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HomeMy WebLinkAbout01-04-111505610101 REV-1500 °`f°~-1O' m PA Departmertt of Revenue ~a OFFICUU_ USE ONLY Bureau of Irtdiv(dual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 28D6oi Harrisburg. PA i~us-ocoi RESIDENT DECEDENT ~ ~ 1l~_ I_l_! 1~_ ENTER DECEIDENT INFOfRMI!>I<fON BELOW Soaal Security Number Date of Death MMDDYYYY 3 ~ 0 1,~ ,~ o' C~ Decedent's Lit Name Suffix (M Appltcabie) Enter Surviving Spouse's Information Below Date of Birth MMDDYYYY o / Decedents First Name MI ~~~ Spouse's Last Name Suffix Spouse's First Name rrTT MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FH11N APPROPRU-TE OVALS BELOW ~ 1. Original Retum O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of III) O 9. t.itiyation Proceeds Received O 2. Supplemental Retum O 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 Retum (date of death prior to 12-13-82) O 5. Federal Estate Tax Retum Required d 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) COR~ONDEtfT- THLR 8ECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ' ~~~~~ REOIST~F YYILL8 USF~N LY First line of address ~ C.-. W C-~ ~"" =j.~ ' ©~~ ~ ~;1 Second line of address ~„ ~ -~r- c ~' , © r 3 ~ r J ~~ ~ ~ FILED ~-' City or Post Office State ZIP Code m Comsspoadertt's e-mail address: Under penalltirises 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. Dedarefion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA ' ~ PERSON/SPONSI ' F~~~IN RETURN DATE ~~ ~ ~' f (~ / /~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEAiE UsE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J REV 1500 EX Decedent's Name: I r ~ R' APITULATION 1505.610105 3, SosT~ ~ t Decedents Social Security Number 1. Real Estate (Schedule A) ............................................. 1. oo~i . iri uomoio ~~ iii 2. Stocks and Bonds(Sd~edule B) ....................................... 2. 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. 6. Jointly Owned Property (Schedule F) O Separate Bitting Requested ....... 6. 7. Inter-Vrvos Transfers & Miscellaneous Non-Probate Properly (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ......................:...... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. Q 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. Net Value of Fatale (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Nit Value Subject to Tax (Line 12 minus Line 13) ........................ 14. IAA GALGUV111UIU - 3Ct: IPIS r KUG 1 WNS FUK APPLIGAESLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (ax1.2) X .0_ 16. Amount of Line 14b1e at lineal rate X .0 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT sjae s 1505610105 1505610105 O REV-1600 EX Page 3 Decedent's Complete Address: Fils Number DECEDENTS NAME ` A ~ ~ ~ ~ n ~©~~ 1v ~~~ STREET ADDRESS ©~ , ` ~R 8`37 ~. ~"~r~a~~ ~~ CITY ~`-~ ~ ~~ ~ ~ ~ ~ V STATE n f'~ ZIP / `y~~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPalyrrlents A. Prior Payments B. Discount 3. Interest (~) lo, ~~~, 59 Total Credits (A + B) (2) , ©/ (3) 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fiq in oval on Page 2, Line 20 to request a refund. (4) 5. ff 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. 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 Ule property transferred :.......................................................................................... ^ b. retain the right to desgnate who shall use the property transfemed or its income : ............................................ ^ c. retain a reversionary intere~; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. ff death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ Ir~~1 3. Did decedent own an in trust for" or payable-upon-death bank account or seanity at his or her death? .............. ^ Irs,t 4. Did decedent own an individual retirement account, annuity or other rwn-probate property, whic~l 1~tr contains a treneficiary designation? ..................................................:..................................................................... lc-. ^ IF THE ANSYVER TO ANY OF THE ABOVE QUESTIONS IS 1(ES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. For dates of death on or after Juty 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or forthe 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 nat exempt a transfer to a surviving spouse from tax, and the s~tutory requirements for disclosure of assets and filing a tax retain are stiN 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 rret value of transfers from a deceased drild 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 unposed on the net value of transfers to or .for the use of the decedertYs Hneal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) p2 P.S. §9116(a)(1}J. • The tax rate imposed on the net value of transfers to or for the use of the deoedenYs siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Sectial 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVAN~~ COUNTY OF CUMBERLAND SHORt CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and, ar CUMBERLAND County, do hereby certify that on the 23rd day of November, Two Th usand and Ten, Letters TESTAMENTARY ~! in common form were granted by tie Register of said County, on the i estate of MAR/EBSOSTAR late of HAMPDENTO IN~MiP Esc ~ua~s, c.sa in said county, deceased, to CAROLS S EGAN ~'~ ~~ rr~ ,w;aaro, c.:u ~I 'I and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and seal of said office at CARLISLE, PENNSYLVANIA, this 23rd c1a Two Thousand and Ten. File No. PA File No. Date of Death S.S. # 2010- 01161 21- 10- 1161 10/16/2010 167-36-6036 fixed the f November NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED a REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF (~R~4NT OF LETTERS No : 2010- O 1161 PA No . ~, 21- 10- 1161 Estate Of: MAR/EB SOSTAR lFbst, Midge, Lash Late Of : HAMPDEN TOWNSH/P CUMBERLAND COUNTY Deceased Social Securi ty No: 167-36-6036 WHEREAS, on the 23rd day of November 20.10 an instrument dated July 6th 1999 was admitted to probate as the Iasi wi11 0.~ MARIE B SOSTAR fFlrs4 ta~et/ Late of HAMPDEN TOWNSH/P, CUMBERLAND County, who died on the 16th day of October 2010 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STR,4SBAUGH Regi s ter bf Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvanila, hereby certify that I have this day granted Letters TESTAMENTARW tm: CAROLS S EGAN who has duly qualified as EXECUTOR(R/X~ and has agreed to administer the estate according to Iaw,',a'1I of which fu11y appears of record in my office at CUMBERLAND COUNT' aOURT HOUSE, CARL/SLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set my hand and',a!ffixed the seal of my office on the 23rd day of November 2010. egiste~ o erw.ty i ~.r 4 - _ ..~a. ~~v Y .- K~ a~ ~_. ~~ r~~~ `,- i ~_, 3" ~_ y ~1 I~ t'iARI~ B. uOSTAft~ Or TF~1 i30R0UGH OF 2U;':d CUMI3~RLAND~ ~I C~it~~"IY OF CUMBERLAPID, AND STATv OF P.~tdNSYLVANTA, B~, NG OF SOUND MIIytORY, AND UNDERSTANDIi`IG, DO Y~tEBY MAKF~ PUBI,ISHi A~t~D II AS MY LAST WILL AND TESTAMENT, T~REBY DECLARING 3~tTt,L AND AND ALL PRIOR '.ILLS, TOGETHER WITH ANY CODICIL THERETO. 1~r>, AS TO I~IY WORDLY E.~'ATE AID Ate, i~ . Pi~(}PERTY,Rr~AL ~,~:_ PERSONAL, OR MI.~D, OF WHICH I SHAZL DIE SEiZED,iPOSSESSED OFD TO WHICH I SHALL BE ENTITLED AT THE T11+IE OF MY DEC.~ASE~ I BEQtIEATHy AND DISPOSE THERDOF IN THE MANNER FOLLOWTNG~ TO WIT: THIS FIRST: I ORDER AND DIR~-'CT THAT ALL MYJUST DEBTS AND '', ~~ FU1AL EXPENSES SHALL BE PAID OUT OF MY ESTATE AS SOON AFTER I~Y DECEASE AS SHALI, BE FOUND CONVENIENT BY MY EXECUTRIX HERE:CNAFTT~R NAMED. S_EGOND: I GIVES DEVISES AND HEQt3EATH ALL OF MY REAL, PERSONAL, OR MIXED! OF WHICH I SHALL DIE SEIZED AND OFD OR TO-WHICH I SHALL BE ENTITLED AT THE TIME OF MY DECEASE MY DAUGHTERS CARtILE S. ELAN. THIRD: IN THE EVENT MY DAUGHTER SHOULD PRIDECEASE MEN T: ALL OF MY PROPERTYt REALM PERSONALS OR MIXED WILL BE SIiARF~ BY GRANDDAUGHTEF{~S~ KRISTIN ELAN STEEL AND ZISA ~. EGAN~ SHARE AIdD SHARE ALIKE. FOURTH: IN THE EVENT EITHER OF MY GRANDDAUGHTERS NAMED SI~ULD AI,9O PREDECEASE Z~iE~ I THEN BEQUEATH ALL OF MY PROPERTY PERSONAL, OR MIX, TO THE SURVIVOR. , . } F IFTIi: I I~~VL~' Ic~?'?+~ITIONA.LLY r'i-'~TD ?JZ^t.: - r I~?0 ~•iZ~:DG~ O~~i~CT~', Tf: PROVIDE : 0:3 TTa±, SPOUa si OR ~;~:l r"^[3"1U~'_~ C;LT.LD~ ~; CF i N~ I~ZTd` I iii B~+;I?TME'TCI?'iF~2 ~S. I i SI~'~"_. I t ~,~:~ D~:tII.~:~~~~ Is..;,G~~T~~ 0?~ ~. ~'•"z.'°~ U~u3~ '~': SI I Y7T ~ ^:.~ i~:.;_ ?t:.:iliJOl ~:~I!_~ :iv lllrll ~~~YlIA1LL'tJ 1V Jai2Y~ I.t~ i:ti :.'sJli~ ~:^L~G,~: _;. . • :i?T SG`,"'•:~IO~~ ii°,AT., ~~ `Y ~f '~ t~3iilS'L?~ .. ~ ~: L Ii. flii .~ tu~l'.:~. 'ICTii^R DI R~:=.Q`l'i~Y OR II:~ITi~l^LY? OPPOSy~ tx!Y~Tf;,,"T~ OR ATTACH T~iIS `1"- i nR TIC DISTRZ3UTION OF MY n~"TAT=1 IiE«ZIT~i ITS+IDFR~ OR S ~ ~ ' TO IMPAI ~ I~JIILID.l11.~~ OR .5.~~2' I~LiID AIfi.~ OF TTI Ps^~OVI~OIYS OF THIS ;~JII,L~ .t ? It1 TH.iT L'V~'~'i' T H^F-'~''' rIVE A1~iD B~~U~~,ATH TO ANY SUCH P~tSO1+T TIC SUhi OF OIUB DOLLAR (~~1.Ov) 0~1I,Y~ TPA LIEU OF At~Y OTHER SHARE OR ~I TS~.ST IN hiY ,ESTATE. ~ I, LA:STLY~ I DO HER_~BY ITOt~fINATE~ CONSTITUTES AND P.PPOINT MY ~'~ i DAUGHT£ft~ CAR4LE S. EGAId~ AS THE E~CUTRTg OF THIS t1Y LAST WILL A~ TESTAH~IT. IF FOR rTdYY REASON' SHE IS UNABLE TO SL'ftVE, TIiEI3 I HCRE~ NOMIPTATE AtTD APPOI2IT MY SZSTL'R~ ~(?DIA M. BAftBZ~3I0~ AS ALTERNATE ~.~C[TTRI~. . Ili Y1IfiIS 4>H~OF~ I~ MARIL B. SOSTAR~ HAVE HERE[INTO SET MY HAND AND SEAL THIS SIRTH DAY OF JULYS A. D.~ ~;Q~9, - ~ ., - ~.~.. ~ WITIaF.SS .~ -._.._._.-~....._. ~~GT~p a~y,±saaex.t»n COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ ~ D I C ,~'~ SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY CFl CTn D t 1 ~ ~ ~ \ ~ ~. 1.J' vv~...r rT I ~ Indude the proceeds of litgation and the date the proceeds were reoslived by the estate, All property jointly-owned with the right of sun o hIP must be discbsed on Schedule F. ITEM NUMBER i DESCRIPTION VALUE AT DATE OF DEATH ~ PS ~ c CL I~l©he F~t~.c'~et ~~ ~ ~~ ,, I Q~ ~ 3 ~ sr m ~ eirs ~ M . ` s ~?~~' ~ SQU~I'~~C ~, ~ 5~7~~, ' ~ ~ S ~cf '~ 9 ~ DDP~•~ . ~~, ~, l5 D, ~ C° D '~. ~~ ~~ ~~ ~~ ~~ ~~~~ '~,I ~~~ '~'~~ TOTAL (Also enter on line 5, Recapitul tic ) , ; ~ ~ 3 ~~ (If more space is needed, insert additional sheets of the same size) ~ 7 1 r D i L _ ,_ _ r er~aamow~z~oo (~ j~~~Bj~y~ Your account was DEBI'1'~D for the followi p cx~eac ~ p ~ emrrorr-- p~ ~ inoomecc acaourrt ® GOaad aCCOtI~ ~ ans a:~8 - :`~ ~ -~ ~ ~ O er ~ (brar-ch name) ~ ~` ~ ~~ ~.. n oa,er: R CCDP AMOUNT ~ 123, 8~1 ~ 99 5140ZZ93Z8 D ~ TSE ES?7-TE Ole ~ 1Q1~tI8 H 8OST31R B Z4Z f~ L11~i8 DR T C~ HIX.L, P71 17011-8318 040 p~ gaak a iaaal as,ociation FOR BANK USE Y Branch #~Dept. # I Date 0000101 1Z/06J2010 Prepared By (PRINT Name) ~ aY 8LIZ118ETS UHRICFI ~j I, ~ Advice of Charge .~_ o mo 1f>4- M P RI 1~~ 1 ~ q N !S h ' i a s ~ t H- • Q, o:~. mo n n 0 r ~e > +t ~ ~ ~ a N ~ ~ ao ~ M ~ r a i ~ ° r p p A b N O -1 A i , . t : ~~ o o «~ pp Q e_v~nel vov~ '" N O N .~ ~_ K1 V O?~ O o R-~o~o r `o~.rvo~ v rf.~@ N r q e~1 r Pl O 11f ~ `? O Q N..:Ohl!! ~O h ao~ ~o .~ O .r ~ .Q .O ,$ O O a_~ .~M O a 0 ~ , ~ ~ ~Dq bopy~ ~ K. IG O s+ .~ .. a r~Gm ~Y a r, as ° ~ ~ rl N a ~ .a .i .. o 'a~4~ ~ NC ~ '~ .. ,i C~7 ~ ~,~~. O C ~ ~ o''/~0 ~ p N ? N O O N V r r . . i m~ O O 1 ~ r ,~ E ; ~ I ~! p ~ ~ r o r • ~ ,-1 ~+ ~ ~ ~ ~ v • A ~ r ~ O > ~ ~ ~ '~ • . ~ m y ~ oc - o`0 1, ' . as ., ~ ewe a •+ .a °;~~ $' s a' oa~ .n - -cwE ~ ~ • • na, s~ ''~ u ~_ c iv I O ~p O 0 M !+. C I l '~i \ .-e r N .+ i r N ! ~ ~ ~ Q O N h O r • ~ ~ ~ " A o~ " ~ 1 ~ „ + N N V • i + ~ ~ 6 ~ p r r O w1 !q h ° ~ K n~ ~+wi,y O' rH~ O O O °~ o o m o n O p 0 0 ~~~ h irOp O 'yO,yO O ~ ~ ~ ~ O ~ • aar~ a .r O O -i IC O Y .y Y ~ ~ M O "'~ •y .. it ~ ~ ~ ~ C ~ ~~' a° ~'~~~i a~ ~a~ieic~,g~a~~o~ d ~~ 6 A v • a a 4 •• o v 7 ~ ~ ~ ~ m°Am~~ ~ C7C1~7 M • ~++ 1C U A~' ~ 'a N ~~ ~ +•1 r W ~ .C _ ~t z 4 ati ~ '~+ A a ~ aa~ al si •~ U > pO0D~0 R ~~~0 ~. > i A~ '~ • N ~.- O R ~ j r i ~ N i1 R 'a " U ~ K 6 •~ e-1 W ,p q N ~m o ~~ c~ +~ q ~ ° + w --a----------- '~~ i ~; '~ ~~.t~ ~ Aassaoyns II 3000 Louiss Drive Msahaniasburq ?]1 17055 OO~uiss Drive inquiries Call: 717-795-5100 y~ha~oiasbur9 Flt 1705 ~,' 717-785-5100 71act 7QQIXX~t215 SOST]Ut,M71RiE 8 Inquiries Call: Sff: 12/17110 Date: 12/17!10 15 li ~tIS 8 Tlr: 0233 Tins: 11:08am mat ~ I ~ts~12/17/10 Bff: 12/17110 I ,'tine: 11:07ass filr: 0233 ~ 1Pithdrwl frow 60 MOSTH CEa? 0046 ____LL~~,, Prrv Sal: 150,593.85 60 MOSRHI~T 0046 Maturity data: 01/25!11 Deposit to 150,287.51 Aoount: 150,593.85 ~~ mil' 01125/11 Maturity dats~ I 306.34 .Sal: X481158 Ataouat: ~~ 150.593.85 Dapasit to CHSCKISG 0011 Srw Sal: ~; X481025 ]trust 7Cpti00CX311 Saq: 0006 SST7ITS OF M71AIE Coesent for 4073512 0 ~10 tc Pram Sal: 47,871.68 ~-pY Sarnsd 12/16/10 74wunt : 150, 593.85 II 306.34 Saar Sal: 198,465.53 Share Dividend 8rq: X481150 I '~ I i 1J ~ ~ ~~-c.....-- 7Wthorised b~ i AutharisaKl by ID gousas: II Drv Lia __~_.._._--- ID Souroe: ~ SigCard I ~ ^ Drv Lic I (~ lanonn I ^ SigCaxd ^ Othsr .r I ^ ~~ ^ Othar . C slit Caxd Satas VIgS Qlatiaus Sela~at assoaiats 11 k' an " Vi8J1 Platinust Srlrat Credit Card Ratss • as lar as S .25~ 11P8 fes details. ~I as lox as 8.25 11PRf 11ak an assoaiatr ~~ ~ for details. li ~, I i ~ Vi ~ i, eA711tIS S ~ ' MXRIE B SOS?~R ~ I I l ~I REV-151 IX • (1-?Tj . ` ~ SCHEDULE G INTER•VIVOS TRANSFERS 8~ COMMONWEALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RE DENT DECEDENT ESTATE OF ~ ~ ~ D ~ ~~ ~ FILE NUMI This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER ; PTION OF PROPERTY % C is yes. DESCRI ITEM INCLUDE THE NAA1E Of 1NE TRAN6FEREE, THEiRREUTIONSHIP TO DECEDENT AND THE DATEOF TRANafER' DATE OF DEATH DECD'S EXCLUSION ~ TAXABLE VALUE ATTACH A COPY of THE DEED fOR REAL ESTATE. VALUE CAF ASSET INTEREST JMB R -, ©4~~.~ ~~ ~~ ~~ ~~ ~~ TOTAL (Also enter on line 7, Recapitulation) I I i ~~ (If more space is needed,. insert additional sheets of the same size) ~i ~,fl ~,o4a.a5 r History s Account History Account Statement is available. Date ^ Transaction WITHDRAWAL AT ATM #00009047/PE0317 12/06/2010CATM PSECU 1 CREDIT UNION PLA ! HARRISBURG PA 12/06/2010 ~ CHECK 001000 TRACE: 0001184393 -~, $56,78'.72 !.12/07/20101 CHECK 000997 TRACE: 0001444158 12/07/2010 `CHECK 001001 TRACE: 0001351064 -12/07/2010 CHECK 000999 TRACE: 0001322428 12/08!2010 Page 1 of 3 Amount Balance ~ ChecklMlsc. 12/08!2010 ! CHECK 000994 TRACE: 0001147228 12/08/2010 i CHECK 000996 TRACE: 0001251249 BILLPAYER CHECK 120905 FOR $391.61 1 2/09/201 0 1 WAS MAILED TO USAA AUTO & ;HOMEOWNERS INS. WITHDRAWAL AMERIPRISE FINC 12/13/2010 TYPE: AUTH PMT ID: 1410329910 CO: AMERIPRISE FINC 12/13/2010 CHECK 001002 TRACE: 0001438676 '.:12/15/2010 12/15!2010 ~ CHECK 001005 TRACE: 0001190362 ':12115/2010'; CHECK 001003 TRACE: 0001336229 WITHDRAWAL AT ATM #00006942/DU1011 12/16/2010'ATM PSECU 1500 CEDAR CLIFF D CAMP 'HILL PA 12/16/2010 i CHECK 001004 TRACE: 0002033690 12/16/2010 !;CHECK 001006 TRACE: 0001903275 ' DEPOSIT AT ATM #00000826lTQ2832 12/17/2010'ATM PSECU 111 LIMEKILN ROAD NEW CUMBERLAN PA DEPOSIT AT ATM #00000827lTQ2832 12/17/2010 ATM PSECU 111 LIMEKILN ROAD NEW CUMBERLAN PA -$500.00 $25,95~.1~3 -$225 40 i, $25,73 ~3 ~ ~ 001000_-- _ -$37.00 $56, 7 .7 000997 -$180.00 ~ $56, .7 001001 -$2,844 00 ~ $53,72 .7 ~-__.._- 000999 $1,275.00; $54, -$25 00' $54,97 7 - 000994 W _.______ ___ . _ ._. _ 000996 -$1,080.00;$53,8 _ 7~'___.__ _ I_ .... .. . .... . ._ _____~ -$310.40 ~ $53,580 3~ -$59.00 f $53,521137 ! 001002 $1,156.50 I $54,677 -$50.00 j $54,627 8 001005 -$92.87 ~ $54,534 9 j 001003 __.__.__...--t ___ -__._ __ __ _._______-__. ___ _ _ -$500.00 ~ $54,034.95 I _._ ....$27.00 ' - ____ _ _ _ _ . _ ...__. __ _ . ---_.__.. - 1$54,007. 5 ; 001004 ._...,_..._. ___...._.. _~. i____~..._.__.-_.~_ ....._._ __..__ ,._.~_._.-_ -$1,650.00', $52,357.5 001006 i $2,133.15 ~ $54,491. h 0 View Deposit ! $2,923.84. $57,414. Vew Deposit ~, ' _. ______.. _ _.-- -._____l . _..__ __. _.__, https:!/homebarilc.psecu.com/HistorylHistory.aspx?ID=SO4 1 /2/2011 REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~E N FUNERAL EXPENSES 8~ ADM{NiSTRATIVE COSTS E&TATE OF ( ) f.., n ~ r, n ~ f1 lwr-n FILE Debts of decedent must be reported on Schedule I. ITEM (UMBER DESCRIPTION A. FUNERAL EXPENSES: 1. ~ n Q~e~ ~c~.ner~ ~,c.~ cG~ ps~~~-~e o~' 1J~a-~h P~Q~u~ 3 U ~ ~~~~ l~o.oo X05,00 g. ~ ADMINISTRATIVE COSTS: ~ . Personal Representafive's Commissions '~ Iii '~ Name of Personal Representative(s) --`-+- Street Address '~ City State Zip _~~ Year(s) Commission Paid: I~ ~ W ~ 2. Attorney Fees "~ ' ~' 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) II Claimant Street Address City State Zip _~ i Relationship of Claimant to Decedent ~ ~ ~ /1 `~ 4. Probate Fees ---~ 5. Accountant's Fees ~~~ 6. Tax Retum Preparer's Fees j ~ I 7. '~ '. it i ~, I TOTAL (Also enter on line 9, Recapitul tior~) ' S' i ~ ~ ~ (If more space is needed, insert additional sheets of the same size) office of Cathotic Cerne~eries ®iocsse of Harrisburg PO Box 3651 Harrsk~wrg,' Pennsylvania 17105 Phone (717) 657=4804 SALES EF1rRACT DATE '~!~/~ ~'~ : ,~~ CEMETERY ~ili`l~+$~,#.~Jr CEMETERY# A/N 'K- PAN A/R NAME ~•~G~"" ~. ~~3A~,./ PHQNf ( ) ADDRESS ~'i~oZ G~c?G~iiJ •1,4~1~ ~~ .CITY ~s~ ~/.G.[ STATE ~"~ /?'B/,/ ZiP CCfIaE~T Interment Spaces ....... ~ $ 1. Price.... Bronze Memorials....... ~ $ J~ . ~ ' 2. down Paymen#.. ~'~ . aG- Size S~-~oLL. ' ' ' Granite Fcaundation...... ~ $ 3. Unpaid Balance?-3) ..~.., . -~-' __ Burial Vaults ........... ~ $ 4. Finance Charge . Crypt Spaces .. _, ~ $ 5. Deferred Payment (3-~4{) Niche Spaces ...... ~ $ 6. Total Price (1+4) .... '' ~~+~ Other Gji•~y~y //+tS~' s+D ... . $ ~'~• 7. rox. Monthl Pa ml APP Y Y ~n~ ,~_. Section Lot:.,. Grave(s) 8. Number of Payments ..I . g art/."f,~ f Side C t or Niah~ Buikiin rYP ~ '" 9: First Monthly Payment u ""'~ be `"~'"~"" ~° ~ ~ ~ ~~ ice. 10. Mnual Percentage Rat The payment is due on the date. stated.: above and the remaining payments on the same day of e~acFh succeeding month. Buyer may prepay in advance the full amount due without penalty and will be entitled to a prop~rtipnate refund of the unearned finance charge. Upon default in the payment of any installment due hereunder for a period in excess of one hurt~l twenty (120) days, Seller may, at its option, void this agreement and retain all payments made by Buyer as liquidated d~~mages. ~: r ~: `~~ rcpt of an exact executed co of this _ Py agreement at the time: of exeqution hereof. Before any burial is permitted in this lot, or any memorial placed on this lot, the price of the grav~ aid memorial must be paid in full. The Pur+chaser(s) agree(s) tc3 abide by all rules-and regulations of the cemetery now in force as we~H as any rules and regulations which may hereafter be adopted. Said rules and regulations may be seen upon request at the Seller's office. Upon fulfiNment of the conditionsof this agreement:and receipt of ail the above described binds itself to convey to the Buyer, by its cemetery easement, for intermen# Pay~~' Seller ~~ and . P~+rP~s may. the above mentioned number of Yf.1tJ Ti-!E PURCHASER,-.MAZY CfWCEI THIS TRANSACTION BY WRITTEN NOTICE AT ANY TP-111E PRi~R Td MlDN1GHT ~ THE THIRD B DA AFT .THE DATE OF TH1S TRANSACTION. BY , . (Au resentative) {Pur+chaser's 5'igrra#ure) F~?'17~:`rSee ot#t,ar side for additional infomaa#ion. (Co-purchaser's Signature} ~Iistory Page 2 of 5 Date ~ Transaction Description Amount Balance Check/Misc. `CHECK 110305 TRACE: 0001254519. ' 11/18/2010 ~ Irsiurance _ _- ----- 11l18/2010 iCHECK 111508 TRACE: 0001223521 _ _-f----------__ _.__-____.--------------__-_----___ -, 11/19!2010' ELECTRONIC BILL 0014 FOR $207.67 WAS SENT TO VERIZON __~ _ ._..-_ ._.___._ .~..___.._v___ __ ____ _ ____._ _._...__ DEPOSIT DISCOVER BANK :11/22/2010 OVER BANK 11/23/2010 ~ ELECTRONIC BILL 0002 FOR $56.89 WAS SENT TO PENNSYLVANIA-AME 'WITHDRAWAL VERIZON ;11/23/2010; TYPE: E-BILL CO: VERIZON Utility 11/23/2010; ~ m .- ~~~~ ~ ~ ~ ~~~n~~~~~. R.~~,~ ~.~~,- CUMBERLAN PA %% CHECK HOLD 'RELEASE 12/03/10 1,422.44 ;1THDRAWAL AT ATM #00007847ffQ2832 11/23/2010 ATM PSECU 111 LIMEKILN ROAD NEW CUMBERLAN PA j 11!23/2010; CHECK 000986 TRACE: 0001409451 -----._._ __...__-_ _ _________ _ __-- __--_-_-~_ ______ _ ._w_ , 11/23/2010 j CHECK 000990 TRACE: 0001499759 'WITHDRAWAL PENNSYLVANIA-AME "' 11/26/2010 TYPE: E-BILL CO: PENNSYLVANIA-AME Utili __. , WITHDRAWAL AT ATM #00008233/TQ2832 11/26/2010'ATM PSECU 111 LIMEKILN ROAD NEW 'i CUMBERLAN PA _-.-___. _, _...__ ___._ _.._.__ ._-__-_ _____.._ _--____ ..______.._u 11/26/2010 ~ CHECK 000995 TRACE: 0001375505 ' ELECTRONIC BILL 0001 FOR $146.98 WAS 11/29/2010 . SENT TO PPL 11/29/2010:; ELECTRONIC BILL 0004 FOR $5,805.58 WAS SENT TO USAA USB MASTERC 11/29/2010' ELECTRONIC BILL 0015 FOR $52.09 WAS ;SENT TO KOHLS DEPOSIT AT ATM #00008611/TQ2832 11/29/2010 j ATM PSECU 111 LIMEKILN ROAD NEW CUMBERLAN PA ' i DEPOSIT PA TREASURY DEPT 11/30/2010TYPE: ANNUITANT ID: 1236003133 CO: PA ;TREASURY DEPT --~ 11 /30/2010 -$82.26 ~ $20,41 -$260.31($20,1 $427.32 $20, -$207.67 $11,422.44 j $31,80 110305 $9' 111508 __.a .M___ ... __.-- -__.___ ~I_ _~ ...___ _ _ ----_._ _ ___.___ _ ~.9~1 -$500.00 j $31,301 -$1,0.00 00. $30,301 $105.00$30,196 -$56.89 I $30,1 -$500.00 ! $29, 000986 000990 -$10,160.00 $19,479. 000995 $9,205.00; $28,684. $2,011.17 $30 000993 https://homebank.psecu.comlHistory/History.aspx?II~SO4 ~ 1/2/2011 File No 2010 - 01161 ~' 1 Date 11/23/2010 11/23/2010 11/23/2010 11/23/2010 11/23/2010 SOSTAR MAKlr; ~ Cost/Fee Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCS FEE AUTOMATION FEE Total F2=Doae F12=Cancel RECEIPT .FOR PAYMENT GLENDA FARNER STRASHAUGH Cumberland County - Register Of Wills One Courthouse Sqquuare Carlisle, PA 17Q13 SOSTAR MARIE B Amount 260.00 15.00 16.00 23.50 5.00 319.50 Receipt Dat :I' 12/212010 Receipt Tim 0: 8:20 Receipt No. I 1063742 i ~, - Estate File No.: 2010-01161 Paid By Remarks: CCAJROLE S EGAN ~ ~, ------------------------ Receipt Distribution ----------~--+----------- Fee/Tax Description Payment Amount Payee Name -I!, ADD PROBATE FEE 50.00 CUMBERLAND COUNTY .GENERAL FUN -- i, Check# 1008 50.00 ~! Total Received......... 50.00