The URL can be used to link to this page

Home My WebLink About04-18-07 . . . ..J 15056051058 REV-1500EX(~) PAOeparlment of RMnue *' Bureeu d Indvidual T8Xtl8 PO BOX 2DlO1 HanisbuJg, PA 1712&(J6()1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY ~nty ~~{ File NUmberO.3~ , ~ . i "W- .1Q&Qae Date of Birth 09/13/1917 19740-8619 11/2512006 Decedent's Last Name Clites Suffix Decedent's First Name Katharine MI H {If AppIIcRIe) Enter Surviving Spo...... Informlltlon Below Spouse's Last Name Sulftx Spouse's First Name MI Spouse's Social Security Number T1f1S RETURN MUST BE FILED IN DUPLICATE WITH T1fE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW <t> 1. Original Reb.m 2. Supptemental Retum c:::> c:::> 3. Remainder Return (date d death prior 10 12-13-82) 5. Federal EsIlilt8 Tax Retum Requi'ed c:::> 4. LImitsd Estate c:::> 4a. Future Interest Compromise (date of c:::> de81h after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty Credit (date d de81h <::::) 11. Election 10 lax ooder Sec. 9113(A) belween 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - 1lIIS SECTION MUST BE COIIPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DllECTED TO: Name Daytime Telephone Number .--- -...-- c:::> 6. Decedent DIed Testate (Attach Copy d WII) c::> 9. Litigation Proceeds RecelY8d 6. Total Number of Sate Deposit Boxes Richard L. Clites Firm Name (If Applicable) ~ r--, -.~w.LLI.iiONL'( 1--' ~22 ~ ;-~-~ ~'-f<o -0 ,-. c,; I _"'r::r-::::O ':-J I .._--;rn - - '--..: r ,....::0 , I )-:".:A 00 ~.'(b I l. ) c) -0 ' ~. ~, I g"7] - '1 i I ~ : - :'.i .. . ., ; DAlE RU!8- ", -----.- --------.-----m------- First line of address P. O. Box 37 Second line of address CIty or Post Otrice Elllottsburg State ZIP Code 17024 PA Correspondenfs e-mail address:rcIltesQearthlink.net Under pensItIes d petpy, I declInIlhBt I h8Ye 8lal1Ined lhI8 return, Indudlng it Is true, correct IN carnpleaI. 0edIInI1on of ....... other ltWIthe SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS PO Box 37 Elliottsburg, PA 17024 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE lId1edules and 8lIIIIImenls, and 10 the best of my Il.nowIlIdge and belief. on 8I1nfomlelIol. of WhIch pnIplnI' h88 MY knowledge. DATE 04/17107 DATE ADDRESS PLI!AIII! ~ OIIICIINAL POU ONLY L 15056051058 Side 1 15056051058 -1~. . . . ..J 15056052059 REV-1500 EX Dec8denfs Name: RECAPIlVLATION Katharine H Clites 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . " 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. CIosety Held Corporation, Partnership or SoIe-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . .. . .. . . . . . . .. . . . . . ; .. . .. . . .. 4. 5. Cash. Bank Deposits & Mlscelaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Proparty (Schedule F) c::> Separate Billing ReqU88l8d . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Sch8dule G) c::> Separate Sling Requested... . . . .. 7. 8. ToteI Groes AMets (total lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative CosIs (Schedule H).. . . . .. . . . . . . . . . . . . .. 9. 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. ToteI Deduction. (total lines 9 & 10). .. . . . . . . . . .. . . . . .. . . . .. . . . . . . . . . . . 11. 12. Net VIIlue of eatat. (Line 8 minus line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental 8equestsISec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net VIIlue Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUcnONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X.O ~ 16. 17. Amount of line 14 taxable at sibling rate X .12 17. 18. Amount of line 14 taxable at cdIal8raI rate X .15 18. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUD'nNG A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Deoedenrs SocIal Security Number 197-40-8619 0.00 0.00 0.00 0.00 3,915.22 0.00 4,888.80 814.00 5,716.22 8,630.22 -1,641.62 -1,841.82 0.00 c::> 15056052059 -I REV-1500 EX P8ge 3 Decedent's Complete Address: H Clites r--'---1 ~----- .~"\!m!:!tI: , 50 J 07 ;106Q3S l . DECEDENt'S SOCIAl. SECURITY NUMBER 197-40-8619 CITY Elliottsburg STATE PA ZP 17024 Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. CredIlsIPayrnents A Spousal Poverty Credit B. Prior ~ts C. Discount 3. InterestlPenalty if applicable D. InfIrest E. Penalty (1) 0.00 Total Credits ( A + B + C ) (2) 0.00 TotaIlnterestlPenalty ( 0 + E ) 4. If line 2 is greater lhan line 1 + LIne 3, enter the dlfl'er8nce. This is the OVERPAYMENT. Fllln OVII on PIge 2, line 20 to rIqUIIt . refund. 5. If line 1 + LIne 3 is greater than LIne 2, enter the dlfl'er8nce. This is the TAX DUE. A Enter the interest on the tax due. (3) 0.00 (4) 0.00 (5) 0.00 (SA) 0.00 (58) 0.00 B. Enter the btaI of LIne 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS ,. Did decedent make a transfer and: Yes No a. retain the use or income of the property lransl'8rr8d;.......................................................................................... 0 [iJ b. retain !he r9ll1o des91ate who shall use the property lransI'8rred or its income; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 Ii] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death ocwrred after December 12, 1982. did decedent transfer property wllhln one year of dealh without reoeiving adequate consideraIion? .............................................................................................................. 0 iii 3. Did decedent own an "In trust for" or payable upaI dealh bank account or security at tis or her delllh? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which conlalns a beneficiary designation? ........................................................................................................................ 0 [iJ IF THE ANSWER TO ANY OF THE ABOVE QUESTlONS 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 10 or for the use of the surviving spouse is three (3) percent [72 P.S. 59116 (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. 59116 (8) (1.1) Qi)]. The statute does not exempt 8 transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and flfing a tax return are stiR 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 deceesed child _ty..one years of age or younger at death to or for the use of 8 natural paren~ an ~ paren~ or a stepparent of the child is zero (0) pen:ent [72 P.S. "'11(8)(1.2)]. .tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries Is four and one-haIf (4.5) percent, except as noted in .S. 59116(1.2) [72 P.S. 59116(8)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is twelve (12) percent [72 P.S. 59116(8)(1.3)]. A sibling is defined, under Section 9102, as an individual. has at least one parent in common with the decedent, whether by blood or adoption. . . . "- REV-1508 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RUIDENT DECEDENT ICN.DUU . CASH, BANK DEPOSRS, & MISC. PERSONAL PROPERlY ~TE OP Katnanne H. elltel FILE NUMBER 50- 07/0603 '8" Incble the pI'llCMdI of Iiption Ind the dIlllhl procelds Will received ~ the estate. AI property ~ willi rigid 01 eurvMnhIp IIlUIt be II..... 011 ~ F. ITEM NUMUR 1 Membn 1st er.dIt Union DESCRIPll0N VALUE AT DATE OF DEATH 973.38 TOTAL (Also enter on fine 5, Recapitulation) $ (If more space is needed, In8ert addIIionaIlIheets of the same 8Ize) 973.38 REV-1509 EX+ (8-98. COMMONWEAlTH OF PENNSYLVANIA . INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Katharine H. Clites ICHIDUU . JOINny-oWNED PROPERrY FILE NU.ER 5O'~07/06038 If .. ..... WlI .... joint wIItIn on. ,.... of tile ....dlld'l..... of...... It nit be reported 011 SchIduIe Go SURVIVING JOINT TENANT(S) NAME A. Richard L. Clites ADDRESS RELATIONSHIP TO DECEDENT PO Box 37 Elliottsburg, PA 17024 Son B. c. JOINTLY.owNED PROPERTY: . LEITER DATE DESCIW'11ON a: PROPERTY "'OF DATE OF DEATH ITEM FOR .10M MADE INCI.UllE NAME OF FlIWlClAL INSIlTUTIOH AN[) IWI( ACCOUNT NUMBER OR SINI.AR DATE OF DEATH lJEa)'S VALUE OF NUMBER TENANT JOINT IlENTIFYING NUP.8:R. ATTACH DEED FOR JOINTlv.tELD REAL ESTATE VALUE OF ASSET IN1mEST DECEIlENT'S INTEREST 1. A. 1011M>5 PSECU Acct # 8604786429 411.31 50 205.86 2 A 101171U5 PSECU CD # 8604786429-555 7,419.12 50 3,709.56 TOTAL (Also enter on Hne 6, Recaptu/ation) $ 3,915.22 (If more space is~, insert adclillonal8heets of the same size) . I _ REV-1511 EX+ (12-99* CClMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCH.DUU H FUNERAL EXPENSES & ADMINISTRATIVE COSTS . ESTATE OF Katharine H. Clites FILE NUMBER 50-07106039 ITEM NUMBER A. DIbt8 '" dlIc:edent must be I'tIIICII1Id an Schedule L DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Myers Funeral Home - Flowers Fiala Hall Rental Luncheon and Suppies 254.00 100.00 460.00 2 3. B. ADMINISTRATIVE COSTS: 1. Personal Represenlaliwl's Commissions Name of P8ISOn8I RepresenIalMl(s) Sociaf Security Number(s}IE1N Number of Personal Represenlative(s) Street Address . City Slate Zip Year(s) CommIssion Paid: 2. AlIomey Fees 3. FamIy Exemption: (If decedenfs addlellS is not the same as cIlIimanfs, attach explanation) Claimant Street Address City Slate . ZIp Relationship of Claimant to Decedent 4. Probate Fees 5. Accounlanfs Fees 6. Tax Retum Pnlparer's Fees 7. . mAL (Also enter on line 9, Recapitulation) $ (If more space is 1lll8ded. Insert addIIIonaI sheets at the same 8Ize) 814.00 ReV-1512 EX+ (12-00) . IeN.DUU I DEBTS OF DECEDENT, MORTGAGE UABlunES, & UENS COMMONWEAlTH OF PENNSYlVANIA . INHERITANCE TAX RETURN RESIDENT DECEDEHT ESTATE OF FILE NUMBER Katharine H. Clites 50-07106039 R8poIt dIIlls IncurNd by tile clIcectent prior to ..... wIIicIl fImIIned unplld . of tile ... of deIItI, IncIucIllI UIlI'IImIlurIed ftlIdIcII ........ VAlUE AT DATE OF DEATH ITEM NUMBER DESCRIPTION 1. Claremont Nursing Md Rehabilitation CentBr 5.716.22 . . TOTAL (Also enter on line 10. Recapitulation) $ (If more spece Is needed,;n.rt 8ddIIIonaJ sheets of the same size) 5.716.22 COMMOtIIIEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE IUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISIURG. PA 17121-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE ~-:0ZJ57- 38;1 NO. 51r 07106037 02-14-2007 REV.IS41 EX IFP (It-II) EST. OF KATHERINE H CLITES 5.5. NO. 197-40-8619 DATE OF DEATH 11-25-2006 COUNTY PERRY TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [i] CERTIF. PA 17024-0037 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS PERRY CO COURT HOUSE NEW BLOOMFIELD, PA 17068 RICHARD L 332 KISTLER PO BOX 37 ELLIOTTSBURG CLITES RD PSECU has providad tha Departaant with tha infonaation listad-balow which has baan usad in calculating tha potantial tax dua. Thair racords indicata that at tha daath of tha abova dacadant. YOU wara a joint ownar/banaficiary of this account. If you faal this inforaation is incorract. plaasa obtain writtan corraction froa tha financial institution. attach a cOPY to this fona and rat urn it to tha abova addrass. This account is taxabla in accordanca with tha Inharitanca Tax Laws of tha Coaaonwaalth of PannSYlvania. Questions-aay ba answarad by calling (717) 787-1327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8604786429-555 Date 10-17-2005 Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 7,419.12 50.000 3,709.56 .045 166.93 TAXPAYER RESPONSE To insura propar cradit to your account. two (2) copias of this notica aust accoapany your payaant to tha Ragistar of Wills. Maka chack payabla to. "Ragistar of Wills. Agant". Established x NOTE. If tax payaants ara aada within thraa (3) aonths of tha dacadant's data of daath. you aay daduct a 5X discount of tha tax dua. Any inheritanca tax dua will bacoaa dalinquant nine (,) aonths aftar tha data of daath. Tax PART [!] -;~-(~;:t~:;-,:_ ~,-: :*-:~:: - -,: - - - ~_ :,_ :-:> ::~;~~:~~~K;~-~:-:L~~:~~:;;ii~;:~~::;~;-~ -,:i;-~-- :;:;~~:~~~,~__ .~_::"1:;::_~_'::"'~;~~:;f:::~~:~Z_:-:;':;:-~::"~~~;,:~::~ c~~~::i~:~"::~i~;;~= _~!: A. 0 Tha abova inforaaUon and tax due is corract. 1. You aay choosa to raait payaent to tha Ragistar of Wills with two copias of this notica to obtain a discount Dr avoid intarast. or you aay chack box "A" and return this notica to tha Ragistar of Wills and an official assassaant will ba issuad by tha PA Dapartaant of Ravanua. [CHECK ] ONE BLOCK ONLY I. ~ The abova assat has baan or will ba raportad and tax paid with tha PannSYlvania Inharitanca Tax return ~to ba filad by tha dacadant's raprasantativa. C. 0 Tha above inforaation is incorract and/or dabts and daductions ware paid by you. You aust coaplata PART 0 and/or PART [!] balow. - PART I!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED If yoU indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount SUbject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate .. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 . x x PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) . Under penalties of perjury. I declare that the facts I have reported above are true. correct and complete to the best of my knowledge end belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2BO'11 HARRISBURG, PA 17128-0'01 *' INFORMATION NOTICE , . AND TAXPAYER RESPONSE FILE ACN DATE NO. 50 07106038 02-14-2007 1EW-1S41 EX lIP nt.II) EST. OF KATHERINE H CLITES 5.5. NO. 197-40-8619 DATE OF DEATH 11-25-2006 COUNTY PERRY TYPE OF ACCOUNT o SAVINGS [i] CHECKING o TRUST o CERTIF. RICHARD L CLITES 332 KISTLERRD PO BOX 37 ELLIOTTSBURG PA 17024-0037 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS PERRY CO COURT HOUSE NEW BLOOMFIELD, PA 17068 PSECU has provided the Oepart.ent Nith the info~ation listed belov Nhich has been used in calculating the potentiel tax due. Their records indicate that at the death of the above decedent, you Nere a jOint.ovner/beneficiary of this account. If you feel this infor.ation is incorrect, please obtain Nritten correction fr.. the financial institution, attach a copy to this fo~ and return it to the above address. This account is taxeble in accordance Nith the Inheritance Tax Lows of the Co..onwealth of PennSYlvenia. Questions.ay be ansNered by calling (717) 787-8321. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8604786429 Dde 10-13-2005 Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x 411. 31 50.000 205.66 .045 9.25 TAXPAYER RESPONSE To insure proper credit to your account, tNo (2) copies of this notice .ust acc..pany Your pay.ent to the Register of Wills. Make check payable to. "Register of Wills, Agent". Established x NOTE. If tax pay.ents are .ade Nithin three (3) .onths of the decedent's date of death, YOU .ay deduct a 5X discount of the tax due. Any inheritance tax due Nill bec..e delinquent nine (9) .onths after the date of death. Tax PART [!] [fi;;~~~:~~;;~;~:;:~~i;;~:~;~-::::-: - / :: --- ~~:~:~~:~:~J ~;~-~~;-~:- _::]~;;:-_:)-:;:~~ _j~-::;::;r~~ c::_~~1J~~: [: ~~T;~~:':;-:;r~ :_:~;~~:i:t;:-;-:-~::~:~li;~"i~';:::::~;~~~:;~~:;~_:;r~ A. r=J The above info~ation end t.x due is correct. 1. You.ey choose to re.it pay.ent to the Register of Wills Nith tNO copies of this notice to obtain e discount or avoid interest, or you .ey check box "A" and return this notice to the Register of Wills and an officiel esses~ent Nill be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. ~ The above asset hes bean or Nill be reported end t.x peid Nith the PennSYlvenia Inheritance T.x return ~o be filed by the decedent's representetive. C. r=J The above info~ation is incorrect end/or debts end deductions Nere peid by you. You .ust co.plete PART ~ and/or PART ~ belov. If YOU indicate a different tax rate, please state your relationship to decedent: TAX ON JOINT/TRUST ACCOUNTS PART I!l TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account lalance 3. Percent Taxable ~. A.ount Subject to Tax 5. Debts and Deductions 5. A.ount Taxable 7. Tax Rate a. Tax Due OF 1 2 3 ~ 5 5 7 8 x x PART l!I DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Co.putation> . Under penalties of perjury, I declare that the facts I have reported above are true, correct and co.plete to the best of .y knowled,e and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE FRONT /BACK CHECK IMAGE VIEW Bill Payer Check #122902 _HCUIlElS _LQJII!B ..-- ~....-... IIIDIlB CIIIM'i ~i ~ a.t'IBS- 47 MY: Fl'9B ~.- ~ "'."1Il) s~ 1lOIJ.IIItS All) 22 CBII!S Page] of] .... .. 80. 12290Z JIUI: 12/2'/2016 ~} ~:.,,}_,~-_:tr~ _to.. ... of ~ I ......'" ~ IItBSIS All) 'ltRDRTT.TDrICII CBR A'IDr: _DISS DBPr 1000 ::~ BD ~~TAT~ PA 110J.3-880S L:at.:a..J I .lllqo~ CZiLilLAL&C O~5lq&qOa? IOOOOS?A&l~ 47821 818587 _ 161 J712680974 010B2007 03UJOO040 Fm-PHJU 1Df7>..2DOa 1JK>2OJ6 Ar=2fi ~ >2313r.dil91o< 1"l P\?- _ .. ~.~. u, ~~~.PA 8 ~ I -t .. . p o ~ d~ t~ ,1/1 ! I ~ ?C i .PIase Note: lnfonna1ion written on a check using a Gd Pen may cause the information to not appe8.( as part of1be check image. l:,;,)"",;",.,"r!II*"':MII_:.~i.~~s"ii;,,'.,...;i bUps:/Ihomebank.psecu.comfOJeckImageslPrintView.aspx1O] 052007J 229020006SOOJ 6J ... lIJ2J2007 Myers Funeral Home, Inc. Boyd L. Myers Jr., Supervisor 37 East Main Street Mechanicsburg, Pennsylvania 17055 (717) 766-3421 Fax (717) 795-7291 A standard ofexceIIence in Central Pennsylvania since 1910 Friday, December 29, 2006 Mr. Richard Lee Clites P.O. Box 37 Elliotsbuirg, Pa. 17024 Dear Mr. Clites, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form and herein indicated as PAID-IN-FULL. Katharine H. Clites SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED LESS: Credits granted LESS: Total Payments PLUS: Items ordered later CURRENT BALANCE $8,703.40 1,788.40 7,169.49 254.40 $0.00 Credits Granted: $193.40 Preneed Discount $1,595.0 Package Price Discount PLUS: Items ordered later Flowers 254.40, If there are any questions or concerns that remain unanswered, please call me. vr Send Inquires to: 5000 Loul.. Drive PO Box 40 MechMlcsburg. PA 17055 www.membe..1.t.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZeall: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 elCl. 5312 TeleBr1Inch: (717) 795-6049 or (800) 237-7288 MEMBERS 1st FEDERAL CREDIT UNION ~- -= ~.. ~ !iiiI .. J iliiIIiii& :>- ~- - 15 1 AV 0.293 15-15 1...111...111.111.1.,.1..111.1111111.111111',1.1111, .'.11.11.1 KATHARINE H CLITES PO BOX 112 ELLlOTTSBURG PA 17024-0112 Statement of Accounts Oct 25, 2006 thru Nov 24, 2006 Account Number: 83370 - Account Balances at a Glance: Checking: 676. 18 Savings: 297.00 Certificates: 0 . 00 Loans: 0.00 Money Management: 0.00 Page: 1 of 1 - - - - - Please read the enclosed insert regarding 1 099-1 NT forms. ~o 'hlUd. CHECKING ACCOUNTS 11 - CHECKING . Date Oct 2$ Nov 01 Nov 24 Transactton ~ BIIIancs FOI1NlII'd Deposit Transfer From Share 00 Ending /1tIIIIIIce AddItions 676. 18 Subtractions -~ 0.00 676. 18 676. 18 SAVINGS 'ACCOUNTS 00- REGULARSAYIHGS Date Oct 2$ Nov 01 Nov 01 Nov 03 Nov 24 T~...~ B1!IJancs'. Fl1I'WINd Oeposit AeH CIVIL. SERV 1D.:.~3121736:t56 Withdrawallran$~rToShare 11 ~ OepO$it ACHSOC SEC ~ 10: 3031036030 ~ .EhtJihg . BsIst1t;s ~ ~ M ~ ~ $ '~},:: ~: -\; ;- \ \ ~;~ il 'i ,~ '" ,~ .;J'- ,.:!" YTD . SUMMARIES . TOTALQlVlOEND$ PAlO 00 REGULAR' SAVINGS 11. · CHECKING Total YearTo....Oat.ONildends Paid NOTE: Total . Includes closed shares Don't fcqeta~ut OUr new Member L,oyaity The mote Ptoducts you have with uS,the more Ask an associate for details or visit our websHe at, . . ~ ~. AddItions 678.18 Balance 25.00 701. 18 ~~.. r- J it! 676.18.. 25.00 297.00 297 . 00 272.00 i'. ..., ~~. ~. 'fit 1.64 s. Program. .. . yoU'HreCeWe. IMirs1$torg for details. , ~'~":> ~ ..' ';'::'->'/':~:"'Y , -::?~i'::t ~ '" uJ <I: - ~ D: r-- L..f").!... tii ~",:Ol- ('Y'1~ OCl::lN'Z .00 a..<i:ffiR':::el --6 vJa..t=-a:~ i;A-g . 0 a.. ::l ...... <I: ....I ....I uJ M o I"- qn n ~ ..~ h ~ 51 ~ =s c:....:>> ~. ~ :.i ' Q) L- m ::J -=~ 0- -= C CJ) C0 -::J ~ -=0 C/) Q)o - -C/) -=U=::JI'-- "':"OSo~ = c_..c<( :motQ.. -= 1:: L-::J _ -:Q)$R-<!2 - .0 C/) \oJ C/) ...: E '0, Q) .~ -=::JQ)cm -=UO:::OU "3" N o I'- (/l ~ Q) <( :!: c.. <3 . . I'- OJ ..J<">:J "Ox.o ..... 0 (/l (000::: .s:::. 0 00= fia..w ,1111 III1I11111111111111111