HomeMy WebLinkAbout02-23-06
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REV-1500
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Heisey, Glenna J.
DATE OF DEATH (MM-DD-YEAR)
06-22-2005
DATE OF BIRTH (MM-DD-YEAR)
12-24-1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
g] 1. Original Return
o 4, Limited Estate
[] 6, Decedent Died Testate (Attach copy of Will)
o 9, Litigation Proceeds Received
o 2, Supplemental Return
o 4a, Future Interest Compromise (date of death after 12.12.82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12.31.91 and 1-1-951
FilE NUMBER
21 -05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
188 -30
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o 6 4 9
NUMBER
-7762
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03. Remainder Return (date of death pnorto 12.13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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Ifrl~~Ql:lOl\iMtI~I;'Qt:!C()M~~.'A!.J,.qQa~~n;)QNDEN.Qf:;~NP:<>()~~~(4;r~ifNffQ'l~tlPtJI,m.;"r'~'
NAME COMPLETE MAILING ADDRESS
Randall K. Miller 1255 S. Market Street
FIRM NAME (If Applicable) Sui tel 0 2
Elizabethtown, PA 17022
TELEPHONE NUMBER
717-361-8524
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
(1)
(2)
(3)
(4)
(5)
0.00
0.00
0.00
0.00
32,829.88
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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)
(7)
(6)
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)
(9)
(10)
7,873 .50
t:;?? 18
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of Line 14 taxable at the spousal tax 0.00
0
~ rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15)
0.00 x.O_ (16)
~ 16. Amount of Line 14 taxable at lineal rate
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D.. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
:E
0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
0
X 19. Tax Due (19)
~
0.00
0.00
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Fl.~qt:;_nA
(11)
(12)
(13)
24,434.20
24.434.70
0.00
0.00
0.00
0.00
0.00
0.00
(8)
32,829.88
(14)
Decedent's Complete Address:
STREET ADDRESS 751
Oak Oval
CITY Mechanicsbura, I STATE lZlP
PA 17055-8408
Tax Payments and Credits:
1. Tax Due (Page 1 line 19) (1)
2. CredilslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
Tolal CrediIs ( A + B + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TolallnterestJPenall ( 0 + E) (3)
4. If line 2 is greater than line 1 + line 3, enter !he difference. This is !he OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
0.00
5. If line 1 + line 3 is greater than line 2, enter !he difference. This is !he TAX DUE. (5)
A. Enter the interest on the lax due. (SA)
B. Enter !he total of line 5 + SA. This is 1he BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X. IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain !he use or income of !he property lransfened;........................................_............................................... 0
b. retain !he right to designate who shaH use !he prq:lerIy Iransilrred or its ilalme; ............................................ 0
c. retain a reversional}' inleresl; or......................................................................_......_...._.........__..............._.. 0
d. receive the promise for life at either payments, benefits or care? ...................................................................... 0
2. If death OCCUlTed after December 12, 1982, did decedent lrarlsh" prq:lerIy wiItin one year of deaI1
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "m trust b" or payable upon death bank acmunt or security at his or her death? .............. 0
4. Did decedent own an Individual RetirementAccount, annuity, or other ncn-pmbale property whic:h
contains a beneficiary designation? ...................................................................................._.................................. 0
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU IIJST COIIPlETE SCHEDULE G AND f1LE IT AS PART OF THE RETURN.
Under penalties of ~, I declare IhaII have examined lhis relum. inclWng ~ng sdIedt.Es and sIaienEnIs. and .. lie DeS of my lIoMiedge and hoief, it is We. coned. and aIIIlJlIBe.
Declaration 01 preparer oIher than the pernmal represenlative is basal on all infllmIaIion of whicI; preparer has IIIIf ~
SIGNATURE OF PERSON RESPONSiBlE FOR FILING RETURN DATE
ADDRESS
SIGNATU~F PREPAIWR O~~ THAN REPRE~TIVE
~K~~-1
ADDRESS ,
1255 S. Market St., Ellzabethtown, PA 17022
DATE
-Z -;;:2 "C7?
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the netvalleoflransfers morforthe use oflhe surviving spouse is 3%
[72 P.S. ~116 (a) (1.1) 0)1.
For dates at death on or atter January 1, 1995, the tax rate imposed on the net value of transfers m or for \he use of 1he suMving spouse is 0% [72 P.S. S9116 (a) (1.1) (ti)].
The statute does not exemDt a transfer 10 a SUIViYing spouse from tax, and the statuby requirements for disclosure of assets and fing a tax return are sIiI 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 Iransfers from a deceased child twenty-ooe )'elIIS of age or younger at death m (I' for the use of a nallllat parent, an adoptive paIeIlt,
or a stepparent of the child is 0% [72 P.S. i9116(a)(1.2}j.
The tax rate imposed on the net value of !ransfers to or for the use of the decedenfs lineal beneIiciaries is 4.5%. EllCcept as noted in 72 P.S. S9116(1.2) [72 P.S. f9116(aX1}j.
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. S9116(aX1.3)l. A siJing is defined, under Sectioo 9102. as an
individual who has at least one parent in common with !he decedent, whether by blood or adoption.
---.
SCHEDULE E
CASH, BANK DEPOSffS, & MISC.
PERSONAL PROPERTY .
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Glenna J. Heisey
fI.E lUMBER
ESTATE OF
21-05-0649
Irdude 100 pIOaleds of ifigalion and file dale file poceedswem received by file eslale.AI pnlfIeI1,y joinIIy-oImedwi8l8le rigIltof_~ lIIUStbe disclosed on Sctaedwe F
ITEM VAUJEAT DATE
NUMBER DESCRIPTION OF DEATH
1.
2.
Brethren in Christ Foundation TAP Special Account
#1577
Brethren in Christ Foundation SIC Five-year (m)
#1577-13095
PNC Bank account # 5002056246
PNC Bank Senior Checking Plan Acct. #5080029964
Cash from purse
Penn Treaty Network America Ins. refund of premium
Coins appraised at
Mechanical Bank
Washingon National Insurance Company refund premium
Brethren in Christ SIC 3-Year Paid directly to.
'~essiah Village Endowment Fund and Messiah Colleg~
3.
4.
5.
6.
7.
8.
9.
10.
TO'TAL
3,480.88
15,786.32
3.44
339.94
46.56
207.77
58.00
150.00
93.85
(12,663.12)
32,829.88
Brethren in Christ Foundation
PO Box 290
Grantham PA 17027
Estate of Glenna J Heisey
751 Oak Oval
Mechanicsburg PA 17055-8408
Date
7/212005
7/21/2005
7/21/2005
Check #
Total Deposits: $0.00
Total Interest: $4.76
Total Withdrawal: $3,480.88
Statement Date: Jul 21, 2005
Statement Date: Jul 21, 2005
Account: 1577
Account Name: Estate of Glenna J Heisey
Tvpe
Beginning Balance
Interest
Withdrawal
Closing Payout upon Death
Account Type: TAP - Special
Maturity Date: N/A
Interest Rate: 2.50%
Amount
3,476.12
4.76
-3,480.88
Unposted Interest $0.00
Ending Balance: $0.00
Inception Date: Aug 13,1998
Brethren in Christ Foundation
PO Box 290
Grantham PA 17027
Estate of Glenna J Heisey
751 Oak Oval
Mechanicsburg PA 17055-8408
Date
7/2/2005
7/21/2005
7/21/2005
Check #
Total Deposits: $0.00
Total Interest: $38.83
Total Withdrawal: $15,786.32
Statement Date: Jul 21, 2005
Statement Date: Jul 21, 2005
Account: 1577-13095
Account Name: Estate of Glenna J Heisey
Type
Beginning Balance
Interest
Withdrawal
Closing Payout upon Death
Account Type: SIC - Five Year (m)
Maturity Date: 9/13/2009
Interest Rate: 4.50%
Amount
15,747.49
38.83
-15,786.32
Unposted Interest $0.00
Ending Balance: $0.00
Inception Date: Sep 13, 2004
EFORM100472-0900
o
(BAN<
Your account was DEBITED for the following reason:
o Check # posted on
IXl Closed account 5080029964
o Branch adjustment (branch name)
o Service charge error
o Other'
encoding error _ posted to incorrect account
Account Number File 10
AMOUNT $ 339.94
5080029964 040
PNC Bank, National Association
FOR BANK USE ONLY
o GLENNA J HEISEY
E 751 OAK OVAL
B MECHANICSBURG, PA 17055-8408
I
T
I
EFORM 1 00472-0900
o
. (BAN<
Your account was DEBITED for the following reason:
o Check # posted on
IXl Closed account 5002056246
o Branch adjustment (branch name)
o Service charge error
o Other:
Account Number
5002056246
o GLENNA J HEISEY
E 751 OAK OVAL
B MECHANICSBURG, PA 17055-8408
I
T
Branch #/Dept. #
0000046
Date
07/21/2005
Prepared By (PRINT Name)
MARY LYNN THRONE
Authorized By
Customer's Advice of Charge
encoding error _ posted to incorrect account
File 10
040
AMOUNT $ 3.44
PNC Bank, National Association
FOR BANK USE ONLY
Branch #/Dept. # Date
0000046 07/21/2005
Prepared By (PRINT Name) Authorized By
MARY LYNN THRONE
Customer'S Advice of Charge
PENN TREATY NETWORK AMERICA INSURANCE CO.
3440 LEHIGH STREET, ALLENTOWN, PA 18103
ESTATE OF GLENNA J HEISEY
Invoice Date Invoice Number Customer No.
08/04/2005 UNEARNED PR 15340
Check Date
DETACH AND RETAIN TIllS STATEMENT
THE ATTACHED CHECK IS IN FULL PAYMENT OF ITEMS DESCRIBED
BELOW AND THE PAYEE ACCEPTS IT AS SUCH NO RECEIPT REQUIRED
08/04/2005 Check 553538
Memo
P417116/UPD
CHECK TOTAL
Amount
207.77
207.77
, - -TH8FACE'OF TAIS DOCUMENT HAS A COLOREDCSACKGROUND ON WHITE PARER, THIS DOCUMENT CONTAINS A JROE'WAT:ERMARI.<" HOL't);l;<fCIGHTijO,VIEW':;: '.::. ';:i~
First Union
National Bank
i
PENN TREATY NETWORK AMERICA
INSURANCE COMPANY
(PTNA Life Insurance Company in California)
3440LEmGH STREET
ALLENTOWN, PENNSYLVANIA 18103
3-50
310
NO. 553538
PAY
~lL~
VOID AFTER 90 DAYS
DATE
AMOUNT
08/04/2005 ********$207.77
TO TIlE
ORDER OF
ESTATE OF GLENNA J HEISEY
MESSIAH VILLAGE 751 OAK OVAL
MECHANICSBURG, PA 17055
11155:1 5 :18111 ':0 ~ ~OOO 50 :I': 2 ~OOOO ~ ~ ?... :18 ~II.
m;s I'llORSSlQNA'
COIN
GRADING
SfR\1CE
f~
NUMISMATIC
ClWWm'
CO<fO<<A11QN
Of AMBlIeA J
ATe 013
SLOATS PA74
FAX 717-299-0289
E-MAIL dsteinco@aol.com t.
NAME ./' / TA '/~
350 Centerville Road
Lancaster, PA 17601
(717) 299-1211
800-334-3903
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DATE 7hbf
SALES INVOICE 0
PURCHASE ORDER 0
CONSIGNMENT 0
SPECIAL INSTRUCTION OR
TERMS
SHIPPED VIA
o CONVENTION 0 OTHER
THE GOODS DESCRIBED AND VALUED AS ABOVE ARE DELIVERED TO YOU FOR EXAMINATION AND INSPECTION ONLY AND REMAIN OUR PROPERTY SUBJECT TO OUR ORDER AND SHALL
BE RETURNED TO US ON DEMAND. SUCH MERCHANDISE. UNTIL RETURNED TO US AND ACTUAlLY RECEIVED ARE AT YOUR RISK FROM ALL HAZARDS. NO RIGHT OR POWER IS GIVEN TO
YOU TO SELL. PLEDGE. HYPOTHECATE. OR OTHERWISE DISPOSE OF THIS MERCHANDISE REGARDLESS OF PRIOR TRANSACTIONS. A SALE OF THIS MERCHANDISE CAN ONLY BE EFFECTED
AND TITLE WILL PASS ONLY IF, AS AND WHEN WE THE SAID OWNER SHALL AGREE TO SUCH SALE AND A BILL OF SALE RENDERED THEREFOR.
BPI1 0736
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FOLD AT H TO FIT DRAWING BOARD ENVELOPE #EW10P
INVOICE
ADAMSTOWN ANTIQUE GALLERY
CONSIGNMENT FORM
2000 NORTH READING ROAD. DENVER, PENNSYLVANIA 17517. (717) 335-3435
SOLD TO&~-h
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SHIPPED TO
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Reorder Item #NVN73 The Drawing Board. P.
@EGI. 1982. Printed in U.S.A
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Transferred from Certificate #12081
BRETHREN IN CHRIST FOUNDATION
SIC 3- YEAR
HOLDER
GLENNA JEAN HEISEY
751 MESSIAH VILLAGE BOX 2015
MECHANICSBURG, PA 17055-2015
ACCOUNT #
1577
188-30-7762
12742
ADDRESS
SOCIAL SEC. #
CERTIFICATE #
$12,637.15
06/09/2000
06/0912003
ANNUAL
INTEREST
RATE
0.0600
ISSUANCE IN THE NAME OF TWO OR MORE
HOLDERS INDICATES
o JOINT OWNERSHIP WITH FULL RIGHTS
OF SURVIVORSHIP
o OWNERSHIP AS TENANTS IN COMMON
o OTHER:
CERTIFICATE AMOUNT
ISSUE DATE
MATURITY DATE
GENERAL:
This certifies that the certificate holder{s) hOld{s) a Stewardship Investment Certificate (Certificate)
with the Brethren in Christ Foundation in the principal amount and at the specified annual interest rate
set forth above and for the initial term expiring on the initial maturity date shown hereon.
yOU/ HVings benefI tIw churctll
INTEREST:
If left to accumulate interest is compounded semiannually on the basis of a 365-day year. The first
interest payment shall be made on the payment date next following the date of this Certificate, to be
computed on the time said principal sum has been retained by the Foundation as of the date of said
interest payment date. The Foundation reserves the right to adjust (increase or decrease) the interest
rate stated above at the beginning of any calendar month. Decreases in the rate are effective only if
the Foundation sends written notice of such decrease to the certificate holder's last known address not
less than thirty (30) days prior to the effective date of such decrease.
-
BI-CF.-~.
-
An Ag.ncy olIN lkethrwl ill Ctltisf Chutth
Interest is to be:
o Accumulated
00 Paid to Account No. 1577 - 02
o Mailed to Account Holder{s) next business day
Interest is credited to the certificate holder{s):
o Monthly - On the last day of each month
o Quarterly - On the last day of Mar, June, Sept, Dee
00 Semiannually - On the last day of June and Dec
PENALTIES:
The Foundation may authorize early redemption of this Certificate upon request of the certificate holder. The Penalty for early redemption shall
equal ninety (90) days interest at the current rate being eamed by the Certificate at the time of redemption.
RENEWALlTERMINATlON:
The certificate holder may withdraw this deposit at the Certificate's termination date upon written notice thereof to the Foundation prior to the
termination date. Upon receipt by said Foundation of such notice of withdrawal, the Foundation shall repay to certificate holder the principal
sum with unpaid interest accrued to the date of termination within ten (10) days of the expiration of said term. Unless said notice is received as
hereinabove set forth, the term of this Certificate may be automatically renewed for a like term, subject to any restrictions in the state where
sold. Notice of impending automatic renewal and termination along with a current Prospectus will be provided certificate holders at least forty
(40) days prior to maturity.
OTHER PROVISIONS:
Unless revoked in writing by the certificate holder, and said revocation is received by the Foundation prior to certificate holder's death, ceriificate
holder and the Foundation further agree as follows: (indicate choice)
~ tb c~~ic'ifl ~~<1-efggr-~ th~3sc.ft''i\F~~cfJk ~~ q.y~iM~leaWa'ViEft'R~~eEWagr~~~ gf tpt~'dth11';1Jn ~ri~kT~gd~"J. 'rg'ge
o At the certificate holder's death, the Foundation shall pay the proceeds of this Q!rtificate at its maturity to the person(s) legally entitled to
said proceeds; provided that in the event death occurs within sixty (60) days of the expiration of the term of this Certificate, the Foundation may,
in its sole discretion, elect to renew the term of this Certificate for one additional like term.
(The date of certificate holder's death shall be deemed to be that stated on an official certificate of death in the form prescribed by law, such
certificate to be forwarded to the Foundation within a reasonable time following the certificate holder's death.)
The Foundation reserves the right to terminate any and all obligations incurred by the execution of this Certificate by refunding to certificate
holder the principal sum at any time, plus unpaid interest to the date of termination.
Brethren in Christ Foundation, Inc.
PO Box 290
Grantham, PA 17027
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POST OFFICE BOX :90
431 GRft,NTH,l\1\t1 ReAD
GR.A.NTHAiV1, P;.\l 7G27
July 22,2005
Dr. Jon C. Stuckey, Interim Director of Development
Box 3013
Messiah College
One College A venue
Grantham, P A 17027
Dear Dr. Stuckey:
Enclosed please find Check #3978 in the amount of $6,33 1.56. These funds are being sent upon the
death of Glenna J. Heisey since Messiah College was listed as a beneficiary on one of her certificates
with the Brethren in Christ Foundation. The address of the executor of Miss Heisey's estate is listed
below so that an acknowledgment of this gift may be made.
If you have any questions, please do not hesitate to contact me at Extension #5420 or at
ki acobsra)bicfoundation.onr.
Sincerely,
k4-T?'1~
Kimberly R. Jacobs
Account Officer
KRJIlaj
Enclosure
pc: Estate of Glenna 1. Heisey
C/O Lloyd R. Heisey, Executor
3768 Meadow View Road
Manheim, PAl 7545-9447
P h () n e: (71 7) 697, 2 63 ... . F ,1 :<: (7 1 7) 697 - 771 -i . E.. mail: bicf.9n-;..~.idiud1J
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t'OST OFFICE BOX 290
431 GRANTHAM ROAD
GRANTHAM, P.>l170::7
July 22, 2005
Mrs. Sharon Engle, Vice President of Gift Development
100 Mount Allen Drive
Mechanicsburg, P A 17055-6171
Dear Mrs. Engle:
Enclosed please find Check #3979 in the amount of $6,331.56. These funds are being sent upon the
death of Glenna J. Heisey since Messiah Village Endowment Fund was listed as a beneficiary on one
of her certificates with the Brethren in Christ Foundation. The address of the executor of Miss
Heisey's estate is listed below so that an acknowledgment of this gift may be made.
If you have any questions, please do not hesitate to contact me at 717-697-2634, Extension #5420 or at
kiacobs(Ci!bic foundation .org.
Sincerely,
K~R.~~
Kimberly R. Jacobs
Account Officer
KRJlkrj
Enclosure
pc: Estate of Glenna J. Heisey
C/O Lloyd R. Heisey, Executor
3768 Meadow View Road
Manheim, PA 17545-9447
P h 0 n e: (71 7) 697 - 2 6 3~ . Fax . (7 1 7) 697 77 1 4 . E. 111.1 i I: bicf(':cmer"j,llJ.eciu
REV-1511 EX+ (12-99) _
*
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAl. EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Glenna J. Heisey
ALE NUMBER
21-05-0649
ITEM
NUMBER
A. FUNERAl EXPENSES:
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
1.
Frank S. Miller/David T. Sekely Funeral Services, Inc
130 North Market St reet, Elizabethtown, PA 17022
Gift to Conoy Brethren in Christ Church, 1722 Bain-
bridge Road, Elizabethtown, PA 17022 for hOlding
services
5,038.00
200.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of PelSOnaI Representative(s) Lloyd R. He i s ey
Social Security Number{s)/EIN Number of PelSOnal Representative(s} 1 65':::' 3 6 - 5 8 8 9
S~t~ress 3768 Meadow View Drive
City Manheim
Year(s) Commission Paid:
Slate~Zip 17545
2005 ($500.00); 2006 ($500.00)
1,000.00
2.
AttomeyFees Randall K. Miller, Esquire
1,500.00
3. Family Exemption: {If decedent's address is not the same as claimant's, attach explanation}
Claimant
Slreet ~ess
City
Slate _Zip
Relationship of Claimant to Decedent
4.
Probate Fees
133.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Reimburse executor turnpike fees
2.50
...
1UTAl. (Also enter on line 9, Recapilulation) $ 7 , 8 7 3 . 5 0
FRANK s. MILLER FUNERAL HOME, Inc.
130 North Market Street, Elizabethtown. Pennsylvania 17022
David T. Sekely, President and SUpervisor
717/367-1543
July 27. 2005
To: Mr. Leroy R Heisey
616 Ivy Drive
Mount Joy. PA 17552
Funeral arrangements for: Glenna J. Heisey
Date of Services: Tuesday. June 28, 2005
Merchandise and Services Rendered:
Non-Declinable Services of Funeral Director & Staff
Embalming and Necessary Care
Other Preparation of the Remains
Use of Facilities and Staff Services for Viewing
Funeral at Facility or Other Location and Staff Services
Graveside Services
Transfer of remains to Funeral Home
Funeral Coach
Clergy/Lead Car
Car for errands related to funeral arrangements
Printed Material FolderslPrayer Cards
Guest Register Book
Acknowledgement Cards
Other: Engraving
Subtotal ~ Selected Merchandise and Services
Aa:ottunodation Items:
Copies of Death Certificiates
Cemetexy - opening/closing
Newspa.per Notice(s) LancIHBG
Clergy/Church honorimn
Subtotal - Accommodation ltenJs:
Total - Merchandise, Services & Accommodation Items:
DO NOT DETACH THIS VOUCHER
PAYMENT OF THIS CHECK WILL SE REfUSED. UNLESS
RECEIPT IS SIGNED AND CHECK ENDORSED
DATE 7 - d.. 7-05
$1395.00
$595.00
$325.00
$395.00
$495.00
$255.00
$190.00
$195.00
$85.00
$85.00
$50.00
$30.00
$5.00
$78.00
$4178.00
$72.00
$350.00
$328.00
$110.00
$860.00
$5038.00
/(;7
No. . I
60-906
313
PAY ./1
TO THE /
ORDER OF
IC}'
,":;U/l/-e./
DATE 1- :27-o_C)
. ;4~dmJ/CU?~
!YI~1A/l{ lLt 1JC(,~
f v I
THE SUM OF :If 5, 0 "6 f . co
f Jdf
-' -",4M
IN PAYMENT 0 , ~'l( (
6JO 3F.(}~
.0. __
DOLLARS LlJ ='.....
(;\ UnionNational
~ COMMUNITY B^NK
ESTATE OF .
.j2J[t YLvl ^- ~ -f~[.u1f
M'
"f~
...
Frank S. MILLER/David T. SEKEL Y
Funeral Services, Inc.
David T. Sekely, President/Supervisor
130 North Market Street
Elizabethtown, P A 17022-2040
Phone: 717-367-1543
Invoice
DATE INVOICE #
6/23/2005 2238
BILL TO:
Leroy R. Heisey
616 Ivy Drive
MountJoy, PA 17552
DECEASED ACCOUNT #
Glenna J. Heisey 55205108
QUANTITY DESCRIPTION RATE AMOUNT
Professional Service 2,315.00 2,315.00
Use of Facilities and/or Staff Services 1,145.00 1,145.00
Use of Auto 555.00 555.00
Engraving 78.00 78.00
Memorial FolderslPrayer Cards 50.00 50.00
Guest Register Book 30.00 30.00
Acknowledgement Cards 5.00 5.00
12 Certified Copies of Death Certificates 6.00 72.00
Cemetery Charge-Opening/Closing 350.00 350.00
Obituary - Lancaster/Harrisburg 328.00 328.00
Clergy/Church Honorarium 110.00 110.00
Total $5,038.00
WEB SITE
www.mi1Ierfuneralhome.com
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Rece:j..pt Date:
Rece+pt Time:
Recelpt No.:
7/21/2005
12 : 50 : 52
1041358
HEISEY GLENNA J
Estate File No. :
Paid By Remarks:
2005-00649
RANDALL K MILLER ESQ
JA
------------------------ Receipt Distribution ----____________________
Fee/Tax Description PaYment Amount Payee Name
PETITION LTRS TEST
WILL
AUTOMATION FEE
SHORT CERTIFICATE
JCP FEE
CODICIL
Check# 7612
Total Received. ........
60.00
15.00
5.00
28.00
10.00
15.00
----------------
$133.00
$133.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
REV-1512 EX+ (1-93) *'
COMMONWEAIJH Of' PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or Type
FILE NUMBER
21-05-0649
ESTATE OF
Glenna J. Heisey
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
2.
3.
Verizon phone service
Messiah Village - resident fees
PPL
3tJ. 85
474.87
16.45
lOTAL (Also enter on line 10, Recapitulation)
$ 522.18
Mail payments to:
Verizon, PO Box 28000, Lehigh Vly PA 18002-8000
Change of billing address?
Go to verizon.comlbillingaddress or see page 2.
- - - - - - - - - - - - - - - - _ _ _ _ _ _ _ _ _ _ !: ~~h.! ~lu.!:.n e.alT'e.!!1 ~ip ~i~ Y2u!:...C~c~ P!y<!,I~lo 'ye.!!z~. _ _ _
~-
Veri701J
Account: 717 795 8925 599 48 Y
Total Due
$30.86
Amount Paid:
$ ~[QJ.[ill~
GLENNA HEISEY
MESSIAH VLG
751 OAK OVAL
MCHNCSBRG PA 17055-8408
1...111.11111....1.1..1.1.1111..1..11111I1111..1.1....11.11..1
Verizon
PO BOX 28000
LEHIGH VL Y PA 18002-8000
1..111I..1.1111.11.11111.11..1.1111I11...11..111111I
11771707958925599902802137999991000000234570000003086600000
IN PAY~ENT OF
. / ~i'" C!}'
T) I 1/'/1..1_' -U'L '.
.~
PAY / '/
TO THE M/4 'U "di1.
ORDER OF t".{./ ./r. U
,0l;J {/
Jr~-tu t./t/fLl
(';\ Union National
\.0' COMMUNITY BANK
ft> /;00
No. to 5
DATE/f/:r15, ~5
I $ .go~Y0
I)OLLARS {D
60-906
313
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.1
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-~....
'HESUM OF ii',:;!), fl:.
t..,/
ESTATE OF
___ {j&'J1/r~)~~~~~J .~
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----p"~....""';m.;iiT"'""~,~"i,,..,,,,,,: ."J",,~ ~
SIGN HERE -'-'Ai:Si5ENi3ORS"'f8"ACKOFCHEC~
I:O:l.:lOgOI;BI: 10 014
Ft "'" "
c.C 1. i.J
g
~~~~~ah
Form PB-Q1
100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055
LLOYD HEISEY
3768 MEADOW VIEW DRIVE
MANHEIM, P A 17545
QUESTIONS? CALL: (717) 697-4666
RESIDENT# I UNIT STMT. DATE
39407 I 06/30/2005
RESIDENTfS
Miss GLENNA J. HEISEY
TOTAL AMOUNT DUE $474.87
. DATE DUE
07/31/2005
$
I-f 7+~1/1
DATE DESCRIPTION . RATE UNIT CHARGES CREDITS BALANCE
Balance Forward 483.39
06/21/05 PAYMENT RECEIVED - THANK YOU!!! 483.39 0.00
#1847
*** Residential Livin~ ***
06/01/05 MNTHL Y CHG CONESTOGA 06/01-06/21 15.30 21 321.30 321.30
06/01/05 MNTHL Y CHG CONESTOGA 06/22-06/28 15.30 7 107.10 428.40
06/01/05 TRANSPORTATION 25.00 1 25.00 453.40
MOFFIT, PEASE GROUP
06/01/05 EMERGENCY CALL LEASE 06/22-06/28 7.67 1 7.67 461.07
06/01/05 EMERGENCY CALL MONITORING 0.60 23 13.80 474.87
06/22-06/28
DO NOT DETACH THIS VOUCHER
f'AY~ENT OF THIS CHECK WILL Be REFUSED, IJNLESS
RECEIPT IS SIGNED AND CHECK ENDORSED.
CHECK NO.
RECEIVEO OF; J /' , 1 . ~
f:... _/I:~' - '-I ./ ~'"
l""'-1.~ ~~_' _
~VII[sEN'ATin EXl'fU O~ a:EClITIIIXADMIN'SlIlATtlRAOMlrll$Tlt.l.tfllll '!'lll/ST
OF THE ESTATE OF
-,
i /, '7 ~ c: ~~
DATE;;'/A..-y-<"7f,J/:)/O )
~, $ .Lj l-'f,? 1
- y~ /1- YZ;1 -DOLLARS ~ e~:..
t'
No. kif"
/ () Cv DATE
7 - JS'-6
Qi . \ 1lt" -
L.. ;, -, 1
.{/i ~1 /\t ,?c. ~. , . '" AL1k'(f--
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- - jj, -7
THE SUM 0' ff~ 1 ' , ~ _
/
----~~~~7"" " "'".,,,"''''',,,::;:,,'",,"",,, _____Ii!
(ju~~::: DF~. 1~{~~1-
j cI M'
---_.._---_._------_.__.~.-
If'l PAYMENT Of
WuT{U.;\.,
ti\ UnionNational
~ COMMUNITY BANK
1:03 I. 30 qO 1;81:
SIG N HER E ---;;IsoY;ii06RSEBAci"'O"FCHErjr~
10014713
RESIDENT #
39407
CURRENT
474.87
OVER 30
0.00
OVER 60
0.00
OVER 90
0.00
OVER 120
0.00
TOTAL AMOUNT DUE
$474.87
RESIDENT NAME Miss GLENNA J. HEISEY
A I % finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you!
Form PB-01
N/A
If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You!
PPL Electric
Utilities
ppl
Page I
"::::::'::::~:~;f~:ymit-:BIlt:i\~NUitiliei::i:,!i;;'f;::'i::
03100-75006
.'e,,'::,','. "'.....:oi"~tmi.:;'::,?::::::,;:.
Electric
Service
Summary Page
Balance as of Ju114, 2005
Char~s:
T otarpPL ELECTRIC UTILITIES Charges
Total Charges
$ 0.00
For:
GLENNA) HEISEY
751 OAK OVAL
MECHANICSBURG PA 17055
$16.45
$ 16.45
Account Balance
$16.45
Questions about
this bill? Please
contact us by Aug 4
at 1-800-342-5775 or
484-634-4900
i
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or write to:
Customer Sernce
827 Hausman Rd.
Allentown, P A
101rLAI I'\""V,\
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DO NOT DETACH THIS VOUCHER
PAYMENT OF HilS CHECK WILL BE REFUSED. UNLESS
flECEIPT IS SIGNED AND CHECK ENDORSEO
CHECK NO.
; /~ ,V /j _ -Iei' _ Aj.<
" L/ ,/ DATE I <::-: / to"-""
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'HISoN"LfI{r~l.";;ijt:;;;;m;;;"""""",,",.~,.,,,...,,,: "J",,! TO THE .D _'I
. 0' THE ESTATE P' - ORDE"R OF _ ~
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/j ",7/- C>> ~!1J~~N~~onal
Jf'\: !"AVMENT Of I
/7 2 ~
DATE '-'x. (I--rl')
60-906
313
If:; Ii t(/
$ 10... '-1-5
DOllARS lil
---
........
....~ ....
ESTATE OF
;J L fL lV- f- 'fie ( ;JC SJ-
1:0 3 ~ 301101;81:
;2~' " I" M>
---- -_._.._______' . t-1I~
PERSO..Al PIlHfliTATIVIEUCUTORUEClITRIXADUiU:SlRMDIlI\ll ';15~~N--
M'
SIGN HERE ...._._____.___..__._..__._II!
ALSO ENDORSE BACK OF CI"U:O.
(. DELuxe eSTWAa
10014113
Other important information on back ..
-_. -- --- ---------- ------- . -------- --~ --- ------. -------.----- ------ --- --- ----- .- -------..----------- ----_.- --. - -. - -- --- --- ---- --
Return this part to address below with a check payable to PPL Electric Utilities Corporation
03100-75006
........." ....... ..., .............. rp"""'-"I
.::;:::;::/:;:;:;;; . ......: a',:, ".:;::::';:':;;:':;::,;: ::::::;:::'::'" ::,' s". ...:.... ::;:':':;:;:
Aug 4,2005 $ 16.45
Amount Enclosed
DDDD[2J[J[]~
AV 01 022021 942438145 A**5DGT
GLENNA) HEISEY
751 OAK OVAL
MECHANICSBURG PA 17055-8408
PPL ELECTRIC UTILmES
2 NORTH 9TH STREET RPC-GENN1
ALLENTOWN PA 18101-1175
1.1111111.111....1.1..1.1.1..1..11." 1...1..1..1.1....11.11..1
1 6600000164560000016457 0310075006
""'513""".
COMMONWEALlli OF PENNSYlVANIA
INHERITANCE TAX RE1lJRN
RESIDENT DECeDeNT
ESTATE OF
Glenna J. Heisey
SCHEDULE I
8ENEROAREs
RElATIONSHIP TO DECEDENT
NUuael NAME AND ADDREss OF PERSoN(S) RECEIVING PROPERTY DoNat UstTfUSfee(s)
I TAXABLE OISTRlBUTlONs [mc/ude 0Ulright spousaJ distribuOOns, and 1mnsfers under
See. 9116 (a) (1.2)1
AlE NlIMBER
21-05-0649
AMOUNT OR SHARE
OF ESTAlE
1.
ENTER DOllAR AMOUNTS FOR DISTRIBUOONS SHOWN ABOVE ON UNES 151HROUGH 18, ASAPPROPFIIATE, ON REV-1500 COVER SHEET
n NON-TAXABlE DlSTRlBUTIONs:
A SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN B.ECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVEflNMENrAl.. DlSTRlBUnONS
1. Messiah COllege, One College Ave., Grantham, PA 50%
2. Messiah Village, 100 Mt. Allen Dr., Mechanicsburg, IA 50%
14am Ifill nub Wt.&tnuttttt
Lancaster, and Commonwealth of Pennsylvania, hereby make, publish and
I,. GLENNA ]. HEISEY, of the Borough of Elizabethtown, C0unty of
wills and codicils by me at any time heretofore made.
declare the following to be my Last Will and Testament, revoking any and all
funeral expenses, including all taxes due by reason of my death, be paid as soon
FIRST: Payment of Debts: I order and direct that all my just debts and
as can be conveniently done after my decease.
SECOND: Bequest: I give, devise and bequeath all my entire estate, real,
personal and mixed, as follows:
M
A. One-~(l~ to Messiah C~Mege, Granth~m, Pa. 17027. t I
~ ,,~,,~/1-'''- ~ ~ ~ L'~''4
B. One~(l~ to Messiah NIl..-zoco-,".~ =~.. ~~ .~;r"'~j;m'l:g, ..... 6"
C..-Oue-thirrf (1;~3) to Mt::l:il:iiah ChIldren Nome, RuuLc I, MaHRt ]~
,Ea-.
.---_..._._-,-~._..__._-. -- '--
THIRD: A ppointment of Executor: I nominate, constitute and appoint
mJ.~ ,-1I'h..~c:-$~ ~ ~--:--n-~E:l'", -as- r:n6Mtar ~ill and Testa-
ment. ~-se-me-e~i~-i-ng:-to-serve,
then-t-nemina.te, constitute and appoint my brother, LEROY R. HEISEY, sub-
stitute Executor hereof. <tb.e ~(\i'. ~
IN WITNESS WHEREOF, I have hereunto set my hand and seal this r:;.:s-~
-
D. If any of the above charitable organizations is no longer in ex-
istence or cannot take its share for any reason whatsoever, then
that share shall be divided between the remaining organizations.
day of
~~/'<
, A.D., 1972.
Jill 11_'
~Vft..:L.- '54. ' ~ ~4
GLENNA'/]. HEISEY 0
(SEA L)
~ ~~~"--"'-'--"'--'-- -.
Signed, sealed, published and declared by the above-named Testatrix,
GLENNA ]. HEISEY-,as--and for her Last Will and Testament, in the presence
of us, who, at her request, in her presence, and in the presence of each other,
have hereunto subscribed Our names as witnesses thereto.
\
9Jf ,L" ~ -'"'-"'"' c-1. ,1' cfrt{ -'-7
/dt.- / JL~
residing at ~;, 4./~ , rf.
residing at x::i--,,:~ / /if
November 8, 1983
CODICIL TO WILL
ITEM THIRD: APPOINTMENT OF EXECUTOR:
Substitute Lloyd R. Heisey in place
of Avery A. Heisey, as Executor of My Last Will and
Testament and to serve without Bond.
c
~}'~(Seal)
Witness: (/}L;~,/ '1~
Witness: ~rJ. ~
~~
~
.. ! ~ :.~ ~.Y~,t-, '::~:".:. ...
d':i CiI.r.1,';~R. _".. ,. ~ ,. . _ . ..'
UZASETlt10WIl BOllO, UmCi.2lF:; >.:......
MY COi'l1fAlSSIOfl EXPIlll:S 1:!',,?L:..
M.mllO(, P~nnsylvania Asscci~t:(;;. ;,' .: .
[jlandafl :I{" M.ifle4
Attorney at Law
1255 South Market Street, Suite 102
Elizabethtown, Pennsylvania 17022
(717)361-8524 -- Fax (717)361-9071
February 22, 2006
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
RE: Estate of Glenna J. Heisey
Will No. 21-05-0649
Dear Sir or Madam:
Enclosed herewith are an original and two copies of the Inheritance Tax Return in the
above-referenced estate. I have enclosed a check in the amount of$15.00 to pay filing fees.
Kindly return a stamped copy of the return and a receipt for fees paid to our office in the
enclosed self-addressed stamped envelope.
Thank you for your kind attention to this matter.
Very truly yours,
fJn '1"tU;:) ) 7. /j If tJ0,
Joanne M. Miller
Legal Secretary to
Randall K. Miller
Enclosure
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