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Home My WebLink About02-0243R~-1500 EX PENNSYLVANIA ~ ..... v v v DEPARTMENT OF REVENUE DEP'F. 280601 J INHERITANCE TAX RETURN HARRISBURG PA 17128-0601 / RES--- IDENT DECEDENT I-- Z LU DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DF~TH (MM-DD-~_~R) '- ' I DATE OF BIRTH (MM-DD-YEAR) IO -/o - O l o / - ,.:Z.3 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INmAL) J~l. Original Return ~'-'] 4. Limited Estate /~6. Decedent Died Testate (Aaac~ copyo~Wa! F--] 9. Litigation Proceeds Received I- Z Z o FIRM NAME TELEPHONE NUMBER 1. Real Estate (Schedule A) 2. Slod(s and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Prol~orship 4. Mortgages & Notes Receivable (Schedule D) r~2. Supp~ernantal Retain ~:] 4a. Future Interest Compromise (dale (~ dealh alt~ 12.12-82) ~]7. Decedent Maintained a Living Trust (Arch c~/~ Trust) ~'110. Spousal Povedy Credit (da. ~ ~m bav, e~ ~2-3~-g~ a~d 1-1-95) (1) (2) (3) (4) ~/~.5.~ Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) , . Jointly Owned Property (Sdledule F) (6) L~ Separate Billing Requested ~ 7. ~er-V'wos Transfem & Miscellaneous Non-Probata Property (7) I-- (Sc~edde G or L) ,~ ~ Total ~ As~eta (total Lines 1-7) C1 ~ Funeral M,J Expenses & Administrative Costs (Schedule H) (9) ~ of Decedent, Mo~gage Uab~rdes. & Uens (Schedule ;) (10) 11. Tetal Deductions (total Lines 9 & 10) 12. NM Value of Estate (Une 8 minus Une 11) 13. 14. FILE NUMBER SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WI~ ~ S SOCIAL SECURITY NUMBER ~-'~ 3. Remainder Retam (~ ~ ~ m~ ~o 12.13.82) r-'-] 5. Federal E~ Tax Ream R~a~ __ 8. To~I Num~ of S~e ~s~ Box~ ~11. E~n to ~x u~r ~. 9113(A) (~ ~ o) ~E~ T~ INFOR COMPL~ ~ILING ~DRESS Cha~tabie and Governmental Bequests/Sec 9113 Trusls for which an eleclion to tax has not been made (Schedule J) Ne~ Value Subject to Tax (Line 12 minus Une 13) SEE INSTRUCTIONS ON RE'v'E~E SiDE FOR APPLICABLE RATES (8) (11) (12) (13) 15. Amount of Uno 14 taxable at the spousal tax rate, or tmnafem under Sec. 9116 (aX1.2) x .0 (15) 16. Amount of Line 14 taxable at lineal rate x .0 (16) 17. Amount of Line 14 taxable at sibling rata x .12 (17) 18. Amount of Une 14 taxable at collateral rote x .15 (18) 19. Tax Due (19) 2o. r-I Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 1 Line lg) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3. Interesl/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. If Line 2 is greater lhan Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 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. Total Credits (A + B + C ) (2) --, (3) (4) (5) (5A) (5B) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 7%..- O "'-' 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; .......................................................................................... [] j~, 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 cam? ........................................................... 2. If death occurred alter Be(ember 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 propo~ which contains a benefidary designation? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND RLE IT AS PART OF THE RETURN. SIGN.A'rURE OFj~-~..SOI~SPON.~iLE FOR_FILING RETURN DATE 17011 ADDRES.~- SIGI~ATURE OF f'~uT:PAkER OTHE[~ THAN REPRESENT~,~i: - DATE ADDRE.$.$ 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 sun~iving spouse is 3% [72 P.S. §9116 (a) (1.1) (~]. 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 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exem~)t a transfer to a su~ving spouse fron~ tax, and the statutop/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 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of lmnsfers to or for the use of the decedent's lineal benelidades is 4.5%, except as noted in 72 RS. {}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 12% [72 P.S. {}9116(a)(1.3)]. A sibling is definad, under !Se(tion 9102, as an individual who has at least one parent in common with the decedent,:whether by blood or edoption.- LAW OFFICES OF STEPI-II~N j. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 WILL OF THELMA K. KRAMER I, Thelma K. Kramer, of Enola, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: I leave my estate to be divided equally between my three children, Walter E. Kramer, Carol L. Besch and Gayle L. Kirkpatrick. Should any of the above individuals predecease me I direct that their distributed share go to their heirs. I appoint Walter E. Kramer as Executor of this my last Will. If he should predecease me or cease to act in Such capacity, I appoint Gayle L. Kirkpatrick as alternate. o The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 day of IN /{~/~"g//J'~ , 20~..~ hereunto my hand this ~ ~ 7~ WIT~IESS WH_ ~REOF, I have set THELMA K. KRAMER WITNESS The preceding instrument cOnsisting of this and two other pages was on the day and date hereof signed, published.and declared by ;HELMA K. KRAMER, as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. W'~'r'NESS ~ LAW OFFICES OF STEPI-IF~N J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 LAW OFFICES OF STEPHEN j. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 state 0~;'~Sylvania County of Cumberland I, THELMA K. KRAMER, the testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. THELMA K. KRAMER Sworn to or affirmed and acknowledged befo K. KRAMER, the testatrix, this ~ day of_ ~ re me by THELMA I Notarial Seal ~~~, 2001. J Stephen J. HoDD, Notary PublP_..~. I M ~Carli'le B°r°" Cumberland C°u~tl~°tar~ P'ubf~A"o~/~'J j~ ¥ L;ommission ~:xpire$ Septen'~ber 3, 2001J ...... ' .... State of Pennsylvania County of Cumberland ss yneo to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. . ~worn to or a~med and.s.~bscribed to before · this ~ day of C/'.,,~,,.~'./., .,rT/'~ .__ me by w~tnesses ^ · gg, Notary Public ~ uar/isle 8oro, Cumberland Cour~ty My Commission Expires Septerr~ber 3, ~ Ple~;~ote: Your Sale Proceeds Check is Attached BROKER'S Name, Address, ZIP Code. Federal Identification Number and Telephone Number: Mellon Investor Services 85 Challenger Road Rldgefield Park, NJ 07660 22-3367522 1-800-649-3593 Form 1099-B COPY B FOR RECIPIENT ' ' * IMPORTANT TAX INFORMATION* ' * This is important tax information and Is being furnished to the Ioternal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be Imposed on you if this lncome is taxable and the IRS determines that It has not been reported. TO WHOM PAID Walter E. Kramer 103 Hillside Circle Camphill, PA 17011-2525 Proceeds From Broker and Barter Exchang~ Transactions U.S. INFORMATION OMB NO. RETURN FOR 200: 1545-0715 ia Date of Sale lb CUSIP Number 01/08/2002 59156R10 Stocks. Bonds. etc. 3. Bartering $970.39 FEDERAL INCOME TM WITHHELD $0.00 REPORTED } i--I Grossproceed$1esscommlsslons TO IRS ~ Gross proceeds 5. Description Metlife, Inc. Investor ID 8065 3182 2747 Recipients Identification Number on File 195-32-4824 · IMPORTANT TAX RETURN DOCUMENT ATI'ACHED · Date Description Shares Sold Sale Price Gross Proceeds Tax Withheld Net Proceeds (S) (S) (S) ($) Balance ' Shares Sold 32.0000 30.3246000 970.39 0.00 Trust Interest Balance SFULL (8-01) YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. Retain this number for future reference: · Investor ID: 8065 3182 2747 For information concerning this statement, call MetLife, Inc.'s Transfer Agent, Mellon Investor Services toll free at 1-800-649-3593 PLEASE DETACH ALONG THE PERFORATION F O110 0000376 TOTAL' (Nso enter on line 2, Recapitulation) (ff more sPaCe, is ~, insert additional sheets of the same size). ~MONWEALTH OF PENNSYLVANLA INHERITANCE TAX RETURN ESTATE OF SCHEDULE B All property jointly-owned w~th right of survivorship must be disclosed on ~chedulo F. ITEU FILE NUMBER NUMBER DESCRIPTION VALUE AT DATE OF DEATH I~=V-l~e ~ * (1..97) (I) ~ SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ~TH OF PENNSYLVANIA INHERITN~,E TAX RETURN RESIOENT DECEDENT ESTATE OF Include Ihe proceeds of IhigaUon and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on SchM,,,~ F. ITEM NUMBER DESCRIPTION 1. VALUE AT DATE OF DEATH TOTAL (Nso enter re,lin6 5, R~:~,;;m,L~jn) (If i~,oi'e ,~ i~ F~' in~ert a~ilk~al shee~ of the same size) arity 50 Plus Account Statement PNC Bank PNCBAI For the period 0W15/2001 to 10/17/2001 THELNA KRAHER WALTER E KRAHER 17 SHARON RD ENOLA PA 17025-1824 Primary account number. 51-4011-4301 Page 1 of 2 Number of enclosures: 10 ~' For 24-hour customer service or current rates: Call 1-888-PNC-BANK ~ Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at www. pncbank, com ~TDD terminal: 1-800.531-1648 For hearing impaired clients ordy PNC Bank Begins 2-Sided Bank Statementa During the n~onths of November and December, you,Il notice a slight change to your PNC Bank account statement. We will begin printing statements on both sides of the page, using less paper. Just another reason why You're Better Offat PNC! Stay on Top of Your Finances Sign up today to receive information via e-mail about new products, services, and special offers through Account Link Fl/Is & Deals. Just log on to Account Link at pncbank.com, then select E-mail Address from the top navigation bar. ~Eriori[-]~ $0 Phle Thelma Kramer Interest Checking AcCount Summary Walter E Kramer Account number. 51-4011-4301 Account Link ® number. 0815138597 Balance e ...... Beginning balance 4,477.44 Deposits and Checks and other Ending other additions deductions balance 1,682.30 1,997.80 4,161.94 Average monthly Charges balance and fees 4/6oo.o] .00 Checks paid/ Bank card/POS Account Information Teller withdrawals transactions assistance calla transactions 1o. o o Total ATM PNC Bank MAC Other MAC ATM Other ATM transactions ATM transactions transactions transactions 0 0 0 0 Annual Percentage Number of days Average collected Interest Earned Yield Earned (APYE) in interest period balance for APYE this paflod 0.29Z 33 4,5g~.86 1.22 Please see the Activity Detail section for additional information. As of 10/17, a total of $7.80 in interest was eamed this year. 50 Plus Account Statement For 24-hour customer service: Call: 1-888-PNC-BANK Accotmt number: 51-4011-4301 - continued PNCBANK For ~® period O911~12OO1 to 1011712OO1 THELMA KRAMER Primary account number: 51-4011-4301 Page 2 of 2 Detail Deposits an~i Other Additions Date yAmount Description 09/17 g/ 270.60 Deposit Reference No. 023660837 lO/01 ~/1,/560.48 Direct Deposit- RR Ret / . US Treasury 303 WA203104555 1 10/16 V' /50.00 Branch Deposit Tel 0400010801 0114 10./17 .V1.22 Interest Payment ~,.~. -- _--_ -- There were 4 Deposits and Other Additions totaling $1,682.30. Check Date Reference number Amount paid number 3476 8.99 09/19 029874548 3477 5.92 09/19 029~1562 3478 25.00 ]0/0] 027075165 3479 70.13 09/21 022545419 3480 659.00 10/01 02~07570 Check number 3481 3483 * 3484 3485 3486 * Gap in check sequence · T" Teller Cashed Check Online and ElectTonie Banking Deductions Date ~k'~ount Oescdptlon 09/17 %//97.68 Direct Payment - Elec Bill Pp 4957072001Ws 0~/20 4 7~6.00 Direct Payment- PAC Pymts 54 Montour Oil Serv 300224030 09/26 .13 Direct Payment - Payments Verizon Phone Bi 717732040851919 lQ/05 4.00 Direct Pa)anent - Oct Dues Priority 50 Plus 019072100000 10/11 .80 Direct Payment - ACH Subcab Subtuban Cable 049390901 lQ/12 V'/24.67 Direct Pa)anent- Payment PAXVC 0669889 lQ/17 y 49.99 Direct Payment - Elcc Bill Pp 4957072001Ws T Date Reference Amount paid number 90.00 09/27 20.14 10/03 15.09 10/16 02276S7 I 3.26 10/17 024s615s0 7~.~ 10/12 0~s 7 There were 10 checks listed totaling $1,0ST.S3. There were 7 Online or Electronic Banking Deductions totaling $340.27. Date Balance Date Balance Date Balance Date Balance 09/15 4,477.44 09/21 4,489.32 10/03 5,001.53 10/16 4,213.97 09/17 4,650.36 09/26 4,435.19 10 05 _ 10/17 09/20 4,559.45 .... -10/01- ~W ~ ~,-179.06~ starting to Plan for retirement?. A fixed rate annuity may be the tax advantaged investment that meets }'our needs. Contact a PNC Brokerage Investment Consultant today and set up a free no obligation consultation to determine if a fixed annuity from PNC Insurance SerVices' Can help you achieve your financial goals. PNC Brokerage Investment Consultants can be reached through our Customer Service Center at 1-800-762-§111, its web-site at www.pncbrokerage.com or an)' PNC Bank branch office. . "' 7/ .... -:::_::::,: .... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER ESTATEO . _ ___,.~,.~'f~ ~/,~1// _ . . If an assst was made joint within one year of the decedent'$ date of death, it must be repoded on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Co JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank a~count number o~ similar ident~/ing number. Attach DATE OF DEKrH DECD'S VALUE OF NUMBER TENANT JOINT deed for ~nW-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTERES pRENEED couNSELOR SALES RECEIPT 624 ROLLING GF~EN CEMETERY cOMPANY 1811 CARLISLE RD ~ HILL. PA 17011 7t7-761-4055 No.0004748 FROM ~PurchaSer O~ ~.'P'~'~ . ~ ~~~ DOLLARS ~ RECEIVED ~ REGU~ PAYMENT THE ~ouNT OF. ~ ~: ~WN PAYME~ ~ pAYMENT IN FULL Vi~~R c~RGE CHECK c~H ~ MERCHANDts~AND SERVICES FROM THE ~VE NAMED GEM~ERY. FOR THE PURCH~E OF iNTERMENT RIGHTS AND/OR ~~ SAL RECEI~D BY CEM~ERY- NAME DA~ I~~ BY_ ~ ,.itvrca~ ctr 1/VLF 73~-~~ STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we aze required by law or by a cemetery or crematory to use. any ]terns, we will explain the reason in writing below. Ii you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalm- ingyou did not approve if you selected azrangements such as direct cremation or immediate burial. If we charged for embalming, we will explain why below. For the Service of I`~tr8• ~~'-lr~ ~• ~~~'r Date of Death 1nw/~n~al Walter Kratn~r Charge to: Name Address City State A. CHARGE ;FpR SERVICES SELECTED: 1. PROFESSIONAL SERVICES L~ Services of Funeral Director/Staff ... , E ~° ~ ~, ~j Embalming ...................... E~yl Other preparation of body Other clothing E Cremation urn ................... i (Description) OTHER .................. E ~ i ............. SUB-TOTAL OF PROFESSIONAL SERVICES :........ A l E "~ E 2 TOTAL MERCHANDISE SELECTED .............. . ... B E~_~• FACILITIES AND SERVICES Use of facilities and services for viewing (Visitation/Wake)......... E Use of facilities and services for funeral ceremony ............ E Use of facilities and services for Memorial Service ............... E Use of equipment and services for graveside service ............. E Other use of facilities .....................:....... E_~._ SUB-TOTAL OF FACILITIES/EQUIPMENT ........... A2 E 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home. r Local ........................... E Hearse (Casket Coach) ~ 5 ..,,1 Local ...........................E 1 • U v Limousine Local ........................... E Family car Local ...........................:.E , Flower car or floral disposition Local ...........................E L. Lead car/clergy car ~ Local ........................... E Car for pallbearers Loral ........................... E Out of town transportation ........ , E E E SUB-TOTAL OF AUTOMOTIVE EQUIPMENT...... , . TOTAL OF PROFESSIONAL SERVICES, C. SPECIAL CHARGES: Forwarding of remains to t " (Funeral Home) Receiving of remains from f (Funeral Home) Immediate Burial ................. i Direct Cremation ................ . E SUB-TOTAL OF SPECIAL CHARGES ............... . C E E ~ r. SUB-TOTAL OF ADVANCES ...... . ................ D E, ~Q~ D. CASH ADVANCED ~ Opening Grave ............ ~' ~ r ~, J~l•'il .. Cemetery Equipment .......... E Lot and Deed .................... E Newspaper Notices-Local ......... i Newspaper Notices-Out-of-town .... i Telephone & Telegrams ........... E Airfare ......................... E Clergy/Mass Offering ... . .......... E~ Pallbearers .... . ................. i Certified Copies of the..p ath !Z ~ 1 ~ ~ ~ O • rt^.~. Certificate , . 1?' ... .•.~ . i Police Escorf„~ 4U ~ ~ • :~` ~~ y Flowers ~ ~ f ' E /~. . . . .. .. . Vault Service Charge .............. i i ~~T.~ ~~""' E =,~~ d ~ ~ 4.t~ ~ C E A3 E .~~•~We charge you for our services in obtaining:. (specify casb advances that are marked-up) FACILITIES AND AUTOMOTIVE r ,~. EQUIPMENT ................................... A S ,.,~,~ B. CHARGE FOR MERC~IANDISE SELECTED: / ~ ~. Casket } h !~`:": ~•r! ............ E ~ tv 1 ~. ~~ (Description' ~a-'ti't'er--- Other Receptacle . ............... . E (Description) SUMMARY OF CHARGES A . Professional Services, Facilities and Equipment, and Automotive ~,., . r Equipment ........ . . . . . . ...... . . i ~ ~ 'd.,a . B. Merchandise ..................... E~• C. Special Charges ............ . ..... i D. Cash Advances ................... E ~~ ~ • ~ ~ ~'~i~ (,[j ~;:, TOTAL OF ALL SECTIONS ........................ E~- Jr~ v •o ~ Outer burial container . ~ PAID AT TIME OF OR PRI~~TO', ...-~-~+, ~ (~ .... (Description) /~++ti__ta:-t1Y-""" ARRANGEMENTS....... , ~^'~"~. ...... i ~~ BALANCE DUE .. , ... ............ . ......... i''11 . Acknowledgement cards ~ REASON FOR EMBALMING ~ (~ ~~ ~ ~ !- 7~ G ........E Register book(s) .................. E ~ ,„ Memory folders ......:. . . . .... . .. E /'~ C.~ If any law, cemetery, or ry teq is ave req d the pu'tchase Prayer cards ......... . .. . .. . ..... E ~""""• of any of the items listed above the la r i e t lained be w. Temporary grave marker ....... E '^"'" Burial clothing~,:2>.L.~x . *~ • • ~ i v,<<, . [agree that I have examined the items of goods and services se erred above and found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for payment of the cash price for the goods and services selected. I ;;Iso agree to make payment of E within days. I agree to be jointly and severally liable with anyone else who >igns below. A late charge of per month amounting to per year will be applied to the unpaid balance beginning days `rom the date of this agreement. I will also pay to the Funeral l,~irector all reasonable costs paid by the Funeral Director to collect amounts 1 owe under this agreement. those costs may include attorneys' fees, rout[ costs and other costs:' Any additional services or merchandise ordered or requested after the date of this agreement will >e considered part of this agreem %and eaost thereof will be reflected on the final bill or statement. Seal) s...z .,~ _ _.=~ .<.r1~'~-' ~ /f~ ~ yt .. .. ~ >{ (Purchaser) • (Da ) Seal) (Purchaser) '(Licensed a Director) Pennsylvania Funeral Direr[ors Assoclatlon WHITE Funeral D e r YELLOW Funeral Director PINK Customer °orm - 600 Revised 494 ., COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE 0.~,~ Debts of ~ent mu~ be repo~ on ~h~ule I. FILE NUMBER ITEM NUMBER 5. 6. 7. DESCRIPTION AMOUNT FUNERAL EXPENSES: Street Address C~y State Year(s) Commission Paid: Attorney Fees Farray ExemplJo~: (if decedents address is not the same as daimant's, attach explanation) Claimant Z~ Sl~eet Address C~y RelalJonship of Claimant t~ Decedent Probate Fees Accountant's Fees Tax Retum Preparers Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of lhe same size) REV-1513 EX+ (g-D0) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY De Not List Trustee(e) OF ESTATE ! 1. !1 1. TAXABLE DISTRIBUTIONS [include ou~ghl spousal distributions, and transfers under Sec. 9116 (a) (1.2)] [.:. ,,'l l~ ~ L L . 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) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS $ REV-IS12 EX * (1-97) ~j~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Include unreimbursed medical expenses. FILE NUMBER ITEM NUMBER DESCRIPTION 1. TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT )/,¢1 _35, BUREAU OF TNDIVTDUAL TAXES TNHERTTANCE TAX DTVTSTOH DEPT. 280601 HARRTSDUR% PA 17128-0601 '02 t~PR 29 WALTER E KRAMER 105 HILLSIDE CIR. CAMP HILL L,;iP'A 1701! COMHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF /NHERZTANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX :2t DATE Oq-ZZ-ZOOZ ESTATE OF KRAMER DATE OF DEATH 10-10-2001 FILE NUHBER 21 02-02q$ COUNTY CUMBERLAND ACN 101 I Aeoun~ Remitted RE¥-1547 EX AFP (01-02} THELMA K HAKE CHECK PAYABLE AND RENZT PAYMENT TO; REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS L/NE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOT/CE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KRAMER THELHA K FILE NO. 21 02-02~$ ACN 101 DATE 0~-22-2002 TAX RETURN NAS: { X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate {Schedule A) {1) 2. Stocks end Bonds (Schedule B) (2) $. Closely Held S~ocklPar~narship In~erast (Schedule C} ($) Q. Mortgages/No,es Receivable (Schedule D) $. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Dabts/Hortgaga Liabilities/Liens (Schedule l) (10) 11. Total Deductions 12. Ne~ Value of Tax Return 970.39 276.10 .00 NOTE: To insure proper credit to your account, .00 submi~ ~he upper portion .00 of thLs form with your tax peyaent. Z/~81.87 .00 5,697.80 218.55 (8) ~,728.$6 15. NOTE: ASSESSMENT OF TAX: 15. Amoun~ of Line lq at Spousal rate 16. Amount of Line lq taxable et Lineal/Class A rata 17. Amoun~ of L/ne lq et Sibling rate 18. Aeount of Line lq ~axabla at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYHeNT ReCeZP1 D~SCOUNT (+J DATE NUMBER ZNTEREST/PEN PA~D (-) (11) 5 .gl&. 33 (12) 2,187.97- Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Net Value of Estate Subject to Tax If an assessment ~as issued previously, lines 14, 15 and/er 16, 17, reflect f/gures that include the total of ALL returns assessed to date. .00 2,187.97- IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. 18 and 19 will (is) .00 x O0 = .00 (16) .00 x Oq5= .00 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= . O0 AMOUNT PAID TOTAL TAX CREDZT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REBUZRED. TOTAL DUE 1S REFLECTED AS A 'CRED/T' (CR), YOU MAY BE DUE REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)