HomeMy WebLinkAbout02-16-07
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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~
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Second line of address
f-~)
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--
First line of address
=:::;
~
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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'~ < )"
( .. . \. ..', \ ,-
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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:
, !
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;LI, ,Jjv~u..? '
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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
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WITNESS:tf'MUi.J'-' ~/-';'l 'd' t;v1 v.,.).-c~
, , reSl mg at \...:e; l.- )
S'i~j" ,:~
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( 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.
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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.
"
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'--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
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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
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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
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~~..',
=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.
-
-
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....-........-..........
. . .. . . . - . . . .. ......
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......................
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. . ".... ....., ..' .---,-- .-..
.. .... ..............-..............
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.. .............
..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
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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 "
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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)
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Amount i" P8St Dllt' Pll';l"'t~ Pel\' Promptly.
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MA S~ r'i:; ~: :~..
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.~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
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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
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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~'::>-
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t
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35
CAMBRIDGE CT
KAREN GARMAN
35 CAMBRIDGE CT
CARLISLE, PA 17013-2733
t
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CODE
FFO\!
TO
p~= ..iIJUS
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CUi'iFii:i'.jT
READI,\iG
USAGE ICUi
CHARGE
~
11/15/2006 11/21/2006
5/8" 1ilATER ,
223
223 F
o
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.:.
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5/8" SEWER
.00
f
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12/25/2006
16.18
.00
16.18
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.
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
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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)
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