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HomeMy WebLinkAbout09-29-10 1.50560?121 ~ R~/-"1'J~~ Ex cos-os) PA Depahmem of Re~we ofFICUL UsE ONLY ~f Irsil Taxes< INHERITANCE TAX RETURN ~~~~ Code Year File Number PO 8t?X 280601 PA 171 1 I'~1E31~ENT ~ NEWT 2 1 1 0 0 3 5 6 ENT~t t~cEt3~a~rt' v~11-noN BELOW Sodal Security Number Date of Death Date of Birth 0? 2 1 6 6 1 5 7 0 3 1 0 2 0 1 0 0 6 0 6 1 9 2 0 Decadence Last Name Suffix Decedents First Name MI R I C H A RD S O N H E L E N (If Appticaible) Enter Sunrivinp Spouse's Informa~lon Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FIND ~N ~lUPUC~A-TE WITH THE RE~~~1'~R ~JF'VVILLS ® 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Rehm (date of death prior to 12-13-92) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of 1IVNI) (Attach Copy of Trust) 9. Utigation 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) GORRESPONE)ENT -THIS SECTION MUST BE Ct>~LETED. ALL CORRESPOIVDF.NCtc ANO CONFIDE NTGt TAX tNFORMATIOlI &iOl1LD B! DIRECTED Tt~: Name Da me Td ~ .,~¢~! yd eptwne Number R M A R K T H O M A S E S Q D I R E 7 1 7 7 9 6 2~- 0 0 Firm Name (if AppNcable) First line of address 1 01 S O U T H M A R K E T Second fine of address City or Post Office M E C H A N I C S B U R G Correspondents e-mafi address: ail.corn S T R E E T State ZIP Code r~ -~~, '~ ~t ~~ C:.~ ~~ ~~ ~.! i .... °i DATE FILED -,.~ j r "~ J .:_~. F +~ ~ J P A 1? 0 5 5 Untkr p of`t~7, I t4edltne tlle~ t lave >fli3 retium, iritq ~9 ac~lati~e:~ and , anti b the beef my knawbdpe and belief, n ~ true, oortact and of Prep' otl~ t#IaEt 6ae Personal repre~ntatMe ~ based on a~ ink ~ amide prspdrer fiae any la~owledpa. SI 18LE FOR HUNG RETURN DATE ADDRESS 1.00 ~ L_ANE s~ MECHANICSBURG PA 1?050 TH/W REPRESENTATNE 101 SOUTH MARKET STREET MECHANICSBURG PA .17055 PLEASE USE ORtt,1iNAL FORM ONLY Side 1 15D560?121 1505b07121 `J, ~,0~b~t~~c~ REV-1500 EX Decedent's Soria{ Security Number osN.~.• HELEN RiEHAR~~4N 0 7 2 1 6 6 1 5? RECAP1TUUTx~N 1. Rea{ estate (Schedule A) ............ .......................... 1 2. Stocks and Bcx~ds (Schedule B) .................................. 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages 8 Notes Receivaf~{e (Schedule D) ........................ 4. • 5 5 6 1. 5 0 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jdntly C~med Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 4 5 2 ? $ . 2 4 7. Intel-Vivos Transfers b MiscsNaneous N~PrObate Property t d Bilii R t S 7 • eques e rtg epara e (Schedule G) u ....... . 8. Total Gross Aseewts (total Lines 1-7) ........................... ~. ]+ 5 0 $ 3 9. 7 4 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......... ....... 9• 2 2 °~ 4 1 . ~ 5 10. Debts of Decedent, Mortgage Uabditi~, & Liens (Schedule f) ..... ....... 10. 6 3 4 2 . 5 2 11. Totsl Deductions {total Lines 9 & 10) .................... ....... 11. 2 9 2 8 3. 8 ? 12. Net vslue of Estate (Line 8 minus Une 11) .................. ....... 12• 1 2 1 S 5 5 . $ ? 13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........... ....... 13. • 14. Nst Vslus Suti~ct to Tax (Line 12 minus Line 13) .................. 14. 1 2 1 5 5 5 . $ 7 TAX CCaMPUTATK)N - 8EE INiTRUCT10N8 !~ APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 i6. Amount of tine 14 taxable 1 2 1 5 5 5. 8 at lineal rate X •~~ ? 1 g• 5 4 7 0. 0 1 17. Amount of Line 14 taxable 0 . 0 0 17 0 • 0 0 at sibling rate X .12 • 18. Amount of Une 14 taxable 0 0 0 0 • 0 0 at coils#erai rate X .15 18. 19. Tax Due ................................................19. 20. FILL IN Tt~ OYAL {F YOU ARE REQUESTINti A REFUND OF AN OVERPAYMENT 5 4 ? 0. 0 1 a Side 2 15US607221 1505607221 REV-1500 EX Pepe 3 File Number Decedent's C.Ctrrtnietie Addre$s: 21 10 0356 DECEDENTS NAND HELEt~I RiCHAtZbSpN STREET ADDRESS BRIDGES AT BENT CREEK 2100 BENT CREEK ROAD CITY STATE ZIP MECHANlCSBURG PA 17050 Tax Payn~s and Credits: 1 • Tax Due (Page 2 Line 19) 2. CreditsiiPayments A. S!pousa! Poverty Cn3dit (1) ,5,470.01 B. Prior Payments ~ 5,250.00 C. Discx;'unt 262.50 Totbl Cret~s (A + B + C) (2) 5,512.50 ~_~..~._ 3. InterestlPenalt)r g alb D. Interest E. Penalty Thal interastlPenadty { D + E ) 4. ff Line ? is 1fi~ Line 1 + Line 3, enter the differerxe. This is the 4YERPAYMENT. F91 in ovat at 2, Lune Zfl to request a ntrttrnd. 5. 8 Une 1 + Une 3 is meter fan Line 2, enter the difference. This is the TAX QUE. A. Enter the interest on the tax due. B. Enter the total of Lire 5 + 5A. This is the BALANCE DUE. (3) 0.00 (4) 42.49 (5) ~ 0.00 (5A) (58) o.oo Make Check Payable tv: R~~IS~'~R aF VILLS~ A~`El~T ... ~ ~ ~ s ; ;i: " v . ; ~ x~ ~ ' ~ ..• ~ xFw.k, `b•u a .~' ~t. ~f iy PLEASE AldSWER THE FOLLG1i111NG QUESTIfi~NS BY PLACING AN "X" IN THE APP'tttlATE BL4CICS 1. Dkt deceder~ make a transfer and: Yes {~ a. rc~ain the use or income of the property transferred : ...................................................................... b. s9eiain the right to desigr-ate who shall use the property transferred or its inccxne; ............................... c. rain a reversionary interest; or ................................................................................................ d. r~eceiiwe the promise for life of either payments, benefits or c~e7 ....................................................... ^ 2. ff dead occurred after December 12,1982, dkt decedent transfer property witltin ors year of death without receiving adequate consideration? .....: ................................................................................. 3. Dist decedent own an "in trust for' or payable upon death bank acawnt or seantty at his or her dew? ......... 4. Did decedent own an individubl Retirement Account, annuity, or other non-probate property which contains a benefrclary desigriefion? .................................................................................................. ^ IF THE ANSWER TO AMY OF THE ABOVE QUESTIONS IS YES, YOU MUST t,,OMPLETE SCHEDUi.E G AND FILE IT A~ PART OF THE i~TUi~N. > • . ;. For dates of death on or after ,iuty 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) perroent (72 P.S. §9116 (a) (1.1) (i)l. For dates of death on or after Jar~y 1,1995, the tax rate imposed on the rat vaaus of transfers to ~ fa the use of tt~e surviving spouse is zero (0) percent [T2 P.S. §9116 (a) (1.1) (ii)). The statute does rlot_exerr~~ ~ transfer to a surviving spcwse from tic, and tltie statutory requirements for disclosure of assets and flung a ta~c n~tum are stilt applic~bte even ~ the surviving spouse is the only beneficlary. For dates of deatfi on or after July 1,2000: The taut rate imposed on the net value of tr~fers from a deceased childtwenty-one years of age a younger at death to ~ for the use of a natural parent, an adoptive parent, or a stepp~ent of the chiki 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 tl~e decedent's lineal beneficiaries is four and one-half (4.5) pen~nt, e~pt as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a}(1)). The teat 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 iubl who has ~ feast one part in Qommon wig the decedent, whether ~ blood or adoption. REV-1508 F.X + (8-98) ~~~~~~ cbiutrioNw~-int ~ PE1-lNSnv~w~A CASH, BANK DEPO~lT~, & MISC. ~rr~NCE Tex ~ PER~t?NAL P~t4PERT1( _- EST~-TE t~ FN^E ~ r~^ .r. ^ HELEN RICHARDSON 21 10 036 ~ ~.^~.r, r~.rw g,~ ~~~~{{.,.,~~~ y~ ~ ~ ~i ~ ~ ll tl~e ~ 8f id ~ d~ C .• ~ ITEM VALUE AT TE NUMBER DESCRIPTION 4F DEAT 1, tifet Nk~taus & Company, inc., IRA #11N81 1505-9731 ''1,332.51 Z25 Fn~nklin Avenue, Suite 150 en City, NY 11530 2. NC Bank, N.A., Checking Account #5005787562 1,442.58 Grant Street, 36th Floor ittsburgh, PA 15219 3. ridges at Bent Creek, 2100 Bent Creek Botdevard, Mechanicsburg, PA 17050 2,741.11 On 3/15h0, the Bridges, an assisted living fak~ty, took 54,279.86 from deced®nt's accost for the month f March 2010, see Schedule I. Since deceden# died on 3/10/10, the amotmt shown here is the refund for e month of March 2010.) 4.'residential Lice (monthly annuity payment) ~ 45.30 Ta1'AL (Also enter online 5, -) ~ 1.50 (tfmExe speice ~ needed, t adk~onal aheeb of1{'~e s~rie'a~e) F{EV-1509 EX + (6-98) SCH~i~ ~~,,,,,~,,,,,~~,~ ~ ~,,~;~,,,,~,,,, J0INTLY•OWhIED PROPERTY INh1ERITANCE TAJ( RETUi~N HELEN RiCHAR©SON ,~~ . , _ ~ 2_, ,.,, 0~g~ if sin ass+~t wu made jolt min ota yar of tM decedertl: dales of lath, k be nPorted oA SchedWe ~. SURVIVING JOINT TENANT(S) W1ME ADDRESS TO D~CEDENT A. Kenneth C. Richardson h 0 Oak Lane PA 17050 J4MfT1.Y-0M~+lEit3 PROPEt~tTY: ITEM NUI~ER t.ETTER FOR JOMIT TENANT DATE MANE J6JIMI' Diw$CI'f1ON OF RFt4PERTY MICLUDE NAME OF FINMIC{AL INSTr~l1TION ANO HAlll(ACCOUNT NUMBER'OR SIMgJ1R IDENTIFYING NIN~ER ATTACH DEED FOR JOINTLY-HELD REAL-ESTATE. DATE.OF DEATH VALUE OF ASSET ~~ INTEREST DATE ~ TH INTEREST 1 • 3/04!08 NC Bank, Certificate of Deposit #31900315756 53,388.32 50. 2,694.16 2. 3/04/09 Bank, Chec~dng Account #5004895845 5,349.18 50. ~t,674.59 3. 3/04/ NC Bank, Savings Account #5004715479 231,818.97 50. 11~,9(?9.49 TOTAL (Also enter on line 6, Rehllation) : 14 Z78. 4 (11 ma+e apsoe is needed, insert adds sshee~ of the al>ane sins) REV•1511 EX + (10-06) ~~ COMMONViIdALTH OF PEt~ISYLVANIA FUNERAL E~CPENES ~t iN t ~ TAX Rt~TURN ADMINfSTRATIYE C45TS E8TATE OF FB.E NU~ER HELEN RICHARDSON 21 10 0356 .~. ~- Debte of decadsrrt mud be r+pforMd,on Schedule I. ITEM NUN~ER DESCRIPTION 'AMOUNT A. FUNEI"tAL EXPENSES: 1. Kohn bTaylor-Howe Funeral Home 2. Memorial Solutions 3. Crosan~ads Cafe (funeral dinner) B. 1. 2. 3. 4. 5. 6. 7. City Stab Zip ADMINISTRATIVE COSTS: Perscnad Rtative's Comrr~ssions Name of Personal Repreeentatitre (s) Street Address Year(s) Conunission Paid: Attorney Fees R. Mark Thomas, Esquire Famly Exemptia~: (if decedenCs address is not the same as daimanYs, attach explanation) Claifriant _~ Street Address 15,91.00 X2,370.00 629.85 $,500.00 Cry Stab _~ Zip Relationship ~ Clafrr~ant to Decedent Probab fare Cumberland County Register of calls 293 50 AooDUntar~'s Fees Tax Return Preparers Fees Waggoner, Frutfiger ~ Daub, LLP 150.00 TOTAL. (Also enter on line 9, Recapitulation) ~ ; 2Z~941 ~...~... ~ neec~d insert additia~al ~" ~ , ~_ ~ ~ - (If more space sf1e81S of the same else) Fti1/-1512 EX + (12-03) ` ~~~~~~ coMMONw~un~ of P~ra~SnvaruA DEBTS OF DECADENT, '" ~ rNC 1~:, MORTGAGE LIABIUTIE3, ~ LIENS ESTATE OF FILE NUR HELEN RlCHARDSON 21 10 f 336 ~... Report debt in~urr~d by the ~~acedent {>~lor to death whkh remained unp~d ae of die dalDe ofi tieeth, inciudir~ urF*rebnbureed n~edkal ~., STEM VALUE AT DA E NUMBER DESCRIPTION OF DEATH 1. tephanie Rid~ardson (reimburse for purchase of Depends adult diapers) 216.24 2. Pharmacy Services, Inc. 300.30 3. iiton S. Hershey Medical Center (doctor visit) 63.41 4. ast Permsboro Ambulance Service (wheel chair van transport) 51.20 5. a Instead Senior Care (private nurse) 62.85 6. . S. EMS (ambulance) 920.36 7. sited States Treasury (2009 federal income tax) 403.00 8. ridges at Bert Creek + #,279.86 9. residential Life 45,30 I,.~III _ TQTAL_so ,ender on line 10, Rec~piU~lsdion) I S (If more agave isneeded, insert ar~ianel sheets of the sauna size) RFV-1513 EX + (9.OOi COMMf)NWEaI.TH OF PENNl3YLVANtA BENEFICIAI'~fES INHERITANCE TAX RETURN ESTATE OF FN,E NUIwI>YER VC! C\I ~i~-LIAt~hQA!•1 G I t VJW RELATfONSHiP TO DECEDENT AMbUNT ORS RE NUMBER NAME AND ADORES`S OF PERSON~Sj RECEIVING PROPERTY Opt Not List Truglw(:j OF ESTAT I. TAXABLE DISTRI IONS t distributions, and trarrar~a under Sec. 9116 (a (1 j.2 ] 1. Kenneth C. Richardson Linerad 0.50 10 Oak Lane Mechanicsburg, PA 17050 2. Phyllis Roemer Uneal 0.50 1057 Pulaski Road East Northport, NY 11731 ENTER DQL#.AR AI~NTS FOR DISTRI KaNS SHOWN. A80VE ON UNES 15 T HROUGH 1`8, AS APPROPRIATE, tNd REV 1500 COVER SHE II. t+~h!-TAXABLE CN U~'I A. SPOUSAL. DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL 4F PART II -ENTER TOTAL NaN-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV i 500 COVER SHEET : to rraxe apace ~s rreeaea, tnserf acz~lon~1 meets of the same Sze) LAST WILL AND TESTAMENT OF HELEN RICHA]RDSON I, HELEN RICI~ARDSON, a resident of and domiciled in Cameron County,. Texas, being of sound and disposing mind, do hereby make, publish, and declare this insttvrnent to be my Last Will and Testament, revokir3g all prior wills or codicils made by me. ~a ~. rn ~ ~ ARTICLE ONE ~ f -~ v, Declara~l ~'' C7p (~ ~ .~? ~' = ~~i. --~ .: 1.1 T declare that I am the wife of LESLIE J. RICHARHSON.. I fiutl~ declare tit t~ I have two living children, PHYLLIS ROEMER and KENfNET~I RiCHARDSON. I have one child, RONALD FALKOWSKI, who has predeceased me. I have two step-children, KATHLEEN De,TARDINE and BEVERLY PARI~:ER. I have intentionally made no provision in this Last Will anal Testament or in the Trust Agreement referred to in this Last Will and Testament for RONALD FALKOWSKI's descendants or KATHLEEN DeJARD~TNE and BEVERLY PARKER, or their descendants. ARTICLE TWO Adm~a~stratiun ~r~~.~~. 2.1 I hereby appoint LESLIE J. RICHARDSON as Independent Executor of this my Last Will and Testament. If LESLIE J. RICFfARDSON shall fail or refuse to act as Independent Executor, or, having qualified, shall fail or refuse to serve, then I appoint PHYLLIS ~~ ~- _~ F r -. , .-'~ ~ ,w ', cT; - ~. ~-~ `'' . ; ROEMER and KErINETH RICIaARDSON as successor Co-Independent Executors. If either PHYLLIS ROEMER or KEI~iNETH RIC~iARDSON shall fail or refuse to act as a Co- Independent Executor; or; having qualified, shall fail or refuse to serve, then I appoint the other as sole successor Independent Executor. I direct that no bond shall be required of my Independent Executor. 2.2 In addition to such other debts and costs which my Executor is required to pay; I authorize my Executor to pay costs of ancillary ~stration, expenses of my last illness and funeral, and, at the discretion of 'my Executor, to pay the cost of a suitable monument at my grave. .- ,, .-,.r,~,a~--~.t --~. ~ ~--~---~---~-- .... . ,. 2.3 My Executor is authorized to do any end ail things which, in my Executor's opinion, are necessary to complete the administration and settlement of my estate. My Executor shall have, in extension and not in linutation of the powers given. by-law or by other provisions of flue Will, the following powers with respect to the settlement and aa3~riinistiration of my probate estate: A. To retain any and all property received for as long as such retention appears advisable. B. To invest and reinvest in stocks, shares, and obligations of corporations of unincorporated. associations or trust and. of investment companies or in any other kind of personal or real. property, natwithstan .ding the fact that any or all of the investments made are of a character or size which but for this expressed authority would not be considered proper far executors. C. To hold securities or other estate property in the name of my Executor as Executor or in my Executor's name or in the name of a nominee or unregistered in a condition where ownership will pass by delivery. D. To sell for cash or on deferred payments at public or .private sale, to exchange, and to convey any portion of my estate, real persona, or mixed at the time or price and. on the terms and conditions which my Executor may determine. E. To lease any real or personal property of my estate for any purpose of terms within or extending beyond the term of the settlement of my estate. F. To manage, control, improve, and repair real and personal property belonging. to my estate. G. To procure and carry, at the expense of my estate, insurance of the kinds, forms and amounts deemed advisable by my Executor to protect my estate and my Executor against any hazard. H. To comprise, submit to arbitration, release with or without consideration, or otherwise adjust claims in favor of or against my estate. I. To enforce any deed of trust, mortgage, or pledge held by my estate and to purchase at any sale thereunder any property subject to any such -hypothecation.. . , ., ~~- J. To commence or defend at the expense of my estate any litigation affecting my estate deemed advisable by my Executor. K. When distributing my estate, to make such:. distribution wholly or partly in kind by allotting and transferring specific securities or other personal or real properties or undivided.. interest therein as a part of the whole of anyone ormore shares at current value i:n the manner deemed. advisable by my Executor. ARTICLE THREE Diatws~~ons 3.1 I give, devise and bequeath all of my property of every kind and character, wherever situated, whether community or separate, owned by me at my death, including all the rest and residue and including any property over which I have a power of testamentary disposition to the then acting Trustee of the LESLIE J. RIC~[ARDSON AND HELEN RIC~3[ARDSON REVOCABLE TRUST, executed on September 10, 1996, to be held, administered and disposed of according to the terms of the said trust as they now exist or may hereafter be amended to the date of my death. I, HELEN RIC~[ARI)S4N, the Testatrix, sign my name to this instrument this .~ rc~ day of ~, , 2007. I acknowledge that I sign this document. as my Wi11. I declaxe that I sign it willingly, in the presence of the witnesses, that I sign it as nay free and voluntary act, that I am eighteen years of age or older, of sound mind, and under no constraint or undue influence. ~, HELEN RIC SON Testatrix - ~ ATTES'1~'A'T~ON CLAUSE f~ The foregoing instrument, consisting of four (4) Pages, including this, Rage, was in our presence signed by HELEN RICHARDSUN and declared by her to be her Last Will. We, ax her request and in her presence,. and in the presence of each other, have hereunto subscribed our names as witnesses on the ~ day of ~ ~ ~, 2007. ,~ Si tug of Witness ignature of V~Jitness -~ L~~~. '. X01 ; h ( ted Name of Witness) (Printed Name.. of 'aVitness) ~L_~~t~ (City, State) ~ {City, Sta SELF-PR~'''`~ .A.~~~IDAVT'"I~ County of Cameron ss.. BEFORE ME, the undersigned authority, on this day personally appeared HELEN RICF[ARDSON, known to me to be the Testatrix and. the witnesses,. respectively, whose names are subscribed to the annexed or foregoing instrument in their respective. capacities, an+d all of said persons bung by me duly sworn, the Testatrix, HELEN RICBAR~SON, declared to me and to the said witnesses in my presence that said instrument. is her Last Will and Testament,. and that she had willingly made and executed it as her free act and.. deed. for- the purposes therein expressed; and the said witnesses, each on his or her oath- stated to me in the presence and hearing of the said Testatrix, that the said. Testatrix had declared to therri that said instrument is her Last Will and Testament, and that she executed the same as such and wanted each of them to sign it as a Witness; and upon their oaths each witness states fiurther that they did sign the same as witnesses in the presence of the said Testatrix at her request; that she was at the time eighteen {18) years or over and was of sound mind; that each of the said witnesses was then at least fourteen (14) years of age. ~ ~ Subscribed and acknowledged before me ~ by the said Testatrix, HELEN RICF[ARDS#ON, and subscribed and sworn to before me by the said ~(t}17~~t ~+~~~-af ~ and ~o ,witnesses, on this the ~ ~ day of 2007. . moo.*R!!a~'~.,~ Og80RA~i P.~ HILBIIR!Ai :^ = Notary i fate of Texas Pubs c. 5 ;, = N{y~Cyprnnnissi4ot~ ~ExApine®s Notary Public, State of Texas i~' ;~'~~ '~:y~ A~N~,~ ~tl3Ct~/ 03~ L~Yv P RECEIPT FAR ~A~MENT GLENDA FARMER STRASBAUGH Receipt Date: 4/06/2010 Cumberland County - Register Of Wills Receipt Time: 08:29:35 One Courthouse Square Receipt No.: 1060615 Carlisle, PA 17613 RICHARDSON HELEN E-state File No.: 2010-00356 Paid By Remarks: R MARK THOMAS CJ ------------------- ----- Receipt Distribution ----- ------- -------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 210.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23..50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE -~ 5.00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5.00 CUMBER~,AND C(JUNTY GENERAL FUN SHORT CERTIFICATE 20.00 CUMBERLAND COUNTY. GENERAL FUN Check# 3107 ---------------- $278.50 Total Received..... .... $278.50 h 1S~,o COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES oEPT. 2sosol HARRISBURG, PA 17128-0601 RECEIVED FROM: . PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THOMAS R MARK 101 S MARKET STREET MECHANICSBURG, PA 17055-3851 r, -- fold ESTATE INFORMATION: SSN: _a72-~ s-si 57 FILE NUMBER: 2110-0356 DECEDENT NAME: RICHARDSON HELEN DATE OF PAYMENT: 06/07/2010 POSTMARK DATE: 06/07/2.010 COUNTY: CUMBERLAND DATE OF DEATH: 03/ 10/2.010 ~ REMARKS: RECEIPT TO ATTY SEAL CHECK#3125 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ $ 5, 250.00 TOTAL AMOUNT PAID: 55,250.00 INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX(11-96) N0. 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H ~ n , ~ C zp Q ~~< ~ C y ~a ~~R ° 00 a ~~ y~~ b n ~~o ~t - ~ o `o' _:~ ~.,a ` ~r- z o o~^ ., ., ~ ~ n ~ ~~ ~~,a ~ ~ . 0 w ~ ~ Cn j y fl'; ( f9 O A o 'v ~e . . C ~ '+ G~ tD o `d -, w ~• ~,~e O o ~' ~ N ~ ~ . ~+ (~,~ ~ m ~ O ~ . -_r 'v ~. ~, c ~~ ~ w w ~ ~ ~ . A ~ ~ A ~ ~ ~ C ^ ~ A y• n aN ~O ~~ ~ Dz ~ ~ a~~~ ~ ~.am ~-'-' ~~ ~c go ~n ~m m ~ 3 0 `D v1 c~c :~o~C $~'~'~~0 ~~~c`~~o~,~C ~ Q ~?~D• O ~ ~ N ~ ~ ~ g~ !~ ~ -• ;Z ~ ~ ~ ~`° ~ ~ ~ Qo~ ~~ ~ O A C!J fD~cQ c ® rd~Z co -~ ~~0 o~ p -- 0~D O ~' A ~ ~ N ~ -~ _ SAAG ca ~ ~_ ~ D p ~. ~~w~° c~~o~~ cc win ~ ~ ~ ~~ C ~ j 0 ~ ~ .~. • rO pp o~ ~ ~ °D ~ o _ ~ r- y < o rn171 cp ~ y A ~' N ~ ~~ ~ -• ~ ~ ~ o o ~ c D '~. n 3. ? coo ~ -n ~ m ~ 5 o~~~ ..• ~ -~~~'~m 0~?3~' = ~ ~~~ o ? Z C7 m m n c O 0 V+ m n r r n 0 to ~~_ ~.' C~ ~ ~~~ ..~ x A. ~~~ ~i~A~ W N ~' g o ~e~ ~ vm"' Tt ~oZ~ to ~ ~ r n• Z .... ~ m~ w C o m •~ 0 ^. ~/ m°m-f ~ ~ r ~ ~ m.. z ~ ~ ~ 1 ~ n Z ~~~~ o~ cm='s ~ ~ vc cA to D ~C r~'' o- m ~ S ~ ~ 0 ~ i ~ ~ h o o a n ~ 3' m `~• o ~ ~ ~ ~. C N ~ ~ ~ 0 a 0 c~ Q n rt Q '~ co- o. N O Q C K 0 g ~ ~ "" ~ ~ ~-'m co ? ~~'~ ~ Q ~ ~ p ~'~ n ~~`~". m ` ~. o <~'.°-~ O ~ Q ~ C ~ rt o ~ O N .~. C m zz~ ~ d ^- ~- M i ~ C ? rn o Q ~. Q m w ~ ~ ~ .. ~ a a~ ~ ~ .« :.; N m 0 ''~ww VI n 0 ~.. ,~ M ~ + ~ ~y iY w W O O n N N n ° ~ w ~ • ~ w ~ ~ w 1 ~ (~ . w ~ ~.. ~ ~ ~ ~ <O p ~ ~ N - to CJ7 O V ./ ~ ~ Cn r C/~ ^~ l J O D ~'' ~ C ~ ~ Z '~ 3 N 0 o ~. C l + • Z ~ ~ J `''T ~ 0 W r ~ ~ c:U ~olan ~c ~Ja~lor - e~awe ~uneral came li!1GdR1~0ftATED t t 5 LAUREL AVENUE NORTHPORT, NEW YORK 11765-3166 JAMES ~. NOLAN JAMES P. NOLAN, JR. PETER J. NOLAN HAROLD R. MOWS MARTIN 8. KONLER DOUGLAS R. ROBiN80N MARK J. NOLAN 631-754-2400 March 23, 2010' Mr. Kenneth .Richardson 10 Oak Lane Mechanicsburg, PA 17050 Statement of Funeral Expenses for. Helen Richardson Date of t3eeth: March 10, 2010 _ .. _ All Professional Services and Facilities Cherges: $5,445.00 Casket: Andover $4,875.00'. Sta#ionery Items and Other Merchandise: $815.00 Automotive Equipment: $395.00' Funeral Home Charge: $11,530.00' Cash Advances Items: Total Cash Advance Items: 54468.00 Total Funeral Charges: $15,988.00 ~'' Less Payments Received by: Mar 17, 2010 $-1 S~!l98.00 Tota! Amount !)ue: $O.OA'~ PAID IN FULL ~~ J. NOLAN ~.. ~~ ~ . 5 - Ly./v ~M~t.s:~- ~ ~ls1~ .~ w~s ~'13gs.so ~,oo~r.~- k ., ~ - .~ 6"f'~ 1 ;~ ` ~'I~rliiri~ ''~~ i31.~~f~9~ ~ lit ~3f.'fl` - . Date. ~„~ ~'~ / l ~~ ~ ;. ~` " _ ~~` :., Pur`k'sset`' " ~a .~ ~ ~ Relatior>shi~ 5'tr~t Adtlress ; ;"~"~ 1 ~` ,, ~Y State .~~ ~ ~ ~~ k Home ~ "~,, s - ..~ . ,~ ~ # ~ ~. 77 mice Phv~e ( ~ WC~ic J Y c Js~ y _ ~ C ~„ ' Purchased- Fa~€ ~.~ ,;, . ~~ ~ - Cate: at'Bii~th, ~,~C ~' L . Qate .of Death . .~ . L k f ~, ,y r• ,,,~ si Cemefi+ery: (~~ .~ 1i~ r .~ n,... 'I r 1 pity: ". State ~~~ _. , , ~~L~ ~'~ ~ • ~, Y t i, Phone Number ( ) , .. , ., ; - Deed ava~t~er , ~~ ~ Sectiort~ ~ Range: Grave: "~ . ~ w. ~~,*~~~ ~S'+3~ r ~ ~ Bi ock: Path:. Plot: ~~ ~"~ Tl ~.~ ~ '" ~ ~~~ ~r ~r ~ ~ .. ~ ~~ ~' ¢$ ;f' in ~ .- •~W il~r; 1 ,~ Z F ~ »~! of ~E ~~ _ t~ - ~.Y7, Q~i~ M M+' ~ ~ , ~: t ~1~'~ ,~ L +yj , 111 : ~ ..... i r ;4'.+ F,. ~. s'A .ry;a ~, . ,+ T q . .. r . .. C ,~j ( }~ ~y~ f'~ ~ ~ ~ P~I{~ i:d ,7~'QC~ Purch~ Price ~,_' j~ {~ j~(~ Top.{i~ ~~~~ ' t11 r ~~~ _ r.. ~ j ~.-' x ~t ~ Side - h~ ~-~~ ~' Bench ~' a Yearly t=local Prograrrr ~~ ` ~'~ ' ,fi,_ Tops ~s~, ~~1tee~:.. ~ t~lamtenar~e Program : ~ ~;; Sides. :Rough Q Smooth ~ ~] Palish C3thtr i =,~ ~~ ~~ ,.4 ~ ., ~„~ ~, >=r~a~-t ; Ra~rgh C~ 5mc~oth ~1 Parlish ~ '~~'a Tit ` " =~ ~ ~`r ' t 'u ~ ~' ~ ~ ywi er`> ~ le~ti i ~` F, j7~ ~~~<y~.~3 :l ~ -~ y(y'~ IMTi . i i . Vases: x ~~ .: ,° ~pi»-l~cetibrr Fee ~~ ,~ : F,.. x~ C©rner Lost: Size:.. ~ Insvil,~e 8~!'(ort Fee. ~ " '~,t ~~ - Beath. Desigrf # ~ ` Co or Deed Received: (!f Regaired} D Yes Na l Dt~ "` ` 5 .~~;;:: ,~0.ffidavit-Restived: Qf Requaed) D Yes. ~ _ 'ist DeposkCP~ Ck-}~- 3~ -~-12-1~ $, Notes: Balance Due ~ "" 2r-d D+ep~ast 6ala~ce Que ~ - FlNdt. PAYi6pt~fitT c ; ._ ~ ~ ;,. -~ ~~~s . ~~, C rocs reads Cafe 26 Laurel Rd East No rthp^ ~f , NY 11731 13 Mary Ann ~. Chk 958 - ,PARTY ast 18 Mar15 i0 11.42AM . ~ ..... r . -----Bar------------- ----------------- .:.. `_ ~ Gewa r~ ~c^~s 8.50 .. ~ - ~ ~ . , :.... ~. .. , . , ,r 9 .,,50 ~y Mary 7.!,50 1 ~~ ~ ; : Uay ~'~a ry 7 . ~~50 - 1 ~. °Pr 2,50 3 Cotree Irish 27.',00 1 Ketel One Cranberry B.Otl 1 Ketel One Granberry 8,00 18 Price Fix Lunch 324. 0 1 Ketpl One 8, 0 1 Vodka Bioady Mary 7. 0 1 Ket2i One Cranberry 8. 0 3 Seaggram VO 22. 0 1 Sambuca Ramona 9. 0 2 Coffee Irish 18. 0 2 G1 Merlat 15.0 2 G1 Chard 15. 0 Open $ Grat. 96..0 Subtotal ~ 505, 0 Tax 28. 5 Totajce Chrg 6°~~ 96~. 0 Thank You for Joining Us Have a Great Day _. .: :~ ~ ~~ . LE T CY SERVICES INC. 219 North Baltimore Ave Mt H~IIy Springs, PA 17065 800-26 -9954 (717)486-8606 www.alertpharmacy.com (STATEMENT ~F AC~tiUNT Dates PMT DUE..03 3 0- DAYS . ,. . , A FINANCE CHARGE OF 1.50 ~ PER MONTH ;( (AN ANNUAL PERCENTAGE RATE OF 18.0) OROR A M~I~TYMUM SLR~'YCR C1~ARGE OF $ 1.0 0 WILL BE C GED ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE 02/1.9/2010 ~ 5 10 RICHARDSON, HELEN 82.18 KEN RI£HARDSON 10 OAK LANE MECHANICSBURG PA 17050 P~EAEE DETACH AID iiET1JRN .TOP PORTION WITN YOUR PAYMENT RICHHE GRP-58 PAGE 1 Amoun# Paid ,~ m a ..sta. ,i,. ~ ~. x ~~ . , . . . ... _. .., , .. , z.y~ : _..~ _ .._ _...~t~ 7 6.61 5 .~ 5 7 ,, ' LEGEND `.~, NOI~~LE FOI? MONTI*i F(~>=. 82 . ~8. + 82~•.18 + I.23 165.59 . a0 "'.. FOR ALL PF~AI~~tAClf RELATES ':PLEASE,CALL Alert Pharmacy Servicos, tt~ at 1 ~OQ6-9R85~t .ae~it~prt-inolo~y oer~r~verse ~.IE~ YOt7 RECEIVE:: A NEW INSURANCE CARD FOR YOUR PR~SCRIPTTONS' BE SURE TO SUPPLY US WITH A COPY. ~~.T~ E 165.59 i E= L, PHAR~CY SERVICES INC. 219 North Baltimore Ave Mt Holly Springs, PA 17065 800-]66-9954 s (717)486-8606 www.alertpharmacy.com S"1"'ATMENT OF AG+~tlNT A FINANCE CHARGE OF 1.50 ~ PER MONTH (AN ANNUAL PERCENTAGE RATE OF 18.0) OR A MINIMUM SERWICE CHARGE OF $ 1.00 WILL BE CHARGED ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE gate 12/ls/2oo9 f R~:.: . RICHARDSON, HELEN RICHHE ;' - KEN RICHARDSON GRP-58 10 OAK LANE PAGE 1 MECHANI CSBURG PA 17 0 5 0 Amoujnt Paid _ __ PLEASE DET'ACN AND RETURN TOP PORTION WiTN YOUR IrAYMENT ,~ ~ r~~,-YOU RECNT A- NSW IN3IIR.~NCF CARD FOR YOUR `"}'~ {`~`EiBSCRSPTIC7NS' HE SURE.: T~ SUPP~,Y: US WITH.. A COPY . ii.3-a ;,, , ... ~?~.LE T PfiXRMACY SERVICES INC. 219 North Baltimore Ave Mt Holly Springs, PA 17065 800-266-9954 ' (717) 486-8606 www.alertpharmacy.com STATEMENT OF ACC~O-U~IT ~:~~ ~. RR ~~~ r ''~i~+.~. _ _._ , ~,• ' ~- ~~ ~_ n A FINANCE CHARGE OF 1.50 ~ PER MONTH ,,J (AN ANNUAL PERCENTAGE RATE OF 18.00 OR A "~ MINIMUM SI~RVICE CHARGE OF $ 1.00 WILL BE CHARGED ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE Date 03/19/2010 PMT. DUE. .04/15/10 RICHARDSON, HELEN KEN RICHAR.DSON 10 OAK f LANE ~' MECHANICSBtTRG PA 17050 PLEAS DETACH ANO RETURN TOP PORTION MII1N YDt~R MY1881~N RICHHE GRP-58 PAGE 1 Amount. Paid - __ _ . .~+'~ SPA . PA 17 0 65 x.,57: 6<.~61c 10.OOc ~o.0oc 6`. Z? ~. 4,a~c 4.7T 1b 5" : 59- 5:1~.F61 16~ r 51 L\`~~~ ~ FOR ~'~. ~'~R. i - "65.5g ~ + 68. l~ + .00 = X33 :.?~ v 16S.5g FORALL PHARMACY RELATED El~IJ1RES PLEASE CAU. Alert Pt~tamaacy Sarvipes~ fttc at 4-800-26f~=J854 ~ t lie~rni~ologY cn reverse, . " ~P'' , YOET ~ R:13CE2VB A, N INSURANCE CARD FOR.. YOUR ~RBSCP2'TONS BR'" SIIRE' TIC} SI<PPL1C' II3' WITH A COPY . oue - 68.12 .;1 .. . ,._ ~ .~ ,. , _.., ;~ ~ WEST SHORE EMS -ALS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 170,11 t x Phone #: {800j 367-0512 Fec~et~al Tax ID 23-2453©02 '' ~~.~i El'IERUENCY 1IEDICAL SERVICES PATIENT NAME: HELEN RICHARDSON INSURANCE: MEDICARE B PATIENT NUMBER: CALL NUMBER: 072166157A DATE OF CALL• 1 OQ41 SSA HELEN RfCHAR~?SON 2100 BENT CREEK BLVD MECHANICSBURt3, PA 17050 TIME OF CALL: CALLER: FROM: TO: ~~ / REASONS, FOR TRANSPORT 1 I ~ 1 ~ o~c~ 89586 MDEN 1004159A ECAR 03/04/2010 BRIDGES AT BENT CREEK HARRISBURG HOSPITAL WEAKNESS -MUSCLE DESCt~lPTION OR CHARGE QUANTITY UNIT PI4~E AMOUNT ALS E1IAERGENCY LEVEL 1 A0999 1.0 879.65 879.65 ANGIOCATH (1424) A0394 1.0 6.07 6.07 GLUCOSE BLOOD A0394 1.0 7.08 7.08 SALINE LOCK A0394 1.0 ,27.56 27.56 otal Chatr~s 920..38 DE9CRIP'170N" OF PAYMENT RECEIPT PAYMENT' DATE. AMOUNT To#a! Credits 0.00 PLEASE PAY THIS AIi~OUNT -INVOICE DUE UPaN RECEIPT -~• RETURNED CHECK FEE - 531.00 Sg20.36 DETAILED INVOICE Service For :Helen Richardson ~ ~ Billed To ; Mr. Ken Richardson invoice #: 1244-0310-1 lnvoice~Date : 3/iS/2010 Service Period : Mar O1, 2010 -Mar 1S, 2010 Total ,., s .,....... ~ y~:s::_~.. r ~ntw~r75 r_.2... .. fi.. .~ ~`~ ice: 0.00 ~ SO.S8 - 50.00. Mnc:altaaecxtis ~ - 50.00 Additional Char~ea/Credits: 50.04 Servicx Deposit Applied: - 50.00 Current Invoice Tobi: 562.85 r Total Amount Due: ~Z,gg Due Date : Due upon Receipt •AU overdue ~~,~ she ou as lax a-at~l sates ~ Home~nstead ~~' 5002 Zenker Streit Mechanicsburg, PA 17050 (717) 731-9984 www.Homelnatead.com Plaaae For Your Racoeela Piave Detach Md Rewen Thin PortiooWiilt Your Payment Payable a Home Instead SeniorGee - STATEMENT OF PHYSICIAN SERVICES ~ PENN~TATE The 1V.GI~on S. Hershey Medical Centex The Ccsllege of Medicine HELEN RICHARDS~N Q I ~ I' 4 ~, 4 ~ SUITE 117 ty.'3_ 2100 BENT CREEK BLVD r/' MECHANICSBUR6 PA 7T050.1 ~ ~ ~ 2 STATEIIIENT DATE: 03l05~'t o LAST STATE~IIENT DATE: O9JZJ/~,9 ACCOUNT # 1HE3431 -~- tF ANY QuEST1~NS, PLEASE COfIi'ACT: MA6HMC PATIENT FINANCIAL SERVICES '., .: ~,:::....:. r: .. .. ..:: :_...:~s p:;: •.~ tom.,..,,;U:::.,s';m.~:rr.~.p •.eY: ^,{:n~i'=,r.':)iMt :: ~.:;,:»•:!: ;:~c;:u:,yrq:r.'.:: •;•;YC:>.;..N R%5:1..:: ~, .... ,,,, ' - _ r_l. e,. ., ~.:.. of :.:. ~.). il'N r~ ;y;~~e ~.. ;r~ ytir~ :°•" 4 ..i ~.~'~~.yl~i'% ~.+•,; ) Yl Sr { . y , '~.i~. ~' ~ 'tor :.~.~ ~.y. _ o-~.' ... ~3sW~5` :.'_ ,.. ,.: L.. i.V ..~~._it_ !.ar. ~:.ass: FED TAX ID # 2S185TOS: 1413si91 PEI~EiEO BY: K,~TfE.EB~t L SEI~LES >!~ PF.MI STATE F~ILY IEA PL~:E OF SViC: SATELLITE ~ OZ/2i/ld 49213 4i6 ~'PATIB!R VISIT EST 162.Q0 ~ O~Jt~i/18 lE~ARE PAYS 0.45 ~ DS/~'iI10 I~E'biG~ Cati'R~G'TUrAL A~ 9d.S9-- ~ 010 !~~ DE~1'IbLE~ i3,~1 6u,.a ~~ ~ - , ~63.4i 1 ~ D~ICA7'ES l~EII FDii~IAL 1CfIVITY SIDE LAST sll.l.. PiY1fN1'S OF 40.OA A~IED TO Yt~ I~1'' D~E~® d+l TNtS BILL. YF YiEI HAVE ~ QI ~!1' TIE lNS:E. ~~ PAID, C~tt'irfa' Tt@I ERECTLY . FIB! N!!Y tR'IER SINS ~ ~ dALN~E, PLEA'RE t'~'1' ~ QI~CE. IF PAYlENt' 1NS I MADE, 1'1IN~C YIRJ MO 8l'All® Ti~S GILL. PI.ENi'E ICE: TD KEEP Y~ ~tf tom', a#t A~LICY IS TD .Y 'Y~ PAC T~ T'1~ OLDEST txtTS~ dAt.~E. Tit YOU T01! t I~i!'C P11l~~CINlS F~ Y4E! PIRSICIMI lE If 1N~J NEYE NiIY` "~1~i iSr T'iQS dILI, PLEA tt'~.T !~ AT 717-531~'iK4 ~ SMt-~rti14, ~E"~EE~I a:00~ ~O 5;3~M MR~AY TAN SAY OR dET1~04 asOQN~ MO 4:3aPM i'Alt NOD FRIDAY. r N O! O 41 r l% +East Fennsboro Ambulance Service, Inc. Post O,~ice Boz 47 Errola, PA 17025 (711) 732-5552 FAX (717) 728 9501 Federal Tc~ac Number 23-2464545 BILL TO Richardson,Helen 2100 Bent Creek Blvd. Mtxhanicsburg, PA 1?050 TRIP NUMBER 10-22231 ~, . PATIENT NAME: ADDRESS: ADDRESS: PICK UP: TAKEN TO: DESCRIPTION: In~+ic~ ._..., DATE INVOICE # 3!10/2010 10-0451 Helen Richardson 2100 Beat Cnxk Blvd Mechanicsburg, PA 17050 Harrisburg Hospital Bridges of Beat Cnxk Wheelchair DATE OF SERV... DESCRIPTION UNIT RATE AMOUNT 3/9/2010 Van Rate 1 Way (Non Member) - A0130 48.00 48.00 3/9/2010 Wheel Chair Van Transport -Mileage Rate - 2 1.60 3.20 For your convenience, we now accept Mastercard, Visa a~td lJiscover. Card ~-pe: Name on card: Credft Card Number ~! _.__ _,~ ~ ~ _ ,_ r, _ ,,,_, ~ _ F.zpiratbn:^ / _ Amoant to be charged: S I agree to pay the above total amount according t+o card issuer agreement. Slgnature• Comments: Your payment ~ due upon receipt. Medicare and moat. insuraoees do sot co.-er this service. If you need to check with your iasnrasu coaapany, please ask ifyour pbtn covers trsnsportation code A0130. Please Note: Unpaid accounts may be sent to a collection agency after 90 days. TOTAL CNJE $51.20 WAGGONER, FRUTIGER & DAUB, LLP CERTIFIED PUBLIC ACCOUNTANTS 5406 EAST TRINDLE ROAD SUITE 200 MECHANICSBURG, PA 17050 HELEN RICHARDSON ESTATE. 10 OAK LANE MECHANICSBURG, PA 17050 CLIENT: ACB-RICHE APRIL 5, 2010 PROFESSIONAL SERVICES RENDERED IN THE PREPARATION OF YOUR 2009 INDIVIDUAL INCOME TAX RETURNS, INCLUDING: FORM 1040, U.S. INDIVIDUAL INCOME TAX RETURN SCHEDULE B, INTEREST AND ORDINARY DIVIDENDS FORM 1040-V, PAYMENT VOUCHER FORM 8879, E-FILE SIGNATURE AUTHORIZATION TWO-YEAR COMPARISON WORKSHEET PA 40, INDIVIDUAL INCOME TAX RETURN PA SCHEDULE W-2S/MC, WAGE SUMMARY, MISC INCOME PA 8879, E-FILE SIGNATURE AUTHORIZATION PA SCH A/B, INTEREST AND DIVIDEND INCOME PA SCH SF, TAX FORGIVENESS TAX PREPARATION FEE $ 150.00