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HomeMy WebLinkAbout09-29-10 15O5610],D1 RSV-15~U E>tia~ -~o, ~~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY oir~NiN[NibFMll[NNi County Code Year Flle Number Bureau of IndividualTaxes Po Roxa8osol INHERITANCE TAX RETURN ~~~ ~ ~~~; ~~---"~- -~- ~ ~ ~ G ~'` ~ ~ Harrisburg, PA ~7~&o6os RESIDENT QECEDENT s ; E ~ i ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 186-24-8068 1 06/30!2010 ~ ~ 09/1 511 91 1 1 I Decedent's Last Name _.____-.__._._._.. _.._._. _.~_ _~._-__- Suffix Decedent's First Name Mi STEALER I , IDA (If Applicable) Enter Surviving Spogse's information Below Spouse's Last Name Suffix Spouse's First Name M) ------ ---- --- - --- - -------- N/A .....__......._._ ...._ _-_ ___ j --- r--- ~--------- I - _ ____ Spouse's Social Security Number ~ ~---~---- - i THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ _~_~ _~( REGISTER 0~ WILLS FILL IN APPROPRIATE OVALS BELOW C>b 1.4riginal Return G~ 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) Q 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax F~eturn Required death after 1212-82} ~ 6. Decedent Died Testate p 7. Decedent Maintained a Living Trust 0 8. Total Number of 5afe~ Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9, Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death t~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Bch. O) CORRESPONDENT -- T}IIS SECTION MiIST 8E COMPLETED. ALL CORRESPONDENCE AND CONFlDENTiAL TAX {NFORMATiON SHOULD BE DIRECTED TO: Name _ Daytime Telephone Number _-__-_.-._.._._. _ _ _..- ~ 'Andrew H. Shaw, Esquire ~ ; • 1 ~ ~ (717) 243-7135 RPGIS'r1;R Ql= WILL5 !USE ONLY r~,a c~ <._1 r' Flrst line of address ~ Q ~' ~ - -. 2D0 S. Spring Garden St ~ ~ ~ f~'~ ~rn~ry ~-- ~ "~ ~ f I __ _. Second line of address -~^------ ----- _. + ~ `.. ^" ~ .. _ ... _.._.. -..._ .-__ - _-_------------------ - --- - -- - - ~~ ~ rn N -- ... - _-. .____~.. `~ ~? ~ i `-~ I Suite 11 ~ ~-~ ~~ `~ ;, l ~ ~ T _ _ _.... __.~..._---- --------.. City or Post Office d.__..._ , ~ State ZIP Code [;I~ ~ ~~ -- (Carlisle I ~ ~ PA I ~ 17013 --© r"' '~ ~_ > ~-1 .. . __ ___-.- -.T_____.____~ ~ ~____._..._.-..----.__._..______ ~ Correspondent's e-mail address: andrew@ ashawlaw.cam Under penalties of perjury, I declare that I have examined this return, Ineletding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and co ete. DedaretMn of preparec nibs( than the personal representative is based on all inlornnalion of which prepare( has any knowledge. 7U OR FILING Rf;'i'URN ATE ~ ~ ~ r~ DR S 97 Creek Road, r , PA 17019 SIGN RE OF P E T R THAN REPRE5ENTATIVE DATE 200 S. Spring Garden Street, Suite 11, Cariisie, PA 170'13 PLEASE USE QRIGINAL FORM ONLY L 150561~1~1 Side 1 150561D301 J ~~~til 1 1505610105 .J REV-1500 EX Decedent's Social Security Number Decedent's Name: IDA L. STEALER ' 186-24-8068 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 106,837.50 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Safe-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 0.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property 0 00 (Schedule G) O Separate Billing Requested........ 7. . 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 106,837.50 9. Funeral Expenses and Administrative Costs (Schedule H} ................... 9. ' 975.02 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 4,343.24 11. Total Deductions (total Lines 9 and 10) ................................. 11. 5,318.26 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 101,519.24 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. ;, 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 101,519.24 TAX CALCULATION -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 .0 00 0.00: 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 101,519.24 16. 4,568.37 17. Amount of Line 14 taxable 0 00 0 00 . at sibling rate X .12 17_ . 18. Amount of Line 14 taxable 0 00 0 00 . at collateral rate X .15 ~ g . 19. TAX DUE ......................................................... 19. 4,568.37 20. FILL IN THE OVAL !F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Slde 2 1505610105 150561105 J REV-1500 EX Page 3 Decedent's Complete Address: 0.00 DECEDENT'S NAME IDA L. STEALER STREET ADDRESS 801 North Hanover Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits; 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 228.42 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. 4,568.37 228.42 0.00 0.00 4,339.95 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 :.......................................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ Q c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 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? .............. ^ x^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ !F 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 spouse 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 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 vn the net value of transfers from a deceased child 21 years of age or younger at death to or for the Lise of 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 beneficiaries is 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 sib{ings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ti"`~.! ~ _... LAST WILL AND TESTAMENT ~ --~.~ f _$ ~~~ .~ Ida L . Steager ' _~' ~~; -; , ,_ . ,:~, _., . I, Ida L. Steager, of Carlisle, Cumberland Coi~~a~~~;' =-~- ,- ;, Pennsylvania, being of sound and disposing mind, me'~nory arf '~~~~ ~~ understanding, do hereby make, publish and declare this as my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon aftE~r my death as conveniently may be done. If_ there be no cemetery i;t available for my interment owned by me at the time of my ~E_ ~'~11, L dtJt~'lorl~~e r[1~% ~J~t.SuTlct_L i~~'j~r~~Sen~cz-C i Ve t_o ~Jl~i t'r'_~dS~ .~ cemetery lot with a contract for perpetual care, using funds from my estate in an amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of the lot purchased to be vested in a person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in an amount as my personal representative shall consider necessary and desirable fo:r the purchase, erection and inscription of a suitable marker for my grave. Page 1 of 6 ,~fy ~ ~j r ILS SECOND I give, devise and bequeath one third (1/3) of m~j estate to my husband, Howard Steager, if he should survive me by thirty (30) days, pursuant to current Pennsylvania's statute 20 Pa.C.S.A. ~ 2203 or the then applicable elective share requirement. THIRD I give, devise, beque"ath the rest, remainder, and residue of my estate, to be equally divided between two of my sons, Marlin D. "Bud" Steager and Dale H. Steager, per stirpes. I do not want H. Glenn Steager to receive anything from my estate, FOURTH In -the event that my husband, Howard Steager, fails to survive me by thirty (30) days, I then give, devise and bequeath all the rest, residue and remainder of my estai~e in equal shares unto two of my sons, Marlin D. "Bud" SteagE~r, and Dale H. Steager, per stirpes. I do not want H. Gler.~n Steager to receive anything from my estate. FIFTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Page 2 of 6 ~-~ t~,,~,, ILS Will or otherwise shall be paid out of the principal of my residuary estate. SIXTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrumf~nt, in his absolute discretion: A. To retain in the form received, or to sell either at public or private sale any real or personal property; B. To exercise any options to subscribe for ~>tocks, bonds, or other investments; C o To j oin in any plan. of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust. may hold stocks, bonds or other securities; D. To sell, transfer, convey, mortgage, pledgE~, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; Page 3 of 6 ;~~' ,~ ILS E. To make settlements and compromises on such terms as my personal representative in his sole discretion may deem wise without the necessity of obtaining any court approval thereof; F. To make distribution hereunder either in cash or kind, as my personal representative, in his discretion, may deem wise. SEVENTH " I do hereby nominate, constitute and appoint my son and daughter-in-law, Dale H. Steager and Rita Steager, to act together as Co-Executors of this my Last Will and Testament. However, if he or she are unwilling or unable to act as ro- Executors or either Dale Ho Steager or Rita Steager obliE=ct to the oi,~~er Executor acting in the capacity of an Executor, then both are disqualified and I direct the duties of Executor to be performed by my grandson, Kevin Steager. Eighth I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Ida L. Steager, have hereunto set my hand and seal to this my Last Will and Testament, Page 4 of 6 r ILS consisting of six typewritten pages, the first four of which bear my initials in the lower right-hand corner for identification, this _~ day of (V~~1~`P.yyt~z~ 20~'. Ida L. Steager Signed, sealed, published and declared by the above-named Ida L. Steager, Testatrix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. F~"~--~:~,~J;~~ ~ -,-~~~~• Z~DDRESS : 125 Hayward Heights ~risha ~,JWart !~1en Rock, PTA 1732 i ~'~~ J ~.., ~ ADDRESS: 500 Whiskey Spring Rd. Jason Mathis Boiling Springs, PA 17007 Page 5 of 6 CONIl~IONWEALTH OF PENNSYLVANIA COUNTY OF CUN~ERLAND We, Ida L. Steager, Trisha Cowart, and Jason Mathis, the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that executed as; her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Ida L. Steager, Testatrix ~j y. Trisha Cowart, Witne=s ,- ' /~ ,/ i~ Jason Mathis, Witness Subscribed, sworn to and acknowledged before me by .Ida L. Steager, the Testatrix, and subscribed to and sworn or_ ._..._- affirmed to before me by ~rIS~ Q, C~U~f(~,.r~ and lJ ~..1 Qcs witnesses, this /~~~1 day of /~G11~~~~-~ 20~. /~r~_ Notary Publi NOTARtA~ SEq~~'°"'° Susan J, Lamma, N 8orou °t°rY Publtc Page 6 o f 6 9~ of Cr~rllsfa, Cumbarfcind County My Commission Expires May 2 2(~q REV-1502 EX+ (11-08} ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER IDA L. STEALER 21-10-07E~4 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant Facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. Detailed Results for Parcel L5-~4-u~ ~ ~ - DistrictNo 25 Parcel ID 25-24-0811-275. MapSuffiz HouseNo 411 Direction Street RENO STREET Ownerl STEAGER, HOV~ARD P & IDA L C/O PropType R PropDesc LivArea 1256 CurLandVal 20000 CurImpV'al 65470 CurTotVal 85470 CurPrefVal Acreage .08 CIGrnStat TagEz 1 SaleAmt 16500 SaleMo OS SaleDa 29 SaleCe 19 SaleYr 74 DeedBkPage 0025Q-00044 YearBlt 1901 HF File Date 02/03/2005 HF Approval Status A Z75. in the 2004 Tax Assessment Database r ~-~ ~c / ~~- REV-1511 EX+ (10-09) ~ pennsylvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBEit IDA L. STEALER 21-10-0764 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Parthemore Funeral Home & Cremation Services, Inc. 40.52 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP Z• Attorney Fees: 3. Family Exemption; (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5. 6. 7. City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: ZIP 600.00 334.50 TOTAL (Also enter on Line 9, Recapitulation) I $ 975.02 If more space is needed, use additional sheets of paper of the same size. _ _ __. , ~,,,~ ~tN-15-2010 (lJEO) 20 ; 37 717 240 0924 7 P. 009 03/23.'1995 2L:33 717-240-0924-7 STEALERS COUNTRY OUT PAGE 09 ~~. 1 ~ ~....-~--~ Mr. Oale H. Stenger 97 Creek Road Dillsburg, PA 17019 PARTHEMORE Funeral Home & Cremation Services, Inc. August 10, 2010 1303 Bride Strict P,Q. Box 431 New Gumherlaild, PA 17O7A (717) 77a-7721 {Fax) 774-554h www.parti~~~mc~cc,cam o>>~rc w. p<<nn~~„t~rr. Founder Gi1beR J. ~'a~thcmurc, Supervisu~~ Stephen K. P~rthempr~, CFSP Btvice it, harth~~t~lc-r~•, Pre-Need C'c~c~rdittate~r. C'PC' 'rofessic~nai Mcmbcr.hipc; •1FD,A • P~'DA ~CFDA, • ('CFUA e,,-,,,.n~..r+-titr.~~.Jr 7 ~c Rwlr 1'da Jl'N<r1~'. Dear Mr. Stenger; The following items were either not funded ar not guaranteed in the pre- arrangements for Ida Leona (Cutman~ Stenger: ,A.. ~'axx~i~y Tradition CJf ~axir~g'"' Actual Cost As Funded Death Notice, Harrisburg $ 165.52 ~ 200.00 Certified Death Certificates 60.00 G0.00 Hairdresser 40.00 40.00 Tent & Cemetery Equipment 175.00 175.00 Clergy Honorarium 150.00 150.00 Additional Clergy Honorarium 100.00 -0- Organist 125.00 -0- Fiowers, Casket Spray 200.00 200.00 Grave Opening 450.00 600.00 Subtotals: $1465.52 $1425.00 Qifference: ------- - $ 40.52 Total Due: X40.52 1~~. .- ~ I~ ~~Is Please call if you have any questions. Thank you. klc r. .r. REV-1512 EX+ (12-08) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT E5TATE OF FILE NUMBER IDA L. STEALER 21-10-0764 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. msnts ieese contact Michele Shughart at Ext 3095 with any questions resarding your biNing statement.. Thank you and have a great day.. ~-_-e. -- ~ $o.oo ~se4.oo ~. $~a6.Za ~- $o.oo ~o.oo $~,~~0.28 . ~ .._.... ~ ~ ..... ..v................_._._ . ..,..... ~ Deacrlptlon Days/ ~~ '~il~ _.__~.~ Chargiq~/ Payttrtents 6Alsncs .. ~.U :~~~ Balance Forward $1,190.39 51,190.39 4/10 -06/27/10 Room 8 Board 4 $241.00 S9t34.00 62,164.39 7/13/10 - D7113/10 Payment Check t! 2137 $1,044,19 51,11 TOTAL 6ALANCE DUE: ~)Ty / 51~440.6d ~~Sh~~ 3~ pl. a~,~ rlw~~ `CtLITY NAME RESIDENT NAME MRS. IDA L STEALER ACCOUNT NUMBER 802733 w L-bZ60-0bZ-LZL ££~0Z 566t/£ZI£0 Z~~02 (03(h)0t02-51-d35 awtl/a~e0 xa `LURCH OF coo HOME, INC £0 3Jad 1f10 1~~l1N(10~ S~3Jb31S X00 'd Z V260 OD2 Z t Z _. ..,.,~ ~tN-I5-2010(~JEO) 20:37 03123/1995 26:33 717-240-0924-7 717 2a0 092a 7 STEALERS COUNTRY OUT p. ooa PAGE 04 Cisim questionsT P{ease cau 717/249-2482 •A~Yaunts pending w#th insurance are not included In the balance due. You will be biNed once your insurance responds to our ctefm. ACCT: 010219-00 CURRENT 30-60 DAYS 60-90 SAYS so-~2o oars OVER 120 DAYS INSfaAWNCE 0.00 0.00 0.00 0.00 0.00 PATIENY BALANCE 5 .0 0 0 .0 0 0 .0 0 0.0 0 0.0 0 ~~ ~ 5 CARLISLE DERNtATptOGY ASSOC PC ~ , 850 WALNUT 80TTOM RD 9TE 30 t ~ J, ~ ~ ~ 7 717-245-0272 CARl18l.E. PA 17013 PATIENT DUE (~ X35.00 L ---~--~ 16168-39Q9 `TOXOWIN4F00001 10 '~~~~~~~~~~~~~~~~• Rx Oate/Time SEP-15-2010(41E0) 20;37 03/23/1995 20:33 717-240-0924-7 „~„~,~ ~ PATIENT NAME Ida L St~a,p~r DATE 06!22110 ADJUSTMENT 06/22/10 INSURANCE PAYMENT 717 240 0924 7 P. 002 STEALERS COUNTRY OUT PAGE 02 PATIENT A OUNT DATE 0 TYPE tiVl E 94b5910 05/24!2010 xNPATIENT DESCRIPt10N PA 40,594.89- 15,721,~74- PAYMENTS AND CNAR~f3 RECEIVED AFTER THE STATEMENT GATE Wlll BE REFLECTED OM THE NEXT STATEMENT. ~ ; ~ ~ 1 ~ j , 56 0 , 0 g ' As of today, we have not received payment in full on your account. Immediate payment Is required, please contact our business otflce today. t=QR 8tLL1NG ©UESTIONS, PLE'.ASE CALL: ~» 7~ sso-, sso P 1. ~r ~ ~~~~ -~ I, Bills can be paid onllns at our hospital Internet web s!t tda L Stee~er• DATE 07/12110 ADJUSTMENT 07112!x0 INSURANCE PAYMENT ~"O~ ~' L ~ , o ~ f-3 ~ o i~.~o 9466730 06/24/2010 :INPATIENT DESCRIPTION PAYMENT/ADJUSTMENTS 15,537.29- 6,509.16- ParMENTS aND CHARGES RECEIVED AFTER THE STATEMENT DATE Wlll BE REFIECTEO ON THE NElR STATEMENT. ~ ~ ; ~ ~ 4 7 S 0.0 0 amount shown on this statement is outstanding at FAR BILLING QUESTIONS, PLEASE CAS ~~°~ The this time. Your prompt payment wit! be greatly (717) 960-1680 ~ yK' pJ, g~~~ ~ a g-D ,c~ appreciated. ~~ ~ o S i i Bills can be paid online at our hospital internal web si~s 1NW1H.Car11llel'f11C.C0l1'1 ~ •~ PoN RECEIP _...,. ~r.r- ~ 5-2010(tJEO) 20:37 717 2a0 0924 7 P. 006 03/23/1995 20.33 717-240-0924-7 STEALERS COUNTRY OUT PAGE 06 ` '~' P'L.GMJG Vi..l/hv/ l / 11-f 1f- M/fa/ ..~ . v...• . v. . ve •..vr. ...... .. ~ _ .....-.... ~ l If you have any questi~~ns or concerns about you statement please call 1-500-420-9729 t. 111. ' 11110 IDA Cheat Xray Stngte View 71()10 7H6.2 TEGX 69.30 2.71 Patient: STEAGER, IDA - 237237 06/Q4/2010 Humana Gold Classic 10.K7 ss.71 Applied towwards Coinsurance I I/i (f IDA Traa~~pportat;ou Xray lttl0"f0 786.2 TEGX ZOO.Oq 32.114 Patiesnt: STEAGER, IDA - 237237 061Q412010 Humana Gold Classic t2K.14 39.K2 Applied towards Coinsurance i 1/10 IDA, Set Up Fee QI1t1~I2 786,2 xECX 2ti.6t1 3.A8 Patient: STEAGER, IDA - 237237 06/04/'201() Humana Gold Classic 13.9:3 11.19 Applied towards Coinsurance MAKEY4UF1 MOBILE X RAY IMAGING INC CHECKS ~ 945 BAST PARK DR PAYABLE TO SUITE 1 U2 MARRISBUI~G. PA 17111-25(14_ C(aMMENTS: If you have scut payment in full discegard dais notice 237237 3x.za SEE REVERSE SIDE IF AN INSURANCE MESSAGE APPEARS ~ $~g~Z4 1.J , ',5 ~ n1 ~ ~L r ~~l~r~rr~~w~r~rr~~r~r~rr~ _. .~ ~~~utatD) 20:37 717 240 0924 7 u~~1;~11995 20:33 717-240-0924-7 STEALERS COUNTRY OUT KEEP TNIS PORTpN FOR YOUR REGQROS P. 007 PAGE 07 `:Il. Your Medicare HMD hae finalized thin claim for payment and the balance rema-i ni ng i s your rea pons i bpi 1 i ty, i f you have already made payment pi dae e diaregar this notice. Othezwiae, please remit your payment it'Y ~sul~. .. .. .,, 'L:. ~:'` Y :~ ~ ; . :~.. CHOI'~ ~ E ONE. ~~_' ~ D' 4 '~!>~. ::a;; ~ I~T.Oi~ RY:r~A.0.5r~.2~. ' ~ ~ ~ ~~~~oL ~~ : >:~5 ag l ~~~~ 0 ~; .. ... p ....... ~?~ ~:~;~:>:. ... ...:.c:~ ~~~~ 0 0 3 0 o a SECONDARY I NS UrRANCE PRI VATE PAY PHONE: POL: PLAN C3R~': TOLL FREE PHONE: 1-8 8-223-5649 THIS I S A HI LL FOR P b'ES S = ONAL LAB 8 ERVI CEB, S DPERVI S ED pATBOLOGI T. THESE ERVICL$ ARE REQUESTED SY YOVR ATTE 06-21-10 88305 TISS[7E EXAM SY PATHOLO©I8T 0 7 -1 l -10 PAYD~1~?T PMr- I~DZ C ARE HZd~ 07-i1-10 ADJUST ~DICARE Hl~') LOSS - - DNM YOUR IIBS. COI~ANY' $ EOB IAId~OIUNT OF A D~ 9 U2 3I FOR SERVZ CES PROVIDED. A BOARD ERT'I ~'I ED NG PHYSIC AN. 150. 00 2'7. 70 113. 07 150. 00 122. 30 9. 23 Ya' ~I4'~ PZN6: 026702027603 PLEASE PAY 7N18 AMOUNT , $9. 23 ..... ~~ ~~":,";ti~`,,: ~~.'~" ~::': ~:: ~':::~~.~:' `'~ :~ ~;''`~''':":``" C ARLI 5 LE 1~DI C AL PATHOY.OGY PC p. O. HOX 188 I DA L. BTEAL3ER IRS#: 26-1186991 LAt~IDISVILLE PA 17536-0188 ACCT WO: A267-00X5539-02 _~ e~p~ Msi~-4N srodt r-ao REAL ESTATE TAX NOTICE ~ REAL ESTATE TAX NOTICE fAX YEAR: zoo-~~ INSTALLMENT PAYMENT 3 PAD T'D~ NEW CUMBERLAND ROBIN CA8PERETTI, TIC (717) 7Ti-742 AYAAI.E ROSIN dAiPERETTI, TJG {717 774.7124 1119 9RIOtl-E STREW O: ~ ~1a sRIpQE aTREET PROPERTY ID NEW CUM6ERLANO, PA 170T0.1lSI NEW CUM9ER6AN0. PA 17070-t634 25240011273 LOCATION OF TAXED PROPERTY PROPERTY ID 411 RENO STREET 25240811275 TAX SCHOOL -INSTALLMENT PAYMENT S RATE 10.61 GN 0110l/OR! /ACE RwTE wK~R PENALTY DATE FACE 275.69 er 10/31/2010 275.89 PENALTY 303,28 AFTER 10131 /2010 303.26 ' SCHOOL • INSTALLMENT PAYMENT ] TAXES PAID AT a a 10.61 FACE PENALTY 275.69 O~ or gNor~ 10/31/2010 275.69 FACE 303.26 AtiN 1019tt20to 303.E OENALTY WEdT aHORE 8CH001. DISTRICT T ~ 1 t NET ASSESSMENT ~ WEST SHORE SCHOOL DISTRICT NET ASSESSMENT TY 1t M0 n ~g STEALER, HOWARD P 61DA L 77,848 FOR: 411 RENQ STREET ~ 97 CREEK ROAD TO; >STEAGER, HOWARD P i IDA L ~ pILLSAURO PA 17019 97 CREEK ROAD - DILIlI-BaJR4 PA 17010 ei~~ ~ ooses~ DUE DATE 18 MISSED, INSTALLMENT MUST BE PAID AT PENALTY. elu DATE • o7to1nolo puE DATE -1ot91r:o1o i DATE • 07/01/2010 DUE GATE • 10!31/2010 61LL ~ 002881 !!.GUENT BE.t:< ARE TURNED O~lR TO TAX CLAIM ON +Z/a~/201o TAXPAYER`8 COPY TAX COLLECTOR 'S COPY Y YEAR: 2010.11 REAL ESTATE TAX NOTICE REAL ESTATE TAX NOTICE INSTALLMENT PAYMENT 2 PAID TO: NEW CUM6ERLANR BOROU~iH ROBIN tiABPERETTI, TIC (717) 774-74x4 ABLE ROSH{ GAaPERETTI, T/C I717) 77a-7124 111 ~D~iE ~~ PROPERTY ID _ 111 BRWGE STREET NEW cDMeERwru. PA 17070-1~ NEW CUMBERLAND, PA 17070-1634 25240811275 LOCATION OF TAXED PROPERTY PROPERTY ID 411 RENO STREET 25240811275 SAX SCHOOL • INSTALLMENT PAYMENT 2 -~~ 1 O.B 1 ON OR REioRE fwCE DATE _ wIRlR PENALTY BATE eCE 275.67 ar 08/30!2010 275.67 'fir' 303.24 AFTER09130/2010 303.24 SCHOOL • INSYALL.MENT PAYMENT ~ TAXES PAID AT 10.61 FACE PENALTY 275.67 o.6.rorA o9t30t20t0 275.67 FACE 303.21 A/t~r 09130/2010 303.14 PENAt.7Y WEST SHORE SCHOOL DISTRICT IN f NET ASSf:SSMEN'f yYEgT SNORE SCHOOL DISTRICT NET ASSE5SMENT IY S ~fi: 411 RENO STREET 77,948 STEALER, HOWARD P 6 IDA L n-~ !7 CREEK ROAb ~; STEAaEIi. HOWARD P A IbA L DII.L$BURG PA 17019 _ >i7 CREEK ROAD OIt1•slpURQ PA 17019 BILL !! 002881 •ATE IS MISSED, INSTALLMENT MUST BE PAID AT PENALTY, 811E DATE - 0~~+no~o I?UE DATE -OW301Z010 TE - 07/01/2010 DUE DATE • 0!130!2010 B~t-L # 002881 ' ~ NT lZILLS ARE TtJRNEO OVER TO TAX CLAIM ON t11]1n010 TAXPAYER`S COPY TAX COLLECTOR'S COPY 50 3Jt~d 1(10 1~~I1Nf10~ SJ3Jb31S L-tiZ60-0bZ-L ZL 66 ~ 0Z 566 Z /£Z /60 ~OO~d L D260 OV2 LtL L~~02 (03m)Ot02-S1-d35 awtl~aaen xy REV-1513 EX-F ~LIi-1~; ~ ~ennsylvan~a SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT -__ ESTATE 4F: FILE NUMBER: IDA L. STEALER 21-10-0764 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) {1.2).] 1. Dale H. Steager, 97 Creek Road, Dillsburg, PA 17019 child 50% 2. ~ Marlin D. "Bud" Steager, 619 Mountain Street, Enola, PA 17025 child 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER 5HEET.'$ If more space is needed, use additional sheets of paper of the same size. _~ CRS r ~ ~ \~ `` ~~-- `` ~V