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HomeMy WebLinkAbout07-01-0815056041169 REV-1500 EX (06-OS) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Poaox2sosot INHERITANCE TAX RETURN ~ I ~~ n ~ ~~ Harrisburg, PA 17128.0601 RESIDENT DECEDENT l.~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 195-22-4826 12222007 05291929 Decedent's Last Name FRYE Suffix Decedent's First Name CLARA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE BOXES BELOW © 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Wilt) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death afler12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death MI B MI prior to 12-13-82) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCEANDCONFIDENTIAL TAX INFORMATfON SHOULD 13E DIRECTED T0: Name Daytime Telephone Number LINDA L PHILLIPS Firm Name (If Applicable) 717-528-7162 First line of address 650 FICKEL HILL ROAD Second line of address City or Post Office GARDNERS Correspondent's a-mail address: State ZIP Code PA 17324 REGIST OF WILLS U~ONLY Q O m C.. r ; ` t'^ ~J ~ ~~ r ~ t ~C%~ ; ra ~= / ' ~~ -gyp ~ ~ © ~ ..~ c_- TE FILED" ~"` n r ~ _y Under penalties of perjury, f declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. FILING RETURN 650 FICKEL HILL ROAD GARDNERS, PA 17324 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE PLEASE USE ORIGINAL FORM ONLY Side 1 15056041],69 150560411,69 J 15056042160 REV-1500 EX Decedent's Social Security Number Decedent's Name: CLARA B FRYE 19 5- 2 2- 4 8 2 6 RECAPITULATION 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) .... .... 5. 1, 698.32 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ... .... 6. 10 , 4 8 0 . 0 9 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ... .... 7. 8. ............................... Total Gross Assets (total Lines 1 - 7) g_ .... 12 , 17 8.41 9. P ( ) ................. Funeral Ex enses & Administrative Costs Schedule H 9. .... 10 , 651 .4 6 1 D. 9 9 ( ) ............ Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 10. ... 5 , 4 61.4 7 11. Total Deductions (total Lines 9 & 10) ............................... ... 11. 16 , 112.9 3 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. (3 , 9 3 4 . 5 2 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. 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_ 15. 16. Amount of Line 14 taxable at lineal rate x .04 5 16. 17. Amount of Line 14 taxable at sibling rate x .12 17. 18. Amount of Line 14 taxable at collateral rate x .15 18. 19. TAX DUE ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (3,934.52) 0.00 0.00 Side 2 15Q56042160 15Q56Q4216D REV-1500 EX Page 3 Decedent's Complete Address: File Number 2 0 0 8- 0 018 2 DECEDENT'S NAME CLARA B FRYE STREETADDRESS 650 FICKEL HILL ROAD CITY GARDNERS STATE PA ZIP 17324 Tax Payments and Credits: 1. Tax Due {Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total InterestiPenalty (D + E) {3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) o.oo 0.00 0.00 Make Check Payable to: REGISTER OF WILLS, AGFNT 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 : ........................................ .. ^ ^X b. retain the right to designate who shall use the property transferred or its income : .................. .. ^ c. retain a reversionary interest; or ....................................................... .. ^ d. receive the promise for life of either payments, benefits or care? .............................. .. ^ 2. If death occurred after December 12,1982, did decedent transfer properly within one year of death without receivingadeguate consideration? .................................................. .. ^ 0 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... .. ^ 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 ITAS 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 oftransfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116(a)(1.1.)(i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value oftransfers to or for the use of the surviving spouse is zero (0) percent [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 oftransfers from a deceased childtwenty-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 oftransfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. 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-1562 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 2008-00182 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 properly would be exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 2008-00182 All properly jointly-0wned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER 2008-00182 A11 property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 2008-00182 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. (If more space is needed, insert additional sheets of the same size) ,~ ~~~~ ~'ka~~t ~..~.~ .~~ i r~~~r~~~t~t~°~a. !~~~ ;Y:~~rk ~~~tr }~x~~ L~~:-~F' Ft~~}~~: ,K ----- -----------------o -~---- -~--- -- -- P.O. Box 841005 Boston, MA 02284 March 14, 2008 Ms. Linda L. Phillips 650 Fickel Hill Rd. Gardners, PA 17324 RE: Estate of: Clara B. Frye Date of Death: December 22, 2007 Dear Ms. Phillips: Per your request, enclosed please find the account information as of date of death for the above-named decedent. Please note the balances do not include accrued interest. There were no other accounts on file. If you should have any further questions, please do not hesitate to call. Very truly yours, l~ , Linda Spavento Team Leader Court Order Processing (617) 533-1789 (617) 533-1931-fax Sovereign Bank ESTATE OF Clara B Frye SOCIAL SECURITY #: 195-22-4826 DATE OF DEATH: December 22, 2007 Account #: 0574107777 Type: Savings Open date: 6/16/1979 In the name of: Clara B Frye, Linda L Phillips POA Date of Death Balance: Int.(YTD) from 1/1/2007 Accrued interest to date of death: Otherlnfo: to 1/22/2007 $0.00 $0.00 Account #: 0771033877 Type: Checking Open date: 1/14/1998 In the name of: Clara B Frye, Linda L Phillips POA Date of Death Balance: $1,698.29 Int.(YTD} from 1/1/2007 to 12/14/2007 Accrued interest to date of death: Otherlnfo: $1.20 $0.03 $0.00 Page 1 of 1 REV-1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA ,JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 2008-00182 If an asset was made joint wffhin one year of the decedent's date of death, it must be reported on Schedule G SURVIVING JOINTTENANT(S) NAME ADDRESS RELATIONSHIPTO DECEDENT A. LINDA I,, PHILLIPS 650 FICKEL HILL ROAD GARDNERS,PA 17324 DAUGHTER B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT 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 Or' DECEDENT'S INTEREST t. A. OCT-2005 MEMBERS FIRST FCU ACT #273342-00 3,422.12 50 1,711.06 2. A OCT-2005 MEMBERS FIRST FCU ACT#273342-11 7,538.05 50 8,769.03 TOTAL (Also enter on line 6, Recapitulation) ~ $ 10 , 4 8 0 . 0 9 (If more space is needed, insert additional sheets of the same size) St MEMBERS 1St FEDERAL CREDIT iJhIION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Bafance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Estate of: Clara Belle Frye Date of Death: December 22, 2007 Social Security Number: 195-22-4826 5000 Louise Drive P.O. Box 40 Mechanicsburg, 273342-00 10/21 /2005 $3,420.05 $2.07 $3,422.12 Linda L. Phillips 10/21 /2005 273342-11 10/21 /2005 $17,533.35 $4.80 $17,538.15 Linda L. Phillips 10/21 /2005 MEMBERS 1ST FEDERAL CREDIT UNION ~~ Leigh- nne Stallings Insurance Services Assistant March 19, 2008 ~~8 www.memberslst.org REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER 2008-00182 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ J. J.HARTENSTEIN MORTUARY INC 9,669.31 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) SireetAddress City Year(s) Commission Paid: 2. 3. Attorney Fees Family Exemption: (1i decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees 110.0 0 5. Accountant's Fees 6. Tax Return Preparer's Fees 7 5 . 0 0 7. CUMBERLAND LAW JOURNAL 75.00 8. THE PATRIOT NEWS 222.15 9. CAPITAL CONSULTANTS 500.00 State ZIP TOTAL (Also enter on line 9, Recapitulation) I $ 10 , 6 51.4 6 (If more space is needed, insert additional sheets of the same size) • c ~~~-~~ ~•yy~~ 0 a ~~t-~l~1..111 ~ MORTUARY INC. January 2, 2008 Mrs. Linda L. Phillips 650 Fickel Hill Road Gardners, PA 17324 Professional Services for: C. Belle Frye Date of Death: December 22, 2007 Personal and Professional Services Services of Staff and Use of Facilities Automotive Equipment ~~e~c Freedoru L I. Hartenstein, Supen7sor Ashland Solid ASh Casket ?4 Second Street Post om~e Bo. ~~ ~ Sundry Items: Acknowledgement Cards, Register Book, ~e,~~ Freedom, QA n34~ Memorial Folders, Laminated Obituaries ,17.23>.38>' Voice 800.235.3857 Toll Free Family Flowers '(7.235.6688 Fax Two Rose Casket Panels ,~ r e ~~~ a r r s r o ~~~„ Cemetery Charges at Rolling Green Cemetery Charles T. Bo~~~en, Supervisor ~~> soutn Main street Five Certified Copies of Death Certificate @ $6.00 each Post OBice Boy 325 titewartstown. PA 17363 Clergy Honorarium "17.993.2307 voice 8??.993.2307 Toll Free Organist {',.993.352? Fay Newspaper Notices: Patriot News $252.78, Altoona Daily Mirror $235.52 Hairstyling TOTAL CHARGES Received on Account INVOICE Account Number: 07189 BALANCE DUE BY JANUARY 24, 2008 $ 3200.00 875.00 350.00 2575.00 200.00 371.01 60.00 1295.00 30.00 100.00 75.00 488.30 50.00 $ 9669.31 -9481.01 $ 188.30 Please make checks payable to J.J. Hartenstein Mortuary, Inc. and note Account Number on check. A return envelope is enclosed for your convenience. VISA and MASTERCARD are also accepted. TERMS: A late penalty fee of 1.5% per month (18% per year) will be assessed on the unpaid balance beginning 30 days from the date of the signed Statement of Funeral Goods and Services Selected. H n nr c' ~~ n r F u n era i s .S i ~i c e l N X 5 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 FRYE CLARA B Estate File No.: 2008-00182 Paid By Remarks: CLARA B FRYE AJW Receipt Date: 2/20/2008 Receipt Time: 15:17:21 Receipt No.: 1051642 ------------------------ Receipt Distribution ------------------------ FeejTax Description Payment Amount Payee Name PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 375 Total Received........ 60.00 15.00 20.00 10.00 5.00 $110.00- $110.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN Check Image Page 1 of 2 HOME ABOUT US CONTAC Check Image ~ Front of Check: ~,II~tD~ ~. F'~-IILT~I'~ ~ARD~ PA 17~3~ ~A~ ~: ~~ ~ Tii~ e•z yr ~ ~~. ~ ~ .,~.~: __ >. ~~~`f ~ i L`~!^ .i ._ - 1 Back of Check: Account Summary ' Transfers ~ eStatements ;Bill Payer Services 'Visa 'Loan AK Close https://m 1 online.members 1st.ors/OnlineBankin~/AccountSummary/Checklmage.px?accou... 4/22/2008 Check Image Page 2 of 2 alp ' ..~ , r 4qq~. LI ~ ~ },., ~ i a ~~~ ~ ~~ ~.1 ~ ~ ~ _ 3~ s y ~,- ~ ~~ ~ ~` 74~ } ~~ ~ jj . ~ i • X (] ~ h i l " ,.y , x r l~ ~ ~ -~~~ Gose Window ©2008 MEMBERS 1ST FEDERAL CREDIT UNVON MECNANICSSURG; PENNSYLVANIA INTERNET TERMS OF USAGE ~ PRIVACY STATEMENT ~ FRAUD & SECURITY t https://m 1 online.members 1st.org/OnlineBanking/AccountSummary/Checklmage.px?accou... 4122!2008 Check Image Page 1 of 2 HOME AE3C7UT US CONTAC Account Summary Transfers ` eStatements ;Bill Payer ,Services 'Visa :Loan AK Check Image close Front of Check: CLtV~A B. FRYE LINDA L. nHILL~'S nSU FICkEL HlI,L Iip. G,9RU,'~RS,, PA 17~?.1 rN~o~~r: t ~~~ s~~ ~ ~ ~~ j ~~.~ .. ~ ~xl~ hIC.41t7 -y " -°~.~ 1.,11'-s ~ ~1A ~.~ Back of Check: ~~' 37 C?~'~ rt4 ~,:.? ~J ~~ -~---.-~ 1A~5 1!' r dal. ~1 ~ 7~ .~~'C3t~~~~1~ i ~aD,~ https://ml online.membersl st.org/OnlineBanking/AccountSummary/CheckImage.px?accou... 4/22/2008 Check Image Page 2 of 2 ~~ ~R ~~:~~ca ~~~~ ~~ ~ ~ t7~ o~,p~ ~ ~ ~' ~ ~ ~~, ~ ~C- ~ ~C.C~.TC7~CC?'T9 ~~~Q~'369~~'~'OG ~~i Ct~ftS ~f"IX~~~~~~ ObOf~~OI~t~ ~c0~~~; I _ v ..___~_ __~a Ctose Window 02008 MEMBERS 1ST FEDERAL CREDIT UNION MECHANICSBURG, PENNSYLVANIA INTERNET TERMS dF USAGE ~ PRIVACY STATEMENT I FRAUD ~ SECUf2lTY c https://m 1 online.members 1st.org/OnlineBanking/AccountSummary/CheckImage.px?accou... 4!22/2008 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 March 7, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Linda L. Phillips Clara B. Frye Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: February 22, February 29 and March 7, 2008 Advertising Cost 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director PROvr Ut+' YU13L1C;A1'1VIV OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: February 22, February 29 and March 7, 2008 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Marie Coyne, TO AND SUBSCRIBED before me this 7 day of March, 2008 ~• Notary Frye, Clara B., deed. Late of Fairview Township. NOT!{R1AL SEAL Executrix: Linda L. Phillips, 650 DEBORAH A COLLINS Fickel Hill Road, Gardners, PA Notary Public 17324. CARLISLE BORO, CUMBERLAND COUNTY Attorney: None. My Commission Expires Apr 28, 2010 Check Image Page 1 of 2 HOML=: ABOUT US CC)NTAC Account Summary 'Transfers ~ eStatements 'Bill Payer ,Services !Visa 'Loan AF Check Image Close Front of Check: ~~ ~, ~ LINDA L. P~LLIPS tiSt~ ~7Cf~L H(LL Rt? G14RDI~i'ERS; FA ~T3"'.,~ 6~2~73t3 2i~+ IMle-(~' ~~ ~ ~~~~ ~ ~ C t~ ~' a~~ ~ ~ /~~~4 I ~ ~ ~~ ~.t~i `~ ntj m~ 1R ~LTblf169 wv~aslm~ay :~t~~~o Back of Check: https://m 1 online.members 1st.org/OnlineBanking/AccountSummary/CheckImage.px?accou... 4/22/2008 Check Image Page 2 of~ 2 a ~ ~ ~ .., ©~~ ~ .: ~[~as.,~cr~mS~! - ~ . C~v~,~tJ17-tau { ~ ~ ~" _ z:~ _ - - ~~ .~~ Close Window ©2008 MEMBERS 1ST FEDERAL CREDIT UNION MECHANICSBUR^v, PENNSYLVANIA INTERNET TERMS OF USAGE ~ PRIVACY STATEMENT ; ERAUO b S;=CURITY t https://m 1 online.membersl st.org/OnlineBanking/AccountSummary/CheckImage.px?accou... 4/22/2008 YLN;A IN; I)N. 1'A1:M ANI/ KN; I'IIKN IIYI'M:K P(IK'1'1l IN W 1 (H Tl11IK KN,M11 f ANt:N ~' ~ • • • ~ • 02/28 0001812657 800P-Main Legals EXECUTRIX NOTICE Estate of Clara B 1.00 x 15 Li 3 222.15 DA PennLive, PNCO, Start Date: 2114!2008 45 CL 4.9367 Amount to Pay: $222.15 ;, !; ~`7j t /C STATEMENT OF ACCOUNT AGING of PasT ouE aMOUNTs 1.• .1 .. •,.• .. . $ 222.15 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 222.15 c~.he ~latriot 1~ews All Billing Inquires (717) 255-8213 Now you know Fed. ID # 23-1304402 * UNAPPLIED AMOUNTS ARE INCLUDED IN TOTAL AMOUNT ~TM 1M Check Image ~~ Yage 1 of HOME ABOUT US CONTAC Check Image =ront of Check: ' ~LAiiA ~. T"RY ~ ~.IND~ ~. PHI~,LIPS tS~t ~1Ct{~E~ HILL gyp. 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A ~, .; -- ~;-r ~: r C A P I T A L CONSULTANTS INTERNATIONAL June 18, 2008 Linda L. Phillips, Ezecutrilz ESTATE of CLAI~A B. FRYE 650 Fickel Hill Road Gardners, Pennsylvania 17324 Dear Linda: Please find enclosed this statement for professional Services rendered on behalf of: Services related to Estate $500.00 Please make check payable to: CAPITAL CONSULTANTS T Thank you/ it ,~ $500.00 L 820 VOGELSONG ROAD YORK, PA 1 7404 USA 717.767.4899 fc~x.717.767.C~9h0 REV-1512 EX+ (12-03) SCHEDULEI DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER 2008-00182 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses, (If more space is needed, insert additional sheets of the same size) cNTL 5 0 41 Cla mont Nursin & Reha 2 ___-~_ 3a PA • • 0 0 C1 arernont Drive aEG ~. 5 0°.41 w t~ ~ ~'~~~ 0 0 02 Carl 1 S 1 e PA 17 013 s FED. TAx No. .'^ ~'~"'' ~ '```~"°' ' ~l oli - ~:3i~ EE's 243-2031 23-600311 112 07 1 3 07 ~~ ~~~'~~ ~ 5041 sPArFNr QDDR= ,. t °1Fr e Clar B b, - - - dl 10 BIRTHDATE 17 SIX ~~ ~ , MIBSIONYf#,~ ~= 76 DHR 17 STAT ~` ". -:, -- ' GO'VDITION CJD S2 ~ _ -~ _ , .: ?9 A OT .~` ~ca~~~--~~ ~; .tls'~ta'N~'~ia:~.., ..d3s~i : i. t ~ :._zn~ . z s.,;~, zy .. ' ~ a~ aT- ~,r~ ~....~..-..:~~- _,.ca._: i 05291929 F 112__80 01 3 ~4 30 ' I I ~ ~ 1 i3b;,~000URRENC~-s'~- a 3~OC6C~RRENPF.' a -RS ~.CUFRENCES ARl -%"~ ~ '. JCC 19 ANC S A~ ~- _: ~'S,yp, ~ qr s. ~COD~".~n-z: ~`~Aic x,..t;:h •n ~• .xCODL~''~e ,?~CYAI,> ~ _ •~ ~. -ODE - ~'~____ „ai ~ ,. _CODE, aJM _~ :HRYi ,ki~.,.,.., r..,.c.. ~~.c~ ~ ~ ~ ~„~ ~ "C ~I:~€5 ~ ~,... ~ ~~ ~_. _ ~ ~-. szr1~,,.,.,.'A~..,,'.r'~I". ~ .r ~ I `. r i ~#5-~-, x z+~`` ~S~a~'~ ~ ~~~ .~~,.. a-~ iro a f~ ~ . .&u r~ _ ,~_.,a,, :~ ..~ .,.~ ,., y^. .4 ~, lA iY7h 4 f~'i ~ ri as `k~. t'~v '. -_ - 3 ;'~~ VAtUE ~D~ - . ~ • • J, r6 VQ1C~.~DDESav"~h 'Clara B Frye CQDE_.. -'7EMUUNr __ •• a sC00 _~°AfAOUNT~.~'•~ CNRC a 8 0 3 , b _..s~-e ~"~:.7.~~a»~~~ -•.l.- S T a.. x'rs :`, ~3~ i7°°~ sl.t w ~ ~~ C + 42 REV. CD 43 DESCRIPTION 44 HCPCS /RATE / HIPPS CODE 45 SERV. DATE 46 SEFN, UNITS 47 TOTAL CHARGES ~ 48 NON-COVERED CHARGES 49 01_20 R & B NURSSNG CARE - SEM 225.00 3 675.00 - LaAdfi .,~^bl°m F 'a. .x2~ 4~ na ~„~.,~.at ~ -.~' ~-. ~.~ ~ w- i~vs~ _r, $ y ttgr~ an s. 0 0 01„ ' HARGE_ ~~'~~~~~~~~ ~`" is ~.~~. ~ s~. i y _'` p ~ . 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"§~~r: ~~ :r~FO ->ee:r _ - _ _ _ I_ PRIVATE PAY ~~~,IL~F_EI~~tONT ' I - ~ ~ - ~ CLAREMONT is ', ~ PRA .D _ i "' S". 59 P.pE~e 601NSUR,EDq UN10UE.1[ ,,:- 61 r'aQUP DIA' ~,r, ti',,,- ~-, - ~F ! z-1 ~~ f 41d= ., ' }A INSURANC GROUP NO `. , , .. _ • ,:. -. ~. app.. :. '. ~ry~ ~ lai ~ B ~ ~ 18 195224826 -i ys a'I TREATM ENT Au?HDRIZAT10NaCDDES ~~ ~~2~ ~ 64 DOCUMENT CONTROL NUMBER :z - - 6o EMPLOYER NF r ~__- __ I ~z 29410 ~ 244-9 ~ t:' ez:' ~ ~~ t;~ -,- - 66 ;: i.~ irY ~ A. ~; . #I"1 '9 ADMVF t. D~; - 2 4 4 9 70PATlENT REasoN D °. x~> +.. ~ i . ~ „ J7 PPS , - cooE << ., 72 .. _ ~Ea :•~ - :: 73 - . . _ .. 74 ,, :~.~° PRINC~PAI PROCEDURE "- _ ,;_ .,.CODE _,:..: DA7E • " •~ •• + •• b- OTPIEF PROCEDURE .: '~- ,_CODP-"~. ~. .DATE -o.~T-r_noiruG NPI - oua G 42366 ~sTWENNER, DO FIRSrDAVID • •-• • d. ~ YOTHER PROGEDURE __-- - • ~ i7 OPE4a71N3 - NPI IXLL -~ • ~ • . ODE-' ~ =31 DATE • • • • : LAST FIRST BO REMARKS - 91C•C 3 31 4 0 0 0 0 0 0 - ~780THER>.-- NPI ~ __ CL.41L. ~ ~ _~~ ~- :y'? b _ - - - - LAST FIRST c -- 790THEI7 ~- NPI QLbL - . d LAST FIRSi Claremont Nursing & Reha --- - - _ 2 ~NTA„ 5041 • • 10.0 0 _ .Cl aremont__ _Dr.ve------_- __ __ ---- -_----- -- _ _ R ~E~ 5 041 0 0 0,4 Carlisle PA 17013 -- ------- . _ __ _-_ -- _ _ SEED TAX NO 6 STATEMENT CONFAB PERfDD FROM THROUG 7 "" ' y ~ ~ 717 243-2031 23-6003.13_ 120,1.p7 12 .~.0 8 PATIENT NAME a CJ O 4 1 9 PATIENT ADDRESS a ,"~y ~ b Tara B e ~ tl a 10 81flTHDATE 11 SEX ADMISSION 12 CATE 13 HR 14 TYPE 755RC 16 OHR 17 STAT CONDITION CODES '18 19 20 ~21 22 23 24'~ 25 26 27 28 29 ACDT STATE 30 2 F 11280701 3 4 04 20 31 OCCURRENCE CODE DATE • •• -••' 33 OCCURRENCE CODE DATE • •• _ •~ 35 OCCURRENCE.SPgN CODE <FROM •THROUGH 36 OCCURRENCE SPAN CODE FROM THROUGH 37 Clara B Frye 39 VALUE CODES CODE AMOUPIT •~ s• •• • 41 VALUE CODES LODE AMOUNT Linda Phillips 650 Fickel Hill Road Gardners, PA 17324 a b a 80 21 42 REV CD 43 DESCRIPTION 44 HCPCS 1 RA7E I HIPPS CODE 45 SERV DATE A6 SERV UNITS 47 TOTAL CHARGES 48 NON-COVERED CHARGES 49 0120 0001 R & B NURSING CARE - SEM TOTAL CHARGES 225.00 21 4725.:00 4725.:00 ,~ ~ J ~ ^ `~ -y~ ' ~~ .~r _ I PAGE OF ~_ CREATION DAT E 010 7 0 8 • ~ 4 72 5 . 0 0 i0 PAYER NAME - 51 HEAL7N PI;AN ID 2 RE •INFO. :. 53-ASG 9EN.. , 54 PRIOR PAYMENTS 55 ESL.AMOUN7 DUE. - -56 NPI. PRIVATE PAY CLAREMONT Y Y 57 OTHER PRV 10 CLAREMONT 381NSURED'S NAtv1E - 59 P. REL 60:INSURED'S.UNIQUEID 6tGROUP NAME 62'INSURANCE GROUP NO. Frye Clara B 18 63 TREATMENT AUTHORIZATION CODES 64D000MENT CONTROL NUMBER 65 EMPLOYER NAME - ~x 29410 2449 66 69 ADDAgiT 2 4 4 9 REPSON O X 71 PPS ' CODE r2 73 - ECI 74 PRINCIPAL PROCEDURE CODE DATE • "• • • • • • b.. OTHER PR CODE OCEDU RE DATE 5 76 ATTENDING NPI OUA 4 • -• s - tl OTHEH PROCEDURE LASTWENNER, DO FIRSTDAVID •~ o• . CODE GATE • •• •• • •. 770PERAl'ING NPI OVAL LAST FIRST 80 REMARKS __... 87Co _ B 31 4 0 0 0 0 0 0 78 OTHER fJPI DUAL b ~ LAST FIRST .._ -...__.__..__. -. _._. .__. ____..__ 79, OTHER NPI DUAL {9251.-R07 www Rrinncfnrn rnm VE~04 CMS-1450 APPROVED OM tl R ND. D 938-1) 997 LAST FIRST 1V Utll: ,.~.:; ~„m.;:: TFP24394638 " •` "' •' •' '""""'"" v~v r nc nc vcn~e grrLr lu I HIS 61LL AND ARE MADE A PART HEREON Check Image Yage 1 of 'l HOME ABOUT US CONTACT Account Summary ', Transfers eStatements .Bill Payer Services ;Visa Loan AK Check Image Close Front of Check: i ,. ~L;~18, F`~Y 6501'lCk"`~ Hill: f~E7. A W ~r7~87Nf23i3 , ~ 1~733t2d ES~~`E ~ ~ ~J, ~t~° ,.. ~" 1~S~~~Il~ 2' rrnie~~[1~rru~a+ 1~Vn AtF, i ~ ......,.. .~ ~~82733~,~~~r' X335 ~,'D~~R~~'?~-~~~~' . Y~•+. na,~i Back of Check: https://ml online.membersl st.org/OnlineBanking/AccountSummary/CheckImage.px?accou... 4/22/2008 Check Image rag u,. # ~*=~ . - w ts. _ ;/ r ~F~^'"..t~l (_Y:~ ~)!'1_Ai I~ Ill S, %".I '~ f)t'.1<~ L I ~ t~ 43?~t?L~`.3 ~'~~ rC.lose Window ©2008 MEMBERS 1ST FEDERAL CREDIT UNION MECHANICSBURG. PENNSYLVANIA INTERNET TERMS OF USAGE ~ PRIVACY STATEMENT ~ "rRAUD 8 SECURITY 1 https:!/m 1 online.membersl st.org/OnlineBanking/AccountSummary/CheckImage.px?accou... 4/22/2008 l:hecx Image rage i or ~ i-iOME AF3QUT" US CONT'AC Account Summary '; Transfers ! eStatements Bill Payer 'Services Visa ;Loan AK Check Image Close Front of Check: s ... i hiEtlii;~ERS 1" -ur~~ut:auvrt s _..,~' ~t 4 Sack of Check: https://ml online.membersl st.org/OnlineBanking/Account5ummary/CheckImage.px?accou... 4/22/2008 SARA ~. FRYE ~-,~;~ ~rL~N1~A L~.}-r[~'Hi'LyLI~S 2-;~. 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', 7. io 7 a~~~ a~uurT ~Taau7 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 2008-00182 RELATIONSHIPTO DECEDENT AMOUNT OR SHARE NUMBER NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS include outright spousal disiribulions, and transfers under Sec.9116(a)(1.2)} 1. GARY P FRYE SON 33 1/3 0 144 MACINTOSH DR PALMYRA, PA 17078 2. LINDA L PHILLIPS DAUGHTER 33 1/3 0 650 FICKEL HILL ROAD GARDNERS, PA 17324 3. DEBRA E FISHER DAUGHTER 33 1/3 0 503 BENYOU LANE NEW CUMBERLAND, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 1 8,AS APPROPRIATE, ON REV-1500 COVER SHEET [I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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 ofthe same size) ~~~.t i.~~ ~~~ C~.~~.k~~.errt OF CLARA B. FRYE BE IT RL+"MEMBERED, that I, CLARA B. FRYE, of 115 Sunset View Drive, New Cumberland, Fairview Township, York County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. T~ EM _1~ T direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my three children, GARY P. FRYE, LINDA L. PHILLIPS and DEBRA E. FISHER, in equal shares, per stirpes. ITEM ~: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property ~eguired tc be inc~uded in ;ny grc:.s ~stat~, under the provisions of any state or federal law norr in force or hereafter enacted, shall. be prorated among the persons W~~TESS C- vv~. ,~ ~ .,s / ,. ~~ /,, C~ARA 8. FRYE G -1- interested in my estate to whom such property is or may be transferred or to whom any benefit accrues- ITEM 4: T appoint my daughter, LINDA L. PHILLIPS, as Executrix_ of this my Last Will and Testament. Should my daughter, Linda L. Philips predecease me, fail. to qualify, cease to act or renounce probate, I then appoint my daughter, DEBRA E. F=SFtER, as alternate Executrix of this my Last Will and Testament. JTEM 5: I direct that my Executrix. or her successor shall not be required to give bond Par the faithful performance of their duties in any jurisdiction. IN WITNESS AHEREOF, I have hereunto set my hand and seal this ~~ day of ~'~~ ~~__~ 2000. I I i NESS : r A /' w, - (J"-~ ,~,K ~" r.~'iL..ai .~~,~il.i '~ ( SEAL) - ~ARA B. FRYE i/ i -2- CpMMONWEALTH OF PENNSYLVANIA, ss COUNTY OF YORtc We, CLARA B. FRYE, JAN M. W:CLEY, E6QtTIRE and MICHELE A. RENERER, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her tree and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and Testament as witness and that to the best of their knowledge the Testatrix was at the time eigYtteen (la) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this ~~'~~ day of ~) G-~-v ~~ z o 0 0 . ~~ NOTARY PUBLIC MY COMMISSYON EXPIRES: Notarial Seal ~~ S, pawn Gladletler. Nolary Publie Dillsburg Boro, York County My Commission Expires May 77, 2001 em er, annsy vania gssanatiptt a otanes ~'`. i t 1 Q Z e}' Q r J ~ f4 ~ ~ ~C ~ ~ f~ Z ~> ~Uv°~c C i r~i~ ~ ~~.~ 0 ~~~ -~-~~~ w f W V ~ o ~w o C N O ~ O Fa. 2 ~ ~ y w 2 L r U } F ~ - Z r- ~ ~ 'c = O ~ p ~ _ ~ ` (n ' N ~ Z ~ ~ ~ N ~ Boa- m ~ ~' -= s ~ o :~ = c _ ~ a~ U .- U _ Q t , F l i~ . ':. '..