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HomeMy WebLinkAbout07-09-0915056051058 REV-1500 Ex (O6-os, OFFICIAL USE ONLY PA DepartrneM of Revenue County Code Year File Numtx~r Bureau of Individual Taxes Po sox 2eo6o1 INHERITANCE TAX RETURN n ~ On ~ n O` I ( a Hanisburg, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 202-20-1712 02/21/2009 11/11/1927 Decedent's Last Name Suffix Decedent's First Name MI Weller Anna M (H 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 ~ 1. Original Retum r~ 2. Supplemental Retum C~ 3. Remainder Retum (data of death prior to 12-13-82) ~ 4. Limited Estate C~ 4a. Future Interest Compromise (date of C„:a 5. Federal Estate Tax Retum Required death after 12-12-82) c"'~ 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) CJ 9. Litigation Proceeds Received r;:.:~ 10. Spousal Poverty Credit (date of death C"~ 11. Election to tax under Sec. 9113(A} between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS 8ECTION MUST BE COMPLETED. ALL CORREBPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Cheryl Weller (570) 937-4737 Firm Name (If Applicable) _ _ REGISTER OF WILLS USE ONL~ ~ u'.? I C _~ ' - First line of address " ~ ~ L._ r 23 Lake Shore Dr ~ ~~ ~ tom" ~ t ; i =-~. r- ~, r T'l I ~ ~- i i Second line of address -~? ~D cry ~ _. 7 .-_ - r ~ f -` C J ;!'~+ r ~ C 3 C~ `~ l ~ i OAT .~ City or Post Office State ZIP Code - , - t~rt ;; _ - ` ' Waymart PA 18472 ~ ~„y ~. E3 Correspondent's e-mail address: Shay26m~yahOO.COm 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. DeGaretbn of preparer other than the personal representative is based on all intonnation of which preparer has any knowledge. SIGNA~RSON RES ~ONSI L FOR FILING RETURN ~DATEJ r ZOO 7 p, ~~CC (/V ` ~ ADDRESS23 ~ .~ ~ I/~~y m a r~- fit}- / ~ `f 7 Z. G _ SIGNATURE OF PRE P ARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number D«~de~rs Name: Anna M Weller 202-20-1712 RECAPITULATION i 1. Real estate (Schedule A) ............................................. 1. 2. stocks and Bonds (Schedule B) ....................................... 2. 647.85 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 1...._ _. _.. _.__ _. _._ __... .. _._._. _ _......: 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 8. Jointly Owned Property (Schedule F) Q Separate Billing Requested ....... 8. ; 19,696.45 , ~ 7. Inter-Vivoa Transfers 8 Miscellaneous Non-Probate Property _ _ ~__. (Schedule G) O Separate Billing Requested........ 7. ', 8. Total Oros Assets (total Lines 1-7) .................................... 8. ', 20,344.30 ', 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. ' _ 8,054.72 __ 10. Debts of Decedent, Mortgage LlabillUes, 8 Liens (Schedule I) ................ 10. 1,327.33 11. Total Deductions (total Lines 9 8 10) ................................... 11. I 9,382.05 12. Net Valw of Estate (Line 8 minus Line 11) .............................. 12. ' 10,962.25 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has net been made (Schedule J) ........................ 13. '. 14. Nst Valw Subiact to Tax (Line 12 minus Line 13) ........................ 14. ! 10,962.25 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 18. ' 493.30 17. Amount of line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 B. 19. TAX DUE ......................................................... 19.I y 93:3~I 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 c:.~ 15056052059 REV-1500 EX Page 3 rlssr_srlant'A Cemnlete Address: FIN Number i._ __iI-__ ---~ DECEDENTS NAME DECEDENTS SG~CIAL SECURITY NUMBER Anna M Weller 202-20-1712 STREET ADDRESS 1711 Cornell Rd CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 493.30 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (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, Llns 20 to request a refund. (4) 5. Ii Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 493.30 A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 493.30 Make Check Payable to: REGISTER OF WILLS, AGENT .. ~ _ fix, .. 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 lice 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 consideratbn? .............................................................................................................. ^ 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 designatan? ............................................................................ ............................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. ,_ 3 , . . , _. _ _ _ .. -- .~ -. , For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) {1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets 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)]. 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. REV-1503 EX+ (6-98'~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Anna M Weller All prop~rttl lolntly-owned with r19M of survivonhlp must b~ disclosed on Seh~dul~ F. (lf more space is needed, insert additional sheets of the same size) iiii iiu iiiii iii iiiiiii inii iiiii iiiii iiiii iiin iii iiiiiin i Prudential 000136 II'I'IIIII~lllll~~~~l~~ll~ll~~ll'~~II~I~II~II~~~I~~I~~III~I~II~~I ANNA M WELLER 1711 CORNELL RD CAMP HILL PA 17011-3941 ~omputershar~e Computershare PO Box 43033 Providence AI 02940-3033 Within the US, Canada 8 Puerto Rico 800 305 9404 Outside the US, Canada b Puerto Rico 732 512 3782 vvvvw.c omputers hare.coMinvestor Dear Holder: Re: NNA M WELLER Company Name: Prudential Financial, Inc. Account Number: 0027373488 DRS book-entry shares: 35 Certificated Shares: 0 .. .. .. . .~ _ ~_ _ _ ~__u- _~--i. ~- - --... -...... ,..1 .........K.... 1...1.1... IA/n Lnun nlnn AnfJnccl) Historical prices for PRU (Prudential Financial, Inc.) -Google Finance Page 1 of 1 Web Images Video MaQs News Sho. ping Gmail 'more . Portfolios ~ Sign._In. Get quotes ~ Stock_screener Example: "CSCQ" or "Google" Historical prices « Back_to overview _. Prudential Financial, Inc.(NYSE:PRU) - Daily ~ Weekly Feb 21, 2009 -Feb 21, 2009 Update Download to spreadsheet Date Open High Low lose ~ Volume 20-Feb-09 18.09 19.41 17.09 18.51 17, 778, 710 International Google Finance: Canada - U.K. - IN_~~#?~_(China~ - 1#:~1~ (Hong_Kong~ information is provided 'as is' and solely far informational purposes, not for trading purposes or advice, and may be delayed. To see all exchange delays, please see disclaimer. ©2009 Google Google Ho_.me -Help -Privacy Policy -Terms of Service ---- - -- ----- - _ OoH2NG REV-1509 EX+ (6-98 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~E ~ JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Anna M Weller N an asset was made joint within one year of the decedent's dab of death, It must be roported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Patty J Weller B. C. JOINTLY-OWNED PROPERTY: 1711 Cornell Road Camp Hill, PA 17011 daughter ITEM NUMBER LETTER FOR JOINT TENANT DAIS 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 % aF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 01101101 M&T Bank Checking Account 89604776 39,392.89 50 19,696.45 TOTAL (Also enter on line 6, Recapitulation) I s 19,696.45 (If more space is needed, insert additional sheets of the same size) ©1•~ ACCOUNT N0 .' ACCOUNT ?YPE 89604776 DIRECT DEPOSIT CHECKING 00 0 06123M NM 017 MRS _ANNA M._WELLER TTY J W 1 CORNELL RD CAMP HILL PA 17011-3941 19334 ACC(~iTNT SiiMMARY STATEMENT PERIOD PAGE FEB.24-MAR.23,2005 1 OF 2 older fhe~ -fir-,ts WEST SHORE PLAZA HEG~NNING ,: ALANCE _ D~P03ITS & : ' : HER `ADDITION : ' ! _!. HS X PA D OTYiER. I' TRA I CURREIIT I EkE T PD &NAxNG: _ C!S NO. AMOUNT N0. AMOUNT N0. AMOUNT 41,883.51 3 1,959.36 16 1,428.80 2 18.54 0.00 42,395.53 ACCOUNT ACTIVITY 'POSTING. ISATE- . ' _ - _ -,_ LIES RIPTION > IRAN CTI DEPOSIT ',I1~ITEREBT - THS ADD I _ CH£CKS 6_OTHER S TRA TION _ ' DAILY 02-24-OS BEGINNING BALANCE $41,883.51 02-24-OS CHECK NUMBER 5538 57.87 41,825.64 02-25-OS CHECK NUMBER 5536 235.75 02-25-OS CHECK NUMBER 5537 42.24 02-25-OS CHECK NUMBER 5539 27.62 41,520.03 02-28-OS CHECK NUMBER 5542 200.00 02-28-OS CHECK NUMBER 5540 40.76 02-28-OS CHECK NUMBER 5541 33.52 41,245.75 03-Ol-OS PINNACLE HEALTH PENS PMTS 720.36 03-O1-OS CHECK NUMBER 5535 62.20 03-O1-OS CHECK NUMBER 5534 22.32 41,881.59 03-07-OS CHECK NUMBER 5543 200.00 41,681.59 03-09-OS CHECK NUMBER 5547 100.00 03-09-OS CHECK NUMBER 5548 40.74 03-09-OS CHECK NUMBER 5545 23.78 41,517.07 03-10-OS CHECK NUMBER 5546 100.00 41,417.07 03-14-OS AT&T Consumer CHECKPAYMT 000000000005544 8.54 41,408.53 03-16-OS US TREASURY 303 SOC SEC 1,229.00 92,637.53 03-17-OS CHECK NUMBER 5549 42.00 42,595.53 03-21-OS CHECK NUMBER 5550 200.00 42,395.53 03-23-OS SERVICE CHARGE 10.00 03-23-OS DIRECT DEPOSIT REBATE 10.00 42,395.53 ENDING BALANCE $42,395.53 CH$CKS. PAID $IfMMARY ' i : 5534 03-O1-OS 22.32 5535 03-O1-OS 62.20 5536 02-25-OS 235.75 5537 02-25-OS 42.24 5538 02-24-OS 57.87 5539 02-25-OS 27.62 5540 02-28-OS 40.76 5541 02-28-OS 33.52 5542 02-28-OS 200.00 5543 03-07-OS 200.00 5545* 03-09-OS 23.78 5596 03-10-OS 100.00 5547 03-09-OS 100.00 5548 03-09-OS 40.74 5549 03-17-OS 42.00 (.:,~ 11'1QL1 iKtll.l~ ~ ~ `.`'~~ ::'~ ~ ~~ ` ''` ~~ ~~ :~ 4 "~ #CCOIINT NO. ACCOUNT TYPE STATEMENT PERIOO pA~ 89604776 DIRECT DEPOSIT CHECKING JAN.24-FEB.23,2009 1 OF 4 0• • 06123M NM I17 _. _ __ _ 5312 MRS ANNA M WELLER PATTY J WELLER 1711 CORNELL RD CAMP HILL PA 17011-3941 HEST SHORE PLAZA ....a.v~n ~ aYrir lART A N NO. AMOINIT N0. AMOIRlT T N0 AMOUNT 40 124.62 . ~ 0 ACCOUNT ACTIVITY ,~R 0.00 39 174.24 01-24-0 BEGINNING BALANCE 01-26-0 CHECK NUfR;ER 6195 040,124.12 01-26-0 GIANT F000 0253 NEN CUMBERLAN 300.25 01-26-0 CHECK NUMBER 6185 132.44 01-26-0 CHECK NUl03ER 6189 70.00 01-26-0 CHECK NUlR~ER 6188 ~'~ •1-26-0 [HECK NU103ER 6190 57.62 01-26-0 NN SUPERCENTER CARLISLE 57.25 O1-2i-• VERZZON ARC CHECK PYMT 000000000006191 31.37 01-26-0 RITE AID STORE 1074 LEMOYNE 29.49 01-27-0 AT6T MOBILITY CHECKPVMT 000000000006192 3'29 39,304.76 01-27-0 UCI UTILITIES UTIL PMT 000000000006187 47 22 •1-27-0 CHECK NUIR)ER 6194 30.53 01-29-0 CHECK NUMBER 6193 22.32 39,284.69 01-30-0 CHECK NUMBER 6196 33•~ 39,250.85 02-02-0 RETIREMENT PENSION 199.00 39,051.85 02-02-0 GIANT F000 •253 NEN CUMBERLAN 720.36 •2-02-0 AMERICAN HOME MEDICAL CAMP HILL 168.00 02-02-0 RITE AID STORE 1074 LEMOYNE 95.96 02-09-0 DEPOSIT 81.99 39,426.26 118.13 02-09-0 CHECK NUMBER 61 % •2-09-0 GIANT FOOD 0253 NEN CUl03ERLAN 320.00 02-09-0 CHECK NIRRIER 6201 193.04 02-09-0 RITE AID STORE 1074 Lp~Dy~ 35.96 02-10-0 CHECK NUIR3ER 6200 x•00 38,980.39 02-10-0 UCI UTILITIES UTIL PMT 000000000006199 62.50 02-11-0 AT6T ConsuMr CHECKPAYMT 000000000006197 27'18 38,890.71 02-13-0 SEARS ROEBUCK 2624 CAMP HILL 10.06 38,880.65 02-13-0 RITE AID STORE 1074 LEMOYNE 906.28 02-18-0 US TREASURY 303 SOC SEC 5.48 ~ 37 L968.89 1,424.00 39,392.69 uos,a ~sro~~ ACCOUNT N0. ACCOUNT riPE STATEMENT PERIOD pAQE 89604776 DIRECT DEPOSIT CHECKING JAN.24-FEd.23,2009 2 OF 4 MRS ANNA M WELLER PATTY J WELLER wrrn~~ur .nTT...~.. DA E T TI R ION N R A IONS SUdT CTI dA E 02-23-0 GIAIiT FOOD M253 NEM CUMdERLAN 216.46 02-23-09 MEIS MARKETS •125 S CAMP HILL 2.19 02-23-0 SERVICE CHARGE 10.00 02-23-0 DIRECT DEPOSIT REBATE 10 00 . 39,174.24 ENDING BALANCE 039 174.24 6185 01-26-09 70.00 6188 01-26-09 6190 01-26-09 57.25 6193^ 01-29-09 6195 01-26-09 300.25 6196 01-30-09 6200* 02-10-09 62.50 6201 02-09-09 57.62 6109 01-26-09 58.15 33.04 6194 01-27-09 22.32 199.00 61%• 02-09-09 320.00 35.96 ~cosa islm~ f.':! ~. . , ~~~'- REV-t511 EX+(12-991 scNEOU~~ x COMMONWEALTH of PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FlLE NUMBER Anna M Weller Dabb of dac~rd mwt ba raporbd on SctNduN L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 ~ Myers-Hamer Funeral Home Inc -Funeral Bill 6, 567.00 2. Clothing 10.00 3. Cookies for Caregivers -Funeral Expense 56.00 a. Cadee, Inc -Memorial Bookmarks 45.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Sadal Security Numl>ar(s)/EIN Numtxsr of Personal Representative(s) _ Street Address City State Zip Year(s) Commission Pald: 2. Adomey Fees 500.00 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) 647.85 Ciaimant Patty J Weller street Address 1711 Cornell Rd City Camp Hill state PA . Zp 17011 Relationship of Claimant to Decedent daughter (claim for value of stock) 4. Probate Fees 5. Ar:countant's Fees 6. Tax Retum Preparer's Fees ~. small claim & inheritance filing fee 30.00 s. Register of Wills -Affidavit of No Probate 5.00 s. Cheryl Weller -Mileage -travel to Court House 185.37 ~ o. PostagelCopies 8.50 TOTAL (Also enter on line 9, Recapitulation) s 8,054.72 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (t2-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAx RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Anna M Weller __ Report debb incurred by the decadaM prior to death that romainad unpaid at the data of death, Including unraimburaad madlcal expenia. ITEM VALUE AT DATE NUMBER DESCRIPTION Of DEATH t • Cumberland County Office of Aging (Personal Care) 46.54 2. PPL (Feb payment -processed March) 50.94 3. PA American Water (Feb payment -processed March) 50.56 4. Comcast (Feb payment -processed March) 57.26 5. Shipley Oil (Feb payment -monthly payment -budget plan -processed March) 320.00 6. Penn Waste (Feb payment -processed March) 66.75 7. Janet Miller Tax Collector (2008 taxes) 668.79 8. Verizon (Feb payment -processed March) 29.36 9. UGI Utilities (Feb payment -processed March) 27.07 10. ATBT (Feb payment -processed March) 10.06 TOTAL (Also enter on Line 10, Recapitulation) I; 1,327.33 if more space is needed, insert additional sheets of the same size. -~~ M&l~ 1ia11K ACC011MT NO , ACCOtMT TYPE 89604776 DIRECT DEPOSIT CHECKING STATElIENT PERIOD PACE FEB.24-MAR.23,2009 1 OF 2 00 0 06123M NM I17 5138 MRS ANNA M WELLER PATTY J WELLER 1711 CORNELL RD CAMP HILL PA 17011-3941 HEST SHD1tE PLAZA ACCOUNT SUMMARY BALANCE OTHER ADDITIOlIS CHECKS PA SU87RACTIONS INTER T A N0. AMOUNT N0. AMOUIti N0. AMOUNT 39,174.24 0 0.00 8 0 96. 0.00 37,934.83 eCCAUNT ACTTVTTY PT 7 02-24-0 $EGINNINC BALANCE (39,174.24 02-24-09 CHECK NUMBER 6202 50.00 39,124.24 02-27-0 CHECK NUMBER 6204 50.94 39,073.30 03-02-0 GIANT FOOD 0253 NEN CUMBERLAN 128.16 03-02-0 CHECK NUMBER 6206 57.26 03-02-0 CHECK NUMBER 6205 50.56 03-02-0 ATiT MOBILITY CHECKPYMT 000000000006207 - -- ---- 47.22 03-02-0 VERIZON ARC CHECK PYMT 000000000006203 ~7 29.36 38,760.74 03-03-09 CHECK NUMBER 6209 17.40 38,743.34 03-09-0 GIANT FOOD 0253 NEH CUMBERIAN 100.53 03-09-0 CHECK NUMBER 6211 66.75 03-09-0 RITE AID STORE 1074 LEMOYNE 15.00 03-09-0 LISPS 4134870011 CAMP HILL 3.40 38,552.56 03-10-0 ATiT Consu~rr CHECKPAYMT 000000000006212 10.06 38,542.60 03-11-0 CHECK NUI'~ER 6210 320.00 38,222.60 03-13-0 CHECK NUMBER 6213 30.32 38,192.28 03-16-0 GIANT FOOD 0253 NEM CUMBERLAN 96.40 38,095.88 03-23-0 GIANT FOOD 0253 NEM CUMBERLAN 151.05 03-23-0 SERVICE CHARGE 10.00 37,934.83 ENDING BALANCE !37,934.83 CHECKS PAID SUMMARY 6202 OZ-24-09 50.00 6204* D2-27-09 50.94 6205 03-02-09 50.56 6206 03-02-09 57.26 6209 03-03-09 17.40 6210 03-11-09 320.00 6211 03-09-09 66.75 6213* 03-13-09 30.32 Coosa (sro~~ "s ~i irt~u i7iclilK ACCOtNI'T PAGE 000000089604776 2 OF 2 ~a~~U ~~o~ ANNA K. wtit~ll aM7o ~''" 6 2 0 2 PA77Y J. w911lR y .,,, 00R1l,. ,p,1p ~- ~ -7r~f 9 urP,+~. M ,m, wn:~fiJ n. ~.^>> F... r i no,.~AU 8 ._.... hank Y,~ g~ boo! _~~~/ • x:0 3 1 30 295 5': 89CO~.T76+' 202 ~DOU0O050D0.~ Chack (6202 Paid :02/24/2009 ....t...~w.~..........~......~.~_..__..._...__...._..~.._._ _ . ANIY M. wuiEq a-ro ~"~ B204 -Am J. wtueR ,~„ C0R7Nll ROAo .,..,, i r~.n,,,`~f /~i P-~cc<!uC_-°C/~rc.t..f{.~1.. _ _.. _! s../C.~ l+Y ~Ma< Dank ~ ~:03i302955i: 89G0~7?C-6ib4 ,r00000050g4~' Paid :02/2712009 - /~ 50.94 .~ata..~ l1// . P mr a w`eueR 0,a ~ 8208 ~. ,7,. ~~~ ~~AO ~/1~j G4F qLL. M :707 t on~i~~- i r7 ~ 50.00 Chaalc (6204 ANNA N. W[IlEll o2-7D ~ 6205 PATTr J. w~LLER ,n, oar.aac aoAO 4A/f _. ,G, off', ~9 CAMI NIIL PA 170,1 .A770 rK L.~~~w1aw~C/.h 7 ~4^~ i ~ ~ o~ogtor ~_ - ~OCLAaS ® ~` ~,~,,,., B~ 022899 09034 276 2d063~~6543 ~:O3i302955~: 89C0ti7?6r D r0DOO0O5056/ uMivmTV(wf,o •~ ~~~~1,w~.~f7~~ ~ s. ~r. /. snG V. ~" S6l~fA~ OOI.LAIIS W ~.~ /a~-1 Hank ~03i3O2955~: - ~~ 89COw77G E 6'--• .- _ Chao! •6205 .Paid :03/02/2009 50.56CFwek 16206 Paid :03/02/2009 ~ 57.26 - r/.6~~ i ANNA M, wiLiR oa 7o p,~i 'g 6 2 0 9 PATTY J. vreuea ,~„ coiwau Row '-~s~7•. x.26 ~'~~ a CAM/P NI,J. PA 17/0~1/ Mrt ntcrza-l.L fI? .~jv~. ~ D/7.. . /Y~I/~6f1/L,4i~~CJ~'L~-l>•_.'~" UUlLAR5 ® Lbw ~ I~M6eTBanlc . ~:03:i02955~: 896O477f,u~ ' 0''~ ,~OOOOO0i740.~ ANNA M. wEUSR eF,s ~7m 6 210 PAm J. wELLlR CMO 11RL M ,70„ rwv7vna - - ~n_ --J s3sta. o0 was ®a~ /~M~7"Bank ~:031302955-: 896047T6r LO /Q0p0032000~ 'hack 96209 Paid :03/03/2009 /~~ 17.40 Chaclc 16210 Paid : 03/11!2009 320.00 L/- "..-----^ ~~ .. ~_ ANNA M. wELLER pQnO "` •. f41•.a~' a ~ ..a.~_... g 211 PAITY J. MIiLLiR 77„ coa«Fi. RoAO w><~e~ifo acog CAMP MLL .A .7Q, ~ ' j .-- rA,n.n:, c r~~ ~'~'_-.i~~~-!~ri _ ~,.tiYi~~srn~~. zx7u ARS 8 .ice' II I~1ittseTl3ank /~'' - r:0313DI955~: 8960~.776~~62Li r•OOOD006G75r' ...-~_ ~~...-.~..•>.~-.._..~.: -~~ ...~~..--..rte..- ~...-...~. -~..~...~.. acl: 96211 Paid :03/09/2009 ANNA M. wdJ.Ait mm s~"" 8 213 PATTY J. WRJitR sr t COINEt~ NMD CA11P NlL PA ,7P,1 ~~ ~~ i~f~ .1 ~~ a0 R nlNA- M. u76l.~6~ _~7 y~eJUC?~`~' ~:Q3i3029551: 89604776x6 3 66.75 Chock (6213 Paid :03/1312009 30.32 V tv~tt l~IIK • ACCOtMiT MQE OA0009~96MT7i 3 OF +M.w.~ro ~" 6214 ~~w NSMEL7+M^.C7IALNEALTIfl~RYl.^.3s 1 ss(`+,, ?s~l ~-*'_-~~ DOLL.aI[{ ~ i'ce' /~! 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Weller, 1711 Cornell Road, Camp Hill, PA 17011 Daughter 100% (Distribution of remainder of estate to Patty J. Weller per Family Agreement pending approval by Court.) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I ~ If more space is needed, insert additional sheets of the same size. ~~ :~c~d_iso~i sr~ ~ Q~ ~ C' i ~ ~~ ,. ~ ~' ~~l ~' E :r ~ o ~' iy ~ LL /~ a .. ~ b~lSYl i ~~ti• L 9. ~. ~ ' ~' j ~~I~~l i ~~9E }ti` -+~ 2409 Ju-- _g ~~ ~~ ~ 29 (~ ~11~1'~ ~ i_j1J~ ~'~ ~ ~ . ' ,~., ~_: U ~.. W a M O ^ ~ ~ Q A v1 rLi '`J Q ~ ° Q 0 ~ U ~ Z ~ ~ z ~ d ~ ~ - ~ 'd ~ Dui lp ~ ~ ~ c ~} UR" c~ ~ ~~~a - °W ~ J ~ Cpr ~ ~ ~ ~ w .e ~ (~ u •~ ., t ~ i - ~ ,.,, UOOU 0 H