HomeMy WebLinkAbout01-0712
PETITION FOR PROBATE and GRANT OF LETTERS
dl- 01 - 7}:1.
No.
To:
Estate o/Rohert F M~Kephi=ln, ,Tr.
also known as :QQ.... M,..VggRAB (jol
Register of Wills for the
. Deceased. County of Cumber 1 and in the
Social Security No. 1 92 - 3 0 -1 51 1 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who@are 18 years of age or older an the executr ix
in the last will of the above decedent, dated October 30
and codicil(s) dated nonp
named
, 19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumber 1 and County, Pennsylvania, with
his last family or principal residence at1905 Esther Drive, Carlisle, PA 17013
(list street, number and muncipality)
Decendent, then 62 years of age, died Janun ry 2nn
~ Carlisle Hospital, Cnr1i~lp, P~nn~ylvani~
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 killing and was never adjudicated
incompetent: Daughter born after execut i on of wi 11 .
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: Real property located at 1905
Carlisle, PA 17013 valued at $ \0\..\ t\(X)
.
,-l~ ?001,
$ 1,000.00
$
$
$
Esther Drive,
· JQ'nH:1 "~lrl.
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.
~
Q)
u
c::
Q)
~~
'" '-'
Q)'"
~~
-00
c';:
C':$"'=
3~
Q) "-
50
~
C
tlO
(i5
MfRtJ!~4U
11f\R R~nwonn
Carlisle, PA
Or; '\Tl?
17013
OATH OF-PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1- ss
COUNTY OF CUMBERLAND 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 and tr~ly admin' er the estate acc rding to law.
Sworn to or affirmed and
before me this 27th
'7naMl ~!,t
R-p.&. 'tr~~~
/~ -;;) L) 7 - 4
subscribed {
day of
~2001
Register
No. 21-01-712
Estate of Robert F. McKeehan, Jr.
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW AUGUST 2 }flJ2001 ,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 10-30-1974
described therein be admitted to probate and filed of record as the last will of
ROBERI' F. McKEEHAN ,JR.
and Letters TESTAMENTARY
are hereby granted to SHIRLEY R. McKEEHAN
~ c..1f,J'~ OI...pJ.~.\
_ Re~ster of Jills
FEES
$ 18.00
$ 3.00
$
$ 3.00
5.00
TOTAL $ 00
Filed ..... ..NJ~q~'f. ~.,.4Q9~. . . . . ~:. . . . . . .
Probate, Letters, Etc. .........
Short Certificates( 1) . . . . . . . . . .
Renunciation ................
X PAGES
JCP
"If. '0), S7 3
f)Q\lid C. ~der>c Y1 I t.ov[)'
ATTORNEY (Sup. Ct. I.D. No.)
L\ /.^ <1 l\mer-roY\ ~. r\~n~\:Ny-q PA
ADDRESS U , 7 \ oq
( -(7) SL.\ \. \\ q~
PHONE
lr~ ~ ~ afu;. 8-~ -Of
21-01-712
REGISTER OF WILLS OF 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_
Register
(Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF Cumhp-rl rlnn COUNTY
OATH OF NON-SUBSCRIBING WITNESS
Matt McKeehan and Shirley R. McKeehan
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
they are familiar with the signature of Rnhp-rt F M~Kp-phrln, .1r.
codicil
testat~ of (one of the subscribing witnesses to) the will presented herewith and
codicil
that thpy believes the signature on the will is in the handwriting of
Sworn to or affirmed and subscribed before
me this 27th day of
July ~2001
fYI~e.. tw";.
B..,.l~.~ Register
,,:,0~ ""..''':\,~ ^l,:,f'..
This is to certify that the information here given' is correctly copied fran: an original certificate of death dul~ 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.
21-01-712
n:.-~. ~~&-.~
~ocal Registrar
No.
JAN I,,, 4 2001
Fee for this certificate, $2.00
p
6947637
Date
.5.143 R.... 2117
COMMONWEALTH OF PENNSYLVANIA a DEPARTMENT OF HEALTH a VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (f..... _.l_'
t.
SEX
$TAU ~'I.E NU_A
SOCIAL SfCUA'n' NUMBER
~I
z. Male
3. 192 - 30
2, 2001
62
UHOER I DIIt
....! MIftut..
IIlATHPLACE lCoIV aIld
Sl.Ie or forllOfl CounrrYl
Carlisle, PA
PUCE OF OE.qH <CNlck oNy.,..., - __,"""""' on""'" _,
HOSI'ITAl.:
,__0
~,O
..
COUNTY Of OE.crH
Cumberland
..
....
""II.
~.
PA 17013
"l..
NoD
[ ::
d.
~c.~" J.~"I""" ~ v-.-o"", ""^"\ ~
DUE lotoR AS A CONSEQUENCE Of):
\,\ . ...., ~
DUe lOCOR AS A CONSEQUENCE OF}:
IS.
I Ac>Iwo_
'--
:---
I
I
I
plJn .:
0lMr oign_ -........-.nv 10 Cle8lll.llolI
_..-..gin""~_gMninPNn I.
DUE 10 (OR AS A CONSEQUENCE OF):
WEllE AUlOPSl' F1tIOlNGS MANNEII OF DEATH DATE OF INJURY
~PRlORlO (Month. Ooy. -I
~OIFCAUSE Hat",.. ~ Hom;c;oe 0
Of 0E.4lrH7
- 0 Paneling _igollon 0
Nog'" v.. 0 NoD Suicide 0 ~_INI~.rm_ 0
TIME Of INJUFIY
INJURY .q WOFIK7 DESCRIBE HOW INJUFIY OCCURRED.
v.. 0 NoD
'MEDlCAL EXAMINER/CORONER
~ ~:i:t::.d.~~~~~l.'~~ .a.~~ ~~:~~l~~~l.~~: ~n. ~.y. ~~'.n.i~~: ~~~~~ ~~~~~~~ ~~ ~~~ ~I~~..~~t~: ~~~. ~I~~~: ~ .~~~ ~~ ~~~ ~~~~~~). ~~
3to.
REGISTRAR'S SlGHotJURE A)\EA
'~JNl~. ~
o
__ 2Ilt. ~.
CEJIT_~......._
'CEJlTII'Y_ ~SIClA" (Ph_ ~ cauM "'_ _ ~noIh.. llhvsoc.an naSll'cnouncacl de"'" ."., completed ".", 231
To... _ of",y ~. do.", occu"" _ to'" .auaa{s,"nct ",anno'" llOtad. . . . . . . . . . . . . . . . .
.~ AND CEIlTIFYINQ PHYSICIAN (__ ""'" ;''''"Ou'''''''9 oelth and c...~_1O cau.. 01 death!
To"- tMeI of "'Y ItftOwladg.~ deathoc.e"'" at the time, ct.'.,.nd p'ece. and due to the cauH(l) Ind m.n".r.. .tated.
~f tdJ \ ,(') I
34.
~l
.'
llinsllfill nub (TI-rslnm-eut
I, ROBERT F. McKEEHAN, JR., of North Middleton Township,
Cumberland County, Pennsylvania, declare this to be my last will and
testament and revoke all wills which I have previously made.
I I give, devise and bequeath my entire estate, real
and personal, unto my wife, Shirley R. McKeehan, absolutely and in
fee simple if she shall survive me, to the exclusion of any child now
living or born to me subsequent to the date of this will.
II If my wife, Shirley R. McKeehan, fails to survive
me, I glve, devise and bequeath my entire estate, real and personal,
unto my issue per stirpes, absolutely and in fee simple.
III If neither my wife nor any issue shall survive
me, I direct my executor to convert into cash and sell at either public
~
or private sale all real and personal property which forms a part
of my estate, and to add the proceeds thereof to my residuary estate
which I give and bequeath one-half thereof to my next of kin and one-
half thereof to my wife's next of kin as determined by the Intestate
Laws of Pennsylvania in effect at the time of my decease.
IV I appoint Farmers Trust Company as testamentary
guardian of the estate of any beneficiary hereunder or other person
with respect to whom I am authorized to appoint a guardian, including
'"
~
~
.~
~
J
R
but not limited to the proceeds of policies of life insurance, not
z
~
C--~ or all of the principal as in the sole discretion of the guardian
of full legal age at the time of my decease, to receive the share
of said beneficiary or other person, to apply the income and so much
may be proper for the support, maintenance, welfare, medical and educa-
tional expenses of said minor after considering the minor's age, sex,
aptitudes, interests, abilities and needs, and any other assets and
resources available to said minor, and to distribute to the minor
upon attaining the age of 18 years the remaining balance of said share.
V In addition to the usual powers provided by law
the guardian is authorized to:
. Ill' " .. "
A. Retain in kind any real or personal property
which forms a part of my estate and to invest according
to the guardian's best judgment but without restriction
to investments authorized for fiduciaries in Pennsylvania
without regard to any principal of risk, diversification,
underproductivity or non-productivity.
B. Hold property in the name of the guardian
or its nominee.
C. Allocate stock dividends to income or princip I
as it deems proper.
D. File all necessary tax returns and pay all
taxes thereon together with interest and penalties.
E. Sell at either public or private sale, mortga e,
lease for a term including a term of more than three year ,
any real or personal property which forms a part of my
estate or which may be acquired by the guardian under
this will.
F
F. Distribute in kind or cash or both on the
termination of the guardianship.
VI If my wife fails to survive me, I appoint Charles
and Judy Chronister, or the survivor of them, as testamentary
guardians of the person of my children during their minority.
VII I appoint my wife, Shirley R. McKeehan, as
executrix of this will. If for any reason she shall fail to qualif
or cease to act as such during the administration of my estate I app int
Farmers Trust Company as substituted executor.
this
IN WITNESS WHEREOF, I have hereunto set my hand and seal
,tI day of 0 c.t.
(SEA )
Signed, sealed, published and declared by Robert F. McKeehan, Jr.,
testator herein named, as and for his last will and testament,
written on two sheets of paper, in our presence, who, in his presenc ,
at his request, and in the presence of each other have hereunto
subscribed our names as attestingwitnesses:
(Y\~ d'
C}J -
Letlr- \ ('-Vy~ ~v
/ /< '. {'
A. // /' /.
J. j J, .c' 'I
fAI.- /-- / /"
7..: "~,". (/ 1/ ...('. (" f. ) ../
f.
---
CERTIFICATION OF NOTICE UNDER RULE 5.6
Name of Decedent: Robert F. McKeehan, Jr.
Date of Death: January 2, 2001
Will No. 2001-00712
PA No. 21-01-0712
To the Register:
I certify that notice to beneficiaries and heirs required by Rule 5.6 of the Orphan's Court
Rules, in the form prescribed by Rule 5. 7 ~ was served on or mailed to the following
beneficiaries of the above-captioned estate on August 15, 200.l.
Name
Mrs. Shirley R. McKeehan
Mr. Matthew L. McKeehan
Ms. Melissa B. McKeehan
Address
1168 Redwood Drive, Carlisle, P A 17013
1021 Northtield Drive, Carlisle, P A 17013
1168 Redwood Drive, Carlisle, P A 17013
Notice has now been given to all persons entitled thereto under Rules 5.6 and 5.7.
Date: August 16, 2001
Signarnre$ ~
Name: David C. Anderson, Esq.
4229 Elmerton Avenue
Harrisburg, P A 17109
(717)541-1194
Capacity:
Personal Representative
----- Counsel for Personal Representative
.,
...
l
IN THE COURT OF COttiON PLEAS, ~b2r~ COUNTY
,; J
-. i'-
"&
PENNSYLVANIA
ORPHANS' COURX DI~SION
ESTATE OF
Register's # ;2\n\,+\":) ~
Deceased
CLAIM
To the Clerk of the Orphans' Court Division:
~
Index and make proper entry in your official records'of the
clai~ of CmCORP CREDIT SERVICES. INC. in the amount of
,~~LD~-53 against the estate of the above-named decedent. This
claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S.
ss. 3532 (b) (2).
at 19(")5'
~R{Jr~ Qw J!}tm~~Jl\- ~n tci\\~~
Manager for Citicorp Credit Services, Inc, -,
Underli~i~edPo.werofAttorneYtor ~. Q
Cltlbank, S.D., N.A.
~imaritj ~ --=.;
Tammy Anzelone anager for CITICORP CREDIT
SERVICES, INC.
7930 NW 11 0 Stree~
Kansas c:ity, MO 64153
(Claimant's Address)
. .
..
~
...
'. l
rOll)
~
02/16/01
~~
$6637.53
~.ft~!';~~!!.I~~tl
$6637.53
[.......MJ~~~1P.Vg$1
SITE:KC-CD
TM:CD-6375
ACID:KCB1258
FO-BT
34 Al 3 0985 TC
0014 CM 4
CHOICE MASTERCARD
P.O. BOX 8114
S HACKENSACK, NJ
USA 07606-8114
08/17/01
21:45:52
ROBERT MCKEEHAN
ATTNY ACCOUNT-CODE=DU12
CARLISLE PA
17013-1028
For Customer Service call or write
CHOICE
CHOICE MASTERCARD
Account Number
1-800-568-5000
BOX 6248
SIOUX FALLS, SD
57117
For billing inquiries write to
this address; calling will not
preserve your rights.
5423 7960 2215 8472
Payment must be received by 1:00 pm local time on 02/16/01
Statement Date Total Credit line Cllh Advance limit
01/22/01 $9800 $3500
New Balance
$6637.53
Available Credit line Available Cash line
$0 $0
Bin # or Mer # A Sic
0000000000
Sale Dt Post Dt Reference #
Activit Since Last Statement
10
LATE FEE - NOV PAYMENT PAST DUE
Acc
Previous
Balance
purChases 6622 3
Advances
Total 6622 3
Amount Due
+ Purchases - Payments - Credits + Finance + Late = Balance Pur Min Due 0
& Advances Charges Charges Adv Min Due
Amount OCL
663753 Fees
Past Due 61300
663753 MinAmtOue 663753
PURCHASES ADVANCES
Rate Summary
Number of days
this Billing Period
33
Balance SUDjectto
finance Charge
Periodic Rate
Nominal Annual
Percentage Rate
Annual Percentage Rate
1.86667%
22.400%
22.400%
.06137%
22.400%
22.400%
Ci ticorp Credit Ser,,'ices, Inc.
:::..: ~~:~r:? c=~'.:..:.:. .3~::".":':~:J. . ::"'.-:.
:\ SuhsiJiary of Citi-:orp
K.ln~Js City R.:~innJI C~:1tt:r
7\)::0 :--.. \V 110M St
!-\..1ni;\S City :\10 ~4153
~Ol
~umbJr land (1UI)'J1I ON. irfhbLl:sJl
{
I ('fMr+b Q( I SP ~ j(jr~ , Rm tb~
I
(\) r \'i' ~ If' ) PA 1'70 \ ~
~::: : The Est: a ': eo:: RD bri- t1t kee~Gf)
~ile Nl::7lbe::::-: ~\\)lll ~
Dear Si::::-/Madam,
_?lease1find e~closed our claim a~ai~st tte above me~tio~ed es':a~e. ~~ease
retu::::-~;a FILED stamped c09Y in tta e~clcsed e~ve~o~e.
iha~k you for you::::- atte~tion to this ~atter.
Very Truly Yours,
~.~
Unit Manager
-
'#-
- "
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
ROBERT F MCKEEHAN
, Deceased
No. 212001712
of 2001
To the Clerk of the Orphans' Court:
Enter the claim of CAPITAL ONE
Acct. 5291071798596613
In the amount of
$523.85
, against the above entitled estate.
The decedent, who resided at 1905 ESTHER DRIVE CARLISLE PA 17013
died on
01/02/2001
. Written notice of said claim was given
to SHIRLEY MCKEEHAN
,if known to claimant, at
(Personal Representative or counsel)
1168 REDWOOD DR, CARLISLE, PA 17013
on
March 12, 2002
(Date)
L 1L1A.Q.. ~ vt \t\M) Va...--
(Claimant) "{L
Address: 5330 East Main Street, Suite 200
Columbus, Ohio 43213
tV/A
Claimant's Counsel
Address
()
r-
)>
~ "'0 )> ~ m
(f)
:t 0 )> -i
0 0 z ~
Z ?J -I
0 m m cii m 0
(f) 0 ?J
- VJ Z "'0
:::t\ )> -n
Q) - s: ?J :t
-0 00 (J'1 ~
"Q. -.J ~ f1:' 0
-.J ~ to (f)
o' .......... 0 ()
Q) .....a m m ()
C' ~ )> ~ 0
(1) ~ s: "'0 ("')
~ )> =4 -n c
r- ~
z ~ Z ~ ~ s:
-.J
0 ~ (f) 0 3C () Z
-i co ;-i "- 0
z m
)> m
"'0 ~ m N
"0 :t ~
r- m )> N
0
() N Z 0
0 0 ~
)> 9 .....a
to m ~
r- () () N
m 0 m
r- )>
C (f)
s: m
CD 0
C
(f)
0
:t
~
W
N
~
W
.. '. .
STATE OF VIRGINIA
)
) ss:
)
INDEPENDENT CffY
LlMITED POWER OF ATTORNEY
Now comes Mike Stevens, a representative of Capital One,
and hereby appoints Estate Information Services, Inc. as its attorney-in-fact for the
purpose of executing, filing, amending, and/or withdrawing estate claims with probate
courts and/or executors throughout the United States on behalf of Capital One.
Be it known that this Limited Power of Attonley will be abolished upon the
termination of the contractual agreement between Estate Information Services, Inc. and
Capital One.
DATED this
'a.~
day Of~r'lb.,... , 200 1.
CAPITAL ONE~~
By: A-- ~ ~ :::...
It D. '-.:::>
s: Irector
Printed Name: Michael Stevens
Sworn to an subscirbed before me this --1(1-, day of September, 2001, a Notary
Public in and for the State of Virginia.
xpires:~6
IMPORTANT NUTlCE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS EST A TE OR OTHERWISE
Whether you will receive any money or property will be determined
wholly or partly by the decedent's will. If the decedent died
without a will, whether you will receive any money or property
will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
In re Estate of Robert F. McKeehan, Jr., deceased
No. 20DH)O/i2
PA No. 21-01-0712
Late of North Middleton Township, Cumberland County
To: Shirley R. McKeehan
1168 Redwood Drive
Carlisle, P A 17013
Please take notice of the death of the decedent and the grant of letters to the personal representative named
below,
The Decedent, Robert F. McKeehan, Jr., died on the 2nd day ofJanuary, 2001, at Cumberland County,
Pennsy I vania.
T ecedent died testate (with a will); 0
The Decedent died intestate (wit out a wIll).
The personal representative of the Decedent is Shirley R. McKeehan, 1168 Redwood Drive, Carlisle, PA 1701.3
(717)243-6298.
If the Decedent died testate, the Will has been tiled with the Office of the Register of Wills of Cumberland
County (Cumberland County Courthouse, Carlisle, Cumbetland County, Pennsylvania (717)240-6345).
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of
the Register of Wills of Cumberland County {Cumberland County Courthouse, Carlisle, Cumberland County,
Pennsyl'.'ama (717)243-6345.
A copy ofth.e Will or Petition may be obtained by contacting the Regisler of Wills an~harges for
duplication. ~
Date: 7-/ y. 6 ( Signature: ~
( Name: David C. Anderson, Esquire
Address: 4229 Elmerton Avenue
Harrisburg, P A 17109
(717)541-1194
Capacity: Counsel for personal
Representative.
v
Date of Death: 01/02/01
Date of Executor's Appointment: 8/2/2001
Date of First Advertisement of the Grant of Letters:
Accounting for Period: i,1II:t1.~~ present
FIRST AND FINAL ACCOUNT OF
Shirley R. McKeehan, Executrix
For
ESTATE OF Robert F. McKeehan, Jr., Deceased
c2l -- 0 f .:-, J ~
8/10/2001
Purpose of Account: Shirley R. McKeehan, Executrix, offers this account to acquaint interested parties with the transactions
that have occurred during her administration. The account also indicates the proposed distribution of the estate.
It is important that the account be carefully examined. Requests for additional information or questions or objections
can be discussed with:
David C. A nderson, Esquire
The Law Firm of Anderson & Gulotta
4229 Elmerton Avenue
Harrisburg, PA 17109
(717)541-1194
Summary of Account
Page
Current
Value
Fiduciary
Acquisition
Value
Proposed Distribution to Beneficiaries
Principal
Receipts . (No Receipts after Death)
Net Gain (or Loss) on Sales or Other Disposition
3
3
$0.00
$0.00
$350.00
$0.00
$1,000.00
$1,350.00
Less Disbursements:
Debts of Decedent
Funeral Expenses
Administration Expenses
Federal & State Taxes
Fees and Commissions
2
2
2
2
2
$5,389.00
$208.82
$0.00
$500.00
$6,097.82
-$4,747.82
$1,350.00
-$6,097.82
Balance before Distributions
Distributions to Beneficiaries 3
Principal Balance on Hand--
*.Negative balance was paid by surviving spouse on behalf of the Estate
For Information:
Investments Made
Changes in Investment Holdings
4
4
$0.00
$0.00
Income
Receipts
Less Disbursements
Balance Before Distributions
Distributions to Beneficiaries
Income Balance on Hand
Combined Balance on Hand
4
4
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
4
L l: ! Hi 9l lnr (0.
;J.:.'d
~:uo:)e8
The Law Firm of Anderson and Gulotta
Disbursements of Principal
Date Descriotion
Debts of Decedent
NO DEBTS OF DECEDENT WERE PAID- ESTATE INSOLVENT
Total
Funeral Expenses
1/612001 Hoffman - Roth Funeral Home
Basic Services
1/612001 Hoffman - Roth Funeral Home
Casket and Container
1/612001 Hoffman - Roth Funeral Home
Opening Grave and Rock
Total
Administration Expenses
8/212001 Register of Wills
Probate Fees
8/31/2001 Cumberland Law Journal
for Publication of Estate Notice on 8/17/01,8/24/01,8/31/01
8/29/2001 The Sentinel
For Publication of Estate Notice on 8/10/01,8/17/01,8/24/01
Total
Federal & State Taxes
Commonwealth of Pennsylvania
for Inheritance & Estate Tax
Commonwealth of Pennsylvania
for Inheritance & Estate Tax
Commonwealth of Pennsylvania
for Inheritance & Estate Tax
Fees & Commissions
Various The Law Firm of Anderson & Gulotta
for attorney's fees
Total
The Law Firm of Anderson and Gulotta
Amount
$0.00
$3,390.00
$1,600.00
$399.00
$5,389.00
$29.00
$75.00
$104.82
$208.82
$0.00
$0.00
$0.00
$500.00
$500.00
~
Family Exemption
Family exemption claimed against assets subject to will or intestacy.
$1,500.00
The Law Firm of Anderson and Gulotta
. l
Cash
Stocks:
Distributions of Principal to Beneficiaries
TO: Shirley R. McKehhan
Proceeds of sale of 1988 Plymouth Voyager Van
Miscellaneous Personal Property
Principal Balance on Hand
Total Distributions of Principal to Beneficiaries:
Current Value
(date)
or as noted
Fiduciary
Acquisition
Value
$0.00
$0.00
$0.00
$0.00
The Law Firm of Anderson and Gulotta
$1,000.00
$350.00
$1,350.00
. .
Date Investments made
None
Dividends
Interest
None
None
None
None
Information Schedules - Principal
Receipts of Income
Disbursements of Income
Distributions of Income to Beneficiaries
Proposed Distributions to Beneficiaries
Current Value
(date)
or as noted
Fiduciary
Acquisition
Value
The Law Firm of Anderson and Gulotta
Cost
." ..
Shirley R. McKeehan, Executrix under the Last Will and Testament of Robert F. McKeehan, deceased,
hereby declares under oath (penalties of perjury) that she has fully and faithfully discharged under the
duties of her office; that the foregoing First and Final Account is true and correct and fully discloses
all significant transactions occurring during the accounting period; that all known claims against the
estate have been paid in full; that, to her knowledge, there are no claims now outstanding against the
Estate; and that all taxes presently due from the estate have been paid.
Subscribed and sworn to
by Shirley R~cKeehan before
me this day of 7' UN4 2003
NOTARIAL SEAL
SHARON L. GROSS. Notary- Public
North Middleton Twp., C~ Co.
My Commission Expires Ja~. 2007
Member, Pemlytvania At 'of HotIPtt
The Law Firm of Anderson and Gulotta
8-
File No. 2001-00712
REGISTER OF WILLS
Commonwealth of Pennsylvania
County of Cumberland
INVENTORY
Shirley R. McKeehan, Executrix of the Estate of Robert F. McKeehan, deceased,
being duly sworn according to law, deposes and says that the items appearing in the
following inventory include all of the personal assets wherever situate and all of the real
estate in the Commonwealth of Pennsylvania of said decedent, that the valuation placed
opposite each item of said inventory represents its fair value as of the date of the
decedent's death, and that decedent owned no real estate outside of the Commonwealth
of Pennsylvania.
.. Is! ShirleyR.McKeehan <0L~/Jf$ftl~J
Sworn to and Subscribed before me this
, 2003
Notary Public
NOTARIAL SEAL .
SHARON L. GROSS, Notary Pub\ic
North Middleton Twp.. Cumberland Co.
My Commission Expires Jan. 24, 2007
tftt1lr. p__~ania Assoclalion of Notaries
My Commission Expires:
Date of Death: January 2, 200 1
Last Residence: 1905 Esther Drive, Carlisle, P A 17013
Decedent's Social Security #: 192-30-1511
Personal Property
1.
1988 Plymouth Voyager Van
Serial # IP4FH4032JX303645
$1500
'~quln~)
$350" r:: ,;1
2.
Miscellaneous Personal Property
TOTAL:
L l: llil 9 L tt85<<tO.
Prepared by David C. Anderson, Attorney for the Executrix
4229 Elmerton Ave., Harrisburg, PA 17109
.:08
iC'J88
/6-~~1
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-li07 EX AFP 101-03)
:~,j .J) -.'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-22-2003
GIBBS
04-29-2000
21 00-0712
CUMBERLAND
01101315
JOHN
R
JULIA A GIBBS
121 W PORTLAND ST
MECHANICSBURG PA 17055
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax pay.ent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y:i60j-ix--AFP--foi-:oil-------...--iNHERITANCE"-fAX--STATEME-tif-OF-ACCOljNT--...---------------------
ESTATE OF GIBBS JOHN R FILE NO. 21 00-0712 ACN 01101315 DATE 09-22-2003
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-17-2001
PR I NCI PAL TAX DUE: ...........................................................................................................................................................................................................................
644.82
PAYMENTS (TAX CREDITS):
INT
AT
REV
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
*** SUMMARY OF ALL 012 PAYMENTS ***
09-10-2003 .00 300.00
EREST IS CHARGED THROUGH 10-07-2003 TOTAL TAX CREDIT 300.00
THE RATES APPLICABLE AS OUTLINED ON THE
ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 344.82
INTEREST AND PEN. 104.85
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 449.67
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
/1,1</;7-/
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT" ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
.03
s::r -9
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
'}, 7 ':~ ~.cOUNTY
" "~-ACN
09-01-2003
MCKEEHAN
01-02-2001
21 01-0712
CUMBERLAND
101
Allount R...itted
DAVID C ANDERSON
ANDERSON & GULOTTA
4229 ELMERTON AVE t..
HBG PA 1710;91 ,-
*'
REV-1S.7 Ell AFP [o1-D3>
ROBERT
F
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:i54j-ix-AFP-rol-':oil--No~fici--oF-iNHERiTAiicE-';--AirjrpPRAisEMENi'~--ALi-oWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MCKEEHAN ROBERT F FILE NO. 21 01-0712 ACN 101 DATE 09-01-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
If an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 Nill
reflect figures that include the total of abb returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
AX CRED S:
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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
1.850.00
.00
1.773.33
(8)
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
14. Net Value of Estate Subject to Tax
6,,097.82
(9)
(10)
59.717.37
(11)
(12)
(13)
(14)
(Schedule J)
NOTE:
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
DATE
NUMBER
+
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account"
subllit the upper portion
of this forll with your
tax paYllent.
3,,623.33
6~.81~ 19
62,,191.86-
.00
62,,191.86-
(19)=
.00
.00
.00
.00
.00
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED" SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
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.)
. /6- /' ? /- /
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-liD7 EX AFP (Dl-D5)
JULIA A GIBBS
121 W PORTLAND Sf
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY .
ACN
01-21-2003
GIBBS
04-29-2000
21 00-0712
CUMBERLAND
01101315
JOHN
R
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-y-:i6oj-ix--AFP--foi-:031-------...--itii..-ERITANc'E-fAx--sTATEMENy-ifF"-Acco[;NY--.-..---------------------
ESTATE OF GIBBS JOHN R FILE NO. 21 00-0712 ACN 01101315 DATE 01-21-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-17-2001
P R I NCI PAL TAX DU E : ...........................................................................................................................................................................................................................
644.82
PAYMENTS (TAX CREDITS):
INT
AT
REV
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
*** SUMMARY OF ~LL 007 PAYMENTS ***
01-03-2003 .00 175.00
EREST IS CHARGED THROUGH 02-05-2003 TOTAL TAX CREDIT 175.00
THE RATES APPLICABLE AS OUTLINED ON THE
ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 469.82
INTEREST AND PEN. 91.37
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 561.19
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( 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. )
\'/6 ..02~7- Y"
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-IU7 EX AFP (Ul-05>
JULIA A GIBBS
121 W PORTLAND ST
MECHANICSBURG P~ 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-18-2003
GIBBS
04-29-2000
21 00-0712
CUMBERLAND
01101315
JOHN
R
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=i6oj-i3f-AFP--Coi-:63.r------...--iNHERITANc'E-fAx--STATEHE-tif-ifF-ACCouiif--...---------------- -- ---
ESTATE OF GIBBS JOHN R FILE NO.21 00-0712 ACN 01101315 DATE 02-18-2003
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 DUEl APPLICATION OF ALL PAYMENTS I THE CURRENT BALANCEI ANDI IF APPLICABLE I
A PROJECTED INTEREST FIGURE.
DATE OF lAST ASSESSMENT OR RECORD ADJUSTMENT: 12-17-2001
PR I NCI PAL TAX DUE: ...........................................................................................................................................................................................................................
644.82
PAYMENTS (TAX CREDITS):
INT
AT
REV
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
*** SUMMARY OF ~LL 008 PAVMENTS ***
01-30-2003 .00 200.00
EREST IS CHARGED THROUGH 03-05-2003 TOTAL TAX CREDIT 200.00
THE RATES APPLICABLE AS OUTLINED ON THE
ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 444.82
INTEREST AND PEN. 93.06
. IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE 537.88
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRll
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
'--',
" .... . , - ".'".! ). O. I' - .... .
l-.( ';. '.~ :f::-.
('c"- _ :.:; C)
\.? ~;- .. ,,-,
\).') '. <.'>(' \
\'~!J;~
1
~
~
""
-
~
)-
-::::.
~
"'"':
-!
....-:.
~
-.::
-:.'
~
..
..
~
~
..
-
-::
-::.
-:::
~
-
"'-
~
'"
"
~
/t'\
~r{\
\.
.....
:\\
\ .
..,.t
"
~..
.~
'\
r.. /
vo~
,
"
STATUS REPORT UNDER RULE 6.12
d Robert F. McKeehan, Jr.
Name of Dece ent:
Date of Death: January')., 2001
Will No.
Admin. No. 2001-00712
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No xx
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: March 1, 2003
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Da te : 1 ~! 27/02
David C. Anderson, Esq.
Name (Please type or print)
4229 Elmerton Ave., Hbg. PA
Address
(717) 541-1194
Te 1. No.
Capacity:
Personal Representative
xx
Counsel for personal
representative
(MAH:rmf/AM3)
,.
r#>
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/06/2002
MCKEEHAN SHIRLEY R
1168 REDWOOD DR.
CARLISLE, PA 17013
RE: Estate of MCKEEHAN ROBERT F JR
File Number: 2001-00712
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 1/02/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
MARY C. LEWIS
REGISTER OF WILLS
cc: ;/ File
Counsel
Judge
(VI
oK.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Robert F. McKeehan, Jr.
Date of Death: January 2, 2001
Will No.
Admin. No.
2001-00712
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes xx No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes xx No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes xx No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
July 15, 2003
J~a~~~
David C. Anderson, Esq.
Name (Please type or print)
:;:,:,Hl~)
)'>;)
L i' f fl-' 9 L lnf'
:," I.- dj. I
EO.
4229 Elmerton Ave.HArrisburg,
Address PA 17109
(717) 541 - 1194
Te 1. No.
:';:]8
.,,'c.looaH
Capacity:
Personal Representative
xx
Counsel for personal
representative
(MAH:rmf/AM3)
REV-1500EX 16-00J
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
~llo-ZY1-lo ~
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
C
W
o
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
McKeehan, Robert F.
DATE OF DEATH (MM-DD-YEAR)
01/02/01
DATE OF BIRTH (MM.DD- YEAR)
10/16/38
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
McKeehan, Shirley R.
w
,..,
:i:::9;U)
0.""
w"O
,,00
0"'''
...,
..
<
[!] 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Altacl1 copy of W~I)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a living Trust (Altach copy of Trusl)
o 10. Spousal Poverty Credit (dale of death between 12-3H1 and 1.1-95)
FILE NUMBER
21 01
00712
COUNTY CODE YEAR
NUMBER
SOCIAL SECURITY NUMBER
192-30-1511
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
I ~,l - "] j - J )). ..,
o 3. Remainder Return (date of death plior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AltachSch0)
...
Z
W
o
Z
o
..
..
w
'"
'"
o
o
NAME
David C. Anderson
FIRM NAME (tf "Pplicable)
Anderson & Gulotta
TELEPHONE NUMBER
(717) 541-1194
COMPLETE MAILING ADORESS
Law Firm of Anderson & Gulotta
4229 Elmerton Ave.;:I C
Harrisburg, PA 171~ '; 8
c-
(, l:.-
:JJ
~~ 9:'
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(1)
(2)
(3)
(4)
(5)
z
o
!;;:
..J
:>
!:::
a..
<(
o
w
~
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (Iotal Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)
11. Total Deductions (Iotallines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(8)
6,097.82
59,717.37
(11)
(12)
(13)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
I-'
:>
a..
:::E
o
o
~
15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
u:~g,06:1,1Jl_ x .0
:62,062.19 x.O
:62,062.19 x .12
__=62,062.19 x .15
16. Amount of Line 14 taxable at lineal rate
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~,oo
0.00
0.00
0.00
1,850.00
r
~
b->
:23
~
'--J
0.00
1,773.33
3,623.33
65,815.19
-62,191.86
0.00
(14)
-62,191.86
(15)
(16)
(17)
(18)
(19)
0.00
0.00
0.00
0.00
Decedent's Complete Address:
STREET ADDRESS
1905 Esther Drive
CITYC r I I STATE I ZIP
arise PA 17103
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
0.00
0.00
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C) (2)
0.00
TotallnteresUPenalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is lt1e OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
0.00
0.00
A. Enter the interest on the tax due.
(SA)
(58)
0.00
0.00
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
.Ut] I II U
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
HH" 0
.................0
.....0
.............0
o
......0
o ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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? ....... ................... ....................... . ............. ............ ........... ....................
No
~
~
[KJ
~
~
~
Under penalties of perjury, 1 declare that I have examined this retum, including accompanying schedules and statements, and to the besl of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than !he personal representative is based on all infOl1l1ation of which preparer has any knowledge.
SIGNAT~RE 0 P.ERSO~RESPO~E FO~I N RETU N
~ f/) t/~-t..--
---- - Y-/1 ------ - -- - --
ADDRESS
DATE
.---------~:JE;~
-....------------.-.--..--------------...---------------....-..----------------.---.----...-.---------------.......-------------.---.-.------------
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
__________n_ _ _______________ ....._.__..____~_._.._..._.._..____________........_ _..______________ ._________..___...______________._____.._______
ADDRESS
.~ ] I .~ L
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for lt1e use of lt1e surviving spouse is 3%
[72 PS. 99116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, lt1e tax rate imposed on the net value of transfers to or for the use of lt1e surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 PS. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) 172 P.S. 99116(a)(1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)). A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV~'508 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
McKeehan, Robert F.
FILE NUMBER
210100712
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointty-owned w;th right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
Miscellaneous personal property including clothing, medals and household items
VALUE AT DATE
OF DEATH
$350.00
2. 1988 Plymouth Voyager Van - Serial #1 P4FH4032JX303645
$1500.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,850.00
REV-1S10 EX+ 16-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
McKeehan, Robert F.
FILE NUMBER
21-0100712
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
ITlEM IOCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DEceDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATIACHA COPY OF THE DEED FOR REAl. ESTATE VALUE OF ASSET INTlEREST IIFAPPUCABlEI VALUE
1- 401 K Plan Union Profit Sharing Plan 1773.33 100 1773.3
TOTAL (Also enter on line 7 Recapitulation) $ 1,773.
3
3
(If more space is needed, insert additional sheets of the same size)
,12/.11/2002 11:27
9734731852
NVA
REPORT R~5
()4NIPAY '4.0
FIRST UNION NATIONAL "ANK
CMECX REGI STER
02/06/2001 . 02/06/2001
PAYEE PAYEE PAY
HI FOI'U'lA Tl QJJ NUMBE. G'OOP LOC CHECK DATE CD T~PE
MCKEEMAN,SHIRLEY L 161323227 NPU 02/06/2001 4 LUMP
1905 ESTHER DR ORD: 2,216.66 EEC: 0.00 FEDTK
CARLISLE, PA 17013 CAP: 0.00 NUll: 0.00
TAX: 2.216.66 NTX: 0.00
NET PAYMENT
FUND= OAILY
ADM: BAKER,RAY
.-.*WTOTAlS FOR PAY GROUP NPU
NPA UNION
401' PST PLAN
~;'c/J:
fIl eke'" L-, j2..,j..;:r
/)~~~.J- t/~/DI
fh, 1<--- G ~ J \ r
,;'11 _f,n-f
(IlL '711 ' '1 tf
,[1.// /1
1)... j{7
NPA UNION
401. PST PLAN
FORM
CURRENT YEAR TO OATE ID
2,216.6~
443.33
1,773.33
PAGE 02/03
PAGE, 162
DATE' 02102/2001
TIME: 21,27
CHECK ST
NUMBER
2,216.66 CHKl 00001708526 0
443.33
2,216.66 1095ge7884
GROSS TOTAL,
OEDUCT TOTAL
EFT TOTAl
NET TOTAL.
HO OF C~Er.KS
0.0 TOTAL
CAP TOTAL
TAX8L TOTJl.L
EEC TOTAL
NUA TOTAL
NONTAX TOTAL
RECUR TOTAL
NONRC:R TOTAL
2,216.66
443.33
0.00
1,773.33
000000001
2,216.66
0.00
2,2\~.bb
0.00
0.00
0.00
0.00
2,216.66
,12/11/2002 11:27 9734731852
1I!IaSJ: Cap"al Management
"ONIUN' Group
NVA
PAGE 03/03
Section I . PLAN NAME NPU
DAILY RETIREMENT SERVICES DISTRIBUTION REQUEST
ST''''
CARLISLE PA
RaATIONs\o\lfl SOCIAL SECURIT'l" NUMElERI
WIFE Ie-I 31. .,'1.2-7
CrTY STA.lE ~
19~THER DRIVE CARLISLE PA 17013
'FOR MULTIPLE BENEFICIARIES, ATTACH LIST, AND CALCULATE PRO RATA SHARE OF /jlISTRIBUTlON
PARTICIPANT NAME
ROBERT MCKEEHAN
"..n,,'.,,_ 10/16/38 "AR1lCIP^,ONDAT"E 01/01/90
ADDReSS
1905 ESTHER OR!VF;
BENEFICIAAV NM'Ie (IF APPUCABlEIr
~RTRTF.V T Mr.KF.~~AN
AODAI!SS
SOClALSECtJRfTY""M.'. 192-30-1511
""TEO'_ 09/05/89
VES'TED PEACeNTAGE
100r.
""TEOFTtIIMINATION Ol/02/0l
7J1'
CITY
17013
Section III . TYPE OF PAYMENT
Il Total AC":ount Balance
D Specific Amount $
o Return Ineligible Contribution
Taxable Yea,
S --;;-ERIODIC PAYMENT SPECIFICATIONS/DEDUCTIOJj.s---
Commencement Date 0 Joint & --~.
D L~e Only , "eellon VII)
o Speclffc p~menl Amount $ , d Certain of Years
o Employee !ler Tal( A e~1987 $ 6~
o Insuranc 'cLite $ Health $
Section II . REASON FOR DISTRIBUTION
tI Termina~on D Disability [J Hardship
D Retirement 0 Wnhdrawal 0 Other
Ii Dealh 0 Minimum Distribution
S_U~II' ~.I FEAI9Ble fR[&lfCNeV
BM......lI.I,
Section IX.
SPOl.I8E. N1\ME SSIf DATe OF SlFfTH n distribution
Section X - FEDERAL WITHHOLDING ELECTION/PARTICIPANT DIRECTION
This distribution 10 be r.celved may be eubJoct to MANDATOIlV Federal Tax withholding, Withholding wilt only apply to the portion 01 t~e distribution that Is
included in your Income subject to Foderar Income Tax. lIthe distrlbudon is not subject to the MANDATORY FedsreJ Tax you may sleet ~lto wl'lhhold
FedQl'a1 Tax from your dlstrlbution_ It you eleel not to have Federal Income Tax withheld, you will be liable for payment at Federal Income Tax on the tax3ble
portion of your dlstributlon, A change CANNOT be msdelO YOUf Federal and Slate WIIt,;'joldlng Election once a distribution is processed. Since First Union
cannot advise participants on tax mattars, we recommend you mn.uIt. your~ atMsor prior to authorIZing Ihis dill'trIbutlon.
Section VII - JOINT & SURVIVOR
Check ONE ot the followlnq:
o I DO NOT want Federal Income Tax withheld.
o I DO want Federal Income Tax wilhheld.
o I want to have $ (Fedaral) wIIhheld.
o I want to have % (Federai) withheld.
o Pariodlc (See Sec. IV, VI)
o Annuity (AIt, Form #9201)
o Rollovar (Alt. Form #534042)
S
Section V . MAILING INSTRUCTIONS
Mail participant check to:
[] ComPl*1y IlD Participant
Mail rollover check 10:
[] Company D Participanl
[] Rollover Institulion
EJ Sug.l..l,
o Bbl,,; 1..,4...411,
tJ ..Id .nbally
Section VIII. ATTACH SPECIAL INSTAU
STOCK (Attach Form #9311)
I:] Ye. Cl No
~ ONE at the follaWil\g;.
t11 DO NOT want Siale Income Ta'(wnhheid (Wapplic.).
0100 wanl State Income Tax withheld (n applic.). State_
o I want to have S (Stale) wnhheld.
o I want 10 have % (Slate)wllhheld.
I have received and read the Spedal Tax Nollce an~ Olstr\b\Jtion' Election Notice regarding plan dlli'trtbutlons and ut1dllr_nd the ta"JC8blllty of this dlsb1bVtion.
I understand that I may elect to receive my dlstribudon Immediat8ly but that I may consIder the deC'sion of wheth6f or not to erect a direct rollover for at teast
30 day rthe oIlce ~ d to I hereby dl . this distribution In 1\0 amOUf1l8 Mdlor",.
pARTICIPANl'S S~ BI:! CIAAV Sl FE
Sectlon XI . DISTRIBUTION AUTHORIZATION
OI.Oq .01
DAlli
ntlon of: Election to Waive JoInt & SurvIvor Annuity and Spouse~ COMent to Watver.
/--21'..-() )
MoTe"
PlAN ADMI
PLAN RECORDKEEPER
Apprrc:abl~ 10 non pAtiodlc payment OIlly;
""..""'c~ $
Pal"llolpsnt Chock S
!<>!Il.C~$
Out$landlng t.Oan $
!!!!!lPJIIJ!Hud19l! $
Non-T~bIe Tom! S
Tauble Total $
IllBurGlnC8 Policy Ofl!ltrlbulRd In-KInd
TBXBble OJMlh eut'lfOt\der val~ $
N(]n-taxlt~B cumtll!J:J\re P9-58 Costs s:
WHITE - FUNS OArl y
YELLOW. FUNS PAYMeNT UNrT
PINK - PAATJCtPANT
??oo 5-12333 ( M/Dko \
ewe. PIAN ADMINISTRATOR
REV.1511 EX+ 112.991*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
McKeehan, Robert F.
FILE NUMBER
210100712
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,.
Hoffman-Roth Funeral Home Basic Services 3390.00
Hoffman-Roth Funeral Home Casket and Container 1600.00
Hoffman -Roth Funeral Home Opening Grave and Rock 399.00
5389.0
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions 0.00
Name of Personal Represenlative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State _Zip
Year(s) Commission Paid:
2. Attorney Fees 500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State_Zip
Relationship of Claimant to Decedent
4. Probate Fees 29.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Estate Publicalion Fees
179.82
TOTAL (Also enter on line 9, Recapitulation) $ 6,097.82
Debts of decedent must be reported on Schedule I.
o
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (6-98)
..
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
FILE NUMBER
210100712
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
Include unrelmbursed medical expenses.
VAlUE AT DATE
OF DEATH
$5020.20
$6622.53
$35.00
$5497.55
$7508.59
1480.50
500.00
33,053.00
ESTATE OF
McKeehan, Robert F.
ITEM
NUMBER DESCRIPTION
1. Sears Roebuck and Co. Accl. No. 0558973112557 (-unsecured creditor)
2 Citicorp Credit Services Inc. Acct. No. 5423796022158472(joint debt- unsecured
creditor)
3: Cartisle Hospital - unreimbursed medical expenses of final illness
4 Franklin County Teache~s Credit Union Acet No. 26400-50(Joint Debt- unsecured)
5. Franklin County Teache~s Credit Union Acct No. 26400-51 (Joint Debt- unsecured)
6. MBNA America Acet No. 4313081750151536 (unsecured - joint debt)
7. Capital One Acct No. 5291071798596613 (unsecured creditor)
8 M&T Mortgage Corp. Acct No.978709-4 (joint debt - secured creditor)
59 717.17
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of:
ROBERT MCKEEHAN
Deceased
Court File No:
TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. !i3532(b)(2).
1) Claimant's name: SEARS ROEBUCK AND CO
2) Claimant's address:
C/O Balogh Becker, Ltd.
3100 W. Lake St. Ste. 110 Minneapolis, MN 55416
3) Creditor listed below is the owner and holder of a claim in the amount of
$5,020.20
4) The facts upon which this claim is based is a credit agreement between Creditor
and Decedent, identified as account number which is evidenced by the
attached Affidavit of Account Stated.
5) Decedent's address: 1905 ESTER DR CARLISLE PA 17013-1028
6) "Date of Death: 01/02/2001
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm un
perjury that they Information and representations made her'
to the best of my knowle ge, information and belief.
-0
Dated:
er the penalties of
are true and correct
CH, Attorney for
Claimant
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
SAVIO C ANDERSON
Name
4229 ELMERTON AVE
Add ress
HARRISBURG. PA 17109
City /State/Zi R
q-IL(-O/
"
IN THE COURT OF COt-MON PLEAS, ~b2.rW-rc\ COtlN'1'Y
PENNSYLVANIA
ORPHANS' COURX DIVISION
ESTATE OF
Register's # .;2\n\"+\':) ,
Deceased
CLAIM
To the Cl.erk of the Orphans' Court Division:
..
Index and make proper entry in your official records 'of the
claim of CmCORP CREDIT SERVICES.INe. in the amount of
1\J.ala.Qd.-"5' against the estate of the above-named decedent. . This
claim is filed under Section 3532 (b) (2) PEF Code, 2(1 Pa. C.S.
ss. 3532 (b) (2).
The
at -,q()~_'
Written notice of this claim was given to ~
~ Fl~r-ic:A Qv9 t.}Jm~?1A
)
on IrY\\~\
:y1Jilage, for Clticorp Crecit Services, Inc.
Under llllllted Power of Attorney for
Cltibank. S.D., II.A.
7930 NW 110 Street,
Kansas City, MO 64153
(Claimant's Address)
. .
.
r
I ..
~~L~
02/16/01
[EMf,DIJ~ DATE J
$6637.53
b N_EVi8ALANCfi..)
$6637.53
l~~~_Mr DUE~
SITE: KC-CD
TM:CD-6375
ACID:KCB1258
FO-BT
34 Al 3 0985 TC
0014 CM4
CHOICE MASTERCARD
P . O. BOX 8114
S HACKENSACK, NJ
USA 07606-8114
08/17101
21:45:52
ROBERT MCKEEHAN
ATTNY .ACCOUNT-CODE=DU12
CARLISLE PA
17013-1028
For Custom.1' Servic. call or writ.
CHOICE
CHOICE MASTERCARD
Account Number
1-800-568-5000
BOX 6248
SIOUX FALLS, SD
57117
Forbilling'nquincs....'.'teto
this address: eatlingw,II not
preserve your rights.
5423 7960 2215 8472
Payment must be received by 1:00 pm local time on 02/16/01
SlatemMt Date Total Credit Liflll Cuh AdvaflU Limit New Balance Availablll Cr.dit Line Available Cash Line
01122/01 $9800 $3500 $6637.53 $0 $0
Sale[JIPostLJI ReterCllcel#
Acti,,; S,ncclastStal"ment
Amoutlt TIC
8," ;tg'"Mer" A 5;1;
010,
LATE FEE - NOV PAYMENT PAST DUE
1500 6 0000
0000000000
v:-
I ~?J25)
I
I......
-
Ace hi Summar"
Previous
Balance
Amount DUll
+Purchlls., . PlIyments - Credits +Flnanc:. + Lat. = Balance "'urMinDue 138100
& AdvanclIB Charge. Charges Adv MlnDue
I I I ^mountOCl
~];O 663753 Fees 61: 00
Past Due
1500 663753 MinAmlUue 663753
PURCHASES ADVANCES
PurChases
AClv.l1ces
rOlat
6622~3
6622b
R.t. Summary
~~~;~~~I~~:~~~iOd 33
Bal<lI'CO'UlIljec!!o
flnallCeCll<lrge
Period;cR.lle
NOll'llnalAnnltaf
Pere"nt/JgeRate
Annual Percentage Rate
1. 866677.
22.4007.
22.4007.
.061377.
22.4007.
22.4007.
~
. MAY-22-2001 13:23 FROM:CUSTOMER SERVEXT5423 5234
CARLISLE HOSPITAL
'246 PARKER STREET
CARLISLE PA 17013
Return Service Requested
tEE
C!!!C
l1li
CIlIDlTCAJU) FAVJof'.NTINJ'ORMAnON
CAIlDTYrt T f'.xP.DAT!
AC('OUNTNtJMBlR
CAltD "OLDOl SIGNAnm.r.
PLEASE
f,,'lX
AC
CARLISLE HOSPITAL
246 PARKER STREET
CARLISLE, PA 170130310
1",111",111"",.11"11",11"11,,,,.111,,1,,1,,1.11,,111111
TO: 7175411194
P.009
p' '"
';
~
PAn NTNAU
ROBERT F MCKEEHAN
PATIENT NUM&eA DtSGHAAQIi;: I SGRVICG DAn
2742872 OllOZlOl
CURFI~ BAI.ANCE. BlUING DATI
35.00 04/09/01
AGREEMENT mOlMT PA'r'MENT DU' OATG
.00 04/30/01
- .", nn J ~~l
PAl H
o ERE
ROBERT F MCKEEHAN
1905 ESTHER DRIVE
CARLISLE PA 17013
1111111...111......".."....1111.....1,",,1.11....1.1"'1.11
2742872 3 65 2 1 6 27 CK
o PLEAS~ CHECK HERE AND SIofOW
n. ~ ,_~I;IADOAESS.COR~TION.ON,~S:I.$IOE.....-.-__.._,,______,_. -...-.........------ ''''-"----
TO ASSURE ROP~ Q)fT PlEASe WAI YO ATlENT Nlt.A'8~ ON YOUR CkECKNoID RETURN UPPER POR'nON WITH REMITTANCE
DATE DESCRIPTION - -- QUANTITY
w
!<
o
w
u
~
w
~
'"
o
~
~
~
OllOZlOl
OllOZlOI
0110Zl01
01/0Zl01
OllOZlOl
OllOZlOl
0110Zl01
OllOZlOl
OllOZlOl
OI/OZlOI
OllOZlOl
01/0Zl01.
OI/OZlOI
OI/OZlOI
OllOZlO1
OI/OZlO1
OIIOZlO1
01/02101
OllOZlOl
OllOZlOl
0110Zl01
OllOZlOl
OllOZlOI
OIIOZlOI
OllOZlOl
OI/OZl01
01/02101
CHEST PORTABLE IV
NO CHARGE
CT HEAD UNENHANCED
PHLEBOTOMY FEE
CBC
PROTHROMBIN TIME
APTT
BASIC METABOLIC PANEL
LORAZEPAM 2 MG INJ 2MG
VENTILATOR, INITIAL 24 HOURS
VENTILATOR, SET-UP
ARTERIAL BLOOD GAS ANALYSIS
ARTERIAL SAMPLING
SYSTEM TRACH SUCTION CLOSED 2205
BLOOD GAS KIT
BLOOD GAS KIT
CATH TRAY FOLEY 16FR W/URINEMETER
YANKAUER SUCTION INSTRUMENT
TUBE ENDO 7.5 MM CUFFED
BLOOD GAS KIT
NSS IRRIG. BOTTLE 250 ML 2F7122/P
STYLETTE 14 FR.
TUBE SALEM SUMP W/VALVE 26641
HOLDER PM ET TUBE
IV SOL SOD CHL 0.9Y. 1000 ML
IV SOL SOD CHL 0.9Y. 1000 ML
CLASS V VISIT EMERGENCY DEPT.
ass AUTO .up. alP
TOTAL OF CHARGES NOT DETAILED
-IMPQRTANTMESSAGE
Your eccount is PAST DUE. Pleese remit
payment to prevent further action from our
~olle~tion department. Thank you for your
1mmed1ete attention to this mstter. If you
have any questions please call
717-218-8833 between the hours of 7am and
4pm. Thank You.
~
~
Vou may re.ch Patient Financial Svcs
at 419 Stoneh~dge Dr Carlisle Pa. Our
RETAIN me PORTION
AMOUNT
1
2
1
1
1
1
1
1
1
1
1
2
2
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
103.00
.00
551.00
9.00
33.00
22.00
Z9.00
45.00
10.00
434.00
61.00
Z46.00
20.00
45.00
6.00
3.00
60.00
3.00
11.00
3.00
3.00
14.00
15.00
8.00
3.00
3.00
309.00
---9Z2..0-5C
1, 091 .95C
~~~s
~"G"
~~rSl
.00
CUlattNT
<<0"",
35.00
o 0
35.00
bISCHAldl!/
$D:Vler: DI
AaAEeMeNT
AMowr
01/02101
PAYM9IT'
DUE OA'"
PAY
THIS
PAVM~ REC&I\lEO AFTi!R BILLING DATE WILL APP~A ON ~ eTAT9.4ENT
.--
-
..........
Not1".., See reveree .ide for important infoI'lllatlon regarding
your right to di..pute error. On your statement.
Franklin County Teachers' Credit Union
1156 Kennebec Drive. Chambersburg
P.O. Box 505. Chambersburg, PA 17201-0505
Phone: 717-264-6506
Toll Free: 888-968-7828
ACCOUNT NUMBER:
26400
YTD DIV RECEIVED:
1.58
PAGE NUMBER:
1
8167
ARB YOU EXPECTING A TAX REFUND
THIS YEAR? SEE PAGE 2 OF THE
QUARTERLY REVIEW I
04 .
SHIRLEY R MCKEEHAN
ROBERT F MCKEEHAN
1905 ESTHER DR
CARLISLE, PA 17013-1028
1..,111,.,111".".11,.11,."1111".,,1,11,,1,11,,,,1,1.,.1.11
KIDS CLUB MEMBERS:
MARCH 1ST IS THE DEADLINE TO HAVE YOUR NAME SUGGESTION IN FOR OUR NEW FISH! YOU COULD WIN A $25.00 SHARE DEPOSIT!
I -~~----r--'-----
I SUFFIX 01 BASE SHARE ACCT I SUFFIX SO USED VEHICLE
I STATEMENT PERIOD 10/01/00 12/31/00 I STATEMENT PERIOD 10/01/00 - 12/31/00
I BEGINNING BALANCE 21.74 I BEGINNING BALANCE 15,217.79
I DEPOSITS 1 .31 I PAYMENTS 3 706.00
I WITHDRAWALS 0 .00 I INTEREST FOR PERIOD 485.07
I ENDING BALANCE 22.05 I LATE FEES .00
I I ADVANCES 1 294.00
I DIVIDEND YEAR-TO-DATE 1. 58 I ENDING BALANCE 15,017.18
I DIVIDEND THIS PERIOD .31 I
I AVERAGE DAILY BALANCE 21.74 I INTEREST YEAR-TO-DATE 1,395.61
I DAYS DIVIDEND EARNED 092 I LATE FEES YEAR-TO-DATE 12.50
I ANNUAL PERCENTAGE I ANNUAL PERCENTAGE RATE 8.500%
I YIELD EARNED 5.78% I PERIODIC RATE .0232\
I I PAYMENT AMOUNT 353.00
I I PAYMENT DUE DATE 12/25/00
I- I
su. ~
HI ~\~ c\~0-L
D NSACTION AM V ~ \ (){)Y\
12/ .3
SU!'j
HI!
DATE
10/11/00
11/21/00
12/06/00
12/19/00
PAYMENTS
DATE
10/11/00
11/21/00
12/06/00
ADVANCES
DATE
12/19/00
SUFFIX
HISTORY
DATE
10/30/00
10/30/00
11/21/00
12/06/00
12/19/00
SUMMARY OF YOUR ACCOUNTS
I
I
- 12/31/00 I
11,331.52 1
647.00 1
355.50 I
2.50 I
59.00 I
10,995.10 1
I
1,289.49 I
15.00 I
11. 500% I
.0315\-1
294.00 1
12/10/00 I
I
SUFFIX 51
STATEMENT
BEGINNING
PAYMENTS
INTEREST FOR PERIOD
LATE FEES
ADVANCES
ENDING BALANCE
PERSONAL LOAN
PERIOD 10/01/00
BALANCE
4
1
INTEREST YEAR-TO-DATE
LATE FEES YEAR-TO-DATE
ANNUAL PERCENTAGE RATE
PERIODIC RATE
PAYMENT AMOUNT
PAYMENT DUE DATE
~vY\J..
}JltYr
DESCRIPTION TRANSACTION AI ANCE CHAI
LOJl-1J PAYMENT 353....... 152.39
LOAN PAYMENT 59.0f) 15,017.18 59.00
LOAN PAYMENT 294 . 00 14,860.02 136.84 157.16
RETURN CHK NSF 294.00 15,017.18 136.84 157.16
AMOUNT DESCRIPTION PRINCIPAL FINANCE CHARGE
353.00 LOAN PAYMENT 200.61 152.39
59.00 LOAN PAYMENT .00 59.00
294.00 LOAN PAYMENT 157.16 136.84
AMOUNT DESCRIPTION
294.00 RETURN CHK NSF
51 PERSONAL LOAN
DESCRIPTION TRANSACTION AMOUNT ACCOUNT BALANCE FINANCE CHARGE LOAN PRINCIPAL
LOAN PAYMENT 291.50 11,211.39 171. 37 120.13
Late Payment Fee 2.50 11,211.39 2.50
LOAN PAYMENT 294.00 10,995.10 77.71 216.29
LOAN PAYMENT 59.00 10,988.06 51.96 7.04
RETURN CHK NSF 59.00 10,995.10 51.96 7.04
REV-1513 EX+ (9-00)
..
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
McKeehan, Robert F.
FILE NUMBER
210100712
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Shirley R. McKeehan Spouse 100
1168 Redwood Dr.
Carlisle, Pa 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S
(If more space is needed, insert additional sheets of the same size)
~tNI tll;~tateWlQeAutomatl~n
1-=,-11 4:14AM
AOP.C'"
111 ,40 19,2;. 2
,
,
\
\
,
\
~
i
J
~
!
Q--
.~
i
I
I
I
IDaslllllIUl mW ID~slmttent
I, ROBBRT F, McKEEHAN, J~" of North Middleton Township,
Cumberland County~ Pennsylvania. declaTe ~his to be my last will and
testament and revoke all wills which I have previously made.
I 1 give, devise and bequeath my entire estate, real
and personal, unto my wife, Shirley R. McKeehan, absolutely and in
fee simple if she shall survive me, to the exclusion of any child now
living OT born to me subsequent to the date of this will.
Ir If my wife, Shirley R. McKeehan, fails to survive
. me J I give, devise and bequeath' my entire estate, real and personal,
unto my issue per stirpos, absolutely and in fee simple.
III If neither my wife nor any issue shall survive
me) I direct my executor to. convert into cash and sell at either pUblic
or private sale all real and personal proFerty which forms a part
of my estate, and to add the proceeds thereof to my residuary estate
which I give and bequeath one-half thereof to my next of kin and one-
half thereof to my wife's next of kin as determined by the Intestate
Laws of Pennsy_lvania in ef_fect at the time of my decease.
IV I appoint Farmers Trust Company a5 testamentary
guardian of the S'state of any beneficiary hereunder or other person
with rosp-ect to whom 1 am authorized to appoint agusrdian, including
but not limited to the proceeds of policies _of life insurance J not
of full legal age at the time of my aece~$eJ to receive the share
of said beneficiary or other person) to apply the income and so much
or all of the principal as 1n the sole discretion of the guardian
may be proper for the support, maintenance, welfare~ medical and educa-
tional expenses of said minor after cons.ideri~g the minor's !lge, sex,
a~titudes, inteTest$~ abilities and needs, and any other assets and
resources available to said minOT} and to distribute to the minor
upon attaining the age of 18 years the remaini~g balance of said share.
V In addition to the usual powers provided by law
the guardian is authorized to:
,_, I
:.'
--......."''','.''''.....,,,'
S~NT eY:State~ideAutQmatiQn
1--\-81 4:34AM:
AOPC-+
717 540 1952:# 3
A. Retain in kind any real or peTsonal property
wh.ich forms e. part of my estate and to invest acC'ord.ing
to the, gua.rdian's best ju?gment but without ~estriction
to investments autho~ited for iiduclaries in Pennsylvania
without ~ega~d to any principal of risk, diversificationJ
underproductivity or non~productivity.
B. Hold property in the name of the guardian
or its nominee.
C. A1IDcate stock dividonds to income or princip 1
as it de-ems proper.
D. Pile all necessary tax returns and pay all
taxes thereon t~gether with interest and penalties.
B. Sell at either pUblic or private sale) mor~g~ e,
lease for a. term including a term of more than three year ,
any Teal or personal property which forms a part of my
estate or which may be acquired by the guardian under
this will.
F F. Distribute in kind or, cash Or both on the
termination of the, guardianship.
VI If my wife fails to survive me, I appoint Charles
and Judy Chronister, or ~he survivor of them, as testamentary
guardians of the person of my children ,duripg their minority.
VII I appoint my wife, Shirley R. McKeehan, as
executrix of this will. If far any reason she shall fail to qualif
or cease to act as such during the administration of my estate I app int
Farmers Trust Company 8.$ sub'stituted exec'Ut'or.
this
~.
IN WITNESS WHEREOF,
day of 0' cf
I have hereunto sot my hand and seal
1974.
1J#~<-,,(2.<'f "
(SBA
Signed, sealed, published. and declared by Robert F. McKeehan, Jr.,
te~tatoT herein named. as and for his last will a.nd testament,
JT~tten on two sheets of paper, in OUr presence, who, in his presenc
tt his request, and in the presence of each other have hereunto
ubscribed our names as attestingwitnesses:
f.Pa T "'"'<' ....a7
jj' .,
:I -' I, . l . ~ .. or
., <kl:/9Y:///u,)