HomeMy WebLinkAbout02-15-08
REV-1500 EX + (6-00)
*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FilE NUMBER
2 1 -0 7 1 1 5 8
""OOUNrv"COiiE -YEAR- - - NUMiiER- -
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DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
FISHER
DATE OF DEATH (MM-DD- Year)
HELEN
SOCIAL SECURITY NUMBER
R.
DATE OF BIRTH (MM-DD-Year)
1 62- 2 2 - 3 0 4 1
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
11/25/2007 09/19/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
o 4. Limited Estate
~ 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 between 12-31-91 and 1-1-95)
o 3. Remainder Retum (date of death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required.
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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tfiS'SECTlONMOS";8EtiOMPtEtED~!Allt'cORRESPONDENCE;ANDtiONFtDENmfl;:rDINFORMATlOiRoOL:D;SE'DIREOTEDtQ:;';il'ii,';!,i;;l
NAME COMPLETE MAILING ADDRESS
MARCUS A. McKNIGHT III 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
14,500.00
24 281
(6)
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,e 552
168,337.8i )(-:)
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11,225.98
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(7)
OFFICIAL USE ONLY
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(8)
(9)
(10)
13,426.55
2,047.51
(11 )
(12)
(13)
218,345.40
15,474.06
202,871.34
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
0.00 X _ (15)
0.00 X _ (16)
33,645.23 X .12 (17)
169,226.11 X .15 (18)
(19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
202,871.34
0.00
0.00
4,037.43
25,383.92
29,421.3€
\>>BESORE;\t(j:XNSWER'~t.;[l~QOES'ttONS;(jNiREVERSE:istf::)I3AND'RE<=HE<=K'MA'tH <<
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Decedent's omplete ress:
STREET ADDRESS 509 HUNTINGTON AVENUE
CITY I STATE I ZIP
ENOLA PA 17025
C Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
29,421.35
1 471 07
Total Credits (A + B + C)
(2)
1,471.07
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF AGENT
0.00
27,950.28
27.950.28
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; ........................................................................... D [&]
b. retain the right to designate who shall use the property transferred or its income; ........................................ D [&]
c. retain a reversionary interest; or ...................................................................................................... D [&]
d. receive the promise for life of either payments, benefits or care? ............................................................. D 00
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, 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.
ADDRESS
DATE
2 -IJ--~() ~
PA
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 3%
[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 0% [72 P.S. ~9116 (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 0% [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 4.5%, 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 12% [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-15Q2 EX + (6-.
~OMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FISHER HELEN R 21 07 1158
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 proDertv which is iointly-owned with riaht of survivorshiD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
4.71 ACRES - LEG WILLISTON HYLNDS GOLF & C CLUB EST BLK 101 LOT 5
BOOK 70 PAGE 792, LEVY COUNTY, FLORIDA
ASSESSED VALUE
VALUE AT DATE
OF DEATH
14,500.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
14.500.00
REV-1503 EX + (6-98)
-*
SCHEDULE B
STOCKS & BONDS
.COMMONWEAl TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FISHER
FILE NUMBER
21 07
1158
HELEN
R
All property jointly-owned with right of sUNivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
SERIES E AND EE SAVINGS BONDS
INVENTORY ATTACHED
VALUE AT DATE
OF DEATH
24,281.60
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
24 281.60
REV-15GB EX + (6-9B)
-.
!COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FISHER
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
HELEN R 21 07
Include 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.
1158
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
DESCRIPTION
WACHOVIA BANK, N.A.
CERTIFICATE OF DEPOSIT #24-741-211-2895223
SUSQUEHANNA BANK PA - SAVINGS #4600689120
SUSQUEHANNA BANK PA - CERTIFICATE OF DEPOSIT #346007064
SUSQUEHANNA BANK PA - CERTIFICATE OF DEPOSIT#403300003718
SUSQUEHANNA BANK PA - CERTIFICATE OF DEPOSIT #403300003726
SUSQUEHANNA BANK PA - CERTIFICATE OF DEPOSIT #403300003734
M&T BANK - CERTIFICATE OF DEPOSIT #031003913808887
VALUE AT DATE
OF DEATH
10,004.40
6,986.43
22,793.53
50,642.95
25,315.44
22,274.01
30,321.06
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
168.337.82
REV-1509 EX + (6-98)
*
.COMMONWEAl TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
FISHER
FILE NUMBER
HELEN
R
21
07
1158
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. SHELBY JEAN RAUB
509 HUNTINGTON AVENUE
ENOLA, PA 17025
NIECE
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 DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL EST AlE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 08/2003 M&T BANK - CHECKING ACCOUNT #9834709470 4,344.33 50. 2,172.17
2. A. 2000 BLUE CHIP FEDERAL CREDIT UNION 1,511.22 50. 755.61
SAVINGS ACCOUNT - 1236 SUFFIX A
3. A. 2000 BLUE CHIP FEDERAL CREDIT UNION 16,596.39 50. 8,298.20
CERTIFICATE OF DEPOSIT -1236 SUFFIX C
TOTAL (Also enter on line 6. Recapitulation) $ 11,225.98
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
Ow
-COMMONWEALTH OF PENNSYL V ANJA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FISHER
HELEN
Debts of decedent must be reported on Schedule l.
R
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 07
1158
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. RONALD C.L. SMITH FUNERAL HOME 2,359.93
2. HOSS'S - FUNERAL LUNCHEON 130.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s)JEIN Number of Personal Representative(s)
Street Address
City State Zip
Yea~s) Commission Paid:
2. Attorney Fees IRWIN & McKNIGHT 10,000.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS 298.00
5. Accountants Fees
6. Tax Return Prepare~s Fees PATRICIAA. ROSENDALE, CPA 350.00
7. REGISTER OF WILLS - FILING FEE 30.00
8. CUMBERLAND LAW JOURNAL - EST ATE NOTICE 75.00
9. THE SENTINEL - ESTATE NOTICE 158.62
10. NOTARY FEES 25.00
TOTAL (Also enter on line 9, Recapitulation) $ 13.426.55
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
..
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FISHER HELEN
R.
Include unreimbursed medical expenses.
FILE NUMBER
21 07
1158
ITEM
NUMBER DESCRIPTION
1. WEST SHORE EMS - AMBULANCE
VALUE AT DATE
OF DEATH
139.09
2. LINDA FUGATE, LEVY COUNTY TAX COLLECTOR - REAL ESTATE TAXES
224.31
3. M&T BANK - REIMBURSEMENT OF DIVIL SERVICE DIRECT DEPOSIT
1,444.52
4. KINKORA PYTHIAN HOME CORPORATION - NURSING
12.50
5. QUANTUM IMAGING & THERAPEUTIC ASSOCIATES - MEDICAL
227.09
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2.047.51
_-1~13~+1*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
.-,'" 'r-r"lo HELEN R 21 07 1158
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRI BUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
1. SHELBY JEAN RAUB Collateral
509 HUNTINGTON AVENUE 1/6TH REMAINDER
ENOLA, PA 17025
2. CHARLES SHEAFFER Collateral
486 N. LOCUST POINT ROAD 1/6TH REMAINDER
MECHANICSBURG, PA 17050-1518
3. VIRGINIA DORSHEIMER Sibling
106 LEONARD LANE 1/6TH REMAINDER
HARRISBURG, PA 17111
4. BARRY SHEAFFER Collateral
190 CORE ROAD 1/6TH REMAINDER
DUNCANNON, PA 17020
5. DENNIS SHEAFFER Collateral
1750 V ALLEY ROAD 1/6TH REMAINDER
MARYSVILLE, PA 17053
6. CHARLES SHEAFFER Collateral
486 N. LOCUST POINT ROAD 1/6TH REMAINDER
MECHANICSBURG, PA 17050
7. SAMUEL MARKS Collateral 1,000.00
6332 HUNTINGDON STREET
HARRISBURG, PA 17111
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA TE, 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)
LAST WILL fu~D TEST&~ENT
QE
HELEN R. FISHER
I, HELEN R. FISHER, residing at 6330 Huntingdon Street,
Harrisburg, Dauphin County, Pennsylvania, being of sound mind,
memory and understanding, do make and publish this my Last will and
Testament, hereby revoking and making void all former Wills by me
at any time heretofore made.
ITEM I.
I direct that all my just debts
and funeral expenses be fully paid and satisfied as soon as
conveniently may be after my decease.
ITEM II.
I give all of the rest, residue
and remainder of my estate unto my husband, Melvin L. Fisher,
provided that he is living on the thirtieth day after the date of
my death.
ITEM III.
In the event my husband, Melvin
L. Fisher, does not survive me by thirty (30) days, I give unto my
good neighbor, Samuel Marks, a cash bequest of One 'Thousand
($1,000.00) Dollars, provided he survives my death.
ITEM IV.
In the event my husband, Melvin
L. Fisher, does not survive me by thirty (30) days, I give all the
rest, residue and remainder of my estate equally among such of th
following as survive my death:
(a) My husband's sister, Virginia Dorsheimer.
(b) My niece, Shelby Jean Raub.
(c) My nephew, Richard Sheaffer.
( d) My nephew, Barry Sheaffer.
(e) My nephe~.." Dennis Sheaffer.
(f) My nephew, Charles Sheaffer.
ITEM V.
In addition to the powers
2
E. To compromise claims without court approval, and without
the consent of any beneficiary.
ITEM VI.
It is hereby directed that my
Executor, hereinafter named, shall pay all inheritance, state,
succession and legacy taxes to which my estate or the transfer of
any property hereunder may be subject and to charge such tax as
part of the admini.stration, payable out of my residuary estate.
ITEM VII.
I
nominate,
constitute
and
appoint my husband, Melvin L. Fisher, to be and act as my sole
Executor of this my Last Will and Testament.
In the event of
renunciation, death, resignation or inability to act for any reason
whatsoever of my husband, Melvin L. Fisher, I nominate, constitute
and appoint my niece, Shelby Jean Raub, as Executrix of this my
Last Will and Testament. No personal representative or fiduciary
appointed herein shall be required to post bond or give any
security.
3
IN WITNESS WHEREOF, I have hereun~o set my hand and seal this
J L day of
rv7 ;;.~ ~ ( 1\
, 1999.
, /" .f)-r
\l~:U~J <- 11\< crr),*~?
HELEN R. FISHER
( SEAL)
The preceding instrument, consisting of this, and three other
typewritten pages, was on the date thereof signed, published and
declared by HELEN R. FISHER, the Testatrix therein named, as and
for her Last Will, in the presence of us, who at her request, in
her presence and in the presence of each other, have subscribed our
names as witnesses hereto.
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Wal:hovia Bank, N.A.
P.O. Box 50018
Roanoke, VA 24040-5018
Automatic Renewal Notice
WACHOVIA
023065 10/13/2007
HELEN R FISHER
c/o SHELBY JEAN RAUB
509 HUNTINGTON AVENUE
ENOLA PA 17025
DETAIL INFORMATION
Open Date: 02/12/07
Maturity Date: 11/12/07
Maturity Value.: $ 10,004.40
Thank you for your business. Your Time Deposit Account # 24-741-211-2895223 matures on 11/]2/07. This account
will automatically renew for 9 months unless you change the term, add to, or redeem your account by 11/19/07. Interest
after 11/12/07 \-"ill be eanlcd if the funds are renewed or reinvested in any \Vachovia account. The maturity date for the
renewed account will be 08/12/08 and the rate will be based on a minimum balance requirement of$ 10,000.00. The
account earns daily compounded interest paid every 1 month. The renewal interest rate and annual percentage yield will
be available on or after 11/ 13/07 and can be obtained by visiting your nearest Wachovia Financial Center or by calling
866-GET RATE (866-438-7283). We welcome the opportunity to further discuss your investment needs. *Maturity
value may not include recent activity.
Wachovia Bank, N.A.
Wachovia Bank of Delaware, N.A.
are Members FDIC.
~
9
susquehan~
January 26, 2008
Susquehanna Bank PA
26 North Cedar Street
P.O. Box 1000
Lititz, PA 17543-7000
Toll free 800.311.3182
Irwin & McKnight
West Pomfret Professional Building
60 West Pomfret Street
Carlisle PA 17013-3222
RECEIVED
fJAN 2 9 200K
IRWIN & McKNIGHT
LAW OFFICES
RE: Helen R Fisher Estate
88#: 162-22-3041
DOD: November 25, 2007
To Whom It May Concern:
In response to your request of December 24, 2007, we have prepared the attached list of accounts.
There is no safe deposit box registered in the name of this decedent.
If I can be of further assistance, please feel free to call.
Sincerely,
/J-!J-
11.ti.i~
anet M Peters
Support Services Supervisor
717-625-6295
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'IM\N & McKN\G\\l
LAW Off\CES
Phone (888) 502-4349
Fax (302) 934-2955
January 3, 2008
499 Mitchell Road, MilIsboro, DE 19966 Mail Code DE-MB-12
Law Offices
Irwin & McKnight
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, Pennsylvania 17013-3222
Re: Estate of Helen R Fisher
Social Security: 162-22-3041
Date of Death: November 25, 2007
Dear Sir or Madam:
Per your inquiry dated December 24,2007, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
A ccount Number
9834709470
Ownership (Names oj)
Helen R Fisher *
Shelby Raub *
Opening Date
08/08/03
Balance on Date of Death
$4,344.23
Accrued Interest
$ 0.10
Total
$4,344.33
2.
Type of Account
Certificate of Deposit
Account Number
031003913808887
Ownership (Names oj)
Helen R Fisher *
Opening Date
08/04/00
Balance on Date of Death
$30,002.84
$ 318.22
Accrued Interest
Total
$30,321.06
Please be advised, there was no safe deposit box found for the above decedent. * For further account information,
regarding ownership, closures and/or reimbursement of funds, etc., please call the Summerdale Plaza Office # 717-
255-2261.
Sincerely,
~/~a?4P
Nancy Clagett
Records Management
~ ,~:,"I'::~ltfBup~~9.!t~9.v{ yt)I.Irn8m~
December 27,2007
Re: Estate of Helen R. Fisher
To Whom It May Concern:
5050 Derry Street
Harrisburg, PA 17111
PHONE: 71 7/564-3081
FAX: 71 7/564- 1469
~1&~e:llWlt~
DEe 2 8 2007
lR WIN (..~. McKNIGH1;
The account for Helen R. Fisher is a joint account with Shelby J. Raub. This account was
established on December 26, 1967. There is a savings account and a certificate of deposit
on the account. The interest through November for the savings account is $17.19. The
interest through November for the certificate is $656.46. The balance in the savings
account on date of death was $1,511.22 and the certificate of deposit balance was
$16,596.39.
--
If you should need any further information, please call me.
Thank you, pJ
&tiy ~t~d
Amy Schmoyer
Ronald C.L. Smith Funeral Home
325 North High Street
Duncannon, PAl 7020
Invoice
Date
Invoice #
11/27/2007
99
Phone #
717-834-4515
Bill To
Shelby Raub
509 Huntington Ave.
Enola, P A 17025
Client Terms Due Date
Helen Fisher Net 30 12/27/2007
Quantity Description Rate Amount
Professional Services 995.00 995.00
Embalming 375.00 375.00
Other Preparation of the Body 150.00 150.00
Transfer of Remains to Funeral Home 150.00 150.00
Graveside Services 175.00 175.00
Funeral Coach 150.00 150.00
Memorial Folders 35.00 35.00
Clergy Offering 200.00 200.00
12 Death Certificates 6.00 72.00
Obituary in Patriot News 57.93 57.93
Total $2,359.93
Payments/Credits $0.00
It's been a pleasure working with you!
Balance Due $2,359.93
bA
P.O. Box 4650
ACH/EDI Services
Buffalo, NY 14240-9975
(800) 724-2240
*** This is an Advice ***
HELEN R FISHER
SHELBY RAUB
509 HUNTINGTON AVE
ENOLA PA 17025
Date: Friday, December 07, 2007
Subject: Notification of Death / Reclamation
Case Number: 13024
Funds Deposited to Account:
Funds Deducted from Account(s):
9834709470
9834709470 $1,444.52
This is to advise you that on 12/7/2007 we deducted from the account(s) shown above the amount of$1444.52,
for the Civil Service Direct Deposit of 12/1/2007.
Due to the fact that HELEN R FISHER has passed away prior to the issuance of the credit, the Treasury of the
United States is requesting reimbursement. In accordance with Federal Regulations, direct deposits may not be
retained by the beneficiary unless the beneficiary lived through the entire month prior to the date of issuance.
If the number of the 'account deducted from' is different from the account into which the funds were originally
deposited, the deduction is authorized under the bank's rules for right of offset because one or more of the
owners on both accounts are the same.
Should you have any further questions about this charge, please call and refer to the case number above.
This advice is provided to facilitate the reconcilement of your monthly account statement.
Respectfully, -: JC~. . .'. .
K~
ACH/EDI Services
M&T