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Home My WebLink About01-0226 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of ERVIN CHESTER HElM No. j 1- ~ 1- 2..." also known as E. CHESTER HElM a1k1a CHESTER HElM , Deceased Social Security No. 189-30-2555 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) c;I A. Probate and Grant of Letters and aver that Petitioner is the executor named in the Last Will of the Decedent, dated 11/13/81 and coclicil(s) dated N/A State relevant circumstances. e.g.. renunciation, death of executor. etc. Except as follows. Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: c;I B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate) Petitioner after a proper search has ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 313 Monroe Street,Mechanicsbura, Cumberland County, Pennsylvania -mcn-u.L du.r' . (list street, number and municipality) Decedent, then 79 years of age, died January 18, 2001, at Harrisburg Hospital, Harrisburg, Dauphin County, PA (Locstion) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property. . . .. . . . . . . . . . . . . . .. . . ... .. . . . . . . . .. . . . . . " . . .. $ 10,000.00 (If not domiciled in PA) Personal property in Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ (If not domiciled in PA) Personal property in County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ Value of real estate in Pennsylvania ........................................................... $ Total ............................................................................ $ 10,000.00 Real Estate situated as follows: Wherefore. Petitioner respectfully requests the probate of the last Will and Codicil presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Sadie M. Heim -VV\ I 313 Monroe Street Mechanicsburg, PA 17055 I {, .-' d. /3 ~~ Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. ct a ~c~ Sadie M. Heim yn f ~~~Yl Sworn to and affirmed and subscribed ~re me this .:2 0 -e- day of '-ej,~ ,2001. ~}aQr!.. ;.uO fJU .e t1 ~)~dft DECREE OF REGISTER Deceased No. 21-01-0226 Estate of ERVIN CHESTER HElM E. CHESTER HElM also known as a/kJa CHESTER HElM Social Security No: Date of Death: 189-30-2555 January 18. 2001 AND NOW, MARCH 1 , 2001, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters. Testamentary 0 of Administration (c.t.a.; d.b.rt.c.t; pendente lite; durante absentia; durante minoritate) are hereby granted to Sadie M. Heim in the above estate and that the instrument( s), if any, dated 11/13/81 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters... .................. ...... Short Certificate( s)...?..... Renunciation................. . Affidavit ( )................. Extra Pages ( 3)............ CodiciL............. ............ JCP Fee........................ Inventory & Tax Forms... Other.......................... .. TOTAL. ........... .... $ 40.00 ~e~~(!..a~/~ Register of Wills $ 9.00 $ $ $ 9.00 $ $ 5.00 $ $ Attorney: Gary J. Heim 1.0. No: 32774 Address: 3401 North Front Street Harrisbura. PA 17110-0950 Telephone: 717-232-5000 DATE FILED: MARCH 1, 2001 $ 63.00 MAIL LETTERS AND ORDERS TO EXECUTRIX ;252595 _1 H105.1 12 RE'/ 8.88 (FEE FOR THIS CERTiFiCATE S20G:i WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CEf~T. NO. T 4 6 9 0 5 9 7 /Jiilli7i;:'-;;;;---,;-- <<,,,,,i~~WiJlf Pl~ /",#/ ~.'fJ>.I-."-~\ I\~~:I Wi&',.. \<-:::~ I~~.~. '''!'i~'''\'-::'~ I~~/, ~_ - \~~ \% ~;, _{i~' ;i:'~ "' \" . " ~ \~ * '( " --~-", - ~<." f ~<%'" --. /~/ '?-_ -1'P~- /<. ~ .,1 --- 'l'hl~---(. ~'- I' -----~~"'ENl \\, II!!!l'~' "'-'///////11/11111 ________ 1-19-2001 Date of Isn19 of ThlS Certif'catiol1 Name of Decedent --.--------- E "'not . ~hester 189-30-2555 -------- - --- H eim___ ___ Sex___ Male__ Social Security No. Date of Death______l:1Jl~2J2()J______ Date of Birth ____ 7-01-1921 Birthplace Pitman, P A Place of Death --Harr~WJntHospital Dauphin COUI'I', Harrisburg__ ______E'~D D.?yly9.QI~ C;I} tlrY'j:.ig~:' ,y T,~,;"~' Race__ . White ____Occupation Farmer & FA State Employee Armed Forces? (Yes or No) __~!.*'!'****!**_'!'.:"", Decedent's Marital Status - Married Mailing Address 3lcl,Monroe Str-e~t----M~~anjcsburg U---- Funeral Director St-ephen R. Rothennel---------------- Informant__ Sadie M. Heim Name and Address of Funeral Establishment Part I: Immediate Cause Stephcn R. Rothermel Funeral Home, R.R. 1, Box 128 A, Klipgerstown, -P-A-1-194l- Interval Between Onset and Death (a)____________ CAD (b) ____ ______ . .. _..~-~_.~..._._.--.--,.-~....__.._--- _.~._.._---. (c)_ ___________ (d) ___________ Part II: Other Significant Conditions ---A;S.C.V.D.- Manner of Death Describe how injury occurred: Natural Accident ~ Homicide Pending investigation Could not be Determined o Suicide Name and Title of Certfier _ Peter Brier, M D. (M.D., D.O. Coroner. M.E) Address --- 108 Lowther Street, Lemoyne, P A 17043 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. Tt1e original certificate wi!1 be forwarded to the State Vital Records Office for permanent filing. 'd:~fJ4tL --~~98- --'-ci".1,9~2().Ql Recc:,ey----- 1004s~i\lW1t Street __U ~lcy uiQV"-- -_. Y -,_.gt' ~( i' 21-01-226 LAST WILL AND TESTAMENT I, ERVIN CHESTER HElM, now of Mechanicsburg, Cumberland County, and State of Pennsylvania, do hereby make this my Last Will and Testament, and revoke all Wills and Testamentary instruments of whatsoever nature which I have previously made. ARTICLE I. PAYMENT OF DEBTS. I direct my Executors to pay all my just debts and funeral expenses. ARTICLE II. SPECIAL ITEMS. I intend to attach to this Will a list of items which have a personal or sentimental value to me, and the names of the persons who are to receive those items. I request my Executors to follow the instructions on that list to the best of their ability. ARTICLE III. REMAINDER. All the rest, residue and remainder of my property, whether real, personal or mixed and wheresoever situate, of which I may die seized or possessed, or that I may be entitled to dispose of or to appoint at the time of my death, I give, devise, bequeath and appoint to my wife, SADIE M. HElM, if she survives me. ARTICLE IV. REMAINDER IF MY WIFE FAILS TO SURVIVE. In the event that my wife, SADIE M. HElM, shall predecease me or in the event that we die under such circumstances that there is no sufficient evidence that we died otherwise than simultaneously, then I give, devise, bequeath and appoint all the rest, residue and remainder of my property in three (3) equal shares, one (1) equal share for each of my daughters, and their names are DIANNE L. HERB, SADIE DENISE HElM, and DEBRA L. SMITH. In the event that any child fails to survive me and leaves issue then living or a surviving spouse, that deceased child's share shall be paid over and transferred to her living issue and her surviving spouse in equal parts. (For example, if a child dies leaving three [3] children and a surviving spouse, each of the three [3] children shall receive an equal one-fourth [1/4] share and the surviving spouse shall receive an equal one-fourth [1/4] share.) In the event that any child fails to survive me and leaves no living issue or a surviving spouse, that deceased child's share shall be paid over and transferred in equal parts to my other surviving children or the living issue or surviving spouse of a deceased child. ARTICLE V. APPOINTMENT OF EXECUTORS. I, name, constitute and appoint my wife, SADIE M. HElM, to be the Executrix of this Last Will and Testament. In the event that she is unable or unwilling to act or to continue to act in said office, then I appoint the following as alternates: First Alternate Executor: GARY J. HElM. ARTICLE VI. WAIVER OF BOND. To the extent that such requirements can legally be waived, I direct that no fiduciary named in this Will shall ever be required to post any bond or give any security in connection with its duties, whether in the State of Pennsylvania or elsewhere. ARTICLE VII. FIDUCIARY POWERS. My Executors shall have the power to lease, sell, mortgage, transfer and convey, in such manner and on such terms as they may deem advisable, any and all property, real or personal, belonging to my estate without the necessity of obtaining leave of any Court. No purchaser shall be held liable to see to the application of any purchase money. -2- ARTICLE VIII. ADDITIONAL EXECUTOR POWERS. All of the foregoing powers together with those granted by law to Executors, may be exercised by the Executors hereinabove named, and by all persons succeeding in said office, including administrators with the Will annexed. IN WITNESS WHEREOF, I, ERVIN CHESTER HELM, the Testator, have to this my Last Will and Testament, typewritten on three (3) sheets this /3~ay of paper, of which this is Sheet No.3, set my hand and seal of /1~, 1981. ~ ' .A ~"' efL~/ A ~AL) vin ~ester 8eim {~ SIGNED, SEALED, PUBLISHED, AND DECLARED, by the above-named, ERVIN CHESTER HElM, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses this ;I~~day of1~1981. ~/~ &irkJ~' \M',O l.Q. ~ ~ tOUA- L ADDRESS ~ Cter/ ;j ADDRESS---.11t ./L ~~<o.s ~J ,rf? ADDRESS '^^ I<:'~:"-.-..Q~ ~Q -3- ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY.?~~ SS I, Ervin Chester Heim, the Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as 'my free and voluntary act for the purposes therein expressed. ~ ~I/~(SEAL) Ervin Chester Heim Swo~nuto and ac~ledged!be~ore me, by Ervin Chester Heim, the Testator, this /.i:z1'.j day of ~~~ , 1981. (Notary Public) AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY ox(!-Jw SS The w1tnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Ervin Chester Heim, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge and belief the Testator was at that time 18 or more years of age, of sound mind and under no onstraint or undue influence. (SEAL) 8~~~ ~ ~ fl"'~AA (SEAL) (SEAL) };2. to and sp before me this - day of W by the above-named witnesses, , 1981. ~tary blic State College, Centre Co., a. My Commission Expires June 13, 1983 Public) E. -- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ERVIN CHESTER HElM A/KlA E. CHESTER HElM, A/KlA CHESTER HElM Date of Death: January 18, 2001 File No. 21-01-226 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 March 29. 2001: Name Address Sadie M. Heim Sadie Denise Brenner Dianne L. Herb Debra L. Smith 313 Monroe Street, Mechanicsburg, PA 17055 2283 Forest Hills Dr., Harrisburg, PA 17112 1238 Erdman lane, lykens, PA 17048 7953 lake Street, Monroe, MI48161 Notice has now been given to all persons entitled thereto under Rule 5.6(a) Date: Ate r L t,,- ':Z ~. 2CC( /Le<t/~~ Signature , Gary J. Heim. Esquire Name 3401 North Front Street Harrisbur9. PA 17110 Address (717) 232-5000 Telephone Capacity: _ Personal Representative ~ Counsel for Personal Representative :255835 _1 Vv STATUS REPORT UNDER RULE 6.12 NAME OF DECEDENT: ERVIN CHESTER HElM alkJa E. CHESTER HElM alkJa CHESTER HElM DATE OF DEATH: January 18, 2001 FILE NO: 21-01-0226 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 No X b. account is: The separate Orphans' Court No. (if any) for the personal representative's c. Did the personal representative state an account informally to the parties in interest? Yes X 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. DATE: 1/1 <'>? L ~ ~....... ~ $;9""'"'. i - 'f, Gary J. Heim. Esquire 3401 N. Front Street. Harrisburg. PA 17110-0950 (717) 232-5000 Capacity: Personal Representative x Counsel for Personal Representative :292377 _1 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of ERVIN CHESTER HElM No. 21-01-0226 also known as E. CHESTER HElM A1K1A CHESTER HElM Date of Death January 18, 2001 Deceased Social Security No. 189-30-2555 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all ofthe real estate in the Commonwealth of Pennsylvania of said Decedent, thatthe valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Gary J. Heim Personal Representative: Sadie M. Heim '" ~~uk Yvl .0L Dated: I b 1/5/ 0 I 1.0. No.: 32774 Address 3401 N. Front Street, Harrisburg, PA 17110-0950 Telephone: (717) 232-5000 DESCRIPTION VALUE 1. 462 Shares of MetLife Common Stock $14,596.31 2. PNC Bank IRA Account #65001005252 $ 154.24 Accrued interest on above account $ .08 3. PNC Bank IRA Account #65001005253 $ 6,322.16 Accrued interest on above account $ 12.46 4. PNC Bank IRA Account #65001005254 $ 5,229.22 Accrued interest on above account $ 2.09 5. PNC Bank IRA Account #65001005256 $ 4,507.71 Accrued interest on above account $ 9.29 6. PNC Bank IRA Account #65001005257 $ 1,531.77 Accrued interest on above account $ 2.25 7. PNC Bank IRA Account #65001005260 $ 4,239.17 Accrued interest on above account $ 3.68 TOTAL: $36,610.43 :274392 _1 \. /b-~/~ - 9 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP 112-DDI Recoroed Renl' C..t{'i ~ dt..l<:i4 ;;8 of VViHs 12-17-2001 HElM 01-18-2001 21 01-0226 CUMBERLAND 101 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN ERVIN C .01 DIe 27 Al0:11 GARY J HElM ESQ METTE ET AL PO BOX 5950 HBG Allount Rellitted Clerk.C . p,pli~iarxj ,PA MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV :i5'~rj-E;f-AFP--(i2:0oT-NoYicE--c:iF-YNHEiiiTANcE-YAx-APPRAisEMENY-,--ALi-c:iwANCE-oi-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HElM ERVIN C FILE NO. 21 01-0226 ACN 101 DATE 12-17-2001 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) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets .00 14,596.31 .00 .00 .00 .00 29,676.12 (8) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. ll) (2) (3) (4) (5) (6) (7) 44,272.43 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 11,985.07 .00 (9) llO) 11 .985 07 32,287.36 .00 32,287.36 (11) ll2) ll3) ll4) 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 .00 .00 .00 .00 32,287.36 X 00 = .00 X 045= .00 X 12 = .00XI5= ll9)= TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. /6 - c.2 /..3 - 10 / REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 01 0226 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Heim, E. Chester 189-30-2555 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 01/18/01 7/1/1921 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Heim, Sadie M. 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return 8 (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date 01 du.th aHer 12-12-&2) PRIATE 6. Dec;edent Died Testate 7. OecedentMaintainedaUvingTrust 0 8. Total Number of Safe Deposit Boxes (AttachcoPyofWjll) (Attach acopyofTrust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A) 12-31-91 and 1-1-95) (Attach Sch 0) jffll\'lgQjI!.m~ji\i;~~pi'il'I;i~Qlij\'l~~'fiJ1iQilll\l,*fnlm;T**.jl'li!Q~MAi'll:lJIjllQlIl$!\Il!lIf\i.lill!lI;ltPi NAME COMPLETE MAILING ADDRESS COR- r<_ J. Heim, ",,,,,,,ire 3401 N. Front Street RE- FIRM NAME (If Applicable) Fa Box 5950 SPON DENT M=tte, Evans & W:Jodside Ha=isburg , PA 17110-0950 TELEPHONE NUMBER 717-232-5000 None OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 14,596.31 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) None 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) Nane RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 29,676.12 8. Total Gross Assets (total Lines 1-7) (8) 44,272.43 9. Funeral Expenses & Administrative Costs (St::hedule H)(9) 11,985.07 10. Debts of Decedent, Mortgage Liabilities, & Liens(Schedule I) (10) Nane 11, Total Deductions (total Lines 9 & 10) (11) 11,985.07 12. Net Value of Estate (Line 8 minus Une 11) (12) 32,287.36 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 32,287.36 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amountof Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 32,287.36 X .0 0 (15) 0.00 TAX 16. Amountof Line 14taxableat lineal rate 0.00 X .0 45 (16) 0.00 0.00 - COMPU- 17. Amount of line 14 taxable at sibling rate x.12 (17) 0.00 TATION 18. Amountof Line 14 taxable at collateral rate 0.00 )(.15 (18) 0.00 19. Tax Due (19) 0.00 20. 0 l~cK!l~!leifYQljiijji!iji!QijS$jjiiGAijlWl)i!!!rQFAi!~RP4V'M!'ifnl . ...... ..,..,.....;,.,,;.;))!i!i....lp/.iil!JIlJ;;TP;IlNiilWERAW.;.QQIii$;nQN$Q.I!!.!"AGi;Z.IlNli'Ri;GHJ;;g<l\I\AIHMi{............ o PA15001 NTF 29755 Copyright 2000 Greatland/Nelco LP~ Forms Software Only PA REV-1500 EX (6-00) Page 2 Decedent's Camorete Address: STREET ADDRESS 313 M:mroe Street CllY I STATE I ZIP Mechanic-'- .- PA 17055 Tax Payments and Credits: ,. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty (D + E) 4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) 0.00 (4) (5) 0.00 (5A) 0.00 (5B) 0.00 ~t~~~g~!~!~!+~~~gEEg!i!~~Gg~+lg!~~~~l!8i!~~!;;~';I!+~g~~~~8~!i~+g~E88k~f 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; .........................,.... b. retain the right to designate who shall use the property transferred or its income; ..,...,. c. retain a reversionary interest; or, . . . . , . . , . , . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . d. receive the promise for life of either payments, benefits or care? .............".......,.,.. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? , . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , . . . . . . . , . . . . Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . , . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . .. ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of 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 preparer other tlian the personal representative is based on information of which re arer has an knowled e. NATU OF PERSON RESPONSIBL F R FILING RETURN DATE t> / 3. 4. Yes No ~ I B ~ o t Street, PO Box 5950, Harrisburg, PA 17110-0950 c( on on or use [72 P.S.!i 9116(a)(1.1j(i)]. For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. i 9116 (a) (1.1)(ii)]. The statute doe!'; nnt p.xp.mnl 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 orafterJuly1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natura! parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. i9116(aX1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72.P.S. i 9116(1.2) [72 P.S. 9 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% [72 P.S. 9 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 oradoption. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco LP - Forms Software Only Estate of: E. Chester Heim 21-01-0226 The following persan(s) are signing the return. as representative(s) of the estate: Sadie M. Heim 313 l'bnroe Street M2chanicsburg, PA 17055 REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF E. Chester Heim SCHEDULE B STOCKS & BONDS FILE NUMBER 21-01-0226 All property Jointly-owned with rIght of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 462 Shares of MetLife O:mron St=k 14,596.31 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 14,596.31 7 CPA31 NTF 10905 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF E. Chester Heim SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-01-0226 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S (IF TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) 1 PNC Bank IRA AcCOlll1t #65001005252 154 . 24 Accrued interest an above aCCOlll1t 0.08 2 PNC Bank IRAAcCOlll1t #65001005253 6,322.16 Accrued interest an above aCCOlll1t 12 .46 3 PNC Bank IRA AcCOlll1t #65001005254 5,229.22 Accrued interest an above account 2.09 4 PNC Bank IRA AcCOlll1t #65001005256 4,507.71 Accrued interest an above account 9.29 5 PNC Bank IRA AcCOlll1t #65001005257 1,531.77 Accrued interest an above account 2.25 6 PNC Bank IRA AcCOlll1t #65001005260 4,239.17 Accrued interest an above aCCOlIDt 3.68 7 Ken}ler Annuity 6,060.00 8 Travellers Insurance Annuity 1,602.00 TOTAL (Also enter on line 7, Recaoilulation) $ 29,676.12 7 CPA01 NTF 10910 (If more space is needed, insert additional sheets of the same size) Copyrigt1t Forms SoHware Only. 1997 Nelco, Inc. REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF E. Chester Heim SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 2l-Ol-0226 Debts of decedent must be reported on Schedule I. ITEM NO. A. FUNERAL EXPENSES: DESCRIPTION AMOUNT l Stephen R. Rothenrel Funeral Heme 6,500.00 2 Grave rrarnnrent l,500.00 B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number{s)/EIN No. of Personal Representative(s) Street Address City State 0.00 Zip Year(s) Commission Paid: 2. 3. Attorney Fees Narre : JllEt te, Evans & W:Jodside Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Sadie M. Heim StreelAddress 313 M:mroe Street City M=chanicsburg State PA Zip l7055 Relationship of Claimant 10 Decedent SUrvi viner Spouse 250.00 3,500.00 4. Probate Fees 63.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 o..nnberland Law Jow:nal - legal advertising 75.00 8 The Sentinel - legal advertising 97.07 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) n,985.07 7 CPA11 NTF10911 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES E. Chester Heim No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Sadie M. Heim 313 M::mroe Street f'Echanicshrrg, PA 17055 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) Survi v:i11g spouse 21-01-0226 AMOUNT OR SHARE OF ESTATE 32,287.36 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 Copyright Forms SoHware Only, 1991 Nelco, Inc. (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, ERVIN CHESTER HElM, now of Mechanicsburg, Cumberland County, and State of Pennsylvania, do hereby make this my Last Will and Testament, and revoke all Wills and Testamentary instruments of whatsoever nature which I have previously made. ARTICLE I. PAYMENT OF DEBTS. I direct my Executors to pay all my just debts and funeral expenses. ARTICLE II. SPECIAL ITEMS. I intend to attach to this Will a list of items which have a personal or sentimental value to me, and the names of the persons who are to receive those items. I request my Executors to follow the instructions on that list to the best of their ability. ARTICLE III. REMAINDER. All the rest, residue and remainder of my property, whether real, personal or mixed and wheresoever situate, of which I may die seized or possessed, or that I may be entitled to dispose of or to appoint at the time of my death, I give, devise, bequeath and appoint to my wife, SADIE M. HElM, if she survives me. ARTICLE IV. REMAINDER IF MY WIFE FAILS TO SURVIVE. In the event that my than simultaneously, then I give, devise, bequeath and appoint all the rest, residue and remainder of my property in three (3) equal shares, one (1) equal share for each of my daughters, and their names are DIANNE L. HERB, SADIE DENISE HElM, and DEBRA L. SMITH. In the event that any child fails to survive me and leaves issue then living or a surviving spouse, that deceased child's share shall be paid over and transferred to her living issue and her surviving spouse in equal parts. (For example, if a child dies leaving three [3] children and a surviving spouse, each of the three [3] children shall receive an equal one-fourth [1/4] share and the surviving spouse shall receive an equal one-fourth [1/4] share.) In the event that any child fails to survive me and leaves no living issue or a surviving spouse, that deceased child's share shall be paid over and transferred in equal parts to my other surviving children or the living issue or surviving spouse of a deceased child. ARTICLE V. APPOINTMENT OF EXECUTORS. I, name, constitute and appoint my wife, SADIE M. HElM, to be the Executrix of this Last Will and Testament. In the event that she is unable or unwilling to act or to continue to act in said office, then I appoint the following as alternates: First Alternate Executor: GARY J. HElM. ARTICLE VI. WAIVER OF BOND. To the extent that such requirements can legally be waived, I direct that no fiduciary named in this Will shall ever be required to post any bond or give any security in connection with its duties, whether in the State of Pennsylvania or elsewhere. IARTICLE VII. FIDUCIARY POWERS. My Executors shall have the power to lease, 18e11, mortgage, transfer and convey, in such manner and on such terms as they I may deem advisable, any and all property, real or personal, belonging to my estate without the necessity of obtaining leave of any Court. No purchaser shall be held liable to see to the application of any purchase money. -2- ARTICLE VIII. ADDITIONAL EXECUTOR POWERS. All of the foregoing powers together with those granted by law to Executors, may be exercised by the Executors hereinabove named, and by all persons succeeding in said office, including administrators with the Will annexed. IN WITNESS WHEREOF, I, ERVIN CRESTER HELM, the Testator, have to this my Last Will and Testament, typewritten on three (3) sheets this 13i~ay of paper, of which this is Sheet No.3, set my hand and seal of J;~,-v.e~4?-4' 1981. eJ1c'J~' (~{~Pdffi, ~-/;;i~AL) vin C ester Heim ( SIGNED, SEALED, PUBLISHED, AND DECLARED, by the above-named, ERVIN CHESTER HElM, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses this ~3~day of 1t'-V'e/pJ~ 1981. JJ; d Ik;~ jI 1~J ~-<-' ~ ' ADDRESS >dto C-t~~~ It j' ADDRESS '711 ,12- c.hd.h~LS e~J ,r:? \\:\',,0 ~'Q 1 ~tcl.-v,-L,~ ADDRESS 'v'v\ (,(OUL"'~A D.'-'-'-'J ?o.. -3- ACKNOWLEDGMENT COMl10NWEALTH OF PENNSYLVANIA COUNTY og..J SS I, Ervin Chester Heim, the Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. 9/17~ ~ ;/~(SEAL) Ervin Chester Heim Swornl! to and acls- this 1-1;:leJ day of Ervin Chester Heim, the Testator, ewftNotary Public) AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ,,, il' -- COUNTY o~j tV The witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Ervin Chester Heim, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of uS in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge and belief the Testator was at that time 18 or more years of age, of sound mind and under noa/onstraint or un:ue influence. ~'1/~~A'1~. (SEAL) ~u9-<^h ~t~ \J \Vv&.~d a -:I; SS (SEAL) D . ~ ('-'1...1'____'\ A -'1 (SEAL) Sworr} to and this lJ;cfci day of sU9~cribe4 before me ~ll:-o-e/YvcI<-j C by the above-named witnesses, , 198!. j) Public) 0PNCBAN< Decedent Reporting Firstside Center P7-PFSC-4-F 500 First Avenue Pittsburgh, PA 15219-3128 /SCP August 15,2001 Sadie M. Heim 313 Monroe Street Mechanicsburg, P A 17055 RE: Estate of Chester Heirn, Deceased SSN: 189-30-2555 000: 1/18/2001 Dear Ms. Heim: Please find the date of death balances you have requested listed below. CERTIFICATE OF DEPOSIT #31700189826 Established 06/22/2000 CHESTER HElM SADIE HElM 000 Balance: $5,173.38 + $26.00 accrued inlerest CHECKING ACCOUNT #5070080192 Established 03/18/1980 CHESTER HElM SADIE HElM 000 Balance: $5,944.14 + SUI accrued interest Page 1 00 A member of The PNC Financial Services Group One PNC Plaza 249 Fifth Avenue Pittsburgh Pt'rHlsylvani<l 15222 2707 o PNCBAN<. SAVINGS ACCOUNT #5030121789 Established 07/2111983 CHESTER HElM SADIE HElM DOD Balance: $5,435.54 + $3.81 accrued interest IRA ACCOUNTS #65001005252 Established 06/14/1983 E CHESTER HElM DOD Balance: $154.24 + $0.08 accrued interest #65001005253 Established 01104/1987 E CHESTER HElM DOD Balance: $6,322.16 + $12.46 accrued interest #65001005254 Established 01/22/1985 E CHESTER HElM DOD Balance: $5,229.22 + $2.09 accrued interest #65001005256 Established 08/04/1987 E CHESTER HElM DOD Balance: $4,507.71 + $9.29 accrued interest #65001005257 Established 09i07/1988 E CHESTER HElM DOD Balance: $1,531.77 + $2.25 accrued interest #65001005260 Established 04/12/1990 E CHESTER HElM DOD Balance: $4,239.17 + $3.68 accrued interest For Beneficiary or IRA information please call 1-888-PNC-IRAS l'OTAL .:I.R.A~"'t:lon"'$' ::Jd.DI'-I. ld, Page 2 of3 A member of The PNC Financial Services Group Om' PNC Planl 249 Fifth Avenue Pitlsburgh Pennsylvania 15222 2707 Estate Valuation Date of Death: Valuation Date: Processing Date: 01/18/2001 01/18/2001 10/08/2001 Estate of: Chester Heim Account: 10963.1 Report Type: Date of Death Number of Securities: 1 File 10: heim Shares or Par Security Description High/Ask Low/Sid Mean and/or Div and lnt Adjustments Accruals Security Value 1) 462 METLIFE INC 159156Rl081 NYSE 01/18/2001 32.43750 30.75000 H/L 31.593750 14,596.31 Total Value: Total Accrual: Total: $14,596.31 514,596.31 $0.00 Page This repor': was produced '"ith EstateVal 2000, a product of Estate valua:ions & Pricing Systems, Inc. If you have questions, please contact SVP Systems at (818) 313-6300. (Revision 6.1.0)