HomeMy WebLinkAbout01-24-08 (2)
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
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 c::::)
2. Supplemental Return
c::::)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c::::) 4. Limited Estate c::::)
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
between 12-31-91 and 1-1-95)
c::::)
_ 6. Decedent Died Testate c::::)
(Attach Copy of Will)
c::::) 9. Litigation Proceeds Received c::::)
8. Total Number of Safe Deposit Boxes
c::::)
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Da ime Telephone Number
(,,;)
(-~-
First line of address
. I r'o)
...-. -,)
(j) ;',
Second line of address
( -) :~j C~~
( ,--
-n
- ~ r.....)
:r2DATE FILED ..
<:::)
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge.
SIGNATURE OF PERSON RESPO
ADDRESS / / /8 /ow~ /-IaJ('LJ DR
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
1\JEW A-..e.f4-DE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
--.Jc;
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15056052048
REV-1500 EX
Decedent's Name:
Ev
RECAPITULATION
1. Real estate (Schedwle 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) C=> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(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 Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
'~n electiol") 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 .0'$5
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
~~L
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15056052048
Decedent's Social Security Number
15.
16.
17.
18.
C=>
15056052048
~
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
. fXREETADDREss--_Evy LEEllI RoBS olJ
77 0__ S.__jj,lt^"ey~~Sj_
File Number
~h.cl-P~ I _ r~"1t~_o_ f_ .La. y lis le-
u_ _J1I1edl(a.( Ce VL 4 yo-
CITY
C.A
L{;"
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
5~79
- ---
1 0.5:z.(".3
Total Credits ( A + B + C ) (2)
~g3
3. InteresUPenalty 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 Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
~o9~
5. If Line 1.+ ~ine 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
-
r:;09b
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESflONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D I8l
~: ;::::~ :h~e~;~:i~~:~s:~t:~::;:~. .~.~.~~~. ~~~. ~~~. :.~~:.~.~. t.r~,~~~~~r~~ .~r. ~t~ .i.~.~o.~.e.;.:::::::::::::::::::::::::::::::::::::::::::: B ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12, 1982, did aecedent 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 1)(1
4. Did decedent own an Individual Retirement Account, annuity, 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. 39116 (a) (1.1) (i)]. ,
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. 39116 (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. 39116(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. 39116(1.2) [72 P.S. 39116(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. 39116(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-1503 EX+ (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
r-
t::. V V L E~tJ
(
RossoAl
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
~b) 5'94
TOTAL (Also enter on line 2, Recapitulation) $ 8 L ~9 4
(If more space is needed, insert additional sheets of the same size)
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REV-1509 EX. (1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
EVYLEEN RDSSoA!'
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.
WAYNE RoBSoN
III B P6WDC~ Ho~tV-:DR.
NEwARK, DC ''17 J3
So",
s.
A Q fJoLD J:<() 8S-c/IJ
7 lOp V tEt.-J Coc..u<.1""'
NE0AR J DE /9702-
Soyt.
c.
JOINTLY-OWNED PROPERTY:
3
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.B. /qgi W AC.liovl A BANK CApItAL q Kow-rH ~3, D9r 33.3 7 J&' <( 2
AeLt 11 3 b0C07/5f)Q(,,3S
~. Pr 1977 WACtfOVI t1 'BAAl \::' CH~ck 11J6 5<6.5"2-
/', 7~4 So
A c.c.+ 1f. I a:za3f.I 9 7 ~:2 9 I
A AP~,'I WSFS BANK. Mo;J€Y rnAflkGT
'2Do7 4-5"", &8'7 ,5'l) ;;~) ~44
Al.'ct # O.2,0<{73St.4-7
Above. I S ~ r-o I { 0 U C;-R.. F"vo WJ
1Su. \ r WSFS C.t:;RTt F fCA-T{; o-tUP051 t
Accf # 0414Jc~7;J7
'Zooi
TOTAL (Also enter on line 6, Recapitulation) $ 3b,3gg
.. ,
(If more space IS needed, Insert addllional sheets of the same size)
'.
-~~
~~~-
WACHOVIA
Consolidated Statement
03 1000034197629 752 30
o
2
4,962
11/ 6/2007 thru 12/5/2007
Custom Checking
Other Withdrawals and Service Fees
11/30
Amount Description
~5.44 PURCHASE VCA KIRKWOOD #426 11/10
4828650045550 NEWARK DE 0054V212001
""68.07 PURCHASE APPLEBEE S CAR0710 11/23
4828650045550 CARLISLE PA 0054V29491 0
~56.86 PURCHASE FTD*GEORGES' FLOWE 11/28
4828650045550 CARLISLE PA 0054V220383
-
!!!!!!!!!!!
;;;;;;;;;;;;
-
;;;;;;;;;;;;
!!!!!!!!!!!
Date
11/13
11/26
-
=
;;;;;;;;;;;;
3000071589638
EVYLEEN C ROBSON
WAYNE K ROBSON OR ARNOLD R ROBSON
-
;;;;;;;;;;;;
-
====
;;;;;;;;;;;;
-
---
-
!!!!!!!!!!!
===
-
!!!!!!!!!!!
~
Total
pital Growth Account
Acconn
o en in balance 11/06
Interest paid
Closing balance 12/05
1.90 +
$23,098.59
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Z
Z
Deposits and Other Credits
Date
12/05
Total
Amount Description
1.90 INTEREST FROM 11/06/2007THROUGH 12/05/2007
$1.90
Number of days this statement period
Annual percentage yield earned
Interest earned this statement period
Interest paid this statement period
Interest paid this year
30
0.10%
$1.90
$1.90
$31.56
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Interest
WACHOVIA BANK OF DELAWARE, N.A., PRICES CORNER
page 3 of 4
'.
-~~
~~~
WACHOVIA
Consolidated Statement
02 1000034197629 752 30
o
2
4,961
1000034197629
EVYLEEN CROSSON
WAYNE K ROSSO
$18,449.04
2,670.91 +
7,180.08 -
570.37 -
$.13,~
~ ftJ. l.J~ 6
~ tkck ~
04... 00 !r!2y!o7
Account u
Opening balance 11/06
Deposits and other credits
Checks
Other withdrawals and service fees
Closing balance 12/05
,.---
Deposits and Other Credits
12/03
Amount Description
148.30 .IJEPOSIT
'-.--
689.11 AUTOMATED CREDIT STATE OF DE. DE PENS CK
CO. ID. 1516000279071130 PPD
584.00 AUTOMATED CREDIT CMWC TREAS 303 FEDANNUITY
CO. ID. 3031736123 071203 PPD
1,166.00 AUTOMATED CREDIT US TREASURY 303 SOC SEC
CO. ID. 3031036030 071203 PPD
83.50 ;e#DEPOSIT
$2,670.91
Date
11/06
11/30
12/03
12/04
Total
Checks
6532*
6534*
Amount
200.001'
300.00.t'
Date
Number
Amount
Date
6529
6530
Amount I
6,389.31 ,j
\
290.77r
Date
Number
Number
11/09
11/20
12/05
12/05
Total
$7,180.08
* Indicates a break in check number sequence
WACHOVIA BANK OF DELAWARE, N.A., PRICES CORNER
page 2 of 4
WSFS~
&A
06 I~,>~?
302-792-6000.1-888-WSFSBANK
Last statement: November 16, 2007
This statement: December 16, 2007
Total days in statement period: 30
Page 1 of 1
0208735647
(0)
Direct inquiries to:
Customer Service, 302 792-6000
EVYLENE ROBSON OR
WAYNE K ROBSON
1118 POWDERHORN DR
NEWARK DE 19713-3247
WSFS Bank
500 Delaware Avenue
Wilmington DE 19801
Account number
Low balance
Average balance
Avg collected balance
Interest paid YTD
0208735647
$45,686.73
$45,686.73
$45,686.00
$1,367.28
Beginning balance
Total additions
Total subtractions
Ending balance
0.00
$45,816.08
DEPOSITS/CREDITS
DATE TRANSACTION
12-16 Interest Credit
AMOUNT
129.35
DATE
11-16
AMOUNT
45,686.73
DAILY BALANCES
DATE AMOUNT
12-16 45,816.08
DATE
AMOUNT
Annual percentage yield earned
Interest-bearing days
INTEREST INFORMATION
3.50% Average balance for APY
30 Interest earned
$45,686.73
$129.35
Interest for 2007 to be reported to the Internal Revenue Service on your tax
return is $1,367.28
Thank you for banking with WSFS Bank
,.,
.....
WSFS~
DATE: MARCH 26, 2007
ACCOUNT NUMBER: 0494125727
1
MATURITY TERM: 9 MONTHS
CERTIFICATE OF DEPOSIT
EVYLENE ROBSON
1116 POWDERHORN DR
NEWARK DE 19713-3247
FOR PERSONAL ASSISTANCE CALL:
1-888-9 -_______'-
LU ~\
1/2S-~7 /1
fo IAJSf5
YOUR ACCOUNT WILL MATURE ON 04-25-07. IT AUTOMATICALLY /1In_I;~
RENEWS UNLESS YOU CONTACT US NO LATER THAN 10 DAYS AFTER r~(r~
MATURITY. IF THE ACCOUNT RENEWS, THE NEW MATURITY DATE WILL -?1
BE 01-25-08.
THE INTEREST RATE AND ANNUAL PERCENTAGE YIELD HAVE NOT YET
BEEN DETERMINED. THEY WILL BE AVAILABLE ON 04-25-07. PLEASE
CALL 1-302-792-6000 ON OR AFTER 04-25-07 TO LEARN THE INTER-
EST RATE AND ANNUAL PERCENTAGE YIELD FOR YOUR NEW ACCOUNT.
CURRENT:
INTEREST RATE
BALANCE
AT MATURITY:
INT PYMT
INT WITHHELD
3,163.11
.00
5.212%
79,279.34
.. ..
. ,
W5F5~
302-792-6000 '1-888-WSFSBANK
Last statement: April 26, 2007
This statement: May 16, 2007
Total days in statement period: 21
Page 1 of 1
0208735647
(0)
Direct inquiries to:
Customer Service, 302 792-6000
EVYLENE ROBSON OR
WAYNE K ROBSON
1118 POWDERHORN DR
NEWARK DE 19713
WSFS Bank
500 Delaware Avenue
Wilmington DE 19801
Account number
Low balance
Average balance
Avg collected balance
Interest paid YTD
0208735647
$82,448.80
$82,448.80
$82,448.00
$174.84
Beginning balance
Total additions
Total subtractions
Ending balance
$0.00
82,623.64
0.00
$82,623.64
DEPOSITS/CREDITS
DATE TRANSACTION
04-26 Deposit
TLR 163 BR 31 5
AMOUNT
82,448.80
174.84
05-16 Interest Credit
DATE
04-26
AMOUNT
82,448.80
DAILY BALANCES
DATE AMOUNT
05-16 82,623.64
DATE
AMOUNT
Annual percentage yield earned
Interest-bearing days
INTEREST INFORMATION
3.75% Average balance for APY
21 I nterest earned
$82,448.80
$174.84
Thank you for banking with WSFS Bank
REV-1511 EX+ (10-06).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
NUMBER
A.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
EVY-U~EN Rof2scIILJ
Debts of decedent must be reported on Schedule I.
FILE NUMBER
1.
DESCRIPTION
FUNERAL EXPENSES: Ho-frmCck Ruth Fu \-\ e VO\.{ Ho*"1 G"
G e()r'qe~ Vlowe Vs
fYlA RCLj CEVJ1t=fFR. Y Asroc.
DuPc,~+- W\ol-1l.o\.VJ'\elAf Shop
P~5"+Ov~ Lt1vS' t...eoVl ~Ol.{ "'-9
P Q~ 4=0 v hP V~ II\. Sa.!:f'" a. ~ K
~ h.6. fJfL I Po i"l {..(: ku ",-eke 0 v--.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City
State _Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
4.
Claimant
Street Address
City
State _Zip
Relationship of Claimant to Decedent
5. Accountant's Fees
Probate Fees
7.
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TOTAL (Also enter on line 9, Recapitulation) $
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AMOUNT
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Hoffman-Roth Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, P A 17013
(717)243 -4511
December 26, 2007
Wayne Robson
118 Powderhom Drive
Newark, DE 19713
The Funeral Service for Evy1een F. Robson
15182-248
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE:
Traditional Funeral Service Package . .
USE OF STAFF AND EQUIPMENT:
150 miles@$2.00/mile. . . . . .
FUNERAL HOME SERVICE CHARGES
$4150.00
$300.00
$4450.00
SELECTED MERCHANDISE:
Provincial Casket. . . . . . . . . . . . . . . . . . . . . .
Monarch Interment Receptacle. . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
$2680.00
$1120.00
$8250.00
Cash Advances
Newspaper Obituary Notice- Sentinel. . . . . .
Newspaper Obituary Notice - Delaware News Journal .
Certified Copies of Death Certificates. . . . . .
Hairdresser. . . . . . . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$93.24
$199.22
$42.00
$40.00
$374.46
Total
Total Cost .
4 . . . . . . . . . . . . . . . . . . . . . . . .
$8624.46
History
12/26/2007 SecurChoice.
12/26/2007 Discount Received.
$-7801.44
$-220.56
TOTAL AMOUNT DUE
$602.46
This statement is net and payable in full within 30 days of receipt.
- - - -. - -.... - -. -. - -. - - - - - - - - - - - - - - --- - - - - - - - - - -. - -. - - - -.. - - -. - - -. --
Please return this portion with your Remittance
$
Amount Enclosed
Service 10 # 15182-248
Evyleen F. Robson
EVVLEEN C. ROBSON
WAYNE K. ROBSON
11 t 8 POWDERHORN DR.
NEWARK. DE 19713
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273 MAIN ST
DUPONT P A 18641
(570) 654-0561 FAX (570) 883-0380
CEMETERY LETTERING AGREEMENT
DATE: Dec 17,2007
PHONE: 302 737-3994
NAME:
ADDRESS:
Wayne Robson
1118 Powder Horn Dr
Newark DE 19713
CEMETERY:
Marcy, Duryea
FAMILY NAME ON MEMORIAL: ROBSON
INSCRIPTIONS: Edward Evyleen
LETTERING TO BE ADDED: FiB in 19 and add 2007 under Evyleen
TYPE OF MEMORIAL: Barre Vemont Granite Flat Marker
LOCATION:
p~a. (:411/,:) 7
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SIGNED:
DATE:
NOTE: Due to weather conditions lettering may not be completed until Spring 08
PLEASE SIGN AND DATE CONTRACT AND RETURN WITH PAYMENT
please allow 5 to 6 weeks for work to be completed
EVYLEEN C. ROBSON
WAYNE K. ROBSON
1118 POWDERHORN DR.
NEWARK, DE 19713
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770 South Hanover Street
. Carlisle, PA 17013
Telephone: 717-249-1363
Fax: 717-249-9511
Website: www.chapelpointe.com
To: Nancy Robson
From: Cindy Paloskey, Director of Dining Services
Date: December 17,2007
Subject: Memorial Service Luncheon for Evyleen Robson
The cost for your Memorial Service luncheon held on December 1 S\ 2007 is $185.78.
This includes $175.00 + $10.52 tax = $185.78. Please make your check payable to
Chapel Pointe. All payments can be sent to Chapel Pointe, 770 South Hanover
Street, Carlisle, Pa 17013, attention Evelyn Smith, with-in 30 days from this billing
date.
Thank you for using our catering services here at Chapel Pointe and I hope that
we can serve you agam.
Sincerely Yours,
CY!lthia Paloskey~-\
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Director of Dining Services
.. A retirement community of The Christian and Missionary Alliance ~
EVYLEEN C. ROBSON
WAYNE K. ROBSON
1118 POWDERHORN DR
NEWARK, DE 19713
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RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
ROBSON EVYLEEN C
Estate File No. :
Paid By Remarks:
2007-01163
WAYNE ROBSON
MW
Receipt Date:
Rece~pt Time:
Recelpt No.:
12/27/2007
10:35:12
1051020
------------------------ Receipt Distribution --------------___________
Fee/Tax Description
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 6539
Total Received.........
Payment Amount
260.00
15.00
16.00
10.00
5.00
----------------
$306.00
$306.00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
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-EVVLEEN C. ROBSON
WAYNE K. ROBSON
1118 POWOEAHORN DR.
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'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
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FILE NUMBER
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
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2880 Bergey Rd. Ste. AA
Hatf'eld PA 19440 'Due by 12J3012OO7 8lIIIng" hours:-..=rtgem. 5pm. Tott F_: 1......m9 I
INVOICE
11/30/2007 Account Number: CHAPS88
EVYLEEN ROBSON 05-19
cio WA VNE ROBSON
1118 POWDERHORN DR PVT
I Amount Due: NEWARK DE, 19713
... I Amount Paid:
Please Detach Here and Return Top Portion With Your Payment
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Invoice Date 11/30/2007 Acct#CHAP588 ROBSON EVYlEEN Chapel POlnte NC. B, George Branscum
am I Rx NumbAr t g~~.1 ~. AI1lQWl I ~1Il. ~-.JJl1iL.1 IltI1tl
11/01/2007 6041148 100 Furosemide Inlectlon SOlutIon 10 MGlMl S 4.32 S 0.00 S 432 RX
00517 -5704-25
11/08/2007 6017377 1300 Furosemide Oral Talllet 40 MG $ 587 $ 000 $ 587 RX
00378.0216-10
11/08/2007 6044792 7500 Albuterol.lpratrOOlum IMalatlon SolutIOn 2 5-0.5 MG/3Ml $ 53.21 $ 000 $ 5321 RX
00185.7322-30
11/08/2007 6044793 6000 Furosemide Oral Solution 10 MG/Ml $ 1336 $ 0.00 $ 1336 RX
00054-3294-46
11115/2007 4001862 100 lorazepam Oral Tablet 1 MG S 4.79 S 000 S 479 RX
63304-0773-01
11/18/2007 6044792 90.00 Albuterol.lpratroPlum Inhala/lon SolutIOn 2 5-0 5 MG/3Ml S 6305 S 000 $ 6305 RX
00185-7322-30
11/19/2007 6017608 1000 Cosopt Ophthalmli: SOlullon 2-0 5 % $ 11979 S 0.00 S 11979 RX
00006-3628-36
11/19/2007 6017609 250 Xalatan OphthalmiC Solution 0 005 % S 6786 $ 000 $ 6786 RX
00013-8303-04
'11121/2007 6054250 100 Furosemide Oral Solution 10 MGlMl S 416 S 0.00 $ 416 RX
00054.3294-46
11/23/2007 2001762 3000 Moronme SUlfate Oral Solution 20 MGIMl S 2076 $ 000 S 20.76 RX
58177 -0886-0 1
11/24/2007 2001824 100 Morphine Sulfate Oral Solullon 20 MGiMl $ 456 $ 0.00 S 456 RX
58177 .0886.01
11/25/2007 6044793 6000 Furosemide Oral SoM,on 10 MG/ML S 1336 S 0.00 S 1336 RX
00054-3294-46
11/28/2007 6017219 6000 Doc:usate Sodium Oral CapSule 100 MG S 299 S 000 $ 299 OTC
00677-0191-01
11/28/2007 6017220 3000 Veraoamil HCI CR DIal Tablet Extended Release 180 MG $ 4287 S 000 $ 4287 RX
00172-4286-60
11/2812007 6017233 3000 liSlnopnl Oral Tablet 40 MG S 4601 $ 0.00 S 4601 RX
00378-2076-01
I ~I LastPvmt I Last ~ RFinance ~ b YTO Fm C~II Qlbl[1 BI I m I Mie . M?B I~
S 0.00$ ooor 1$ oooKs 000 $ 000 $ 46397 S .... 299 S 0001$ 000 ~
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12/2b/2007
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This is a LEGAL COpy of your
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EVYLEEN C. ROBSON l2-1li311 653 5
WAYNE K. ROBSON
t 11' POWDERHOIlN DR. J I
NEWARK, DE 11713 osm-./ :2. J 9 I/.J 7
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JPMorgan Chase Bank, N.A.
syracuse, NeW York
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VOID AFTER 180 DAYS
PAY ROBSON
TOrRE
ORDER OF
EVYLEEN c
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Thisberiefft proVided by DE STATE BENEFITS OFFICE
II. Is 1s88 Is b bll. ':0 2 * 30 q 3 7 q.: bo *1118111050 b 211.
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Page 1
REV-1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
C. VYLEEAl I<O~SOM
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not ListTrustee(s)
I TAXABLE DISTRiBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
W(l.~Vl~ Qobso~
I { (8 po wd~v Hen'h i)"
Ne.-wctv-k, DE- 197/3
5011
"2.
Ar.< VlO/d R, RobsoVl
7 lop VI€W Couv+
Nl-uJa..V' \< \ 1) E {q 702.
SO""
AMOUNT OR SHARE
OF ESTATE
:i/ .;J. tJ 00 .-f
5 D C;o 0 { ba./a '1 <::~
50Jto a tbak/.1C<....
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRiATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - 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)
...
.
fEClS! Jlil1 Club QT~,!ilClm~ul
I, EVYLEEN C. ROBSON, Widow, 06 the County 06 New Ca~t~e,
State 06 Delawake, being 06 ~ound mind and di~po~ing memOky, do hekeb
make, publi~h and declake thi~ a~ and 60k my La~t Will and Te~tament,
he~eby ~evoking any and all Will~ he~et060ke made by me.
Fl RS T :
I he~eby dikec~ my ExeQu~o~~ he~einai~e~ named
~o pay all my ju~~ deb~~ and iune~al expen6e~.
SECOND:
I he~eby bequeath the 6um 06 TWO THOUSAND DOLLARS
1$2,000.00) ~o my ~on, WAYNE K. ROBSON, a~ a ~oken 06 my appkecia~ion
! 60k hi~ kindne~~e~ and help given to me dUking hi6 late 6athe~l~
illne~~ and ~ub6equent death.
THIRD:
All the ke~t, ~e6idue and kemaindek 06 my
I devi~e and bequeath unto my two 60n~, WAYNE K. ROBSON and
E6tate, 06 what~oeve~ natuke and wheke~oevek the ~ame may be ~ituate,
ARNOLD R. ROBSON, in equa~ ~ha~e6.
FOURTH: I he~eby nominate, con~titute and appoint
my 60n~, WAYNE K. ROBSON and ARNOLD R. ROBSON, to be Co-executo~6
06 th,L~ my La.~t Wil.t and Te6tament. 16, 60k any ~ea60n, one 06
then 6hould be unable 60 to act, ~hen the othe~ may be 60le
Execu~o~. Neithe~ 06 my ExeCU~0~6 6hall be kequi~ed to p06~ bond
in any jUki6diction whe~ein my Will may be p~obated. And ~n o~de~
'tha~ the~e may be an o~de~ly di6t~ibution 06 my E~tate, I hekeby
autho~ize and di~ect them to 6ell any and all ~eal e6tate 06 which
I may die 6ei6ed and give a~ good a deed 60~ the 6ame a6 I might
have done dUking my li6etime.
IN WITNESS WHEREOF,
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have hekeunto ~ et my handa~'~~l, eat:;
,~hi6__dC(y 0 6 Oc~obvl, 7974.
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EVYLEEN C. ROBSON
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SIGNED, SEALED, PUBLISHED AND DECLARED by the above named
Te6tC(t~ix a6 and 60~ he~ La6t Will and Te6tament in the p~e6cnce 06
'U6 who have he~eunto 6ub6c~ibed ou~ name6 a6 witne66e6 in the p~e6ence
06 6aid Te6tatkix and each othe~.
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