Loading...
HomeMy WebLinkAbout08-17-07 AlV-1SOOElCf&o8lI COMMONWEAl.1H OF PENNSYlVANIA DEPARTMENT OF REVENUE DEPT. 280001 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ IIi 0=:.... a...m ~ :z: o ~ ~ I- a: <C (.;) W 0::: :z:: o ~ ~ :::J a... :E o ~ I- z:: w c w (.;) w c OECEDENT'S NAME (LAST. FIRST. AN> MIDDlE INITIAl) Kanode, Elizabeth L. DAlE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OO-YEAR) 11-18-06 03-28-1916 (IF APPLICABlE) SURVIVING SPOUSE'S NAME (lAST. FIRST. AND UIDDlE INITIAL) N/A ~ 1. 0rVnaI Return o 4. U1llted Estate JiOl ~. Decedent Died Tesfate (AlIadl alPYd Will o 9.litigaIion Proceeds Reooiwld ;;. :~~.. . :,". ; .~~ .:..' ~:..;. ::-- :.... ')~@~ . ... ,.. --....' .., , ~ Randa1l K. Miller o 2. SuppIemenIaI Refl.m 0-43. Future Inletest Cclmpromise (daIeddlllll1der12-12-82) o 7. Decedent MainlaIned a ~ Trust (AlIIch cqJyalTnlsl) o 10. Spousal Poverty Credit (dale d delIlI1l1eMeen 12-31-8I1IIIl1-1-85) 0rf!{;tAL. US!: ONL':' FiiiiNUiiBER -..-.,.-.-. ....-. ..... _. .----.-. 21 - - ..0.... ~ ...Q...1. --1 J ....J COON1YQD: 19R MIllER socw.SECURITY NUMBER 162 - 12 - 6552 1IIS RETURN IIUST BE FIlED IN OUPUCAlE WI11f 1HE REGISTER OF WILLS 5OCW.SECURlTYtQ&R o 3. Remai1derRelum (dIIIeddelllpdortJ 12-13-82) o 5. Federal EsIale Tax RebIn Reqli1ed 8. TdaI ttrier d SIte Deposit Boxes o 11. EIediln blax lIIIerSec. 9113(A) (AlI;dISdlO) !Ii: w Cl :z: o a... (0 w c::: c::: o o FIRM NAME (lrAppblJle) Law . 1ELEPHONE NUMBER COMPLETE MAlUNGADOOESS 1255 S. Market Street Suite 102 Elizabethtown, PA 17022 717-361-8524 1. Real EsIafe (Sc:heduIe A) 2. Sb:IIs and Bonds (Sc:hedaE B) 3. CtlseIy HeldCol~.. Partlllll~orSole-Fl~.s11ip 4. ftb~ & Notes Receivable (Sc:IIl!l1JIe 0) 5. Cash, Bank Deposits & Misc:eIaneous Personal Property (Schedule E) 6. ~ Owned Property (SchedUe F) o SepaIate Billing Requested {1) 0.00 (2) 0.00 (3) 0.00 (4) 0.00 (5) 12,955.93 (6) 0.00 (7) 0.00 7. Inler-VIVOS T ransfeIs & Miscellaneous Non-Probafe Property (Schedule G or L) 8. ToCaI Gross Assets (taaI Liles 1-7) 9. Funeral &penses &AdninlsbaIiwl Cos1s (ScheOOIe H) 10. Debls d Decedent, M:qjage UaIliIies, & Liens (Sc:IlecUe Q 11. T oCaI Deductions (1olaI Lines 9 & 10) 12. Net Value of Esfafe (li1e 8 minJs Line 11) 13. ChatIIable and Governmental BequesIsISec 9113 TIUSIs ilr whi:h an eIeclion tllax has not been l11lIfe (Sc:hedule J) (9) 7,305.43 (10) 91.120.90 14. Net Value Subject to Tax (lile 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABI-E RATES 15. An1llIlt d li1e 14 Iallab/e at tie spousa/ 1ax RIle, or fr.lnSl'e1S under See. 9116 (a)(1.2) x .0 _ (15) 16. AmotI1t of li1e 14 Iallab/e at halo 17. An1llIlt d li1e 14 Ialcable ~ sibIi1g '* 18. An1llIlt d li1e 14 taxable at allIaIeIaI ~ x .0 _ (16) x .12 (17) x .15 (18) !"- OFFIC~USE ONLY ~-f 0 -' 'F~8 - ~ \ _ :r.: ( ) G") ~,~ CompIeteAddl8$$: 18._......""" Messiah Village . 100 M::>unt Allen Drive Cf1Y Mechanicsburq Tax payments and Cr8dits: 1. lax Due (Page 1 Ule is) 2. QediIsIPaynIenI A. SpcusaI PcMrty Cndl 8. Prior P'ci)'lRllIlts C. DisauIf 170'\'\ I 1STA1E .. PA J2P (1) 0.00 0.00 0.00 o 00 tialOlds (MS +c J (2) 0.00 3. .~~.~nalyif~ D.1nIeIesI O. 00 E. PeaalIy O. 00 'i3la!u. ~(D"EJ 4. f1iJe 2 is g&derihan Li1e 1 .. lile 3. enter lie dIieRn:le. lbis is lie OVERPA.... a.ect bal CIA Page11.iDe2ll to ft!qIIeSta..... (3J (4j (5) M (SB) Make Check Payable to: 1tI:6I:i1tJ( tEB.LS,AGEIlT o 00 0.00 0.00 5. f line 1 + Une 3 is gJeaIer Iban lile 2. enIer IledilJerence. ThIs ish TAX DUE. A. EftIBr I1e i1IeRlst Qfl the far die. 0.00 B. Enler1he tIIal dlile 5.. M.. This is lie IlAlMCE DUE. 0.00 ~'\. ~:;.~''-.' . .,';.. '.~ '. :".'. ".>: .":: .. :.~ ~. " '. .'.' '. . .. .: '. ::.".. . ~.'.. .." . . ~" .. :. .0', ( ," ~. '..: :' t.". ~ . ~~1lEFOWMJNGQfJEStms8YPl.ACIGM"'l7.1IE~1E8LOCKS .. 1. 00 cfeaedeIi..... atansllr and: .. Me 8. IeIaiItIe ase<< incanIedlle prqIeI\t....eJ: 0 lXI b. relai'lIIeJtlt.,des\1t.......llepmpedyA. ~ "<<Is~ 0 m c. lletainaae.: .8)'''''<< 0 IXI d li8lleNe1le palIllise tlr.4....,..., ......<<c.e1 0 IXI 2. lde&lh GCQRedalerJlllclelDr 12, _ ..........tansIBr~..._,........ 'lIIiIloul ~ .....ro.......a 0 IXI 3. Dtf decedenI own an "mbst far OI'JI8JIllIIIe -.on....ba*8IXIIIUIt<< ""..<<llerdelllQ_ 0 m 4. Dtf decedeafCMll an InlMi.laI AeIin!nlenlAa:oarnily.oraller........pqledJtIIidI QlI1Iailsa......y~laIbt1 0 OJ FlHE ANSWER TO MYOFlHEABOVE CUSIDlS ISlES, 100 IIJS1'CCIREIEsamlfGAIIlIUJI' ASPMTtFlIElEIIB. UIIlIr.....d~I......,'-.......Iis......ilI:Wag. .: _......_~......lIIIIltf.,T . '" JHo(lis_-s_ :. 0Ic:IIIIIixl d,......__IlIn..,...,.... . - Ils...,c..~CIhIIIiII.........--. SI3NAlURE OF ~ RESfO&II.EFOR FILIIG REI1Rf OOE NJlRESS SBWURE~~ AOORESS 1255 S. Market Street, Suite 102, Elizabethtown, IWE . August 16, 2007 PA 17022 .:... ..>.t~..'.. '.. '~:;.:'."" '~-.: ..~..~:.<:.-.' .... ;,;....... ..~:':'..:~.... . ....;:..:......:. ~.:. .'. I:'.....';~ Fer dales d dealt OIl ar aIer ~ 1. 1994_ bebeJaauely1. 1995. tie fal mIe illposed Olll1easl,*cfflall6lsllorfarllelllBaflleSlniwiV splllIl8.~ (72 p.s.,me (4) (1.1) (i)J. Fer dales d d8aIh 0Il<< afer JaIlaaIy 1, 19!JS.1I6 fax.. iIIplIllld aa1l1& - ..cffrallsfels 10 <<idle .-.. 1IIRIilIiB.-15. P2 P.S. S9ft6 (a) ((.1) (i)J. TIle sIafaIe dr-= not 8IeIImt a .... iJ a $GAfwi1g spouse tom tar. _ fie""" ., . '" Ilf'dIilfll&lE flalII!Is ad.. a CalIll111lr& 88 ........ f I1eSUlVMng...is"~" . "'1- Fcrdales or.... OIl<<afIer July f.2IDJ: . TIle lax _1IIIpoIed 00 .... ... dbasils ... a cleceased d1tf....,... JIIl'lIS fl. C1rJlllllll'...... _.IIe... a IIIIIIlRlI paIllIIl. aa........... ora ~~-'Ilor.. dill Is OS (l2 fA fIf16(a)(1.2I. 11lefall:l8Iebposed...nsl...aft.alBrst>>ar...ae..d.... ~ -.....1 1 r' 1 ~1sUI,..as...Ia12P.S.tIfII(I.2)(l2PA,.m( 1[lJ. 11Ilil fall: .. ..... . lie _... ....... b arblle IIIB file .~... is ta (12 P.S.. t9t&Nt31-A.... is...... CRIer SIll:iIt ... as.. bhiduaI_ _811erlsl ale'" ill....... lie tfellelId. It 1l1l!"1r!l.IlbId<<...... -.-. ~nlElU:RCOFfSINS1I.WIIA IlERlTMEE'DX IEIURN .~~ 1= ~=~ - -~ - -- SCHEDJLE E CASH, BAfl(Ut:rOSIIS, & lEe. PmSONAL I'Id61Y . ESTAlEOF Elizabeth L. Kanode fI.E.-& 21-2006-01143 IalWetle~of""_"'dalettepull!l!ds_1l!Illliled1lftle"""""'J ~ 1. J m'...._~ ~ ~1J...66M1I_Sr:I.wef I1BA VAUEATn\1E tIMER ~ <FlEAlH 1. IN:: Bank - Checking account 5070099256 1,041. 75 3. IN:: Bank - M:>ney Market account 5080032215 pr.c Bank - CD Burial Reserve account 31100231885 6,.565.21 5,348.97 2. i 12,955.93 .../ Ln - .r ..0 ..0 .D o ~ - - ... == . 0.:0 ... Ill' 0.< Gl-+ ... 0 0-+ -:r Gl - ru - - r ~ ru 11:: . - .. o u.J - u.J - ru ~ UJ OJ - .. , /7' / ( "-.1" /~, ./) ~. j -.,r.../ ~...- ~ "~ ~' .' ._"~,,,/' c .....-., . ,',/ ....- j"'" ;'''~l ( ~'I ~ ,.- C'1 ~. ::r J-oI . (1) '"i '" CI.l .0. . ':P'" . .(1) (1' ~. 0"'0 .. gz~ g.oW g r -..4 [~Z ~ t. 1""\ g I I !?.....4 t'~ B:'~ '~L g. ..,...... tl " o .Z ! 0 (~- ~ # j3 ~ fv f.~ ~~ '.~ ~. .~~ (,A~ i"\J I.,) ':1 ..' :=,} ....; C) o , ... N ..., ~ to) ---'-- ;.t; i 8! .; ~ ~: 2 I '. I~ I , I I I i i ... I 0 ~ 0 U-I ~ u.J ru 0 I Ln - ... I I - I .. 0 I u.J I - u.J - ru ~ u.J ..tJ:j "... .. Ln 0 0 0 - 0 0 [J':I .r Ln ... ..,;~.~~~>2093~;" ,,/: i I . I "'<;>.:1 ...1 .. >~.. .', I ~:.\J ::: i .' ..., I - ~ ":. i ,.".";;;..,.....:. .~-) ! ~r')'H' i ~~::~:i:;; 1 'ii~~" .i.>'} . .....,.J ..;.<<-.:.:.: ;.. .~. ....,;.; 'I g .' ~ I j ,'.. .j ,y I ~ . 1 :..~.:. .1 i ! ; i I .! _..~....J . "1 J if;l i t ", .......J ,..,.,.~ .;... -"\ .1 .~ .' {if.) l';';>~:~ ""'1 .. 00 ~;' . ~ t:1 Z .....-... .. .-.., S>> .:p' - 0 G : 'lI\ .O\:: ..... "0 "~::: ~ 0 .% ::N:: 0 n .: ......:: S>> W = ~ ~ ~ .' .. ...... 0 % 9' lI\ '" ..... =. ~ 0 e- . .. 0 > -...J '" ~ a o' :> .~.,..'..:;l ~:""'~:\{l '..~: ,~::.j i ". i "".! i I I I ; :::1 ~ i 9 ! i:i i w I 1 I _.,__--"'-_.______J -;:::::::::. ~.~ r- --.:;' "--,-..~ ~,-:-:~'" ,~~ r-'- .'-:-:-.~~~.:.~.\... U'1 o o o - o o IJ'3 r U'1 .. ~ o o U-I U-I ru o r - .. - .. o cU-lH_ ...- U-I - ru -.J U-I OJ - .. I / I f I l , I~ I ~ s ,.. i I 1 / I I I, I ", . _: - - - ';::'~}...'::. ~'~~~~~:. ... EF0Rll4120935-06Ol) ,j.) .i':~ i;i So fn ..'."'~.1.1 ..t .:~ .....~.~-.;. i,~. :~. ~l .... I ,.'t;'.'~:'l 'k"'] .. "~I ~ ~.;::. -:~ :<<-';:;~.~':~~ ',. .".-.:..;......../ <'..m'... . 'f';);:;"::1:i :~".\{,~r;~~.. ~~~2i::: .:"";~:. ,~....~ .w.. 4?~h ~'-;;'" I ......... n~. I ..,...;:.....' ~, *~N........l .z F><<I"'}}: ~.c:d""" tt1~::;:.>~:.. ! ~'.ii~:'/ /:''2':;:'.~~:::;i i ~:'<;;'~i';: "" , :~ l..r~~;"'''/ .~ .., . -$.' ..... \q ..... 'x".,.,"".'. .-../.. '.~:;;..::.::..-... i'~... ~~~ .,;\,...1 il "I <. ...:-;.....~..~......~ . : ~~, ..:~.::.;..... () t:T CD o -~. ~ t:1 Z "";..-. C> '. ......: ..... 0 ::~> (I) ~ .S\) _. ~ 8 -~ .......!. n "Ul:; W ~ W J tv - ~ 0\ ~ ~ - ~. " N 0 0 !. .. ... " 0 i ---.J S' ~;. 0 :0 . . . --..;...- -.'..----- elt ('Ie l \'\~ Susquehanna Bank PA Elizabethtown Drawer 01302 Trans . 43 2/09107 10:39 AIt . DepoSits Transaction Account tmtmUU8348 Transaction iItIt 8139.93 Cash Received .00 Avillable Balance $.00 This Transaction will post on 2/09/07 Deposits are subject to validation and collection. Thank you for banking with Susquehanna Bank PA Visit us at ...susquehanna.net EFORM100472-Cl9OO o PNCBAN< Your account was DEBITED for the following reason: o Check # posted on IXI Closed account 5070099256 o Branch adjustment (branch name) o Service charge error o Other. encoding error _ posted to incorrect account (...."'""i .(.... 'f D.' !~I'l().. '1'\.1.1).17..' "R-')r'\ ......, J~ l'f li>\.. ~. I Jf ,,>>>:.J . .,.J.. ~__~..;;o....w<""....a.",,-i.-.,::>> -'_:~.,,_< Account Number File 10 AMOUNT $ 1,041.75 5070099256 040 PNC Bank. National Association FOR BANK USE ONLY BSTATE BL1:ZABB'l'B L KANODE DEeD 222 MBSSl:AB C1:R RH 60 IIBCBAHJ:CSB'ORG, PA 17055 Branch #lDept # 0000041 Prepared By (PRINT Name) I v:rCKJ: L BOGUS Date 01/16/2007 D E B I T J I Authorized By CUstomer I s Advice of Charge EFOfIM100472-0900 ePNCBAN< Your account was DEBITED for the following reason: o Check # posted on IX! Closed account 5080032215 o Branch adjustment (branch name) o Service charge error o Other: encoding error _ posted to incorTect account (':u.' 'S' TOl'\ /'UE?R'. C" , . . J",lH ... p'\/ Account Number File 10 AMOUNT $ 6,565.21 5080032215 040 PNC Bank. Rational Association ESTATE BLJ:ZABB'l'B L KANODE DBCD 222 MBSSl:AB CJ:R RH 60 MBCBANJ:CSBURG, PA 17055 FOR BANK USE ONLY o E B I T _I Branch #lDept # 0000041 I Prepared By (PRINT Name) . v:rCKJ: L BOGUS Date 01/16/2007 I Authorized By CUstomer's Advice of Charge Certificate of Deposit Account Verification p~c :earl~:. r~.:rtio~:.J.l i:~S"scci.:lt~o:; rLIZAE.ETf~ 1 r..ANC!IJE IRF\.E\:OCABI~E BD~I".L RESERVE GEHALD liE,". V'EY:, FuriERJi.l HOj.E; 60 liESSI~E 'JILLilGE 1',~.I~{~HAl"J I CSBtn-,:G PI> li0552015 :.:.~l~;':' Ir~t.e.r._9't ~:..~! t.,:, PackarJe f'olnt;:.; ::. . '~:3 !\", ... , - -." \). .1 :~')1-, o PNCBAN< .--.----._._-..~., -""-.. ( Cer:~~ .~u~~~~ . \ Reference Number jJ.1UtJ~_-:'lC-~~ ._'"./ ;,1(ttjOetS626 Purchase__Date ---- Purchase Amount rs~ ~'a '::"(,f,":- s4 300.0(1 I..il..._. ....... _ ....___ Maturity Date Term 3\Hl~ 2<i Lut! ; 59 14ont.h Annual Percentage Y"eld 4. 05~'j Renewal Type A1.~tomatic Product Descr"ption 59 ~lO:NTH3 FIXED f.,ATE For Infonnation, Call 1-677 -tiAN?.- PNC ;Ctj/J ({{{UCI;)tfg,YJ Is-:-t::c~r?8r, Ra!:,c It f. e~~ti ~,,"e Url't:t 1 :1. 981~: .j\l!.~~ :':4.r :007 S('tfI"HCENTFJt..1 PA ..,.1511 a;..(t2e9) *' SGIEDfIt- H IUBAI. EXPlN5ES& ADMNSIIA1WE CXlS1S COI~~OF~ ~-mxREl1Hl ~~1Il9tIT ESDlTE OF Elizabeth L. Kamde fI.E-.& 21-2006-01143 DeflbCJIIleoelJept lllastlle A!(IGded oaSctlelWeL I1'BlI tIJIEER A. ~tJ)N FUNERALEXPBG:S: s. Gerald Weaver Funeral H:Jre, P.O. Box 247, WOOdbury ,PA 16695 Alice Heisey - funeral .dinner wis 9ni th - funeral flowers 1. ! , } j B. 1. AIJMINISTR,(IlV COS1S: PasonaI~~~~ IIaII1Ie ciPelSoaalReflJUI '11 111..) Alice P. Heisey So.:tl.f ~.....~)iijtI~"of~~_~I.I"rf~) SRet-Mfless 112 T.irrber Villa ar Elizabethtown SE PA ~ 17022 I v.(:s) Q~ 1. .....Nt 2007 2. Mxneyfees Randall K. Miller, BSquire 3. FanIy&A..pIbl (If~--is atae_as~""""'''''' 0aJmant SIeelMiess av Rtidb.sbfl, dClaialantwllecelllR SI!ae_~ 4. PadJaleFees 5. Af:couIfaat's Fiees 6. 18xReflm~fees 7. ,. MOlIfl' 4,816.60 915.00 67.84 391.99 . 1,000.00 114 .00 - 0 - - 0 - .......: ........,.. ~ S. GeaIil Weuer ....... ..... . Woadllal::v. ~J""" .. SIIeIdOII H. Weawr. s.pen.isor ........... : ~ (IHJ__ STA'IEMENT OF PVNERAL GOODS AND SERVICES SELECTED CIoqcI-.., iIr dae __ ... JI'III1CIcacd or'" are teqIIIraI. II_are ftlIlIIIed br .... or br . -r ... -,. to _"" Ilaas, _ will apIoIIl ill ....,.. 1Idow. . IflGll...... fIIIIcnd .....,ftIIIIIIn:......... -"..........1rIdI...... JI'III..,..topII'J fGrCiIIIIIIaIaJ. Y_dD_ ..,.,fGrClllllllallaJ ,... del _.,......--- - 1i _......dln:a __... ...........lfwcdllqplfGr~ _wIIG:/1!!111l'!llr~. FordleScnlccaf UaJ."-".JlAIJi 11. J.drlUD.t; lbecaf~' 18. ZOO6 Oaracco.ALICE P. IE:S&Y 112 tnmlm VIlLA JLI~. PA 170"~ N.- .. Addsas CkJ s.: &. CBdGI! I'OIl SIIMCES SI!I.ICIIDo, 0dIcr dol/Iias I. I'IIOI'I!SSlONA SBVICI!S Inc:l ScmcoI of ~ DIrclcIoI&:IIr .... .---= ..................;.... .......... '- 0dICt ......... olllodr SOI8f.AU Of CIWlGIS A. frobIIoaaIlicntca. PdIdcs &ad ........... ~ 100 ~ .......................z:I9u .. ~..................... 'em' c. SpcdoI ClaIaes .................. '9lOf.60 D. c.h""-....................---: 4 816 6C '1'01'A1 OF AU. 5l!r.J1OIIIS . ... .. . . .. .. ... .. '" .....~ . PAID AT11III 01' oa PIIIOIl 10 -AvOllIl!RlS.... ..... ............... .........'1r.<n'6 60 12/19/06 PAID ~'a::'nJ031Z3OI"""'''''~'60 IIEAlIOIt JOaIllJloUlaNG ". ....0. nJA ;~~ -0- If"".....-r.or-,. L!We~ ofay (1/" .......~....".,... II ClIfI:*od Ildaor. cuetery ~ ~t. ~~cads ............_ IqIIau lIooII(a) ............ '" ... '- ~faIdas ..................._ ra,erards ............ ......... '- T.......,. pne ...... . . . . ... . . .. ._ .....~ ....................- 1.....IIlno:--....dIe.....(I/......................lIaIIddlalllOlIc_.......lOdIe......JIlno:......l...... aaldpt (1/. CllpJ (1/ dIIs..... 01 '-aI CiocIlk",SaIIlleI Slla:lal.1..- ~I_...... iIadr lIflIlIIIIIefGr,.,.. (1/ die _.. _die..... ....mcatdlar:d. 1_.. 10 ~~(l/Ii.tilO. till . "*'1t . __ JlplIttollc""" ...-...,IiIWc.......... ............ -cIaIF ol_ . per............ 10 per JlClfd lie..,.. _..... bIIIaoe..........&-.,. ... *..(I/"'~ I".,.,.. .....__III......_poidbr.r-at'lllIor:wlOaaIea_I_............. 'I1IoIe _.., lIdede ...,.. ..... _ _...., __,.,......... ocnila<<........ GllIoIaI<<........ die.. of _...... .... lie cmIib:II P.l ~ _ ~ ...n:.:: - dICIllIaf..1Ie JdIlaal CIII * fIad 1IlII<<_. (SaI) ~. ;:. ..p. ~) (SaI) (Pan:IloIaj ............ ....., .... ......... '- Inc1 SIJB.. TOI'A1 01' NOI'IlSSIOIUL SEaVIaS. . . . . . . . .. AI .______ 2. 'ACIU'I1ES AND SEaV1C1!5 ~ vf radIIIics lIlId tcnlca fGr ..... (V/IlalIalIIW*)......... '_ u... Of.....liiclIldcs... i c:lIuK:h-w.e"'"""-........._ iIae 01 fdIdca lIlId tc:nIa:s fGr ........ ScnIa: ............... '_ Use (1/ CIJlIIpIIcIIllllld tcnlccs fGrpawlideRnl<<............. ._ Odltr _ (1/ &.cIIllks ......... ....... ............... .- nla SIJB..'I'01'A1 Of PAa1I1'D!SIIlQO. ... . .. . . . . A2 '___ ~. AUT<lII01'IVE 1!QUIftmIT ,,~.~--........~ tGa1..... .... .... ...............~ . .1Ialk piIIDi:l. C'.od) - ................................. . Incl. J.IoIooIIIlIe LoaI...... ......................_ "-II)' at . 1.oaI........... ......... ....... ._ flower ar<< IIonI clIIpaIIIlao 1.oaI........................... '_ !all ClIrfdcIsy at 1.oaI...... ..... ..... ..... ...... '_ e. far pIIIIaIas 1.oaI........................... .~ 0lIl (1/ __ raaspacadoa .. . . " . .. '---:" '- .- 100 S1JI.'I'01'A1 01' o\U1ufl1Ol~..~........ M'--=-' T01'4L 01' noDSSlOlfM. SEnICES. =~.~................... A .100. L cu.GlE JIOIlIIDCIIAImISI ~ 308 ~~~~~~~~. 0dIcr IlcIClepIa:Ic ................. '_ (Dca:ripcIoIl) ==)~'seaxer' .~ '- '- ~....................... '- . (DaaIpdaa) 0I1lEIl .- '- '- , 19<1 '1'01'''''~ 1i!ulCrEo. .. ., ... .. ........ B C!..- . c. SI'IlCW. CIWIGIS: I'onr.adiIw (1/ __ to (taomJ --=) .......... (1/ RIIIIIas fnlm .- ~~~......... .!.715. Dlrect~................. ._ '- 1 715 SOIl-rorA1 CII' SI'IlCW. auaGES ................ C.~ . D. as& ADVAJIfCID 75 0paI/0IcGQw, .................. ~ c:c..ay....................... '- Lot..Docd.................... '_ New.IJIoIIcr~,. .,..... "''237:TJO:Pat:r1otlelB' - ~............o.-ot_.....--=-. 'I -.T~aT__ .,-...,;;..;.,1-= . AIdafc .........................._ ~0Bcrl,. ..............._ I'II8Icaa$ .. .. .. ... ... . .. .. ..... ._ CadlIod C4Ics (1/ .. DalJ1 CadIlIat ~.~P.J.~.A.~.....l1.- ~ .....VM~.~ts.....la...- l'lowas ....::...'c\:,:.;.i..... .....-nr- v.Ir knIoc ~."!"'~...... '-ll!lU- '- '- .- .- .- .- 803 60 su.-rorA1 Of ADVANCIlS..... ....,. .... ........ D'--=-' We dIIlF ,... fGr _1CniIa lD GIIaiaIII: (fIedh.......... lIMIt --w."pJ xx '- ~ /& ~ ......... ........... ' (l.i:aied "-enI........ --- . <_.:::::;t} ~1'~; ;~:L.::~5/ r~;':1Jj '~~;, . , ~~.::::~;, !~~ Cashier's Check .; . t:: ):;"~''-:':~:'''' \r~\~r;lj1\~~~p' .<."-',,\ ~~: ..;.~ ." :t. ..... .'^ . "t{Noi)... :--..:: 't". ~. ~ ~: ;. :; . ""'.<': . -;. '.,,;' ':'.~......" .,~ ;. f} W~BAl<< .-'. PNC BaDk. NaIiooaI Association ';;,11 ttJ~\~~~} '~-x.'''~. ;-; ~::...: ~~ 3100086626 '(..1-( 1fr13 {,l1:L-'<Jt-NDbE:. . Remluer . .,._f'...:.....::~.:~.... .~.,..~.:..>. ,. ~ \._~ :.,.'. ~} ". ".";.. ~.'.'~~:'." . " ( .. . .} ~ . ~_:.. ;.<<~..:._- \\.~~~i,).~~:<{ <:;~" No. 00312301 Date December $': ." .. 4,816.60 PNC BaDk, N ~ ~OO~~l~O~. ~O~~~~2?3a~ 5000~OO~~SP I. Fire Side Grille Service RequestIBill . -"'.. " ,'" . --...... '. S da'''''''D' .' 'l"oth"" Uti' . .', y: . ec.> "., ' Time:3:3Opm Contact: Alice Heisey Telephone: 367-4888 Address: Organi7.ation: Memorial for Elizabeth Kamode Service Type: served Service Time: 3 :30 Room: FS as is "'--~~~~~~~~ 'Small house salad, Chicken Marsala, baked pot, green beans, jCheeSe cake w/strawberry topping, iced tea, coffee, tea, etc. $10.95 tnll1t 'M .1L~ //f)' 2/ I ?~ !;:fJ;i~~i1:r:g 67( ~~ A~.. IO#", 4 .3:30 f'lM; ~.iJ~ YYl~:J! ~~'~ ~~~~'a~ I ~~~~~~~~~~~~~~~~-~~ Account # to be billed: ? Final Count: 5"' .) ~m~~~~,~~~~~~~~~,~~~,~v"'V"N'~'^'W~' Tax:S "34 . R '- Less Deposit:$ . _ ' Amount Due:$ "t / s: I / Please make checkS payable to :Messiah Village . 100 Mt. Allen Drive Mechaniesborg, Pa 17055#, Attn: Fire Side Grine Man82er / / r , ~, AliCE P. HEISEY ELIZABEllfTOWN. PA 17022 13135 ~~JL Z;U ~lI$r /1-- to-at.- ~ . '7 /s", Z;-V fY/br~~ .'-y?14~. AUCE P. HEISEY EUZABETHTOWN. PA 17022 PAULINE ALLISON Gift Money Checking #1 . .~C~tK:E'P.H'EISEY". ..... EUZABETHTOWN. PA 17022 MESSIAH VIUAGE Chartty:Other Donations CheCking #1 12/1112006 FOR ELIZABETH'S MEMORIAL SERVICE - .--- ~.- ,,:'.':.-.---~~.:':-':::':::;:~'-'~,::"~"~^:-:::'_-':~~:.~::~ " . '.' -,-- -- ," 12/1112006 FOR ELIZABETH'S MEMORIAL SERVICE 13138 100.00 100.00 13139 100.00 100.00 .,-", " ,d';;~~L,..,...... k;i~~~;;~ili"g 5prir1~$.PAt~gg7'_',41(717)258-6436 : s..~~{,':-js*$~-: :"?;~ '~:~~-' :;:.,::;, ADDRESS CITY RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17U13 I .S",.t...1'J C :';\J~\~4 ~;;~~::~sqt' H~~~r~~. M~.jVJ!.\ .._____.__]j~?:~ <( Ji, .K~~ KANODE ELIZABETH L Estate File No.: Paid By Remarks: Fee/Tax Description PETITION LTRS TEST WILL AUTOMATION FEE SHORT CERTIFICATE JCP FEE CODICIL Check#8239 Total Received......... -[",7 ;1.,.: M Receipt Date: Receipt Time: Receipt No.: 12/27/2006 14:11:37 1046792 2006-01143 RANDALL K MILLER ESQ JA Receipt Distribution -----------------_______ PaYment Amount Payee Name 45.00 15.00 5.00 24.00 10.00 15.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN kb ..J.\..1. p-' . /i' {rv.;; ~ [too ; ~ .l.\v-C. ,> .... . .d..,....~-.-~--..~-....-....-.- (Ill qc: II " ;;1"; ./'_ ,-J ......,-... , . j~), ....~,{"iil ,k"\,,"J .' ?',_I:,--",'Wt,.c."'Vl , . liYt\;l '-\.,t-" 1 NON-NEGOTIABLE flECQRO OF,E~RI',lINGS OR PAYMernS ,10. AG~6-8PD , . -.... ; -', ~ -,.' - " " ; . .'.11 ......';~~~~ .t_ 4) e ...*,~,. t. ,:,S '_r:.'. .~c"k:~. ,. r,; --~'~,,~..II .: 5 rc Mr'i 1, ~~~~-~ - - . (J~ la. ) .... ....., " ~..~ '11itJ--- '1 lm//lId . EST~TEOF,. ..exa; ,02-07, .', ........ '. ,.;P '.' l=o.<..~~~ .......... ..{=~Q~~,-P~~~-+;};;i 1 ~~,.,~w:~;[}~~:IQ 'l~.i!:I.;~tltlo i!.?!;81l,1Il" v NO. 103 "'. .tJ.... d.......~. ". ....9...fJ01...1.. .................. DATE " . .. I ' . .' ...... .' , · '. '. $ Q/5,ttJ to-sl2l313 13 . ..' A-- uULLARS L!.I ::..."":'"_ ~~~mo=.:~ ... ....o4e'M0t1,x~~~; ,.l,.:a. ~.....~.....~.o...~~. ~......(.<7).z..i..66....IIS. is............rUli.i................................i.....'.-................ .... 1$~?:t-tfA =- J V '. +vJUJ.J4\,rwv/, f.r;#QJ ........ ....... .. ....... ". .... .... '.' .... J:>OLLAflS.':""? .1 >. .... ..' 'JE$TA-n;9i'FI ...~~'~.C.~.>_"L~+~.~:~~r~ ....... .... . . .......... '. ~!.f:;.~.......... :......, :. ....-...~~..~t.]..r..~.?c..~f..~......qc../.l.".!r'.:0:;...-;'-.'.--. ..:....H.E;:J, ".,'."1,' if :.,'rr"......,'.'o.,...,.....o.. ',"0',.-,:.".(0.'.,.... '.:i",' " ., ltJho:2?&ai~B"" ", '. ", .. , .. '. '..- . '~" ~" ..;....~- .',,' ;.......-''''..... " ". ',' "..; -", .-.t'.".,".(-r'. .~_'iJ_c'.IlIli,t".,,-.$ ," " '- - 60-9121313 13 101 ~~.4~/t<1Zf;ti~'''~ '-,'$ ~p-tJ-{),1O fd' :J ;l DOI..LARsti'J .==: i.E8TATEO" .W. '~f'C7'.'.~..~... ',....2. ~;..if. ._}v1........._".?_;.....,......~.~.!.~....._.~'.":-:~. ~ . ,.' "',' .'EI.1ZABErHrowN.PA 17022'. ." .. "--~ .. ~... ......~.. . ..,...,.F......=.9fi...'.hS-... ....'.....'............'... '.'.' '...'.......'.....'.............. ". ..'.......'.....'.....'....-.....'............. '.... ..' '=~ .~it:lJEtl/ft1t.:g~..... .... ..t-:Jic...........~...i0...~......~f.::::;-.1 J ..... ....... .... . ..... . ...r .~QQ~P~~.!:tl..~l~Q~~i!~!t;:lotitlQi!?j;'1I1~1I" .... . m s i-;:-"" r;' v ~n If. IIc-e.[J-;-' '!-"'-( ;;-:'-:-...5 r-~ -b!-.c-r-"_, f'_ r -o-d-0.'"}_~/I;~m: M I !eSTATEbF '(/J 11 ...,"'" MrE(juY;t I ~&(jO J " '. . .... 1$ Ilth'O NO. 105 DOLLARS @=:-:: ~ ... ..ru~~-~1~~~ ~ l- _ ...: _.__ ~_._.___._.,_____~'"._.~_ ...:..... .:.,.:.____.:_~:j ~AnVE 1:03 J.30 q J. i! 31: J.OOO i!? 1;83 L,S" llEV'U12 ex+ p.93J *' COMMCNWEAUH(IF~ NtEIlIWlCI! TAX IIE11AlI'I III!SmEMT Dl!CBlEHT SCHEDULE I DEBIS OF DECEDENT, MORTGAGE UABlUTlES AND UENS I5TA1'E Elizabeth L. Kan:.:xie Please Print 01' Type FlU NUMBER 21-2006-01143 AMOUNT DESCRIPI10N Dept. of Public Welfare lien Mount actually paid - 4,931.51 90,416.31 2 Messiah Village, 100 M:>unt Allen Drive, Mechanicsburg,PA 17055 704 . 59 1OI'AL CAIso eaIer oa line 10, ~) $ 91,120.90 _ h S tate ill en t eSSIa Fam~ ~. L-L.-~c:::::;..e:::::: '. 100 MOUNT ALLEN DRIVE,MECHANICSBURG, PA 17055 RANDALL K MILLER ESQ SUITE 102 1255 SOUTH MARKET STREET ELIZABETHTOWN, PA 17022 .' ;TOf:/u3~MOtJNTOOE . ,":., '.-: ,',...-:.<_.,;.:......:>,.'..,..~. "..: ",' -- '-',~-',: .,"... .." ",-' .>:".U'\~i;p~~~~~.... $ $704.59 0713112007 ..'~~I~9iJ:f;r2;t,.:.;:y.:".. .'. Balance Forward ~,. ,^.. ~..~ ";"'_"".',!,"<l"'~"~,>!,':",.;:",;->.' ",y . ._~<.. ...._._.........' . :;i':~~J~>;;':i .~;:_9~' 704.59 mS~"'u.r.:;t' ',.It,,,-c"j." '~ClC".~...t. ~.e~ -l..;c.t tl r .~.., '-il $; m SUsquehclrmQ~........;;....... t? ~ /!!!-('7 NO. 1 ~""~ -.-q....-- " DATE l2.. ~TOi~ 'rr/fd-.),j~_1jd~.~ . . I $7(Jrf.5<J i .;~~{ k~uJ.'ie~,~/L(1irfi/YJ/ldrJ - DOL(ARS~ ~ I r ESTATE OF FII7.68ETH ODE 02-m r\. %L. . ESTATEOF ~:=~ f .v.4~-1'--""8~"l~ . ELJZABETHTOWfil,PA17022 , .t .._-~-._"_.~... ..~....~, R~I""~ FOR' . '. . '. '. J" "...~ ! ___IMle.-t+.Q tnhUf, 11.( .~_~,..c..~.c......c.-_".-~-_,"-~~---"" "'- I..oool.rn;.. ':0:11.:10 q I. i! :II: J.1J0(Ji!? I;S :I "S" D~VL ESCAPED YOUR IOTICE RESIDENT # 108604 CURRENT 0.00 OVER 60 0.00 OVER 90 0.00 OVER 120 704.59 TOTAL AMOUNT DUE $704.59 OVER 30 0.00 RESIDENT NAME Miss ELIZABETH L. KANODE A I % finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! Fam f'B.{)1 MA If you have any questions or concerns about your bill, please address them direetIy to Fiscal Services at 790-8220. Thank You! . COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF PUBlIC WELFARE BUREAU OF FINANCIAl OPERATIONS DMSION OF THIRD PARTY lIABIlITY ESTATE RECOVERY PROGRAM ' PO BOX 8486 HARRISBURG, PA 17105-8486 December 20, 2006 RANDALL K MILLER ESQUIRE 1255 S MARKET ST STE 102 ELIZABETHTOWN PA 17022 Re: ELIZABETH KANODE CIS #: 240172365 SSN: 162-12-6552 Date of Death: 11/18/2006 Dear Mr. Miller: Please be advised that the Department of Public Welfare maintains a claim in the amount of $90,416.31 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Propate Estate is now responsible to.reimburse the ,cc>'~Pf!!par~1).t:".~~t::<>~d!~g.' "'1:'-t51lr,:1::::4~;' "~:;rJ? :"S."J.~1.~;"~ffi!rgely~:1i,1.i9U~t"15;'.".rg'g4; ',a's amended by "Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $22,538.58, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $67,877.73, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, "' 't"ll~.:':1~bn' 1'-- Jessica L. Strawbridge TPL Program Investigator 717-772-6238 717-772-6553 FAX Enclosure '* COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF PUBliC WELFARE BUREAU OF FINANCIAl 0PERA11ONS TPLSECnON-~~1YUNrr PO BOX 8486 HARRISBURG PA 17105-8486 December 18, 2006 STATEMENTOFC~MSUMMARY Estate of KANODE, ELIZABETH 240 172365 INPATIENT OUTPATIENT LONG TERM CARE DRUG .00 .00 22,513.44 25.14 .00 71.84 .00 71.84 89,120.03 1,224.44 66,606.59 1,199.30 22,538.58 67,877.73 90,416.31 !RntuUdl J(. JJtlil&t Attorney at LaW' 1255 South Market Street, Suite 102 ElizabethtoW'n, Pennsylvania 17022 (717)361-8524 -- Fax (717)361-9071 August 16, 2007 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013-3387 RE: Estate of Elizabeth L. Kanode Estate No. 21-2006-01143 Dear Sir or Madam: Enclosed are an original and two copies of the Inheritance Tax Return in the above- referenced estate. I have also enclosed a check in the amount of$15.00 to cover the cost of filing fees. Kindly file this document and return a stamped copy, along with a receipt for fees paid, to our office in the enclosed self-addressed stamped envelope. Thank you for your kind attention to this matter. Very truly yours, ~Irm fY\ Fta1f(LQ{tcO~~ Kim M. Beamenderfer Legal Assistant to Randall K. Miller Q )~~ .' -D !::.:to --'>r- ~.~~ ~~ ~:3 '~il\ '-- ::':0 ---j "....) ("~:""' B -.J ~ c:: G") 'J -.l v -;;r" N w (JJ