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Home My WebLink About10-27-08i ' r REV-1500 ~ (as-o5) OFFICIAL USE ONLY PA Department of Revenue County Code Year Fle Number 9ureau of Individual Taxes ~ INHERITANCE TAX RETURN ~j ~ ~ ~ O ~ S~ PO BOX 280601 QC.~ Hartisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 007 03 S~S~ 6 1 ~a~o~ g /~~3 /9~.~' Decedent's Last Name Suffix Decedents First Name Mt ~ e. rZ s ~ ~ Stz.. ~c~, h C (ItAppl~abls) Enter Surviving Spouse's Irrformation Below Spouse'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 r 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 t= 5. Federal Estate Tax Return Required death after 12-12-82) t~ 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number r-a ,A d n, i./ ~ ~. a a- ~ ~ 7 / 7 907 0 ~ 6 7 :. Firm Name (If Applicable) REGISTERO)=1AlI~LS USE~1 LY ' ' ` ` _ _ -t ~.' -- -- _,-> T, iv - ~.,J _ First line of address ~' ~` , ~ , .--,, - Second line of address f~ N ` W +J CNy Or POSt Office State ZIP COde DATE FILED 15056051047 Correspondent'se-mall address: Q~~1Altrs;tt:: ~ ~dM CQST• ir1/e:~ Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, coned and complete. Declara0on of preparer other than the pefsonai representative is based on atI intorrnation of which preparer has any krwwiedge. SIGNATURE P~RS~1~ ESIBLE F ~ LANG ~ ~R= ~ rT~,/G ADDRESS ~av amo~~ s ~~ ~y, ~b~,~~ ~ 17030 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE U8E ORIGINAL FORM ONLY Side 1 15056051047 15D56D51047 J ~y a J 15056052048 REV-1500 EX Decedent~sjSocial Security Nqumb~e^r Decedent's Name: O O ( ~~ ~O~ J RECAPITULATION 1. Real estate (Schedule A) . . ........................................... 1. • 2. StocKs and Bonds (Schedule B) ....................................... 2. • 3. Ck>sey Held Corporation, Partnership or Sole-Proprletorsh~ (Schedule C) ..... 3. • 4. Mortgages 8 Notes ReceNable (Schedule D) ............................. 4. • l P t h d l E ll P S & i 5 ~ 'T l9 ~ ~ f~ 5. ) ........ y ( c e u e ersona roper sce aneous Cash, Bank Deposits M . 6. Joinriy Owned Property (Schedule F) O Separate BRling Requested ....... 8. • 7. Inter-VNos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. S ~ T ~ ~ 8r 8. Total Gross Assets (total Lines 1-7) .................................... . .y 9. Funeral Expenses & Adminishatirre Costs (Schedule H) ..................... 9. ~ S Cl i~ d ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. • 11. Total Deductions (total Lines 9 8 10) ................................... 11. ~ ~ ~~" Q 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ ;J 3 ~`, O Q 13. Gharitable 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 Lfne 13) ........................ 14. ~ . ~3 ~. ~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. (a)(1.2) X .0_ . Amount of Line 14 e at lineal rate X .0 ~ ~d 0 ~ 15. 16. .~,~~ ~$ 17. Amount of Line 14 taxable at sibling rate X .12 • 17. • 18. Amount of Une 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE ......................................................... 19. ~ D U 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ' O Side 2 15056052048 15056052048 J REV-f500 EX Page 3 File Number Decedent's Comalete Address: DECEDENTS NAME a Btz ~ 1~GP.fsc STREET ADDRESS t~ ~ ~[~ .. `` ~ N CITY ,^ , n ~ ~ ~ t ~S (_ ~ ~~ STATE n~ ZIP / ~O~O Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit _ B. Prior Payments C. Discount rural credits (a + B + c ) 3. InterestlPenalty if applicable D. Interest E. Penalty Total InteresNPenalty (D + E ) 4. If Line 2 is greater than Line 1 + tine 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page Z, Line ZO to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (1) ~ ~ ~~ (3) (4) (5) oG ~ ~ • 0 (5A) B. Enter the total of Line 5 + 5q. This is the BALANCE DUE. (5B) ~D ~ ()Q 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 .......................................................................................................................... ^ d. receive the promise for I'rfe of either payments, benefits or care? ...................................................................... ^ 2. If death orxurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate oonsideration7 .............................................................................................................. ^ 3. Did decxdent own an 'in trust 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 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 ar for the use of the ~trviving sparse 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 ar after Juty 1,2000: The tax rate imposed on the net value of transfers from a deceased child tvventy-one years of age or younger at death to ar for the use of a natural parent, an adoptive parent, ar 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 ~ the decedents lineal benefiaaries is four and one-half (4.5} peroent, 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 far the use of the decedent's siblings is twelve (12) percent [72 P.S. §911fi(a}(1.3)j. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. • Rt:1/-1508 EX+ (698) SCNEptILE E COMMONWEALTH of PENNSYLVANIA CASH, BANK DEPOSITS 8c MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT E8TATE OF ~ FILE NUMBER Include th d IAigetion and the date the proceeds were received by the estate. NI property jointly with right of survivorship must hs disclosed on Sohaduls F, ITEM VALUEAT DATE NUMBER DESCRIPTION OF DEATH ,~1,/6s Qec~ ~~C ~ ~~ CEC~ ~So cv3~~- gob ~~, ~p ~c~s h a ~ ~ Q ~ /r ~ 9~ ~Lt2~iJi f cae ~ - ..~",~/~~f -~e~ y er ~~c~i e~ ~~ ~ 00 3a~eS ~~ ,-aJ~e.~~'~n~y Q '~QCi..~ ~¢c~ ,~Soa •o-0 ~i2..cr `~( ~ lm~~~t ~ ~ 1 ~/~(F C~i~luc.~ e .~~%3 S . o ~ TOTAL (Also eater on Gne 5, Recapitulation) 5 I ~ ~~~' (K more space is needed, inseR additional sheets d the same size) Senl~r Checking Plan Account Statement ~ PNCBANK P~iC Bank For 4ha period 01N6/2008 to O?J13/2008 SALLY E HERSEY OR ADA H SLOANE 820 PAMELAS LN MECHANICSBURG PA 17050-2362 Primary account number: 50-0066-7465 Page 1 of 1 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to 'II' PNC Bank Online Banking at pnc.co-n. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espar~ol, 1-866-HOLA-PNC Movingi Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaled clients oiily Senior Checking Plan Sally E Hersey Or Ada H Sloane Regular Checking Account Summary Account number: 50-0066-7465 Balance Summary Please see the Activity Detail section for additional information. Beginning Deposits and Checks and other Ending balance other additions deductions balance 2,898.15 1,039.00 22.00 3,91. ri.15 Average monthly Charges balance and fees 3,343.42 .00 Activity Detail Dspo:its and Other Additions ~ There was 1 Deposit or Other Addition Date Amount Description ~ totaling $1.039.00. 02j01 1,039.00 Direct Deposit - Soc Sec ~~(~ US Treasury 303 XXXXX6632D Online and Electronic Banking Deductions Date Amount Description 01/18 22.00 Corporate AGH Cash C&D Asbury Comm 162 810 There was 1 Online or Electronic Banking Deduction totaling $22.00. Daily Balance Detail Date Balance 01/16 2,898.15 Date 01/ 18 Balance Date Balance 2,876.15 02/01 3,915.15 FORM963R-1006 Reviewing Your Statement Please review this statement caretitlly and reconcile it ~t•ith your reconls. Call the telephone number on the upper right side of the ~Cirst page of this statement it: • you have any yuestions reganiing your accounts(s); • your name or address is incorrect; • you have a business account and your tax identification number is missing or incorrect; • you have any questions regarding interest paid to an interest-bearing account. Balancing Your Account Update Your Account Register Compare: T7te activity detail section of your statement to your accoutt register. Check Off: ~VI items in your account register that also appear on your statement. Remember to begin with the ending date of your last statement. (An asterisk { * } will appear in the Checks section if there is a gap in the listing of consecutive check numbers.) Add to Your Account Register Airy deposits or additions including interest payments and ATA1 or electronic deposits Balance: listed on the statement that are not already entered in your register. Subtract From Your Account :any account deductions including fees and :1'fAl or electronic deductions listed on the Register Balance: statement that are not already entered in your register. Update Your Statement Information Step 1: Add together deposits and other additions listed in your accotmt register but not on your statement. Dana of Deposit Amount Total A Step Z: Add together checks and other deductions listed in your account register but not on your statement. Step 3: Enter the ending balance recorded on your statement $ Add deposits and other additions not reconled Total rt + $ SlibtOtal= $ Subtract checks and other deductions not recopied Total B - $ T?te result should equal your account register balance = $ CAaalr Mrnior er Tetal B Dasc~iptiow 1 Amount Verification of Direct Deposits T'o verity whether a direct deposit or other transfer to your account has occurred, call us 7 days a week from 6:00 A.A[. to Midnight (F."I') at the customer service number listed on the upper right side of the first page of this statement. Electronic Funds Transfers Ia case of emxs or questions about your ekrtnmic tr.-nsfers or if yon need m~xe infimnation about a hansfer, call os 7 days a week fn~m 6:00 A.M. to Midnight (E7) at the cnstixner service number listed on the apper right side of the first page of this statement. (1r, if yrw prefer, please anite ns at: Customer Service, F.O. Box 609, Fittcborgh, I'A 15230-0604. If you believe Wert is a problem, yew most ccwbict ns no later than 60 iL~iS aRer the em6ng date of the tlrst s4~tement on which the ernx or pml+lem appeared. Yrw wiU need N pnnide the fidhn~iag infinma6on: Yor-t name and acccwnt number(s); • A descriptirm of We emrr or the dansfer yrw are questiiwing. Please explain as clearly as yoo can why yiw need mrm; informatirw or why you believe an emx w:-s made; • The drdlar amount of We suspected emir. we will investigate your complaint and will correct any errr,r pmnrpdy. If the im~estigation trkes longer than 10 business da~5, we will crertit your account for We amount you think is in error, so that yon will have use of We fonds daring We time it takes ns to crnnplete our invesdgauon. Member FDIC 0 Equal Housing Lender S;~ni+~r Checking Plan Account Statement P1~C Bank For ffio poriod O?J14/Z008 to 03/14/Z~8 SALLY E HERSEY OR ADA H SLOANE 820 PAMELAS LN MECHANICSBURG PA 17050-2362 B PNCBANK Primary account number: 50-0066-7465 Page 1 of 1 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to 'a' PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espaflol, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaired clients oiily Senior Checking Plan Sally E Hersey Or Regular Checking Account Summary Ada H Sloane Account number: 50-0066-7465 Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 3,915.15 .00 1,039.00 2,876.15 Please see the Activity Detail section far additional information. Average monthly Charges balance and fees 3,083.95 .00 Acdvity Detail On~ne and Electronic Banking Deductions Date Amount Description 02,/20 1,039.00 Direct Payment -Reversal U5 Treasury 309 KXXXX6632D There was 1 Online or Electronic Banking Deduction totaling $1.039.00. Daffy Balance Detail Date Balance Date Balance 02/14 3,915.15 02/20 2,876.15 Do you receive a Social Security or SSI check by mail? Here are three good reasons to switch to direct deposit. It's Safer -mailed checks can be lost or stolen; Easier -your funds are deposited to your PNC Bank account electronically; and best of all it's Convenient -your money is available without making a trip to the bank. Enrolling is easy. Stop in at any PNC Bank branch or call us at 1-888-762-2265 Gam-12 midnight for more information on how to enroll. FORM963R-1006 Reviewing Your Statement Please ret•iew this statement carefully and reconcile it ~ritlt your reconis. ('ail the telephone number on the upper right side of the firsi page" oflhis statement iE • you hai•e any questions reganiing your account(s); • your name or address is incorrect; • you hati~c any questions reganiing interest paid to an interest-bearing accotmt. Balancing Your Account Update Your Account Register Compare: '17tc acti~~ity detail section oCyour statement to your account register. Check Ott: All items in your account register that also appearort yrntrstatentent. Rententberto begin Frith the ending date oC}'our last statement. (r\n asterisk { * } „•ili appear in the Checks section it'there is a gap in the listing of conseruti~-e check rtttntl>ers.) Add to Your Account Register :\ny deposits or additions including interest payments and :\7•~1 or electronic deposits Balance: listed on the statement that ate not already entered in your register. Subtract From Your Account :\ny account deductions including tens and :\TAI or electronic deductions listed on the Register Balance: statement that are not already entered in your register. Update Your Statement Information Step 1: :\dd together deposits :ntd other additions listed in ~•our :recount register but not on your statement. Dana of Deposit Amount Tetnl A Step 2: .\dtl togcUter cheeks and other deductions listed in ~•ottr accotmt register but not on your statement. Step 3: Enter the ending balance reconted on your statement $ :Add deposits and other additions not reconled 't'otal :A + $ Subtotal= $ Stsbtwtci checks and other deductions not recorded Total 13 - $ 71te insult should equal your account register balance = $ Tetal B Verification of Direct Deposits ~'o verily tic'hether a direct deposit or other transfer to yonr account has occurred, call us 7 days a creek Rant G:00 ;\.11. to Midnight (1?"C) at the custontcr sen~ice number listed on the upper right side of the first pace olthis statement. Electronic Funds Transfers to case ofem~rs iw questions about yixtr elcctnwic transfers or ify~w need mote, infixmation ahcwt a trtnsCer, call ns 7 days a week Cmm 6:1Nt A.At. to M1tidnight (tit) at the customer sen•ice number tilted on the upper right sick of the first page of This sC-tement. t h•, if yew prefer, please write ns at: Custnmer Service, P.t). Box 609, Pittchutgh. PA 15230-0609. ]C you believe there is a problem, yaw must contact us no later than 60 days aRer the ending date of the Rr~t statement at which the eme tx problem appeared. 1'oa will need to pnnick the follcniing in&mnation: four name and account aumher{s); • A description oC the emx or the trmsfer yon are questioning. Please explain as cleatiy as you can why yew need more intinmati~w ix why you believe au emx was mask; • the d~>tlar amatnt of the suspected emir. «~e wili investigate yewr c~Hnplaint and wilt comet any ema~ promptly. if the investigation Cakes hwger than 10 business days, we will emi6t yoar account fiX the amount you think is in ern~r, so that you wilt bare use of the funds during the time it Crkes as to ccnnpkte cwr investigation. t:Mck Nwwrar er D.dactioa Descei~tMa Amount Member FDIC ~ = e Equal Housing Lender Priority Benefits Account Statement ~ PNCBANK PNC B~ttk` For tho poriod 01/28/2005 to 02/28/2008 SALLY E HERSEY ADA H SLOANE 820 PAMELAS LN MECHANICSBURG PA 17050-2362 Primary account number: 50-0378-9062 Page 1 of 1 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to a' PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espaPiol, 1-866-HOLA-PNC MovingT Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaired clients only Priority Benefits Sally E Hersey Savings Account Summary Ada H Sloane Account number: 50-0378-9062 Balance Summary Beginning Deposits and balance other additions 25.30 .00 Checks and other Ending deductions balance .00 25.30 Average monthly Charges balance and fees 25.30 .00 Interest Summary Annual Percentage Yield Earned (APYE) 0.00% Number of days in interest period 31 As of 02/25, a total of $.01 in interest was Average collected Interest Paid paid this year. balance for APYE this period 25.30 .00 FORM953R-1005 Reviewing Your Statement Please mvie~r• this statement camtully and mconcile it with your mconis. Call the telephone number on the Wryer right side of the 5it~i page: ofthis statement if: • you have any questions mgatding your account(s); • your name or address is incormct; • }~ou have any questions reganiing interest paid to an interest-hearing account. Balancing Your Account Update Your Account Register Compare: 'I7tc activity detail section of your statement to your account mgister. Check Oft: :VI items in your account register that also appear on your statement. Remember to begin \vith the ending date of your last statentenl. (:fin asterisk { * } will appear in the Checks section if them is a gap in the listing ofconsecutive check numbers.) Add to Your Account Register Any deposits or additions including interest payments and A"fl~l or electronic deposits Balance: listed on the statement that are not already entered in your register. Subtract From Your Account :any account deductions including fees and :~"I'A1 or electronic deductions listed on the Register Balance: statement that are not already entered in your register. Update Your Statement Information Step 1: :1dd together deposits and other additions listed in your account mgister but not on your statement. Dsto of Daposk Amount Total A Step 3: Enter the ending balance mconded on your statement :\dd deposits and other additions not mconied "Ibtal A + Step 2: :1dd together checks and other deductions listed in your account mgister but not on your statement. Subtotal= ~ Suhtrnct checks and other deductions not mconied Total i3 - $ dlte insult should equal your account mgister balance = 5 Crook N^aabor or Dod^ctio^ Msc~iptis^ Amount Total B Verification of Direct Deposits To verity \ti•hether a dimct deposit or other transfer to your account has occutmd, call us 7 days a week from 6:00 A.111. to ltlidnight (F.T) at the customer service number listed on the upper right side of the first page of this statement. Electronic Funds Transfers [n case of urors or questions about yanr elcchvnic transfers or if yon need mare infinmation about a trnsfer, call us 7 days a week fivm 6:00 A.111. to \tiitnight (l:~ at the cashNner senice number tilted on the upper right side of the first page of this su~tement. Ur, if you prefer, please wtite ns aC Customer Service, P.O. Box Cr09, Pittsburgh, P:\ 15230-0009. If yon belie.•e there is a problem, you must conr~ct us no later than 60 iL~ys after the encfing ~6-~te of the Orst statement on which the emw or problem appcareJ. Yon ~~~11 need to pmcide the fo1loH~ing infi~nnation: • Your name and account m~mbet(s); • :1 dexc~iption of the envy or the h~nsfer yon are questioning. Please explain as clearly as you can why you need miuL info~ma6on or why y~ut helie~•e an emir w;ts made; • The dollar amount of the saspccted ernN. \1'e will im•estigate your complaint and H711 contct any envy promptly. if the im•estigation takes longer than t0 business iL~ys, we will crei6t your account tier the amount you think is in e~mr, so that you will ha~•e use of Qlc funds during the time it takes us to complete our in~•estigafion. Member FDIC ~ _ ~ Equal Housing Lender 1 ` SEH INVENTORY -April 23, 2008 FURNITURE 1. Corner cabinet (glass front doors, maple) 2. End table (maple, louvered front doors) 3. Secretary (5-drawer) (pine) 4. File cabinet (3-drawer, pine, marred) 5. TV tray set (4 trays under small 2-leaf table, maple finished hardwood) 6. N tray (light hardwood finished) 7. TV stand (light hardwood finished) 8. N (27" (est.) RCA) 9. Rocker-recliner (overstuffed, dark green, slight stains) 10. Rocker (overstuffed, light brown) 11. Bookcase (1-shelf, low, pine, marred -believed made by Hobart) 12. Bookcase (1-shelf, maple) 13. Desk lamps (3) (in boxes except cloth shades) 14. Floor lamp (high intensity -supplied by Lenor) 15. Floor lamp (antique with glass shade) B 16. Medium (desk lamp, electric cords, 2 surge- protectors, empty jewelry box, 1 cup & saucer, lV remotes) 17. Medium (Magnifying reading lamp, basket with pot pouri, glass boot planter, cork book ends, glass candle holder) 18. Large (bedding ~ °Happy Lamp") 19. Small (cups ~ saucers, pitchers) 20. Small (cups & saucers, figurines, misc glass) 21. Large (wall pictures, commorative plates, wall clocks, baskets) 22. Medium (china, bric-a-brats) 23. Medium (glass lamp shades, straw goose, silk flowers, straw baskets, waste basket, dish cloths) 24. Large (seasonal door hangings, couch pillows, 3 table lamps, desk caddy) 25. Small (books) 26. Medium ("For grands" -miscellaneous items to be sorted by grandchildren) 27. Plastic (long, low box with towels) 28. Plastic tub (misc boxes and other items) Donated to Salvation Army 29. Suits (6) 30. Pants (13) 31. Jackets (5) 32. Sweaters (16) 33. Night gowns & house coats (4) 34. Belts (13) 35. Shoes (4 pr.) 36. Blouses (16) 37. Apron (1) 38. T-necks (9) 39. Undershirts (4) 40. Sweater (1) 41. Pants (3) 42. Bedspread (1), shams (2) & dust ruffle (1) 43. Jackets/blazers 44. Long rain coats (2) 45. Short jackets (2) 46. Winter coat (1) & hat (1) 47. "Happy Eyes Magnifying Lamp" (1) 48. "Happy Eyes Hair Lamp" (1) 49. "Mini Massager (1) -- - _. ~. _- . _. ~, _~~ ~~ ---~,. .."~~_ ~, • ~ REN~1511 EX+ (129) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FlLE NUMBER ~ Debts of decedent must be reported on Schedule L A. FUNERAL EXPENSES: o ;`l~~¢;p~,eae~ B. ADMINISTRATIVE COSTS: 1. Personal RepreseMaUve's Commissans Name of Personal RepresentaWe(s) Social Secur&y Number(S~EIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Pafd: 2. Attorney Fees 3. Famiy Exemption: {B decedent's address is not the same as daimeM's, attach explanation) Claimant Street Address City State Relationship of CIeM1aM to Decederd 4. Probate Fees 5. Accarntant's Foes 6. Tax Return Preparer's Fees 7. scN~aou~ x FuNr~uu ex~rs~s ~ ADMWISTRATIVE COSTS a ~~~~~® to,o ~ ~ ~' ~ ~~ Zip Zip TOTAL (Also enter on lime 9, Recapitulation) I ; ~ 9 ~ ~ . (K more space is needed, insert additional sheets of the same size) - V Boyd L. Myers Jr., Supervisor ` + ~ - 37 East Main Street Mechanicsburg, Pennsylvania 17055 (717) 766-3421 Fax (717) 795-7291 A standard of excellence in Central Pennsylvania since 1910 Tuesday, March 25, 2008 Mrs. Ada H. Sloane 820 Pamela's Lane Mechanicsburg, PA 17050 __ Dear Mrs. Sloane, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form on the services for. Sarah E. (Sally) Hers SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED 512,543.00 LESS: Credits granted 606.59 LESS: Total Payments 11,936.41 PLUS: Items ordered later 558.00 CURRENT BALANCE ;558.00 Credits Granted: 5606.59 Preneed Adjustment PLUS: Items ordered later Winter Storage 115.00 Spring Service 265.00 James Browning 125.00 Flowers Bethany ~ 53.00 - ' Interest at the rate of 1.5 % per month (18 % per anntxn) will be added to balance after 30 days. If there are any questions or concerns that remain unanswered, please call me. Since ly, ADA A SLOANE _ 170 pERAMELA 3 L i~ MECHAI`naBURG PA 17055-2362 PAY TO THE `: 4~' ORDE~F i i~ i . _ 366 i1 /, ~ /o ~ DATE so-e2xans~a DOLLARS ®~~ ~"°" U ~," ' _ Mem ,,bersl~ Pj'~~~,ppu~ ry, PA 17056 ~f ~ MEMO t:23L38224L~;0366 ~p2L81050L68~'44 ouu~ `~~ ~ / ` ~ ~ ~~ / ~ 133 Center Street, Bangor, Maine 04401 207 / 942-8815 Fax 207 / 942-1997 www. BrookingsSm ith.com CLARK-PIPER CHAPEL LaBEAU CHAPEL Brewer, Maine Orono, Maine February 13, 2008 Ada Sloane 820 Pamela's Lane Mechanicsburg, PA 17050 Re: Services for Sarah Hersey Dear Mrs. Sloane, Please find enclosed an itemized statement for the services of Mrs. Hersey. Please note that you are only responsible for the highlighted items, which come to $300.00 as Myers Funeral Home will be billed the rest. Should you have any questions, please contact us at 207-942-8815. Sincerely, Anne Duncan Office Manager MEMBER BY SELECTED INVITATION Independent FUNERAL HOMES r` Frank's Bike Shop 199 State Street Bangor ti1E ~~440t 207- 94 %-4594 Credit Card Receipt Purchase Sale #: 67772 Trans #: A205 Register: Al Name: Gard #: x~ooooooooc~ a2854 T Vi ~C~//~ ype: sa ~ ~ Ref#: 02547C ~'~ `~"~ Date: 02/01/08 Time: 12:25 PM Amount: $291.82 ~ ..~ Frank's Bake Shop 199 State.~~treet Bangor, ME 04401 Tel. 207-947-4594 Transaction: A206 Feb 1, 2008 Cashier: Teresa 12:25 PM Order #7180 276.00 Vegetable & Dip Tray Cheese and Cracker Fruit Tray Medium Tea Meatballs Medium Spanakopita Dozen Coffee Airpot Regu{ar Coffee Airpot Decaf Lemonade Gaiion Ice Tea Gallon Tableware Plate Table~nrare Napkin Delivery, Setup & Pickup Chaffer Full Subtotal 276.00 7% 15.82 5% 0.00 0.00 0.00 Total 291.82 Amount Tendered VISA 291.82 Change 0.00 Order #: 7180 . Required: Fl`i~.l=~~a-$,.2008 PM 3:00 Customer: Sloane, Robert Phone #: 717-697-0467 Delivery Deli very Address Robert Sloane, Brookings -Bangor Bangor 717-697-0467 Notes Web Order #: PO #: Order Date: 2(1(2008 Taken By: Teresa Dupiisea Vegetable & Dip Tray Medium Qty: 1 P;+ce: 25.00 Total: 25.00 Cheese and Cracker Medium Qty: 1 Price: 25.00 Total: 25.00 Fruit Tray Medium Qty: 1 Price: 49.00 Total: 49.00 Tea Meatballs Medium qty: 1 Price: 25.00 Total: 25.00 sweet and sour hot in chaffer Spanakopita Dozen ~ ' Qty: 2 Price: 15.00 Total: 30.00 in chaffer - Coffee Airpot Regular Qty: 2 Price: 14.00 Total: 28.00 cups, creamers, sugar, sugarsubst.; stirrir Coffee Airpot Decaf Qty; 1 Price: 14.00 Total: 14.00 Lemonade Gallon ~~ ~ / ! L t ~~ ~ 1 133 Center Street, Bangor, Maine 04401 207 / 942-8815 Fax 207 / 942-1997 www. BrookingsSmith.com CLARK-PIPER CHAPEL Brewer, Maine February 13, 2008 Ada Sloane 820 Pamela's Lane Mechanicsburg, PA 17050 T'he Funeral Service for Sarah Hersey LaBEAU CHAPEL Orono, Maine 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 ARR ANGEMENTS. 1. PROFESSIONAL SERVICES Funeral Director & Staff $1895.00 Use of Facilities & Staff for Viewing ($130.00 per hr after $260.00 Use of Facilities & Staff for Funeral Ceremony $445.00 Use of Family Center (with service) $225.00 Use of Equipment & Staff for Spring Burial (w/ceremony) $265.00 Use of Winter Receiving Vault $115.00 Transfer of Remains to Funeral Home $285.00 Use of Hearse for Transportation to Place of Disposition $275.00 Use of Other Automotive Equipment (Courier & Flowers) $75.00 Additional Mileage Charge -Boston ($3.00 per mile) $675.00 FUNERAL HOME SERVICE CHARGES $4515.00 SELECTED MERCHANDISE: Titan Vault $1395.00 THE COST OF OUR SERVICES, EQUIPMENT AND MERCHANDISE THAI YUii RAVE SELI~;CTED $5910.00 CASH ADVANCES Clergy Honorarium -Rev. Stephanie Salinas $175.00 Cemetery Fee -Village Cemetery - Surry $450.00 Bangor Daily News (2) $246.75 Organist -Steven Weston $75.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . 5946.75 TOTAL . . . . . . . . . ~ ~ $6856.75 HISTORY 02/06/2008 Paid by Myers Funeral Home $-5860.00 MEMBER BY SELECTED INVITATION Independent FI;NERAL HOMES Sarah ersey . ~ -.• ~~~ / L 133 Center Street, Bangor, Maine 04401 207 / 942-8815 Fax 207 / 942-1997 www.BrookingsSmith.com CLARK-PIPER CHAPEL Brewer, Maine SUB-TOTAL INITIAL PAYMENT /DISCOUNT /CREDITS ADDITIONAL PAYMENTS /CHARGES TOTAL AMOUNT DUE Returning this statement with your payment is not necessary. After receiving your payment, a receipt wilt be mailed b you. LaBEAU CHAPEL Orono, Maine $6856.75 $5860.00 $996.75 MEMBER BY SELECTED INVITATION Independent - FUNERAL HOME Sarah ersey Brookings-Smith 133 Center Street Bangor, ME 04401- Phone: (207)942-8815 Fax: (207)942-1997 08-M-067 9a Sloane 20 Pamela's Lane echanicsburg, PA 17050 he Funeral Service for Sarah Hersey . Professional Services , Staff for Sunday Burial ..................................... :ash Advances Extra Cemetery Fee .......................................... Extra Vault Charge .......................................... Always Flow_ers .......................... ........ ___ __ Stone Lettering ............................................. Total Cost .................................................. Cn $75.00 --------------------- $75.00 575.00 $200.00 $225.00 _ _ $124.95 $175.00 $724.95 $799.95 $799.95 crent Balance: $799.95 ~~~~~~ _~ . r"~, WILL OF SARAH E. HERSEY I, Sarah~E. Hersey (also known as Sally Hersey), of Ocala, County of Marion, State of Florida, do make, publish and declare this ~o be my Last Will and Testament, hereby revoking all former FIRS: I direct my personal representatives to pay my legal debts, last illness and funeral expenses, and the expenses of administering my estate. I,further direct that all legacy, in- heritance, estate, succession, transfer and death taxes or duties (together with interest and penalties thereon, if any) levied, assessed or imposed with respect to any, and all property included in my gross estate for the purposes of determining such taxes or duties (whether such property passes under this Will or otherwise) shall be paid out of my residuary estate. SECOND: i may leave a writing located with this, my Will, devising some of my personal possessions to certain individuals. It is my request that my personal representatives comply with the terms of that writing and distribute such property pursuant to my wishes, I devise my remaining tangible personal property in equal shares to my two daughters, Lenor G. Hersey and Ada Sloane, if they survive me, or all to the survivor. "Tangible personal property" meaning clothing, jewelry, personal effects, household -1- ~~ ~IMaI~_.;. ~. m~g~ lent and tools of all sorts, a~e~r '~~'~ a31 ~~ gr~perty iteans of a tangible nature; tangible personal property shall not include bank accounts, se- curities, and ,evidences of debts or assets used in connection with an tangoing trade or business. L devise any and all real estate, together with the ~ ~ ~r~ at ~`oddy Pond, Surry, Maine, to my ,~ .~' -• , ~;. spy , i f she s urgr.ve s me . F3"S. All the rest, residue and .remainder of my estate, real, personal and mixed, of whatever nature and wherever situated a and however and whenever aqui~ed, of which i shall die seized or possessed, or of which T shall be entitled to dispose of at the time of my decease, including, but not limited to, the proceeds of my life insurance policies on my life, insofar as the same may be or become payable to my estate or to the personal representatives of my estate, i devise as follows: one-third (1/3) thereof to my daughter, Lenox G. Mersey; one-third (1/3) thereof to my daughter, Ada Sloane, and one-third (1/3) thereof to be divided equally by ~C,: ,, .7eaQnifer Blanchard, Jocelynn Blanchard, Jacquelyn B?ancharc~ and Joellyn Blanchard. In the event either of my said daughters shall predecease me leaving no issue who are surviving at my death, then such daughter's share shall be divided between my surviving daughter and the aforesaid grandchildren by right of representation. Provided further, that in the event any of ,. -2- . ~ '~1tl~';`" :..~.9'~ ~ ~iha~.~~ bi: Wield 23i trust tie eyes hereinafter named under the following terms and ditit~s: Via; 'i'he trustees shall pay to or apply for the u< rte, +~ ~ grandchild such amount or amounts of r prat and... such amount ~, . a~~ ~f tie principal as t.st~s, in trz~.stees" sole .discretion may deter- mine necessary or advisable for the comfort, care, sup- 3 port, maintenance, health, welfare and education of said grandchild.. (b) The trust for each grandchild shall continue until said grandchild attains the age of twenty-five (25) years, at which time the trust shall terminate and the then remaining principal and undistributed in- come of the trust shall be paid over and distributed ,outright and free of trust to such grandchild. ~r y1 ~'~' ~N, this trust, neithex prin- ~~~aY tsar lne shall be subject to anticipation or assignment by my said children and both principal and income shall be free from the control of their creditors. (d) I direct that wherever herein my Trustees are authorized to act in their judgment or discretion, -3- ;, s .,, _ ._ ~ i ~ , `_, , " '~, :~ _ ., ~ z~. ~~ `, ~- .a~~. Pi~*s' ~.nterest +~I ~~t t~ r~e~ie~° 'b ate' persan or ~ ~ ';=a ~~' ~ , ry~ in lis~t.ation of the powers ~ _. .: ~ .a.~ ~~l, Amy Personal repre- ~~ ~.~:: `~ yam- tta the i t(~V 1y N 1 4,. - r r ~, , , , ~ " Est whic~a mad: ~~i.s ~~ ~lsse fourth of this, my ~..:~, shall fia~'e the following powers with respect to such trust and its property, in, each case to be exercised from time to time in the discretion of my personal representatives and/or my trustees without order or license of court: 1. To sell and convey the whole or any part of any assets, ,real, personal and mixed, which I may own at the time of my decease and for such purposes to execute and deliver such deeds, bills of sale, assign- gents and other documents as my personal representatives ~ to tam: deem wise . ,. 4.$~ '. ~~ such germs as rsonal '~''. ~' ~ re~aresentatives may approve, any and all claims of whatever nature which may be presented against my estate or which may result from qty decease, including, but not limited to, debts and taxes. z -4- • s' SIX~F: Z i~-t daughters, L,enor G. Hersey and Ada Sloane, to act a~ ~sersc3nal representatives of this Will and my estate and as trustees of -the trust created hereunder. I ~st_that they be authorized to serve in both of said capacities x ~. -.~.~ a~aa~t'~e~rt.i~,e.~..;~~.a~+ead, that they x r a t. 1 ,,a ~' r.M1 ~ ci e ~ ,. L~ '~ ~ _ :_'~~~w~~~~ '~.~~~oR1. In the evea~t eit3~r €~f daua.~ter:~ fai' tc ~~alify, . or having qualified, die, resign, become incapacitated or otherwise cease to act as either personal representative or trustee hereunder,. then it shall not be necessary to appoint a sulastitute personal representative or trustee in his or her place and the remaining daughter shall serve as sole personal representative or trustee. IN WITNESS WHEREOF, I, the said Sarah E. Hersey, being first ~` ~ .j4 duly sworn, on the v day of ,~ ~. ~:~ ~ ~ ~ 19 •~~~, do hereby de- clare to the undersigned authority that I sign and execute this instr°nt, written on six (6) numbered pages, including this ~:- sz-de only of each page being used ~~~ ~~ . .~ '. ~ ~~ 'ham zsg been i~itiaied by me at ~_~ tt€~ as =''~'' Fast Till and Testament and that I sign it will- ingly as my free and voluntary act and that I am eighteen (18} years of age or older, of sound mind, and under no constraint or undue influence. r- 1 ~ _ .'~ f /"~' ~J ~ 't i" ' Sarah E. Hersey -5- -- . +~ ' `~.. ~.° ~ ~ ~ ~,. ~~.~~ and. - b the ''~,~ ~eia~' .ly stern, do hereby declare to the under- s -auti~rit~ that t?:e testatrix has signed and executed this i~tstru~ent as her: Last Will and Testament and that she signed it ~.ilingiy and that each of us, in the presence and hearing of the 3~tats.~.x signs this Will as witnesses to the Testatrix's signing, t tt3 the .best. o€ our knowledge, the Testatrix is eighteen ~~~~ yea.rs of ac;e or raider, c~~ sc~ajnd mind az~d under no constraint or undue influence. ~ - ,. .. R ~-~ . witness ,.-: ~ , , ~' Witness STATE OF MAINE PENOBSCOT, ss. Subscribed, sworn to and acknowledged before me by Sarah E. Hersey, the Testatrix, and subscribed and sworn to before me by - - ~.> ~ ~ ".-~ x_ ,~" ='y.r~ f~~< <„ ~ ;~',y and ~ ~ , , ~~ ~ , the witnesses, this ~~ day of ~~4 ct,S f- 19 ~~ . ` Notary Public ~ - - ~° _.. ,;:_ --° ~ ~, - My Commission expires: ~~ jo~na M. Ptuard _ 6 _ ;~' ~ Notary Public (~ammissiga Expires 10~18f91 ..• ~ ~ • FIRST CODICIL TO LAST WILL AND TESTAMENT of SARAH E. HERSEY I, SARAH E. HERSEY, a resident of Marion County, Florida, being of lawful age and of sound and disposing mind and memory, do make, publish and declare this to be the First Codicil to my Last Will and Testament executed by me on August 5, 1986, in the presence of Susan R. Kominsky and Jill Foss as witnesses. I revoke and annul paragraph THIRD of my Last Will and Testament in its entirety. I make the following changes to paragraph FOURTH of my Last Will and Testament: I delete all references to life insurance policies, since I do not own and my estate is not a beneficiary of any life insurance policies. Since my granddaughter Jocelynn Blanchard is now married, her name is corrected to Jocelynn Priestley. In all other respects paragraph FOURTH shall remain in full force and effect. In all other respects I ratify and confirm all of the provisior~s of my said Will dated August 5; 1986. IN WITNESS WHEREOF, I have hereunto set my hand and seal at Ocala, Marion County, Florida, this ~_ day of February, 1993, to this my First Codicil to my Last Will and Testament. ~-f SARAH E. HERSEY The foregoing instrument was on the aforesaid date, signed, Page One of Three Pages L i , sealed, published and declared by the said Testatrix, SARAH E. HERSEY, as her First Codicil to her Last Will and Testament, in our presence, who at her request and in her presence and in the presence of each other have hereunto signed our names as attesting witnesses thereof, the day and year last written. /, JUDITH MOXLEY 2320 N.E. 2nd Street, Suite 4 Ocala, Florida 32670 PATRICIA D. WOOD STATE OF FLORIDA COUNTY OF MARION 2320 N.E. 2nd Street, Suite 4 Ocala, Florida 32670 We, SARAH E. HERSEY, JUDITH MOXLEY and PATRICIA D. WOOD, 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 officer that the Testatrix signed the instrument as her First Codicil to her Last Will and Testament, that she signed voluntarily and that each of the witnesses in the presence of the Testatrix,.at her request and in the presence of each other, signed the Codicil as a witness and that to the best of•the knowledge of each witness, the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. SARAH E. HERSEY '{ yip '; /L-: ' /t.~~'7 , J. DITH MOXLEY ~{ PATRICIA D. WOOD Page Two of Three Pages .~ +~ '~ Subscribed and acknowledged before me by SARAH E. HERSEY, the Testatrix, and subscribed and sworn to before me by JUDITH MOXLEY and PATRICIA D. WOOD, the witnesses, all of whom are personally known to me, on the ~~~day of February, 1993. ARY PUBLIC y commission expires: ...~.... JOHN MOXLEY ~~ State of Florida My Comm. Exp. March 24,1994 CQMM #AA747992 Page Thr,~e of Three -Pages -