Loading...
HomeMy WebLinkAbout09-12-08REV-7500 EX ~ (6.00) ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partrtership or Sole-Proprietorship (3) C~ ''`a 4. Mortgages & Notes Receivable (Schedule D) (4) ~ °~ ~ c~ Q `~' - 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 863.53 rl r--- G') ~ O ~j (Schedule E) ~ ' `'~ '~~~ ~~' lV _ 6. Jointly Owned Property (Schedule F) (g) -. Separate Billing Requested ,; ~ i I 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) '~ N ~-- ` ~ ~ H W REITZ ALMA M. ~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) U 11/13/2007 01/12/1926 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) (Schedule G or L) ~ : ' } 8. Total Gross Assets (total Lines 1-7) (g) _ 160,863.53 9. Funeral Expenses & Administrative Costs (Schedule H) (9) _ 23 958.04 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) _ 155 421.85 11. Total Deductions (total Lines 9 810) (11) 179,379.89 12. Net Value of Estate (Line 8 minus Line 11) (12) -18 516.36 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) F ®1. Original Return ~ 2. Supplemental Return ~ 3. RemainderRetum (date ofdeampriortol2-13-82) w o ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date or seam after tz-12-e2) ~ 5. Federal Estate Tax Return Required 0 c=i a in ©6. Decedent Died Testate (A6acb copy drwlp ~ 7. Decedent Maintained a Living Trust (anacb copy orTrust) 8. Total Number of Safe Deposit Boxes a ~ 9. Litigation Proceeds Received ~ 1 O. Sp0US81 POVerty Credit (date of Beam between 12-31.91 and 1-1-95) _ ~ 11. Election to tax under Sec. 9113(A) (A6acn scb o) F THIS SECTIQN MUST BE COMPLETED: ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD; BE' DIRECTED TO: ' o NAME COMPLETE MAILING ADDRESS o ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET - ra FIRM NAME (NApplicabie) ~ IRWIN & McKNIGHT p TELEPHONE NUMBER 717 249-235360 CARLISLE PA 17013 1 Real Estate (Schedule A 160 000 00 OFFICIAL USE ONLY Z g H a V W 14. Net Value Subject to Tax (Line 12 minus Line 13) Z 0 H Q F- a O xU Q H OFFICIAL USE ONLY FILE NUMBER _2..._. ~ -- - 0.-- 8 0 7 SOCIAL SECURITY NUMBER MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (14) -18,516.36 stt ms i rcuc I IONS vN REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 0.00 X (15) 0.00 0.00 X .045 (16) 0.00 0.00 x .t2 (17) _ 0.00 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 19. Tax Due > > BE SURE'TO ANSWER ALL QUESTIONS ON REVERSE su (18) 0.00 (19) 0.00 MATH.-<< Deceder>~t's Complete Address: STREET ADDRESS 24 GALE ROAD CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1• Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 0.00 Total Credits (A + B + C) (2) 0.00 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. (3) 0.00 (4) 0.00 (5) 0.00 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 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 : ........................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ ^X c. retain a reversionary interest; or ...................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................................. ^ ^X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... ^ 0 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ................. ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................... ^ ^X ........................................................................ 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 return, including accompanying schedules and statements, and to the hest 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 DATE ADDRESS 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 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 beneficiaries 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% [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 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. REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER REITZ ALMA M 21 08 076 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 property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 24 GALE ROAD, CAMP HILL BOROUGH, CUMBERLAND COUNTY, PENNSYLVANIA 160,000.00 SOLD -SETTLEMENT SHEET ATTACHED TOTAL (Also enter on line 1, (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER _BE1TZ ALMA M 21 08 0762 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. PERSONAL PROPERTY -APPRAISAL ATTACHED 716.00 2. CITIZENS BANK -CHECKING ACCOUNT #6100784282 147.53 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size} REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER 13EITZ ALMA M 1 08 076 Debts of decedent must be reported on Schedule (. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ROTHERMEL FUNERAL HOME 8,617.47 B ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees IRWIN & McKNIGHT 8,200.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3, 500.00 Claimant DENNIS I. REITZ Street Address City State PA Zip Relationship of Claimant to Decedent SON 4• Probate Fees REGISTER OF WILLS 290.00 5 Accountant's Fees 6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 350.00 7. REGISTER OF WILLS -FILING FEE 30.00 8. REGISTER OF WILLS -SHORT CERTIFICATE 4.00 9. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 50.00 10. STEVEN W. BARRETT REAL ESTATE -APPRAISAL ON REAL ESTATE 325.00 11. C.W. FRITZ COMPANY -SERVICE 368.27 12. CLOSING COSTS FROM SALE OF REAL ESTATE 2,223.30 TOTAL (Also enter on line 9, Recapitulation) $ 23 958.04 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER REITZ ALMA M 21 08 0762 _ Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. COMMERCIAL ACCEPTANCE COMPANY -AMBULANCE BILL 196.00 2. QUANTUM IMAGING -MEDICAL 357.75 3. CAPITAL CITY OIL 942.00 4. EAST PENNSBORO TOWNSHIP - WATER/SEWER 150.00 5. COUNTRYWIDE HOME LOANS -LOAN PAYOFF 153,355.08 SEE SETTLEMENT SHEET 6. COUNTRYWIDE HOME LOANS -FINAL PAYMENT 421.02 TOTAL (Also enter on line 10, Recapitulation) I $ 155 421 8 (If more space is needed, insert additional sheets of the same size) REV-1573 EX +to_nni COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER REIT7 AI nnn ne .,, 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 [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. DENNIS I. REITZ Lineal REMAINDER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ lir more space is neetled, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, ALMA IVI. REITZ , of East Pennsboro Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my personal representative to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate to my son, DENNIS I. REITZ. 5. I nominate and appoint DENNIS I. REITZ to be the Executor of this my Last Will and Testament; he is to serve as such. without bond. I hereby suggest that my personal representative retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 17th day of January, 2003. ~ o ~~~ ~ -.. ~ N ! / r _ A L` ~~ - _ .C, %~' ~ (SEAL) t ~ -_ `ALMA M. REITZ ''~- --?~~~ = " ~ ~ -- cn , Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witness ;V`Yi i ~~ ACKNOWLEDGMENT AND AFFIDAVIT WE, ALMA M. REITZ, JACQUELINE L. DRAWBAUGH 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 her Last Will, and 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 Will 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. COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND . /~ Subscribed, sworn to and acknowledged before me by ALMA NI. REITZ the testatrix herein and subscribed and sworn to before me by JACQUELINE L. DRAWBAUCH and MARTHA L. NOEL, witnesses, this !'~~ day of January, 2003. ~~~ ~. %"~Nota~rv Public Notarial Seai Roger B. Irwin, Notary Public Carlisle Born, Cumberland County My Commission Expires Oct. 3, 2004 Member, Penrsyt~~niaASSOCiationof Notaries LAW OFFICES ~~ ~~/~~ ~ ~t~~1 r ~~J~1 A. Settlement Statement U.S. Department of Housing and Urban Development OMB No. 2502-0265 ex fires 11/30/2009 B. TYPE OF LOAN ~! WEST POMFRET PROFESSIONAL BUlLD1NG 1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 4. ^VA 5. Conv. Ins. 60 WEST POMFRETSTREET CARLISLE, PENNSYLVANIA 97013-3222 797 249 2353 6. FILE NUMBER BENDERD7.08 7. LOAN NUMBER 0177937091 ( ) - 8. MORTGAGE INSURANCE CASE NUMBER s orm rs um o g you a s amen o a a s men cos un pa o an y se emen agen aro s own. C. Note: Items marked -(p.o.e.)' wars pakl oubkle the Dosing; they aro shown here for Informatbn purposes and ara not hcluded in the totals. WARNING: It b a crkne to knowinppty make false stabmenb tD the Unlbd Stabs on this or any other similar form. Penaltles upon convletlon can Include a floe and Im Asonment For debits see: Title 18 U. S. Code Section 1001 and SsD:bn 1010. TItIeEXpreSS Settlement System Printed OB/Q1 /2008 at 16:11 JMR D. NAME OF BORROWER: DONALD G. BENDER, JR. and LAURA E. BENDER ADDRESS: 1608 KATHRYN STREET NEW CUMBERLAND PA 17070 E. NAME OF SELLER: ALMA M. REITZ ESTATE ADDRESS: 24 GALE ROAD CAMP HILL PA 17011 F. NAME OF LENDER: GUARANTEED HOME MORTGAGE CO ADDRESS: G. PROPERTY ADDRESS: 24 GALE ROAD, Camp Hill, PA 17011 LOT 36 COUNTRY CLUB PARK East Pennsboro Townshi H. SETTLEMENT AGENT: 18~M REAL ESTATE SERVICES, LLC, Telephone: 717-249-2353 Fax: 717-249-6354 PLACE OF SETTLEMENT: West Pomfret Professional Bld 60 West Pomfret Street Carlisle PA 17013 I. SETTLEMENT DATE: 08/01/2008 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 160 000.00 401 • Contract sales rice 160 000.00 102. Personal Pro ert 402. Personal Pro rt 103. Settlement char es to borrower line 1400 11 578.47 403. 104. 404. 105. 405. Ad'ustments for items aid b seller i n advance Ad'ustments for items aid b seller i n advance 107. Count taxes 08101108 to 12131108 198.18 407. Coun taxes 08/01108 to 12131108 198.18 109. Sewer/Trash 08101108 to 09130108 76.25 409. SewedTrash 08101!08 to 09!30108 76.25 110• 410• 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 171852.90 420. GROSS AMOUNT DUE TO SELLER 160 274.43 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest mone 500.00 501. Excess De sit see instructions 202. Princi al amount of new loans 158 746.00 502. Settlement char es to seller line 1400 2 223.30 203. Existin loans taken sub'ect to 503• Existin loan s taken sub'ect to 204. 504. Pa off of First Mort a e Loan 153 355.08 COUNTRYWIDE HOME LOANS SERVICI U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT Fle Number. BENDERD7.08 PAGE 2 TiflaFmrocc CcHlomnn+Cvc4um Drin+nrl llAM1/~r1AA ~f ~R•11 I~AD L. ~ SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALESlBROKER'S COMMISSION based on rice 5160 000.00 = BORROWER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701. t0 SETTLEMENT SETTLEMENT 702. t0 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee %GUARANTEED HOME MORTGAGE CO 1 564.00 802. Loan Discount %GUARANTEED HOME MORTGAGE CO 1 020.73 803. A raisal Fee to SW BARRETT P.O.C. 350.00 Bu er 804. Credit Re ort 805. Underwritin Fee to wfb LR 615.00 806. Processin Fee to GUARANTEED HOME MORTGAGE CO 499.00 807. Flood Cert Fee to WFFS LR 19.00 808. UFMIP FINANCED to HUD LR 2 346.00 809. Mt Broker Com to GUARANTEED HOME MORTGAGE CO 057.55 POC b Lender 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to Ida 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to ALLSTATE 488.85 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo. 40.74 Imo LR 122.22 1002. Mort a e Insurance mo. 64.87 Imo 1003. Ci Pro a Tax mo. Imo 1004. Coun Pro Tax 6 mo. 39.51 Imo LR 237.06 1005. School Tax 2 mo. 132.86 Imo LR 265.72 1009. A re ate Anal sis Ad'ustment to GUARANTEED HOME MORTGAGE CO LR -198.81 0.00 1100. TITLE CHARGES 1101. Settlement or closin fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Pre aration 1106. Nota Fees 30.00 14.00 1107. Attome 's fees includes above items No: 1108. Title Insurance to STGCII&MREAL ESTATE 1042.88 includes above items No: ' C:~ e~r~r ~ ~l2, ~~~ ~a-~~ C%.~ ~ 5 ~ d~-- ~~ ~/ ~t ~~ f•~I~, ~~8~,~ J-7/`~C. / / ~^~ `~4 R../'% ~- C.~Or~^~sl'f ~%~+~'~%FfJ G•'GC'G.~!~ y,. ~ J/may" N~ S ~ / LLr~/` ~~"` I / ~~• "~^ ~ /' /I'/ ` ~~~~ ~ 7~/ /~ ~ i ~~' ~ / ~ -~ ~~~~~ ' /O is~ Ah i lr ~` ~//~~~~ ~ iii SS~~ F ~'G-rr.~-~~~~aa~.: ///'J ` 1 / ~/ I~ ~~,~~~- r ~ ~ ~ ,~z .,-G% e~C-s~-a~L~--~ ~i8-G. ~,,,,t~,,.~.,~.r _.,i ~.rL.2R'e~'~r ~ ...mot. er-.:r~~.~G. <~" ,~ s~• x- , ~~ C~.e9~-him- G=r~---.LC ~.~" ~lf~-l e. ~ :~.~:-~~-- vt~ :...Ga?..t ~ ;'• E" ~' ~' ~~l ; /' ~ , ~~~~~' ~J //~~~ ~. , ,may% ,. ~ ~ ,' `.. f ~~ -,~ v wa~ , f/~~ 4~~ r ~ ~ ~,~~.~- _.~ .~ . ~, .. ~=~'.~'v'~.~:~ _~-~r~-~-:%~. .mil >,~ i~c2,s-:~:~ . '1~ f .~ ~ i ~n j ....~ ~ f ~~~f V f ~~~~~i~ ~ ~~ ~ ~~~~~ / w~~~--.'."-~~. ~-~~~-€.. ,tea ~--- ~~ e fIV ~,/' ~~~. G...~1~-" mss.- V ~~ ~ ~}_. ~ T....~.. ,!' _ ~~ .rte / ..~ ~~~ 4~ 1G'~"`~(; ~~ -. .~ ~/ /' / j: C/ G~~ r i : , ~G'-~ %`~ =eQ- ~.~-~~~-ate..- ~ ~:_~ G"' _ ~y / c_ ~-,sl,%L~if~' i ~ 5--- 506.00+ ~~~~~ 1~~'~H~CZI ~E~~~~4~~' 210.00+ ~ 716 • * ~~ - `: ~ 0• o °oa 70 ~ °m=~ zm o T r ~ :., '~ ~n~ m = D ~ N n ~ j~m~00 ~' m ~ Avon L 7° ~ ~ ~y~o Z n, 1 a ~' Wo~~~ ~ ~, ~~ W~ ~~ ~ Nm ~ Z O ~ ~ w ~ _ r ~ W O ti to to :. ru ~ i -a O W ru ~ ~ v r ~ m ~ '~ it 0 0 r ^ ~ N b m h-' m ~- ~ N ~~~ `~ ~ ~~ ~ ~ w N ~~ tt' ~~ Account Number 6100784282 Account Title ALMA M REITZ OR DENNIS I REITZ Date O ened 6/10/1976 Account T e Checking Princi al Balance as of DOD $147.53 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $147.53 YTD Interest to DOD $ .00 - SEP-1-2008 23:58 FROM: STEPHEN R ROTHERMEL 5706480681 T0: 17172496354 P:2 • Stephen R.~Roth~ermel x'uneral Home ~~ ~ 1133 Ri~gc Road ~t , ; Kllrtgerstown, PA 1`7941 ' (570)' 648-0681 or 648-5085 Family Affiliated Since 1914 Third Gener'8fion Wednesday, November 21, 2007 ~FOR;THE SERVICES Oi~ : AImH M. Reitz DATE OF SERVICE Snlurday, November 17.2007 'J'Q; Mr. Qonnls I. Rellz 24 Gale Road Camp HIII„ PA 17011 TERAI.t', 1• ~ PF. R CENT I,'~'7'F. R1iST PER AIOA'TI/ ~I1JI.7CD 4N T1IE 31 ST DAY FUNERAL SERVICE ('11:\I~C.f;ti Standard puneral Services with No Cvening Viewing Professional Services, (Jse of Facilities R F:quiltment & Automnbilcs (5crvicc Charge) Casket - 18 Gauge Grecian Gold Gaskctcd +v/ kosetan Crepe Interior w/Gold Cross in Lid Panel Burial Vault - Wilhert Monticello Top-Seal w/ Inner Strentcx liner in Goldlone +vith Cross &c Tent 'fransporiation Charges '1'n R rrnm riolY Spirit f Ios(tital, Camp I till, 1'A R.egistcr Book Memorial polders (75) Acknowledgement Car~l~ (2S) Temporary Aluminum C~rnvc Nrarkcr Laminated 3 "Foot PrinC' 13nah Marker Obituaries No Charge ~ 3nso.oo x 2875.00 $ 1350.00 $ 75.00 $ AS.00 $ 35,00 $ 15.00 ~ I5.00 $ 0.00 $ ruNrRn1, SLRv1CL' C1 rA~GG ~ 74~aoo CASH aDVANCED Items For Whlch We Ad+-ancal 1'a~ mciu•. opening & Clusing ~f Grave (hull l till I Inuling ~C F_.xcavatink) $ 350.00 ,• Flower -Casket Spra}~ of Ycllm+~ Mums, L3rrntzc Pam Prams +v/ Culorcd Leaves w/ Mom on ~ Yeltmv $ 196.10 Satin I•leart Pillmv +v/ ScVcn I_igltt fink Roses Rc r3aby Breath +Vith Plq,m Mam on fink Ribbon S 58.30 Single Pink Rosc +v/ 1:3aby Breath & Pink Ribbon S 10.07 Newspaper Obituaries - I~larrisbnrr~ Patriot $ 138A0 and Sunbury Daily Item $ 110.00 $ 248.00 Salem Church Kitchen r'imd - r'uneral luncheon for arProx. 50 people plus donation - $ ZSO.UO Rcv. Mark R~thcrmcl $ • ' 75.00 Certlfed Death Certificates (IO ('eriificd Death C'erti0cates (~ $G.00 each) $ ~ 60.00 Vault Company fuel Sur-Charge $ 10.00 f`unc.r'~ k~~c~.~ ~ Q--c. ~jt ~cl ~ ~ ~~.~~~ a's r~ VQr)U4r, /9,~ Luo~~ d~, ~ .. Dena ~ s 1. i2e ~~i'2. Cheek ~ 10o Z. ~ ~ (1 n - '1'UT~r, CnSr~t nUVnNCLMrNTS $ 1257 47 U~a-r~ ~ ' TOTAL SEIZV1Cr;5 AND ADVANCEMENTS $ 8717.47 1'11.Yiv1GNT RL•CCIVFfy''~~)~t~~ ~~rnn Cumbcrhnd r„n vn $ ~ 100.00 ' ~''`~ I /20/OS in full from r~ennis 1. Reitz $ ~-8617.47 R A I. A N(' T', n i f T'. ~ 0.00 SEP-1-20018 23:58 FP.OM: S T EPHEhI P. P.0 T HEP.MEL 5?06480681 T0: 1?172496354 ,, ... '. nFNNIS i REIT2 ~ Ar r'! ~ OQZ GAMPMIII„ M 17Q1,?610 l~~/11 ~/ ' Un+c_Q1~1502000_ oo a+ar+na u Pn} lu the ,. mr-rrut_~reAhcn R . Rotklerme3.~un~ara._ Nnme ~ ~ 9 , fi 17.41 ,..~~ ~E.ight Thou~a.nr~ titx...l~~tndred Seve.lll,een 6 42/,.OQ,+,Im~ + ~::'~~ P~fSOgM ttm,5111tm Account Nor valid lo• le:: Ihpn 5?Ffl Pnyoblq Through Mn11nn Rank, N. A. Rpllgstar Lilc I,ratuancc Company Plttsburgl,, PA ~:Clti33D2493~:8~3Dbti~LU406~1n'ioo2 ~ P:3 _ ._. -ie~~~woores..N.,roanra~~~cnr,~•..~ ~„o .,,,., ~~,~..~,, ..,,.,.,. -,..,<. .~..,.., ,~~~ ~,,.~~ ~ ,n. n~a r~~.rm„ Lr~ rt'arnrni nau iniwn~ rn~wi a~n;a:. c.n~.~c. r, ~.o~. ~Ne OHECKv io _. ~ ~ . , , ~ ~ .~ ~ ~ ~ ~ i.n n AT AMf11d' ~ ~,,• • • . ' it o minour , (;VUPTTY OF CLIn'113T'.Rt.f1~Vt) `n+~rrtign 1{anll cv.~?e~~.a,a ~rrrcnnl,nrml~nrr CARLISLB.PENN~\'L~'AVIA DI1T<; I;HrCR NO. AMOUN'T' i enY ~~: HUNrJRED nlap oo/too--.. ---- -----------------'------------------ nrn.LARS ' c,~ ~~.~ rD ,v~,rn an Dnys rvrH~ STEPHEN r:. RpT.1[i?RMr•.L Fv~iEr~x~~~, i~ ~ ~~~ -- ORDETitIF' 1133 RIDGE Rn KLINGERSTOZ'~r7 F'A 17 99 1 ~ ~/ EL! •SC'~L D ~nU -10ni2fOSIGn1 TUIlB . ~_ I~'683~~''I~' r: 23L3726g11: ~74~r1F,~~5611' ~~'~OOOD~D000,1' ,•~,