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Home My WebLink About04-22-08 (3) -I 15056041046 REV-1500 EX (05-04) PA Department of Revenue Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAl. USEnNLY , County Code Year File Number 21 og 002-6'1 Date of Birth 02-2.lf2D()B IOglerlS Decedent's Last Name Suffix Decedent's First Name MI ])AvilJ (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 c:::> 2. Supplemental Return c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::> c:::> 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust NDA/I! 8. Total Number of Safe Deposit Boxes (Attach Copy ofTrust) c:::> 10. Spousal Poverty Credit (date of death c:::> 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 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received c:::> c:::> 4. Limited Estate c:::> c:::> City or Post Office State ZIP Code 7 I 7 5 I 7 o REGIST ;?::~WILLS U~ONLY: :c~\~g ~ '..i :-~:::-3~~ N . C) (:) -U (---:; (_} ,.'1 :Jt ::J~ 1'3 -0---1 15"ATE FILED (...) Firm Name (If Applicable) First line of address 14--38 RAV l-L- r<. 0 A D Second line of address MfC/+/fNI u. ~ G- Pt\ 7()~5 Correspondent's e-mail address: re that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. YI SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041046 15056041046 ---I.~ -.J REV-1500 EX Decedent's Name: RECAPITULATION 15056042047 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 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 an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. . . . . . . . . . . . . . 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~ 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. 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:::) ~~ A~ ~~ -zL 15056042047 Side 2 15056042047 ....J REV-1500 EX Page 3 File Number :2/ - tJ g- tJ() 2- 6 'r Decedent's Complete Address: DECEDENT'S NAME -- 7Jt;-t/l1J _G4I~L_ STREET ADDRES~1, /J -f/9oS"_. - Ea~r_72b1dlb Jr1Ad - .1i;2.~dd ~~ CITY AfeC},417/Cfl, ZIP f 7o~o Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) $' 6f: 7!J 3. Interest/Penalty if applicable D. Interest E. Penalty 5'% Ir~1t!/tfsi&~~~~ti;r $ Total Credits (A + 8 + C ) (2) - 3. ~'/ Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is nreater 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 8 t5: 31 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) A. Enter the interest on the tax due. · 65: 3/ 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 m b. retain the right to designate who shall use the property transferred or its income; .....................,..................." 0 129 c. retain a reversionary interest; or................................................................................................................,........ 0 ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..........................................................................."................................. 0 129 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.............. 0 g] 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. S9116 (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 PS. S9116 (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. 99116(1.2) [72 P.S. s9116(a)(1)J. 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 PS. s9116(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-I508 EX. (1-91) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF j).#J1/J UAMe.. FILE NUMBER '2-/- (}t:tJIJZlf Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER G- -7 DESCRIPTION 1l~~1110I)i IE J '2(1)Z J-'l7Zi~N ;t!dj)lrL- ,S L/j ~ cg'L.J /, 7 L) 7fC-A!-./ .tit{ 10 11-1# f/t/" $i Ii> tier; 23; 12 ? o L1; IJIIA.€ &rf/~ V;l-lv/!--h7!v?: H<o/" Ir>T bf 1w~ /4/,e 4NO G-oo o. F41tf - $ J~6~ MHpJMr= #Jfft1d 6-oqt:J ~ g~/ 3 ~< VALUE AT DATE OF DEATH ;I 3%00, fJO , r!:l-~ CLoT/' 1YJt l- "2J141}1?).,, 4NJ/<'.s J FA i~ CLJtrlP;-I-!cM $ I / 7. ~o ~t:,e.. Coer.) Will :Z;/.-t d IAJlv1 <<J) TOTAL (Also enter on line 5, Recapitulation) $.3 ,91 7 (If more space is needed, insert additional sheets of the same size) REV.1509 EX + (1.!17) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1\ v,.fr;/J (fA/dE FilE NUMBER 2-/- tlf7-jtJztl 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. -.ToEL CeAf7fC& /ij-3 % }J~V~n f/-/Lt Jlot'<d~ /\-1~ch/-l",'csl1tA1J' fJlf '7()5!7 S'oAJ B. c. JOINTLY -OWNED PROPERTY: 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. -zoo3 ,oNe 8AAlK At-It 5{)-OJf/~ r;S5'6 t' /~7f./'T 5'"07tl ~ 539.5'7 ~. 4. 1-01J J ;J AlC- 61?11/( ~/c-l Sa -tJ'I1J5 - 7f't'J t -YOO{),OO Go~ <.t 7pOd. 00 I ~ I i TOTAL (Also enter on line 6, Recapitulation) $ '2539.5" ) ;1 (If more space is needed, insert additional sheets of the same size) REV-151'1 EX+ (10-06) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF D/ll/IIJ Cf A/rtt? L- ITEM NUMBER A. FilE NUMBER 2/- tJY-Oti ztf Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: /ALA!.. ME /VJ~"e/A'- f/;111~ j cRlEl?1l1TitJAI SE~YI'C-I.ES $' /~3S-: ()tJ / B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. 3. 4. 5. Name of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent Probate Fees 4 Go- /S7iE~ or tJ,/dls, Gtt1 /J€tl!411P {t;{/YI 'Ij ro ~ r~-r';+n;M, W/l1, FlttJ;tr C!E:~I-/Pvl~ ,z,-c. Accountant's Fees # 77, ()(/ 7. 6. Tax Return Preparer's Fees DEt4rh C,6~-IIH <.J4-t~./;: ;J/).e~ 1L~~mtJrNIt.. /fIJIJ1I& ~ //9otJ f. ~G-I.s-rlf~ o~ tJ;J/, CaWl/./IEd.I.AI1/J Cou04'fy NV F; l ; (3 reF-- 0 r- ,4; ~1Yl ~ ~t/-/ 5tJ tJ $ 15,otJ TOTAL (Also enter on line 9, Recapitulation) $ ~ ~7 /" ()J (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF P/lv//J C,eA/pee:- FILE NUMBER Z / ~?J ,?^-tftJ ;zt fI' ITEM NUMBER 1. Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH DESCRIPTION A.4Al..Jo~CA,t2/E. I!-C/1L r# JE~(/'"c.t!: ,. (-:TOC:> A-/A ~/<'€r S'r~"rEr U/J1r' /)1//, jJA TE:-~ 7.J'7-J?5SI $ c5 7/00 '2-, StE.:AfrO;e /-It~IC.Jts I 28~J /II: r-~/'7r J~~€r; /-//1-retf;J'/.JutPtf--; j?A /7//0 TEl--. r :2o-07tJ7 ~ :z ~ z5,oo ) 3. 1I~Ii"rM"() jJ!,/J,d/114'! 17" ;?:""sy/v""t"--' fJtJ 13t!>~ 72-lf/J.J c)Ei/Et/1-11&.- 011 '/'/19 7--cJ~dL- y€Li gOO ~ Z. 7/1 -655"1 :$ 6/ ~() TOTAL (Also enter on line 10, Recapitulation) $ 3 3 5';;7. f? r;1 -J (If more space is needed, insert additional sheets of the same size) ........--_.~_....~ o PNCBANl< Total/Banking Statement PNC~ () , {0 tJV D 2 /~9/o1J For the period 01/29/2008 to 02126/2008 DAVID CENTRE JOEl CENTRE 1438 RAVEN HILL RD MECHANICSBURG PA 17055-6764 I j f We value your relationship with PNC. For questions about your account, please call1-866-PNC-4000. Primary account number: 50-0415-9556 Page 1 of 4 Number of enclosures: 0 C For 24-hour banking, and transaction or ~ interest rate information, sign on to 1:r PNC Bank Online Banking at pnc.com. For customer se/Vice call1-866-PNC-4000 between the hours of 6 AM and Midnight ET. Para se/Vicio en espaflol, 1-866-HOLA-PNC Moving? Please contact us at 1-866-PNC-4000 I:!!iI Write to: Customer Se/Vice PO Box 609 Pittsburgh PA 15230-9738 J5l Visit us at pnc.com III TOD te~mi~al: .'-80~-531-1648 For h"armg .mpau'ed clients only Relalionship Overview Bank Depoeit Accounts Description Interest Checking Premium Money Market Total Deposits Deposit Balance ],111.29 2,569.10 3,680.39 Senior Premium Plan Intere.t Checking Account Summary Account number: 50-0415-9556 David Centre Joel Centre Balanc. Summary Please see the Activity Detail section for additional information. Beginning balance 1,095.84 Deposits and other additions 2,980.58 Checks and other deductions 2,965.13 Average monthly balance 2,002.09 Endi ng balance 1,111.29 Charges and fees .00 Tranaaction Summary Checks paid/ withdrawals . Check Card POS signed transactions Check Card/Bankcard POS PIN transactions 1 o Total ATM transactions PNC Bank ATM transactions Other Bank ATM transactions o o As of 02/26, a total of $.32 in interest We paid this year. Int.r..t Summary Annual Percentage Yield Earned (APYE) 0.09% Number of days In interest period Average collected balance for APYE 29 2,002.09 o o Interest Paid this period .15 ~)Jt-1 f\ FORM863 Total Banking Statement 02/01 Activity Oeta Deposits and Other Additions Date Amount Description 02/01 1,:'39.00 Diretot Deposit - Ret Nt,t DFAS-CleVt'land XXXXX:ltH3 479.00 Din'tot Dqlosit . SOt' Set' US Treasmy :lO:1 XXXXX:lti-1:IA Online Transfer' FWIII t)()()()()():,0010 Deposit Reft'retlt'e No 024829209 Dt'pusit Refen'lKc No 02.178G:,49 Intt"rest PaYIIlt"nt For the period 01/28/2008 to"';2,2.,a108 DAVID CENTRE Primary account number: 50-0415-9556 Page 2 of 4 There were 6 Deposits and Other Additions totaling $2.880.58. 02/0-1 02/19 02/2!', !)().l. -13 26.00 32.00 .I:' 02/26 Check. and Sub.titut. Ch.ck. Check Dale number Amount paid 7128 2,9H.91i 02/ II Reference number 087775293 Online and Electronic Banking Deductions Dale Amount Description 0~/2() 20.17 Wt"b Pmt Sin~le - Online Plllt Verizon Ckf'l83tH32(HPOS There is 1 check listed totaling $2.844.86 There was 1 Online or Electronic Banking Deduction totaling $20.'7. Daily Balance Detail Date Balance 01/29 1,09:..81 02/0 I 3, I l:l.81 Date 02/(H 02/11 Balance 4,018.27 1,07:l.:l1 Premium Money Market Account Summary Account number: 50-0405-7883 David Centre Joel Centre Balanc. Summary PIl"ase see the Activity Detail section for additional information. Beginning balance 4,904.43 o Deposits and Checks and other Ending other additions deductions balance 4.10 2,:l:l9.4:l 2,:.ti9.1O Average monthly Charges balance and fees 4,137.78 .00 Check Card pes Check Card/Bankcard signed transactions pes PIN transactions 0 0 PNC Bank Other Bank ATM transactions ATM transactions 0 0 Number of days Average collected Interest Paid in i ntere st peri od ba I a nee for AP YE thi s period 29 4,1:'7.78 4.10 Tranuction Summary Checks paid/ withdrawals Total ATM transactions Int.r..t Summary Annual Percentage Yield Earned (APYEI 1.2!'l% As of 02/26, a total of $13.53 in interest w paid this year. Total B.anking Statement o PNCBANl< 9 For 24-hClur information, sig~on to PNC Bank Online Banking on pnc.com. Account number: 50-04 5-7883 - C lti.l1ued For die period 01/28/2008 to 02128/2008 DAVID CENTRE Primary account number: 50-0415-9556 Page 3 of 4 Activity Detail Deposits and Other Additions Date Amount Description 02/26 4.10 Interest Payment Checks and Substitute Checks Check Date number Amount paid III 1,435.00 02/26 There was 1 Deposit or Other Addition totaling $4.10. \!\~ 0 1\)E 'j M A r2 r<t:--r ActOUIf\/ Reference number 087585483 Online and Electronic Banking Deductions Date Amount Description 0~04 904.43 Online Transfer To 00000050041595 6 There is 1 check listed totaling $1.435.00. There was 1 Online or Electronic Banking Deduction totaling $804A3. Daily Balance Detail Date Balance 01/29 4,904.43 Date 02/26 Balance 2,569.10 FORM963R-l005 ~ Kelley Blue 8.ook - Trade-In Pricing Report - Saturn, SLl -~~~ DAVftl looking for the pertect car? Find it now on KBB. C€~+~ advertisement Make: Acura Alfa Rbmeo AM': Amlo'!8n Ast<.rn Page 1 of3 ~It I 2.' - o-t-(){J '2. by I ~ ZIP: Home New Cars Used Cars Research a Explore News" Reviews Classlfieds Auto Loans" Insurance lL.,j Enlol ~IP Code Requited . W.lcom. leck Used Car Valu.. Classilleds I Certllled Pre-Owned Recently Viewed Compar. Vehicles I Perfect Car Finder I Most Researched Used Vehicles Free Dealer Pnce Quote ZIP Code 170551 Clw1lIa tuLf'J!'!: :> 1Jitd.,QID )0 2.0..0.2. )0 Sitwll :> ~ :> 4~doar Sediln 40 2002 Saturn SL1 Sedan 4D l'rade.In Value Private Party Value Suggested Retail Value Photo Gallery Compare Vehicles ",",I B>lue Book ReVIew Consumer Ratings Find Your Next Car Specifications 1lCl. Shopping Tools Free CARFAX Record Check A,uto lOan tram 5.74% APR Compar. Insurance Rates Pilyment C,lcul'tor SEll YOUR USlO (AR on Blue Book ClaRified.'. Reacn millions ot shoppers on kbb.com, AutoTrader.com, and oth'er popular sites. find out more, Click 8Ul' A USiO CAR on Ilu. look Clessifleds'. Sltum Sll 301 Mil.. or les5 ZIP Code 17055 To View Ad.. Click FINO THE RIGHT CAR Compare UHd vs. N.w Under $5,000 Il<.th New end Used Sllden To View Uet. Click VIE'iV ANOTHER VEHICLf Select Year... 01' Search by Category 01' Change ZIP Code BLUE BOOK'. TRADE-IN VALUE. c',,'"', '"', ~"' c.. ~ ~ ",- ~~""'~ '" You Might Also Like Condition "",''''', ,,,,," Value Excellent Good Fair $4,525 $4,135 $3,465 NEXT STEPS: Get PriCing on New Vehicles SeU Your Sedan Most Researched Sedans Pnnt U Email iiill'lnencs . Insursnce Get a New Car Loan tram 5.74% APR Get a Pre.Owned loan trom 6.09% APR Your Credit SCore tor Free Get a Free Insurance Quote adwrtl'3ement 1'38DO I'S b~..+vr~t\"; (YIlt> pMt1"" Go d J) ~ p,trl(( More Photos Search Locsl Listings: (" View Saturn SL 1 ,":' Search all Class,lIeds in 17055 Average Consumer Rating (110 Reviews) Check Out Our 10 Most Researched Sedans Read Reviews 1001 Honde Accord 1008 Honda Civic 1001 Nissen A1tlma 1001 M.rcede....n. C.Cle.. 2008 Chevrolst Mallbu 2009 Toyota Cemry l00ll Toyota Corolle 1001 Ma.de MAZDA3 2008 Cedlllac CTS 1008 Ac:ure TL Check out N.w V.hld.. From Seturn Change Equipment http://www.kbb.com/KBBIU sedCars/PricingReport.aspx?V ehicleId=4 729&SelectionHisto... 3/11/2008 Vehicle Highlight. Mllugs: fnglne: Tr.n.mllllon: Drlvetreln: 23.329 4-Cyl. 1.9 Liter Automatic FWD Selected Equipment / / / Kdley Blue Book - Trade-In Pricing Report - Saturn, SLI Stand.reI Atr CondltJonlng Power SlHrIng Option.' Till Wheel AMlfM Stereo Ouol fronl Air Bags c._ Blue Book Trade-In Value Trade-in Value is what consumers can expect to receive (rom a dealer tor a tradeMln vehicle aSSuming an accurate appraisal of condition. This value will llkelv be less than the Prtv.te Party Value because the reselling dealer incurs the cost of 5,rety Inspections, reconditioning and other costs o( doing business. Vehicle Condition Rating. Check Vehicle Title History Excellent CJOCJCO $4,525 . LOOi(S new, b in extellent mechaniCJJI c.ondlt.lon ana needs no rer.ondltionlng. . Never had any paint or body wOrk and Is free of rust. . Clean title history and will pass a smoQ and safety Inspection. ( . fnglOe compartment Is dean, with no flujcJ leaks and is free of any _"- wvar or VI'itlble d.'..c..1s. f) A-:'\' . Complete and verifiable se,vlce records.. .~) ... , less than 5% of all used vehkles fall,nlO thiS cat"!lory. S V.fr'-- Good -~,Jo t'JOOO ). v-.-fr' #,.. $4,135 . Free ot any major de.fec:ts. /: . Clean title tlJ<.JtOry, me D.,Hnb, bOdy, and interior have onl'l ff\lnOr {i1 any) blemlshe5, and tnere are no major mechanical problems, . little or no rust on this vehlcte. . Tire:.; match and have substantial tread wear left . A ~Ij}OOd" vehicle will need some reconditioning to be sold at retaiL Most c.c)llsun1er ownea vehlde~ Fal! into l1)IS cC1Itegory. Fair 000 . Sam echantcal r cosmetic defects and needs servtCi still in r ,sona unning condition. · ~~~~r~: ~i:t~~;o:~: body and/or inte~r need W:: uv . Tires may need to be replaced. S'~1't1 v ~ ,. e There may be some repairable rust damage. ll..tH'f ~ ~D.? l) Poor r ..~ D ~\("'IT N/A . Severe mecnanlc,! antJlor c.osrnetlc defe~ and b 10 poor running, condItion. . May have problems that cannot be readily fixed such as a damaged frame or a ru~ted~through body. . 6rarlded title (salvage, f1oud, etc.) or unsubstantiated rruleaQe. Kelley Blue Book does not attempt to report a value on a "poor" vehIcle beCause the value of these vehicles varies greatly. A vehicle in Doo.r c.ondltion may require an mdependent appraisal to determine il'i value. . Pennsylvanlll 3/11/2008 Accur.te Condition Appral.al Ch~nge Condition Accurately appraiSing the condition of a vehicle is an important aspect in determining its Blue Book value. Taking our 16 question condition quiz will ensure you know the correct condition rating. NEXT STEPS: Get Pricing on New Vehicles Sell Your Sed.n e 2008 Kelley BJue Book co., In~. AI' rights reserved. Milr~Apr 2008 Edition. The specific Information requJred to determine me vaJue for this PdrtJcular vehicle was supplied by the person gelleriltm9 thIS report. VehICle v.J/wljo(lS are opmions and may viiI'! lrom vehk/e to vehicJfJ. Aau.' vilJ4J_tions will ".rr based upon milrket conditions, specJl1c4t1Ons, vehicle conQltlOn or other particular CIrcumstances pettJnent to thiS p.lrticul4t vehicle or the tr"ns.crion or tM /Hllties to the transilctkm. This report is .intended ror tht IndlyiehJ,a1 use 01 the ~rson gener.tting this report only .nd shaP not Page 20f3 NtJ ~"'ST; +-t~r F",...1"o- ~,A. ~ A-tJC ~ ':: 0 /<. N1'DPdu,,-r- Cl-toes,t;;: (. tf-OeJ:. t,'r'tl ~ ...,.. MiHU' 1fT ifo ad /J p'" (Jc<,4f rli"''''''- ~7ffl ';:u~ J"fII'tJ .1YMf ire- C'11 A L1"-~"'~ftI""- ,..~ 1l1~ ::M..+~V' v~ tdvi \0\ r \dr fly.. W'~ http://www.kbb.com/KBB/UsedCars/PricingReport.aspx?V ehicleld=4 729&SelectionHisto... 3/11/2008 ..".---- Putting a Value on Your Donations I Qoodwill Industries of San Diego County Page 1 of2 Text Size; Sm I Med I Lg Putting a Value on Your Donations D" V)J~ CtYJ+-/Lc ~. U. 'Ii ?. 1- 0 i,.. 00 2 ~ DONATIONS OF CLOTHING & HOUSEHOLD GOODS: updated February 2008 If you are a taxpayer who itemizes deductions on federal tax retums (use of the long form), you may be entitled to claim charitable deductions for Items that you donate to charity. Please contact your tax pre parer for clarification. Goodwill will provide you with a receipt that Indicates the number of boxes or bags per category or lists larger, bulky Items In general terms. We suggest that you make a detailed list of the Items that you donate, along with any original purchase receipts or appraisals to keep with your receipt from Goodwill. Under U.S. 'tax law, we are expressly prohibited from assessing value. See the IRS website regarding allowable charitable contributions. . The listing below provides you with general price ranges for certain categories of items sold In Goodwill retail stores. We are unable to sell items that are broken, torn, or stained. The amounts shown are approximate and should only be used as a general guide. For all tax related questions, we recommend that you speak with your tax advisor. chase software on line and In computer stores that has this tax function built In, such as 's de Ible" . ~ t\1'~~~ {fr' . t~\" / ~/ , \tJ~' ~I\"" 0\' ~~ILl ~~~~ RIPr~i1l Cf.-. http://www.sdgoodwill.org/donation_values.shtml 3/11/2008 / ./ - --'-"0 - . .uw,", UU I uue uonatIons I Goodwill Industries of San Diego County '1U Itf'^~ ANTIQUES, COLLECTIBLES, CASH & ITEMS VALUED OVER $600 If you plan to make a contribution of cash, real estate, stocks and bonds, or other significant assets we request that you contact our CEO or Marketing Director. These types of donations are only accepted at our corporate offices and we will provide you with a receipt for tax purposes. It is important to note that by law we are unable to provide you with a value for the non-cash items yOU donate. We suggest that you keep any appraisals, purchase receipts or other documentation of the value of the donated Items with your donation receipt. Note: for information on HOW to donate, please see our main donation page on this site. Home I About Goodwill I Donate to Goodwill I Computer Recycling I Shop Goodwill I Business Services and E- Business I Secure Document Destruction I On-the-Job Training I Supported Employment I Employment Services I San Diego Outsourcing Systems, Inc. I Job Listings I News 1 Contact Us I Customer Survey Form I Request InformatIon @200B Goodwill Industries of San Diego County. 3663 Rosecrans St. San Diego, CA 92110-3226 Voice: (8B8) 446-6394 I Fax: 619-225-1934 I S. SOB I Privacy I Employee Login http://www.sdgoodwill.org/donation_values.shtml Page 2 of2 3/11/2008 AVER MEMORIAL HOME AND CREMATION SERVICES, INC. 4100 Jonestown Road · Harrisburg, PA 17109 · 1-800.720-8221 . Fax 717 -541-9943 . Shawn E. Cqrpe S . . -... r, upervlsor ;" t r) ,:j-.., . 280212 J'T-5 i - IJ , : ' C,' .) i' . - , Feb 25, 2008 , Lj, t. . Mr. J'oel A. Centre 1438 Raven Hill Road Mechanicsburg, PA 17055 ~ l I 1 ).~ .II, David Centre - Deceased l' ' .l..', ... ,.-'1 I SPECIAL CHARGES X Direct Cremation Forwarding Remains Receiving Remains Immediate Burial Nationwide Guarantee Program Worldwide Travel.1'rotection TOTAL SPECIAL CHARGES $1,295.00 ~.\; , _J .../ j ", ,.. -1 _, : '. y ~ i!' ,. 1-, . " \ ,""" .....' > $1,295.0Q ~ d I PROFESSIONAL SERVICES Services ot Funeral Director & Statt Embalming. Dressing/Cosmetizing/Casketing Facilities & Statt tor Viewing ($200/hour) Facilities & Statt tor Funeral Service. Facilities & Statt tor Memorial Service Statt & Equipment tor Viewing ($200/hour) Statt & Equipment ~or,Funeral Service Statt & Equipment tor Memorial Service Private Family Viewing Witnessing the Cremation Packaging/Forwarding ot Cremated Remains X Personal Delivery ot Cremated Remains Scattering ot Cremated Remains .j .'; -:: ", .\ ,.[' $85.00 ,j I 't)~li~~ TOTAL PROFESSIONAL SERVICES .~.t,. .:, $85.0 AUTOMOTIVE EQUIPMENT Removal Vehicle Casket Coach Flower Car Lead'Car/Clergy,Car Service Vehicle Fami I y Car TOTAL AUTOMOTIVE EQUIPMENT . ~m1 ~\Af Vi $0. (l MERCHANDISE Register Book Memorial Cards Thank You Cards .. Remembrance Package Casket X Cardboard Container Alternative Container Outer Bur i a I Conta.iner Veterans Flag Case Grave/Memorial Marker TOTAL MERCHANDISE CASH ADVANCED ITEMS Grave Opening Cemetery Equipmen'tJ,.' Vault Service Charge Newspaper Notice Newspaper Notice Clergy. Church/Organist/Soloist, " Flowers X Crematory Charge X County Coroner Fee X 5 Certified Copies of Death Certificate TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES Special Charges Professional 'Services Automotive Equipment Merchandise Cash Advanced Items SUB TOTAL ..! $1,295.00 $85.00 $0.00 -' 'l- , $ 0 . 00 ,_,r;.. $55.00 ,$1,435.00 ,. J .' . .. ~ " I, . CREDITS $q).00 TOTAL I,': ~. $1,435.(ll0, ~ ;-~. . I _ AMOUNT PAID Feb 25, 2008 -$1,435~00 '_ $0.00 ;. J BALANCE DUE 'J; "r; . .- .$0.00 Included $25.00 $30.00 ) . $55.00 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPE8, CHARGES RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17(J13 CENTRE DAVID Estate File No. : Paid By Remarks: Receipt Date: Receipt Time: Receipt No.: 3/10/2008 11:21:09 1051869 2008-00264 JOEL ALLEN CENTRE WZ Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Cash Total Received......... Receipt Distribution ------------------------ PaYment Amount Payee Name 30.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 12.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $72.00 $72.00 Comeast Webm.ail - Email Message Page 1 of2 From: auerhome@comcast.net To: jc060@comcast.net Subject: FW: VitalChek Order Confirmation Date: Monday, March 10,2008 4:19:13 PM Forwarded Message: ------- From: DoNotReply@vitalchek.com To: auerhome@comcast.net Subject: VitalChek Order Confirmation Date: Mon, 10 Mar 200820:16:27 +??oo YhaIChekllw.<T, .l Cf1('i~t;'PUlFr~ t')fi~~4'~I. Thank you for choosing VitalChek. The following message concerns your order from Pennsylvania Vital Records. Please print this message for your records. Your order was placed on 3/10/2008 through VitalChek Network, Inc as detailed below: Order Detaillnfonnation Certificate Description & Quantity: DEATH - 3 Order Number: 12167219 Order PIN: 845719 Agency Fee: $27.00 VitalChek Shipping & Handling Fee: $22.00 Order Total: $49.00 7V /Yl, {, J ~ Shipping Method: UPS Air Joel A Centre Shipping Address: 1438 Raven Hill RoadA Mechanicsburg, PM 17055 estimated Proce..lng Time: 3-5 business days (excluding weekends and holidays) Estimated Processing Time: Estimated processing time may vary according to the resources and workloads of the agency. VitalChek has no control over these variations or the amount of time an agency requires to process an order. For these reasons, we do not guarantee processing times. Shipping is not included in processing times. Order Status Information: Check the status of your order at any time by clicking on the following link: Check Order Status. Please be advised that if the order has already been transmitted to the government agency, we will not be able to cancel or make changes to the order. If you have any additional questions or would like to e-mail VitalChek about this order, please http://maileenter.comcast.net/wmc/v/wm/4 7D5C34DOOOB6E5000006AC32200750784CFCOCFO... 3/10/2008 ~ ManorCare Health Services Camp Hill 1700 Market Street Camp Hill, PA 17011 717/737-8551 PATIENT INVOICE Patient: ;Patient #: David Centre 2403 2125/2008 IDate Description Charges Payments Balance Due I 2/17 -2/19/2008 Room and Board 2/17-2/19/2008 2/21/2008 Beauty and Barber $654.00 $17.00 Total Due: $671.00 $671.00 ~~ef~f~ Carini "n-.Home Companions Invoice 1843 N. Front Street Suite 20 I Harrisburg, PA 17110 (717) 920-0707 fax (717) 920-0808 www.seniorhelpers.com Date [!i11 To Joel Centre 1438 Raven Hill Road Mechanicsburg, P A 17055 2/25/2008 Amount Enclosed $ . Invoice # Service For Terms Due Date 20053 Due on receipt ON RECEIPT Quantity Description Rate Amount 11.5 2/18/2008 Personal Care Services 17.50 201.25 .24 2/19/2008 Personal Care Services 17.50 420.00 24 2/20/2008 Personal Care Services 17.50 420.00 24 2/21/2008 Personal Care Services 17.50 420.00 24 2/22/2008 Personal Care Services 17.50 420.00 24 2/23/2008 Personal Care Services 17.50 420.00 18.5 2/24/2008 Personal Care Services 17.50 323.75 We are very sorry for your loss. We appreciate you allowing us to help him in his last hours. Thank you for allowing us to help you with your Father. Total $2,625.00 Note: hours worked (Quantity) are displayed in decimal format. Payments/Credits $0.00 Thank you for allowing us to help you in your home. Our goal is to Balance Due $2,625.00 b t ssible! make sure you are safe and that you receIve the es care po Thank you for your prompt payment. Phone # Fax # E-mail Our Web Site 717-920-0707 717-920-0808 mbockes@seniorhelpers.com www.seniorhelpers.com ~.~ ~ IJ 0101 IF PAYING BY MASTERCARD, DISCOVER OR VISA, FILL OUT BELOW. U CHECK CARD IJSING FOR PAYMENT o .0 ~~SA MASTERCARD DISCOVER CARD NUMBER AMOUNT SIGNATURE I SIG. CODE EXP. DATE STATEMENT DATE PAY THIS AMOUNT CUSTOMER ID 3/31/2008 $98.61 117470 1 of 1 I SHOW AMOUNT $ PAGE NO. PAID HERE 33978 MAIL FACILITY: 55830 CAMP HILL PAY PLAN: PPPA PRIVATE PAY EASTERN PENNSYLVANIA 1111 III ...111.... 1.1..1.1.. I 1..1... 1.11...1..1.. II. 1..1.1.. 1.1 DAVID CENTRE C/O JOEL CENTRE 38 RAVEN HILL RD /t,"CJIII/.u;~ R/I';/? ~ O~ ;}IHW" r * k t4-11) 1"11' .,i 6/ FtJ _ 65286: I. I.. I .1.,1...1 11.1",,1 ,IIJ ,.,11... II 11...1,1...11 1111 ,,1..11 HEARTLAND PHARMACY OF PENNSYLVANIA PO BOX 72413 CLEVELAND, OH 44192-0002 I- ~t/~-r 33978'TC406P82N001504 33978 MAIL 'TC406P82NOOl504 PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMEN' 1IIIIIIUIIIIIJ.EIIIIUJJ/lIIIJlWIIIII DATE 2/17/2008 2/17/2008 ' 2/17/2008 2/17/2008 2/17/2008 2/17/2008 2/17/2008 2/17/2008 2/17/2008 2/17/2008 2/18/2008 2/19/2008 2/19/2008 2/19/2008 2/19/2008 2/19/2008 RXNO. 3098968 3098970 3098970 3098975 3098975 30989n 3098980 3098982 3098984 3098984 3107276 3115058 3115059 3115062 3134095 3134097 3/31/2008 INVOICE DATE DESCRIPTION CIPROFLOXACIN HCL 250MG TAB PREVACID 30 MG SOLUTAB PREVACID 30 MG SOLUTAB COlAAR 25 MG TABLET COlAAR 25 MG TABLET WARFARIN SODIUM 1 MG TABLET SPIRONOLACTONE 25 MG TABLET FUROSEHIDE 40 MG TABLET ISOSORBIDE MN 30 MG TAB SA ISOSORBIDE MN 30 MG TAB SA MILK OF MAGNESIA SUSP LORAlEPAM 0.5 MG TABLET LORAlEPAM 0.5 MG TABLET MORPHINE SULF 15 MG TAB SA LORAlEPAM 0.5 MG TABLET OXYCODONE HCL 10 MG ER TABLET oo172-~f1~~ 00300-1544-30 00300-1544-30 00006-0951-28 ??oo6-0951-28 00555-0831-05 00378-2146-05 00172-2907-80 581n-0222-08 581n-0222-OS 00904-0788-16 00781-1403-05 00781-1403-05 00406-8315-01 00781-1403-05 00093-0024-01 f) fr'D Iii/ f1J MESSAGES Finance charges are ca cu a mon y per IC ra e 0 0 or a minimum of $1.00 per month) for a total annual rate of 18%. The charges listed ,on this invoice do not reflect any balance billed to your insurance. QU~I'n 27 EA 27 EA 27 EA 27 EA 12 EA 27 EA 27 EA 27 EA 27 EA 473 ML 2 EA 2 EA 2 EA 2 EA 2 EA A~'qtER 169.95CR 22.00 73.61CR 73.61 11.22CR 18.85CR 6.91CR 52.99CR 3.00 7.05CR 2.OSCR 2.OSCR 6,54eR 2.08eR 7.53eR . DAYS OUTSTANDING AGED BALANCE 1 - 30 31 - 60 61 - 90 91 - 1 20 121 + 0.00 0.00 0.00 0.00 o DUE DATE: AMOUNT DUE: 7010 SNOWDRIFT RD ALLENTOWN, PA 18106 800-270-6351 A~~"r6W5boSED: CODE TYGl RX e RX RX RX RX RX RX RX e RX OTC RX RX RX RX RX . ' . 98.61 4/30/2008 $98.61 Date April 21, 2008 To Register of Wills - Cumberland County One Court House Square Carlisle, P A 17013 From Joel Centre Telephone: 717-766-7517 1438 Raven Hill Road Mechanicsburg, P A 17055 RE REV -1500 for David Centre File No. 21-08-00264 Enclosed please find the following in regard to my submission ofREV-1500: (1) /))/'0 // r.c..~r Or- .t / r; 11 ~v ~ f)M-t-. Check of $15.00 for filing fee. r/1V1 L/1l:.1 It I).:J. /~ I' /, (2) Pa. D.C. Rule 6.12 Status Report (3) REV -1500 , original & 1 copy (4) Supporting documentation for all amounts which appear on Schedules E, F, H and I: Bank statement, Automobile and clothing valuation, Funeral expenses, Debts incurred prior to death. Please contact me if any questions. ,...... ("') fi! ::.r: Q.. C\J C\J ~ a.... ~ Q::) C:::> '= ~ 1-_ is: 0:: =:> ;:"1,-0 VC) ,-- fJ:f() LuZ d~.r". &t!~ o~ C5