HomeMy WebLinkAbout08-26-0815056051058
REV-1500 EX (06-OS) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 21 08 0329
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03/06/2008 ' ` 02/16/1926
Decedent's Last Name Suffix Decedent's First Name Ml
Downes Lois J
(If Applicable) Enter Surviving Spouse's Information Befow
Spouse's Last Name Suffix Spouse's First Name MI
E~pouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return 2. Supplemental Return ,,, 3. Remainder Return (date of death
prior to 12-13-82)
:+ 4. Limited Estate 4a. Future Interest Compromise (date of _ 5. Federal Estate Tax Return Required
death after 12-12-82)
~: 6. Decedent Died Testate 7. Decedent Maintained a Living Trust _Q 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received „~_ 10. Spousal Poverty Credit (date of death . ,;... 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Michael A. Scherer, Esq ! (717) 249-6873
Firm Name (If Applicable) _ _ __
REGISTER OF WILLS USE ONLY
U'Brien Baric & Scherer
First line of address _ ty' r~
,-.
19 West South Street
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Second line of address _ ~-~ 1 -
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__ IIATE~ED
.....
City or Post Office ZIP Code -,
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State
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-
'Carlisle ._
.
' PA 17013 _t; =,; .,~
Correspondent's a-mail address: mscherer@ObS18W.COm ~
Under penalties of perjury, I 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN TE
\~cv~•~- k lrr c ~.~..L.~...-'. ' ID' ~A
ADDRESS
1954C Walnut Bottom Road, Carlisle, PA 17015
OTHER THAN REPRESENTATIVE
•/O-J
19 West South Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
15056052059
REV-1500 EX
Decedent's Social Security Number
Lois J Downes
' '
Decedent
s Name:
RECAP{TULATION
1. Real estate (Schedule A) ........................................... .. L
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. ' 202,336.46
6. Jointly Owned Property (Schedule F) :w~;; Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) _=':::';~ Separate Billing Requested...... .. 7.
8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ' 202,336.46
9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ' 17,225.35
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 487.90
11. Total Deductions (total Lines 9 & 10) ................................. .. 11. ' 17,713.25
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ' 184,623.21
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. '
. 184,623.21
..,
.
. .,..
. ._ .
.
...... _.
..
_. .,.,,,_ _.._....__ .. ._ w.,,,,...__.__. ..,,, ., ~....._.~.._.._ , ....
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 .0 45 184,623.21 ',
16.
8,308.04
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 OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 0329
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
Lois J Downes 201-16-2208
STREET ADDRESS
1954C Walnut Bottom Road
CITY
Carlisle: STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments 7,750.00
C. Discount
387.50
Total Credits (A + B + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total InteresUPenalry (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
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.
(5)
(5A)
B. Enter 1:he total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
8,308.04
8,137.50
170.54
170.54
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 sha11 use the property transferred or its income : .................................. .......... ^ ^x
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 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? .... .......... ^ 0
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.
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. §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 zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)], The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 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. §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-1508 EX+ (6-98)
SCHEDULE Ep
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois J. Downes 21-08-329
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. RVS Bond Fund, Acct. No. 0011236430289002 4,472.35
2. RVS Tax Exempt High Income Fund, Acct. No. 0011535630286002 5,355.47
3. Fixed Retirement Annuity, Acct. No. 0930023022419004 39,126.27
4. Citizens Bank checking account # 6100727300 5,076.21
5. Citizens Bank checking account # 6106439129 5,637.15
6. Highmark refund for medical insurance 445.96
7. Orrstown Financial Advisors : Account # 50000781007 107,188.03
8. United States Treasury 300.00
9. Securities Benefit IRA Contract Number 00392870 34,735.02
TOTAL (Also enter on line 5, Recapitulation) $ I 202,336.46
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE N
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois J. Downes 21-08-329
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t' Hoffman Roth Funeral Home & Crematory, Inc. 8,787.54
2. Carlisle Memorial Service: inscription of grave marker 170.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)IEIN Number of Personal Representative(s)
Street Address
City .State
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
z. Midland National L{fe Insurance Company -March 15, 2008 payment
s. Cumberland Law Journal: legal advertising
9. The Sentinel: legal advertising
Zip
Zip
7,500.00
338.00
95.00
37.35
75.00
222.46
TOTAL (Also enter on line 9, Recapitulation) I $ 17,225.35
(If more space is needed, insert additional sheets of the same size)
REV•1512 EX+ (t2-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Lois J. Downes 21-08-0329
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)
REV-15'13 EX+ (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois .J. Downes 21-08-329
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trusteets) AMOUNT OR SHARE
OF ESTATE
t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
2• Donna McKeehan, 1954C Walnut Bottom Rd., Carlisle, PA 17015 daughter 0.25
3• Frank Cohick, 201 West Pine St., Mt. Ho!{y Springs, PA 17065 son 0.25
4• Megan Cohick, 242 Old Tioga St., Wellsboro, PA 16901 grandaughter 0.05
5• Adam Cohick, 242 Old Tioga St., Wellsboro, PA 16901 grandson 0.05
6. Tamara Fitzwater, 15 Kim Acres, Mechanicsburg, PA 17055 grandaughter 0.05
~• Tina Cohick, 623 Mallard Drive, Etters, PA 17319 grandaughter 0.05
8• Charles Cohick, 147 Stoney Run Road, Dillsburg, PA 17019 grandson 0.05
9• Christy Lee Cohick 2571 Walnut Bottom Road, Carlisle, PA 17015 son 0.25
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
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 ~ $ 0.00
(If more space is needed, insert additional sheets of the same size)
W I L L
I, LOIS J. DOWNRS, of R. D. ~5, Carlisle, Cumberland
County, Pennsylvania, make this my will and revoke any wills
or codicils to wills heretofore made by me.
1. I give, devise, and bequeath my entire estate to my
husband, Carl N. Downes, if he is living thirty (30) days
after my death• otherwise ;I give, devise, and bequeath the
same to'ray~chi~dren', Char~es'S.•Cohick now of R. D. #5 Carlisle,
Pennsylvania, Do a K. Rhoads now of R. D. #2, Carlisle, Penn-
sylvania, Christ~ee Cohick now of R. D. #5, Carlisle, Pennsyl-
vania, and Frank S. Cohick now of R. D. #$, Carlisle, Pennsyl-
vania, in equal shares.
2. I appoint the Commonwealth National Bank (Carlisle
Branch) guardian of any property which passes, either under
this will or otherwise, to a minor and with respect to which
I am authorized to appoint a guardian and have not otherwise
specifically done so. Such guardian shall have the power to
use principal as well as income from time to time for the
minorts support and education (including college education,
both graduate and undergraduate) without regard to his or her
parents ability to provide for such support and education,
or; to make payment for these purposes, without further respon-
sibility, to the minorts parent, the minor, or to any person
taking care of the minor. The term °minor" as used herein
shall mean a person under the age of.twenty-one pears.
3. I appoint my husband, Garl N. Downes, executor to settle
my estate. If he fails to qualify or ceases to act as such,
I appoint Donna K. Rhoads, above, executrix to settle same. If
neither of .them survive me, I appoint the Commonwealth National
Sank (Carlisle Branch) executor to settle my estate. My executors
shall serve without the necessity of filing bond. And I direct
that the service of A4arion R. Lower, Attorney at law, of Carlisle,
Pennsylvania be used in the settlement of my estate.
March ~, 1974 ~~-~ 't~ ~d~-w~~
ois ownes
Signed, published, and declared by Lais J. Downes, the
within testatrix, as her last will, in the presence of us, who,
at her request, in her presence, and in the presence of each
other, have subscribed our names as witnesses thereto.
,..- ~ ~
~it~cc~ey
~ --'~~
- e'i-U'R-~.~.
t ~ t,,~
:;;
~~ Citizens Bank
Account Number 6100727300
Account Title LOIS J DOWNES
Date O ened 6/6/1966
Account Tye Checking
Princi al Balance as of DOD $5,076.21
Interest from Last Postin to DOD $ .00
Account Balance as of DOD $5,076.21
~'TD Interest to DOD $ .00
~~ Citizens Bank
Account Number 6106439129
Account Title LOIS J DOWNES
Date O ened 6/17/2002
Account T e Checking
F'rinci al Balance as of DOD $5,637.15
Interest from Last Postin to DOD $ .00
Account Balance as of DOD $5,637.15
YTD Interest to DOD $8.43
The Personal advisors of
Ameriprise =W
Financial
March 27, 2008
Michael A. Scherer
O'Brien, Baric & Scherer
19 West South Street
Carlisle, PA 17013
Dear Michae{:
PE~r your request, the following is a list of the accounts held by Lois Downes here at
P.m~riprise Financial as of March 6, 2008 and their balances as of tha*. da±e.
RVS Diversified Bond Fund -Account #0011235630289002
Ownership: Lois J. Downes
Value as of March 6, 2008: $4,472.35
RVS Tax Exempt High Income Fund -Account #0011535630286002
Ownership: Lois J. Downes
Value as of March 6, 2008: $5,335.47
Fixed Retirement Annuity -Account #0930023022419004
Ov/nership: Lois J. Downes
Value as of March 6, 2008: $39,126.27
Also, we will require a certified copy of Lois' death certificate, rather than a copy, in
order to process her estate settlement. Please send that to me at 30 D East Roseville
Road, Lancaster, PA 17601.
If you have any other questions or need additional information, please do not
hesitate to contact me at 717-431-2996, ext. 141.
Thank you,
~~~lt~~ S
Scott M. Bechtold, ChFC®, CRPC~, CLUB, CFS
Senior Financial Advisor
Bechtold & Associates
A financial advisory practice of
Ameriprise Financial Services, fnc.
30-D East Roseville Road
Lancaster, PA 17601
Tel: 717.431.2996
Fax: 717.431.2998
Toll Free: 877.791.6268
An Ameriprise Platinum
Financial Servlces~ practice
Scott M. Bechtold, ChFC~,CLUm,
CFS, CRPC°
Senior Financial Advisor
scott.m.bechtold@ampf.com
CA Insurance #OD02523
James E. Davis II, CFP~, CFS, CRPC~
James W. Kelm III, CFS, CIMA~
Gary 1. Kreider, MBA
Associate Financial Advisors with the
practice of Scott M. Bechtold, ChFC 3 ,
CLU%,CFS,CRPC§
cc: Donna McKeehan 04j08/08
~.' 6,~0~
An Ameriprise Fir.anc~al franchise. Ameriprise Financial Service,, Inc. offers financial advisory services, investments, insurance and annuity products.
RiverSource' products are offered by affiliates of Ameriprise Financial Services, fnc., Member FINRA and SIPC.
Account: 50 00 0781 0 O7 LOIS J. DOWNES
INVESTMENT HOLDINGS AS OF 3/6108 (DOD)
Cusip No. Security Name
19765J830 COLUMBIA MIDCAP VAL
2908:38103 FORWARD ENi GR.:.YVTH
31428010 i FED TOTAL RETURN BD
60934N625 FED MONEY MKT-PRI
60934N621 FED MONEY MKT-{NC
'41479109 T ROWE GROWTH STK 40
922031810 VG IT INVESTGRD ADM
9220`_i1836 VG ST INVESTGRD ADM
922038203 VG GLOBAL EQUITY FD
922908496 VANGUARD 500 IX SIG
TOTALS
DATE.
COMPLETEDIBY:
4/25f/200/8
•'~/l 1
Shares /Par DOD Price DOD Value Accrued Income
749.4870 12.86 $9.638.40
910 *~ ~ 70 10.56 59.614.00
1,379.7820 10.62 514,653.28 S12.47
15.058.8400 1.00 515.058.84 S7 74
3.724.6500 1.00 $3,724.65 52.07
331.5260 29 53 59.789.96
1.489.5180 9.84 S 14.656.86 512.91
927.1810 10.74 $9;957.92 57.84
471.5830 21.03 59.917.39
101.7540 99.59 $10.133.68
$107.145.40 _43.03
CHARLENE L. ~EUCHTENBERGER
FIDUCIARY OF~"{CER
art i = - - ,_ _ - -
-~~~ SECURITY BENEFIT"
~~~
June 9, 2008
BENEFICIARIES FOR LO1S J. DOWNES
ATTN MICHAEL SCHERER
i 9 W SOUTH ST
CARLISLE PA 17013
Subject: Contract Number: 00392870, LOTS J. DOWNES
To Whom It May Concern:
We received notification that Lois J. Downes has passed away. Please accept our condolences
and extend them to the family.
Our records indicate the primary beneficiaries for the above contract are Donna K. Rhoads and
Christy L. Cohick. This letter is to notify each beneficiary of the options they may exercise with
the Security Benefit annuity. As with any decision that may impact your finances, we recommend
contacting a financial planner or tax advisor for guidance.
Please review the options below, complete and return the enclosed Proof of Death Form along
with the original certified copy of the Death Certificate.
1. Lump Sum Payment: Under this settlement method, a tax liability may be incurred on the
entire distribution. Please note this distribution would not be eligible for rollover to an IRA
or other qualified retirement plan. To receive a distribution, select option "A" under section
3 of the Proof of Death Form.
2. Establish Beneficiary Account: Under this option, the account will be registered as "Jane
Doe beneficiary for Jack Smith, deceased", where you will remain as beneficiary. As a non-
spousal beneficiary, you are required to begin taking distributions using one of the
following two options:
a. Payout within 5 years of date of death -Withdrawals may be deferred for a full 5 years
following the date of death. Distributions may be taken systematically or in a lump sum.
A tax liability is not incurred until you begin receiving payment. To choose this option,
select option "C"under section 3 of the Proof of Death Form, and, if you're ready to
being taking distributions, select option "C" or "D" under section 5 of the Proof of Death
Form.
b. Life Expectancy -This option allows you to spread your tax liability over your life
expectancy. You must receive your first distribution within one year following the date
of death. Select option "C" under section 3 if you wish to use this option. 1f you're
ready to begin taking distributions, select option "A" under section 5 of the Proof of
Death Form.
In the event the deceased client was receiving Scheduled Systematic Withdrawals (SSW), any
payments made after the date of death must be returned to Security Benefit before a distribution
due to death can be processed.
~r. ,.^~~. -~ ..,_ Top ~~~~ ~ .asas :,ob.;5-G~~~ . ~ "i .-., z _ e ~~
=~~~ SECURITY BENEFIT"
/l~''
The va{ue of the client's account as of the date of death, March 6, 2008 was $34,735.02. This is
the only contract we have for this client. It is not joint owned.
We recognize this can be a difficult time for making financia{ decisions. If you have questions,
please call our National Service Center at 1-800-888-2461. Our representatives are available
Monday through Friday from 7:00 a.m. to 6:00 p.m. Central Time.
Sincerely,
~ ~ ~ ~~~~
Angela Moser
Client Service Specialist IV
Service Operations
Security Benefit
,:
~
`
Hoffman-Roth Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, PA 17013
(717)243-4511
April 3, 2008
Donna Rhoads McKeehan
1954 C. Walnut Bottom Road
Carlisle, PA 17015
The Funeral Service for Lois J. Downes
15273-66
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE:
Traditional Funeral Service Package $4150.00
FUNERAL NOME SERVICE CHARGES $4150.00
SELECTED MERCHANDISE:
Livingston Casket, $2490.00
Monarct~ Interment Receptacle , $1120.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $7760.00
Cash Advances
Opening Orave $500.00
Newspaper Obituary Notice- Sentinel , $146.54
Newspaper Obituary Notice -Valley Times Star, $35.00
Clergy Offering . $75.00
Certified Copies of Death Certificates , $72.00
Flowers. $159,00
Hairdresser, $40.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES . $1027.54
Total
Total Cost , $8787.54
TOTAL AMOUNT DUE $H7H7.S4
This statement is net and payable in full within 30 days of receipt.
Please return this portion with your Remittance
$ Amount Enclosed Service ID # 15273-66
Lois J. Downes
CARLISLE MEMORIAL SERVICE, INC.
41 SOUTH BEDFORD ST
CARLISLE, PA 17013
~ BILL TO ~
DONNA MCKEEHAN
1954C WALNUT BTM RD
CARLISLE, PA 17015
INVOICE
DATE INVOICE
6/5/08 28-052
[TERMS TELEPHONE
[ NET 15 DAYS 717.243.5480
ITEM DESCRIPTION AMOUNT
MONUMENT __
LETTERING FOR LOIS COHICI;; SUPPLIED THE
DATE 2008 PROSPECT HILL C1?P,~TERY 170.00
TOTAL BALANCE DUE 70.00
THANK YOU FOR ALLOWING US TO SERVE
YOU.
~,~ ~ ~
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
James Kleinklaus Advertising, Operations Director, of The Sentinel, of the
County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL,
a newspaper of general circulation in the Borough of Carlisle, County and State
aforesaid, was established December 13,1881, since which date THE SENTINEL has
been regularly issued in said County, and that the printed notice or publication
attached hereto is exactly the same as was printed and published in the regular editions
and issues of THE SENTINEL on the following day(s):
Apri19,16, 23, 2008
COPY OF NOTICE OF PUBLICATION
NOTI E ~ GRANT OF LETTERS '
j
Notice is hereby given that the undersigned has been i
granted letters testamentary by the Register of
Wills of Cumberland County, Commonweatlti of
Pennsylvania, as Executrix of the Estate of
LOTS J. DOWNES, late of the above-named county.
Request is hereby made that all. persons having claims
against the Estate of the decedent make such claims
known to the personal representative or to such
person's attorney without delay. Request is
also hereby made that all persons indebted to the
decedent make payment to the personal
representative without delay.
Dated: April 3, 2008
Donna K. McKeehan
1954C Walnut Bottom Road
Carlisle, PA 17015
Michael A. Scherer, Esquire
O'Brien, Baric & Scherer
19 West South Street
Car{isle, Pennsytvania 17013
(717)249-8873
Affiant further deposes that he/she is not
interested in the subject matter of the
aforesaid notice or advertisement, and that
all allegations in the foregoing statement
as to time, place and character of
publication are true.
Sworn to and subscribed before me this
23=d day of April, 2008.
Notary P is
My commission expires: ~1! /~0
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Christina L. Wolfe, Notary Public
Carlisle Bono, Cuntbedartd County
My Commission Expires Sept 1,2008
Member, Pennsvtvania Association Ot Notaries
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May lb, 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 ,vas printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
April 11, April 18 and April 25 2008
Affiant further deposes that he is authorized to verify this statement by the Cumberland
I,aw 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,
Downes, Lois J., deed.
Late of Cumberland County.
Executrix: Donna K. McKeehan,
1954C Walnut Bottom Road, Car-
lisle, PA 17015.
Attorneys: Michael A. Scherer,
Esquire, O'Brien, Baric & Scherer,
19 West South Street, Carlisle, PA
17013, (717) 249-6873.
SWCSRN TO AND SUBSCRIBED before me this
25 day of April, 2008
Notary
NOTARtAI SEAL
DE80RAH A COLLWS
Notary Public
CARLISLE BORO, CUMBERWN~ COONT(
My Commiss!on =xpires Apr 28, 20}0
~ MIDLAND NATIONAL
Life Insurance Company
Lisa M. Olson
Repetitive Payment Specialist
Phone: (605) 3355700 • Fay: (605) 335- 3621 • e-mail: lolson@mtilife.com
March 27, 2008
O'Brien, Baric & Scherer
Attn: Mr. Scherer
19 West South Street
Carlisle, PA 17013
RE:. Supplemental Contract Number 1600187329 -Lois J. Downes
Dear Mr. Scherer:
Thank you for the recent notification of the death of Lois J. Downes. On behalf of the
Company, please extend our sincere condolences to the family.
Ms. Downes' contract was annuitized on February 15, 1996, as a Ten Year Certain and
Life Contract. It provides a monthly payment of $37.35, for a guaranteed ten years and
life thereafter. No further benefits are payable whin she passes away.
Unfortunately, we must ask for reimbursement for the March 1 S, 2008 payment. Please
submit a check for $37.35 made payable to Midland National Life. I have enclosed a
return envelope for your convenience.
If you have any questions, please contact me at 800-923-3223, Extension 32276.
Si erely,
L sa Olson
Claims Department
Enclosure
cc: Donna McKeehan 04/03/08
MIDLAND NATIONAL LIFE INSURANCE COMPANY ~'t'~-~~l~-~
ONE ~I II~i.A Nib Pi ale cr~r.v r ... c .. .~ .... ,.- ^---