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Home My WebLink About05-22-08 (2)~,-'s°°~x``~' , ` COMMONWEALTH OF ~ REV 1500 O~rcruusEONl.v PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ~ °- 3 ~ ~ ~ - 00- $ - ,,,, R Y DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL W 0 DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DO-Year) THIS RETURN MUST BE FB.ED NJ DUPLICATE WfTH THE REGISTER OF WILLS V 02/27/2008 01/18/1931 W (IF APPLICABLE) SURVIVING SPWSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOGAL SECURITY NUMBER 0 ~ ®1.Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (da6e ofdealh priorb 12-13-82) ~ d ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise (aa~ ordeam arBer 12-rz•ez- ^ 5. Federal Estate Tax Retum Required ~ m ®6. Decedent Died Testate (aaxn eopy awl ^ 7. Decedent Maintained a Living Trust (AUacn wpyarnaq _ 8. Total Number of Safe Deposit Boxes ~ a ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit fda~ aaeam beMreeo rz-31-e~ ana t-t-es) ^ 1 t. Election to tax under Sec. 9113(A) IAd~n scn of Tti15 SECTN]N 1iAUST BE`>;OMPLETEO:'`ALL'CORR~SP'ON`DENQ - ` l'3~~ONFI L Tic f ~ 'v f~,$tIOULD BE flIRECTED TO: , <;-', F w NAME COMPLETE MAILING ADDRESS Z ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET FIRM NAME (If Applicable) ~ IRWIN & McKNIGHT p TELEPHONE NUMBER 717 249-2353 CARLISLE SPA 17013 OF tAl USE pf 1. Real Estate (Schedule A) (1) n :~: " - 2. Stocks and Bonds (Schedule B) (2) 287.28 : r? _°` ! , - -~r, rv 3. Cbsely Hekt Corporation, Partnership or Sole-Proprietorship (3) _ .. ~~ -' !, .. J 4. Mortgages b Notes Rece'wable (Schedule D) (4) .. - - ~_ ~ ',. -i~ ~ ~ ~ i _ ;~ ~b - 5. Cash, Bank Deposits & MisceAaneous Personal Property {5) 100,182.9fi -, , __ W `=; i (Schedule E) ` -:= „~- . _-> Z O 6. Jointry Owned Property (Schedule F) (6) 16, 324.65 tv F' ^ Separate Billing Requested 7 Intor_Vivnc Transfers R Misrpllaneous Non-Probate Prooeriv f71 63,190.73 H a Q U W (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 179,985.62 9. Funeral Expenses b Administrative Costs (Schedule H) (9) 19,650.28 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1, 779.28 11. Total Deductions (total Lines 9 & 10) (11) 21,429.56 12. Net Value of Estate (Line 8 minus Line 11) (12) 158,556.06 13. Charitable and Govemmenfal Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 10,000.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 148,556.06 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z O IQ- a XV Q 1- 15. Amount of Line 14 taxable at the spousal tax rate, ortransfers 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 20. ^ • 0.00 x (15) 0.00 0.00 x (16) 0.00 0.00 x .12 (17) 0.00 148,556.06 x .15 (18) 22,283.41 (19) 22,283.41 > > BE; Decedent'ty Complete Address: srt~E-rnoor~ss 77 SPRING GARDEN EST. Gn CARLISLE srnrE PA ZIP 17015 Tax Payments and Credits: 1 • Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1.114.17 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (1) 22,283.41 Total Credits (A + B + C) (2) 1,114.17 (3) 0.00 (4) 0.00 (5) 21,169.24 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 21,169.24 Make Check Payable fo: 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 : ........................................................................... ^ b. retain the right to designate who shall use the property transferred or its inwme : ........................................ ^ c. retain a reversionary interest; or ...................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................. ^ 2. If death oaxtrred after December 12,1962, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... ^ 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. ^ Q 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this velum, indudin$ acrwrt~~anying schedules and statements, and to the best of my knowledge and belief, it is true, correct and compk;te. Declaration of preparer ocher than the personal representative a based on all mfomrabon of whkh preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 1190 NEWVILLE ROAD CARLISLE PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENT/~TIVE DATE 60 WEST Pt21~AFRET STREET PA 17013 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 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-0ne 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 09'0 [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 benefiaaries 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°h [72 P.S. §9116(a)(1.3)]. Asibling 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 F>C + (6-98) SCHEDULE B 'COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ANDERSON ANNA MAE 21 08 0348 All property jointly-owned with right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. A.G. EDWARDS ~ SONS, INC. 287.28 24 SHARES TELEFONICA DE ARGENTINE S A SPNS ADR (TAR) 11.970 PER SHARE TOTAL (Also enter on line 2, Recapitulation) I ; 287.28 (If more space is needed, insert additional sheets of fhe same size) REV-1508 EX + (698) SCHEDULE E ,COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY itESIDENT DECEDENT ESTATE OF FILE NUMBER ANDERSON ANNA MAE 21 08 0348 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2001 DODGE 5,000.00 VIN #: 183EJ46XX1 N626854 2. PERSONAL PROPERTY -SETTLEMENT SHEET ATTACHED FROM ROWE'S 7,850.00 AUCTION SERVICE 3. MOBILE HOME -COMMODORE 15,000.00 TITLE #: A36766747 SOLD 4. ORRSTOWN BANK -CHECKING ACCOUNT #106004186 9,236.54 5. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 33,136.76 SAVINGS ACCOUNT #1925-00 6. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 5,752.13 CHECKING ACCOUNT #1925-40 7. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 16,056.32 CERTIFICATE OF DEPOSIT #5309 8. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 7,976.68 CERTIFICATE OF DEPOSIT #5337 9. A.G. EDWARDS & SONS 4.07 CASH/CENTENNIAL MONEY MARKET 10. CASH 170.46 TOTAL (Also enter on line 5, Recapitulation) I S 1 nn 1 R9 9B (If more space s needed, insert additional sheets of the same size) REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ,RESIDENT DECEDENT ESTATE OF FILE NUMBER ANDERSON ANNA MAE 21 08 0348 ff an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I ADDRESS (RELATIONSHIP TO DECEDENT A. RICK A. HOOVER e HARRY DONSON C JOINTLY-0WNED PROPERTY: 1190 NEWVILLE ROAD (NEPHEW CARLISLE, PA 17013 25 CIRCLE DRIVE (FRIEND CARLISLE, PA 17015 ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. ORRSTOWN BANK 391.07 50. 195.54 CHECKING ACCOUNT #417254 2. B. 06/06 MEMBERS 1ST FEDERAL CREDIT UNION 12,957.27 50. 6,478.64 ACCOUNT NO. 205040-51 3. B. 06/06 MEMBERS 1ST FEDERAL CREDIT UNION 12,806.49 50. 6,403.25 ACCOUNT NO.205040-43 4. 6. 06/06 MEMBERS 1ST FEDERAL CREDIT UNION 6,494.43 50. 3,247.22 ACCOUNT NO.205040-53 TOTAL (Also enter on line 6, Recapitulation) I E 16,324.65 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ,RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY FILE NUMBER ANDERSON ANNA MAE 21 08 0348 This schedule must be completed and filedrf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE,THHRRELATIDNSFAPTODECH7ENTAND THE DATE CF TRaHSFER. ATfncHncoPr oP THE DEED wRREx.ESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION pr APPUCAeIE) TAXABLE VALUE 1. AMERICAN FUNDS -IRA 63,190.73 100. 63,190.73 ACCOUNT #59858286 INVESTMENT COMPANY OF AMERICA CLASS A (AIVSX) TOTAL (Also enter on line 7 Recapitulation) ~ S 63,190.73 (If more space is needed, insert additional sheets of the same size) EV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ANDERSON ANNA MAE 21 08 0348 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 3,441.00 2. FUNERAL LUNCHEON 366.46 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative (s) RICK A. HOOVER 5,000.00 Sodal Security Number(s)IEIN Number of Personal Representative(s) 178529415 Street Address 1190 NEWVILLE ROAD City CARLISLE State PA Zip 17013 Year(s) Commissan Paid: y, Attorney Fees IRWIN 8~ McKNIGHT 6,950.00 3. Family Exemption: (If decedent's address is not the same as daimanCs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 317.00 5 Acx:ountanfs Fees PATRICIA A. ROSENDALE, CPA 110.00 INCOME TAX PREPARATION 6. Tax Return Preparer's Fees PATRICIA A. ROSENDALE, CPA 350.00 FIDUCIARY TAX RETURN 7. REGISTER OF WILLS -FILING FEE 30.00 8. ROWE'S AUCTION SERVICE -AUCTIONEER COMMISSION 2,747.50 9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 10. THE SENTINEL -ESTATE NOTICE 166.60 11. REGISTER OF WILLS -SHORT CERTIFICATES 12.00 12. CAR REPAIR PRIOR TO SALE (BATTERY & FLOOR MATS) 84.72 TOTAL (Also enter on line 9, Recapitulation) S 19.650.28 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) SCHEDULE i DEBTS OF DECEDENT COMMONWEALTH OF PENNSYLVANIA , IN RESIIDE TEDECEDENTRN MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER ANDERSON ANNA MAE 21 08 0348 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. EMBARQ -TELEPHONE 76.04 2. CALAMAN'S LAWN SERVICE -LAWN CARE 130.40 3. DARRYL K. GUITSITE, M.D. -MEDICAL 80.00 4. QUANUM IMAGING & THERAPEUTIC -MEDICAL 1.71 5. MOFFITT HEART & VASCULAR -MEDICAL 10.00 6. CARLISLE HMA PHYSICIAN MANAGEMENT -MEDICAL 33.33 7. SUSQUEHANNA VALLEY FEDERAL CREDIT UNION -CREDIT CARD 197.26 8. HCR MANOR CARE -MEDICAL 30.00 9. SPRING GARDEN ESTATES -LOT RENT 360.00 10. PP&L -ELECTRIC 353.03 11. DISH NETWORK -CABLE 20.80 12. HEARTLAND PHARMACY -MEDICAL 13. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 123.54 363.17 TOTAL (Also enter on line 10, Recapitulation) I S 1 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (o.nn~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN FZESIDENT DECEDENT ESTATE OF FILE NUMBER 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 [indude outright sppoousal distributions, and transfers under Sec. 9116 (a) (1.2)I 1. RICK A. HOOVER Collateral 148,556.06 1190 NEWVILLE ROAD 1/16TH REMAINDER CARLISLE, PA 17013 2. LYNN E. HOOVER Collateral 202 WITHERSPON CT. 1/16TH REMAINDER WARNER ROBINS, GA 31088 3. JOHN SHEAFFER Collateral 135 RELLIM ST. 1/16TH REMAINDER CARLISLE, PA 17013 4. EDWIN BOLDOSSER Collateral 235 EWE ROAD 1/16TH REMAINDER MECHANICSBURG, PA 17050 5. RAY BOLDOSSER Collateral 768 W. SOUTH STREET 1/16TH REMAINDER CARLISLE, PA 17013 6. ROSS BOLDOSSER Collateral 50 GREYSTONE ROAD 1/16TH REMAINDER CARLISLE, PA 17013 7. TOM BLOSER Collateral 210 BARNSTABLE ROAD 1/16TH REMAINDER CARLISLE, PA 17015 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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. ST. PAULS LUTHERAN CHURCH OF CARLISLE 5,000.00 CARLISLE, PA 17013 2. BOROUGH OF CARLISLE 5,000.00 CARLISLE, PA 17013 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 10 000.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent ANDERSON ANNA MAE 21 08 0348 Decedent's Name Page 1 File Number ScAedule J -Beneficiaries - 1 NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. STEPHEN BLOSER Collateral 150 BARNSTABLE ROAD 1/16TH REMAINDER CARLISLE, PA 17015 9. RANDY WATTS Collateral 116 HOPE DRIVE 1/16TH REMAINDER BOILING SPRINGS PA 17007 10. DIANE H. NUGENT Collateral 7013 WOLFTREE LANE 1/16TH REMAINDER ROCKVILLE, MD 20852 11. BRIAN HOOVER Collateral 1785 BUCK HOLLOW ROAD 1/16TH REMAINDER BIG COVE TANNERY PA 17212 12. KELLY MOONEY 502 MAPLEWOOD DRIVE 1/16TH REMAINDER DOUGLASVILLE, PA 19518 13. JEFF WAGNER 1623 FOXWORTHY AVENUE 1/16TH REMAINDER SAN JOSE, CA 95118 14. JED WAGNER 5310 FOXBORO CT. 1/16TH REMAINDER ALEXANDRIA VA 22315 15. BRAD WAGNER 550 MOORELAND AVENUE 1/16TH REMAINDER CARLISLE, PA 17013 CHILDREN OF DANNY P. KINGSBOROUGH (DECEASED) 16. DAVID KINGSBOROUGH Collateral 40 MALVERN DRIVE 1/2 OF 1/16TH MANCHESTER, PA 17345 REMAINDER 17. MEGAN KINGSBOROUGH Collateral 40 MALVERN DRIVE 1/2 OF 1/16TH MANCHESTER, PA 17345 REMAINDER a __ ~___ _~ I, Anna Mae Anderson, of 77 Spring Garden Estates, .Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within my family's burial plot, in accordance with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto all my nieces and nephews in equal shares, per stirpes. FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto all my nieces and nephews in equal shares, per stirpes. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto all my nieces and nephews in equal shares, per stirpes. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes i?rposed t:pon my estate passing under my~;~~ill cr otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my nephew, Rick A. Hoover as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of Rick A. Hoover, I nominate, constitute and appoint my nephew, John E. Sheaffer Jr., as Executor of this my Last Will and Testament. I hereby relieve my Executor from-the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. NINTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two typewritten pages this f~ day of July, 1994. y ~: C~ -Y i "Z'..._-~/l~~ C ` ~- "L Lc~ G/.G -,,,tee Anna Mae Anderson Signed, sealed, published and declared by the above named Testatrix Anna Mae Anderson as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. R COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ss. I, Anna Mae Anderson, 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 willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. _, %` Anna Mae Anderson Sworn or affirmed to and acknowledged before me, by Anna Mae Anderson this /q day of July, 1994. ~' 7 i No ~ry Public (SEAL) COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ss. S .«:.~.,. ......._ a ~.. .....,cv Ay9 ' ~ 1' We, i.->~r~r~~„rj-~Cc~~CGt,.~-= and C~~~%<«~c 5 ~9'~,~-~'-` 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 Anna Mae Anderson sign and execute the instrument as her Last Will; that Anna Mae Anderson signed willingly and that Anna Mae Anderson executed 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 that time eighteen (18) or more years of age, of sound mind and under no constraint or Sworn or affirmed to and subscribed before me by I~LGCc~~-.- Ct f~~t.-7 c' -;~„~.'1 and un ue influ nce L`LC ~ -, GJ~P-~ .~~.~~ witnesses, this Vic; day of July, 1994. L ~ l ,:v - ~!L ~~ n J Not ry Public ( EAL) TARirL SEAL C nthi ~L. Darr. P~~_=rY P~bli~ y -r;~~~,.(;urrt,erlau~l County ,cuth ?a iddle~on `ices ';` y ?O. 199`. ~Jlv Commission ExF' ' FIRST CODICIL TO THE LAST WILL AND TESTAMENT OF ANNA MAE ANDERSON 1, ANNA MAE ANDERSON, of Middlesex Township, Cumberland County, Pennsylvania, having made my Last Will and Testament dated July 19, 1994, do hereby make, publish and declare this to be the First Codicil to my Last Will and Testament. FIRST: I hereby modify, amend and add to Paragraph Sixth of my Last Will and Testament to read as follows: (b) I hereby specifically give and bequeath a total sum of Five Thousand and no/100 ($5,000.00) Dollars to St. Pauls Lutheran Church of Carlisle, Pennsylvania, to be used for meals and other necessities for needy families; (c) I hereby specifically give and bequeath a total sum of Five Thousand and no/100 ($5,000.00) Dollars to the Borough of Carlisle to be used for equipment and/or maintenance for the Letort Park. SECOND: I hereby ratify and affirm all the other provisions of my Last Will and Testament dated July 19, 1994. IN WITNESS WHEREOF, I have set my hand and seal this Y~' of September, 2006. ANNA MAE ANDERSON The preceding instrument, consisting of this one typewritten page was on the day and date thereof signed, sealed, published and declared by ANNA bIAE ANDERSON, as and for a Codicil to her Last Will and Testament, 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. - E. ACKNOWLEDGMENT AND AFFIDAVIT WE, ANNA 1VIAE ANDERSON, SHARON L. SCHWALM and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as a First Codicil to her Last Will and Testament, that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the First Codicil as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ANNA MAE A~N/DERSO~~N SHARON L. SCHWALM MARTHA L. NOEL COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by ANNA MAE ANDERSON, the testatrix herein, and subscribed and sworn to before me by SHARON L. SCHWALM and MARTHA L. NOEL, witnesses, this so"~ day of September, 2006. -` ~..-ti~ ~j . C ~c_ Notary Public COMMO EALTH OF PENNSYLVANIA Notarial Seal Roger B. Irwin, Notary Pu61ic Carlisle Bore. Cumbe+iand Count`j My Commission Expires Oct. 3, 2008 Member. Pennsylvania Association Of Notaries ROWS' S AUCTION SERVICE 2505 Ritner Highway Cazlisle, PA 717-249-2677 249-1978 697-4794 May 4, 2008 To: Roger B. Irwin, Attorney 60 W. Pomfret St. Carlisle, PA 17013 From: Rowe's Auction Service 2505 Ritner Highway Cazlisle, PA 17015 Re: Estate of Anna Anderson Personal Property Auction Total Sales $7850.00 Less 35% commission 2747.50 Total Due $5102.50 .~ William G. Rowe ~- Y SECOND LIEN LIEN RELEASED D LIEN HOLDER D B h AUTIiORIZED RHpRHSHNTATIVE ~,. e I certify that reasonable dili8ence has been used to examiningg t statements presented in the application for Certificate of Tit]e to and that the p•oof of ownership of ribed hereon d i l • ~ - n , esc the veh c e said vehicle yresented with said application warrants the issuance certificate naming the applicant as lawful owner of said thi ~, .Two ~ D s of Wherefore, I eerttfY that a8 of the date inscribed hereon, vehicle T+iDIW43R Lk - . the official records of the pennsytvania Department of Tranapor- the lawful owner of said uehicie. t i li '- can s tation reflect that said app ~ 3ecrefary of Transportattotr 1 ~. ~~~ I { ~~ AGREEMENT OF SALE THIS AGREEMENT, made this ~ day of 2008, by and between RICK A. HOOVER, Executor of The Estate of Anna Mae Anderson, hereinafter called SELLER, and CELTNE MYERS, of Mechanicsburg, Pennsylvania, hereinafter collectively called PURCHASER. WITNESSETIi: 1. SELLER agrees to sell and convey to PURCHASER, ,and PURCHASER agrees to purchase and accept the conveyance of 77 Spring Garden Estates, North Middleton Township, Cumberland County, Pennsylvania. 2. PURCHASER agrees to pay the sum of Fifteen Thousand Dollars ($15,000.00) for said premises in the following manner: twenty percent (20%) at the time of the execution of this Agreement, receipt of said sum being hereby acknowledged by SELLER, and the balance of Twelve Thousand Dollars ($12,000.00) in cash on or before May 16, 2008. 'The down payment shall be held in escrow by SELLER's attorney, IRWIN & McKNIGHT, until settlement. 3. Settlement shall be held on or before May 16, 2008, and it shall be held in the offices of IRWTN & McKNIGHT, Attorneys-at-Law, 60 West Pomfret Street, Carlisle, Pennsylvania, unless otherwise mutually agreed to between the parties. At settlement, SELLER shall convey good and marketable title in fee simple, free and clear of all encumbrances except easements or restrictions, visible or of record. 4. The SELLER agrees to retain all liability for loss, damage or destruction of the property, including all fixtures and improvements thereon, if applicable, from the time of the signing of this Agreement until closing, and hereby voluntarily waives all rights and privileges, both expressed and implied, which may otherwise be available to SELLER under the doctrine of equitable conversion. 5. Possession of said premises shall be delivered to PURCHASER at the time of settlement; and until said time of said settlement, SELLER agrees that the said premises shall remain in substantially the same condition as at the time of the execution of this Agreement, reasonable wear and tear excepted. Should said premises not be in such condition, PURCHASER may declare this Agreement null and void and the obligations of the parties hereunder shall cease and terminate. 6. SELLER is not aware of any municipal assessments or charges currently levied or about to be levied against said premises. 7. The PURCHASER has had the opportunity to inspect the premises prior to executing this Agreement of Sale. 8. The interest of the PURCHASER in this Agreement shall not be assignable in whole or in part without the prior written consent of the SELLER. 9. The PURCHASER shall be responsible for the arrangement of and the payment for any and all inspections required by the PURCHASER'S lending institution or any other inspections of the property as desired by PURCHASER in contemplation of this transaction. In the event that the results of any inspections which are required by the PURCHASER'S lending institution are not within industry standard levels of acceptability and require remediation, such remediation shall be conducted by a qualified professional acceptable to the SELLER, however, the PURCHASER shall be responsible for the arrangement of and payment for remediation which may be warranted pursuant to the terms of this paragraph. 10. Should the PURCHASER fail to make settlement for the property as herein provided, the amount paid down as hand money, to wit: Three Thousand Dollars ($3,000.00) may be retained by the SELLER as liquidated damages. Should the SELLER fail or refuse to convey as herein provided through no fault of PURCHASER, the PURCHASER may require the return of the hand money paid and reasonable title examination expenses actually incurred by the PURCHASER. 2 04-09=2008 10:56 FR0~1-IRWIN 8 ~IcKNIGHT LAW OFFICES +7172496354 T-533 P.004/004 F-233 11. The PURCHASER hereby waives the formal tender of the title if the monies due hereunder are not paid as agreed upon herein. 12. The PURCI~'ASER agrees to accept this conveyance of the premises in an "as is" condition, including matters of survey, and they have not relied upon any representatipns by either SEY.Y,ER or SELLER's attorney, if any, as to the condition of the premises or the state of the title thereto. 1~. This Agreement has iier.~i exe~:uicxl in the Commonweaith of rennsyivania and shalt be construed and interpreted in accordance with the laws of this Commonwealth. 14, This Agreement together with the Exhibits attached hereto constitutes the entire agreement between the parties with respect to the property, and there are na agreements, representations or warranties, oral ar written, vtrhich have not been incorporated herein. This Agreement shall not be amended, modified, altered or rescinded or any rights or remedies hereunder waived, except in writing signed by the parties hereto. IN WITNESS WHEREOF, AND INTENDING TO BE BdUND LEGALLY HEREBY, the parties have hereunto set their hands and seals the day and date first above written. WITNESS: THE ESTATE p~' ANNA IviAE ANDERSON rl--r. r~'~ ,~~~~ - ~ Ey RICK ~. HoovER., EXECUTOR CELINE 1V>IYERS, ' COMMONWEALTH OF PENNSYLVANIA /~~ Notarial Seal ~~I ~r~~~~G~~~~~-' ~-' ~~ ~ Ann M. Anderson, Noun,; s~ublic !/„ ~~ Mechanicsburg Bono, Cumberiarod County ~~~ My Comrrussion E>e;~res Feb. 24, 2011 ?L. Member, Penneylvrnia Association of Notaries C /' `` ~~-- ~' ~~ ~ ~ E~ ,, ORRSTO~ITN sari A Tradition of Excellence March 14, 2008 TO: Roger B Irwin Irwin & McKnight 60 W Pomfret St Carlisle, PA 17013 FROM: Andrew G Ott Cust. Service Specialist P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF ANNA H ANDERSON DATE OF DEATH: February 27, 2008 77 East King Street P.O. Box 250 Shippensburg, PA 17257 DECEIVED MAR l 9 2006 IRWIN & McKNIGHT IAW OFFICES IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST _106004186 Anna H Anderson 8/7/06 9,235.64 & $0.90 = 9,236.54 (2.98 interest accrued to date of death for calendar year.) 417254 Anna H Anderson 9/11/97 391.07 Rick A Hoover SAVINGS ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST CERTIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST USQUEHANNA ALLEY FEDERAL CREDIT UNION March 18, 2008 Irwin & McKnight West Pomfret Professional Building 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Estate of Anna H. Anderson Date of Birth: February 27, 2008 Social Security Number: 180-26-5055 Dear Mr. Irwin: ~~GElVE6 MAR 2 0 2008 IRWIN & McNNiGNT IAW OFFICES The following is the information regarding the Estate of Anna H. Anderson that you requested. 1. Share Savings Account (1925-00) and Checking Account (1925-40} a. Registered Owner(s): Anna H. Anderson b. Date established: Savings -May 11,1981; Checking -May 17,1993 c. Change of ownership within one year: None d. Interest accrued on Savings Account (1/1/08 to 2/27/08): $39.14 e. Date of death balance: i. Savings: $33,136.76 (principal only -interest is added to the account quarterly) ii. Checking: $5,752.13 (checking does not earn interest) 2. Certificate #5309 a. Registered Owners}: Anna H. Anderson b. Date established: 03/17/2004 c. Change of ownership within one year: None d. Interest accrued: i. January: $44.75 (posted to account on 1/31/08) ii. February 1-27: $39.15 (not posted to account until 2/29/08) e. Date of death balance: $16,056.32 (principal plus January's interest only -February's interest is added at the end of the month) 3. Certificate #5337 a. Registered Owner(s): Anna H. Anderson and Christopher J. Sheaffer b. Date established: 04/01/2004 c. Change of ownership within one year: None 3850 HARTZDALE DRIVE • CAMP HILL, PA 17011-7809 V LOCAL: (717) 737-4152 TOLL FREE: (E00) ~4a-1454 FAX: (717) 737-OSa9 t~ d. Interest accrued: i. January: $22.23 ii. February 1-27: $19.44 e. Date of death balance: $ 7,976.68 (principal plus January's interest only -February's interest is added at the end of the month) Ms. Anderson also has a Visa Credit Card with the Credit Union with a current balance of $197.26. Additionally, there is a life insurance policy on her share savings account. The beneficiary that she has listed is D. Heather Watts. Would you be able to provide the Credit Union with any information on this individual? The address we have for her is from 1981. Please let me know if you need any additional information. Kind regards, Kathy Jo Shoaff Member Services Supervisor A.G. EDWARDS & SONS, INC. 802 Tilton Road Northfield, NJ 08225 609/484-0400 toll-free: 800/274-8569 Anna H Anderson Acct#1321-4311 ~~1 E DWARD S. Date of Death Values as of 02/27/2008 #Shares/Uts Description Cash/Centennial Money Market 24 Telefonica De Argentine S A Spns ADR (TAR) 30 Telefonica De Argentine (cusip#879991016) Not Traded 30 Telefonica De Argentine (cusip#879991024) Not Traded Total Account Valu Price per Share Total 11.970 0.000 0.000 e as of 02/27/2008 $4.07 $287.28 $0.00 $0.00 $291.35 Positions NOT held @ A.G. Edwards American Funds -IRA Acct#59858286 DOD Values as of 2/27/2008 2,016.940 Investment Company of America Class A (AIVSX) 31.330 This report has been prepared for your convenience. The pricesrnformaGon contained herein have been obtained from sources believed reliable, and although every attempt has been made to make it as complete as possible, it's accuracy is not guaranteed by A.G. Edwards & Sons, Inc. This report should not be considered a replacement for offical documents such as trade confirmations, account statements, and 1099 forms which should be retained for tax purposes. $63,190.73 A.G. Edwards is a division of Wachovia Securities, LLC. Member SIPC. COMMONWEItLTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE No. 21 BUREAU OF INDIVIDUAL TAXES DEPT. 280601 N ACN 08119126 HARRISBURG, PA 171za-0601 TAXPAYER R E S P O N S E DATE 05-05-2008 REV-1543 EX AFP (09-00) HARRY DONSON 25 CIRCLE DR CARLISLE PA 17015 TYPE OF ACCOUNT EST. OF ANNA H ANDERSON ^ SAVINGS $,$. N0. 180-26-5055 ^ CHECKING DATE OF DEATH 02-27-2008 ^ rRUSr COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decadent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by eallirg (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 205040-51 Date 06-19-2006 To insure proper credit to your account, two Established C2) copies of this notice wust accompany your payment to the Register of Wills. Make check Account Balance 12, 957.27 payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax Dayments are made within three Amount Subject to Tax 6,478.64 (3) wonths of the decedent's date of death, Tax Rate X , 15 You may deduct a 5X discount of the tax due. Any inheritance tax due will become delinquent Potential TaX Due 971.80 nine C9) months after the date of death. PART TAXPAYER RESPONSE - - ~~=~ A. ^ The above information and tax due 3s correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will ba issued by the PA Department of Revenue. BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennrilvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your relationship to decedent: TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) s Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D DEPT. 280601 WIRRISBURG. PA 171za-o6o1 TAXPAYE R R E S P O N S E Iffy-1543 IX IIFP (09-D O) FILE N0. 21 ACN 08119125 DATE 05-05-2008 HARRY DONSON 25 CIRCLE DR CARLISLE PA 17015 TYPE OF ACCOUNT EST. OF ANNA H ANDERSON ^ savINGs S.S. N0. 180-26-5055 ^ CHECKING DATE OF DEATH 02-27-2008 ^ TRUST COUNTY CUMBERLAND a CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departaent with the intonation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this inforsation is incorrect, please obtain written correction fros the financial institution, attach a copy to this fon and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Cossonwealth of Pennsylvania. Questions say be answered by telling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 205040-43 Date 06-19-2006 To insure vroper credit to your account, two Established I2) copies of this notice oust accospa-ry your Account Balance 12,$06.49 paysent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax paysents are lade within three Amount Subject to Tax 6,403.25 (3) sonths of the decedent's date of death, Tax Rate X , l~j You say deduct a 5Y. discount of the tax due. Any inheritance tax due will becose delinquent Potential TaX Due 960.49 nine C9) sanths after the date of death. PART TAXPAYER RESPONSE 0 `:~ - ~ - A. ^ The above inforsation and tax due is correct. 1. You way choose to resit paysent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you ^ay check box "A" and return this notice to the Register of Wills and an official assesssent will be issued by the PA Departaent of Revenue. ONE BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to ba filed by the decedent's representative. C. ^ The above inforsation is incorrect and/or debts and deductions were paid by you. You ^ust cosvlete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your .~, a'' n relationship to decedent: a '~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS '? ~ - LINE 1. Date Established 1 ._ 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) i Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONYIEAL!TH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE No. 21 BUREAU OF INDIVIDUAL TAXES AND ACN 08119127 DEPT. 280601 TAXPAYER RESPONSE HARRISBURG, PA 17128-o6o1 DATE 05-05-2008 REV-1543 EX 11FP (09-00) HARRY DONSON 25 CIRCLE DR CARLISLE PA 17015 TYPE OF ACCOUNT EST. OF ANNA H ANDERSON ^ SAVINGS $.S. N0. 180-26-5055 ^ CHECKING DATE OF DEATH 02-27-2008 ^ TRUST COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departaent with the inforaation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ioint owner/beneficiary of this account. If you feel this infonation is incorrect, please obtain written correction frog the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaaonwealth of Pennrilvania. Questions aay be answered by calling 0717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 205040-53 Date 06-19-2006 To insure proper credit to your account, two Established C2) copies of this notice aunt accoapany your payaent to the Register of Wills. Make check Account Balance 6,494.43 payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payaents are aade within three Amount Subject to Tax 3,247.22 C3) aonths of the decedent's date of death, Tax Rate X .15 you aay deduct a 5X discount of the tax due. Any inheritance tax duo will becoae delinquent Potential Tax DUe 487 • 08 nine (9) months after the date of death. PART TAXPAYER RESPONSE 3:n -5:i' A. ^ The above inforaation and tax due is correct. 1. You may choose to resit payaent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you aay check box "A" and return this notice to the Register of CHECK wills and an official assessaant will be issued by the PA Departaent of Revenue. C ONE BLOCK B. ^ The above asset has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above inforaation is incorrect and/or debts and deductions ware paid by you. You must coaplete PART 2^ and/or PART ^ below. PART If you indicate a different tax rate, please state your ~' relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS :, ,~~ ,5 LINE 1. Date Established 1 ~-~' 2. Account Balance 2 ~' ~' 3. Percent Taxable 3 X r _ -~, 4. Amount Sub~ect to Tax 4 e_ ~ __ ,;~~' ~~~ 5. Debts and Deductions 5 - ': ~;,`~„ ~ -_ ~ '~ 4'~~' a 6. Amount Taxable 6 '" ~ - :~~ `~~ ~ :~ , _ 7. Tax Rate 7 X ~d 4 _ , _.~~ 8. Tax Due .~~ , PART DEBTS AND DEDUCTIONS CLAIMED a neTF P,4Tn PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Llne s or iax ~ompuca a un, Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) . WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE Hoffman-Roth Funeral Home & Crematory, Inc. 219 North Hanover Street Carlisle, PA 17013 ;~ (717)243-4511 March 12, 2008 Rick Hoover 1190 Newville Road Carlisle, PA 17013 The Funeral Service for Anna Mae Anderson 15258-51 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. (A) OUR SERVICE: CREMATION PACKAGE # 4 _ $1790.00 Facility,Staff, and Equipment Graveside Service, $190.00 FUNERAL HOME SERVICE CHARGES $1980.00 SELECTED MERCHANDISE: Camero Bell Jar Urn , $320.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $2300.00 Cash Advances Grave Opening $500.00 Organist. $100.00 Clergy Offering $100.00 Certified Copies of Death Certificates , $60.00 Flowers, $106.00 Additional Grave Opening $250.00 Coroner Authorization Cremation Fee, $25.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $1141.00 Total Total Cost , $3441.00 TOTAL AMOUNT DUE $3441.00 This statement is net and payable in full within 30 days of receipt. ------------------------------------------------------------------ Please return this portion with your Remittance $ Amount Enclosed Service ID # 15258-51 Anna Mae Anderson