The URL can be used to link to this page

Home My WebLink About12-31-09--~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year file Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2sosol 21 0 9 0 3 6 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204281006 03272009 05231937 Decedent's Last Name Suffix Decedent's First Name MI HAVERSTOCK PAUL R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82j ^ 5. Federal Estate Tax Return Required ® g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust ~ 8. Total Number of Safe De osit Boxes (Attach Copy of Will) (Attach Copy of Trust) p ^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) ^ (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SCOTT M. DINNER ESQ. 7177615800 Firm Name (If Applicable) LAW OFFICE OF SCOTT M. DINNER First line of address 3117 CHESTNUT STREET Second line of address City or Post Office CAMP HILL State ZIP Code PA 17011 T REGISTE~F WILLS l.ly ONLY - _7 -~w~ ,...~ ~ ~' t7 ~' ao k r-~ : ~ ~ 'f f`~ t -'~: 1(-1 '17 -' - D4T ~ ILED t : t, ~,. -~ .~ i t Correspondent's e-mail address: d i n n e r@ I O C a I n e t. C O m Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF~RS N RESPONSIBLE F R FILINt? ETURN DATE ~I.I~,rli( ~ ~~ David Scott Haverstock ~ a I~ 3 /~' 9 26201. Rosegarden Blvd., Mechanicsburg, PA 17055 SIGNAT E OF PRE9ARERiOTHER T At•~l\EPRESENTATY/E Scott M. Dinner Esq. DATE 2 2 2009 3117 Chestnut Street, Camp Hill, PA 17011 Side 1 1505607120 1505607120 ~ ` 1505607220 REV-1500 EX Decedent's Social Security Number oeoeae~,~sName: HAVERSTOCK, PAUL RICHARD 2 0 4 2 810 0 6 RECAPITULATION 1. Real Estate (Schedule A) ......................................................................................... . 1. 2. Stocks and Bonds (Schedule B) .............................................................................. . 2. 6, 4 7 9. 6 4 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... . 3. 4. Mortgages 8 Notes Receivable (Schedule D) ......................................................... . 4. 5• Cash, Bank De osits & Miscellaneous Personal Pro e p p rty (Schedule E) ................ 5. 3 5 , 9 9 8 . 2 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 1 6 , 0 0 0 . 0 0 8. Total Gross Assets (total Lines 1-7) ...................................................................... . 8. 5 8, 4 7 7. 9 1 9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 5 , 4 3 5 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 3 1 , 3 9 9 . 8 7 11. Total Deductions (total Lines 9 & 10) ..................................................................... . 11. 3 6 , 8 3 4 . 8 7 12. Net Value of Estate (Line 8 minus Line 11) ............................................................ . 12. 2 1 , 6 4 3 0 4 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. 2 1 , 6 4 3 . 0 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 21 , 6 4 3. 0 4 16. 9 7 3. 9 4 17. Amount of Line 14 taxable at sibling rate X ,12 17~ 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................................................................................................................... . 19. 9 7 3. 9 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15D5607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21 - 09 - 0367 DECEDENT' NAME Haverstock, Paul Richard STREET ADDRESS - -- 2620 North Rosegarden Boulevard CITY Mechanicsburg STATE PA ZIP ----------- 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 973.94 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable - --- ----- D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request arefund - --- 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 973.94 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 9 7 3.9 4 Make Check Payable to: REGISTER OF WILLS, AGENT r _. ._ .~.~ _ .. 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? .............................................................. [_] x0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... ~] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ^ ~~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Haverstock, Paul Richard 21 - 09 - 0367 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION _ UNIT VALUE VALUE AT DATE OF DEATH 1 12 trust shs. MetLife, Inc. 24.77 297.24 cusip # 001 928 59156R10 2 512 trust shs. Manulife Financial Corporation 12.07 6,182.40 I I cusip # 001 750 56501 R10 TOTAL (Also enter on line 2, Recapitulation) 6,479.64 SCHEDULE E CASH, BANK DEPOSfTS, & MISC. COMMONWEALTH OF PENNSYLVAN4A PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HBVt?rStOCI(, PaUI RlChard FILE NUMBER 21 - 09 - 0367 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 2003 Jeep Wrangler Sahara [VIN: 1J4FA59S13P322676] -average of estimated trade-in values 13,100.00 per NADA/Kelly Blue Book pricing 2 BELCO Community Credit Union savings account (see attached Statement of Account for 790.27 period ending 3-31-09, includes aced dividend of $10.99) 3 BELCO Community Credit Union checking account (see attached Statement of Account for 808.00 period ending 3-31-09, includes aced dividend of $1.02) 4 Camper (tag-a-long) 2008 Freedom FS370Q-DSL-BS (sold on 6/10/09) to third party 21,300.00 VIN # 47CTDFU2X8G527173 r TOTAL (Also enter on Line 5, Recapitulation) ' 35,998.27 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS ~ RESVDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Haverstock, Paul Richard FILE NUMBER 21 - 09 - 0367 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF EXCLUSION TAXABLE VALUE NUMBER Include the name of the transferee, their relationship to decedent VALUE OF ASSET INTEREST (IF APPLICABLE) and the date of transfer. Attach a copy of the deed for real estate. 1 Property gift to David Haverstock, decedent's son, on 6,000.00 100% 2,000.00 4,000.00 8/1 /2008 2 Cash gift to David Haverstock, decedent's son, on 8/5/2008 3 Cash gift to David Haverstock, decedent's son, on 3/26/2009 4 Cash gift to Linda Haverstock, decedent's daughter, on 8/5!2008 5 Cash gift to Linda Haverstock, decedent's daughter, on 12/21 /2008 6 Cash gift to Linda Haverstock, decedent's daughter, on 3/26/2009 7 Cash gift to Shirley Haverstock, decedent's daughter, on 8/5/2008 8 Cash gift to Shirley Haverstock, decedent's daughter, on 3/26/2009 9 Cash gift to Ashley Haverstock, decedent's granddaughter, on 8/4/2008 10 ~ Cash gift to Ashley Haverstock, decedent's granddaughter, on 3126/2009 11 Property gift to Timothy Haverstock, decedent's grandson, on 8/4/2008 12' Cash gift to Timothy Haverstock, decedent's ~ grandson, on 3/26/2009 2,000.00 100% 1,000.00 1,000.00 5,000.00 100% 3,000.00 2,000.00 2,000.00 100% 2,000.00 0.00 6,000.00 100% 1,000.00 5,000.00 5,000.00 100% 3,000.00 2,000.00 2,000.00 100% 2,000.00 0.00 5,000.00 100% 3,000.00 2,000.00 2,000.00 100% 2,000.00 0.00 1,250.00 100% 1,250.00 0.00 2,000.00 100% 2,000.00 0.00 1,250.00 100% 1,250.00 0.00 TOTAL (Also enter on line 7, Recapitulation) 16,000.00 4 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF Haverstock, Paul Richard I FILE NUMBER 21 - 09 - 036 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM ~ NUMBER DESCRIPTION OF PROPERTY InGude the name of the transferee, their relationship to decetlent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 13 Cash gift to David Stough, decedent's grandson, on 1,250.00 100% 1,250.00 0.00 3/26/2009 14 ~ Cash gift to Brian Stough, decedent's grandson, on 1,250.00 100% 1,250.00 0.00 1 3/26/2009 Page 2 of Schedule G ~ n~ ~~~~~Tpp.Iw~r'~-GLJ~/J~pLC~~H~~~~~~+ p rU`~V'1L E:~'~GI~a7G~7 ~ ~. COMMONWEALTH OP PENNSYLVANIA ~~Yc ~'p~ INHERITANCE TAX RETURN 5~~~ ~~ RESIDENT DECEDENT ---- ----i-- FILE NUMBER - ' ---!- ESTATE OF Haverstock, Paul Richard 21 - 09 - 036T _ _ _ _ Debts of decedent must be reported on Schedule L -~ - ---- ITEM i DESCRIPTION AMOUNT NUMBER ~ FUNERAL EXPENSES: A. B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 2. 3. 4. 5. 6. 7 1 City State Zip Year(s) Commission paid Attorney's Fees Marlin R. McCaleb, Esq./Scott M. Dinner, Esq. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant David S. Haverstock Street Address 2620 N. Rosegarden Blvd. City Mechanicsburg state PA zip 17 Relationship of Claimant to Decedent SOn Probate Fees Cumberland County Register of Wills Accountant's Fees Tax Return Preparer's Fees Scott M. Dinner, Esq./Accounting Associates Other Administrative Costs 875.00 3,500.00 110.00 950.00 TOTAL (Also enter on line 9, Recapitulation) ' 5,435.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI I~' DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS i ESTATE OF HavPrstnr•.k Paul Richard FILE NUMBER 21 - 09 - 0367 Include unreimbursed medical expenses. ITEM DESCRIPTION NUMBER 1 Bank ofi America (BoA) installment loan acct# 591-02017045414 [collateral for this loan was decedent's camper listed in Sch. E, original loan balance was $31,585.84 (see attached BoA letter of Aug. 18, 2009, payoff amount plus wire fee per Estate Acct. Register also attached) 2 Pinnacle Health Hospita{s (co-pay) 3 Orthopedic Institute of PA 4 Direct N 5 outstanding draft/check # 3794 paid ', AMOUNT 31,175.52 100.00 15.00 59.35 50.00 TOTAL (Also enter on Line 10, Recapitulation) ~ I 31,399.87 REV•1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES ESTATE OF Haverstock, Paul Richard ` RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT RECEIVING PROPERTY Do Not List Trusteets) _- _-------i. I. I 11 i 2 3 II. TAXABLE. DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Linda Sue Haverstock 124 Robson Road Dillsburg, PA 17019 Shirley Louise Martin 417 Hillside Road New Cumberland, PA 17070 David Scott Haverstock ', 2620 N. Rosegarden Blvd. Mechanicsburg, PA 17055 Daughter Daughter Son FILE NtlMBER '. 21 - 09 - 0367! SHARE OF ESTATE P (Words) /4 of residue /4 of residue 1/4 of residue 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 T OF ESTATE ($$$) TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~' 0.00 REV•1573 EX+ ~9A0) SCHEDULE) i COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER I Haverstock, Paul Richard - I 21 - 09 - 0367 ~ RELATIONSHIP TO SHARE OF ESTATE ^ - AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Uo Not List Trustee(s) i ____ I~ TAXABLE DISTRIBUTIONS [include outright spousal f ers distributions, and trans i under Sec. 9116 (a) (1.2)] 4 i Ashley Haverstock Granddaughter 1116 of residue i !! 2620 N. Rosegarden Blvd. ~ '~ Mechanicsburg, PA 17055 ! ~ i 5 ~ Timothy Haverstock Grandson 1/16 of residue '~ i '~ 2620 N. Rosegarden Blvd. Mechanicsburg, PA 17055 6 David Stough Grandson 1/16 of residue ~, 417 Hillside Road New Cumberland, PA 17070 7 Brian Stough Grandson 1/16 of residue ~~ 417 Hillside Road ~ New Cumberland, PA 17070 8 Ii Susan Haverstock Daughter-in-Law motor vehicle ~ 2620 N. Rosegarden Blvd. ~ Mechanicsburg, PA 17055 i ! i f ~ ~~ I ~ i I I j i I - ~~ I I I ! i I I'. ~!r -- Page 2 of Schedule J Bank of Americar~~...~ Bank of America, N.A. FL9-600-02-65 PO Box 45144 Jacksonville, FL 32232 August 18, 2009 PAUL R HAVERSTOCK 2620 N ROSEGARDEN BLVD MECHANICSBURG PA 17055-5311 RE: 591020170454Y4 075299624100412 Dear PAUL R HAVERSTOCK, This letter is to confirm that Bank of America, N.A. , no longer has a security interest in the property described below: Vehicle Identification Number: 47CTDFU2X8G527173 Collateral Description: 2008 FREED Lien Date: 04.07.2008 Lien Amount: $31,585.84 Date of Release: 06.16.2009 We value your business and want to provide you the best possible service. If you have additional questions regarding this matter, please contact a customer service associate at 1.800.215.6195. Sincerely, J.AY~NC Ban~C of America N.A. Document Management Sw~rn`and Subscribed to me this ~ 8 day of AUGUST 2009. ~ ~ t , ~ ~ _ ~~, ,.~ ~ , ~:--~: .~.~ Notary ~'ublic 1, 4~ ` ` ,lea Personglly known totme nd did not take an oath. ~ p~ PAt4ELASHEFFIELD / 1, \, ,~ ~~`~ ~ Notary Public, State of Horida .~~- -~'~ _ ~r $ ~. ~ Commissiot~# DD8i2008 J.AYING is an authorized agent for Bank of America, My comm. expires Aug. a5, 2n1z .~:-~; Account Register (No. ***702) Another month: June 2009 ': C' Most Recent First S4 - CHECKING (S 4~ _~1IIlP Anna https:/1www.belco-online.org/register.aspx Check ~. Effectiu~ Date Tra~saclian Desc~iplion Flmou~c Entli~g Balance 06/30/09 DIVIDEND 0.20 090601 090630 0.00 S0 7495.90 L22 $ 2,658.16 06/26J09 PAYMENT VIA OFFICE/MAIL 12550 $ 2,656.94 06/17/09 PAYMENT VIA OFFICE/MAIL 156.28 $ 2,S3L44 06/15/(x) MEMBER WIRE FEE -20.00 $ 2,375. ] 6 06/15/09 OUTGOING WIRE -31,155.52 $ 2,395.16 06/12/09 PAYMENT VIA OFFICE/MAIL 388.00 $ 33,550.68 06/10/09 PAYMENT VIA OFFICE/MAIL 21,300.00 $ 33,162.68 06/09/09 PAYMENT VIA OFFICEIMAIL 1181.20 $ 11,862.68 1001 06/08/09 DRAFT PAID TRACE # 012009510-0008787020 -21.36 $ 581.48 1002 06/05/09 DRAFT PAID TRACE # 012066] 88-0008787020 -5.22 $602.84 1004 Ofi/04/09 DRAFT PAID TRACE # 012016487-0008787020 -15.00 $ ti08.06 1003 06/04/09 DRAFT PAID TRACE # 011019202-0008787020 -100.00 $ 623.06 1(105 06/04/09 ACFI DRAFT VZ WIRELESS ARC ARC -TRACE # 02100002555522 -17.25 $ 723.06 Another account: S4 -CHECKING (S 4) !, ~~ELCo MAIN OFFICE: 449 Eisenhower BNd. Harrisburg, PA 17111 STATEMENT OF ACCOUNT Paga 1 S Effective 5/1/09, if Easy or Smart Motley accountfpk,g r equ i cement s n,o,t , met , interest will drop to basic account rate. Na more fees! ~COUN-CUMBER 9 31 l A V 0 .3 2 4 Jt)1NT OWNERS I„.III,,, I I I, ~ ~, I, i„I,1„I, I„, I I,,,, 11,,,11„i i l l 1,,, l 1,,, i PAUL R HAVERSTOCK 2620 N ROSEGARDEN $LVD MECHANICSBURG PA 17055-5311 7RA3J 5~CTIOH ~FFE~TIYE 4r~e uATC DESGRIPTiQN 0301 PREVIOUS BALANCE SI - SAVINGS 0322 BELCOo1NET TRANSFER PARIDISE, AND OTHER BILLS 0326 TRANSFER/OTHER PRIME ACCT 427500 0326 TRANSFER/OTHER PRIME ACCT 151120 0326 WITHDRAWAL 032f; TRANSFER/OTHER PRIME ACCT 712580 0326 TRANSFER/OTHER PRIME ACCT 727260 0331 DIVIDEND THE ANNUAL PERCENTAGE RATE IS 0.75 THE ANNUAL PERCENTAGE YIELD IS 0.75 THE ANNUAL PERCENTAGE YIELD EARNED IS 0.75 0331 NEW BALANCE 0301 PREVIOUS BALANCE S4 = AVVY SENIOR 0303 ~ DEBIT/CHECK CARD TRANSACT *VBA$E4005 KMART 4275 MECHANICSBURG PA 0305 * DEBIT/CHECK CARD TRANSACT *016717594 ANDREWS & PATEL ASSOC CAMP HILL PA 0306 DRAFT PAID 3793 0307 * DEBIT/CHECK CARD TRANSACT *001514487 BAKERS RESTAURANT DILLSBURG PA 0309 * DEBIT/CHECK CARD TRANSACT *016717594 ANDREWS & PATEL ASSOC CAMP HILL PA 0309 * DEBIT/CHECK CARD TRANSACT *VBASE-934 SUNOCO SVC STATION CAMP HILL PA 0309 * DEBIT/CHECK CARD TRANSACT *002 8000 RED LOBSTER US00001958 MECHANICSBURG PA 0315 * DEBIT/CHECK CARD TRANSACT ~1 -015 WEIS MARKETS #199 S MECHANICSBURG PA XXXX20 rrom l o -._~ ~ ___,_.___ ____ 030109 31 09 AMOURIT f1CNARGE HNES BAtANGf: 21279 '28 -500 00 20779 28 -5000 00 15779 28 -5000 00 10779 28 -7500 00 3279 28 -125 00 2029 28 -1250 00 779 28 1 99 790 27 790127 -4 4 -469 -50 0 -3 5 -1 0 -265 -276 -467 0322 BELCOo-1NET TRANSFER 500 00 PARIDISE, AND OTHER BILLS 0325 * DIRECT DEPOSIT 3031036030 163 00 US TREASURY 303 SOC SEC 0325 PAYMENT VIA OFFICE/MAIL 9 74 0326 DRAFT PAID 3798 -100 00 0326 DRAFT PAID 3799 -b 00 0327 DRAFT PAID 3797 -1000 00 0331 DRAFT PAID 3794 -5 00 TOTAL DIVIDEND YEAH-TO-DATE far all savings except IRA. Dividends shown, if S 10 or over, will ba reported to the Intamal Revanua Service for this calendar year. *IfdDICATES EFFECTIVE r1ATF TOTAL FINANCE CHARGE YEAH-TO-DATE for aA bans. NOTICE: See reverse side for Important Informedon. 06231198 ~BELCo MAIN OFFICE: 4 d 9 Eisenhower Blvd. Harrisburg, PA 17111 PAUL R HAVERSTOCK STATEMENT OF ACCOUNT Page 2 S Effective 5/1/09f if Easy or Smart,Mon.ey account/pkg r~_clt~irements nnt~ m,e~k,, int~re.st '~~ti 11 drop ta~ base accounf rate. No more fees! JDINT OWNERS Taw+sacnor+ EFF~cnvE p1PT1QN AM(7UNT "~ ~' ..DATE PaTE G33i DIVIDEND 102 THE: ANNUAL PERCENTAGE RATE IS 1.24 THE ANNUAL PERCENTAGE YIELD IS 1.25 THE ANNUAL PERCENTAGE YIELD EARNED IS 1.25 0331 NEW BALANCE ------------------------ CLEARED DRErFT SUMMA Y --- 3793 3794 **** 3797 3798 3799 --------------------------------------------- ------ TOTAL DIVIDEND YEAR-TO-DATE for all savings except IRA. Dividends shown, if S 10 or over, will be reported to the lntemal Rwenw Servke for this calendar year. 49 .26 I TOTAL FINANCE CHARGE YEAR-TO-DATE for a8 loans. NOTICE: See reverse side far impertent Infermetlan. XXXX20 rrom ~ o 030109,1033.109 ~E Fif~ES ~ 1NGE . I 7~$f00 758100 0.00 oe2ae~9 'INDICATES EFFECTIVE DATE SCOTT M. DINNER, ESQUIRE TEL: (717) 761-5800 31 17 CHESTNUT STREET FAX: (71 7) 761-5008 CAMP HILL, PA 1701 1 December 23, 2009 Glenda Farner Strasbaugh Register of Wills and Clerk of the Orphans' Court One Courthouse Square Carlisle, PA 17013 Re: Estate of Paul Richard Haverstock ("Estate") #21-09-0367 The following items are being submitted on behalf of the Estate: 1. REV-1 SOO Inheritance Tax Return Resident Decedent [2 copiesJ. 2. Estate check # 1010 in the amount of $973.94 payable to the `Register of Wills, Agent' representing the balance due per the REV-1500. 3. My check # 2443 for $1 S. ding fees) payable to `Register of Wills'. Thank y u. Scott M. Dinner, Esquire ~ ~ ~-_ enclosures (4) --.,~z~ o ~:'~ '- ~, T c-~ c-~ , ;=, cc: David Scott Haverstock, Personal Representative ~ ~ ~ `-_~ ' ;, ~, . , -, r- ~~, ,•~ *-, N , w - _ .' ~ a o G i M OOWP Z ~i~j d~ZoM~ ~ J O f f ~~ ~~~ r ,7 ~ ~ G ~ ~ Q d Wa rf~ C1 ~1 .-~ U r i--1 . p 3 ~ ~ .+- O ~ ~ ~ H H D ~ ~ , 60 4-- F+I U! ~~ p C3.~e U ~ ~ ~ U U