HomeMy WebLinkAbout12-31-14 (2) J
REV-1500 EX (02-11)(FI) 1505610140
DFI iCiAL I..1raG ONLYPA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 9 9 6
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 0 0 1 2 0 1 4 0 5 1 0 1 9 2 6
Decedent's Last Name Suffix Decedents First Name MI
H E B E R L I G MI L D R E D C
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
H E B E R L I G FRANK S
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1.Original Return 2.Supplemental Return F1 3.Remainder Return(Date of Death
Prior to 12-13-82)
4.Limited Estate 4a.Future Interest Compromise(date of Fj 5.Federal Estate Tax Return Required
death after 12-12-82)
❑X 6.Decedent Died Testate 0 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
9.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death El 11.Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J OE L R . Z U L L I N GE R 7 1 7 2 6 4 6 0 2 9
REGISTER OF WILLSi E ONLY
First Line of Address
te
1 4 NORTH MAI N STREET r- c.a � r
� rs1 t'tii
Second Line of Address
p,1 � Q � •-s-I `r1
S U I T E 2 0 0 � ter,
City or Post Office State ZIP Code pb4TE FILE n
C=)
I" rn
C H A M B E R S B U R G P A 1 7 2 0 1 C>
Correspondent's e-mail address: jZUllirlger Ct71'ZUlllftger-daVIS.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of prepay other than the personal representative is based on all information of which preparer has any knowledge.
SIG URE OF PER N PONSI LE I NG RETURN
DDRESS
421 BRIAR LANE CHAMBERSBURG PA 1 X02
SI E OF REPA RER TH EPRES`P_NTATIVE D
ADDR
14 RTH MAI TREET, SIZE 200 CHAMBERSBURG PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 \
J 1505610240
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent'SNarne: MILDRED C. HEBERLIG
RECAPITULATION
1. Real Estate(Schedule A) . ......... . . . . .. . . . . . . ... .............. . . . . 1.
2. Stocks and Bonds(Schedule B) 2. 6 5 4 7 2 7 . 6 2
... . . . . . . . . . . . . . . . .. .............. . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
4. Mortgages and Notes Receivable(Schedule D) .. ... ................. . .. . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property 1 9 3 0 9 . 6 2
p p rty(Schedule E). . . . ... 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . ..... 6. 5 0 5 8 1 8 0
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 3 2 7 6 4 4 1
(Schedule G) [:] Separate Billing Requested ..... .. 7.
8. Total Gross Assets(total Lines 1 through 7) . .. ... . . . . .. ... ......... .. . 8. 7 5 7 3 8 3 . 4 5
9. Funeral Expenses and Administrative Costs(Schedule H) . ....:. ........ . . . 9. 1 5 7 9 8 . 4 2
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ........ . . . .. 10. 1 0 7 . 6 9
11. Total Deductions(total Lines 9 and 10) . . . . . . . .. . .............. .. . .... 11. 1 5 9 0 6 . 1 1
12. Net Value of Estate(Line 8 minus Line 11) . .......... . ... .. .. .. . . . .... 12. 7 4 1 4 7 7 . 3 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ... . . .. . . . .. . ... .... .. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . .... .......... .. . . 14. 7 4 1 4 7 7 . 3 4
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)x.000 1 1 5 9 6 0 . 1 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X-045 6 2 5 5 1 7 . 2 4 16. 2 8 1 4 8 . 2 8
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE ... . .. . . . ....... . .. . . ........... . . . ............... . .. . 19. 2 8 1 4 8 . 2 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 14 0996
DECEDENT'S NAME
MILDRED C. HEBERLIG
STREET ADDRESS
11 Darrin Avenue
CITY STATE ZIP
Newburg PA 17240
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 28,148.28
2. Credits/Payments 125.38
A.Prior Payments
B.Discount 1,407.41
Total Credits(A+B) (2) 1,532.79
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 26,615.49
Make check payable to: REGISTER OF WILLS, AGENT
_-
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ...................................................................... ❑ X❑
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ X❑
c. retain a reversionary interest ..................................................................................................... 1710
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ X❑
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑X ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)).The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in(72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPINHERITANCE OF
STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MILDRED C. HEBERLIG 21 14 0996
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 17,751 shares common stock Orrstown Financial Services, Inc. @16.26 per share 288,631.26
2. 10 shares Prudential Financial, Inc. @86.76 per share 867.60
3. Investment Account#1085 held with Orrstown Financial Advisors, including investments 365,090.65
shown on attached date of death valuation
4. Accrued dividends to date of death on investments held in Investment Account !085, with 138.11
Orrstown Financial Advisors
TOTAL(Also enter on Line 2,Recapitulation) $ 654 727.62
If more space is needed,insert additional sheets of the same size
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
MILDRED C. HEBERLIG 21 14 0996
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Federated Money Market Account held in Investment Account#1085 with Orrstown 18,563.32
Financial Advisors
2. Interest accrued to date of death on Federated Money Market Account held in Investment 0.01
Account#1085 with Orrsotwn Financial Advisors
3. Senior Health Insurance Company of PA, refund of unearned premium 746.29
TOTAL(Also enter on Line 5,Recapitulation) $ 19 309.62
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MILDRED C. HEBERLIG 21 14 0996
If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Frank S. Heberlig 11 Darrin Avenue spouse
Newburg, PA 17240
B. Mary Burkholder 421 Briar Lane daughter
Chambersburg, PA 17202
c.Wayne F. Heberlig P.O. Box 386 son
Mount Wolf, PA 17347
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 6/1973 Checking Account#100919, Orrstown Bank, including 3,313.09 50. 1,656.55
interest accrued to date of death
2. A 1/1999 Checking Account#102210069, Orrstown Bank, 93,821.84 50. 46,910.92
incuding interest accrued to date of death
3. B,C,D 6/1991 Certificate of Deposit#20040614, Orrstown Bank, 8,057.32 25. 2,014.33
including interest accrued to date of death
TOTAL(Also enter on Line 6,Recapitulation) $ 50 581.80
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MILDRED C. HEBERLIG 21 14 0996
Decedents Name Page 1 File Number
Schedule F-1 -Jointly Owned Property
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
D.Rodney E. Heberlig 713 Pinola Road son
Shippensburg, PA 17257
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MILDRED C. HEBERLIG 21 14 0996
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPUCABLE) VALUE
1. IRA Certificate of Deposit#602000001, Orrstown Bank, 2,017.67 100.00 2,017.67
including interest accrued to date of death, with named
beneficiaries being May Burkholder and Wayne F. Heberlig,
children of the decedent
2. Annuity Contract#008912409A with Jackson National Life 30,746.74 100.00 30,746.74
Insurance Company,with named beneficiaries of the
decedent's grandchildren equally, as follows: Joni Anderson,
Scott Burkholder, Wendy Latshaw, Jason Heberlig,Abigail
R. Miller, Jonathan Heberlig, Alyssa Heberlig, Philip
Heberlig, and Allen Heberlig
TOTAL(Also enter on Line 7,Recapitulation) $ 32 764.41
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERRESIDENT
EDENAX TURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MILDRED C. HEBERLIG 21 14 0996
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home, funeral services 10,286.40
2. Honorarium for pianist at funeral 100.00
3. Flowers for funeral 170.00
4. Nursery services during funeral 40.00
5. Meal after funeral 750.00
6. Thank you notes and postage 46.52
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. Attorney Fees: Joel R. Zullinger 3,750.00
3. Family Exemption:(If decedents address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: Letters-310.00; will- 15.00; renunciation- 15.00; JCS fee-35.50; auto- 635.50
mation -5.00; inventory- 15.00; return 15.00; shorts-25.00; additional probate 200.00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Transfer of vehicle titles held jointly with spouse 20.00
TOTAL(Also enter on Line 9,Recapitulation) $ 15 798.42
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MILDRED C. HEBERLIG 21 14 0996
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Goodwill Fire & Rescue EMS, ambulance transport 101.35
2. Telephone service due at nursing facility 6.34
TOTAL(Also enter on Line 10,Recapitulation) $ 107.69
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MILDRED C. HEBERLIG 21 14 0996
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Frank S. Heberlig, 11 Darrin Avenue, Newburg, PA 17240 Spousal 115,960.10
Items 1 and 2 on Schedule F- 48,567.47
Life interest in Residuary Trust under
paragraph IV of will- 67,692.63
2. Joni Anderson, 9820 Aberdeen Drive, Leawood, KS 66206 Lineal 9,980.08
1/9 share of Item 2 on Schedule G - 3,416.31
1/9 share of 10% remainder interest in
residuary trust under paragraph IV,
subparagraph E 1 of will
10%of 590,738.50 =59,073.85; 1/9 share= 6,563.77
3. Scott Burkholder, 1101 Montomery Ave., Bryn Mawr, PA 19010 Lineal 9,980.07
1/9 share of Item 2 on Schedule G- 3,416.31
1/9 share of 10% remainder interest in
residuary trust under paragraph IV of will
subparagraph E 1 of will
10% of 590,738.50= 59,073.85; 1/9 share= 6,563.76
4. Wendy Latshaw, 345 Appletree Lane, Mount Wolf, PA 17347 Lineal 9,980.07
1/9 share of Item 2 on Schedule G- 3,416.31
1/9 share of 10% remainder interest in
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
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,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MILDRED C. HEBERLIG 21 14 0996
Decedent's Name Page 2 File Number
Schedule J -Beneficiaries- 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
residuary trust under paragraph IV,
subparagraph E 1 of will-
10% of 590,738.50 = 59,073.85; 1/9 share= 6,563.76
5. Jason Heberlig, 2596 Turnberry Court, York, PA 17404 Lineal 9,980.07
1/9 share of Item 2 on Schedule G- 3,416.31
1/9 share of 10% remainder interest in
residuary trust under paragraph IV,
subparagraph E 1 of will -
10%of 590,738.50= 59,073.85; 1/9 share= 6,563.76
6. Abigail R. Miller, 521 Northbrook Ave., Oak Point, TX 75068 Lineal 9,980.06
1/9 share of Item 2 on Schedule G- 3,416.30
1/9 share of 10% remainder interest in
residuary trust under paragraph IV,
subparagraph E 1 of will-
10%of 590,738.50= 59,073.85; 1/9 share= 6,563.76
7. Alyssa Heberlig, 713 Pinola Road, Shippensburg, PA 17257 Lineal 9,980.06
1/9 share of Item 2 on Schedule G - 3,416.30
1/9 share of 10% remainder interest in
residuary trust under paragraph IV,
subparagraph E 1 of will-
10% of 590,738.50= 59,073.85; 1/9 share= 6,563.76
8. Jonathan Heberlig,1931 Dickinson St., Philadelphia, PA 19146 Lineal 9,980.06
1/9 share of Item 2 on Schedule G - 3,416.30
1/9 share of 10% remainder interest in
residuary trust under paragraph IV,
subparagraph E 1 of will-
10% of 590,738.50= 59,073.85; 1/9 share= 6,563.76
9. Philip Heberlig, 38 Revere Rd., Apt. 10, Drexel Hill, PA 19026 Lineal 9,980.06
1/9 share of Item 2 on Schedule G- 3,416.30
1/9 share of 10% remainder interest in
residuary trust under paragraph IV,
subparagraph E 1 of will -
10% of 590,738.50 = 59,073.85; 1/9 share= 6,563.76
10. Allen Heberlig, 38 Revere Rd., Apt. 10, Drexel Hill, PA 19026 Lineal 9,980.06
1/9 share of Item 2 on Schedule G - 3,416.30
1/9 share of 10% remainder interest in
residuary trust under paragraph IV,
subparagraph E 1 of will
10%of 590,738.50 = 59,073.85; 1/9 share= 6,563.76
11. Mary S. Burkholder, 421 Briar Lane, Chambersburg, PA 17202 Lineal 178,901.84
1/3 share of Item 3 on Schedule F- 671.45
1/2 share of Item 1 on Schedule G - 1,008.84
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MILDRED C. HEBERLIG 21 14 0996
Decedent's Name Page 3 File Number
Schedule J -Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1/3 share of 90% remainder interest in residuary
trust, paragraph IV, subparagraph E 2 of will
90%of 590,738.50= 531,664.65; 1/3 share= 177,221.55
12. Wayne F. Heberlig, P.O. Box 386, Mount Wolf, PA 17347 Lineal 178,901.82
1/3 share of Item 3 on Schedule F- 671.44
1/2 share of Item 1 on Schedule G- 1,008.83
1/3 share of 90% remainder interest in residuary
trust, paragraph IV, subparagraph E 2 of will
90%of 590,738.50 = 531,664.65; 1/3 share= 177,221.55
13. Rodney Heberlig, 713 Pinola Road, Shippensburg, PA 17257 Lineal 177,892.99
1/3 share of Item 3 on Schedule F- 671.44
1/3 share of 90% remainder interest in residuary
trust, paragraph IV, subparagraph E 2 of will
90%of 590,738.50= 531,664.65; 1/3 share= 177,221.55
REV-1514 EX+(4-09) SCHEDULE K
pennsylvania
DEPARTMENT OF REVENUE LIFE ESTATE,ANNUITY
Bureau of Individual Taxes &TERM CERTAIN
PO Box 280601
Harrisburg PA 17128-0601 (CHECK BOX 4 ON REV-1500 COVER SHEET)
ESTATE OF FILE NUMBER
MILDRED C. HEBERLIG 21 14 0996
This schedule should be used for all single-life,joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single-life calculations can be obtained from the Department of Revenue.
Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return.
® Will ❑ Intervivos Deed of Trust ❑ Other
CALCULATIONLIFE ESTATE INTEREST
NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH LIFE ESTATE IS PAYABLE
Frank S. Heberfi 10/17/1926 88 ®Life or El Term of Years
❑Life or ❑Term of Years
❑Life or ❑Term of Years
❑Life or ❑Term of Years
❑Life or ❑Term of Years
1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 658,131.13
2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.10240
Interest table rate— ❑3.5% ❑6% ❑10% [K Variable Rate 2.20% 9/6
3. Value of life estate(Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 67,392.63
ANNUITY INTEREST CALCULATION
NAME OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH ANNUITY IS PAYABLE
❑Life or ❑Term of Years
❑Life or ❑Term of Years
❑Life or ❑Term of Years
❑Life or ❑Term of Years
1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
2. Check appropriate block below and enter corresponding number . . . . . . . . . . . . . . . . . . . . . . . . . . .
Frequency of payout— ❑ Weekly(52) ❑ Bi-weekly(26) ❑ Monthly(12)
❑ Quarterly(4) ❑ Semi-annually(2) ❑ Annually(1) ❑ Other( )
3. Amount of payout per period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
4. Aggregate annual payment,Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Annuity Factor(see instructions)
Interest table rate— ❑3.5% ❑6% ❑10% ❑Variable Rate
6. Adjustment Factor(See instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Value of annuity—If using 3.5%,6%, 10%,or if variable rate and period
payout is at end of period,calculation is:Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . .$
If using variable rate and period payout is at beginning of period,calculation is
(Line 4 x Line 5 x Line 6)+Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
NOTE:The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the
tax return.The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return.
If more space is needed,use additional sheets of the same size.
Annuity, Life Estate, and Remainder Factors 12/15/2014
Transfer Date: 10/2014
§7520 Rate: 2.20%
Calculation Type: Life
Principal: $658,131
Lives: 1
Ages: 88
Life Estate Remainder
Factor: 0.10240 0.89760
Value: $67,392.63 $590,738.50
jRZ - 5 . 1 heberlig.2 March 4, 1999
LAST WILL AND TESTAMENT
I, Mildred C. Heberlig, of 11 Darrin Avenue, Newburg,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby declare this to be my will, hereby
revoking any and all former wills and codicils thereto by me
heretofore _Wade_
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense. of the administration of my estate .
II.
I give and bequeath mzT automobiles, household and personal
effects and other tangible personalty of like nature (not including
cash or securities) together with any existing insurance thereon to
my husband, Frank S. Heberlig, if he survives me by thirty days .
Should my husband not be living on the thirty-first day following
my death I bequeath such tangible personalty and insurance thereon
to such of my children who are living on the thirty-first day
following my death to be divided among them by my executor with due
regard for their personal preferences in as nearly equal shares as
practical .
In the event my husband survives me, and I direct that for the
purpose of this item of my will my husband shall be deemed to have
survived me unless it appears unmistakably that my spouse
predeceased me, and if the Federal estate tax due because of my
death will be reduced by making this gift for my spouse' s benefit,
I devise and bequeath to my spouse absolutely the least amount
(based upon values as finally determined by Federal estate tax
purposes) , as shall be needed for the Federal estate unlimited
marital deduction to reduce the Federal estate tax to the lowest
possible figure after full use of all other deductions and credits
allowable in calculating the Federal estate tax except that such
amount shall be calculated without regard to the augmenting of my
taxable estate by reason of the generation skipping transfers and
without regard for any credit for state death taxes that would not
otherwise be payable. Accordingly I direct that :
A. If the marital deduction or any similar benefit is
allowed with respect to any property including property
held by entireties which my spouse has received prior to
my death or at my death will receive otherwise than
pursuant to this item, the value of such property shall
be taken into consideration in calculating the size of
Page 2
the gift in this item;
B. No property ineligible for the marital deduction or any
similar benefit shall be distributed to this gift for my
spouse pursuant to this item;
C. Either cash or investments or both may be allocated to
the gift under this item;
D. Any property allocated under this item in kind shall be
valued at the value at which it is finally included in my
gross estate for Federal estate tax purposes, provided,
that the aggregate market value thereof on the date of
allocation (plus the value as finally determined for
Federal estate tax purposes of all other property
qualifying for the marital deduction) is at least equal
to the dollar value of the marital deduction as finally
determined for Federal estate tax purpose;
E. If any provisions of my will shall result in depriving my
estate of the marital deduction for Federal estate tax
purposes, such provision is hereby revoked and my will
shall be read as if any portion thereof inconsistent with
allowance of the marital deduction for Federal estate tax
purposes is null and void.
iv.
I give, devise and bequeath the residue of my estate of every
nature and wherever situate to Orrstown Bank, IN TRUST for the
Page 3
following uses and purposes :
A. To pay the net income therefrom to my spouse for life in
such periodic installments as my trustee shall find
convenient but at least as often as quarter-annually.
B. To pay so much of the principal of this trust as my
trustee from time to time thinks advisable for the
support of my spouse to maintain my spouse in the station
of life to which my spouse is accustomed at the time of
my death after taking into consideration other readily
available assets and sources of income, or during illness
or emergency shall be either paid to my spouse or else
applied directly for my spouse' s benefit by my trustee.
C. My trustee may apply the net income of this. trust and so
much of the principal as it deems necessary for the
support of my spouse should my spouse by reason of age,
illness or any other cause in the opinion of the trustee
be incapable of disbursing it .
D. In addition to the above provisions my spouse shall have
the power to direct my trustee to pay to said spouse or
apply out of principal in each year including the year of
my death and the year of my spouse' s death an amount not
in excess of the greater of $5, 000 . 00 or 50 of the then-
aggregate value of the trust principal . This power is
non-cumulative and can be exercised only by an instrument
in writing intended to take effect during - my spouse' s
life, signed and delivered to the trustee.
Page 4
E. Upon the death of my spouse or upon my death if my spouse
predeceases me, the then-remaining principal and any
accumulated or undistributed income shall be distributed
as follows :
1 . Ten percent thereof divided equally among my
grandchildren living at the time of my death. At
the present time I have the following
grandchildren: Joni Burkholder, Scott Burkholder,
Wendy Latshaw, Jason Heberlig, Abigail Heberlig,
Jonathan Heberlig, Alyssa Heberlig, Allen Heberlig
and Philip Heberlig.
2 . The balance of the residue of my estate of every
nature and wherever situate to my children namely
Mary Sara Burkholder, Wayne F. Heberlig and Rodney
Heberlig, in equal shares, provided that the share
of. any child who predeceases me or dies on or
before the thirtieth day following my death shall
be distributed to his or her issue, per stirpes,
living on the thirty-first day following my death,
and in default of any such then-living issue, to my
other then-living children.
3 . Should any of my beneficiaries be under the age of
twenty-two years at the time set for distribution
of this trust, the same shall not be distributed to
said beneficiary directly, but shall be held in
further separate trust . My trustee may apply the
Page 5
net income and so much of the principal of each
trust as my trustee shall consider advisable for
the support and education (including college
education, both graduate and undergraduate) of that
child. Upon the beneficiary' s attaining the age of
twenty-two years, this trust shall terminate and
the principal and any accumulated income shall be
distributed outright to said beneficiary. If any
such child shall die before receiving final
distribution of his or her entire share, the
undistributed balance shall be distributed to my
then-living issue, per stirpes .
V.
The interest of the beneficiaries hereunder shall not be
subject to anticipation or to voluntary or involuntary alienation;
and the principal and income shall be paid by the trustee or
guardi&n direct to or for the use of the beneficiary entitled
thereto, without regard to any assignment, order, attachment or
claim whatever.
Vi.
All Federal, estate and other death taxes payable because of
my death with respect to the property forming my gross estate for
Page 6
tax purposes, whether or not passing under this will, including any
interest or penalty imposed in connection with such tax, shall be
considered a part of the expense of the administration of my estate
and shall be paid out of the principal allocable to the residuary
trust created in item IV hereof without apportionment or right of
reimbursement . All such taxes on present or future interest shall
be paid at such time or times as my executor or my trustee may
think proper regardless of whether such taxes are then due;
provided that any postponed taxes on future interests in the
residuary trust shall be charged against the principal of the
particular share with respect to which the taxes are imposed_
VII.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property, whether principal or income,
including property held for minors, exercisable without Court
approval and effective until actual distribution of all property:
A. No fiduciary shall be required to execute any instrument
appointing anyone to accept service of process or file
inventories or accounts of any kind, except as ordered to
do so by a Court of competent jurisdiction or as required
to do so under a state statute not providing for release
of such requirements by a testator. Any beneficiary
Page 7
however will have the right at any time to request and
receive a complete accounting of such matters as are
pertinent to that beneficiary.
B. If there is no corporate fiduciary acting hereunder, my
executor or trustee may designate a corporation,
regardless of where organized or headquartered, with
fiduciary powers to act as agent or custodian hereunder,
may delegate to it such duties as may be appropriate,
including investment recommendation duties, may pay to it
reasonable compensation for its services, and may
discharge it with or without cause.
C. To retain any or all of the assets of my estate, real or
personal, including stock of any corporate fiduciary,
without regard to any principal of diversification or
risk.
D. To invest in all forms of property including stock,
common trust funds and mortgage investment funds whether
operated by my fiduciary or others, without restriction
to investments authorized for Pennsylvania fiduciaries,
as my fiduciary deems proper, without regard to any
principal of diversification or risk.
E. To - sell at public or private sale, to exchange or to
lease for any period of time any real or personal
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as my fiduciary deems proper.
Page 8
F To allocate receipts and expenses to principal or income
or partly to each as my fiduciary from time to time
thinks proper in my fiduciary' s sole discretion.
G. To borrow from or to sell to my trustee even though such
trustee may be my executor.
H. To cause the title to any property held hereunder to
stand in the name of a nominee or nominees .
I. To repair, alter or improve any real or personal
property; to borrow money including the right to borrow
money from any fiduciary hereunder and to pledge,
mortgage or create a security interest in any property
held by my fiduciary as security thereof, and to make
loans, secured or unsecured, for such purposes and upon
such terms and conditions, as my fiduciary deems
advisable including loans to my estate, with or without
interest, for any purpose whatsoever, and to exercise
options of any kind.
J. To subscribe for or to exercise options for stocks, bonds
or other investments; to join in any plan of lease,
mortgage, merger, consolidation, reorganization,
foreclosure or voting trust and to deposit securities
thereunder; to vote securities in person or by proxy, in
such connection to delegate discretionary powers; and
generally to exercise all the rights of security holders
or employees of any corporation.
K. To compromise, submit to arbitration or release any claim
Page 9
of my estate or any trust hereunder against others and to
pay, compromise or submit to arbitration any claim of
others against my estate or any trust hereunder.
L. To exercise any law-given option to pay death taxes in
installments, the payment of interest due on such
installments to be a charge against principal .
M. To exercise any law-given option to treat administrative
expenses either as income tax or as estate tax
deductions, without regard to whether the expenses were
paid from principal or income.
N. To receive other property of any type acceptable to the
trustee, including, but not in way of limitation, life
insurance proceeds which may be devised, bequeathed,
assigned, granted, conveyed or made payable to the
trustee by any other person, to be added to and
administered in accordance with the then-applicable
provisions of the trust or trusts hereunder; provided,
however, if more than one trust is then being
administered hereunder, such other person may specify in
the instrument of transfer among which trusts and in what
proportionssuchproperty shall be allocated.
O. To treat the entire trust estate as a common fund for the
purpose of investment, notwithstanding any provisions
herein for division thereof into shares or separate
trusts .
P. Any trust beneficiary will have the right at any time to
Page 10
request of and receive from the trustee a complete
written accounting of such matters pertaining to the
administration of the trust as are pertinent to that
beneficiary. In the trustee' s discretion income tax
returns of the trust may be used to satisfy such request.
Q. In making distribution of my estate, my executor, and in
making distribution of any trust, my trustee, is hereby
granted the power to make non-prorata distribution of
assets in kind.
R. My trustee in addition to other powers granted shall have
the authority to purchase life insurance on the lives of
any or all beneficiaries of the trust . In addition,
specific authority or power is granted to pay premiums on
existing policies as well as those purchased after the
creation of the trust even though said policies may not
be owned by or payable to the trustee as beneficiary.
Premiums may be paid from the income of the trust estate
or, if necessary, from principal .
S-1. Should the principal of any trust herein provided for be
or become so small that in the trustee' s discretion
establishment or continuance of the trust is inadvisable,
my , trustee or my personal representative may make
immediate distribution of the then-remaining principal
and any accumulated or undistributed income outright to
the person or persons and in the proportions they are
then entitled to. If any such person is . then a minor,
Page 11
distribution may be made to that person' s guardian, or to
a person selected by the trustee to be custodian for such
person until the age of twenty-one years under the
Pennsylvania Uniform Gifts to Minors Act.
T. To continue the operation of any business in which i may
be interested or engaged 'at the time of my death,
regardless of the form or organization of any such
business, which business or an interest in which shall be
received by my fiduciary. This authorization shall
include the right to change the form of any such business
by the reorganization or incorporation thereof, or the
formation of a general or limited partnership with
respect thereto, and shall also include the right to
invest in any such business including the right to invest
in any business the property of any trust hereunder for
such periods of- time and upon such terms and conditions
as my fiduciary shall deem advisable . No fiduciary shall
be liable for any loss resulting from continuing any such
business, but my fiduciary may, in my fiduciary' s
discretion, sell, liquidate or otherwise discontinue any
such business at such time or upon such terms and
conditions as my fiduciary shall deem advisable.
U. My fiduciary generally shall have full power and
authority to exercise all rights and privileges
appurtenant to any property held by my fiduciary, and to
execute and deliver any and all instruments which may be
Page 12
necessary or expedient in the exercise of the powers
granted herein.
V. My fiduciary is authorized to make distribution in any
manner which my fiduciary deems to be in the best
interest of a beneficiary including:
1 . To such beneficiary directly including mailing to
said beneficiary' s last-known address or depositing
to the beneficiary' s bank account or to a bank
account to be opened by said beneficiary; and
2 . To an existing trust or fund thereof for the sole
benefit of such beneficiary and providing no less a
right to present enjoyment of income and principal
that would be the case under the trust hereunder;
and
3 . Directly to third persons for the sole benefit of
such beneficiary or such beneficiary' s dependents.
4 . The receipt for any distribution made in conformity
with the above provisions will fully discharge
trustee from any further liability for that
distribution.
5 . No fiduciary will exercise any discretionary
authority to distribute principal or income for the
benefit of any beneficiary to reimburse any
governmental entity which may have incurred
expenses for the benefit of that beneficiary or pay
any obligation of a beneficiary if that expense or
Page 13
obligation is otherwise payable by any governmental
entity or pursuant to any governmental program of
reimbursement or payment.
W. The situs of any trust created hereunder shall be in the
County of Franklin, State of Pennsylvania, and all
questions pertaining to the construction or validity of
the provisions of this instrument shall be governed by
the laws of that state. Despite the foregoing the
trustee may at any time and from time to time change the
situs of any trust created hereunder as the trustee in
trustee' s sole discretion deems desirable for the benefit
or security of this trust. The trustee may elect or
decline to elect the law of a different jurisdiction and
thereafter the Court of such other jurisdiction shall
have the power to effectuate the purposes of this
instrument to such extent . The trustee may change the
situs of any trust created hereunder and may change the
situs of one trust without changing the situs of other
trusts created hereunder. This is a continuing power
which will not be exhausted by its use. The
determination of the trustee as to the change of situs
shall be conclusive and binding on all persons interested
or claiming to be interested in any trust hereunder.
X. In any proceeding legal or equitable, formal or informal,
in Court or out of Court, in any jurisdiction concerning
any property or personal rights or interest, whether
Page 14
vested or contingent, which arise hereunder, the
interests of the following persons shall be represented
as hereinafter provided for:
I In the case of beneficiaries whose whereabouts
cannot be ascertained, trustee or executor will
represent them;
2 . In the case of beneficiaries who are unborn,
unknown, incompetent or otherwise subject to the
appointment of a guardian and a guardian for such
beneficiary has not been designated, the following
persons in the order named will represent them:
a. The oldest competent parent, or if there is no
competent parent, the oldest competent
grandparent, of such beneficiary;
b- The oldest competent sibling;
C. The oldest competent child or if there is no
competent child, the oldest competent child of
a sibling of such beneficiary;
3 . Unborn beneficiaries will be represented by their
parent who is related most closely to me. No
person will represent a beneficiary if it could or
would result in an increase of Federal or state
income, gains, gift, death or other taxes .
Page 15
VIII.
I appoint my husband, Frank S. Heberlig, as executor of this
my will . Should my husband predecease me, fail to qualify or cease
to act, I appoint my three children, Mary Sara Burkholder, Wayne F.
Heberlig and Rodney Heberlig, as executors of this my will .
IX.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of seventeen typewritten pages,
the first fifteen of which bear my signature in the margin for the
purpose of identification this _ /p— day of
P
e
SEAL)
Signed, sealed, published and declared by the abo e-named
testatrix as and for her last will and testament in our presence,
who in her presence, at her request and in the presence of each
other have hereunto set our hands as attesting witnesses .
4eW Ale-, 42
Page 16
We, Mildred C. Heberlig, -j-00— (� r t�G � and
P,4uL,A k. &LPzS , the testatrix and the witnesses respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument as
her last will and testament and that she executed it as her free
and voluntary act for the purposes therein expressed and that each
of the witnesses, in the presence and hearing of the said testatrix
signed the will as witnesses and to the best of their knowledge
said signer was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence .
4 � �
1
testatrix
/ itness
Witness
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the-
above-named witnesses this 19`�— day of
No ary Public 5 NOTARIAL'�EAL--
'): .OIS.A.SO�IENSERGERI Notary Putsi;c
�I VOOn-sbu�Sm.:Gu ibedand County
FSI:Oomnips�n929m .o_3i�t3rt h 3.,2t?OA
Page 17
Orrstown Financial Services Inc., ORRF Historical Quote - (NASDAQ) ORRF, Orrstown... Page 1 of 1
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^�) Enter Symbol: jorrf Enter Date: 10/01/14
Otrstown Financial Services Inc.
Wed,Oct 01,2014
closing Price: 16.25 16.75
r
Open: 16.25
16.25
High: 16.57 16.00
15.75
Low: 15.9501
vowme: 23,233 Oct
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Prudential Financial Inc. II
Wed,Oct 01,2014
Closing Price: 85.69
Open: 87.66
High: 87.89
Low. 85.63
Volume: 3,286,264
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Intraday Data provided by SIX Financial Information and subject to terms of use.
Historical and current end-of-day data provided by SIX Financial Information.Intraday data delayed per exchange requirements.S&P/Dow Jones Indices(SM)from Dow Jones 8 Compeny,Inc.All quotes are in local exchange time.Real time last sale
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9
Estate Valuation / Orrstown Financial Advisors
Daniel K. Baer
VP, Trust Officer & Financial Advisor
Date of Death: 10/01/2024 Estate of: Mildred C. Heberlig,
Valuation Date: 10/01/2014 Account: 1085
Processing Date: 10/06/2014 Report Type: bate of Death"
Number of Securities: 13
File ID: M. Heberlig #1085
Shares security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 499 ACNB CORP (000868109)
COM
OTC Bulletin Board
10/01/2014 19.43600 19.10000 H/L
19.265000 9,613.24.
2) 30000 ARMSTRONG SCH DIST PA (042467GL8)
Interactive Data Corporation
DTD: 06/15/2006 Mat: 03/15/2022 5%
10/01/2014 108.92900 Mkt
108.929000 32,678.70
Int: 09/15/2014 to 10/01/2014 66.67
3) 500 CHEVRON CORD NEW (166764100)
COM
New York Stock Exchange
10/01/2014 119.35000 117.38000 HIL
118.365000 59,182.50
4) 100.962 DODGE & COX FDS (256206103)
INTL STK FD
Mutual Fund (as quoted by NASDAQ)
10/01/2014. 44'.48000 Mkt
44.480000 4,490.79
5) 1539.154 FEDERATED EQUITY FDS (314172560)
STRG VAL DV INST
Mutual Fund (as quoted by NASDAQ)
10/01/2014 6.11000 Mkt
6.110000 9,404.23
6) 7171.035 FIDELITY MON TR (316203207)
LTD TRM MUNI INC
Mutual Fund (as quoted by NASDAQ)
10/01/2614 10.74000 Mkt
10.740000 77,016.92
Daily Div. Accrual as of 10/01/2014 3.82
7) 2948.178 FIDELITY PA TAX FREE PORTFOLIO (316344209)
PENN MUN INCM
Mutual Fund (as quoted by NASDAQ)
10/01/2014 11.30000 Mkt
11.300000. 38,314.41
Daily Div. Accrual as of 10/01/2014 3.08
8) 4762PETERS TWP PA SCH DIST WASHING (716090TE5)
Interactive Data Corporation
DTD: 06/15/2003 Mat: 12/01/2014 3.7%
10/01/2014 100.24100'Mkt
100.241000 4,773.48
Int: 06./01/2014 to 10/01/2014 58.73
9) 320.624 ROWE T PRICE EQUITY INCOME FD (779547108)
SH BEN INT'
Mutual Fund (as quoted by NASDAQ)
10/01/2014 33.38000 Mkt
33.380000. 10,702.43
10) 353.205 VANGUARD/WELLESLEY INCOME FD (921938205)
ADMIRAL SHARES
Mutual Fund (as quoted by NASDAQ)
10/01/2014 62.10000 Mkt
62.100000 21,934.03
11) 1235.566 VANGUARD FIXED INCOME SECS FD (922031737)
INFLT PRT ADMR
Mutual Fund (as quoted by NASDAQ)
10/61/2014 26.39000 Mkt
26.390000 3.2,606.59
Page 1
This report was produced with EstateVal, •a product of Estate Valuations & Pricing Systems, Inc. If you have questions;
please contact EVP Systems at (818) 313-6300 or www:evpsys.com. (Revision '1.4.0)
Date of Death: 10/01/2014 Estate of: Mildred C. Heberlig
Valuation Date: 10/01/2014 Account: 1085
Processing Date: 10/06/2014 Report Type: Date of Death
Number of Securities:. 13
File ID: M. Heberlig #1085
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid: Adjustments Accruals Value
12) 4766.418 VANGUARD PA TAX FREE FD (922041,302)
LONG TAXEX ADM
Mutual Fund (as quoted by NASDAQ)
10/01/2014 11.67000 Mkt
11.670000 55,624.10
Daily Div. Accrual as of 10/01/2014 5.81
13) 92.681 VANGUARD INDEX FDS (922908496)
500 IDX FD SHS'
Mutual Fund (as quoted by NASDAQ)
10/01/2014 148.35000 Mkt
148.350000 13,749.23
Total Value: $365,090.65
Total Accrual: $138.11
Total: $365,228.76
Portfolio Endnotes
Federated Money Market - Principal # 66934N625 $ 18,563.32 Acc. Int. 0.01
Completed in 10/07/2014
By:
Michele J. Reed, Fiduciary Administrative Assistant
Page 2
This report was produced with EstateVal, a product of Estate valuations & Pricing Systems, Inc. If you Have questions;
please contact EVP Systems at (81B) 313-6300 or www.evpsys.cbm. (Revision 1.4:0)
Nov^ 4. 2014 2:57PM HC DAVIS No. 2821 P. 1
OR-RSTOWN
. BANK
A Tradition of Excelknee
November 04,2014
Zuliinger-Davis
Law Office
20 E Burd St Po Box 40
Shippensburg, Pa 17257
Fax: 717-530-5222
Re: Estate of Mildred C Heberlig
Social Security Number
Date of Death 10/0 1/2014
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
Time Deposit Account
Account No- 20040614
Account Type- 30 Month Income CD
Account Title- Mildred C Heberlig/Wayne F Heberlig/Mary Burkholder/
Rodney E Heberlig
Date Opened- 06/06/1991
Joint Account(nameldate) Yes/06/06/1991
Balance- - $8,055.60
Accrued Interest $1.72
TSme Deposit Account
Account No- 602000001
Account Type- IRA Prime Statement Savings
Account Title- Mildred C Heberlig
Date Opened 09/04/1997
Joint Account(name/date) No
Balance- $2,016.14
Accrued Interest $1.53
(Named Beneficiaries - Mary S. .Burkholder and
Wayne F. Heberlig, children. (bevel 1)
Contingent beneficiary ,-- Rodney E. Heberlig,
child)
2695 Philadelphia Avenue• Chambersburg,PA 17201
Nov. 4. 2014 2:57PM HC DAVIS No. 2821 P. 2
CheLkin
.jAccount
Account No- 100919
Account Type- Relation Interest Checking
Account Title- Mildred C Heberlig/Frank S Heberlig
Date Opened- 06/01/1973
Joint Account(name/date) Yes/06/01/1973
Balance- $3,313-07
Accrued Interest $.02
Checkinz Account
Account No- 102210069
Account Type- Money Market
Account Title- Mildred C f4eberlig Frank S Heberlig
Date Opened- 01/04/1999
Joint Account(name/date) Yes/01/04/1999
Balance- $93,810-02
Accrued Interest $11.82
Best Regards,
Lisa R.Kline
Deposit Processing Representative M
Carol Gratton
From: Carol Gratton
Sent: Friday, October 24, 2014 10:05 AM
To: 'Ronda P. Dick'
Subject: RE: Mildred Heber|ig
Ronda,
Thank you for the information onthis. Joel told the executor vvewould take care ofthis. | have not contacted
Jackson as ( amsure they will only speak with the named beneficiaries. | assume each beneficiary will berequired to
complete separate form,correct? |fyou have aform please email tnmneand }work with the beneficiaries. Thank you.
Carol
'
From: Ronda P. Dick[mnaibo:rdick@orntown.cnm]
Sent:Thursday,October 2S, 2O145:16PK4
To:Carol Gratton
Subject: FW: Mildred UeberUg
Hi,Carol:
Mildred HeberUoscontract value asof was$30,746.74. The cash surrender value was$3O711.74. K4o.
HebediQnamed nine beneficiaries, proceeds tobedivided equally. The names follow.
]oanieMarie Burkholder
Scott Allen Burkholder
Wendy Carol Latshavv
Jason Andrew HeberUg
Abigail Ruth Heber|ig
Jonathan David Heber|i8
E|yssaKay Heber|i8
Allen Luke Heber|iQ
Philip Kyle Heber|ig
They will all need tocomplete death benefit claim forms. |fthey haven't already contacted Jackson, | can email aform
toyou for them.
From: Melinda Gochenauer
Sent Tuesday October 21,2O1412:19PK8
To: Ronda P. Dick
Subject: FW: Mildred Hebedi8
Hi Ronda,
Carol etJoel's office needs information onMildred HebeMiO. Please see the message below.
Thanks,
Melinda
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