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HomeMy WebLinkAbout11-20-09 (2)15056051058 R~.~~~ ~~~ EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~- ~ C~ It Code Year 9 Flle Number INHERITANCE TAX RETURN y Po Box 28oso1 0 914 Harrisburg, PA 17128-0601 °~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 17 6 - 3 4 - 9 0 81 September 28, 2009 ';July 20, 1945 Decedent's Last Name Suffix Decedent's First Name MI Sauve Stephen c (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW +• : 1. Original Return 4. Limited Estate • ? 6. Decedent Died Testate ~;,""'~* (Attach Copy of Will) 9. Litigation Proceeds Received ' Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return a~ 3. Remainder Return (date of death prior to 12-13-82) 4a. Future Interest Compromise (date of ,,_ H 5. Federal Estate Tax Return Required death after 12-12-82) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 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 Andrew C. Sheely, Esquire '717-697-7050 Firm Name (If Applicable) _ r~., _ REGISTER O~VILLS USE O Andrew C. Sheely, Attorney at Law `->•c~ ~~ ~, , First line of address -" C ~ _ ,' - -. ' 127 South Market Street 4 ' ' ~' ~' c.~ Second line of address , ;,' ~~ c P.O. Box 95 '-, - ~f, , ... _ .... Dn~~ ~Ii.ED _.., •- City or Post Office ZIP Code ! State _~- Mechanicsburg ?PA ,17055 ', Correspondents a-mail address: andrewc.sheely@verizon.net UndE:r pe allies of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it~ rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. PERSON RESPONSIBLE FOR FILING RETURN - - _- pnrlRFS ~lllr~~J Erik D. Sauve, Ex., 210 Fox Drive, Mechanicsburg, PA 17050 SIGN E OF PREPARER O T EPRESENTATIVE ~QT pnr Fcc ©'t Andrew C. Sheely, Esquire, 1 outh Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: SaUVe ~ Stephen C . _. d . _ __ ~ 176-34-9081 . ~~ ..~.~...e_ .~.» 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. '1. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. `.i. Cash, Bank De osits & Miscellaneous Personal Pro ert Schedule E p P Y( )...... .. 5.+ 78,079.45 (i. Jointly Owned Property (Schedule F) ":.`":.,°r Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~„~a Separate Billing Requested...... .. 7. 104,858.48 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. " 182,937.93 !a. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 16,711.45 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10, 1,943.87 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. ' 18,655.32 1 2. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ' 164,282.61 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ' 164,282.61 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 1!i. Amount of Line 14 taxable at the spousal tax rate, or transfers unc~o~ cec. 9116 (a)(1.2) X .0 15. 16. Amount of Line 14 '°~~ble at lineal rate X .045 ' 164,282.61 16 ' 7,392.71 1 ?. Amount of Line 14 taxable at sibling rate X .12 17. 1l3. Amount of Line 14 taxable at collateral rate X .15 18, 19. TAX DUE ....................................................... ..19. '! 7,392.71 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 FttV-1500 tX Page 3 File Number Decedent's Complete Address: ~ 21 09 0914 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Stephen C. Sauve 176-34-9081 STREET ADDRESS The Bridges at Bent Creek 2100 Bent Creek CITY STATE ~ ZIP Mechanicsburg ~PA ~ 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 7,392.71 2. Credits/Payments - A. Spousal Poverty Credit B. Prior Payments 7,023.10 C. Discount 369.62 - Total Credits (A + B + C) (2) 7, 392.72 3. Interest/Penalty if applicable - D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. - Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter thE; interest on the tax due. (5A) B. Enter thE; total of Line 5 + 5A. This is the BALANCE DUE. (5g) 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 :...................................... ...... ^ ^X c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 0 2. If death occurred after December 12, 1952, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................ ...................... ...... 0 ^ 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)j. 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 (O) percent [72 P.S. §911Ei (a) (1.1) (ii)]. The statute does not exemot 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 isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1.5(?8 E;{+ (6-98) scN~ou~~ E COMNtONWEAI_TH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INIiERfTANCE TAX R!=TURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Stephen C. Sauve", also known as Stephen Sauve" 21-09-0914 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly iointiy-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUt A I UA I t NUMBER DESCRIPTION OF DEATH 1. Decedent's 1989 Baker Trailer, title #424957$5102 SA ~ 1 QO.OC 2. Three {3) American Express Travelers cheques - $50.00 each $150.OC 3. Metro Bank-checking account#0513305128 $51,988.6? 4. Van Guard Money Market Fund -account#9948926975 $25,840.82 tOTAL (Also enter on line 5, Recapitulation) $ ~ 78,079.45 (If more space is needed, insert additionaV sheets of the same stze) ~~ prv ~ ~i ~ i t i r R~ ~ a l 'S^WAO ~~ t i ~ 1 f jl ~ ,~" ~~ Iz ~+r .;'re t{}~ a o~ r a op u rPd L ~ ~ Pr l~ i t f G I ' w S I" ~i~ ; I w I°....~ IwP d .~ ''~• ~' . , ~ I a B~ w ~ ~ ~ ~ ! ' t a~ r.~ ' .'r ~°s ,. ~'a~E ~, ~P d~YSe~~ S y: ~F~7~ t .~ r f~l?'-. ~ IIL~~ rr~ S f~io9~ PSi?~.~~u~'~~1. ^~i ' ~ f P S ~ i • ' t ~~ 4'g~ I tl ii'}Y7~~`s~° n~ / `~ ~Y L P f 10 .i ~!y ,{~W~ ~ 6 R t t P Si P~ r i 1 !, ~ P' {>.~ 3P ~ ~ P r~ IS p T p~~ {G7 i ~ ~'.~ {~~ 7 1 ~ P 'S I y~ ~ ~pb1 7~ "'; ~Rt::~•117. 5?~ t ~ ~ ,~ ~~ . ~',IP ^ t , ~ +a'P{~I ; ~ ,,1 ~1 P~ ~h11P^,:, ~!I p~ ~ ~d"6 {r I P I~a~.~, tP tP fa s ~ Ial B I ao ~ .,. ~ s :; i»: r?k'i'~ k~,~ ~~ E~4 rt~~ Is~au'~ , l -; u~~~A~~jt~~d~l~' ~,; r3un7 ~ ' ~„~s.>'~u, ~ ~ i~~ 9 5 Yet( \h 4 ~ ~u - ht}~vi 'ray tr I {~ ~ c ~ ~ ~ e - .. 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V~unguard® STEPHEN C SAUVE 210 FOX: DR MECHANICSBURG PA 17050-2515 accou N~ vnw E Voyager Services Tele-Account 30 9948926475 On 12/31 /2008__ On 9130!2009 $ 25,712.12 $ 26,840.82 Trade dace Transaction - Dollar amount - -Share rice ___ Shares transacted Total shares owned Satance on 12/31 /2008 ~ $1".00 - ~_ ~ 25,712.120 1 /30 Income dividend $ 40.97 1.00 40.970 25,753.090 2/27 Income dividend 25.66 1.00 25.660 25,778.750 3/31 !ncome dividend 18.02 1.00 18,020 25,796.770 4/30 Income dividend 12.41 1.00 f 2.4i 0 25,809.1 BO 5/29 Income dividend 9.95 1.00 9.950 25,819.130 6/30 !ncome dividend 7.31 1.00 7.310 25,826.440 7/31 Income dividend 5.27 f .00 5.270 25,83f .710 8/31 Income dividend 4.57 1.00 4.570 25,836.280 9/30 Income dividend 4.54 1.00 4.540 25,840.820 Balance on 9/30/2009 $1.00 25,840.820 income dividends September 30, 2009, year-to-date Page 1 of l Vanguard Prime 1Vloney Market Fund 800-284-7245 - ~„ wwu+.vanguard.com .__ 1 (800) 662-6273 - -""`-" N Fund number: -~= Account number: $ 128.70 As you requested, a copy of this statement has been sent to: CHURCH CAPITAi. MANAGEMENT 301 OXFORD VALLEY RD STE 801 B YARDLEY PA 19067-77f 4 Fund /Account no. VANGUARD AR1ME MONEY MARKET FUND 0030 / 09945926975 "Do not alter this invest-By-Mail slip. Stephen C. Sauve "Vlsii wNm,vanguard,com or call to change your address. List each check $ ~ _~ ~ r~ ~~lll t~!II f ~L~-f L~~.~I (~~~ • ?_~ (I~~I separately• $ ~_; ~ I___ J ~__I ~__J ~ hJ I~J ~- • ~J L._~ Total amount $ ~ ~ ~ - ~ ~_~ ~ ~ ~~ ~ ~ , ~ i_ DD301 X99419926975 307 3D Make checks payable to:.he Vanguard Graup - 0030 VANGUARA VOYAGER SERVICE PO BOX 13750 PHTLAOELPHIA PA 19101-9897 IIIIIIIIIII/1iIIII1Al IIAIII !III Il1I1I1I11IIIIIIIIIII 000000548079069 2 1_ 1 032742 ?712 316C M1 4~ IIIIIIIIll11111IIIIIlIIIIlllllllllll! I illllll IIII11111IllIIIauIIlli RFV-1510 EiX+ (6-98} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT bECEDENT SCHEDULE G INTER-VtVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Stephen C. Sauve", also known as Stephen Sauve FILE NUMBER 21-09-0914 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 COlER SHEET s yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCL~CE TH£ NAME OF THE TRANSFEREE, THEIR RELATlCNSHIP TO OECEDENTANC rHEDATEOF'RANSPER,AI'TACHACOPYOFTHEDEECP°RREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION pFAPPL~GABLE) TAXABLE VALUE t. ~'an Guard IRA#09930250523 18,501.60 100% $t8,501 E 2. Fidelity IRA -account #579-374377 66,356.88 100% I ~ 586,356.E TOTAL {Also enter on line 7 Recapitulation) $ 104,858.4E3 (If more space is needed, insert additional sheets of the same sizeV .,~ ?'~ ~o -n -n ?i ~ ~, Qv c~~;O ~ ~_ ~ ~ a~~~t~ ~ Q ~ ~ ~ mo ago ~ ~~o °-' , r'~r~~ a; ccro'~~~ ~ m zp~ _ ~ h n' o' ~ ~I ~ ~ a+ ~' `~ ~ `~ Z ~ ~ _ ~ p i N ~ ~ , ~ ~ _ ~ ~ Q~ ~ y / ~ j~, w Y~ ~ , ~ ~ (~ a. 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(.' is ~' ~aun,~-r~`~ VANGUAR;CI FIDUCIARY 7R CO CUS7 403(B)7 A1C Sl'EPtiFN C 5AUVE zlo s4ax DR MECHANICSBUR6 PA 17050--2515 T O'7'/k L O t= A L r,.. p C: ~ t~ U rYl "H ~ RET~RE:MEIVT PLAtriS S'1~AR Furrd (403(b}('7)) -- 500 ludcx Fund lnv (403(b)(7) ) Total re~lirernent plans----_ ~~--~ 09930250523 VGSTX 09930250523 VFINX Value cn 12131 /?J08 ~lakie on 9(3012004 15,450.16 $ 18,501.60 Value on 12/31 /2008 Value on 9/30/2009 -----__ $ 6,033.82 $ 7,268.15 9,416.34 1'I ,233.45 $ 15,450.16 ~ 16,501.60 403(bX7) income year-to-date $ 239.62 Portfolio allocation Short-terra investments 4.7% _ ____ _ ___ 2009 contributions io 403(bX7) __ _ _ $ O.OU Bands 9.8 2UU9 employer conlributions to 0.00 Stocks 85.5 403('bX7) 100.0% 2008 contributions l0 403(b}(7) 0.00 2008 errrployer contributions to 0.00 403(bX7) 2009 distributions from 403(bK7) 0.00 C3ET C>UT C9 F' LINE-LINK 'Y'OU12 E3ANK Tt7 VANC3UAlFtb Sign up for our electronic bank transfer service and invest or withdraw money anytime-without stamps, paper, or waiting in Nne. You'll move money securely through Vanguard.corn and rvcoive coryfirrnationsfnr all of your transactions. y'ou won't 41ave !o worry about chocks getting delayed in the mail, and your transactions will be completed within two business days. Signing up far electronic bank transfer is easy. Visit www.vanguard.com/easyfink today. IIYIIIIngVBVIBl~IIIII~IV 1k'IEIIVIp~IIIWIVd ,, 5epternber 30, 2009, ye~~r-to-date Yaffe 1 of 800- 662-2739 - ------ www.vanguard,carn _ o (800) 6b2-6273 - A 1~rruYiw~aao Account number Ticker Clir~rrt 5ervicPs `l'ele-Accaernt REV-1511 EX+ {f 2-99) SCNEDt~ILE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINI5TRATII/E COSTS RESIDENT DECEDENT ESTATE: OF FILE NUMBER StephE~n C. Sauve", also known as Stephen Sauve" 21-09-0914 Debts of decedent must be reported on Schedule 1. fTEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Myers Funeral Home, Inc. 510,235.00 2. St. Johns Lutheran Church -family meal and rental of church facilities $1, 000.00 s. Rolling Green Cemetary -burial marker $3.330.00 g. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions $0.00 Name of Personal Represeniative(s} Erik D. 5auve" Social Security Number(s)lEIN Number of Personal Representative(s) _J ___, _ Street Address 210 FOX Drive cicy Mechanicsburg _ state F'A .zip 17050 Year(s) Commission Paid: 2. Attorney Fees Andrew C . Shee 1 51,250.OU y, Esquire 3, Family Exemption; (1f decedent's address is not the same as claimant's, attach explanation) Clamant Street Address City .state _Zip Relationship of Claimant io Decedent $260.OC q. Probate Fees g, Accountan?'s Fees 6, lax Re?urn Preparer's Fees ~, Postage $21.4! $15.01 e. Filing Fee 9. Reserves to conclude Estate administration ~600.0~ 16,711.4 TOTAL (Also enter on line 9, Recapitulation) $ flf more space is needed, insert additional sheets of the same size) Myers Funeral Horne, Inc. °' Boyd L. Myers Jr ,Supervisor 37 East Main Street Mechanicshurp. Pennsylvania 17055 (7'171 766-3421 Fax 1717; 795-?291 STATEMENT OF FUNERAL, GOODS AND SERVICES SELECTEll (:barges are onhi for those items that you selected or that are required. If we are required by law or by a cemetery a• crematory to use any items, we will explain in writing bc;low. ff you selected a funeral that may require embalming, such as a funeral with viewing, you !nay have to pay for embalming. You do not !.ave w pay for embalming you did not approve if you selected an•angements such as direct cremation or immediate burial Ii' we charge you for an embalming, we will explain wh v below. For Services of _ Stephen C. SauVe Charge to Eril: D. Sauve -Name A. CFIARGE FOR SERVICES SELECTED: 1. PROFESSIONAL SERVICES Services of Funeral Director and Staff Embalming _ _ - Casketing, dressing, cosmetolog _ ___ $ Other Preparation oP body $ _ _ --$ _ $ SUB=fO'I'A1. PROFESSIONAL SERVICES 2. USE OF FACILITIES AND SERVICES For visitation /wake service ___ $ Fvr funeral ceremony $ For memorial service $ __ Equipment cti services for graveside service S 395 00 _ _._ _.. S SUB-TOTAL FACILITIES AND EQUIPIVIENT 3. AUTON10T1VE EQGIPNIENT Vehicle to transfer remains to Funeral 1-lome_- $ _ __350.00 Hearse (Casket Coach) $ 325.00 Flower Car! Floral Distribution $ Inci Family Car $ Lead Ceu• /Clergy C _3r _- --_-__- ._._ -_-- 5 195.00 Utility Car $ Out of town transportation $ SUB-TOTAL AIJ'fUMOTiVI; EQUIPMENT A3 $ 870.00 '1'O'1'AL SERVICES, FACILITIES, AUTOMOBILE A S 5,925.U0 B. CHARGES FOR iylEItCF1ANDISE SELECTED Casket Classic $ 2625.00 Other Receptacle _ _ $ Outer Burial Container Eagle Sentinel $ 1~9~.00 Acknowledgment Cards ________ _ $ Register Book - -- - $ 95.00 -- Memorial Folders $ Prayer Cards $ Temporary Grave Markers $ Burial Clothing $ Other Clothing $ Cremation urn $ $ ----- 'fOTAL ML:RCHANDISE SELECTED B $ 3,815.00 --------arty -- _.Jli~[e - --_.. - -... -. -.. _. _._. _ Zip C. SPECIAL CHARGES Forwarding Remains to other Funeral )-Iome $ _ _ Receiving Remains form other FuneraE Homy . ._ $ _ . Immediate Burial _ $ - _ Direct Cremation - $ -_ -- -. SUB-TOTAL OF SI'EC1AL CIIAI2GLS C D. CASH ADVANCED -__.- Opening Grave/Crypt Rolling Green Memorial S 1 395.00 Newspaper S . 300.00 1~ewspaper ____ __ _---. $ 200.00 Clergy /Mass Offering Reverend Michael i . - $ ___ 125.00 Certified Copies of Death Certificate 1~ ~ ~, 90.00 Family Flowers Flowers Ordered S 25.00 Organist --- - - '~ 125.00 2nd Pastor.---, -- _-- $ 75.00 _.__- $ SUB=TOTAL OF CASH ADVANCED St llue Bttte CHIC S 2,335.00 1Ne charge you for our services in obtaining the follo~sing~ NONE SUMMARY OF L ~-IARGES TOTAL ABOVE ITL1ViS (A,B.C.D) S 12,075.00 Sales Tax (if App) @ 0 _ % _ _ 5 __.__-__-_-- 'COTAL OFALL SECTIONS $ _1.2,_0.7.5_.__0_0_ LESS: Payment Made $ LESS: Credits Pending 5 __.____.__--- -___.r___- ._ _-___.__._-_- (LESS: Other Credits/Payments Package Price Discount $ 1,630.00 ~ BALANCE DUE Jan 30, 0001 $ 10,~3~15.00 A late charge of 1.5% per month on the outstandi~ .g balance (annual rate of 18°iul will be added to the balance. rzuean>vsntiur.ntmrrnc~nv-~FCnz~ ct:,rzr~unnrn>ICe _ - - DISCLAIMEF2 OF WARRANTIES Our funeral home makes no representations or warranties regarding caskets or outer burial containers- The only warranties, expressed or implied, granted in connection with goods sold with the funeral service are the express written warranties, if any, extended by the manufactt.rer thereof. No other warranties including the implied warranties of merchantability or fitness for particular purpose are extended by the seller. requested. I acknowledge receipt of a copy of this Statement of Funera! Goods and Services Selected. I represent that {have sufficient funds available for payment of th!a cash price for the goods and services selected. I also agree to make payment of $ 10445.00 within 30 days. I agree to be jointly and severally liable with anyone else who signs below. A LA'(E CHARGE of 1.5% per month {18% per annum) wi~pTed to the unpaid balance beginning 30 days after the date of th+s contract. I will also pay the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorney fees and court costs. Any items requested after the date of this a reement will be considered part of this agreement and will be reflected on the final bit{. I acknowledge that a Casket Price List and a Outer Burial Container Price List were made available tp me and that a copy of the General Price List was given to me prior o my making financial arrangements. ~ (Sea]) ~ _~ ~ ~ ~ C/~~' Purchaser •~/~/ ~ (. act rj~i/~-/'' •• 1 ~ 1.....-•' (Seal) ~-ir~~ ~- , .- ..1[µm--_ ... _- -. .. _-_.-.____._._- __ _-._. _. _...--_-_ _-.._- _- - -__- Purchaser Boyd L. Myee's, Jr. icense u era! Di ecior '` $ 2095.00 -----995.00 ------~~s nn Date Of Death September 28, 2009 Date of Contract Al $ 3,~E85.00 575.00 600. UO A2 $ 1,570.00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 9/29/2009 Cum~~erland County - Register Of Wills Receipt Time: 15:23:45 One Courthouse Sgqware Receipt No.: 1058437 Carlisle, PA 17ff13 SALVE STEPHEN C Estate File No. 2009-00914 Paid. By Remarks: CJUVE ERIK ------------------------ Receipt Distrib ution ------ -------- ------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 210.00 CUMBERLAND COUN~.'Y GENERAL FUN WILL, 15.00 CUMBERLAND COUN'T'Y GENERAL FUN SHORT CERTIFICATE 20.00 CUMBERLAND COUN"'Y GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 -------- - - CUMBERLAND COUN'_'Y GENERAL FUN Check# 3183 ---- - - $260.00 Total Received......... $260.00 REV•1512 E:X+ i12-03j SCNEDVLE 1 COMMONWEALTH OF PcyNSYLVAN~A DEBTS OF DECEDENT, i>uHERITaNCE rAx REruRN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTOTF ~F FII F NIIMRFR Stephen C, Sauve", also known as Stephen Sauve" 21-09-0914 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, includfrrg unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Rosa Lucidon, Personal Care Assistant X1,435.00 2. Bridges at Bent Creek -final bill $21.63 3. Alert Pharmacy Services, Inc, B487_24 TOTAL {Also enter on line 10, Recapitulation? ~~ 1,943.87 (If more space is needed, insert additional sheets of the same sizel REV-1513 EX+ `9-00) COGIMONWEALTN OF PENNSYLVANIA ~NHERII'ANGE TAX REi'URN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE CIF FILE NUMBER Stephen C. Sauve" 21-09-0914 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS linclude ou',right spousal distributions, and transfers under Sec. 9116 {a} {1.2)] 1. Erik D. Sauve" Son 100% rest, residue & rpmainclpr ~I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV"-1560 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTION5 ONLINE 13 OF REV-15U0 COVER SHEET I $ Of more soace is needed. insert additional sheets of the same sizel LAST WILL AND TESTAMENT OF STEPHEN C. SAUVE I, STEPHEN C. SAUVE, of 6026 William Drive Mechanicsburg, (Hampden Township), Cumberland County, Pennsylvania, make, publish and declare this as and for tn~r Last Will and Testament, hereby revolting all other Wills and Codicils heretofore made by me. FIRST: I direct that all inheritance, estate, transfer, succession and death taxes, as v~~ell as nay just debts and funeral expenses, of anv kind whatsoever, ~~,~hich tray be payable by reason of my death, sha11 be paid out of the principal of my estate as the same can conveniently be done. SECOND: I give, devise and bequeath all the rest, residue and rei~~ainder of my estate of whatever nature and wherever situate, including anv property over which I hold power of appointment and together with anv insurance policies thereon, unto my son, ERIK D. SAUVE, of Mechanicsburg, Pet~.nsylvania, pro~rided he survives me by thirty (30) days. THIRD: Should ERIK IJ. SAUVE predecease tzif~ or die on or before the thirty-first (31st) day follo~ti~ing my death, I give, devise and bequeath all the rest, residue and remainder of my estate of w~tatever natur+ and wherever situate, including any property over which 111o1d power of _~ appointment and together with any insurance policies thereon_ as follo~~,rs: {a} Thirty-three and one-third percent (33 1/3 %) thereof unto 111V gra11dS011, ALEX M. SAUVE, of Mechanicsburg, Pennsylvania; and (b) Thirty-three and one-third percent {33 1/3 %) thereof uzlto my grandson, DERII~ S. SAUVE, of Mechanicsburg, Pennsylv~~nia; and (c) Thirty-three and one-third percent {33 1/3 %) thereof unto my grandson, CORY J. SAUVE, of Mechanicsburg, Pennsylvania. FOURTH: Should zny grandchild or grandchildren not have attained the age of twenty-two (22) years at the time for distribution to 11311, I give, devise and bequeath the share of each such grandchild to my hereinafter named Trustee, IN SEPARATE TRUSTS, to hold, manage, invest and reinvest the shares so received, and to use and apply from time to tulle such portion of income and principal for the said grandchild's education (including college, trade school or other similar training or education}, support and welfare as my Trustee, in her sole disc~~etiorl, deems advisable. My Trustee nlav inalce the payments for the .>upport and maintenance of my grandchild directly to said grandchild or to :such grandchild's Guardian, as required. Any payments made by my Trustee pursuant hereto shall be made without further responsibility to the said grandchild or to any person taking care of said grandchild. Thf~ Trustee, in exercising her discretionary authority with respect to the payment of income or principal of the within Trust to n1y grandchild, shall take izlto consideration any income or other resources available to zny gr~uldchild from sources outside this Trust. In addition, zny hereinafter r1«nled ~, Trustee shall have the right, in her sole discretion, to purchase and pay for 2 out of the principal, as well as iz-zcozne, such insurance policies as will provide for tYie minor's medical care. Any income or principal not so applied sha11 be distributed to each grandchild when he attains the age of twenty-two (22) years. FIFTH: In addition to all powers grazlted to them by law and by other provisions of this Will, 1 give the fiduciaries acting hereunder the follo~nring powers, applicable to all property, exercisable witholrt court. approval and effective until actcial distribution of all property: (A) To sell at public or private sale, or to lease, for anv period of tune, anv real or personal property and to give options for 4ales, ex- changes or leases, for such prices and upon such terms (including credit., with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, iniproveznent, zozung or management of real estate and to impose or extinguish restric- tions on real estate. (C) To compromise any claim or controversy and to abandon anv property which is of little or zoo value. (D) To invest in all forms of property, including sY ocks, common trust funds and mortgage investment funds, without ~~estriction im~est~nents authorized for Pennsylvania fiduciaries, as are deemed proper 3 without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by ~_he Federal axtd other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G~) To make distributions to my herein named beneficiaries in cash or in kind or partly in each. (H) To borrow money from themselves or others i.n order to pay debts, taxes, or estate or trust. administration expenses, to protect ox improve any property held under my will, and for investment }purposes. (I) To select a mode of payment under any qualified retire- ntent plan (pension plan, profit sharing plan, eYnployee stock ownership plan, or any other type of qualified plan) to the extent provided for by the plan or the law. SIXTH: I nominate and appoint my daughter-in-law, MICHELE R. SAWS, of Mechanicsburg, Pennsylvania, as Trustee, of arty trust created for the benefit of the issue of ERIK D. SAU~'E. I direct that iriv Trustee named herein shall serve without bond and slkall receive fair and reasonable compensation. SEVENTH: I nominate and appoint my daughter-in-law, STEPHANIE J. SAUVE, of Mechanicsburg, Pennsylvania, as Trustee, of anv trust created for the benefit of CORY SAUVE. I direct that Inv 4 Trustee named herein shall serve without bond and shall receive fair and reasonable compensation. EIGHTH: I nominate and appoint ERIK D. SAUVE, Executor, of this, Inv Last Will. and Testament. I direct that my Executor or his successor, shall not be required to post security or a bond i~or the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to J this, my Last Will and Testament, this ,~ day of March, 2~~07. ~~'" ~ ~ .~~ (SEAL) STEPHEN C. SAUVE Signed, sealed, published and declared by the above-Wanted Testator as and for his Last Will and Testament in our presence, v~rlio, ~~t his request, in his presence and in the presence of each other, have heretinro subscribed our names as attesting witnesses. ~ ,~ - ~ y Address ~ 7~~5~, Name lr ~ ~ /~i'/ ~- err ",L~d /f,~~~~<! ~~ / t _% ~G6` Ct.y , ~' ti ,_,~`" i ~ ~' ~~ , ~---- - - -_ _ ~i . . Adc--lYeSS f %'~ i f~.-~ ~- ' Na Elie _ _~ ~- 5