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Home My WebLink About02-0986PETITION FOR PROBATE anti GRANT OF LETTERS Estate of Iona M. Thomas No. _ a ).~j.], - 9 ~(~ also known as To: Register of W' for tie Deceased. County of rand in the Socra! Security No. - 7 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/~x8t18 years of age or older an the exe rix named in the last will of the above decedent, dated February 29, . ~ and codicil(s) dated (state relevant dreumstanccs. e.g. renunciation. death of executor, etc,) Decendent was domiciled at death in Cumberland County, Pennsylvania with e~_ last family or principal residence at 1102B Columbus venue, Lemoyne Borough, Cumberland County, Pennsylvania (list strret, number and muaeipality) Decendent, then 81 years of age, died October 17, 2002 .~ at M.S. Hershey Medical Center, Hershey, Dauphin County, PA Except as follows, decedent did not marry, waz 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 progeny with estimated values as follows: (If domiciled in Pa.) All personal property S 5, 000.00 (If not domiciled in Pa.) Personal property in Pennsylvania ~ (If not domiciled in Pa.) Personal property in County S Value of real estate in Pennsylvania 3 situated as follows: WHEREFORE, petitioner(s) respectfull}• recqq~uest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters tes~amentarv (testamentary; administration e.t.a.: administration d.b.n.c.t.a.) theron. ' u //~ J u y, / _ C (/ / ~ .~ ' 2.'t/j c!i z ~ Shawna N. Hemperly 518 Sawmi Roa ^~ Mechanicsburg, PA 17055 N 1:. u 0 00 N OA'T'H OF PERSONAL REPRESENTATIVE . .~, -.. r. ..._ COMMONWEALTH OF PENNSYLVANIA 1 ~s COUNTY OF ~UMB~tD f The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that az personal represen- tative(s) of the above decedent petitioner(s) will well and trtily administer the estate according to law. Sworn to or affirmed and subscribed o`' - e me tris _. °=th day2~f 2 Sha H 1 A Nove r 0 Tlnnna _ _lJ~. NO. 21-2002-986 Estate Of Iona M. Thomas ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW November 4th ~ 2~, is consideration of the petition on the reverse side hereof, satisfactory proof having becn presented before me, IT IS DECREED that the instrument(s) dated February 29, 2000 described therein be admitted to probate and filed of record as the last will of Iona M. Thomas and Letters Testamentary ' are hereby granted to Shawna N. Hemperly l~; FEES Probate, Letters, Etc. ......... g 25 .00 Short Certificates( 3) ......... , g 9 .00 Renunciation ................ S x-Pages (3) $ 9.00 JCP TOTAL S~~ Filed November 4th, 2002 $53.00 n ~~ ~~~is~r Donna M. t t o ~~).~,( lst Deputy David H. Stone #39785 ATTORNEY (Sup. Ct. I.D. No.) 414 Bridge St., New Cumberland, PA 17070 ADDRESS (717) 774-7435 PHONE MAILED TO ATTORNEY ON 11-4-02 , ,, ~,. S` r. ,I- },,. ,,,.1,. .,..15 ;• ,,,, I ('t: tt. S ,,t;~ CO F~'I( .3s~: ...... .. ... I ~ _ ~a, ~ , '" ~'._~; ~~ !~ !13'4`'~s°.e~ ~~ ~@ts~IlLai~ ~I~i~ ~>Iq~9yf +ii,' 315 ~~aa,,'9; .~ ---•° 'i ,..:. '. L.. . 'lIL rl T3i 1f .~ - J .. _: r .. .,ro r ~L.~ / .._ -.. 1 .~ may..-,. ~,,., L. .._-~.,m d ,_.._ _. .~ [ . , ~ •~ ~ t, ~ ~~ ; '.~~A P ~ 6 4 2 8~ 5 ~- ~~~~, ~, ~.~~~~~~~ OGT 2 2 X002 aJ Rev. 2787 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT Ifuv Middle.;asl SE% SGCIAL SECURITY NUMBER DATE OF UEATH,MCnm. Day. real) ~ ,. Iona M. Thomas. 7. female ~. 579 - 28 - 8784 IOctober 17, 2002 AGE llav BrtttwaY) UNDER 1 YFAR UNDER I DAY DATE OF BIRTH BIfTTHPIACE :Car era _ PLACE Oi DEATH ICnaca .n+y ore nsu,..l,.r~, nn%nnel ,alai Re MonIM r Daya Flews T Mnutp ~MOnm. UaY earl Slated raeyn CounnYl February 15 Yra Snellin MN t F g HOSPITAL: _--- --_-------_-~---~ OTHER' -''-''11-- - IrrpalwM ~ ER/Outpallenl LJ OOA ^ ~w ^ Rsa.dlnG U la$pMecrayl ^ . . s. 81 e. 1921 i _ ' a. COUNTY OF DE/QH CTTY, BORO. TWP OF DEATH FACILITY NAME OI ntrl ~nv~tul~un. Glue vreel and numeer, WAS DECEDENT Of HISPANIC ORIGIN? RACE ~ Amarv:an Irolan, Black, VYhM. Nc. k~ NO Has 1 ~ H M ' Cu4an •cd s ISyrrG/YI his D Derry Twp M. S. Hershey Medical Center . y . , p , F~ M.alGarr.PuenaRrcan.elG white au ,,. . k. ,~. __ _ .. ,.. DECEOEM'S USUAL OCCUPQION KIND OF BUSINESSlINWSTRV WAS DECEDENT EYERIN DECEDENi'S EDUCATION MARITAL STATtiS~Manred SURVIVING SPOUSE (Grua krddwaxk ddM dwdrg rrlast d workaq Mle: do nd use reW00l U.S. ARMED FORCES? Y ^ N ^ _S d unl na ~, ads cart nIN ENnwnHryfSecorMary Coaegs Haver Marrls0, Wrlowed. Dlvaced lSpeeay) III «aa. °ne maden nasal l l i Retail Sales es o 'o-izj 1'adarl M i d N ca er C - ,,.. ,,,- ,: „ 12 ever arr e ,. „- DECEDENT'S MAILING ADDRESS(Street. Cdy/Town. SIaY.Zp Cwel DECEDENT'S Pennsylvania 17G U YN deM av O i OK 1102 B Columbus Avenue . . a e n Np. Db ACTUAL 17e. Stale __ RESIDENCE - oxederu Lemo ne PA 17043 Y (See mvruelkxrs kve n a °^°'n•rsldel '°°'^a"'p? "°deCB0011I"•d Lemo ne Cumberland 7 lXl ~ ,.- ~ _____________ , wennanaall.nll.^t-------_-_ d --------___-----Ga+f„o,, ,T4.cdanly_ FQHER'S NAME (Fast Mlddte. Leal) MOTHER'S NAME IFaal. Matlle. Malden Surname) Th l Anna Amelia Johanna Gentz omas „- Char es ,9. INFORMANT'S NAME (iypefPru,q INfORMANT'S MAILING ADDRESS tSneet. CdY/Town. Slate. Zip Cade) 2a. Shauna Hem erl eon. 518 Sawmill Road, Mechanicsbur PA 17055 METHOD OF DISPOSITION DATE OF DISPOSITION PUCE OF OISPOSNION -Name of Cemetery. Crsmalrxy LOCATION ~ C.y/T , Slala, Zlp CuW l b ^ R St ^ ~ G IM^nln, DaY. ~) or OIMr Plxe are emalrorr emova om Banal DanMidn^ Ollwrlspeadvl ^ ]le, October 23, 2002 tin. Rolling Green Memorial Park 210. Lower Allen Twp. , PA 17011 ltd. ' SIGNATURE OF FUNERAL SER LICE E OR PERSON AC71NG AS SUCH LICENSE NUMBER _ NAME AND ADDRESS t)F FAGLITY art emo r e~~ Cam- nc . 27a. FD 013 3_40 L 22b. _ p.0. Box 431 New Cumberland, PA 17070-0431 22<. s Compels isms 27a<only wlwn umrying _ b the best of my krowledgs, daadr occurred at Ina ume, dale arw place staled LICENSE NUMBER DATE SIGNED pnyak;wr n nd avadalrk al bme o1 deem b ISyrrawre arr0 Iule) (Monty. Da Y. Yearl candy prlae of death. 2L. 27n. ______ xx_ /~+~ WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER7 hams 21-26 moat W competed oY TIME OF DEATH DATE p) NOUN(/; ED DEAD IMdlm. Uay./Y/Lea P/g rf) person wlro pronounces deals. ^ ~ , T Y., No / / t ~~//~r l ~, /~X~V /` l D ~ 1 ~ M M. 23. V 21. 27. PART 1: Enter tM diseases. Inryrres or COnrpkaatkwp wnicn caused tfw deem Do not enter me rtldde oI tlying, sU[h as cartlrac or respaalory anasl. slack or seen Iadure r Approalmate PART 11; poet slgndkanl corrAlrons cOMri4ulMrg to dsWh. oW Lot only one cause on eaUr kra ~ ImervN Delwasn not rew4rrq m Bra urrderlyrng prise 9rr'•rr In PART I. ~L , onset and dean IYYEaATE CAUSE (F~nal ®, // C /1 ~ ~ ~ arsease a conanorr (~ A.-a~ G 11 (1/Gr~..A~'_ 5 Ja~-~ d m -~- ___- -- rey taq rr oira l DUE 701OR AS A CONSEQUENCE OF); $BgNniWYy sal GOrrddiona D. - it airy, 4adng to xnmadute DUE TOION AS A CONSEQUENCE OF). I cause. Enter UNOERLYI/q l • CAUSE 1[Aseaae a m,wy c ~-- - . Yral vMialed events DUE 1D (OR AS A CONSEOUE NCE OF): I reyy/rrp n deaml LAST I d __ -_-- _____.-___..._- __-___ ___-_. ._--__.._.__._--_ WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH _ __ GATE OF INJURY TIME OF INJURY INJURY AT VKiRK7 DESCRIBE HOW INJURY OCCURRED. PERFORMED? AM\IIABLE PRIOR 1D IMdlm. Uay. rear) COMPLETION OF CAUSE l t~ Fb d U OF DEATH? mKl Natura s rl Yes U No l.J ACCa]anl C~ Pendlrg lnveatiyalan U Yea ^ Nd ~ ^ Yea ^ No SuicWa U Could nd De Jelermmed ^ 70a. _ _..___. -_._... 704..___.-.._._- M 70c. __ __-_ 70d. _ PUCE OF INJURY - At some. Iarm. sweet taclory, alnce LOCATION ISkeel. Cary/Town, Stale) Ousdirrq, etc. ISpacdvl 2M. 2tln. 29. 70e. 301. CERTIFIER (Check orxY Onel slcHn c W ulyrrq cause d deem woes Jnuher W+vsK~an has prdrounced deem arul cdnuleletl Item L.71 'CERTIFYING PHYSICIAN IPn SIGNATURE LE OF CERTIFIER y To tM Wet of mY krowMdge, deem ottumd WJe b tM causela) arw manner ss slated ..................................................... r_~ 714. - LICENSE UMBER DATE SI~aNEDI arm. Uay, ve arl 'PRONOUNCING AND CERTIFYING PHYSICIAN II'lryscun twill ~r;;~uwt~ng Ueem ar d..erlAyaly locawa of nealfl 1 ~ nd l nd d m cauae a and manner as staled l rs d 11M Il d t e 1 T f b d d / 7 A.~ h~(j~ ~ V 71d !(///j•/•~ // S,(O ! a+ rJ C! ~! ' - ...................... ) occurre a nw, a e, a p ace, a u 0 e o IM Oeel o my row a ge, ea l __ _ __ _ _ WHO COMPLETED CAUSE OF DEATH NAME AND ADDRESS OF PE 5 - -~ 'MEDICAL EXAMINER/CORONER ((tern NI Type a Pnnl '~ ~/. n/(J~A/ /(zh ~~ ` On the naaie of eaamina,lon and/or inrestigahon, in my oplnlon, death occurred al the time. dale, and piece, and due to the cause(eland - L I % YY G ~~~JJJ . 7tamenner as atated ........................................................._._.............. ...... .. .............. 1/ 72. h~. ~. tll'CJ~II\ '~~CdIC11~ CCl IL'1 ~tCIS~II~. fTr'~ I?Ili3 REGISTRAR SSIGNATURE AND NUMBER / .... -' ~ DATE FILED Munm D y fear // ' ~7 ~ y ep\wills\thomas.ion\2 00 LAST WILL AND TESTAMENT OF IONA M. THOMAS I, IONA M. THOMAS, of Borough of Lemoyne, Cumberland County, Per~r~sylvania, declare this to be mjT last ~~~ill and revoke any wi 11 previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I bequeath all of my personal property and personal affects to SHAWNA N. HEMPERLY. ITEM III: I bequeath the sum of $5,000.00 to SHAWNA HEMPERLY. ITEM IV: I devise and bequeath the residue of my estate, of every nature and wherever situate, as follow: A. One-quarter thereof to the BETHESDA MISSION OF HARRIS- BURG, Pennsylvania. b. Three-quarters thereof to the SALVATION ARMY of Harris- burg, Pennsylvania. Page 1 of 4 ITEM V: I appoint SHAWNA N. HEMPERLY, Executrix of this my last will. Should SHAWNA N. HEMPERLY fail to qualify or cease to act as Executrix, I appoint PNC BANK, N.A., Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, IONA M. THOMAS, have hereunto set my hand and seal this day of ~: ',(i.1...~, 2000. rt . ~ f'Y` ~ i ~ `" ` -~~~~-'~, IONA M. THOMASI SIGNED, SEALED, PUBLISHED and DECLARED by IONA M. THOMAS, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. ,~_ y ,..~ , ~. , ...... 6 R /~ ~, Wi~t,ness :.~-' ~ ,~ Address .. - _ :• ~, Witness ~ Address Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND SS: I, IONA M. THOMAS, the Testatrix whose name is signed to the at- tached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~~ IONA M. THOMAS Sworn to or affirmed to and acknowledged before me by IONA M. THOMAS, the Testatrix, this f~''~ day of 1--~'~,~;.L:.u-~.__`~, 2000. NCTA,RIAL SEAL ~ ~KAYE H. LUCKEY, iJotary Public Ne~v Curr~berianG± Bcro. Cumberland Co. My Ccm+nission Expirfls March 27, 2(?91 COi1i~tONWEALTH OF PEND~SYLV_ANIA . SS. ~ \_~; , t ~-!~. ~. Notary Publ'r COUNTY OF ERLAND )~r ~._ ,~- _~ We, ~"~ l ~'~~ ~ ?" and .~-~-~ ~2-~2-C~ ~7"7 ~_ ~- ' ~= ~.~~C r 1 ~.~ , _~_ -'`~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that Page 3 of 4 we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as 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; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influenc ~~-~- ," ;-~ r Witf ess._ _, ' - `_. ~ . Witness Sworn to or affirmed to and acknowledged before me by ( t ,' , ~ ,.~ ,, .., i'+ :~' i and '~~ % ~ r ~c ~ ~' , J„ :. : } . L~ r~T, witnesses, this L~~ day of c~~aw 2000. 7 ,; Notar Public' NQTARIAL SEAL KAYE R. LUCKEY, idatary Public New Cumberland ~cra. Cumberland Co. My Commission Expires March 27, 2001 Page 4 of 4 STONE LAFAVEA &SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E GERALD J. SHEKLETSKI NEW CUMBEELAND. PA 17070 ELIZABETH B. STONE www.stonelaw.net January 17, 2003 Register of Wills Office Cumberland County Court House Carlisle, PA 17013 RE: Estate of Ion M. Thomas No. 21-02-0986 Greetings: OF COUNSEL CHARLES H. STONE JON F. LnFAVER TELEPHONE (717) 774-7435 FACSIMILE (717) 774-3869 Enclosed please find check No. 00067225 in the amount of $10,000.00 representing inheritance tax paid on account for the Estate of Ion M. Thomas. Please note the postmark date for purposes of the 5o discount. Thank you for your cooperation in this matter. Very truly yours, STONE LaFAVER & SHEKLETSKI Dav' Stone DHS/tmb Enclosure COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT STONE DAVID HEAN ESQUIRE 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 -------- fold ESTATE INFORMATION: ssN: 57s-2a-s~8a~ FILE NUMBER: 2102-0986 DECEDENT NAME: THOMAS IONA M DATE OF PAYMENT: 01 /21 f 2003 POSTMARK DATE: 01 /1 7/2003 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/ 1 7/2002 REV-1162 EX(11-96) NO. CD 002064 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $10, 000.00 TOTAL AMOUNT PAID: REMARKS: DAVID H STONE ESQUIRE CHECK# 00067225 INITIALS: JA SEAL RECEIVED BY: $10, 000.00 DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Iona M. Thomas Date of Death: October 17, 2002 Wi11 No. 21-02-0986 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court rules was served on or mailed to the following beneficiaries of the above captioned estate on February 19, 2003. Shawna Hemperly 518 Sawmill Rd. Mechanicsburg, PA 17055 Bethesda Mission 611 Reily St. Harrisburg, PA 17102 The Salvation Army, Harrisburg Branch 1122 Green St. Harrisburg, PA 17102 Notice has now been given to all persons emit ed thereto under Rule 5.6(a) ~ i J Date : ~?~~-.- ~~.3 ~ ~ Davl dne, Esquire 414 Bridge Street New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative X Counsel for Personal Representative ss: Shawna__ N ._ Hemperl~ being duly ~wnrn according to law, deposes and says thatS he i ~ hP FxPC~ ~ ri x _ of the estate of Iona M. Thomas late of _ _Lemoyne Borough__ ___ Cumberland County, Pa., deceased and that the within is an inventory made by Shawna N. _ H~merly_ ,the said Executrix of the entire estate of said Decedent, consisting of ail the personal proparty and real estate, except real estate outside ~t the Commonwea!tn o Pennsylvania, and that the r'igures opposite each ..=_m rf the Inventory represent it's fair value as of the data cf decedent's death . 1 and subscribed before me, ~ I 19 Shawna N . FYe ~~r~ - -a,•am~mn r Hemperly nix 518 Sawmill Rd. Mechanicsburg, PA _17055 _ Addre:s vale of Death _ 1Z- 10 2002 Day ivlonih Yaer !~l57~lJv~3~~~~ i. A.n inventcr•~ . ...rt be flied within three months after appointment of personal representative. ~. A. :;up~iement :,,,~ntory must be filed within thirty Gays of discovery of additional assets. ?. ,Additional _„_ ,~ ,nay be attached as to personalty or realty fee. Article `!, =fiduciaries Act of 1949. l i ~ ~ w ~ , U1 ~ ~ I ('~] t - W y 1.11 ` ~ ~ ~ m ~i ~ ~ ~ I o ~ - _ ~. -r' J _._ - H ~ - i ~. ~ N 9 ... `~ ~ ~ ~`I A ~ N ~ r ! ~ } ":: in `' "- _ ~ o ~ N 1 ' ' `~ H i ~ a J ~ ~ fi o ~~ ~ _s ~~ ,~ o _ ~ _ o T d c O Q Inventory of the real and personal estate of Iona M. Thomas deceased PERSONAL PROPERTY Memorial. Garden Plan-proceeds held for burial trust Miscellaneous personal property REAL PROPERTY NONE TOTAL PERSONAL PROPERTY i 9,277 74 250 00 (!$9,527 li ~I li ;i ~~ 74 e:~ ='~~ COMMONWEALTH OF PENfJSYLVANiA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX~11-961 NO. CD 002540 STONE DAVID HEAN ESQUIRE 414 BRIDGE STREET NEW CUMBERLAND, PA 17079 told ESTATE INFORMATION: ssrv: 579-2s-s~s4 FILE NUMBER: 2102-0986 DECEDENT NAME: THOMAS IONA M DATE OF PAYMENT: 05/08/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/ 1 7/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $61.39 TOTAL AMOUNT PAID: 561 .39 REMARKS: DAVID H STONE ESQUIRE NO CHECK # INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1500 Ex (aao7 COMMONWEALTH OF PENNSYLVANIA DFPARTMENi OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 ~'k ~~.~~~ _ .. T „ . b,_ REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DEGEDEM'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Z Thomas, Iona M O DATE OF DEATH (MM-DD-NEAR) DATE OF BIRTH (MM-DD-YEAR) ~ to/17/zooz oz/ls/19z1 QW (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICtaL USE ONLY 21 _ - 2002 _0986___ COUNIV CODE VEaR NUMBER iOCIAL SECURITY NUMBER 579-26-8784 u=~ow.mw~ ec swum uurucwie wain ine REGISTER OF WILLS NUMtltK Q N ®1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Return feats of death pd« m 1z-1b62) U yV ~ 4 Limhetl Estate ^ 4a. Future Interest Compromise (data of death after t2-12-e2) 0 5. Federal Estate Tax Retum Requiretl = 00 p ¢-~ o_m 6. Decedent Died Testate (Attach copy of Wup O 7. Decedent Maintained a LiNng Trust (Atach copy of Tmsry 8. Total Number of Safe Deposit Boxes a Q 9. Litigation Proceetls Received I~ I 110. 5oousal Pnvertv CrMit,..~.,., ...~..........., ,, e~....... o•, I~I I I ~~ Fm~r,.~e,.r~~~~ne.ca o~~um..... THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULI i w NAME COMPLETE MAILING ADDRESS i David H. Stone, Esquire a FIRM NAME (If Applicable) 414 Bridge Street w rc Stone LaFaver & Sheklatski New Cumberland, PA 17070 O TELEPHONE NUMBER 717-774-7435 1. Real Estate (Schedule A) (1) O~a(. W OFFICI~I~ONLY ~ 2. Stacks and Bonds (Schedule B) (2) O D 3 ~;( '- ~ ~ 3 Cl l H ld C ti P d hi ~Q~ U ~ f ' : " . ose y e orpora on, a ners p or Sde-Proprietorship (3) : I 4. Mongages 8 Ndes Receivable (Schedule D) (4) D •/'00~ ~ I 'r 5. Cash, Bank Deposits 8 Miscellaneous Personal Property 9 527 r7/~ ~ ~ 11y'. " (Schedule E) (5) , C7 - ) 'D r, r' Z O 6. Jointly Owned Property (Schedule F) (6) ,y 0 .31'y[~J. O . ^ ~ H Separate Billing Requested 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly (7) 73 , 383.3 B ~ (Schedule G or L) F a Q 8. Total Gross Assets (total Lines 1-7) (6) 62 , 911 .12 ~ 9. Funeral ExpensesB Administrative Costs (Schedule H) (9) 11,875.67 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (6dietlule p (10) 450.77 11. Total Deductions (total Lines9810) (11) 12,326.44 12. Net Value of Estate (Line 8 minus Line 11) (12) 70 , SB4 . 66 19. Charitable and Governmental Bequests/Sec 9113 Tmsts for which an election to tax has not been 0 00 made (Schedule J) (13) . 14. Net Value Subject to Tax (Line l2 minus Line l3) (iq) 70,584.68 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal lax 00 0 0 • 00 = rate, or transfers under Sec. 9116 (a)(1.2) x .00 ' (15) O Q ifi. Amount of Line 14 taxable at lineal rate 0 • 00 x.095 _ (16) 0.00 H u 17. Amount of Line 14 taxable at sibling rate 0 ' 0 D x .12 (77) 0 . 0 0 S ~ ifi. Amount of Line l4 taxable at cdlaleral rate 70,584.68 x.15 (18) 10,587.70 x ~ 1s. Tax Due (19) 10,587.70 20. ^ • • • » BE SURE TO ANSWER.ALL QUESTIONS:ON REVERSE SIDE AND RECHECK MATH « awasas t.ooo Decedent's Complete Address: STREET ADDRESS 1102 H Columbus Ave. CITV STATE ZIP Lemoyne PA 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 10,000.00 526.31 0.00 0.00 (1) 10,587.70 Total Credits (A+B+C) (2) 10,526.31 Total Interest/Penalty (D + E) (3) 00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page t 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) 61 .3 A. Enter the interest on the tax due. (5A) 6. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 61.39 Make Check Payable to: REG/STEROFWILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl decedent make a transfer and: Yes No a. retain the use or income of the property transferred; . . . . b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . . d. receive the promise for life of either payments, benefits or care? . . . . 2. If death occurred after December 72, 1982, did decedent transfer property within one year of death without receiving atlequate consitleration? .... .. 0 3. Did decedent own an "in trust tor" or payable upon death bank account or security at his or her death? 0 4. Did decedent own an Indivitlual Retirement Account, annuity, or other non-probate property which contains a beneficiary tlesignation? . . . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN Untler penalties of perjury, I tledare that I base examined Nis carom, Including accompanying schedules end statements, and to the bell of my knowletlge and beli ef, it is tma, coned and wmplete. nadaralion of prape~r ocher Nan the personal representative is Cased on all intortnation of which preparer has any knowledge. ~,l ~ ~ !ii I ". ~ n: r ':::. v,,v ..., .. '. ..St n ., ..r 1 For dates of death on or after July 1, 1994 and before January 1, 1995, the taz rate imposetl on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. § 9976 (a) (1.1) (iJJ. Far dates of death on or otter January 1, 1995, the tax rate imposetl on the net value of transfers to or for the use of the surnving spouse is 0 % 172 P.S. § 9116 (a) (1.i) (ii)] The statute does not exempt a transfer tp a surviving spouse from lax, antl the statutory requirements for disclosure of assets and filing a tax return are still applicable even it the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposetl on the net value of transfers from a tleceased child twenty-one years of age or younger at death to or for the use d a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 91 ifi(a)(L2)]. The tax rate imposed on Ae net value of transfers to or for the use of the decedent's lineal benefitlades is 4.5%, except as noted In 72 P.S. § 971fi(L2) [72 P.S. §9116(a)(1 )]. The lax rate imposed on the net value dtransters to ar for the use of the decedent's siblings is 12% (72 P.S. § 9716(a)(7.3)]. A sibling is defined, under Sedion 9102, as an individual who has al least one parent in common vnth the decedent, whether by blootl or adoption. 2W4646 1.000 REV-1500 E%+(1-0]) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8t MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY Thomas, Iona M 21-2002-0966 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlybwned with the right of survivorship must be disclosed on Schetlule F. iw46AO 2 000 (If mare space is needed, insert add'Aional sheets oRhe Same sae) REV-1510 E%+ry-W) SCHEDULE G coMMONwEAt TN of PENNSYLVANIA INTER-VIVOS TRANSFERS & wRERITANCE TAx RETURN MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Thomas, Zona M _. 21-2002-0986 This schedule must be completed and filed it the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER AITACHACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S NIIEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1. Bankers Life and Casualty 9,693.90 100.00 0.00 9,693.90 Co.-Annuity No. 8,161,875, beneficiary-Shavma N. Hemperly 2 Bankers Life and Casualty 6,951.94 100.00 0.00 6,951.94 Co.-Annuity No. 8,161,876, beneficiary-Shavma N. Hemperly 3 Midland National Life 30,861.11 100.00 0.00 30,861.11 Insurance Co-Annuity Policy #8500028986 beneficiary Shawna N. Hemperly 4 Midland National Life 25,876.43 100.00 0.00 25,876.43 Insurance Co.-Annuity Policy #8500021536 benef icary Shawna N. Hemperly TOTAL (Also enter on line 7, Recapitulation) $ (I( more space is neetletl, insert adtlitional sheets of same size.) 2 W 4fiAF 2 000 Rey-,s„ ex. n-s,l SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDEM DECEDEM ESTATE OF FILE NUMBER Thomas, Iona M 21-2002-0986 Debts of decedent must be re ortetl on ScnetlWe I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t Parthemore Funeral Home-funeral expenses 8,920.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0 .00 Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Atltlress City State Zip Veer(s) Commission Paid: 2. Attorney Fees Name: David H. Stone, Esquire 2,500.00 3. Family Exemption: (If decedent's adtlress is not the same as claimant's, attach explanation) 0 . 00 Claimant Street Address 4. 5. 6. 7. 8 9 10 City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees I, Cumberland Law Journal-advertising grant of letters The Patriot News Co.-advertising grant of letters Register of Wills-filing Inheritance Tax Return and Inventory Reserve for closing expenses 53.00 0.00 0.00 75.00 102.67 25.00 200.00 2W46AG 2.000 TOTAL (Also enter on line ! (If more space is needed, insert additional sheets of same size) 11,875.67 REV-1512 EX+ (LW) SCHEDULEI CDMMONWEALTH OP PENNSYLVANIA DEBTS OF DECEDENT, INHPEERSIDENi DECEDEMRN MORTGAGE LIABILITIES, 8 LIENS ESTATE OF FILE NUMBER Thomas, Iona M 21-2002-0986 zwasnR zooo (If more space is needed, insert additional sheets of the same size) REV-1513 EX+(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEM DECFAENf SCHEDULE) BENEFICIARIES IMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS[include outrightspousal distributions,and under Sec. 9116 (a) (i.2)] 1. Hesperly, Shawna N 518 Sawsill Rd. Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) friend AMOUNT OR SHARE OF ESTATE 70,584.68 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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. 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE C 2W46A~ 1.000 (If more space 13 OF REV-1500 CO\ ial sheets of the same 0.00 STON&, LAFAVER 8e SH&BL~TSHL ,. .« ., ... ... .....v o-.. ., ._ _. .. .. , LAST WILL AND TESTAMENT OF IONA M. THOMAS I, IONA M. THOMAS, of Borough of Lemoyne, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I bequeath all of my personal property and personal affects to SHAWNA N. HEMPERLY. ITEM III: I bequeath the sum of $5,000.00 to SHAWNA HEMPERLY. ITEM IV: I devise and bequeath the residue of my estate, of every nature and wherever situate, as follow: A. One-quarter thereof to the BETHESDA MISSION OF HARRIS- BURG, Pennsylvania. b. Three-quarters thereof to the SALVATION ARMY of Harris- burg, Pennsylvania. Page 1 of 4 ITEM V: I appoint SHAWNA N. HEMPERLY, Executrix of this my last will. Should SHAWNA N. HEMPERLY fail to qualify or cease to act as Executrix, I appoint PNC BANK, N.A., Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, IONA M.{T~H~OMAS, have hereunto set my hand and seal this ~ day of ~~Z,',e~; 2000. ~~ ~ ~ " C ~ ~'~~~ rl-~% IONA M. THOMAS SIGNED, SEALED, PUBLISHED and DECLARED by IONA M. THOMAS, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. l .-- ~ ~ ~~ --~'- a Wi~tness~/~ Address ~; r ~ ,~,~!,^ ;~ita~t-YY1 . ~~CYZC-C,C~'~-GY /~Ll°-lt ~ i E~ t ~~~ i ~: (: ~ ~C~ 1,-) Witness J Address Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND SS: I, IONA M. THONIAS, the Testatrix whose name is signed to the at- tached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~. i IONA M. THOMAS Sworn to or affirmed to and acknowledged before me by IONA M. THOMAS, the Testatrix, this r~ day of ~CiG_~__~r 2000. NOTARIAL SEAL r KAYE R. LUCKEY, iJOlary Public New Cumberland Boro. Cumberland Co. My Ccmrnission Expires March 27, 2001 Notary Publl COD7idONWEALTH OF PENNSYLVANIA SS COUNTY OF ERLAND ~~~ ~, , i ~ _,', We, ~ Lys A and /~'k=~~2n 2 Yl7 C ~-~. ,~tt-~Zc~. T ~ ~_ ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that Page 3 of 4 we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as 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; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence.~~ Wi ~~'Mt,v~ ~'I ) - ~~fZ ~ Lc n Witness Sworn to or affirmed to and acknowledged before me by ~~ u ~ ~~ ~ y"Il*-~ and l 1F r ~2. ~, ;~c witnesses, this Z~ day of ~ ~2.i 2000. J Notar Public KAYE R.. LUCKEYI, No ery Public New Cumberland 9oro. Cumberland Co. My Commission Expires March 27, 2001 Page 4 of 4 I BANRF_7LS LlFF. AND CASUALTY COMPANY Life Division • 222 Merchandise MwP Plaza Chicago, LL 60654-2009 • Telephone: 372-396-6000 ~_"~,~ Shawna Hemperly 518 Sawmill Rd Mechanicburg PA 17055 Novembec 20, 2002 Policy 8,161,876 8,161,875 7,581,676 RE: Iona M Thomas, Deceased Dear Ms. Hemperly: We are sorry to hear the sad news You certainly have our sympathy. Iona M Thomas was receiving monthly annuity payments from the above num- bered policies which were payable for her lifetime with guaranteed pay- ment periods of 10 years. The monthly amounts were $197.80 from Policy 7,581,676 as of November 12, 1992, $146.33 from Policy 8,161,875 as of April 10, 1999, and $104.94 from Policy 8,161,876 as of April 10, 1999. We were informed that Iona M Thomas died on October 17, 2002. Since this is after the guaranteed payment period expired on October 12, 2002 for Policy 7,581,676, no further benefits are due under this policy af- ter the death. Iona M Thomas named Shawna Hemperly as the beneficiary of Policies 8,161,875 and 8,161,876 in the event of her death before receiving the 120 guaranteed installments. Enclosed are Claim Filing Instructions for Policies 8,161,875 and 8,161,876 along with a Beneficiary's Annuity Claim Form and Death Bene- fit Option Election Form for each policy. The figures shown on the Death Benefit Option Election Forms represent the values available as of the date of death which does not account for any annuity installments that may have been sent in the deceased's name after the date of death. If any such payments have been sent and are not returned, they will be deducted from the death benefit with the as- sumption that the beneficiary is in receipt of those funds. I. .iii ~ ~"~ ~i (~l• ~(~ l••~ ~~ i'r~t~ t,'al:a,r .:, ~ , `t'ai, ~( 1 ~. ..'V- 6LOOB] 10]199 Attorney Dave Stone also contacted us, requesting beneficiary informa- tion for Policies 7,581,676, 7,582,011, 7,585,090 and 7,586,628. The named beneficiary of Policy 7,581,676 was Shawna Hemperly, friend. How- ever, as stated above, no benefits are due for this policies. As for Policies 7,582,011, 7,585,090, and 7,586,628, these annuity policies were ended for their cash surrender values in 2001. Therefore, no fur- ther benefits are due under these policies. We tried to call Mr Stone with this information but were unable to reach him. Therefore, we are sending him a copy of this letter. If you have any questions, or if we can be of further assistance, please let us know. May we hear from you within the next 10 days with the extra copy of this letter? Sincerely, i ' ~" L. Willard Life/Annuity Claim Department LCLW 261281 BSO 1052 BSM Robert P Birty Agent C6115 Robert P Birty .\ \ ***TO: Dave Stone ~~ Attorney At Law 4414 Bridge St New Cumberland PA 17070 Page 2 ~~~ MIDLAND NATIQNAL 4601 Westown Parkway • Suite 300 ~ West Des Moines, lA 50266 December 17, 2002 SHAWNA N. HEMPERLY 518 SAWMILL RD. MECHANICSBURG PA 17055 Re: Iona Mae Thomas, Deceased Policy: 8500028086 Dear Ms. Hemperly On behalf of Midland National Life, please accept our sincere condolences, which we wish to extend to you and your family. Enclosed please find our check in the amount of $31,001,35, which is payable to you as the primary beneficiary of this contract. The total amount of the death benefit was $30,861.11, plus death claim interest of $140.24. As requested, no taxes were withheld. Of the total claim amount, $1,001.35 will be represented as a taxable distribution, and will be reported to the Internal Revenue Service at the end ofthe year. If you should have any questions, please do not hesitate to write or call the Claims and Benefit Department at 1-877-586-0240, ext, 35927. Sincerely, Lindsay Michalski Claims Specialist Claims and Benefii Department cc: Mohammed Sharifi encl. Midland National Lite Insurance • Annuity Division P0. Box 79907 • Des Moines. Iowa 50325 Phone:877-586-0240• Fax;877-586-0249 /~~ MIDLAND NATIONAL Lile insurance Company • Annuity pivislon 4601 Westown Parkway • Suite 300 • West Des Moines, IA 50266 December 17, 2002 SHAWNA N. HEMPERLY 518 SAWMILL RD. MECHANICSBURG PA 17055 Re: Iona Mae Thomas, Deceased Policy: 8500021536 Dear Ms. Hemperly: On behalf of Midland National Life, please accept our sincere condolences, which we wish to extend to you and your family. Enclosed please find our check in the amount of $25,994.02, which is payable to you as the primary beneficiary of this contract. The total amount of the death beneftt was $25,876.43, plus death claim interest of $117.59. As requested, no taxes were withheld. Of the total claim amount, $994.02 will be represented as a taxable distribution, and will be reported to the Internal Revenue Service at the end of the year. If you should have any questions, please do not hesitate to write or call the Claims and Benefit Department at 1-877-586-0240, ext. 35927. Sincerely, Lindsay Michalski Claims Specialist Claims and Benefit Deparhnent cc: Mohammed Sharifi encl. Midland National Life Insurance • Annuity Division P.O. Box 79907 • Des Moines, Iowa 50325 Phone:877-586.0240• Fax:877.586.0249 i'~ ~r ~- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 DAVID H STONE ESQ STONE ETAL 414 BRIDGE ST NEW CUMBERLAND PA 17070 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX RfP (01-03) DATE 10-13-2003 ESTATE OF THOMAS IONA M DATE OF DEATH 10-17-2002 FILE NUMBER 21 02-0986 COUNTY CUMBERLAND ACN 101 Amount Remitted 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 -~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF THOMAS IONA M FILE N0. 21 02-0986 ACN 101 DATE 10-13-2003 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) .0 0 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 form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 9,527.7 4 tax payment. 6. Jointly Owned Property (Schedule F) (6) .0 0 7. Transfers [Schedule G) (7) 73,383.38 8. Total Assets (g1 82,911.12 APPROVED DEDUCTIONS AND EXEMPTIONS: 11,875.67 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 450.77 11. Total Deductions (11) 12.326.44 12. Net Value of Tax Return (121 70,584.68 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14 of Estate Subject to Tax lu t V N (14) 70,584.68 . e a e NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 00 15. Amount of Line 14 at Spousal rate (15) • = X . 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 04 5 . .00 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) 70,584.68 X 15 10,587.70 19. !. Principal Tax Due !.!. T T!~ - (1q1= 10,587.70 ^ DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 01-17-2003 CD002064 526.32 10,000.00 05-08-2003 CD002540 .00 61.39 TOTAL TAX CREDIT 10,587.71 BALANCE OF TAX DUE .O1CR INTEREST AND PEN. .00 TOTAL DUE .O1CR * 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.) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-02-0986 FIRST AND FINAL ACCOUNT AND PROPOSED DISTRIBUTION OF IONA M. THOMAS, DECEASED SHAWNA N. HEMPERLY, EXECUTRIX LATE OF THE BOROUGH OF LEMOYNE Social Security No.: 579-28-8784 Date of Death: October 17, 2002 Date of Executrix's Appointment: November 4, 2002 Date of Advertising Letters Testamentary: Cumberland Law Journal - December 13, 20, & 27, 2002 The Patriot News Co. - December 31, 2002, January 7, & 14, 2003 Accounting for the Period: October 17, 2002 to October 30, 2003 Purpose of Account: Shawna N. Hemperly, Executrix, offers this account to acquaint interested parties with the transactions which have occurred during her administration. The account also indicates the proposed distribution of the estate. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Shawna N. Hemperly 518 Sawmill Rd. Mechanicsburg, PA 17055 David H. Stone, Esquire Stone LaFaver Shekletski 414 Bridge Street New Cumberland, PA 17070 SUMMARY OF ACCOUNT Estate of Iona M Thomas For Period 10/17/2002 Through 10/30/2003 Fiduciary Acquisition Page Value Principal Receipts 1 $ 9,527.74 Net Gain (or Loss) on Sales or Other Dispositions 0.00 Other Peceipts 0.00 $ 9,527.74 Less Disbursements: Administration Expenses (Prin) 2 $ 921.44 Fees and Commissions (Prin) 2 2,500.00 Funeral Expenses (Prin) 2 5,920.00 12,341.44 Balance before Distributions $-2,813.70 Distributions to Beneficiaries 3 250.00 Principal Balance on Hand 4 $-3,063.70 Income Receipts $ 0.00 Less Disbursements 0.00 Balance before Distributions $ 0.00 Distributions to Beneficiaries 0.00 Income Balance on Hand $ 0.00 Combined Balance on Hand $-3,063.70 RECEIPTS OF PRINCIPAL Page 1 Estate of Iona M Thomas As of 10/30/2003 Fiduciary Asses Listed in Inventory Acquisiticn (Valved as of date of death) Value Checking Accounts Memorial Gardens Plan-proceeds held $ 9,277.74 Misc. Personal Property Miscellaneous personal property 250.00 TOTAL INVENTORY $ 9,527.74 DISBURSEMENTS OF PRINCIPAL Estate of Iona M Thomas For Period 10/17/2002 Through 10/30/2003 Administration Expenses (Prin) 11/02/2002 Dr. Norton-debt of last illness Check number 1 11/02/2002 Pinnacle Health Hospital-debt cf iast illness Check number 2 11/C2/2002 Silver Spring Ambulance-service Check number 3 05/07/2003 Register of Wills-filing inheritance Tax Return and Inventory 10/30/2003 David H. Stone-Reimb. on probate ($68.00) and advertising in 2 newspapers ($177.67) 10/30/2003 Reserve for filing First and Final Account and closing expenses Fees and Commissions (Prin) 05/07/2003 David H. Stone-Attorney's fee on account 10/30/2003 David H. Stone-balance due on Attorney's fee Funeral Expenses (Prin) 10/29/2002 Parthemore Funeral Home-funeral expenses TOTAL DISBURSEMENTS OF PRINCIPAL $ 32.07 28.70 390.00 25.00 245.67 200.00 $ 1,250.00 1,250.00 Page 2 $ 921.44 2,500.00 8,920.00 $ 12,341.44 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Page 3 Estate of Iona M Thomas For Period 10/17/2002 Through 10/30/2003 To: Shawna N Hemperly Miscellaneous personal property as per Item II of will 11/25j20C2 Miscellaneous personal property TOTAL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES $ 250.00 $ 250.OC Checking Accounts Estate checking account PRI'v'CIPAL BALAIv'CE ON HAND PRINCIPAL BALANCE ON HAND Estate of Icna M Thomas As of 10/30/2003 Current Value $ -3,063.70 $ -3,063.70 Page 4 Carrying Value $ -3,063.70 $ -3,063.70 COMMONWEALTH CF PENNSYLVANIA: COUTTTY OF CUMBERLAND SS: Shawna N. Hemperiy, Executrix under the Last Will and Testament of Iona M. Thomas, deceased, hereby declares under oath (penalties of perjury) that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to her knowledge, there are no claims now outstanding against the estate; and that all taxes presently due from the estate have been paid. ''t r Shawna N. Hemperl E cutrix Sworn to and subs~ibed before me this ~_ day of N(~~ 2003. Notary Pub i NOTARIAL SEAL TINA M. BURKEY, Notary Public Nuw Cumberk'u~d Boro, Cutatbesi~~z' is ~,nv Cu~iimission Expires April 13,1::` ~:•, STONE, LAFAVE$ 8e SHEKLSTSHI ATTORNEYS ATE LAW - ~ _ ;. [.. .~ Z ,< -,,4t4 BRIDGEKSI'REET ,~y~ r.- ~q a „ ~ ~ 2SLW~GTJMB~gHLAND~~d12707Q,r ~ ~ ~ _~ ~~#' ~f ~ ~' ~t K ...:.::..zse..-._- v.... _... ....~ ...<.....:. ..r ___... ,.- .ems,-»+. ~,_ ... ... ,_.......~"i'i. ,s "- .a~...~~ '' iia ,~L.b .-.._i~ _.54i~a.._.,,-_.~5~' '.'~`".. e. -v ~~:: LAST WILL AND TESTAMENT OF IONA M. THOMAS I, IONA. M. THOMAS, of Borough of Lemoyne, Cumberland County, Pennsylvania, declare this to be my last will and revoke any u.~~il previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I bequeath all of my personal property and personal affects to SHAWNA N. HEMPERLY. ITEM III: I bequeath the sum of $5,000.00 to SHAWNA HEMPERLY. ITEM IV: I devise and bequeath the residue of my estate, of every nature and wherever situate, as follow: A. One-quarter thereof to the BETHESDA MISSION OF HARRIS- BURG, Pennsylvania. b. Three-quarters thereof to the SALVATION ARMY of Harris- burg, Pennsylvania. Page 1 of 4 ITEM V: I appoint SHAWNA N. HEMPERLY, Executrix of this rely lase will. Should SHAWNA N. HEMPERLY fail to qualify or cease to act as Executrix, I appoint PNC BANK, N.A., Executor of this my last ~.aill. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in anv jurisdiction. IN WITNESS WHEREOF, I, IONA M. THOMAS, have hereunto set my hand and seal this ~~ day of ~-E~~`~;'!` ~-tr; 2000 . -1 r, ~ 1 IONA M. THOMAS SIGNED, SEALED, PUBLISHED and DECLARED by IONA M. THOMAS, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. {., ` __ , Wi'tness~%- ~ ,, Address ~.,., !' ; ~7 iJ ; ,(t-. ~'~; i _ ~ i. `.{-'~"~., C.~C,'j'~,!~ii _ f L ~ i 7f C i ~ ~ 1 ~ 5 _ { ~ % ') i <~C_ % 1 , Witness J Address Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND SS: I, IONA M. THOMAS, the Testatrix whose name is signed to the at- Cached or foregoing instrument, having been duly qualified acco~-ding to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I sinned it as my free and voluntary act for the purposes therein contained. IONA M. THOMAS Sworn to or affirmed to and acknowledged before me by IONA M. THOMAS, the Testatrix, this ~~ day of ~~;.[~_, 2000. NOTARIAL SEAL ' KAYE R. LUCKEY, idotary Public New Cumberland Boro. Cumberland Co. My Ccmrnission Expiros March 27, 20011 COi•1MONWEALTH OF PENrdSYLV.ANIA ~ ~~ ~~ 5 !X /.~ c ?t _!_t -r Lam. Notary Publ~ SS: COUNTY OF ERLAND , ~ ~ ,a We `~' ' ~-~-=~~,1.° P and ,1~~~~~~z-t~ ~'~~ ~' ~`'' ~;~~~-1 z.~ ~, \ , `-' the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that Page 3 of 4 we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as 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; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound m~.nd and under no corLstraint or undue influence Wit<~s ~~~~/-i , , 1 ~t ~~~ ) - ~~l i~Q LC ~t c~ Witness ~ `~- Sworn to or affirmed to and acknowledged before me by ~ ,, ,, ~ ~~ and ~_~~ ~ ~ , '2.; _ --~. ;l~u, ~ , witnesses, this 2~ day of ~~~2i 2000. Notar Public NOTARIAL SEAL KAYE R, LUCKEY, iJotary Public New Cumberland Coro. Cumberland Co. My Commission Expires March 27, 2001 Page 4 of 4 Inventory of the rea{ and persona{ estate of Iona M. Thomas deceased i _~-~ PERSONAL PROPERTY Memorial Garden Plan-proceeds held for burial trust ~ 9 27 7 i Miscellaneous personal property 1 250 TOTAL PERSONAL PROPERTY $ 9 , 52 7 ~i REAL PROPERTY NONE ~~ Ij :E: Fi~ "~ ~l~- .n CS" f~~~t? ~tJ. -. .- _r}> PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law TOLlrllal, a legal perodlcal published fli the L~iCr:~:.lgh of ~arilSle lr'i tiie ~Cl.lnty aiid State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz' DECEMBER 13, 20, 27, 2002 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. 1 r' r Roger M. Morgenthal, Editor Thompson, Iona M., decd. Late of Lemoyne. Executrix: Shawna N. Hemperly, 518 Sawmill Road, Mechanics- burg, PA 17055. Attorneys: David H. Stone, Es- quire, Stone LaFaver & Sheklet- ski, P.O. Box E, New Cumberland, PA 17070. SWORN TO AND SUBSCRIBED before me this 27 day of DECEMBER, 2002 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss JOSEPH A. DENNISON being duly sworn according to law, deposes and says: That he is the Asst. Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular dailya.nd/or Sunday/ I~!etro editions which appeared on the 31st day(s) of December 2002 and the 7th and 14th day(s) of January 2003. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. ...~ z t ) `~ df, ; ` '~ PUBLICATION ~ ~s'........... I ~~::...~ .~rA : f : COPY Sworn to and subs~be befor this 17th d~y`of,Jaiiuary 2003 A.D. ~ Notarial Sb~l > , j ~°'~ i Terry L Russell, Notary/Fubll~ ~ r jr/' /` , ~, ,r`~ ~ ~ -~ •~'` ~,~A/' _ -~ ~. / City Of Harrisburg, Dauphin Gount~', i~1yG~mmissionGx~iresJune6,20C6 ~ N`t`~TARY PUBLIC 1Aerrlt~r,Pennsyl~~^ri-rssociaSonOfNcraries My commission expires June 6, 2006 EXECUTOR'S NOTICE Letters Testamentary on the Estate of Io- na M. Thompson, late of the Borough of Le- moyne, County of Cumberland, and Common- STONE, LAFAVER &SHEKLETSKI wealth of Pennsylvania, deceased, have been ATTN: GERALD J. SHEKLETSKI granted to the undersigned. All persons indebted to the saidEstateore 414 BRIDGE STREET requested to make (mmedlate payment and those havingclalmswlllpresentthemwithout NEW CUMBERLAND, PA. 17070 delay to: Shawna N. Hemperlr 518 Sawmill Road Mechanicsburg, PA 17055 ~ David H Stone Esquire Statement of Advertising Costs . , STONE LaFAVER &SHEKLETSKI P.O. Bax E ~ To THE PATRIOT-NEWS CO., Dr. New Cumberland, PA 17070 For publishing the notice or publication attached hereto on the above stated dates $ 100.92 Probating same Notary Fee(s) $ 1.75 Total $ 102.67 Publisher's Receipt for Advertising Cost The Patriot News Co., publisher of The Patriot-News and The Sunday, Patriot-News, newspapers of general circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. By .................................................................... ~~.. ABC.`„ ~~e:,-~~~ - ~~ ~ fir.., ~a5. i~ is: ___--__-_Shawna_ N ._ Hemperl~ .,einq uiv _~ Sw~r-r1 according to law, deposes and says thatS he _ i s fi}~P FXPCt1ty1X - cf the =state of Iona M. Thomas a:,, o; Lemoyne BorOUgh _ r--., ~ti=_nd County, Pa., deceased and ,hat th wi'~'.in is an inver,tor~- made by __ S~"laWna i~T. H~er1V _ the said EX2CUtr 1X - ----- of =he m=ire estate .~r said decedent, ~ensisting of ail he persor,ai prooarty ar,d real estate, except real estate outside ,1 tha :ommonwe!~h _. ?ennsylvania, and that the figures opposire _acn ~m cf the Inventor, represent it's fair value as ofyhp date c= ._ced°nt~s death. r. and subscribed bafore me, ~ ~ - Shawna N . ~xecuTaT - -AV'rs'~xirtrvr'or i9 I Hemperly rix • ~ __518 Sawmill Rd. --- I Mechanicsburq, PA 17055 ________ Addresz mat.. ~~ .~~eath -- --17 any 10 _- 2 Month Yeer '. ~.n .nvantcr! ,._,r be filed within three months after appointment of personal representative. _ j ,upniemen` :..,e:tor~ must be filed within thirty days of discovery of additional assets. _. ,adcitionai .„_.:-s ,nay be attached as to personalty or realry wee Article i`~, =fiduciaries .~".ct of 1949. '' ~ b? ~ O N ~~ .y ,,~ ~- ~ u! ~ ~ .~: a ~ W ~ u '~ i O ~ ~ _._ Y .- ~ 1 -1 ~ ~ Q) ~9 i N ,.. ,~ J `~ Q ~ r ~ LJ . ~r ~ ~'I ~ A ~j .; y (n ~ ~ ~ _ o i w H '~ r ' o `, o~ ~ ~" L C I I~ Q I ,s tr' 4 I _- `-~ Y STATUS REPORT UNDER RULE 6.12 Name of Decedent: Iona M. Thomas Date of Death: October 17, 2002 Will No. 21-02-0986 To the Register: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes X No (b) The separate Orphans' Court No. (if any) for the personal representative's account is: N/A (c) Did the personal representative state an account informally to the parties in interest? Yes No (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. I Date: ~ ' 3~-U~ Dav one, Esquire 414 Bridge Street New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative X Counsel for Personal Representative