HomeMy WebLinkAbout01-28-08
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15056041125
REV -1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128~601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2 1 0 7
File Number
o 4 3 2
Date of Birth
21720 5 4 2 3
042 8 2 0 0 7
Decedent's Last Name
G ill e 1 and
Suffix
Decedent's First Name
J 0 s e phi n e
MI
E
(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
[:&J 1. Original Return
D 4. Limited Estate
[:&J 6. Decedent Died Testate
(Attach Copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of
death after 12-12-82)
o 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
o 10. Spousal Poverty Credit (date of death 0 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
o
o
1
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
R .
Mar k
Tho mas ,
E s qui r e
717 796 210 0
Firm Name (If Applicable)
First line of address
REGISTER OF ~'5LS USE ON~
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1 0 1
SOU t h
Mar k e t
S t r e e t
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Second line of address
c~
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City or Post Office
State
ZIP Code
DA'f6,Ftt.€D
M e c h ani c s bur g
P A
1 7 0 5 5
Correspondent's e-mail address:rmtesa@deiazzd.com
Under penalties of pe~ury, , decl ave examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete eclaration reparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA OF P ON ISLE OR FILING RETURN DATE
Mechanicsbur
PA 17055
Market Street Mechanicsburg
PLEASE USE ORIGINAL FORM ONLY
UP S-
PA 17055
Side 1
L
15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Josephine E. Gilleland
RECAP ITU LA TION
217205423
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
167312.00
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. 2 7 8 3 7 . 0 0
............ ..
6. Jointly Owned Property (Schedule F) o Separate Billing Requested . . . . . . . 6. 7 3 5 8 . 1 2
7. Inter-Vivos Transfers & Miscellaneous NoProbate Property
(Schedule G) Separate Billing Requested. . . . . . . 7.
8. Total Gross Assets (total Lines 1-7) 8. 2 0 2 5 0 7 . 1 2
.................. .. .." .. .............. . .. .. ........
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 8 3 4 6 . 8 3
.............................. ..
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) ............10. 2 1 2 5 . 2 2
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 0 4 7 2 . 0 5
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . .... . . . . . . . . . . . . . 12. 1 8 2 0 3 5 . 0 7
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.
1 8 2 0 3 5.0 7
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 _
16. Amount of Line 14 taxable
at lineal rate X .012-
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
182035.07
16.
O. 0 0
8 1 9 1.5 8
O. 0 0
O. 0 0
8 1 9 1.5 8
o . 0 0
15.
o . 0 0
17.
o . 0 0
18.
19. Tax Due
. .............. ............................ . . ...19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
D
Side 2
L
15056042126
15056042126
.-.J
REV-1500 ~ ,Page 3. '
Decedent's Complete Address:
File Number
21 07 0432
DECEDENrs NAME
Josephine E. Gilleland
STREET ADDRESS
222 Messiah Circle. Room 408
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
8,191.58
9.000.00
450.00
Total Credits (A + B + C) (2)
9,450.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T otallnterest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
1.258.42
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
8. Enter the total of line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
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; .. . . .. .. .. . .. .. . .. .. .. . .. .. .. .. . .. . . .. .. . . . . . .. .. .. .. .. .. .. .. .. . .. .... 0 00
b. retain the right to designate who shall use the property transferred or its income; ............................... 0 IX]
c. retain a reversionary interest; or ................................................................................................ 0 l&l
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... 0 IX]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . ....................... .......................................................................... 0 lID
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. 99116 (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-'502 FX.+ (6-.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Josephine E. Gilleland 21 07 0432
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real Drooertv which Is jolntlv-owned with riaht of survivorshlD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
167,312.00
1115 Charles Street
Mechanicsburg, PA
Irhis is a single story home which sits on .24 acres in a residential development. The home was built in
1962 and has a total assessed value of $144,160.00. The Cumberland County common level ratio was
1.14 when decedent died which results in an overall value of $164,342.00.
Irhe property is currently listed for sale with a real estate agent. The asking price is $179.900.00.
Pursuant to the listing agreement, the agent will receive a commission of 6%. In addition, the estate will
have to pay a 1 % transfer tax.
The value assigned to this real estate represents the listing price minus the realtor's commission and transfer
tax. (A copy of the listing agreement is attached.)
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
167312.00
REV-150~ EX + (6.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21 07 0432
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
Josephine E. Gilleland
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
3,675.00
-lousehold furnishings
2.
n 987 Ford Thunderbird
600.00
3.
Miscellaneous coin sets (see attached inventory)
2,335.00
4.
bNC Bank, checking account no. 5140023418
3,462.00
5.
)001 Mercury Grand Marquis
6,405.00
6.
ong Term Care Insurance Refund
11,360.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
27837.00
REV-150~ El< + (6.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Josephine E. Gilleland
FILE NUMBER
21 07 0432
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
~ELATIONSHIP TO DECEDENT
A. Ira G. Gilleland, III
606 Henry Street
Mechanicsburg, PA 17055
:ion
B
c
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. ~. Members First, savings account no. 4965-00 10,713.27 50. 5,356.64
2. ~. Members First, saving account no. 4965-04 4,002.96 50. 2,001.48
TOTAL (Also enter on line 6, Recapitulation) $ 7358.12
(If more space is needed, insert additional sheets of the same size)
REV-1St' ex+(,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Josephine E. Gilleland
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
21 07 0432
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cremation - Auer Memorial Home and Cremation Services, Inc. 1,735.00
2. Luncheon 220.00
3. Obituary and memorial service 450.00
4. Flowers 106.00
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 R. Mark Thomas, Esquire 6,075.00
3. Family Exemption: (If decedenrs address is not the same as c1aimanrs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 333.00
5. Accountanrs Fees
6. Tax Return Preparer's Fees
7. Appraisal fee - Chuck Bricker 100.00
8. Nationwide Homeowners Insurance 569.00
9. Nationwide Car Insurance for 2001 Mercury 418.40
10. Oyster's Painting and Remodeling (painting and remodeling, window replacement) 3,550.00
11. Cash (yard maintenance) 540.00
12. PPL Electric Utilities Corporation 432.30
13. United Water Pennsylvania 59.90
14. Ehrlich (termite service) 284.08
15. Shipley (fuel oil) 820.18
16. PNC Bank (check charges) 13.50
17. Borough of Mechanicsburg (sewer/trash) 213.64
18. Barry L. Heckard. Sr., Tax Collector (school taxes) 1,873.33
TOTAL (Also enter on line 9, Recapitulation) $ 18.346.83
(If more space is needed, insert additional sheets of the same size)
REV-151t eX + (12-03) ,
..
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21 07 0432
Josephine E. Gilleland
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. V1essiah Village (final nursing home bill) 1,876.00
2. Mobile X-Ray Imaging, Inc. 12.71
3. Quantum Imaging 17.18
4. ;)PL Electric 75.86
5. lIerizon 15.02
6. Jnited Water Pennsylvania 8.52
7. ~hrlich (termite service) 119.93
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2 125.22
REV.,5131'X8<*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 07 0432
Josephine E. Gilleland
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. Ira G. Gilleland, III 100.00
606 Henry Street
Mechanicsburg, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON 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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART IT - 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)
.~ ')(
15
16
17
18
19
20
21
Z2
23
24
25
26
27
28
29
30
31
32
ESTIMATED COSTS (subtotal) $
Adjustments (+/-) (e.g., real estate taxes, association fees, utilities)
TOTAL ESTIMATED COSTS/ADJUSTMENTS $
Purchase Price
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
Total Estimated Costs/Adjustments (from above)
ESTIMATED PROCEEDS (before loan payoffs) $
Seller's Estimate of Mortgages, Equity, and Other Loan Balances
(including prepayment penalties), liens, assessments, etc.
ESTIMATED NET PROCEEDS TO SELLER $
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$
$
The estimated proceeds do not take into account any other undisclosed mortgage obligations, liens, assessments, judgments
or other obligations levied against the Property or Seller.
Seller understands that the estimated costs stated above are based on the best information available at signing and may be
higher or lower at settlement.
Seller understands and has received a copy of these estimated closing costs before signing the Agreement of Sale.
SELLER
SELLER
SELLER
i5
BROKER (Company Name)
PROVIDED BY (Licensee)
C40 ~i. iJfa [ak j~ ~SCC .
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DATE
DATE
DATE
DATE
~ I Pennsylvania Association of REAL TORS@
COPYRIGHT PENNSYLVANIA ASSOCIATION OF REALTORS@ 2005
12105
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REV-485 EX (05-04) _~
SAFE DEPOSIT ~
BOX INVENTORY
PA Department of Revenue
Social Security or Death Certificate Number Date of Death
J. I ,aC) slf J-3
Decedent's Last Name
48500041046
PLEASE USE ORIGINAL FORM ONLY
County Code Year File Number
C) id$ a.oU ~
Suffix
a l or7 ej43 a
First Name
,:TO:S EPlfl tL}f:
STA~:
(j!-"c-, tJ A
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E.
ZIP CODE:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
c. NAME:
RELATIONSHIP:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
ZIP COD~:,,-
/7~"::>
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
a. NAME~ 6;., G//Jlcvtcll :JR,.
STRE!;:T ADDRESS: , ""-'.. /
J}Ef'~~c J--74
CITY:
STATE:
ZIP CODE:
NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY Beck e
WAS A WILL IN THE BOX? 0 YES ,Sl NO If yes, a. Date will:
b. Name and address of personal representative, if named in the will
NAME: I:LJ (c? ~ 1J:J::
~ 4 ~ (~/L.i... R-L,+U'b: - .
STREET ADDRESS; , '. CITY:
&t)47 ff1CJJRY ~ 'r, tllEf /I~L)ICS 8 t)L?tfJ J ~'w9
c. Name and ad~ress of attom~!Ji-t(;tJ1 ;45', c sa. '
NAME: R, ~1t~ 4
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STATE: ZIP CODE:
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ZIP CODE:
L
48500041046
48500041046
-I
REV-485 EX SAFE DEPOSIT BOX INVENTORY
'-'lSTRUCTIONS
Page
of
(1 )
~.2)
Cash: Report total only.
Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by
name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership,
i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book. last date appearing in book, name of bank
and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible.
(8) All other contents.
(9) Return completed form to:
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
ITEM
NO.
ITEM DESCRIPTION
'SI
PERSON RECEIVING COPY OF
SAFE DEPOSIT BOX INVENTORY:
SIGNATURE
PRINT TITLE
DATE
A-1TC>te 1-) ~
7-;)7-67
JirExecutor(triX) 0 Administrator(trix)
o Estate Representative 0 Joint owner of safe deposit box
NOTE: Attach additional 8112" x 11" sheet(s) if necessary or use duplicates of this page of form.
The Department is authorized by law, 42 U.S.C. 3405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the
Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements
with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes.
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.Kelley.Blue Book - Private Party Pricing Report - Mercury, Grand Marquis
.,,~~
advertisement
2001 Mercury Grand Marquis LS Sedan 4D
BLUE BOOK~ PRIVATE PARTY VALUE
Condition
Value
Excellent
$6,905
.., Good
$6,405
(Selected)
Fair
$5,775
Average Consumer Rating (78 Reviews)
Read Reviews
tt1t1rtr~ 4.7 out of 5
Review This Vehicle
Vehicle Highlights
Mileage: 40,000
Engine: va 4.6 Liter
Transmission: Automatic
Drivetrain: RWD
Selected Equipment
Standard
Air Conditioning
Power Steering
Power Windows
Power Door Locks
Tilt Wheel
Cruise Control
AM/FM Stereo
Cassette
Dual Front Air Bags
Power Seat
Blue Book Private Party Value
Private Party Value is what a buyer can expect to pay when buying a used car from a
private party. The Private Party Value assumes the vehicle is sold "As Is" and carries
no warranty (other than the continuing factory warranty). The final sale price may
vary depending on the vehicle's actual condition and local market conditions. This
value may also be used to derive Fair Market Value for insurance and vehicle
donation purposes.
Vehicle Condition Ratings
Excellent
DDDDr:.1 $6,905
"Excellent" condition means that the vehicle looks new, is in excellent
Page 1 of2
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http://www.kbb.comlKBBfUsedCars/PricingReport.aspx?ManufacturerId=32&Yearld=200...1/3/2008
AUER MEMORIAL HOME AND CREMATION SERVICES, INC.
4100 Jonestown Road · Harrisburg, PA 17109 · 1-800-720-8221 · Fax 717-541-9943 · Shawn E. Carper, Supervisor
?1(;)48,:'
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charges are only for items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items you have not selected, we will explain the reasons
in writing below. If you have selected services that may require embalming, you may have to pay for embalming. You do not have to pay for embalming that you did not approve. Embalming
is not required for direct cremation or immediate burial. Embalming is not required by law, except in certain special cases. If you are charged for embalming, we will explain why below.
For the Service of .J 0 .; f? p h 1. neE. G 5. 1 .L e 1. d II dDate of Death
M r-. J. t' l'1 t;, 1,:1.1 .1 J e ). ,:/ n d . J J. L
Charge to: 6 (.(:) 6 H E~ n t~ V S t r {.J r;:'! t. l'I1 P. C rl (J n i c s b lJ r 0, P A
Name Address
A. SPECIAL CHARGES:
Direct Cremation .................................... 1, B ::J b . Ql(2)
Forwarding Remains to ........................
(Funeral Home)
Receiving Remains from ......................
(Funeral Home)
Immediate Burial..................................
Nationwide Guarantee Program............
Worldwide Travel Protection ................
Pre-Arrangement Registration ..............
TOTAL SPECIAL CHARGES ...............................................$.8 9 5 . 00
B. CHARGE FOR SERVICE SELECTED:
PROFESSIONAL SERVICES
Services of Funeral Director/Staff ........
Embalming ............................................
Other Preparation of Body....................
FACILITIES, STAFF AND EQUIPMENT
Use of the Facilities and Staff for
ViewinglVisitation ..................................
Use of the Facilities and Staff for
Funeral Ceremony..................................
Use of the Facilities and Staff for
Memorial Service ..................................
Use of the Staff and Equipment for
ViewinglVisitation at another location ....
Use of the Staff and Equipment for
Funeral Service at another location ........
Use of the Staff and Equipment for
Memorial Service at another location ....
Private Family Viewing ..........................
Witnessing Cremation ............................
Packaging and Forwarding Cremated
Remains (Registered Mail) ..................
Personal Delivery of Cremated Remains..
Delivery of Cremated Remains..................
Delivery and Coordination of Cremated
Remains to a Private or National Cemetery
Scattering of Cremated Remains Over
Land or Sea ............................................
TOTAL OF PROFESSIONAL SERVICES ................................ i. (JI f?H)
C. AUTOMOTIVE EQUIPMENT:
Removal Vehicle ....................................
Casket Coach..........................................
Family Car (eg. Limo) ..........................
Flower Car or Floral Delivery ..............
Lead Car/Glergy Car ......................t.........
i". (
Service Vehicle ..,............................,......
TOTAL OF AUTOMOTIVE EQUIPMENT ................................ $ 0 . 00
4... 2 8 - 2 It)~) i'
Date of Arrangements 4-- 2 9 - ;2 00 ;'
<< l J. 7)) 1 6 b "" 5 4 3 8
Slate/Zip Phone No.
J It.~~t~)b
City
D. MERCHANDISE
Register Book ........................................
Memorial Folders/Prayer Cards............
Thank You Cards ..................................
Remembrance Package ........................ ;:~ 13 ((.1 , ,:;; (~)
Urn (s) ....................................................
(Description) ~ '2~~11j~...J:...~4i......~~-~""'~~
Alternative Container ............................
(Description)
Urn Outer Burial Container ..................
(Description}) ute r 8 u rial C 0 \1 t din e t'
Veteran Flag Case # .............................. ~. 71 h. (10
Casket ....................... ........ .....................
(Description) ~.-Jw..=
Outer Burial Container..........................
Grave Marker/Memorial........................
Other
Other
TOTAL MERCHANDISE ........................................................ $ 2 9 5 .00
E. CASH ADVANCE ITEMS:
Grave Opening ......................................
Cemetery Equipment ............................
Newspaper Notices ................................
Newspaper Notices ................................
Airfare.............................. ......................
Clergy/Mass Offering ............................
Pallbearers......................... ....... ..............
Certified Copies of the Death Certificate.. 'f 1. ? ({) . 0 '.!)
Flowers................................................... .
Vault Service Charge ................................
County Coroner Fee ................................ 1; 2 F) .00
Organist............................... ........ ...........
Soloist ........ ...... ........ ............ ....... ...........
Honor Guard ..........................................
Crematory Charge.................................... '1. tJ GH;~ . 0((.1
Other
TOTAL OF CASH ADVANCES .................................................. :t 5 4 !~ . (.QQl
We charge you for our services in obtaining:
(specifY relevant cash advance items)
SUMMARY OF CHARGES
A. Special Charges ......................................$ P <.;/ S ~)0
B. Professional Services, Facilities ............ $ I~ .00
C. Automotive Equipment............................ t 1,1 (/) It)
D. Merchandise ..........................................1. ? <.) IS (1)0-
E. Cash Advance Items ................................$ 5 4 5 . 'Q~)
SUBTOTAL .................................. ............. .:'...................... ..1;.,1., , ~ J:;
t~~~U:E..::::::::::;:::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::~::~ J 1 t :~J
t~~~CE' 0 uE'::::: :::::::'::: ::::::::::: :::: :::: ::::: :'~:::::::::::::::::::: :::: ::*:~.: 7 ~ ':
0(1)
~)0
0',)
(2)0
Ql (~)
If any legal, cemetery, or crematory requirement has required the purchase of any of the items listed above, we will explain the requirement below:
REASON FOR EMBALMI~O C~rp'm',v,.
I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy
of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for payment of the cash price for the goods and services selected.) ~sR agree to make
payment of $ F I I 1 1 within ,.~ days. I agree to be jointly and severally liable with anyone else who signs below. A late charge of 1 J .... 1, per month
amounting to 1 g ~i; per year will be applied to the unpaid balance beginning 4 days from the date of this agreement. I will also pay to the Funeral Director all reasonable
costs p~~ by the Funeral Director to collect amounts I owe under this agreement. Those costs may include allorneys' fees, court costs and other costs, Any additional services or merchandise
or~~d o/'request~d ~f~~~ the,~~t~,of thi~a reement ,willb,econs;deredpart ~f t,his agr~e~~~tand,t~e cost thereof will be reflected on the final bill or statement.
(skal) ':c.~ "t: ' . '~"biri;'. ~1 .- ? '=? ,., ,:' 11.)01
, ',. /.. . (Date)
(Seal)
(Date)
cot~"f~:::'NWEAL,TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND EST A TE TAX
OFFICIAL RECEIPT
THOMAS R MARK
101 S MARKET STREET
MECHANICSBURG, PA 17055-3851
_n___u fold
ESTATE INFORMATION: SSN: 217-20-5423
FILE NUMBER: 2107-0432
DECEDENT NAME: GILLELAND JOSPEHINE
DA TE OF PAYMENT: 07/27/2007
POSTMARK DATE: 07/27/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 04/28/2007
NO. CD 008459
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $9,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 2847
SEAL
INITIALS: JA
RECEIVED BY:
TAXPAYER
$9,000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Recetpt Date:
Rece.:J-pt Time:
Recelpt No. :
5/04/2007
09:31:24
1048338
GILLELAND JOSPEHINE
Estate File No. :
Paid By Remarks:
2007-00432
IRA GILLELAND III
CJ
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 9805
Total Received.........
260.00
15.00
28.00
10.00
5.00
----------------
$318.00
$318.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
~.
- .-
.~
LAST WILL AND TESTAMENT
BEITREMEMrnEREDTHAT
I, JOSEPHINE E. GILLELAND, a resident of Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do make, publish and declare
this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and
Codicils previously made by me.
I
I declare that I am married to IRA G. GILLELAND, JR. and that I have one (1) child,
IRA G. GILLELAND, III born December 17, 1946. I declare that I have one (1) grandson,
MICHAEL JEFFREY GILLELAND born October 23,1971.
II
I direct that all my just debts and funeral expenses shall be paid from my residuary
estate as soon as practicable after my decease.
III
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 expense of the adnlinistration of my estate.
IV
I give, devise and bequeath all my property, whether real or personal, wherever situate,
including any property over which I may have a power of appointment to my husband, IRA
G. GILLELAND, JR. provided that he survives me by thirty (30) days.
V
If my husband, IRA G. GILLELAND, JR. shall predecease or fail to survive me by
thirty (30) days, I give, devise and bequeath all of Iny property, whether real or personal,
wherever situate, including any property over which I Inay have a power of appointment, to
my son, IRA G. GILLELAND, III.
,..
,
VI
If my husband and my son shall predecease or fail to survive me by thirty (30) days, I
give, devise and bequeath all of my property, whether real or personal, wherever situate,
including any property over which I may have a power of appointment, to my grandson,
MICHAEL JEFFREY GILLELAND.
VII
I nominate, constitute and appoint my son, IRA G. GILLELAND, III as Executor of
this LAST WILL, to serve without bond. If my son is unable or unwilling to act in that
capacity, then I nominate, constitute and appoint my grandson, MICHAEL JEFFREY
GILLELAND as Executor of this LAST WILL, to serve without bond.
IN WITNESS WHEREOF, I, JOSEPHINE E. GILLELAND, have set my hand to this
LAST WILL this J- day of ;J1t:1 'I ,1999.
Sli~g~ t:~~Ld~
'JOS PHINE E. GILEELAND
Signed, sealed, published and declared by the above-named JOSEPHINE E.
GILLELAND, as and for her Last Will and Testament, in the presence of us, who, at her
request and in her presence, and in the presence of each other, have hereunto subscribed our
names as witnesses.
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, JOSEPHINE E. GILLELAND, Testatrix, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my LAST WILL; that I signed it as my free and
voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowledged before me by JOSEPHINE E. GILLELAND,
Testatrix, this.j- day of /pi a y , 1999.
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AFFIDAVIT
Notarial Seal
Anne Carr!JOdy, No~ Pubflc
Mechanlcsburg BOlO, Cumberland County
My CommissIon Expires Mar. 11, 2002
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTYOFCUMrnERLAND
W e, ~ /?1A.~1: ~.s . and Q ~- 2t s: ;J/a ;!-/_t H::- ,
the witnesses whose names are signed to the attached or foregoing instrument being duly
qualified according to law, do depose and say that we were present and saw Testatrix sign and
execute the instrument as his LAST WILL; that JOSEPHINE E. GILLELAND signed
willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses;
and that to the best of our knowledge, the Testatrix was at the time 18 years of age or more, of
sound mind and under no constraint or undue influence. ~ ~ ~
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Sworn or affirmed to and ac
this 'S,"'Lday of /J1(J1-
Notarial Seal
Anne Carmody, Notary Public
Mechanlcsburg BOlO, Cumberland County
My Commission Expires Mar. 11, 2002
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