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Home My WebLink About06-16-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 March 6, 2009 Klinger & Associates, P.C. 236 South Hanover Street Carlisle, PA 17013 Telephone (717) 787-3930 FAX (717) 772-0412 Re: Estate of Mary D. Minnich File Number 2108-0710 Dear Sir or Madam: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 09/09/09. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. We now offer you the option to request your extension request via a-mail. Please use the following e-mail address: RA-InheritanaeTaxExt®state.oa.us. We are also able to respond to your extension request via a-mail. Please refer any questions to me concerning your extension. No questions will be answered from this e-mail address. incerely, ,~ ~~ i Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division ~ ~ J 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PD BOX 28DSO1 Harrisburg, PA 17128-osot RESIDENT DECEDENT 21 08 0710 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 192-34-5991 06/09/2008 09/01/1915 Decedent's Last Name Suffix Decedent's Fi rst Name MI Minnich Mary ' D (If Applicable) Enter Surviving Spouse's Infortnatton Betow 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 ~~ 1. Original Return "m~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate v_. 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) !:' 6. Decedent Died Testate :..'~ 7. Decedent Maintained a Living Trust 0_ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) {Attach Copy of Trust} ._.., 9. Litigation Proceeds Received ,__~ 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number John H Klingier (717) 243-7743 ~ Firm Name (If Applicable) a LLS USENLY ,--; REGISTEIr I~ Klingler & Associates E ~.. ~ ~n ~ 4 ~ , First line of address J ~t~ C~ r r..` +_,_-~ i , .) 236 S. Hanover St ~ t ^+ t -.; -~~a ~,,,, - _ ~ ~ Second line of address ~ j ~ ~ ~ . ~ ----I .. ~ ,-, ,< DATE FILED O City or Post Office State ZIP Code - - Carlisle PA 17013 Correspondent's a-mail address: Under penalties of pery'ury, I deGare 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 cAmplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON R SPONSIBLE FOR ING RETURN DATE t..., - -- -- - _ _ _ ----- --- - ___ _ _ _ ___ - ~ -I t~ ~ ov`~ ADDRES 104 Virgi 'a Avenue, Carlisle, PA 17013 SIGNATU P PAR T R THAN REPRESENTATIVE DATE - -- - -- - ADDRES 236 uth Hanover Stree arlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Mary D MinniCh ' 192-34-5991 s Name: Decedent ..__.w._..___.~. _ ....... ....... _ ~,~..... v......._ .,. _ ..._. ~,.,._. _ ....... _ _ .._..,.. . _. .~..__ , RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. L 2. Stocks and Bonds (Schedule e) ..................................... .. 2. 37,322.22 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 32,449.84 6. Jointly Owned Property (Schedule F) ~~ Separate Billing Requested ..... .. 6. 97,370.85 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~=:m`r Separate Billing Requested...... .. 7. 53,985.00 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 221,127.91 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ................... .. 9. 13,127.91 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............. .. 10. 1,576.41 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 14,704.32 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 206,423.59 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 7,500.00 14. Net Value SubJect to Tax (Line 12 minus Line 13) ...................... .. 14. 198,923.59 .._. ~.,.~-....._a~...~_~ ~.,,..__v .a-a.~o.....~ ,-..~~,,~_,.~~,.._~..~r... ~..-~q.. .~ ..__n......... TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES .~~__ _ ,... , ,r_ . .... .~.~..,., ~~.,....~ , e...,. 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .045 198,923.59 16, 8,951.56 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ....................................................... .. 19. 8,951.56 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~'i 15056052059 Side 2 15056052059 r r REV-1500 EX Page 3 File Number -._._ . ~~___-. 71 FIR (1710 LJCGC{.ICI1~ ~ vV111~JICaG /+a.+v~ ~aa. ncPCnG\IT•C \IA\K Mary STREET ADDRESS CITY_ D Minnich DECEDENT'S SOCIAL SECURITY NUMBER 192-34-5991 STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 line 19) (1) 8,951.56 2. CreditsiPayments A. Spousal Poverty Credit ___ _ __-___ __` -- - B. Prior Payments _ ,_-___________9,361,00__ C. Discount - - -- - -- - -----------_ _ - Totai Credits (A + B + C) (2) 9, 361.00 3. Interest/Penalty if applicable D. Interest E. Penalty -- ~----~ - --- Tota{ {nterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 409.44 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (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 .......................................................................................................................... ^ 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 cansideration? .............................................................................................................. ^ 3. Did decedent 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)J. 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 benefiaaries 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-1503 EX+ (6-98) SCNEpVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary D Minnich 2108-0710 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~~ American Funds - 683.623 shs. Amer. Bal. Fd. - A, alc no. 74010721. Value $18.01/share 12,312.05 2. American Funds - 892.585 shs. The Bond Fund of America - A. Value on 6/9/08 $12.73/share 11,362.61 3. American Funds -13,647.56 shs. The Cash Management Trust of America, Value $1.00/share 13,647.56 All above titled "Mary D Minnich PA/TOD Myma F Minnich Doris E Hurley" TOTAL (Also enter on line 2, Recapitulation) I E 37,322.22 (If more space is needed, insert additional sheets of the same size) [ ~ REV-1508 EX+ (8-98) SCHEDULE E /~~ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary D Minnich 2108-0710 Indude 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. Wachovia Bank, NA -Time deposit registered "Mary D Minnich POD Doris E Hurley" 17, 354.00 2. Round Brilliant diamond ring .34 ct. 675.00 3. Claremont Nursing 8~ Rehabilitation Center -Refund of prepayment & incidental a/c 5,141.31 4. Commonwealth of PA Treasury Dept, Bureau of Unclaimed Property -Prudential Fin'I demutualization 881.64 5. Homesteaders Life Company CL # 543046 -prepaid funeral expense policy 8,073.86 6. State of New Jersey Bureau of Unclaimed Property -Prudential Fin'I demutualization funds 324.03 TOTAL (Also enter on line 5, Recapitulation) S I 32,449.84 (If more space is needed, insert additional sheets of the same size) " REV-1509 EX+ (6-98) SCNEDI~LE F COMMONWEALTH OF PENNSYLVANIA JOINTLY OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary D Minnich 2108-0710 A• Myrna F. Minnich e• Elaine Hurley C. Brian Hurley 104 Virginia Avenue, Carlisle, PA 17013 daughter 918 West Louther Street, Carlisle, PA 17013 daughter 7 Rockledge Ct., Carlisle, PA 17015 JOINTLY•OWNED PROPERTY: grandson ITEM NUMBER 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 DATE DF DEATH VALUE OF DECEDENT'S INTEREST ~' A' 04124106 Cornerstone Federal Credit Union, share draft alc 170.00 50 85.00 2• A 04124106 Comerstone FCU, cert. due 10!24/08, "Mary Minnich Myrna Minnich" 44,832.15 50 22,416.08 ~ 3• A 04124106 Cornerstone FCU, MM alc, Mary Minnich Myma F Minnich" 72,427.21 50 36,213.61 4• B 04124106 Comerstone FCU, cert. due 10/24/08, "Mary Minnich Elaine Hurley" 50,275.83 50 25,137.92 5• C 04124106 Comerstone FCU, cert. due 10/24108, Mary Minnich Brian Hurley" 23,057.63 50 11,528.82 6• A 09115104 M&T Bank, Classic cking alc 2678014727, "Mary Minnich Myrna Minnich" 3,978.84 50 1,989.42 Kan asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT TOTAL (Also enter on line 6, Recapitulation) 13 97,370.85 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) ~ ~~_ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary D Minnich 2108-0710 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-OB) ~ Pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary D Minnich 2108-0710 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. Myma F. Minnich, 104 Virginia Ave., Carlisle, PA 17013 daughter 45% 2. D. Elaine Hurley, 918 W. Lowther St., Carlisle, PA 17013 daughter 45% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Otterbein United Methodist Church, Forge Rd., Carlisle, PA 7500.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. # 7500.00 If more space is needed, insert additional sheets of the same size. LAST WILL AND T~STAM~NT OF MARY D. MIN1vICH KNOW ALL MEN BY THE SE PRESENTS, that I , Mary D. Minnick , o~ 325 South Pitt Street, Carlisle, Cumberland County, Pennsylvania, being in good kealth and oI• sound and disposing memory, do hereby maize, declare, and publisk this as my Last Will and Testament, Hereby revoking all dormer Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts and expenses o~ my last illness and funeral expenses shall be paid by my Executrix, hereinafter named, {prom my estate as soon a~ter my decease as shall be ~ound convenient. SECOND: (a) I bequeath my diamond solitaire ring to my daughter, Myrna F. Minnick. I~ my daughter, Myrna F. Minnick should predecease me, my executrix is to distribute the ring to my otker daughter, D. Elaine Hurley. I~ ske should also predecease me then tke ring shall become part o~ the residue o~ my estate. (b) I give, devise, and bequeath all the rest, residue, and remainder o~ my estate, whether real personal or mixed, o~ any nature wkatsoever and wkerever situated, including any lapsed or void legacy, in the percentages indicated to my two daugkters, Myrna F. Minnick, 104 Virginia Avenue, Carlisle, Pennsylvania (45 percent) and D. Elaine Hurley, 918 W. Lowther Street, Carlisle, Pennsylvania (45 percent) i{ they survive me by ninety (90) days. I give tke remaining ten (10~ percent of my estate to flee Otterbein United Metkodist Ckurch on Forge Road, Carlisle, Pennsylvania. (c) I~ eitker o~ my two daughters predecease me, then the skare tkat flee deceased daughter should leave received shall lee distributed to my surviving daugkter. (d) I~ my two daugkters, Myrna F. Minnick and D. Elaine Hurley predecease me or are not living on flee ninety-~irst day a~ter my deatk, tken I give flee ninety (90) percent earmarized ~or them in subparagraph (b) above, to flee following benekciaries in flee percentage indicated: Brian Hurley, 7 Rockledge Court, forty (40) percent, and Franlzlin Hurley, 918 W. Lowther Street, Carlisle, ~~ 1 Pennsylvania, ~orty (40) percent. The remaining ten (10} percent to be divided equally between The Salvation Army, Inc., 125 S. Hanover Street, Carlisle, Pennsylvania and The American Bible Society. If either Franlzlin Hurley or Brian Hurley predecease me, the percentage share that would otherwise be distributed to that predeceased devisee shall lapse, and the share that devisee would have talten shall go to the other devisee who survives me. THIRD: I hereby nominate, constitute, and appoint my daughter Myrna F. Minnick, as Executrix of this my Last Will and Testament. I~ my Executrix ails to serve, or for any reason fails to continue to serve, I then appoint Franlzlin and D. Elaine Hurley to serve as Co-Executors. FOURTH: I direct that my Executrix, or her successor, shall not be required to ~urnish any bond or other security for the faithful performance o~ her duties, notwithstanding any provisions o~ law to the contrary. FIFTH: My Executrix shall have, in addition to the powers and authority conferred upon her by law, the following additional powers and authority: 1. To gilt, sell at public or private sale, exchange, lease, mortgage, or pledge any property, real or personal, constituting a portion of this estate, at any time, and upon such terms and conditions as she shall deem wise. s 2. To invest any money at any time in such bonds, stoclzs, notes, real estate, mortgages, life insurance, annuities, or other securities, or such property, real or personal, as she shall deem wise, without being limited by any statute or rule of law regarding investments by the Executrix. 3. To retain, without incurring any liability, as investments, any property owned by me at ~f the time of my death, as long as she deems it wise, and even though such property is not the hind of ~ property she would purchase as an investment, and even though to retain such property might violate '~ sound diversification principles. 4. To cause any security or other property which may at any time constitute a portion of my estate to be issued, held, or registered in her own name, or in the name of a nominee, or in such ~orm that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the {financial structure, or sale of• the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to talxe any action with reference to such securities which, in the opinion o~ my Executrix, is necessary to obtain the bene~it o~ any such reorganization, consalidation, 2 readjustment or sale; to exercise any conversion privilege or subscription right given to her as the owner of• any securities constituting a portion o~ my estate; to accept and hold as a portion o~ my estate securities resulting from any reorganization, consolidation, readjustment, sale, conversion, or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of• my estate. 7. To determine what is "Income" and what is "Principal" hereunder, and her decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as she may determine. 8. To gi~t, transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by her, at public or private sale, or otherwise. 9. 'I'o borrow money from any person, firm or corporation, for the purpose of protecting and preserving or improving my estate or to execute promissory notes or other obligations for amounts so borrowed. 10. To employ legal counsel, accountants, brolxers, investment advisors, custodians, managers, and other agents and employees and to pay them reasonable compensation out o~ my ` estate or out o~ any ~und held hereunder to which said compensation is attributable. 11. To do all other acts in her judgment necessary or desirable ~or the proper and ` advantageous management, investment, and distribution of• my estate. ~ SIXTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of- my death, whether the funds, property, or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as i~ they were my debts and none of those taxes shall be charged against any beneficiary; that my Executrix pay, or provide ~or payment o~ all such taxes at such time or times, and in such manner as my Executrix deems best. SEVENTH: All questions as to the validity of this, my Last Will, or the administration o~ the Will shaft be governed by the laws of the Commonwealth o~ Pennsylvania. EIGHTH: Except as otherwise provided in this Will, I have intentionally failed to provide f'or any other relatives or other persons, whether claiming to be an heir of mine or not. Inso~ar as I have failed to provide in this Will ~or any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistalze. 3 IN WITNESS WHEREOF, I, Mary D. Minnick, tke Testatrix to this, my Last Will and Testament, typewritten on our (4) sheets o~ paper w~ic~ I ~ave identified in tie margin o~ each page by my signature, )iereunto set my kand and seal this I2tk day o~ October, 2005. Mary D. innic~ Tie preceding instrument consisting of our (4) typewritten pages, each identified by tie signature o~ tie Testatrix, Mary D. Minnick, was on this day and date signed, published, and declared by her, t~e Testatrix therein named, as and ~or ~er Last Will, in flee presence o~ us, wlio at her request, in ~er presence, and in the presence o~ each ot~er have subscribed our names as witnesses. / ~_ i ~.. ~-~ COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) I, Mary D. Minnick, Testatrix, whose name is signed to the attacked or foregoing instrument, leaving been duly qua~ied according to law, do hereby ac)xnowledge that I signed and executed the instrument as my Last Will on flee 12th day o~ October, 2005; that I signed it willingly; and that I signed it as my ~ree and voluntary act for flee purposes herein expressed. /~/ c • Mary D. mnic~ Sworn or a{~rmed to and aclxnowled~ed before me, by Mary D. Minnicb, the Testatrix, this 12th day o~ October, 2005 . r ~ ~ ~'1.. Notary Public Notarial Seal Niven J. Baird. Notary public Carlisle Boro, Cumberland County_ _ COMMONWEALTH OF PENNSYLVANIA ) My Commission Expires Nov 2.2006 Mernber,Penns;~!v'"`° °cs'•xiationotNotanes ) SS: COUNTY OF CUMBERLAND ) We, the witnesses whose names are signed to the attached or ~ore~oin~ instrument, being duly quali~ied according to law, do depose and say that we were present and saw Mary D. Minnicb sign and execute the instrument as a codicil to her Last Will; that she signed willingly and that she executed it as her {ree and voluntary act ~or the purposes therein expressed; that each o~ ua in the bearing and sight of Mary D. Minnicb signed the codicil as witnesses; and that, to the best o~ our bnowled~e, Mary D. Minnicb was at the time eighteen (18) or more years o~ age, o~ sound mind, and under no constraint or undue in~luence. ~~ f ~ V Sworn or a~{irmed to and subscribed to before me by the above-named witnesses, this 12th day o~ October, 2005. c Notary Public Notarial Seal Niven J. Baird, Notary Public Carlisle Boro, Cumberland County My Commission Expires Nov. 2, 2006 5 .,_.,,.__ c,,,,,,~,ih,tlniaACSOCIabOnOll~lOlalieS The right choice For the long term' American Funds Quarterly statement Pie I °` 3 June 30, 2008 PO Box 2280 Norfolk VA 23501-2280 AV 02 144627 354D2H673 AssSDGT (IIII'~IIII~~111111'~11'I1111"~~111~111'll~l~lltlllltl'IIII~) MARY D MINNICH PA/TOD MYRNA F MINNICH DORIS E HURLEY 104 VIRGINIA AVE CARLISLE PA 17013-1072 Yow tlnandsl adviser BISTLINE (717) 249-4441 AMERICAN GENERAL SECURITIES INCORPORATED 301 S HANOVER ST CARLISLE PA 17013-3933 Considering e-delivery? We've got your backup. Did you know that you can get your quarterly statement electronically -- and still print or request paper copies at any tima7 Log in to your account at americanfunds.com to learn more and sign up. Just click the e-delnrery banner on the Account Summary page. Quarterly summary (April 1 -June 30, 2008) -- For more account information ^ Call dour financial adviser ^ Automated information and :srrica Webaite - americanfunds.com American FundaLine ' - 800/325-3590 ^ Peaonal assistance - a a.m. to t p.m. Easbm time M-F Shareholder Services - 800/421-0180 Reinvested Change r' Value an dh~~dends and account 4'aiue on Endmp 03/31/08 + Addidona + cep/ta/ pama - WKhdrawala +/• velue = AN~fYAB ahere bslence ............................................................. .................................................................................. .......................................................................................................... MARY D MINNICH PA/TOD MYRNA F MINNICH DORIS E H[JRI.EY American Balanced Fund-A Account #~ 7+1010721 512,146.85 50.00 591.61 50.00 -S425.45 S11,813.01 683.623 The Bond Fund of America-A Account # 7+1010721 511,213.69 50.00 S148.84 50.00 -S142.54 511,219.79 892.585 The Cash Management Trust of America-A Account ~ 7/010721 513,583.87 50.00 583.69 S0.00 50.00 S13,641.56 13,647.560 Total: 136,941.41 M.M 5393.81 M.N -5567.99 IM.AB.M • f 14MU Wachuviu Bunk. N -iU I tiouth 'I nrni titre.: NC I I W Charlotte. NC 28288-I ItW WACHOVIA MARY' D MINNICH POD/DORIS ELAINE E~URLE?Y It)-I• VIRCENIA AVE CARLISLE PA 17u 13 Account Change Notice 7 hank ,ou for Maur contmu~;d backing ~clatiunship aitl~ W:tcfiucia. Your TIn1E DLPO 1 T #2~-711-2tK>,-It)IG901 has lx,:n changed to rcOc~c1 the follo~~ing infonnatiou cETcctiv l-9/l!7/2IX17. If ~~ou ha~c questions. call ~~our tuc:tE Wacho~•ia Firk~ncial Ccnicr or $(H)- WACHOVIA (8oU-922-~168~i). DETAII. INFORMATION ACCOUNT BALANCE: SIb.828.i5 INTEREST RATE: x.55% ANNUAL PERCENTAGE YIELD: ~.fi5% MATt1R1TY DATE: U~)/I-7/2(N-l TYPE: 2Z(- TERM: 2.1 MONTHS AUTOMATIC RENEWAL Wacho~ is Bank, N.A. Wach+rvia Bank of DcEaeare, N. A. are Membrr~ iMDIC. RRORD[R of • U.f. MTfNT N0. NgMO, g70M, M/ltq, ~fggi, qM 2172 9 THE ESTATE OF MARY MINNICH CHECK NUMBER '7 0 210 8 DATE 0 7 ~ 0 3 ~ 0 8 INVOICE NUMBER DATE DESCRIPTION GROSS AMT. DISCOUNT NET AMOUNT 4963 $):>~iD PRBPAY 06/10/08 6900.00-1840.00 5060.00 0.00 5060.00 Coeory of Coaetberlsad TOTALS 5 0 6 0.0 0 0.0 0 SQ60.0 0 PI.LASE ADDRESS ANY CORRESPONDENCE REGARDING THIS VOUCHER OR TRANSACTION TO THE OFFICE OF THE CONTROLLER, CUMBERLAND COUNTY CO L'RT HOUSE. CARLISLE. PA. 1701]. ~-~"''~ ~ ~~ l~ J~S1a CLAREMONT NURSING !~ RENA9ILITATION CTR. The Estate of Mary Minnich Date Type Reference Original Amt. 6/30/2008 Bill Mary Minnich 4963 81.31 Checking 4563 close PCA 6/30/2008 Balance Due Discount 81.31 Check Amount ~~ r'' ~'~ I c,o N 39~ Payment 81.31 81.31 ~t.31 Pennsylvania Treasury -Bureau of Unclaimed Properly ~ SSIc~ Property ID's: 465san Commonwealth of Pennsylvania Treasury Department Bureau of Unclaimed Property PROPERTY DESCRIPTION Page 3 of 8 Pro /Holder Information s) Id: 4858877 (A) Original Owners Name (B) Original Owners Address as Reported MINNICH, MARY D Rr 6 CarNsle, PA 17013-0000 (C) Holder Reporting Funds (D) last Transaction Date Prudential Financial lnc Demote Kba a 01R5J2002 (F) Type of Funds Reported (G) Certificate, Policy or Check Number Demutualization Cash CLAIMANT INFORMATION NAME OF CLAIMANT(S): Myma Minnick ____ SOCIAL 8ECURITY NUMBER: ~ `~ ~o ~`I ~' 3.LI ~ CURRENT MAILING ADDRESS: 104 yrginia Ave. cITY: sadi~.~ PHONE NUMBER: R17) -24 -3-12 02 DATE OF BIRTH: 12/02/1943 STATE: ~ LP: 17 EMAIL ADDRESS: mminnich~taa.net I certify that I am legally entitled to try to claim the properly, as stated bebw, that has been reported and delivered to the Treasury Department, Bureau of Unclaimed Property. I further hereby certify that the iMonnation provided, herein, is true and oorred subject to the penafliea of 18 C.S.§4904, relating to unswom falalhcation to authorities. ,_ SIGNATURE OF CLAIMANT (IN INK): __ Date: ~ ~ x009 SIGNATURE OF ADDITIONAL CLAIMANT (IN INK): Dais: State law limits the fee a third party can charge an owner for the recovery of unclaimed properly to 15 peroent of the property value. Please corrtad the Bureau of Unclaimed Property at 1-800-222-2046 with any additional questions. " If You Paid A Fee To Claim Your Property, Please Complete The Following" The Pennsylvania Treasury Department does not charge a fee to claim or recover unclaimed property. Third parties who assist with the recovery of unclaimed property are subject to requirements set forth under section 1301.11 of Pennsylvania's Unclaimed Property Ad. They must disclose the nature and value of the property as weN as where it is being held. (Pennsylvania Treasury Department). The fee a third part can charge to assist with the recovery of property cannot exceed 15% of the total value of the property. Wasps a third party involved in providing this claim form to youlthe claimant or assisting with the claim in any way? Yes ,~_No Name, address and phone number of third party Did the third party d~arge or inform you/the claimant of a fee, or recreive payment, for any service or assistance in connection with the claim? If so, please state the amount of such fee/payment. Yes No 3 Please speclfy amount of fee/payment. https://www.patreasury.org/unclaimed/C1aimForm.asp 1 /3/2009 Item 3 ltin~ One I-ik •cllo+s gold and dianxmd tittan+ st+l~ sc~litairr rim_. Ibis rin_ ee~lttains t I i round hrilliaat cut Jiamund sip rrong set in a tall head. 'I'h~ inside shank i; stantl•ai !-il. and 1 ~1 in a circle. 7~hi. pircr ++ci~lts I?~ Uhl'"I'. Diamond :attributes Sltahc ;llld Clit: Kl~Und I11'Illlant ~tca,urrntrnts: -l.'~ x -t.l ~ s ~.~47 lttnt tahPm~imatct ~'1'ei~~ht 11. ~-+ C ts. t estinrued Color. I Item Attributes 1lctal: I-IK +rllm+ and ++'hite _c+1.1 I~ finish: Polished ~cttilt:=: his Pr+~3t ~a I *a~i:.,,..r4: "E~11 Condition: ~"rr+ ~,~~~ I~utal appresi-natr KrtaiE ~'alur 56?~.U(f (1.(1(1 "n -I'it\ 1-~(1.`1! "Total :'1i+Pntsimatc KetaiE t'alur tncltl~lin~~ ~r;:x s-1~.~n STATEMENT OF ACCOUNT Cornerstone Federal Credit Union 5 East Gate Drive -Carlisle PA 17013 Telephone (717) 249-1661 Fax (717) 249-8208 MARY MINNICH MYRNA F. MINNICH 104 VIRGINIA AVE. CARLISLE PA 17013 NOTICE SEE LAST PAGEFORIMPORTANT INFORMATION REGARDING YOUR RIGHTS TO DISPUTE BILLING ERRORS NOTICE SEE LAST PAGE FORIMPORTANT {NFOAMATION iN CASE OF ERRORS OA QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS IDENTIFIED WITH LETTERS 'EFT Member Number Statement Period 81505 06/01/2008 - 06/30/2008 TRANSACTION f TRANSACTION I FRI AND CREDITSE~ I FINANCE I gACANCE DATE TRANSACTION DESCRII?ION I AMOUNT CHARGE J SHARE Ol..REGULAR SHARE ACCOUNT 06-01 Previous Balance 06-30 New Balance » Year-to-Date Dividends this account - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 07..SHARE DRAFT ACCOUNT 06-01 Previous Balance .00 .00 .00 « - - - - - - - - - - - - - - 06-06 DRAFT # 1051 0031066867 -5000.00 > A Dividend of .43 will be posted to this account on JUL O1 < 06-30 New Balance » Year-to-Date Dividends this account .00 « 5170.00 170.00 170.00 Draft# Amount Draft# Amount Draft# Amount Draft# Amount 1051 5000.00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - C~Q SHARE 10..SHARE CERTIFICATE 1~ » SHARE CERTIFICATE « » Rate 3.1500 Maturing on 10/24/2008 « 06-01 Previous Balance 44712.53 06-01 CERTIFICATE DIVIDEND 119.62 44832.15 > A Dividend of 116.07 will be posted to this account on JUL O1 < 06-30 New Balance 44832.15 » Year-to-Date Dividends this account 868.49 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 18..MONEY MARKET PLUS ACCOUNT 06-01 Previous Balance ?2273_.71_.. 05-31e DIVIDEND 153.50 72427.1. ~ > Annual Percentage Yield earned from 05/01(2008 - 05/31/2008< > on an average daily balance of $ 70874.14 was 2.58 < > A Dividend of 151.80 will be posted to this account on JUL O1 <, - 06-30 New Balance - - 72427.21 - » Year-to-Date Dividends this account ,913.81 zk ~ -- Total Dividends Earned This Year $ 1782.30 Total Finance Charges Paid This Year $ .00 *** CONTINUED NEXT PAGE *** CORNE~NE ~' Federal Credit Union Mrtmbe'f6~>ratded- Service 6aseld. P.O. BOX 1181 CARLISLE, PA 17015 717-249-1861 003475 MARY MINNICH ELAINE HURLEY 104 VIRGINIA AVE. CARLISLE PA 17013 501- STATEMENT OF ACCOUNT NOTICE SEE ENCLOSED FORM FOR IMPORTANT INFORMATION REGARDING YOUR RIGHTS TO DISPUTE BILLING ERRORS. NOTICE SEE ENCLOSED FORM FOR IMPORTANT INFORMATION IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS IDENTIFlED WITH LEITERS'EFT' MEMBER' NUMBER' 2 3219 STATEMENT DATE 04 Ol 2008 - 06 30 2008 OWNERSHIP OF SHARE. DEPOSIT AND CERTIFlCATE ACCOUNTS SHOWN ON THIS STATEMENT IS NOT TRANSFERABLE IXCEPT ON THE BOOKS OF THE CREDIT UNION. Transaction Date Transaction Description Transaction Amount. Principal Payments New Looees~s end Grechts flNANCE CHARQE BALANCE SHARE Gi.REC3ULAR SHARE aCC4UNT 04-01 Previous Balance .00 06-30 'New Balance .00 Year-to-Date-Dividends this-account .00 - - - - - - - - - - - _ - SHARE 10..SHARE CERTIFICATE - - - - - - SHARE:CERTIFICATE Rate 3.1500 Maturing:: an 10/24/2008 04-01 Previous Balance 49807.55 04-01 CERTIFICATE AIVIDEND 173.44. 49980.99 04-24 CERTIFICATE DIVIDEND 134.74 50115.73 05-01 CERTIFICATE DIVIDEND 25.95 50141`.68 06-01 CERTIFICATE DIVIDEND 134.15 50275.83 A Dividend of 130.17 will be posted to this. account on JUL O1 06-30 New Balance 50275.83 Year-to-Date Dividends this account 973.96 Total Dividends Earned This Year $ 973.96 Total Finance Charges Paid This Year. $ .00 Cornerstone FCU is now a Community Charter Credit Union!-~ Cornerstone Federal Credit Union is pleased to announce that more people are now eligible to'expperience the Cornerstone difference: affordable financial service delivered by caring professionals. Now anyone who lives, works, worships or attends school in Cumberland County and the°entire borough of Shippensburg is eligible. to become a member of Cornerstone. Additionally,_family members of these individuals: are also eligible to join. This is great newsi Go #ell all of your neighbors and friends. Let th em enjoy the same great rates, 'products and services that you enjoy. Watch for-a special edition newsletter for more details. ~ i r~ t JrMDIV I yr li~,~,vuln t Cornerstone Federal Credit Union 5 East Gate Drive -Carlisle PA 17013 Telephone (717) 249-1661 Fax (717) 249-8208 MARY MINNICH BRIAN HURLEY 104 VIRGINIA AVE. CARLISLE PA 17013 NOTICE SEE LAST PAGE FOR A~ORTANT INFORMATION REGARDING YOUR RIGHTS TO DISPUTE BILLING ERRORS NOTIC>r SEE LAST PAGE FOR Il~ORTANT INFORMATION IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS IDENTIFIED WITH LETTERS'EFr Member Numbs Statement Period 91505 04/01/2008 - 06/30/2008 TRANSACTION ~ PRINCIPALPAYM®~'rS FINANCE DATE TRANSACTION D13SCA1PTION AAR)UNT ~ ~~~ CyAR(~ B~'~~ SHARE Ol..REGULAR SHARE ACCOUNT 04-O1 Previous Balance .00 06-30 New Balance ,00 » Year-to-Date Dividends this account .00 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 10..SHARE CERTIFICATE » SHARE CERTIFICATE « » Rate 3.1500 Maturing on 10/24/2008 « 04-01 Previous Balance 22842.87 04-01 CERTIFICATE DIVIDEND 79.54 22922.41 04-24 CERTIFICATE DIVIDEND 61.80 22984.21 05-01 CERTIFICATE DIVIDEND 11.90 22996.11 06-01 CERTIFICATE DIVIDEND 61.52 23057.63 > A Dividend of 59.70 will be posted to this account on JUL O1 < 06-30 New Balance 23057.63 » Year-to-Date Dividends this account 446.68 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total Dividends Earned This Year $ 446.68 Total Finance Charges Paid This Year $ .00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cornerstone FCU is now a Community Charter Credit Union! Cornerstone Federal Credit Union is pleased to announce that more people are now eligible to experience the Cornerstone difference: affordable financial service delivered by caring professionals. Now anyone who lives, works, worships or attends school in Cumberland County and the entire borough of Shippensburg is eligible to become a member of Cornerstone. Additionally, family members of these individuals are a~.so eligible to join. This is great news! Go tell all of your neighbors and friends. Let them enjoy the same great rates, products and services that you enjoy. Watch for a special edition newsletter for more details. I~ M&TBaunk ACCdtJNT NO. ACCOUNT TYPE 2678014727 N8T CLASSIC CHECKING N/INTEREST STATEMENT PERIOD PAGE MAY.14-JUN.13,2008 1 OF 2 00 0 04319M NM I17 16521 MARY D MINNICH MYRNA MINNICH 104 VIRGINIA AVE CARLISLE PA 17013-1072 INTEREST EARNED FOR STATEMENT PERIOD 0.20 INTEREST PAID YEAR TO DATE 1.26 dCC~l1NT Sl1MMdRY HIGH STREET-CARLISLE EA ANCE S i OTHER ADDITIONS CHECKS PA H R T CiI RR ER Et PD _ EN 8A NCE N0. AMOUNT NO. AMOUNT NO. AMOIMIT 4,820.54 0 .00 2 0 6. 0 1 0 0.21 3,979.05 dCC[]l1NT dCTTVTTV GATE T ANSACTION'DESCRIPTION ~. i TNER #DDYfitONS O HE SUBTRACTIONS DA BALANCE 05-14-08 BEGINNING BALANCE 14,820.54 05-29-08 CHECK NUMBER 3013 26.20 4,794.34 05-30-08 JACKSON NATIONAL INS PYMT 360.00 5,154.34 06-03-08 US TREASURY 303 SOC SEC 1,042.00 06-03-08 CNECK NUMBER 3015 150.00 6,046.34 06-05-08 HARP HEALTH CARE PREMIUM 167.50 5,878.84 06-06-08 CHECK NUMBER 3014 1,900.00 3,978.84 06-13-08 INTEREST PAYMENT 0.21 3,979.05 ENDING BALANCE !3,979.05 CHECKS PAID SUMMARY ~~ 3013 05-29-08 26.20 3014 06-06-08 1,900.00 3015 06-03-08 150.00 ANNUAL PERCENTAGE YIELD EARNED = 0.04 NELCOME TO THE COMFORT ZONE! MiT NOME EQUITY RATES ARE THE LONEST IN YEARS! MAKE HONE IMPROVEMENTS OR CONSOLIDATE DEBT NON. CONSIDERING BUYING A HOME OR REFINANCING YOUR MORTGAGE? MAKE YOURSELF COMFORTABLE NITH OUR MANY MORTGAGE OPTIONS. CALL 1-866-236-0479 AND LET'S TALK TODAY. _L00lA (l+07~ '' r ,~ . AC K S Ns~ IVA'T I~~NAI :.ll`t If~J1 ItA~~1CE C.GMI':1N}' t'Lum. AdnuntsU~aUun (w Proceeds Pa~~able to: Myrna F. Minnich Police Number: Claim Number: Police Information: li~tl~triiliiewre~'+r. Lunn Payoff: Premium Due: Beneficiar~~ Information: Benefit Paid: Interest Paid: M isc Interest Paid: Premium Refund: Foreign Withholding: Federal Withholding: State Withholding: Distribution .-amount: 003SS661A0 0800018767 _.; x,.-71 $0.00 $O.UO $26.992.36 '''~o e'thc.Yl, ° t '~'S $0.00 $0.00 $0.00 $0.00 $2.398.47 $0.00 S24,S93.89 Jackson National Life Insurance Cumpar ~~ I Corporate V4'ay. Lansing. MI ~1t{9~ PO Box_'406tt, Lansing, MI ~1K9U9--106 :~ ~ ~ T,.11 Fr~.~ IV~~~nhar• SZStf; ~/.G_:14Q Hoffman-~th Funeral Home & Cremator ~~nc. , 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 June 18, 2008 Myrna Minnich 104 Virginia Ave. Carlisle, PA 17013 The Funeral Service for Mary D. Minnich 15350-134 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: Traditional Funeral Service Package $4150.00 FUNERAL HOME SERVICE CHARGES 54150.00 SELECTED MERCHANDISE: Whitmire II Casket $2170.00 Monarch Interment Receptacle , $1120.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED S7440.00 Cash Advances Rock Removal Charges-charged by cemetery, $845.00 ~ ~~ ~~~ L -~ Certified Copies of Death Certificates , $60.00 ~Q 1 Flowers, $222.60 Hairdresser, $40.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . S2017.50 Opening Gtave-charged by cemetery $750.00 Newspaper Obituary Notice- Sentinel , $99.90 ~~ Total Total Cost , $9457.50 History 06/18/2008 Hometeaders Life Company Cl # 543046 $-8073.86 06!18/2008 Discount Received , $-398.64 TOTAL AMOUNT DUE . ~ l $9H5.00 This statement is net and payable In full within 30 days of nacelpt. Please return this portion with your Remittance a Amount Enclosed Service ID # 15350-134 Mary D. Minnich Dine In Carlisle 1151 Harrisburg Pikz Carlisle, PA 17013 7112584468 www.hosss.c~m 2:17:40 PM 6112/2006 ewer: 2~8 a ab~e ~~ l Check 1~1 JO SubTotal 136.71 tax 8.20 ~ Gratuity 26.08 Total 1 1 0.99 TIP _ _ _._ ...__. ~r..-._ ~fOTAI - - Visa 170 99 Acct:XXXXXXXX04 `__ _- AuthCode:00h451 ~~ ~~~~~~~~~CUSI~ER COPY~~~~~~~~~~~ db . ~ /~ Tell Us Hnw We Dtid! You Could Win a ~1U.U0 G~fit Card! Visit our websitr at: www.hosss.com/survey Enter the 16 digit code below Survey Code:4010-?386-2501-5854 Dine Iri Carlisle 1151 Harrisburg Pike Carlisle, PA 17013 1172584468 www.hosss,cam 6/13/200 .,erver : Jacob C~CIc 4~3~ Seat , 1 Adult Salad Bar Water Seat 1 11:26:13 AM Table 99 5.99 total:[ 6.35] Seat 2 1 Adult Salad Bar 5.99 Unsweetened Iced Tea 1.89 Seat 2 total:[ 8.35] SubTotal 13.87 Tax 0.83 Gratuity 2.64 Total 11,34 TIP TOTAL ,~ ~ Visa ( 17.34 Acct : XXXXXXXX0402~,__.--r AuthCode:001547 ~~~~~~~~CUSTOMER CDPY~~~~~~~~~~~ Tell Us Haw We Uid! You Could Win a $10.00 Gift Card! Visit our arebsite dt: www.hasss.coe/survey Enter the 16 digit code below Survey Code:1340-2348-3501-5063 !l~ES~~~w ~~8~. ~ ~~ a ~ ~ 3,~~ ~o~ ~ ~~ ~~~o i. :~ Carlisle Memorial Service, Inc. DESIGNERS AND BUILDERS OF e.~, ~.~. 41 South Bedford Street Carlisle, PA 17013 Carlisle Memorial Service, Inc. Carlisle, PA. Telephone 243-5480 Price . ~.. `~ y' G ~ ~/o v~ ~ ..........,rJ.o2 , Q .~.. . (, f~ ' Total Pri ~ . . 0 ~.~~. Please design and build the following memorial DATE ...~.~ ~ !~/G~. ! . For ...~ ~~. . ~~.!-:~;1~--, , / ~ •~/:y~.;)'f-<<:~^.~ .. ..... r .... s.,,. ~~ .- .............. . Address ... l ~% . ? ...~f!.P~' ..~~ :K-!~•~. C..:~ .. 4-~~~.:~~C~Q~""`~ . C-~~.- ...~ . ~ ~ / .~ . . ~ ~ ~~ ~~ Design No. ~. ..-!~'•+""~" Material ..... Die .................. Base .................. Markers ~ -: ~ .~ . ~ . •. ~. ~ ~ ~ ~ ' ~ ~Y1 ~ rv ~ , e. Posu .. .......... ~ ~f / Price t~ .. .. Tax ... .r ~ ff ` Jr Deposit . ~,. c>'r ~`:~. ~... ~.~~ ~Q r17 / , ~(J/ ~„? ..u:~......... / ~ ~ Balance Due V ~ U `~ '' ~ ~~ , ~~, Family Name ............ `•'~ ~~ / Inscription . • .. . • .. • • 1G~ ~-', `,~- l t~ Style of Letters ~`.Es~ .•••S. /1,~ ~~ •~) ~ Foundation to be furnished by .............. .~ • • • • • • • • • • • • • • • • • ~ ~~ Material to be best selected monumental grade and to be free from imperfections and first class in every way. Work to be finished in a workmanlike ~ manner. --~J L~ ,/~ ~ ~,...,r ~ This memorial to be erected in ... .. ... ... . `../../. v.r..:. ~„~C/l/. /"' ..Cemetery in or near .. .. .. .. .. .. .. ... .. .. during th onth of ... .. ................ ............ . unless unavoidably delayed by labor troubles and other contingencies beyond our control and then as soon as possible. Additional lettering and other work on this memorial in the future is not included in the Contract Price. Title and right of possession and removal of said stone, monument or appurtenances shall remain for all purposes in Carlisle Memorial Service until work and materials ordered are fully paid by purchaser or purchasers. In consideration of the acceptance by Carlisle Memorial Service of this order, the undersigned (hereinafter knpwn as the purchaser) agrees to pay Carlisle Memorial Service ...... ~~.._ ......................... . ...:.................... ......... ........ ...............................Dollars on or before the 15th day following the billing bf the work or job upon completion thereof by Carlisle Memorial Service said billing to be notice of completion thereof, this order shall become a contract between the purchaser and Carlisle Memorial Service upon acceptance thereof in the space below by a duly authorized representative of said Carlisle Memorial Service; it being understood that this instrument upon such acceptance covers all of the agreement between the purchaser and Carlisle Memorial Service and that no agent or representative of Carlisle Memorial Service has made any statements or agreements, verbal or written, modified or adding to the terms and conditions herein set forth. It is further understood that upon the acceptance of this order the contract so made cannot be cancelled, altered, or modified by the purchaser or by any agent of Carlisle Memorial Service or in any manner except by agreement in writing between the purchaser and Carlisle Memorial Service, and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers, twenty-five per cent of the total original coat of the work or work and materials ordered, as the case may be, shall be specified correct sum as liquidated damages which purchaser shall owe Carlisle Memorial Service, less any payment on account made prior to such default, this specification of damages to be due regardless of removal and taking possession of stone, monument or materials from purchaser or purchasers by Carlisle Memon I Serv a upon~ollowing such default. ~ /7~ ~ ~00 n) (~ (/` \ aa .....~.Q .............................................20.~..g ........ ....,.................................,...................................................ISEAL) Carlisle Memorial Service Approval 8y ~ . • • . • • • • • • • • • • • • • • • • • • • • • • • • • • • . ISEAU White: Offic opy; Canary: Cu omer Co Pink: Salesman Copy: Gotd: Office Copy LINDSAY DARE BAIRD, ESQUIRE 37 S. Hanover Street Carlisle, PA 17013 (717) 243-5732 Fax: (717) 243-8110 STATEMENT FOR LEGAL SERVICES RENDERED To: Myrna F. Minnich RE: Estate of Mary D. Minnich EIN # 74-6565 5196 DATE SERVICE RENDERED DATE: February 23, 2009 UNITS OR HOURS RATE TOTAL 6/24108 Initial meeting and information gathering 0.50 175.00 87.50 7!2/08 Create Probate Petition & Estate Information 0.50 175.00 87.50 7/3/08 Meet and file probate petition 0.75 175.00 131.25 ?/12!08 File EIN application and Form 5.6 0.50 175.00 87.50 7/16/08 Legal Notices 0.75 175.00 131.25 1/8109 Meet 0.50 175.00 87.50 2/23/09 Meet 0.50 175.00 87.50 3/09 File Form 6.12 0.30 175.00 52.50 0.00 0.00 Thank you, Myrna! 0.00 0.00 TOTAL UNITS OR HOURS 4.30 SUBTOTAL 752.50 Less BALANCE DUE $752.50 a~ ~9 ~ ,oo~ RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARMER STRASBAUGH Receipt Date: 7/03/2008 Cumberland County - Register Of Wills Receipt Time: 12:34:30 One Courthouse Sqquare Receipt No.: 1053255 Carlisle, PA 17Q13 MINNICH MARY D Estate File No.: 2008-00710 Paid By Remarks: MCAJRY D MINNICH Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 20.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN ----- Check# 3020 ----------- $. 70.00 -Total Received......... . $"70.00 ,.., _ ~ _ ~ C~5 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Telephone - 717 249-3166 Fu - 717 249-2663 August 8, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Lindsay D. Baird, Esquire . Mary D. Minnick Estate RE: All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement publication date: July 25, August 1, and August 8, 2008 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ .00 Total Amount Due $ 75.00 n~ ~ ~ RETAIN THIS PORTION FOR YOUR RECORDS TEE SENTINEL - LEGAL ~~ P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS 353089 10 PUBLIC NOTICES AD DESCRIPTION EXECUTRIX NOTICE LETTERS TESTAMENT PUBLICATION INSERTIC 3 THE SENTINEL - LEGAL 3 TOTAL AD CHARGE 3 PROOF OF PUBLICATION BAIRD LAW OFFICES SALESPERSON BILLING DATE wolfs 08/03/08 START DATE 07/19/08 RATE NET AMOUNT LGL 151.62 15T.62 O1PRF 7.00 i ` PAY THIS AMOUNT ~ lss . 6 Est.MaryMinnich 38 * 2 TOP DATE 08/02/08 190.34* MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 717-240-7176 Fax your legals to 717-243-3754 attention Tammy Shoemaker You can also EMAIL your legal to Classified ads: classifiedc~cumberlink.com Please send a cover letter including your name and address as an attachment 'p~ ~1~~ o~ to ~ ~' DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL -LEGAL Est . MaryMinnich o n env ~zn reci icl ~ on ~~n~z AD NUMBER CLASSO STAR DATE STOP DATE 353089 PUBLIC NOTICES 07/19/08 08/02/08 AD DESCRIPTION ILLING DATE TELEPHONE NUMBER EXECUTRIX NOTICE LETTERS TESTAMENT 08/03/08 717-243-5732 BAIRD LAW OFFICES 37 SOUTH HANOVER ST CARLISLE, PA 17013 i~nlll~~~ill~n~~~llull~l~~i~l GROSS AMOUNT OF 190.34 DUE AFTER 09/02/08 TOTAL AMOUNT DUE 158.62 ENTER AMOUNT ENCLOSED 20200000003530890000000000000001903400000158626 ~ coRnlEiestlolil6FCU - ~.~ •, MYRNA F MINNICN r aye ~ v~ c Account Number: 4114 9950 0000 C `~ ~~~~ Closing Date: 06/02/08 Credit Limit: 16,588 Available Credit: 55,952 Cash Limit: 56,588 Available Cash: 55,926 Account htquirMs Account Summary Customer Service: ® (800) 4330506 NATL 800 (717) 2~-e711 Pnma~s Balance Purctases ~ credits S + - 736.48 635.45 o.oo 27.98 To Report a Card Lost or Stolen: Payrnsnts - 708.50 (717) 24A-8711 LOCAL Iru~xance + 0.00 (800) 991981 AFTER HRS Other Debits + 0.00 Please Direct Written Inquiries to: ~ Fk~ance C + 0.00 CUSTOA~ER SERVICE '""` NEW BALANCE S ~ PO BOX 30495 TAA~PA, FL 33830 To vMw or pay your account on-Nne: vrww.eZCardlnfo.oom PBynMR11R b>~o~n~ion . Total Minimum Payment Due 520.00 ~ s Payment Due Date 06/27!08 I~__ _- ~'"'"" Pea Due Amount Over Limit, Fees s s S 20.00 o.oo 0.00 Mail Payments to: CORNERSTONE FEDERAL CREDIT UNION PO BOX 4519 CAROL STREAM IL 60197-4519 '~ inipOft~it f1rllAfi • YOU HAVE EARNED 542.10 IN CASHSACK SO FAR THIS YEAR! • IT fS NOT NECESSARY TO MAIL YOUR PAYMENT. A DEBIT TO YOUR CHECKING /SAVINGS ACCOUNT FOR 635.45 WILL BE INITIATED ON 08/2608, PER YOUR AGREEMENT WITH US. • MANAGE YOUR CARD ACCOUNT ONLINE. IT'S FREE! IT'S EASY! SIMPLY GO TO WWW EZCARDlNFO. COM AND ENROLL IN OUR ONLINE SERVICE. YOU CAN REVIEW ACCOUNT INFORMATION. TRACK SPENDING, SET ALERT NOTIFICATIONS, DOWNLOAD FILES, AND MUCH MORE. MANAGING YOUR ACCOUNT IS FAST, SECURE AND EASY WITH EZCARDINFO. ENROLL TODAY! • CELEBRATE SUMMER BY USING YOUR SCORECARD. AT HOME OR AWAY YOU ALWAYS EARN CASH. Account Activft Since Your Last 8tabart~nt Trans Date Past Date MCC Code Reibrencs Number Deacr>iafion Amolmt 800451.6245 PA ' 05ro8 05!09 5994 24717058f30131304577768 THE SENTINEL 12 DO 711-2432811 PA 05/10 05/12 5542 24164078132799131890188 AMOCO 0!L 06141687 -x'46 00 CARLISLE PA 05/13 0515 5411 24427338135710001556647 NELL'S -SPRING ROA 25 29 CARLISLE PA ' PLEASE DETACNCOUPON AND RETINMI PAYMENT USING THE ENCLOSED ENVELOPE - ALLOW S DAYS fOR MAIL DELIVERY ewo - ' CORNERSTONE FCU Accout~ IWNnbar P O BOX t 181 4114 9950 0000 0402 CARLISLE PA 17013 -0927 ~ Cloairq Dale New Balanoa 06/02/08 5635.45 Total Minrrwm PaynM>~t Du• Dab Paynwk Gus 320.00 06/27/08 heck boy to indicate namegddiess change on back of this coupon AMOUNT OF PAYMENT ENCLOSED ~u MYRNA F MINNICH 1~ MAKE CHECK PAYABLE TO: 104 VIRGINIA AVE CARLISLE PA t7ot3- to72 i~ I~Il~~ll~~~~~~lll~l~~l~~~l~i~tl~l~l~~~~lll~l~~~~tlll~l~~l~~l~l =~ CORNERSTONE FEDERAL CREDIT UNION PO BOX 4519 It~~116~~III~~~~~JI~~II~~~~IIiL~J~~~I~~LIII~~ttI~J~6~11 CAROL STREAM iL 60197 -4519 PJ1F1Kt 1.11 t1.1~J F'NTHtSLt I V: V.. j ~ MASTERCARD ~ DISCOVER VISA ,.Special Event Emergency Medical Services Inc Bllllrl~ OfrlCe TIN: 51-08A9g77 P.O. Box 726 New Cumberland, PA 17070 Patient Name: MINNICH, MARY D. Patient SSN: XXX-XX-5991 ~ ~ Date of Service: 3218008 15:16 ~ From: Carlisle Regional Medical Center To: CIAREMONT NSG & REHAB-COMB CTY Primary Payor. Bill Patient Secondary Payor: i INVOICE DATE RUN NUMBER S'AY' '+i;S kMGl1Fv 7/2/2008 08-37079 - Local Telephone: 1-717-214-6018 ~ ~` Pan Esplar'for lame f-86&7?4.4114 Toll Free : 1-877-214-6018 FAX: 1-717-214-6020 emaN: info(~ambulancebillingoffice.com ~\ MARY D. MINNICH ` ~ 164 VIRIGINIA AVENUE 1 CARLISLE, PA 17013 I~~~I I TI N TO AUDRE S ABOVE III~~~~~~II~IIIIIIIIIIIIIIIIII'III CF/SSE~'~C~~ O S S DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT pYocsdYne Tote/ Discounts Date Description Coat Qty Unit P-ice C-~s-pe AdfusbnerKs Payments _ ... _ _ 3/21/08 Wheelchair Van Transport A0130 1 50.00 50.00 3/21/08 Mileage S0209 5 2.00 10.00 Total 60.00 0.00 0.00 This type of service is not covered by ambulance memberships, Medicare, Medicaid and most secondary insurances. Payment is your responsibility. Special Event Emergency Medical Services Inc, 877 2146018 MINNICH, MARY D. 08-37079 PAY THIS AMOUNT !III 660.00 i~rri ~ •"~ , =-., PHARMERIC'A 1 CU3'F•QLVIER: MARY MINNICH FACILITY: CLAREMONT NSG & REHAB _NTER ~ ~ ii ~.}:,~ ti•~wa:~r BATE: 06107~p); ACCOUNT: 5713-48-03704 f~Rcx'K'1'c)K. stn 02301 PAGE: 1 of 2 PRIMARI' PAl'OR: INSURANCE POLICY#: PHP7161OU EFFECTIVE DATES: 05/02!08 PREVIOUS PAYMENTS NEVb' BALANCE BALANCE: RECEIVED: CREDITS: CHARGES: 5152.46 DUE: SI52.• DATE I RX NUMBER DESCRIPTION I QTY BILLED AMT DUE FROM INSURANCE INSURANCE ADJUST CHARG ( CRED17 Balance Forward: 05/05/08 228786.02 IPRATR-ALBUTEROL 0.5-3 MG 180.000 141.40 83.34 30.28 27 05/05/08 228790.01 XALATAN O.OOSIS EYE DROPS 2.500 85.21 53.57 13.78 17 05/06/08 228789.01 ATENOLOL 50 MG TABLET 28.000 33.36 5.68 25.79 1 05/06/08 228814.01 CAL CARE W/VIT D 600-400 56.000 5.94 5 05/06/08 229810.00 ALENDRONATE SODIUM 70 MG 4.000 91.95 33.75 46.95 11 05/06/08 230081.00 FUROSEMIDE 20 MG TABLET 168.000 30.63 10.39 16.78 3 05/07/08 229811.01 SERTRALINE HCL 50 MG TABL 16.000 53.40 7.31 43.65 05/07/08 229812.01 AMLODIPINE-BENAZEPRIL 10- 16.000 63.14 36.38 14.63 12 05/09/08 228791.01 POLYETHYLENE GLYCOL 3350 527.000 49.06 25.81 14.65 8 05/14/08 230909.00 MORPHINE SULF 20 MG/ML SO 30.000 28.62 11.51 13.27 3 05/22/08 229572.01 POTASSIUM CIdLORIDE 101s LI 473.000 14.90 6.55 6.16 2 05/27/08 228790.02 XALATAN 0.005$ EYE DROPS 2.500 85.21 53.57 13.78 17 05/27/08 231844.00 FUROSEMIDE 10 MG/ML VIAL 32.000 21.50 11.40 6.30 3 06/03/08 228789.02 ATENOLOL 50 MG TABLET 28.000 33.36 5.68 25.79 1 06/03/08 229811.02 SERTRALINE HCL 50 MG TABL 28.000 85.94 9.42 73.38 3 06/03/08 229812.02 AMLODIPINE-BENAZEPRIL 10- 28.000 102.99 55.34 29.20 18 06/03/08 232355.00 FUROSEMIDE 20 MG TABLET 28.000 13.44 5.48 6.13 1 ADJIISTML TO CIIST R'S ACCOUNT FOR COPAYS 05/27/08 8X229344.01 5/27/08 RXEXP 8.11 8 BILLING QUESTIONS: M11EDlCATION QUESTIONS: W~~~ PAYMENT ADDRESS: 08:00 AM - 05:(10 PM UR:3U AM - 05:(X) PM P.O. BOX 6413 PHONE: Sb6-251-5966 PHONE: 717-249-237(1 `~ , , ~ ~i ~ CAROL STREAM, IL 60197-h4 ( ~; ~~~ Aulhon2ed Signature __. --_ ~~~~i~~~~~rr~~~~~~ Date Statement CLAREMONT NURSING & REHAB CTR 1000 CLAREMONT ROAD CARLISLE, PA 17013 Telephone: (717) 243-2031 Statement Date: 07/20/2008 Mary Minnich 104 Virginia Ave. Carlisle, Pa 17013 Due Date: 08/01/2008 Re: Mary Minnich Account Nr: 4963 -------------------------------------------------------------------------------- Date Description Days Rate Charges Payments Balance Quant -------------------------------------------------------------------------------- BALANCE FORWARD -4,688.00 -4,688.00 06/30/08 PAYMENT -5,060.00 372.00 ~ ~ o~~ ~ K 9~t ~1~•~® c~ ~~ • C\JL YUC.Jl.1Vil.~," please conLacL 1Jenlse Lenman at 717.240.1908 ~~466E-9Z90LS xejElt£-tl9Lll ~ ~ ~ ~ 9£ZS-lLZ 008.O6ZZ-BZ9 OLS 9601.688 008.OOEZ-Z9L L t L 106L L Vd 'eN!~stlod Ol lL L Vd '~~!ueH ~Id oei6eMaN ~0 t0E ~~0 P~-il3 SOLE ~+nr ur~~e ~r ~V~H ~ ~. ~. a~dsoH Hllb'3H3l~VNNid ~~ ~~ ~-a~~,~~ 30-`~ /~ier peo, pie come into our ~'ves ~ quickly 90... Some stay for a while ~ ve foo~rints on our hearts.. . e are never the same. -Anon~moiis L - ~--. ;~ W~ ~ ~~ I O nv ~ ~ € ~~ ~ . ~~~ ~ ~ ~ ~ Ala a ~ ~ ~~ ~' ~~ ~ a' " m i ~ ~ :~ ~~• ~ ~ , J F; ! wi ' 1 ~ J N ~ V I ti '~ 1 o i m ! O ~~ 7 ~~ r I `~ G ~ a ~ ~ f ~ i' O - '~ / N~ d ( ( ~ ~ 0 I ~ C I 1~ ~ ~ .', ~ ~ , (~ ®~0 M ~ 0 ~ I ~ _' ~ , O I 1 tl I I ~,.w.w.~r~.e r...+...~7wM.• I R I ~ I ~ ~ ~ ,. ,. _,._ s( . c ~.;~ , o '~ : i ill ~ ;~ ! r., , ~ .~ N ~~ ~. ,~,_ ... I ~BtZiE'c:'Y1000t r taffy u08epurwy ul?NN i-~YUMd Mio t+sorsa~ ~a~ 1 •.r ~s~'.ur, ~ ~ • r I Carlisle Small Animal Veterinary Clinic 25 Shady Lane Carlisle, PA 17013 717-243-2717 "Our Goal Is To Keep Your Pets Healthy and Treat Th FOR: _ Myrna Minnich 104 Virginia Ave. Carlisle, PA 17013 Date For ty Description Printed: 06-13-08 at 10:54a Date: 06-13-08 Account: 1296 Invoice: 330175 Price Discount Price 06-13-08 Petey 1 Frontline Plus 0-22 Ib 6 pk 81.00 O6-13-OS 1 Frontline Plus (Promo) 0-22 Ib 0.00 06-13-08 1 Fecal Ova/Parasites/Giardia 20.50 06-13-08 1 Toe Nail Trim 13.00 06-13-08 1 Office Visit 42.00 06-13-08 1 Today's Doctor Was Dr. Strock. 0.00 06-13-08 1 Processed by Marilyn. Thank You! 0.00 06-13-08 Visa payment -156.50 Old balance Charges Payments New balance 0.00 156.50 156.50 0.00 Reminders for: Petey (Weight: 14.1 Ibs - 12y) Last done - 08-16-10 Rabies, Canine 3 Year ~ 08-17-07 y,~ ~o1,P1 ~ ` 06-13-09 Office Visit 06-13-08 / ~ ,p ~ 04-OS-09 Lyme, HW, Ehrlichia, Anaplasmo 04-OS-OS V o ~,~ 08-16-08 DHP-P Annual Booster 08-17-07 ~ •..... ... ~. `..~.. .. j :~5;., .... y 4 ~.. i. ~ ~ ~ ,~ r .. ;r : ...~.. . ) ... ~, .., ;~ . - ~ i - i J~ ~ + µ` A ; ~.f . ... . - ~ t ~ ~ S' 'r . ~ F, ~ i ~ ~ ... 1 r :.. 1 ... ~.... . .. ... ' ~. . REV-15t0 EX+(g-g8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE 6 INTER-VIVOS TRANSFERS 8L MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Mary D Minnich 2108-0710 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATfACHACOPV OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION pF APPLICABLE) TAXABLE VALUE t ~ Jackson National Life Ins Company, Lansing, MI 48909, Non-qualified 53,985.00 100 53,985.00 annuity, Policy No. 0035566140, issued 7120192 p TOTAL (Also enter on line 7 Recapitulation) E I 53,985.00 (If more space is needed, insert additional sheets of the same size) . c. REV-1511 EX+ (12-99) SCHEpYLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary D Minnich 2108-0710 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Hoffman Roth Funeral Home & Crematory -Total cost $9,457.50 less discount of $398.64 9,058.86 2. Dine In Carlisle -funeral refteshments 188.33 3. Carlisle Memorial Service -monument 809.60 e. ADMINISTRATIVE COSTS: 1. 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 752.50 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 70.00 5. Accountant's Fees 6. Tax Return Preparer's fees 2,000.00 ~. Cumberland Law Journal -advertising 75.00 s. Cornerstone FCU -additional statements fee - 15.00 s. The Sentinel -advertising 158.62 TOTAL (Also enter on line 9, Recapitulation) I S 13,'127.91 (If more space is needed, insert additional sheets of the same size)