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HomeMy WebLinkAbout03-09-11 (3)J 1505610140 REV-1500 EX (°'-'°) PA Department of Revenue !OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 0 1 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 7 4 0 5 2 1 8 2 1 2 1 7 2 0 1 0 0 2 2 3 1 9 1 6 Decedent's Last Name Suffix Decedent's First Name MI W H I S T L E R M A B E L (If Applicable) Enter Surviving Spouse's Information Below M 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 ~ 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate ~ prior to 12-13-82) 4a. Future Interest Compromise (date of ® 5. Federal Estate Tax Return Required ® death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Livin Trust (Attach Copy of Will) g 8• Total Number of Safe Deposit Boxes (Attach Copy of Trust) [~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 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 R O G E R B I R W I N 7' 1 7 2 4 9 2 3 5 3 First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E State ZIP Code ~ P A 1 7 D 1 3 REGISTER OF WILLS USE ONLY j n ~ _~ ~7 ~ '- ~~ 7 _ '> ~ . 5.., ._~~ .. ~ ~~ 'i ~--, ~:- -,; __ i~~1~ FILED ~ :. ,= _-+ ' ~•~ C=~ ,- -,-T ~r Correspondent's a-mail address: 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 JPE_RSOyN~RESPONSIBLE F R FILING RETURN ADDRESS ~ °f~ ~~ _ 3~Q~~! 146 PORTER AVENUE CARLISLE PA 17013 SIGNATUR P EPARER OTHER TH REPRESENTATIVE DAT ADDRESS 3 q I! 60 WEST P FRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 P O M F R E T S T R E E T 1505610140 J~ -f?EV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME MABEL M. Wf STREET ADDRESS CITY Tax Payments and Credits: ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ File NumbE~r 21 11 0019 STATE ~ ZIP (1) 8 627.17 B. Discount 431.36 3. Interest Total Credits (A + g) (2) 431.36 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill In oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8 195.81 Make check payable to: REGISTER OF WILLS, ,AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIAT „ ., ~ BLot^.KS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; ................................................................ Yes ...... ^ No a 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 December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................. ^ O 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ... ...... ...... ^ 0 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 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 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 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 ['2 P.S. §9116(a)(1.3)]. Asibling is defined, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. • REV-158 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDUL EE CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY MABEL M. WHISTLER FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. I 00 All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION ~ • WACHOVIA BANK -CERTIFICATE OF DEPOSIT #247402053898591 2• WACHOVIA BANK -CERTIFICATE OF DEPOSIT #247402093898595 3. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #247402092061637 4. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #247412051235402 5• WACHOVIA BANK -CERTIFICATE OF DEPOSIT #247412061022280 6• WACHOVIA BANK -ACCOUNT #1000324264330 7• WACHOVIA BANK -ACCOUNT #1010080462039 8. WACHOVIA BANK -ACCOUNT #3000202812640 TOTAL (Also enter on line :i, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 26,293.05 27,093.99 13,827.27 38,637.41 23,668.52 4,051.68 79,603.60 812.69 213,988.21 ' REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ~~iHit yr FILE NUMBER MABEL M. WHISTLER 21 11 0019 Decedent's debts must be reported on Schedule I. ITEM NUMBER A. 1. 2. B. DESCRIPTION FUNERAL EXPENSES: EWING BROTHERS FUNERAL HOME OPENING OF GRAVE ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP _ Year(s) Commission Paid: 2. AttomeyFees: IRWIN & McKNIGHT, P.C. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant WANDA K. WALTIMYER Street Address 146 PORTER AVENUE City CARLISLE State PA _ zIP 17013 Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees: REGISTER OF WILLS 5. I Accountant Fees: 6. I Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 9. THE SENTINEL -ESTATE NOTICE TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. AMOUNT 6,395.34 1,595.00 9,800.00 3,500.00 307.50 350.00 30.00 75.00 187.54 240.38 REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MABEL M. WHISTLER FILE NUMBER 21 11 0019 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed ITEM NUMBER DESCRIPTION ~~ CENTURYLINK -TELEPHONE lexpenses. VALUE AT DATE OF DEATH 33.05 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS TOTAL (Also enter on Line 10, Recapitulation) $ If more space is needed, insert additional sheets of the same size. 33.0 REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE 7AX RETURN RESIDENT DECEDENT CC~T •T~ ~ SCHEDULE J BENEFICIARIES rvlralV VI. MABEL M. WHISTLER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. WANDA K. WALTIMYER 146 PORTER AVENUE CARLISLE, PA 17013 FILE NUMBER: 21 11 001! RELATIONSHIP' TO DECEDENT Do Not List Trustee(s) Lineal AMOUNT OR SHARE OF ESTATE 191,714.78 REMAINDER I 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: 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, LAST WILL AND TESTAMENT I, MABEL M. WHISTLER, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do herby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix or Substitute Executor to pay al:l of my debts, fujneral and administrative expenses as soon as convenient after my decease. Furthermore, I direst that all state, inheritance, succession and other death taxes imposed or payable by reason of Imy death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executrix or Substitute Executor from my estate, and that none of the aforesaid taxes shall be prorated among those persons or entities named herein or otherwise beneficiaries hereunder. 2. My Executrix or Substitute Executor may, at her or his discretion, compromise claims, borrow money, retain property for such length of time as she or he m.ay deem proper; pease and sell property for such prices, on such terms, at public or private sales, as she or he may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. 3. I authorize and empower my Executrix or Substitute Executor to sell any malty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My Executrix or Substitute Executor is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executrix or Substitute Executor. 4. I give, devise and bequeath all of my estate of every nature and wherever situate to my stepdaughter, WANDA K. WALTIMYER. 5. I nominate and appoint WANDA K. WALTIMYER to be the Executrix of this my Last Will and Testament. In the event she has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint ROGER B. IRWIN to be the Substitute Executor of this my Last Will and Testament, whereby the said Substitute Executor shall have the same powers as are given to the original Executrix hereunder. 6. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. 7. No Executrix or Substitute Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 2 8. No beneficiary may assign, anticipate or pledge her interest in any income 4r principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 9. I hereby suggest that my personal representative retain the services o~ Irwin & McKnight, P.C. as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27~' day pf October 2010. ~'"W~. ~ ~'~ (SEAL MABEL M. TLER ' ) Signed, sealed, published and declared by the above-named Testatrix, as and fox her Last Will and Testament, in our presence, who, at her request, in her presence and in the priesence of each other have hereunto set our names as subscribing witnesses. ~ ~ 3 ACKNOWLEDGMENT AND AFFIDAVIT WE, MABEL M. WHISTLER, MARTHA L, NOEL and SHARON L. SC~HWALM, the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testa 'x signed and executed the instrument as her Last Will and that she had si geed willingly, d that she executed it as her free and voluntary act for the purpose herein expressed, and that ach of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness end that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. 2U -' MAB M. STLER ~ n MAR L. N EL SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: Subscribed, sworn to and acknowledged before me by MABEL M. WHISTLER, the Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and SHARON L. SCHWALM, witnesses, this 27`~ day of October 2010. `~-~ Notary Public COM ~~ ~ SYLVANIA Meng nC~erlandPCounty OCL 8 2012 . PennsylvaMe q~~ a ~ 4 WACHOVIA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name NE CNTRL PA /CARLISLE PA Date 01 /05/2011 CURRENT BALANCE : $26,265.97 + ACCRUED INTEREST : $27.08 Avail Int WD/PenFree: $542.02 - PENALTY AMOUNT : $0.00 -FEDERAL W/HD DUE : $0.00 -WITHDRAWAL FEE : $0.00 -OUTSTANDING PYMT : $0.00 PAID TO CUSTOMER : $26,293.05 Customer Name(s), Address and Taxpayer ID Number MABEL M WHISTLER 146 PORTER AVE CARLISLE PA 17013 SXXXXX2182 FULL REDEMPTION CD ACCOUNT NUMBER: 247402053898591 WACHOVIA Opening Date TIME DEPOSIT Account Number This Receipt Acknowled es That The Depositor Named ****************VQ ID***** Below Has Deposited Wnh This Bank The Sum Of Depositor Name And Address TaxpayerlD Number NOT TRANSFERABLE Term Matudty Date Interest Rate Per Annum Annual Percentage Yield Interest Payment Frequency/Pedod Interest Payment Disposition Account to Credit Issued by WACHOVIA BANK ' 588694 (Rev 02) PROD-TYPE X reed Signet Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A. PROMO CD: ~ 4 X .ter Date ' WACHOVIA ' TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name NE CNTRL PA /CARLISLE PA Date 01 /05/2011 CURRENT BALANCE : $27,038.77 + ACCRUED INTEREST : $55.22 Avail Int WD/PenFree: $2,093.99 - PENALTY AMOUNT : $0.00 -FEDERAL W/HD DUE : $0.00 -WITHDRAWAL FEE : $0.00 -OUTSTANDING PYMT : $0.00 PAID TO CUSTOMER : $27,093.99 Customer Name(s), Address and Taxpayer ID Number MABEL M WHISTLER 146 PORTER AVE CARLISLE PA 17013 SXX~CX2182 FULL REDEMPTION CD ACCOUNT NUMBER: 247402093898595 WACHOVTA Opening Date ~~~ TIME DEPOSIT NOT TRANSFERABLE Account Number This Receipt Acknowledges That The Depositor Named ****************VOID***** Below Has Deposited With This Bank The Sum OF Depositor Name And Address term Interest Payment Disposition Maturity Date Account to Gedit TaxpayerlD Number Interest Rate Per Annum Annual Percentage told Interest Payment FrequencylPeriod PROD-TYPE: lasued by WACHOVIA BANK Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, (Rev 02) PROMO CD: Date WACHOVIA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name NE CNTRL PA /CARLISLE PA Date 01 /05/2011 CURRENT BALANCE : $13,811.23 + ACCRUED INTEREST : $16.04 Avail Int WD/PenFree: $446.27 - PENALTY AMOUNT : $0.00 -FEDERAL W/HD DUE : $0.00 -WITHDRAWAL FEE : $0.00 -OUTSTANDING PYMT : $0.00 -------------- PAID TO CUSTOMER : $13,827.27 Customer Name(s), Address and Taxpayer ID Number MABEL M WHISTLER 146 PORTER AVE CARLISLE PA 17013 SXXX)CX2182 FULL REDEMPTION CD ACCOUNT NUMBER: 247402092061637 WACHOVIA Opening Date TIME DEPOSIT Axount Number This Receipt Acknowledges That The Depositor Named ****************VOID***** Below Has Deposited With This Bank The Sum Of Depositor Name And Address Tenn Interest Payment Disposition Maturity Date Issued by WACHOVIA BANK oz> PROD-TYPE: X Authorized Signature Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A. PROMO CD: x ` ~ ~. Date Account to Credit TaxpayerlD Number NOT TRANSFERABLE Interest Rate Per Annum Annual Percentage Yeld Interest Payment Frequency/Period WACHOVIA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name NE CNTRL PA /CARLISLE PA Date 01 /05/2011 CURRENT BALANCE : $38,609.22 + ACCRUED INTEREST : $28.19 Avail Int WD/PenFree: $784.62 - PENALTY AMOUNT : $0.00 -FEDERAL W/HD DUE : $0.00 -WITHDRAWAL FEE : $0.00 -OUTSTANDING PYMT : $0.00 -------------- PAID TO CUSTOMER : $38,637.41 Customer Name(s), Address and Taxpayer ID Number MABEL M WHISTLER 146 PORTER AVE CARLISLE PA 17013 SXX~CX2182 FULL REDEMPTION CD ACCOUNT NUMBER: 247412051235402 WACHOVIA Opening Date TIME DEPOSIT Account Number This Receipt Acknowled es That The Depositor Named ***************"VOID***** Below Has Deposited W~th This Bank The Sum Of Depositor Name And Address Taxp~yerlD Number NOT TRANSFERABLE Term Maturity Date Interest Rate Per Annum Annual Percentage veld Interest Payment Frequency/Pedod Interest Payment Disposition Account to Credit ~P}ROD-TYPE: PROMO CD: Issued by WACHOVIA BANK /~ ~ I I /~ ~-- ~~r X ~ ~ S Authorized Signature Date Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N. (Rev 02) WACHOVIA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name NE CNTRL PA /CARLISLE PA Date 01 /05/2011 CURRENT BALANCE : $23,635.28 + ACCRUED INTEREST : $33.24 Avail Int WD/PenFree: $769.50 - PENALTY AMOUNT : $0.00 -FEDERAL W/HD DUE : $0.00 -WITHDRAWAL FEE : $0.00 -OUTSTANDING PYMT : $0.00 PAID TO CUSTOMER : $23,668.52 Customer Name(s), Address and Taxpayer ID Number MABEL M WHISTLER 146 PORTER AVE CARLISLE PA 17013 SX~OCX2182 FULL REDEMPTION CD ACCOUNT NUMBER: 247412061022280 WACHOVIA Opening Date TIME DEPOSIT Account Number This Receipt Acknowled es That The Depositor Named ****************Vr~ ID*+'*** Below Has Deposited W~th This Bank The Sum Of Depositor Name And Address Term Interest Payment Disposition Account to Credit TaxpayerlD Number NOT TRANSFERABLE Interest Rate Per Annum Annual Percentages Yield Interest Payment FrequencylPedad PROD-TYPE lasued by WACHOVIA BANK X thonAU 'zed Signat~ Wachovia Bank and Wachovie Bank of Delaware are divisions of Wells Fargo 588594 (Rev 02) PROMO CD: I f (r Date Maturity Date WACHOVTA Deposit Account Close Confirmation (Debit) WACHOVIA BANK Date 01 /05/2011 Customer Name(s) and Address MABEL M WHISTLER TaxpayerlD Number S174052182 146 PORTER AVE CARLISLE PA 17013 ACCOUNT NUMBER: 1000324264330 Available Balance $4,051.68 + Accrued Int : $0.10 -Fed W/Hd Due : $0.00 - Admin Fee : $0.00 -Outstanding Db : $0.00 -Closing Fee : $0.00 -------------- Paid To Customer : $4,051.78 Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A., Member FDIC. 566596 (Rev 01) CUSTOMER COPY WACHOVIA Deposit Account Close Confirmation (Debit) WACHOVIA BANK Date Customer Name(s) and Address 01/05/2011 MABEL M WHISTLER 146 PORTER AVE CARLISLE PA 17013 ACCOUNT NUMBER: 1010080462039 Available Balance $79,580.05 + Accrued Int : $23.55 -Fed W/Hd Due : $0.00 - Admin Fee : $0.00 -Outstanding Db : $0.00 -Closing Fee : $0.00 Paid To Customer : $79,603.60 Taxpayer ID Number S174052182 Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A., Member FDIC. 566596 (Rev 01) CUSTOMER COPY WACHOVI~ Deposit Account Close Confirmation (Debit) WACHOVIA BANK Date Customer Name(s) and Address 01/05/2011 MABEL M WHISTLER 146 PORTER AVE CARLISLE PA 170130000 ACCOUNT NUMBER: 3000202812640 Available Balance $812.69 + Accrued Int : $1.96 -Fed W/Hd Due : $0.00 - Admin Fee : $0.00 -Outstanding Db : $0.00 -Closing Fee : $0.00 Paid To Customer : $814.65 Taxpayer ID Number S174052182 Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A., Member FDIC. 566596 (Rev 01) CUSTOMER COPY • Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 December 23, 2010 Wanda K. Waltimyer 146 Porter Ave Carlisle, PA 17013 The Funeral Service for Mrs. Mabel M Whistler We sincerely appreciate the confidence you have placed in us and will continue to assist you in eve feel free to contact us if you have w any questions in regard to this statement. ry ay we can. Please THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT AND MERCHANDISE THAT YOU SELECTED , WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff Embalming, $1840.00 Dressing, Casketing, Cosmetics, $875.00 2. FACILITIES AND SERVICES $290.00 Complete use of Facilities viewing,service , 3. AUTOMOTIVE EQUIPMENT $790.00 Vehicle to transfer remains to Funeral Home , Heazse (Casket Coach) ~ ~ $275.00 Lead car/Clergy ~ ~ ~ ~ $250.00 Utility Vehicle to retrieve/file DC $125.00 FUNERAL HOME SERVICE CHARGES ~ $125.00 SELECTED MERCHANDISE: ~ $4570.00 20G Spartan Blue (Gask), • Acknowledgement cards, $1350.00 Register Book(s) , $10.00 Memorial folders $40.00 THE COST OF OUR SERVICES EQUIPMENT A $75.00 , , ND MERCHANDISE THAT YOU HAVE SELECTED , . :66045.00 Cash Advances Clergy/Mass Offering, • Certified Copies of the Death Certificate ~ ' Flowers Sentinel Newspaper TOTAL CASH ADVANCES AND SPECIAL CHARGES.. Total Total Cost $125.00 $30.00 $132.50 $62.84 $350.34 • $6395.34 C GV e.t2- I~Z-~ea~.~~ i SUB-TOTAL $6395.34 INITIAL PAYMENT /DISCOUNT /CREDITS 0.00 TOTAL AMOUNT DUE $6395.34 The unpaid balance over 30 days is subjected to a 1.50 % service charge per month -18.0000 % per annum.