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HomeMy WebLinkAbout05-11-07REV•1300 E7(+ (600) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 DECEDENTS NAME (LAST, FlRST, AND MIDDLE INITIAL) H Z W W V W DATE OF DEATH (MM-DD•Year) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DATE OF BIRTH (MM-DD•Year) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FlRST, ANO MIDDLE INITIAL) OFFlCIAL USE ONLY FILE NUMBER 2 1 -0 7 0 2 6 2 SOCIAL SECURITY NUMBER 1 7 1 -2 4-4 7 2 6 TFnB RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ ®1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (daeadamnpdorro 12-~3ez) W ~ ~ 4. Lanited Estate ~ 4a. Future Interest Compromise (deH a dead aver 1z•12.82) ~ 5. Federal Estate Tax Retum Required ~i ~ m ©6. Decedent Died Testate (AMech copy a wiq ~ 7. Decedent Maintained a Living Trust (Attach cap1~ a rrusU _ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (dme of damh between i2at-st and t•t•es) ~ 11. Election t0 tax under Sec. 9113(A) (Attach scn o> Z H a a W Q Z O Q a O V (n Applicable) E 60 WEST POMFRET STREET 1. Real Estate (Schedule A) (1J 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, PaMership orSole-Proprietorship (3) 4. Mortgages 8 Notes Receivable (Schedule D) (4) 5. Cash, Bank DeposiLg & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (g) Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) PA 17013 OFFICIRL USE ONLY ;~.s __, •,_ , _ ., - _ _; , ,__ - ; 18 `~ `-~ _.-- ` _.. .- - ---; .~ ~.. ,.i __ -, -`~ ~ ~•~ .~ (=i 8. Tasl Gross Assets (total Lttles 1-7) (8) 80.038.18 9. Funeral Expenses & Admuristrative Costs (Schedule H) (9) 15.025.57 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10} 2,347.62 11. Taal Deductions (total Lines 9 & 10) (11) 17,373.19 12. Net Valw of Estate (Line 8 minus Line 11) (12) 62,664.99 13. Charitable and Governmental BequestsJSec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Nst Valus Subject to Tax (Line 12 minus Line 13) (14) 62,664.99 aec rna r nuc r wits vn REVERSE 51DE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X (15) 0.00 16. Amount of Line 14 taxable at I~eal rate 62.664.99 X .045 (is) 2 g1 g,g2 17. Amount of tine f 4 taxable at sibl~g rate 0.00 X .12 (17) 0.00 18. Amount of Lie 14 taxable at collateral rate 0.00 X .15 (18) 0.00 19. Tax Due (1s) 2.819.92 20. L J~ ,-,~Re1ty. r. S Decedent's Complete Address• _ srREETAOORESS 59 EAST SOUTH STREET c~Y CARLISLE sTnTE PA ~P 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,819.92 Total Credits (A + B + C) (2) 0•~ 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresVPenalty (D + E ) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Chock box on Page 1 Line 20 to request a refund 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. (3) 0.00 (q) 0.00 (5) 2,819.92 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 2,819.92 Make Check Payable fo: REGISTER OF WILLS, AGENT ~.-~:. PLEASE ANSWER THE FOLLOWING GIUESTIONS 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; X b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ c. retain a reversionary interest; or ...................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................. ^ 2. If death ocxurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... ^ 3. Did decedent own an "intrust for' or payable upon death bank account or security at his or her death? ................. ^ 4. Did decedent own an Individual Retirement Account, annuity, orothernon-probate property which contains a beneficary designation? ....................................................................................................... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. under pera~laes d pefjury, l dedsro thot 1 nave exemmed tl~is ream. indudm~ axompenyinp aclbdAee and statemenb, and ro tlb best d my wedge and bdbt, n is tme, correct and car late. l)edaretion d propuer aver n,an the represa,tadve is based an all edarnaaon d vrtwch preparor ~ any lvawledge. SIGN• Oi~ERSON RESPONSIBLE F~R FIUNG RETURN DATE ADD(iES~, ~ 17 E. LOCUST STREET 'MECHANICSBURG PA 17055 SIGNATURE OF PREPARER 0 ER THAN REPRESENTATIV DATE ADDRESS 60 WEST PO~R~T STREET 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 3°k, (72 P.S. §9116 (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 096 [72 P.S. §9116 (a) (1.1) (ii)]. The statute d 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 liter 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 0%(72 P.S. §9116(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 4.596, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12°~ [72 P.S. §9116(a)(1.3)). Asibling is defined, urxier Section 9102, as an individual who 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 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY -- FILE NUMBER ~RICCLE JESS E 21 07 0 ~~ Include the proceeds of litlga6on and the date the proceeds were received by the estate. All property jointly-owned witl~ of survivorshi must be dlecload on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. PERSONAL PROPERTY -CARLISLE-RENT-A-SPACE 171.00 APPRAIS AL ATTACHED 2. PERSONAL PROPERTY - 59 E. SOUTH STREET CARLISLE PA , , APPRAISAL ATTACHED 3,543.00 3. MEMBERS 1ST FEDERAL CREDIT UNION SAVINGS ACCOUNT #12068-00 28,943.52 4. MEMBERS 1ST FEDERAL CREDIT UNION CHECKING ACCOUNT #12068-11 1,452.99 5. MEMBERS 1ST FEDERAL CREDIT UNION MONEY MANAGEMENT ACCOUNT #12068-05 32,189.92 6. VEHICLE - 1GCEK14X47Z141141 13,700.00 7. CASH ON HAND 37.75 TOTAL (Also enter on line 5, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) EV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL FJEPENSES ~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BRlGGLE J SR E 21 07 0 ~~ Debt of decedent must be reported on SdreduN L ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME, INC. 4,866.54 B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) NORA M. MORENO Social Security Number(s~EIN Number of Personal Representative(s) street Address 117 E. LOCUST STREET city MECHANICSBURG state PA zip 17055 Year( on Paid: 2, AttomeyFees IRWIN & Mc IGHT 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address C~' State ~ Relationship of Claimant to Decedent 4• Probate Fees REGISTER OF W ILLS 5. ~ Acco~tanrs Fees 6. I Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8- ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY (2) 9. .THE SENTINEL -ESTATE NOTICE 10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 11. ZIEGLERS -MOVING EXPENSE 4,000.00 4,750.00 177.00 350.00 30.00 90.00 137.03 75.00 550.00 TOTAL (Also enter on line 9, Recapitulation) ~ S (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (8-98) , SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, '" RES DENT D eon iR" MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER WRIGGLE JESS E 21 07 026 Include unreimburaed medical sxpenaea. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PP&L -ELECTRIC 582.03 2. CARLISLE RENT-A-SPACE -RENTAL 239.24 3. EMBARQ -TELEPHONE 4. OPAL MASON, LANDLORD -RENT (4 MONTHS) 5. OPAL MASON, LANDLORD -REIMBURSEMENT OF WATER BILL TOTAL (Also enter on line 10, Recapitulation) I ; (If more space is needed, ~sert additional sheets of the same size) 135.35 1,300.00 91.00 REV-1573 EX + (¢mf SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFlCIARIES INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NU118ER NUMBER NAME AND ADDRESS OF PERSONS} RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [(ndude ou ' t spousal distrbutlans, and transfers molder sec. at is (a~(tzyl 1. NICOLE MORENO Lineal 117 E. LOCUST STREET 1/3 REMAINDER MECHANICSBURG, PA 17055 2. MARC MORENO Lineal 1565 HELFFRICH ROAD 1/3 REMAINDER KUTZTOWN PA 19530-8409L 3. JORDAN LEFORTE Lineal 117 E. LOCUST STREET 1/3 REMAINDER MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. REV-1500 COVER TOTAL DEPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S (If more space is needed, insert additional sheets of the same size) ~c~# i11 tt~r~ ~PS~rrmP~ I~ JE.SS E. WRIGGLE, of 59 E. South Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this to be my Last Will and Testament, hereby revoking all Wills and Testaments or writings in the nature thereof. by me heretofore made, and I direct as follows: FIRST I direct that all my just debts and the expenses of my last illness and funeral shall be paid from the assets of my estate as soon as practicable after my decease. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable market for my grave. SECOAID I give and bequeath all automobiles, household effects and other tangible personal property, not including cash or securities, owned by me at my death, together with all policies of insurance thereon, such of my grandchildren who survive me on the sixtieth (60th) day after the date of my death. Such property shall be divided among such grandchildren as they shall agree, any grandchild who is a minor to be represented in such agreement by my Executor. In the event that no agreement is reached, the said personalty shall be sold, in whole or in part, as my Executor shall determine, and the proceeds shall become a part of my residuary estate. Any item of personalty passing to a minor under this paragraph may be delivered to the minor or to any person to hold for the minor, as my Executor thinks advisable, and the receipt of any such person, including the minor, shall constitute a full and complete discharge to my Executor. THIRD I give, devise and bequeath the residue of my estate, of every nature and wherever situate, in equal shares to such of my grandchildren who survive me on the sixtieth (60th) day after the date of my death. In the event no grandchild survives me on the sixtieth (60th) day after the date of my death, then I give, devise and bequeath the residue of my estate, of every nature and wherever situate, in equal shares to my children to be divided between them equally, share and share alike, the share of any deceased child to pass to his or her descendants, per stirpes. F(wRTH In the event any beneficiary who is entitled to a share of the residue under Item Third has not yet attained the age of twenty-one (21) years at the time for distribution to him or her, then I give, devise and bequeath the share of .each such beneficiary to my trustee hereinafter named, IN TRUST, nevertheless, upon the following terms and conditions: A. The income and so much of the principal as may, in the sole discretion of my trustee, be necessary for the maintenance, support, medical expenses, and education of the beneficiary, shall be paid to the beneficiary or shall be applied directly for his or her benefit. B. Any income not so paid or applied shall be accumulated and added to such beneficiary's share of the trust estate. C. Any income and principal remaining in such beneficiary's share of the trust shall be distributed to such beneficiary when he or she attains the age of twenty-one (21) years. D. In the event any such beneficiary who has not yet attained the age of twenty-one (21) years at the time of my death dies before distribution of his or her entire principal share, then such share shall be distributed to such beneficiary's then living descendants, per stirpes, absolutely; or in default of such descendants it shall be distributed in accordance with Item Third of this Will. E. Any income or principal payable to a beneficiary under this Item Fourth may be accumulated or expended for the maintenance, support, medical expenses, or education of such beneficiary as the trustee, in his sole discretion, may determine. My trustee may, in his discretion, pay the said income or principal directly to the beneficiary, to the person having the care or control of such beneficiary, or to any institution entitled to such payment by reason of services rendered to or to be rendered to said beneficiary, without the intervention of a guardian. FIFTH All principal and income, until actual distribution to the beneficiaries, shall be free of the debts, contracts, assignments, alienations and anticipations of any beneficiary, and the same shall not be subject to any levy, attachment, execution or sequestration. SIX1~ I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expenses of the administration of the estate. SEVffidPH My personal representative and trustee shall have the following powers in addition to those vested in them by law and by other provisions of this Will: A. To retain any or all assets of my estate, real or personal, without regard to any principle of diversification, risk or productivity. ~'"' B. To invest in all forms of property (including stocks or other securities of my corporate fiduciary or its successor, or of a holding company controlling my corporate fiduciary or its successor, and common trust funds and mortgage investment funds, whether maintained by my corporate fiduciary or its successor or others) without restriction to legal investments, as they may deem proper, without regard to any principle of diversification, risk or productivity. C. To purchase investments at a premium or discount. D. To exercise all rights of a security holder or shareholder in any corporation; to give proxies; to join in any merger, consolidation, reorganization, voting trust plan, or other concerted action of security holders; and to delegate discretionary duties with respect thereto. E. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. F. To allocate receipts and expenses to principal or income, or partly to each, as my corporate trustee thinks proper. G. To borrow money from my corporate fiduciary or others and to mortgage or pledge any real or personal property as security therefore, in their sole discretion. H. To compromise any claim or controversy without order of court or consent of any beneficiary. I. To exercise any option, right or privilege granted in insurance policies or arising from ownership of investments. J. To make any distribution herein provided for in cash, in kind, or partly in each, at valuations fixed by my personal representative or trustee at the time of distribution. M. My .fiduciary may, in his or her sole discretion, donate any part or all of my tangible personal property to any charitable organization(s) which would benefit from such donation. My fiduciary is then instructed to use the value of said donation(s) as a tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. EIGHTH I appoint my brother, Charles M. Briggle, of Queen, Pennsylvania, Executor of this, my Last Will and Testament. Should my brother, Charles M. Briggle, predecease me or for any reason fail to qualify as such Executor, or having qualified, fail to serve as such Executor, then I nominate, constitute and `!7 '' ~ appoint my brother George Thomas Briggle of Imler, Pennsylvania, Executor ~ this My Last Will and Testament. NINTH I appoint my brothers Charles M. Briggle and George Thomas Briggle t jointly serve as Trustee of the trusts created under this Will. If both c brothers, Charles M. Briggle and George Thomas Briggle are unable to unwillin to act or to continue to act in that capacity, then I appoint the Trus Department of Central Bank, a division of First Commonwealth Bank, or it successor, as Trustee of the trusts created under this Will. TENTH My Executor and Trustee shall not be required to post security in an jurisdiction. Ild WITNESS fi~iEOF, I have hereunto set my hand and seal to this, my Will and Testament, this 6th day of August, 1999. Z ~ Al a (SEAL) s E. Briggle, Tes ator Signed, sealed, published and declared by the above-named Testator, Jess E. Briggle, as and for his Last Will and Testament, in the sight and presence of us, who, at his request, in his sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~ ~ ~~~ residing at ~~ --"- p C ' s /~~~/ residing at.~~3 ~_9 ~~ ~ s~ R ~ ~ ~~~ ~ ~ ~ l ~ ~~ s ,, ~ -~.:-~- ~.. - _ _ i. • ,. AC~~i2 b~~~ _, ~~, ~.r ~~ ~` ~.+~ t - e /~ ~- _ ~cs, ~ .' ~f'...- -.~-~c..: ± +'~.~ jy~~~~ f ~t .. ~ ..,. ..~ ~d /~ i~- _ _ _ _ _ __ _ ., ~ ~~~~ ~ r ~~ ~, ~~1e~ ,' ~ ~ - /U ~~~ I ~~ ~' {'' r , E' ~ ,~ iii ~~ ~,~~w~ /v ~~~~~~ ~ ,. ~ ~ i ~f .~~~ hr~.~,~ Q I s- ~.~~iz~-~ ,~ ~~ ~. 3 ~ raw s .38' ~'- ~'~ it p© ii ,~ ~~, ~ ~i ~' ~ ~r _ i _ _ _ - - - ~,. ~ ' ~ ~~~.~- `; !~ . ~'~-~ ` ~: -.~c.~?~ '~ '~ .ter. ~a ,, G Gi~~ 'r i `~ "'' ` .asy_ ~_. `' ~__ _ _._ _ ~' ~-~ ter, ~ ~~f'~_.!1'Iop _ c~~~~~~' ~~ _~ - ~ _ ~~. _ d ~._ ,,~ O ' U . ~_ _ _ .~'_ ~_~d~t7 ..ado'- ~_~ .. ~.t _ _ j ~_ _,%~'~' '~. ~- r __~ ~~ O ~ ~ y~ ~ d~ i ~~ ' i ~~iQ S1F'./~~.e.. _„& ~~„~' .ems ,,S'-U ~ -~ ~f /,3 ,.~ . r~os~~. >'~~~-. ~:~ Gy~ a~ _ . ~ _ ~~ as ;; 1~ i~!_~~~~o ~~ -ado %~: % /loL. w~c~...~.~~ / ~'~ ~ e~a•no+ ' __ . •_ ~ V a~. _ ~4-rri~~GQ.I~iX. o :, L ~ .f . ~~- _0~ ~. _ _ f~~ _3a.~o~__- _ /Gd ,, _ _ _ e~r.~~y,~?,~ / ~D ~G s-. ., ~~~P- A~ , ;,, -? , ~~ y ~ ~~.~: .3 ~~3 MEMBERS 1't FEDERAL CREDfr UNION SAVINGS ACCOUNT: Account Number/Suffix Date Acxount Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Oeath Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner MONEY MANAGEMENT ACCOUNT: Account Number/Suffix Date Acxount Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner VISA ACCOUNT: Account Number Date Opened Credit Balance at Date of Death Estate of: JESS E. BRIGGLE Date of Death: 01/03/2007 Social Security Number: 171-24-4726 12068-00 04/12/1971 $28,941.96 $1.56 $28,943.52 None 12068-11 06/27/1988 $1,452.97 $.02 $1,452.99 None 12068-05 08/05/2002 $32,185.99 $3.93 $32,189.92 None 4287590000120689 06/11 /1998 $.31 a~~~~ MAR 16 2007 ~~~~~~ ~ ~iC~~~~~ BERS 1ST FE ERA CREDIT UNION U.~L_ Danielle A. Kline Insurance Services Specialist March 14, 2007 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (717) 697-1161 wwwmemberslst.org ,,, Sores M er ~ 700 M.R. Rt. 15 N. "'~`:~ ~ P.O. Box 446 ~, ?oo ~R. R~: 1 N.~~DI ,PA 1TOt9 Iisburg, PA 17019-0446 E-tnai[: - remail.com X66-2003 432-9614 ~,.,.*Yisit us at ;~~r.bobruthford.com 1-800-522-7283 ~....: DILLSBURG PA FAx 717-76s-88oo ~1l~~r ; f ,vu~ Co,~ ~.~ ~ % M o P; N~ ~ ~~- ~ ~S'A-~ d U~,G. ~ ~~~ I GCEt~ I ~Fx ~F 7 ~ l ~~r ~~ Y ,rrra~l~-~ ~l 3,70 0 s ~b"~~ ~ s~~-- ~h~ ~-- __ ~ =-~ ~ OIl.LSBURG, PA , . ~ " F . ~~ January 9,20 Charles M. Briggle 1630 Beaver Dam Rd. Queen, PA 16670 -, Ewing Brothers Funeral Home, Inc. 630 Sottth Hanover Street Carlisle, PA 17013- (717)243-2421 The Funeral Service for Jess E. Briggle We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff , $3695.00 FUNERAL HOME SERVICE CHARGES $3695.00 SELECTED MERCHANDISE: 20G Silver Baron Casket, $935.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $4630.00 Cash Advances ClergylMass Offering, . Certified Copies of the Death Certificate , , Altoona Mirror, . The Sentinel . . . . . . . . . .. . . . . . . . . . . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES . Total Total Cost , , ' . SUB-TOTAL INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE $75.00 $24.00 $163.24 $74.30 $336.54 $4966.54 $4966.54 / 100.00 ~~'/P~~~o,/~~~~Gt.c~, $4866.54 V` ~ - TG -J e ~~~v~ The unpaid balance over 30 days is subjected to a 1.50 % service chazge per month - 18.0000 % per annum.