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Home My WebLink About11-10-101505610101 REV-1500 Ex ~°1.1°' ' PA Department of Revenue pennsylvania OFFICIAL USE ONLY DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi jj /~ /' Harrisburg, PA 1128 0601 RESIDENT DECEDENT ~ C~' t~ ~ L!3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~ ~;~ ~.3 ~~y~ 08 ~3~G rG ~ ~ l ~ l ~l ~ Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) . O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number REGISTF~ OF' WILLS IJ~ONLY ~"" ~? F--p_9 ~ ~ .. ~ I ~ +~ n ti1~.# ~_ r., ... C`~ ~>C - - ~ ~ c -[~1A7'~ FILED - •' ' ,..._h Correspondent's a-mail address: ~ /~. /~/~~ ~ /~(i~L,~~~ First line of address Second line of address City or Post Office State ZIP Code Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF 1 ~~~~ ~~ LING RETU DATE r~_.-- ~ Y- ~~ ADDRESS / ,~ s ~' ,3:~ ~ ~~ c.~ a.~'~i~~ ~ ~ -~ f~~iP~'i SBA/iP~ ,/iii} 1,~/~~ _ ~~~ ~, SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE wDATE~~~~ ADDRESS _-- ~ ' ~_.. PLEASE USE ORIGINAL FORM ONLY ~w ~~ Side 1 1505610101 1505610101 J J 1505610105 REV-1500 EX Deced ent's Social Securi ty Number J'/~ ~ / Decedent's Name: / ! f~~ ~ ! ! ~~~C~.- ~] ~ ! ~ O / / U -_ RECAPITULATION . 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. ~ ~ ~ ~ ~ ~ • ~ ~j 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ (1 ~ Gl . ~ Gl 6. Jointly Owned Property (Schedule F) ~ Separate Billin Re uested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. , 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~; (~ ~~ ,%! ~j" ~ .. ~ • ./ , 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. / ~ l ~j ~ ~ ~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. l l '~ ~( ~~ , ~ ~ r 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ ~ G ,~ / 3 , ~ -~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. , 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~~~ ~~z73. ~s/ 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- . 15. 16. Amount of Line 14 t xable at lineal rate X .0 ~ ~ ~ `' ~ ~ , ~ ~ { 16. 1 ~ r'~ ~ ~ r ~ > / l 17. Amount of Line 14 taxable , - at sibling rate X .12 . 17. • 18. Amount of Line 14 taxable at collateral rate X .15 . 18. ~ 19. TAX DUE ......................................................... 19. ~ ~~ ~) ~ ~~ ~ .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610105 1505610105 J REV-fi500 EX Page 3 File Number Decedent's Complete Address: ~~~ ~ ~ ~- C/ ~ ~~~ ~~ UGl'CUCIV 1 J IV/11VIC STREET ADDRESS ` ~~ '~~ ~ ~~~ ,~ `j ~ vi ~~ l/tff =` / cITY ~r~ ~ ~~~~~ ~CS~L~~~ STATE /~~ i ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _____~ B. Discount ____ _ ~ ~~ __ 3. Interest 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. -~ ~~~~~3 (3) (4} a ~~ ~ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) , ~~~ ~ ~ ~,~~ Make check payable to: REGISTER OF WILLS, AGENT. .. _.~ .,~.~, _ ,, $,.,, ,t 1 ~ ~ z~,_ _~~ r, .d ,_ .wu ...ry._ ,. -. _. _.... is .. .1»:,,}. 5. r ^-u... k s .. ~.. .r:: n, ..'C .»,..;. ., ...:: ~ .r.:. .:::: ~ ,F z. _. a•Yw"F. T!i'A, ... {'~~ !". _, ~ Si ~r d a 3' ~af. ~S.i G. ~> ,,~.: fiti:. xy{ ,xi. ~ F~~::. r... .i;.~~ ~y r.rt~... .~, ,. . k~"'. . ~ . -.,aACt. ,~~....s ~ „ ,.,..~. .~.c . ., :..kc„ '.~ri'+". '~ -.~k'"42~ ~.. >~C r .~. -' `, .~ i ~" .. .. C ;'£ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 1N THE APPROPRIATE 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 shat{ use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ Q 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? ........ ...... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ................................................................................................................. ....... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .w _ _~. ~ ~ _ .. _ y _~ ~ .. ~~`` For dates of death on or after Juiy 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 Bing a tax return are still applicab{e even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for thE~ use of a natural parent, an adoptive parent or a stepparent of the child is 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 siblings 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. Total Credits (A + B) (2) i ' REV f 50Ci EX+ {6-96j C~CnNMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEOtlLE B STACKS & BONDS ESTATE OF ^~ Q~ / ~ ~/~~~ FlLE NUMBER . /) ! ~U ~~~ Ali proP~Y Ian with right of survivorship must be disd~osed an Schedule E. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1~(n7i N~~ ~~R P2o~~ ~~1~~ - L ~'~~ _ ~c 10886.34 Bank Deposit Program 1.00 / ~ ~~~, ~ y ~, 12992.37 Western Asset Money Mkt 1.00 / .. ~.~ ~~~', -%' `~ ,.3, 617.64 Capital Income Builder Fund 46.88 ~~~ ~=5 ~~ ~~ 488.73 Capital'~it~orld Growth & Income Fund F1 31.83 /z'~~ ,~~SF~~ ~.~8 5 , 490.53 Fundamental Investors Fd 31.60 ~ ~ ~~, ~7 j ~7 Class F1 ~ ~ , 1000 Gabelli Equity Trust Inc. 26.05 ~;~~ OS ~r C~ 0 6.2 Series F 1000 General Electric Capital 25.79 ~~ '~1'C1 r D ~ Corp. 6.625% ~; 146.92 Growth Fund of America 25.97 ~, ~~~, ,S Class F1 ~ 92.89 Harding Loevner Emerging 44.32 ~ /~ ~~r ~c~ Markets Portfolio Fund ~ ~, 1216.93 Loomis Sayles Strategic 14.36 ,! `1 y ~'~, l Income ~ C ~, 527.86 Pimco Total Return Fund 11.47 ~ d5 ~.~~ Class P ~ /~r 500 Royce Value Trust Inc. 25.28 r'~~ ~ ~~~ C?C~ TOTAL (Also enter on Gne 2, Recapitulation) ~ .$ ~"~ ~y ~` ~'S,~ ~ `f (if more space is needed, insert si~eets of the scone sire) REV-1500 EX t (1-97) I i SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSfTS, a MASC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE, NUMBER ,c,.,~ DESCRIPTION OF DEATH 1. C /~.~ // ~ /~.~ Chi L~ ~;~ f r , / ~1 ~ry ~r ~ ~-V ~l~~N`~ ~CSG~ ~~-%~~ .3~ LiE~~L ~'~' ~N~ J ~~~~ P~/~S4rvr~L. ~~~~f~ ~~ ~;~ ~ O j ~ ~ TOTAL (Also enter on {ine 5, Recapitulation) I $ ~f ~~ (~(~~ t~~ ---~ (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS ~3~' ~ Gv ~OD~~l6~ Gc/i9y~ h'~i~~r~~,~~~~'~f~ /'7,/1.x; ,~ B. ~. ~ ~~~ ~, .~ ~~~~~c~ i~Z ~sv~T~~/,~ Tcif ~~~~ /~~~ffr~i~sB~r~G ~~ C ~ ~~~~, RELATIONSHIP TO DECEDENT ~s~,~ D.~t~G/fTfi(' JOINTLY-OWNED PROPERTY: ITEM LETTER FOR JOINT DATE MADE DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH % OF DECD'S DATE OF DEATH VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. ~-~-~"/ ~S~C ~ ~CC/~ ~n~~ly>~C~~ -~ S/ ~ ?~,~,,~~ SG"rd / ~~Ci ~~ ~ l r'~~f= ~ ~~ ~-~ T ~~96~Y.~:~'V3~~ - s y d ~~~ ~~~ °~~ `~~i - ~~~ YY~'~ ~~ p 0 SCHEDULEF JOINTLY-OWNED PROPERTY TOTAL (Also enter on line 6, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) lC~~~3,~~~` REV-1,511 EX+ (10-06) . ~ ,~, 'r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDIJLE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: Nei ~ G ~~~~,; ~~. ~~ ~"'~~ '~ ~ ~~~ I ~.-~ 3~ v /' ,~',~rP~' ~ _S ,~.E'L`~ ~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City ____ _ State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claima/nt's, attach/explanation) Claimant .L '~ °~~r~ /7, ,/ G' f~/V 5~l V Street Address ~ ~ -~ L~'~t~f~ ~~ l ~~~ ~~",~i~/~- City ----- ~~ ~f~~~i' ~`~~G~ State ~ Zip /`~ ,~~ ~~.) Relationship of Claimant to Decedent 1-f~~L~~,/~~~~i'~ 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ~" ~,~,~ ~~ ~~ arc"~ TOTAL (Also enter on line 9, Recapitulation) ` ;$ (If more space is needed, insert additional sheets of the same size) 3 ~~, :S~U ~~, ~ ,~ REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF ~ FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. FD r,.~',~r; d ~; sC'~i~'~ ~S GI/l1 3 3 3 3 , ~ v ~ ~~ /~ ,~1 ~,I L n /~ >/,~^ /FTC ~? (i /vI ~ ~ f~f}/lfi CS ,~ ~~6- ~,/,~ /'7~5 ~ //, e ,~ 5 ~ ~ T/Y~G/f TCff G. f ~V,~ /'7~ ~ H',~~i ~ S ,~'~IPG ~~ /~G~C~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON RE.V-1500 COVER SHEET II 1. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ' 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ...~- ~ ---' (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF MARY F. KARL Dated: July 7, 2007 MILITARY TESTAMENTARY PREAMBLE: This is a MILITARY TESTAMENTARY INSTRUMENT prepared pursuant to Title 10 United States Code, Section 10444, and executed by a person authorized to receive Legal assistance from the military services. Federal law exempts this document from any requirement of form, formality, or recording that is prescribed for testamentary instruments under the laws of a state, the District of Columbia, or a territory, commonwealth or possession of the United States. Federal law specifies that this document shall be given the same legal effect as a testamentary instrument prepared and executed in accordance with the laws of the jurisdiction in which it is presented far probate. It shall remain valid unless and until the Testatrix revokes it. LAST WILL AND TESTAMENT OF MARY F. KARL I, MARY F, KARL, a resident of the Commonwealth of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. FIRST: I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will, and any interest or penalties thereon, shalt be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. SECOND: I give all tangible personal property owned by me at the time of my death, including without limitation personal effects, clothing, jewelry, furniture:, furnishings, household goods, automobiles and other vehicles, together with all insurance policies relating thereto, to those of my children (EDWARD J. KARL, LINDA M. JOHNSON and DONNA L. SHOEMAKER) who survive me, in substantially equal shares, to be divided among them as they shall agree, or if they cannot agree, as my Executor shall determine. THIRD: I give all the rest, residue and remainder of my property and estate, both real and personal, of whatever kind and wherever located, that I own or to which I shall be in any manner entitled at the time of my death (collectively referred to as my "residuary estate"), as follows: (a) To those of my children who survive me and to the issue who survive me of those of my children who shall not survive me, per stirpes. (b} If no issue of mine survives me, I give my residuary estate to those who would take from me as if I were then to die without a will, unmarried and the absolute owner of my residuary estate, and a resident of the Commonwealth of Pennsylvania. FOURTH: If any property of my estate vests in absolute ownership in a minor or incompetent, my Executor, at any time and without court authorization, may: distribute the whole or any part of such property to the beneficiary; or use the whole or any part for the health, education, maintenance and support of the beneficiary; or distribute the whole c-r any part to a guardian, committee or other legal representative of the beneficiary, or to a custodian for the h,~ - ficiary under any gifts to minors or transfers to minors act, or to the person or persons with wti~~n the beneficiary resides. Evidence of any such distribution or the receipt therefor executed by the person to whom the distribution is made shall be a full discharge of my Executor from any liability with respect thereto, even though my Executor may be such person. If such beneficiary is a minor, my Executor may defer the distribution of the whole or any part of such property until the beneficiary attains the age of eighteen (18) years, and may hold the same as a separate fund for the beneficiary with all of the powers described in Article SIXTH hereof. If the beneficiary dies before attaining said age, any balance shall be paid and distributed to the estate of the beneficiary. FIFTH: I appoint my son EDWARD J. KARL to be my Executor. If my son EDWARD J. KARL :-.hall f;~il to qualify for any reason as my Executor, or having qualified shall die, resign or cease to c for any reason as my Executor, I appoint my daughter LINDA M. JOHNSON as my Executor. If my daughter LINDA M. JOHNSON shall fail to qualify for any reason as my Executor, or having qualified shall die, resign or cease to act for any reason as my Executor, I appoint my daughter, DONNA L. SHOEMAKER as my Executor. :[ direct that no Executor shall be required to file or furnish any bond, surety or other security in ar~y jurisdiction, SIXTH: I grant to my Executor all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers conferred upon executors wherever my Executor may act. I also grant t:o my Executor power to retain, sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to borrow money and encumber or pledge any property to secure loans; to exercise alI powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys, accountants and other persons for services or advice. The term "Executor" wherever used herein shall mean the executors, executor, executrix or administrator in office from time to time. SEVENTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease rr~ unless such beneficiary survives me by more than thirty days. 2 IN WITNESS WHEREOF, I, MARY F. KARL, sign my name and publish and declare this instrument as my last will and testament this 7th day of Juiy, 20Q7. M Y F RL The foregoing instrument was signed, published and declared by MARY F. KARL, the above-named Testatrix, to be her last will and testament in our presence, all being present at the same time, and we, at her request and in her presence and in the presence of each other, have subscribed our names as witnesses on the date above written. ~~~~~~~ ~~-~- z ~ ~ J~~~ Y having an address at ~'/fiPSt/E~ ~j~ ~~~ -~ ~'~ ~ ~' ~~ ~ 'having an address at ter. s~~ ~~ 3 MILITARY TESTAMENTARY INSTRUMENT SELF-PRUNING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA, COUNTY OF CUMBERLAND, ss. We, the Testatrix and the witnesses, whose names are signed to the attached or foregoing instrument, being fast duly sworn, do hereby declare to the undersigned authority that in the presence of the military legal counsel and the witnesses the Testatrix, MARY F. KARL, signed and executed the instrument as her military testamentary instrument, that .she had signed willingly, and that she executed it as her free and voluntary act and deed for the purposes therein expressed. It is further declared that each of the witnesses, at the request of the Testatrix, in the presence and hearing of the Testatrix, the military legal assistance counsel and each other, signed the military testamentary instrument as witness, and that to the best of his or her knowledge the Testatrix was at the time at least eighteen years of age or emancipated, of sound mind, and under no constraint, duress, fraud or undue influence. MARY F. KARL Testatrix print:6~Z~~' ~` Witness /z6 ~J print: 1~,,,t.~ ~ ~'S~ Witness Subscribed, sworn to and acknowledged before me by the said MARY F. KARL, Testatrix, and subscribed and sworn to before me by the above-named witnesses, this 7th day of July, 2007. I, the undersigned officer, do hereby certify that I am, on the date of this certificate, a person with the power described in Title 10 U.S.C. 1044a of the grade, branch of service, and organization stated below in the active service of the United States Armed Forces, and that by statute no seal is required on this certificate, under authority anted to me by Title 10 U.S.C. 1044a. l ~ - /~ Name of Officer and Position: Kerry E.'MalonPy~, Judge A~ Grade and Branch of Service: Major, U. S. Army Reserves Command or Organization: 153d Legal Support Organizat~ Neil{ Funeral Home, inc. 3501 Derry Street Harrisburg, PA 171111817 (717) 564-2633 Supervisor :Stephen J. Wilsbach The following is a detailed bill for the professional services and/or merchandise arranged for Mary Karl Date of Senvice :August 19, 2010 Edward J. Karl Statement Date September 21, 2010 321 Woodruff Way Contract Number 741200200691 Harrisburg, PA 17112 Arranger Name Daniel C Huff Jr. Initial Selection Final Selection Difference Funeral Director and Staff Services Basic Professional Service Fee Total Funeral Director and Staff Services Cane and Preparation of Remains Embalming Dressing and Casketing of Deceased Total Care and Preparation of Remains Use of Facilities and Related Services Visitation Religious Facility Funeral Ceremony Total Use of Facilities and Related Services Transportation Transferring Remains to Funeral Horns Funeral Vehicle/Hearse Total Transportation Other Goods and Services Memorial Booklet Service Folders Total Other Goods and Services $2,680.00 $2,680.00 --- $2,68a.o0 $Z,sBO.oo -- $795.00 $795.00 -~-- $395.00 $395.00 -- $1,190.00 $1,190.00 --- $495.00 $495.00 --- $495.00 $495.00 --- $990.00 $990.00 -- $495.00 $495.00 --- $395.00 $395.00 ---- $890.00 $890.00 -- $25.00 $25.00 -- $60.00 $60.00 --- $85.00 $85.00 -- Merchandise Initial Selection Final Selection Difference REVERE SILVER $1,095.00 $1,095.00 --- Total Merchandise $1,095.00 $1,095.00 -- Cash Advance Clergy/ Religious Facility $150.00 $150.00 --- Musicians or Singers $175.00 $175.00 --- Certified Copies $48.00 $48.00 -- Hairdressing $45.00 $45.00 --- Newspaper Notice - $329.32 $329.32 Total Cash Advance $418.00 $747.32 $329.32 Total Services, Merchandise and Cash Advance $7,348.00 $7,677.32 $329.32 Total Charges (Total Services +/- Allowances + Taxes) $7,348.00 $7,677.32 $329.32 Less Cash Received ($7,677.32) Unpaid Balance Due $0.00 Page 2 of 2 ,. ~ ~~ _ .. _ - 103 arta~ y ~ rr~~ a ~:' DATE ,~ PAY TO THE ORt1ER 0 f r ~. O u t f ~ ~. . 6~ ~L~ DOLihRS 8 ~ , r=: ts,: ~. . r ;~ r ~ r~ ,,, a~~xsBU~ ~ Tia2s+so fQR ~ ~ , .off C--'~'E~GI~'c~~~~/' ( ~ ti%G~.q~(, I' ~$ ~:23 i38 i i i6~:0 i03- ~0456944636~~• ~, _. .n . ~. _, ._. _,~.._,_. _.. ... r _ r~ ESTATE OF MARY F. KARL EDIAIAR~ J. KARL, EXECUTOR 321 WWORUFf WAY HARRlSSURG, PA 17112 ~~~ ~.-- /~ RECEIPT FOR PAYMENT -----_____~__s~,===_ GLENDA FA-RNER STRASBAUGH Receipt DatE~: 8/27/2010 Cumberland County - Register Of Wills Receipt Time: 12:03:44 One Courthouse Sqquuare Receipt No.:: 1062.410 Carlisle, PA 17U13 KARL MARY F Estate File No.: 2010-00886 Paid By Remarks: EDWARD J KARL DM ________________________ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310.00 C~UMBERL~TD COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS ~ CNTR M.D AUTOMATION FEE 5.00 CUMBERS COUNTY GENERAL FUN Check# 5158 - -373.50 Total Received......... 373.50 The Patrio#-News Co. 2020 Technology Pkwy Suite 300 ----~ Mechanicsburg, PA 17050 Inquiries - 717-255-8213 KARL. ~ _ ~ ~: _~,:. .. w... v t' . 321 1/VOODRUFF WAY ' HARRISBURG PA 17112 c~he ~latriot Nevus Now you know THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Holly Blain, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, Counfiy and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed andf published in their regular daily and/or Sunday/ Metro editions which appeared on the date(s) indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duty authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION COPY This ad # 0002092595 ran on the dates shown below: ESTATE NOTICE Motice'is hereby siven #hat Letters TesfamentarY on the Estate;at: Mary F. Karl, Irate of Hampden Township, Cum- berland County, have been gran#ed to Edward J. Karl All persons #heretore indebted to stud estaie are requested to matte immediate payment, and those having lust claims wilt please present the same, duty au- thentlcated fur setttemen# without delax. Executor: Edward J. Kart 321 WOOdrutf way iiarrlsburg, PA 17112 September 10, 2010 September 17, 2010 September 24, 2010 ~-~ Swom to artd<su ibed before me this 29 day of September, 2010 A.D. ~. °. ,. Notary Public CofVIM{3N~F.At,Tt~ 0~ PEfifh15YLVAN[A Nc~sria! Seal Sharrfe ~. Klsri~r, Notary Public Lower Paxton Twp., Dauphin Counfiy MY ~nmissiort Expfr+es Nov. 2b, 2012 Member. Pennsylvania Assc~ciafiion of Notaries The Patriot-News Co. ' 2020 Technology Pkwy Suite 300 Mechanicsburg, PA 17050 Inquiries - 717-255-8213 KARL 321 WOODRUFF WAY HARRISBURG PA 17112 c~he ~latriot News Now you know __ _ I I~Vt~IC E ..__ _. _ _ ALL CHARGES ARE NET .CCT # NAME AD ORDER # DATE EDiT{ON ADDTL. INFO. TYPE OF CHARGE AMOUNT 18972 KARL 0002092595 09/10/10 REGULAR BASIC: AD CHARGE $75.62 18972 KARL 0002092595 09/17!10 REGULAR BASIC; AD CHARGE $75.62 18972 KARL 0002092595 09/24110 REGULAR BASIC: AD CHARGE $75.62 AFFIDAVIT CHARGE $5.00 TOTAL: REMITTANCE ADDRESS The Patriot-News Co_ 23794 Network PL Chicago, IL 60673-1237 $231.86 Please include the Account # or Ad Order # above) with your remittance--"t"hank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication