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HomeMy WebLinkAbout09-21-09.r . , ~~~ 1505607121 9~i8~a~q 06-05 "'' REV-1500 EX ( ) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 6 9 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 8 2 4 2 5 5 1 0 6 1 1 2 0 0 9 0 6 0 1 1 9 3 0 Decedent's Last Name Suffix Decedent's First Name MI B O W E N R O B E R T C (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) OX 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 M A R C U S A M c K N I G H T I I I 71 7 2 4 9 2 3 5 3 Firm Name (If Applicable) I R W I N & M c K N I G H T P C First line of address 6 0 W E S T P O M F R E T S T R E E T Second line of address City or Post Office C A R L I S L E REGISTER OF WILLS USE ONLY N_ "~ ". i G L V r~ ~ / ~ ~// ~; i7 -~ ~ S `` ~~ 33 ~~y r~rrn - ra i - -- - ' v:, ~' - _l C:7 "rl ~ `--~ TE FI LE - --t .. ZIP Code L 1 7 0 1 3 State P A w 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. IRE ^OF PER~N ~ FIQNSIBLE FOR h~Y ~1 ~1 OA.Ya DRIV DA~~ PA 17065 DATE ~ / ~r 2ee 9' • HOLLY SPR PLEASE USE ORIGINAL FORM ONLY Side 7 1505607121 REPRESENTATIVE 1505607121 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0694 DECEDENT'S NAME ROBERT C. BOWEN STREET ADDRESS 1892 MARY LANE CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments _ (1) 14,203.23 C. Discount 655.55 Total Credits (A + g + C) (2) 655.55 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) 13,547.68 (5A) B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (56) 13,547.68 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0 c. retain a reversionary interest: or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^ 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? ......... ^ X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^X ^ 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. REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT C. BOWEN 21 09 0694 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real orooertv which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1892 MARY LANE, CARLISLE, PENNSYLVANIA 200,000.00 PRUDENTIAL HOMESALE SERVICES GROUP OPINION OF VALUE ATTACHED TOTAL (Also enter on line 1 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DAENT DECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER ROBERT C. BOWEN 21 09 0694 Include the proceeds of litigation and the date the proceeds wen: received by the estate. All property jointty-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. CORNERSTONE FEDERAL CREDIT UNION -SAVINGS ACCOUNT #38-01 570.39 2. CORNERSTONE FEDERAL CREDIT UNION -CHECKING ACCOUNT #38-07 1,704.86 3. CORNERSTONE FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT #38-10 1,547.50 4. CORNERSTONE FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT #38-11 3,511.82 5. CORNERSTONE FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT #38-13 1,784.93 6. CORNERSTONE FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT #38-14 2,187.40 7. CORNERSTONE FEDERAL CREDIT UNION -MONEY MARKET #38-18 5,433.86 8. PERSONAL PROPERTY -NONE HOME EPTY FOR TWO YEARS TOTAL (Also enter on line 5, Recapitulation) I $ ~ a ~dn ~a (If more space is needed, insert additional sheets of the same size} REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER ROBERT C. BOWEN 21 09 0694 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 INCLU~ETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECECENTAND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEECFCRREALESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IFAP%JCABLE) TAXABLE VALUE 1. EDWARD JONES 121,749.00 100. 121,749.00 BENEFICIARIES: KATHLEEN CRULL 8~ JULIE O'BRIEN TOTAL (Also enter on line 7 Recapitulation) I $ 121, 749.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT C. BOWEN 21 09 0694 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS 7,224.00 2. CARLISLE ELKS -FUNERAL LUNCHEON 419.50 3. THE WHIMSICAL POPPY -FLOWERS 238.77 B. 1 2 3 4. 5. 6. 7. 8. 9. 10 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: State Zip Attorney Fees IRWIN & McKNIGHT, P.C. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS Accountants Fees Tax Retum Preparers Fees PATRICIA A. ROSENDALE, CPA REGISTER OF WILLS -FILING FEE CUMBERLAND LAW JOURNAL -ESTATE NOTICE THE SENTINEL -ESTATE NOTICE NOTARY FEES 7, 500.00 298.00 350.00 30.00 75.00 198.16 25.00 TOTAL (Also enter on line 9, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) IYEV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT C. BOWEN 21 09 0694 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ROBIN K. SOLLENBERGER, TAX COLLECTOR -REAL ESTATE TAXES 1,711.02 2. (NORTH MIDDLETON AUTHORITY - WATER/SEWER 3. IPP&L -ELECTRIC 4. (CONTINUING CARE RX -MEDICAL 5. (YORK WASTE DISPOSAL -TRASH 6. IDIAKON LUTHERN -NURSING 7. I IN HOME BETRA CARE -NURSING 8. (PENN NATIONAL INSURANCE -HOMEOWNERS INSURANCE 82.30 52.33 285.05 45.45 3,948.78 250.00 129.00 TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT C. BOWEN 21 09 0694 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 outrightspousaldistributions, and transfers under Sec. 9116 (a) (1.2)) 1. KATHLEEN LOUISE CRULL Lineal 303 OAK DRIVE 1/3 REMAINDER MT. HOLLY SPRINGS, PA 17065 2. JULIE ANN O'BRIEN Lineal 10 GERLOFF ROAD 1/3 REMAINDER SCHWENKSVILLE, PA 19473 1/3 REMAINDER 3. TIMOTHY BOWEN Lineal 14 CHURCH STREET CARLISLE, PA 17013 4. BRADLEY BOWEN Lineal 1241 McCLURE'S GAP ROAD CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (It more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, ROBERT C. BOWEN, of North Middleton Township, Gtiimberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, fimeral and a+dminislrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my Executrix to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate to my wife, WILMA RUTH BOWEN; providing she shall survive me by sixty (60) days. 4. Should the gift in Paragraph No. 3 not take effect, I devise and bequeath all of my estate of every nature and wherever situate as follows: a. One-Third (1/3) to my grandsons, TIMOTHY BOWEN and BRADLEY BOWEN, share and share alike; b. One-Third (1/3) to my daughter, KATHLEEN LOUISE CRULL; and c. One-Third (1/3) to my daughter, JULIE ANN O'BRIEN. 5. I nominate and appoint WII.MA RUTH BOWEN to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint KATHLEEN LOIIISE CRULL and JULIE ANN O'BRIEN as substitute Executrices, also to serve as such without bond and with the same powers as are given herein to my Executrix. 6. I hereby suggest that my personal representative retain the services of Irwin 8c McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereuato set my hand and seal this r ~ ~ day of June, 2005. `~:c,-~Lf' ~ ~..Sa+~-~iw~ (SEAL) ROBERT C. BOWEN Signed, sealed, published and declared by ROBERT C. BOWEN, the Testator above- named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have subscn'bed our names as witnesses hereto. ~f~Jli ~~r,~Y~ ~ `jCbT~ial~t 2 ACg1VOWLEDGMENT A_ND AFFIDAVIT WE, ROBERT C. BOWEN, KAREN S. NOEL and SHARON L. SCIIR'ALM, the Testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, that he had signed willingly, that he executed it as his free and voluntary act for the purpose herein expressed, anti that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of their knowledge the Testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. C ~.~-~.L~.~ ERT C. ~OWI ~~ ~~r S. ~~~r~~:~~ ~~~ ~~~~ ~~~ SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUN'T'Y OF CUMBERLAND . Subscribed, sworn to and aclmowledged before me by ROBERT C. BOWEN, the Testator herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON L. SCHWALM, witnesses, this ~~ ~ day of June, 2005. ~. Pablic Notarial Seat Roger B. irvYin, Notary Pubfic Carlisia 8txo, Curnbarlarrd county My C.orron Oct 3, 2008 Member. Pennsylvania Association Of Notaries 3 Prudential September 14, 2009 Marcus McKnight, Esq. 60 Pomfret Street Carlisle, PA 17013 Re: Estate of Robert Bowen - 1892 Mary Lane, Carlisle, PA 17013 Dear Sir, ;fv~f>; t ~ ;~~ u' ~ft'~liili U rl~i l.~ii~~~`~'~~11 ~'~. As per your request, I am providing you with my opinion of value for 1892 Mary Lane, Carlisle, PA 17013. In my professional opinion, I would put the value of this home, according to current market values, at $200,000. If you have any questions or need any other information from me, please don't hesitate to call me at 3 85-4500. Sincerely, c_---- ~~~~ Ne~. Tricia Negley Prudential Homesale Services Group 8 Brookwood Avenue, Suite A Carlisle, PA 17015 Office 717 245-2100 697-2492 Fax 717 245-0683 fl An independently owned and operated member of Prudential Real Estate Affiliates, Inc. CORNERSTONE F e d e r a l Credit U n i o n P.O. Box 1181, 5 East Gate Drive, Carlisle, PA 17015 Telephone (717) 249- 166 I FAX (7 17} 249-8208 Member founded -Service based www.cornerstonefcu.coop August 14, 2009 Irwin & McKnight, P.C. West Pomfret Professional Building 60 West Pomfret Street !1=~rliglQ Pon~cyluani~ 171713-32.2? RE: Estate of Robert C. Bowen Mr McKnight, III: "^`~`~`Sji~'~1"~~' ~'~ Ezn~'.~~ ; °<~ ~~ ~~ ~~0[~~~, ~~~ The following is the information you requested regarding the account of Robert C. Bowen:, 1) Registered owner- Robert C. Bowen, single owner 2) Date the accounts were open: Acct # 38-01, savings, opened July 6, 1976 Acct # 38-07, checking, opened April 4, 1994 Acct # 38-10, certificate, opened July 7, 2004 Acct # 38-11, certificate, opened March 30, 2005 Acct # 38-13, certificate, opened December 15, 1997 Acct # 38-14, certificate, opened June 20, 2007 Acct # 3ti- i 8, money market, openLdrebruary 1 ~, 1992 3 & 4) N/A 5) Interest accrued to date of death for calendar year: Acct # 38-01, savings, $2.62 Acct # 38-07, checking, $4.49 Acct # 38-10, certificate, $33.15 Acct # 38-11, certificate,. $64.92 Acct # 38-13, certificate, $38.22 Acct # 38-14, certificate, $49.51 Acct # 38-18, money market, $52.45 YOUR SAVINGS FEDERALLY INSURED TO AT LEAST $ I OO,000 BY THE NATIONAL CREDIT UNION ADMINISTRATION Page - 2- 6) Date of death balance (principal plus accrued interest): Acct # 38-01, savings, $570.39 Acct # 38-07, checking, $1,704.86 Acct # 38-10, certificate, $1,547.50 Acct # 38-11, certificate, $3,511.82 Acct # 38-13, certificate, $1,784.93 Acct # 38-14, certificate, $2.187.40 Acct # 38-18, money market, $5,433.86 If you need any further information, please do not hesitate to contact me at 717-249- 1661 ext 240. Sincerely, ~~~ Donna J. Mickey Financial Services Administrator ga v n a P ~~ ^~ m° ~° ~ N p i t0 OD V Q C7 (71 ? W p N -+ p ? W m W ~ o ~ ~ ~ o ~ p ~ ~ o CA < ~ (~ ~ ~ ~ co O O y N _ ~ aQi a ~ ~ ~' v A ~ 3 ~' $ 'o' s c°"o o m < ~ ~. vv ~ ~ a O ~. ~ ? ~ ~; < c ~ ~ A ~ ~ m N ~ V? W C ~ ~ _•. 3 ~H ~ ~ ~ ~ ~ o ~rt ~. '"' N ^ ~ .. ~ N ~ G.. L N ~ d1 GH f!i to ffl ~ ifl {!i ~ ift ttt N ro ~ 7 ~ C r- ~ ~ ~ ~ -. ~ ° ~ ° ~ ° ~ `~ 0 0 °' ~ ~ n o 0 ¢1 N ~ m ~ CO <C ~o ~~ ~ ~ ~ ~° ~° coo -~ ° ~ w W ^` mq' _coa~''' c ~' ~ co ^" o ~ o c~ w C7 ~ o ~o o ~ c,~{, _ c. ~ _c o ° ~ a 3~ ? ~ Q -w ~ fe O~ 3 < .~.- 'O W m (~ m ~ ~ ~ O ~ ~ ~ ~ = ~ O 1 ° ~' y ~ o ~ < O m ~ ~ ~ Q O .. ~ pO Q' ~ n ~ N .:; - w ~ °i a cgo ~ °''• c = o -~ sv ~, c n N C1 ~ ~ a ~ ~ N ~ ~ tea n ~ to A C_ ~ ~ ON ~ ~ (O c ~_ S 0 N ~. m D 0 w 0 W m! D' ~ D 0 ~~ (~ ?. o ~ ~ 0 c Z w v 0 0 W L C V N O CD m N 2 O n d cD v ~D 3 G d O 3 O H I? I~ O 7 !p M H~ 8. ~W ~ N m ~m d ~ _~ N A~ m N o~ "a ~' ~ ~. ~Q N 7 C n per, S C, me ~O~ 30 ~~ ~ o ~ ^' ,~. 'Q ~ g. v m ~• ~C ~°'-,,-. o~ ~~ o s o ~' ra o ~'• ~ wo m~ g' ui ~~ ~< `~ a 0 ~o m ~~ A f! L11 w g .~ m ~« ~ ~ r: N n r) C n 7 a W m O n~ a s. g~ d v O a G c N_ V co r0 OD V C ~ ° a ~ ~ o N ~ ~ ~ c N Q- ~ ~ N ~ ~ i~`' n ° ?. m ~ ~ $ ~, a m a w O < , o O 00 ~ (fl A W p ~ ~ W y~ ~ ~ ~ m id ~ pl f A N (p -w ~ g 3 N 0 cn y~ m N rfl l~ lr~ i~ A O Cfl N ~ ~ w ~ ° o o° N -` O o ~ ~ ~ `~~C ~ _ ~ ~ m Imo, w 0 w c ~ N .~ a~ ~~ N "'. O a$ 5 ~ m a~ fD ? ~s Q N ~~ 3 ~ U1 ~ A~ ~a = Z' ~~' m~ ~o N ~~ o ~ `~ -v o re m e o ~ o •* 0 ~ma m mo m ~' ~ n z 'm3 W ^' a Qw om" Leo cc a rn ao~ ~,~cp' c~ ~ w ~a tD m ~ oa ~c N O d O ~ ~L C ~C 7 m vv rA a' O ~ O G. ~ N 7 a m d N O ~. A ~1 v v .•} C 01 C rt~ c c O N O D !P ~ rfa,S ?h S4-t.-~.-o~S Steven A. Ewtng, Supervisor ~'Jv ing Brothers Funeral Home, Inc. seymour A. Ewing, F.D. 630 South Hanover St.; Carlisle, PA 17013 Since 1853 Phone: (717)243-2421 Fax: (717)243 7553 E-Mail: admin@since1853.com William M. Ewing, F.D. STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are oaty for those items that you selected or diet are required. If we are, required by law or by a oeme~y or a crematory W use any items, we wilt explain the reasons in wri below. Tf you selected a furterat that may regture embalming, such as a funeral with vrewmg, you may have to pay for embalming. You,do not have to ppay~ay~ embalming you did not approve if you selected arrangemems such as cremation or immediate burial. If we charged for embalming we writ explain why below. For the Service of: Robert C. Bowen Date of Death June 11,2009 Charge to : ~~ L Crull 303 Oak Drive Mount Holly Sprin s ~ Name ress ~ 4. CHARGE FOR SERVICES SELECTED: Traditional Package itemized Services PROFESSIONAL SERVICES Services of Funeral Director/Staff ......... $ 1,795.00 Embalming ...........................s 785.00 Other preparation of body Dressing Casketing Cosmo. etc. ................................... $ 295.00 SUB-TOTAL OF PROFESSIONAL SERVICES.......... Al S 2,875.00 ~~~ c'~ina $ -a $ -0- Cremation Um .....................$ -0- SDescrip6on) $ -0- $ -0- $ -0- TOTALMERCHANDISE SELECTED .......:... B $ 1,840.00 2. FACILITIES AND SERVICES C. SPECIAL CHARGES TOTAL OF ALL SELECTIONS ................. $ 7.224.00 PAID AT TIME OF OR PRIOR TO Outer burial container ...................$ -0- ARRANGEMENTS ........................... $ 0.00 (DeSCrIptlOn) Aaamatra [`.nntainer Acknowledgement cards.......... BALANCE DUE ............................. $ 7.224.00 ' ' ' ' '~ 10.00 REASON FOR EMBALMING Register Book(s) .......................$ 35.00 Memorial folders ...................... ~. ~ 65.00 Required for traditional funeral with viewing. Player cards ......................... ~ -0- fan of tf e'items ' abo~ a dierYaw~omrements have required the purchase of y Irs 7 requirement is expiamed below. Temporary grave marker ................ $ -0- OBC by cemetery Burial clothing ........................ $ -0- _ 1 agree that I have examined the terms of goods and services selected above and found them to be correct and according to the arrangements I .have . requested and i adknowledge a copy of this Statement of Funeral Goods and Services selected. I represent that i have sufficient funds available for payment of total price for goods and services selected. I also agree to make payment of $ 7.224.00 within 30 days. I agree to be jointly and severalty liable with anyone who signs below. A late charge of 1.596 oer month amounting to 18% per year vnll 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 tolled amounts I owe under this agreement. Those costs may include attorney's fees, court costs and other ~. Any additional services or merchandise ordered or requested a r th date of this ag t will be nsidered rt of this ment and the cost thereof vinli be fleded on the final biq or statement. (Seal) ~ d ~~ ~~ urchaser) (Seal) (Purchaser} (Licensed Fune tx) p~~!p'L,(JI FOR REORDERINra Pt1RPOSES 7Z'J prolectrour b.la CASau score yar~nya,cl,agc eoa. [Q(7Fadr your expenses... p rnx-pEpUCTIBLE Iral ^ Gothing ^ Forrd O Tran~tatron ^ credit card t7 UNities ^ Mortgage Foavlrnao pEntertainment ^Iluurance ^Other: ~ ,~ y_, (, :!-.. ;;.; y/ ~-"`~ r., - i ~ . _ .~ THIS REM ~ ,1.1 y' ~ LI r 5 ~ : BAI-ANCE aALANCE FpriWARD X11 ;. r . NOT NEGOTIABLE 6'ar/a/~ G/.4~ 120 W. Ridge Street • Carlisle, PA 17013 • (717) 249-9202 } Banquet -Catering Department ~ _ --~, F' 1 Day ,/ ~' "` ~'~~ .--r___ ___ ___ Date ~ ~ ~ c ~- ~ ~~ ~ Time: Start f End Group Name ~ ~!~ r-lC1° ~ . ~;iy ~,,'t~ t,.s.~k!~ J2-t.d ~+-r 5.:'.:d :~ Lif ~ Person In Charge ~! ~- f r ~~ ~~~ ~r Tel. Street City s~ MENU ~ "' ~~,. ° ,.,`' ~.f:~~.P ~f _ } f ~ a~ .~ ....~' ~ 6 L a~ °/ ~°~ f~ ~ r 9 ~ j ~ ~6.J ~~ .,~ "{~ !j. mss:...- . e"3 ~ j~v ~ ~~~ T ~ ~y ~r'.E..~ s --~. ~ '.-^d ' ~ ,-~ yy~~_ ; , _ Contract # r~' ~ ~.. ~ -' ,~: f i 7 Home State Zip FUNCTION SET-UPBEVERAGEBAR ~/rrd ~~3~ Pd~ ~`~S`p9 ALL CATERED FOOD AND BEVERAGE IS SUBJECT TO 6°~ SALES TAX AND 15% GRATUITY. DEPOSIT AMOUNT $ Receipt # FOR FINAL PAYMENT DATE DUE Customer Signature Date f ' , Club Representative o~ eecc c~r_u wun oer~~uu Tn rue rwor im a c~ arc in~~cTne~co ~rccp vc~ ~ nw enrav- Date i ROBIIT~SOLLENBERtiER, TAX ODLL 6HILL-DRIVE (!17)248.0747 = CARLISLE, PA 17013 ENO - 29002231 MAP NO: 28.1&1098.068 1892 MARY LANE ACRES .280 DEED 00280/ 00986 NOLL MANOR LOT 18 Reeidantial Building RESIDBdTIAL r~x w-vei ROBERT c a WILMA R 303 OAK DRIVE MOUNT HOLLY SPRINGS PA 170-1808 ,iUL-At1G TuES 1 o-a & THt1R 1o~s: wtAY,luN-sEP-ocTTHURS ~o-s APPT ONLY JAN-FE&NOV-0EC F' ` N Pr!-~ f IF NO'T PAD BY 1R18710,'iMS BEJ. MIltl BE RE't1fRItt1D TdTAX = CL,ASI ta~JW FOR COLLBC710N AIiD FLNti ~ A~~1 AQiI~BT ._ . ; € YWJR PROPERLY. NF TAJfRB ARE a E8CROIM FDRM/ARD TO YOUR YORit311QE OOIpAN1f.;'1.00 FEE FOR ADD'L OOHS. Your enclosed tax ~ includes tax reduction for ~~ prop..e~rpty~. As an a homestead and/or iarmste d ~own~~y~.~L- ~~ ~ ~~~ ugh a hanestead erKihr farrns4asd erodusion which tms ter t• under the Pennsylvania Taxpayer Relief Act, a law passed by she. Permsyhranie~ ,;- '~ -.: .. Assembly designed to reduce your properly saxes. ,~ - - 6 ;~~ erNG PURP,osEg fir 1~M ON.Y fhs 1ttT coupon bMorr 13u aibniR Paf-nwA t Dyaurazpe `~`~` _ 8S1I 418 ~ Em~ ~ ~ t! ~ ~ Mo^sPonation ^ tax-oenucne~ ~ ment ^I-~su-ance ^par~~ 727 - ~ JC .. ~~ i , .:_; - F .. .-'- f 6 i -R E FOf 10/31/2009 s d securih; tour name and - - - aOCDO"~ ^u"rier do not appear on y~ ~ 12009 ~ _... ; ... : :.......: .. : : _ .. NOT NEGOTIABLE _, i - ~ - ~W Assese Land Values 30,000 Homestead 1Dcclusion hoop 101,20 9 175- AREA S.Di. Flea Rates 14.33000 SC1r00L S 429.90 14.33000 1 450.20 14.33000 2 1 842.50 1 88 10 10 2 068.11 Haoeetead t 131.48- 131.48- "131;48- TAX AMOUNT DUE ~ ;txt~~oat =f,>r~ses ~~ss tl Raid Om os alter I! laid Olt or salFora 7 Ol 2 09 31 200 9 O1 9 10 31 2 09 1 01- '0.09 _12 .31-:2009 TAX PAYER COPY ~ No: 41tt Control No: 0~'-"OOZ~1 of Reel Esdls Taoss BiN Date: 7I~D17Z~1U9 rOVeaent Rbtal . 0 0 131,200 COtVTItVUI1VG GARS RX ~8 S S1EC0lVD ST hiEWPORT PA 171374 # •~ S T A T E M E N T~# Statement Date: b/3Q009 Page Account #: 100043482 CC ROBERT LOWEh~ i+,AT'riLEEi~'! CR!1L.1_ 303 OAK DRIVE MY HOLLY SPGS. PA 17065 3 Date Descri~Tion Qty Amount b130l09 P,X# 6595548 fentahlYL 25MCGIHR PATCH 1 5.00 bf09fJ9 RX# 6587599 LORazegam 0. 5MG UD TAB 2 1.39 6t©9.'09 RX# 6588974 DIAZEPAM 5MG TAB 3t? 7.96 t~i10l09 RX# b59~4.94 LORazepam C1. 5MG UD TAB 2 i. 39 b/10109 RX# b592497 DIAZEPAM 5MG TAB UD 1 .32 6108!09 RX# 6622762 ACETAMIh10PHEh.I 650MG 5UPP 1 .53 Ending balanc+~ - Pay this amount ----- Past Due Past Due Current 3i-bG days 6i-9C~ days ~~ i . 40 . oa . 00 ~..e_ k DO-RIOT USE FOR REORDERING PURPOSES PrcT:~nut W ;Jjcate Cheeks Stwe your duplicate checks in your check boz. C~1Track your expenses... ^ Clothing ^ Food ^ Transportation ^ Credit Card ^ Ufilities ^ Mortgage ^ Entertainment ^ Insurance ^ Other: _ 27 i . 40 Past Due 90+ days 00 ^ TAX-DEDUCTIBLE ITEM 722 ~/ f~~ ~ ?ALANCE LLJJ/aL FORWARD i - C [~ ~i_(¢.l/~-~.~.~-tom ' ` n / C ._. ~'~.J THIS fTEM ~ , . - ; y - ~ BALANCE DEPOSIT OTHER ^ BALANCE FORWARD jft ;~ --_zd security, your name and account number do not appear on this copy. I '-""--~ ~---- ---- NOT NEGOTIABLE ~_...__.__. i t~.._,..._-_ _ - --- __~. CQPAY u~'~~:iT3:1`JUZ1~~~~ ',iFE RX t r+ ~ ~~Lt1~~Nr ~~-f h !~Ct~~CT rO~JFi~a ((~ ~-. ra~:e nes ~l^~%Cf n ~ ;~: j'.~_'^'fs±~' ~ 143' ~r;3:! iC.~9 Page: 1 •1 r~1n~l~~.;~z,.s,3 ~ I ^ ~~~~~~~~ ~tg ~.t 2^0 :~ b . ~.1~ . _. r-l,rf iF~q 17a:lc==??Ci? - ~~~'s? ~:1"s l~ ~s?1u!!7'!'~ ._-----._--- ~~mount ~. ~~ 14. QS F'a_.t rug= i'as•c rue Past rue 1:!r•~~en•r ,::,:I.•--:~~. ~Ja!)s ~1•-~t~ da!~~ t?na- r~ayG ~~,)~~? f .f. ~. f:~~ ~'~?ti Ci4t ~J'>w t. t"-l,L .. _. _'_~ ,~-y~~7~ ~~ S 'F ~t?!{. _. 5 ., ~: ,_ .: ~~ ~~ ~ ,_ :::. , Vi..w.~ ._ _ - ~. l~a[arrt:e Forward ', $8,470:38 ~,, 0,39_ _ p6/0tf0$=°4109' Rltemating Afessure Mattress 4 368.68. ~'~; 0610t1b9 =-06Jtb1U9 Personal-:Laundry Monthly Chg 10 $18.70 38:~•n 'p~02/09'--06102109 'BarlieNBeauty Chargeable 1 $12;00• $8,567..77 _ ,: 06/0710 - Q6J0T/09 Incontinence Charge. 18 349:5D 38,612:27 0$1b8109 -06/10108 Alternating Pressure Mattress 3 $51.51 X38.668.78 08/i 1109 -08/30/09 R8B PrivatePay (20) 3(4,720.00) 33,948J8 TOTAL BALANCE DUE: 33,948.78 ~~~-zl ~~~Z`Q~ ., ~QT FOR REORDER/NG PURPiOSES Promo krm ChsdmSlao your duplieale dbdcs h your deck 6o>L - E~Tradc your expenses... p rax-oeoucrraeF irEnn 724 ^ Cbttrng ^ Food p TrensportaNon ^ Credit Card ^ UUiides ^ Mortgage a ~ ~~ p ErrtertainmeM ^ Insurance ^ Olher. f ~ ; , ' . - D~EPOSR . OfHErt eauntce ronwnao :.. .. _ _ PLEASE RETURN 70P PORTION NIF'R~I YOUR PAYMENT, AETAIN BOTTOM PCfRTION`FOR YOUR REGARDS 1'A 1 ItN 1 NAmt Mr. Bowen DESCRIPTION HOURS RATE SERVICED AMOUNT H~iA/NEW PATIENT 2 25.00 6/1/2009 50.00 HHA/NEW PATIENT 2 25.00 6/2/2009 50.00 P~~,!~/NEW PATIENT 2 25.00 6/3/2009 50.00 F~3A/NEW PATIENT 2 25.00 6/4/2009 50.00 I-I]HA/NEW PATIENT 2 25.00 6/5/2009 50.00 '~ ~I~~D~ All work is complete! Please accept our sympathy. Total $250.00 PENN NATIONAL INSURANCE PennayNania Natione~ ~tnivet Casualy i Campmry Penn Nemmu Y ~nwrance Company Foundarsirreurance Company P.O. Box 22~i7 • Flert~burg PA 17105 MAIL TO: BOWEN ROBERT C C/0 KATHLEEN CRULL 303 OAK DRIVE MT HOLLY SPRINGS INVOICE AGENT: STRICKLER AGENCY INC AGENT NUMBER 12 - 0121 TELEPHONE: ? 17 - 243 - 2921 AccouNr NunneER: 3755955780 001 00001 INVOICE DATE: 06/09/2009 DUE DATE 06/30/2009 ACCOUNT NAME: PA 17065 BOWEN ROBERT C C/0 KATHLEEN CRULL 303 OAK DRIVE MT HOLLY SPRINGS PA 17065 TOTALS 518.00 129.00 ~*~ S C H E D U L E O F F U T U R E I N S T A L L M E N T DUE DATES *** 09/26/2009 $129.00 12/26/2009 $129.00 03/26/2010 $131.00 EACH INSTALLMENT WILL BE CHARGED AN INSTALLMENT SERVICE FEE P~. ~1~d ~ i33 SEE REVERSE SIDE FOR IMPORTANT CLAIM HISTORY INFORMATION YOU CAN ALSO MAKE A PAYMENT OR /NQ(//RE ABOUT RECURR/NG PAYMENTS AT www.PennNationalhtsurance.com OR BY CALL/NG OUR CUSTOMER CONTACT CENTER AT (8001 766-2245. --------------------------------------------------------------------------- 04/02/2009 PAYMENT -THANK YOU 133.00- 05/18/2009 RENEWAL 5550955780 I1 HOMEOWNERS 1 518.00 129.00 - r ,;F `..SOLD TO: Kathy Crull 303 OAK DR MOUNT HOLLY SPRiNGS,PA 17065-1806 L • ~t/~ INVOICE AMOUNT REMITTED DELNERED TO: Robert Bowen Ewing Brothers Funeral Home 630 S HANOVER ST `' `r' CARLISLE, PA 17013-4103 ~' tDERNO: a~_ ORDER DATE: 6/15/2009 8:01AM PAYMENT: House ,CCT. NO: 0001643 DELIVERY DATE: Mon, 06/15/2009 SALESPERSON: David ORDERED BY: -~n° - -1 - - - - - - - - - - - ' THE WHIMSICAL POPPY 717-486-5202 417 N. BALTIMORE AVENUE `' MT. HOLLY SPRINGS, PA 17065 -~;~ ~ ,~ SOLD TO: _'`_ Kathy Crull 303 OAK DR MOUNT HOLLY SPRINGS.PA 17065-1808 INVOICE DELNERED TO: ORDER NO: 0033#211 _ ORDER DATE: 6/22/2008 4:11 PM PAYMENT: House ACCT. NO: 0001643 DELNERY DATE: Mon, 06/22/2009 SALESPERSON: David ORDERED BY: .-~ IA -•.'~-+ '''a r!~ V N W~ S ~ ~~. ~,; _ x _ ; ~ ' THE- WHIMSICAL POPPY =':- 717-48f~5202 417 N. BALTIMORE AVENUE MT. HOLLY SPRINGS, PA 17065 ~ C O L (A 1~-~ ~ y~#~ ~a :-} Of NO ~ _. O O n r+ O ~+ O m ar ~'a ~~ GF-~ Z 7 Y M U d ti L O ~ O Y m E .G /p 7~ Z ~ ++ 7 U O U O Q Q of ' N [fl 01 *y N N„ Of Of O\DQW mCm P\~ m Tm ~ d U U la f0 OD On m Z t~~~~tO 00 i NlfA m L • H ~ C O Q 41 i m O L N m LL E O N O -~- M~- N L O i+ ~O m L ~9 O N O O\O.-~ O O t~..a ~ ,-~ ~ ~ O~ ~ 1- i+ a+ C C d $ ~~ AMOUNT REMITTED ,~ ;- ~~YOiJT f7 ~;, , ~'3 A ~, THE WHIMSICAL POPPY 7~7-ass-5zo2 417 N. BALTIMORE AVENUE r MT. HOLLY SPRINGS, PA 17065 ~ 'f ~ 7a INVOICE AMOUNT REMITTED SOLD TO: Kathy Chill 303 OAK DR MOUNT HOLLY SPRINGS,PA 17065-1806 DELIVERED TO: Robert Bowen Ewing Brothers Funeral Home 630 S HANOVER ST CARLISLE, PA 17013103 x.+4+ ORDER NO: "`~"`'-` ORDER DATE: 6/152009 8:01AM PAYMENT: House ACCT. NO: 0001643 DELNERY DATE: Mon, 06/15/2009 SALESPERSON: David ORDERED BY: nv ui+. ~ .:.. .. _. ~'~ F~ ~._ _. >. SOLD TO: ,,-,~ Kathy cn,u - 303 OAK DR MOUNT HOLLY SPRINGS.PA 17065-1806 THE WHIMSICAL POPPY 717-486-5202 417 N. BALTIMORE AVENUE MT. HOLLY SPRINGS, PA 17065 s 3'7. ~c~ INVOICE AMOUNT REMITTED DELIVERED TO: Robert Bowen Ewing Brothers Funeral Home 630 S HANOVER ST CARLISLE, PA 17013-4103 a~3'. ORDER NO: ORDER DATE: 6N5/20pg g:01AM ACCT. NO: 0001643 DELNERY DATE: Mon 06/1 PAYMENT: House 5/2009 SALESPERSON: David rnav un. ~ ORDERED BY: PRIN' `ED: 6/15/2009 8:02AM ,- g'•1~REDIT CARD INFORMATION .:~_ ~1. _~ ~= c ~ Y -.:rr~iao: ~_ ~ _- --------- PRINT.EO: 6/15/2009 8:02AM CREDIT CARD INFORMATION ;~,; PRODUCT QUANTITY PRICEftJT DISCOUNT IXTENDED Delivery Charge 1 5.00 5.00 LR -Loose Roses 3 pink and 1 blue 1 12.00 12.00 rose in a cluster for casket LR -Loose Roses Heart Pillox xith5 1 25.00 25.00¢" red roses for in casket ~ '` ~ ~` ~ ~~. ~ ~:., ~~~t~ SUB-TOTAL Sales Tax TOTAL PRINTED: 6/15/2009 8:02AM ZREDIT CARD INFORMATION ~4 . ~~ tfxr ; , _. „}~. • ~~ ~ ': ~~ 1505607221 ~'Q~~b ~O REV 1500 EX ~,~ Decedent's Social Seclu(nber i~cedenrs ~~: R 4 B E R T C. B 4 W E N 1 6 8 2 4 2 5 5 1 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 Deposits 8 Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 2 D 0 0 0 0. D 0 0. 0 0 1 6 7 4 D. 7 6 1 2 1 7 4 9. 0 0 3 3 8 4 8 9. 7 6 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 11. Total Deductions (total Lines 9 & 10) ........................... 11 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 13. Charitable and Govemmenta! Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. 13. 1 6 3 5 8. 4 3 6 5 0 3. 9 3 2 2 8 6 2. 3 6 3 1 5 6 2 7. 4 D 14. Net Value Subject to Tax Line 12 minus Line 13) 14. ~ 1 5 6 2 7 • 4 D TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o _ D. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 3 1 5 6 2 7. 4 0 16. 1 4 2 0 3. 2 3 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. D. D 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18, 0. 0 D 19. Tax Due ........................ ................. ....... 19. 1 4 2 0 3. 2 3 20. FILL IN THE OVAL tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 • '~ 1505607221 1505607221 J