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HomeMy WebLinkAbout01-0334 -~ PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of HAZEL M. HEBERLIG No. 21-01- 3:3+ also known as HAZEL S. HEBERLIG To: Register of Wills for the Deceased. County of CUMBERLAND in the Social Security No. 189-09-4629 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl ies for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 110 Harbeth Avenue, North Middleton Twp. (list street, number and municipality) Decendent, then 90 years of age, died March 8 , 2001 , at Carlisle Hospital Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ 85 ,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 $ 60.000.00 situated as follows: 110 Marbeth Avenue, North Middleton Township, Cumbo Co. Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence Phyllis R. Durham daughter 130 Lakeview Drive Carlisle, PA 17013 THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ~ ~~; .r ~~~ v u C ., "'0.- . -- y 18 R. Dur am . .- ~ ~- ., .... ~<l) C "CO c.= 130 Lakeview Drive r:\1"= ~~ Carlisle. PA 17013 <:),- ;0 717-243-5862 ~ en ~ \ tc - ~ "'D - 10 OATH OF PERSONAL REPRESENTATIVE r COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } 55 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 as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and before me this 28th . March ~ . 'ma, ~. . fLP6,vn subscribed J day of 2001 I Register L ~~(~,Lr ,/: r/J~~fU/ Phyl s R. Durham - '" - ClJ ... ::s ... t\3 C ~ rn No. 21-01- 334 Estate of Hazel M. neberlig a/k/a Hazel S. HeberlipI>eceased GRANT OF LETTERS OF AI>MINISTRATION AND NOW March 29 2001 ,in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Phyllis R. Durham is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Phyllis R. Durham in the estate of Hazel M. Heberlb; a/k/a Hazel S. Heberli~ FEES Letters of Administration ..... $ 235.00 Short Certificates(3 ) . . . . . . . . .. $ 9 . 00 Renunciation ................ $ JCP $ 5.00 TOTAL _ $249.00 Filed .... .f:'t?T:C7lJ.. ;2.9.I.~9P.1. A.D. '(1)~~ c... ;e~o J2h- p!J ~M Register Jr Wills " IRWIN McKNIGHT & HUGHES (V4.~ -'3. ~ ' Roger . Irwin, Esq. (06282) A RNEY (Sup. Ct. 1.0. No.) 60 w. pomfret Street Carlisle. PA 17013 ADDRESS 717-249-2353 PHONE Hl05.80' 1<PV 918(, This is to certifY that the information here given is correctly copied fro~ an original certificate of death dul~ filed with Local Registrar. The original certificate will be forwarded to the State VItal Records Office for permanent fillllg. me as 21-01-334 WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7247625 No. / H105.143 Rev. 2187 COMMONWEALTH OF PENNSYLVANIA 0 DEPARTMENT OF HEAL THo VITAL RECORDS CERTIFICATE OF DEATH "YPE/PRINT IN :RMANENT LACK INK NAME OF oeCEOENT(FirIt, Middle. Last) SEX 1. Hazel M. _l\AOl_I Li-~.~~~~ Local Registrar MAR II 9 2001 Date SOCIAL SECURITY NUMBER DATE OF DEATH{MonItl, Oey, v..,.) 90 V>t. 2. Female 2. 189 _ 09 _ 4629 =-~~I :::T::DEAT Checkonlyo.......inttructIonsanoltMlfsldl) Cumberland ,_ 0 T.PA h. FAOlITY NAME (If not lMtiIution, 1iI""-..... rod rwmber) 0lIw ,-,0 s. . COUNTY OF DEATH ~, ... Cumberland OECEDENrS USUAL OCCUPAnoN (GlYe kind of 'IO'k Gont during m<<* ofWOfttIngIlh;donotUN~.) . "..Homemaker ".Own DECEDENTS MAILING AOORESS CSnet, CilylTCM'I'I, $tn, rip Code) Ie. Carlisle KINO OF BUSlNEssnNOUSTRY Home DECeDeNTS ACTUAl RESIDENCE {Seeinltr\lclionS onOltMtr,1de1 171. SWhI 4.March 8 2001 RACE-AmericM tndien, Black, WhIte, lit I_' 10. Whi te SURVIVING SPOUSE (If", oM maiden '*"") 110 Marbeth Ave. 11. Carlisle, PA 17013 FATHeR'S NAME (First. Middlt. ltlIl) 10. Ra mond Shearer INFORMANT'S NAME (TypelPtint) ..Ph llis Durham METHOD OF OISPOSITIO~ . ...... ll\l "- 0 _____St... 0 -D""""s_, . 21.. Old _t ...~. Cumberland -...., "d. 00 ~"=Im",::" Carlisle MOTHER'S NAME (First, Middle, Maiden SurnarMI 1t. Ruth Ensmin er INFORMANrs MAlLlNGAOORESS (Street, CltylTown, Stale, lip Code) H~130 Lakeview Dr., Carlisle Pl.ACE Of DISPOSITION - N.mt of Cemetery, CremMoty "''''''''- 17b.County " .., "/) " "/) s ;t 2001 '4. 4: 55 am M. ... March 8, 2001 21. PART 1. Enttrh......, '""'"" Otc:ornplicMionswhic:t1 cauMcl h dNth. 00 notem.rlhe mo6eofdying. ~.. cardiecOt ~."..., lhock<<hArt faIluN. lilt Cll'IIy one c.uM on ud'l IN. I: d. WERE AUTOPSY FINDINGS AVAJl.A8lE PRIOR TO COMPLETION Of CAUSE OF DEATH? tMNNEA OF DEATH DATE OF INJURY (Month. o-y, VMr) I)i1 o o N..... - o o o "'.. .... =.'::~~~ home, fwm,.... fKtofy, offic>> .... -. Pending IlWHtiglltion V_ 0 No [ZJ V-D No[ZJ ..- Could not be ~ 2Ia. Db. CERT1f'IER(Checlt only one) ;~~::::f:,~~~:~=.n:c~:::C:::a~v:;:r:~:r~;:~:-:~:r~n_o~~_d~a~_a~.~~~~~t~m_2_3)_ _ _ _ __ .PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and cenifying to cause of death) n. -MEDICAL EXAMINERlCORONER On the ba. of examination .ndlor investigation, In my opinion, d.eth occurNd at the time, dat8, and plac., and due to the ceu..(a) .nd manner...tated. _ _ _ _ _ _ _.. _ _. _ _. _ _ _ _ _ _ _ _ _. _... _.. _ _ _ _ _. _ _ _ _ _ _. _ _ _. _ _. _ _ _ _ _. _. _ __ ... ""..... PART I: OCher IignIfIcant conditions contrIlu1ing II:) 1lHth, but I'IOtrnultinglntheundeftylng~gIvenInPAATI. TIME OF tNJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. V-D No 0 M. 3Oc:. .,.. lOCATlON (Strwt, CIylTCMIn, State) SIGNATURE o ".. lICENSE NU R DATE SIGNED (~, Dey, YUT) 5?I ",!/,M.J a ~ J2 f 2. ' /&.. 3". -3 ' '7"' 0/ NAME AND AOORE~ OF J'ER~ WHO COMPlETED CAUSE OF DEATH ,-", Tyeo",P,,", "". 1)J:ftV.Ifl<.-.J ~ o to 1 N ft4..t~ /i. ;.2.Af6 .- 32. tv+- T" "oJ DATE FILED (Monttl, Dey, y. 34. ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: HAZEL M. HEBERLIG aIkIa HAZEL S. HEBERLIG Date of Death: March 8. 2001 Estate No.: 21-01-0334 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 12. 2001 Name Address Phyllis R. Durham 130 Lakeview Drive. Carlisle. PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none. Date: 04/12/01 r'--]~ ./). d.-. Signature "" <' ) IRWIN, MCKNI~& HUGHES Name Roger B. Irwin. Esquire Address 60 West Porn fret Street Carlisle. P A 17013 Telephone (717) 249-2353 Capacity: Personal Representative .":::;' x Counsel for Personal Representative r 1- ] r j r ] ! J ] I r I ! r [ f r ! ] r [ ( [ I I I J ] I r b I r 1 r I I I I I I I [ I ! I f t ! r co q> x w C\J CD :> w a: N ex:> <D <.0 OJ oq- <( <( o z >< ~I- WQ. 1-' - <C <C W -I- 0 ~f3 W > c CC ..Jz > <C ...J ~w <I: z() - wZ 0 Q.<C _ !::u. D:u. ~O ~ <C Z <C ~ UJ >- w ~W~ c; z::::ll- ~ WZ...l cO ~~~ N o~e r::: Iu..::: <C ~oc a. <CI-i: - WZu.c;a? ~~O~::::l ~!i:~~f8 ::2:c:lH::~ OW:JW<C 001ll0I j o a: II. Q W > jjj o W a: L w a: w :I: 9 12 f' l'- ..0 ..0 ~ . "l, . l- t") t") z N QI- ::::l 0 0 0 .. .. ::!: an Il < . . I- ffi....lcr o z::!:crW uCJ)1-1J) <CJ)z::!: Wo::::l ~uz < ~ 0- N ..0 .:t I 0- ~ 0 I j::" 0- UJ CD a: ... ~ : z 03 ~ CD I: ..J ~ ,.-- w I) j::"N Z UJCl ...lD 0 p) ~J: ... 0 Q i= 0 0 8 i 8 <( I I!'.l 0 ::E ... I- _ N .J OJ a: 0 Z..J 1-' , It: , 0 0 ~a: Zlf) wg ~ ICD U. a:N ww ~o ~ 1-0' ~ w I frlm >-, 0, us' W Ill_ ~~ 0:'- fEO crt) CJ) lI::: S ~ru u. ~ ~u u. a: 0 0 Z W W I- Z W < w :E ~ UJ ::::l ~ :!: C/) ...I <C 0 0 w w u:: Z 0 Q. 0 C a: .... o .... U1 W t!) J: Q f!) .J :::H- tZlt") J:W .... . LtL.J 0 ",a:<rl'- ~z- J-COO J: t-t (!)~CD<r ....WtDll. Zo=w :t: l.L l.L .. UE:OIJJ EOl'r...l ll.Cl..tn Z t-t ....3~.J ::I me: lrewct -..o3U .. '., w a: w :I: ~ - ~ ",. ~ I I.. _ _ I., o <( ll. I- Z ::::l o :!: < ....I ~ o I- I I I I I 1 I I J en J ..J ..J ~ LL 0 a: " w I CD ~ ~ (!) I ~ w a: .. ... ] :r C) I ~ ~ I ~: 1 .,. I Zl' 1 .... ... I 3 0::. J ...~ u I E!!t I uu I ....I < I w CJ) j I I j .. I / fnventory of the real and personal estate of HAZEL M. HEBERLIG deceased , l. 110 Marbeth Avenue, Carlisle, North Middleton Township, Cumberland County. . 57,000 00 2. U.S. Savings Bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51,459 08 3. 4 U. S. Series HH Bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,000 00 4. M&T Bank - Checking Account. . . . . . . . . . . . . . . . . . . . . . . . . 8,315 57 5. M&T Bank - Checking Account. . . . . . . . . . . . . . . . . . . . . . . . . 4,996 00 I .~~ 6. M&T Bank Certificate of Deposit. I 10,031 82 ~ - . . . . . . . . . . . . . . . . . . . . . I ~~': I 7. M&T Bank - Certificate of Deposit. . . . . . . . . . . . . . . . . . . . . . 2,995 19 .~ :;; 8. Miscellaneous Personal Property. . . . . . . . . . . . . . . . . . . . . . . 1,000 00 TOTAL . . . . . . . . . . . . . . . . 137.797 66 ., , .~ ~, ,:.Ji .~ ." , - - ~- '-.. .- :, , .:: . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I J ss: Phyllis R. Durham according to law, deposes and says that she is the Executrix of the Estate of Hazel M. Heberlig late of _No~~~~_~~~!~!.~~__,!,?_~shi:e._ , Cumberland County, Pa., deceased and that the within is an inventory made by Phyllis R. Durham "' the said Executrix of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. being duly sworn Sworn and subscribed Phy 130 Lakeview Drive Notarial Seal Jacqueline L. Drawbaugh, Nota blic Carlisle 8oro. Cumberland Co i1ty My Commission Expires Aug. 14,2003 Member, PennSYI~sociation of NotarIes Death Day Carlisle, PA 17013 Address Date of 03 2001 Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be aHached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. .~ ..c: (IJ ~ tf) -0 Q) ~ >- 0 l-l ::c C!) E-l GI .~ C!) I- W ... c:: I- H III ::l P -::t ~ W -<( ~ l=l GI ::c C"") a.. I- 0 U GI (IJ 0 ~ -1-1 GI ~ <.c:l C"") 0 l.I' 0\ ~ 0 w c:: w pq Q) C III GI I ~ J: a.. ~ M a.. ~ c E-l I- ...J LL ::c '"d l=l ... ::c ...... III 0 0 Z ...J -<( 0 '"d a.. .~ == C!) I W LL -<( w ~I .~ ~ H 0 c:: ~ .;.. l-l -<( ~ ...... > Z - H N Z 0 H ..c: c cJ C ~ -1-1 :l . ~ I/) Z 0 0 c:: N l-l U pq Z w -<( ~ 0 "" ~ a.. Z -0 l-l Z c Q) H III 00 ~ ... 'i: 0 0 GI p:: H J:J " ~ GI E 0 - :l ..! 0 III u: ...J U CD [I STATUS REPORT UNDER RULE 6.12 Name of Decedent: HAZEL M. HEBERLIG Date of Death: March 8. 2001 No. 21-01-0334 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: -X.. Yes _ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. Ifthe 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: c. Did the personal representative state an account informally to the parties in interest? -X.... Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. Date: 8/29/01 :Ir.~ Signature IRWIN, Mc ' GHT & HUGHES Roger B. Irwin Esquire Name (please type or print) 60 West Pomfret Street Address Carlisle. P A 17013 City, State, Zip (717) 249-2353 Telephone Number Capacity: x Personal Representative Counsel for Personal Representative 'v / h -0.20.2.0 - /0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DA TE OF DEATH FIL,E NUMBER COUNTY ACN 07-16-2001 HEBERLIG 03-08-2001 21 01-0334 CUMBERLAND 101 , '" ROGER B IRWIN ESQ IRWIN ETAL 60 W POMFRET ST ' CARLISLE PA 17013 , Amount Remitted '* REV-1547 EX AFP liZ-ail HAZEL M 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 ~ REY=is4-j-EX--AFP-ri'2-:o0Y-NOYfcEOF-YNHEiifTANCE-YAX-irPPRAfsEi.fENT~--ALDjwANCE-(fR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HEBERLIG HAZEL M FILE NO. 21 01-0334 ACN 101 DATE 07-16-2001 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax TAX RETURN WAS: (X) ACCEPTED AS FILED 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 I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: PAYMENT DATE 06-05-2001 NOTE: RECEIPT NUMBER AA496682 DISCOUNT (+) INTEREST/PEN PAID (-) 264.40 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ) CHANGED (1) (2) (3) (4) (5) (6) (7) 57,000.00 .00 .00 .00 80,797.66 .00 .00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 137,797.66 20.281; 05 117,512.61 .00 117,512.61 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 5,288.07 .00 .00 5,288.07 5,288.07 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) (9) (10) 14,274.33 6.010.72 Ul) (12) (3) (4) .00Xoo= 117,512.61 X 045= .00 X 12 = .00 X 15 = (9)= AMOUNT PAID 5,023.67 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .)J1 ~ 0-~' . OFF1C1AL USE ONLY EV-1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN FILE NUMBER COMMONWEALTH OF PENNSYLVANIA. 21-01-0334 DEPARTMENT OF REVENUE RESIDENT DECEDENT DEPT. 280601 COUNTYCQOE YEAR NUMBER HARRISBURG. PA 17128~O601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 Heber1ig Hazel 189-09-4629 E M. C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DO-YEAR) THIS RETURN MUST BE FilED IN DUPLICATE WITH THE E 0 03/08/2001 04/13/1910 REGISTER OF WILLS E N (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FiRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER T .1- 1. Original Return 2. S'pp'emeo',' ReW," 0 3. . (date of death r- Remall"lder Retum prior to 12-13-82) CAPB - 4. Limited Estate r- 4a. Future Interest Compromise (date of death after 12- 12-82) 5. Federal Estate Tax Return Requited HpRL 6. Oecedent Maintained a U\ling Trust 1 EplO - Decedent Died Testate '-- 1. 8. T etal Number of Safe Deposit Boxes CRAC - (Attach copy ofWJlI) (Attach copy of Trust) KOTK 09. 010. 0 ES Litigation Proceeds Received Spousal Poverty Credit 11. Election to tax under Sec. 91 t3(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) TllISSECTICllftolUS'l'1l1ii I:!O!llpLE'J'$P. "l.I.',I:!ClI'lR.ESPONDENCE$..CO$FIIJIiiN']'I,,1. j'AJ(lNFOIlMATIONSflOUI.P,!E1EIlIR.EI:!TEDTO' P NAME COMPLETE MAILING ADDRESS C 0 0 Roger B. Irwin Esq. 60 West Pomfret Street R N FIRM NAME (If Applicable) Bldg. R 0 West Pomfret Professional E E IRWIN McKNIGHT & HUGHES Carlisle, PA 17013 S N T TELEPHONE NUMBER 717/249-2353 1. Real Estate (Schedule A) (1) 57,000.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule 8) (2) Non-ti. 3. Closely Held Corporation, Partnership or (3) None Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule 0) (4) None R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 80,797.66 E (Schedule E) C A 6. Jointly Owned Property (Schedule F) (6) None P I 0 Separate Billing Requested T 1. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (1) None U L (Schedule G or L) A T 8. Total Gross Assets (total Lines 1-7) (8) 137,797.66 I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,274.33 0 N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 6,010.72 11. Total Deductions (total Lines 9 & 10) (11) 20.285.05 12. Net Value of Estate (Line 8 minus Line 11) (12) 117,512.61 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Line 13) (14) 117,512.61 C SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES 0 M T P 15. Amount of Line 14 ta)(able at the spousal tax U A T rate. or transfers under Sec. 9116(0)(1.2) X 0 0 (IS) 0.00 X A 117,512.61 45 (16) T 16. Amount of Une 14 taxable at lineal rate X .0 5,288.07 I 11. Amount of Line 14 taxable at sibling rate X .12 (11l 0.00 0 N 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 19. Tax Due (19) 5,288.07 20. 'fl. L.!(:",Iiic::I!i.f1I1!lIii.IF.'(qO,A!lEI'lI;QO,,~tIN(\"!l);FUNPqFAAClVEIl~A,(M!i1ll']"...1 /0 -;);10 __10 S;{' C!.. V > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH < < Copyright (c) 2000 form software only The Lackner Group, Inc. FormREV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 110 Marbeth Avenue CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,288.07 264.40 Total Credits ( A + B + C) (2) 264.40 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (S) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WillS, AGENT 0.00 0.00 5,023.67 0.00 5,023.67 .....PlEASE ANSWE~ T~E F:~l[~~I~~ijUESTIONSBY PLACING AN t. "X" ,i:<:":<<>>,,,:>::,;::<,,:,:,,:,:::;;:::,:;"::::'i"',i',::n::::',i:'::i:': IN THE APPROPRIATE BLOCKS Yes No ~~ 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? . 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? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. o o o IT] IT] IT] 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 than the personal representative is based on all information of which preparer has any knowledge. DATE PhylliS R. Durham 130 Lakeview Drive ----------------------------------------------------- Carlisle, PA 17013 IRWIN McKNICHT & HUCHES 60 West Pomfret Street ----------------------------------------------------- Carlisle, PA 17013 &/ r; ()f SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE For dates of de th or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivingspous rs3% [72 P.S. 9116 (a)(1.1)(il]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 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%, except as noted in 72 P.S. 9116(1.2) [72 PS. 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. 9116(a)(1.3l]. 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) R€V~ 1S02 EX + (1-97) COMMONWEALTH OF PENNSYL.VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hazel M. Heberlig SS# 189-09-4629 03/08/2001 21-01-0334 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be ex.changed between a willing buyer and a wm\ng seller, neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts. Real property which is jOintly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 110 Marbeth Avenue, Carlisle, North Middleton Township - 57,000.00 settlement sheet attached SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recapitulation) $ 57 l 000.00 (11 more space is needed, insert additional sheets of the same size) Copyright (el 1996 form software only Cpsystems, Inc. Form REV-1502 EX (Rev, 1-97) R~V 1508 EX . \ 1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hazel M. Heberlig SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SSfl 189-09-4629 03/08/2001 FILE NUMBER 21-01-0334 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 U.S. Savings Bonds (list attached) 51,459.08 2 4 U.S. Series HH Bonds 2,000.00 3 M&T Bank, checking account 8,315.57 4 M&T Bank, checking account 4,996.00 5 M&T Bank, certificate of depos it 10,031.82 6 M&T Bank, certificate of deposit 2,995.19 7 Miscellaneous personal property 1,000.00 TOTAL (Also enter on line 5. Recapitulation) $ 80,797.66 (It more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-'511EX~\'-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Hazel M. Heberlig SSfI 189-09-4629 03/08/2001 FILE NUMBER 21-01-0334 Debts of decedent must be reported on Schedule J. ITEM NUMBER A. B. AMOUNT DESCRIPTION 1 FUNERAL EXPENSES, Cumberland Valley Memorial Gardens 815.00 2 Hoffman-Roth Funeral Home 5,722.50 ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name at Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid; 2. 3. Attorney's Fees IRWIN McKNIGHT & HUGHES Family Exemption; (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 7,250.00 City Relationship ot Claimant to Decedent State Zip 4. Probate Fees Register of Wills 249.00 S. Accountant's Fees 6. Tax Return Pre parer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal - estate notice publication 75.00 2 Patricia A. Rosendale CPA - 2000 income tax prep. 35.00 3 Register of Wills short certificates 9.00 4 Register of Wills filing fee 25.00 5 The Sentinel, Legal - estate notice publication 93.83 TOTAL (Also enter on line 9, Recapitulation) $ 14 , 274. 33 (If mare space is needed, insert additional sheets of the same 5128) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512. EX ~ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERIU,NCE T~ RETURN RESIDENT DECEDENT ESTATE OF Hazel M. Heberlig SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSfI 189-09-4629 03/08/2001 FILE NUMBER 21-01-0334 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Carlisle Imaging Associates AMOUNT 9.57 2 Carlisle Suburban Authority - water/sewer 70.95 3 Hoffman-Roth Funeral Home - (husband Deemer d/o/d 02/23/01) 5,695.50 4 PP&L 37.42 5 Sico, oil - check written 03/08/01, cleared bank 03/09/01 139.83 6 Yellow Breeches EMS 30.00 7 York Waste Disposal 27.45 TOTAL (Also enter on line 10, Recapitulation) $ 6,010.72 (If mare space is needed. insert additional sheets of the same size) Copyright (c) 1996 tormsottware only CPSystems, Inc. Form REV-1512 EX {Rev. 1-97} REV-1SI3 EX + \9-001 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [indude outright spousal distributions. and transfers under Sec. 9116(a)( 1.2)] Phyllis R. Durham 130 Lakeview Drive Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Do Not List Trustee{s} FILE NUMBER 21-01-0334 AMOUNT OR SHARE OF ESTATE ESTATE OF Hazel M Heberlig 5511 189-09-4629 03/08/2001 NUMBER I. Daughter remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC, 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed. insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group. inc. 0.00 Form REV-1513 EX (Rev. 9-00) A. Settlement Statement U.S. Department of HousIng and Urban Development ~ , B. Type of Loan 1. 0 FHA OMB No. 2502-0285 FmHA 3.0 Conv. Unins.Fi1e Number DURHAM Loan Number Mortgage Insurance Case Nu, 201. DeposIt or earnelt money 20~; 'Ptil1cl~af iUn()~;'f ()t ~.;,. tciiwr:il'" 203. Existing loan{s) laken subJecl 10 IO:1~.ri6tilt.Ci(Uf.a::':p(tt~i::::"": :.' 102. Personal property 1 03". a8tt~~~a.ti~ .';~h~~"~.: to' o : "WQm "Umi""f4QOr: . 104. 1& F!h:~::i)~::::?:::?:~~iiW~:~:::h:x~~~~:~,:~={;.;::::;.:7:~;j;..;::t. ~:/' ;:::<{t(t:/:k':<~ ,k.: ',,;,:..0'. 0 "." f De. ca:y/'t~~n' tax,.' : 107. County taxu . : 10,9,. Iti...il:'-rhittftil". 109. 205. 20&. 207. ,oi. - - - . ... .... . . ... .... ...... . ..... .... .. . ..... .;.::..:.::..;",".. 209. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210. C1ty/town taxes 211; COUnty fix.. to "'.tij"::.." 212. Assusments 10 2ta; . 214, 215. "" 216. 211. 218. 219,"" 753.4 57,255.9 __ '''_''',,753.4 56,502.~ HUD-1 (3-86) - RESPA, HB 4305.2 PAGE 1 1"1. '112::...... 1113. HuO-l (Rlv. 3/86) L . "..:"".,:.".",'.,..,.':,::,:.':,:.,,/:::.,',:,::':'::::::::::::::i.\::..:{::Ai 7OQ. TOTAL SALES/BROKER'S COMMISSION OMB No. 2502-0285 ::.::' :::::(:~:~:::i:::::: ::::.::. ,~::/:: :~:: }':::::;:::'K;,;:~:: BASED ON PRICE $ @ %. PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FRm SELLER'S FUNDS AT SETTLEMEI DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: . oj; 702. 103;::(jomml..lOrr . 'lld Al . 704. iio't:::tc:I;{.~i:'" 604. Crldlt rl orl 10: ','. ..tt' 806. Morl a I Inlurancl a f 608. ::,:,:".".".:,.,.., 9oi:::.Mlfli...'.#om.... 1001:..Hatard'm.'li,:' "c.'.;:' 1002. Mort a I Insurance 'f \. 1004. Counl ro Irt taXIs . 'S: rin".. 1008. Rood Inlurancl n 1067;' .:.. 1008. A re at~ 1100. TITLE CHAR ES: 1101, Settlemlnl or clolln fee to 110"2'.' Abafnic'f ./it. :lrlte:' s.art~' to 1103. Title examlnallon to 1l04~.tlit"lrt.~riffi~.'bl' a.r'ta:'.. . . 1105. Document re aratlon 10 . i~',:N .' at' lee:.": 1107. n .' 'a 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES: ~~;~ Aecordr;;" 'tin:" ". ". .... bflea' '..... .'., ;'.:': ,,2 5:.~,50.).;,.,'{'~tl:ti...;a'. ."i' 570.00 570;00 1202. ClI count ta starn s: ltloi!<'Elfita la' uiirri ''s: 1204. 120$.: . 1300. ADDITIONAL ETTLEMENT CHARGES: Deed .'.;:....;r)._d 570.( ...... ... ............... "'1 Si.'i{~' . IIi{: .' 1302. Pes' Ins ecUon to 193' 1304. o 1306. t 07 2001 OfT\<iP AXE 1< erN 0 LEN ERG R ............;'.:,'::::,.,':;':';:":.;:,':"".".:,:. .,". .. .. ".,: '.17 .4 1,072.50 753.4 nt at ment and to the besl 01 my knowledge and beUel, It II a Irue and accurate Itatemenl 01 all recelpte and disbursements made lun er certify Ihal I have received a copy of the HUD-l Selllement Statement. ESTA OF HAZEL M. HEBERLIG 4/26/01 s."" 0' Dale: Agenl: DOl" 4/26/01 Borrower: Date: Sener or Aglnt: Dais: The HUD-l Senlement Slate men I which I havI prepared III a Irue and accurale accounl of Ihls trilnllaCtJon. I have caulled or will cause the lundll to be disbursed In accordanClI with Ihls statement. Dale: Belllement Agenl: 3.d- IN ESQUIRE DOl" 4/26/01 WARNING: It Is a crime 10 knowingly make lalse stalemllnts 10 Ihe United Statn on Ihls or any other similar form. lInatll s upon convlcllon can Include a fine and Imprlllon- menl. For delalls SOl: Tille 16 U.S. Code SecUon 1001 and Section 1010. ~M&rBank April 3, 200 I RE: Estate Search The Estate of: Date of Death (D.O. D.) HAZEL M HEBERLlG 3/8/2001 To Whom It May Concern: Identified below is the account information requested. 1. M&T Bank accounts in which the decedent's name appears: Account Account Number Account Title Opening Branch Type CHK 417165 DEEMER L HEBERLIG 4319 OPENED 9/67 HAZEL M HEBERLIG CHK 1081489 DEEMER L HEBERLIG 4319 OPENED 8/90 HAZEL M HEBERLIG CD 31003911161930 DEEMER L HEBERLIG OR 4319 OPENED 2/92 HAZEL M HEBERLIG CD 31003911162384 DEEMER L HEBERLIG OR 4319 OPENED 3/92 HAZEL M HEBERLIG 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed D.O.D. Accrued Interest Balances (Includes Accr. Int.) $8315.57 $.00 $4996.00 $.00 $10,031.82 $31.82 $2995.19 $139.42 Account Description A Safe Deposit Box titled in the Decedent's name existed at our HIGH STREET CARLISLE. The Safe Deposit Box Number is 0000238. If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK CORPORA nON BY: ~ flA ~~Vv? ~--<f /~ Authorized Signature DATE: L( ~ '2.,-0 I Manutacturers and Traders Trust Company. 1100 Wehrle Drive, PO Box 767, Buffalo, NY 14240-0767 Hazel M. Heberlig Estate Accrual Bonds Redemption Date: 3/2001 Issue Yield Next Final Serial Number Denom. Series Date Value Interest To Date Accrual Maturity 1262364026E $50 E 7/1953 $331. 62 $294.12 5.52% 7/1993 3 M43888855EE $1,000 EE 2/1992 $851. 60 $351. 60 6.01% 8/2001 2/2022 * M43888856EE $1,000 EE 2/1992 $851. 60 $351. 60 6.01% 8/2001 2/2022 * M43888857EE $1,000 EE 2/1992 $851. 60 $351.60 6.01% 8/2001 2/2022 * D102709885E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709876E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709887E $500 E 2/1974 $2,281. 80 $1,906.80 6.80% 8/2001 2/2004 D102709873E $500 E 2/1974 $2,281. 80 $1,906.80 6.80% 8/2001 2/2004 D102709872E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709874E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709875E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709878E $500 E 2/1974 $2,281. 80 $1,906.80 6.80% 8/2001 2/2004 D102709888E $500 E 2/1974 $2,281. 80 $1,906.80 6.80% 8/2001 2/2004 D102709879E $500 E 2/1974 $2,281. 80 $1,906.80 6.80% 8/2001 2/2004 D102709886E $500 E 2/1974 $2,281. 80 $1,906.80 6.80% 8/2001 2/2004 D102709884E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709883E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709880E $500 E 2/1974 $2,281. 80 $1,906.80 6.80% 8/2001 2/2004 D102709882E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D102709881E $500 E 2/1974 $2,281.80 $1,906.80 6.80% 8/2001 2/2004 D11455440EE $500 EE 3/1986 $636.60 $386.60 6.33% 9/2001 3/2016 D010796057EE $500 EE 3/1986 $636.60 $386.60 6.33% 9/2001 3/2016 D010796058EE $500 EE 3/1986 $636.60 $386.60 6.33% 9/2001 3/2016 D11455439EE $500 EE 3/1986 $636.60 $386.60 6.33% 9/2001 3/2016 M43888850EE $1,000 EE 2/1992 $851. 60 $351.60 6.01% 8/2001 2/2022 * M43888848EE $1,000 EE 2/1992 $851. 60 $351. 60 6.01% 8/2001 2/2022 * M43888849EE $1,000 EE 2/1992 $851.60 $351.60 6.01% 8/2001 2/2022 * M14478690EE $1,000 EE 3/1986 $1,273.20 $773.20 6.33% 9/2001 3/2016 M14748691EE $1,000 EE 3/1986 $1,273.20 $773.20 6.33% 9/2001 3/2016 M43888851EE $1,000 EE 2/1992 $851. 60 $351.60 6.01% 8/2001 2/2022 * M43888852EE $1,000 EE 2/1992 $851.60 $351. 60 6.01% 8/2001 2/2022 * M43888853EE $1,000 EE 2/1992 $851.60 $351. 60 6.01% 8/2001 2/2022 * M43888854EE $1,000 EE 2/1992 $851.60 $351. 60 6.01% 8/2001 2/2022 * 1271264440E $50 E 2/1954 $337.72 $300.22 5.57% 2/1994 3 1274800429E $50 E 5/1954 $345.38 $307.88 5.63% 5/1994 3 1257768344E $50 E 3/1953 $326.76 $289.26 5.49% 3/1993 3 1 = Not eligible for payment (purchase price) 2 = Matured (exchangeable for HH) 3 = Matured (not exchangeable) . = Possibly eligible for U.S. Savings Bond Education Benefit Program. See footnotes on Inventory Summary page. 1 Hazel M. Heberlig Estate Inventory Summary Redemption Date: 3/2001 Number Inventory Redemption of Bonds Value Value Interest Accrual Bonds Pre-January 1990 Issue Dates: 26 $42,943.08 $42,943.08 $34,793.08 January 1990 and Later Issue Dates: 10 $8,516.00 $8,516.00 $3,516.00 * 36 $51,459.08 $51,459.08 $38,309.08 Current Income Bonds 0 $0.00 $0.00 $0.00 Inventory Totals 36 $51,459.08 $51,459.08 $38,309.08 Footnotes * Proceeds from Series EE & I Savings Bonds with issue dates beginning January 1990 may be eligible for special tax exemption when used for post-secondary education. For further information concerning the benefits and restrictions that apply, please contact the Internal Revenue Service. 1 These bonds are not eligible for payment within 6 months of their issue date. 2 These bonds have reached final maturity and will earn no additional interest. They can be exchanged for HH Bonds within a year of their final maturity date. 3 These bonds have reached final maturity and will ear~ no additional interest. They are not eligible for exchange for Series HH Bonds since they have been held over a year past their final maturity date. 2