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HomeMy WebLinkAbout09-30-09a J 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po sox 2aosol 2 1 0 9 0 2 9 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT_ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 1 2 0 6 5 9 1 0 3 1 4 2 0 0 9 0 3 0 3 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI S A L I S B U R Y R O S E M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number 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) © s. 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 T0: Name Daytime Telephone Number R O G E R B- I R W I N E S Q U I R E 7 1? 2 4 9 2 3 5 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Firm Name (If Applicable) I R W I N & M c K N I G H T P C• First line of address 6 0 W E S T P O M F R E T S T R E E T Second line of address City or Post Office C A R L I S L E State P A EBIt~F WILLS 1i15~ ONL1G-i-; ; ~_+ a ~~ -v ~.. , r` ~ ~ ~....1 V . j ~ '"'lam ~ ` , .. `... --p .. ~f':~ _. , ~ ?DATE FILED '""' ` ZIP Code ~ 1 7 0 1 3 Correspondent's e-mail address: Under pe of perjury, I d tare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and beliet, it is tru and compl eclaration o reparer other than rsonal representative is based on all information of which preparer has any knowledge. SI 6CT E OF~2RS RESf~ONS FOR FILING R U /~ D~~ ~/7 7802 WERTZVILLE ROADS CARLISLE PA 17013 SIGNATU~~R•EAF PREPARER OTHER THAN,REPRESENTATIVE ~ ~~ y/v~ ' l./( in ~ _/1, ~K,,~. _ 60 WEST PtbM~RET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121, 15D5607221 REV-1500 EX Decedents Social Security Number 2 0 1 2 0 6 5 9 1 Decedents Name: ROSE M• S A L I S B U R Y RECAPITULATION 1 9 5 0 0 0.0 0 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• 1 4 2 9. 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. .. • • • 5. 4 7 8 7. 6 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .. ..... 6• 7. Inter-Vivos Transfers 8~ Miscellaneous N¢rt;Probate Property U Separate Billing Requested .. G ..... 7. ) (Schedule s 2 0 1 2 1 6. 6 4 B.TotaiGrossAssets(totalLines1-7) .•••••••••••••••••••• 9 6 5 7 9 2. 4 0 9. Funeral Expenses & Administrative Costs (Schedule H) . • • • • • • • • • • • • • • • . 1 4 6 5 6 6. 7 8 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ..... . 10 11 2 1 2 3 5 9. 1 8 ............... 11. Total Deductions (total Lines 9 8 10) • • ..... . . 12. - 1 1 1 4 2. 5 4 12. Net Value of Estate (Line 8 minus Line 11) • • • • 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13. an election to tax has not been made (Schedule J) • • • • • • • • • • • • • • • • • • - 1 1 1 4 2. 5 4 .............14. 14. Net Value Subject to Tax (Line 12 minus Line 13) • • TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 . 0 D 15. 0. O D (a)(1.2) X .0 16. Amount of Line 14 taxable Q . 0 0 16 0 . 0 D at lineal rate X .045 • 17. Amount of Line 14 taxable D . 0 0 17 D . 0 0 at sibling rate X .12 18. Amount of Line 14 taxable D . 0 D 18 D . 0 0 at collateral rate X .15 D. o D .. ..... ..19. 19. Tax Due ....................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .~ ~~ 1505607221 Side 2 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0299 DECEDENTS NAME kOSE M. SALISBURY STREET ADDRESS 7804 WERTZVILLE ROAD CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: ~• Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 108.21 C. Discount Total Credits (A + B + C) (2) 108.21 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) 108.21 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ............................................................ .......... ^ b. retain the right to designate who shall use the property transferred or its income; ..................... .......... ^ c. retain a reversionary interest; or ...................................................................................... .......... ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death . without receiving adequate consideration? ............................................................................. .......... ^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE 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 p2 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 childtwenty-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 isdefined, 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 ROSE M. SALISBURY 21 09 0299 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is intl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 7804 WERTZVILLE ROAD, CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA 195,000.00 SOLD -SETTLEMENT SHEET ATTACHED TOTAL (Also enter on line 1, Recapitulation) ~ $ 195,000.00 (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. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ROSE M. SALISBURY 21 09 0299 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PERSONAL PROPERTY -APPRAISAL ATTACHED 1,429.00 TOTAL (Also enter on line 5, Recapitulation) I $ 1 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) . ' ,A COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER ROSE M. SALISBURY 21 09 0299 If an 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 2069 SPRING ROAD CARLISLE, PA 17013 DAUGHTER ADDRESS RELATIONSHIP TO DECEDENT A. ALFREDA RIVERS e c 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 DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. MEMBERS 1ST FEDERAL CREDIT UNION #151893-00 2,076.51 50. 1,038.26 2. A. MEMBERS 1ST FEDERAL CREDIT UNION #151893-11 2,188.61 50. 1,094.31 3. A. MEMBERS 1ST FEDERAL CREDIT UNION #144864-11 893.58 50. 446.79 4. A. MEMBERS 1ST FEDERAL CFEDIT UNION #144864-00 3,838.73 50. 1,919.37 5. A. SOVEREIGN BANK #1694000751 577.81 50. 288.91 TOTAL (Also enter on line 6, Recapitulation) I $ 4,787.64 (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 ROSE M. SALISBURY 21 09 0299 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. RONAN FUNERAL HOME 7,848.46 2. GINGRICH MEMORIALS 190.00 3. FUNERAL LUNCHEON 277.72 B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: State Zip 2, Attorney Fees IRWIN & McKNIGHT, P.C. 9,750.00 3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 299.00 5 Accountants Fees 6. Tax Return Preparer's Fees PATRICIA A. ROSENDALE, CPA 350.00 7. REGISTER OF WILLS -FILING FEE 30.00 8. CLOSING COSTS FROM SALE OF REAL ESTATE 7,704.68 9. GIFT OF EQUITY -SEE SETTLEMENT SHEET 39,000.00 10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 11. THE SENTINEL -ESTATE NOTICE 187.54 12. ROY GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 55.00 13. NOTARY FEES 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 65.792.40 (If more space is needed, insert additional sheets of the same size) REV-1~~2 lJC + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER ROSE M. SALISBURY 21 09 0299 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. PAYOFF OF FIRST MORTGAGE TO INDYMAC FEDERAL BANK 146,566.78 SEE SETTLEMENT SHEET TOTAL (Also enter on line 10, Recapitulation) I S 146,566.7 (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 RC1CF M SL11 I~RI 1RY 71 OA n7AA 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 sppoousal distributions, and transfers under , Sec. 9116 (a) (1.2)] See Attachment Page(s) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET jj. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent ROSE M. SALISBURY 21 09 0299 CJ~cedent's Name Page 1 File Number Schedule J -Beneficiaries -1 NUMBER NAME AND ADDRESS OF PERSON S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. ROY B. SALISBURY, JR. 7802 WERTZVILLE ROAD CARLISLE, PA 17013 2. ALFREDA MAE RIVERS 2060 SPRING ROAD CARLISLE, PA 17013 3. ROSE E. BREAM SETCHELL 1550 WILLIAMS GROVE ROAD, LOT 51 MECHANICSBURG, PA 17055 4. ROY B. SALISBURY, III 7804 WERTZVILLE ROAD CARLISLE, PA 17013 5. THOMAS DAVID SETCHELL 150 AMY DRIVE CARLISLE, PA 17013 6. PAMELA DIANE SETCHELL 923 FOREST CT. CARLISLE, PA 17013 7. LISA MARIE SALISBURY APONTE 7804 WERTZVILLE ROAD CARLISLE, PA 17013 8. LETIZIA M.M. BATES 2069 SPRING ROAD CARLISLE, PA 17013 RELATIONSHIP TO DECEDENT I AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal Lineal Lineal Lineal Lineal Lineal Lineal Lineal 1/6TH REMAINDER 1/6TH REMAINDER 1/6TH REMAINDER 1/10TH REMAINDER 1/10TH REMAINDER 1/10TH REMAINDER 1/10TH REMAINDER 1/10TH REMAINDER ~. T.1sST SILL AND TESTA~SNT Rn~g ffiARIE SALIS~DRY I, ROSS MARIE SALISBIIRY, of 7804 Wertzville Road, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make and declare this as mY Last Will and Testament and revoke all wills and codicils heretofore made by me. FIRST I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as ~ conveniently may be done. If there is no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from .. my estate in such amount as my personal representative shall consider necessary and desirable. Further, in this connection, I authorize my personal representative to expend reasonable funds from my estate, in such amount as my personal representative shall consider necessary and • desirable, for the purchase, erection and inscription of a suitable marker for my grave. SSCOND I make the following specific bequests to the following individuals: A. My husband's guns and personal mementos, except for his West Point Medal, to my son, ROY B. SALISB'ORY, JR. B. My husband's West Point Medal to my grandson, THOMAS DAVID SETCHELL. r C. My husband's one-half interest in the trailer located on my property to my son, ROY B. SALISBIIRY, JR. D. My jewelry to be divided, as they deem appropriate, among my female grandchildren and great-grandchildren. THIRD I give, devise and bequeath the rest, residue and remainder of my estate, per stirpes, as outlined below, with the exception of 3/4 acres off the back of my real estate. This 3/4 acres shall be subdivided and given to my son, ROY B. SALISBIIRY, JR. The balance of my estate shall be divided as follows: A. One-sixth to my son, ROY B. SALISBIIRY, JR.;,/ B. One-sixth to my daughter, ALFREDA MAR RIVERS;;/ r C. One-sixth to mY daughter, ROSE E. BRED; D. One-tenth to my grandchild, ROY B. SALISBORY, III; E. One-tenth to my grandchild, T80MAS DAVID-SETCBELL;'~ F. One-tenth to my grandchild, PAULA DIANg SgTCH$LL;- G. One-tenth to my grandchild, LISA MARIE SALISBURY;/ ~ H. One-tenth to my great-grandchild, LETIZIA ~.~. BATES..- ( These gifts to my grandchildren and great-grandchild are f subject to the provision of paragraph Fourth, infra. FOtTRTS A. I appoint FARMERS TRUST COMPANY, of Carlisle, Pennsylvania, as Trustee of any property which passes to any of mY grandchildren or great-grandchildren, under this or otherwise, by reason of my death. B. Such Trust shall continue until each grandchild or great-grandchild attains the age of eighteen (18) years. C. In addition to the powers given by law, I authorize the Trustee to use such amounts of both income and principal, as it, in its discretion, deems proper for the support, education and welfare of such minor grandchildren or great-grandchildren without leave of any court. D. The Trustee shall not be required to give bond or furnish sureties in any jurisdiction. 1 ~ ~ ~ V. 1 ~ 1 FIFTS I nominate and appoint my daughter, ALFRSDA NA13 RIVERS, as Executrix of this my Last Will and Testament. Should my daughter fail to survive me or be unable to serve in this capacity, then I nominate, constitute and appoint mY son, ROY B. SALISBIIRY, JR. as Substitute Executor of this my Last Will and Testament. I hereby relieve my Executrix or Substitute Executor from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act insofar as I am able by law to do so. IN WITNESS W8LRf30F, I have hereunto set my hand and seal to this, mY Last Will and Testament, consisting of four (4) typewritten pages, the first three (3) of which bear my signature in the margin for the purpose of identification, this ~ ~ day o f /`t ~ ~ 19 9 7 . C'~~~~ /~ ~ ( SEAL ) Rose Marie Salisbury .{ ~ . r r e r r i Signed, sealed, published and declared by the above-named Testatrix, ROSL ffiARIL SALISBIIRY, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. 6 ~~ /6 9 4i H,a~.S~`, l;,/ d~J- /7d73 ~~ ~ e. 9 nua urn ~sn~s~eas A. B. TYPE OFLOAN: - U S DEPARTMENT OF HOUSING b URBAN DEVELOPMENT 1.QFHA 2'C]Fmtip' 3.[X CONN. UNINS. 4. ~VA 5. (]CONN. INS. . . SETTLEMENT STATEMENT 6. FILE NUMBER; 2009040035CONANG 7. LOAN NUMBER: 209047553 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to glue you a steternent of actual settlement costs. Amou-hs paid to and by the settlement agent are shown. Items marked '~POCJ" were paid outside the closing; they are shown here for Jnfom-atlo-ral purposes and are not inducted in the totals. fA 3165 0 D. NAME AND ADDRESS OF BORROWER: E NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Roy B. Salisbury III Estate of Rose Marie Salisbury Bank of America, NA 7804 Wentzville Rd. 8511 Fallbrook Avenue, Attn: Wire Dept, 4t Carlisle, PA 17013 West Fiitls, CA 91304 SSN:187-66-3621 G. PROPERTY LOCATION: 7804 Wentzville Rd. Carlisle, PA 17013 H. SETTLEMENT AGENT: Consumer Settlement Services I. SETTLEMENT DATE: Ma ZZ 2009 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 3800 Market Street Camp Hql, PA 17011 y , J. SUMMARY OF BORROWER'S TRANSACTION K SUMMARY OF SELLER'S TRA NSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROS8 AMOUNT DUE TO SELLER: 101. contract sales Price 195 000.00 ao1. Contras sales Price 195000.00 102. Personal ~ 402. P 103. Settlement to Borrower Une 1400 655.88 403. 104. # 404. 105. Pa e # 405, Adirstrr-errts For items Paid Sellerin advance rKa FwlAemsPaJd SeNerM advance 106. TWPTaraes 0523/09 b 01/01/10 0 . 40B. TWPTexes 05@3109 b 01/01N0 101.53 107. Coun Taxes 05/2;!/09 b 01/01!10 231.96 407. Cou Taxes 05/231'09 iq 01/01/10 231.96 108. School Taxes 05/23109 to 07/01/09 154.46 408. Sdtool Taxes 05/23/09 b 07/01!'09 154.48 109. 409, 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 202,143.83 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 420. GROSS AMOUNT DUE TD SELLER 500. REDUCTIONS MI AMOUNT DUE TO SELLER: 195,487.97 201. t or eaRreat 501. Excess See Instructlons 202. Prin I Amount of New Loans 158000.00 502. Settlement b Seder 1400 560.85 203. Existln loans taken s to 50.3, loans Taken to ~• 205. 504. of first to i c Federal Bank, 505. second Mo 146,586.78 206. 506. 207. ~, 208. 508. 209. Closi cost setler 7,143.83 Ad'ustments For Items U Seller 509. Ck~si cost setler 7,143.83 us6rrents For hlems Un d Seiler 210. TWP Taxes m 211. Coun Taxes to 212. School Taxes b 510. TWP Taxes >b 511. Cou Taxes fA 512. Sdtool Taxes to 213. Gift Of E u 214. 39,000.00 513. Gift Of ~ 514. 39 000,00 215. 515. 216. 516. 217• 51T. 218. 518. 219. 519. 220. 710TAL PAID BY/FOR BORROWER 300. CASH AT SETTLEMENT FROMf TO BORROWER: 202,143.83 520. TOTAL REDUC710N AMOUNT DUE SELLER 600. CA8H AT SETTLEMENT TWFROM SELLER: 193,271.46 301. Gross Amount Due From Borrower Line 120 302. Less Amount Paid B Borrower Una 220 202143.83 ( 202,143.83 801. Grass Amount Due To Seiler LMe 420 602. Less Reductlons Due Seller Line 520 195,487.97 ( 193,271.4 303. CASH ( FROM) ( TO) BORROWER 0.00 603. CASH (X TO) ( FROM) SELLER 2,216.51 ~ ne unaersignea• nereoy acxnowledge receipt of tad copy of pages 182 of this statement & any attachments referred to herein. Borrower Seller Roy I II of Rose Marie Sal ~~ Roy B. Salisbury Jr. - Execuhix • L. SETTLEMENT CHARGES 700. TOTAL COMMISSION eased on Price S ~ PAIO FrtOM PAID FROM Division o Comma 700 as Mows: soRROwerrs sF.u.errs 701. $ t0 FUNDS AT FUNDS AT 702.3 to sErne~'r sErnEla:NT 703. Commission Pa d at Settlement 704, to 800. fTEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan O ' inatlon Fee 96 to 802. Loan Discount °i6 tD 803. Appraisal Fee to The Appraisal Firm POC:B375.00 804. Broker O ' inatlon Fee to Guardian I Mo age Svcs. 995.00 805. Broker Credit Report to La afe Creel 15.00 806. YSP Pd B Lender t0 Guardian Svcs. POC:L585.00 807. Broker Credit Rsport to u tan 1 Mori Svcs. 55.72 808. Broker Processing Fee to rdian a cs. 6~•~ 809. Broker Application Fee to Guardian a Svcs. 395.00 810. Lender Fee to Bank , NA 6~•~ 811. Tax Service Fee to Tax rvice rpora n 100.00 812. Flood Chedc Fee to Land afe cod De~rm nation , nc 26.00 813. 814. 815. 81B. 817. 818. 818. 820. 900. ITEMS REGUtltED BY LENDER TO BE PAS N~ ADVANCE 901. Interest From 05/22/09 to 06/01/09 3 20.840000/day ( 10 days 96) 208.40 902. Mo nsurance Premium months to 903. Hazard Insurance Premium for 1.0 to Friends Cove Mutual POC:B372.00 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months S 31.00 month 93.00 1002. Mort Insurance months S month 1003. TWPTaxes 4.000 months Z 11.48 month 45.92 1004. Coun Taxes 4.000 months $ 31.64 month 126.56 1005. School Taxes 12.000 months S 12295 per month 1,475.40 1006, months r mon 1007. s r fh 1008. to Ad ustrnent months $ month -265.55 1100. TITLE CHARGES 1101. Settlement Fee tD Noel Gevers 2~-~ 1102. Title Search Fee to 1103. Title Examinatlon t0 1104. E-mail Doc Fees fp Noel Gevers 35.00 1105. Document ration to 1106. Nota Fees to Noel Gevers 20.00 1107. Attorneys Fees to includes above item numbers: 1108. Title Insurance to Consumer Settlement Services Re-issue 1 .38 fndudes above Item numbers: 1109. Lenders erage 156, .00 1110. ere coverage s 195,000.00 1,2 .3e 1111. ALT ndorsements to Consumer t ervk~s 8.1 5 220.03 1112. CPL Fee to tevvart 1113. 1114. Express Overnight Fee to Consumer Settlement Services 65.00 1115. Wire Fee to nsumer Settlement Services 15.00 1116. Tax rt Fee to Consumer 5.00 1117. Bankru Search Fee to Consumer Settlement Services 15.00 15.00 1118. 1200. GOVERNMENT RECORDMIG AND TRANt3FER CHARGES 1201. Recording Fees: Deed S 50.00: Mortgage 3 90.00 ~ Releases 5 140.00 1202. C % n T m :Deed • Mo 1203. Spate Tax/Stam Revenue Sts 1204. 1205. 1300. ADDRIONAL SETTLEIAENT CHARGES 1301. Surve to 1302. Pestles on to 1303. 09 Coun R Taxes b Penn Davis 21-13-0971-008 545.85 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lures 103 Section J and 50 Section 6,655.81 1 560.85 oY HBn~ Pew 1 W Ywf iwnMln. YA M~WIWICi 8R11{IA10w0 fOWIPI W i G{J1~'IIOWY wP1 W P)Y6 < W •w awu IOW eremww Consumer Settl t Services Settlement Agent Certified to be a true copy. ( 20080,0036CONANG / 20000/0035CONANG f to ) .~ ~ ~ .~~..- ~io~x~~~~ ~,~ ~ __ r f_ ~~2-~3~~~~~~`' r tr . , r r ~' p ~; ,.. ~~ (~~r _ _ __. -- /'jf ~Q ~ _.. ._ ._/D_~. ../~d._~_ ._._ ~D ` _ _. __. .. ...~ .. ,.:, ._. }_ r ' /,-r _ ~~. _. __ / - _,,. .w f~ 1 ~ ~~~ r.,,., -. -- -- - ----- - ~~ ------ --------- ----- i_ ~~ ~~, ~.. ' ;r_ ~, ... r ,% i ~~ f _ _ _ _ ___ f ~ ~ r r ,. _. _ ~ y-~~~' .._ __ . _ _ J` .~ ~~ ~ur:r:unwtw~ i n ur rtnnsY~vAntw DEPARTMENT OF REVENUE . ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION • PO BOX 280601 HARRISBURG PA 17128-0601 ALFREDA RIVERS 2069 SPRING ROAD CARLISLE PA 17013 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ~i~ REV-1548 EX AFP CO1-09) DATE 05-18-2009 ESTATE OF SALISBURY ROSE DATE OF DEATH 03-14-2009 FILE NUMBER COUNTY CUMBERLAND SSN/DC 201-20-6591 ACN 09118410 APPEAL DATE: 07-17-2009 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS !~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-18-2009 ESTATE OF SALISBURY ROSE M DATE OF DEATH 03-14-2009 FILE N0. S.S/D.C. N0. 201-20-6591 COUNTY CUMBERLAND ACN 09118410 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT N0. 151893-00 TYPE OF ACCOUNT: 4()SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 06-05-1995 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 2,076.51 NOTE: X 0.500 _ ._..._. ------ - 1, 038:26 1,038.26 .00 X .45 .00 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORT30N OF THIS NO1"ICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN Sl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. CFF RFVFQCR RTT1F fIF T41TC FfIQM FAR TNCTQIIf:TTf1NC. 7 ,' BUREAU OF INDIVIDUAL TAXES ~ PO BOX 280601 HARRISBURG PA 17128-0601 REV-1543 IX AFP COB-06) INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 ACN 09118410 DATE 03-26-2009 ALFREDA RIVERS 2069 SPRING ROAD CARLISLE PA 17013 EST. OF ROSE M SALISBURY SSN 201-20-6591 DATE OF DEATH 03-14-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is .taxable in accordance with the Inheritance Tax laws of the Commonwealth of Nennsylvania. Please call 0717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE rvrn~ ~~nLear on ~1ne ~ [7T laX ~omputatson) $ ~UREAU OF INDIVIDUAL TAXES PO BOX 280601 y HARRISBURG PA 17128-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE mEV-3543 IX AFP (OB-08) ALFREDA RIVERS 2069 SPRING ROAD CARLISLE PA 17013 FILE N0. 21 ACN 04118411 DATE 03-26-2009 EST. OF ROSE M SALISBURY SSN 201-20-6591 DATE OF DEATH 03-14-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you feel the inforoation is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please tali CT17) 787-8327 with quastio~s. COMPLETE PART_1 BE~I~~;O~M~I * SEE REVERSE ~ SIDE FOR FILING AND PAYMENT INSTRUCTIONS ~: t N ~- 1 ' Date 06 - 05-1995 Accoun o. ; , 3" .: ~- To ensure prover credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 2, 188.61 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 1, 094.31 months of the decedent's date of death, Tax Rate ~( ~ Q({rj deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 49.24 nine months after the date of death. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check bax "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state 2 relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON'JOINT/TRUST ACCOUNTS LINE 1. Date Established. 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject: to Tax 4 $ ~ 5. Debts and Deductions 5 - 6. Amount Taxable' 6 $ 7. Tax Rate 7 X ~ 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED a . DATE PAID? PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 M E C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S ~.vru•wnn~n~. ~ n ur rump ~ ~.~e+~~a,+ DEPARTMENT OF REVENUE rBUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE ~ PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 05-18-2009 ESTATE OF SALISBURY DATE OF DEATH 03-14-2009 FILE NUMBER ALFREDA RIVERS 2069 SPRING ROAD CARLISLE PA 17013 REV-1548 EX AFP CO1-09) ROSE M COUNTY CUMBERLAND SSN/DC 201-20-6591 ACN 09118411 APPEAL DATE: 07-17-2009 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ --- -------------------------------------------------------------------------- ----------- --- REV-1548 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-18-2009 ESTATE OF SALISBURY FILE N0. ROSE M DATE OF DEATH 03-14-2009 COUNTY CUMBERLAND S.S/D.C. N0. 201-20-6591 ACN 09118411 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT N0. 151893-11 TYPE OF ACCOUNT: C )SAVINGS 4() CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 06-05-1995 Account.Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 2,188.61 NOTE: X 0.500 1,094.31 1,094.31 .00 X .45 .00 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER~PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. cF~ QFVFRCF CTT1F nF THIS FORM FOR INSTRUCTIONS. ) INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PO BOX 280601 TAXPAYER RESPONSE 'HARRISBURG PA 17128-0601 REV-1543 EX AFP COB-00) FILE N0. 21 - d~ ' °~~~ ACN 09118414 DATE 03-26-2009 EST. OF ROSE M SALISBURY SSN 201-20-6591 DATE OF DEATH 03-14-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: ALFREDA RIVERS REGISTER OF WILLS 2069 SPRING ROAD CUMBERLAND CO COURT HOUSE CARLISLE PA 17013 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided the Department with the information below, which has been used. in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a 3oint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C7i7) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) .WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) # DEPARTMENT OF REVENUE i BUREAU OF INDIVIDUAL TAXES DEPT. 280601 • r HARRISBURG, PA 17128-0801 ~, RECEIVED FROM: RIVERS ALFREDA 2069 SPRING RD CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: sSN: 201-20-6591 FILE NUMBER: 2109-0299 DECEDENT NAME: SALISBURY ROSE DATE OF PAYMENT: 06/05/2009 POSTMARK DATE: 06/05/2009 COUNTY: CUMBERLAND DATE OF DEATH : 03/ 14/ 2009 N0. CD 011320 ACN ASSESSMENT AMOUNT CONTROL NUMBER 09118412 ~ $28.79 09118414 ~ 56,70 TOTAL AMOUNT PAID: REMARKS: SEAL INITIALS: JN RECEIVED BY: 535.49 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER ~ BUREAU OF INDIVIDUAL TAXES PO BOX 2806D1 t HARRISBURG PA 17128-0601 ~ REY-1543 Ex AFP C08-08) INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 •-~~ ~~~ ACN 09118412 DATE 03-26-2009 ALFREDA RIVERS 2069 SPRING ROAD CARLISLE PA 17013 EST. OF ROSE M SALISBURY SSN 201-20-6591 DATE OF DEATH 03-14-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Taz laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW__* SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Under penalties of perjury, i declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H O M E C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE ~v~N~ •nnzer on ~1ne 5 or iax computation) # DEPARTMENT OF REVENUE ~ BUREAU OF INDIVIDUAL TAXES DEPT. 280601 ° t • HARRISBURG, PA 17128-0601 .. RECEIVED FROM: BATES LETIZIA 2069 SPRING ROAD CARLISLE, PA 17013 told PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: 201-20-6591 FILE NUMBER: 2109-0299 DECEDENT NAME: SALISBURY ROSE DATE OF PAYMENT: 06/05/2009 POSTMARK DATE: 06/05/2009 COUNTY: CUMBERLAND DATE OF DEATH: 03/ 14/2009 N0. CD 011321 ACN ASSESSMENT AMOUNT CONTROL NUMBER 091.18413 ~ $28.79 09118415 ~ $6.70 I TOTAL AMOUNT PAID: REMARKS: INITIALS: JN SEAL 535.49 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER ~~ BUREAU OF INDIVIDUAL TAXES ~' PO BOX 28D6D1 ~~.~~ ~ HARRISBURG PA 17128-0601 {t r+•~r. i^.....I~Y .. y mEV-1543 ~~.AEJ~:':(b~-jy~)ij1 ^ r^\^\V ^ i-•A^•iA i^\^^i-^\i ^A^•Vr INFORMATION NOTICE AND ~`{~;•1~ ;~ ~~'AXPAYER RESPONSE `,' ~;~.~ ~_ * REVISED NOTICE ~ ~ ~ ^ A/~ ~ FILE N0. 21 09-0299 ACN 09136246 DATE 06-12-2009 ~Q~~ SEA E 5 PM f ~ 55 CLERK ~F oR~yAv~s c~~~R~ CUP,:"fir! '~'t~l~~C~ ~~~ ~,, , PA. LETIZIA M BATES 7804 WERTZVILLE RD CARLISLE PA 17013-9047 EST. OF ROSE SALISBURY SSN 201-20-6591 DATE OF DEATH 03-14-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING ® TRUST CERTIF. SOVEREIGN BANK provided the Department with the information below, which has been used in calculating the potential tax dua. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. It you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pannaylr-ania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1694000751 Date 05-31-1 95 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 577.8 payable to "Register of Wills, Agent". Percent Taxable X 100.0 NOTE: If tax payments are made within three Amount Subject to Tax ~ 577 • 81 months of the decedent's date of death, lax Rate ~( ~ OCFj deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 26 • 00 nine months after the date of death. PART TAXPAYER RESPONSE a A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to bs filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the t of my knowledge and belief. HOME C ~~ WORK C ) AYER SIGNA U E TELEPHONE NUMBER DATE TOTAL tEnter on Line 5 of Tax Computation) 8 ~ . : ~ Ronan Funeral Home 2S5 York Road Carlisle, Pennsylvania 17013 one 717-ZSS-9863 Lynn A. Ronan, Funeral nirector Vi/e Care 100% Our F~miiy Serving Your Family Thursday, March 19, 2009 Mrs. Alfreda Rivers 2069 Spring Road Carlisle, PA 17013 Fax 717-241-4041 Dear A,l~aeda, 'I1>mnk you for selecting our funmral home m provide services for your family during your time of bcrcavemcat, I hope that you foxmd our services, so far, to be o4'the highest standards that we always try to achieve. Tice following is a summary of the service charges as prcviously explained and provided in written fbrnn on the services for: '1Z05~ MARIE SALISBURY pROFE88>IONAL SERVICES cx of Itmeral director and staff ti ~ $ 4,5 9 && mb~ and Cosmetology f3ressing, Cas]cetin $ $.Incl. ~ Other Preparation of Body S Incl. TOTA-L)P><t,001'~AL SERVICES '54,590.00 Use of Facilities & Staff for Visitatiox+ $ Incl. Use of Facdlities ~ Steff for Ceremony at Funeral Horne $ Incl. Use of Staff & fiquipmcat for Graveside Service $ Inc], Transfer of Remands to Funeral Home $ Incl. I~arse /Funeral Coach 5 Incl. Flower Vehicle $'Incl. Flower /Lead Car $ Inc]; I~RC~DYSE SEL~C"rED Casket: Aurora "Ella" 20~~a LMO O B i l C C $980.00 Q uter oataaaer M ur a CA TED TOTALME1tCAAND~ ~ 52 075.00 CA.~AD~VANCER Cemifled Copies of Drath Ce1tificste $ 24.00 Clergy HonorsQium 5 175.00 Newspaper Notice Sentiael $ 217.46 Flowers $ 212.00 Ope~g Grave $ 450.00 st $ 1 00 4 Caator $ . 5 Altar Servicrs $ 30.00 CASHADVArTCETOTAL Si,Z83.46 LESS; Credits granted $100.00 $100.00 ----7T0'fAL O~ SERVICES VA u t Cu be l d C 57,848.46 n y m r an v LESS: Payments Made 5,099.48 B,A.LANCE DCJE SZ, g 98 If there are any questions or eoncems that remain unanswered, please call me. S1IICerely r ~~ L~ .Ronan FUDQ~I DirCCtOr !~ ~[ . INSCRIPTION ORDER FORM • zn rzc MEMORIALS Since 1921 5243 Simpson Ferry Road, Mechanicsburg, PA 17050 (717) 766-562 • Fax (717) 766-8007 • www.gingrichmemorials.com CEMETERY S~• I Oi~rICX.~S LOCATION ~.lIY'~LSIe NAME OF DECEASED R'~SC M. ~Ll.~ 1 S I~wrV LETTERING REQUIRED: fvl~l~. ~4, 2~00~ Add ono ~'e ~-~~ ~~I~c,~ N~ FAMILY NAME MEMORIAL J !'S IL I S Q U I` ~ IND. NAMES ON MEMORIAL ~o ~p ~ TYPE OF MONUMENT U G~Y'I G 11~ COLOR OF GRANITE Q I~Qv BILL TO: ~`~~eo(A Q 1 ver'.S DATE OF ORDER ~(` 3 - Oq 06 rtn ORDERED BY Sahf1-'2 r c5~~ b 3 PHONE #( ~ q 3a-~)oda_,.,~c~a 6 UPON EXAMINING THE ABOVE INSCRIPTIONS, I/WE THE UNDERSIGNED, FIND THE SPELLING AND DATES TO BE CORRECT.~iE WORK WILL BE COMPLETED AS IT IS ACCUMULATED. NO SPECIFIC COMPLETION DATE IS GUARAN E n ~ ..~ SIGNED(~fl(X~-/~ / / Y.~~ No. 12- 20565 SIGNED PRICE f s• ~~~c` 1e~ $ ~ 3 s. 0 O ex~"~na woraLs $ ~c DEPOSIT J BALANCE DUE $ ~ _~`~ WHITE-Office YELLOW-Production PINK-Customer GOLDENROD-Branch