The URL can be used to link to this page

Home My WebLink About12-16-10r ' 1505610101 REV-1500 Ex col-lo, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania ~~:FaF,MENT~FF~,,,~~~~~ County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi jj Harrisburg, PA iyi28-0601 RESIDENT DECEDENT ~ / ~ ~ ) r ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 177-10-9252 05/06/2010 11 /23/1917 Decedent's Last Name Suffix Decedent's First Name MI MOSEMANN ALTA E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH T'HE REGISTER OF WILLS FILL 1N APPROPRIATE OVALS BELOW (~ 1. Original Return O 4. Limited Estate C>D 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 2. Supplemental Return (~ 4a. Future Interest Compromise (date of death after 12-12-82} O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-E12) O 5. Federal Estate Tax Return Required ~ 8. Total Number of Sate Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD IBE DIRECTED T0: Name Daytime Telephon~Number r~°.:.-s~ ~~ cc Andrew H. Shaw, Esquire .. (717) 243-71 ~ ~ 'y"t = rr,~ ~ i REGISTER 1~l~USE Ql~tl-Y ~ 1~ ~f} ^ ~ First line of address C"-~<~'~'- 200 S. Spring Garden St ~ ~~ ~' Second line of address ap Suite 11 City or Post Office State ZIP Code DATE FILED Carlisle PA 17013 Correspondent's a-mail address: andrew a~ashawlaw.com _ - -., ;•-~ -; , 1 f ~ ..:. _.. ..f} ~i J! .; Under penalties of perjury, I dec{are that 1 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. SIGjaIATURE OF PERSON RESPONSIBLE FOR FIL{NG RETURN DATE ~AI~ORESS 3776.~1llell Ridge R mouton, KY 42129 SIGIaV~TURE t~'F~RE R R HE THAN REPRESENTATIVE DATE 00 <~ e~ RESS ` 200 S. Spring Garden Street, Suite 11, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 ],50561,0101, J r ' J 1505610105 REV-1500 EX Decedent's Social Security Number decedent's Name: Alta E. MOSemann 177-10-9252 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. 9 9 ( ) ........................... Mort a es and Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 24,967.58 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0.00 7. {nter-Vivos Transfers & Miscellaneous Non-Probate Property 0 00 (Schedule G) O Separate Billing Requested........ 7. . 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 24,967.58 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 914.50 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 171.07 11. Total Deductions (total Lines 9 and 10) ................................. 11. 1,085.57 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 23,882.01 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 2,000.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 21,882.01 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 00 0 15 0.00 . (a)(1.2) X .o ~ . 16. Amount of Line 14 taxable at lineal rate X .0 45 21,882.01 16, 984.69 17. Amount of Line 14 taxable 0 00 00 0 . at sibling rate X .12 17 . 18. Amount of Line 14 taxable 0 00 0.00 . at collateral rate X .15 18 19. TAX DUE ......................................................... 19. 984.69 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: 0.00 DECEDENT'S NAME Alta E. Mosemann STREET ADDRESS 47 Mt. View Terrace C~-~y - Newville STATEPA Z1P17241 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A, Prior Payments B. Discount 3. Interest 0.00 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 (1) Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. 984.69 0.00 0.00 984.69 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 :.................................................................................... ...... ^ 0 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, 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? ....... ....... ^ 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 1T A,S 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)J. 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 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(x)(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(x)(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)]. A sibling is defined, under Section 9102, as an ind'+vidual who has at least one parent in common with the decedent, whether by blood or adoption. Last Will and Testament of Alta E. Mosemann I, Alta E. Mosemann, of 47 Rock Run Road, Mountain View Terrace, Newville, PA 17241, County of Upper Frankford Township, State of Pennsylvania, being of sound mind, memory and not acting under duress or undue influence, and fully understanding the nature and extent of all my property and of this disposition thereof, do hereby make, publish, and declare this document to be my Last Will and Testament, and do hereby revoke any and all other wills and codicils heretofore made by me. FIRST: a. I direct that all my debts, and expenses of my last illness, funeral, and burial, be paid as soon after my death as may be reasonably convenient, and I hereby authorize my Executor, hereinafter appointed, to settle and discharge, in his absolute discretion, any claims made against my estate. SECOND: I direct the following disposition be made of my estate: a. $2000 be given to : Blue Ridge Mennonite Church of Centerville, PA c/o Larry Halteman, Treasurer 690 Mt. Rock Road Carlisle, PA 17013. b. $1000 be given to daughter: Barbara A. Mosemann 2518 Oakland Avenue Apt # 104 Elkhart, Indiana 46517 c. Set of six (6) plank bottom chairs be given to: Carol J Beachy (Mosemann) Box 43 Mylo, ND 58353 d. One piece of furniture of their choice be given to: Joel M. Mosemann, James E. Mosemann, Wendall A. Mosemann, respectively. e. The remainder of the estate to be divided equally between: Joel M. Mosemann, James E. Mosemann, Carol J. Beachy, David R. Mosemann. THIRD: I appoint James E. Mosemann as my personal representative as Executor of tlus my last will and Testament. The Executor of this will, shall receive ~ 1000 for his services and more if necessary in administering this will. I grant to my Executor full power to do everything in administering my estate that said Executor deen~.s to be for the best interest of my beneficiaries. FOURTH: I direct that my estate be settled by informal probate, and that my personal representative does not need to purchase a bond. LAST~,Y: This Will has been prepared in duplicate, each copy of which has been executed as an original. One of these executed copies is in my possession and the other :is deposited for safekeeping with my son, James E Mosemann. Either of these wills is to be considered as the original. If only one copy of this Will can be found, then it shall be considered as the original, and the missing copy will be presumed inadvertently lost. Any clarifications or instructions concerning this Will may bey obtained by calling the above-mentioned person who is requested to do everything necessary to implement the provisions of this Will. IN WITNESS WHEREOF, I, Alta E. Mosemann, the testator, sign my name to this instrument consisting of 2 pages this 6`~` day of January, 2002, do hereby declare that I sign and execute this instrument as my Last Will and that I sign it willingly, that I execute it as my free and voluntary act for the purposes expressed in it, and that I am of sound mind, and under no constraint or undue influence. Alta E. Mosemann Testator , ~ ,fa.. f„ , ~ We, Wendall A. Mosemann, Lisa D. Mosemann and W. Matthew Eisenberg, the witnesses, sign our names to this instrument, and do hereby declare that the testator declares it to be her Last will and requested us to sign as witnesses thereof, and that she signs it, and that each of us, in the presence and hearing of the testator and of each other, hereby signs this will as witness to the testator's signing, and that to the best of our knowledge the testator is of sound mind, and under no constraint or undue influence. ~Vendall A. M~s~emann 68 East Pomfret Street, Carlisle, PA 17013 Residing ~. ~ ~ . 1 ~,~//~ ~ ,. 6 -~ Lisa D. Mosernann 68 East Pomfret Street, Carlisle, PA 17013 Residing ~~;.~ ~ ~~~~~~~1~~1~ ~J. Matthew Eisenberg 20 West Big Spring Avenue, Newville, PA 17241 residing , j-' d ~~' REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER ALTA D. MOSEMAN N 21-10-0710 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (ir more space is needed, insert additional sheets of the same size} . ~ ~ II, I 1 ~" Irl~~l, ,,RT[E'1CATE OF TITLE F'Of~ A V~H~II~L _ ~ - ~ 1 f,t , o.. jI~ ~x ! __.- '~ ~ _ _. ~ ~ ~ ~ ~~ ~: _ VEHIGLE tDEt~f7'tFICATtON NUMBER YEAR MAKE OF VEHICLE ~ TITLE NUMBER $C?CfY TYPE ~ DUP ~ SEAT CAP PRIOR TITLE STA E T. ~ ODOM.PROCD.DATE # ODOM.MILES ~ ODOM.STATUS DATE PA TITLED DATE OF ISSUE UNLADEN WEIGHT ~ raVWR ( GCWR I TITLE BRANDS ~~ W uuN 1~ ^~ 1 W R STC-f~'LD OW ~ 1' ri '1(111 II 11~~~ rl~~~~~~~~ ~'I~I~~~I~~~("ill'~~~j'1i1~41~y ~IIII'I .,~ ;'r ....p,,,yro~ III ~~ ~ ~ ~~ I .r.~r ~u,~ v ~ .. ~~~~ ~';~~III~~i~ ..°u~i,,, iii , ~t~j'~ilt(' ~ I ~ 1W~ T ~ ~t R ft(+tBT LIEN FAVOR OF' SECOND LIEN FAVOR OF: If a second lienhotder' Is listed upon satisfaction of the first lien, the first lienholder musE forward this Tttle t4 the Bureau of Motor Vehicles with tt59 Fff35T LIEN RELEAS;:D appropriate form and fee: DATE. gY SECOND LIEN RELEASED AUTHORIZED REPRESENTATIVE DATE fvfAl LtNC^ri -ADDRESS BY {~ p AUTHORIZED REPRESEfV'rATIVE #~."~ ~ hSEMANN ~~' ~"gtJI~V~Ai1d YiE4# TERM ~fE~1t IL~.E f'A ~?2w ~ I certdy as of the dat® Of }slue, the official records of the Pennsylvania Department 8~~~~~~ 1 rtt~~~~~~ of Transportation retleot tftstt the parson(s) or company named herein is the lawful owner #. I'i of me said vefjlcfe: ~ Secretary of Transportation IgSCRiBED AND SWORN I ~EFOR~ ~E ~u~;~~~IlIi~11,'1'Ii ~, ~~ i~uf atGNAr~ta~ of p~RSOt ! If a co-purchaser other than your spouse is listed artd you want the title to be listed as "Joint Tenants With Right of Sulvivorshlp' n death pf one oav veAa i owner; title goes to surviving owner.) GHE:Ci< HERIv C7. "id~rwis®, the ?itie will be issued as "Tenants in Common" (On deatf~ of one owner, interest tip deceased owner goes to his/her heirs or estate). ~. RiN(", BATH I 1ST LIEN DATE; --~ IFtdJ LIEN, CHECK i r 1ST LIENHOLDER ~ STREET CITY ' FINANCIAL INSTfTUTI(~N NUMBER ~~ ~ ~ 2ND LIEN i~ATE': The undersigned h3feby melees appllCaHpn !or Ganifir:ite of Tltle to the vehicle described: above. wbjact ro the encumbrTrn;yfi and otheriegar c.aims set ioAh here. 2rdD LfENHOLDER ', STREET SIGNATURE OF APPt:ICANi OR AUTHORIZED SIGNER 4 ~ CITY ~GIw4TUflt:OP CO•APPk:JCANTmrLE of buTNOalzee slGNea FINANCIAL INSTITUTION NUMBER ODOMETER STATUS 0 ACTUAL MILEAGE 7 = M1M1ILEAGE EXCEEDS THE.MECHANtCAL L IM 4T5 2-= nlOT THE ACTUAL MILEAGE _- 3 =NOT THE ACTUAL MILEAGE-ODOtvtETER 1'AMPER{Nf., VERfFIED-- 4 = E:~XEMPT FROM ODOMETER DISCLOSURE TITLE BRANDS A - AN'rIC~Ltt_ VEHICLE' C = CLAS9ICVEHICLE-:' L~ - Ct7LLECTt9[.E VEr-IICLE F OU70FCOUNTRV' ~~ c, ORIGINAI-LV MFGQ. FOR NON-iJ.B OtSTRIBl77CON H = AGRIC11LTlJRAL VEHICLE L =LOGGING VEHICLE P = IS/WAS A POLICE VEHICLE R =RECONSTRUCTED S =STREET' ROD T = RECOVEREA THEFT VEHICLE V .VEHICLE CONTAINS REIS5UE0 VIN W a FLOE)D VEWiGLE X a IS~YJAS A TAXI STATE Zlp -• IF NO LIEN, CHECK 5"ATE z!P .... ~ C ~ e. November 18, 2010 Law office of Andrew Shaw 200 S Spring Garden St suite 11 Carlisle Pa, 17013 Dear Mr Shaw, S Brookwood Avenue Carlisle Pa, l 7G-13 717-245-2100 c-ffice 717-226-2868 cell robneidlinger(~yahoo.com As per your request to give you a market value for the property located at 4~7 Mountain View Terrace Newville Pa, 17241. From my experience and comparables I would value the home at $10,000. The poor condition of the home is another variable that was used to determine this price. This valuation should not be used as an appraisal. If anyone should have any question please give me a call anytime 717-226-2868. Have a good day! All the Best, : . . ~_ ~.~mo. 3a ~.e F,,,. ~~w ~.. ~~ ~~° ~~ Rob Neidlinger "C?h, by the way I'm never too busy for any of your referrals" a 0 U m 0 N v 1 O CQ I !4 Q U o o ;k ~ ;. ~:t l4 I 4 4 k l i as _,~~ ~ ._, Q ,.~ r ^ T c m Q ~ .. ~- ~ ^ ~ ~ z ~ ~ c ~ '~ ~ ~ ~ a c0 ~~ N ~s .. ^ k 4 O ~ m ~ m o O p ~ n~ ^ ~ z.. ~ P1J y+ ~ W ^ ` +. t ~ D G ~ m ^ $ Z Q O ~ v ~ ~!l ~• ~ Ll. ~ r r # ~ {{ ~ . ../ ~~ tiM t j 1 ~ 0 0 U rf7 >- v, o ,,~ O ~ ~ ~ ~ 0 n W o w ^ u ~ :.' ~ ~ ~ O o ~ ~ v W Z ^ ^ o ;' as V .. ~ t°- oC c c m 0 ~ ~ rn ,' LL ~ l ~ ~ ~, N do t'- ~` ~ Wr' l0 y ~ j N m ~ !~~ ~ ~ Q- ~ ~ ~ ~ ~ ~ m ® a o O m = U ~J i G ~ Q Z V i-- _._ ~~cki~ag :Stat~mer~t ~cnb.c®m ***'`**'`********AUTO*'`3-DIGIT 172 1566 0.9860 AB 0.360 10 1 56 ~Ill~~~lll~il~l~l~fi~lll~~~l~ll~~lllll~i~l~ii~i~li~~lli~~i~ll~ ALTA E MOSEMANN 47 MOUNTAIN VIEW TER NEWVILLE PA 17241-9024 Statement (Date: 06/02/10 Account #: 224006 Page 1 801 SPECIAL FIXED RATE HOME EQUITY LOANS consolidate bills, redo the kitchen, pay tuition or take a vacation! Low rates are available on our Fixed Rate Home Equity Loans. Take advantage of fees waived and low minimum loan amounts. stop by, call 1.877.883.2262, or visit acnb.com to find out more. Equal Housing Lender. Equal Opportunity Lender. Member FDIC. SUPERNOW ACCOUNT Account #~ 224006 Account Summary Beginning Balance Activity Ending Balance Previous Statement Balance 05/04/10 514, 312.25 + Deposits and Other Credits 1 400.00 -Checks Paid or Other Debits 9 8,400.83- ..,.wa, - Service Charges .00- +Interest Paid .45 Ending Balance 56, 311.87 0 Days in Statement Period 29 Account Detail Date Activity Description Deposits/Credits Checks/Debits Balance BEGINNING BALANCE 14, 312.25 05-11 CHECK # 1127 25.00` 14, 287.25 05-17 CHECK # 1128 450.00 f- 13, 837.25 05-17 CHECK# 1129 1,ooo.aoL 12,837.25 OS-17 CHECK # 1132 ' ~~ .~^ ~~ ~~;,~, ,,~-__.__...~~ ~. 71.83 ~ '` 12 , 765.42 05-18 CUSTOMER DEPOSIT ~~t ~,.~.,,.,,,..~.~ ~~ .~ X400.00 "' ~ 13,165.42 05-20 CHECK # 1130 ~`'` _~. `~` ~~~~--.-- ~''`~ 875.00 u' 12, 290.42 05-25 CHECK# 1133 3,319.00 ~- 8,971.42 05-25 CHECK # 1135 460.00 ~ 8, 511.42 05-26 CHECK # 1131 2,000.00 ~ 6, 511.42 05-26 CHECK # 1134 200.00 6, 311.42 06-02 INTEREST PAYMENT .45 6, 311.87 ~~~. 06-02 ENDING BALANCE , ` 6, 311.87 ~,--~ , P,C~. ~®x 3129r ~e~ty:~6~ar~, PA 17325 Pl~an~ 717,334.3161 Tot{ Free 1.888.334.ACN6 (2262) F~EI~"- 5I 1 EX-~- (l ~i- C~9 ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ALTA D. MOSEMAN N 21-10-0710 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Pre-paid 0.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) 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 claimant's, attach explanation.) Claimant Street Address City ___ State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5• Accountant Fees: 6. Tax Return Preparer Fees: ~. 0.00 750.00 0.00 164.50 0.00 0.00 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 914.50 If more space is needed, use additional sheets of paper of the same size. ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER ALTA D. MOSEMANN 21-10-0710 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. II I I f 2010 Statement of Real Estate Taxes Control No: 043- 000424 I III II I III II II I IIII I I II ~~~~ ~~~~ ' ~~ Bill Date: 7/01/2010 AYABIE __ Assessed Land Improvement Mineral Total To: Values 0 27,580 0 27,580 SHIRLEY J. ARMOLD, TAX COLLECTOR xomestead Exclusion 8, 22s- 650 MOHAWK ROAD BIG SPRING S.D. Discount Face Penal NEWVILLE, PA 17241 rates .01607200 2 S 10 ~ SCHOOL R/E _ 443.27 Esc: ASSESS.NO -43000424 xomestead credit 132.24- MAP NO: 43-05-0417-024C TR04218 47 MOUNTAIN VIEW TERRACE TAX AMOUNT DUE > $304.81 $311.03 $342.13 MOUNTAIN VIEW TERRACE M H P If Paid On or 1-fter 7/01/2010 9/01/2010 11/01/2010 LOT 47 If Paid Oa or Before__~ 8/31/2010 10/31j2010 12/31/2010 Mobile Home - No Land IF TAXES ARE ESCROWED FORWARD TO MORTGAGE COMPANY MOBILE HOME -LEASED LAND 1.00 FEE FOR ADDI770NAL RECEIPTS IF NOT. PAID BY 1?J15h0 THIS BILL WILL BE RETURNED TO TAX CLAIM TAX MOSEMAN EARL &ALTA Y 47 MOUNTAIN VIEW TERRACE A ER NEWVILLE PA 17241 NOTICE OF PROPERTY TAX RELIEF= Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property. As an eligible homestead and/or farmstead property owner, you have received tax relief through a homestead and/or farmstead exclusion ~Nhich has been provided 1FFICE TUESDAY 5PM-8PM THURS 11AM-5PM under the Pennsylvania Taxpayer Relief Act, a law passed Iby the Pennsylvania General ~auas: OTHER DAYS BY APPOINTMENT Assembly designed to reduce your property taxes. PHONE 717-776-5065 CLOSED JAN & FEB /`!____ $ Return Biif with Payment. For a Receipt, Tax Collector Signature Date Paid Amount Paid Enclose aself-addressed stamped envelo ff paying installments; use the coupons below to submit pa~/ments. ff paying in full; submit the remittance copy above. TAX YEAR 2010 BILL DATE 7/01/2010 BILL # 709 _~ PAYABLE TO SHIRLEY J. ARMOLD, TAX COLLECTOR ~~ 650 MOHAWK ROAD NEWVILLE, PA 17241 CONTROL ~ 043 - 000424 ~_ MAP # 43-05-0417-024C TR04218 SCHOOL BIG SPRING S.D. ~ .~ ~_ ~~ ~_ TAX PAYER MOSEMAN, EARL &ALTA 47 MOUNTAIN VIEW TERRACE ~~ NEWVILLE PA 17241 ~- 3rd Please return coupon with third payment. $103.67 ON OR BEFORE OCTOBER 31, 2010 $114.04 AFTER OCTOBER 31, 2010 10 % _/-/ $ Tax Collector Signature Date Paid Amount Paid TAX YEAR 2010 BILL DATE 7/01/2010 BILL ~ 709 TAX YEAR 2010 BILL DATE 7/01!2010 BILL 8 PAYABLE TO SHIRLEY J. ARMOLD, TAX COLLECTOR ~ PAYABLE TO SHIRLEY J. ARMOLD, TAX COLLECTOR 650 MOHAWK ROAD 650 MOHAWK ROAD NEWVILLE, PA 17241 ~ NEWVILLE, PA 17241 CONTROL # 043 - 000424 ,~ CONTROL # 043 - 000424 MAP 8 43-05-0417-024C TR04218 ~- MAP #' 43-05-0417-024C TR04218 SCHOOL BIG SPRING S.D, ~ SCHOOL BIG SPRING S.D. TAX PAYER MOSEMAN, EARL &ALTA ,~ TAX PAYER MOSEMAN, EARL &ALTA 47 MOUNTAIN VIEW TERRACE 47 MOUNTAIN VIEW TERRACE NEWVILLE PA 17241 ~~ NEWVILLE PA 17241 INSTALLMENTS CANNOT START AFTER OCTOBER 31, 2010 1 St Please return coupon with first payment. $103.68 ON OR BEFORE AUGUST 31 2010 $114.05 AFTER AUGUST 31, 2010 10 % //~ $ .~. ~ .. .+ . n ._ n_ _~ • __ _..._~ Pl_._I 709 ~~ ~~ 0 s>, ~~ ~.~~ ~. 2nd Please return coupon with second payment. $103.68 ON OR BEFORE SEPTEMBER 30 2010 $114.05 AFTER OCTOBER 31, 2010 10 % -_/-/ $ T_.. /~. 11,..a-.. f~: ~._.a. ..... f9...a~ /9-. :.J A.,... ... .-.a 19..:..1 REV-1513 EX+ (O1-10) pennsylvania SCHEDULE DEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ALTA D. MOSEMAN N 21-10-0710 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• Barbara A. Mosemann, 2518 Oakland Ave., Apt. 104, Elkhart, IN 46517 daughter 2. Carol J. Beachy, 4824 85th Street, Mylo, ND 58353 daughter 3. Joel M. Mosemann, 30 Mountain View Terrace, Newville, PA 17241 son 4. James E. Mosemann, 3523 Mell Ridge Rd, Edmonton, KY 42129 son 5. David R. Mosemann, P.O. Box 252 TOK 250, Raymond, Alberta, Canada son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. Blue Ridge Mennonite Church of Centerville, PA TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. $1,000.00 $5,220.50 $5,220.50 $5,220.50 $5,220.50 $2,000.00 2, 000.00