HomeMy WebLinkAbout11-15-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes .
PO BOX 280601
Harrisbu ,PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
(:)
2. Supplemental Retum
(:)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
(:)
4. Limited Estate
(:)
(:)
(:) 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 Da ime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
-
Correspondent's e-mail addreSs:
fA. 170S~
ADDRESS
\ ,(,., (3 9.., ~ t L'l 1~ ~ , J1 E c. ~ A t\J I C ~ ~ v R. G-- ,
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
.,
Side 1
L
15056051047
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15056051047
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15056052048
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
~
RECAPITULATION
1. Real estate (Schedule A). ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
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) 0 Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & MiscellaneoUs Non~ProbateProperty
(Schedule G) c:::) 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 ValueofE~tate (line 8. minus line 11) .(.l.~ .S. CP.~. ~.~T. .\ . . . . 12.
13. Charitable and Govemmental Bequests/See 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} ~~.S f>.~.~~\ . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS.FOt{ APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under See. 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 collateral rate X .15 18.
19. TAX DUE.. .. ... .. .. t~ . 5. ~. ~V f.N T .. .. . .. .. .. .. . .. .. .. .. .. .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
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15056052048
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15056052048
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number
DECEDENTS NAME
K' l.. l N G-E R, I 'RusseL L
STREET ADDRESS .~
a.- PArt\< R~
CITY I STATE PA- I ZIP
ME-C~I\N l t.s ~ut...lr I 7 0 ~o
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-
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
---- Total Interest/Penalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Pag!! 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
-0-
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QU~STlONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decEJdent 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 ~
c. retain a reversionary interest; or.........................................:.~;............................................................................. D CiS
d. receive the promise for life of either payments, benefits or care? ...................................................................... D M
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, anrtuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D ~ .
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. ~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 zero (0) percent
[72 P.S. ~9116 (a) (1.1) (ii)). The statute does 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 be~eficiary.
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 deceqent'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 wifh the decedent, whether by blood or adoption.
--.."'" *' SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBE
K L f}.J G-EI< J 'K lJ SSE L E.
, !
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survh/orship must be disclosed on Schedule F.
ITEM i VALUE AT DATE
NUMBER DESCRIPTION I OF DEATH
1. MerT CHEC.fo< IN G- PI C coLJJ-JT a 9 'if 4 ~~3.J091<6 ~<ac.oo
J C.AsH- , YS.oo
3. dOQ \ c I-frvRol..E T ~MpALA- 7/ 50-00
4, M ISC. P f~ s 6 fo..l fit L f,ec>p tA. T Y ItcS-o'D
q <10/0 oF- Pf~ONf>ll... p~opr~ r'f CU A ..>
. PET f}oG- Af'JO
R U 1J.J t 0 f),-/ I< LIN 6-0..' ~
.
MIC~ CONIAM ItJAftoN
CAN SE CJI-J F. ~t.I\ ~D B'I N E' (;. N.!lOft>
I
I
I
I
TOTAL (Also enter on line 5, Recapitulation) $ 7'lfo.oo
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
R\JSSE'L
t.
k l \ IV GE. R..
FILE NUMBER
ITEM
NUMBER
A. FUNERAL EXPENSES:
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
1.
M ~ L. P f "Z.. 'Z. ,. FUN E It A L H 0 /VI E...
~ MR~W~I W~...,
M €. c. t-I. ~!-II t 5 ~ u ~ 6- \ r A . 1 r 7 - "q 7 - 4- (. 'f "
la77,Oo
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) _'R~ I P f{ R . vJ 11 1< E F,E (. 0
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address II ~ B R,'NOLE:.. 'RJ
City M e.. c. H lOr N I C ~ B lJ R. 6-
State~ziP /705;
Year(s) Commission Paid:
- 0 -
2.
Attorney Fees
..JAME,s "...,. g"'C.H
Iso,eo
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
.- '-. -~:
%0.00
5.
Accountant's Fees
'RE(hJT€~ c> F W.&.t.S
(P'!.E' rAy.. RETuU/'
6.
Tax Return Pre parer's Fees
, r. 0 0
7.
i
!
TOTAL (Also enter on line 9, Recapitulati6n) $
(If more space is needed, insert additional sheets of the same size)
, 5 J. d . 00
REV-1512 EX+ (12-03)
ESTATE OF
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I~L-t IV 6-eR.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
Ru 55FL
FILE NUMBER
E,
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimltursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
(CR.ED,T CARD)
7 d. 1../.. 00
~.
3.
5-
,.
7.
9.
q,
10.
LOWE'S
CA plTtll\~ otJE. (c f\.~O,T c.p\~1) )
ASPI~~ (C,Qlt01T"' CA~O\
4'" 09.00
("J.i.oo
4-.
CRf,(J,.r ONE..
(c R EP,"" CAitO)
I "?>G,q. 00
Jq"OC)
MAS If R
CA~D
(C(<eD1T' C.ARD)
(c.~fPlr C.A~D)
.5CJ~,OO
J.S3,oO
~ 0 o. 00
ASP'y\rL(#J. )
j,.). S~eL.TON
u..H~ " l- .f! l e. c-l')
I
W~"'EF,E.L..D I
f? t ,..,TE 0
H",....tL
( \4 EIA TIN (,. 0 ILl
R" 1 {> h A. fhL. ON dOC I ~MPIl1.r:\
~A-(p" A. DA-f'04.I\GE PONE. To
~ P,.rtl< P.J. M f C.f.(A,...C.Sa....A c,. In-
;;',",000.00
3f.t\~'f..F.fi{".D . fJf+lf'ff A. R fMov f. / Vt>{JogA L 0 F
PfflS6r-JAL f^ol't.A..T"I
Fv~N Ir()~~A"'~
~ 50, 0'0
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
-
35,5;2. 7,00
./ cD
ft&1
Fill In amount completely $ DDDDD . DD
D
Yes, I have moved or I have changed
my email address. Check the box and
submit changes on the reverse side.
......-........
..............
...............
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Ilml_lllun~IIII~~
RUSSELL E KUNGER
2 PARK RD
MEOHANIOSBURG PA 17050-2731
11141
1111.1..11111.1.1.11.11..1.1.111.111..1111.1111111..1.11.111...111.1.111
11..111..11111..11.1.111....1.11...1..11...11111..1.11.1..1.11
MaIat Payments to: LOWE'S
P.O. BOX 530914
ATLANTA, GA 30353-0914
11.11.11,,11111,1111,1.11.11 i 1.1.111'; .11.1..11.111I.111111111
0002100DOOOOOO OOOb300000723~5 0007~81~2 43~b042 ~7003
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Previous Bal~ Payments.~ Cred~$
( $4,471.41 )-( $200.00 ')+(
'-------_/ "'-.-.-
FINANCE
CHARGE
'..------
$53.22
Transactions
New Balance
Minimum Payment
Due Date
\ I
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$84.63
H
$4,409.26
II $132.00 ) I Apr. 11,2007 I
@
Feb. 13,2007 -'- Mar. 13,2007
Page 1 of 1
.~,~
$4,650.00
$240,74
$1,767.00
$240.74
~ments. .C@~jts,l~jusbne!Jts ','_
1 10 MAR PAYMENT
T ransactionsu
2 05 MAR WM SUPERCENTER MECHANICS BURG PA
---,-
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PUM~ PAY AT ltAST THIS AMOUNT
~-----'--"""'------~-...,......._--_._.._-
Visa Platinum Account
4862-3623-1635-5497
Your Account Infonnation
TOTAL CREDIT LINE
TOTAL AVAILABLE CREDIT
CREDIT LINE FOR CASH
AVAILABLE CREDIT FOR CASH
$200.00-
$84.63
, FinanCe Charges (Please see reverse for important information) J'
Balance rate Periodic CorresJlQnding FINANCE
applied to rate APR CHARGE
Purchases $4,495.76 0.04082% 1490% $53.2t'
Cash $0.00 0.06641% P 2424% $0.00
" ANNUAL PERCENTAGE RATE applied this period: 14.90%
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VUN(,t:2__
At Your SelVice 1-8OQ.903.3637
To caR Cuslomer Relations or 10 report a lost or slolen card:
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Send payment$ tCl:
Cap~al One Bank, P.O. Box 70884 . Charlotte, NC 28272-0884
Send inquiries to:
Cap~al One. P.O. Box 30285. Sall Lake City, UT 84130-0285
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1 7 11 070313 PAGE 1 of Z COLRZ..OA
PLEASE RffURN PORTION BElOW WITH PAYMENT
018C6056
77417
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as pi reat
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For Customer Service Information, see the
Cardholder Service. Information ..ction below.
.-/
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For billing errora, and other Information about
your card, ... fever.. lide.
Account Summary
Account Number
Closing Date
Total Credit Une
Available Credit
Payment Due Date
Minimum Payment
4146 7500 0055 7014
MARCH 26, 2007
$800.00
$171.50
APRIL 20, 2007
$52.00
Previous Balance
Payments & Credits
Purchases & Debits
Cash Advances
Periodic FINANCE CHARGE
New Balance
$597.88
$20.00CR
$41.50
$0.00
$9.12
$828.60
Important News
YOUR ACCOUNT IS PAST DUE $28.00. FAILURE TO PAY MAY
RESULT IN REVOCATION OF YOUR CHARGING PRIVILEGES.
Transaction Detail
Trans Date
2/27/07
3/1/07
3/26/07
Post Date
2/27/07
3/2/07
3/26/07
Description
ACCOUNT MAINTENANCE FEE
PAYMENT RECEIVED -- THANK YOU
LATE PAYMENT CHARGE
$
$
$
AmoUnt
6.50
20.00 PY
35.00
Finance Charge Summary
AVERAGE
DAIL V BALANCE-
MONTHL V CORRESPONDING ANNUAL PERIODIC
PERIODIC RATE PERCENTAGE RATE' (APR) FINANCE CHARGE
Purchases
Cash Advances
$
$
470.78
0.00
1.8375%
1.9375%
,23.25%
:23.25%
$
$
9.12
0.00
@
5385 0005 HAG
1
7 25 070225
Page 1 of 1
5727 9610 K662 D1BU5385
10422
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--- ~
CreditOne
BAN K
Your Account Number
44479611 1535 8620
Payment Due Date
Your New Balance
Minmum Payment Due
Please Ent~r Amount Of Payment Enclosed
03/22/07
$1,369.00
$55.00
$
O For address and telephone ohanges, please oheck the box
and oomplete reverae side.
To ensure proper oredit, please retum this portion with your
payment. Please write your acoount number on your oheck,
made payable to CREDIT ONE BANK. We may process your
paymenleleotronioally. See Pll\ymenls paragrll\Ph on back.
CREDIT ONE BANK
PO BOX 60500
CITY OF INDUSTRV CA 91716-0500
111111111111111111111111111111111.1111111111111111111111111111
RUSSElL KLINGER
2 PARK RD I 31
HECHANICSBURG PA 17050-2731
10422
11111111111111111111111111111111111111111111111111111111111111
0136900 0005500 4447961115358620 2
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(90m) HO~<:lVUS
;)UI Sd8!/Uas Pj88 88SH 900(;
HOUSEHOLD BANK MASTERCARD STATEMENT
N 01/ r:. lC f) '1- (0 - 0"
.
(5)
RUSSELL E KLINGER
Page 1 of 1
BALANCE SUMMARY
PAYMENT SUMMARY
PAST DUE AMOUNT $15.00
$260.37
$0.00
ACCOUNT SUMMARY
ACCOUNT 54ll8-9750-2621"()859
NUMBER
CASH CREDIT LIMIT t $300
PREVIOUS ,BALANCE
PAYMENTS/CREDITS
PURCHAS~~DEBITS +
LATE PAY~ENT CHARGE +
MISC. FIN1NCE CHARGE +
FINANCE HARGE +
NEW BA NCE
$15.00
$30001
04127107
$0.00
MINIMUM PAYMENT'
I CURRENT PAYMENT D~~
PAYMENT DUE DATE
OVERLlMIT AMOUNT
CASH LIMIT AVAILABLE $0
$30.00
$0.00
~
$295.86
TOTAL CREDIT LIMIT $300
TOTAL CREDIT LIMIT ~. $0
AVAILABLE
STATEMENT DATE 04102107
'See reverse side for an explanation of
these amounts.
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-
- ::;
0
0
~ ::;
- 0
0
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-
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0
~ 0
- 0
0
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..
- 0
...
- ...
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- 0
-
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t Cash Credit Umitis a 'on of the Total Credit Limit
TRANSACTION SUMMARY
(For additionallransaction detail go 10 www.householdbank.com)
TRANS POST TRANSACTION
QMS QMS DESCRIPTION
03126 03126 LATE CHARGE ASSESSMENT
REFERENCE
NUMBER
1999999996000099913010
AMOUNT
CHARGES I CREDITS
$30.00
--
-
!!!!!!!!!!!!!
-
--'
-";.
-
-
. .
-
--
!!!!!!!!!!!!!
$0.00
-
--
--
YOUR ACCOUNT IS NOW PAST DUE. PLEASE CALL TODAY TO MAKE YOUR PAYMENT OVER THE PHONE CALL US AT 600-434-4954.
-
-
-
-
-
=
-
--
-
--
!!!!!!!!!!!!!
$48.00
Isri?1 i
4146750000557014 000048009: 000597880
, 3-11-0 f
Plea.e detach and return with your payment ,
--------------------------------------------------------_._~----------------------
. I
aSplree 9 For Customer Service Inl....mation. .ee the
~ Cardholder Service. Inlo~mation .ection below.
CD <@
aspire
I MAR 23, 2007
Payment Due Dale
1 $597." I;
New Balance I
Minimum Payment Amount Enclosed
Vi.it www.a$pirecard.com
1..11.. ..111.1..11... ..1.1..11.11.. .11...1...111...1...11..1.1
PAVMENT PROCESSING
PO BOX 23007
COLUMBUS GA 31902-3007
c~
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171rJ ~ - e" LI r
10'2 1 MB 0.326 02-2~2S26-~762-2223-T;1~'
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RUSSELL E KLINGER **P00010'2
2 PARK RD I 31
MECHANICSBURG PA 17050-2731
tl.t{l& C-cr~ r'r"'\(..... 1../
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Change In address?
Please complete reverse side.
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For billing .rror., and ot~r information about
your card, ... rever.. si~..
-
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%;) ".". SICEL TON
INVOICE
Nobody serves you better
Send all inquiries to:
40 West Manoa Road
Havertown, PA 19083
www.iiskelton.com
For questions on your account, please call us:
610-525-3600
-
0000000055
1...111...'11111.,.1..1.1...,.11
RUSSELL KLINGER
2 PARK ROAD
MECHANICSBURG PA 17055
d
T Previous Balance
Account Number
28556 $57.07
Invoice Date Current Charges
03/07/07 $252.90
Payment Due D~e Total Amount Due
For Current Invoir e
10 days from receipt $309.97
Delivery/Service Address: 2 PARK RD 17055
Purchase Order:
Important Notice;
CALL TODAY TO SCHEDULE YOUR HEATING AND/OR AIR CONDITIONING TUNE-UP. REFER AN AUTOMATIC DELIVERY
ACCOUNT TO SKELTON AND EARN $50.00
REV-1513 EX. ,....
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
KL1N&!r~ I
RuS'SEL
E.
FILE NUMBER
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDBNT
Do Not List Trustee(s) i
T
AMOUNT OR SHARE
OF ESTATE
1.
W A k It. FIELD I {< A I P A. It.
II~ (3~INDlf RJ
f'1~'-~ANtC~8oRG-. p~
17o~5
/ 0 0 o(()
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, 9N REV-1500 COVER SHEET
n NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE :
1.
I
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET :$
(If more space is needed, insert additional sheets of the same size)