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Home My WebLink About11-13-07 (2) -I 15056051058 REV-1500 EX (0fH)5) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Hanisburg, PA 17128-0001 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN - /J ( '/)Vi '1 RESIDENT DECEDENT CY e>X-U FUe Number jo3C) Date of Birth 149-24-7091 02/14/2007 02/18/1933 Decedent's Last Name Suffix Decedent's First Name MI NOll JUANITA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 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 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8, Total Number of Safe Deposit Boxes RENATHA HAMilTON (717) 649-2800 Finn Name (If Applicable) REGISTER OF WIllS. USE ONLY First line of address 9'15 INDIANA AVENUE Second line of address --I C.:'l City or Post Office LEMOYNE State ZIP Code DATE FILED PA 17043 Correspondent's e-mail address:ho1yfire7@comcast.net 9ATE 1111~/o/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ....J ~ -I 15056052059 REV-1500 EX Decedent's Name: JUANITA NOLL RECAPITULATION '1. Real estate (Schedule A). ............................................ 1. :~. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation. Partnership or SoIe-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/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) . . . . . . . . . . . . . . . . . . . . . . . . 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 .0_ 16. Amount of Line 14 taxable at lineal rate X.O _ 258.38 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 L 15056052059 Side 2 149-24-7091 Decedent's Social Security Number 15056052059 0.00 0.00 0.00 0.00 5,645.00 1,794.80 7,439.80 1,698.00 1,698.00 5,741.80 5,741.80 258.38 258.38 ....J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME DECEDENTS SOCIAl SECURITY NUMBER JUANITA NOLL 149-24-7091 STREET ADDRESS 1942 CHATHAM DRIVE CITY I STATE I ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousaij Poverty Credit B. Prior Payments C. Discount 258.38 Total Credits ( A + B + C ) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( 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 tl1e total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 0.00 0.00 258.38 0.00 258.38 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. 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;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 Iil c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 Iil 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 Iil 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [!] 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 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. 99116(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) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF JUANITA NOLL FILE NUMBER Indude 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH SOFA 175.00 CHAIR WITH OTTOMAN 50.00 2 END TABLES WITH LAMPS 125.00 BOOK SHELVES 75.00 TV STAND 50.00 TV 25.00 GAS FIREPLACE 175.00 KITCHEN TABLE WITH FOUR CHAIRS 125.00 HUTCH 175.00 DISHES, COOKWARE, BAKEWARE, FLATWARE 175.00 SINGLE BED 75.00 DRESSER 75.00 NIGHT STAND 25.00 BENCH 35.00 DOUBLE BED 150.00 WICKER NIGHT STAND 35.00 LINENS 75.00 NIK NAKS 175.00 JEWERL Y 400.00 MANTLE 50.00 2001 KIA OPTIMA SE V6 VIN# KNAGD124515064674 3,400.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets ofthe same size) 5,645.00 M _ MECHANICSBURG · PA ~~ B 1=1 I lUll I ITI I ..Ig I Immnl PIIDIIID rmDl ~ To Whom it May Concern, The 2001 KIA Optima SE V6 serial # KNAGD1245 I 5064674 with 46590 miles. Titled in the name of Renatha Hamilton, as appraised on 10/25/07 Has fair market value of $3400 in its present condition. t Mark Turner Inventory Control Manager McCafferty Ford Mechanicsburg 6320 Carlisle Pike · Mechanicsburg · PA 17050 · (717)-766-4733. www.mccafferty.com REV-1509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLy-oWNED PROPERTY ESTATE OF JUANITA NOLL FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. c. JOINTlY'-owNED PROPERTY: LETTER DAlE DESCRIPTION OF PROPERTY %OF DAlE OF DEATH ITEM fOR JOINT MADE INClLIDE NAME OF FINANCIAL INSTTTUnON AND BANK ACCOUNT NlMBER OR SIMIlAR DAlE OF DEATH DECO'S VAlUE OF NlMBER lENANT JOINT IDENTIFYING NIMlER. ATTACH DEED FOR JOINTl Y-HELO REAl ESTAlE. VAlUE OF ASSET INlEREST DECEDENT"S INlEREST 1. A. 11101103 COMMERCE BANK CHECKING # 536322647 224.62 50 112.31 11101103 COMMERCE BANK SAVINGS # 626199988 3,364.98 50 1,682.49 TOTAL (Also enter on line 6, Recapitulation) $ 1,794.80 (If more space is needed, insert additional sheets of the same size) COmmerce "Bank Commerce Bank/Harrisburg N.A. 3801 Paxton Street Harrisburg, Pennsylvania 17111 1-888-937 -0004 018402lNY1 N6649 JUANITA NOLL RENATHA HAMILTON 1942 CHATHAM DRIVE CAMP HILL PA 17011 We're here 7 days a week, 24 hOUTS a day oJ 1-888-937-0004. Transactions By Date 01/23107 CHECK # 996 $26.38 01126107 CKCD DEBIT 01125 WINE & SPIRITS 210LEMOYNE PA $20.13 $296.66 $2.15 01129/07 CKCD DEBIT 01127 RITE AID STORE 107LEMOYNE PA 01129107 CHECK # 999 $5.00 $82.17 02101107 CKCD DEBIT 01/31 KARNS QUAUTYFOODLEMOYNEPA $15.31 $45.86 02105/07 AC-SEARS PAYMENT ..cHECK PYMT CK-OOOOOOOOOOO1004 $35.98 $918.41 011 Cycle Page 1 of 5 _ _ ____ ___ ..._""I"W'PA""'" ...II:naUATlnN Member FDIC Commerce Bank Transactions By Date (continued) 02106107 CKCD DEBIT 02104 WEIS MARKETS #125 CAMP HILL PA $34.50 $805.82 02/12/07 CKCD DEBIT 02108 RITE AID STORE 107LEMOYNE PA $10.16 02113/07 CKCD DEBIT 02111 RITE AID STORE 107LEMOYNE PA $5.35 02114107 CHECK # 1013 536322647 0184021NY1N6649 Page 2 of 5 _ ___ _____ ____ ___ ......"".......&..1""1" luenDUATlnU Member FDIC Commerce .Bank Check Transactions (continued) Number Date 02107 Amount Number Date Amount 1010 $69.91 1013 02114 $23.59 536322647 018402INY1N6649 ___ __ _.__ ___ ...__..........T ...IE:I"\DUATlnN Number Date Amount Page 3 of 5 Member FDIC Check"W 0184021NY1N6649 This item has been accura18ly processed. A cheCkvieW Image is not awila/:lle. .... --- -.. I sl lJQl.UllS ap::: =- ...:..................... ...:...............=..~~.....n=.==..=~.........mJ . - ... on .Check 993, $15.83 Date Presented 01/2312007 I:r~-~~~ --- _/~/"P;-~ "'~... ___ _ I $ 02,.:f-;;'~ : ". _/ ~. v .; /,\Jvn ,( / ..t,...;f{L - Doll..... /!\::s::- . Conamen:e. 01 . ~ ..BanIc__.....__. * r:. W'. ......to-ocIU ~ ForJ.//J'-4'f1d /.f:L..'1 .,<1'7-1 ,- ira.2l-~.. ~-~~~~~~~:;~~,~~~... ...: Check 996, $25.00 Date Presented 01/23/2007 .. ~ :. JUAIlJTA NOLL ~ . 1S.~= M :~~ c If.lJ/;f c!--- . . 'j . h~ Commetce.. 'Bank _.....__ . --- ~ f: For ~ I:OH:IO~a..r.I: 51 I'.Hi!I'." ..~ 999 . D~fp / ,2J/ CI "l. ...'-: I iYOaJ :.- Dollars. /!\ === ;j/ ........~. . ..1 - n~~ . _...!!.' ,", ~ ... .~ 1Y' Oqqq. ~ .~'''''''''':' 1. Check 999, $5.00 Date Presented 01/2912007 ':.;'!,:'_~l:'_.__ . .. --._...:: .... ....'------ -- r-'-'~ .~-d30.:;'1 '.:~~:~:"_. ,:~$~~~~~) Com".e..>>' . . .. . . .8ankr:;:n-=....-- /. ---c 7;!#?.::.... FwZ~d'f' ~69" 7 . - ..~ .. , .." "0 ..,.., " .. "., ~ .L~OOOOO. 5 "'" ~-.: ~ ~y-......~~?'" -= Check 1001, $65.20 Date Presented 0210712007 "'-" ..-,.......~..._':--.....:'-:... ........~ ... ....-.........-. --a...._ l .lllAlllTANOLL . 1003 .. ._THAIlAIIIB.TON I I ..=:--- D...:'2-4061"'""':":. PaytlOUu, ...-.- .~.: . Oirder..r :.t'~1:::'7Ol' I $ /tJ dP r. .~ Ao..lZAU. .. .. .. Dollars &I ~I .Comnren:e ... .. :...0 '. :. . I' flJIanIc.............~.....ft.....,,;;;,.4. -?~~~~~~..cf.~Q-:'l':;.O.; . ,~ '" -:v. .~ ___ _-w....~ _'""'''''_.....~ , ~ F(f.43r..i..~7-i'3t4.1<1d7'f <2- .. H x_!.2~-,,-, ~ ~BO~a"l'.t: . S!-=-H 21'." ? ~OO:i "'OOO~~'" ~ Check 1003, $10.00 Date Presented 02108/2007 Page 4 of 5 Date 02116/2007 Account 536322647 . ~; "r.,.. ,.... . . '.~.. ,p_ _ . . .- .' Dot. J- J 7-0 1 ...:;, ~I I" rt:.:.':re. :P A /1-.";; if ;). ... . . 1$ 3 3?.:L.1~ ~. .A'::t;;; ,,~~ .. - .6 02--,DoJlars ~ ~ . ",'Bank .. .' ...... _._~.,....~~-"'..."."_._.-... ..~._-. ---- i~f:~~iif~~~~::c~~;E~~ 1-' ---.~ ....~........ ' .'. ~ JUAlirrA NOLL REMAlHA HAMILTON . .1842 ctIA1'HAM ORNE CIM/I' HI.l. PA lm1 Check 994. $33.62 Date Presented 01/2312007 ___u__...~__u_.._u_ _u~~u~.___.__.._n__.___________.___n n._________~..._____ -_. ..__u__ This illlm has been 1ICCIJIlI18Iy processed. A cheCkview image is not available. -- -.. I sl - '~._~4W .--....__.... r-" - Check 997, $50.00 Date Presented 01/2512007 t=r-- ~NOLL . --'.' ... .-;~~I ~4}J RENAlHA_LTON. I '"7 '" tJ 7 ...""'" . . ............. _ . . Dote ~ ~. II If =the C$i::;'70~,G .. 1$ ,;1([e) OcJ \: ; 2'u-". )j ;i~J,,;../I~ . Dollars 61.== i COIII~ 1-13 : 4,5SPil 01120.-0; Ii) 5. -;.i4, . .. . ~-~~- =~ ' . o~ 18~ CEllA? CLiFt l~ -:?I ~ /1/'7 .... I' '\ For'..!' 1- ~ .' :t~- ~~~~!~.!.~-~<""'.~~--=-=--==~- - Check 1000, $200.00 Date Presented 01/2612007 -';" .. -.... ~ .~ If ' ~~~=~:::=::-<:=~. I':1ytlOthe /'J /'r /1 .. , Orderof. ~ .... K4-?!:1...'kt, /". ~ I 1$ QtJ.cro' Dollars I!l ==- ., @Bank==__ ~ d ~ For ,(:).;7 ~~ fJ-7 7 <<..ui/ "4(T-~.;Z ~ . ~ I! .:O:lUO~a..&I: B 1'.:122.... II' .-- .0::4.(,-.::'_~.!"' ..::.:::='="'=~__.._ _. .. _"""",.~OO 2 "'001;10005000'" _.. ~~~:..::CA:::. Check 1002, $50.00 Date Presented 0210712007 .__n_n_____H.~___._.n__u._~~______..._____.______n_~u__h._~_U.;.....___nn..u__.... ThIs illlm has been ~ processed. A cheCkview image Is not available. -- - I sl - ~.-- .,...,...-' .....- ..... .~-- ..~._---_._-- ...-- -*---------~-_..~------_._----_._~-- _._-----_..._------~---~ Check 1004, $35.98 -Date Presented 02/05/2007 Chec~w 018402INY1N6649 .['" . '~-:':A~OU. -. :;;, '. ' , REllATHAHAMlLTON '~-z C1 h' "''''''0 '. 1IG: ~THIIM DRIVE . Dat....r-.. ( - II '~_.._..:...-- ~.,' ,::,.:'. . For-?::? 0 09i! __ .. , - _.,_ __:#~ I L'~92:'1.!.,!l ~~~~=......~...~~~.~..} _ 11~.o.~ >Y'''''''''__ ,I "'.- - Check 1005. $42.00 Date Presented 0210512007 r' " "U~ANou:.: , , ' ' 1007--1 ~ ,REllATIIA HAMILTON ' I '.',""all\THAMIlIWE,. .'..'. Do' #.. -cJ.j"e77 "'''''. ~O. - CMF HI.!.. PA 110ft . . p . .. =~~" t? Po? (!' A..:JE:.; 1$ -3t9OS ,. , ::r.~, J!;;-~' ,- ,03 Dollars '~ ~-I :CommeIce ' ' , "~ >, llBan1c:=-..=--- , ~ ~ For4l=fJ-tJ 7Mbl ~~ -:-7L~..!!: i ~ ':0113018101::..:, 51 to1i!i!I::.r. a.. 1.001 "'0000005to03~' ~ ~ --...- _~ t; Check 1007. $56.03 Date Presented 0210612007 - ,,-~ -~~~ -~'rJ2,,"7.. :::'. :.o:....m:: . Datp :;- *' ~ 01 r- ~th"t?M<U ~fJ-ItJ';dl- , " $ /j/S J . ' : .~~ ' . ,. " ~-, ' " Don.;.;,~,~ Conrmeir:e ' p' , , " .Bank_.._~... /2/1 A~~~./ ' ," '. ~~~-U~i!&~~~~~~ ~ - 'l_ Check 1009, $4.37 Date Presented 0210712007 ...... ;.. ..,....;. ... ~ .....-~. ..- . .lUAIII1'A NOLl. RElfATIIA HAMILTON _CHlOIMM_ e".. fC.1. PA non '1012 nof~,2 / / P 'J / 1$ /CJ ,t:;) (/ ~ Donars; /ii' , ~12:. .. =-~!:-" ,0' /l1/}fJ e.. ", :,cl'//h) CotDmerce "Bank ___....' , , ~~~~:~ .~~ Check 1012, $10.00 Date Presented 0211212007 ....__..._..............__.._uu..___nn_nn................u.....______.u.no.__n._.__O. Thill iIem has been accura18Iy processed. A checkvillw image is not avaiIatlle. ..... -- , $1 1 -- IlcIWU a.-.. -- "...,. - - H... _._..._.._un.___.___h___n~~___~__~____._ -------~ .~.__.----------_._-----~... Check 1014, $26.00 Date Presented 02115/2007 Page 5 of 5 Date 0211612007 Account 536322647 -.. .... -. -. f REN~:=~ - _. ' , ~~~6 '~i ~ ~~:.':': Date:P 03 C-? .......~ jj , l'aylotbe I. 'r: r ~ a I. Onl",of '/ , /,u.... , c.vY-f'./ I $ if 600 ~ t.~ .."f./-/~ ,,;3 -:f- ./~ B ~t . , noDars ~ is:'; .Bank_.__~ - f t For~2/,p /.,J?'7'7:,o 0 /C/ 9- _~ '2a~ 11 g.~iO 18r.,:~~_~. &3 ~ i!&1o k~~~o~Oll.li~P4jj Check 1006, $85.00 Date Presented 02/0712007 __~~x.~~ _____~1! :;=-~~ l..::' "-=w. r - a n ~ .lUAIII1'A NOU. 1008 r,' 1 RENATHA IfAMlLTON ..:J A = 0 7 ""W1l1 it" 1 J:, 1942 CHA1'liMt ORNE Date I /-.. V. ~ 01 ::i ~ ,r: CAMPHa1..PA 17011 ~ 'I $ L J70 (J ~i 11 ~:~e c,' ~fi4? ,7 ~ ~ .if~.~YL.,.....--..!.-- Dollars fi\ =--=- i ~ eommerce .1 ;. 4 r::JBank _.....~...... j ~ '-7 ,.....wc:.axt... .....~ - L -,..... -" :.. ;' _.' (~J~, ,e../.""-' //~'( . 3 ~ ForCf/5".y7~.:L:l~ "'"'" ab;P ,_~~?~.... ______.,.____' n,n' , ':03 ~_30 1alob~: =~,~,~~?":.,~~~~~.~~2~~~ Check 1008, $47.00 Date Presented 02108/2007 r-' L- .RIANJiA NOU.' , 101~"'j I' JIEIlATHA HAMILTON ~, 1M2 CMlHMI ORNf D6tP~ -d..;;'O '7 ..~ ~ C,IIII)...... PA 1781\ lJ. '1i:\:~ . ,$ t:l'.'1f _ I_~_i?../' - ~JI:mo Ilt=. I' Col. -.--- O. '. T ' For CJ~/9~6cP/ -.~2'~~, ~~~,e'L~.~~l ~ i!&~,,,,!~,..;:10 ~O .......O~~~ :1..._ Check 1010, $69.91 Date Presented 02107/2007 1- , , . -~:=-TON ,_'--'r. 1013 ~ I " ':.~= Dor~ r? -/107 "'-:1 '. Pq.~ ~ 12':~',~~~ - 621$~~~-:-=- .r ~Bank ___.._~..... .. -- ~ F"".;!//{{.C~/d /5'd/,5;aPJ.'f C:;Z" 4-n4-_.4.~. ~~~~~~~~..~)..!~!!!'~...:!G ~... .~_<<?9.1!...D2!:!;~.~5..'l.!.:. ~ Check 1013, $23.59 Date Presented 02114/2007 Commerce Bank Commerce BanklHarrisburg N.A. 3801 Paxton Street Harrisburg, Pennsylvania 17111 1-888-937-0004 01 B4D4NNY1N2662 RENA THA HAMILTON JUANITA NOLL 915 INDIANA AVENUE LEMOYNE, PA 17043 We're here 7 days a week, 24 hOUTS a day at 1-888-937-0004. PERSONAL STATEMENT SAVINGS 0626199988 Transactions By Date 01119107 DEPOSIT .ctli2~i!l'{.x~iTq~*9'f~:P~~22ij7.f}... 01131/07 INTEREST PAYMENT 02121107 Interest Summary OOCII REG E SnapShot Page 1 of1 IYnTI:. ~cc DI:'ICD~C ~.nc enD .aaonD'TAl\JT 'MenD.'Ann... ""o",h.o... c:nlt"" REV-1511 EX+ (12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Juanita Noll FILE NUMBER Debls of decedent must be reported on Schedule L ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Musselman Funeral Home Direct Cremation 1,523.00 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 175.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,698.00 ~\ ~ 't6 o 1- ~ 'r' ~ 1: "'" ~ ~~\UW"3 0 ~ %\'to~ \:: ......".. t\.-\ii~z "; ~ O:Z:.<Z$; 'tJ .J 't5 4. 0 '&. <q ~ ~ O:~tn ci '; \.1.0 ~ 'tA\iiO~ 1- 'J_ u.l <{ 0: tn ~ ~ ~ u.l (J'l J ~ <{O> 0 .:.::t '& N ~ ... J: :s ~ ~ ~ '" ($("1 a'b ~ (\) r- O~r-I Vi::!: r4 .,-\ ro,:t ~~p. ..... ro _ ......,-\ (\) ro~ ~ ..c.r\'?-< ~ % ~ to (\) (\) r-I ,.::\ ~O'\ -- (\) ~ ~ V r4 .,-\ ~ >;r. ~ !;1 o ~ a: ~ o ~ 'tJ. t tJ ;;; "' Ul U- ~ !l. ~ U- o o to r- r-I w ~ .- ~~ V ro''-\ ta .,-\ 0 'a (:0 ~ {) - (\) .,-\ ~ ~~O t;M~ U) b~Q} '$. -- 0' ro '% ..c.~~r4m v 0''-\ r4 r:> .,-\ ~ v 0 ~ I.\-\~..c. rom v ~ v ~ (\)''-\ ~ .,-\ A .,-\ ~ .~ ~ ~ ~ ~ v?ror:>~ r4 r:> Q) ?I.\-\~~~ U) 0 ~ ~ 0 .,-\ 1.\-\ 0 o (\)Vmo.. OvrocU) ...~~(\) Q} 'u ro ~ ~ uVp..O~ .,-\ ~ (\) tl-< 0 1.\-\ ~ ~ 0 1.\-\ P. o Jt~~1 ~L\'jJ l~~ ~:!;~>j Musselman Funeral Home & Cremation I t ~.~~~e~, Inc. J Established 1895 Brian C. Musselman, ED. SUpervisor William G. Pegan, ED. P.O. Box 137 324 Hummel Avenue Lemoyne, PA. 17043-0137 (717) 763-7440 Fax: 717-730-9798 www.musselmanfuneral.com To Funeral Expenses of Juanita Noll Robert Hamilton 915 Indiania Ave. Lemoyne, PA 17043 Direct Cremation Transfer Container CASH ADVANCE ITEMS: Certified Copies (8) Cremation Authorization Fee Aug. 30,2007 $1300.00 $ 150.00 $ 48.00 $ 25.00 $1450.00 $ 73.00 Total. . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $1523.00 FOR APPOINTMENT PHONE 717-763-7440