HomeMy WebLinkAbout01-0334
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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.
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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
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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
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. 21..
Old
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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
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'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)
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=.'::~~~ home, fwm,.... fKtofy, offic>>
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Pending IlWHtiglltion
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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. _ _ _ _ _ _ _.. _ _. _ _. _ _ _ _ _ _ _ _ _. _... _.. _ _ _ _ _. _ _ _ _ _ _. _ _ _. _ _. _ _ _ _ _. _. _ __
...
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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:.
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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.
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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
.":::;'
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Counsel for Personal Representative
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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 ~~':
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7. M&T Bank - Certificate of Deposit. . . . . . . . . . . . . . . . . . . . . . 2,995 19 .~
:;;
8. Miscellaneous Personal Property. . . . . . . . . . . . . . . . . . . . . . . 1,000 00
TOTAL . . . . . . . . . . . . . . . . 137.797 66
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I
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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.
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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