HomeMy WebLinkAbout88-0256 v
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of MILDRED M. HEISEY No, 21-83—p��p
also known as To:
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 17 5—5 0— 6 2 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/�� 18 years of age or older an the execut rix named
in the last wil}of the above decedent, dated y�x�tPmber 2 6� , 194 7
and codicil(s) dated N/A
(state relevant circi�mstances,e.g. renunciation, death of executor, etc.)
Decedent w�as domiciled at death in Cumberland County, Pennsylvania, with
h P r last family or principal residence at 10 0 0 W S outh S t. , C ar 1 i s 1 e,
PA (Carlisle Borough)
(list street, number,Twp. or Boro.)
Decedent, thcn 3� years of age, died r'iarch 24 , 19 �� ,
at S�rah Tnr�r� Memnri al H�mP,.., ('ar'lisle, pA .
Except as follows, decedent did not marry,was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a ki!ling and was never adjudicated
incompetent:
Decedent at death ow�ned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ unestirnated
(If not domiciled in Pa.) Personal property in Pennsylvania $ —�—
(If not domiciled in Pa.) Personal property in County $ —�—
Value of real estate in Pennsylvania $ ��'
situated as follows: Nf A
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
� ,.�.� � • ���
V /
C. �vp,�/
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�v Gene M Gibney
° 1140 Baish Road
-d,o
�� Mechanicsburq, PA 1
�a ('1 71 �SR—F21 �i
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a
on
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA � ss
COUNTY OF CUMBERLAND
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 represen-
tative(s) of the above decedent petitioner(s) will well a truly administer t estate according to law.
Sworn to or affirmed and subscribed
�c.� �l ' ,-���f�-a z�- v,
4th Gene M. i ney oo'
before m ril —19d�� of _ A
�
� rL ,�.-G �
Ivlq � C. wis Register �
_ r��:�
� ,� - �Z� �� � �— I l� :��;,�
NO. 21-88 - 256
Estate of MILDRFD P�I. HEISFY , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW April 5 , 19 8 8 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated S ep tembe r 2 6 . 19 4 7
described therein be admitted to probate and filed of record as the last will of Mildred M. Heisey
and Letters Testamentary '
are hereby granted to Gene M. Gibney
WILL BOOK #106
v/' � �
PAGE 8 0 8 ETC. Mary C. &6�i��of w� s
FEES
Probate, Letters, Etc. . . . . . . . . . $ 7 5 . 0 0 Rob e rt '.2. B l a ck, E s q. #0 6 2 6 7
Short Certificates( � . . . . . . . . . . $ 4. �� ATTORNEY(Sup. Ct. I.D. No.)
Renunciation . . . . . . . . . . . . . . . . $ 36 South Hanover Street
$ Carlisle, ��DRESS
TOTAL $ 79 • 00
. . . �g��� . . . . (717) 243-3727
Filed 5. . . ,. .19 8 8 . . . . . . . .
YHONE
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Called attorney on 4-5-88 .
, ..'�.
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kl4�ARNING: It is i�legal to�ItPr this capy or to duplicate hy photostat or photograph.
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i, Mildred 2�. Heisey, of �onroe Townshi�, Cumberlan�
County, Pennsylvania, do make this my 2ast �ill and testament
hereby revokin� all wills at any time heretofore made by me.
After the payment of my just debts and funeral exnenses
I give, devise and bequeath all of my estate, real �nd personal,
to my husband, Chester H. Heisey.
8hould my said husband predecease me, in that even� I give
and devise all of my estate , real and personal, to my daughter,
Gene M. Gibney.
I nominate, constitute and appoint my said husband, Chester
H. Heisey, executor of this my last will and testament and in
case �y said husband should h�ve predeceased me I nominate,
constitute and �ppoint my daughter, Gene M. Gibney, to b e the
executrix of this my last will and testament.
In �itness whereof I have hereunto set my hand and seal
to this my last will and testament this � b �. day of
29 47.
AL)
9igned, eealed, published and declared by r�ildred r.2. Heisey,
the testatrix above nar�ed, as and for her last will and testament
in the presence of us, who in her presence at h�er request and in
the presence of each other have hereunto set our names as
w' tnesses:
��
J t..��3�;4
21 - 88 - 256
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
;
/
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� ,
codicil
(each) a subscribing w' ess to the will presented herewith, (each) being duly yualified according to
law, depose(s) and say(s) t -��'_ present and saw
,
the testat , sign the same an at .- signed as a witness at the
request of testat in tL_ presenlse and (in the presence of each other) (in the presenee of the
other subscribing witness(es)). `,,ti
�,.
Sworn to or affirmed an�subscribed before ~
�.
—��
me this day of (Name)
19 _
�=f f L (Address)
Register
'jYYame)
(Addre
REGISTER OF WILLS OF �iL1 yv113C- t.�N�COUNTY
OATH OF NON-SUBSCRIBING WITNESS
��N� i�Jl. (�s N��1 � �n✓�T � ��/-�C K ,
�
(each),a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
'�FI�� �__ familiar with the signature of 1� I L-12�2E I? h�. ��l S��
�eeke�•
testat��C_ of (one of the subscribing witnesses to) the will presented herewith and
•�s�iiw�
t}��t }�alia.iao fl,o ot„ .f��,.:1�6�..�i....:c...,._�L
that THEY
Xc,��i�
believes the signature on the will is in the handwriting of MILDRED M. HEISEY
to the best of THEIR knowledge and belief.
Sworn to or affirmed and subscribed before '`
me this 4TH day of (Name)
APRIL 19 88 J/ � �� - �-�ln��� ,p-
I d �
Register �
� (Name)��G����
3(� S G,r•r.s�, �_
(Address)
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REV-2500 EX+ (8-86) � `-`' -� �"`-' � ` FILE NUMBER
INH�RITANCE TAX RETURN
� �' RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA (TO BE FILE� IN DUPLICATE 21-58-256
DEPARTMENT OF REVENUE
POST OFFICE BOX 8327 WITH REGISTER OF WILLS)
HARRISBURG,PA 17105-8327
DECEDENT'S NAME(LAST,FIRST,AND MIDDLE INITIAL) DE�EDENT'S COMPLETE ADDRESS
F
W Sarah A. 'Ibd.d M�norial Home
o Heisey, rti.ldred M.
� SOCIAL SECURITY NUMBER �DATE OF DEATH �OOO j,7est South Street
0 175-50-4962 March 24, 19�8 ��'lisle, PA 17013
_-_ ---- - r Ctmlberland
- -- ----------------- --- ---
W
F- � 1. Original Return ❑ 2. $upplemental Return ❑ 3. Remainder Return
Y�Y (for dates of death prior to 12-13-82)
W a V ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise ❑ 5. Federal Estate Tax
v�m (for dates of death aRer 12-12-82) Return Required
� 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust �8. Total Number of Safe Deposit Boxes
a (Attach copy of Will) (Attach copy of Trust�
-_. _.__ __
ALL CORRESPONDENC� ANd CONFIDENTIAL TAX INFORMATIaN SHOttLD BE DIR�C�ED TO:
1 F, NAME - --- --- _ _COMP jE MAI AD RESS - ---_ _ - - _ '
�Lan�.is, �3"�ac� & Schorop
� c Robert R. Black, Fsquire �36 South Fianover Street
� O TELEPHONE NUMBER C�Z1Sle� PA 17013
_- _L��'� ) 243-3727
1. Real Estate (Schedule A) ( 1) �.�� - . ,� �
2. Stocks and Bonds (Schedule B) ( 2) 9,752.34 • ��.
3. Closely Held $tock/Partnership Interest (Schedule C) , 3) �•�� -. �
4. Mortgages and Notes Receivable (Schedule D) ( 4) �•�� .
5. Cash, Bank Deposits&Miscellaneous Personal Property( 5) 38,530.�5
(Schedule E)
Z 0.00
O 6. Jointly Owned Property (Schedule F) ( 6)
�
J 7. Transfers (Schedule G) (Schedule L) ( 7) �•00
h 8. Total Gross Assets (total lines 1-7) ( 8) 4c��2�3.19
� 7 303.24
Q 9. Funeral Expenses, Administrative Costs, Miicellaneous ( 9) �
W Expenses (5chedule H)
oe
10. Debts, Mortgage Liabilities, Liens (Schedule 1) (10) �-,358.0�
11. Total Deductions (total lines 9 & 10) (��) �,661.24
12. Net Value of Estate (line 8 minus line 11) (12) 39,621.�5
13. Charitable and Governmental Bequests (Schedule 1) (13) �•��
14. Net Value Subject to Tax (line 12 minus line 13) (14) 39�F21.95
15. Amount of line 14 taxable at 6% rate (15) 39,621.95 x .06 = 2 r 377.32
(�nclude values from Schedule K or Schedule M.)
16. Amount of line 14 toxable at 15% rate (16) x .15 = _
(Include values from Schedule K or Schedule M.)
Z
� 17. Principal tax due(Add tax from line 15 and from line 16.) (17) 2.377.32
F _.
� 18. Credits Prior Payments Discount Interest
� 2,000.00 + 105.26 _ (�8) 2.,105.26
Q 19. If line 18 is greater ihan line 17, enter the difference on line 19. This is the dVERPAYMENT. (19) �•00 _
u A.❑Check here if you are requesting a refund of your overpayment.
K
� 20. If line 17 is greater than line 18, enter the difFerence on line 20. This is the TAX DUE. (20) 272•Oh
A.Enter the interest on the balance due on line 20A. (20A) �•�n __
B. Enter the total of line 20 and 20A on line 20B. This is the BALANCE DUE. (20B) 272•n6
Make Check Payable to: Register of Wills, Agent
--- --- - __.. _ _ --- -
■► �► BE SURE T4 ANSWER AEL QUESTIdNS t?M REVERSE 51DE AND'TO RECHECK MI1TH� i
- - - ----- _ _� __ _-�-
Under penalties of perjury, I declare that I have axamined this return, including accompanying schedules and stotements,and to the best of my knowledge ond belief,
it is true, correct and complete. I declare that all real estate has been reported ot true market value. Declaration of preparer other than the personal representative is
based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING�ETURN ADDRESS DATE
Gene � Gibne ..� �� > ,
-•- Baish Road, N[echanicsburq, PA 17055 ���8g__
SIGNATU E P RE TH . N PRE TATIVE ADDRESS � DATE
� � U 36 South Hanover Street, Carlisle, PA 17013 9/ � /88
� R.J-obert R. B ack
- - --_ ._
.
� .
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK ( �) IN THE
APPROPRIATE BLOCKS.
YES i NO
� �
1 . Did decedent make a transfer and: I�I�
a. retain the use or incame of the property transferred, ....................................... ___� x_
b. retain the right to designate who shall use the property transferred or its income, I� X
c. retain a reversionary interest or .................................................................... X
�—
P P Y z ... _x
d. receive the romise for life of either a ments, benefits or care. .................... �i
2. If death occurred on or before December 12, 1982, did decedent within two years �I
preceding death transfer property without receiving adequate consideration? If death 'I
occurred after December 12, 1982, did decedent transfer property within one year of ' x
death without receiving adequate consideration? ................................................. �_
3. Did decedent own an 'in trust for' bank account at his or her death?...................... I', Y
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
i, Mildred td. Heisey, of �2onroe Totivnshi�, Cumberland
County, Pennsylvania, do make this my last will and testament
hereby revokin� a11 wills at any time heretofore made by me.
After the payment of my juat debts and funeral expenses
I give, devise and bequea.th a11 of my estate, re�l �,nd personal,
to rny husb�,nd, Chester H. Heisey.
Should my said husband predecease me, in th�.t even� I give
�,nd devise all of my estate , real and personal, to my daughter,
Gene M. Gibney. '
I nominate , constitute and appoint my said husband, Che�ter
H. Heisey, executor of this my la,st wi11 and testament and in
case my said hueband should have predeceased me I nominate,
constitute and appoint my daughter, Gene �1. Gibney, to be the
executxix of this my last will and testament.
Tn witness whereof I have hereunto set my hand and seal
to this my last will and testt�ment this o16 "� day of
1�4'7.
AL)
gig'ned, eea,led, published and declared by �dildred �li. Heisey,
the testatrix above narned, as and for her last will and testament
in the presence of us, who in her presence at h�ex request and 3.n
the presence of each other have hereunto set our names as
w' tnesses ;
t�-�,�-'�
REV•1503 EX t(9•81)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE "B"
INHERITANCE TAX RETURN STOCKS AlVD BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Heisey, Mildred i'•Z. 2?-88-256
lAll 4roperty jointly-owned with Right of Survivorahip must be disclosed on Schedule"F")
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 5�0.657 Shares of Gaellington F�uid, account no. �73061_l90 at �16.3
See attached letter. 5�t,323.53
2. 32 Shares of Y.eystone �i-4 F`und, accotmt no. 046-8304700305 at
6.89. See attached letter. 22�.48
3. � Share of Keystone B-1 Fund, account no. 047-8305368J_09 at ��.33 8.33
n. 21 Shares of TCeystone S-1 F�,ind, account no. 0�9-g304��0305 at
$19.45 q0�,a5
5. 35 Shares of Ye_ystone K-1 F�ind, account no. 0�7�330470�J305 at
$8.33 2i9.55
TOTAL (Also enter on line 2, Recapitulation) $ g,'752.34
(If more space ts needed insert additional sfieets of same size)
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ty1�I�I� 27 , 19BB
I��,(7bT�F 1 Ft. I3i,ACK
T.Ai�I 5, BI.ACK, s� SCH(3RPP
3 8 SOt7Ti-? Ii�AP10V7CR S�'I�d.EET
C1�tL I aLE , PA 17 013 Rr:FE�i.i�;i`3CE:
WELL I1"d(�TOI'� FUND j
ACCOUNT # 978061190 NAMi; OF:
iVII LL1I;E�7 Pr� HE I SEY
C/O GEIv1E 1V! G I BNEY
114 0 BA I�H R3�
1!,IECf�AAN i CSI3URG PA 17 0 5 5
ilear Mr. . I31 ack:
Thank yaix for your recent letter ecn.cernir��; ttyis account . In
order t�� transfer this accaunt v�e �vill need some additional
inform�.tion.
44�e must be furni �tieci with a certified cop� of the ix�str�ient
is�uecl Uy the court of proper jurisdictioxi appointiri�; tlie
Executrix. 'i,he certification must be macle by the court or clerk
of the courfi . It must be dated c��ithin sixty � 60 ) days of the
proposed tr�zris�xction, bear the raise�l court seal or stamp a�d
iridicate th�t the letters are in full f�rce and effect . Please
b� sure the certification is origixial ; we cann�t rzccept a
photocopy.
In additioii, we will neeci tlie Lxecutri�: to provicle us with a
si�nature gu�.-rantee . �� stock assi�nmeizt has Ueerz enclo�ed for
�,�our converiience.
A si�n�iture gudrantee can be oi�tained by a bank or major stock
e:zchan�;e brokertage firm. Notariz�tian by a notary public is not
�.cceptr�ble . If a si�nature guaraiitee stamp is x�ot available , we
�vill require the words "sign�.ture guaranteecl" either t�ped or
handwritten , along with the branch naine of the Uank or brokers��,�e
f irm, ariel i:he si�nsture and t i t le of the representat ive i ssuing
t h e s i gn a t u r �R�".'�""""""'�"�=°-_
__.. _._.
_.... . _ .
__. . _ . ..... . ....,..._.,„�,.��:.�.�.-•..
As of tlie date of death, t�ii � account held 540 . 65'l �Yiar•es ut a ,, �
pricc, <>f �16 . 3� er share _f�„�;�a t,otal value of. $8 , 823 . 52 .
���._ ._..._ _ .
, •
-----____�.._.��._�.n .. . . .�.---------�--��---_
1 i;i,i .r "• "'"`, " ' , `rnnsyl�rania 1�'1t�2 _ _ __
c,�, ,.,,•� , . ,,E •,, ,t„.
. . _ _- -__.___ -- ___
�Cz�il r're. t -t",,'.�.. , , ',I+r� � . , . ia;lt�) 6�1-Z7��i
� KEYS"I�t��:�I�.�E �I�'�TES'T��?R ��I�SC�?._��.{�'E i�;�:�"�?T�Fi, IN;°.
F�<�}. .�'.1�:
(�t)sC�_);}. f.1.''. t�L IOr�-.?1 J j
(,�i�1') )'�.7.�::;1�`S
VALUATION
ACCOUNT # 046-8304700305
REGISTERED TO: Mildred M. Heisey
At the close of business on March 24, 1988 , the net asset
value of the Keystone B-4 Fund was $ 6 . 89
per share. To calculate the value of the above account, multiply
$ 6 . 89 (the price per share) by the number of shares owned
� 32 ) .
This should not be considered a stable quotation as �he price
of stocks and mutual funds fluctuates daily. To keep abreast
of the current value of the R_4 Fund, we suggest you
consult the mutual fund listings on the financial pages of
your local newspaper.
Very truly yours,
_..�c���.--�-�- ,f;�z-%r',-t--�
Investor Se� vices De artment
, .
KEY�T'�-;j�°a� �Iti���°�'���R �ZI:S��?.��Z��E �;��"�T�R, IN��;.
T�<,x 't�'.1
ii�is;un, t.t,-"'s .�._�('ti-�?'l
(,tii'�����'�:i .���>�-_';'i`)�`�
VALUATION
ACCOUNT # 047-8305368109
REGISTERED TO: Mildred M, Heisey
At the close of business on March 24 , 1988 , the net asset
value of the Keystone K-1 Fund was $ 8 , 33
per share. To calculate the value of the above account, multiply
$ � _ �� (the price per share) by the number of shares owned
( 1 . 000 ) .
This should not be considered a stable quotation as the price
of stocks and mutual funds fluctuates daily. To keep abreast
of the current value of the K-1 Fund, we suggest you
consult the mutual fund listings on the financial pages of
your local newspaper.
Very truly yours,
..i•G--�"7�.e��..^..,:�(✓' F7�,r--cw . >._
/ ����
Investor S ices Department
� K��YS"I't:::fT.l� �N�'��'T:�Ik �I����?-'�r'E �;E�"��'�:IZ, IT��:.
,
T.�<,1. Z 1_.:
i3c�:;tun, ,'�f,': i:�Zii'�t_�-�!'(
(.`'1i��i,i �'��i.�i�,�%��
VALUATION
ACCOUNT # 049-8304700305
REGISTERED TO: Mildred M. Heisey
At the close of business on March 24 , 1988 , the net asset
value of the Keystone S-1 Fund was $ 19 . 45
per share. To calculate the value of the above account, multiply
$ 19 . 45 ( the price per share) by the number of shares owned
� 21. 000 ) •
This should not be considered a stable quotation as the price
of stocks and mutual funds fluctuates daily. To keep abreast
of the current value of the S-1 Fund, we suggest you
consult the mutual fund listings on the financial pages of
your local newspaper.
Very truly yours,
_ �--s--�--" I�''`: �--.
�
Investor S rvices Department
� K���Pr�t�;�ra� ����Esr�4��: x�s��7.,����. �.�:.�a��x, Ir��.
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VALUATION
ACCOUNT # 047-8304700305
REGISTERED TO: Mildred M. Heisey
At the close of business on March 24, 1988 , the net asset
value of the Keystone K-1 Fund was $ 8 . 33
per share. To calculate the value of the above account, multiply
$ 8 . 33 (the price per share) by the number of shares owned
� 35 ) .
This should not be considered a stable quotation as the price
of stocks and mutual funds fluctuates daily. To keep abreast
of the current value of �the K-1 Fund, we suggest you
consult the mutual fund listings on the financial pages of
your local newspaper.
Very truly yours,
�. �f-�- �-�.�,�c..��
.�C..--v�.es-:%z
Investor vices e artment
_. P
REV-1508 EX+ (7_83)
SCHEDULE "E"
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS AND
INHERITANCE TAX RETURN MISCELLANEOUS
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Heisey, Mildred M. 21-88-256
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule "F")
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
�• D D account - Ccgm�onwealth Plational Bank # 220-70314. See attach
letter. Principal 38,168.28
Interest 125.07
2. D D account Ca�wnwealth National Bank #222-452640 ]_80,pg
3. Health Insurance Reftmd 57.42
4. Purdential Life Insurance Policies: p,pp
A. M10-321-£i55 issuec� 1947 - 500.00
B. 71-588-4.36 issued 1927 - 236.00
C. 71-588-427 issued 1927 - 236.00
Face Sheets attached. Not t�ble.
TOTAL (Also enter on line 5, Recapitulation) $ 38,530.85
(If more space is needed insen additional sheets of same size)
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Ptudentia/ Tne Prudentiai Statement of Bene•
Insurance Company
of America
Check no.
N W SH MRN D MAY- 18- 1988 0895483 �
Benefit Insured Letters Check amount Certificate no. Certificate amount
DEATH ( M HEISEY ��$2 , 252 . 47
lPolicy Claim
Numbers 071588436 , 071588427 Number 4731�
IAddressee Payee
GENE M GIBNEY ADMININST OF EST OF* GENE M GIBNEY ADMININST OF EST OF
MILDRED M HEISEY* MILDRED M HEISEY*
1140 BAISH ROAD
MECHANICSBURG , PA 17055
INCLUDED AMOUNTS $2 , 231 . 18 AMOUNT OF INSURANCE ( INCLUDING PAID UP
ADDITIONAL INSURANCE )
2? . 2� �'C�i.�,l' GR i,uivTK�iC► i�l i ERES7
$2 , 252 . 47 AMOUNT OF PAYMENT
Instructions for Payee on reverse of this form.
Please see paragraph(s)
1.
Comb 34771 A VA71A1
���,/��'a, The Prudential St�tement of Benefi
�/ Insurance Company
of America
Check no.
N W SH MRN D MAY- 19- 1988 0896273 L_
Benefit Insured Letters Check amount Certificate no. Certificate amount
DEATH M HEISEY $1 , 315 . 98
IPolicy Claim
Numbers M 10321855 Number 473924
Addressee Payee
GENE M GIBNEY ADMIN OF THE EST OF* GENE M GIBNEY ADMIN OF THE EST OF�
MILDRED M HEISEY* MILDRED M HEISEY*
1140 BAISH ROAD
MECHANICSBURG , PA 17055
INCLUDED AMOUNTS $540 . 00 AMOUNT OF INSURANCE
746 . 81 PAID UP ADDITIONAL INSURANCE
_ 16 . 50 TFRMINATIQN DIVIDEND
12 . 67 POLICY OR CONTRACT INTEREST
$1 , 315 . 98 AMOUNT OF PAYMENT
Instructions for Payee on reverse of this form.
Please see paragraph(5)
I7
I
Comb 34771 A VA71A1
(�, U ia .i. .L Poiicy Numoer
Date of '
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E�r, � _ A MUTUAL L`IFE INSU�tANCE COMPANY = _ _ I�I i� �
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� �;' (HER�INAFTER D$SIGNATCD AS THF, A i
�'.�`ap �
�(tC�Olt�l'bCr�tl011'bf the'�ppYication`for this Policy and of the payment of the monthly premiurns '°
will a subject to the provisions of this Policy, tlie amount of insurance provided herein, ' ��II
stated herein, p Y,
upon legal surrender of this Policy at the Home Office of the Companq, to the Beneficiary under this ,, ; ,I
immediatel upon receipt at the Home Of�'ice of due proof of the death of the Insured. II � �,I;�
Policy Y �' 'il�'.
��
SCHEDULE �
I'll,'
Insuring Age Face Amount of Insurance dl,
Name of the Insured (Last name firsc) Payabt�ae Deaeh � �V�
I�I�II
HE ( SEY � M I LDHEU t� 48 � '` � UO - ��I,
�
,,,,
Name of the Beneficiary (Last name firat)
Relationship to the Insured o I,Illi
i
Hk I SEY � CHES �t� � K H NUSE3AIVU I;
Policy Number Monthly Premium due immediately, and a like amount due at the end of one month �I'
from the date of issue of this Policy,arid at the end of each monthly �I I'
interval thereafter until twenty fu l l years' premiums hav e b e en paid i i l!�', +.
I� 1 U j �.�. 1 � 5 5 � `�,,.�j L} or until the prior death of the Tnsured. Any premium not paid �I .' i �j�li
II ii,j; .
when due ahall be deemed to be in default. ' � , �,'�I
The premium specifiod above is in accordanee with the Company's table of premiums for policies of the Intermediate class I I, I'I�li'
on the lives of persons engaged in the same occupation as tho Insurod. �
Payment of Premiums:All premiums are payable at the Home Office or to an authorized agent of the �P j, ,i�,;
onl in exchange for an official receipt signed b1� the President, Secretary or Treasurer of the � , � '��,Ilii
Company, but y q
Company and countersigned by the agent receiving the premium. If for any reason the premium is not called I; i
for when due, it shall be the duty of the policyholder, before the premium is in default more than thirty-one I; i
The a ment of any premium shall not �� '�' !
� days, to bring or send the premium to an office of the Company. P Y , ;'
maintain this Policy in force beyond the clate when the next premium becomes due except as provided in this ,,, �
Policy.
Control.—The Insured alo
ne shall be entitled during his or her lifetime, without i;he consent and to the ' IIIII
' exclusion of the Beneficiary, to obtain any loan, cash surrender value and any other benefit and value accruing ,illll�
hereunder, and to change the Beneficiary, to assign this Policy and to exercise any other right or option conferred I,
;: � � I � �I �;,;.
` by this Policy or allowed by the Company. ��� ,, iii',.
�, , ,i�.
' Any sum payable by the Company under this Policy shall be payable at its Home Office. I�
�
�'- The provisions set forth by the Gompany on the following pages are a part of this Policy. �� i i II
� I
� ENTIRE CONTRACT.—This Policy together with the Application, a copy of which is attaclied hereto, I, i'j, �j,,
�i I; ,,
acontains and constitutes the entire �ontract.between the parties hereto. All statements made in the ly i ,
,, III , �il
�; Application shall in the absence of fraud be deemed representations and not warranties, and na statement i III
;�: shall avoid this Policy or be used as a defense to a claim hereunder unless it is contained in the Application I �
n�, I I'' ��'�
and a copy thereof is attached to this Policy when issued.
� .
f �j� ��trie�� ��jereof, THE PRUDENTIAL INSURANCE COMPANY OF AMERICA has eaused this li� , ;� �;�
�
Policy to be executed at its Home Of�'ice in the City of Newark, New Jersey, on the above date of issue of this �: �
`� '�
Polic .
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� President. �i� '��
j''?' ' /����'� i
,c Secretary. i i
� �II�,���IIIJ'�'I�IIr� ��
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Twenty-year Payment Life Intermediate Monthly Premium Poliey. Premiums Yayable for Twenty Years or Until ry , I,
� I�
��i i i . Prior Death. Insurance Payable Only at Death^ Annual Dividends. BeneRts in Event of Total and
__ .���� ...,. ,K 1.,,. upf,.rP AvP Fin_ i I���. v,t
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} ta � ..y.. . ��,'� . .��.�{L /91"r4Pi� � `��y ����.
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:��(lLongiberAtiot�of the a ment of the weekl remium herein s ecified on or before each and ever 1Vioriday in eve ear �'
P Y Y P P , Y 1'Y Y I,;I
during the continuance of this Policy until premiums for twenty full years shall have been paid, or until the prior death of
e Insured,will pAy at its Home Office,Newark, New Jersey, immediately upon};eGei�t of due proof of the death of the Insured
ig the cotttinuance of thia Policy,the amount of insurance herein apecified,��o�the esecutors or administrators of the Insured,uttlesa
be made under the rovisions of the nest succeedin ara aph; subjeet to the "General Provisions" on the second page hereof, ,
P g B �'
a hereby made part of this contract.
LITY OF PAYMENT.—It is understood and agreed that the said Company may make any payment or grant any non-forfeiture proviaioti
for in this Policy to any relative by blood or connection by maniage of the Insured, or to any person appearing to said Compaay to be
entitled to the same by reason of having incurred eapense on behalf of the Insured,for his or her burial,or for any other purpose, and ji
iction Uy the Company of a receipt signed by any or eiYher of said persons or of other sufficient proof of such payment orgrant of such
to any or either of them shall be conciusive evidence that such payment or pnovision has been made or granted to the peraon or peraona
hereto,and that all claima under this Policy have been fully satisfied.
,IMINARY PROVISION.—This Policy shall not take effect if the Insured die before the date hereof,or if on euch date the Inaured be not il,
liealth, Uut in either event the premiuma paid hereon,if any,shall be returned. j�
�I
3CHEDUL�. �
I
Name of Insured AGE NEXT Amount
BIRTHDAY29 of Weekly �
u1 I L u R E 0 i'vi H E I S E Y If inenmet,nntify C�mDan� Insurance �23�— Premium �? c ts ,j
if Eyesight or Limbs.—If the Insured while this Policy is in full force and effect and while there is no default in the payment of premium shall sustain f
impairment such as specified below, total and permanent disability shall be deemed to exist and the disability benefit hereinafter provided shall be q`^
imediately upott reeeipt of due proof of such impairment: in event of the loss by severance of one hand or one foot,an amount equal to one-half of �
.t of insurance shall be paid in cash;or in event of the loss by severance of two hands or two feet, or one hand and one foot, or the permanent ��
; sight of both eyes, an amount equal to the full amount of insurance shall be paid in cash; and in either event no further premiums shall be {t
iercafter and the Policy shall be endorsed as fully paid-up for the amount of insurance as specified in the Schedule above. The amount payable in �•
� this provision on account of disability as herein defined shall in no event exceed an amount equal to the full amount of insurattce under this Policy. I'
DIVIDEND PROVISION.
ally,during its continuance in force,the proportion of the divisible surplus accruing upon thie Policy shall be ascertained and apportioned
ard of Directora and credited to thia Policy at the end of the policy year as a dividend. Such dividend ahall be in the form of a paid-up !'
:o the amount of insurance.
�e to Policyholder.—Owing to the low rate of premium at which policies of this nature are issued, the surplus accruing thereon will probably not be
�enable the Company to credit any dividend to this Policy before the fifth year.)
NON-FORFEITURE PROVISIONS. I�I
s Policy lapae for non-payment of premium after premiums have been duly paid for three full years or more,the Insured,without atty action upon his ;'
,will become entitled to non-participating�xtended Insurance for the respective term specified in the following table. The amount of insurance payable
cur within said term shall be the same amount as that which would have been payable ii this Policy had been continued in force,except as to dividend
ubsequent to the date of lap5e.
lieu thereof,the Insured may sunender the Policy within three months af ter such lapse and will then be entitled at his or her option to receive either
icipating Paid-up I,ife Policy or payment in cash as specified in the following table. '
•e be any indebtedness under this Policy, such indebtedness will be deducted from the Cash Surrender Value,or the term of the Extended Insurance ��',
tlnt of the Paid-up I,ife Policy will be reduced to such term or amount as the net single premium value of the respective provision reduced by such ��I�
ss shall provide according to the mortality table hereina.fter specified, �l;
l-P 3 Yrs. 4 Yrs. 5 Yrs. 6 Yrs. 7 Yrs. 8 Yrs. 9 Yrs. 10 Yrs. 11 Yrs. 12 Yrs. 13 Yrs. 14 Yrs. 15 Yrs. 16 Yrs. l7 Yrs. 18 Yrs. 19 Yrs. 20 Yrs. �,��
Yrs. W4-s.Yrs. Wks.Yn. Wks.Yrs. \Vks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Nks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks. l���.
ted 3 4 4 47 7 9 8 35 10 32 12 26 14 17 16 2 17 34 19 9 20 31I21 49I23 13 24 29 25 48 27 24 29 19 Paid-up ��
nCe The Estendad Insurance period dates from the date to which premiums uavc been paid and is the same for any amount of weekly premium. at end of
�p $5.20 188.00 �$11.40�513.70�$16.70�$19.60�$22.60��25.60��28.60��31.50��34.60�$37.60�$40.60�$43.70�$46.80�$49.90�$53.10 Twenty ;�
licy These Paid-up Life Policies are for each five cents of wcekly premium. YearB !
rren- None � None � None � None � None� None � None�$11.74�$13.35�$15.03�$16.77��18.58�$20.4?��22.43�$24.47�526.60�$28.82� $32.62 li'
lue These Cas6 Surrender Valucs are for each five cents of weekly premium.
:A taUle of Cash Surrender Values aftcr twenty years will be furnished on request. I��';
nsis of the non-forfeiture values is the net reserve according to the Standard Industrial Mortality Table with three and one-half per cent.interest �
i. The figures in the above tables up to the end of the twentieth year inciude a surrender charge of not more than two and one-half per cent.of the �
' insurance. Should the amouttt of insurance be increased by dividend additions the reserve thereon shall be included with the net reseroe on which the i.
ture values are based attd the total surrender charge shall not be mare than two and one-half per cent.of the total amount insured. At the end of twenty �
therea[ter no surrender charge is made. ��I
nputing values from the foregoing tables,due ailowance will be made for each completed quarter of a year's premiums paid over and above the full number i'I;
'aere indicated.
Policy containa the entire contract between the parties hereto. ��'
�ittte�� ��jereof, the President and the Secretary of said Company have signed this Policy at its Home Office in the ';
Vewark, N. J., on the above date. "
I I
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,� 1 r � �� � ,,. .% ✓ r,
������ ��....�. �, � J ��a:� • �, � � � � � � �� �� � ' �� � �������g.X�� � ��� �A 1� Pre, W�'�.'wfi'r �,���� � -./ .
� I a� �' r
� ,..` ,; d � ',� � 'v m f ��, �� J. 1'���rt� �
• � . . _ �e.�sr _ � _. . . . _ „u:t�uw .�r�._.. t�' A��"„ �.:.�;+' �^;' �* �r
�����'j��� �,
.; � ,
,� �.�:�
����� ��i �
l,a�ri�� ki� �, �".
� � a„ 11�,;� l�r,!i��S i,����ltr��jj° , '
Rr"4��.z Y t7. � �7���Rti u.GC�g.'��� {� �
�`1� c; »�iy "` ��t:c5�r�'h�' ' 1
�S�l y)fi`'d"tla.r�' � � �c it� �'1
V: +�Xl�l��)44
n�i � -�i'.iS•,tt 7 � 4v4�GtiCf2' � �s
�3 y t6��Y'���* ` t. l.;Cc1}.�fkJ'C•' Q�.,�� ��,. �Y,,6
�,t.'}� � 6 r y f�.t t.' .. � �.+�,c ,,�
�rtt t .;� �.. ,,� .
a.e ��rF `?r,x,'s 1�.: � � ` F ,�� �i� c.`'';
�tt QCO1t�IbCrAtlO1T of the payment of tl�e weekly premium herein specified,on or before each and every Mon���' }�C,�'very ye��y�y;
uring the continuance of this Policy untii premiums for twenty full years shall have been paid, or until�•the prior death of
Insured, will pay at its Home Office,Newark,New Jersey, immediately upon r@ceipt of due proof of the death of the Insured
;the continuance of this Policy,the amount of insurance herein specified,to the esecutors or adr����strators of the Inaured,unleae
�e made under the provisions of the nest succeeding paragraph; aubject to the "Ge�G��. �rod'isions" on the second page hereof�
hereby made part of this contract. ti��'', �
ITY OF PAYMENT.—It is underatood and agreed that the said Company may make any payment or grant any non-forfeitureDrovisioa
�r in this Policy to any relative by blood or connection by marriage of the Insured, or to any person appearing to said Compauy to be ,
rntitled to the s1m�by reasou of huving incurred expense on behalf of the Insured,for liis or her burIal,or fur any other purpoae, and
:tion by the Company of a receipt signed by any or either of said persons or of other sufficient proof of such payment orgrant of auch
o any or either of them shall be conclusive evidence that such payment or provision has been made or granted to the peraon or peraons
.ereto,and that all claims under this Policy have been fully satis8ed.
MINARY PROVISION.—This Policy shall not take effect if the Insured die before the date hereof�or if on euch date the Insured be not
.ealth,but in either event the premiums paid hereon,if any,shall be returned.
SCFTEDULE. I�II
Name of Insured AGE NEXT Amount
� ;, _ BIRTHDAY z 9 of �, Weekly
c� �
� LUrZ �u� — Premtum (,
E D I i E I S E Y Insurance
11 ineermN,aoliry Cemp�a� �23� "—� '��S
'�yesight or Limbs.—If the Insured while this Policy is in full forcc and effect and whilc there is no default in the payment of premium shall sustain
npairment such as specified below, total and permanent disability shall be deemed to exist and the disability benefit hereittafter provided shall be {
nediatcly upon mceipt of due proof of such impairment: itt event of the loss by scvcrance of one hand or one foot,att amount equal to one-half of
of iusurancc shall Ue paid in cash; or in event of the loss Uy sevcrance of two hauds or two fcet, or one hand and onc foot, or the permanent '�,
sight of both eyes, an amount equal to the full amount of insurance shail be paid in cash; and in either event no further premiums shall be
;reafter and the Policy shall be endorsed us fully paid-up for the amount of insurance as specified in the Schedule above. The amount payable in �
this provision on account of disability as herein defined shall in no event exceed an amount equal to the full amount of insurance under this Policy. '!;
DIVIDEND PROVISION. I�'
lly,during ite continuance in force,the proportion of the divisible surplus accruing upon this Policy ahall be ascertained and apportIoned "
rd of Directors and credited to this Policy at the end of the policy year as a dividend. Such dividend ahall be in the form of a paid-up ��;
i the amount of inaurancc.
to Policyholder.—Owing to the low rate of premium at which policies of this nature are issued, the surplus accruing thereon will probably not be �
enable the Company to credit any dividend to this Policy before the fifth year.) I
NON-FORFEITUR� PROVISIONS.
Policy lapse for non-payment of premium after premiums have been duly paid for three full years or more,the Insured,without any action upon his
will become entitled to non-participating�xtended Insurance for the respective term specified in the foilowing table. The amount of ittsurance payable
ar within said term shali be the same amount as that which would have been payable ii this Policy had been continued in force,except As to dividend ��.
bsequent to the date of lapse.
ieu thereof,the Insured may surrender the Policy within three months after such lapse and will then be entitled at his or her option to receive either
ipating Paid-up I,ife Policy or payment in cash as specified in the following table, i'
be any indebtedness under this Policy, such indebtedness will be deducted from the Cash Surreader Value,or the term of the$xtended Insurance
nt of the Paid-up Life Policy will be reduced to such term or amount as the net single premium value of the respective provision reduced by such
s shall provide according to the mortality table hereinafter specifiecl. �'!
�-P 3 Yrs. 4 Yrs. �Yrs. 6 Yrs. 7 Yrs. 8 Yrs. 9 Yrs. 10 Yrs. 11 Yrs. 12 Yrs. 13 Yrs. 14 Yrs. 15 Yrs. 1G Yrs. 17 Yrs. 18 Yrs. 19 Yrs. 20 Yrs. �
Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yro. Wks.Yrs. Wks.Yn. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wlcs.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks.Yrs. Wks. ���
:� 3 4 4 47I7 9 8 35 10 32 12 26 14 17 16 2 17 34 19 9 20 31I21 49I23 13I24 29 25 48 27 24 29 19 Paid-up �
Ce The Eatended Insurance period datea from the date to wfiich premimns fiave been paid and is the same for any amount of weekly premium. at end of
Twenty �-
� ;5.201$8.00 �$11.40��13.70�$16.70��19.60�$22.60�$25.60�$28.60�$31.50��34.60�$37.60�$40.601$43•�DI$46•8flI�49.90��53.10 �
cy Theee Paid-up Life Policiea are for each five cents of waekly premium. Yeare
en- None � None� None � None � None� None� None �$11.74�$13.35�$15.03�$16.77�$18.58��20.47��22.43�$24.47�$26.60�$28.82� �32.62
le These Cash Surrender Values arc for cach five cents of weekly premium.
A table of Cash Surrender Values after twenty years will be furnished on request. I,
�sis of the non-forfeiture values is the net reserve according to the Standard Industrial Mortality Table with threa and one-half per cent.interest I
The figures in the above tables up to the end of the twentieth year include a surrender charge of not more thatt two and one-half per cent.of the
insurance. Should the amount of insurance be increased Uy dividend additions the reserve thereon shall be included with the net reserve on which the
ire values are based and the total surrender charge shall not be more than two And one-half per cent.of the total amount insured. 9t the end of twenty i;
hereafter no surrender charge is made.
puting values from the foregoing tables,due allowance will be made for each completed quarter of a year's premiums paid over and above the full number j
�
:re indicated. I:,
'olicy contains the entire contract between the parties hereto.
'�tt1TE��i l��jErCOt, the President and the Secretary of said Company have signed this Policy at its Home Office in the I I
;'.
'ewark, N. J., on the above date. i;
_ �'� A, ,� i i
RE�.;S„ Ex� �5-85) SCHEDULE "H"
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
IN RESI ENTED CEDENTRN MISCELLANEOUS EXPENSES Please Print or Type
ESTATE OF FILE NUMBER
Heisey, Mildred M. 21-8R-255
ITEM DESCRIPTION AMOUNT
NUMBER
A. FuneralExpenses:
1. Cocklin Funeral Hcane — $4,525.90 4,525.90
B. Administrative Costs:
1. Personal Representative Commissions _ _
Social Security Number of Personal Representative:
Year Commissions paid none 0.00
2. Attorney Fees 2,41a,l�
3. Family Exemption
Claimant none Relationship �•��
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees l. Register of Tr�ills - Probate �Vill 79.00
2. C�rland County Law Journal - Adv. Letters Test 30.00
C. Miscellaneous Expenses: 3. The Sentlnel 31,19
4. Register of Wills — Short Certificate 4.00
�• Register of [aills - File Inheritance Tax Return & Appraisal 15.00
2. Notary Public Fees n.On
3. Reserve for filing account and releases 200.00
TOTAL (Also enter on line 9, Recapitulation) $ ']�30.3.24
(If more space is needed, insert additional sheets of same size)
RE'V-1512 EX+ (7.g3)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE "I"
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS
ESTATE OF FILE NUMBER
HeisEy, Mildred M. 21-88-256
ITEM
NUMBER DESCRIPTION AMOUNT
�. Mobile X-Ray Services - Invoice 19.40
2. Clarc�nont Phazm - A-Care - Trivoice 52.40
3. Sarah A. Tod.d Hane - Nursing Care J_,232.40
4. Belvedere P�tedical Corporation - Invoice 3.80
TOTAL (Also enter on line 10, Recapitulation) $ 1.353.00
(If more space is needed insert additional sheets of same size)
� REV-1513 EX+�9�86�
� �`�`f� �� SCHED�.JLE J
,�,,>��;,�.
COMMONWEALTH OF PENNSYLVANIA gEN EFICIARI ES
INHERITANCE TA%RETURN .
RESIDENT DECEDENT
ESTATE OF FILE NUMdER
Heisey, Mildred M. 21-88-256
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHI/ AMOUNT OR
NUMBER tMARE OF ESTATE
A. Taxable Bequests:
�� Gene M. Gibney Da.ughter 1000
1140 Baish Road
Mechanicsburg, PA 17055
S S rT: 202-20-6314
irenn annoue�a�o�
NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE QF �5TR3'E
B. Choritable and Governmental Bequests:
�. None
TOTAL CHARITA6LE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, RecapitulationJ S O OO
(If more space is needed, insert additional sheets of sam�siz�)
COMMONWEALTH OF PENNSYLVANIA 'l
ss:
COUNTY OF CUMBERLAND f
Gene M. Gibney
being duly S�rn according to law, deposes and says that ShE? is
�e��'� of fhe Estate of Mildred '�4. Heisey
late of 1000 ��Iest_South Street�Carlisle , Cumberland County, Pa., deceased and that the
within is an inven4ory made by h�' __ _ , the said ��u��
of the entire estafe of said decedent, consisting of all the personal proparty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and thaf the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death,
�� and subscribed before me, ,�J
�
�� �eCutra.x
19� Gene D�[. Gibney
/
T,1,Rii1� 1140 pa.ish Road, Mechanicsburc�, PA 17055
K!!lY A, NiC EL, N�Isry►tlbiiC Address
� Ca� is�e 8�ro, Culnhw�lapd Co., Pa.
�A'CuM+NRiasiOn f�tPicK luiy 13, 19�'1
���.�
Da+e of Death 24th n'larch 1938
Day Mon+h Ysar
INSTRUCTIONS
I. An inventory must be filed within three months after appoin4ment of personal representative.
2. A supplement inven�ory must be filed within +hir+y days of discovery of addi4ional assets.
3. Additional sheets may be attached as to personalty or realty
4. $ee Article IV, Fiduciaries Act of 1949.
oc�
�
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Z � � U
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lnventory of the real and personal estate of � '
Mi3clred M. FIeisey deceased
21-88-256
1. Stocks and Bonds as set forth on Schedule "B" of PA Inheritance Tax Return 9,752 3�
2. Cash, Banlc Deposits and Misc. Personal Property as set forth on Sched.ule
"E" of PA Inheritance Tax Return 38,530 35
'IiOTAL �48,283 19
�
r n i .
4
t.?
lL:�...., �. __ '
�-.. �i "
J
REV-1547 EX (12-87)
COMMONWEALTH OF PENNSYIVANIA ��� d� NOTICE OF INHERITANCE TAX
DEPARTMENT OF REVENUE ACN 101
BUREAU OF INDIVIDUAL TAXES r APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
P.O. BOX esz� OF DEDUCTIONS, AND ASSESSMENT OF TAX
HARRISBURG, PA 17105-6327 DATE 10-11-
ESTATE OF HEISEY MILDRED M FILE N0. 21 88-0256
DATE _OF DEATH 03-24-88 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT".
REMIT PAYMENT TO:
ROBERT R BLACK ESQ REGISTER OF WILLS
LANDIS ETAL CUMBERLAND CO COURT HOUSE
36 S HANOVER ST CARLISLE, PA 17013
CARLISLE PA 17013 Amount Remitted
CUT ALONG THIS LINE � RETAIN_LOWER PORTION FOR YOUR RECORDS `
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
REV-1547 EX (12-87)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HEISEY MILDRED M FILE N0.21 88-0256 ACN 101 DATE 10-11-88
TAX RETURN WAS: (X ) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VAIUE OF RETURN BASED ON: ORIGINAL RETURN -:�
1. Real Estate (Schedule A) ( 1) .00 r -
2. Stocks and Bonds (Schedule B) ( 2) 9,752.34 -
3. Closely Held Stock/Partnership Interest lSchedule C) ( 3) .00
4. Mortgages/Notes Receivable (Schedule D) ( 4) .00
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ( 5) 38,530.85
6. Jointly Owned Property (Schedule F) ( 6) .00
7. Transfers (Schedule G) ( 7) .0 0
8. Total Assets ( 8) 48,283.19
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/Miscellaneous
Expenses (Schedule H) ( 9) 7,303.24
10. Debts/Mortgage Liabilities/Liens (Schedule I) (1 Q) 1,358.00
1 1. Total Deductions (1 1) 8,661.24
12. Net Value of Tax Return (12) 39,621.95
13. Charitable/Governmental Bequests (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 39,621.95
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16 and 17 Will
reflect figures that include the total of ALl returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of line 14 taxable at 6% rate (15) 39,621.95 X.06= 2,377.32
16. Amount of tine 14 taxable at 15% rate (16) .00 X.15= .00
17. Principal Tax Due (17> 2,377.32
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST (-)
07-19-88 401764 .00 2,000.00
PAYMENT MUST BE MADE BY 12-24-88*. TOTAL TAX CREDIT 2 .�
BALANCE OF TAX DUE 377.32
INTEREST .00
* IF PAID AFTER THIS DATE SEE REVERSE FOR CALCULATION TOTAL DUE 377.32
OF ADDITIONAL INTEREST
(IF BALANCE DUE IS LESS THAN S 1 OR IS REFLECTED AS A "CREDIT" (CR), NO PAYMENT IS REQUIRED)
�.�..s....�;.;,.....-.d".....-...:,.+-�-�.s-�—v�.....�......---:...��..;.+.....i=�+.....�;+w�..,. ......-.'��+-,+r-...�,....�....�...�.--..."-.-.. ...�.._�+-..».�. �, ��-.-.�+.�_�..__.�w_. � - . .
.���.� .-........�.--.._�a........�—..,. T_ ,..-_
ONo. ������� ' ca�nnc��w�,���rH o�: P����x�.�r�Nr�► � �
�?I�PARTMENT O�REY�IVtJE ' �r "
�ev.>>a7�x t�2_a6� I�FFI�IAL F2ECEtPT' • PEIti1N'�YLVANIA Ii�HE�ITANCE AND ESTA7'�TAX
ACN
RECEIVED FROM: Ggng �, �j,}�j�@� � ASSESSMENT � AMOUNT
CONTROL
NUMBER
Rabert R. B�,�ck, E�c��
101 $3'7'�_ 32
3f+ 5cauth Hanov�r S��set
Ct�rJ.i�zle:, PA 17f313
— FOLD HERE FOLD HERE—
ESTATE INFORMATION:
� FILE NUMBER
21-8�-256
� NAME Of DECEDENT (LAST) (FIRST) (M1)
H@�.�E Mi.l.dx'sd M.
� DATE OF PAYMENT
t�CtOkier l4 3,9�H
� POSTMARK DATE
COUNTY
C'tItCt�J�3r�.F�TIc�
�ATE OF DEATH
����h �� �'��8 � TOTAL AMOUNT PAID __-_- $377,��
REMARKS
SEAL r�! ;' , :
RECEIVED BY �� ��� !�� � � % �1,,�� _.��'•--�"�
/ GNATURE �—
/
REGI5TER OF WILIS
REV-1607 EX (12-87) �
;
COMMONWEALTH OF PENNSYLVANIE.
DEPARTMENT OF REVENUE � �,�� �I INHERITANCE TAX ACN 101
BUREAU OF INDIVIDUAL TAXES - �,�k
���� P.O. BOX 6327 � ����� " -� STATEMENT OF ACCOUNT
�,� HARRISBURG, PA 17105-8327 DATE
1 —31-88
ESTATE OF HEISEY MILDRED M FILE N0. 21 88-0256
DATE OF DEATH 03-24-88 COUNTY CLiMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT
TO THE ADDRESS SHOWN. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: �
ROBERT R BLACK ESQ REGISTER OF WILLS
LANDIS ETAL CUMBERLAND CO COURT HOUSE
36 S HANOVER ST CARLISLE, PA 17013
CARLISLE PA 17013
Amount Remitted
CUT ALONG THIS LINE '� RETAIN LOWER PORTION FOR YOUR FILES �
- - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
REV-1607 EX (12-87) *� INHERITANCE TAX STATEMENT OF ACCOUNT **
ESTATE OF HEISEY MILDRED M FILE N0. 21 88-0256 ACN 101 DATE10-31-88
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN
BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, THE APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND,
IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-03-88
PRINCIPALTAX DUE:................................................................................................................................................... 2�377.32
PAYMENTS lTAX CREDITS):
IPAYMENT RECEIPT I DISCOUNT (+)
DATE NUMBER ! INTEREST (-) AMOL;NT PAID
I 07-19-88 401764 .00 2,000.00
� 10-14-88 402045 .00 i 377.32 �
I i _ ,
I —
I I
i i I
i I i
I
I
TOTAL TAX CREDITS 2,377.32
BALANCE OF TAX DUE .00
INTEREST .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST
(IF BALANCE DUE IS LESS THAN $1 OR IS REFLECTED AS A "CREDIT" (CR), NO PAYMENT IS REQUIRED)
G�
ftEGISTER OF WILLS OF CUMBERLAND COUNTY
REPORT OF STATUS OF ADMIliISTRATION
(For Resident Decedents Dying After July 1. 1984)
ESTATE NO. 21-� Z S�p r: �
Name of Decedent:
���(.�v""`� 1'✓j• �e�Ge't�j �`�'' "i, �
Social Security Account No.: �'�s" SD' t�y(�?r-
f
Date of Death: /'�-j� Z� �Cf�
Name of Personal Representative(s): ����iv�--e � ��1u"��
Capacity Executor�K � Administrator c.t.a.
(check one) Administrator Administrator d.b.n.
Is the administration of the estate complete? Yes ✓, No
If "yes", how was the administration ended? (check one)
By court accounting
By account stated to parties in interest
Did the parties release the
personal r p��g�e' f/` ��:P�.P
Other (explain) Ct.�-. (�,.l,e
Total amount paid to date to creditors and for funeral and $� G�
administr�tive expense
1'otal value of distributions to date to beneficiaries $� �'�"�'•
Tf administration is not complete, estimated value of assets $ -^ � `
still in administration
NOTE: This status report is due no later than the due date f�r filing the Pennsylvania
Inheritance Taz Return or, if no Inheritance Tag Return is required, nine (9) months
after the date of death; if the administration of the estate has not been concluded.
a summary report shall be filed annually thereafter until the administration is complete.
I certify under penalty of perjury that the foregoing information is correct to the
best of my knowledge, inforrnation and belief.
Date:_ / ��2!>( �� , 19__ /�
, Personal Representative
, A ttorney for F.state
� This report must be signed by the personal representative. or one of them when more
than one, or by counsel for the estate.
�r , � -
�T AND REL�►.�'
� WHERF',AS, MIL�2ID M. HEISEY, late of the Borough of Carlisle,
Ctirmberland County, Pennsylvania, died on the 24th day of March, 1988, having
fi.rst made her I�st Will aryd Testame.nt, in writing, dated Septexnber 26,
��
;� 1947, which since her decease was duly probated before the Register of Wills �
[
`� of said C�nbe`rland County, and Lette.rs Testame.ntary issued to Gene M. �
�
�� Gibney, the �ecutrix riamed in the Last Will and Testament of said decedent. �
,� ;
NOW K�[�TTOW ALL MIN BY Tf�.SE PRESF�]'IS that I, GII1E M. GIBNEY, beirig the �
f� �
�� sole legatee and distributee named in the Will of said decedent, and the �
I ;,
�� person entitled to share in the residuary distribution of the estate of said �
;�
%� a
�� der.edent, do hereby declare and state that I have exami.ned the attached �
� �
�� Account and SChedule of Proposed distribution and find the same to be true 1
;�
�r and correct and in strict accon�ance with the terms and provisions of said �
�� �
#f� Will, and I do hereby aclmcnaledge that I this day have, had arid received of �
1i ,
�� +
�! and from GEEL�IIE M. GIBNEY, Executrix of the Estate of MILDRED M. HEISEY, the 1
I; ;
a^�� cash set opposite my name in the above-stated Schedule of Proposed ',
I
;� Distribution, in full satisfaction, payment and discharge of all such sum or °
'a �
','� stm�s of money, legacies and bequests, share or shares, purparts and �
:i �
','� dividends which were due, owing and payable and belonging to me by any means �
�
?; whatsoever, for or on account of my full share, part or dividend in the �
Ij',i FSTATE OF MILDRID M. HEISEY, DECEASED, arxl all interest accrued thereon. �
';; �
,�� NOW, TF�REFORE, I, the said GII1E M. GIBiVEY, do by these presents �
�I� s
,re
remise, release, quit-claim and forever discharge the said GENE M. GI�IEY, �
ry6
!,f,! her heirs, executors and achninistrators, of and from my said share or
��
G� dividend of the estate aforesaid, and of and fram all actions, suits, �
��
� payments, accounts, reckoni.ngs, claims and demands whatsoever, for or by
9
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� reason thereof, or of any act, matter, cause or thing what�oever, fram the
ibe�ginning of the world to the day and date of these presents.
� AND desiririg to avoid the delay and e�er��e of the settlement of said
� Estate by filing the foregoing Account of said achninistration in the Office
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` of the Register of Wills of said County, and by having the balance in the
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� hands of the �ecutrix as shawn by said Account distributed by the Court of
� Catmnon Pleas of C�unberland County, Orphans' Court Division, I do hereby
`� agree that the foregoirig statement concernirig the matter of settlemexit may
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�� be recorded with the same eff�t upon me as if the same had been reported
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!� upon by said Court, in a decree of distribution made on such report by the
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�; said Court of Conmion Pleas, Orphans' Court Division. �
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'� AND in consideration of the aforesaid settlement being made without
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°� the aid of such Court of Conmion Pleas - Orphans' Court Division, that I, the
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4� said GENE M. GIBNE'Y, do hereby agree that if any debts or demands other than
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'' those included in the First and Final Account of the said GIIJE M. GIBNEY,
�� Executrix of the Estate of MIIDRED M. HEISEY, Deceased, as hereinbefore set
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'r� forth, shall be hereafter recavered agai.nst the Estate of said dec,edent and !
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�'� be legally payable out of the same, that I will return to the said E�ecutr�
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'� such amount thereof as may be necessary to pay such debts or demands.
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',; IN tiVIZNFSS Wf-IEFt�OF, I have hereunto set my hand arid seal this 2
'�' day of �*�G�f'�l (�j�Gie
, 198�.
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fi Gene M.^ Gibney
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� OF PENNSYLUANIA )
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OOUN'I'Y OF �UMB�ERLAND )
ON Tf-IIS, the �l y of , 1988, before
me, the undersigned officer, personally appeared GENE M. GIBNEY, l�awn
to me (or satisfactorily praven) to be the person whose name is
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� subscribed to the within instnnne.nt, and acJ�awledged that she executed
��the same for the therein contained.
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fi, ' KEILY A.NlCKEI,NOTARY PUBLIC t` 4 r.;
�l USLE 80R4..CUMBERlJINO COUNTY, PA ,���'� �� .
� MV CO�iiMtSSi4N E�tP1RE3 JillY 13. is92 ���� �,t�� "�: ' �
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� IN RE: . IN THE C�URT OF C'OI�M�ION PL�A.S OF
9 . C:Cm�2LAND OOiJNI'Y, PII�INNSYLUANIA
ESTATE OF MILURID M. HEISEY, .
. ORPFIANS' OOLIRT DIVISION
DECF�ASED . NO. 21-88-256
FIIZST At�ID FI1�iL AOOQIl�iT OF G@IL M. GIH�Y,
E}�QTIItZX OF 73� ES'�ATE OF 1�IIIII2ID M. �I� •L�, D�CEASID,
T ATF: OF CA1ZT-S7 F.
� Q�I�1D �I'Y� PIIVNSYIATANIA
���, Date of Death: March 24, 1988
E Ietters Grant�ed: April 5, 1988
� Letters Advertis�ed: Sentinel - April 16, 23, 30, 1988 �
i� C�unberland Iaw Journal - April 22, 29, May 6, 1988
Account Stated as Final
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�� �d� � & INDEx �
��u PRIlIC:IPAL P�e �
{� Receipts 2 48,582.42
'S Less Disbuzsem�nts 2 6,766.52
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�� Balance Before Distributions 41,815.90
Ij' Distributions to Beneficiaries 2 32,000.00
;; Principal Balance Remaining 9,815.90
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����^� Receipts 3 872.77
� L�ess Disbursements 3 0.00 �
1� Balance Before Distributions 872.77
�� Distributions to Beneficiaries 3 0.00
��§, Ipcpme galance Rp.nyajnjnq 872.77
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�''F �I►�p $�T_ANc"�: �G 10,688.67
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R�IS OF PRII�TG',�AL
l. 540.657 shares Wellirigton F1uid at
16.32 per share 8,823.53
2. 32 shares Keystone B-4 ��.irid at 6.89 per share 220.48
3. 1 share Keystone B-1 Fund at 8.33 per share 8.33
4. 21 shares Keystone S-1 FUnd at 19.45 per share 408.45
5. 35 shares Keystone K-1 Furxl at 8.33 per share 219.55
6. DD Account, CoYrnnonwealth Natior�al Bank
#220-70314 38,670.58
7. DD Account, Carrnnomaealth National Bank
#222-452640 174.08
8. Health Insurance Refund 57.42
'POTAL PKINCIPAL RECEIP'I'S 48,582.42
D OF P��7NC'TP�AT
1988
Mobile X-Ray Service - irivoice 19.40
Claremont Pharm-A-Care - irrvoice 52.40
Sarah A. Todd Hame - imioice 1,282.40
CoCklin Funeral Harne - im�oi.ce 538.12
Belvedere Medical Corporation - invoice 3.80
Rer�istex of Wills, Agent - PA Inheritance Tax 2,000.00
Register of Wills, Agent - PA Inheritance Tax 377.32
Reserved•
Landis, Black & Schorpp - Attorney's Fees 2,308.89
Register of Wills - probate Will 79.00
C�unberland Law Journal - advertisirig I�tters 30.00
The Sentinel - advertising Letters 31.19
Register of Wills - Short Certificates 4.00
Register of Wills - file Inheritance T� 15.00
Closirig & Release 25.00
TOTAL DISB[JRSII�V'].'S OF PR.IlICIPAL 6,766.52
DT.S'i�2T1�TITCI�i OF P��TNCTPAT qp �1C1'.AR�S
TO: Gene M. Gibney 32,000.00
'I'OTAL DISTRIT�JTION OF PRINCIPAL 'PO BE�IEFICIARIES 32,000.00
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l. Wellington Fund - withdrawal 200.00
2. Keystone Fune - dividerid 4.35
3. Co�tnnonwealth National Bank - interest to 10/19/88 668.42
TOTAL RECEIPI'S OF INC�OME 872.77
D OF Il1CJCl�
0.00
TOTAL DISS[JR.SII�I'.PS OF INC�'� 0.00
DT.�IRSII�'-� OF Il�K)Ci�: 20 �31f?F'TCIARII�
0.00
TOTAL DISB[JR.SIlK�]TS OF INCOME TO BErtEFICIARIFS 0.00
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Gene M. Gibney, Fx ix
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IN RE: . IN � C�OU�I' OF OONIMfJN PI�AS OF
. CUMB�ERLAI�TD OOiJNTY� PII�IIISYLUANIA
FSTATE OF MILDRID M. HEISEY, .
. ORPF�IJS' CJOURT DIVISION
' DECEASID . NO. 21-88-256
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S��n'F OF PROPC)6ID DISII2I�l.ZC�i �'
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�1 Combined Balance for Distri.bution Re- �
,�maini.rig As Fer First arid Final Account 10,688.67 ;
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, T0: GINE M. GIBNEY
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�� 1. 540.67 shares Wellirx�ton at ;
�� 16.32 per share 8,823.53 k
ja 2. 32 shares Keystone B-4 F1ux1 at }
�3 6.89 per share 220.48 �
�; 3. 1 share Keystone B-1 at �
� 8.33 per shar'e 8.33 �
4. 21 shares Keystone S-1 FUnd at �
a 19.45 per share 408.45
�� 5. 35 shares Keystone K-1 Ft�nd at �
8.33 share 219.55 �
�' 6. Cash 1,008.33
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��� 'I7�e above distribution is proposed in accordance with the Last Will '�
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i�arid Testament of Mildred M. Heisey. �
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