HomeMy WebLinkAbout03-20-09 (2) 1505607121
OS
05
REV-1500 EX
(
-
)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box zsosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601
RESIDENT DECEDENT 2 1 0 8 1 2 6 2
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 3 5 0 9 0 5 2 1 2 0 9 2 0 0 8 0 7 2 1 1 9 1 9
Decedent's Last Name Suffix Decedent's First Name MI
T A Y L O R V I R G I N I A H
(If Applicable) Enter Surviving Spouse's Information 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
Q 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)
Q 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 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 - fHIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
M A R C U S A M c K N I G H T I I I 7 1 7 2 4 9 2 3 5 3
Firm Name (If Applicable)
I R W I N & M c K N I G H T P C
First line of address
6 0 W E S T P O M F R E T S T R E E T
Second line of address
City or Post Office
C A R L I S L E
State ZIP Code
REGISTER OF WILLS USE ONLY
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Correspondent's a-mail address:
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 pr arer has any knowledge.
S,t~NAT~RE OF PERSON RE PgNS~E FOR FILING,~Eyp~RN ~' DATE
`_ >CU .~.~,, off. ~ Y YL .mil ~ZJ!.1,~~~ /'- ~/' U~-. _~ t ~-- ~-c'~, Cj
ADDRESS
305 LAMP
SIGNATURE I
60 WESq" POMFRET STREET
C
CARLISLE
USE ORIGINAL FORM ONLY
Side 1
L 1505607121
PA 17011
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PA 17013
1505607121
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1505607221 h-~ _vi
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REV-1500 EX
Decedent's Social Security Number
~ecedent'sName: VIRGINIA H• TAYLOR 2 0 3 5 0 9 0 5 2
RECAPITULATION ~
1. Real estate (Schedule A) ................. 1 0 3 3 0 7. 4 0
....................... 1.
2. Stocks and Bonds (Schedule B) .................................. 2•
3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ................. ....... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 1 O 5 1 • 2 8
6. Jointly Owned Property (Schedule F) ^ 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. 1 0 4 3 5 8. 6 8
9. Funeral Ex enses & Administrative Costs Schedule H
P ( ) ......... 9.
....... 1 4 2 7 D . 2 7
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I
9 9 ( } .....
.......
10. 1 8 O 4 O . 7 $
11. Total Deductions (total Lines 9 & 10) .................... ....... 11. 3 2 3 L 1. 0 2
12. Net Value of Estate (Line 8 minus Line 11) .................. ....... 12. 7 2 O 4 7 . 6 6
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ........... .... ... 13. 7 2 D 4 7 , 6 6
14. Net Value Subject to Tax (Line 12 minus Line 13) ........... .... ... 14. 0 , 0 O
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.o , 0. 0 O 15. 0. 0 D
16. Amount of Line 14 taxable
at lineal rate X .045 O O O 16, 0. O O
17. Amount of Line 14 taxable
O
O
O
0
O
O
at sibling rate X .12 . 17. .
18. Amount of Line 14 taxable
O O
0
0
0
0
at collateral rate X .15 1 g. .
19. Tax Due ................................................19.
20. FILL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
0. O O
1505607222 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 1262
DECEDENT'S NAME
VIRGINIA H. TAYLOR
STREET ADDRESS
403 VALLEY ROAD
PO BOX 65
CITY _ _
STATE ZIP V
SUMMERDALE PA ~ 17093
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A +B +C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (D + E) (3) 0.00
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) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 0.00
Make Check Payable fo: 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; ............................... ^ ^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 "intrust for" or payable upon death bank account or security at his or her death? ......... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^
IF THE ANSWER TO ANY OF THE A80VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after Ju{y 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 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-1502 EX + (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VIRGINIA H. TAYLOR 21 08 1262
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 roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 403 VALLEY ROAD, SUMMERDALE, EAST PENNSBORO TOWNSHIP, 103,307.40
CUMBERLAND COUNTY, PENNSYLVANIA
TAX ASSESSMENT - $81,990 X COMMON LEVEL RATIO 1.26 + $103,307.40
TOTAL (Also enter on line 1, Recapitulation) ~ $ 103,307.40
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
VIRGINIA H. TAYLOR 21 08 1262
Include the proceeds of litigation and the date the proceeds were received by the estate.
All orooerly iointlvowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC BANK -CHECKING ACCOUNT #5140113288 801.28
2. (PERSONAL PROPERTY
250.00
TOTAL (Also enter on line 5, Recapitulation) ~ $ 1,051.28
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
VIRGINIA H. TAYLOR 21 08 1262
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME 1,555.92
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) DINAH MARKLEY
Street Address 305 LAMP POST LANE
City CAMP HILL State PA Zip 17011
Year(s) Commission Paid:
2. AttomeyFees IRWIN & McKNIGHT
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation}
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. I Probate Fees REGISTER OF WILLS
5 Accountants Fees
6. Tax Return Preparer's Fees PATRICIA A. ROSENDALE, CPA
7. REGISTER OF WILLS -FILING FEE
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE
9. THE SENTINEL -ESTATE NOTICE
10. TIGER TRASH -TRASH REMOVAL
11. DINAH MARKLEY -REIMBURSEMENT
5, 000.00
6,000.00
244.00
350.00
30.00
75.00
158.62
700.00
156.73
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-Q3)
SCHEDULE l
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
VIRGINIA H. TAYLOR 21 08 1262
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. REDEVELOPMENT AUTHORITY OF THE COUNTY OF CUMBERLAND 16,480.00
DEFERRED LOAN AGREEMENT
2. SEARS -CREDIT CARD #5049 9481 2161 7767 410.66
3. {PP&L -ELECTRIC
4. ISADLER OIL COMPANY -FUEL OIL
5. BEAST PENNSBORO TOWNSHIP -SEWER
6. (CARDIOLOGY DIAGNOSTIC, LLC -MEDICAL
7. (PENNSYLVANIA AMERICAN WATER -WATER
8. ACCOUNTS RECOVERY BUREAU, INC.
FOR PINNACLE HEALTH EMERGENCY -MEDICAL
9. SOCIAL SECURITY ADMINISTRATION -REIMBURSEMENT
200.57
113.75
96.51
1.63
38.66
31.97
667.00
TOTAL (Also enter on line 10, Recapitulation) ~ $
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (5-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VIRGINIA H. TAYLOR 21 08 1262
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)]
I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
RIVER OF GOD CHURCH
747 WERTZVILLE ROAD
ENOLA PA 17025
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
S
72,047.66
7.
(If more space is needed, insert additional sheets of the same size)
WILL OF
VIRGINIA H. TAYLOR
I, Virginia H. Taylor of Cumberland County, Summerdale,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever ti~hich gray be
payable by reason of my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A. I direct that my real estate located at 403 Valley
Road, Summerdale, Pennsylvania go to the River
of God Church, 747 Wentzville Road, Enola,
Pennsylvania.
B. I reserve the right to attach a separate
memorandum to this Will.
4. I appoint Dinah Markley, as Executrix of this my last Will.
If Dinah Markley should predecease me or cease to act
in such capacity, I appoint Thomas W. Markley as
alternate.
5. The Executrix of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
6. I direct that no Executrix acting under this Will shall be
required to enter bond in any jurisdiction.
LAW OFFICES OF
STEPHEN J. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
IN WIT~I~FSS WHERE , I have her to set my hand this
~_ day of GTE , 2006.
~~ ~ ~- ~ ~
Virginia . Taylor
The preceding instrument consisting of this and one other page
was on the day and date hereof signed., published and declared by
Virginia H. Taylor as and for 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 hereto.
WITNESS NESS
LAW OFFICES OF
STEPHEN J. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
ACKNOWLEDGMENT
State of Pennsylvania
County of Cumberland
ss
I, Virginia H. Taylor, the Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that 1 signed and executed the
instrument as my last Will; that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
Virginia H. Taylor
Sworn to or affirmed and k-nowl
H. Taylor the Testatrix, this L~ day of .
2006.
erra-gr,~.roo~ roorn~arv~. .
~ ptpp~EBrALJ4`•~r' L%.. r•,.
~~ 3. :: mr
Notary Public/Atto
AFFIDAVIT
State of Pennsylvania
rginia
ss
County of Cumberland
We, !~ e and~g~~ot ~ ~~~s(~J, the
witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the Testatrix sign and execute the
instrument as her last Will; that the Testatrix signed willingly and
executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the T statrix signed the Will as a witness; and that to the best of our
kno I dge the Testatrix was at tha~,e 18 or more years of age, of
son mind anti nder no constrai ~ or ndue influence.,, n
S~ r~c~ or affirm
this ~ ay of
to before me by witnesses,
~ .2006.
LAW OFFICES OF
STEPHEN J. HOGG ~_m_.~ Nota Public/Attorney
19 S. HANOVER STREET "DY~~ ~`~"~'
eogo~' Nararj~~ ruuuc
SUITE 101 ' wraoiruauw, ""~'~~ ~',
CARLISLE, PA 17013 ss,..,~f
1'axlll3 Kesult lletails
Detailed Results for Parcel 09-12-2994-076. ii
DistrictNo 09
Parcel ID 09-12-2994-076.
MapSufffx
IlouseNo 403
Direction
Street VALLEY STREET
Ownerl TAYLOR, NORMAN B & LURA
C/O C/O VIRGINIA TAYLOR
PropType R
PropDesc
LivArea 1248
CurLandVal 20000
CurImpVal 61990
CurTotVal 81990 ?C , . ~(~ =
CurPrefVal ~ ~ 3~ 3~~, ~~
Acreage .17
C1GrnStat
TaxEx 1
SaleAmt
SaleMo
SaleDa
SaleCe
SaleYr
DeedBkPage
YearBlt 1929
IIF File Date 02/27/2007
HF_Approval_Status A
Page 1 of 1
i the 2004 Tax Assessment Database
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http://taxdb.ccpa.net/details.asp?id=09-12-2994-076.&dbselect=l ~ `~ 2- 12/29/2008
Jan, 7. 2009 9;17AM PNC BANK 412-1Oh-1141
~I 1i~
E~d1NG THg MfAY
January 7, 2009
Marcus A Mckrught III, Esq.
Irwin & Mcknight
60 W Pomfret St
Carlisle, PA 17013-3222
RE: Virginia H Taylor
SSN: 203-50-9052
DOD: 12-09-ZOOS
Dear 1VIr. Mckxught:
IVo. 6161 r. I/ I
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Account
Account# 5140x13288 Established: 02-O1-1970
VIRGINIA H TAYLOR
DOD balance: $ 801.28 + 0.06 accrued interest
Interest paid 01-01-08 thru 12-09-2008 $ 0.71 YTD
Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
airy of these items, please call 1-888-P1~lC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank, N.A.
Member FDIC
JAN-302009 16:17 FROM-REDEVELOPMENT ~ HOUSING AUTHORITY +7172494071 T-Z54 P.ooZ~oOZ r-4au
January 30, 2009
Irwin & McKnight
60 W. Pomfret Street
Carlisle, PA 17013
To whom it may concern,
REDEVELOPMENT AUTgORiTY
OF THU COUNTY OF CUMBEI[tLAND
• Flousing Development • Housing Rehabilitation
• Housing Management . • Homeownership Programs •
• Downtown Revitalization • Public I+'acility Improvements •
• Economic Development •
Re: Virginia Taylor
403 Valley Street
Summerdale, PA
Virginia Taylor received assistance from the Authority for the purpose of
rehabilitating her home at the above address. Ms. Taylor signed a Deferred Loan
Agreement with the Authority in the amount of $16,979.75 ova May 21, 1999. An
Addendum to the Agreement was signed December 15, 1999; the actual rehabilitation
cost came to $16,480. Therefore, the pay-off to release the lien is $16,480, at no interest.
Please make check payable to the Redevelopment Authority of Cumberland
County in the anzount of $16,480. This would need to be mailed to my attention,
Judy Smith, at the Redevelopment Authority of Cumberland County, 114 N. I~anover
Street, Carlisle, PA 17013.
We will prepare the Release document and ask you provide a check in the amount
of $27.00, made payable to Recorder of Deeds. This will be recorded in the Recorder
of Deeds office at the Cumberland County courthouse.
If you have any questions, please call me at (717)249-0789 ext. 121.
Sincerely,
THE REDEVELOPMENT AUTHORITY OF
THE COUNTY OF CUMBERLAND
Ju mi
Commtuuty Development Specialist
SERVI`NCx CUMBERLAND COUNTY SINCE 1975
114 N. IiANOVER ST. ~ ST1C. 104 • CARLISLE PA 17013-2445
'I'elophoue/TDY (717) z49-0769 • (717) B97-7703 • (717) 53?-6505 • Ihx(717) 249-4071 • E-mail: acJminC)a ecl~ra.com
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, PA 17013-
(717)243-2421
December 17, 2008
Dinah Markley
305 Lamp Post Lane
Camp Hill, PA 17011
The Funeral Service for Virginia H. Taylor
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.
I. PROFESSIONAL SERVICES
Services of Funeral Director/Staff , $855.00
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral Home, $265.00
C. SPECIAL CHARGES
Direct Cremation , $315.00
FUNERAL HOME SERVICE CHARGES $1435.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $1435.00
Cash Advances
Certified Copies of the Death Certificate , $36.00
Coroners Fee $25.00
Cremation Pouch , $35.00
Patriot Obit. $24.92
TOTAL CASH ADVANCES AND SPECIAL CHARGES . $120.92
Total
Total Cost , $1555.92
SUB-TOTAL $1555.92
INITIAL PAYMENT /DISCOUNT /CREDITS 0
TOTAL AMOUNT DUE $1555.92
The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum.
era z
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Social Security Administration
Supplemental Security Income
Notice of Overpayment
ESTATE OF
VIRGINIA TAYLOR
1000 W SOUTH ST
CARLISLE, PA 17013-2722
Dear ESTATE OF VIRGINIA TAYLOR
SOCIAL SECURITY
200 S SPRING GARDEN 5T
CARLISLE, PA 17013
Claim Number: 203-50-9052
February 03, 2009
DPD
We are writing to let you know that we have paid you $60.00 too much Supplemental
Security Income (SSI) money. The overpayment happened January 2009 through
February 2009.
Our records indicate Ms. Taylor passed away on December 9, 2008. Accordingly, she is
overpaid benefits received in January and February 2009.
This new overpayment is in addition to the old overpayment of $607.00 already on your
record.
Later in this letter, we'll give you a detailed explanation of your overpayment.
You must pay us back unless we decide you shouldn't have to pay us back or we are
wrong about the overpayment. If you think you shouldn't have to pay us back or disagree
with the decision about the overpayment, you can:
• Ask for a waiver,
• Ask for an appeal, or
• Do both.
This letter will tell you more about these things you can do.
If You Think You Shouldn't Have To Pay Us Back
You may not have to pay us back. Sometimes we can waive the collection of an
overpayment, which means you won't have to pay us back. We can do this if both of the
following are true.
• It wasn't your fault that you got too much SSI money.
AND
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