HomeMy WebLinkAbout01-0782
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of/-.. IlLi C_€- l3i~~~6R... No.
also known as A-/rCE ec.e'Q'.E.
Register of~ills hor the
County of UnJ >JlP.-(.~in the
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 e~c~ fi!./J<
in the last will of the above decedent, dated ml1P{!Jf a:t
and codicil(s) dated
21-01-782
1!3ceased.
Social Security No.l79 -2tJ - ~" 1.
named
,19~
f(fly
If . D i c.SZ:.C-I<.E.R. "7Jt!:C f /i":;Ed- 7l71112fl./I 4~ /1/4 ~
I '
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ell h1 h.t7p. J....fi/)d- County, Pennsylvania, with
h F: R- / last family or principal residence at I J (JJ.f .s"Ll~ m/2 .e~~r .srUEr.
'7rY /- )\/1 ~ ; ~ oS h 11 Tq, /J fJ P~f.l /fLLf/J ~.
(list street, number and muncipality) tJ'
/It{ f/l.5r
/ tJ Tf,
,
, P1" 0<.00/,
years of age, died
at - !L/
Excep as follows, decedent di 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:
Decendent at death owned property with estimated values as follows: .3/7 r-6
(If domiciled in Pa.) All personal property $ " $.1""tJ.
(If not domiciled in Pa.) Personal property in Pennsylvania $ ~
(If not domiciled in Pa.) Personal property in County $ '~15CO'
Value of real estate in pegn21vania $ ~ ~. r6 /.;; I IJ/
situated as follows: /~O rS/}//M rl)t1..Li".;;.r .5Tti~r; 0) M 'CSh//~, ~tfl.
t J..vJ /1''- f}jp /} -fb gh iJ .
, r' ,
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWE~TH OF PENNSYLVANIA I S8
COUNTY OF // I'Yl h ~ P / .I.. /J/'YL-. 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 decodeot petitione<(s) will W~IY administer th~ estate according to law.
Sworn to or affirmed and subscribed { . c-- of ~h-- ~
before me this 21st day of ~
~UGUSo/. . Jl1}x 2001 ~'1 L. jr)/Ylff)p# ./ ~
~y~ CI/n~#'I~~<.~ ' ~
RegiS r ~
/?-c2 - ?
No. 21-01-782
Estate of
L ALICE BIESECKER
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW AUGUST 22 ~200 1 , 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 3-26-1993. 6-13-1996. and 11-16-1996
described therein be admitted to probate and filed of record as the last will of
L. ALICE BIESECKER
TESTAMENTARY
KAY L TRIMMER
and Letters
are hereby granted to
~7/ af:tl,_;.-..w)".<l~ ) 4<"'7
ster of WIlls
FEES
235.00
6.00
J.UU
21. 00
5.00
710.00
Probate, Letters, Etc. .........
Short Certificates( )..........
x-pag~s .
RenuncIatIon ................
CODICIL
JCP
$
$
$
$
TOTAL _ $
08-21-2001
A TIORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE
a~~~ ~~~<< h ~.e~uv~
r:::J l' .g - .5'.!J "t' I
H10",.R0'1 RFV 9/';((,
This is to certify that the information here given is correctly copied from an original certificate of death d~ly filed with me as
Local R<;gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent tIling.
WARNING: it is illegal to duplicate this copy by photostat or photograph.
No.
(~J~<<~~
Local egistrar
Fee for this certificate, $2.00
p
7555709
~~.2~ ;<~ I
Date
21-01-782
H105.; 4J Rev 2.'87
COMMONWEALTH OF PENNSVLVANIA' DEPARTMENT OF HEALTH' YITAL RECORDS
CERTIFICATE OF DEATH
74 v..
COUNT't' OF oeArH
Ut<<JER 1 OM
HouN ! WinutM
SEX
.Female
STAff FilE ~UM8ER
SOCIAL SECURITY NUMBER
.. 179 20
TYPEJPRINT
IN
PERMANENT
BLACK INK
NAME OF DECEOENT lFltSl Middle. LasI.
.. Alice L. Biesecker
AGE (lasl BotW'Ioayl uNDER' YEAR
....... Dsys
BiRTHPlACE ,Coty iiI".d
SWeOlfcreognC(lUtlUYJ
....
CUnberland
DECEDENT'S USUAl OCClJPlQ'lOH
(l~r:o.~J:':io~~;zt~
ilL Hanernaker "0. Hane
DECEDENT'S MAlLiNG AOOAESS (Sat". CltylTown. se.. Zrp Code)
Ie.
SURVIVING SPOUSf
In ..... "... tNoOeO t\If1\8l
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5l
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o
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z
'o.
FATHER'SHAME tFnt hWaIe.laSlI
". Ralph Brenizer
tNfORMANl'S NAME (l ypetPflOU
. Ka L. Trinmer
METtK)() OF D1SPO$ITtQN
O 8unM IE CtMMbOn 0 RMTlOWaIlromStalaO
00nMa0n Olhaf (Spec.",.)
21..
SIGNATURE OF FU RAL RY
....
CUmberland
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.....
......1 l1d.0 :'::':::=01
MOTHER'S NAME (Fit.. ModtIe. Maden Sutllamel
Martha Elzada Ball
14.
Ih.at.... dac.-.lwdiP
Allp-n Twp
.....
1804 S. Market street
Mechanicsburg, PA 17055
12. 1 .
".. ..... Pennsylvania
,-
...
INFORMANT'S WALING AOORESS $... CtyITown. SIaIa.lip Code)
2Gb 33 Audubon Park, Oillsburg, PA 17019
PLACE OF OISPOSITK>N. Name of Cemetery. CrlltNlDfY lOCRtQN - Cityf1i::rwft. Stal.. rip eo.>>
011 Other P....
PA 17055
PA 17055
)
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~s CASE REFERREO 10 MEDICAl EXAUINERlCOAONEFl1 ~'
....0 ""
H.
,Apptoxtmata PAA'T H; Odtef significant 00fdIl0ns conIflbuling 10 de&ttl. but
: inlelWl btCween noI,.auIing in the ~ C&UM 9Nan in PART I
I 0IIMl and duIh
I
I
, l
..........
,,l
DATE OF INJURY
jUOllUlOay._iU)
TIME Of INJuRY
INJURY IC1 WORK"
DESCA68E HOW' INJURY OCCURRED.
Su"","
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o
o
Hom~,,"
lice,,""
Psncllng InlfMl~lion
o
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o PlACE OF INJURY. AI home.latm. su....ladOIIV. odic.
but6dIng. ell::.1Spectlll'l
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l;u I bl.11 LL I
Hb. p/'l J1 Ill-
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Could not be dellrmttled
He. :lab.
CERTifiER ICI'ectI oniy one!
.CERllf'VING PttYStclAN (Physocoao Ct!<',i1y,"g C4U5e 01 dl:>ath wiler"' ..l"\Oltler LJtlIl'Sl(;',)ll has Pfot'oOUnced dedlll ana COIfllJlttltld Hem 231
To Ihe "'el 01 1ft., kno_ltMtga, death oc:cUfNd due 10 the ca....M(.) and manne, as .t.led. . .
D.
.PRONOUNCING AND CER1IFYlHG PHYSICIAN \Phys!c.an bolt' ;)l:lrlOlJnctOg lIe~tl and ..:e.I,I'(IflQ 10 ..:au~ 01 ,1ea.[(11
To tha besl at my knoWlfllgfl, de.~ occurr" ,lIthe u.n.. 11.1.. ~ plac.. and dua 10 lhe c.u..... and manni' ill. Ilated .
.MEDICAL EXAMINER/CORONER
On Ihe baai. ot...mtnaUon and/or Investlg~lion. in my opinion, dealh occurred allhe lime. dale, and place, and duelo Ihe ca"ae(s.and
mannar as '1.'".
JI.
,.
LAST WILL AND TESTAMENT
I, L. ALICE BIESECKER, of the Township of Upper Allen, County of
Cumberland and State of Pennsylvania, being of sound mind, memory and
understanding, do make, publish and declare this to be my last Will and
Testament, hereby revoking and making void all former wills, codicils
and other testamentary dispositions by me at any time heretofore made.
1.
I direct my Executor, hereinafter named, to pay as soon as practicable
after my decease all my just debts and the expenses of my last illness
and burial.
2.
I glve, devise and bequeath all of my estate, whatsoever and wheresoever
situate, unto my husband, Ray A. Biesecker, absolutely.
3.
Should my said husband predecease me, than and in that event, I
give, devise and bequeath all of my said estate unto my children, David
R. Biesecker, Kay L. Trimmer and Ann M. Kline, equally, share and share alike.
4.
I nominate, constitute and appoint my husband, Ray A. Biesecker,
executor of this my Last will and Testament. Should my said husband,
Ray A. Biesecker fail to qualify or cease to act as executor, then and
in his stead, I nominate, constitute and appoint my daughter, Kay L.
Trimmer, executrix of this my Will.
I direct that my executor, and his successor, shall not be required
to give bond for the faithful performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I, L. ALICE BIESECKER, the testatrix, have hereunto
set my hand and seal to this my Last Will and Testament this ~tetday of
March, 1993.
/'
~ ~ LL/iiSEAL)
/
Signed, sealed, published and declared by the within named L. Alice
Biesecker, 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 thereto.
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21-01-782
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21-01-782
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
\ codicil
(each) a subscribing witne~"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 anq,.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
me this
d subscribed before
day of
19_
(Name)
(Address)
Register
",
'...,....
(Name)
'''''(1ddreSS)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
hy .L. 7/( in)/n~R / dd JJ/Jv;c-IR. G/1,(..~1!J bJA-,! '
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
they are familiar with the signature of L ALIC~ BIl';.SECKER
~diciI) ~
testatr.i.x- of (OOleX)(!Jfx:ilt&~~x:lWi~x~:llhe will ~ herewith and
~
that they believexthe signature on the will is in the handwriting of
L ALICE BIESECKER
to the best of their knowledge and belief. , ) ,
Sworn to or affirmed and subscribed before ~ eX: U ~,n"I/rdh
me this 21 s t day of -r (l'fjme) _
AUGUST ~9200 1 33 ,dttd.tl /,. Ct"7'J T tlltJ0, (j).(.t Ch
'7i?~~_.L~LL~tt~~~'4
' '/ Reglstif
---
21-01-782
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
/
/
.//
/
codicil /'
(each) a subscribing witness t~ will presented herewith, (each) beiruly 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 (lh'l~~ pr~nce of each other) (in the presence of the
other subscribing witness(es)). "X
,.",- """',
Sworn to or affirmed and subscribed before
me this day of
19_
'"
"
"
(Name)
"
"
Register
(A~~SS)
/
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) ~riber hereto, (each) being duly qualified according to law, de~se(s) a~(s) that
. --'- ~ familiar with the signature of ,/. du ~6ec~,r-
codicil
of the subscribing witnesses to) the c:3' presented herewith and
codicil
that believes the signature on the will is in the handwriting of
/~f
Uz
to the best of "n-?~ __-:- knowledge and belief.
Sworn to or affirmed and subscribed before
me this 21st day of
~UGUST ~ 2001
~~~"~~J~'~~/~
/ Reg;;ter I
(Name)
(Address)
21-01-782
REGISTER OF WILLS OF CuMBeRLAJ/O COUNTY
OATH OF SUBSCRIBING WITNESS
Jft''!,Dd/n L. ",::jJtuJd~
~ a subscribing witness to the will presented herewith, ~) being duly qualified according to
law, depose(s) and say(s) that.z: W~ present and saw
the testat"'~ , sign the same and that I. signed as a witness at the
request of testat.&l.X.- in h E:J1.. presence and (in the presence of each other) (in the presence of the
other subscribing witness~. ""HI) J's Nt:IV "J'?I!SIPEA/7' OF ;:;'~NIM
Sworn to or affirmed and subscribed before ~ ?L.-',:
me this dll ~ day of .9? WA57 /'/lfN (Name) :5'"~1!5Ifff
1II~ ~Ec."'AN"le.56~ yA .J7~ (,Q)14
I
(Address)
(C'- ,
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(Name)
(Address)
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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
presented herewith and
codicil
believes the signature on the will is in the handwriting of
testat_ of (one of the subscribing witnesses to) the
that
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
~/
TEl'- EAST HIGH S mEET
C~PLlSLE. PENNSYI VANIA 17013
IN RE: ESTATE OF
L. ALICE BIESECKER, DECEASED,
LA TE OF UPPER ALLEN
TOWNSHIP, CUMBERLAND
COUNTY, PENNSYL VANIA
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: NO. 21-01-0782
PRAECIPE
TO THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYL VANIA:
Please withdraw the appearance of William L. Sunday, Esquire, on behalf of the Estate ofL.
Alice Biesecker.
By~~ ~~
William L. Sunday, Esquir
39 West Main Street
Mechanicsburg, P A 17055
(717) 766-9622
Dated: October 8' , 2001
Enter the app€arance of MARTS ON DEARDORFF WILLIAMS & OTTO on behalf of the
Estate of L. Alice Biesecker.
"
MARTSON DEARDORFF WILLIAMS & OTTO
By
k A. DenlInger, Es
Attorney J.D. 83794
10 East High Street
Carlisle, P A 17013
(717) 243-3341
Dated: October /0 ,2001
t
-
TEN EAST HIGH STReET
CARLISLE, PENNSLVANIA 17013
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: L. Alice Biesecker
Date of Death: August 19, 2001
File No. 21-01-0782
To the Register:
I certify that notice of estate administration 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 or
about October 16, 2001.
Kay L. Trimmer
33 Audubon Park
Dillsburg, P A, 17019
Mark C. Trimmer
33 Audubon Park
Dillsburg, PA 17019
Ann M. Kline
117 Ballantrae Drive
Elkton, Maryland 21921
J. Kurtis Kline
117 Ballantrae Drive
Elkton, Maryland 21921
David R. Biesecker
P.O. Box 27
Elliston, MT 59728
David R. Galloway
154 West High Street
Carlisle, PA 17013
Shepherdstowll United Methodist Church
c/o Reverend Tom Willard "
1934 South York Street
Mechanicsburg, P A 17055
Kristin A. Giakas and her Minor Children Alec M. Giakas, Kyra E. Giakas, & Kristina A.
Giakas
8 Vivian Court
Newark, DE 19702
Kelly L. Johnson and her Minor Children Gabrielle K. Johnson & N. Grant Johnson
43175 Center Street
South Riding, VA 20152
Amy K. Shumaker and her Minor Children Cole A. Shumaker & Graham R. Shumaker
17 Homewood ~treet
Dillsburg, P A 17019
MDW~6
INFOR,\1ATION . ADVICE. ADVOCACY
ATTORNEYS & COUNSELLORS AT LAw
WILLlAM F. MARTSON
JOHN B. FOWLER III
EDWARD L. SCHORPP
DANIEL K. DEARDORFF
THOMAS J. W1LLlAMS *
Ivo V. OTTO III
GEORGE B. FALLERJR.*
CARL C. RISCH
MARK A. DENLlNGER
DAVID R. GALLOWAY
"BOARD CERTIFIED CIVIL TRIAL SPECIALIST
TEN EAST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE (717) 243-3341
FACSIMILE (717) 243-1850
INTERNET www.mdwo.com
November 15,2001
Mary C. Lewis
Register of Wills
Cumberland County Courthouse
Carlisle, P A 17013
RE: Estate ofL. Alice Biesecker
Estate No. 21-01-00782
Date of Death: August 19,2001
Dear Mrs. Lewis:
Enclosed with this letter is estate check number 1014 in the amount of $5,300.00
representing payment of Pennsylvania Inheritance Tax in the above-referenced estate.
Will you please issue the appropriate receipt and forward it to me at the above address. I
thank you in advance for your prompt attention to this matter.
Very truly yours,
DRG/clm
Enclosure
HAND DELIVERED
F:\FILESIDATAFILEIEST A TES\I0468-row. I
I N FOR MAT ION · A D V ICE · A D V 0 CAe y SM
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712B-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 000533
MARTSON DEARDORFF ET AL
TEN EAST HIGH STREET
CARLISLE, PA 17013
CONTROL
NUMBER
_uu___ fold ---------- --------
101 I $5,300.00
ESTATE INFORMATION: SSN: 179-20-6693 I
FILE NUMBER: 21-2001- 0782 I
DECEDENT NAME: BIESECKER L ALICE I
DA TE OF PAYMENT: 11/15/2001 I
POSTMARK DATE: 00/00/0000 I
COUNTY: CUMBERLAND I
.-
DATE OF DEATH: 08/19/2001 I
I
TOTAL AMOUNT PAID: $5,300.00
REMARKS: DAVID R GALLOWAY ESQUIRE
CHECK# 1014
INITIALS: AC
SEAL RECEIVED BY: MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
~
ACN
ASSESSMENT
AMOUNT
MARTSON DEARDORFF WILLIAMS & OTTO
MQW8iO
ArrORNEYS & COUNSELLORS AT LAw
TELEPHONE (717) 243-3341
FACSIMILE (717) 243-1850
INTERNET www.mdwo.com
WILLIAM F. MARTSON
JOHN B. FOWLER III
EDWARD L. SCHORPP
DANIEL K. DEARDORFF
THOMAS J. WILLIAMS'
Ivo V. Orro III
GEORGE B. FALLER JR.*
CARL C. RISCH
MARK A. DENLINCER
DAVID R. GALLOWAY
*BOARD CERTIFIED CIVIL TRIAL SPECIALIST
TEN EAST HIGH STREET
CARLISLE. PENNSYLVANIA 17013
May 17,2002
Mary C. Lewis
Register of Wills
Cumberland County Courthouse
Carlisle, P A 17013
RE: Estate of L. Alice Biesecker
Estate No. 21-01-00782
Date of Death: August 19, 2001
Dear Mrs. Lewis:
Enclosed with this letter is estate check number 1045 in the amount of$340.83 representing
payment of Pennsylvania Inheritance Tax in the above-referenced estate.
Will you please issue the appropriate receipt and forward it to me at the above address. I
thank you in advance for your prompt attention to this matter.
Very truly yours,
ILLIAMS & OTTO
Enclosure
HAND DELIVERED
cc: Ms. Kay L. Trimmer
F :IFILESIDA T AFILEIEST A TES\ 10468-row.2
I N FOR MAT ION · A D V ICE · A D V 0 CAe y SM
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
NO CD 0011 89
MARTSON DEARDORFF ET AL
TEN EAST HIGH STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---.---- fold ---------- --------
101 I $340.83
ESTATE INFORMATION: SSN: 179-20-6693 I
FILE NUMBER: 2101-0782 I
DECEDENT NAME: BIESECKER L ALICE I
DATE OF PAYMENT: 05/17/2002 I
POSTMARK DATE: 00/00/0000 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 08/19/2001 I
I
TOTAL AMOUNT PAID: $340.83
REMARKS: KA Y L TRIMMER
C/O MARTSON ET AL
CHECK# 1045
INITIALS: DO
SEAL RECEIVED BY: MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
,
REV .1500 EX + (6.(10)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
/7- c2. - 1
FILE NUMBER
21
01
00782
NUMBER
.__~______.~GOUNTY CODE~EAR___
..---.---~________SOCIAL SECURITY NUMBER--
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DECEDENT'S NAME (lAST--;FiRST. AND MIDDLE INITIAL) .
Biesecker, L. Alice
:~~~~;;~~:YEAR)~ I ~A~~~~~I~;H2(~M-DD-Y~R) -
I (IF APPliCABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INiT~----~--~~
la-1~ OriginalReturn ~------i::JT Supplemental Return
179-20-6693
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
. SOCIAL SECURITY NUMBER.
o it<eiilamaerRellirn\C!ale ~oTdeathpr;or to 12'13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 4. Limited Estate
DlI 6. Decedent Died Testate (Attach copy
ofWiU)
o 9. Litigation Proceeds Received
o 48- Future Interest Compromise (date of death
after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach
copy of Trust)
o 10. Spousal Poverty Credit (date of dealh between
12-31.91 and 1.1-95
o 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
.....
(1)%
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(.)0..
AME COMPL
. David R Galloway, Esq.
~IRM-NAME (Ifap~'-Hcable) .-..----------..-~-----I
i Martson Deardorff Williams & Otto : 10 East High Street
lfELEPHONENUMBER~~----~-------_d_- Carlisle, PA 17013
717 /243-3341
" .".
~
--_.::.===--=~..~-~~-~-'---~---~_.-------=--==------------~-
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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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 (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
'''-0FFICI!\L USE ONLY
(1 )
(2)
(3)
(4)
125,000.00:"
~..~-~-
1,393.56
None
None
(5) 45,609.94
(6) None
----J
(7) None
(8)
172,003.50
(9) 31,349.27
.----.....-----
(10) 7,173.47
(11 )
38,522.74
(12)
133,480.76
2,000.00
131,480.76
(13)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
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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
x .00 (15)
~-----'--._-
131,450.76 x .045 (16)
----.--.,- --~.----
x .12 (17)
30.00 x .15 (18)
-- -----_._._._-----~-_.~
(19)
5,915.28
4.50
5,919.78
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
1804 South Market Street
CITY
Carlisle
pTATE PA
ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
5,919.78
5,300.00
278.95
Total Credits (A + 8 + C)
(2)
5,578.95
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 340.83
(5A)
(58) 340.83
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;............................................................................. 0 ~
b. retain the right to designate who shall use the property transferred or its income;................................ 0 ~
c. retain a reversionary interest; or............................................................................................................ 0 ~
d. receive the promise for life of either payments, benefits or care?.......................................................... 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................................................ 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?...... 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.............................................................................................................. 0 ~
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 perjury. I declare that I have examined this return, including accompanying scheduies and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
F PERSON-RESPONSIBLEFOR-FILlNG-RETURN - --- ADDRESS----
E~R'~ESS RI~g~:,of:a[~019___~
DATE
5-/0 -t:J~
---- . --- ---- - -DATE
ADDRESS
10 East High Street
Carlisle, PA 17013
fore January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
(i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (i1)]. 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 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. 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.
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
,L-___ ,_" __'
---I FILE tiUMBER---
,I 2~_?2.- 007~~__
ESTATE OF .
Biesecker, L Allce
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the
price at which property would be exchanged between a willing buyer and a willing sellerL neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property whicti is jointly-owned witn right of survivorship must I)e disclosed on
schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
125,000.00
Residence situated at 1804 SOlidi MarkeTStret{ Upper AUenTownshlp,' deSignated ascumEei-Tand
County parcel No. 42-28-2419-060 and conveyed by Deed dated January 3, 1991 and recorded in
Cumberland County, Pennsylvania, Deed Book "X," Volume 34, Page 983. Value is actual sale price.
TOTAL (Also enter on Line 1, Recapitulation)
125,000.00
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Biesecker, L. Alice
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21 - 01 - 00782
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER i DESCRIPTION
I
1 . 49Shares,Prudelltial Common Stock, Account No. 5190493
UNIT VALUE
28.44
----,.._---~.__.__._._-_.._-
TOTAL (Also enter on line 2, Recapitulation)
VALUE AT DATE
OF DEATH
1,393.56
1,393.56
~." SCHEDULE E
~ CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA I' PERSONAL PROPERTY
INHERITANCE TAX RETURN
RE~EN~DECE~NT_~ ~__L_____ ____ u__
-- ,---------._------- ----'-.----.,--.-.-...---.. --
ESTATE OF
Biesecker, L. Alice
I FILE NUMBER
21 - 01 - 00782
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
MiffonBarlkCID #4704016.298% dueT2/27/2001
VALUE AT DATE
OF DEATH
19,000.00
2
Accrued Interest
75.55
3
Mellon Bank CID #904368 5.44% due 9/7/2001
7,000.00
4
Accrued Interest
12.55
5
Mellon Bank C/D #1185912 3.44% due 3/18/2002
5,180.98
6
Accrued Interest
0.49
7
Mellon Bank C/D #575939 6.298% due 11/28/2001
6,000.00
8
Accrued Interest
22.82
9
368.04
Mellon Bank, checking account 142-152-0477
Property Tax Rebate
532.47
10
11
1996 Mercury Sable
3,425.00
12
Household Fumiture/Furnishings
1,965.00
13
Diamond Wedding Band, per appraisal
300.00
14
Diamond Earring, per appraisal
25.00
15
Opal Ring, per appraisal
30.00
16
Silver and Pearl Bracelets, per appraisal
20.00
17
Gold Band Ring, per appraisal
25.00
18
Mink Stole, per appraisal
100.00
19
Family Bible
0.25
20
Bicentenial Silver Pennant
10.00
Total of Continuation Schedule(s)
1,506.79
45,609.94
TOTAL (Also enter on Line 5, Recapitulation)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
---- ~-'.._--_._' -_..._----------,---- ---
---_._._-_.__._-~_._._---------~-----_._-_..._--- -----_.---,--------
I FILE NUMBER
_L_2~-Ol-~0~2_ _
ESTATE OF
Biesecker, L. Alice
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
Diamon.d StUcl Earrings, per appraisal~
VALUE AT DATE
OF DEATH
100.00
ITEM
NUMBER
22
DESCRIPTION
23
Blue Cross/Blue Shield Refund of Premium
158.45
24
Nationwide Insurance, Refund of Automobile Premium
33.00
25
Travelers Insurance, Refund of Homeowner's Premium
284.00
26
Clothes on Consignment
49.40
27
Valley Rural Electric Cooperative, Inc. - Refund ofInvestment
145.58
28
! Pro-ration of real estate taxes
736.36
_L__ _____.. .._
Page 2 of Schedule E
.
SCHEDULEH
FUNERAL EXPENSES &
ADMNISTRA11VE COSTS
_"L_"___""_"___"_"__"____
~__.__l___
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-- ---- ------._---- -_.._--~-_.- ------ -_._----~_._-_.._--_.._------_.._----._--
ESTATE OF. .
Biesecker, L. Alice
FILE NUMBER
21 - 01 - 00782
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Malpezzi Funeral Home, Mechanicsburg, P A
2 Church, Minister, & Food
,
3 " Flowers
4 Condori Memorials - Headstone Inscription
5 Flight for Son to attend funeral
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Martson Deardorff William & Otto (estimated)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
4.
City
Relationship of Claimant to Decedent
Probate Fees Issue of Letters Testamentary
6 Short Certificates
State
Zip
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Removal and Disposal of Misc. Trash
Appraisal Fees for Estate Jewelry
McNeal's Auctioneering - Appraisal of estate
2
3
Total of Continuation Schedule(s)
31,349.27
TOTAL (Also enter on line 9, Recapitulation)
8,624.00
277.17
254.93
125.00
1,063.50
8,630.14
264.00
18.00
225.00
35.00
50.00
11,782.53
ESTATE OF
.
ScheckJIe H
COMMONWEALTH OF PENNSYLVANIA Funeral Expenses &
INHERITANCE TAX RETURN AchW1istraIive Costs continued
RESIDENT DE~EDEN~m m__.~ __m_~ ___m_m_______m______ _I____m_____
_'_ __..____ __..._~.,~______.".___.. _n_'.'_._ __________..__~_____.___
I FILE NUMBER
21 - 01 - 00782
Biesecker, L. Alice
4
Moving Expenses
5
6
7
8
9
10
11
12
13
14
15
PP&L
Cleaning Service
AT&T Telephone
Verizon Telephone
Cumberland Law Journal, Advertising Letters Testamentary
The Sentinel, Advertising Letters Testamentary
eR.E. Appraisal Service, appraisal for real estate
Jones Accounting Services - 2001 Personal Income Tax Preparation
Commissions paid for sale of Prudential Stock
Deductions on sale of house (see Settlement Statement attached)
Reserved for additional probate fees, filing fees and misc. expenses
__ L__
____~~____~______L_______
Page 2 of Schedule H
228.77
322.49
100.00
34.15
62.36
75.00
93.83
275.00
68.00
58.99
9,963.94
500.00
*'
I
I
L~__~ __
--_.~,~._----_._~ ------- --"'-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
I FILE NUMBER
21 - 01 - 00782
ESTATE OF
Biesecker, L. Alice
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
Mel10n rEllk Loan-=- Account Number 414-40 17467-
2
Real Estate Taxes for real estate located at 1804 South Market Street, Mechanicsburg, Pennsylvania, due
7/1/01
3 Personal Taxes, 2001
4 Bank of America Visa
5 Waste Management
6 PP&L
7 Medicare
8 Patriot News
9 Verizon - Telephone
10 A T&T Wireless
11 Mellon Platinum Master Card
12 Erhlich Green Team
13 Sewer Bill - 3rd Quarter
14 AT&T
15 Gene Eberly - Lawn Mowing for 2001
7,173.47
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
4,458.20
1,535.85
9.80
15.50
22.32
110.71
12.72
18.35
65.21
35.89
204.84
72.08
100.00
12.00
500.00
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R~ID~NT D~CEDENT_ ___~___
----
----------- -- --- --
I FilE NUMBER
1_ ~u 21 - 01 - 00782
RELATIONSHIP TO
DECEDENT
Do Not LlstIr!t$~) _
AMOUNT OR SHARE
OF ESTATE
ESTATE OF
Biesecker, L. Alice
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Kay L. Trimmer
33 Audubon Park
Dillsburg, PA 17109
Daughter
11/3 Estate Residue and
!Property in Kind
2 'I Ann M. Kline
1117 Ballantrae Drive
E1kton, MD 21921
Daughter
1/3 Estate Residue and
IProperty in Kind
3 David R. Biesecker
P.O. Box 27
Elliston, MT 59728
Son
I
'1/3 Estate Residue and
iProperty in Kind
4 Mark C. Trimmer
33 Audubon Park
. Dillsburg, PA 17019
i Grandson
1$1000 and property in
Ikind
See Continuation Schedule(s) attached
Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover sheet
n.1 NON-TAXABLE DISTRIBUTIONS:
IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Shepardstown United Methodist Church
2,000.00
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEh
2,000.00
*'
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Biesecker, L. Alice
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
5 1. Kurtis Kline
117 Ballantrae Drive
Eldton, MD 21921
6 David R. Galloway
154 W. High Street
Carlisle, P A 17013
7 Kristin A. Giakas
8 Vivian Court
Newark, DE 19702
8 Alec M. Giakas
8 Vivian Court
Newark, DE 19702
9 I Kyra E. Giakas
: 8 Vivian Court
Newark, DE 19702
10 Kristina A. Giakas
8 Vivian Court
Newark, DE 19702
11 i Kelly L. Johnson
43175 Center Street
South Riding, VA 20152
12 Gabrielle K. Johnson
43175 Center Street
i South Riding, VA 20152
13 N. Grant Johnson
43175 Center Street
South Riding, VA 20152
14 Amy K. Shumaker
17 Homewood Street
Dillsburg, P A 17019
15 Cole A. Shumaker
16
117 Homewood Street
. Dillsburg, P A 17019
Graham R. Shumaker
17 Homewood Street
Dillsburg, P A 17019
.. FILE NUMBER
I 21-01-00782
RELATIONSHIP TO \
DECEDENT I AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Grandson
Grandson
i
I
! Granddaughter
Great Grandson
Great Granddaughter
Great Granddaughter
Granddaughter
Great Granddaughter
Great Grandson
Granddaughter
Great Grandson
Great Grandson
I
J_
1$1000 and property in
kind
$1000 and property in
ikind
1$1000 and property in
Ikind
500.00
500.00
500.00
'.$1000 and property in
,kind
I
I
500.00
500.00
1$1000 and property in
kind
500.00
500.00
Page 2 of Schedule J
*'
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER---
I 21 - 01 - 00782
-- I - RELATIONSHIP TO AMOUNT OR SHARE
DECEDENT
--t-~o HotList Trustee<!L OF EST ATE
i Neighbor 1$30.00 (Opal Ring)
I I
ESTATE OF
Biesecker, L. Alice
NUMBER I
NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
17 I Julie Eisenhower
11806 South Market Street
Mechanicsburg, PA 17055
_I
Page 3 of Schedule J
A. Settlement Statement
u.s. Department of Housing
FINAL
B. Tvpe of Loan and Urban Development OMB No. 2502-0265
l. DFHA 2. oFmHA 3. oConv. Unins. I 6. File Number I 7. loan Number I 8. Mortgage Insurance Case Number
~. OVA 5. oConv. Ins. TI2001-296RCS
C. Note. I nls orm IS UmtSneCllO give you a s a emen 0 a,ctua sememen cos s moun s pal~ to anCl oy II Ie sa.l\Iaman agen are snown
Items marked "(p_oe.)" were paid oulsldethe closing; they are shown here for mformat,lOn purposes and are not included In the lotals
WA~N!NG: II is a cnme to knowingly ,!,ake false statements to the Unrted States on thIs or any other similar form. Penalties upon
conviction can Include a fine and Imprisonment For details see: Title 18 U. S. Code Section 1001 and Section 1010
D. :-.lAME OF BORROWER: Joshua A. Parrish and Amanda L. Parrish
ADDRESS:
E. NAME OF SELLER: Estate of Alice Biesecker
ADDRESS:
F. NAME Of LENDER: ABN AMRO Mortgage Group, Inc.
ADDRESS: P.O. Box 57068, Irvine, CA 92619-7068
G. PROPERTY ADDRESS: 1804 South Market Street, Mechanicsburg, PA 17055
Upper Allen Township
H. SETTLEMENT AGENT: Saidis, Shuff, Flower & Lindsay, Telephone: 717-243-6222 Fax: 717-243-6486
PLACE OF SETTLEMENT: 2109 Market Street, Camp Hill, PA 170] I
I. SETTLEMENT DATE: 01/07/2002
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER:
101 Contract sales orice 125 000.00 401. Contract sales Dnce 125 000.00
102. Personal Pro~rtv 402. Personal Property
103. Settlement charaes to borrower (hne 1400} 4 482.75 403.
104. 404.
105 405
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. Cilv/town taxes 406 City/town taxes
107 Countv taxes 407. County taxes
108 School Taxes 01/07/02 to 06/30 /02 736.36 408. School Taxes oi/07 /02 to 06/30/02 736.36
109 409.
110. 410
111. 411 I
112. 412
120. GROSS AMOUNT DUE FROM BORROWER 130 219.11 420. GROSS AMOUNT DUE TO SELLER: 125 736.36
200 AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deeosit or earnest monev 3 000.00 501. Excess Decosit (see Instructions)
202 Princioal amount of new loan(5) 100 000.00 502. Settlement charaes to seller (line 1400) 9 963.94
203 Existina loan(s) taken sUb.ect to 503. Existino loan(s) taken subject to
204 504. Payoff of First Mortaaae Loan
205 505. Payoff of Second Mortgaae Loan
208 I 506.
207 507
208 508
209 509
Adiustments for items unpaid by seller Adjustments for items unpaid by seiler
210. Citv/town taxes 510 Crtvltown taxes
211. Coun\'V taxes 01/01/02 toOl/07 /02 5.17 511. County taxes 01/01/02 to 01/07 /02 5.17
212. School Taxes 512 School Taxes
213 Sewer 01/01/02 to 01/07/02 6.57 513 Sewer 01/01/02 to 01/07/02 6.57
214. 514
21S. 515
216 516.
217. 517.
218. 518.
219. 519
220. TOTAL PAID BY/FOR BORROWER 103 011.74 520. TOTAL REDUCTION AMOUNT DUE SElLER 9 975.68
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower (line 120) 130 219.11 601 Gross amount due to seller (line 420) 125 736.36
302. Less amounts oaid bvJfor borrower (line 220) 103 011.74 602 Less reduction amount due seiter (line 520) 9 975.68
303 CASH FROM BORROWER 27 207.37 603. CASH TO SELLER 115 760 . 68
SUBSTITUTE fORM 1099 SELLER STATEMENT The info(mati~ln cont~ined herein is important tax information and is being furnished 10 the Internal Revenue Service If you are required to file
a return
a negligence penalty or other sanction will be imposed on YOLllf thiS item IS reqUired to be reported and the I~S determines that it has not been reported, The Contract Sales Price descnbed
on
line 401 above conslitutes Ihe Gross Proceeds ot this transacllon
SELLER INSTRUCTIONS' tf this real estate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, With your Income tax return; for other transactions
complete the applicable parts of Form 4797, Form 6252 and/or Sclledule 0 (Form 1040)
You are required by law to provide Ihe s':!tUement agenl (Fed. Tax ID No , )with yourcorrect taxpayer identification n~mber, If you do nol prOVide your correct taxpayer identification
number, you may be subJecllo CIVil or Criminal penalties Imposed by law Under,penallles of pequry, I certify that tl'\e number shQ'J\ln on \hlS sta\ement IS my correcltaxpayer Identification
number
TIN
SElLER(S) SIGNATURE(S)
SElLER(S) NEW MAILING ADDRESS
TitleExpress Settlement System Printed 01/0712002 at 1136
REV. HUD-l (3/86)
- SCH. A
:set-I. H > :C~ J4
(,!z)
L .S. DEPARlMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number: TI2001-296
PAGE 2
FINAL
L SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $125 000.00 @ 6.000 = 7 500.00 BORROWER'S SELLER'S
Division of commission (line 700\ as foIIO'NS: FUNDS AT FUNDS AT
701 $ 3.725.00 to Homestead Groun SETTLEMENT SETTLEMENT
702. $ 3 775.00 to C-21 Wa1ak
703 Commission oaid at Settlement 7 500.00
704. Transaction Fee to Homestead/Walak/Waltz 100.00 125.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori lnation Fee %
802. Loan Discount %
803 ADoraisal Fee to Moraaaes Unlimi ted 250.00
804 Credrt Report to Mort...anes Unlimi ted 18.00
805 Processina Fee to Mortnanes Unlimited 100.00
806 Lender Admin Fee to ABN AMRO Mortaa...e Groun Inc. LR 375.00
807 Escrow Waiver Fee to ABN AMRO Mortaaae GrouD Inc. LR 250.00
808. Flood Cert to Mortaaaes Unlimited 10.00
609
810.
811. Deferred Prem $1,500.00 by to AMRO to Mtn Unlimited POC
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 01/07/2002 to 02/01/2002 @$ 19.4400 Idav 25 Davs LR 486.00
902. Mortoaoe Insurance Premium for to
903 Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
i 1001 Hazard Insurance mo t!lI $ Imo
1002. Mortaaae Insurance mo@$ Imo
1003 City Prooerty Taxes mO.11l> $ Imo
1004. County Pronertv Taxes mo.l1l>$ 26.23 Imo
1005 School Taxes mo@$ 127.99 Imo
1009 Aoareoate Analysis Adiustment
1100. TITLE CHARGES
1101 Settlement or closina fee
1102 Abstract or title search
1103. Title examina1ion
1104 Title insurance binder
1105. Document PreDaration
1106 Notary Fees to Saidis Shuff Flower , Lindsav 14.00 4.00
1107 Attorney's fees to David Gallowav Esa. POC SELLER
(includes above items No; \
1108. Title Insurance 10 Robert C. Saidis Anent 983.75
(inCludes above items No )
1109 Lender's Coverane $ 100 000.00 -
1110 Owner's Coveraae $ 125 000.00 - 983.75
1111. 300.8.1 10 Robert C. Saidis Aaent 100.00
1112. Insured ClosinQ Ltr (2) to Robert C. Saidis Acrent 70.00
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees Deed $ 25.50 , Mortoaoe $ 51.50 , Release $ 77.00
1202 City/Countv tax/stamps Deed $1 250.00 ,Mortgage $ ~ 250.00
1203 State Tax/stamps Deed $ 1 250.00 ,Mortoage $ 1 250.00
1204
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Overnicht Ldr Pko to Saidis Shuff Flower , Lindsav 20.00
1302 UV Licht \0 Eichelberners 634.94
1303. Water Test to Eichelberaers 89.00
1304 Termite/Home Insoection to Biechler , Tillerv POC
1305 Radon Mitioation to Biechler , Til~erv 290.00 350.00
1306. 4th Qtr Sewer to Unner Allen Townshin 100.00
1307
1308
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K) 4 482.75 9 963.94
HUO CERTIFICATION OF BUYER AND SELLER
I have carefully reViewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts a.nd di$bursements made on my
account or by me
in this ~~ctlon I funner y \ \ ha'le r 'JeO a copy of the HUD-1 Settlement Statement
O~_"v.<' /~/l/l6i
Amanda L I-'arrlsn
-4~;::~J
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITEO STATES ON TI1\S OR ANY SIMILAR FORM PENAL TIES UPON CONVJCTION
CAN INCLUDE A FINE AND JMPRISONMENT FOR DETAIlS SEE TITLE 18
US CODE Se:CTION 1001 AND SECTION 1010
rilleExpress Settlement System Printed Oll0712002 at 11:37
By
REV. HUD-l (3/86)
(Z/2- )
Promissory Note
@ Mellon
11111111111111111111111111111111111
(Secured)
Creditor MELLON BANK, N. A.
10 SOUTH HARKET SQUARE
HARR I SBURG. PENNSYl VAN I A 17101
Account Number 414-4017467
Federal Truth in Lending Disclosures
Date 01/31/00
ANNUAL FINANCE CHARGE Amount Financed Total of Payments
PERCENTAGE The dollar amount the The amount of credit The amount I will have
RATE credit will cost me. provided to me or on paid after I have made
The cost of my credit as my behalf. all payments as scheduled.
a yearly rate.
7.74 % $ 1276.61 (eJ $ 6000.00 $ 7276.61
My payment schedule will be: Number of Payments Amount of Payments When Payments Are Due
59 121.30 Monthly, beginning on 03/16/00 e
1 119.91 02/16/05 e
Variable Rate (Applicable if checked): [!I My loan contains a variable rate feature.
Disclosures about [he variable rate feature have been provided to me earlier.
Se<urity: You will have a security interest in:
o motor vehicle o life insurance policy U.e.e. filing fees $ .00
o mobile home I!I dep05it account Fees for encumbering certificate of title $ .00
o securities o real property Fee for recording mortgage or deed of trust $ .00
o Beneficial interest in land trust Recordation tax $ .00
0 Fee for satisfying mortgage or deed of trust $ .00 (e)
0
(K] deposits which I have with you
Collateral securing other loans with you may also secure this loan. If this loan is secured by a deposit account, the annual percentage rale
does nol take imo account your required deposit.
l...ate Charge: If a payment is more than 15 days late, I will be charged $20.00 or 10% of the payment, whichever is greater.
Prepayment: If I payoff early, I will not have to pay a penalty.
Assumption: Someone buying the property securing this loan cannot assume the remainder of the loan on the original terms. See the contract
documents for any additional information about nonpayment, default, and any required repayment in full before the scheduled date.
(e) means an estimate
Itemization or the Amount Financed or $ 6000.00
$ .00 Amount paid on my account (refinancmg of previous loans):
Date Loan Number
([I Amount given to me directly $ 6000.00
o See separate Authorization to Disburse Prc>ceeds $
Amount Refinanced
/
/ / I
Amount paid to others on my behalf: $
$ to credit bureau $,
$ 10
S to
$ \0
$
$
(0 public officials/government agencies $ to insurance company
to appraiser $ to notary
$ to
$ to
$ .00 prepaid finance cbarge
Terms of Note
In this note, the words I, me and my refer to anyone signing this note as a Borrower. Each Borrower is responsible for the repayment of all
amounts owed under this note, and agrees to all of the terms of this note. The words you and your refer to the creditor named above.
The word CoIlateral means any personal property in which I am giving you a security interest in this note, or which is covered by any separate
security agreement securing this note.
I promise to pay you $ 6000.00 . This amount is called the "Principal Amount". I also promise to pay you interest on the
unpaid balance of the Principal Amount at a simple interest rate of .021205480 % per day. Interest will be charged on the unpaid
balance of tbe Principal Amount for each day (including February 29). I will pay tbe Principal Amount and tbe interest at any place
designated by you, according to the payment schedule shown above. On the last payment date I will pay any part of the Principal Amount
and any interest which remains unpaid. I will continue to pay interest at the rate shown above on any part of tbe Principal Amount as long as
it remains unpaid. I agree that any judgment for any part of the Principal Amount will bear interest at tbe same rate until it is paid.
(Applicable if checked): IKI If I change, or you require me to change, to Payment Method #2, the simple interest rate on this note will change
to .023260274 % per day.
(Applicable if cbecked): ([I The simple interest rate is a discounted rate based on a separate agreement which I have entered into with you.
H I discontinue that separate agreement or you discontinue it because I no longer meet the requirements of that agreement in effect as of
the date of this note, but I continue to make payments under Payment Method #1, the simple interest rate on this note will change to
.021890411 % per day.
Effective witb tbe first payment that is due at least 30 days after any change in the simple interest rate, my regular monthly payment will
change to the amount necessary to repay by the original due dale of the final payment that part of the Principal Amount which remains
unpaid on tbe date of the rate change, with interest at the new rate, in equal payments_ If I select credit disability IDsurance on this loan, the
monthly disability benefit will be limited to the amount of the original benefit as disclosed on the certificate of insurance.
~ t-I . .:L
CUSTOMER COpy
;I~I (I//P)
Page 1 of 4
IL-2180 Rev_(9m) Le. 8f')9 LD 8m
J understand that making payments on time is essential to avoid default on this note. In addition, if any payment is not made in full within 15
days after it is due, I will pay a late charge of $20,00 or 10% of the payment, whichever IS greater.
I have paid or will pay the following fees and charges:
U,e.e. Filing Fees
Fees for encumbering certificate of title
Fees for recording mortgage or deed of trust
Recordation tax
Fee for satisfying mortgage or deed of trust (estimated based on current rates)
Appraisal fee
Title examination fee
Title insurance premium
Notal)' fee
Fee for determining flood hazard status of property
Settlement or closing fee
Loan origination fee
Continuing verification of flood status fee
Broker fee
Document preparation fee
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
I am giving you a security interest in the property described below, including all attachments and parts which are installed in or attached to
the property, or which may be installed or attached in the future, and all proceeds of the property and attachments and parts,
Year
o New 0 Used
Make
Model
Serial Number
Model Number
Payments Methods:
I choose to make payments by the method checked below:
~ Payment Method #1: I authorize you to take payments out of CHECKING ACCOUNT 142-152-0477 on or afte
the dates they are due, I will keep a large enough balance in this account to cover the full amounts of the requirec
payments.
o Payment Method #2: I will mail or deliver each payment to you so that you will receive it no later than the date it IS due,
If I have chosen Payment Method #1, you may require me to change to Payment Method #2 if 1 fail at any time to have a large enoug
balance in the deposit account shown above to cover the full amount of a payment required under this note, or if the deposit account i
closed.
o is
Property Insurance: Insurance against loss of or damage to the Collateral 00 is not
required.
Insurer:
Agent (if known):
o is
Flood insurance 00 is not
required in connection with this loan.
If flood insurance or other insurance on real or personal property is required in connection with this loan, I may obtain such insurance frorr
anyone I want that is acceptable to you,
THE ADDITIONAL TERMS ON PAGES 3 AND 4 OF THIS NOTE ARE A PART OF THIS NOTE.
Notice to Cosigner
You are being asked to guarantee this debt. Think carefully before you do. If the borrower doesn't pay the debt, you will have to, Be sure
you can afford to pay if you have to, and that you want to accept this responsibility,
You may have to pay up to the full amount of the debt if the borrower does not pay, You may also have to pay late fees or collection costs,
which increase this amount.
The Creditor can collect this debt from you without first trying to collect from the borrower. The Creditor can use the same collection
methods against you that can be used against the borrower, such as suing you, garnishing your wages, etc. 1f this debt is ever in default, that
fact may become a part of your credit record.
This notice is not the contract that makes you liable for the debt.
Slgnature(s)
BY SIGNING THIS NOTE, I ACKNOWLEDGE THAT I HAVE RECEIVED AN EXACT COPY OF PAGES 1 THROUGH 4 OF THIS
NOTE AND THE DISCLOSURES ON PAGE 1 WITH ALL APPLICABLE BLANKS APPROPRIATELY FILLED IN, PRIOR TO THE
CONSUMMATION OF mE TRANSACTION. mE ADDITIONAL TERMS ON PAGES 3 AND 4 ARE PART OF mls NOTE.
Borrower ALICE B BIESECKER
Borrower
x
Borrower
(Seal)
x
Borrow~r
(Seal)
(Seat)
x
(Seal)
If applicable, this installment loan corresponds to relationship demand deposit account 142-152-0477
NOTICE: If I have a dispute with you regarding my loan, I understand that any check or other instrument I submit to you
as payment in full of my loan must be sent or delivered to Mellon Bank, N .A., P.O. Box 535001, Pittsburgh, PA 15253-5001
or any other address for such payments you advise me of in the future.
IL-2180 Rev.(9199) LC. 8199 LD 8199
013100 14:00
Page 2 of 4
H ) I
(2-}{P)
Additional Terms
Events of Default:
It is a default under this note if: (1) any payment is not made when it is due; (2) I break any promise in this note; (3) you
discover any false or misleading statement in this note or in any other information I have given you; (4) anyone attempts to
seize, attach, or create a lien on the Collateral under any legal process; (5) the Collateral is lost, destroyed, stolen, or
abandoned; (6) I die; (7) I make any assignment for the benefit of creditors; (8) I become insolvent; (9) any petition relating
to my debts is filed under any federal or state bankruptcy law; (10) I default under the terms of any lease, mortgage, or deed
of trust on the property where the Collateral is kept; (11) anyone attempts to garnish or attach any deposit or other property
belonging to me which is in your possession; (12) any insurance policy securing this note matures for any reason; (13) any
event occurs which, under the terms of any mortgage or deed of trust securing this note, gives you the right to foreclose on
the property securing this note; any person who signs a separate security agreement to secure this note breaks any promise
in the security agreement; any person who signs a mortgage, deed of trust, or separate security agreement to secure this
note dies, becomes insolvent, or makes any assignment for the benefit of creditors; any petition relating to such a person's
debts is filed under any federal or state bankruptcy law; or you discover any false or misleading statement in such a
mortgage, deed of trust, or security agreement.
Your Rights in the Event of Default:
If any of these events of default occurs, or if I voluntarily give you possession of the Collateral, you have the right, if you
choose to do so, to declare all amounts which I owe under this note immediately due, subject to any requirements for notice
and a right to cure the default imposed by law. You may, without judicial process, take possession of the Collateral and
anything contained in it or allached to it. You can enter any private property in order to do this, so long as you do not
commit a breach of the peace. If you tell me to do so, I will deliver the Collateral to any place you choose which is
reasonably convenient 10 both of us.
I must send you a notice by certified mail within 48 hours after you take the Collateral in order to get back any property
contained in the Collateral or attached to it which I do not believe is covered by your security interest. If I do not do this, I
will lose the right to claim such propertY.
You can also sue me in court to get the Collateral if you choose to do so. If you employ an attorney who is not your salaried
employee to collect any amount which I owe under this note or to protect your rights under this note in any way, I will pay
reasonable allorney's fees permilled by law, and costs of any legal proceedings. I hereby waive the benefit of all Indiana
valuation and appraisement laws.
My Duties Regarding the Collateral:
If I am obtaining this loan in order to purchase any of the Collateral, I will purchase it promptly after receiving the loan
proceeds from you. Anyone who has or will have an ownership interest in the Collateral is signing either this note or a
separate security agreement. No one else except you has or will have a security interest in the Collateral or any legal rights
in it.
I will tell you promptly in writing if I change my address. Unless you keep the Collateral, I will keep it at the address in my
loan application or I will tell you in writing where I am keeping it. I will not permanently remove the Collateral from that
location unless you give me written permission to do so.
I will not allow the Collateral to be attached to real property or to any other goods without your written permission. I will
not allow the Collateral to lose its identity or to be used for any illegal purpose.
If the law of any state requires or permits a certificate of title to be issued covering any of the Collateral, I will make certain
that your security interest is noted on the certificate of title. I will see that the certificate of title is delivered to you within 10
days of the date of this note.
I will keep the Collateral in good condition and repair, except for reasonable wear and tear, and will pay all taxes and other
charges which may be assessed on it. If I fail to do so, you may, if you choose, take reasonable steps to protect the Collateral
and pay such taxes, other charges, or costs of repair and maintenance for me. If you do this, you may require me to
reimburse you, immediately or at any later time, for any such taxes, charges, or costs which you have paid. At the time you
pay such amounts or at any later time, you may add the unpaid balance of such amounts to the unpaid balance of the
Principal Amount of this note. You may require me to pay interest on the unpaid balance of such amounts at the rate
shown on page I of this note or at any lower rate. You may, if you choose, increase the amount of my monthly payment
until I have fully reimbursed you for such amounts.
I will give you written proof of payment of any such taxes or charges and the costs of any repairs, if you request it. You have
the right to inspect the Collateral at any reasonable time. If thc Collateral is lost, damaged, or destroyed, I will still pay
everything I owe under this note.
Insurance:
If you require me to, I will insure the Collateral against loss or damage. If you require me to buy flood insurance, lwill buy
the amount of insurance coverage which you require. Any insurance policy will provide for payment of the insurance
proceeds to you to the extent necessary to pay the amounts which I owe under this note. I will give you any insurance policy
or a certificate to show that I have it. If I do not buy and maintain the required insurance, or if I do not pay the premiums,
you may, if you choose, do these things for me. If you do this and I do not reimburse you for the premiums within a specified
time, you may add the unpaid balance of the premiums to the unpaid balance of the Principal Amount of this note. In this
case, interest will be charged on the unpaid balance of these premiums at the rate shown on page 1 of this note, beginning
on the date you paid the premiums.
I direct all insurance companies providing flood insurance, other insurance on real or personal property, or credit insurance
in connection with this loan to pay you any money owed to me (including any premiums which are returned for any reason).
You may use any such money to pay amount which I owe under this note. I appoint you as my attorney in fact to endorse my
name to any draft or check for such purpose.
IL-2180 Rev.(9/99) LC. 8/99 LD 8/99
CUSTOMER COpy
H ~ I
( 3/ Ie ')
Page 3 0(4
Miscellaneous:
This note is secured as indicated in the Federal Truth in Lending Disclosures on page 1 of this note. All the provisions of
any mortgage, deed of trust, or other separate security agreement which I have signed to secure this note are a part of thiS
note.
I will sign any documents you consider to be necessary, and I will pay all fees and taxes which must be paid to public officials
and WhICh are disclosed in Ihe Federal Truth in Lending Disclosures on page 1 of this note, to perfect any security interest
which I have given you and to record and satisfy any mortgage which I have given you. I appoint you as my attorney in fact
to do whaIever you consider to be necessary to acquire and maintain the lien of the mortgage and to perfect and mamtain
perfection of these security interests.
If at any time you agree to extend the dates on which payments are due under this note, you may charge me a fee .for such
extension not exceeding $50.00 for each month or partIal month of the extension period (subject to any limitations Impo.sed
by law). You may also require me to pay interest for the extension period at the beginning of the extension peflod, subject
to any limitations imposed by law. You have no obligation to agree 10 any extension; and, subject to any limitatIOns
imposed by law, the terms of this paragraph can be changed if you and I later agree to different terms.
If at any time you reasonably believe that the value of the Collateral has become insufficient to secure the amounts which 1
owe and any amounts which I may owe in the future under this note, [will give you additional collateral.
If any money which [ owe under this note is not paid when il is due, you have the right to take that amount from any deposit
which I have with you, now or in the future, ofher than deposits in Individual Retirement Accounts or Keogh (H.R. 10)
Plans, or deposits in which the law prohibits you from having a security interest.
You will continue to have any security interests which you have taken in connection with any previous note which is being
refinanced by this note. If you have any liens on my property as a result of entering judgment under the terms of any
previous note which is being refinanced by this note, you may retain those liens to secure the amounts refinanced. I do not
have any defense to the enforcement of any such judgment.
Regardless of the terms of any other document, this note will not be secured by any deposit other than Ihose which I have
with you individually or jointly, nor by any other property, unless a security interest in such deposit or other property has
been given to you in this note or in a document referring specificalIy to thiS note or another extension of credit. Further,
this note will not be secured by any real property unless a security interest in such realJroperty has been given to you in a
document referring specifically to this note or a previous note which is being refinance by this note, or you have a lien on
such real property as a result of entering judgment under the terms of a previous note which is being refinanced by this note.
I authorize you to pay that part of the Principal Amount shown in the Itemization of the Amount Financed on page 1 of this
note as "Amount gIVen to me directly," and any money which you may owe me for any reason in connection witfi this loan, to
any or to all of the persons signing this note as "Borrower." My endorsement of a check for any part of this amount will
eVldence my consent to payment of that part of the Principal Amount to any other payee named on tlte check.
If, on any particular occasion or for a period of time, you do not charge me a rate or amount which I am obligated to pay
under thIS note, or charge me a lesser rate or amount, or do not enforce a right or remedy which you have under this note,
or enforce a right or remedy to a lesser extent than permitted by this note, you will still have the right to charge the full rate
or amount or enforce that right or remedy to its funest extent at any subsequent time. If I make a partial payment and you
accept it, even though it is designated as full payment, I will still owe the rest of the money I shoulcfhave paid; however, see
the nouce ~n page. 2 regarding such payments when I have a dispute with you regarding my loan. In addition to the rights
and remedIes proVIded m this note, you will have all rights and remei!ies provided by law.
1 may pay all or any part of the Principal Amount before it is due, without any penalty.
The unpaid balance of the Principal Amount for any day is determined by taking the beginning balance for that day, adding
any amount which you add to the Principal Amount that day under the terms of this note, and subtracting that portion 01
any payment which is applied that day to the Principal Amount. Payments will be applied first to interest and any other
charges due, then to the Principal Amount. Payments received on Saturdays, Sundays, or holidays will be credited as if
made on the following business day.
If I have signe<! a request for credit insurance, the provisions of that form and the Group Credit Life Insurance Certificate
are a part of thIS note.
If it is determined for any reason that a part of this note is invalid or unenforceable, this will not affect any other part of this
note. This note will then be read as if the invalid or unenforceable part were not there.
You can transfer y~lUr rights and privileges under this note to anyone you choose. My duties under this note will be
performed by my hem and personaf representatives. I will not transfer any rights which I have under this note to anyone. I
unde~tand t~at my obligauo~ to you under this note will not be affected by any divorce proceeding nor by any order of
court Issued In such a proceedmg.
Federal law applies to certain aspects of this Promissory Note, including but not limited to the finance charge. The laws of
wIll apply to all other aspects of iliis Note.
Mellon is committed to furnishing complete and accurate information about your relationship with us to consumer
reporting a~encies. If you believe that the information we report about your account is incomplete, inaccurate or outdated,
you may wnte to us at the following address in order to notify us of a problem concerning our reports: Mellon Bank, N.A.,
P.O. Box 149 Pittsbul'2h. PA 15230-0149 ATTN: IL Research.
I/We acknowledge that Ihese are pages 3 and 4 of the Promissory Note (Secured) which I!we have signed on page 2.
ALICE B BIESECKER
(Initials)
(Initials)
(Initials)
(Initials)
IL-2180 Rev.(9/99) LC. 8/99 LD 8199
013100 14:00
Page4014
1-1 ~
(4- liP)
Request for Insurance
@ Mellon
11111111111111111111111111111111111
Agency Number:
E02750000
Borrower # 1
Mellon Account Number
ALlCE B BIESECKER
414-4017467
Borrower #2
The maximum life insurance benefit is limited to $60,000 or less. The maximum disability insurance benefit is limited to the
monthly payment or $800 a month, whichever is less. "See the certificate of insurance for details."
Insurance charge:
Single Life $
Joint Life $
Disability $
Group Credit Single or Joint Life Insurance and Single Disability Insurance are available to you in connection with your
loan, if you are under age 66. Insurance is not required. Insurance is provided by Union Security Life Insurance Company
(Wilmington, Delaware). If you qualify and elect the insurance, you will be charged at the rate(s) shown above. Only one
Borrower may apply for Disability coverage. A certificate describing the insurance in detail will be given to you within 30
days from the date you request it, providing you are eligible.
YOU MUST TRUTHFULLY ANSWER THE FOLLOWING QUESTIONS IF YOU WANT INSURANCE (If you answer
'Yes", you will not be insured)
Within the past two years have you been (a) treated by or consulted
with any doctor for high blood pressure, any heart or circulatory disorder,
cancer, diabetes or lung, kidney or liver disorder, or (b) diagnosed as
having AIDS or AIDS-related Complex (ARC)?
Borrower #1
Borrower #2
DYes 0 No
o Yes 0 No
Please indicate your choice below and sign.
Single Life
Credit Insurance
J oint Life
Credit Insurance
Disability Insurance
o is elected on borrower # [
o is elected
o is elected on borrower # [ 1 ]
00 is not elected or borrower is
not eligible
00 is not elected or borrower(s)
is/are not eligible (If this
insurance is elected, both
must sign below.)
00 is not elected or borrower is
not eligible
I acknowledge that I have read and understood the above disclosures and received a copy of this Request.
Date
Signature of BolTower #1
Birth Date
01/31/00
ALICE B BtESECKER
10/09/26
Date
Signature of Borrower #2
Binh Date
Note: This insurance is for the original term of the loan.
PENNSYLVANIA, NEW JERSEY AND OHIO RESIDENTS: Any person who knowingly and with intent to defraud any
insurance company or other person .fiJes an application for insurance or statement of claim, containing any materially false
information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a
fraudulent insumnce act, which is a crime and subjects such person to criminal and civil penalties.
MXECOOOl
V005
NOTICE OF PROPOSED GROUP CREDIT INSURANCE
This is to advise you that if group credit life insurance coverage andJor group credit life and disability insurance coverage
has been requested above, in connection with the installment loan, it will be provided under a group credit insurance
policy issued to the creditor by UNION SECURITY LIFE INSURANCE COMPANY, Wilmington, Delaware. The amount
of charge is indicated above for each type of credit insurance to be purchased. This insurance, subject to the acceptance
by the insurer covers only the person or persons named above provided that they have signed the request for such
insurance. If insurance coverage is issued, it will become effective either on the date of indebtedness or on the date
finance charges begin to accrue. It will expire on the original maturity date of the indebtedness. If the indebtedness is
prepaid, a refund of unearned premium will be made. If insurance is issued, a certificate which describes the coverage in
detail will be delivered within 30 days.
PANPOOO6
XL.12IS Rev.(SI97) LC 4197 LD Si99
CUSTOMER COpy
013100 14:00
HJ I
(y/&)
,;.
. Mellon
Transaction
Description
Date
Account Number
It. F'MT
27 422600(~)13 08/24/2001 i4~43
CHECK WTH (C) 0008264509
(E) 414-4017467
/ /'
Customer Receipt.
Please be sure to enter this
transa~tion in your records.
Visit our web Bite at www.mellon.com
A1nount
$4;458::20
o;v~
$4,458.20
SEE REVERSE FOR CREDITING OF DEPOSITS AND PAYMENTS
, '
1-1 )
(&/b)
'"
'..,..,.... ~~~~'~~ii!'f~j:'-!i'~,{.~~t;~~~~,,,r~.,,\~".'....;r\'"
LAST WILL AND TESTAHENT
I, L. ALICE BIESECKER, of the Township of Upper Allen, County of
Cumberland and State of Pennsylvania, being of sound mind, memory and
understanding, do make, publish and declare this to be my last Will and
Testament, hereby revoking and making void all former wills, codicils
and other testamentary dispositions by me at any time heretofore made.
1.
I direct my Executor, hereinafter named, to pay as soon as practicable
after my decease all my just debts and the expenses of my last illness
and burial.
2.
I gIve, devise and bequeath all of my estate, whatsoever and wheresoever
situate, unto my husband, Ray A. Biesecker, absolutely.
3.
Should my said husband predecease me, than and in that event, I
gIve, devise and bequeath all of my said estate unto my children, David
R. Biesecker, Kay G. Trimmer and Ann M. Kline, equally, share and share alike.
,,'~d, "':i~"i,'~:'.l""
;~'. L,:_'_~i'~Ji.~ ~t~'i(;"':~1f,i"~1:~~1;';f',,::~,,,' -; . -I' "~i,? 7,,~,,~','::i '::.0ll'lt.;..~~W;~~';! '.'
4.
I nominate, constitute and appoint my husband, Ray A. Biesecker,
executor of this my Last Will and Testament. Should my said husband,
Ray A. Biesecker fail to qualify or cease to act as executor, then and
in his stead, I nominate, constitute and appoint my daughter, Kay L.
Trimmer, executrix of this my will.
I direct that my executor, and his successor, shall not be required
tu give bond for the faithful performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I, L. ALICE BIESECKER, the testatrix, have hereunto
set my hand and seal to this my Last Will and Testament this ~~eLday of
March, 1993.
;;{/ 6-LcC/ ~~,L/tSEAL)
/
Signed, sealed, published and declared by the within named L. Alice
Biesecker, 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 thereto.
~. /~?1 .~ l /
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~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
'1 q~~TY
ACN
DAVID R GALLOWAY
MARTSON ETAL
10 E HIGH ST
CARLISLE
ESQ
'02
JJL -1
PA 17013
Ct I.
06-24-2002
BIESECKER
08-19-2001
21 01-0782
CUMBERLAND
101
Allount Rellitted
'*
REV-15~7 EX AFP IOI-D2I
L
A
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 ~
ifiv=is4j-Ex-AFP-coY:02Y-NoYicE--oF-YtitiEifiTANcE-YAx-APPRAisEiiENT~--Aii-oWANCE-OR------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BIESECKER L A FILE NO. 21 01-0782 ACN 101 DATE 06-24-2002
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. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
( ) CHANGED
125.000.00
1.393.56
.00
.00
45.609.94
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage 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
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
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
TAX CREDITS:
DATE
11-15-2001
05-17-2002
..."'.."'....
NUHBER
CD000533
CD001189
l+J
INTEREST/PEN PAID (-)
278.95
.00
(9)
(10)
31, 349.27
7.173.47
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
172.003.50
38.522 74
133.480.76
2.000.00
131.480.76
14, 15 and/or 1&, 17, 18 and 19 will
returns assessed to date.
.OOX 00 =
131.450.76 X 045 =
.00 X 12 =
30.00 X 15 =
(19)=
AHOUNT PAID
5.300.00
340.83
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
5.915.28
.00
4.50
5.919.78
5.919.78
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT 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.)
F: IFILESIDA T AFILEIEST A TESI 1 04681. If.
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-01-0782
EST ATE OF L. ALICE BIESECKER, Deceased
Late of Upper Allen Township, Cumberland County, Pennsylvania
FIRST AND FINAL ACCOUNT OF KAY L. TRIMMER. EXECUTRIX
Date of Death: August 19,2001
Date Letters Testamentary Issued: August 22,2001
Date of First Complete Advertisement of Grant of Letters: October 19,2001
Account Stated to July 19,2002
SUMMARY
PRINCIPAL:
Receipts
Net Losses on Conversions
$172,022.07
-1.1 18.52
170,903.55
41.954.34
Disbursements
Principal Balance Remaining
128,949.21
INCOME:
Receipts
Disbursements
Income Balance Remaining
173.72
0.00
173.72
PARTIAL DISTRIBUTIONS TO BENEFICIARIES:
-105.535.25
COMBINED BALANCE REMAINING
ASSETS COMPRISING ESTATE:
MARTSON DEARDORFF WILLIAMS & OTTO, escrow account
Less any amounts reserved for future disbursement
TOTAL FOR DISTRIBUTION:
$23,587.68
$32,349.51
-8.761.83
$23,587.68
PRINCIP AL RECEIPTS
Residence at 1804 South Market Street, Mechanicsburg
49 shares, Prudential stock
Assets listed on Schedule E, Inheritance Tax Return (copy attached), as corrected
Miscellaneous refunds
TOTAL RECEIPTS OF PRINCIPAL:
CONVERSIONS TO CASH! ADJUSTMENTS
49 shares, Prudential:
Cost basis:
Redemption:
$1,393.56
$1.528.46
Property tax rebate (Sch. E, Item 10):
Amount on Schedule:
Actual receipt:
$ 532.47
$ 500.00
Household furniture/furnishings (Sch. E, Item 12):
Appraised value: $1,965.00
Actual proceeds: $ 743.25
Nationwide refund, (Sch. E, Item 24):
Amount on Schedule:
Actual receipt:
$ 33.00
$ 33.80
TOTAL LOSSES ON CONVERSIONS/ADJUSTMENTS:
PRINCIPAL DISBURSEMENTS
08/24/01
08/25/01
08/28/01
08/28/01
08/28/01
09/04/01
09/11/01
09/11/01
09/17/01
09/17/01
09/17/01
09/17/01
09/17/01
Mellon Bank, loan balance
Derrs Hauling, trash removal
Real estate taxes
Personal tax
CRE Appraisal Service, real estate appraisal
McNeals Auctioneering, appraisal of household furnishings
Shepherdstown United Methodist Church, funeral reception
Malpezzi Funeral Home
Verizon
Waste Management
PPL
Bank of America, credit card
Holy Spirit Hospital
$125,000.00
1,393.56
45,599.94
28.57
$172,022.07
134.90
-32.47
-1,221.75
.80
$-1,118.52
$ 4,458.20
225.00
1,535.85
9.80
275.00
50.00
277.17
8,624.00
65.21
22.32
230.34
15.50
12.72
09/17/01
09/17/01
09/17/01
09/17/01
09/17/01
09/28/01
10/08/01
10/08/01
10/11/01
10/15/01
10/15/01
10/19/01
10/31/01
10/31/01
10/31/01
11/12/01
11/12/01
11/16/01
12/17/01
01/07/02
01/21/02
02/14/02
02/19/02
05/17/02
07/18/02
Reserved
Reserved
Patriot News
AT&T
AT&T Wireless
Mellon Bank, Mastercard
Ehrlich Green Team
House cleaning
AT&T
Verizon
Cumberland Law Journal, advertise Letters Testamentary
Sewer Authority
PPL
Grave marker inscription
Lawn and leaf maintenance
Veri son
AT&T
PPL
Citizens Bank, checks
Register of Wills, Pennsylvania Inheritance Tax
PPL
Expenses of sale of residence
PPL
Jones Accounting, 2001 income tax return preparation
Citizens Bank, checks
Register of Wills, balance, Pennsylvania Inheritance Tax
Charles Furriers
Martson Deardorff Williams & Otto, attorney fees
Martson Deardorff Williams & Otto, disbursements:
The Sentinel, Advertising Letters $ 93.83
Short Certificate 3.00
Filing fee, Inheritance Tax Return 15.00
Filing fee, Account (estimate) 150.00
18.35
12.00
35.89
175.84
72.08
100.00
34.15
51.98
75.00
100.00
37.59
125.00
500.00
23.96
5.99
41.83
31. 75
5,300.00
62.62
9,975.68
60.82
68.00
22.04
340.83
120.00
8,500.00
261.83
TOTAL DISBURSEMENTS:
$41,954.34
INCOME RECEIPTS
Mellon Bank, interest on accounts 470401,904368 and 1185912
Mellon Bank, interest on account 575939
Citizens Bank, estate checking account, interest
$ 56.61
11.39
105.72
TOTAL INCOME RECEIPTS:
$ 173.72
None
INCOME DISBURSEMENTS
$
0.00
$
0.00
TOTAL INCOME DISBURSEMENTS:
Specific Bequests:
TO: Family
Silver bicentennial pendant
TO: Kay L. Trimmer
Diamond wedding band
Diamond earrings
TO: Ann M. Kline
Mink stole
TO: Julia Eisenhower
Opal ring
TO: Kristin Giakas
Silver and pearl bracelet
Cash
TO: Kelly Johnson
Family Bible
Gold band ring
Cash
TO: Amy Shumaker
Diamond stud earrings
Cash
J. Kurtis Kline, Cash
David R. Galloway, Cash
Mark Trimmer, Cash
Alec Giakas, Cash
Kyra Giakas, Cash
Kristina Giakas, Cash
Gabrielle Johnson, Cash
Grant Johnson, Cash
Cole Shumaker, Cash
Graham Shumaker, Cash
Shepherdstown United Methodist Church, General Fund
Shepherdstown United Methodist Church, Building Fund
David R. Biesecker (upon agreement of parties)
1996 Mercury Sable
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
PARTIAL DISTRIBUTIONS TO BENEFICIARIES
$
$ 10.00
10.00
$ 300.00
25.00
$ 325.00
100.00
100.00
30.00
$ 20.00
1.000.00
1,020.00
$
.25
25.00
1.000.00
1,025.25
$ 100.00
1.000.00
1,100.00
1,000.00
1,000.00
1,000.00
500.00
500.00
500.00
500.00
500.00
500.00
500.00
1,000.00
1,000.00
3,425.00
Residue:
TO: David R. Biesecker
9/4/01, Cash
12/10/01, Cash
2/14/02, Cash
TO: Kay L. Trimmer
2/14/02, Cash
TO: Ann M. Kline
2/14/02, Cash
$ 1,000.00
1,000.00
28.000.00
30,000.00
30,000.00
30.000.00
TOTAL PARTIAL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES:
$105,535.25
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
Kay L. Trimmer, being duly sworn according to law, deposes and says: That she is the
Executor/Administrator of the Estate of L. Alice Biesecker, deceased; that she has fully and
faithfully discharged 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.
~~ '- J/u~~
Kay L. 'mmer /' ~
(Executrix and ~6untant)
Sworn to and subscribed before me
this~3rd. day of % ,2002.
~~~
No ary Public
NOTARIAL SEAL
CORRINE l. MYERS, Notary Public
Carlisle Boro, CumberlandCounty
My Commission Expires Mav 27, 2003
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-01-0782
SCHEDULE OF PROPOSED DISTRIBUTION
BY KAY L. TRIMMER. EXECUTRIX
Kay L. Trimmer, Executrix ofthe Last Will and Testament ofL. Alice Biesecker, deceased,
proposes to distribute the balance in her hands, to wit: $23,587.68, in accordance with the said Last
Will and Testament as heretofore filed in the Office ofthe Register of Wills of Cumberland County,
Pennsylvania, as follows:
TO: DAVID R. BIESECKER, per Item 3 of said Will:
Cash
$ 7,862.56
TO: KAY L. TRIMMER, per Item 3 of said Will:
Cash
$ 7,862.56
TO: Ann M. Kline, per Item 3 of said Will:
Cash
TOTAL DISTRIBUTION:
$ 7.862.56
$23,587.68
STATEMENT OF THE REASONS FOR THE PROPOSED DISTRIBUTION
The above distribution is proposed in accordance with the Last Will and Testament of L.
Alice Biesecker.
4-~ ~&^,~Wp
Ka L. mmer ;0
Sworn to and subscribed before me
this ~3 ~day of n ,2002.
~;Y~
Notary Public
NOTARIAL SEAL
CORRINE l. MYERS Notary Public
Carlisle Bora. Cum~rlandCounty
My Commission Expires May 27, 2003
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAl. TH OF PENNSYLVAN....
INlERITANCE TAX RE1UVI
RESIDENT DECEDENT
"'-
ESTATE OF. .
Biesecker, L. Alice
I FILE NUMBER
21 - 01 - 00782
-
--.
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
--.-. -.-- ----. .
ITEM
NUMBER
I
VALUE AT DATE
OF DEATH
19,000.00 .
DESCRIPTION
Mellon Bank C/O #4704016.298% due 12/27/2001
2
Accrued Interest
75.55
3
Mellon Bank C/O #904368 5.44% due 9n/2001
7,000.00
4
Accrued Interest
12.55
5
Mellon Bank elD #11859123.44% due 3/18/2002
5,180.98
6
Accrued Interest
0.49
7
Mellon Bank C/O #575939 6.298% due 11128/2001
6,000.00
8
Accrued Interest
22.82
9
368.04
Mellon Bank, checking account 142-152-0477
Property Tax Rebate
532.47
10
11
1996 Mercury Sable
3,425.00
12
Household FurniturelFurnishings
1,965.00
13
Diamond Wedding Band, per appraisal
300.00
14
Diamond Earring, per appraisal
25.00
15
Opal Ring, per appraisal
30.00
16
Silver and Pearl Bracelets, per appraisal
20.00
17
Gold Band Ring, per appraisal
25.00
18
Mink Stole, per appraisal
100.00
19
Family Bible
0.25
20
Bicentenial Silver Pennant
10.00
Total of Continuation Schedule(s)
TOTAL (Also enter on Line 5, Recapitulation)
1,506.79
45,609.94
C"-I+-I/!HT IV f ~,tV'Ut"A-,- tel!.ElfI/-S
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY continued
COMIIONWEAL TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF . .
Biesecker, L. Alice
I FILE NUMBER
21 - 01 - 00782
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
22
DESCRIPTION
VALUE AT DATE
OF DEATH
100.00
Diamond Stud Earrings, per appraisal
23
Blue CrossIBlue Shield Refund of Premium
158.45
24
Nationwide Insurance, Refund of Automobile Premium
33.00
25
Travelers Insurance, Refund of Homeowner's Premium
284.00
26
Clothes on Consignment
49.40
27
Valley Rural Electric Cooperative, Inc. - Refund of Investment
145.58
28
Pro-ration of real estate taxes
736.36
I
Page 2 of Schedule E
E)(I-h&I1-- ~ I'..6Ne/~ If'EeEr!7S
'f; .. ~'I!t~.S'1~~~.t'''M.tf\'ll!lat~ir.fi/''''~~~-'ti~.r~~
;,;""'ill;!;,?~~!.t";;':>",, . '_M.,:~,,..ii"2~~;:f\~sA~l~~~~:1l~~l!J'~.f~,.,, .. " ',' . "0'
.l!. ,- -... .
LAST WILL AND TESTAMENT
I, L. ALICE BIESECKER, of the Township of Upper Allen, County of
Cumberland and State of Pennsylvania, being of sound mind, memory and
understanding, do make, publish and declare this to be my last Will and
Testament, hereby revoking and making void all former wills, codicils
and other testamentary dispositions by me at any time heretofore made.
L
I direct my Executor, hereinafter named, to pay as soon as practicable
after my decease all my just debts and the expenses of my last illness
and burial.
2.
I give, devise and bequeath all of my estate, whatsoever and wheresoever
situate, unto my husband, Ray A. Biesecker, absolutely.
3.
Should my said husband predecease me, than and in that event, I
give, devise and bequeath all of my said estate unto my children, David
R. Biesecker, Kay L. Trimmer and Ann M. Kline, equally, share and share alike.
CXlfnJ Ir
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4.
I nominate, constitute and appoint my husband, Ray A. Biesecker,
executor of this my Last Will and Testament. Should my said husband,
Ray A. Biesecker fail to qualify or cease to act as executor, then and
in his stead, I nominate, constitute and appoint my daughter, Kay L.
Trimmer, executrix of this my Will.
I direct that my executor, and his successor, shall not be required
to give bond for the faithful performance of her duties in any jurisdiction.
j
;~
IN WITNESS WHEREOF, I, L. ALICE BIESECKER, the testatrix, have hereunto
set my hand and seal to this my Last Will and Testament this ~t~day of
, ,
,
'-'j
March, 1993.
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signed, sealed, published and declared by the within named L_ Alice
Biesecker, 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 thereto.
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REGISTER OF WILLS OF CUMBERLAND COUNTY
STATUS REPORT UNDER RULE 6.12
(For Resident Decedents Dying After July 1, 1992)
Name of Decedent:
L. Alice Biesecker
Date of Death:
August 19,2001
File No.:
21-01-782
Social Security No. :
179-20-6693
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 X 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. I is Yes, state the following:
a. Did the personal representative file afinal account with the Court?
Yes X No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account informally to the parties in
interest?
Yes X No
d. Copies of receipts, releases,joinders and approvals offormal or informal accounts
may be filed with the Clerk of the Orphans' Court and may be attached to this report.
Date: October 25, 2002
Signature:
f~A~
Mark A. Denlinger, Esquire
MARTS ON DEARDORFF WILLIAMS & OTTO
Ten East High Street
Carlisle, P A 17013
(717) 243-3341
Counsel for personal representative
Name:
Address:
F: IFILESIDA T AFILEIEST A TES\ I 04681-srep
� 1505610140
REV-1500 �` �02_,,,�F',
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 1 0 7 8 2
Harrisburq,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Soaal Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 7 9 2 0 6 6 9 3 0 8 1 9 2 0 0 1 1 0 0 9 1 9 2 6
Decedent's Last Name Suffix Decedent's First Name MI
B I E S E C K E R L • A L I C E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Soaal Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum � 2.Supplemental Retum � 3.Remainder Retum(Date of Death
Pnor to 12-13-82)
� 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Retum Required
death after 12-12-82)
� 6.Decedent Died Testate � 7.Decedent Maintained a Living Trust 8.Totai Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
� 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � 11.Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESP�NDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
" Name Daytime Telephone Number
D A V I D R • G A L L 0 W A Y , E S Q 7 1 7� 6 9 ? R= ' 6�5�
�
REG F WILLS�E O �
..�.
� A t"` � '�# �
First Line of Address ��,, � � d � �'7
� � � � a
5 4 E • M A I N S T R E E T � � 4 � � �
Second Line of Address p � � ;,� h
"� --� � � t�"!
City or Post Office State ZIP Code �'"` DATE FIL � �
M E C H A N I C S B U R G P A 1 7 0 5 5
CoRespondent's e-mail address: david(�nraltersgailoway.com
Under penaltles of perjury,I declare that 1 have examined this retum,including accompanying schedules and statemeMs,and to the best of my kno�e and belief,
it is true,correct and complete.Deciaratlon of preparer other than the personai representative is based on ail i�ormation of which preparer has arry knowledge.
SIGNA E OF PERSON SPONSIBLE FOR ILING URN DATE
� 1
A D
KAY L• TRIMMER 33 AUDOBON PARK DILLSBURG PA 1?019
SI RER OTHER THAN REPRESENTATNE DA
ADDRESS
DAVID R• G LLOWAY,ESQ 54 E• MAIN ST• MECHANICSBURG PA 1 O55
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140
J 150561�24�
REV-1500 EX(FI) Decedent's Social Security Numbe�
�ecedent'sName: L• ALICE BIESECKER 1 7 9 2 0 6 6 9 3
RECAPITULATION
1. RealEstate(Schedule A) .... .. ... .... .................... ...... ... . 1• •
2. Stocks and Bonds(Schedule B) . .............................. ..... 2. •
3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. •
4. Mortgages and Notes Receivable(Schedule D) .......................... 4. •
5. Cash,Bank Deposits and Misceilaneous Personal Property(Schedule E)... .... 5. �' � � � • � �
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property
(Schedule G) � Separate Billing Requested ....... 7. .
8. Totai Gross Assets(total Lines 1 through 7) ........................... 8. 1 0 0 � . 0 0
9. Funeral Expenses and Administrative Costs(Schedule H) .............. .... 9• 7 4 • � �
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) ...... ....... 10. •
��. Total Deductions(total Lines 9 and 10) ... ............................ 11. 7 4 . � 0
_ _ __ __ _
12. Net Value of Estate(Line 8 minus Line 11) ........................ .. .. 12. 6 . � �
13. Cha�itable and Govemmental Bequests/Sec 9113 Tn�sts for which
an election to tax has not been made(Schedule J) .................. .... 13. .
14. Net Value Subject to Tax(Line 12 minus Line 13) ...................... 14. 9 2 6 . � �
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(ax1.2)X.0 0 . 0 0 �5. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 9 2 6 . � 0 �6. 4 1 . 6 ?
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 � 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 � • � � 18. 0 . � 0
19. TAX DUE ...................................................... 19. 4 1 • 6 �
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15�5610240 1505610240 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 2� 01 o7s2
DECEDENTS NAME
L.ALICE BIESECKER
STREET ADDRESS
CIN STATE ZIP
Tax Payments and Credits:
1• Tax Due(Page 2,Line 19) (1) 41.67
2. Credits/Payments .
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 41.67
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
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 ..................................................................................................... ❑ ❑
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.
For dates of death on or after July 1, 1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the suroiving spouse is 0 percent
[72 P.S.§9116(a)(1,1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disdosure of assets and
filing a tax retum 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 aansfers from a deceased child 21 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 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in p2 P.s.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
L.A�ICE BIESECKER 21 01 0782
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorshlp must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. INHERITANCE OF THE ESTATE OF JOSEPH HALLMAN 1,000.00
FILE NO. 758-1988
_ _ _
TOTAL(Also enter on Line 5,Recapitulation) s 1 000.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
L.ALICE BIESECKER 21 01 0782
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
Gity State ZIP
_ _ .
Year(s)Commission Paid:
2, Attomey Fees: DAVID R.GALLOWAY, ESQUIRE 50.00
3, Family Exemption:(If decedenYs add�ess is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relatlonship of Claimant to Decedent
4. Probate Fees: REGISTER OF WILLS-FILING FEE SUPPLEMENTAL 24.00
REGISTER OF WIL�S-2 SHORT CERTIFICATES
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7. �
TOTAL(Also enter on Line 9,Recapitulation) S 74.00
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT ��
ESTATE 0�: FILE NUMBER:
L.ALICE BIESECKER 21 01 0782
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 [Indude outr'g ht spousal distributions and Uansfers under
Sec.91'�6(a)(1.2).J
1. KAY L- TRIMMER Lineai 33•33
33 AUDOBON PARK
DILLSBURG, PA 17019
2 • ANN B• KLINE Lineal 33.33
1],? BALLANTRAE DRIVE
ELKTON, MD 21921
3• DAVID R- BIESECKER Lineal 33•33
P•0 • BOX 2?
ELLISTON, MT 59728
. _ _ __ __ _
_ __ __ __ _
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
ji. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL Of PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. a
If more space is needed,use additional sheets of paper of the same size.
_ _ _ _ _ _ i
LAST WILL AND TESTAMENT '
I, L. ALICE BIESECKER, of the Township of Upper Allen, County of
Cumberland and State of Pennsylvania, being of sound mind, memory and
understanding, do make, publish and declare this to be my last Will and
Testament, hereby revoking and making void all former wills, codicils
and other testamentary dispositions by me at any time heretofore made.
1.
I direct my Executor, hereinafter named, to pay as soon as practicable
after my decease all my just debts and the expenses of my last illness
and burial.
2.
_ _ _ _ _- - ----------------- - -----------
I give, devise and bequeath all of my estate, whatsoever anca wheresoever
situate, unto my husband, Ray A. Biesecker, absolutely.
3.
Should my said husband predecease me, than and in that event, I
give, devise and bequeath all of my said estate unto my children, David
R. Biesecker, Kay L. Trimmer and Ann M. Kline, equally, share and share alike.
.�
,
:y..
_ _ .
�. •
I nominate, constitute and appoint my husband, Ray A. Biesecker,
executor of this my Last Will and Testament. Should my said �husband,
Ray A. Biesecker fail to qualify or cease to act as executor, then and
in his stead, I nominate, constitute and appoint my daughter, Kay L.
Trim�ner, executrix of this my Will.
I direct that my executor, and his successor, shall not be required
to give i�ond for the faithful performance of her duties in any juriscliction.
IN WITNESS WHEREOF, I, L. ALICE BIESECKER, the testatrix, have hezeunto
set my hand and seal to this my Last Will and Testament this ���day of
March, 1993.
, .
�� (SEAL)
Signed, sealed, published and declarec7 by the within named L. Alice
_ _ . _
Biesecker, 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 subscribecl our names as witnesses thereto.
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LAW OFFICE OF DAVID R. GALLOWAY
54 E. Main St.
Mechanicsburg, PA 17055
Telephone: 717-697-4650 Facsimile: 717-697-9395
david�a,walters alg lowa. .�
November 19, 2013
Pennsylvania Department of Revenue
Bureau of Individual Taxes
P.O. Box 280601 .
Harrisburg,PA 17128-0601
RE: L. Alice Biesecker,Deceased S.S.#: 179-20-6693
Estate No.: 21-01-0782 --Cumberland County,Pennsylvania
Supplemental Inheritance Tax Return
Dear Madam/Sir,
This office represents the Estate of L. Alice Biesecker who died August 19, 2001. On or
about May 17, 2002, an original return was filed with your Department and a Notice of Assessment
was issu�ed on June 24, 2002, showing all taxes paid. On or about, August 14, 2013, the Estate
_ _- ---___-�eeei�ed-a�1;90E}-bequest�or���e-Est�te-o€-�osepl�-Hal-lr��n:�r:�a��ian's-Estate-�vas-prob��ed-i�r-- - -- ___
Dauphin County in 1988 but no distribution was made until August of this year.
Because the Estate only recently received the Hallman bequest, we respectfully request the
Department waive penalties and interest. Consistent therewith, we enclose a check for $41.67
itemized in the Supplemental Inheritance Tax Return, attached hereto. If additional tax, interest or
penalties remain,please let us know.
Should you have any questions or concems,please feel free to contact me at 717-697-4650.
,
Very truly yours,
�.--------,..
David R. Gallo ay
� �
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COMMONWEALTH OF PENNSYLVANIA REV-11B2 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAI TAXES
DEPT.280601
HARRISBURG,PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 018424
TRIMMER KAY L
33 AUDUBON PARK
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ----------
101 � $41 .67
ESTATE INFORMATION: ssrv: 179-20-6693 �
FILE NUMBER: 2101 -0782 �
DECEDENT NAME: BIESECKER L ALICE �
DATE OF PAYMENT: 1 1/20/2013 �
POSTMARK DATE: 1 1/20/2013 �
COUNTY: CUMBERLAND �
DATE OF DEATH: 08/19/2001 �
�
TOTAL AMOUNT PAID: $41 .67
REMARKS: RECEIPT TO ATTY
CHECK# 991
INITIALS: HMW
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 019102
TRIMMER KAY L
33 AUDUBON PARK
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
lo,a
101 ( 52193
ESTATE INFORMATION: SSN:
FILE NUMBER: 2101 -0732
DECEDENT NAME: BIESECKER L ALICE
DATE OF PAYMENT: 05/02/2014
POSTMARK DATE: 05/02/2014
COUNTY: CUMBERLAND
DATE OF DEATH: 08/19/2001
TOTAL AMOUNT PAID: $23.93
REMARKS: RECEIPT TO ATTY
CHECK#0996
INITIALS: DMB
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
NOTICE OF INHERITANCE TAX I pennsytvarna
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF TAX INDIVIDUAL OF DEDUCTIONS AND ASSESSMENT OF TAX
Pa BOX 280687 iv
RECORDED OFFICE OF REV-1547 IX AFP <o8-I3)
HARRISBURG PA 17128-0601 REGISTER OF WILLS
DATE 04-14-2014
201q MY Z Ail 8 12 ESTATE OF BIESECKER L A
DATE OF DEATH 08-19-2001
CLERK dt1F FILE NUMBER 21 01-0782
GALLOWAY -ESQ O%PA I�bNS COURT COUNTY CUMBERLAND
54 E MAIN s-IMMBERLAND CD., PA ACN APPEAL DATE: 06-13-2014
MECHANICSBURG PA 17055-3851 (See reverse side under Objections)
Amount Remitted C 61q3
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
- 1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE - --1 RETAIN LOWER PORTION FOR YOUR RECORDS +-REV-1547 EX AFP {08-133 NOTICE OF INNERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX -
ESTATE OF: BIESECKER L AFILE NO. :21 01-0782 ACN: 101 DATE: 04-14-2014
TAX RETURN WAS: (X) ACCEPTED AS FILED { ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01
1. Real Estate (Schedule A) Cl) •00 NOTE: To ensure proper
2. Stacks and Bonds (Schedule B) (2) .00 credit to your account,
submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C7 {3} Q0 of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment.
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1,000.00
6. Jointly Owned Property (Schedule F) (6) •00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 1 .000.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 74.00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) . 00
11. Total Deductions (11) 74.00
12, Net Value of Tax Return (12) 926.09
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax {14) 132,406.76
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will
reflect figures that include the total of all returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Linn 14 at spousal rate (15) .99 X 90 = .000
16. Amount of Line 14 taxable at lineal rate (16) 13?.376.76 X 045 = 5,956.95
17. Amount of Line 14 at sibling rate (17) On X 12 = .00
18. Amount of Lino 14 taxable at collateral rate (1B) 30.00 X 15 = 4.50
19. Principal Tax Due (19)= 5,961.45
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-15-2001 CD000533 278.95 51300.00
05-17-2002 CDO01189 .00 340.83
11-20-2013 CDO18424 .00 41 .67
BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-21-2013 TOTAL TAX PAYMENT 51961 .45
BALANCE OF TAX DUE .00
INTEREST AND PEN. 23.93
TOTAL DUE 23.93
IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT CCR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS,
NOTICE OF INHERITANCE TAX a pennsyLvania
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX aFP (0e-13)
17128-0601
PO BOX 288601
HARRISBURG PA
DATE 04-14-2014
ESTATE OF BIESECKER L A
DATE OF DEATH 08-19-2001
FILE NUMBER 21 01-0782
GALLOWAY ESQ DAVID R COUNTY CUMBERLAND
ACN
54 E MAIN ST APPEAL DATE: 06-13-2014
MECHANICSBURG PA 17055-3851 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT-ALONG-THIS-LINE --),---RETAIN-LOWER-PORTION-FOR-YOUR-RECORDS--
REV-1547 EX AFP C08-133 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: BIESECKER L AFILE NO. :21 01-0782 ACN: 101 DATE: 04-14-2014
TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01
1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1,000.00
6. Jointly Owned Property (Schedule F) (6) . OD
7. Transfers (Schedule G) (7) . 00
8. Total Assets (8) 1 .000.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 74. 00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) no
11. Total Deductions (11) 74.00
12. Net Value of Tax Return (12) - 926.00
13. Charitable/Governmental Bequests; Nonelected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 132,406.76
N
NOTE: If an assessment was issued previously, Lines. l4. 15, 16, 17. (458 and/oO_:�19 wiLb
reflect figures that include the total of all returns assessed=tbdate. rn n
ASSESSMENT OF TAX: G p
15. Amount of Line 14 at spousal rate (15) .00 X P�0 0
16. Amount of Line 14 taxable at lineal rate (16) 132.376-76 X ;04 � R5,9 !95
17. Amount of Line 14 at sibling rake (17) -00 X Tr-.2� 0
18. Amount of Line 14 taxable at collateral rate (18) 30.00 X Cy1S '0-_7� 0
19. Principal Tax Due n1�= �ZZ3,96-1 .2215
TAX CREDITS: p c �, = c'>
I-, r m
PAYMENT RECEIPT DISCOUNT (+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (J) .�
11-15-2001 CD000533 278.95 5,300.00 Cl7
05-17-2002 CDO01189 .00 340.83
11-20-2013 CDO18424 .00 41 .67
BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-21-2013 TOTAL TAX PAYMENT 5,961 .45
BALANCE OF TAX DUE . 00
INTEREST AND PEN. 23.93
TOTAL DUE 23.93
IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE \
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS. ��
pennsylvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12.33)
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO BOX 280601
HARRISBURG PA 17128.6601
DATE 05-12-2014
ESTATE OF BIESECKER L A
DATE OF DEATH 08-19-2001
FILE NUMBER 21 01-0782
COUNTY CUMBERLAND
GALLOWAY ESQ DAVID R ACN 101
54 E -MAIN ST
Amount Remitted
MECHANICSBURG PA 17055-3851
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE --► RETAIN LOWER PORTION FOR YOUR RECORDS 4-
REY-I607 EX AFP C12-13J x*1E INHERITANCE TAX STATEMENT OF ACCOUNT(:
ESTATE OF:BIESECKER L A FILE NO. : 21 01-0782 ACN: 101 DATE: 05-12-2014
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACM IN THE NAMED ESTATE. BELOW IS A SUMMARY 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: 04-07-2014
PRINCIPAL TAX DUE: 5,961.45
PAYMENTS (TAX CREDITS) :
ry �aV
PAYMENT RECEIPT DISCOUNT (+) C' °
DATE NUMBER INTERESTJPEN PAID C-) AMOUNT PAID o o s Fri
11-15-2001 CD000533 278.95 5,300.00
0
05-17-2002 CDO01189 .00 340.83 M A C'3 -- c --q O
11 -20-2013 CDO18424 .00 41.67 1 Z m �O m rn
05-02-2014 CDO19102 23.93- 23.93 Z vs 7
C
C7 'L7 "-n --n
C? o --n :3 'TI
C N C7
�)
F- rn
n F ' Co C>
w
TOTAL TAX PAYMENT 5,961.45
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
.00
M IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS. `q
1\