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HomeMy WebLinkAbout08-090415056051047 J- REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT a ~ C ~ ~ ~ a' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ ~ "~ ~ ~- Decedent's Last Name Suffix Decedent's First Name MI ~ ~~k,~ y% ~~ Cites ~TieLa~ ~- (If Applicable) Enter Surviving Spouse's Information Below Sp^ouse's Last Name Suffix Spouse's First Name MI / ~~~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 Firm Name (If Applicable) ~~ ~ / First line of address Second line of address ~/ City or Post Office Correspondent's a-mail address . State ZI)P Code _ ~'~ 7 ~ ~~~ 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 n all information of whi prep rer has any knowledge. SIGNATt~1RE OF PERSONiRESPOp1SIBLE FOR FILING RETURN ~ DATE ~~~.„~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE iii?, ~ 7~JC ADDRESS ,~~~~ PLEASE USE ORIGINAL FORM ONLY 15056051047 Side 1 Ef~tZ~ WILLS ~'-- S1 'CT? ~, j ~.4_ ~:A DATE LED ~ONLY_ "'y ~: ; I : --y'r t.-1 - _ z~ r _., ~-~ =y ~ i ",'S -:. t ,r~ ~~ _.il IV 15056051047 ~' 1,5056052048 REV-1500 EX Decedent's Social Security Number / J J' 1 ` ' ` ~ j~ ~ ~~Z ~ ~-~^ . Decedent s Name: ~ ~ + ~ / -/~ i /"~ -- RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. 1. • ~ ~J 2. Stocks and Bands (Schedule B) 2• d ~~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. • ~~ ~> 4. y q ( ) ........................... Mort ~a~ es & Notes Receivable Schedule D q. .. • CJ 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ...... .. 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ~ ~~ ~ ~ ~~ • ~~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property t d Billi R 7 . ~ ~} ..... eques e ng (Schedule G) O Separate . ... 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. • 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) ............. ... 10. 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 13. Charitable and Governmental BequestslSec 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. !w s,~ ~ L5 K' ~ ~ • ~ / 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 [~ Q Q 15. 16. Amount of Line 14 t xab!e •~" ~ G' ~ 16 Q C'a at lineal rate X .0. j . 17. Amount of Line 14 taxable y / n ~ ~ ~ ( ~ L 17 at sibling rate X 12 _- - _ ,i = - - / -(G ~- - _ -, . ,. - - . _ .. _ ~-_ 18. Amount of Line 14 taxable 0 ~ at collateral rate X .15 18. (c~ • C~ '~ ~'? ~ 19. TAX DUE ....................... ...... ....................... .. 19. , ~.. 20. FILL IN THE OVAL iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 ],505605?048 RE'~J-1500 EX Page 3 Decedent's Complete Address: File Number _ ~.- - SiREETADDRESS _ __ _ __ _ _ s' !, CITY _ __ _ _ g7ArE ~~ ZiP / 7e-' /~ ~~ ~B U~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit _ ._ _ _ _ _. __ _. B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable D. Interest E. Penalty _ _ _ _ _ ___ Total Into-restlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVEIZPAY'ViErVT. 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. (5) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (56) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ Q 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 mast for" or payable upon death bank account or security at his or her tleath~ ........... 4. Ditl decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE AEOVE 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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets an,d 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)]. A sib!irg 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 E% • (t-97) ~- /+ ~+ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF L-/~CkE,Y lyy~ fs ~~N~ ~, FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. .lr~ r Ma~l,~ D NOr. ~ N oft : X71 2Ged crtf ~ i Ve rl W i •}'~ hur' vvw~tr~ w {~.o predeeeASed hex'• IvLosf ~ -~ -~KrniS~i nyS ~'td Con~cn~s ~ -}P,~. res~~en~'i~.l rer.~ es~a~'c hn.ore ~.,lly c~cseri b¢.d on Schecl, ~ ~ ~Itbw~ny H erein ~ WGrG DWhed by deec.~leni'a Mo~X'. ~eeeelex~t owned ~ ~Ilot,~i-1q ~~~'ems ; ,~. v/ct~ bccr , ~i r Cp~cli i~i'vn d ~~~. DD ,,Q. ~iv%n L'tiQirs~ ~rl~eo/ wvd~/ ba.~l~s, cy~~iv/sf~re~ ~scafs ~.sba. Bo L'_ rn,~r6/~ ~P ~ad/c ~/~s, afl ~. eGro~a leri~'- f~filr~n qty/c -~e~Qnyular/js~una~ w_ /eQ~s cyo ~b/e. Heav;/y awl re~eafe~ly P¢,~~A! ~l~p`oea; ,o/s~~ ~ bye Cloflr ~oQrf. al y ~lte/fcu~ ~'~ sfic~.C' fibir~ ~Sc>G~ X35; v~ ~i cl~rl4 - rleea~~ ~/ ,~ /~/r~, p~/aSh~~liin~/ /Loeo~ls ~/3S. d~ ~ /Ylarb~c ~~, Clo~/l ~a/~ /Plan f/c shy/e, /ri~,~ ` ~r has ~f wo~'ked ~Y n~~ ycars~ ~d. eo G • ,C~arr~s~'• s~ lc w~o~~ hook ease ~ /as eo TrJTAL (Also enter on line 5, Recapitulation) I $ R_~.,...ex-, ~r- ~., ~,..~ COiviMOPIWEALTH OF PENNS'i ~VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT E"a?ATE OF S~HE~~1LL~ F J~Ii~ i L~'-®V~N~~3 ~R®~~Rf~ FIE_E NUMBER L /; Ck Ey, C~SIr2~STi.Y~ c If ar asset was made joint within one year of the decedents date of death, iT must be reported on Schedule G. SURVIVING JOIN T TENANT{S) NAME B. LR-~R..~NC~ /YJ. H~~DE~2 C. S l~Z/}-NNE ,F~i4i2TiyE/ytaQE JOINTLY-OWNED PROPERTY: ADDRESS ~~9(, Easf ~'af~:ck ~# ~fit~ci' G.rI ~N 1519 Le~'cl~warfkZoQd Cee.n~ N; bl, pA 17 o t I NGtu C krn bcrla~nd, PA I ~ ono / 7(09 Kelndatl ~r~ ve /Y1CC.~'IAYI~CSIjttrq, ~~ 170 SS' RELATIONSHIP TO DECEDENT rn~!" re ~t¢l' 5 ~s~r- s isfer' ITEM NUMBEP, 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 LATE OF 6EATF; VALUE OF DECEDENT'S INTEREST 1. A. 6)?S/0/ ~e~eden~ waS a -lo'-nf -fean~i,n~' W;'~'~, ~ ' ~'i ~ht v~ Stcrv ~ v o rs l- ~ p ofn deed -}fl ~. ~L°S ~GiP11~Yt~ ~ P_S~Ot~C l^n '~tc .BprpLC ~ B~ Lcm by nc, Ct~.rn ber-land CQ c...nT~, nn- Sytvan i a ~ hcw~ ny Ann u.ctdress o f 31 ~ E Gtlal~bn Sf , as is more p~~:«.la.ly dc- Scribed tnn ~-~ta.# cer~'c~~ n deed fr`owt .Ssalorl S. Ha-rder~ wielpw~ fiu her I've (s) Chi Id t~u~~ -~ (,u ~ ~ : GC V`Aa ~ P N a.rr d G-^, 1. Ccw rGr-c~. YYl . _ _- _ =- -=- - °-- 1 -_ ~ ~,.~ o-re -_ Chris) Hat~dur , Suzanne Pa~hC ~ -__ --- , ~ine. E. Lt~leey (dccc.eton~' hct^e~n~, cw-aP ~afiG,lee~n M. ,Mccr~-~n~ reco~dled w; ~f-{«. office of -F~ ~Reeorder of Deeds ih a,ncl -fir C+•~ber~,nd Cpux,~y w- Deal B©mk a47, P~e 1 b~} g pMd h[Wi n~ ci. ~ ~a.n_e.! Ylo• I a- 1.2-p$22 -21D. ~SGe -}t-ttit a,hc~ Co~rtr'- cc.!- Copy a~ decd a.~t~-a~he.d~. Ct~.-~x-berla,nd Cou.inrt'y ~!SSessrncn.~ = ~I12, 430, t ; z,S t7v. ~0 - 2p fn 05~ ~aS b3`f 'Rcle~a,nt imu.l~~plcer was I,/c{ _ , , ' i b~// afhr~tied~ IOTA! 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O H 3 O O ~ > j > > a m m Y M r m o a N C ~ o ~ 0 C 0 0 0 0 C C C G O O R h A a o. o. a a. a, rt n r. rt c c c c > > a rt ~ ~ ~ C Z 0 0 0 0 0 0 0 0 0 g q q v n n n n o 0 0 0 a 7~~ m rv m m a a m w w 0 0 .- .- .• .- ~ .~ .• .• a 0 0 0 o 0 0 ~ x x x» +~ w w x x .r .r x w x ~ y X A m .c .o r ~.. v ~.. .c o m ~n m u. ~n a to ~u m N o N N m v m r ~+ ~ ~O .'~ S O ~n ~ m n b ~o n n x o n T c ~ µ o o w c v - o n w .n c ~ ° - ~ n o n ~ c n . m ~~ m~ r w Y ~ o Y o n m w~ w 7 a ~ w o n ~ m r ~ °~ m 1° w c `~ ~ o 7 ~ m G < n c w w '< d o d H o ~ W `C ~0 a v y m m V b n w O ~ o c o ~ w w v > > n < - ~Op w `C C O (~ ~ O 3 O' ~ K a N ^ w n ~ ~ n z V m O 3 l0 N O .> O > 0 0 0 0 0 0 0 o rn m m m g n m n Y n n n c ° c c ~ C7 ° n n c n ~ n ~ $ s. ~ a ~e ~ ~< o. 3 Z 0 W t0 ~O ~O t Q Q Q lY m ( D wN ry ry r~ ry < < < < ry ry ry ry ry r ry < < < < < < < < ~ K `G `2 O w x X x x sr X x x x x X k M , + m m sHS a s v. ti ~~ o ~ ~. w~ Hi 3 b Ib'arranty Deed _ ~ ~~ THIS DI=D ~,~ ~~! 5 i i~ i? i6 MADE THE k~' day of June in the year of our Lord Two Thousand One (2001). BET4dEEN IS ABEL S. H_4RDER, a Widow, of Cumberland County, Pennsylvania, Grar~tc. -AND- GERALD P. HARDER, LAWRENCE M. HARDER, SUZA?~NE PARTHMORE, CHRISTINE E. LACKEY and K_4THLEEN M. MARTIN, as Joint Tenants With The Right Of Survivorship, Grantees R'ITNESSETH, that in consideration of -----0?~TE ($1.00) DOLLAR and Other Valuable consideration, in hand paid, the receipt whereof is hereby acknowledged, the said grantor does .hereb3~=~~,:~t-ar3d-co- -P- °~~g~rn~~-,-- --- ALL THAT CERTAIN lot of ground situate in the Borough of Lemoyne, County of - Cumberland and State of Pennsylvania, more particularly bounded and described as follows, to wit: BEGIlv'?v`I?vG at a point on the northern lire of `~%alton Street at the line of property now or formerly of William E. Bowman. said point being two hundred seventeen and eight tenths (? 17.5) feet measured westwardly along the northern line of Walton Street from the western line of Rossmovne Street; thence in a northerly direction aiong said property no~~ or formerly of William E. Bowman, at right an~•les with u~aiton Str°et, one hundred (100) feet to a point. on the line of property now or formerly of Edward Dri:~.h-~-ater; thence in an easterly direction along said last mentioned property and parallel writh J~'alton Street, fifty (50) feet to a point on the western line of a seventeen and eight tenths (17.5) feet wide private alley; thence in a southerly direction along the western line of said alley and at right angles with Walton Street; thence in a westerly direction along the northern line of Walton Street, fifty (50) feet to a point or place of B EGINNP.~IG. IT4V'?~TCY TI-IFRFnr1 ERECTED a tT,~~o-stor;~ ~^e?„ent bincl~ and sh in~l° d~~:>el.ng 1?c~Se known as, and numbered, 319 Walton Street, Lemoyne, Pennsylvania 17043. BEI?vG a portion of Lot No. 1 ] on Plan of Lower Walton, said Plan being recorded i11 the Cumberland County Recorder's Office in Plan Book No. 2, Page 204. BEIIvG the same premises which Gerald P. Harder and Veronica M. Harder, hss wife, by their Deed dated June 27, 1992, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, on July 24, 199^, in Deed Book U, No. 35, Page 295, granted and conveyed unto Isabel S. Harder, Grantor herein. THIS is a conveyance from mother to her five (5) children and, therefore, is exempt frorz the imposition of the Pennsylvania R catty Transfer Tax. Al\TD the said grantor hereby covenants and agrees that she will ~~arrant generally the property hereby conveyed. LN WITNESS YY7IEREOF, said Grantor has hereunto set her hand and seal the day and year first above written. SIGNED, S'E.ALED and DELIVERED he presen f r ~~ Vii: -C~ - % {SEAL) .~ ~~/ ISABEL S. H.A.RDER ,(SEAL) STATE OF PENl~TSYLVAI~'IA COUNTY OF DAUPHLN T~ On this, the ?, day of 3une , 2001 ss. before me, the undersigned officer, personally appeared ISAREL S. HARDERr__, - -- iu~own to be {or satisfactorily proven; to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. Ili WITI~~ESS WHEREOF, I hereunto set my hand and official seal. ~, J r ~~~~.~.~ ~ ~~~~ - ~ l /^~Iil ~/~.- (Seal) ~~•---° _ ~ -- -- - Notary Public h;0 iAR(AL SCAL ~~A'~~!D A. CH~JEc, Not2ry ~ubliC f f~arris~urg, Daup in County ,v;.~ L'onmissior ~xpiros Ffey 2 ; , 2002 ~_.___ STATE OF :ss. eDU.NTY OF On this, the day of , 3001 ,before me, the undersigned ofncer, personally appeared known to be (or satisfactorily proven) to be the person whose name subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. Il~t Vv'ITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public rFRTTFIC ATE OF RESIDENCE (Seal) I hereby certify that the precise residence and complete post ofnce address of the with~ir~ named Grantee is: 319 Walton Street, Lemoyne, PA 17043. - June ~ s~H , 2001 ~~~.,~-~-r'--~- L- ~CZ~12~, Christine E. Lackey, Co-Grantee A vOT•~~ ~~~`.: iLT~'7 Of PiiYl`..7~~.~:~1V 11'~ SS COUNTY OF CUMBERLA?1D Recorded in the Office of the Recorder of Deeds in and for the County of Cumberland in Record Book Paoe Fitness my hand and seal of Office, this day of , ?001_. REV-tb11 EX+ (12-99) ~~,~~'~~ S~I~E~19~.E ~8 ~:~ ~~. COMMONWEP.LTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADNaINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ~ ~c/FEY, e~vi?/sTiN~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. L ~QTTS1CYYlDPC funeral Horne >~ CreMa.~c.on S~'~~s ~~ ~ ~ ~~ l~,S. ~~ C t~.m bcrl on d , .2. .ZrlterA.~tni FCe f Df~ice o~ Calyio%a Cervteferic5 ~ diocese ~`~~5~ p~ of f-larrisbur~ ~$GE Cody ~ b+~~~nys G.~}'arl~GC,I (;~/1rG~ wGi"C •~"JQid by ~cculcnts SiS~'er, Kul IcCn M. f1'lu~rf~i n~ B. ADMINISTRATIVE COSTS: t. Personal Representative's Commissions ~ ~ ( V d ar tfnOre SuZCt,17rIC a Name of Personal Representative(s) ~a-~,leen Ili- IY~ar~"~1~ j rrt u~l ~ J Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. 4. I Probate Fees 5. I Accountant's Fees Zip 6. Tax Return Preparer's Fees 7. Fr /i'n J Fees to ~P~J i~5 ~~' ~ Lt/i%/s ~j,s', D D TOTAL (Also enter on line 9, Recapitulation) Attorney Fees 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 (If more space is needed, insert additional sheets of the same size) Office of Catholic Cemeteries Diocese of Harrisburg PO Box 3657 t-iarrisburg, Pennsyivania 77705 Phone (717} 657-4804 Invoice No. 111382 oN v®rcE -~- ...._ Name KATHLEEN H MARTIN Address 1769 KENDALL DR Cify MECHANiCSBURt Phone State PA ZIP 17055 Dafe 8/23/2006 Order No. 1-1-1382 Rep Holy Cross Terms 90 DAYS Date ^ Description TOTAL 07/27/06 Interment for Christine E. Lackey ~J~ X '~\~ ~~ (~ $465.00 SubTotal $465.00 $0.00 TOTAL $465.00 Please return one copy of this invoice along with your payment. If not paid within 90 days from the date of this invoice, a frnance charge of 6% will be added. _~. ,, P,, ~~ /, ~, A F'an~iiy ~'raclition Of Caring ~'A~ZT~IEMO~E Funeral ~-Io~ne & Cremation Services, Inc. Mrs. Kathleen H. Martin 1769 Kendall Drive Mechanicsburg, PA 17055 1303 Bridge Street P.O. Box 431 New Cumberland, PA 17070 (717)774-7721 (Fax) 774-5546 www.parthemore.com For the services of Christine E. Lackey 7/25/2006 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. Terms Due Date Ivet 30 &i'24i2006 Description SERVICES & MERCHANDISE Cremation with Memorial Service Marbleite Urn Gilbert W. Parthemore, Founder Gilbert J. Parthemore, Supervisor Stephen K. Parthemore, CFSP Bruce R. Parthemore, Pre-Need Coordinator, CPC Professional Memberships: NFDA•PFDA DCFDA • CCFDA GC~?~LDEN ULE , The Rule }'ou Know. The Peap(e Yo;a Tru.rt ~~ - -~ Total Services and Merchandise Account # ~006u62.~ Amount 3,275.00 203.00 3,478.00 CASH ADVANCE ITEMS Death Notice, Harrisburg Patriot 20 Certified Copies of Death Certificates Clergy Honorarium Organist Honorarium Soloist Honora>7uxn Altar Servers Flowers ~ , Cumberland County Coroner Fee, Cremation Authorization Total Cash Advances 152.80 120.00 125.00 100.00 75.00 15.00 75.00 25.00 687.80 !~`^ t ~ ~~~~ ~ ~ ~ ~, 6~` ~ ~ ' ~' j _ ------- __ r -____~_ _ --- --_ ' Total g4,165.ao Payments/Credits ~o.oo Balance Due ~4,165.~0