HomeMy WebLinkAbout97-00330
21. If Line 18 Is grttotor Ihan LI.10 1 Q I anlor the difforonco on Line 21. Thi~ is tho TAX DUE. Pi)
A. fnlM the lnierelt on tho bulClnco due 011 Line 21 A (21 A)
8, Enter the tolal 0/ Llno 21 ond 21 A on line 21 B. This is th'El BA!.ANCE DUE. (216)
___....____~~Ic. _~_h.(k Po.V~!:__I. to: ~.~l~t.r of Willi, Au."' _ ___ __ __
.=~~~.~~.ii ~-~!SUR('i~ANs:WER_A~LQ:uISTLoNSO~.R!V_E.~~~=_S~[~~.Il.T~!E~1l~!=K~AT~~<Il(~~", ., ..'.,
Under penultlf" of p01lury, I doclclfll that I limo IJ)(.(lminod this return, including clnompon)'irlg ~(hodulo\ unci ,'olomonts, and 10 Iho bent of my knowlod{Je und bolief,
.1 is Irue, correct and completo. I c/er.lmo tllnt nil real oslolu hello beM rnporlod ell Iruo mCHkot volve Dllclarcllion of proporer olhor Ihan thtl porsanul roprel1enlctive Is
bClSfld on oil information of which prflpuror hl]s any knowlodgfJ
:::rJf~:':':,',,~" .i:i Lu f'o~ fJ
IHV.l~OO EX. 1I.9AJ
,~ Y,O\))
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",$12
frlfu
Glii"l
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~). 17:.0., (I
'OR OATIS Of DIAIH AfTlR 12131/91 CHIC".
If A SPOUSAl ,
POVIRTY ClIDIT IS t1AIMID I I
/III NUM.IR
f 1-'J7--()'J'l(J
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
.'
C:OMMONWEl\lTH Of" l'fNN5YIYANI^
DEPARTMENT Of RfVfNUf
om 290001
ttARRISdURO. PA 11120.0601
rifFf'DEN'~$'NM;'! 11-';;-ST,--'iA6l: MIO"MIDDlE-'I~ilfl~i) =-~--~_..:; ..__...."_~m.._..__.__
l' Pl:Ittjl'S Zora 1',
'O~~~~U~~i~':'" .u". 1',^;fOO~;~:~1~6 I"^" ~~';'~'~ 1911
01'",,,,,,,,., ''''''''"0 .",,'" I II.Mf '"'' ""1"'" M",,,,, ",,,,,,, !","'^' ,;nl"" NUM,,"
1,lf)7 Cllrl i"l~ ROll<I
Cllrclnurfl, I'^ 17321,
r.o""'r
'MflU'" R!c!l\'EU I""N"':'~N"
I I 3, Remalndor RetUfn
liar do 'e. 0' d.ath prlof '0 12,13,821
1'1 5 Fedoral E.la" lax Re'urn R.quirod
CllUI~rv CODE V1AR NUMBER
- (lfi:fTlftm.t(iMririi-1:lii5inr-.--":'--'"-~-'--';';'---;':;"-=";.;;:".~
m
frl
..
tilffi
10..
IOZ
8~
[ik 1. Original Re'ufn
[] 4. limited E,'ote [J 40. flllure Int.r~ul CO!TlprOmIS8
I'or do'.. 0' d.o'h alt., 12,12,821
[] 6. Oecedsnl Ol.,d TGUall'l [) 'l. pecedenl MaIntained (J lI....lng TrufI
IAlIoch copy 01 Willi IAIlach copy of TfU.11
'A1L COWS;ONDINCI ANDCONPlDINTIAL TAX INFORMATION SHOULD.,I DIRICTIO TO,
NAME ...... ~~'--JOMPlfTe' MAllINO AODR~!t!i
Paul Bradford 01'1', EBquir~ 78 W Pomfr~t StrHbC
""PHON"""';8f"" -- "''' - CarliBl~. P^ 17013
.J,J.Jl..l ~ - 2~8,:-~8.5,58c ,~~~,=c="O,,=.=.~_,', ..c. 'c",= ,c..= ., .= =,="~_=,='==,==,=,=
1. Real Ella'. ISchedule AI 11 ) _50 ,QOQ.. 0.0 . ' '~'"l Q
2, Slock. and Bond. ISchedul. BI I 2) .u .._..~ \"
3. Closely Held Sleck/Portnurship Inler8,I 15cheduln q 131 ___ ._".__.......----!-..-
4, Mortgage. and Nate. Receivable ISchedule 01 (4) __ ""__~'_ ,,,._..,_.,,,,__..,
S, Ca.h, 8ank Depa.I" & MIlc.lloneoUl Pe"anal P,opef'y 15).. ,3T855, 86,,,.-_____,,~,_
ISchedule EI
6, Jolnlly Owned Prop.rty (Schedule F)
7, Trandor. (Schedule GI (Schedule LJ
8. Total Gross Anels (l.alalllnes 1.71
9, Funeral Expenses, Admlnhtratlve Cosh, Miscellaneous
E'p'OIe. ISchedule H)
10, Oebll, Mallgage llabllltle., lien! (Schedule II
11. TOlal O.ducllaOl ('atal Line. 9 & 101
12, Ne' Value of E.'ate (Lin. 8 OIlnv. line 111
13. Charilobl\:! and Governmental Bequo$h (Schedule Jl
.!,4, Ne' V2,luo _~bie~~JL.In.!._'.2..,"inu. Lllle 13)
15, SpoUlal IfaOlle" (far da'e. of d.ath alte, 6,30,94)
See Instructions for Applicable Pflrcenlage on Rev8f1e
Side. Ilnclude value I from Schedule K or Schedule M.l
16, Amount of line 14 tOKoble 01 6% role
(Include values from Schedule K or Schedule M.l
17. Amount of lInfl 14 IClI(oble 0115% rale
llndude valuel from Schedvle K or Schedule M.J
19. Principal tax due (Add 10)(. from lines 15, 16 and 17,1
19. Credits Spousal Poverty Credil Prior Payments
+ 2,000,00 +
2. Supplflll1enlol Return
__'8. Total Number of Safe Deposit BO)(.Els
,....._.......;....-~_..~-_.--
'd
(JI
'1) :0
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11\ n
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161 ---."------.,,,--------
17) -.."...---.,..-'''...-....''---.......:."
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":52,865 86
( 8 )'~"--,,,--..':'.1.:,.-
0;1
'1';
I 9) .,..17..,,202,.,9.6___-'_......:_
(10) ..,...,J..\.H2.i.lL____,__
(11) 20,42~-,.o.Lu_
(12) ,..-U.,A31.1.L.
(13)
114) .....13,,A3.f~.19c~=,,,::_'"
(151 '____._m_..______~,._...
(161 .!i.~]..J,L..,__..____,_~ ,06.. _.f.,iJ06.t.V."
(171 '
__..~__.__....__"_____._..)( .15 .
z
e
I;;:
...
~
.
..
u
II
...
(181
Ol~count
Interest
20. If LIne 191$ greater IhQn line 18, onter the difference on LinD 20. Thls is the OVERPAYMENT,
iii [1
(191
120)
~ Z,ClOO.OO
Ched, hNe if you OfC tC'~UC$ting Q,fofund of vour.o\lol'pctvnwnt
(',27
DAlf
S1
c~jj" V~
ll()l~
"9J8'/t7
." f',
Acl .48 of 1994 provld.. for Ih. r.ducllon of Ih. lox rol.. Impo..d on Iho nol voluo of Irondo,. 10 or for
Ih. UII of Ihe .pOU'O. Th. rol.. a. prtlCllb.d by Iho .IoluI. will bOI
e 3% (.03) will b. applicable for e.loI.. of decedenll dying on or after 7/1/94 and b.fore 1/1/96
e 2% (.02) will be applicable for e.lole. of docedenll dying on or aft., 1/1/96 and b.fore 1/1/97
e 1% (.01) will be applicable for e.lole. of docedenll dyIng on or after 111/97 and b.fore 111/98
. Spou.ol Ironde,. occurring on or after 1/1/98 will be exempl 'r<lm lnherllance lox.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (.....) IN THE APPROPRIATE BLOCKS.
Ylt. J:!~.
1, Old decedent make 0 transfer and:
0, retain the use or Income of the property transferred, ....,.."............""""""..",,,...,,..........
x
b. retain Ihe right to designate who sholl use the property transferred or Its Income, ...............
c. retain a reversionary interest; or ,,,,,,,,,,,,,,,,,,,,,,,,,..,,.,,,,,,,,,,,,,,.,..,,.,,,,,,,,,,..,,..,....,....",,,,
d, receive the promi~e for life of either payments, benefits or coreL...,..""""...................",
2. If death occurred on or before December 12, 1982, did decedent within two .years preceding
death transfor property without ~ecellllng adequate consideration' If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration'""".,.."""""", '"'''''''' ,..""."",,,,,,,,,,,,,,,,,.,...,, '"'''''''' "..".,..,...""
x
3, Old decedent own on 'in trust for' bonk account at hi~ or her death"-..""","..".."....,........""
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
0,
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...
A, SETTLEMENT STATEMENT
o Commonwealth
OMS No 2502.0265
...-.~-_.-.
,0, JYJ)(fJ1.ILlIlII,!.._'_____._ __
IT/ fHA r1-:1ll'mHA ~l. 11 COflV, Uilir19 f,!ilnthIll1htlr
4.11 VA ii, II Conll, IliA,
7.l"an Numbor
-
8 Mort~ao" In"II,Hl~.(J Co1'iU HWllbur
-c-. N(;;'~lW!l form ~!I IWnl!ltlud to (JIVO YOll il slalot\lnnl of flCllJal 90lllflmenl costs, Amounls paid to and by ltln se!Uomonl <loon! mil shown 110m!) marked
"(rI,Q,IJ.)" wurt! plIld oulSido tho closlng:lhuy uro sllown hCifO lor Informational purnoses and are not Included in 1110 10lals,
II 'l,'lltl "111 M/lII" ot lIorruwlU ENilll1llllnd AddfO~! 01 !lollal F Name "lid IIddro'lSo! Londor
.
CreRM Keckler and
LOlli"" Keckler
Estate of Zora T. Peters
N/A
(1,ltollClfliLlIcalll)ll
H Set1lElmllnlAgen!
Paul Bradford Orr
--
4197 Carlialu Road
Gardners, PA 17324
f'lllcool Solllllmllnl
I SQWllnllrl110aif,
78 W. Pomfret Street
Carlisle, PA 170]3
6/5/97
J. SUMMARY OF BORROWER'S TRANSACTION
K. SUMMARY OF SELLER'S TRANSACTION
...!Q.D;,.....Q.~OSS__~MOUNT DUE FROM .ll..ORRQI'I.~!l,: ________. 400,
J.QL_ COJ}!!aclsaler. pric8_, ____.._~. .5QJ),OO 00 401,
~...f.ersonal prolllill'..___ _'" 402,
103, Selllsment charges!o borrower (Ime 1400)._ 702.50 403,
104, 404,
105, 405,
Adluslments for Items paid by seller In advance: Adiustmenls lor Items paid bll seller in adllance:
_.J.QL.9!!Y!tow!l taxes to __ _______, _. 406, Cily/town taxes ._"",l~u_.._.. ,. _u___.~
107, Countlltaxes 6/5/97 to ]2/31/97 47.33 40'fc County taxes 6/5/97 to l~/3IL~Z ...___~.Z.J,L
108, Assessments to 408, Assessments to
-.-.-.. --.--- --~._-"-_._'~'
109, Maintenance to 409, Maintenance to
_ 110, School/laxes 6/5/97 to 6/30/97'=--':l.2.,_~ ~ 410, Commitment Fee '--10-""--..----.- d._._"'____
___~, 10 .-'- 411, School.!ax 6(lliUL~iJjJ.'JL~~=33.5L
112, to 412 to
120, GROSS AMOUNT DUE FROM BORROWER: 50,843.39 420, GROSS AMOUNT DUE TO SELLER:
200, AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500, REDUCTIONS IN AMOUNT DUE TO SELLER:
--
~~ Deposit or earnest money .___ ...2.1.000.00 501. Excess deposiUse~j~![\JC~.9~L___, _.._ ,_.,..,___
.1QS.... Principal amollnt of new 10an(sL_________ _,__, 502, Settlement char9.ll~Jo seller,(linef<ipOL...., 782,2.6.
~3, ExisllnQ loan(s) taken s\l9ject to .,.. 503, Existl,Q[L1.9E.'li~U~.~~fl2~IJjll,L1o ,
204, Commitment Fee ,_._.___ ~uu___~_ .M.L......P..ID'Q1LQfjjH1Ln19I!ga.9.~101ln. "..
?o~, .____ "',__,____ Jj.95,.__..EilYQltQL~l!c_9mLm.QrLqil9o IQil!l __ ,_ '..
,g~ ~06,. ______.~__. ,___. ,_ '''.,.,__
207, 507,
208, 508,
?Oq ~Oq
GROSSJ.MOUtl.T,()IJ~!9,~EL!-ER :",
Conlract salef,.Qric..o..__..___ __u.. ,,___
Personal Qi9.QQ!'lY.___...._ ___.."'.
",,50 ,OOQ~QJI.
50,080.89
..--.......-- ,-~....--._-
Adjustments for items unpaid by seller: Adjustments for Items unpaid by seller:
--
210, City/town taxes to _.._. 510, City/town taxes to._____ m ,uu___u__u'"
211, CDuntytaxas to ____________ 511, Countytaxes_______I.9,_.,,'_____~, _,_.._..,.
212, _Assessments ____L.____,_....." ,..~.___,___ ,512, Assessme~.~u____Jg._'''''_,__'''' __~ "'____
.. 513, Maiolenance to ___ _,___
..11L Schoolfl axes ____L________,~.~_,_ '_.___.__, _. 51 L- SchoolfT axes ____"JQ..__"" ..____.'" _.., ~ __,_____
214, to.._ 515, ._~. "'____,___
_?15, , to ________ 516 to __,_, __'__
_216, 10 517, to __._______."
21'1, to ___ _ 518, _,_____ to ______
218, , to '____- 519, to ____."..,_.__
-i}~.. TOTAL PAID BY/FOR BOR~~WER: ,-.--- 5: 000.00 520, TOTAL REDUCTION AMOUNT DUE SELLER: '/82,26
--
300, CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301, Gross amount due from borrower (line 120)
50,843.39
I 5,000. pO
601, Gross amount due to seller (Iil/e 420)
50,080.89
(iR2,26)
/19,298.6,
302, Less amounts pairl byllor borrowei (line 220)
--
303. CASH (Xl FROM) ([HO) BORROWER:
-"
Form 30"2 (REV, 6/95)
602, Less total reductions in amollnt due sullur
45,843.39 603. CASH (Q(JTO) (LJFROM) SELLER:
Hun 1
RESPA lIB 4305.2
...
P'IIt301
tofU! "'NJlO....d OMO No 1!1O~.OH~
. File Number .
CERTIPICA TION
I direct and authorize the Company to make the distributions Indicated for my acc:ount on the
attached HUD-1 Settlement Statement, approving the tax prorations Indicated therein, and
understand that prorations were based on figures for the preceding year, or estimates for the
current year, and In the event of any change forthe current year, all necessary adjustments must be
made between Seller and Borrower direct; likewise any DEFICIT in delinquent taxes will be
reimbursed to Title Company by the Seller,
I have carefUlly reviewed the HUD-1 Settlement Statement and to the best of my knowledge and
belief, It Is a true and accurate statement of all receipts and disbursements made on my account or
by me In this transaction, I further certify that I have received a copy of the HUD-1 Settlement
Statement. 9k ~k/~
Gregg Ke~kler~. ~
/J) ).ml45L.'L~-
Borrowers Louise Keckler
_~ (L .s ~JI~.- - .
Dor19 Ann Shelleman, ~xe~or
Il;r~r-~' ,j), (Z~
Sellers Darlene D. Peters, Co-Executor
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared Is a true and
accuract account of the fun~h were received and have been or will be disbursed by the under.
"'00' "rj' !LQLy~~hl' "",,,tloo. J". 5. 1991
Settlement Agent Paul Bradford Orr Date
WARNING: It Is a crime to knowingly make false statements.to the United States on this or any
other similar form, Penalties upon conviction can Include a fine and imprisonment. For details see:
Title 18 U.S, Code Section 1001 and Section 1010,
INFORMATION REPORTING ON REAL ESTATE TRANSACTIONS
THIS HUD SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E, G, H, I,
M AND LINE 401) AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE, IF YOU ARE
REQUIRED TO FILE A RETURN, A NEGLIGENCE PENALTY OR OTHER SANCTION WILL BE
IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE
SERVICE DI:TERMINES THAT IT HAS NOT BEEN REPORTED,
Solicitation of TIN
Seller is required by law to provide the Company with his/her correct taxpayer Identification number,
If correct taxpayer identification number Is not provided, he/she may be, subject to civil or criminal
penalties Imposed by law,
Certification of TIN
Under penalties of perJury, I certify that the taxpayer Identification number shown In this statement is
my correct taxpayer Identification number,
SELLER
FOAM ,m,IIAty, 4/117}
SELLER
BRICKERS AUCTION
Buy & Sell on Commission - Complete Sale Service
93 Texaco Rd., Mechanicsburg, PA 17055 766-5785
."....1 ......., .1 ),,1'1/ '/ k~ ~!z.
Addr... 1.J:91 (W~ $. " ~tu.
Sold At Public Sal. .y-;</ 19 9' 7
Outstanding Total Sale J C)f.OIJ
Total Checks III 33, lJ0
--....--..
Total Cash ';;,;1(., /. "D
Cash After Payout 101;-1" oj)
Expenses
Auctioneer & CI.rks
Adv. Cost
Property Fee
Sale Setup or Help
Total Expenses
0,60
~~
330 I 66
..JOb , tJ ()
1'1 d 6, 6 b
00
/W'7'?' ...-
I () C \~ ---rf;f~
~
..~~
Il'-J c-k F0(
~~
+-.J--J-C{ 7
Thank Yc>u For Selecting Chuck Bricker, Audioneer & SIal/
I.
,~ .... 'v' ''I<- ",-'
,
.JChe
,... G~~(:~~,~t~~), I~~'~~~~~'~' I'll /73250781>
(717) 337.4170
, PLEAS!' INCLUDE YOUR ACCOUNT NUMBER '
ON ALL CORl~ESPONDENCE AND INQUIRIES
ZORA TPETERS
4197 CARLISLE ROAD
GARDNERS, PA 17324
~c\
PATIENT NAME ZORA T PETERS
AOCOUNT NUMBER 0300135402
MEDIOAL RECORD # 31-10--80
DATE OF SERVICE 10/24/96
TOTAL AMOUNT DUE
165.50
, .
ACTIVITY OIlTE DESCRIPTION', AMOUNT '
, ' ,
12/02/96
11129196
11/29/96
11/29/96
11/29/96
11/29/96
11/22/96
11/22/96
BLUE SHIELD 65 SPECIAL PAID
BLUE CROSS MC SUPPL PAID
MEDICARE-A (TC) PAYMENT
MEDICARE-A IP (TC) ADJ
REVERSE 14EDICARE-A IP (TC)AOJ n ~C'"""
REVERSE MEDICARE-A TC PYMT r? A, / I 1
MEDICARE-B (PC) PAYMENT .\ I,t'
MEDICARE-B IP (PC) ADJ I)lf-ll1
-21. 68
-736.00
-12000.36
-1061.31
2223.12
6000.18
-86.74
-92.58
aUNT IS PAST DUE. PLEASE PAY THE AMOUNT INDI .TED PER
TICE. THANK YOU.
97
pLEASE PAY .... .
, THIS AMOUNT'"
165.50
Plofls/) koop lor your reoordfl
, l
.
r.
.
\ , .j;,
'J; ;
;.l
.. '. .. J .'
--...... J-""""-
_" ._:~,~,_'_T'~_:-"""~_ [11".... _ 1J, .,-:~-,
r"
'If,'
\,
I SC.tEDULE H
~j;~ fUNERAL EXPENSES,
COM~~~~~~~e~~AS~1llij!i~NIA ..., ,.,l"~~~~~!t~~~~~{~~!:~~~~"JMff~m.~~i'~'~ P!~!"o.t JY~!,c,"'~-~'~
mATE Of' .,.. ...uMO
Zora T. Pet~rH 21~97-0330
RtY.UII Ell.. 1~.1I1
ITEM
NUMBER
~~...._-
A.
1.
2.
3.
DESCRIPTION
AMOUNT
_.__~~__~~~"_._...__._~~.__m~~~~~__'__~_'_~~~"~_.~~~""~-.,........
Fun.tol Exp.n....
Gibson-Holling~r Fun~ral Hom~s
Nt. Zion Luthern Church Ladi~s Aid
Food for "After Fun~ral Dinner" ~ Mt. Zion Ohurch
6,824.20
50,00
]07.36
B. , Admlnl.tratlv. CO.tll
2.
3,
1.
Peraonal Repre"ntatlve Commissions
Social Security Number of. Personol Represental!lIel
Year Commission. paid
Attorney Fee.
Paul Bradford On, Esquir~
Family exemption
CI 1 t Darl~ne Peteers
a man ___
3..231.0.0
RelationsHip dau.!lh ter
3,500.00
Address of Claimant at decedent'. death
Street Addre.. PO Box 64
City _ Bendersvi.lle ,State PA
Zip Cad" 17306
.t.
4,
Probate Fee~
, 45.00
C. MI...llan.ou. Exp.n....
1. Auctioneer Expenses: Brickerfs Auction
2, L~gal Advertising: Cumb~rl"nd Law Jou~nal
3. Legal Advertising: The S~ntin~l
1 ..200.00
6.0 /00
78.26
50.00
, 255.00
125.00
123.20
]33.00
..--J.
$ .15,782.02 (s,,"
,
4, Fairfield P~st Contro]
5. p~Ck'S S~ptic S~rvic~
6. B~H Real Estate - appraisal
7, Dan-Thumma Insurance (home own~rs ios\trance)
8. Th~ Gettysburg Times (advertising for pub]ic sale)
SUB- TOTAL (AI.o ente,. on line 9, Recapitulatlonl
(If mar. .po.. I. n..d.d, In..rt addltlonol.h..t. 01 .am. .1...)
1..111...... ._ " "~' ~ ,
ERIC L HOLLINGER. SUPERVISOR
501 N, BALTIMORE AVE,
MT, HOl.LY SPRINGS, PA 17065
STATEMENT OF FUNERAL GOODS ANIl SERVICES SELECTED
ChIURt'1 nrc lInly ror tholle hems dllll YOUll.tlrl'lrl1 or Illnl nIl' /('111110'(1, If WI' IHl' It'qulm,l hy lnw or l1y" CCnlCllll) or crl11ll11lnry 10 WI(', nny Il(Hll~, WI' will 1':(1'1(1111 III
wrlllltg helo'...., . '
H ynu Iclecled II funrrnl thllllllny H'qulrt'- {'mhnlmhljt. l,lICh 11':1 hlllnnl with vkwln~ )'IIU mn, 1111\11' to JlIlY fur (,lllhllllllln~, VtlU tlo I1U\ t\lIVe to pay em clIlhnlmlllF, you
did IInl npprow If you adeclr'u I\rrRn~CIllCnl!l Kuch l\!; II dlrt'l'1 {'!I'lllillitlJ\ or illlllll'dllltr hurlal, ICw(\ Chllq~('d fUf rmhnlnlh11lu Wl\ will explllln wh:< he low,
For Ille ",,,"/it'e of ",,,___Zora _T"...l',!!t'i'f!! ,'"
Chllr"" \0: _,.....J1..Cl!:t\l.,J\.,,,_She.lJ,.!!J!l,l!!L-. .__~, p'
Non",
A. ClI^,IGE H)K SI-:KVICES SELECn:ll,
1. \'ROFESSIONALSElIYICI'S
SCI"/lcclI of Funerlll Dlreelor/Slllff $
Emhalminl:,' . , . . , . . . . . . . . . $
Olhor prep.rotlon of hody
"_"__"__'''~_____~ I>lIle of 1l<!1I1h _Qot9.P~L__~,~,I",~t9',!,6
"_!J!.Lr.!!cL~!;j!;"_"BeJld!1fqyJ,l~'!..l'I\_--,--..~..,,,,,- '"
Add",,,, Clly StuI<>
Oth(ll' Clolhl,,"
SUB.TOTAI. OF I'Rllt'l';SSJON(\1. SI';RVICES S
2. FACILlT\l!S AND SBll VICES
Use of f6cllltles IInd selVlres for
vlowlng (VlsiloUon/Woke ~ . . . . . $
Use of f6clllllCllllnd selVlce.
for funeral ceremony, . . . . . . . . $_
Use of foellllle. ond selVlc.., for
Mcmorinl Service. . , . . . . . . . . $
U.e of equipmenl nnd selVlees for
Ot'llvesldc Service, . . . . . . . . . . $
Olher ,"w of fodlllles
r001.
$----
$
Croll1utloi'iTiMI-. . , I . . . :7:-::-:-$~__~.___-------,
(l)e'cl'll'till1IL_",~~____._____,___"_,,. __'
0'111 Ell - ~-~---T-=~-':::'::::='~=--:-
--=--=:=--=--..:::=-=~=:..--:====
'\'O'l'AL MER(%\NIlISE SEI,E("I'r.;o, . . S_~f,90~gQ
C. SIJECIAIICIIAJ{(;lt:S,
110rwnrdlng ()f 1'(~Il111ill~ 10
.."..........., ,...... $--~QQ
--(FuneI'1I11l(,me)
Receiving of 1'l'l11nlll' from
$---,--
$
(FunClill Home)
Immediate Burlnl. . . , . . , . , , . , $
OircctCrcmnlion......"... .$
$
SUII-TOTAL OF SI'l\CIAL CIIARlmil, . . $
0.00
....... . ,...... ... .... $
SUD.TOTAl, OF FACU,\TIES/EQUIPMEN'I'
J. AUTOMOTIVE EQllIPMENT
Vehicle to trnnsfer remnln. to Funoral Home
lJlQL.
D. CASHADVANCEn,
Opening Grllvc . . . , . . . . . ~ . , . $
Cemetery ECllIipmcnt . , . . . ~ .., , $
Lolllnd Deed. . , . . , . . . , . . . . $_
Newspaper NLltlces.I.Llca1. . . . . . . $_~__.
Newspaper N<'>llres'()Il1.()f:I'Llwl1. . S__~,
Tclot,hont' &. Tul(J1~rlll1l . . . . . , . . $_ _,'..' ..__.__
Alrfnro........ ,.. .""", .$_.__..__
Cler&y/Ma~' (lI'fcrin!li(ll'gnnis( .., $____________
Pllllhcnmr~. . . . . . . . . . . . . . . . $
C.crlilied COl'io, J)"nth Cert., . . . . $
Police Escort. . . . , . . . . . . . . . . $
Flowers & Tu.'( ..... . . . . . . . . $
Vault SCIV1cC Chllt'gc, . . , . , , . . . $
$
$
$
$
SUn.TO'I'AI. (W AIlV(\NCES. . . . . . , . . $
350.00
70.00
Local . . . . . . . . , . . , . ~ . . , . $
Heorse (CWlkel Cooeh)
Local....,.............$
UlIlous\nc
Local.......,........,.$
Family Cor
Local......,..,........$
12.00
Flower Cltr or Oorl1l dlspo.itlon
Local..................$
127.20
Lead Cltr/cler&y Cltr
Local . . . . . . . , . . . . . . . . , . $
Car for pallbearers
Local . . . . , . . . . . . . . . . . . . $
Oul of town lran,portatlon . . . . . $
$
$
SUn.TOTAL OF AUTOMOTIVE EQUII'MEN'I'$
TOTAL OF I'ROFESSIONAL SERVICES,
FACILITIES ANn AUTOMOTIVE
EQUIPMENT . ,(r~c~'JI~ I'r.lc~\ . . . . . . . . . . . . . $
n. CllARm: FOR MERCIIANDlSE SELEL'1'EIl,
Callkct. . . . . , . . . . . . . . . . . . $ 2795 , 00
(Descriplion) Slnuff." & Miller
Cherry
Other Receptacle, . . . . , . . . . . $
(Description)
Env.rnvlnu Stone
80.00
639,20
I no 1.
We chargc you ror our .sclvkcs in ohtnlnlns
(specify cn.'hadv",,,,e, thnt fire I11nrked UP)
2495 .QQ
Outel' burinl container .,..." $
(De.crlption) Coronl1llon
Conelele Douhle Wnll
Aeknowledgemenl cnrds . . . . . . $
Register book(s} . . , . , . . . . . ,$
Memory foldcrll ,..,..,..,. $
Prayer cards ........ . . . ... $
Temporary grove mnrkcl' . . . . . . $
Durlal clothing. . . . . . , . . . . . . $
895.00
SUMMARV OF CIIARGESI
A, prorcssionnl Smviccllt Fncilitlcs (lnd
Equlpmenl, &. Aulomotlve HlJuil'mcnl$ 2495.00
B, Merchandise. . . . . . , . . . . . , , , . $ 3690. 00
C. Spec.luIChurgcs..,..." -,..... $__~QQ
J), Cash Adval1l'''s . . . . . . . . . , . . . . $ 639.20
TOTAL(WhLLSEJ.EC)'IONS,.... .S.~24.20
"AIIl A'I"I'I~1E OF Olll'llIoll TO
ARR^N(;E~IENTS ...... , ." .. ,S.____ 35(h9.0
IlAI.ANCEllllE..,....,..,...... .$_ 6474.2,Q
REASON FOR EMIIAI.MIN(;
Yiewin for F'~: Ilelc! Over },'lllll"I"
any aw, CCI1\C{l'I)::-'or nt'mntory requlremellts hnvc ruqulred lilt'
rurchtlsc or nllY nf Ihl' ill'IllS Hs(('d llbm't', lhe IIlW Of n'<i"ircII\CIlI is
cltplnined hclow,
CenwtcIY Rcquln's Vllult
I .,recllhlll t havtl cumll1<<lthellllnll of lI(xxb alllllCn'It'C5 ,c!cl'lclt Hhuw mill rnumllholH 10 I)Cl correcl 11Ilt! lu,'~'nr(\lnA 10 the llrrHn"'~'IIlCIII~ I h~l\'c tC(IUC~Ir.d. llu'~lHr.vl!'djl.c receipt ul n
ropy of thls SCalenll:lII of Funer.1 (Iooll,lllld Scrvll'CS Si:lcl'ICd. I u'prcn'I11 lhnl IlulVe sufficient (untl, ftVlIUllble lor p.lyallCIlI 01 the ~'llsh price for the IC(Kxl111ncl 5crvlct'_s !cledel!. lllho
-atC'.(': to maierarm:cnl of SMlt1!Lwllhln 3Q (lh~, IIIIfcC 10 l~ jolnlly /\lId ~\'..cr/llly Ullblc wilh Bnyone ehe who ,illlli bdow. :\ laic dlllrfl,c of I.~% lief monlh 1l111O\llllill~ tnJ!'! pcr leOlr
wUl be IppUlll 10 the uupaJiJDiliiiCo bc!lliiiiJiiR.11 clnY.l hnlllllll1 tllllu ur lhls ll!lrculllt'lll. 1 will also ray 10 Ihe FUlleral nlreclnr ul! f(l4lwltlolt~ com rltid hy the FlInerllll)ire(IOr 10 ('0 lc~'l
M10untJ I owe under lIuI .,~nlolll, 'JlU)fO ~ost. may luduc\o ntlUnluy~' rcc~. l.'tJllrt ~'osl.ltnd oCher !,'osb, Any IltilUtlollll1 &<lrvkc~ or mCrdUll\llJ~e nrtlcfc(1 (Ii rg,qUC!ICtj Uftll! Ihe cllIle of lhi~
a.qroemenc will bel considered pan of Ihllll~'eCl1lellllUld Ihc l'{)sllhuu'uf will be funel'Ced on che final bill or Ill\lemcnl.
(Se.I) i\\C\..:\..\\\ \:lL. I':) \~L
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(717)633-7372 N9
FAIR~IELD PEST CONTROL, INC.
37 Water Street, Box 34
Fairfield, PA 17320
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UNITED OF PA
.
, 11
PAGE 2
717-~86_3869(210)
FEBRUARY O~, 1991
SUMMARY OF CURRENT CHARGES
04 TO MAR 03
FED 04 TO MAR 03
BASIC SERVICE - FED
NON-BASIC SERVICE _
CHARGES AND CREDITS
LONG DISTANCE CALLS
NEHIORK ACCESS
TAXES AND SURCHARGES
~Q.tALc.llRRENT CHARGEL.___
------ - ----. -
CHARGES AND CREDITS
HOLIDAY RATING CORRECTION
PA TEL COM RELAY SURCHARGE
TOTAL CHARGES AND CREDITS
I;:) Prl1llfld I,ll)
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SEE DETAIL
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13,12
5,60
,85-,
2,0~
3,50
2,15
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UNITED OF PA
PAGE 3
117-486-5869 (210)
FEBRUARY 01,. 1997
LONG DISTANCE CHARGES
REF 'DATE 'TIME PlACE CALLED
1 JAN 01 03,2S,46pm OETTV5RU~G PA
2 JAN 18 01,S8'3Spm MGLER'~1. PA
5 JAN 18 01,S8,S7pm BIOI.ERVL PA
4 JAN 18 02'12,S1pm BIGI.ERVL PA
S JAN 18 02, J2,Slpm BIOLERVL PA
6 JAN 18 02'SO,OOpm BIOLERVL PA
7 JAN SO 06,44'41pm BIOLERVI. PA
NUHBER CALLED fROM PLACE
717-n4-7126
717-677-6825
717-677-6823
717-677-64S8
717-677-62B5
717-677-'17S
717-677-917S
rpOH ~ER CODE MIN AHOUNT
AE 7,0 ,71
AN 1.0 ,DB
AN 1.0 ,08
AN 2,0 ,12
AN 16,0 ,68
AN S,O .24
AE 1.0 ._~U_
2.04
TOTAL LONG DISTANCE CHARGES
~"R.I. COddS for 'nl.rt'af. and Intraslale la~a"c. Calls
Customer Dilll Ret6 Ovefsefls Rete
A 1"'1 Automatic Number D"" Oey R = Slllndsrd
Identificrl\IDfl :ANI) E n Evening T "'l Discount
M := Multiple Rale Penod N = NighllWoekend Y 1::1 Economy
ServIce Charae/Custom Feature
C t= ClIlIIng Carel r- = Call Forward
P = Person X ... Conference
5 = 51allon
C =- When this symbol appears In tho left mBrgln, ItlndlcBtes credIt has been tlppUed end the toll CBIt
is being billed 8t lhe red~lCed ratc,
R CO> Whan thfs symbolllPPrlarS In the left mllrgln, Itlndlcllles 8 tolf call hB9 been bUled 10 yon Account
aller being investlgatec! by a tol/ InvestIgatIon group.
NETWORK ACCESS CHARGES
CUSTOMER LINE CHARGE
TOTAL ACCESS CHARGES
DETAIL OF TAXES AND SURCHARGES
FEDERAL TAX
STATE TAX
SURCHARGE DN UNITED SERVICES - TOLLS
SURCHARGE ON UNITED LOCAL SERVICE
PUBLIC SAFETY EMERGENCY TELEPHONE ACT (9-1-1) FEE
TOTAL TAX AND SURCHARGE
. --
SUMMARY OF PAST DUE & CURRENT CHARGES
PAST DUE BASIC
CURRENT DUE BASIC
TOTAL BASIC
PAST DUE INTEREXCHANGE
CURRENT INTEREXCHANOE
TOTAL INTEREXCHANGE
PAST DUE NON-BASIC
3,50
3.50
,6~
,~O
.02'0
,12'0
1.25
2,15
0,00 ,
.
18.3~ )
111.34
0.00
3.~~
3.~4
0,00
G)
CONTINU~D ON iACK OF TNIt PAlIe
THAW VmJ FOil VOUH ~'ri(\MPII'i\'{M' N I
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UNITED OF PA
PAGE 3
717-~86-3a69 (ZI0)
NOVEMBER 04. 1996
LONG DISTANCE CHARGES
MEF DATE TIHE PI.ACE CAI.I.EO IUtIER CAI.I.ED F~OH PLACE FROH IUIlER CODE HIN
1 OCT DZ 07,~3,44'M BIGLERVL PA 717-671-6~511 AN I,D
Z OCT DI 08,Z5.39pM BIGLERVL PA 717-677-6~511 AE &,D
I OCT O~ 09,10'31... HECHANCS8G PA 717-766-&406 AD 1,0
~ OCT 06 OZ' JJ ,29pM BIGI.ERVL PA 717-671-64511 AN ~,O
& OCT 09 06,Z4,02PM BIGLERVL PA 717-671-64511 AE 7,0
6 OCT 10 07,I7,OOpM BIGLERVL PA 717-671-61&2 AE 1.0
7 OCT 14 12,lO,09pM BIGLERVL PA 717-671-64511 AD 1,0
B OCT 11\ 02,31,28pM BIGLF.RVL PA 717-677-64511 An 4,0
9 OCT 16 01,~7,26PM BIGLERVL PA 717-671-B22B AD 1.0
10 OCT 16 0l,4B,3SpM BIGLERVL PA 717-671-B27B AD 2.0
n OCT 16 0I,&O,S3PM OIGLERVL PA 717-671-8228 AD 1.0
12 OCT 46 O~, ~O ,lSpM HEN OXFORD I'A 7l7-624-~lll AD 2.0
1J OCT 16 06,04,36pM BIGLERVL PA 717-6 71-6~511 AE 12.0
1~ OCT 17 09,44,32OM BIGLERVL PA 717-671-8144 AD 1,0
15 OCT 17 09,~6,OO'M BIGLERVL PA 717-671-64511 AD 9.0
16 OCT 17 0l,42,OOpM HEN OXFORD PA 717-62.....4431 AD 1,0
17 OCT 17 01, ~3,14pot HEN OXFORD PA 717-624-4111 AD 2.0
18 OCT If. 09,12,37... HECHANCS8G PA 717-76...&406 AD 1,0
19 OCT 18 01,S3,l4pot BIGLERVL PA 717-671-64511 AD 1.0
20 OCT 18 02:0S,llpM BIGLERVL PA 71'1-671-6152 AD 2.0
TOTAL LONG DISTANCE CHARGES
III""RIII COdfll for Inllnllte Ind Inlrl"llle Long Olttlncl CIII.
Customer Dial Rate Overseas Rate Service Cnarg"/Custom Feature
A .. Automatic Number D = Day r all Standard C" Calling Card F = Call Forward
Identification (ANI) E = EvenIng T ... OISCClunt P - Person X III ConferDnce
M a Multiple Rate Period N = NighUWeekend y. Economy S - Station
C all When thIs symbol appears in the left margln, It Indicalss credit has been applied and the toll call
Is being billed lithe reduced rate.
R .. WneJn this symbOl appears In the left margin, It Indicates a toll c~ll h~9 been billed to your account
after bBlng investigated by a toll Investigation group,
NETWORK ACCESS CHARGES
CUSTOMER LINE CHARGE
TOTAL ACCESS CHARGES
DETAIL OF TAXES AND SURCHARGES
FEOERAL TAX
STATE TAX
SURCHARGE ON UNITED SERVICES - TOLLS
(.)
"I,
CONTINUED ON BACk OF THl8 PAGE
ANOlM"
.08
,41
,18
,20
,&5
,U
.IB
.48
.18
.28
.1B
.14
,90
.18
.98
,22
,14
,IB
.IB
.28
6,45
3 "L
3.50
.86
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GOCEJ BENOf!RSVILLf! WOOD CRAFTS 7'95 ~B606 6641
jml\!"il' PO BOX 64 PII 717,677,6456 OOI~"iA
L.!J · I 6ENDERSVILLE, PA 17306 1,^'h_"~-1!~_2,..l~91
I'AYlOII'" Q O(.t " $ 7..7 !l~'
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r~l~~ers
D"''"lOt-IOfPAUNnIH'I'O\I!WI'l (~\, ^ ' ['\ AliA
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':0:1 ~ :1008 :11.1: 00.8'" aD aan. q q 5!;1,. ,"000000:1 '? Cj:\o1'
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, Definitions
Customer Charge - This Is a monthly charge for Multiplier _ If this Is on your bill, we must
billing your account and other services, The multiply the electric use recorded on your
amount Is the same each month no matter how meter by the number shown, This glvos us the
much electricity you use, total KWHs you used for this billing period,
Estimated Bill - If this is on your bill, we could Prorated Bill _ If this Is on your bill, the amount
not read your metal' this biilinil poriod, Instead, due is for .) billing porlod loss than 2& days or
we estimated your use, We will correct any more than 35 days,
difference between what we estimated and your Service Charge _ nls Is a charge on your IIrst
actual use the next lime we read your mater, bill for thCl cost of opening your new account.
Kilowatt-Hour (KWH) - KWH is a measure of State Taxes _ Your bill Includes several stale
electricity, One KWH equals ono thousand walls taxes, One state tax Is the Gross Receipts Tax,
used for one hour, If you US!! one 100 watt bulb Your bill Includes $,77 In Gross Recolpts Tax,
for ten hours, you use one KWH, The number of The total state taxes In this bill Is $1,14, This
KWHs on your bill Is HIe total KWHs you IJsed does not Include State Sales Tax, If you pay
for the days covered by this bill, Stale Sales Tax, you will see It as a line Item
Late Payment Chg - This IS a charge (chg) for on your bill.
. not paYlnQ~.QlU_QX the day It Is d!!.!L_h..,__...__,_,__
Important Information
For your protection - All of our meter readers
wear photo I,D, badyes, Ask for an 1.0, before
letting anyone In your horne, If you are stili not
sure, plea so call.
Customer Service?
II
Your Electric Use Chart
11
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M J J A SON D J r M A M
May 1996 May fi97
10 G
54 51
28 30
.______. Illllmate
Aver.go Dally Use (KWH)
Aver.ge Temperllfuro
Olyt In Billing Porlod
-_. Aclul!1
QuesClons or complaints?
Please call or write before tho due date,
To check your bill or to get a further
explanation of the chargos, a rate schedule Is
available at your local GPU Energy office:
501 Parkway Blvd,
York, PA 17404
Monday-Friday 8:00-5:00
.
... -. .,. '....
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Special Message
If you arll currently a ZlpChock
customer conllratulatlons, If not,
consider signing up for this plan
now, Wllh ZlpChock your bill Is
automatically deducted from your
bank account on the due date,
Cali 1-800-545-7741 to nnd out
how easy Ii Is 10 sign up and
save yourself lime and postege,
r
.
I
Credit?
Cali 1-800-545-7741,
Mon-Frl 8:00-6:00
Call 1-800-545-7738,
24 Hour Service
Call1-8QO..962-4848,
Mon-Frl 8;QO..8:oo
GPUENERGY@GPU,COM
Emergency?
Internet.
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A SETTLEMENT STATEMENT
o Commonwealth
OMS No 2502'lllli-
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ll, T~perl Loan j-'
-t'u HA 2, II FmHA 3. (] Conv, Unins lI',1oI1hm>b!l1 8 MOtW-llJ"IIIt(lr~IIt" 1'.,';" h','''r~,'
4,0 VA 5, 0 Cony. Ins
C, NOls' This form i& lurnistmd 10 give VOll (l f,\nlomonl ot nclur11 Bolllome/ll COBia AmounlspAld 10 ar.d by the IUJtllemanl a{lunt fl/Il a/lown 11011111 mmked
'(P,Q,c.)' woro paid outsldo tho closing; IhtlV aro shown horelor Informational OUfDOses and are nOllnr.ludfJd In !hfllolnh~
o N.mf IIId AdOre.. of Buno....,! E NJme ~nd "'1k1'~U 01 8""1 f N~1lI<I4NIM''''l1orll'llIl<Ir
.
Gregg Kockl.r end Estate of Zora T, Petera N/A
Louise Keckler
o ~lope"1l00:lloM\ H IklllenlllolAOlol Paul Bradfold
Orr
4197 Carliale Rood PIle. or Stlll,m'Il1 I S~Il'Amqnlll.ll"
Gardners, PA 17324 78 W, Pomfret Strettt 615/97
Carliale, PA '7013
- -
,), SUMMARY OF BORROWER'S TRANSACTION K, SUMMARY OF SEI_LER'S TRANSACTION
JQL9ROSS AMOUNT DUE Ff!Q.M a.Q!j1!QI'{~!j! ---- 400, GROSS AM.OUNTI).lJIi.IQ.9F.tLER:.
1n1. r.ontreclaalQs orlce . .SQ,.Q.Q,Q...!,l.Q. 401 CQ.nlf~j;ilill~s orico _~,__,..._. - , , L,n'~~,~QQ_
102, Personal property ------. 402, Persom!LRroperl''--____,._.___.,_ ,..
103, Solllement chergos 10 borrowor (lino 14iJof'- 702,50 403, ------'-' ..~,-,,--
'104, 404,
105, 405,
Adlustments lor Iiams paid by seller In advance: Adlustments lor lIems paid bY seller In advance:
106, City/townla,es to 406, Cllvllown ta'es to -....-.,-
lot Countv la,es 6 I 5 197 to 12/31/97 ___!I,L~l_ ~_ 407, Counly ta'~s 6/5197 "'1o--r2i3Ifiz __-"-L.-..3l..
108, Assessments 10 408, Assessments 10 ,-
109, Malnlenance to -- . 409 Melntenance to -----
110, Schoollla,es 615/9110 6/3.0/97.__ 33,56 410 Commllment Foo to
111. to .-.-. 411, Schogl tax 6)s[iTlo61} 0/9] __-1,~
112, 10 412 to
120, GROSS AMOUNT DUE FROM BORROWER: 50,843,39 420, GROSS AMOUNT DUE TO SELLER: 50,080,89
200, AMOUNTS PAID BY OR IN BEHALF OF ~ORROWER: 500, REDUCTIONS IN AMOUNT DUE TO SELLER:
201, Oeoo,lI or earnest money . ...i. 000,00 501. E,cess d.eposit (see Inslructlons),__,...._, ..-.------.--.--
202, Prlneloal emount of new loanlsl 502, Selllemenl ch.illl1es 10 sel~, (/ifl~HOQI_ ,.._.7.81.-2J._
203, E,lstlng loan(s) laken subleclto -." 503, E,isling !.oenlillaken su9i!lcUo....... ."'.'-_.~---
,,'" r.,Q!!\IDil~~ -. <n4, p,"nl!.QLI~LroO!.llJillIQJQaL.. . ,,__.. _. ,..-.--....-
2M ---,- ~ Pavolt 01 seconq,!l1Q[!lJllgQJOlln. . ,... _.._ . .----,-.----
208, '506:
207, 507, _.._~-_.~- ..~.__._~---
.
208, 508, . ..~--- -.
M. <no
Adjustments (or Items unpaid by saller: Adjustmants lor lIems unpaid by seller:
210, Cllyllown te,es 10 . 510, QJ!yjtown te'es to ----. <------
211 , County la,es 10 ._-- 511. County la,es 10___,______ -,-_.-
212, AS5assmenls 10 ----- 512 Assessmenls IQ._____ --~._---
-- __M. 513, Maintenance 10.
213, SehooVTa,es 10 -~--~~.,._- 514, SehoollT a'es 10
214, to .. 515, 10
215, to .. 516 to
21 , to 517, 10
2 7 10 r--.--.. 518, to
21, 1"--____._ 519, . to --
~a ~ r--" 520, TOTAL REDUCTION AMOUNT DUE SELLER:
220, TOTAL PAID BYIFDR BORROWER: -- 5,000,00 782,26
300, CASt! AT SETTLEMENT FROMITO BORROWER: 600 CASH AT SETTLEMENT TOIFROM SELLER:
--
301. Gross amount dua Itom borrower (11I1e 120) 50,81,3,39 601. Gross amounl due 10 soller (11004201 \O,O~~
302, Less nmounls paid byJlor horrowor (lint' 2201 ( ~fOOO.PO 602 Los!> total rodllr.lions In nfllOllnl rllll) <;I,lIw (JIl2,16,
l.'-,- / /1 l'
8UREAU OF INDIVIDUAL TAKES
INHERITANCE TAX DIVISION
DEPT, t.6D601
~IS8tN, PA 17128-0601
,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ~EVENUE
NOTICE OF INHERITANCE TAN
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESS"ENT OF TAN
10-20-1998
PETERS
10-26-1996
21 97,0330
CUMBERLAND
101
[=-~-=- A~~un~'R.~~~: 3
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS L,INE ~ RETAIN LOWER PORn ON FOR YOUR RECORDS ~
iiE'y=iS4'-EY-AFP'-f o'9---97y-;:jcjfi CE--OF-YNHEififANCE -j 'Air A-PPRA-isE"ifEN'r; -Ai:UiiiiiNCE'oii-- ---- -- --. - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ZORA T FILE NO. 21 97-0:nn ACN 101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PAUL BRADFORD ORR ESQ
78 W POMFRET ST
CARLISLE
PA 17013
ESTATE OF PETERS
TAN RETURN NAS, (
I ACCEPTED AS FIl.ED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. C?"al Estate (Sohodul. A)
2. Stocks and Bonds I Schedule B)
3. Closely Held stook/Partn.~$hip lnt.rest (Sohedule C)
4. Hortgages/Notes Receivable (Sohedule 0)
S. Cash/Bank Deposits/Hisc. Parson.l Property (Soh.dula E)
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule G)
8, Total Assets
( X I CHANGED
SEE
III
(2)
(3)
(4)
(5)
(6)
(7)
50.000.00
,00
,00
,00
3,855,86
,00
.00
(8)
APPROVED DEDUCnONS AND EXEMPTIONS I
9. Fun.ral EKp.ns.s/Ad~. CostslHIIC, Expens.s (Schedule HJ
10. o.bts/Hortuage l.1abil it ias/Uens (Schedule I)
11. Tot.l Deduotions
12. Net V.lue of T8x Return
15. Ch.,.Uabl.IGoverMlental Bequest.; Non~.l.ct.d 9113 Trust. (Schedule J)
14. Nat Value of Estl'lta Subjeot to Tax
If an assessment was issued previously, lines
reflect figures that include the total of 6bh
ASSESSMENT OF TAXI
IS, AMount of Line 14 at Spousal rat. (IS)
16. AMount of Line l~ tax.ble .t Line.l/Cless A retn (16)
17, AMount of Line 14 taxable at Collat.ral/Class Drat. (11)
18, P,'!noipal Tex Du.
NOTE:
TAX CREDITS:
PAYHENT
DATE
06-09-1997
08-26-1998
RECEIPT
NUH8ER
AA211398
AA296584
DISCOUIIT (+)
INTEREST/PEN PAlO (-)
,00
.00
13,702.96
3,219,11
(11)
(12)
(13)
(14)
(9)
(10)
(>
*
nY-I"" U If I' I.t-',.
ZORA
T
DATE 10"20-1998
ATTACHED NOTICE
NOTE I To insure proper
oredit to your aooountJ
SubMit the upper portion
of this f~r. with your
hx pay.ant.
53,855,86
16 .9?? 07
36,933,79
,00
36,933,79
14, 15 and/or 16, 17 and 18 will
re~urns assessed to date.
.00 x .00=
36,933.79 X .06=
,00 N .15=
(18)
AHOUNT PAID
2,000 :'00
6,27
,00
2,216.03
.00
2,216,05
INTEREST IS CHARGED THROUGH 11-04-1998
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
- TOm ,i, ,,,,,,.._~,,.(;, 1
DALANCE OF TAX DUE 209,76
.. ----
INTEREST AND PEN. 24,76
-----.---.---
TOTAL DUE 234,52
-----_.~ ---.----
. IF PAID AFTER DATE INDICATED, SEE R~VERSE
FOR CALCUl.ATION OF ADDITIONAL INTEREST,
I IF TOTAl. DUE IS l.ESS THAN $1, NO PAY"ENT IS REqUUED,
IF TOTAl. DUE IS REFl.ECTED AS A "CREDIT" ICR I, YOU "AY BE DIlE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,)
,.
RESERVAYlOth Etttte. of dM.-nt. d~Jna on or beforfl Dec8ltber 12, 1982 RW if any future lnt.r..t in the .,tat.it trltltftttlld
1n po...,.lon or onjoy-.nt to Clast 8 (oollet.rall benefIciarle. of th9 deoedent afto( the 8xpJr_tion of any ..tate for
IHe or for y..rt, tho ConaOW.81th hereby 8xpr8uh' r8'8rY85 thEl rlght to ltPpraln and a..... trlm,ferloh4tritanoe Tax"
at the lawful C1.tH II (aol1at.t.l) rato on any luch 1u1:ur9 interest.
PlIlPOSE Of
NOTICE,
PAvttEHTI
REFUHD (CR)t
OBJECTlONSl
....IN
ISTRATlYl::
CORRECTIOHSI
DISCOUMT l
PENALTY:
INTEREST I
To fulfill the rel'luir.a.nts of 'Seotion 2140 of the Inherlhnctl end [state Tax Act, Act 21 of 1995. (72 P.S,
s.oUon 9140),
o.tach tlM top portion of this NoUc~ and sub.It with your payunt to 1:118 Raglstor of Wills ptlntGd on the royer.. .lde.
--Hakfl C'lheck or .onsy order payablll tal REGISTER OF' lULLS} AGENT
A refund of It tftX cred.\t, which ..as not requostod on tho T81( Return. IIlty be rflquosted by cOIIPhUng ,an "ApplicllItion
for Rllfund of Pef\f1syl\,lanlo Inherltanoe amI Estato To)(" (REV-13131. Appl)(:atlons ero nvoUgbh fit the Office
of the Reghtflr of ~lllls, any of tho 23 Revonuo U!striot Offices. or by callIng thil speoinl 24-hour
IM1swrlng sarvioo nu.bers for forllS ordering: III ponnsylv8nia 1-800-362-2050, outaldGl! Pennllylvnnh. ood
within locol Hftf'rhbur{l tireD (717) 767~8094, TDOII (717) 772-27.52 Uloftring I.paired Only),
Any porty in interollt not $atisf1od wUh the eppralsellllnt. allowance or disalloW&Me of d4ductlon., or aI'.UIIltflt
of tax <includIng discount or inter8st> 85 shOlm on this Notl<lo lIuSt Object ...-1thln sIxty (60) days of receipt, of
thls MoUc. bYI
--",r.\tten protest to the PA DepartMent of RevonuG, Board of ApP8ah, Dapt. 26102'1, Harrishurg, PA 17128-1021, OR
--election to have the flatter dat8rnln8u 8t audit of the uccount of tho rerson~1 repr..sentaUve, OR
--appeal to the Orphans' Court.
FlJatual errors dIscovered on thls aSSUSIIent !:hou1d be addressed in writing tal PA Departllont of RuvenijO,
BureBY of IndivIdual TalCes, ATTNI Post AssesSlIent Roviow Unit, Dop\' 180601, H!...risburg, PA 17128-0601
Phone (7l7) 167-6505, 500 pago 5 of th~ bool<lot "Instruotions for InharltanoG TOI( Return for II Resident
Decedent" (REV-ISO}) for 811 explanation of adll.lnl.straUv81'l corr8c'l:8ble SlTors,
If any tax duo h paid within threo (3) cahlOdar lIonths flftor tho decedent./> duth, 8 f1vp percent (5iO dhouunt of
the tal( paid Is allow8d.
Tha 15% tftX lHlfUISty non-partlolpatlon J"lOalty is co.puted on tho total of the tax and in.terest a!luued, and not
paid blilfore January 18, 1996, the first day oHer th(\ pnd of th8 tax a.nest~ p8rlod, Thh non"part.lalpation
penalty is 8Jlpea1flble .In the u.e lIonnAr and in tho tho saMe Uee period os 'lOll ~fOulu !lppeal th9 tax and .Int4lrest
that has been assQsSGcl as .Indlc!itad 011 Hils notice,
Inter..t is charged baglnn.lng with first day of dill inqullnoy, or nino (9) .onths Gnd ono (1) day fro. tho date of
de8th, to thu date of paYllcmt. TalCOS I<hi<lh boca.o delJnquont bofore January i. 1982 boar ir>terost 8t tho n,h of
silo{ (6;0 per-Clent pur ~nnul1 calculated at 8 doily rut" of ,00(1164, All taxifs whiuh oocnMe delinquent on and after
January 1, 1932 wili bear interest at a rato which wIll vary froll calondar y~8r to calendar year with that rate
~nnouncod by the PA Deportllent of kU\lenue. Th9 8pplicab18 .tntore!lt rates for 1982 through 1998 erel
!!!! InterllSt Rl!ltlJ ~nterest factor: Y!!!~ Int8ro~t Rnt8 Dally Interest Faotor
1982 201. .000546 1987 9% ,000247
1983 161. .000436 1966-,1991 11% .000301
19M 11U .000301 1992 91. .000247
1985 13% ,000356 1993"1994 7'1. .000192
1966 10% .000274 }1)95-1996 91. .000247
--Interost is calculated ., follolo/sl
INTEREST . BALANCE OF TAX UNPAID X NU"DER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any flk)tice issued aftilr tho t81( beoo.u delinquent wIll ref180t an Jnterest oalculation to fHteen (15) days
be;yond tho dllte of thCl tluosslllent. If pa....ent if IIIlldn ufter th8 Interest COIlputat1Dn date shown on the
Not1oe, Illdditional interest lIIust be cslculatod,
/.5=: 17~' 9
IUREAU OF INDIVIOIIAL TAMES
J~RtlANC[ TAK DIVISION
Of Pol. ltia6t.'i
",PAIUIUJlQ, VA 1711.8-11601
COMMONWEALTH OF PENMSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
.
l./
IlH,.JU_"m.ttl
DATE 10-1~-1999
ESTATE OF PETERS ZORA T
DATE OF DEATH 10-26-1996
FILE NUMBER 21 97-0330
COUNTY CUMBERLAND
ACN 101
E~-' ~~O~j~~ed -I
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PAUL BRADFORD ORR ESQ
50 E. HIGH ST
CARLISLE PA 17013 ",
HOTEl To in.ure proper oredit to your aooount, subMit the upper portion 01 this 10r. with your tax p.y..nt.
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiifli:j,s'9-:i-Elf"Ai:ii-fil',.--m------.-Ii-iifliiiirfANcii- 'filTii Eciiiiii -iirij-usi'ifENi'--IiM - - --- ------------------ -- - - --
ESTATE OF PETERS
ZORA
T FILE NO. 21 97-0330
10-1~-1999
ADJUSTNENT BASED ONI
VALUE OF ESTATE:
PROTEST BOARD DECISION
1, R..l E.t.t. ISch.dul. AI
2, Stooks and Bonds (Son.dule Bl
3, Clo..ly Held stock/Partnership Int.rest (Schedule CI
4. HartgBgas/Not.. Reo_iv.ble (Sohedule 01
&, C..sh/811nk OeposU"/Hhc, Pe,'sonal Prop8rb (Snhedule E)
fl. JointlY DwOitd P,'op.,.ty (Schedul.e F)
7, Tr~sf.rl (Schedule GJ
8. Tot.l As..ts
DEDUCTIONS AND EXEMPTIONS:
IJ. Funerlll EXP5nse./Adltin1st,'at1va Cost..1
Hilc.llan.ous Exp.nlfts (Soh.dule H)
O.bt./Hortgag. l1abUiH.s/Li.ns (Sch.dule IJ
Total D.duotions
Net Value of Tax R.turn
Ch.rltabl./GoY.r~ntal B.~sts; Non~alaot.d 9115 Trust.
Net Valu. of Estat. Subjeot to Tax
10.
11,
12.
13,
14.
TAXI
1S. A.aunt of Lin. 14 at Spousal r.t.
16. AMount of Line ]4 taxable at Lin.al/Cl.s. A rat.
17. A.aunt of Line 14 taxabl. .t Collat.raI/Cl... Drat.
18. Prinoipal lax Du.
TAX CREDITS:
rAYItGNTI
DATE d-
06-09-19971
08-26-199B
RECEIPT
NUHBER
DISCOIJllT (+)
INTEREST/PEN PAID 1-)
AA211398
AA2965B4
.00
,2~-
ACN 101
DATE
~O, 000.J..!!.lL.
.00
,00
.00
3,855,86
,00
,00
(B)
0.)
(21
(31
(41
(5)_
(6)
(7)
53,055,86
191
(10)
17,20WL
3,219.11
Ill)
(12)
(13)
(14)
(Soh.dule J)
(15)
1161
(17)
,00 M. 00 .
33.~33.79M.06'
,OOX,1S-
(18)
AttOUNT PAID
2,000,00
6,27
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
2 006.03
,00
,_-2~__
,35
· IF PAID AFTER DATE INDICATED, SEE REVERSF. I IF TOTAL DUE IS LESS TNAN .1, NO PAYNE NT IS REQUIRED,
FOR CALCULATION OF ADDHIONAL INTEREST, IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU !lAY BE DUE
A REFUND, SEE REVERSE SIDE DF TNIS FORN FOR INSTRUCTIONS,)
I'
PAYMENT.I
Detach th4 top pQr'~loo of thh Notice II~ .utMlJt HHh !.IourPIII!.I_ent Ilade payable tQ then... ttnd addr...
pr lntld on thCi r,ver.. I ide.
.... HMc;1 ohM;k or .one~ order payable tol ,REGISTER OF WILLS, AGENT.
REFUND (CR)I A refund of a tax oredlt, whioh WQ& not requested on tho Ta~ Returni Ilay bo requasted by coaptetlnt an
"Appll~ation for R.fund of PennsYlvania Inheritance and Estate lax" (REV-l~13), APplioatlons are .valllble .t
the OffIce of .tho Reglflter of Wills, .ny of tha 23 Relllltf\uQ DistrIot Offioell or frOll the Of\.p.rblent'. Z4-hour
""s,,,rlng ,erllloe nUllbers for fOF'lIS ordering: 1n Pflnrlsylvanla 1-800~J62-2050, outside PennsYlvania and
~1thln looal Harrisburg al'es (17) 787-8094, TOD' 1~800-447-3020 (S"rvl08 for taxpayers with ,peolal
hearIng and speaking needs).
REPLY
TO,
QuntlO"1 regal'ding errors contaIned on this notice should be addrusod to: PA Oepartllent of ~ev."uel Bureau
cH Indhddlla1 Taxes, ATTHl POlt Assus.ont Review Unit, Dept. 280601, Harrisburg, Pol 171Z8-0bOl, PhOne
(717) 787~6505.
DISCOUNT:
If IIny tax due Is paid within three (3) calendar .ooths After thfl deoedent's death, II Hlle per-oent (5;:) dhqouot
of toe tax ~aId is ollowBd.
PENALTY,
The 15% tax aMnesty non-participation penalty Is COMputfld on the total of the tllX and Intarest 8ssessed, and not
paId befor~ January 18, 1996, the first day after the end of the tax aMnesty periOd.
INTEREST I
Inter..t is charged beginning wJth first day of delinquency or nino (9) Ilonths and one (} I dtly froll the doh of
death to the date of paYMent, Taxes which beoaMe delinquent before Januory 1, 1982 bear lnterost at thtJ rate of
..\1< (6in pflre;8nt per annuli oalculated at " dsHy rnte of .000164, AU ta)(es which bOCflllle delinquent on and after
January I, 1982 will baftf Intorost at tl rllte which will vflr." froll oalendar yoar to calendar year with that rate
announo.d by the PA OepBrtllent nf ~8\1f1nue. ThQ npll1ioabhl tnterost rRtes for 1982 through 1999 are:
I
,
r
,
~ Interest Rate Dally Interest Factor Yeti; Intarost Rate Dally Intor8st Factor
1982 20% .000.li48 1988-1991 11% .000301
1983 16% ,(100<\58 1992 fJi: .000247
1984 11% ,000301 1993-1994 7% ,000192
1985 U% ,0003!i6 1995-1998 9Y. ,000247
1986 10% .0002i'4 1999 7% ,000192
1987 9% .1l00Z47
.~Inter..t I. coloulated III followSI
INTSREST . BALANCS Of !AX UNPAID X NUNBER Of DAYS DELINqUENT X DAILY INTEREST FACTOR
nAny Hot1ce llllued aftAr the tftx becOIIoll de1JnqlNnt .,1.11 refloct an interllst calculation to fift.en (15) days
beyond the date of the asSllSllHlnt. If pay..nt h lIade after the interest oo..putntloll dnt. IOOwn on the
HoUo.., fildc:Utlonnl Interest "u~t be oalcubt.d.
"
o
STATUS REP0RT UNDER RULE 6,12
---"-~,-_.,~---~--~-~---._~-~,~._"
Name of
Decedentl__L0Rt\. 1\
Death I ~ ....2.~-- ~~'----r'
PE.TEP-S
I ii,
Date of
Will No.
Admin,
NO,J) 19i7-';'~rJ 33c?
Pursuant to Rule 6,12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1, Sta~ether admi.nistration of the estate is complete:
Yes No
m ,.. _'__._,_~
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
completel ,_________
3, If the answer to No, 1 is Yes, state the following I
a, Did the personal r~~sentlltive file II final
account wi th the Court? Yes .-.- No A'"
b, The separate Orphans' Cuurt No. (if any) for
the personal representative's accuunt is:
c, Did the personal represc,ntative st~t;- an
account informally to the parties in interest? Yes_~ No
d, Copies of receipts, releases, joinders and
approvals of formal or Informal ace ~s ay be fi d with the
Cerk of the Orphans' Court and may e teed to t report,
Date: ~ I Iztl O:;;Q \. I () _ _ /V--
~ \l\ecY aLure
.k. {)J'v ' PAUL \'s, t)RR
(......~()J- ~( '0 k Name (Please type or print)
~ n ~ \Jf1\ .~E8SJ: I1lt'rf-l j1 GA12Lt'S'L[.
veJ{ , l Address
X A~vv~o " . g \ nn \-2 r;~ ~ BS;S8,
1 '{N~~l\~ qq Ca' pa<,T1, et;1:"',y:. No,
1\ . ~ . _____Porsonal Representative
~__counsel for personal
/\ representative
( MAH I I'm f I AM 3 )