Loading...
HomeMy WebLinkAbout02-16-07 . It ~ .....I 15056051058 REV.1500 EX (06-05) PA Department of Revenue * Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death OFFICIAL USE ONLY Cc>unty~e Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 06 1060 Date of Birth 195-42-7947 11/18/2006 06/28/1951 Decedent's La')t Name Suffix Decedent's First Name MI Garman Karen E (If Applicable) Enter SurvIvIng Spouse's Information Below Last Name Suffix Spouse's First Name MI N/A Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW <aJ 1. Original Retum THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS c::..<~ 2. Supplemental Retum i:;:::) 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required c=t 4. Limited Estate ,-"''''''l. ~"J c=> C> 4a. Future Interest Compromise (date of death after 12-12-82) C;) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c=> 10. Spousal Poverty Credit (date of death C:) 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Tele~hone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received . ..0_ 8. Total Number of Safe Deposit Boxes ca:> Jacqueline M. Verney Firm Name (If Applicable) 44 S. Hanover Street r-' (717) 243-91~ g 'REG'STER~~I.SllSE~ 'Je) co "~-:r- -~rTl < ~~~) 5% en Second line of address f-~) -,cj ~ -- First line of address =:::; ~ ;> City or Post Office State ZIP Code DATE FILED --.J Carlisle PA 17013 Correspondent's e-mail address: Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. .Slr~N 21SP~~NGRETUR~_ ____ ADRSS .5 () D ~b.. L ~ !I~Wv't I h J~_l].!-tfl ATURE OF PRER RER OTH~ TH'tiEPRESENTATI0 . - ~ I ~~~.~__~________ RES 44 S. ~ M. ~.~. 17&)/"3 PLEASE USE ORIGINAL FORM ONLY DATE ~ -IS-=- 0.7 DATE _ ,??-tS-tJ 7~ L 15056051058 Side 1 15056051058 --1 . -J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Karen E Garman 195-42-7947 ---"---111 __._... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . " 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. . . . . .. 5. 162,922.32 0.00 6. Jointly Owned Property (Schedule F) c..:;) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c..:;) Separate Billing Requested.. . . . . .. 7. 0.00 162,922.32 12,304.29 1,258.63 13,562.9~ 149,359.40 106,769.55 . ,,~,58~.~~ ~. Total Gross A~sets (totaj Lines 1-7'). . . . . . '-' . . . . . . .._....... . .-'.. . . . .. .. . . . . . .. ~. ~. Funeral Expenses & Administrative Costs (Schedule H); . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. !,otal De~uctlons (total Lines 9 & 10). . . . .. . . . . . .~. . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. ~ltt \(~I~lt ~u~ie~.to.T:a)( (LiI1~n1~lTlinusLine 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Arn()lJnl of Une 14 taxable a,tsiblingrate X.12 1,000.00 18. Amount of Line 14 taxable atCOllaterarrate X.15 41,589.85 15. 16. 17. 120.00 6,238.48 6,358.48 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 15056052059 -.J 15056052059 Side 2 L 15056052059 -.J REV.1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Garman, Karen E. STREET ADDRESS 35 Cambridge Ct. : 21 i File Number !: 06 '!1()~? DECEDENT'S SOCIAL SECURITY NUMBER 195-42-7947 -- - CITY Carlisle, I STATE PA I ZIP , 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 6,358.48 317.92 Total Credits ( A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 317.92 Total Interest/Penalty ( D + E ) (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. A. Enter the interest on the tax due. (5) (SA) (58) 6,040.56 8. Enter the total of line 5 + SA. This is the BALANCE DUE. 6,040.56 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 [KJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [KJ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [KJ 2. If de3th occurred after December 12, 1982, did decedent transfer property wilhin one year of death without receiving adequate consideration? .............................................................................................................. 0 [KJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [KJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [KJ 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (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 zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt 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 zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. , . - LAST WILL AND TESTAMENT OF KAREN ELISSA GARMAN I, KAREN ELISSA GARMAN, of 35 Cambridge Court, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, and not acting under duress or undue influence of any person or persons whatever, do make, publish and declare this to be my Last Will and Testament hereby revoking all prior wills and codicils heretofore made by me. FIRST I direct that my memorial be conducted in accordance with the \vishes I have made known to my Executrix, hereinafter named I direct that my body be cremated as soon as practicable after my death, and that said cremation should be conducted by the Cremation Society of Pennsyl vania. I further direct that my remains be given to KATIE DREXLER, to be disposed of in a manner she deems suitable. I request that all friends and family be instructed to present any memorials by a cash donation to their local Humane Society. SECOND I direct the payment of my debts and funeral expenses from my estate as soop after my death as conveniently may be done. I direct that my Executrix shall pay all inheritance, estate. succession and legacy taxes to which my estate or the transfer of any property hereunder may M , . . be subject, and to charge such taxes as part of the expenses of administration, payable out of my estate. THIRD I give and bequeath to my brother, RONALD J. GARMAN, of 13 Mine Road. Lebanon, Pennsylvania, 17042, the sum of One Thousand ($1,000.00) Dollars FOURTH I give and bequeath the sum of Five Thousand ($5,000.00) Dollars to my friend, KATHLEEN KOONS, of211 S. Second Street, Lebanon, Pennsylvania. FIFTH I give and bequeath the sum of One Thousand ($1,000.00) Dollars to TERESA I i' ,: . ---,I /~. FROHM. ,-1,.\''2- ...:1i\.:\"-v)o'~ < )" ( .. . \. ..', \ ,- e" \......~...' . SIXTH I give and bequeath all of my personal and household effects of every kind including but not limited to furniture, appliances, furnishings, pictures, silverware, china, glassware. books, jewelry, and wearing apparel to KATIE DREXLER. SEVENTH I direct that the entire rest, residue and remainder of my estate, whether real, personal or otherwise, and wherever situated. which I may o\vn or be entitled to at the time of my death. or in which I may have any interest whatsoever, vested or unvested, matured or not matured. including any property over which I may have power of appointment, be sold at either private or public sale and the proceeds of such sale, after payment of debts as outlines in paragraph SECOND of this my Last Will and Testament, is hereby bequeathed in equal shares to the following: t/J-' . . 1. HUMANE SOCIETY OF HARRISBURG AREA, WEST SHORE SHELTER, located at Sinclair and Eppley Roads, Mechanicsburg, Pennsylvania. 2. HELEN O. KRAUSE ANIMAL FOUNDATION, P.O. Box 311, Mechanicsburg, Pennsy I vania. 3. KATIE DREXLER. 4. PAPS, Boiling Springs, Pennsylvania. EIGHTH I hereby nominate, constitute and appoint KATIE DREXLER Executrix of this my Last Will and Testament, to serve without bond or security of any type for any purpose whatsoever, and I hereby authorize, empower and direct her to sell and convey, by good and sufficient deed, in fee simple estate, any and all of my real estate, at public sale, for such price or prices, upon such terms and conditions, as in her judgment is best for my estate, ad to that end to sign, seal, execute, acknowledge and deliver all deeds or other instruments necessary therefore, as effectively as I could do if I were personally present. My Executrix shall have all of the pow'er and authority granted a personal representative under presently existing Pennsylvania statutes, and such additional po\vers and authorities as may be granted under Pennsylvania statutes existing at the time of my death. I authorize my Executrix to pay such debts. cremation expenses, administration expenses. and taxes which may be chargeable against my estate from my estate prior to any distribution. In addition, my Executrix is authorized to make any election permitted bY any tax law and no adjustment of any kind shall be made between or among beneficiaries because of the exercise of any powers granted herein. t<.!:f I direct that my estate be settled without the intervention of any court, except to the extent required by law; and that my Executrix shall settle my estate in such manner as shall seem best and most convenient to her, and I empower the same to mortgage, lease, sell, exchange and convey the real and personal property of my estate, without an order of court for that purpose, and without notice, approval or confirmation, and in all other respects to administer and settle my estate without intervention of any court. NINTH If a court of competent jurisdiction rules invalid or unenforceable any of the provisions in this Will, each such provision shall be disregarded, but the remainder of this instrument shall be given full force and effect. All questions pertaining to the interpretation, construction and administration of this instrument shall be determined in accordance with the laws of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have set my hand and Seal to this, my Last Will and Testament. consisting of six type\\Titten pages, the first three of which bear my signature in the margin for the purpose of identification, this ..2 /l~A day of I /" ~ '." t.. ",., v _,~, z-/Jl.:..) L t':....- .2005 /2./ el" ('lQ./7..2h') QvQ~ Lhn.rh/1/'v( / KAREN ELISSA GARMAN, TESTATRIX SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: , ! " t/ ;LI, ,Jjv~u..? ' -J' I ~/,' , ( , ) I aDl.J!.l-A'-,.J ~/ '0f-ti...t1J..AJ-/ I AFFIDA VIT We, KAREN ELISSA GARMAN, j':'C."lA'i-LI"; ,A.V-=-':'N('J, , 1f <:" ' / ~\\cC'\ 'K. ...)St1c\vll$-the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Last Will and Testament as witness and that to the best of their kno\vledge the Testatrix \vas at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. TESTATRIX, ~C1/?J..;Il) ./JaIUI'r./J/h/ , residing I " (.' I 'VITNESS'nr~L.~ IlL)..), residing at /)C-LA...7 J Yk /: J '/. \ ~ .,' WITNESS:tf'MUi.J'-' ~/-';'l 'd' t;v1 v.,.).-c~ , , reSl mg at \...:e; l.- ) S'i~j" ,:~ J . I I)/~ ( let' 7. 17013 Subscribed, sworn to and acknowledged before me by Karen Elissa Garman, Testatrix, and subscri bedaod sworn to before me by 54,,", u. t-I.c N L i" [(^,~' "j and '-~dJ4. .~l...J -/( ~l-f--(,',-I.A.a---/ , the witnesses, this cJ day of._ f/L.Yl't-(li~i '\..... ,2005. -\ L I\..-. " 0/ ILttA._LL .-f{;PU_L- Notary Public () NOTARJAl. SEAl w..ERE F. GSEll, ::JPlt!c CarlIle Boro, ClJnbeI County My ComniIIIon Expne Oct. 9, 2OC8 ACKNOWLEDGEMENT I, KAREN ELISSA GARMAN, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to the law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it 'willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. 1<. ('I' ./.- Cu?t!!'f) eel )l!.l{l jjw~,'[/7Lt n./ KAREN ELISSA GARMAN Sworn or affirmed and acknowledged before me by KAREN ELISSA GARMAN, the Testatrix, this L day of J It-/"'t. J;ct.li L-, 2005. " I '--7 ' ;' !J1tAjj,.. Notary Public ~}:u.... I {" - LL-- / NOTARIAL SSI\J. WEREF.~~ CarIsIe Baro. """"" My Cu.",aeicn expn. Oct. G, IJNQ REV-1508 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Garman, Karen E. FILE NUMBER 21-06-1060 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION M & T Bank checking acct # 611719 2 M & T Bank savings acct # 15004200112792 3 MG Trust401K from employer 4 Orrstown Bank acct # 106800247 5 Comcast refund acct # 09547-365671 6 Donegal Ins Co. refund 7 Highmark Blueshield health ins refund 8 Selman & Co. (Hartford Life Ins premium refund) VALUE AT DATE OF DEATH 23,357.72 60,875.05 42,215.50 35,824.75 124.86 17.00 353.00 154.44 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 162,922.32 rlI M&fBank 499 Mitchell Street, Millsboro, DE 19966 January 8, 2007 Law Office of Jacqueline M. Verney Attorney and Counselor At Law 44 South Hanover Street Carlisle, PA 17013 RE: Estate of Karen Elissa Garman Date of Death: November 18,2006 Social Security No.: 195-42-7947 Dear Mr . Verney: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type..... .... ............... ...Checking Account Account Number........... ........ ....611719 Ownership (Names of)...............Karen E. Garman Opening Date...........................O 1 /28/ 82 (account closed 12/05/06) Balance on Date of Death..........$23,356.14 Accrued Interest $ 1.58 Total............................. ........ ..$23,357.72 2. Account Type........................... Savings Account Account Number.................... ...15004200112792 Ownership (Names of)...............Karen E. Garman Opening Date.......................... .04/08/95 (account closed 12/05/06) Balance on Date ofDeath..........$60,870.46 Accrued Interest $ 4.59 Total................................... ....$60,875.05 . Page 2 January 8, 2007 The above named decedent did not have a safe deposit box. For any additional information on the above accounts, including ownership, statements and closures please contact our High Street Carlisle branch at 717-240-4536. Sincerely, . WL4;nu lJtln flJJr0t;yJ Charlene Warrington, ~::~~~~agement 1-888-502-4349 1" ...."v...,:-..:~<, Y'. ...,...",.700 17lhStreet. Suite 300 ~"'~"""~'f;;,t;.:.";:>;. :,;\..\.; ~nvcr, CO 80202 888-947-3472 .. '.: ..<CHECKNUMBER ..1 A",~"."" . . ....0000549630 11110/2006 P.LI\NACCOUNTNIDrmER 07C17642 PLAN NAME: Carlisle Cardiology DESCRIPTION: Disbursement TAX DESCRIPTION: (l)Early Distribution, No Known Exceptions DESCRIPTION . AMOUNT .', Gross 58,470.09 Fed Tax 14,617.52 State Ta~ 1,637.07 Loan Default 0.00 Net Check Amount $42,215.50 PAID FOR: Karen E Garman 35 Cambridge Court Carlisle, P A 170130000 '\ - ~~ ~~} \V' ^()/D\.o \ \/!T By signing, cashing, and/or depositing this Disbursement check I agree to all of the terms of this distribution. If you have question:; nbot;t your puymc~t, plea~c cal! your employer or p!~n ccrr.1nistr:Hcr. Becau~e the legal and t~x rules for a distribution differ for each person, please consult an attorney or tax advisor. Ta~ forms will be mailed in January of the year following the distribution. ... REMOVE DOCUMENT ALONG THIS PERFORATION ... 1 ') ORRSTOWNBANK A Tradition of Excellence December 26,2006 77 East King Street P.O. Box 250 Shippensburg, PA 17257 To: Jacqueline M. Verney Attorney and Counselor at Law 44 S. Hanover Street Carlisle Pa 17013 From: Traci Shaffer Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of Karen Elissa Garman Date of Death November 18,2006 IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT. ON THE ABOVE DATE. HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK. CHECKING ACCOUNT Account # Title of Account 106800247 Karen E Garman Date opened 8/22105 Principle 35771.83 Accrued Interest 52.92 SA VINGS ACCOUNT Account # Title of Account Date opened Principle Accrued Interest CERTIFICATE OF DEPOSIT Account # Title of Account Date Opened Principle Accrued Interest \VW\\ .urrsto\\ n .coln 'd' UJ \0 ...J \0 0 ...J 0 ..... (I) 0 ;: M CO N (1) '0 Ln <t , e: 'd' M (1) M N ...... t- al 0 0 P:: 0 r:il .... (I) Z ~ 0 ..... en r:il Q,) ~ Ole: M en 0 8: 0 ..... Z t13 ::I: .- u ..... t- ro (\. e: 0- M ro <II - :E: 0- 'U >< <II W <II Z ~: ." < ~~o~ -l:; wi I:t: ~ I Vl:: 1~31 \;j_c:l~ c w en o -I U Z W en - ~ U W J: U 0 0 0 0 ...., ...., If) If) ...., ...., , I '" I '" ~ I I ! i ; I .. ..., .. c ..., ::l C 0 ::l E ~I ~I >- :1 ~ a: U Ej < QJ >, :E ..c: ~I u ~I :E ::> CJ) I i ~ z i w , :2 1 : >- I , < I a. I I ~ I~I o co! Z l""'-1......-l1 <{ ~I~I :2 a: r--I~ <{ N N <.9 \D,"'" W C \.01 o 01 Z ~I w .0 a: \... <{ Qj ~ .0 E 8 ~I~I ~ B 81 I () I- Z W (/) w :s: > 0 0 0 0 .... ...., r-- ... If) \D Ii M M .'. ""'" ""'" w U Z ~ (fJ (3 :.<: w z ~ w ~ ~ E-- U 0:: .:: (fJ ~ W L? Z 0:: 0 \D W H 0 W 0 E-- ...... ::x: Z r-- ~ ~ H W If' .. Z r-i "" 0:: ~ .. ::l ~ ~ ...... ~ M ..., 0 '0 0:: rl .-=: r-- C >< .,... r-i .-=: N ::l III ><: H .. \D 0 .-< 0- W .. ~ 0 0 E ,....; >- . QJ 0 E- o ~ ..... U 8 o:l '0 .... ~ .. ..., III :> L? u ... c >, Qj ... QJ QJ ~ III \... QJ 8 ..c: il :.<: ,....; (fJ .. u ~ ... .:: :3 III ... I+J QJ .-=: ..., Z 0- Q) ..., 0 '0 0:: C '0 0 ..... w Q) ~ E ..... Z QJ :> o:l (fJ U ..... :> ..., 0 :.<: Q) III 0 I+J C1) ... ~ QJ ..c: U h h 0 0- U ~ U 0- - z ~ z ;t, ~ ~ L? >< 0:: L~ ~ W 0 L? ...:J Z 0 W W H ::x: 0 Z ~ ~ 0:: W co ~ ...... ~ 0:: r-i 0 U ~ \D .. 0 ~ r-i QJ M W ...... \D E '" ...:J U"\ ~ ro -d' (fJ 0 ... N Z \D H 0 M '" ...:J r-- ~ \D \.< '" 0:: M .~ 0 ClJ '" ~ '" '0 0 U co .-< r-i N ..... \.< 0 .. 0 :> QJ x .. QJ ..... .0 0 E .. ..., E ..., H III 0 .u ::l U Z H < Z III \... ... QJ g g E E ..., .0 .... ..... c E 0 0 l\l III 0 Q) I-< I-< ..... .-< U :E t? t? () U III ~ Q,)ia Q,)E cnQ,) a: ::It 0'0 >.:;..... 1Il0 ~o-'Oc: C:..OQ,)E 50.-;]::1 EQ,)(5.co < ~ t:.cnu ~c:lIl::l III III >0 Q,)_lll>- :x: a. a. Q,) :0 '';:; ~:; :g :: 0'0 :O>-Q,) 'iij a c: o a. III III Q,) ...... a: 0'0 III .. ;~~ .8 c: 3: Q,) .. E~.2~~ Q,)a.::;:uu :E .............. '0 III lllQ,) c:~~ 0>1lI Z o.c UU III -.. Q,) Q,)Ol '0.. .- III >.c ~u a. N N o ..... a <l' ,., o ..... ..., M- M_ \0 o o o 0. ~ o o. 01 .". .....: o o o o o :1 cD, ,.,: ,., cD ,., ~I I I o o o o 0, ~: ",I ~' "'1 ! ,., cD ,., N ..... o o o 01 0, o ~ 0.... '0 N.... ..., , Nj ,., cD o 0 o 0 <l' ..... c.... .....c.... N IIlj j 8H t:l H Oil Q,)Q,) ._~ u ~ u o 0 .. > 0 H 0 H .-'- - .. 8 >- 8 >- >>'OQ,) 0:: 0:: ..~~ocn W UJ Q,)(J)cnU- 0 Ul ~ Ul '0 _Q,)Oz UJ UJ .:; '0 0 0 :u ..: '-D u '-D U ~ Q,) Q,) O~.o ii! ~ ~ ii! ~ ~ Ul a.-;:;:a.Q,)ErLI<l'...:lOOrLI.......:lU"l...:l Ci>cn::le.....::lNe.....::lN..: ~ z:;~ ~:;~ ~b ..... COMCAST CABLE COMMUNICATIONS 04OCBDT-OOOO03627429 4008 N. DUPONT HIGHWAY ATTN: SUPPORT SERVICES NEW CASTLE, DE 19720 @omcast. 04317 KAREN' GARMAN 35 CAMBRIDGE CT CARLISLE, PA 17013-2733 1'11111'11111'1111111,.11'111,11",1" " .,,11'11 " 111,1111,1,1 Dear Karen Garman, The attached check represents a subscriber refund for account number 09547-365671 in the amount of $124.86. If you have any questions or concerns regarding the refund check you can write us at the address above or call Comcast's toll free customer service number at 1-888-COMCAST. - - - - === - ===- Check Date: 01/06/2007 Check Number: 158161328 - - - - - - === =- =- DETACH AC\D RETAI:\ TIllS ST.HDIE;\T THE A TT,~CHED CHECK IS I" P,~ Y'IE"T OF ITE\13 DESCRlllED ,~!lO\"E IF "aT CORRECT. PLEASE "onry LS PRO\IPTL Y ,,0 RECEIPT DESIRED '~::.;:~~ ~jtt~~~""""""~.l:H ci I~' .ur...: I:{ ~:.: ,.~"'9'., ~.ll{.]:J::.t t] :,.~ t1 ~~ ti;{.Ii I ~ 1-1.'1',. ,: ."~'l H~ :{'):.I:H ~.. ~ .1'N.1:f ~ II ~ [C'J: "U I. 511I ..;:;.; ,. ~ ',:.", .-:"; .: ~~..', =OMCAST FINANCIAL AGENCY CORPORATION \ COMCAST CABLE COMMUNICATIONS GROUP COMPANY 158161328 23.97 1020 01/06/2007 )AY EXACTLY: ONE HUNDRED TWENTY FOUR DOLLARS AND 86 CENTS I S *......124.86 ro THE ORDER OF: KAREN GARMAN ;UBSCRIBER ACCOUNT NUMBER: 09547-365671 /","oi-Y ,llt"d b... lnte\l:r31et1 PJymcnt Svsr~ms Inc.. E",.d~.....ood. ColorJdp '\h,rg;m Ch~s..: Bo1m.. N A.. Dcn..cr, Colori1d~ -.... , J,;'" " i.. . EXPLANATlON OF AOOmONAL SECURITY FEATURES INOlCATED ON REVERSE SID E i .: III ~ ~ 8 :l 0 g III 1:.0 2000 g ? g I: b 800 . 58 . b . :l 28 .111 GARMAN KAREN E C/O KATIE DREXLER EXEC 30 DREXLER LANE NEWVILLE PA 17241 AGENT NUMBER: 0004321 ISSUE DATE: 01/02/2007 Meo 05 ; MOD 10 PLEASE FOLD AT PERFORATiON BEFORE SEPARATlhG CHEC~ 'rJllI_. -,: !;I-J. ~ t1 =I..!.a 1;1!-'"iI t:.~.;.lj 'i::l(.II: 1.\...~,. tJ\.~ ..j:1 ~.] :l.l., ~(ti :i'~'1 ~I'I'] ~ 6','J:I 11::.1 :/.1:.i ~ ;411. ~rl'; 1-1-.1.':, i'~ci ;,.,:.;:, ': II" 11~-1 ;{.] i1 ::1 =t;J ;lj ~ III({.. r. FOR G DONEGAL INSURANCE COMPANIES RETURNED PREMIUM 1057847 INSURED: GARMAN KAREN E ~ARMAN KAREN E C/O KATIE DREXLER EXEC 30 DREXLER LANE ~EWVILLE PA MELLON BAN~ PITTSBURGH. PA 60.16'~ 433 ISSUED BY: DONEGAL MUTlAL I~S. CO. DATE: J~\UARY O~, 2007 CHECK NO. 2623181 PAY TO THE ORDER OF PAY I S ..............................17 00 I ...............,.,..". 17241 CHECK IS VOID OVER $5,000.00 WITHOUT TWO SIGNATURES VOID IF NOT PRESENTED WITHIN 6 MONTHS FROM ISSUE DATE -' II" 2 b 2 ~ l. B ~ II" I: 0 L, ~ ~ 0 l. b 0 l. I: o l. L, III 0 7 g l. II" S~ BUILDING M INSURED EN"lRONMENT. E X P LAN A T ION o F PAY MEN T S PAY TO: KAREN E GARMAN 1701 LINGLESTOWN RD. HARRISBURG PA 17110 DATE: 12/08/06 CHECK: 100077 PAY MEN T DES C RIP T ION PAYMENT AMOUNT REFUND OF PREMIUM 154.44 kd- \ ~ C\" CC<; \ . r; \t " \f-'\ \}\ Ji ~ 154.44 TRLg HARTFORD December 7, 2006 Estate Of Karen E. Garman 1701 Linglestown Rd. Harrisburg, Pa 17110 * * * * TERMINATION NOTICE * * * * RE: H~~TFORD .~MINIST~~TION Insured Number: 901001245 This letter is confirmation that your insurance coverage for the pc:icy(ies) listed be:cw has been (will be) terminated for the reason(s) given. If you would like :0 determine ~: it is possible to have your coverage reinstated, please call our office at the toll free number listed below between 9:00 a.m. and 5:00 p.m. Eastern Time or email us a: customerservice@selma~.cc. INSURANCE COMPANY Hartford Life And Accident POLICY NO. GDC 100009999 10 COVERAGE Member Disability TERMINATION DATE 11'1906 REASON DTII Expanation of Reason Codes Code Description DTH Death Remarks Please accept our sympathy for you~ loss a~d tha~~ you for allowi~g ~s to se~vice your ins~~a~:e nee~s. P:~3S~ d~ r-- hesitate to contact us if we can be of fu:~re se~vice. c.~~ C'~3:~~~~ Ser~ice :~~~ ~ill be tappy ts ass~s: Wlt~ any c~estic~5 y~~ ~~y ~~~e. ...." . .. ,,' .. - - ,...,.... . - - ~ Kep~ese~:atlves a~e ava~_ao~e oetwee~ tne :l~~=S 8: ~:0~ a.~. a~a =:_w . :"c..:::'.:.; .::::-. at 1-877-320-0484. Si:-'~c:e=elYI The Hartford c/o Se.lman & Company Pla~ K~.inist~ator The Hartford 6110 Parkland Boulevard, Su~te 200 Cleveland, Ohio 44124-4187 877-320-0484 Fax: 440-646-9339 REV-1511 EX+ (12-99>* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Gaman, Karen E. FILE NUMBER 21-06-1060 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Auer Memorial Home & Cremation Services, l'1c 41 OU Jonestown Road Harrisburg, PA 17109 Memorial tree planting & luncheon 1,435.00 200.00 2 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 5,000,00 Name of Personal Representative(s) Kathleen A. Drexler Social Security Number(s)/EIN Number of Personal Representative(s) 206-62-5875 Street Address 30 Drexler Lane City Newville State PA Zip 17241 Year(s) Commission Paid: 2007 2. Attorney Fees 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 350.00 5. Accountant's Fees 6. Tax Return Pre parer's Fees 100.00 7. Advartise Letters: Sentinel-$144.29; Cumberland Law Journal-$75.00 219.29 TOTAL (Also enter on line 9, Recapitulation) $ 12,304.29 (If more space is needed, insert additional sheets of the same size) AVER MEMORIAL HOME AND CREMATION SERVICES, INC. 4100 jonestown Road. Harrisburg, PA 171 09 . 1.800-720-8221 . Fax 717-541-9943 · Shawn E. Carper, Supervisor 261258 MC5 11-19-2006 Mr. Ronald Garman 13 Mine Road Lebanon, PA 17042 Karen Elissa Garman - Deceased SPECIAL CHARGES X Direct Cremation Forwarding Remains Receiving Remains Immediate Burial Nationwide Guarantee Program Worldwide Travel Protection TOTAL SPECIAL CHARGES $895.00 $895.00 PROFESSIONAL SERVICES Services of Funeral Director & Staff Embalming Other Preparation of the Body Facilities & Staff for Viewing ($200/hour) Facilities & Staff for Funeral Service Facilities & Staff for Memorial Service Staff & Equipment for Viewing ($200/hour) Arrange/Deliver Ashes To National Cemetery Statf & Equipment for Memorial Service Private Family Viewing/Witnessing Cremation Special 48 Hour/Weekend Cremation Service X Packaging And Forwarding Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains Medical Documents/Courier Fee TOTAL PROFESSIONAL SERVICES $55.00 $55.00 AUTOMOTIVE EQUIPMENT Removal Vehicle Casket Coach Flower Car Lead Car/Clergy Car Service Vehicle Family Car TOTAL AUTOMOTIVE EQUIPMENT 0ver0 p (;.1<-' I $0.00 MERCHANDISE Register Book Memorial Folders Thank You Cards # Remembrance Package Casket X Cardboard container Cremation container Urn Burial Vault Veterans Flag Case Grave/Memorial Marker Other Other TOTAL MERCHANDISE $0.00 CASH ADVANCED ITEMS Grave Opening Cemetery Equipment Vault Service Charge Newspapers Newspaper Clergy Church/Organist/Soloist Flowers X Crematory Charge X County Coroner Cremation Approval Fee X Certified Copies DNA Preservation TOTAL CASH ADVANCED ITEMS $400.00 $25.00 $60.00 $485.00 SUMMARY OF CHARGES Special Charges Professional Services Automotive Equipment Merchandise Cash Advanced Items SUB TOTAL $895.00 $55.00 $0.00 $0.00 $485.00 $1,435.00 DISCOUNT -$550.00 TOTAL $885.00 AMOUNT PAID 11-19-2006 -$885.00 00.00 BALANCE DUE THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES P'\ljt. ;1. PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tanunv Shoemaker, Classified Advertising Manager, of The Sentinel, of the Courtty and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s) Decenlber 06,13,20,2006 COPY OF NOTICE OF PUBLICATION EXECUTRIX~ Letters TeSlamentary on the Eslale of KAREN ELISSA GARMAN, late of the Borough of Carl lise, Cumberland County. Pennsylvania, deceased, have been granted to the undersigned. . All persons knowing themselves to be Indebted to said Eslate will make paymenllmmediately, and those having claims will present them for settlement. Kalhleen A. Drexler, Executrix . c/o Jacqueline M. Vemey; Esquire << South Hanover Street Carlisle, PA 17013 Affiant further deposes that he/she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of pu lication are true. Jacqueline M. Vemey, Attorney 44 South Hanoyer Street . Ca~isle, PA 17013 Sworn to and subscribed before me this 20th. day of December 2006. ~'R~ Notary Pu IC My commission expires: q/, /O~ COMMONWEALTH OF PENNSYLVANIA NomrIaI Seal ChriStina L. Wdfe. Notary ~ CarliSle Boro. Q.Jmbeltand '^"" ", My ~ expires Sepl1, 2008 . Member. Pennsylvania Association Of Nolanes RETAIN THIS PORTION FOR YOUR RECORDS PA 17013 JACQUELINE M. VERNEY PUBLIC NOTICES LETTERS AL N BILLlN DA T LINE robik 12/20/06 38 * 2 TART DATE T DATE 12/06/06 12/20/06 RATE NET AMOUNT GROSS AMOUNT LGL 137.94 137.94 01PRF 6.35 3 PROOF OF PUBLICATION DAYS RUN PURCHASE ORDER PAY THIS AMOUNT Est. Karen Garman 144.29 173.15* * AFTER 01/19/07 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 717-240-7176 Fax your legals to 717-243-3754 attention Tammy Shoemaker You can also EMAIL yourlegaltoClassifiedads:classified@cumberlink.com Please send a cover letter including your name and address as an attachment "" CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 December 29,2006 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Jacqueline M. Verney, Esquire Karen Elissa Garman, ESTATE RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. --------------------------------------------------------------------- --------------------------------------------------------------------- Advertisement inserted on following dates: December 15,22,29, 2006 Advertising Cost Second Proof Request 75.00 $ 0.00 $ 0.00 $ 75.00 ------------- Proof of Publication Payment received Total Amount Due $ 00.00 . --------- -------- Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYL VANIA ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: December 15, December 22 and December 29, 2006 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Garman. Karen Elissa. dec'd. Late of the Borough of Carlisle. Executrix: Kathleen A. Drexler c/o Jacqueline M. Verney. Es- quire. 44 South Hanover Street. Carlisle. PA 17013. Attorney: Jacqueline M. Verney. Esquire. 44 South Hanover Street. Carlisle. PA 17013. '-- {V _ o AND SUBSCRIBED before me this day of December. 2006 U NOTARIAL SEAL LOIS E. SNYDER, Notary Public . Carlisle Boro, Cumberland County .~ My C~mmission Expires March 5, 2009 REV-1512 EX+ (12.03) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & UENS FILE NUMBER 21-06-1060 ESTATE OF Garman, Karen E. Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 10 2 Walmart Credit Card acct # 6032 2031 31598897 48.13 PP & L acct# 73310-71005 electric bill 145.27 Chase credit card acct # 4417 1299 6614 3261 108.73 Comcast acct # 09547 365671-01-0 93.62. Masland Associates, Inc medical bill 20.00 Cumberland-Goodwill Fire Resue 367.00 Detra In Home Care 352.00 SprintlEmbarq acct # 717 243-4458-998 5.82 Carlisle Borough water/sewer bill acct # 06408 16.18 West Shore EMS - Carlisle 101.88 3 4 5 6 7 8 9 1,258.63 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) BALANCE aUMMARY< - - - - - - - - !!!! - = - ::.CCOUNT.INFORMAnoH..i:;:::::~:::.::t::::.::::;:::~:.:::::.:::::~~:;::::::::::::.::~\t::: &032203131598897 1111812006 12/13f2006 31 $4,300 $200 $4,251 $200 $0.00 $4813 $15.00 .. .". $0.00 $0.00 $0.00 $48.13 $0.00 Previous Balance e Paymenls .I-.flNANCE CHARGE (net) . New Purchases + Cash Advances +1- Card Securtty, Insurance, Fees & DebitlCred~ Adjustments (net) = New Balance Minimum Payment Account Number: S1atement Date: Paymenl Due Date: Days In Blllilg Period CradltLile Cash Advance L1m~' Available Cred~ Available Cash. - - - - - - - . SM ,.verse tor CIIsh .ctv.nce guidelines. - - .''',.. ----. ....-........-.......... . . .. . . . - . . . .. ...... . -...... ... ... -..... ...................... ........................... ....... ...-.......... ........... ...... ............ ..... ............... . .............-. . . ".... ....., ..' .---,-- .-.. .. .... ..............-.............. ...-....".', - -. .... ....-.....-.........-. .. ............. ..TRANSACTIONSlJMIIIARVi": Post I Tran I Reference Date Date Number - - - iii !!!!!! = = - = li~:1 I Description Amount 11104 11104 P911200N70117KOWL NOBLE BLVD CARLISLE PA THE PERIODIC RATE SHOWN ON THIS STATEMENT MAY VARY. REG $48.13 .ANANCECHARCl:.:SUMMARY::: ................-.... . .... .,.......... .... ..".- -........ ..-............. ..................... ..... .......................... . . . - . - . . . . - . . . . . . . . . . . . . .. . . . . . . ......".......... ..,-. ......-.....-... .-. .... . . .. .., .,. . .. . ... . . . . . - . . ....._-....... ...........-..... ...............-. How Your FINANCE CHARGE Computed on Pla'n Daily Co"espondlng FINANCE Was Calculated Average Daily Type Periodic Annual CHARGE Balance Rate Percentage Rate Purchases and Cash Advances $0.00 REG .03389% 12.37% $0.00 ANNUAL PERCENTAGE RATE 12.3700/. Total Periodic FINANCE CHARGE $0.00 CARDHOLDER NEWS&: INFORMAT10N<> .... Visit www.ge.comlchangealight and take .Change aUght. online pledge by 11130106. Download coupon for $1 off GE Energy Smart (TM) , ENERGY STAR~ qualified light bulb. Purchase at Wal.MarMD. Replace light bulb at home with an ENERGY STAR ualified Ii ht bulb. PAYMENT DUE BY 5:00 PM ON THE DUE DATE. We may convert your payment into an electronic debit See reverse side for details. NOTICE: See reverse side tor Billing Rights and other important information. 5404 0021 RFD 7 18 061117 Page 1 of 1 2480., . 1 9112 3100 0078 PPL Electric Utilities Electric Service For: KAREN E GARMAN 35 CAMBRIDGE CT CARLlSLEPA 17013 Final Bill Questions about this bill? PI.:as~ contact us by D~c 12 at 1-800-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. AII~ntown. PA 18104-9392 www.ppld.:ctric.com . . . \ ,I, I ".:.~I::.:'::' pp 1::-. +. ..... " '.. Page I 73310-71005 Summary Page Balance as of No v 21, 2006 Char.!',.es: TotarPPL ELECTRIC UTILITIES Charges Total Charges I Pay Thls.AmounfNo Latirthan~c 12,2006" Account Balance w ca S 119.36 $ 25.91 $ 145.27 .' ". ".\: $145.271 S 145.27 Electric Use This graph shows your ~I.:ctric us~ ov.:r th.: last 13 months. Typcs of Mcter Readings: Actual _ Estimat.:d 0 Customer 0 48 40 KWH . Av~rag..: Pa Day 32 24 16 ---- 8 (J D J r M.\\il J J i\ S 0:\ D 2()0~ \-lonths 2()()6 Meter Reading Information Average - Nov Temr~rature K WB Per Day Yearly Lse: Actual Actual KWH BIII~d 31lt 109( ~: 2005 36F 44 2006 49F 34 Total Use 10179 8374 A\"er; Mont! lke 21l()4 . l'OV 2005 Dee 200:' - :\ov 2006 Other important info~mation un back -+ CIHASE 0 Statement Date. Payment Due Date: Minimum Payment Due: 10/19/06 - 11/1&06 12/08106 $10.00 Previous Balance Payment, Credits Purchases, Cash, Debits New Balance $58.48 -$58.48 +$108.73 $108.73 Total Credit Line Available Credit Cash Access Line Available for Cash $9.000 58.891 $1,800 $1,800 CUSTOMER SERVICE In U.S. 1-888-305-4016 Espanol 1-888-446-3308 TDD 1-800-955-8060 Pay by phone 1-800-436-7958 Outside U.S. call collect 1-302-594-8200 ACCOUNT INQUIRIES P.O. Box 15298 Wilmington, DE 19850.5298 PAYMENT ADDRESS P.O, Box 15153 Wilmington, DE 19886-5153 VISA ACCOUNT SUMMARY Account Number: 4417129966143261 VISIT US AT: wwwchase.com/creditcards TRANSACTIONS Trans Date Reference Number Merchant Name or Transaction Description Amount Credit Dee 10121 24164076294091008207256 TARGET 00020990 CARLISLE PA i9"i26 ~f29~2990222012 i~1127~ 890 .~. Payment J~~ci~'i'~ Ele~~ron1: ~hi'. . _ .. . .. 11/0124694146305000502437357 SWIVEL SWEEPER ONTEL PROD 800-2609988 NJ $38- 5848 - --_.._--- -. 69 :' FINANCE CHARGES Category Purchases Cash advances Daily Periodic Rate Corresp. 31 days in cycle APR .02439~;' 890~;' V .06436% 2349% Average Dally Balance Finance Charge Due To Periodic Rate SO CO SO 00 Transaction Accumulated Fee Fin Charge 5000 so 00 5000 so 00 FINANCE CHARGES SO C. SO c: so 00 so 00 Total finance charges SO 0.: Effective Annual Percentage Rate (APR): 0.00% Please see Information About Your Account section for balance computation method. grace period, and other important informatior The Correspondm(J APR is the rate of interest you pay when you carry a balance on any transaction category The Effective APR represents your total finance charges - includmg transaction fees such as cash advance and balance transfer fees - expressed as a percentage IMPORTANT NEWS PLEASE NOTE THAT YOUR PAYMENT DUE DATE HAS CHANGED AND IS EARLIER THAN IN PREVIOUS MONTHS TO SELECT A PAYMENT DUE DATE THAT WORKS BEST FOR YOU. PLEASE CALL CUSTOMER SERVICE. TO PAY THE AMOUNT DUE, YOU CAN ACCESS OUR WEBSITE DISPLAYED ON THIS STATEMENT OR CALL 1-800-436-7958 HOLIDAY SHOPPERS. Get low prices on MP3 players. toys. digital cameras, lIat screen TVs. and lots more through Trilegianl's offer. You can get up to 550 cash back on purchases with your Shoppers Advantage membership. CALL 1-866-883- 7233 TODAY Visit the ASPCA online store at aspca.org & help animals as you shop for the holidays! You'll find great gift ideas for everyone on your list - cards too! Purchases made using ASPCA's links to Amazon.com and 18oollowers.com also support the ASPCA. Give a gift that gives back to animals this year! X GCUOlJ04 F I 533335 C ~ 000 N ., 18 0611 18 Page 1 ct 3 COll..! ~lA ~1A 653tlU 32110CCCC3C;o<.:6:;..:-: @omcast~ ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Visit us on the web at www.comcast.com 09547365671-01-0 12/15/06 $93.62 KAREN GARMAN How to reach us... How to reach us: 339 Baltimore Rd. Shippensburg. PA 17257 717.243-4918 or 800.995-6545 Telephone Customer Service 24 hours a day. seven days a week For service at: 35 CAMBRIDGE CT CARLISLE PA 17013-2733 Summary of Charges Statement Prepared 11/22/06 Billed from 12/01/06 to 12/31/06 F:~~",i9!1?_Bat<!n~~________. __________ __.___.Jl_~.62_ PaY_r:D_~n!?_ (~n~I~_d~paY_f!!e!lt?r~cE3!~~Q..b.Y1JP~Q.~_______ _ 93 .6~ ~r_ Q~.!?I~.0Lig~Q)_~El!"ic~s______________ 4 7.7 ~_ QQm_c~J!;jgl1~p~~~LL~.lernet ______. 42.95 Taxes.Surcharges.& Fees_________ _._____ ___ _H_________ n_ ___ __ ____ __?}2 Total Due $93.62 Detail of Charges on back News from Corn east Thank you lor your prompt paymenl. For your convenience. we now accepl regular and alll0lnalir, m0nrhly cr<?dil card [1ayrn<?nls and direcl d8bil. ....... DATE 11/14106 11/14/06 11/15106 11/16/06 11/17/06 CURRENT $350.00 DESCRIPTION OF SERVICE I AMOUNT I INS. BAL I PAT. BAL I LINE ITEM BAL ENCOUNTER 60820 FOR KAREN WITH BERO MD, CHRISTOPHER J 99222 -Initial hospital care, NewlEst Mod Sev PR $150.00 99231 - Subseq Hospital-NewlEst Stable 1 $52.00 99231 - Subseq Hospital-NewlEst Stable 1 $52.00 99238 - Hospital discharge day $96.00 ENCOUNTER TOTAL $350.00 $130.00 $52.00 $52.00 $96.00 $330.00 Balance is your responsibility. Please notify us of insurance changes promptly. Thank you. . ~~ \J.\,11~lp ~ \~~ $0.00 $0.00 $0.00 $0.00 90-120 DAYS OVER 120 DAYS TOTAL ACCOUNT BALANCE $350.00 30-60 DAYS 60-90 DAYS We are installing a new computer system. You may receive two statements during the conversion process. Both are your responsiblity. Please call (717) 249-8871 with any billing questions. $20.00 $20.00 $350.00 DUE FROM PATIENT 20.00 ;\L\SLA:-.iDASSOCIATESI:-.iC . 220WILSO:-.iSTREETSl'ITEI09 . CARLlSLE.P:\17013 Cumberland-Goodwill Fire Rescu GENERAL RECEIPTS PO BOX 12910 PHilADELPHIA, PA 19101 Phone #: (800) 367-0512 Federal Tax 10: 23-2298422 PATiENT rlA/.1E: KAREN GARMAN 2892 CG0604323 11/14/2006 ?_--\7~:::~;7 ~;'.... \.~:':: . INSURANCE: HIGHMARK ZAR 109996463001 CALL NUMBER D~TE OF c..~:"'_ Tt:'~l~ OF C";__ * NMI INS1 CG0604323 ==18',1 Police/Fire/911 35 CAMBRIDGE CT CARLISLE REGIONAL MEDICAL CTR CA....~i..::,. KAREN GARMAN 35 CAMBRIDGE CT CARLISLE, PA 17013 : : -\ -; ... BREAST CANCER LUNG CANCER CANCER Generalized Weakness .1; __'; _ ._.. .- - ~ --:~-- -~:"j :. = . BLS EMERGENCY BASE RATE MILEAGE CHARGE GLOVES A0429 A0425 A0398 1.0 2.0 1.0 350.00 7.00 3.00 Total Charges - :-.: "':' -:.-' '''',' ,-' = ":' -' _', -' '-', t " ~J- \1-\\1\ C~ ~ ) "~"\ 350.00 14.00 3.00 367.00 Total Credits 0.00 $367.00 . .. BETRA In Home Care 1026 Ritner Highway Carlisle. PAt 70 t 3 Invoice DATE INVOICE# Q/~nI2()nh ") Q 1 Q BILL TO Ms. Karen Garn~:1!l c/o Ur. ua \ III 1'.~1I111 Belvedere Medical Center 850 Walnut Bottom Road r~rli"lf' p~ 1701 i PATIENT NAME Karen Garman DESCRIPTION HOURS RATE SERVICED AMOUNT AIDE: EVE/\;VEEKEND ') 22.00 L) 22 2006 ~-+()() - AIDE: FVF/\VF I: I~ I:N [) ') .., ") ()() l) .., ..J.!: ()()(,\ _L1 (H) AIDE: EVE/y\"[LKLN D ') 22.00 l) 2.5.2006 -+-+.()() - AIDE: EVE/\\'E[KI.:~f) ') ') ') 00 l) 26/2006 Jl.(l() - AIDE: EVE/\VEEKEND ') 22.00 L) :2 7/2006 ~-+.()O - AIDE: EVE/\VEEKEND ') 22.00 9 28/2006 -1--+.00 - AIDE: EV[!\\'E[KI~\;D ') 2:2.00 L) 29 2006 ...;.-i-.(}() - AIDE: EVE/yVTLKLND ') 22.()() LJ .3() 2()O6 -+-+.()i) - .. '1 -\ ~i~j '-. .~ ;.J ~;'..;.: ~...... _~:-.-r- . ;......;.-'"'....... Amount i" P8St Dllt' Pll';l"'t~ Pel\' Promptly. j U leU ...., ,- ~ . .... ..l.' _' ..::.. \I \. J MA S~ r'i:; ~: :~.. r ~.! -...-". .~Sprint. ~Q' Your communications company is now EMBARQ Monthly Statement November 25, 2006 Page 1 of 5 Account Number 717-243-4458-998 Payment Options & Contact Info Current Charges At-A-Glance D Retail Store in Your Area CARLISLE 346 York Road In the Sprint Building Embarq Services Additional Taxes Be Charges Surcharges Total '1 Long Distance - Page 4 3.95 1.87 5.82 Pay Online EMBARO.com/myaccount 3.95 5:82 Pay by Phone 1-877-813-760-t Customer Service 1-800-829-8009 Repair Service '-800-788-3600 Internet Address EM BAR O.com/residenti al Previous Balance Payments & Credits Balance Current Charges Total Amount Due ( 48.83 -48.83 .00 5.82 5.82) Current Charges Due By: If received aher December 25: 12/19/06 5.89 '''''1"1'1'/'" J @ PI~ilS~ R~c:yc!~ . ~... .~ ~ " ~.t:'! '1#""Il~' ,t, '..... '. . f ~ ~~ '~J ',~ .~.. r.. ....;. ~, BOROUGH OF CARLISLE P.O. BOX 340 CARLISLE. PA 17013-0340 UTILITY BILL C;.J.3II'j'::S..3 r1Qi-.ir::j 7~3\j ...l..l\l. TO ~.Jt) i-".I'.1. \,\lG\~O'; ( ,.: ?, 1\)""\ Y I == I ~' .=: ' .:-: 3.=. ...,: j :' ,'1.= -':':':~' , .:;;- 'J -:--. 1'4':::~~..JI~: .';~!~~_/..__.~:"I ~I l"~l~ L_'-} I J 06408 125904 11/30/2006 12/25/2006 16.18 I t, ACCOU'.T CIO. BILL NUI\18ER BILL D"'TE . ' AMOUNT DUE n-.;.; ~I:"L t:.~'.:~ ~.r~'::>- ',._ ~. ,- ~ ~ ::::':"r ,J =~,~\~ -;-:-4:: F:'L-;_ D:. ~:,.:. ~-'..:-:; ;:",:',..'.:_ T', .;;: :".E .-;;~::J'~::'. -.... il.~:::~ :':'_ ;~J::,::~' :,:::.,' ~ ;F ,~:.' '.~::'. ~ ~~:._; ~j()T ~::::_'. ?:EC::I'. ~J t .','. F I"; : t -,.'. '- -"~."'" , 35 CAMBRIDGE CT KAREN GARMAN 35 CAMBRIDGE CT CARLISLE, PA 17013-2733 t f ---_._---~_.._~---_._-- --_.~--~--------_._._------_._--_._~-_..- CODE FFO\! TO p~= ..iIJUS ?::;AD!,'JG CUi'iFii:i'.jT READI,\iG USAGE ICUi CHARGE ~ 11/15/2006 11/21/2006 5/8" 1ilATER , 223 223 F o .co .:. ~ 5/8" SEWER .00 f I 1- 12/25/2006 16.18 .00 16.18 ?..;t;i":',~:fJ::';?';~.---'~'_._--' -- -" . ;.'-/!!,~...,; .:,~;,,~'-\c:r;"T~.~.r~~~~''.~:~::::~~~~ . WEST SHORE EMS - CARLISLE 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 Phone #: (800) 367-0512 Federal Tax ID: 23-2463002 ...JL. ...... ~~ ~ "'T:S"" STI01'"'T ~)L l' I: h1. PATIENT NAME: KAREN GARMAN 148821W PATIENT NUMBER: CALL NUMBER: DATE OF CALL: TIME OF CALL: CALLER: FROM: TO: 56554 WCS 148821W NONE 11/16/2006 12:54 PM CARLISLE HOSPITAL CARLISLE REGIONAL MEDICAL CTR MANORCARE HEALTH SVCS - CARLI: INSURANCE: HIGHMARK ZAR109996463001 HOSPICE OF CENTRAL p, 195427947 KAREN GARMAN 35 CAMBRIDGE CT CARLISLE, PA 17013 REASON(S) FOR TRANSPORT CANCER INVOICE DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT STRETCHER One Way Transport A0999 1,0 98.64 98.64 Transport Van Mileage A0999 1.0 3.24 3,24 , I I I I I I ! I I I I I I I Total Charges 101.88 DESCRIPTION OF PAYi\lENT RECEi?T PAY/.IE,'iT DATE A.'.lGl....;..:-;- '1 ~~ q~ \ V.I)- cf r G~ ~()'\ Total Credits - .. ":':. ,- -, . ! = - - -.. . --- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ..,....._~.._- - . . BENEFICIARIES ESTATE OF Gaman, Karen E. FILE NUMBER 21-06-1060 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 [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] u 1 Ronald J. Garman 13 Mine Roadlebanon,-PA17042 brother 1000.00 2 Kathleen Koons 211 S. Second Street Lebanon, PA 17042 friend 5000.00 3 Teresa Frohm 1111 Redwood Dr. Carlisle, PA 17013 friend 1000.00 4 Kathleen A. Drexler 30 Drexler Lane Newville, PA 17241 friend 35589.85 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE, ON REV.1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Helen O. Krause Foundation, Inc. P.O. Box 311 Mechanicsburg, PA 17055 35589.85 2 Humane Society of Harrisburg, West Shore Branch Sinclair & Eppley Roads Mechanicsburg, PA 17055 35589.85 3 PAPS, Inc. P.O. Box 442 Boiling Springs, PA 17007 35589.85 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 106,769.55 (If more space is needed, insert additional sheets of the same size) TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 106,769.55 (If more space is needed, insert additional sheets of the same size) J JJ~;2{Qo. t5D rpd 165- cD ~PD 12. 5.00 ~ 18.-g,S- . -