HomeMy WebLinkAbout03-15-10C'6 PY 1
BUREAU OF INDIV IDUAL TAXES
PO BOX 280601
WIRRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE N0. 21 -~-U-Uo~6~
';_~:I_''._;~rrl(',~~PAYER RESPONSE ACN 10112825
esv-ISf3IXAiK kl.ou I; ~,,, .. _.:n DATE 03-05-2010
2010 HAR 15 PM 12~ ! 0
CLEFi'r, OF
ORPHhN'S COURT
NANCY A MATTY
601 COCKLIN STREET
MECHANICSBURG PA 17055
EST. OF HELEN ANDRULEWICZ
SSN 181-03-1491
DATE OF DEATH 02-07-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS 70:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided She Departaant with the inforaation below, which has bean used in calculation the
potential tax due. Records indicate that at the death of the above-naaed decedent, you were a joint owner/beneficiary of this account
If you feel the inforaation is incorrect, please obtain written correction frog the financial institution, attach a copy to this tors
and return it to the above address. This account is taxable in accordance with the Inheritarce Tax laws of Lhe Coaaonwealth of
Pennsylvania. Please call C717] 787-8327 with questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
orcen Taxable X 50.000
Amount Subject to Tax $ 2,559.18
Tax Rata X .045
Potential raz Dua $ 115.16
P~T TAXPAYER RESPON
1
Account No. 40089-00 Dato 05-23-1984 To ensure proper credit to the account, two
Established copies of this notice oust accwparo
Aeeount Balance $ 5 ~ 118.35 paysent to the Reoister of Wflls. Make check
pavabla to "Register of Wills, Anent".
P t
BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ON L Y ~(to be filed by the estate representative.
C. ~j~ The ebova inforaa ion is incorrect and/or debts end deductions were paid.
J`1' Ca^pleta PART ~2 and/or PART 3^ below.
PART If indicating a different tax rate, please state
relationship to dacedant:
NOTE, If tax pageants are ^ade within three
aonths of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Am Inheritance Tax due will beeoae delinquent
nine aonths after the date of death.
A. ~ The above inforaation and tax due Ss correct.
Raait pavaent to tho Reoister of Wills with two conies of this notice to obtain
CHECK
C ONE ~ a discount or avoid interest, or
Wills and an official assessaent cheek box "A" and return
will ba issued by the PA this notice to the Reoister of
Departaent of Revenue.
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 $
3. Portent Taxable ; X
4. Amount Subject to Tax 4- $ 2 S.
~
. ~8
5.
Debts and Doductions
5 1
~ ~t
f'nn
'
e
FO77.~a
6. Amount Taxable 6 $ _. f µ 9. SZ
7. Tax Rete 7 X
8. Tax Dua B_. $ Q
PART
~ DEBTS AND DEDUCTIONS CLAIMED
~IfLEN ANDRut.f w -cZ pID Nor NAvE L..~FE ~NSuRANC'~,
DATE P AID PAYEE ... nFCrarprrnu
l 01bE r...v.. .. • • /'.LY
2 9 0
tti I E
- - - - ,an l.p mpu[aLa00J j 00
e
Undor penalties of perjury, I declare that the facts L have roported above are true, correct and
complete So the bolt of ~ kno~edD~and belief. Wnwr t' ~/ 7 i ~~ ~ _ ~ 2 12
WORK (~~7~ 7~~ - 6~' 13 12 /~
rr, rnn r ......-~~
it Muter Nsze IFij . MaeMadierirrt, M 77IS5 Alicllaell. Alafpeul, lhnter
trarrslASSfs FUNERAL HOME 7enmyJ. SAarKer, Raaere(Diraeror
STA`I~MEN'1' OF FUNBRAT, GOADS AND SERVICES SELECTED
Ctvvgcs are only: (or those ¢ems drat you selected or thafare required. If we are required by law m try a cemetery or trermdcaY to use any eems, we will
explain the reason in writing ftelow.
If you selertttil a funeml drat racy require emltaUning. such as a funeral viewing, you may have[o pay for embalming. You dorw[ have to pay foremhatm-
m8 qou dl<t tta approve if yar seleted amngem
e
nts suchas direct cremation or immediate burial. u we chargedfor embalming, we will ex Ain by hebw.
,
/
For tlae SearoItt of 6 w /7r~ ~R U~ ~ /~
Date oP I?esth +~Q ,L?
Charge to:~,r/f~~'j, /~ yf
~~%Y ti~/6SNe0/1~/+f'SdU~I"
Name Address' •" ~ Ley :State
A. QIABGLt F4R'SERVLCFS SF.IECIFD: Other dashing
t: PAOI+ESSIbNAL SPRV[p~S
SenSCes of Wnetal oirecrar/3aff . , .. S".~ ° C.taruUon um . ..:.. .... .. f '
ErdxaWting .. ....:..., ......,.5:.. ~""
, (DeuSipuon).; : it ,
txiter preparation o(body
., F
OTH
R S
. , ....:.: ...... , .:......... S -.
7YY1'Af.1N1?ECBANEIISE S.-
... ........ i .B S 3 ~Gt
9U&1'OTAC OF FROFF~OtIr1i. SI81n4CpS ....... .: .At 3
GSPECIAL CHARGESe
2.. PACAYIIEi ANU 5hRVICES : Fawaniktgof remauu to
~'...
tNkc d'fiotitiea and servktsfor S..
viewing fYukat)onlWake). `.........-5' (FUnenl Haney.
Use of fvdli[ks and serve : ~,.~... Rea7wryt of iemai[ts from:
for tunemletventony ... $`
. ~ ,.
<USe of 6nliFies and aervices~fa (Prmeral Hare)
iNemodal Service .. ..., ..... f ""' Immediate Iiutial ...: . .. .. f
use Of equ[qurnt and services 1)ireci Cremation
:. . Sa~.S~,
tar grwetirle service ....C ........ S •+
O
'
E
A S
'
ou,er use aF faalities sU&1YYIML
F 9PE(
lAt. f.
t
eG89 ...:.. . . .....
.c 3,
D, fA~ ADVANCED
.. .. ..: ....... .::........ 3'.
:...
OpeningGrne
..f.
sue-rotAr.oF FAQ ..... .:.AZ cemetm Fsrvi~em ... .:.. .. f
3. A(ffOMEYf1vE HQUfPMFNf La[ and 1]eed .. : . S
tEftkle W thnsfer remains ro Fut[eral Ha NeA'°WPer NaKes-laal .:. . S
re Newspaper Natices~-Outaftrnm . . f ::
.... f.
ir>raI
.. Tekphnne & Tdegmrns f
Hearse' (Ceske Coach)
~
Aafare ..... .:.
f
:Load .~.., .'./. .,.. ...: ....... f-.~ ~ detgylMass Offenng .... , ; .... .. S
~~~
r .ass'-.'
...._~ .
. r~'~
~ .> ~~~ ~s~r
..
. _
.u
Famdy car. ° ~+' CertiFxare ...... .
.
.. S
:teal .. , .:.: ... ....:..... .. f Polke Escorr _ ... . s . ... .. . S -
.. Mawer cu a Ilaral dtspaakton
/. .
Flowers
l
. '
S
....... f
LO[ai .....: ~ ........ ....
.:
. .: ..
vault Servi¢ Lin
tge ........ .....
.. S
;:. Lead rarJdetgy rar
~ 3.
Local .. ..:: ......:....
...5' .
S
Car far Pill6euas S
Oa of corm rnnsltartaion ... ...... f ; •^-
t
f> r
sUe-IrnAL ON ADVAIVf.ES. .... y j
......:.rif ~/
.
stle-mrAt. or Atttrnr[mtve
eQilA~Yl'...... ._,A3 S
.. We dime you to our servims in oNainiug.
YtiYlikT.4~rF~tP!>99tONAt.
.. -l~edlrm~aar~rmrmemar~ed+rOl
PA(LIflFB ANO At.RthlliTllFE
B. E~A~iB FOe-- S8f~C1130[ SUteMABY OF (]IARfi6S
:'Casket .....'. ~ i ........ S ~'~ A. Ptotessiottal Services, I~iFies and
~[)..~:. } Equipment, and Aumamt)ve
s. Merchandise f
Odrer leccpack .... . ....... S ..
G Spent (Wargo
..: ..
~%~~~
(Ueart$tann) D. (Sdt Advwres ... ...: ,~
t5uter 6uda1 ewaainer ....:: ....... i 70LU.OF A[L SHG7fOM4 .... ...:.... .
.;:.u~
T.(Descritxim)..
'. FAIDAT 771~OF OH-FltWt1D
ABlANC.Baf~tC4 .... $
~
~u f BAIAN(~DT7B , . _.. ...... .,.~
.... S
ge&Aer book(s) ... . . .:.. ....... S sFe.9oN FOR>~AUmvc ,.. O
:..Memory fdde:rs ... ..:..:. .... $'.
.
:Prager ®rds ........'.. . 5.:: if any hw, aatreLay a uanatory ~
Yaaparary grave nauker . ... f d any of die kemsIPted shove, tfitlaw ar ngniaeriiem
':Hmial dnthiog. ....... ,.i ..
..... f
o~
i thw I havt esamkted the+4ms of gouda and services sekded above and found them to be correct and aauding b iheanangerrrmGS i have teepws[ed. I actnovvkdge
receil% of a copy ofdtis Statemem aF Furteal (',nods a
std serrices sek+md:, I abo Agra fa payment d f ~ . I that I have suRaienrfuMs avaihble for payowvd d the w91r price for the goods
wkidn 30.. chya [ agree w be jointly and acwenly 1iaMe with anyate else wtw
aignv tieb[v, A fate dsarge af`., fl,.,_ per mdMh wiowt~g to per year will he applied m the: tmpaid bamnce be~tnnh~ daps
frdn the date of d]fs ig[eement. F wN al9o pay to the 11uKta1 1)kettar reasonable wars paid ty the Eunetal OkecWr to co(ktt amounts f ewe ufder tlsts agreement.
77mse: w9s anay irrelwk ataarxys'.::~ mart casts and alter costs: Any addkiottal services ormerchandise ordered or requested after. the date of TGia agrieercen[ wfg
bt oor'aide[ed pa6 aF'tids agrumoetd and the mss tltenmF wR he mlkped nn dte fkad hill or smremmt.
~ J
(Seep /
'L f7 /2oJU
(P.urclvser)
C
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Lb• f7
(Seep ~ f! /../.f.~Y~ ~..~.~-
m
ervmmlrm FlxeN aaugs Aeoddbi /1 amm~ewcrd nte~ rauAV n eed m
rc nna co+mier
fottn -600 Revised 1/44 ' VV
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NAME
C~#fice of Catholic Cemeteries
~; ' Diocese of Harrisburg
PO Box 3651
' Harrisburg, Pennrylvania 17105
Phone (717) 657-4804
7P~
SALES CONTRACT
DATE ~~£'~Ze.iv ~~
CEMETERY~~'r~-- { ``f/:tiv~,J CEMETERY#~.1
A/N txF P/N A/R
PHONE ( ) 7G ~-~ ~*~/.
ADDRESS et~/f ~~t".~''t. a.i1 =-~'
CITY ~-~ff/«'i~'°y{~`/~~_'ti STATE ~~~ ZIP CODE r'f~r'+~
Intemrent'Spaces ....... ~ $ 1. Price ................. $Iv.~S~
Bronze Memorials....... ~ $
Size
Granite Foundation...... ~ $
Burial Vaults..,...... , .. ~ $
Crypt Spaces.. ::...... ~ $
Niche Spaces ........ /.~ ~ ~~~~' ~ $ .l~~s'~®
Other.
$
Section Lot Grave(s)
Building Side Crypt or Niche
Selection must be made within 30 days or cemetery will make choice.
2. Down Payment....... .
3. Unpaid Balance(1-2) .... .
,t
! .aa
4. Finance Charge.......... .
5. Deferred Payment (3+4j . .
6. Total Price (1+4) ........ /f~'~`~
7. Approx. Monthly Payment
8. Number of Payments ... .
9. First Monthly Payment Due
10. Annual Percentage Rate
The payment is due on the date stated above and the remaining payments on the same day of each succeeding month.
Buyer may prepay in advance the full amount due without penalty and will be entitled to a proportionate refund of the
unearned finance: charge.
Upon default'n the payment of any installment due hereunder for a period in excess of one hundred twenty (120) days;
Seller may; at its option, void this agreement and retain alt payments made by Buyer as liquidated damages.
Buyer hereby acknowledges receipt of an exact executed copy of this agreement at the time of execution hereof.
Before any burial is permitted in this lot, or any memorial placed on this lot, the price of the grave and memorial must be
paid in full.
The Purchaser(s) agree(s) to abide by all rules and regulations of the cemetery now in force as well as any rules and
regulations which may hereafter be adopted. Said rules and regulations may be seen upon request at the Seller's ofFice.
Upon,fulfillment of the conditions of this agreement and receipt of all the above described payments, Seller agrees and
binds itself to convey to the Buyer, by its cemetery easement, for interment purposes only, the above mentioned number of
sites.
YOU, THE PURCH ER Y NCEL THIS TRANSACTION BY WRITTEN NOTICE AT ANY TIME PRIOR TO MIDNIGHT
OF THE THIR SINS AFTER THE DATE OF THIS TRANSACTION.
(Auth6fied Representative) (Purch laser's Signature
NOTICE: See other side for additional information. (Co-purchaser's Signature)
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USA FIRST CLASS fORFVER
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