HomeMy WebLinkAbout08-09-07
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
195-42-8558
Decedent's Last Name
CARTER
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 07
0466
04/21/2007
Date of Birth
10/22/1953
Decedent's First Name MI
JACQUES D
Spouse's First Name MI
KIMBERLY S
Suffix
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
CARTER
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
:e:> 1. Original Return
4. Limited Estate
c.'
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THOMAS E FLOWER
Firm Name (If Applicable)
SAIDIS, FLOWER & L1NDSA
First line of address
2109 MARKET ST
Second line of address
City or Post Office
CAMP HILL
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(717) 737-3405
REGISTER ~61.S USE
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State
ZIP Code
DATE,~ILED
PA
17011
Correspondent's e-mail address:tflower@sfl-Iaw.com
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge.
::::~;1:1tS~ESr~nFI~NG:~T_URN . ____ ______ t l'7jQ~7-~E_
187~ Qouglas Drive, Carlisle, PA 17013
SIGNA~/~~/;f~:E:A:R~~~~~~~N:AT~'-~- lTE
: ~V---t ----r~"'~-un-"_ l' /I'~' 7-
ADDRESS
Saidis, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17013
PLEASE USE ORIGINAL FORM ONLY
L
15056051058
Side 1
15056051058
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15056052059
REV-1500 EX
Decedent's Name:
JACQUES
o CARTER
RECAPITULATION
1. Real estate (Schedule A).
. . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10)..... ..
. . . . .. 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .O~ 3,353.17
16. Amount of Line 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
195-42-8558
Decedent's Social Security Number
2.
15056052059
646.62
6,667.35
7,313.97
3,960.80
3,960.80
3,353.17
3,353.17
0.00
0.00
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
JACQUES D CARTER
STREET ADDRESS
1878 Douglas Drive
File Number
0466
DECEDENT'S SOCIAL SECURITY NUMBER
195-42-8558
CITY
Carlisle
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
--- . -- Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(SA)
(5B)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D [i]
b. retain the right to designate who shall use the property transferred or its income; ............................................ D [i]
c. retain a reversionary interest; or.......................................................................................................................... D [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [iJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [i] [J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 39116 (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 PS. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~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 four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
JACQUES D. CARTER
FILE NUMBER
21-07-0466
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
MEMBERS 1ST FCU SAVINGS ACCOUNT
91.64
2 WACHOVIA CHECKING ACCOUNT
554.98
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
646.62
REV-1510 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
JACQUES D. CARTER
FILE NUMBER
21-07-0466
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF DECD'S
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. TIAA-CREF PENSION BALANCE 6,667.35 100 6,667.35
TOTAL (Also enter on line 7 Recapitulation) $ 6,667.35
(If more space is needed, insert additional sheets of the same size)
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REV-1511 EX+ (12-99)*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
JACQUES D. CARTER
FILE NUMBER
21-07-0466
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
HOFFMAN-ROTH FUNERAL HOME
3,525.80
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 350.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State .Zip
Relationship of Claimant to Decedent
4. Probate Fees 70.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. TAX RETURN FILING FEE 15.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,960.80
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REV-1513 EX. (9-00)
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
JACQUES D. CARTER
FILE NUMBER
21-07-0466
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 KIMBERLY S. CARTER SURVIVING SPOUSE 100
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT OF JACQUES D. ,CARTER
I, JACQUES D. CARTER, of the Township of West
Pennsboro, County of Cumberland and State of Pennsylvania,
being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament,
hereby revoking and making void all former Wills by me at
any time heretofore made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can conveniently
be done.
2,
All the rest, residue and remainder of my estate,
real, personal and mixed, of whatsoever natune and wheresoever
situate, I give, devise and bequeath to my wife, KIMa~Y S;,
CARTER, absolutely and in fee simple,
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3,
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In the. event my wife should predecease me b~ die ,:.:-,
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within thirty (30) days of my death, then I give, devise and
bequeath my entire estate to my daughters, KELLI SUE CARTER
andJIIMIE LEE CARTER, share and share alike.
4,
Notwithstanding the above, should my daughters be
less than the age of twenty-five (25) years at the time of
distribution hereunder, I direct that their shares be paid in
trus.t to my Trustee, my sister-in-law and her husband, STACY
and BRAD STRINE, to be dealt with according to the following;
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I,.. ~~ I'; I !- \' \ . -. I ~: "~ J ~ '~ " .~ ' ."";
(;\:;~t p. ~!:, 1:1 \.' ~ '~"~:i\~'" iI.t ~.'1v~' .~~')'.~ t:L,)-~. ..0., '4" ,,'I .'11 ~ "'1~J' ~",~l\.,':" fJi~tf~jl{~
'1",;4"jf" b: ,Aj'!!..-: ',,;I"I'r. ""~""'I""."~1 .~. ! ^"" ~:.' .,/;,.', i" ';"'- "'(';1(>>
'(1'1,'1 '; (I !. ""I i't!' <~ t ,ti,l' I;' >...,..,,~ 1t ,l(,"!,~,'. ! ~j'\t \I_~'I'."~H~ ''''..tjlf,t'' ,
~"'}'~H' /I'.i'" (11" I'll 'lr '!h l~ ~.) ;l'~#~'l','.:~d~t~:t1I' i!!1':;;~*~ '1!';~,)~ '.If:'li~ 'l<~!" " l1",'"L~;;~-
.~ l~it"ltt ~ 1 :;1 ~\f- ~" I '.' ~ i:~ "1~~,J. 'Il/u'>..: ~'~:;-~;'~~~!~';'$' :.;~t~~1 ,~~~tj:~'!:5ttfl"t~~ ~~J;' .!~". f j
~, .\ ~;1 1, I "~" rtl, to, i,lL tL~~~ ,'I'~}JII",~ '>;i-I";'I{l~:"'4 .i'tt 14 ",;t~""~f~"'4~!/' , 1 :t,~~{i.JiI.kr11k~<~,t'~'''k
. ' " (, I . , ~ I ( ':f' I ,,,,~,,, -, 1'<'~.
(A) My Trustees shall invest the principal and pay
the income thereof to my daughters, or to their Guardian
should they be less than twenty-five (25) years of age.
(B) My Trus.tees may pay such amounts of principal
as in their sole discretion is advisable for the educa~
tion, maintenance, and support of said children,
(C) Upon my daughters reaching the age of-twenty-
five (25) years, then all principal and accumulated in-
terest shall be distributed to them, at which time this
trust shall end.
(D) In the event either daughter should predecease
me or dies prior to reaching the age of twenty-five (25)
years, then the share of said deceas.ed child shall pass
to the surviving daughter.
(E) I authorize my Trustees to make payments ac~
cording to the terms hereof without petitioning the
Court for permission to do so, and I further direct my
Trustees shall serve without bond.
5,
I nominate, constitute and appoint my sister-in-law
and her husband, STACY and BRAD STRINE, to be the guardians of
the persons and estates of my daughters if they have not reached
the age of majority at the time of my death.
6,
LASTLY, I nominate, constitute and appoint my wife,
KIMBERLY S, CARTER, to he the Executrix of tbis, my Last Will
and Testament, and in the. event she should be unwilling or
unable for any reason to act as. such, I nominate, cons.titute
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"'
and appoint my mother, JEAN ~, CARTER, to be the Execut~~
of this, my Last Will and Tel;ltament, in her place and stead.
seal this
IN WITNESS WHEREOF, r have hereunto set my hand and
'l ZeLday of d"~
L_D~
cracquesD. arter
, A.. D. 1987.
Cl)EA,L }
Signed, sealed, published and declared by the above..
named JACQUES D. CARTER, as and for his Last Will and Testament,
in the presence of us, who, at his. request and in his presence,
and in the presence of each othex, havehereunte subscribed O\lX
names as witnesses.
C~l~~W1&~
'~x .43!/,;"w,
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st
Send InqUires to
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.members1sl.org
Statement of Accounts
~
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,tiEMBERS 1st
FEDERAL CREDIT UNION
6215 1 AV 0.312 6215-6215
1",111'11111"1",11,,11.,1..1,11....1,1,,11,111,11111,1,,1,I
JACQUES 0 CARTER
CIO KIMBERLY CARTER
1878 DOUGLAS DR
CARLISLE PA 17013
Mar 25, 2007 thru Jun 24, 2007
@
Main Switchboard: (717) 697 -1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283-2328 ex! 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
Account Number:
40313
=-
-
Account Balances at a
Checking:
Savings:
Certificates:
Loans:
Money Management:
Glance:
0.00
0.00
0.00
0.00
0.00
-
Page: 1 of 1
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Are you looking for a way to invest your hard earned money? Consider a
certificate from Members 1 st. Ask an associate about our monthly specials or
visit www.members1st.org for more information.
SAVINGS ACCOUNTS
00 - REGULAR SAVINGS
Date
Mar 25
Transaction Description
Balance Forward
Joint Owner : KIMBERLY S CARTER
Deposit
Deposit
Withdrawal by Check
REGULAR SA VINGS Closed
"""This is the final statement presenting information on .this product"""
""" Please retain this final statement for tax reporting purposes
Additions Subtractions Balance
27.19
39.03 66.22
25 .42 91,64
91.64- 0.00
May 11
May 11
May 11
YTD SUMMARIES
TOTAL DIVIDENDS PAID
00 REGULAR SAVINGS
0..00
Total Year To Date Intere~t P,aid
NOTE: Total includes closed' loans
Don't forget about our new Member Loyalty Rewards Program.
The more products you have with us, the more 'benefits you'll receive.
Ask an associate for details or visit our website at www.members1st.org for details.
0.00
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OFFICIAL CHECK
III
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WACHOVIA
)ay To The
)rder Of
Remitter
Issued by Integrated Payment Systems Inc., Englewood, Colorado
JPMorgan Chase Bank, N.A., Denver, Colorado
373154291425099562 REV110/05 i ~)mm 8510007542
23-97
1020
,..
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.joI<>o.c.
$ 5~q 3!
Dollars
NON NEGOTIABLE
Retain this copy. Serial No. required for any further inquiry.
CUSTOMER COpy
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FINANCIAL SERVICES
FOR THE GREATER GOOD"'
730 Third Avenue
New York, NY 10017-3206
212490-9000
Y!&7!o7 do d
dol::;> IDldl~/s3,.
/15'-VOJ - "(55"6
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\':i~A t,.".',.,,',>,.
CREF fi.
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Payment For: KIMBERLY S. CARTER
Deceased Name: JACQUES D CARTER
Effective Date: 06/04/07 Check Date: 06/15/07
TlAA
Controct
IH41076-4
Traditional
Payment
Interest Deductions Net
Payment
$41 .65 $1,333.47 $5,375.53
1,333.47(F)
$41 _ 65 $1,333.47 $5,375.53
$41 .65 $1,333.47 $5,375.53
$6,667.35
-
;;;;;;;;;;;;;;;
-
TIAA Iota 1
$6,667.35
-
Grand Tata 1
$6 ,667.35
-
-
-
-
;;;;;;;;;;;;;;;
TIAA-CREF reports all taxable payments to the government for the year in which they are made. If you have
any questions, please call our Telephone Counseling Center toll free at 1 800 842-2776.
F = Federal Tax Withheld
'''ClYIIlCIIL
Please Keep This Statement for Your Records
Per your request, we have sent the payment to the address below:
CORNERSTONE FCU
CR: KIMBERLY S. CARTER
PO BOX 1181, 5 EASTGATE DR.
CARLISLE
PA 17013
CR KIMBERLY S CARTER AIC 0621142108
AUIUUII L "'5, 315 _ 53
KIMBERLY S. CARTER
1878 DOUGLAS DR.
CARLISLE
PA 17013-4623
/,11 Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, PAl 7013
(717)243-4511
.
.re
1015
/ funeral Service for Jacques Douglas Carter
15025-94
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.
FACILITY, STAFF, EQUIPMENT
Visitation/Viewing (Conducted at Funeral Home) . . . . . . . . . . . . . .
USE OF STAFF & EQUIPMENT
Transfer of Remams to Funeral Home . . . . . . . . . . . . . . . . .
$250.00
$442.50
OTHER SERVICES
Receiving of Remains from Another Funeral Home.
Direct Cremation (As Selected). . . . . . .
FUNERAL HOME SERVICE CHARGES
$835.00
$1490.00
$3017.50
SELECTED MERCHANDISE:
Norfolk Casket(Cremation) .
Keepsake Bronze Urn.
Visitor Register . .
Memorial Folders. .
Gold Cross Necklace.
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THATYOUHAVESELECTED . . . . . . . . . . . . .
$925.00
$55.00
$25.00
$25.00
$520.00
$4567.50
Cash Advances
Newspaper Obituary Notice - Sentinel.
Certified Copies of Death Certificate .
Flowers. . . . . . . . . .
Coroner Authorization Cremation Fee.
$69.30
$180.00
$159.00
$50.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$458.30
Total
Total Cost
. . . . . . . . . . . . . . . . . . . . . . . . .
$5025.80
History
06/07/2007 Kimberly S. Carter. . . . . .
06/19/2007 Payment - Check: Kimberly S. Carter
$-1500.00
$-3525.80
Jacques Douglas Carter