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HomeMy WebLinkAbout08-05-10 (2)1505610140 ""~ REV-1500 ~` ~°'-'°' PA Department Of Revenue OFFICIAL USE ONLY i Bureau of Individual Taxes County Code Year FNe Number PO BOx 280601 INHERITANCE TAX RETURN 2 1 1 0 0 5 8 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 1 9 3 1 2 9 9 1 8 0 5 3 1 2 0 1 0 0 8 1 6 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI B R O W N M Y R O N R (If Appllcatrie) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return 4. Limited Estate ® 6. DeoedeM Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITI~ THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) [~ 7. Decedent Maintained a Living Trust _ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Rel prior to 12-13-I 5. Federal Estelle (date of death Return Required 8. Total Number of i,Safe Deposit Boxes 11. Election to tax u er Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIOENTUIL TAX INFORMATION SH~ULD BE DIRECTED T0: Name Daytime Telephone Nu ber R O G E R B I R W I N E S Q D I R E ? 1 7 2 4~ ~,3 5 3 .,,..: ' S U REGIS ~ NLY ~> ~"_" '~ l3'ta C ~ , ~=!- ~ i~~ ~ :.f _ -, ~ First line of address -~ ~ ~ ~ : . ~~ C 6 0 W E S T P O M F R E T S T R E E T '-~~ r, c -o 5~ - .f~ Second line of address ~ ~ N Y~ '~ --+ '' .. • ~ f~'~ City or Post Office State ZIP Code DATE FI D W C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: Under penaltles of perjury, l declare that 1 have examined this return, irxiuding aooompanying schedubs and atatarnents, and to the beat of knowledge and belief, R is true, correct and complete. Dedarafjon of preparer other than fhe personal repreaerMadve b based on all information of which proparer arty knowledge. E OF PERSON RESPO FOR FILING RETURN D E l0 ADDRESS 34 DERBYSHIRE DRIVE CARLISLE PA 705 SIGNATU REPARER O -ER THAN REPRESENTATNE D ADDRESS 60 WEST FRET STREET CARLISLE PA 7013 PLEASE USE ORIGINAL FORM ONLY 150561D140 Side 1 1505610140' J~ J 1505610240 REV-1500 EX Decedent's Social Security Number 1 9 3 1 2 9 9 1 8 Decedent's Name: Irl Y R O N R• BROWN RECAPITULATION 1. ........................................... Real Estate (Schedule A) 1 2 7 9 0 7 8 2 2. ............... Stocks and Bonds (Schedule B) ....................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) , .. „ ......... . .. . ........ 4. ' ~ 4 0 ~ 9 A ~ 3 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... , .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N-Probate Property ~ 2 8 5 0 9 2 3 Separate Billing Requested ....... (Schedule G) 7. , 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 3 0 5 0 6 . 9 8 9. Funeral Expenses and Administrative Costs (Schedule H) ..... .... ...... ... 9. 1 4 9 4 3 . 5 6 10, Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ...... . .. 10. 3 2 9 0 . 8 4 11. Total Deductions (total Lines 9 and 10) .................. ... ....... ... 11. 1 8 2 3 4 . 4 0 12. Net Value of Estate (Line 8 minus Line 11) .............. .... ....... ... 12. 1 1 2 2 ~ 2 • 5 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for whi ch an election to tax has not been made (Schedule J) ........ .... ....... ... 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ .... ....... ... 14. 1 1 2 2 7 2 5 8 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ® 0 0 15 0. 0 0 (a)(1.2) x .o . 16. Amount of Line 14 taxable 1 1 2 2 7 2 5 8 1s 5 0 5 2. 2 7 at lineal rate X .045 . . 17. Amount of Line 14 taxable 0 0 0 17 0. 0 0 at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 0 0 0. 0 0 at collateral rate X .15 1 g. 19. ........................................ TAX DUE .... ....... ...19. 5 0 5 2. 2 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610240 ~ P Side 2 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21 10 0583 DECEDENTS NAME MYRON R. BROWN STREET ADDRESS 442 WALNUT BOTTOM ROAD CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Oisoount 252.61 3. Interest 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FHI in oval on Page 2, Line 20 to request a refund. 5. H Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) ~ 5,052.27 Total Credits (A + B) {2) 252.61 {3) (4) 0.00 (5) ~ 4,799.66 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROP~2IA~TE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefrts or care7 ....................................................... ^ 2. ff death oaxrrred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an 'intrust for" or payaf~le-upon-death bank arxount or security at his or her death? ......... ^ ', 4. Did decedent own an individual retirement arxount, annuity or other non-probate property, which contains a benefiaary designaGon? .................................................................................................. ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS P/~RT OF THE RETURN. For dates of death on or after July 1,1994, and before Jan.1,1995, the tax rate imposed on the net value of transfers to or for thy' use of the surviving spouse 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spe~rse is 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 requiremen{t~ for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefiaary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use ~f a natural parent, an adoptive parent or a stepparent of the child is 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 benefiaaries is 4.5 percent, except ~s noted in 72 P.S. §9116(1.2)172 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ', REV-1503 EX + (8-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MYRON R. BROWN 21 10 0583 AN property johrtlyowned with ripM of survhrorship must be dfecb:ed on Schedule F. ITEM I VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 456 SHARES OF PNC FINANCIAL SERVICES GROUP, INC. STOCK 27,843.36 456 X $61.06 = $27,843.36 2. SERIES EE SAVINGS BOND -INVENTORY ATTACHED 64.46 TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert addfional sheets of the same size) REV-1508 EX + (8-98) CONMAONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER MYRON R. BROWN 21 10 0583 Include Ure of Iitlgation and the date the proceeds were reoeNed by the estate. AN property hdlyowned wNh right of aurvNorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CITIZENS BANK -CHECKING ACCOUNT #6100729443 74,089.93 TOTAL (Also enter on line 5, Recapitulation) ~ ~ (If more space is needed, lesert additional sheets of the same sine) REV-1510 ~JC+ (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANS~EFi$ AND MISC. NON-PROBATE PROPERTY FILE NUMBER MYRON R. BROWN 21 10 0583 This schedule must be completed and filed H the answer to any of questbns 1 through 4 on page three of the REV-1500 b yes.. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAAAE OF THE TRANSFEREE, THEIR RElATIONSFNP TO DECEDENT AND THE DATE OF TRMSFHt. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXC USION PF TAXABLE VALUE 1. CITIZENS INVESTMENT SERVICES #L7C-009342 28,509.23 100.00 28,509.23 BENEFICIARIES: WILLIAM P. BROWN MYRON R. BROWN, JR. DONNA J. WILES TOTAL (Also enter on Line 7, Recapitul~ion) ~ : 28 509.23 If more space is needed, use additional sheets of paper of the same size. REY-1511 F.X+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS t~ ~ Ar t ~ FILE NUMBER MYRON R. BROWN 21 10 0583 Decedent': dells mud be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 8 CREMATORY, INC. 8,081.28 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commissbn Paid: y, Attorney Fees: IRWIN & McKNIGHT, P.C. 6,000.00 3. Fatuity Exemption: (If deoedenCs address is not the same as claimants, attach explanation.) Cla~rrant Street Address City State ZIP Relationship of Claimant to Deosdent 4. probate Fees: REGISTER OF WILLS 190.50 5 Accountant Fees: 6. Tax Retum PreparerFees: PATRICIA A. ROSENDALE, CPA 350.00 7. REGISTER OF WILLS -FILING FEE 30.00 8. REGISTER OF WILLS -SHORT CERTIFICATES 8.00 9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 10. THE SENTINEL -ESTATE NOTICE 2pg.78 TOTAL (Also enter on Line 9, Reco3pitulation) I S 14.943.56 If more space ~ needed, use additanal sheets of paper of the same size. REV-1512fX+ (12-08) Pennsylvania DEPARTI~NT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE( DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS w ~ w ~ ~ yr FILE NUMBER MYRON R. BROWN 21 10 0583 Report debt incurrod by the decedent prior to death that remained unpaid at the dabs of death, including unreimbur:ed ical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MILLENNIUM PHARMACY SYS -MEDICAL 113.53 2. ITHORNWALD HOME -NURSING 3. CITIZENS BANK -REIMBURSEMENT OF SOCIAL SECURITY PAYMENT 4. (CARLISLE HMA -MEDICAL TOTAL (Also enter on Line 10, Recapitulation) If more space is needed, insert additional sheets of the same sine. 1,863.52 1,200.00 113.79 84 REV-1513 EX± (01-10) Pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIAaIE~ INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUN~ER: MYRON R. BROWN 21 10 0583 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(=) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright I distributions and transfers under S 91 ~ ec. 6 (a (1.2).] 1. WILLIAM P. BROWN Lineal 37,424.20 34 DERBYSHIRE DRIVE 1/31 REMAINDER CARLISLE PA 17015 2. MYRON R. BROWN, JR. Lineal 37,424.19 525 CRISWELL DRIVE 1/31 REMAINDER BOILING SPRINGS PA 17007 3. DONNA J. WILES Lineal 37,424.19 507 CRISWELL DRIVE 1/3 REMAINDER BOILING SPRINGS PA 17007 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HE , AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: L ~, TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIB TIN N U 0 S 0 LINE 13 OF REV-1500 COVER SHEET. S If more space is needed, use additional sheets of paper of the same size. ~18l1 ~l epa ~R148g1lM I, MYRON R. BROWN, of Monroe Township, Cumberland County, Pennsylvania, do make and publish this as and for my last Will and Testament, hereby revoking any and all Wills heretofore made by me. 1. I direct my executrix to pay all of my debts, funeral and administrative expenses~as soon as convenient after my decease. 2. I authorize and empower my executrix to sell any realty and/ or personalty owned by me at my death,. and not specifically be- queathed or devised herein, at either .public or private sale or sales) and to give good and sufficient deeds and/or bills of sale therefor, 1 in fee simple, as I could do if living. My executrix is authorized and empowered to continue to engage in any business in which I may be engaged at my death, for a period of one year after my death. 3. All .the rest, residue and remainder of my property, real i and personal, I give, devise and bequeath to my wife, Gladys V. Brown. 4. If Gladys V. Brown should not survive me for a period of 60 days, then I give, devise and bequeath all my property, real and ;personal, to my three children, Myron, Jr., Donna and William, share sand share alike. 5. I nominate and appoint Gladys V. Brown to be the executrix of this my last Will and Testament without the filing of any bond. Should she d1e before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominat e and appoint Myron R. Brown, Jr., Donna B. Wiles and William P. Brown as substitute executors with the same powers as are given here- in to my executrix and also without the filing of any bond. 6. I suggest that my personal representative retain the services of Irwin, Irwin & Irwin, Carlisle, Pennsylvania, as attorneys in the settlement of my estate. WITNESS my hand and seal this ~/'=day of July, 1976. (SEAL) Signed, sealed, published and declared by the within named testator, as and for his last Wi11 and Testament, in our presence, who at his request, and in his presence and in the presence of each other, have hereunto set our names as~sLub-sc~ribingf!~~i~tn~e~sses. rjv~: nistoncaj rnces ror rjv~ ruiancia>. services ~iroup, t -Yahoo! rmance rage i of ~ - Hi, Karen ' SS.ig~n~O+•u~t ' Help Upgrade to Safer IE8 Yahoo! Mail ~~~a,_s~..,/g FINANCE Search Web8groh~ Dow ~ 1.07% Nasdaq ; 1.589b HOME INVESTING NEWS 8r OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER ~- , GET QUOTES Finance Search VVed, Jul 27, 2010, 4:47PM EDT - U.S. Markets dostpd PNC Financial Services Group Inc. (PNC) At 4:OOPM EDT: 58.54 i o.40 io.6A'/.- ,-,~ tt+ ..~~ 1 .~ M. .. ":... ~.:. :....:.. ...,.. Historical Prices cec NtaEOrical Prirxs ror Go SET DATE RANGE Q Daily Start Date Jun 1 2010 Eg. ]an 1, _..__ __..._ ... .............--_..._.. zoio O WeekN _... End Date: Jun 1 :2010 E~ Mornhly Q Dividends Only Get Prices First ~ Previous ~ Next ~ Last PRICES Date Open High Low Cbse Volume Adj Clone Jun 1, 2010 62.21 63.75 61.12 81.16 3,816,300 61.06 ' Close prke adjusted for divklends and splits. First ~ Previous ~ Next ~ Last ~'tDsnemload to SQroadshrtwt ~:<_ ~.. ; ~> ' ~ _. J2 ~ D ~~• 111/// 1r 1i Copyright ®ZOt 0 Yahoo) Inc. All rights reserved. Privacy Pdk:v -Abed OurAds -Terms of Bahian - CowridsllP Poilcv -Sand Fesr~adc - Yahoo) Naves Network Quotes are real-tlma for NASDAQ, NYSE, and AmexSee also delay tknes for . Atl intomredon provided'ss is" for intomtational purposes on,y, not intaxbd for fradirp purposes a advice. Neiltrer Yahoo! nor erry of independent providers Is ilable for arty infonrretlanal errors, . for any adfons Taken in reilanee an krbrmatlon contained herein. BY acoessMg ttrs Yahoo) sits, rncompbtsness, or delays, pr Time contlrxwus straamMg quotes are available through ow pQ~, You may tam strsaminp quotes on orredlalrlbute ~ ~~~~ found therein. Real- Fundamenfal comparry data provded uy ~ jQ. HistodcN Bran data and daly upda6es provided by Cmnwaty Svarma. inc. (CSII. Intemetlonai Mstoncal dart data, deify updates, fund summary, fund performance, dividend data and Momirpstar Index data provided by , Jpg, http://finance.yahoo.com/q/hp?s=PNC&a=05&b=1&c=2010&d~5&e=1&i=2010&g--d 7/21/2010 .~ a>~ i aaaa PNC The PNC Financial Servers Group 009870 Ilirlll"III'Il'Ir'rlllirrllll'it'I"'Irillllllil'Illll"Ilrr'I'I MYRON R BROWN 34 DERBYSHIRE DR CARLISLE PA 17015 Providenc Within USA, US territories 6 Canada Outside USA, US territories 6 Canada Computershare PO Box 43018 e, RI 02940-3078 800 982 7652 312 360 5235 ,, 000096253?2 I N D aac«d oaw 1s I-pr 2010 - CMdc Number.. 00004l69Rt SSNRIN Carlitiad Yea F~11 ©r~up, lt~~. - i~vldend Payne Reoei+-e your dividend faster and more effit~ently! Sim up for fired deposit of your dividends to your ci>eacing tx savings account. Simply complete, detach and mail the enrdlmertt fam located on the reverse side. Dividend Confirmation nt D t I P tion I Participating I Cl s D sc i Dividend I t3ross I Deduction Dedktetion Net ayme a e as r p e Rate Dividend ~) I Amount (:) I Type Dhridend (;) zanpr2oio co~oNSTOac ass so.toooo assa coo wA as.6o Yar-To-0aEa Paid `' 91.20 0.60 81,20 1UDC PNC "~' i~00004 5808 ia' x:06 i L i 2 ?88~: 3 29 90 5 i L ?96' __ __ -_ .~- 0 d rn ca a o vI ~ N N ..... ~~ O C ~t .~ a C m i ~• C _.. 0 0 ~c~ > °txt o ~~~~ ~~~ Z 2~ ~~ a ,~ s~~~ ,~ N c° ~$~ Z ,~ _' NNo ~c~~ ~mm~'a ~~r~ ~~ ~~m~ ~ m~~~ ~~ ~ iu ~ ~' c z~~ g N ~ Q1 M ~ .~ W~jr 'Ct..t~ ~~~~~ ~ T= ~zg-°$ ~_ • ~ ~n t~~jp°~ ~mC N~ C ~ C ~ C~~~r $'~' ~+'!'u~ ~d3~~ ~ww ~ cod co .r-~ ~i ~ .`~ U q v~ n `~ ~~~ N ~ ~ C C~ ~ ~~$~ ,~ ~~ • ~a. y.. ~~ ~~ ~ ~ ~ ~ ~ One Citizens Drive ROP 112 . ~ Riverside, RI 02915 July 2, 2010 Law Offices of Irwin & Mclaright, P.C. West Pomfret Professional Building 60 West Pomfret St Carlisle PA 17013-3222 €, v G~.f ~!d aRWIIV ~~ (~flcrtiU16'i~r '.A~,'J OFFICE Estate of Myron R. Brown Date of Death: May 31, 2010 SSN: 193-12-9918 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For II, or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667 Sincerely, Kelli-Jean Paiva Decedent Account Processing Citizens Bank- Account Number 6100729443 Account Title M n R Brown Sr Date ed 1/24/1983 Account T e Checkin Princi al Balance as of DpD $74087.19 Interest from Last Postin to DOD $2.74 Account Balance. as of DOD $74089.93 YTD Interest to DOD $20.38 m a~~~ x ~-+m~etaz ~~ Vf 7o r-i O .< ~ w,u, - -vss~Z~ ~U a s-~s ~~v o ~ o ,~~f:~;~~ff='' ~ r 8117 ~ tle Z g ~ ~ ~i'i ~°~ ~ ~ m ~7Di ~'r "' lit: i';~ ~ N1 O fA - !V ~~ ~p7 ~ :~~ ~ Z ~ ~ ~ ~' ~'' iji; ~ ~ n ~__ ~ x ;iEi.., ?~ O O ~ t+ ~- W W Nv ~v ~- ni D i.y . sad O ,~ ^ I:iv S S o 0 yi i J 0 ~~ O O W~ O ~~ ~~ CdC O ~~~yQ "O d .~ O 4 H ~~ N a ~!J rrr~ w~_, „ ~~ Z. r V I ~I b~ 11 ~""T ~~ • ~:- __ „ - / ... ~- FUNERAL HOME ~ CREMATORY, INC. 219 North H~ovet Street Cargsle, PeruuyNania 17013 717.243.4511 toll free 1.866.451.4511 fax 717.243.3723 www.hoBrr~arxothcorn infu~txroth.oxn June 15~ 2010 William Brown 34 Derbyshire Drive Cariisie, PA 17015 . Statement of Funeral Expenses for. Myron R. Brown, Sr. Date of Death: May 31, 2010 ~ Account Id:1~95&132 PACKA®E: ~. Traditional Funeral Service TRADITIONAL.FUNERAL SERVICE PACKAGE $ 4,350.00 . ~ Sub Total: ; 4,350.00 MERCHANDI8E: • Casket: Christian II $ 2,790.00 Bub Total: ~ ~t,780.00 TOTAL FUNERAL HOME CHARaEB: ~ $ fi,140.00 CASH ADVANCES: 6 Certified Death Certificates at $ 6.00 each $ 36.00 Newspaper Nonce -Sentinel $ 162.14 Newspaper Notice -Patriot $ 92.72 Clergy $ . 175.00 Flowers $ 159.00 Additional Flowers $ 50.00 Organist ~ $ .100.00 Video Tribute $ 166.42 Sub Total: S 1i41.~ Total Payments Made: ; 7,052.95 iBalance: ; 1,028.33 SERVING OUR COMMUNITY SI E 19 _~ L_ L ~ -5 5 0~/13/10 Barter & 1 12.00 12. ' 503.48 - 18/ib -05/19/1 & Board -Private 2 263.00 526.. I ~.~ 5/20/10 - 05/26/1 & Board -Private 7 263.00 1,841.. 1,863.52 Current 1-30 Days 31-60 Days 61-90 Days Over 90 Dsys Amount Due .00 2,379.00 -515.48 .00 .00 Statement' Date: 06/01/2010 Dui Date:06/25/2010 Myron R Bnrnrn, Sr. -Account #: 1165 Thornwald Horne 442 Walnut Bottom Road Carlisle, PA 17013 Telephone: (717) 249-4118 • ~ ~~ .' ins ~arlk ROP440 I Citizens [hive Riverside, R102915 June 18, 2010 ESTATE OF MYRON R BROWN SR 34 DERBYSHIRE DR CARLISLE PA 17015-9259 Dear Sir or Madam: ACH Operations is in receipt of a "Deceased Notice" from the US Treasury (SSAI) for direct deposits in the name of MYRON R BROWN, to account 6100729443 dated 06/03/2010 in the total dollar amount of $1,200.00. The benefits were paid after'~the date of death listed as OS/31/2010. Our records indicate the account balance of $0.00 which is insufficient to meet the obligations to the government. Therefore, according to the rules and regulatiorns of the bank, we require restitution from the ESTATE in the amount of $1,200.00. We have placed a hold on account number 6100729443 until restitution is made. If restitution has already been made to the government, please forward copies (frgnt and back) of the check and receipt for payment to: ACH OPERATIONS , RQPj440- ACH, Citizens Bank, l Citizens Drive, Riverside, RI 02915-3000. If restitution has not been made directly to the above agency, please remit a check payable to "Citizens Bank" to the above address. Sincerely, SandraDe. ACH Operations i