ar) WAS CASE REFERRED IO MEDICAL E%AMINERK;OROf/ER7 a.raan.,a parawa.s as r..^ Na ~ as ~ ~ 02 x 55 M . aa. 27. IN11LT h. ErvMwww.,:MANS«aaiplcxienswNenaww ua aaam. Do nolaa«da moOMaaykp.axn wa.al.e a,wpraay urw4 NacM ala.n uiw. IApgOdmaa PApt E: onar eaWNar mnaeraYgaewl.. eut %aa,aan•ran na,•MdtlrlgaMa,aar,,Mq•MMgMnnPART1. LroMTarcaawm..rnan.. , ,arraaM dwa, ^ • I ~ I,~IATE DAYlE IFaa ' `IF/,' /y/(//1 drr.aa%aibn I ~~~~t_~ DUE IOIOR AS ACONSE OF'k ~~ IarBt~M aMmaaw e DUE WIOR ASA CONSEOVENCE OFk i ar. Err IIIIDFALYWB r C111dN: tOwwra aFay ar•rr.e wvaa DUE IOTOR AS A CONSEQUENCE DFT - ' raawrgadalnl WT s WAB AN AUTTWSY WERE AUIUPSYFM,dND$ MANNER OF DEATH OATS OFIWUflY TIME OFINJURY INJURYR WORKT DESCRIBE HOW WJURY OCCAIIWED. PERPOM,EDT AWLABLE PR101110 Maw,, Oay,`Mr, OF CAUSE ~ R( ~~ ^ OF OErRNt 11° °~ `M ^ Ne ^ -•raao awalaaa^ ^ A[<Na• ^ M. TYa ^ N• 1aa, 'Aa ^ N• ^ aM 911k1d• ^ Caad no, to dalarrrnn•d ^ la. PLACE OF INJVRY • Af Mna, latm, araa,,acarY, o,Arw auadYR alG ISWCM aa•. LOCIDION ISaaaL CMWwn, Staa1 aa• CEIITIFIEII ICMdi aa,.aa, S NATURE MLE OF CE T E •CERTYYEID PNYfIpAM p+nYawncaa,•g tarMa dean, aan Anwar aMCan,w Vanounc•d Waa+and cwiq•ua Ilan 7a1 7bM Ma Mary Mn•'•ada••de•,n aaean•d AaYMaww(•IaM rrallMlweaW ..................................................... , - -PRONOIa1GNO ANO CEMIFYR10 M1YSICIANIPNyaCan eodraaaurcagwr+Ara caMPnpaca,wadwnl daa•aav,aeaaradwaMearwlp.nam.nn.rwxxw .......................... ^ T•Ma•aa•rYMno.,.sya••aee•v.wxMaa. LICE BER O/SE IM•nn,Dq: N~al/~f 3 UhC to ~M/ L a,a. a, , NAME AND ADORE PERSON WHO COMPLETED CAUSE OF OEQN • •YEDICAL EXAYINER/CORONER 1%am 771 Typo a PnM DONALD J. KDVACS,Im On Ma iwaM el aaarMnatlon andlor Mwa,lgation, N my opMion, d•alh «eunad at tM dma, data, and place, and du. to tM eadse(al and ^ Wba &aadaa Fanly Rtlka Ca1a 0/ IRannat n aatad .................................................................................................. eta. at 19SS L.ax1,al Rd, Beigl~gL 81170 ~GI$TRAR'83KiNATURE ~(Fl(O'Rn11~1.tB,E~R__ i ,at1, I b, f~ ~• ~~ O GttE FILEDIMpae Day.Nwl >.. f ~ ~ v I , HUBERTHA declare this by me. 21-02 -~~3 A. HEATHERLY, of Cumberlan County, Pennsylvania, to be my last will and revoke any will previously made ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM '!'Wn. T give, devise and beq::eath my entire estate to my children, Peter W. Heatherly, Catherine H. Dembowski and Patricia Heather Lea, share and share alike per stirpes. I acknowledge that I have not made provision for my husband, Thomas J. Heatherly, and I acknowledge that I understand that this Will makes no direction that he receive any inheritance from my estate. ITEM THREE: I appoint Catherine H. Dembowski, Executrix of this my Last will. ITEM FOUR: A11 estate, inheritance, succession and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ITEM FIVE: I direct that my person representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SIX: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so Long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. IN WIT~1lES WHEREOF, I have hereunto set my hand this ~ K day of O G /-p 1995 . SIGNED 1~ ~~ HUBERTHA A. HEATHERLY PAGE ONE OF ONE PAGES . , ,~ The preceding instrument, consisting of-this and one other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names. ~" ~ . ~ -c°iv ,~,,... COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss We ~~ ~7~ot1'` />< C%~ lea ~ and ~~ ! l~~.~ L. T 1'~~tiJ ~~Gc~ ~ /fY~l~ witnesses whose names kre signed to the attached or foregoing 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 she signed willingly and executed it her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn and subscribed to before nab this /~~~ day of f/~-~D~~'-a' , 1995. Notarial Seal Karen F. Byers, Notary Public Carlisle Boro, Cumberland County My Commission Expires March 18 JQ9y Notary Pub c COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND . I, HUBERTHA A. HEATHERLY, whose name is signed to the attached 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 as my free and voluntary act for the purposes therein expressed. HUBERTHA A. HEATHERLY ~j'o n ana''arfirnred to and acknowledged before me this ~ day of QLC~ ~ 1995. Notary Publ' PAGE TWO OF TWO Karen F. Byers I otary Public Carlisle Boro, Cumberland County My Commission Expires March 18, 1999 . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY V t7~ to-IO FILE NUMBER 21 -0 2 0573 "COONTYCOOE ---yeA~ - - 'Niii8eR-- ONWEAL TH OF NNSYtVANIA ARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 I- Z W C W () W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 54- 1 8 - 0 6 9 1 THIS RETURN MUST BE FILED IN DUPLICATE WlTH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w .... ::.::~rn 0"'''' w"-O ,,00 0"'.... "-'" "- " ESTATE OF HUBERTHA A. HEATHERLY DATE OF DEATH {MM-DD-Year} DATE OF BIRTH (MM.OD-Year) 06/07/2002 09/03/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) 00 1. Original Return o 4. Limited Estate D 6. Decedent Died Testate (Allach copy of Will) o g, Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dare of death after 11-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10, Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95) o 3. Remainder Return (date of death pliorto 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS HUBERT X. GILROY 4 NORTH HANOVER STREET FIRM NAME (If Applicable) BROUJOS & GILROY PC CARLISLE, PA 17013 TELEPHONE NUMBER 717-243-4574 .... z w. c z o "- '" w '" '" o o z o i= <C ...J ::l l- i[ <C () W 0:: z o i= <C I- ::l 0. :!i o () X <C I- 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) (8) OFFICIAL USE ONLY _----..0. 167,817.82 (6) (7) 167.817.82 13,555.21 6.39345 (11) (12) (13) 19.948.66 147,869.16 3, Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule Dj 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) 19. Tax Due x _(15) 147,86916 X .045 (16) X 12 (17) X .15 (18) (19) (14) 147,869.16 6,654.11 6,65411 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 tax~ble at collateral rate Decedent's Complete Address' .. '" STREET ADDRESS 1 LONGSDORFF WAY CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 6,654.11 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E Penalty TotallnteresUPenalty ( 0 + 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 6,654.11 6,654.11 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; ... ............... ..................... ....... 0 1RI b. retain the right to designate who shall use the property transferred or its income; .................. ................ .... 0 1RI c. retain a reversionary interest; or. ..................... ................ .. 0 [Kl d. receive the promise for life of either payments, benefits or care? .... .................. .... 0 1RI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.... ................. . ..... 0 00 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? .. .... ..... 0 1RI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............................. . ................... ................. ............. ... D IKl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 586 Spring Lane Boilin>! Sprin>!s, PA 17007 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dales of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use o!the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or forthe use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(I.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% 172 PS. 99116(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. ec":~"""",I'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF ESTATE OF HUBERTHAA HEATHERLY FILE NUMBER 21 02 0573 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK - FIRST 1,303.25 Accl # 8892249486 2 M&T BANK - MARKET INDEX 164,41648 Accl # 15004200117924 3 M& T BANK - SELECT 1,42248 Accl # 001279599 4 Refund - Carlisle Regional Medical 633.60 5 Refund - Philhaven 42.01 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 167817.82 "cv.""":,,~,,,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ESTATE OF HUBERTHAA HEATHERLY FILE NUMBER 21 02 0573 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral 291.60 2 Allenberry Resort Inn 639.48 3 Connecticut Post - Obituary 133.60 4 Enterprise Rentacar 606.52 5 Gingrich Memorials 95.00 6 Jeffrey's Flowers 711.26 7 Giant Foods /6/8102 142.95 8 Giant Foods 6/9102 163.59 9 Giant Foods 6/10/02 55.02 10 Oak Grove Farms 6/10/02 29.15 B. ADMINISTRATIVE COSTS 1. Personal Representative's Commissions Name of Personal Representative (5) Catherine H. Dembowski 7,680.00 Social Security Nurnber{s) I EIN Number of Personal Representative(s) Street Address 586 Sprinq Lane City Boilinq Sprinqs State PA Zip 17007 Year(s) Commission Paid: 2. Attorney Fees Broujos & Gilroy, PC 2,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills - Filing Fee 252.00 8 Register of Wills - Inheritance Tax Return 15.00 9 Register of Wills - Family Settlement Agreement 17.00 TOTAL (Also enter on line g, Recapitulation) $ 13555.21 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent ESTATE OF HUBERTHA A. HEATHERLY 21 02 0573 PaQe 1 Schedule H - Funeral Expenses & Administrative Costs - A ITEM NUMBER A. DESCRIPTION AMOUNT 11 12 13 14 15 16 FUNERAL EXPENSES: Mechanicsburg Beverages Office Max - Photo Board Phone Reimbursement - Catherine Dembowski Scalles Restaurant Schenk's Pastry Shoppe Wines & Spirits 45.28 23.91 30.00 31.51 48.40 43.94 SUBTOTAL SCHEDULE H.A 22304 -'"""*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF ESTATE OF HUBERTHA A. HEATHERLY FILE NUMBER 21 02 0573 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Cumberland Crossings -Trust Fund / April Charges 3.42 Cumberland Crossings - Skilled Care /May Charges 4,379.19 Cumberland Crosings - Skilled Care / June Charges 899.00 Reimbursement to Catherine Dembowski for pet (dog) expenses 334.26 Carlisle Small Animal Vet 6/26/02 54.00 Carlisle Small Animal Vet 7/25/02 48.37 Carlisle Small Animal Vet 9/7102 52.72 Carlisle Small Animal Vet 10/8/02 104.37 Carlisle Small Aninal Vet 11/5/02 282.60 Pet Grooming / Mountain View 7/17/02 50.00 Pet Grooming / Mountain View 9/10/02 50.00 Alert Pharmacy 53.95 Benefit Concepts Health Insurance 48.11 Carlisle Regional Medical Center 31.78 Quantum Imaging & Therapy 1.68 TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 6 393.45 .,~- ""'''jC<,'''''~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal dIStributions) 1. Peter W Heatherly 92 Attawanhood Trail Amston, CT 06231 Catherine H Dembowski 586 Spring Lane Boiling Springs, PA 17007 Patricia Heather Lea 38 Pleasant Street Bristol, Vermont 05443 2 3 FILE NUMBER 7 AMOUNT OR SHARE OF ESTATE RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son Daughter Daughter 3333 33.33 33.33 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ElECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DI4ISION DEPT. 2806D1 HARRIS811RG, PA 17128-06D1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOMANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 E% ~FP (O1-PS) DATE 01-28-2003 ESTATE OF HEATHERLY HUBERTHA A DATE OF DEATH 06-07-2002 FILE NUMBER 21 02-0573 `;j_ ,,, ,, _ , ~ -~ COUNTY CUMBERLAND HUBERT X GILROY ACN 101 BROUJOS 6 GILROY Amount Remitted 4 N HANOVER ST _. CARLISLE PA 17"013 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS r ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HEATHERLY HUBERTHA A FILE N0. 21 02-0573 ACN 101 DATE 01-28-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate [Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest [Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this torn with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 167,817.82 tax payment. 6. Jointly Owned Property (Schedule F) [6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (g) 167,817.82 APPROVED DEDUCTIONS AND EXEMPTIONS: 13,555.21 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 6,393.45 11. Total Deductions (11) 19.948.66 12. Net Values of Tax Return (12) 147,869.16 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Nat Value of Estate Subject to Tax (14) 147,869.16 NOTE: if an assessment was issued previously, lines 14, 15 andior ib, 17, 18 and 19 viii reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate [15) •00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 147,869.1b X 045. 6,654.11 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 - .00 19. Principal Tax Due (ig)= 6,654.11 TAY f`DCIITTC. DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 12-03-2002 CD001907 .00 6,654.11 TOTAL TAX CREDIT 6,654.11 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) FIRST AND FINAL ACCOUNT OF WILLIAM M. EWING., EXECUTOR OF THE LAST WILL AND TESTAMENT OF GLORIA S. EW/NG, LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED. DATE OF DEATH: June 6, 2000 LETTERS TESTAMENTARY ADVERTISED: Sentinel: July 29th, 26th, & Aug 2, 2000 CLJ:Aug.lBth, 25th & Sept. 1, 2000 ESTATE FILE NO.: 21-02-0573 PRINCIPAL RECEIVED ACCOUNTANT IS CHARGED WITH THE AMOUNTS OF PRINCIPAL AND INTEREST RECEIVED AND CLAIMS CREDIT FOR THE DISBURSEMENTS MADE AS STATED BELOW.• 2002 June 6 Keystone Financial Checking Acct #708607 $18,269.89 Accrued interest to June 6, 2000 $15.25 June 6 Keystone Financial Savings Club #222000023 $1,760.00 Accrued interest to June ,6, 2000 $10.29 June 6 Refund,Capital Blue Cross $515.00 June 6 Refund, Montgomery Ward $129.00 June 6 Refund, State Farm Automobile Insurance $154.00 June 6 Legg Mason, Account #360-00984 Cash Balance $81,042.19 Alberta Energy Ltd.(AGO)300sh@36.785) $10,618.00 American Home Prods(100sh@53.2187500 $5,321.88 Compaq Computer Corp(300sh@27.406250 $8,221.88 Fulton Finl Corp PA(2211sh@21.093750) $46,638.28 Harris Finl Inc(500sh@6.687500) $3,343.75 JLG Inds Inc(500sh@10:00) $5,000.00 Keystone Financial Inc(1,300sh@22.125000) $28,762.50 LeggMason Global Tr Inc(1,984.138sh@13.4300) $26,646.97 LeggMason Focus Tr Inc(3,144.625sh@25.00) $78,615.63 LeggMason Value TR Inc(3,429.412sh@75.07) $257,445.96 LeggMason SPL Investment(4,285.543@38.33) $164,264.86 Page 1 LeggMason Tax Exempt (15,438.709sh@15.38) $237,447.34 Mylan Labs Inc(7,OOOsh@26.812500) $187,687.50 PA St Bk Camp Hill(296sh@11.062500) $3,263.44 Rite Aid Corp(200sh @6.43750 $1,325.00 Susquehanna Bancshares(5,650sh@14.343750) $81.042.19 $1,226,687.37 June 6 1st Union Securities, Account #3110-8166 Cash Balance $10,617.87 Age High Income Fund(800 sh@2.30) $1,840.00 Eaton Vance Prime Rate(602.41sh@9.85) $5,933.73 Franklin Custodian(1,350sh @6.52) $8,802.00 Kemper Total Return (1,516.496sh @11.31) $17,151.56 Massachusetts Investors Trust(521.648sh@20.64) $10,766.81 Putnam American Gov't Income(870.422sh@8.33) $7,250.61 PLM Equip Growth VAA(420sh @7.25) $3.045.00 $65,407.58 June 6 Merrill Lynch, Account #688-22627 $43,179.65 June 6 1st Union Securities, Account #3110-8282 Income Fund of America(1,005.454 shares @15.81) $5,899.26 June 6 LeggMason Wood Walker, Inc. Allied Irish Banks PLC(1,914sh@20.4063) $39,057.56 Ariel CP(100sh@3.64063) $364.06 Cardinal Health(35sh@62.4063) $20,282.05 Carlisle Companies(800sh@44.9375) $35,950.00 Chemfirst Inc.(100sh@21.3438) $2,134.38 First Union Corp(300sh@34.8750) $10,462.50 Harris Financial (300sh@6.6875) $2,006.25 Lucent Technologies(10,Osh@63.5313) $6,353.13 Lennar Corp (2sh@19.3438) $38.69 Mylan Laboratories(4,150sh@26.8125) $111,271.88 PNC Financial(1,057sh@5.5313) $56,582.53 PPG Industries(200sh@48.5938) $9,718.75 PPL Corp(200sh@23.1250) 4 2 0 $298,846.78 June 6 Keystone Financial(20,167sh@22.125) $ 446.495.00 TOTAL PRINCIPAL RECEIVED $2,117,369.08 Page 2 INCOME RECEIVED Aug. 26 Interest, Estate Checking $50.15 Sept. 5 Interest, Savings Account $271.62 Sept. 26 Interest, Estate Checking $12.30 Oct. 9 Interest, Estate Checking $7.03 Oct. 24 Dividend, The Income Fund of America $225.00 Oct. 20 Dividend, Cardinal Health Inc $10.53 Oct. 20 Dividend, Mylan Laboratories $166.00 Oct. 24 Dividend, Pepsico $56.00 Oct. 26 Interest, Estate Checking $8.46 Nov. 24 Interest, Estate Checking $32.45 Dec. 6 Dividend, American Express $24.00 Dec. 6 Dividend, Lucent Technologies $2.00 Dec. 26 Interest, Estate Checking $39.01 2001 Jan. 26 Interest, Estate Checking $34.75 Feb. 1 Dividend, Mylan Laboratories $166.00 Feb. 2 Dividend, ChemFirst Inc $10.00 Feb. 2 Dividend, PPL $53.00 Feb. 2 Dividend, M&T $1,873.25 Feb.2 Dividend, Cardinal Health Inc. $10.53 Feb.2 Dividend, Carlisle Companies $160.00 Feb. 2 Dividend, PNC $507.36 Page 3 Feb. 2 Dividend, Legg Mason $1,670.07 Feb. 2 Dividend, Pepsico $56.00 Feb. 26 Interest, Estate Checking $36.98 March 8 Dividend, Carlisle Companies $160.00 March 23 Dividend, PPG $84.00 March 26 Interest, Estate Checking $34.27 March 29 Dividend, Legg Mason $982.31 March 29 Dividend, First Union $285.12 March 29 Dividend, Glaxo Smith Kline $12.00 April6 Dividend, M&T $1,873.25 April6 Dividend, Pepsico $56.00 April 6 Dividend, PPL $53.00 April 9 Dividend, PPG $80.00 April 20 Dividend, Cardinal Health Inc $10.53 April 20 Dividend, Mylan Laboratories $166.00 April 26 Interest, Estate Checking $27.12 May 1 Dividend, Legg Mason $4,016.77 May 1 Dividend, Avaya $5.18 May 1 Dividend, PNC $507.36 May 1 Dividend, Allied Irish Banks PLC $869.91 May 1 Dividend, Glaxo Smith Kline $65.82 May 18 Dividend, American Express $24.00 Page 4 May 21 Dividend, Cardinal Health Inc $31.91 May 25 Interest, Estate Checking $23.70 June 7 Dividend, Lucent Technologies $2.00 June 7 Dividend, Carlisle Companies $160.00 June 13 Dividend, PPG $84.00 June 26 Interest, Estate Checking $24.52 June 28 Dividend, First Union $95.04 June 28 Dividend, Legg Mason $1,375.86 July 26 Interest, Estate Checking $23.56 July 31 Dividend, Glaxo Smith Kline $25.86 July 31 Dividend, M&T $1,873.25 Aug. 15 Dividend, American Express $16.00 Aug. 16 Dividend, Cardinal Health Inc $4.38 Aug. 16 Dividend, Legg Mason $1,995.10 Aug. 24 Interest, Estate Checking $23.53 Aug. 30 Dividend, Pennsylvania State Bank $6.57 Sept. 11 Dividend, PNC $507.36 Sept. 11 Dividend, Waypoint $21.00 Sept. 11 Dividend, Glaxo Smith Kline $43.32 Sept. 11 Dividend, Legg Mason $1,183.34 Sept. 26 Interest, Estate Checking $26.19 Sept. 26 Dividend, Carlisle Companies $42.00 Oct. 4 Dividend, First Union $95.04 Page 5 Nov. 15 Dividend, American Express $16.00 Nov. 26 Interest, Estate Checking $19.13 Dec. 21 Dividend, Legg Mason $1,058.82 Dec. 21 Dividend, American Express $24.00 Dec. 26 Interest, Estate Checking $15.64 2002 Jan. 25 Dividend, Cardinal Health Inc $4.38 Jan. 25 Interest, Estate Checking $14.32 Feb. 26 Interest, Estate Checking $15.28 March 8 Interest, Estate Checking $4.78 April 9 Interest, Estate Checking $2.44 April 11 Interest, Estate Checking $ .03 TOTAL INCOME RECEIVED $23, 677.54 LOAN TO ESTATE 2000 Aug. 3 William M. Ewing, Loan to Estate $75.000.00 TOTAL OF LOAN $75, 000.00 DISBURSEMENTS 2000 Aug. 3 Register of Wills, Probate Will $462.00 Aug. 3 Register of Wills Agent, Estimated Pennsylvania Inheritance Tax $96,187.50 Aug. 3 Cumberland Law Journal, Advertising $75.00 Aug. 3 Bank Charge, Estate Checks $52.67 Page 6 Aug.4 Carlisle Hospital, Medical $39.00 Aug. 6 Pain Clinic, Medical $178.00 Aug. 7 Masland Associates, Medical $597.43 Oct. 5 Bank Fee $10.00 Oct. 10 Kelly Assisted Living, Medical $102.40 Oct. 10 Carlisle Memorial Service, Inc. $373.50 Oct. 17 Kelly Assisted Living, Medical $1,459.77 Oct. 19 William M. Ewing, Repayment of Loan $75,000.00 Oct. 19 The Sentinel, Advertising $gg.gg Oct. 19 Register of Wills, (1) Short Certificate $3.00 Nov. 24 Bank Fee $1.00 Dec. 26 Bank Fee $1.00 2001 Jan. 26 Bank Fee $1.00 Feb. 26 Bank Fee $1.00 March 26 Bank Fee $1.00 April 12 Kelly Assisted Living, Medical $574.88 April 16 U.S. Treasury, 2000 Taxes $5,443.00 April 16 PA Department of Revenue, 2000 Taxes $811.00 April 6 Bank Fee $1.00 May 17 Register of Wills, (28) Short Certificates $84.00 May 26 Bank Fee $1.00 June 26 Bank Fee $1.00 Page 7 July 26 Bank Fee $1.00 Aug. 26 Bank Fee $1.00 Aug. 25 Register of Wills, (59) Short Certificates $177.00 Sept. 18 Bank Charge $20.00 Sept. 26 Bank Fee $1.00 Oct. 17 First USA CC Services, Misc. $10.84 Oct. 26 Bank Fee $1.00 Nov. 13 Register of Wills, (1) Short Certificate $3.00 Nov. 21 Register of Wills, (1) Short Certificate $3.00 Nov. 26 Bank Fee $1.00 Dec. 10 Bank Charge $10.00 Dec. 13 Bank Charge $10.00 Dec. 26 Bank Fee $1.00 2002 Jan. 25 Bank Fee $1.00 Feb. 26 Bank Fee $1.00 March 2 Robert M. Frey, Attorney Fee $20,000.00 March 26 Bank Fee $1.00 April 9 Bank Fee $1.00 2003 May 14 Register of Wills, (1) Short Certificate $6.00 May 15 Register of Wills, File PA Inheritance Tax Return $10.00 May 26 Register of Wills, Additional Probate Fee $420.00 June 12 Register of Wills, (5) Short Certificates $15.00 July 7 Register of Wills, (1) Short Certificate $3.00 Page 8 July 25, Register of Wills, Filing Final Account TOTAL DISBURSEMENTS RECAPITULATION TOTAL PRINCIPAL TOTAL INCOME RECEIVED TOTAL RECEIPTS LOAN TO ESTATE TOTAL RECEIPTS LESS TOTAL DISBURSEMENTS BALANCE FOR DISTRIBUTIONS $ 125.00 $202,370.87 $2,117,369.08 $23.677.54 $2,141,046.62 $75.000.00 $2,216,046.62 $202.370.87 $2,013.675.75 PROPOSED SCHEDULE OF DISTRIBUTION BALANCE FOR DISTRIBUTION $2,013,675.75 TO Trust Under Will of Gloria S. Ewing $675,000.00 for the benefit of Colton Robert Ewing and Carrie Jane Ewing TOTAL $675,000.00 TO: William M. Ewing $1,338,675.75 1218 Biddle Drive Carlisle, Pennsylvania 100% of residue of estate: Partial Distribution 3/11/02 $40,000.00 Partial Distribution 3/14/02 $25.000.00 $65,000.00 Final Distribution $1.273.675.75 TOTAL $1.338.675.75 TOTAL DISTRIBUTION $2,033,723.17 Page 9 COMMONWEALTH OF PENNSYLVANIA ) ):SS.: COUNTY OF CUMBERLAND ) Before me, the undersigned officer, personally appeared William M. Ewing, Executor of the Last Will and Testament of Gloria S. Ewing, deceased, who, being duly sworn according to law, deposes and says that the foregoing First and Final Account is true and correct to the best of his knowledge, information and belief. WII..LIAM M. EWING Sworn to and~s~ubscribed efore me this~s day of ~w~ 2003. NOTARWL SEAL TRISHA A. LIESS, NOTARY PUBLIC BOROUGH OF CARLISLE, CUMBERLAND CO., PA MY COMMISSION EXPIRES MAY 20, 200E Page 10 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: GILROY HUBERT X 4 N HANOVER STREET CARLISLE, PA 17013 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: 154-i8-0691 FILE NUMBER: 2102-0573 DECEDENT NAME: HEATHERLY HUBERTHA A DATE OF PAYMENT: 12/03/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/07/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 56,654.11 TOTAL AMOUNT PAID: REMARKS: CATHERINE H DEMBOWSKI C/O HUBERT X GILROY ESQUIRE CHECK#1021 INITIALS: SK SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 001907 56,654.1 1 REGISTER OF WILLS BROUJOS & GILROY, P c. ATTORNEYS AT LAW JOHN H. BROUJOS 4 NORTH HANOVER STREET HUBERT X. GILROY CARLISLE, PENNSYLVANIA 17013 December 2, 2002 Donna Otto Register of Wills Cumberland County Courthouse Carlisle, PA 17013 RE: Estate of Hubertha A. Heatherly No. 21-02-0573 Dear Donna: TELEPHONE: (717) 243-4574 FACSIMILE: (717)243-8227 jbroujos~broujosgilroy.com hgilroy~broujosgilroy.com NON-TOLL FOR HARRISBURG AREA 717-766-1690 ~~ f Enclosed is an original and one copy of the Inheritance Tax Return for the above referenced matter along with a check for $6,654.11 and a check for $15.00 for filing fees. be cr. Catherine Dembowski Sincerely your , Hubert X. Gilroy ~ - BROUJOS & GILROY, n. c. ATTORNEYS AT LAW JOHN H. BROUJOS 4 NORTH HANOVER STREET HUBERT X. GILROY CARLISLE, PENNSYLVANIA 17013 June 10, 2003 Donna Otto Register Of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Hubertha A. Heatherly Docket No.: 21-02-0573 Dear Donna: TELEPHONE: (717) 243-4574 FACSIMILE: (717)243-8227 jbroujos@broujosgilroy.com hgilroy@broujosgilroy. com NON-TOLL FOR HARRISBURG AREA 717-766-1690 Enclosed for filing is an Original Estate Settlement Agreement in the above matter along with a check for the filing fee. With the filing of this Estate Settlement Agreement, the administration of this Estate is now closed. I am also enclosing for filing a status report form indicating that the Estate has been closed. Should you require anything further, please advise. Sincerely yours, ubert X. Gilroy dca Enclosures cc: Catherine H. Dembowski Peter W. Heatherly Patricia Heather Lea Estate of Hubertha A. Heatherly Estate Settlement Agreement THIS AGREEMENT made this ~ day of Vii.-tom 2003, between CATHERINE H. DEMBOWSKI, Executrix of a Estate of Hubertha A. Heatherly, PETER W. HEATHERLY, PATRICIA HEATHER LEA, and CATHERINE H. DEMBOWSKI in her individual capacity (the said Peter W. Heatherly, Patricia Heather Lea and Catherine H. Dembowski hereinafter collectively referred to as the "Beneficiaries"). WITNESSETH WHEREAS, Hubertha A. Heatherly (Decedent) died on June 7, 2002; and WHEREAS, pursuant to the Will of the Decedent dated October 12, 1995, a copy of which is attached hereto and marked Exhibit "A", Catherine H. Dembowski (Executrix) was appointed as Executrix of the Decedent's Estate by the Cumberland County Register of Wills by appropriate action of the Register of Wills on June 19, 2002 and Docketed at Number 21-02-0573; and WHEREAS, the Executrix has truly and appropriately administered the Estate of the Decedent; and WHEREAS, the Executrix has filed a Pennsylvania Inheritance Tax Return with the Pennsylvania Department of Revenue, said Return being attached hereto and marked Exhibit "B"; and WHEREAS, the Executrix has accomplished the payment of all Inheritance Taxes owing on the Estate of the Decedent and has accomplished the payment of all obligations owing on the Decedent's Estate except for miscellaneous obligations as set forth below; and 1 WHEREAS, the Executrix has received the following assets in her administration of the Estate: M&T First $ 1,303.25 M&T Market Index $1 64,490.36 M&T Select $ 1,322.76 Overpayment from Carlisle Regional Medical Center $ 633.60 Philhaven Payment $ 42.01 Interest, July 2002 $ 309.90 Interest, August 2002 $ 359.29 Interest, September 2002 $ 320.85 Interest, October 2002 $ 301.69 Interest, November 2002 $ 367.59 Interest, December 2002 $ 299.81 Interest, January 2003 $ 140.14 Interest, February 2003 $ 85.15 Interest, March 2003 $ 70.02 Federal Tax Refund $ 324.00 TOTAL $1 70,370.42 WHEREAS, the Executrix has made various payments from the Estate assets on various obligations, set forth as follows: Cumberland Crossings $ 3.42 Cumberland Crossings $4,379.19 Cumberland Crossings $ 899.00 Catherine H. Dembowski Care expenses for dog $ 334.26 Carlisle Small Animal Veterinarians $ 54.00 $ 48.37 $ 52.72 $ 104.37 $ 282.60 Mountain View Pet Grooming $ 50.00 $ 50.00 Allenberry Resort Inn $ 639.48 Connecticut Post $ 133.60 Enterprise Rent-A-Car $ 606.52 Ewing Brothers Funeral Home $ 291.60 2 Giant Foods $ 142.95 $ 163.59 $ 55.02 Gingrich Memorials $ 95.00 Jeffrey's Flowers $ 711.26 Mechanicsburg Beverage $ 45.28 Oak Grove Farms $ 29.15 Office Max $ 23.91 Phone reimburseihent to Catherine H. Dembowski $ 30.00 Scalles $ 31.51 Schenk's Pastry Shoppe $ 48.40 Wine & Spirits $ 43.94 Broujos & Gilroy, P.C. -Legal Fees $1,101.00 Alert Pharmacy $ 53.95 Benefit Concepts $ 48.11 Carlisle Regional Medical Center $ 31.78 Quantum Imaging & Therapy $ 1.68 Catherine H. Dembowski -Executrix Fees $7,680.00 Inheritance Tax $6,654.11 IRS & State Income Tax on Interest 789.06 TOTAL $25,708.83 WHEREAS, the Executrix has made an advance distribution to Peter W. Heatherly in the amount of $20,000.00, and an advanced distribution to Patricia Heather Lea in the amount of $20,000.00 and an advanced distribution to herself, in her capacity as a beneficiary, in the amount of $20,000.00; and WHEREAS, the Executrix has provided an opportunity to all Beneficiaries to examine all records of the Decedent in the possession of the Executrix and to examine all records of the Estate; and WHEREAS, the Executrix is prepared to achieve the final distribution of the Decedent's Estate subject to the reserve as set forth below; and WHEREAS, the Executrix and all Beneficiaries desire that the administration of the Estate of Hubertha A. Heatherly be terminated without the expense and delay of a court accounting and the parties are willing to enter into this Estate Agreement in order to expedite the conclusion of the Estate. NOW, THEREFORE, the parties in consideration of the mutual covenants herein expressed and intending to be legally bound hereby, agree as follows: 3 1 The above named Beneficiaries hereby waive the filing of a formal accounting and schedule of distribution in the Estate of Hubertha A. Heatherly. 2 Upon receipt by the Beneficiaries of any payment from the Estate of the Decedent, all Beneficiaries agree to refund to the Estate any portion of any distribution made to them and to which they are not properly entitled and to the extent of said distribution to indemnify the Estate of Hubertha A. Heatherly from any claims and to reimburse the Estate for any expenses and costs in connection with such claims. 3 The parties acknowledge that they have been provided with an opportunity to examine all paperwork and an accounting of all expenses and revenues with respect to the Estate. 4 The parties agree that the Executrix, Catherine H. Dembowski, shall be entitled to take a payment of $5,000.00 from the assets of the Estate to be set aside and held by her to defer cost for the care and maintenance of the dog "Duke" who was owned by the Decedent. The Executrix shall use that money exclusively for Duke's maintenance. In the event Duke dies before all the money is expended, the Executrix will distribute the balance of said monies equally between the three named Beneficiaries. 5 All parties agree that the Executrix shall hold the sum of $6,000.00 to cover contingencies in the nature of final legal fees and any other costs that may be associated with the handling of the Estate. Upon the final payment of all costs and bills owing on connection with the handling of the Estate, the parties agree that the Executor shall distribute the remaining monies from the $6,000.00 in equal shared between the named Beneficiaries without taking any further action or filing documentation with the court. 6 With the payments as outlined above and the reservation of funds as set forth above, the Executrix has remaining the sum of $73,661.59 to be distributed between the three named Beneficiaries. The parties agree that each Beneficiary shall receive a check in the amount of $24,553.86 which represents each Beneficiaries' one-third interest in the monies of the Estate as set forth herein. The parties agree that with the signing of this Agreement by all Beneficiaries and by the Executrix, the Executrix shall distribute said monies to the Beneficiaries as set forth in this paragraph. 4 The parties hereby forever release, compromise, settle and discharge any and all claims, demands, actions or causes of action, legal or equitable, absolute or contingent, which any of them may have against any other party hereto or against the Estate of Hubertha A. Heatherly or against the Estate's Executrix, Catherine H. Dembowski by reason of any matter, cause or thing, growing out of or relating to any property or assets of said Estate, or growing out of or relating to any act of the Executrix in her administration of the Estate. This release shall release the Executrix from all liabilities whether due to her negligence or otherwise, which she may have by reason of her administration of the Estate of Hubertha A. Heatherly. This release shall not release the Executrix from any claims relating to fraud or claims relating to any willful action on behalf of the Executrix in failing to disclose or account for assets of the Estate which the Executrix may have received. Furthermore, this release shall not be binding until signing of this Agreement by the Executrix and all named Beneficiaries. 8 Each party hereby acknowledges that they have been advised that they may present this Agreement to their own private legal counsel for legal advice if such party desires such individual legal advice. 9 The parties agree that this instrument shall be binding upon themselves, their successors, assigns and personal representatives. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first written above. WITNESS ESTATE OF HUBERTHA A. HEATHERLY C~l ~D '~99 CATHERINE H. DEMBOWSKI, ' EXECUTRIX 5 C ~ C QC~ PATR CIA HEATHER LEA ' f. CATHERINE H. DEMBOWSKI ~~~.~,3~~e~ J, ~1I~DER .'~J~_~x'~~' f'~I~T:IC MY COMMISSION EXPIRES MAY 31,2005 6 BENEFICIARIES ~ ~ ~ Z l- 02 -573 I, HUBERTHA A. HEATHERLY, of Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM TWO; ?' give, devise and bequeath my entir~• estate to my children, Peter W. Heatherly, Catherine H. Dembowski and Patricia Heather Lea, share and share alike per stirpes. I acknowledge that I have not made provision for my husband, Thomas J. Heatherly, and I acknowledge that I understand that this Wi11 makes no direction that he receive any inheritance from my estate. ITEM THREE: I appoint Catherine H. Dembowski, Executrix of this my Iast will. ITEM FOUR: A11 estate, inheritance, succession and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ITEM FIVE: I direct that my person representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SIX: In addition to the rights and powers given to the fiduciaries by Zaw or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. The preceding instrument, consisting of this and one other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names. ~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss We ~~ 17~a21` /S Cyr lf~o ~ and l~ ~C..{ U ~j L T J~`!`~~ (~!'LGc~ ~ /f~ witnesses whose names kre signed to the attached or foregoing 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 she signed willingly and executed it her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn and subscribed to before nre this /~~~ day of fic~~~ 1995. Notary Pub c Notarial Seal Karen F. Byers, Notary Public Carlisle Boro, Cumberland County t`dv Commission Expires March 18, 1499 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss I, HUBERTHA A. HEATHERLY, whose name is signed to the attached 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 as my free and voluntary act for the purposes therein expressed. ~ , ~- COMMONWEALTH OF `v'~~`~~~' .. REV 1500 OFFIGALUSEONLY PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRtSBURG,PA17128-0601 RESIDENT DECEDENT s 7 ? °- 5 2 1- - °- - ~ -,~R ~ 0~,,,,~ ~ , DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z ESTATE OF HUBERTHA A. HEATHERLY 1 5 4- 1 8- 0 6 9 1 W 0 DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DO-Year) THIS RETURN MUST BE FlLED IN DUPLICATE WITH THE REGISTER OF WILLS V 06/07/2002 09/03/1920 W {IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, ANO MIDDLE INITIAL) SOGAL SECURITY NUMBER O w 0 1. t)riginal Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum lean oreeaN prio, ro rz-»-ezl r Q ~ a ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise took ordeath a4er rz-rz-e21 ~ S. Federal Estate Tax Retum Required ~ a m ~ 6. Decedent Died Testate tAaxn copy or wlel ~ 7. Decedent Maintained a Living Trust tanacn copy or Tn,sq _ 8. Total Number of Safe Deposit Boxes a a ~ 9. Litigatbn Proceeds Received ~ 10. Spousal Poverty Credit (oak a Beam petween u•3r•9r ala r-+-~sl ~ 11. Election t0 tax under Sec. 9113(A} tnnxn Scn of THIS SEC710N MUST BE COMPLETED. ALL CORRESPONDENCE AN D CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~ ~ NAME COMPLETE MAILING ADDRESS Z ' HUBERT X. GILROY 4 NORTH HANOVE R STREET a FIRM NAME (ItAppllcade) BROUJOS & GILROY PC CARLISLE, PA 17013 ~ 0 TELEPHONE NUMBER 717-243-4574 OFFICIAL USE ONLY 1 Real Estate (Schedule A) (1) 2 Stocks and Bonds (Schedule 6j (2) 3 Cbsely Held Corporation, Partnership or Sole~roprietorship (3) 4. Mortgages 8 Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) 167,817.82 (Schedule E} Z O_ 6. Jointly Owned Property (Schedule F) (6) ~" a ~ Separate Billing Requested j 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (7) F- (Schedule G or L) a Q 8. Total Gross Assets (total Lines 1-7) (8) 167,817.82 U W 9. Funeral Expenses 8 Administrative Costs (Schedule H) (9) 13,555.21 ~ 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) (10) 6,393.45 11. Total Deductions (total Lines 9 & 10) (11) 19,948.66 12. Net Value of Estate (Line 8 minus line 11) (12) 147, 869.16 13. Chantable and Ciovemmental ttequests/sec y 113 1 rusts for which an eleCUOn to tax nos not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) {t 3) (14) 147,869.16 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z ~ 15. Amount of Line 14 taxalale at the spousal lax rate, or Vansfers under Sec. 9116 (a)(1.2) X (15) h Q F- 16 Amount of Line l4 taxable at lineal rate 147,869.16 X .045 (16) 6,654.11 d 17 Amount of Line 14 taxable at sibling rate (11) EXHIBIT U 18 Amount of Line 14 taxable at collateral rate (1$) Q u ~~ t9 ra>< Doe ~ ~ (19J _ 6,654.11 F- SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MISC. '""~s~o~oECEOEr~ PERSONAL PROPERTY ESTATE OF FILE NUMBER ESTATE OF HUBERTHA A HEATHERY 21 0 0573 Indude the proceeds of G6'gation and the date the proceeds were received by the estate. Ag property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK -FIRST 1,303.25 Acct # 8892249486 2 IM&T BANK -MARKET INDEX I 164,416.48 Acct# 15004200117924 3 IM&T BANK -SELECT I 1,422.48 Acct # 001279599 4 ~ Refund -Carlisle Regional Medical 633.60 5 I Refund - Philhaven I 42.01 TOTAL (Also enter on line 5, Recapitulation} I $ 167 817 82 ~n.. ..........................._., ....,,...,,.~......~ _~.--~ ~.,.. . _ _ , aEV unEx •pen COMMONNIEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE of FILE NUMBER ESTATE OF HUBERTHA A. HEATHERI Y 21 0 0573 Debts of decedent must be reported on Schedule L ITEM NUMBER - DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral 291.60 2 Allenberry Resort Inn 639.48 3 Connecticut Post -Obituary 133.60 4 Enterprise Rentacar 606.52 5 Gingrich Memorials 95.00 6 Jeffrey's Flowers 711 26 7 Giant Foods /6/8/02 142.95 8 Giant Foods 6/9/02 163.59 9 Giant Foods 6/10/02 55.02 10 Oak Grove Farms 6/10102 29 15 B. ADMINISTRATIVE COSTS: . ~, Personal Representabre's Commissions Name of Personal Representative (s) Catherine H. Dembowski 7,680.00 Soda) Seaxity Number(s) I EIN Number of Personal Representative(s) 042-36-7778 street Address 586 Spring Lane city Boiling Springs S~ PA Z;p 17007 Year(s) Conxnission Paid: 2. AttomeyFees Broujos & Gilroy, PC 2,500.00 3. FamTy Exemption: (If decederri's address is not the same as daimaM's, attach explanation) Clairtlant Street Address Crly Slate Zip Relationship of Claimant to Decedent 4. I Probate Fees 5. I AccountanCs Fees 6. I Tax Retum Preparefs fees 7. Register of Wills -Filing Fee 8 Register of Wills -Inheritance Tax Return 9 Register of Wills -Family Settlement Agreement TOTAL (Also enter on line 9, Recapitulation} ~ j (If more space is needed, insert additional sheets of the same size) 252.00 15.00 17.00 13, 555.21 Continuation of REV-1500 Inheritance Tax Return Resident Decedent ESTATE OF HUBERTHA A. HEATHERLY 21 02 0573 Paae 1 Schedule H -Funeral Expenses 8~ Administrative Costs - A ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 11 Mechanicsburg Beverages 45.28 12 Office Max -Photo Board 23 91 13 Phone Reimbursement -Catherine Dembowski 30.00 14 Scalles Restaurant 31.51 15 Schenk's Pastry Shoppe 48.40 16 Wines 8~ Spirits 43.94 SUBTOTAL SCHEDULE H•A ~ 223.04 ---- __ _ - REV45~2IX • (t-9~ SCHEDULEI COMMONWFALTHOFPENNSYWANIA DEBTS OF DECEDENT, t ~sr~~ oEC o~E-`~" MORTGAGE LIABILITIES 8~ LIENS ESTATE OF FILE NUMBER ESTATE OF HUBERTHA A HEATHERLY 21 02 0573 Indude unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Cumberland Crossings -Trust Fund /April Char es g 3.42 2 Cumberland Crossings -Skilled Care /May Charges 4,379.19 3 Cumberland Crosings -Skilled Care /June Charges 899.00 4 Reimbursement to Catherine Dembowski for pet (dog) expenses 334.26 5 Carlisle Small Animal Vet 6/26/02 54.00 6 Carlisle Small Animal Vet 7/25/02 48.37 7 Carlisle Small Animal Vet 9/7/02 52 72 8 Carlisle Small Animal Vet 10/8/02 104 37 9 Carlisle Small Aninal Vet 11/5/02 282.60 10 Pet Grooming /Mountain View 7/17/02 50.00 11 Pet Grooming /Mountain View 9/10/02 50.00 12 Alert Pharmacy 53.95 13 Benefrt Concepts Health Insurance 48.11 14 Carlisle Regional Medical Center 31 78 15 Quantum Imaging & Therapy 1 68 TOTAL {Also enter on line 10, Recapitulation) I S 6 393 45 (If more space is needed, insert additional sheets of the same size} .. rtEVasn «~ r+-s~ SCHEDULE J BENEFICIARIES ~ ~ i N ro~a r cor~ la r srwA H r L INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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 (ndude outright spousal dstt~tltions) 1. Peter W. Heatherly Son 33.33 92 Attawanhood Trail Amston, CT 06231 2 Catherine H. Dembowski Daughter 33.33 586 Spring Lane Boiling Springs, PA 17007 3 Patricia Heather Lea Daughter 33.33 38 Pleasant Street Bristol, Vermont 05443 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET ^. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART I I -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I S (If more space is needed, insert additional sheets of the same size) ~~ 7/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: S`r Date of Death: r~ ~~~~ Will No.: o~-~ - rJ~C `' ~~7 ~ Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whe r 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 rep entative 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 re entative state an account informally to the parties in interest? Yes No L] c. Date: ~~ ~... o ..,; . . v cL .=- ,.= .Y. O ;a._ Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the. Orphans' Court and maybe attached to this repo . Signature ~,~ 4,x ~~ r F"IUBERT X. CijLROY ATTORNEY AT LAW 4 NORTH HANOVER STREET - CARLISLE, PA 17013 LAW OFFICE 717-243-4574 BROUJOS d~ OILROY, P.C. 717_766-1890 i hgllroy(g~brouJosgilroy.com FAX 717-243-8227 www. broujosgllroy.com Capacity: ~rsonal Representative Counsel for personal representative