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Home My WebLink About09-10-09J 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ` ~. County Code Year PO BOX 280601 INHERITANCE TAX RETURN n l ~a Harrisburg, PA 17128-0601 P. RESIDENT DECEDENT p( 1 File Number OS`~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 184-26-3888 05/19/2009 Decedent's Last Name MCKEE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received Date of Birth 04/07/1935 Suffix Decedent's First Name MI JR HAROLD J Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number LAURIE SHRAWDER (717) 658-2456 Ire ~ Firm Name (If Applicably) REGISTER 1bIJ,I~LS USE _~:i -,..i Fi t li f dd _n f""' "~"' t.,- ~ rs ne o ress a --- r'1"1 r''' 278 NEWBURG ROAD ~tn~ ~-~--, ~~ _~ Second line of address ' -;rt . - -~- `~ Q ~ ~ r" ~""F"t ~...- DA~I-ILIWD ~ ~~ City or Post Office State ZIP Code tt9 NEWBURG PA 17240 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 preparer has any knowledge. SI N TURE QF PER N RESPONSIBLE FOR FILING RETURN DATE C~c,c. ~c,c..Q ~lvl ~C ADDRESS PREPARER OR THAN~R ESEN T DATE ADDRESS . C' ~ ~E`, U~ e 17 ~ ~~ PLEASE USE ORI I AL FORM ONL Side 1 15056051058 15056051058 REV-1500 EX Page 3 File Number r)ararlant'c rmm~lptp ~rlrlrpcc• DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER HAROLD J MCKEE 184-26-3888 __ STREET ADDRESS 252 NEWBURG ROAD CITY __ _ _ _ _ _ _ _ _ STATE_ ,ZIP NEWBURG ~ PA 17240 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit __ B. Prior Payments __ __ C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (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) 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 consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to 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. J 15056052059 REV-1500 EX Decedent's Social Security Number HAROLD J MCKEE 184-26-3888 decedent's Name: __ REC APITULATION 1. Real estate (Schedule A) . .......................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held 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. 3,410.50 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. 2,425.09 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 2,805.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 8.66 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 1,012.16 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 40 40.49 16. 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. 40.49 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER HAROLD J MCKEE 184-26-3888 STREET ADDRESS 252 NEWBURG ROAD CITY - - _ _ _ STATE ~ ZIP NEWBURG PA 17240 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments __ __ _ -- - C. Discount ___ _ Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest -- E. Penalty Total Interest/Penalty (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 ZO to request a refund. (4) 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. (5g) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ 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 "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)J. 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. 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~, County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 -~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 184-26-3888 05/19/2009 04/07/1935 Decedent's Last Name Suffix Decedent's First Name MI MCKEE JR HAROLD J (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 ~ 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) 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 - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LAURIE SHRAWDER (717) 658-2456 Firm Name (If Applicable) REGIS"#'ER OI~~ WILLS USE ONLY...... First line of address 278 NEWBURG ROAD Second line of address City or Post Office State ZIP Code DAME FILED NEWBURG ' PA 17240 Correspondent's a-mail address: Under penalties of perjury, I declare that f 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 preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE __- ADDRESS __ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: HAROLD J MCKEE 184-26-3888 RECAPITULATION 1. Real estate (Schedule A) . ........................................... . 1. 2. Stocks and Bonds (Schedule B) ...................................... . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 4. Mortgages & Notes Receivable (Schedule D) ............................ . 4. 5. Cash, Bank Depasits & Miscellaneous Personal Property (Schedule E) ....... . 5. 3,410.50 6. Jointly Owned Property (Schedule F) ' :: Separate Billing Requested ...... . 6. 2,425.09 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested....... . 7. 8. Total Gross Assets (total Lines 1-7) ................................... . 8. 9. Funeral Expenses & Administrative Costs (Schedule H) .................... . 9. 2,805.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10. 8.66 11. Total Deductions (total Lines 9 & 10) .................................. . 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 1,012.16 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 40 40.49 16. 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. 40.49 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDI~ILE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER HAROLD J MCKEE JR Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (G-98) ~" .: SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HAROLD J MCKEE JR JOINTLY-OWNED PROPERTY: 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 UEA1H VALUE OF ASSET °.6 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~ ~ A. 03/20/09 M&T BANK ACCOUNT # 90027299 4,850.18 50% 2,425.09 TOTAL (Also enter on line 6, Recapitulation) ~ $ 2,425.09 (If more space is needed, insert additional sheets of the same size) If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER HAROLD J MCKEE JR Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' EWING BROTHERS FUNERAL HOME INC 2,255.68 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Zip Zip TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 196.00 153.32 200.00 2,805.00 RL~:;I-:1.`~1.Z LX-F (12.-,1i3j ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HAROLD J MCKEE JR 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. ~ pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER HAROLD J MCKEE JR 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. 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. STATUE TO MUSEUM 80.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 80.00 If more space is needed, insert additional sheets of the same size. ~~T ICI//L~ A/VD TESTAA~LNT t, HAROLD J. McKEE, of 252 Newburg Road, Newburg., Cumberland County, Pennsylvania 'I724Q, do hereby make, publish and declare this to be my last wi[! and testament, hereby revoking atl wills heretofore made by me. t . l direct my personal representative to pay all of my debts, funeral and administratnre expenses as soon as convenient after my decease. !direct tha# ail inheritance taxes imposed or payable by reason of my death and interest and pena~ies thereon with respect to all property, whether or not such property passes under this Wiil, shat! be paid by my persona! representative out of my estate. 2. !authorize and empower my persona[ representative to se!! any realty and/or personalty owned by me at my death and not specifca[ly devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as i could do if living. My representative is authorized and empowered to engage in any business in which l may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. 1 give, devise, and bequeath ati of my estate of whatever nature and wherever situate as follows: A. !t is my desire that my real estate at 252 Newburg Raad, Newburg, Pennsylvania '! 7240 be offered first to any child or children who may wish to purchase ~. !f none of my children purchase the property within 45 days of my death, then. ft is to be listed for sale. My persona! representative, in her sole discretion, shall resolve any conflicts. . B. My Mauser 7 mm rifle to my son-in-law, Roy Shrader. C. My fishing equipment and 25.06 caliber rifle to my son, Harold .~. MclCe£, ill. Q. My 4'10 gauge shotgun to my daughter, Laurie Jo Shrewder. E. Any other guns to be sold, first to any of ray children who may wish to purchase them, and then to any other party. My personal representative, in her sole discretion, shall resolve any conflicts. F. My brass or bronae sculpture of Teddy Roosevelt riding a horse is to be appraised and sold to a museum and the proceeds thereof are to be included in my residuary estate. G. All the rest, residue and remainder of my estate l give, devise, and bequeath to my children, share and share alike, the child or children of any deceased beneficiary taking the share their parent would have taken if living. 4. I nominate and appoint Laurie Jo Shrewder to be the persona! representative of my estate, to serve without bond. If Laurie Jo Shrewder cannot or does not serve, then I appoint Judith L. Reisinger to be the substitute personal representative, with the same powers and also without band. 5. 1 suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS 1MHEREOF, i have hereun#o set my hand and seal this 30~' day of March, 2009. rs~ ~~~ ~S~> HAROLD J. McKEE ~~~~~. s~a~. published arnd de~ared b~ the above-named person as and far a last will and testament. in our presence, who at said person`s regc.test, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. Ewing Brothers Funeral Home, Inc. Steven A. Ewing, Supervisor 630 South Hanover St.; Carlisle, PA 17013 Since 1853 Seymour A. Ewing, F.D. 1~hone: (117)243-2421 Fax: (717)243-7553 E-Mail: admin@since1853.com William M. Ewing, F. D. STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges aze only for those items that you selected or that are required. If we are required by law or by a cemetery or a crematory to use any items, we will explain the reasons in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. Yogdo not have to pa for embalming you did not approve if you selected arrangements such as cremation or immediate burial. If we charged for embalming we will explain why below. For the Service of: Harold J. McKee, Jr. Date of Death May 19, 2009 Charge to : Susan J. Blessing Mt. Holly Springs PA Name Address ity tate A. CHARGE FOR SERVICES SELECTED: Traditional Package Itemized Services_ Other Clothing 1. PROFESSIONAL SERVICES $ -0- Services of Funeral Director/Staff .... , .... .$ 1,800.00 $ _0_ Embalming .......................... .~ -0- Cremation Urn................... ..$ _0_ Other preparation of body (Description) $ -0- ................................... s -o- $ -o- SUB-TOTAL OF PROFESSIONAL SERVICES..... ..... Al $ 1,800.00 $ -0- 2. FACILITIES AND SERVICES TOTAL MERCHANDISE SELECTED . .......... B $ 90.00 Use of facilities and services for C. SPECIAL CHARGES Viewing (Visitation/Wake) ................ ~ -0- Forwarding of remains to Use of facilities and services for $ ~ 0- Funeral Ceremony ,,,, , , , , , , , , , , , , , , , , , S__TO_ (Funeral Home) _ Use of facilities and services for Receiving of remains from Memorial Service . . .. . . . . . . . . .. . ..... . . g -0- $ _0_ Use of equipment and services for .. (Funeral Home) Immediate Burial,,,,,, , , $ _0_ Graveside Service ...................... $ .. -0- , , , , , , , , ,, , Direct Cremation .................. $ _0_ Other use of facilities $ 0_ SUB-TOTAL OF SPECIAL CHARGES .......... C $ -0- ................................... $. -0- D. CASH ADVANCED: SUB-TOTAL OF FACILITIES/EQUIPMENT . ........... A2 $ 0.00 Opening Grave ..... . . . . . .. . . .. . . . .$ _0_ ` Cemetery Equipment ............. ..$ -0- 3. AUTOMOTIVE EQUIPMENT Lot and Deed .................... ..$ -0-, Newspaper Notices -Out-of--town $ -0- Vehicle to transfer remains to Funeral .... Telephone & Telegrams ,, , , , , , , , , , , , , ,$ -0- Local ............................... $ _0_ Airfare............... $ -0- Hearse (Casket Coach) .......... Clergy/Mass Offering .. . . . ... . . . . . . .. ..$ -0- Local ............................... $ -0- Pallbearers.............. $ -0- Limousine ......... $ 120.00 Certified Copies of the Death Certificate Local ................................ $ -0- Police Escort . $ -0- _ _ Family Car --- ____ .................... .. ocal ................................ -- - $ -0- _._._ _ Flowers...:..-, .................. , ;$ -0- Flower car or floral disposition Vault Service Charge .............. ..$ -0- Local ................................ $ _0_ The Sentinel Obituary, , , , , , , , , , ,, , , , $ 160.68 Lead car/Clergy Shi~oenNaltev Times $ 35.00 Local ............................... $ _0_ Coroners Fee $ 25.00 Car for pallbearers Cremation Pouch. $ 25.00 Local ................................ $ -0- 4 $ -0- Out of town transportation ................ $ -0- $ -0- $ -0- $ -0- $ -0- SUB-TOTAL OF ADVANCES ....... ............ D $ 365.68 We ctLar~e You~or our ~ervi es in obtai sped as a vance r ems ning: SUB-T OTAL OF AUTOMOTIVE EQUIPMENT...........A3 $ 0.00 . TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT .................................... A $ 1,800.00 B. CHARGES FOR MERCHANDISE Casket ..............................$ -0- (Description) Casket Outer Receptacle ......................~ -0- (Description) Outer Container SUMMARY OF CHARGES: A. Professional Services, Facilities and Equipment and Automotive Equipment ....................... $. 1,800.00 B. Merchandise ......................$ 90.00 C. Special Charges ...................S -0- D. Cash Advances ...................$__ 365.68 TOTAL OF ALL SELECTIONS ................. $ 2.255.68 Outer burial container ................... $ • -0- PAID AT TIME OF OR PRIOR TO (Description) Alternate Contain .r ARRANGEMENTS ........................... 2 200.00 Acknowledgement cards , , , , , , , , , , , , , , , $ BALANCE DUE .............. ..:.... $ 55.68 Register Book(s). .......................$ 30.00 REASON FOR EMBALMING Memorial folders .......................$. 60.00 None Prayer cants ..........................$. -0_ If any law,,cemetery or crematoryry re uiremen hav ' -~ any of the rtems listed above the law or re ui ment is ex lained bel aSebf Temporary grave marker .. . ..............$. _0_ q P Burial clothin $ _0_ Pouch b crematorium 5 ~q;Vl, g ......................... I agree that I have examined the terms.of goods and services selected above and found them to be correct-and according to th rangemen s I have requested and I acknowledge a copy of this Statement of Funeral Goods and Services selected. I represent that I have sufficient ' payment of total price for goods and services selected. I also agree to make payment of $ 55.68 within 30 days. I agree to be jointly and severally liable with anyone who signs below. A late charge of 1.5% oer month amounting to 18% per year will be applied to the unpaid balance beginning 30 days from the date of this agreement. I will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorney's fees, court costs and other costs. Any additional services or merchandise ordered or requested after the this agr t ill be co~tsidered part of this agreement and the cost thereof 'll be r fleded on the final bill or statement. (Seaq ~ Q. (Purchaser) ate (Seal) (Purchaser) (Licen uneral Director) • • ,~, , R4~E'S AITCTI4~1~ ~ERVT~E~ (RH 79L, 2505 Rtner Highway .Carlisle, PA 17015 Bill Rowe (AU 1538L) 249-1978 697-4794 249-2677 'Dave Rowe (AU 2295L) Auction Is Action Ccxll "Rowe" For Satisfaction SELLERS NAME ~_....'«~..~,,,. °~ ~~ ''~' ~ ;,,) . ~~,.~ : ~~ _..~ ~ DATE °:~ ~' > i 4 .... _,a., _ - . ADDRESS ...:,: ~ ,,w ~ .~ ~ 6 ,-~.. ~~; „~.~~. ~,,,~ ~ ,:~ ~`' x - - PHONE ; ~ ~- ~•~ ~ ~ ;~,..y~ ...., _ ~ ~ u , .` ~` _ OTHER ' .`; ~ ;' .~' ~ ~~ ~~k~. ~~' '~ ,~' AUCTIONEER % AUCTION DATE/LOCATION ~ ~. ~ Cam. % ~.-~- ,~4-~,~~'~?s~-~ ~ f~ ~- ~r',,,~ DESCRIPTION OF MERCHANDISE ;: C E ~ ,,. ' ~~- •,s `:~ i 1 .5 ' 7^+.. <~~+.~. ,ice A f ~ / `'~'M ~~{{ yy J .iy~...jJ 4~. V ~ ~ ~•r- ~ ~~ 1 r' a t.i~'l:i %. ~• `.:. 'mod'' !~~ i~- :~3 i..._r~ ~~` T Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of the merchandise, goods and or property and have good title and the right to sell .and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in this agreement. AUCTION SIGNATURE ~._ SELI` S SI NATURE Total Sales (Clerking Tickets Attached) ~ '~'.:~ ~ ~ U''~'d Less Sale Expense: ~' +` ~' ~~ % Commission Auctioneer ~"' % Commission Clerks ~ OTHER: ~; y, ~ ~'A~ 1 ~ ~ _._ TOTAL SALE EXPENSE DEDUCTED ~ SELLERS NET ~ '" ~`"'~ ,~. 4 ,~ .°' ~, t '~ " M,y~ ,, ~"~`~ '',L ~ 'N 'fit ~.+.. ~~ ~ ti ,:. ,~; ~s T v1 3 ' ~~ ~u e ~ ~ ~1 d ~ks.a~ N ~~ ~