HomeMy WebLinkAbout01-0634
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of. Fr~i!.r E. f/'Iss~1t;. No.
also known as nCi!S E,I~e" ~ b(J To:
Register of Wills for the
, Deceased. County of C u.rn ber / a. n d in the
Social Security No. /9 3- /~- ~ 77 9 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut<!>y named
in the last will of the above decedent, dated 1e./';'U47 II , 19~
and codicil(s) dated /I-~,..'-; .s: /9 'i 7
21-01-634
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
heY"
County, Pennsylvania, with
E/mUJt:>"d I4venlA.~
Decendent, ~hen 7R years of a~e, died . ~n e :?.3, JIf'- ;ltJo I
at e~M1,"lal'ty 6eJ7~ral ~fl4.i#/c h'oS/J,la/ Ln",er fb..xnn /tud7...tn., nh/"~b~..n,41
Except as follows, decedent did not marry, was'not di~orced and did not have ~ child b6rn or adopt d
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(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:
/ g~ tJOO. 00
$
$
$
$
WHEREFORE, petitioner(s) respectfully rehuest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters +e~ 71 JI1e./JfA.".J
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OFPERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1.. ss
COUNTY OF CU.JYI(3E1UflNP J
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 aJld t,ruly ad~er th~ ~state according to law.
~-L-Jf'~
Sworn to or affirmed and subscribed b '(f>. I ~-,JS;:> ~
before me this 3rd day of '-...) ~
JULY ~2001 ~
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N 21-01-634
O.
Estate of
FRANCES E HYSSONG
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JULY 5 Ji~200 1 ,in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
lT IS DECREED that the instrument(s) dated February 11, 1993 and April 5, 1997
described therein be admitted to probate and filed of record as the last will of
FRANCES E HYSSONG a.k.a. FRANCES E~I~E~N _ HYSSONG
TESTAMENTARY
PNC BANK N.A.
and Letters
are hereby granted to
~"'yt? ~N~~H/AV ^<..~
egister of Wills
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
<<~~u~~fltion ................
JCP
$ 235.00
$ 30.00
$ 10.50
$ 5.00
TOTAL _ $ 280.50
... . ...... :1.tIJ..Y. ;3... .2DP.~... .. .....
~!:~!!T
AITORNEY (Sup. Ct. I.D. No.) 3 FS/3
Ch~r/~s ~ SI1,'elds or
6 CA:;,PS'e'" ~~/ H1ecAev:I /~,S' .6", d ~ /h /7ttJS-S-
ADDRESS
Filed
"7/7-74>~-~A.07
PHONE
H105.Ril5 RFV'J/So
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar I' ,
Fee for this certificate, $2.00
P 7430634
JUN 2 5 200\
Date
21-01-634
lS.143Rov.2187
COMMONWEALTH OF PENNSYLVANIA 0 DEPARTMENT OF HEALTH 0 VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT IF.... ........., Lasl)
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sex
8lflTHPlACE (OIy_
Slate or Fot&q1 COUNty)
7 8 v,..
COUNTY OF llERH
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DECEDENT'S U8UAL OCCUI'IVIOH
(~=:~:'''=~~:'i'
tI.. Bookke.e.pVr. tlb. AmVr...tc.an watVr.
DECEDENT'S MAIUNG AOOAESS (SIr.... C~, SIaIe. Zip Codol DECEDENT'S
ACTUAL
RESIDENCE
(See""""""",
on other SIde)
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27. MIlT I: EtUr the....... ..... or compIk:aIioN whk:h cauMd the death_ 00 not.,..er 1M mode of dying. 1UCh.. cardiac 01 resptraloly an.... lhock 01 heart faihn. I ~
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DUE 10 lOR AS A CONSF,OUENCE OF): _ I
Is t!cJ.. T C lilt yo t!i\ I! r>loA> /- I II Fltl!c. Tlo rf
ef/i'tJf;~ASAC/f:i!d"G~C HEART DlSc/tsE
(.".QAycATHE~SC!~ E~OS/.s
WERE AU1tlPSV FINDINGS MANHEI'l OF DEATH
_l.AIIl.E PAIOfl1O
COMPlETION OF CAUse 0' 0
OF llEAI'H? .......... HomCidl
-.. 0 Ponding ......ogatJon 0
Not'1" ...0 ...Q( Suicide 0 COuld not be determened 0
DATE OF INJURY
(Moolll. Day. _I
TIllE OF INJURY
INJURV III WOAK? DESCRlllE HOW INJURY OCCURRED.
'1M 0 ...0
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CIRTWER 'C/lock only one)
-CERTIFYaG PHYSICIAN (PhYSlCaan Ceftlfying cause of de8lh wheo anochElf phY$IC18I\ has pronounced dealh ana ccrnpleled Item 231
To...bntot"'YknowIedrge.dee1hoccurredclue..thec.uN(l)andrnanner...utecI.................................................... .
29.
. II.
PlACE OF INJURY. AI home, 'arm, SU.... taccory, offtce
building, -'C. (Speclly)
_.
LOCATION (SIr.... C~. SIMeI
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~DmLEOFCE'Y.:'EA //_ _ __ _._ '"
o 31../ ~ fC--....e;gvp~/l.
LICENSE N~R DATE ~DJ-. 0lIy. ....1
o tc. pOfr5~ '3-' 3t V, ~ 3/"
NAME AND ADDRESS OF PERSON WHO COMPLETID CAUSEIJF QE.Wi
(Item 27) Type Of Print # nO L III'J~drJ Pe .c::: {, y It.. Q.A '"
o H ~G I'" A l'?lo"
32.
DATE
-PfIOHOUNCIHG AND CERTtFYlNG PHYSICIAN (Phy$CJan bolh pronounc:tnq ~ and cerulylng 10 cause 01 death)
To IlhIi beMot my knowIedrge, deethOGCurrecletlhellme, date, and piKe, and due lotheC8UM(l)andmannet...qllld..........................
'IIIEDICAl EXAMINER/CORONER
On 11M buIe of examiNdton and/or Inv....gation. In my opinion. d.ath occurr.d at the tlm., dat., and plac., and due to the cauM(a) and
.......,.u atated.. . .. . .. .. ..... ..... . .... .... . . .. . .. . ......,......... . . .. . .. . ................. .. . . . .......
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21-01-634
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21-01-634
LAST Wll.L AND TESTAMENT OF FRANCES E. HYSSONG
I, FRANCES E. HYSSONG, of the Borough of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath as follows:
A. Fifteen (15%) per cent thereof to Mechanicsburg Area Senior Adult
Center.
B. Fifteen (15%) per cent thereof to St Mark's Lutheran Church
Building Fund.
C. Fifteen (15%) per cent thereof to Mechanicsburg Public Library.
D. Fifteen (15%) per cent thereof to Helen Opperman Krause Animal
Foundation, Inc.
E. Fifteen (15%) per cent thereofto my sister, Mildred Schall.
F. Five (5%) per cent thereof to my niece, Barbara Helsel.
G. Five (5%) per cent thereof to my nephew, Robert Schall.
H. Five (5%) per cent thereof to my niece, Maxine McNutt.
I. Five (5%) per cent thereof to my nephew, Mark Russell.
J. Five (5%) per cent thereof to my nephew, Henry Russell.
Should any of my above-named relatives predecease me, then their share shall be pro-rata
apportioned amongst the other surviving beneficiaries named, including the charities as well as my
relatives.
3.
I nominate, constitute and appoint CCNB BANK NA to be the Executor of this my Last
Will and Testament. I further direct that my Executor shall not be required to file bond or other
security in the Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this I / ~ day of
-~
, A.D. 1993.
~f.h
(SEAL)
Signed, sealed, published and declared by the above-named FRANCES E. HYSSONG as
and for her Last Will and Testament, in the presence of us, who at her request and in her presence,
and in the presence of each other, have hereunto subscribed our names as witnesses.
~e~:u;.-
~d~ (2, duJz
21-01-634
REGISTER OF WILLS OF e tf m 13B j2L.4-Nl:> COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat_ in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF Ct{I17~eeLHA1J) COUNTY
OATH OF NON-SUBSCRIBING WITNESS
ell/1-IZLES E. SH/c-LDS!f1 ~ L//II~A
Lt{ /VD~GJe6-
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
he /she. /s familiar with the signature of ~J1C1"-S E:. ~v.s.s~/lJ
@dielD
testat.nK.- of kefte of the stlbseribift! vyitnesses te>) the -wtH- presented herewith and
@ieD
believes the signature on the 'Wffi is in the handwriting of
he /..she
,
that
fk .sKIt! Frances e. IIVSSb/ltf
, --
to the best of 1l/":5 /her knowledge and belief.
Sworn to or affir~ed and subscribed before ~ c!! A/~~
me this 3rd. day of ChArles IE. .s/1,-e.A(Na,ff[)
~JULY JI:~200 1 {;, (!/PHser J€'d / /l/~chAh/C.s61t "(jJ ~.If 17tJS.r
-~Lr 71-<<~?n.jdJ' ~ ,D.. . ,0 (A'/f~ess)
-;;;;;;'rJ ~ ~~~
1.;nt14 LI('{d~ (Name) D/h.sf. y-. J'7.
/IYC 13IU1K. /J",4 PP ~x ~ ();~ ~lt;1..1- 17~/1
(Address)
21-01-634
REGISTER OF WILLS OF (!, ttml$E:/ZLj/-ND COUNTY
OATH OF SUBSCRIBING WITNESS
ellR t2lES E. .5/1IEZ.f)S
eeaieil
.(.eaehJa subscribing witness to the will presented herewith, ~) being duly qualified according to
law, depose(s) and say(s) that he was present and saw
;::=r/l nce.s E. /lV55lJJ1 q
the testatt...~}( , si~n the sage and that he signed as a witness at the
request of testaf r; x in h e.r presence and {in tl1, VI C:'CllI,;C vf each otller} (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before ~ f1. ~~ U--=-
me this 3rd day of ehlfrJes E .sh/eldtN~)
~JULY JI' 2001 ~e~HSH'If'd., h1eCI1tln/cs6tt.r~1 P/I /7os.s--
,,~.oh~"'lv,jt1)U~""7 (Address) u
RegIster .
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
will
that
presented herewith and
codicil
believes the signature on the will is in the handwriting of
testat_ of (one of the subscribing witnesses to) the
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
21-01-634
REGISTER OF WILLS OF C tt /JJ/3G1eL/l/l/.D COUNTY
OATH OF SUBSCRIBING WITNESS
E"LIZ/lgE7/1 A. Cu~LL
eodidl
{each) a subscribing witness to the will presented herewith, ~being duly qualified according to
law, depose(s) and say(s) that She WAS present and saw
ffd/7Ce.s E:. NY$s~n 9
..J
the testatr;)C , sign the same and that 5he signed as a witness at the
request of testat ri )( in her presence and -(in the; presence. of e...dl mher) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this d",'/ day of
~ VI.2e'OI
~ t ~;fdu 'JJL--" Re~i;:,t'r!r
h'ph7
Notarial Seal
Charles E. Shields III, Notary Public
Monroe Twp., Cumberland County
My Commission Expires June 20, 2004
Member, Pennsylvania Association Of Notaries
~~~~a, a-A/~
e/iz. e~ Ao. CurtName) -
/3'13 jet//;;~PJ.5 Gore I?cI./ /J!eMdlll~.sha '}1.14
(Address) 17D~
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
will
test at_ of (one of the subscribing witnesses to) the
presented herewith and
codicil
believes the signature on the will is in the handwriting of
that
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19_
Register
(Name)
(Address)
(Name)
(Address)
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Frances E. Hyssong
Date of Death: June 23,2001
V\fill No. 21-01-0634
Admin. No.
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on July
25,2001
Name
Address
Barbara Heisel
RD#3, Box 157, A1toona, PA 17055
Helen Opperman Krause Animal Fdn PO Box 311, Mechanicsburg, PA 17055
Mechanicsburg Public Library 16 N. Walnut Street, Mechanicsburg, PA 17055
Mark Russell 10 S. Rorida Ave, Atlantic City, NJ 08401
Maxine McNutt 346 S. Broadway, Pendleton, IN 46064
Mildred Schall RD #3, Box 159, Altoona, PA 16601
Robert Schall 5041 Brome1y Ave, Spring Hill, FL 34609
Mechanicsburg Area Senior Center 97 West Portland Street, Mechanicsburg, PA 17055
St. Mark's Lutheran Church Building Fund, 117 W. Keller St., Mechanicsburg, PA
17055
Henry Russell 201 Stanton Drive, Winston Salem, NC 27106
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: July 26, 2001
~~
6 Clouser Road
Mechanicsburg, P A 17055
Telephone: (717) 766-0209
Counsel for Personal Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
PNC BANK
POBOX 308
CAMP HILL, PA 17011
___hh_ fold
ESTATE INFORMATION: SSN: 193-14-6779
FILE NUMBER: 21-2001- 0634
DECEDENT NAME: HYSSONG FRANCES E
DATE OF PAYMENT: 09/21/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/23/2001
NO. CD 000288
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $12,350.00
I
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TOTAL AMOUNT PAID:
REMARKS: PNC BANK
C/O LINDA LUNDBERG
CHECK# 408953
SEAL
INITIALS: AC
RECEIVED BY:
$12,350.00
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
o PNCADV1S0RS
PO Box 308
Camp Hill Pa 17001-0308
(717) 730-2255
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March 20, 2002
3
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Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
1',)
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.!::-.:~
Re: Frances E. Hyssong Estate
Date of Death 6/23/01
File #: 21-01-0634
Dear Register of Wills:
On behalf of the Corporate Executor of the above-referenced Estate, I enclose a check in
the amount of $1736.03 balance due on account of Pennsylvania Inheritance Tax. I have
also enclosed a check in the amount of $31.00 for filing fees and inventory
Also enclosed are two original completed copies of the Pennsylvania Inheritance Tax
Return and two original completed copies of the Inventory.
Kindly acknowledge receipt of the enclosed. Please time/date stamp the letter and both
copies of the first page of the Pennsylvania Inheritance Tax Return along with both copies
of the Inventory. Please return all four copies to me in the enclosed envelope.
Thank you for your assistance.
Sincerely,
\\J)_~,
~,
Linda J. Lundberg
Estate Administrator
Enclosures:
LJUjmh
A member of The PNC Financial Services Group
4242 Carlisle Pike Camp Hill Pennsylvania 17011
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o PNCADVlSORS
PO Box 308
Camp Hill PA 17011
Tel: 717 730-2265
September 19, 2001
Register of Wills
Cumberland County
South Hanover Street
Carlisle, PA 17013
Re: Frances E. Hyssong Estate
Date of Death 6/23/01
File No #21-01-0634
Dear Register of Wills:
On behalf of the Corporate Executor of the above-referenced Estate, I enclose a check in
the amount of $12,350.00 for payment on account of Pennsylvania Inheritance Tax. This
payment will yield a 5% discount in the amount of $650.00 for a total credit towards the
Pennsylvania Inheritance Tax in the amount of $13,000.00.
Kindly acknowledge receipt of the enclosed by stamping and returning the accompanying
copy of this letter to me in the envelope provided.
Please send us the usual customary receipt at your earliest convenience.
Sincerely,
'. \ \ h ~ I.
\:::.J"' ~
Linda J. Lundberg
Assistant Vice President
Enclosure:
l.JLljmh
A member of The PNC Financial Services Group
4242 Carlisle Pike Camp Hill Pennsylvania 17011
c
PNCBANK
ESTATE OF FRANCES E HYSSONG ALSO KNOWN AS
FRANCES EILEEN HYSSONG DECEASED
(DIED 06/23/01)
LATE OF THE TOWNSHIP OF UPPER ALLEN
CUMBERLAND COUNTY PA
WILL NO 21-01-0634
INVENTORY
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
LINDA J LUNDBERG ASSISTANT VICE PRESIDENT OF PNC BANK, NATIONAL ASSOCIATION,
THE EXECUTOR OF THE ESTATE OF FRANCES E HYSSONG ALSO KNOW AS FRANCES EILEEN
HVSSONG DECEASED HAVING BEEN DULY AFFIRMED ACCORDING TO LAW DID DEPOSE AND SAY
THAT THE ITEMS APPEARING IN THE FOLLOWING INVENTORY ARE PERSONAL ASSETS
WHEREVER SITUATE AND REAL ESTATE IF ANY IN THE COMMONWEALTH OF PENNSYLVANIA
OF SAID DECEDENT THAT THE VALUATION PLACED OPPOSITE EACH ITEM OF SAID
INVENTORY REPRESENTS ITS FAIR VALUE AS OF THE DATE OF THE DECEDENT'S DEATH AND
THAT THE DECEDENT OWNED NO REAL ESTATE OUTSIDE THE COMMONWEALTH OF
PENNSYLVANIA EXCEPT THAT WHICH APPEARS IN A MEMORANDUM AT THE END OF THIS
INVENTORY
AFFIRMED AND SUBSCRIBED BEFORE ME
~ /J~/L
THIS /fJ DAV OF r 20.M--'
L
/'
~-
.....----
)
~~
~ ~
NOTARIAL SEAL
DENISE C. SULLENBERGER, Notary Public
Hampden Twp., Cumberland County
My Commission Expires Nov. 22, 2004
- 1 -
TRSN01 ('Ol9S)
PRIVATE BANK
FRANCES E HYSSONG
BONDS
16,000 PAR MORGAN JP CO INC SUB NT
6.25r. DUE 1/15/2009
iil 98.9179
INTEREST FROM 1/15/01 TO 6/23/01
COMMON STOCKS
759.647 SHS AMERICAN WATER WORKS CO INC COMMON
iil 31.1525
FUNDS
619.772 SHS BLACKROCK MUNICIPAL TARGET TERM
TRUST
iil 10.2325
INCOME TO 6/23/01
768.710 SHS DREYFUS INTERMEDIATE MUNI BOND
FUND #947
iil 13.5500
INCOME TO 6/23/01
MISCELLANEOUS
PERSONAL PROPERTY
1995 FORD
CASH
DREYFUS
DREYFUS INTERMEDIATE MUNI BOND
FUND #947 INCOME ON 768.710 SHS
DATED 5/31/01
PENNSYLVANIA BLUE SHIELD
HEALTH INSURANCE BENEFITS
PENNSYLVANIA BLUE SHIELD
HEALTH INSURANCE BENEFITS
THE PATRIOT NEWS
REFUND SUBSCRIPTION CANCELLATION
MEMBERS FIRST
SAVINGS ACCOUNT #15305-00S
DATE OF DEATH BALANCE 61,928.01
INTEREST TO 6/23/01 106.75
MEMBERS FIRST
CHECKING ACCOUNT #15305-11S
DATE OF DEATH BALANCE 8,919.51
INTEREST TO 6/23/01 10.89
AAA MEMBERSHIP
REFUND
- 2 -
PNCBANK
769810
15,826.87
438.89
23,664.91
6,341.82
29.70
10,416.02
31.73
1,089.00
4,830.00
42.86
30.90
7.22
48.10
62,034.76
8.930.40
27.00
TRSN02110/SS1
FRANCES E HVSSONG
CONTINUED: CASH
PRIVATE BANK
PRUDENTIAL FINANCIAL
ANNUITV ACCOUNT IE0038703
DATE OF DEATH BALANCE 17,483.16
APPRECIATION TO 8/8/01 977.57
DONEGAL COMPANIES
REFUND AUTOMOBILE INSURANCE
J GORDON GAINES INC
REFUND RENTERS INSURANCE
PRUDENTIAL SECURITIES
MONEV MARKET FUNDS
ACCOUNT 104423096873
DATE OF DEATH BALANCE
INTEREST TO 6/23/01
3,769.66
12.57
INTERNAL REVENUE SERVICE
REFUND 2000 INDIVIDUAL INCOME TAX
UNITED STATES TREASURV
REFUND 2000 TAX RELIEF
AT&T
REFUND
S G DIAMOND INC
REFUND OF SECURITY DEPOSIT
PNC BANK NATIONAL ASSOCIATION
CHECKING ACCOUNT 15140031311
DATE OF DEATH BALANCE
PNC BANK NATIONAL ASSOCIATION
CHECKING ACCOUNT 15140031311
ANNUITV PAVMENT
COMCAST
REFUND SERVICE
PRUDENTIAL FINANCIAL
DEMUTUALIZATION BEDEFITS
TOTAL INVENTORV
- 3 -
PNClmANK
769810
18,460.73
173.00
76.00
3,782.23
233.00
300.00
1.10
460.00
3,989.24
310.06
18.43
369.72
161,963.69
------------
------------
TRSN02110/SS}
ctu:.?\
o PNCBAN<
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PA
ORPHANS' COURT DIVISION
NO. ;;U-Ol -O~''3'f
ESTATE OF FRANCES E HVSSONG ALSO KNOWN AS
FRANCES EILEEN HVSSONG DECEASED
LATE OF THE TOWNSHIP OF UPPER ALLEN
FIRST AND FINAL ACCOUNT OF PNC BANK, NATIONAL ASSOCIATION
EXECUTOR
AND PROPOSED SCHEDULE OF DISTRIBUTION
DATE OF DEATH JUNE 23 2001 WILL NO. 21-01-0634
LETTERS GRANTED JULV 5 2001
FIRST COMPLETE ADVERTISEMENT OF
GRANT OF LETTERS AUGUST 10 2001
ACCOUNTING JULV 5 2001 TO NOVEMBER 29 2002
PURPOSE OF ACCOUNT: THE EXECUTOR OFFERS THIS ACCOUNT TO ACQUAINT
INTERESTED PARTIES WITH THE TRANSACTIONS THAT HAVE OCCURRED DURING
ITS ADMINISTRATION OF THE ESTATE.
IT IS IMPORTANT THAT THE ACCOUNT BE CAREFULLV EXAMINED. REQUESTS
FOR ADDITIONAL INFORMATION OR QUESTIONS OR OBJECTIONS CAN BE
DISCUSSED WITH:
PNC BANK, NATIONAL ASSOCIATION
C/O LINDA J LUNDBERG
ASSISTANT VICE PRESIDENT
P.O. BOX 308
CAMP HILL, PA 17001-0308
TELEPHONE (717) 730-2265
CHARLES E SHIELDS III ESQUIRE
6 CLOUSER ROAD
MECHANICSBURG PA 17055
TELEPHONE (717) 766-0209
- 1 -
TRSNOl110/021
FRANCES E HYSSONG
PRINCIPAL
RECEIPTS
NET GAIN/LOSS ON CONVERSIONS
ADJUSTED BALANCE
LESS DISBURSEMENTS
DEBTS OF DECEDENT
FUNERAL EXPENSES
ADMINISTRATIVE EXPENSES
FEDERAL AND STATE TAXES
FEES AND COMMISSIONS
FAMILY EXEMPTION
TOTAL PRINCIPAL DISBURSEMENTS
BALANCE BEFORE DISTRIBUTIONS
DISTRIBUTIONS TO BENEFICIARIES
PRINCIPAL BALANCE ON HAND
INVESTMENTS MADE
CHANGES IN INVESTMENT HOLDINGS
INCOME
RECEIPTS
LESS DISBURSEMENTS
BALANCE BEFORE DISTRIBUTIONS
DISTRIBUTIONS TO BENEFICIARIES
INCOME BALANCE ON HAND
COMBINED BALANCES REMAINING
o PNCBAN<
769810
SUMMARY AND INDEX
PAGES
3 - 3
16Z,9Z1.1Z
4 - 4
Z,315.30
165,Z36.4Z
5 - 5
5 - 5
5 - 6
6 - 7
7 - 7
5 - 7
3,486.36-
480.00-
1,138.33-
14,17Z.03-
15,Z48.00-
.00
34,5Z4.7Z-
130,711.70
8 - 9
8Z,OZ4.99
10 - 10
48,686.71
11 - 11
lZ - 13
3,606.8Z
14 - 14
Z04.6Z
3,40Z.Z0
15 - 16
Z,846.65
17- 17
555.55
49,Z4Z.Z6
- Z -
TRSN0100/02.
FRANCES E HYSSONG
5/23/02
8/29/02
PNC ADVISORS
RECEIPTS OF PRINCIPAL
INVENTORY FILED ON 3/21/02
PER COPY ATTACHED
ASSETS NOT INVENTORIED
INTERNAL REVENUE SERVICE
REFUND 2001 INDIVIDUAL INCOME TAX
TV GUIDE
REFUND SUBSCRIPTION CANCEllATION
TOTAL PRINCIPAL RECEIPTS
- 3 -
o PNCBAN<
769810
161,963.69
922.00
35.43
162,921.12
------------
------------
TRSN021101021
PNC ADVISORS
FRANCES E HVSSONG
8/23/01
8/27/01
9/04/01
9/26/01
9/27/01
10/17/01
o PNCBAN<
769810
GAINS AND LOSSES ON SALES AND OTHER DISPOSITIONS
GAIN
16,000 PAR MORGAN JP CO INC SUB NT
6.25Y. DUE 1/15/2009
PROCEEDS: 16,092.64
ACQUISITION VALUE: 15.826.87
768.710 SHS DREVFUS INTERMEDIATE MUNI BOND
FUND 1947
PROCEEDS: 10,539.01
ACQUISITION VALUE: 10.416.02
759.647 SHS AMERICAN WATER WORKS CO INC COMMON
PROCEEDS: 25,492.92
ACQUISITION VALUE: 23.664.91
628.000 SHS BLACKROCK MUNICIPAL TARGET TERM
TRUST
PROCEEDS: 6,524.70
ACQUISITION VALUE: 6.427.53
1.946 SHS AMERICAN WATER WORKS CO INC COMMON
PROCEEDS:
ACQUISITION VALUE:
65.30
63.84
0.372 SHS BlACKROCK MUNICIPAL TARGET TERM
TRUST
PROCEEDS:
ACQUISITION VALUE:
3.71
3.81
TOTAL GAINS AND LOSSES
LESS LOSS
NET GAIN
- 4 -
LOSS
265.77
122.99
1,828.01
97.17
1.46
.10-
.10-
2,315.40
.10-
2,315.30
----------
----------
TRSN02 (10102)
FRANCES E HYSSONG
7/12/01
7/24/01
7/31/01
8/03/01
8/08/01
8/10/01
8/14/01
2/26/02
11129/02
7/11/01
7/24/01
7/27/01
8/02/101
PNC ADVISORS
DISBURSEMENTS OF PRINCIPAL
DEBTS OF DECEDENT
S G DIAMOND INC
JULY 2001 RENT
MEMBERS FIRST
OUTSTANDING CHECK
VERIZON
PHONE SERVICE
MARLIN A YOHN SR TREASURER
BALANCE 2001 CUMBERLAND COUNTY
PERSONAL TAX
HOLY SPIRIT HOSPITAL
MEDICAL EXPENSE
CP02 BILLING CENTER
NEBULIZER RENTAL
PPL ELECTRIC UTILITIES
SERVICE
APRIA HEALTHCARE INC
PROFESSIONAL SERVICE
HOLY SPIRIT HOSPITAL
RESERVE FOR PROFESSIONAL SERVICES
PRIOR TO DEATH
WAITING FOR INSURANCE PAYMENT
BEFORE PAYING BALANCE
TOTAL DEBTS OF DECEDENT
FUNERAL EXPENSES
CREMATION SOCIETY OF PA
BALANCE FUNERAL SERVICES
BLUE RIDGE MEMORIAL GARDEN
FEE FOR INSCRIBING MARKER SCROLL
TOTAL FUNERAL EXPENSES
ADMINISTRATIVE EXPENSES
CLAUDE C WOLFE & ASSOCIATION
APPRAISAL FEE RE PERSONAL PROPERTY
REGISTER OF WILLS
SHORT CERTIFICATES
- 5 -
o PNCBAN<
769810
550.00-
550.00-
12.02-
11.00-
19.08-
5.66-
316 .94-
21.66-
2,000.00-
3,486.36-
290.00-
190.00-
480.00-
125.00-
6.00-
TRSN0211 0'02'
FRANCES E HYSSONG
8/10/01
8/16/01
8/17/01
8/23/01
9/14/01
9/17/01
10/15/101
3/12/102
3/19/02
9/17/01
3/19/02
9/12/02
PNC ADVISORS
DISBURSEMENTS OF PRINCIPAL
STATE EMPLOYEES RETIREMENT
REIMBURSEMENT FOR THE PERIOD FROM
6/24/01-6/30/01
PNC BANK, NATIONAL ASSOCIATION
CHECKING ACCOUNT 15140031311
COMCAST AND PP&L PAYMENTS
INFORMATION NETWORK ASSOCIATION INC
PROFESSIONAL SERVICE
PRUDENTIAL. SECURITIES
MONEY MARKET FUND
ACCOUNT 104423096873
SECURITY FEE
AMERICAN WATER WORKS
SERVICE FEE
RE SALE OF 761.5929 SHS
INFORMATION NETWORK ASSOCIATION INC
FEE FOR ATTEMPT TO LOCATE
MARK RUSSELL
S G DIAMOND INC
REMOVING OF SOFA
CHARLES E SHIELDS III ESQUIRE
REIMBURSEMENT FOR
PROBATE COSTS 280.50
LEGAL ADVERTISING 160.95
REGISTER OF WILLS
FEE FOR FILING
PENNA INHERITANCE TAX
INVENTORY
15.00
16.00
TOTAL ADMINISTRATIVE EXPENSES
FEDERAL AND STATE TAXES
REGISTER OF WILLS
PENNA INHERITANCE TAX
ON ACCOUNT
LESS 570 DISCOUNT
13,000.00
650.00
REGISTER OF WILLS
BALANCE PENNA INHERITANCE TAX
INTERNAL REVENUE SERVICE
FIDUCIARY INCOME TAX ON CAPITAL
GAINS FOR YEAR ENDED 5/31/02
- 6 -
o PNCBAN<
769810
72.35-
182.53-
110.00-
50.00-
10.00-
60.00-
50.00-
441.45~
31. 00
1, 138.33
12,350.00
1,736.03
35.00
TRSN02110/021
FRANCES E HYSSONG
9/12/02
11/29/02
11/29/02
PNC ADVISORS
DISBURSEMENTS OF PRINCIPAL
PENNA DEPARTMENT OF REVENUE
FIDUCIARY INCOME TAX ON CAPITAL
GAINS FOR YEAR ENDED 5/31/02
TOTAL FEDERAL AND STATE TAXES
FEES AND COMMISSIONS
PNC BANK NATIONAL ASSOCIATION
EXECUTORS COMPENSATION
CHARLES E SHIELDS III
COUNSEL FEE
TOTAL FEES AND COMMISSIONS
TOTAL PRINCIPAL DISBURSEMENTS
- 7 -
o PNCBAN<
769810
51.00
14,172.03
8,098.00
7,150.00
15,248.00
34,524.72
------------
------------
TRSN02110/021
FRANCES E HVSSONG
PNC ADVISORS
DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES
BARBARA HELSEL
PER CODICIL DATED 4/5/97
PERSONAL PROPERTY
1995 FORD
8/01/02
CASH DISTRIBUTED
MECHANICSBURG AREA SENIOR ADULT
CENTER
7/26/02
CASH DISTRIBUTED
ST MARKS LUTHERAN CHURCH
BUILDING FUND
7/26/02
CASH DISTRIBUTED
MECHANICSBURG PUBLIC LIBRARV
7/26/02
CASH DISTRIBUTED
HELEN OPPERMAN KRAUSE ANIMAL
FOUNDATION INC
7/26/02
CASH DISTRIBUTED
FLORENCE MILDRED SCHALL
7/26/02
CASH DISTRIBUTED
ROBERT SCHALL
7/26/02
CASH DISTRIBUTED
- 8 -
o PNCBAN<
1,089.00-
4,830.00-
16.61-
12,683.64-
12,683.64-
12,683.64-
12,683.64-
11,029.10-
3,581.43-
769810
5,935.61
12,683.64
12,683.64
12,683.64
12,683.64
11,029.10
TRSN02(10102)
PNC ADVISORS
o PNCBAN<
FRANCES E HYSSONG
DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES
CONTINUED: ROBERT SCHALL
MAXINE MCNUTT
7/26/02
CASH DISTRIBUTED
MARK RUSSELL
7/26/02
CASH DISTRIBUTED
HENRY RUSSELL
7/26/02
CASH DISTRIBUTED
TOTAL PRINCIPAL DISTRIBUTIONS
- 9 -
3.581. 43-
3,581. 43-
3.581.43-
769810
3.581. 43
3.581.43
3,581.43
3.581.43
82.024.99
----------
----------
TRSNOZ(lOIOZI
FRANCES E HVSSONG
PNC ADVISORS
PRINCIPAL BALANCE ON HAND
INVESTED CASH
TOTAL PRINCIPAL
- 10 -
o PNCBAN<
VALUE
11/29/02
48.686.71
48.686 . 71
769810
ACQUISITION
VALUE
48.686.71
48.686.71
------------ ------------
------------ ------------
TRSN02 Cl0I021
PNC ADVISORS
o PNCBAN<
FRANCES E HVSSONG 769810
PRINCIPAL INFORMATION SCHEDULES - INVESTMENTS MADE
6/24/01 2.884 SHS BLACK ROCK MUNICIPAL TARGET TERM
TRUST
INCOME REINVESTMENT 29.70
8/07/01 2.878 SHS BLACKROCK MUNICIPAL TARGET TERM
TRUST
INCOME REINVESTMENT 29.84
8/15/01 1.946 SHS AMERICAN WATER WORKS CO INC COMMON
INCOME REINVESTMENT 63.84
9/18/01 2.838 SHS BLACKROCK MUNICIPAL TARGET TERM
TRUST
INCOME REINVESTMENT 29.98
TRSNOZ(10l0Z)
- 11 -
FRANCES E HYSSONG
7/24/01
7/25/01
8/10/01
8/23/01
PNC ADVISORS
RECEIPTS OF INCOME
INTEREST
MEMBERS FIRST CREDIT UNION
CHECKING ACCOUNT 115305-11S
CLOSING INTEREST
MEMBERS FIRST CREDIT UNION
SAVINGS ACCOUNT 115305-00S
CLOSING INTEREST
PRUDENTIAL FINANCIAL
ANNUITY ACCOUNT IE0038703
DELAYED CLAIM INTEREST
PRUDENTIAL SECURITIES
MONEY MARKET FUND
ACCOUNT 104423096873
CLOSING INTEREST
MORGAN JP CO INC SUB NT
6.25Y. DUE 1/15/2009
8/23/01
8/23/01
DIVIDEND
AMERICAN WATER WORKS CO INC COMMON
8/15/01 63.84
8/21/01 114.68
OTHER INCOME
61.11
105.56
BLACK ROCK
TRUST
8/07/01
9/18/01
10/19/01
MUNICIPAL TARGET TERM
29.84
29.98
29.98
MUNI BOND
DREYFUS INTERMEDIATE
FUND 1947
7/19/01
8/14/01
8/22/01
BLACKROCK US TREASURY MM
INSTITUTIONAL CLASS FD 102
8/01/01
8/01/01
9/04/01
9/04/01
10/01101
10/01/01
11/01/01
11/01/01
12/03/01
12/03/01
1/02/02
- 12 -
8.28
44.17
28.64
.10
49.12
.86
252.08
1.87
331. 47
2.35
286.61
2.39
233.54
2.40
o PNCBAN<
769810
14.39
135.43
2.99
19.69
166.67
178.52
89.80
81.09
TRSN02t10l02)
PNC ADVISORS
FRANCES E HYSSONG
RECEIPTS OF INCOME
CONTINUED: BLACKROCK US TREASURY MM
1/02/02
2/01/02
2/01/02
3/01102
3/01/02
4/01102
4/01/02
5/01/02
5/01/02
6/03/02
6/03/02
7/01102
7/01/02
8/01/02
8/01/02
9/03/02
9/03/02
10/01/02
10/01/02
11/01/02
11/01102
TOTAL INCOME
- 13 -
205.83
2.55
190.43
2.60
176.59
3.09
193.15
3.31
188.93
3.65
194.32
3.61
181.29
3.38
165.89
.40
80.78
.47
77 .53
.56
77 .09
o PNCBAN<
769810
2,918.24
3,606.82
------------
------------
TRSNOZllOI021
FRANCES E HYSSONG
PNC ADVISORS
DISBURSEMENTS OF INCOME
PNC BANK NATIONAL ASSOCIATION
INCOME COMPENSATION
8110/01
9110/01
10110/01
11/09/01
12110/01
1/10/02
2/08/02
3/08/02
4110/02
5/10/02
6110/02
7110/02
8/09/02
9110/02
10110/02
11/08/02
TOTAL INCOME DISBURSEMENTS
- 14 -
10.05-
37.61-
20.00-
17 . 34-
14.16-
12.49-
11 .58-
10.75-
11.77-
11 .53-
11.88-
11 . 09-
10.16-
4.87-
4.68-
4.66-
o PNCBAN<
769810
204.62-
204.62-
----------
----------
TRSN02 (10/02)
FRANCES E HYSSONG
PNC ADVISORS
o PNCBAN<
769810
DISTRIBUTIONS OF INCOME TO BENEFICIARIES
MECHANICSBURG AREA SENIOR ADULT
CENTER
7/26/02
CASH DISTRIBUTED
427.00-
427.00-
ST MARKS LUTHERAN CHURCH
BUILDING FUND
7/26/02
CASH DISTRIBUTED
427.00-
427.00-
MECHANICSBURG PUBLIC LIBRARY
7/26/02
CASH DISTRIBUTED
427.00-
427.00-
HELEN OPPERMAN KRAUSE ANIMAL
FOUNDATION INC
7/26/02
CASH DISTRIBUTED
427.00-
427.00-
FLORENCE MILDRED SCHALL
7/26/02
CASH DISTRIBUTED
427.00-
427.00-
BARBARA HelSel
7/26/02
CASH DISTRIBUTED
142.33-
142.33-
ROBERT SCHAll
7/26/02
CASH DISTRIBUTED
142.33-
142.33-
MAXINE MCNUTT
7/26/02
CASH DISTRIBUTED
142.33-
TRSN02 (1 0/02)
- 15 -
PNC ADVISORS
o PNCBAN<
FRANCES E HYSSONG
DISTRIBUTIONS OF INCOME TO BENEFICIARIES
CONTINUED: MAXINE MCNUTT
MARK RUSSEll
7/26/02
CASH DISTRIBUTED
142.33-
HENRY RUSSEll
7/26/02
CASH DISTRIBUTED
142.33-
TOTAL INCOME DISTRIBUTIONS
- 16 -
769810
142.33-
142.33-
142.33-
2,846.65-
----------
----------
TRSN02(10/02)
FRANCES E HVSSONG
PNC ADVISORS
BALANCE OF INCOME ON HAND
INVESTED CASH
TOTAL INCOME
- 17 -
o PNCBAN<
VALUE
11/29/02
555.55
555.55
769810
ACQUISITION
VALUE
555.55
555.55
------------ ------------
------------ ------------
TRSNOZ(10102J
PROPOSED SCHEDULE OF DISTRIBUTION
FRANCES E. HYSSONG ESTATE
Balance Remaining per First and Final Account
The Executor proposes to distribute the balance according
to decedent's Last Will and Testament in the following manner:
In Satisfaction of Item 2(A):
To: Mechanicsburg Area Senior Adult Center - 15%
Cash
In Satisfaction of Item 2(B):
To: S1. Mark's Lutheran Church, Building Fund -15%
Cash
In Satisfaction of Item 2(C):
To: Mechanicsburg Public Library - 15%
Cash
In Satisfaction ofItem 2(D):
To: Helen Opperman Krause Animal Foundation Inc. -15%
Cash
In Satisfaction ofItem 2(E):
To: Mildred Schall- 15%
Cash
In Satisfaction of Item 2(F):
To: Barbara Helsel- 5%
Cash
In Satisfaction of Item 2(G):
To: Robert Schall- 5%
Cash
17A
$49.242.26
$ 8,244.40
$ 8,244.40
$ 8,244.40
$ 8,244.40
$ 7,112.28
$ (70.76)
$ 2,305.78
In Satisfaction of Item 2(H):
To: Maxine McNutt - 5%
Cash
$ 2,305.78
In Satisfaction ofItem 2(1):
To: Mark Russell- 5%
Cash
$ 2,305.79
In Satisfaction ofItem 2(J):
To: Henry Russell- 5%
Cash
TOTAL
$ 2.305.79
$49.242.26
17B
PNC ADVISORS
o PNCBAN<
0769810
ESTATE OF FRANCES E HVSSONG ALSO KNOWN AS
FRANCES EILEEN HVSSONG DECEASED
(DIED 6/23/01))
PNC BANK, NATIONAL ASSOCIATION
B~ EXECUTOR
TRSN02 C 1 0102)
- 18 -
PNC ADVISORS
o PNCBAN<
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
LINDA J LUNDBERG BEING DULY
AFFIRMED ACCORDING TO LAW DEPOSES AND SAYS THAT SHE IS AN
ASSISTANT VICE PRESIDENT OF PNC BANK, NATIONAL ASSOCIATION,
THE ACCOUNTANT NAMED IN THE FOREGOING ACCOUNT AND THAT THE SAID
ACCOUNT IS JUST AND TRUE TO THE BEST OF HER KNOWLEDGE AND
BELIEF AND THE GRANT OF LETTERS AND THE FIRST COMPLETE
ADVERTISEMENT THEREOF OCCURRED MORE THAN FOUR MONTHS BEFORE
FILING OF THE ACCOUNT AND THE DECEDENT WAS NOT ADJUDICATED
INCOMPETENT
AFFIRMED AND SUBSCRIBED TO
BEFORE ME THIS //11l DAY
OF 'E:ecernber 20 O~
I HEREBY CERTIFY THAT I AM
NOT A DIRECTOR OR OFFICER
OF PNC BANK, NATIONAL ASSOCIATION
~~
~
~~tLfIod-
/
Notarial Seal
Carol A. Leiphart, Notary Public
Hampton Twp., Cumberland County
My Commission Expires Nov. 15, 2003
Member, PennsylVania AsSOCiation of Notaries
TRSN02 (10/02)
- 19 -
/
/'
/
PNCBANK
ESTATE OF FRANCES E HYSSONG ALSO KNOWN AS
FRANCES EILEEN HYSSONG DECEASED
(DIED 06/23/01)
LATE OF THE TOWNSHIP OF UPPER ALLEN
CUMBERLAND COUNTY PA
WILL NO 21-01-0634
INVENTORY
COMMONWEALTH OF ,PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
L.INDA J LUNDBERG ASSISTANT VICE PRESIDENT OF PNC BANK, NATIONAL ASSOCIATION,
THE EXECUTOR OF THE ESTATE OF FRANCES E HYSSONG ALSO KNOW AS FRANCES EILEEN
HYSSONG DECEASED HAVING BEEN DULY AFFIRMED ACCORDING TO LAW DID DEPOSE AND SAY
THAT THE ITEMS APPEARING IN THE FOLLOWING INVENTORY ARE PERSONAL ASSETS
WHEREVER SITUATE AND REAL ESTATE IF ANY IN THE COMMONWEALTH OF PENNSYLVANIA
OF SAID DECEDENT THAT THE VALUATION PLACED OPPOSITE EACH ITEM OF SAID
INVENTORY REPRESENTS ITS FAIR VALUE AS OF THE DATE OF THE DECEDENT'S DEATH AND
THAT THE DECEDENT OWNED NO REAL ESTATE OUTSIDE THE COMMONWEALTH OF
PENNSYLVANIA EXCEPT THAT WHICH APPEARS IN A MEMORANDUM AT THE END OF THIS
INVENTORY
AFFIRMED AND SUBSCRIBED BEFORE ME
THIS ,/fl# DAV OF~",{ 20&y-
, .........:......',' \.~ .,.:,. :. - ,..
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NOTARIAL SEAL
DENISE C. SULLENBERGER, Notary PuNic
Hampden T'r'JP.. Cumberland County
~ My Commission Expires Nov. 22, 2004
~--..."-
- 1 -
TRSN01 110/95)
PRIVATE BANK
PNCBANK
FRANCES E HYSSONG
769810
~
16,000 PAR MORGAN JP CO INC SUB NT
6.2570 DUE 1/15/2009
Q) 98.9179
INTEREST FROM 1/15/01 TO 6/23/01
COMMON STOCKS
759.647 SHS AMERICAN WATER WORKS CO INC COMMON
Q) 31.1525
FUNDS
619.772 SHS BLACKROCK MUNICIPAL TARGET TERM
TRUST
iil 10.2325
INCOME TO 6/23/01
768.710 SHS DREYFUS INTERMEDIATE MUNI BOND
FUND 1947
Q) 13.5500
INCOME TO 6/23/01
MISCELLANEOUS
PERSONAL PROPERTY
1995 FORD
CASH
DREYFUS
DREYFUS INTERMEDIATE MUNI BOND
FUND 1947 INCOME ON 768.710 SHS
DATED 5/31/01
PENNSYLVANIA BLUE SHIELD
HEALTH INSURANCE BENEFITS
PENNSYLVANIA BLUE SHIELD
HEALTH INSURANCE BENEFITS
THE PATRIOT NEWS
REFUND SUBSCRIPTION CANCELLATION
MEMBERS FIRST
SAVINGS ACCOUNT 115305-00S
DATE OF DEATH BALANCE 61,928.01
INTEREST TO 6/23/01 106.75
MEMBERS FIRST
CHECKING ACCOUNT 115305-11S
DATE OF DEATH BALANCE 8,919.51
INTEREST TO 6/23/01 10.89
AAA MEMBERSHIP
REFUND
15,826.87
438.89
23,664.91
6,341.82
29.70
10,416.02
31.73
1,089.00
4,830.00
42.86
30.90
7.22
48.10
62,034.76
8,930.40
27.00
TRSN02C10/9St
- 2 -
FRANCES E HYSSONG
CONTINUED: CASH
PRIVATE BANK
PRUDENTIAL FINANCIAL
ANNUITY ACCOUNT #E0038703
DATE OF DEATH BALANCE 17,483.16
APPRECIATION TO 8/8/01 977.57
DONEGAL COMPANIES
REFUND AUTOMOBILE INSURANCE
J GORDON GAINES INC
REFUND RENTERS INSURANCE
PRUDENTIAL SECURITIES
MONEY MARKET FUNDS
ACCOUNT #04423096873
DATE OF DEATH BALANCE
INTEREST TO 6/23/01
3,769.66
12.57
INTERNAL REVENUE SERVICE
REFUND 2000 INDIVIDUAL INCOME TAX
UNITED STATES TREASURY
REFUND 2000 TAX RELIEF
AT&T
REFUND
S G DIAMOND INC
REFUND OF SECURITY DEPOSIT
PNC BANK NATIONAL ASSOCIATION
CHECKING ACCOUNT #5140031311
DATE OF DEATH BALANCE
PNC BANK NATIONAL ASSOCIATION
CHECKING ACCOUNT #5140031311
ANNUITY PAYMENT
COMCAST
REFUND SERVICE
PRUDENTIAL FINANCIAL
DEMUTUALIZATION BEDEFITS
TOTAL INVENTORY
- 3 -
PNClRANK
769810
18,460.73
173.00
76.00
3,782.23
233.00
300.00
1.10
460.00
3,989.24
310.06
18.43
369.72
161,963.69
------------
------------
TRSN02t10/9S)
.-
LAST WILL AND 1ESTAMENT OF FRANCES E. HYSSONG
I, FRANCES E. HYSSONG, of the Borough of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath as follows:
A. Fifteen (15%) per cent thereof to Mechanicsburg Area Senior Adult
Center.
B. Fifteen (15%) per cent thereof to St. Mark's Lutheran Church
Building Fund.
C. FIfteen (15%) per cent thereof to Mechanicsburg Public Library.
D. F1fteen (15%) per cent thereof to Helen Opperman Krause Animal
Foundation, Inc.
E. Ftfteen (15%) per cent thereof to my sister, Mildred Schall. .
F. Five (5%) per cent thereof to my niece, Barbara Helsel.
G. Five (5%) per cent thereof to my nephew, Robert Schall.
H. Five (5%) per cent thereof to my niece, Maxine McNutt.
I. Five (5%) per cent thereof to my nephew, Mark Russell.
J. Five (5%) per cent thereof to my nephew, Henry Russell.
.
.
~
Should any of my above-named relatives predecease me, then their share shall be pro-rata
apportioned amongst the other surviving beneficiaries named, including the charities as well as my
relatives.
- 3.
I nominate, constitute and appoint CCNB BANK NA to be the Executor of this my Last
Will and Testament. I funher direct that my Executor shall not be required to file bond or other
security in the Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this / / y.l; day of
.~
, AD. 1993.
~.f.h
(SEAL)
Signed, sealed, published and declared by the above-named FRANCES E. HYSSONG as
and for her Last Will and Testament, in the presence of us, who at her request and in her presence,
and in the presence of each other, have hereunto subscribed our names as witnesses.
~C?~:iiL
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REV-1500 EX'. (6'00) . OFFICIAL USE O,..LY .
COMMONWEALTH OF PENNSYLVANIA REV-1500 \(0--2.41 ly
DEPARTMENT OF REVENUE -
DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 0634
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
HYSSONG, FRANCES E 193-14-6779
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
06/23/01 09/12/1922 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
3. Remainder Return
CHECK r Original Return ~' Supplemental Return B (date of death prior to 12-13-82)
APPRO- 4. Umited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
\)'ateof death after 12-12-82)
PRIATE 6. Decedent Died Testate 7. ecedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach acopyofTrust)
BLOCKS 9. Utigation Proceeds Received 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A)
12-31-91 and 1-1-95) (Attach Soh 0)
jjjij!~"MQlfijI;!I!Q_ii,ijilllQ;i@ij4Qflij~g'PQOO!~OO\f4!l18l'QIlMAfjPl!i$l!Q!!Y!iliQ~pjZm
NAME COMPLETE MAILING ADDRESS
COR- LINDA J LUNDBERG P 0 BOX 308
RE- FIRM NAME (If Applicable) 4242 CARLISLE PIKE
SPON
DENT PNe ADVISORS O\MP HILL PA 17011
TELEPHONE NUMBER
717-730-2265
---.;,..- OFFICIAL USE ONLY
1. Real Esfafe (Schedule A) (1) ~ d JJ
... , - .,'3'
2. Stocks and Bonds (Schedule B) (2) 56, 74<.tj~3 N
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None ---,'.
4. Mortgages & Notes Receivable (Schedule D) (4) None .....c
5. Cash, Bank Deposits & Miscellaneous Personal ""
Property (Schedule E) (5) 87,675.02 ~
6. Jointly Owned Property (Schedule F) -;)
0 Separate Billing Requested (6) None ,'":>.
RECA- ,'.-'
.......
PITULA- 7. Inter-Vivos Transfers & Miscellaneous
TION Non-Probate Property (Schedule G or L) (7) 58,919.96
8. Total Gross Assets (total Lines 1-7) (8) 203,344.91
9. Funeral Expenses & Administrative Costs (Schedule H)(9) 17,202.80
10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) Ci0} 1,260.83
11. Total Deductions (total Lines 9 & 10) (11) 18,463.63
12. Net Value of Estate (Line 8 minus Line 11) (12) 184, 881. 28
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) 82,515.28
has not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 102,366.00
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amountof Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2) X.O (15)
-
TAX 16. Amount of Line 14 taxable at lineal rate 0.00 X .0 45 (16) 0.00
20,628.85 -
COMPU- 17. Amount of Line 14 taxable at sibling rate x.12 (17) 2,475.46
TATION 18. Amount of Line 14 taxable at coJlateral rate 81,737.15 x.15 (18) 12,260.57
19. Tax Due (19) 14,736.03
20. 0 ti:lfij!dk:ij~)jjI<<!!lMliij~li,l\iii~Aij~ijpQl!A"~llliA_i",el
~
......................................".,.,.,..,...""""""""""""'~~::B"':!l!i!l"[O::A!'!SMlal:AQiiQVem1Q!'!$Q~"~"'l!:A!'!p:Re9!1!iQ'l:MArn~~::::',...
o PA15001
NTF 29755
Copyright 2000 Greatland/Nelco LP - Forms Software Only
Estate of: FRANCES E HYSSONG
SUJI.1I<1ARY OF ALLOCATIONS TO BENEFICIARIES
Taxable at sibling rate
FWRENCE MILDRED SCHALL
20,628.85
Taxable at =l1ateral rate
BARBARA A HElSEL
ROBERT R SCHALL
MAXINE M MCNUIT
MARK MALCOLM RUSSELL
HENRY M W RUSSELL
54,232.07
6,876.27
6,876.27
6,876.27
6,876.27
81,737.15
21-2001-0634
, '
PA REV-1500 EX (6-00)
Page 2
Decedent's ComDlete Address:
STREET ADDRESS
509 East Elrrw::x:x:l Ave, Ant 3
CITY I STATE I ,ZIP
Mechanic~1-o,~ PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discou nt
(1)
14,736.03
12,350.00
650.00
Total Credits (A + B + C)
(2)
13,000.00
3. Interest/Penalty n applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4, 11 Une 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAVMENT.
Check box on Page 1 Line 20 to request a refund
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This IS the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WilLS, AGENT
(3) 0.00
(4)
(5) 1,736.03
(SA) 0.00
(5B) 1,736.03
n;~t!X~:~X~~!~!~~~~8O:8!1~~~n~~~I~~~~~~l!~!~~x~!!!l!i~+~~X~!!g~!,R~~~t38~~t
Yes No
~ I
B ~
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; ....,..........,.......,.......,.,.....
b. retain the right to designate who shall use the property transferred or its income; ,.,........,.....
c. retain a reversionary interest; or. . . . . . . . . , . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . , . . . . .
d. receive the promise for life of either payments, benefits or care? ............,...............
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . , . , . . , . . . ' . . . . . . . . .
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.
Under penalties of perjulY, 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 ttian the personal representative is based on information of
which preparer has any knowledae,
SlGNAT E8,F PJ~SA>~ RESPONSIBLE FOR FILING RETURN DATE
PNC a , Assistant Vice President
o
ADDRE
See Schedule attached
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
.......,..._,._,-..,..'_..,..,..,..,-,.,..
......-.--..........,...,...-,-....,..'..,..'-.......
...............".,.,'....
.. .............:.:.;,'...,,'.'.,,'..,','-,:::,,',':,,',::,':,::~::;.:::.'.::::.:;.?,',;,'........
. .. .,.":",:,:::-:,:::"..;::::".",,:,.:..,,,.;~;,:,:,:,;,:,::::::":' . ...........:,:.,.:,:.:.,.'.,,'.,::.,..,:,..,,:,':'..:,:..,':":::"::,,:,.,,:,),,,:,,:,,.:.,-.-.,.. ... ... ...
... .....................,........ .
o PA15002
NTF 29756
Copyright 2000 Greatland/Nelco LP - Forms Software Only
Estate of: FRANCE'S E HYSSCN3
21-2001-0634
The follCMing person (s) are signing the return as representative (s) of the estate:
LINDA J lllNDBERG
4242 CARLISLE PIKE
CAMP HILL, PA 17011
REV-1503 EX + (1-97)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FRANCES E HYSSONG
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21-2001-0634
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NO. DESCRIPTION
VALUE AT DATE
OF DEATH
1 622 . 656 SHS BlAO<ROCK MUN
TARGET TERM 'IR
@ 10.2328
6,371.51
2 16,000 PAR MORGAN J P & 00
6.25% DUE 1/15/09
@ 98.91795
15,826.87
INTERFSI' 10 6/23/01
438.89
3 759.6472 SHS AMERICAN WIR WKS
@ 31.1525
23,664.91
4 768.71 SHS DREYFUS INTER MUNI
BCND FUND #947
@ 13.5500
10,416.02
INCOME 10 6/23/01
31. 73
TOTAL (Also enter on line 2. RecaDitulatDnl $
(If more space is needed, insert additional sheets of the same size)
56,749.93
7 CPA31 NTF 10905
Copyright Forms Software Only, 1997 Nelco, Inc.
REV-1508 EX'+ (1-97) ,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FRANCE'S E BY8SCN3
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-2001-0634
Include proceeds of litioation & date proceeds were received by the estate. All Drop. lolntIY-owned with right 01 survlvorshlD must be disclosed on Sch. F.
ITEM VALUE AT
NO. DESCRIPTION DATE OF DEATH
1 TANGIBLE PERSONAL PROPERTY I..CCATED AT 1,089.00
DECEDENT'S APAR'IMENT
APPRAISED BY CLI\llDE C. WJU'E
(CDPY OF APPRAISAL ATTACHED)
2 1995 FORD 4,830.00
OOMM OF PA TITLE #48998387201 BY
AVERAGE VALUE
3 PNC CHECKING ACCI' #5140031311 3,989.24
4 MEMBERS FIRST SAVINGS ACCT #15305-008 61,928.01
INI'EREST TO 6/23/01 106.75
5 MEMBERS FIRST CiA #15305-118 8,919.51
roD TNT POSTED 6/30/01 10.89
6 THE PATRIOT NEW8 REFl.lND OF SUBSCRIPTIrn 48.10
7 o:::tVM:JNWEI\LTH OF PA STATE EMPWYEES 310.06
RETIREMENT SYSTEM
FINAL ANNUI'IY PAYMENT
8 AAA MEMBERSHIP REFl.lND A/c #8238218 27.00
9 !XlNEGAL CDS REFl.lND OF AUTO IN8 roLICY #PAE0240977 173.00
10 J GORDrn GAINES INC REFl.lND OF RENTERS IN8 A/c #HMOO0625209 76.00
11 PRUDENTIAL 8EOJRITIES MJNEY MARKEr A/c #04423096873 3,769.66
PillS ACCRUED INI' 12.57
12 AT&T REFl.lND CANCELIATION OF ACCOUNT #0909006285301 1.10
13 8 G DIAM::MJ INC, REFl.lND OF SEOJRITY DEPOSIT ON 509 E EI..M\'D)D AVE 460.00
14 <X:MCAST REFl.lND IXJE TO CANCELIATIrn 18.43
15 PENNSYLVANIA HEALTH INSURANCE BENEFITS 38.12
16 IRS - REFl.lND 2000 INDIVIDUAL IN<X:ME TAX 233.00
Total fran continuation paqe (8) 1,634.58
TOTAL (Also enter on line 5, RecaDitulationl $ 87,675.02
7 CPA81 NTF 10908
Copyright Forms Software Only, 1997 Nelco, Inc.
(If more space is needed. insert additional sheets of the same size)
. Page 2
Estate of: FRANCES E HYSSONG
21-2001-0634
SCHEIJULE E n Cash, Bank Deposits and Miscellaneous Personal Property
Item
No. Description
Value at Date
of Death
17 US TREI\S - 2000 TAX RELIEF REBATE
300.00
18 DREYFUS - DIVIDEND PAYABLE 5/31/01 ON 768.71 SHS DREYFUS
INTERMEDIATE MUNI BOND ill
42.86
19 PRUDENTIAL FINANCIAL - DEMlJI'UALIZATION BENEFITS
369.72
20 IRS REFUND PERSONAL INCIME TI\X 2001
922.00
'I()TIU,. (Carry forward to rrain schedule) . . . . . .
1,634.58
REV-1510 EX', (1-97) ,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FRANCES E HYSSONG
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-2001-0634
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF EXCLUSION
ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S (IF TAXABLE VALUE
RELATIONSHIP TO DECD & DATE OF TRANSFER.
NO. ATTACH COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE)
1 VEN'IURE ANNUITY CONTRACT 216739 41,436.80
MANULIFE FINANCIAL
2 PRUDENTIAL LIFE INSURANCE CD. 17,483.16
DISCDVERY SELECT ANNUITY
CONTRACT # E003873
\
TOTAL (AlsO enter on line 7, Recaoitulelion) $ 58,919.96
7 CPA01
NTF 10910
COP'Jfight Fo~ms So.Hwar~ Ol\ly, ~9C;H Nelco, Inc.
(If more space is needed, insert addJtiona/ sheets of the same size)
REV-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FRANCE'S E HYSSONG
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-2001-0634
Debts of decedent must be report on c edule .
ITEM
NO. DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 BLUE RID3E MEM GARDEN INSCRIBING MARKEr SCROLL 190.00
2 CRElVIATION SOCIETY OF PA 290.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 8,098.00
Name of Personal Representative(s) PNe BANK.
Social Security Number(s)/EIN No. of Personal Representative(s) ::}.;).-\\""\R~~O
Street Address 4242 CARLISLE PIKE
City CAMP HILL State PA Zip 17011
Year(s) Commission Paid:
2. Attorney Fees Narre: CHARLES E SHIELDS III ESQUIRE 7,150.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) 0.00
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 280.50
5. Accou ntant's Fees 0.00
6. Tax Return Preparer's Fees 0.00
See Schedule attached
Tbtal from ccntinuation page (8) 1,194.30
TOTAL (Also enter on line 9, Recapitulation) $ 17,202.80
ed 5 h
7 CPA11 NTF 10911
Copyright Forms Software Only, 1997 Nelco, Inc.
(If more space is needed, insert additional sheets of the same size)
Estate of: FRANCES E HYSSONG
SrnEDULE H, PART B -- Administrative Cbsts
Item
No. Description
7 REGISTER OF WILlS - 2 SHORT CERTIFICATES
8 AMERICAN WATER IDRKS SERVICE FEE
9 CHARLES E SHIELDS III - REIMBURSElVIENT FOR LEl3AL ADVERTISING
CUMBERlAND CD LI\W JOURNAL
10 CHARLES E SHIELDS III - REIMBURSElVIENT FOR LEl3AL ADVERTISING IN
1HE PATRIOT NEWS
11 S G DIAM::JND INC JULY RENT
12 CLl\JJDE C IDLFE & ASSOC P~ PROPERTY APPRAISAL
13 STATE EMPIDYEES RETlRElVIENT REIMBURSElVIENT
14 PRUDENTIAL SECURITIES SECURITY FEE Ajc #04423096873
15 INFORMATION NEIWJRK ASSOC INC
FEE FOR SEARGI FOR IDST BENEFICIARIES
16 S G DIAM::JND INC - FEE FOR REJ.VDVAL OF SOFA
'IOI'AL. (Carry forward to main schedule) . . . . . .
Page 2
21-2001-0634
Arrount
6.00
10.00
75.00
85.95
550.00
125.00
72.35
50.00
170.00
50.00
1,194.30
REV-1512 EX". (1-97) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FRANCFS E HYSSONG
Include unreimbuTsed medical excenses.
ITEM
NO.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-2001-0634
DESCRIPTION
AMOUNT
1 MEMBERS FIRST e/A #15305-118 BANKERS LIFE INS
2 MEMBERS FIRST e/A #15305-118 OUTSrANDING GIECK
3 VERIZON TELEPHONE BILL A!e #717697130806323Y
4 HOLY 8PIRIT HOSPITAL SVCS A!e #16798506
5 MARLIN A YOHN SR, TREAS 2001 CUMBERIAND cry PERSONAL TAX
6 CP02 BILLING CTR #92410
7 PPL ELEC DrILITIES A!C #44760-65008
141. 94
550.00
12.02
19.08
11.00
5.66
316.94
8 cx::MCAST HVIT8
32.53
9 PP&L HVIT8
10 APRIA HEAL'lliCARE INC - SERVICFS RENDERED PRIOR TO D/O/D
150.00
21. 66
7 CPA12 NTF 10912
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,260.83
Copyright Forms Software Only, 1997 Nelca, Inc.
REV-1513 EX' (1-97) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FRANCE'S E HYSSONG
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 FlDRENCE MIWRED SCBALL
RD #3 BOX 159
ALTOJNA, PA 16601
2 BARBARA A HEISEL
RD#3 BOX 157
ALTOJNA, PA 16601
3 ROBERT R SCBALL
5041 BRCMLEY AVE
SPRING HILL, FL 34609
4 MAXINE M MCNJIT
5644 W 800TH SOOTH
PENDLEION, IN 46064
5 MARK MALCOIM RUSSELL
155 GARDNER ST, APT 7
RENO, NV 89503
6 HENRY M W RUSSELL
2863 E JOY RD
ANN ARBOR, MI 48105
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not Ust Trustee(s)
SISTER
NIECE
NEPHEW
NIECE
NEPHEW
NEPHEW
21-2001-0634
AMOUNT OR
SHARE OF ESTATE
20,628.85
54,232.07
6,876.27
6,876.27
6,876.27
6,876.27
ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPRnpRIATE ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
See Schedule attached
Total fran =ntinuation page (8)
82,515.28
7 CPA13 NTF 10913
TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1500 COVER SHEET $
82,515.28
Copyright Forms Software Only, 1997 Nelco, Inc.
(If more space is needed, insert additional sheets of the same size)
Estate of: FRANCES E HYSSONG
SCHEOOLE J, Part 2
Charitable and Governrrental Distributions
Item
No. Description
1 MEaJANICSBURG AREA SENIOR CENTER
TRESSLER WI'HERAN SERVICES
960 CEN'IURY DR
MEaJANICSBURG, PA 17055-0707
2 sr MARK'S WI'HERAN CHURGJ
117 W KELLER sr
MEOJANICSBURG, PA 17055
3 MEaJANICSBURG PUBLIC LIBRARY
16 N WArnUI' ST
MEOJANICSBURG, PA 17055
4 HELEN OPPERMAN KRAUSE ANIMAL Frn
POBOX 311
MEOJANICSBURG, PA 17055
ror.AL. (Carry forward to ffi3.in schedule) . . . . . .
. Page 2
21-2001-0634
Arrount
20,628.82
20,628.82
20,628.82
20,628.82
82,515.28
Form 706 (Rev, 11-01)
Estate of: FRANCES E HYSS0N3 193-14-6779
SCHEDULE 0 -- Charitable, Public, and Similar Gifts and Bequests
Yes No
18 If the transfer was made by will, has any action been instituted to have interpreted or to contest the will or any
of its provisions affecting the charitable deductions claimed in this schedule? . . . . . . . . . . . . . , . . , . . . . . . . . . . . , . . . . . . . . . . .
If "Yes," full details must be submitted with this schedule.
b According to the information and belief of the person or persons flling this return, is any such action planned?
If 'Yes," full details must be submitted with this schedule.
2 Did any property pass to charity as the result of a qualified disclaimer? . . . . , . . . . , . . , . . . . . . . .
If ''Yes,'' attach a copy of the written disclaimer required by section 2518(b).
Item
no,
Name and address 01 beneficiary
Character of institutlon
Amount
1 MEOJANICSBURG AREA SENIOR CENTER
TRESSLER LUI'HERAN SERVICES
960 CENTURY DR
MEOJANICSBURG, PA 17055-0707
20,628.82
2 ST MARK'S LUI'HERAN cHURCH
117 W KELLER ST
MECHANICSBURG, PA 17055
BUILDING FUND
20,628.82
3 MEOJANICSBURG PUBLIC LIBRARY
16 N WAilIDI' ST
MECHANICSBURG, PA 17055
20,628.82
4 HELEN OPPERMAN KRAUSE ANIMAL FDN
POBOX 311
MEOJANICSBURG, PA 17055
20,628.82
Total from continuation schedules (or additlonal sheets) attached to this schedule. , , . . . . . . . . . . . . . . . . . . . . . . . . . . .
0.00
4a Federal estate tax payable out of property interests listed above. . . . . . . . . 4a
0.00
82,515.28
3 Total.""""
...............................................................
b Other death taxes payable out of property interests listed above. . . . . . . . . 4b
0.00
C Federal and state GST taxes payable outof property interests listed above 4c
0.00
d Add items 4a, b, and c, , , , , , ' , , , , , , " ' , , , , , , , , ' , , , , ' , , , , , , , , ' , ,
4d
0.00
5 Net value of property interests listed above (subtract 4d from 3). Also enter on Part 5, Recapitulation,
page 3, at item 21 ..................................................................... 5
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)
(The instructions to Schedule 0 are in the separate instructions.)
82,515.28
Schedule 0 - Page 31
CAA
1 70501
NTF2SS7SS6
Copyright 2001 GreatlandlNelco - Forms Software Only
Estate of ' FRANCES E HYSSONG
Calculation of Estate Residue Before Taxes
Schedule 0, Item 1
Gross estate (line 1, Fonn 706)
Less:
Deductions listed on Schedules J, K, and L
Preresiduary gifts:
BARBARA A HELSEL:
18,463.63
5,919.00
41,436.80
Total reductions
Residue prior to paynent of taxes
Percent passing to charity
Arrount passing to charity
193-14-6"179
203,344.91
(65,819.43)
137,525.48
15.0000%
20,628.82
Estate of' FRANCES E HYSSONG
Calculation of Estate Residue Before Taxes
Schedule 0, Item 2
Gross estate (line 1, Form 706)
Less:
Deductions listed on Schedules J, K, and L
Preresiduary gifts:
BARBARA A HEISEL:
18,463.63
5,919.00
41,436.80
Total reductions
Residue prior to payrrent of taxes
Percent passing to charity
Arrount passing to charity
193-14-6179
203,344.91
(65,819.43)
137,525.48
15.0000%
20,628.82
Estate of' FRANcrs E HYSSON}
Calculation of Estate Residue Before Taxes
Schedule 0, Item 3
Gross estate (line 1, Form 706)
Less:
Deductions listed on Schedules J, K, and L
Preresiduary gifts:
BARBARA A HEISEL:
18,463.63
5,919.00
41,436.80
Total reductions
Residue prior to payment of taxes
Percent passing to charity
Arrount passing to charity
193-14-6')'79
203,344.91
(65,819.43)
137,525.48
15.0000%
20,628.82
Estate of, FRANCES E HYSS0N3
Calculation of Estate Residue Before Taxes
Schedule 0, Item 4
Gross estate (line 1, Fonn 706)
Less:
Deductions listed on Schedules J, K, and L
Preresiduary gifts:
BARBARA A HELSEL:
18,463.63
5,919.00
41,436.80
Total reductions
Residue prior to payment of taxes
Percent passing to charity
1\rroUnt passing to charity
193-14-6'179
203,344.91
(65,819.43)
137,525.48
15.0000%
20,628.82
~
. ,.,.
.,' .
.~
I "AST WII.1. AND TESTAMENT OF FRANr'F.S E. HYSSONG
I, FRANCES E. HYSSONG, of the Borough of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsOever and
wheresoever situate, I give, devise and bequeath as follows:
A. Fifteen (15%) per cent thereof to Mechanicsburg Area Senior Adult
Center.
B. Fifteen (15%) percent thereof to St. Mark's Lutheran Church
Building Fund.
C. Fifteen (15%) per cent thereof to Mechanicsburg Public Library.
D. Fifteen (15%) per cent thereof to Helen Opperman Krause Animal
Foundation, Inc.
E. Fifteen (15%) }l"1"cent thereof to my sister, Mildred Schall.
F. Five (5%) per cent thereof to my niece, Barbara Helsel.
G. Five (5%) per cent thereof to my nephew, Roben Schall.
H. Five (5%) per cent thereof to my niece, Maxine McNutt.
I. Five (5%) per cent thereof to my nephew, MlII:k: Russell.
J. Five (5%) percent thereof to my nephew, Henry Russell.
,
~.
~
Should any of my above-named relatives predecease me, then their share shall be pro-rata
apportioned amongst the other surviving beneficiaries named, including the charities as well as my
relatives.
3.
I nominate, constitute and appoint CCNB BANK NA to be the Executor of this my Last
Will and Testament. I further direct that my Executor shall not be required to file bond or other
secwity in the Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this / / ~ day of
~/t1
. AD. 1993.
r~ f fJ7
(SEAL)
Signed, sealed, published and declared by the above-named FRANCES E. HYSSONG as
and for her Last Will and Testament, in the presence of us, who at her request and in her presence,
and in the presence of each other, have hereunto subscribed our names as witnesses.
(!/~ E! ~:F
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CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1912
2009 LINCOLN STREET' CAMP HILL, PA 17011
717-761-2763
Appraisal for tbe Estate of Frances E. Hyssong
509 East Elmwood Avenue - Apt. 3, Mecbanicsburg, PA 17055
ENTRY
Oval mirror & sconces
"Roses" picture
LIVING ROOM
Queen Anne style end table
GE portable radio
Candy dish
Wing back chair
Dry sink - reproduction
Bowl & pitcher - reproduction
Misc. glassware
Brass magazine rack
13 Misc. pictures
Elgin quartz clock
Black & natural spool back wooden chair
Samsung 20" portable TVNCR
TV stand
Goose neck rocking chair
Pair of end tables & matching coffee table
Sofa - worn
Trash can
Brass table lamp
Brass table lamp -39"
Pair of sconces
otiC ....!..;~"
"FCEIVEO
JUl 2 6 2uOl
IM&T
serA
July 16, 2001
2.00
4.00
25.00
3.00
3.00
35.00
95.00
5.00
5.00
1.00
10.00
5.00
20.00
45.00
5.00
10.00
65.00
1.00
1.00
2.00
3.00
2.00
CLAUDE C. WOLfE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE /9/2
2009 LINCOLN STREET' CAMP HILL, PA 17011
717-761-2763
Hyssong appraisal
Page 2 of 5
CLOSET
Shopping cart
Hoover upright vacuum cleaner
Baskets
Electric iron
TV trays - wooden
KITCHEN
Magic Chef microwave
Microwave stand
Chest freezer
Electric can opener
Crock pot
Small Mister Coffee
Dust Buster
Misc. everyday dishes
Misc. cookware
Misc. utensils
Misc. flatware
Folding kitchen stool
Trash can
Plastic storage rack
Table & 4 chairs
TV stand
Toastmaster toaster oven
Oldremotetclephone
New remote tclephone
Currier & Ives plates - (2)
2.00
20.00
1.00
1.00
5.00
12.00
1.00
20.00
1.00
1.00
2.00
3.00
5.00
5.00
2.00
2.00
3.00
1.00
1.00
30.00
1.00
2.00
1.00
18.00
4.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1912
2009 LINCOLN STREET' CAMP HILL, PA 17011
717-761-2763
Hyssong appraisal
Page3 of 5
OFFICE
Recliner
Bookshelf
Misc. books
Brass lamp - 30"
Metal 4-drawer file cabinet
Misc. VCR & cassette tapes
Card table chairs - (2)
Attache case
Christmas ornaments - (18)
TI calculator
Trash can
InIout basket
Card table
Metal cabinet
Misc. office supplies
BEDROOM
Misc. costume jewelry
Small diamond ring
Dresser set
Wood-like table lamp
Dresser containers
Single bed, dresser & night stand
Sylvania TV - old
Oak TV stand
TMK VCR
Cedar chest
10.00
10.00
10.00
3.00
25.00
12.00
4.00
1.00
10.00
10.00
1.00
1.00
3.00
5.00
8.00
5.00
65.00
5.00
2.00
5.00
150.00
5.00
20.00
40.00
55.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1912
2009 LINCOLN STREET. CAMP HILL, PA 17011
717-761-2763
Hyssong appraisal
Page 4 of 5
BEDROOM - continued
Bed linens
Quilt
Alarm clock
Brass table lamp
Answering machine
Telephone
Rocking chair
Jewelry case
Hair dryer
Luggage
Old kerosene lamp
Kerosene lamps - (2) reproductions
Pictures - (4)
Trash can
LINEN CLOSET
Misc. Christmas decorations
Misc. linens
Misc. tools
BATH
Scales
Trash can
STORAGE ROOM - BASEMENT
Luggage
Christmas tree
Lawn chairs - (2)
Garden hose
Misc. contents of storage room
5.00
50.00
1.00
1.00
5.00
1.00
15.00
3.00
1.00
1.00
20.00
3.00
2.00
1.00
5.00
7.00
3.00
1.00
1.00
1.00
1.00
2.00
1.00
2.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE /912
2009 LINCOLN STREET. CAMP HILL, PA 17011
717-761-2763
Hyssong appraisal
Page S of S
APPRAISAL TOTAL $ 1,089.00
This Fair Market Value appraisal is true and correct to the best of my ability as an
auctioneer and appraiser with 3S years experience.
Member: Certified Appraisers Guild of America
CLAUDE C. WOLFE & ASSOCIATES
\ -{""', .
vJ .\Z. bI~ C~~----
W. K. "Dusty" Chapman, CAGA
, 1
. .,... Erica L Schlegel
.... ~;.,,~ 07117/01 11 :23 AM
....~
To: Judith M HaflIlPNCAdvisorslSCPIPNC@PNC
ce:
Subject: Date of Death Balances
Estate of, Frances Eileen Hyssong Deceased
SSN#193-14-6779
DOD 06-23-2001
ACCOUNT NUMBER .DATE OF DEATH BALANCE + ACCRUED INTEREST. ESTABLISHED DATE
DDA #5140031311
$3,989.24 Non interest bearing account
09'()1-1973
SDB #428 Located at Windsor Park Branch
If you selected the balances to be sent to the "Branch" they will only be sent to the requestor by LOTUS
Notes.
Have a great day!!! : -)
"'
)
Metnbersl...'....
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
15305 -00
10/02/1973
$61.928.01
$106.75
$62.034.76
None
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
15305 -11
12/31/1979
$8.919.51
$10.89
$8.930.40
None
INSURANCE DEPARTMENT
5000 WUISE DRIVE . '
P. O. BOX 40
MECHANICSBURG. PA 17055
1-800-283-2328 or(717) 697-1161
PNG ;lANI(
''''C!:IVED
JUl 2 5 2001
IMIT
SC:>A
D':"S l,"~ITUNION
1t111-f ;:.
Denise A. Anders
Insurance Products Supervisor
July 20. 2001
Estate of: FRANCES E. HYSSONG
Date of Death: 06/23/2001
Social Security Number: 193-14-6779
AUG-Oti-Ol II :Z~AM F~OM-MA"u.I~~ ~'~A~.'A.
glll,l"l.........1il
,....... ,.....,.... ',....
ImJ M/[anulife Financial
August 3, 2001
Linda J. Lundberg
Estate AdminiStrllto:
PNC Bank
P.O. Box 308
Camp Hill, PA 17001
Re: Venture Annuitf ContraCt 2 L6139. Frances E. Hyssong
Dear Ms. Lundberg:
Please accept this Inter as confirmation of the dale of death value for the abcIVe referenced
V c:nture Annuity cc.ntracl.
The contract value lS of June 2J, 2001 was $41,436.80.
A Death Benefit Package conta rung forms necessary to complete the claim for Ibis contract was
mailed 10 you on 1/27/01. IfycLl have noncceived it, or if you hav~any questions or concerns,
please contacl our .\J!nuilY Cuslomer Service Center al (800) 344-1029.. Our Representatives arc
available Monday through Frid,IY from 8 am until 8 pm, Eastern Standard TIme.
~..~
' .~~
1(, .,
, -----.-.
o uval '
Workflow Coordinator. Annuit ,T Services
Manulife Financial
I',..' :,..<r.-;
I:ECl:IV;"J
AUG 6 2001
IM&T
CPA
The Manul;lctUrers Ufe Insurance Company of Nonh America
SOC Boylston Str.ot, Suite 400. Elaston, MA 021'6-3739
Mail,,'9 Acldro..: P.O. Box 9230, Boston, MA 02205-9230
Phone: 800.908.600B 617.663-3000
Eamail: www.ma.nuJife-vsnture.com
"",",,1lhl ~1I1nCl_OIOClCoeaon'" "8lfi~~"......ot1'rws~lamnta Lift lMwr~Com~ .tWt........-r ~j(0W2....~
PrUdentia.l
1/ ~UI U.l
'i:'iU:
}-'AlI1:.
L.IL.
n.1.~.n L.l" I\A
..~..
Fcrm" I~
(R... 0.0_ 1ll!l7).
Department afthe Tr..".y
Irrternlll Re.<enue SeMce
Decedenl-lnsured (To be filed by Ihe ",ecutll' wilh FCI'm 701, UnIed Sbllo EQle(and GenenllionoSkipping Trans..) TOll Rolum, ll' FCI'm
70UIA Un~od SIaI_ E_ and GenO'lllion-Ski in Transl.. TOll Rolum EllIllIo of nonresident nat a citizen oltha Un~od 5_
1 DecedenfBfirllnO'neandmiddeinitial 2 Dooedenrsiallnamo 3 Decedenruocial oecuritynumb..(il 4 Dsleof_
Frances S. H son known 193-14-6779 06123101
5 Name and adct'ess ofinaJr1l1c:e canpany
PNdenliol p.a BDlI 1271 Phil.del Ie, PA 18101-8278
6 Typo of policy Annuity
80wner'sm:me.lfdecedentisndownB',
alIac:l1 copy of applicalion.
Life Insurance Statement
a.B No. 154S.0D22
. .
9 Dole i88Ued
7 Policy numb.. E0036703
10 Asoignll"s nO'ne. A\lach copy 01
asaiglment.
llDIIe_gned
1212211997
12 Value of the policy althe
time of assilJlment
13 Amount of prBTlium (see inslrudiO'1s)
14 NO'ne of benoficiO'Jes
EstatB of Frances S. Hyssong
15 Foco amount of policy . ..................... .... ............ ........... ...... ......,............................................................. $
16 IndO'nnity banefits ..... ............... .......... ................. ...... ......... ......................... .............. ........ ......... ....... $
17 Addtion.,inllJranco........................... ............. ............................................................................... $
18 Olher benefits ................. ............... .... ...... ............... ...... ..................... ........ .................. ... ...... .... .... ...... $
19 Principal of any indebtedness to the company Ihol is dedUctible in detO'mlningnel proceeds ...................................... $
20 Int..est on indeblednessOino19) .caued 10 dale of _ .............................................................................. $
21 Amount 01 ocoumuloled dllidends ............... ............... ..... ............................ .............. ....... ............ ............ $
22 Amount 01 posl-mll'1O'n dllidends .............................................................................................................. $
23 AmOJnt of rebJmed premium ..... ... ...... .... ............... ...-.... ...... ... ........-. .................. ..... ............ ....... .... .... ..... $
24 Amount of proceeds ilp.ysbleIn one sum .................................................................................................. $
25 Value of proceeds.. of dole ololoolh (If no! payabie in onollJm) ...................................................................... $
26 Policy prcwisioo& CCI'lceming deferred paymS'tt& or inslBlm&'1ts. ... ................. ....... ... .... .... ....... ..... ...... ........ ........
Note: If dher thrt lump4Jm ssttItm.,t is authaized fa a SLIrviving 5pau88, aItach a copy of the
In",ranco policy.
17,483.16
27 AmClJnt of installments ................... ......................... ...... .........n.. .h__. h h n__................... ................. h._.
28 Date of birth, seK, and nM1e of any perscrl the duraliCl1 otvvtloseUfe mffJ measure the number of payments.
29 AmDJnt applied by theinsurll1ce arnpany as a single prEmium representing the purcnase of
in&t8Jment benefits ........... .... .... ....... ....... . .......... ........ ... ...... .............. .......
30 Basis (matality table and rde of interest) used by insurer in valuing installment benefits
31 Was the insured the IW1nuibrlt a beneficill)' 01 any annuity CQ'ltrad issued by the canpany?
32 Nomes 01 companies with which decedent carried oIh.. policies and omount of lIJc:I1 policies ilthis infonnlltion is dsclosed by
YrMJr recads.
DYes 0 No
The underligned officer a,the abave-nned inlUrancecanp~y (a appropriae Federal agency a retirem4rl1 &yItcm dlicial) hereby cer1ifieslhal
Itlis stat.."anl selllorth Irue and cared infamalioo.
Slgn.ur.
c..-L-1-1.,.t II!. )c
e,..L..-
TIll.
Secretary
Date d Certlncatfan
07r.1cnoo1
Ycu ... ncl r~ired 10 prcMde th.lnform~cn rlquestad at . fam
that Is subj8d to the Plpll"NCltk Rea,c:licn Ad uriasslh. farm displays a
V11ldOMB ccntrot numb.. Books or recordt r.aling to afcrm crlts
Instl'Udlons must b. ratlined as leng u thar ca"lttnts may beccma
m....laI in the ac:lminlstrallon of any Int.nal Ravanu.law. GM..Uy. tax
ralUrns and return Infamllllcn are ccnfldantlaJ, as 'lCIulred by sacIIm
8103.
Th.llma nHdeel to campi.. Md III. this term will wry daplndlng on
Indvldual circumstances. 'Th. Htlmillod average time II: R-=rdkeaplna.
18 hcurs, 25 mlnutu; Lumina abcut the farm, 8 minutes; Prlp.-tng
th.torm, 18mlnulas.
If you haw comments ccnC8l'ning the aca.aracy d Ih... time
IIStimal_ or suggllStionsfcr maldngthllfann slmpl.. w.wa.lid b.
happy 10 hNt from you. SHIh.lnstrudicns for th.1aX,"'n wllh which
this form Jsfll~. 00 NOT Stnd th. tax farm to that ofIIca. Ind_, ,eturn
II to th. exeaJlcr Of rep,aunlallva who r~lIII:ad It.
Instructions
Statamenl oflnsur..- 'ThIs statln'ltnl mull b. made, all behalf d Ihe
Insurance canpany that issued 11'I. policy, by an ofIIc.. of Ih. ca1"lpany
having access 10 Ih. records d the ccmpany. For purposu d this
staem.....l, a facslmll. s1g"1atur. may b. used in Mau d a mll'lual signe".
.,d if usecl. shill ba blndng as a manual slgnabJr..
Sip".. statamMts.-F1I. . sap.iIl. Ferm 712 for ..ch policy.
Un. 13.-Repat on IIn.131h. annuli premium, not the a.lmulltiw
pr."lum to daI. d~. If duIh oc::currtd 1ft.. th......d dth.prln'llum
period. repcrt Ihel. Clnual premium.
PaplrWork Rtcludlan Ad Notlc&-W. ask fer 11'I. jntormltion on IhJs
form 10 CIIry cui the Intamll R.....u.laws d 11'I. United Sbttl. You art
r~jrad 10 gi.... us the informallcn. W. nHCl it 10 .....sur. thai ycu ...
complying with than laws and to allew utlo flgur. and celled: 11'I. rlg,1
nounl d tIX.
/6-~~/ 1- G
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8060l
HARRISBURG, PA 171Z8-0601
\,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEHENT~ ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REY-1547 EX AFP (01-021
05-13-2002
HYSSONG
06-23-2001
21 01-0634
CUMBERLAND
101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
FRANCES
E
Pi :M)
'02
hlIY 17
LINDA J LUNDBERG
PNC ADVISORS
PO BOX 308
CAMP HILL
Allount Rellitted
,
'....,,<.
CUM, .17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:is4-j-EX-AFP--foY:02Y-NOYicE--OF-YtiHEiiiTAiici-TAX-APPRAisEHENT~--AiLOWAifCi-(fR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HVSSONG FRANCES E FILE NO. 21 01-0634 ACN 101 DATE 05-13-2002
) CHANGED
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly OWned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
.00
56,749.93
.00
.00
87,675.02
.00
58,919.96
(8)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
(1)
(2)
(3)
(4)
(S)
(6)
(7)
203~344.91
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
17~202.8o
1. 260 . 83
Ul)
(2)
(3)
(4)
(9)
UO)
18.463 63
184,881. 28
82,515.28
102,366.00
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
lS" Allount of Line 14 at Spousal rate
16" Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
US) .00 X 00 = .00
(6) .00 X 045 = .00
(7) 20,628.85 X 12 = 2,475.46
(8) 81,737.15 X 15 = 12,260.57
(9)= 14,736.03
'" ,,~..~...rl (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-21-2001 CDoo0288 650.00 12,350.00
03-21-2002 CDoo0982 .00 1~736.03
TOTAL TAX CREDIT 14,736.03
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
" . ." ~
-PLEASE FILE THIS REPoRT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS O~*
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARL ylI'
UNTIL COMPLETION _.
Name of Decedent:
Date of Death:
Estate No.:
STATUS REPORT UNDER RULE 6.12
Prarx:es E IIyssmg
Jtme 23, 2001
21-0l-{)634
Pursuant to Rule 6.12 of the Supreme Court Otphans' Court Rules, I report the following with respect
to completion of the administration of the above-captioned estate:
1.
State whether administration of the estate is complete:
Yes X No
",
A:..
If the answer is No, state when the personal representative reasonably believes
that the admiilistration will be complete:
(date)
3. If the answer to No. 1 is yes, state the following:
C.
D.
Date: _ 3/5/2003
(MAH:nntJAM3)
A.
Did the personal representative file a final account with the court?
Yes X No .
The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
Did the personal representative state an account informally to the parties in
interest? Yes No
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report. PNC Bl\NK, N.A.
,0.- " ~
B~ .". ...._.___--:-;-___
(:'.0">" 1"_:' ,-'. _.. ,_, ",
S. ~~~. Ioi ~._....,.. ~ .....'~'" t..-~ i1..... .1.
19na .
B.
"(
Linda J. I.un1ftlPl'K
Name (Please type or print)
pg; Bank, PO Bolt 300, ~ Rill PA 17001~
Address
717-730-2265
Telephone No.
Capacity:
X
Personal Representative
Counsel for Personal Representative