HomeMy WebLinkAbout03-18-111505610143
REV-1500 Ex (01-10) ~ OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes oEFnRTMENT OF REVENUE
PO 60X.280601 INHERITANCE TAX RETURN 21 10 00769
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
198 14 5040 06 27 2010
Decedent's Last Name Suffix
HENRY
(If Applicable) Enter Surviving Spouse's Information Below .
Spouse's Last Name Suffix
Spouse's Social Security Number
Date of Birth
07 18 1924
Decedent's First Name MI
ENIl~lA B
Spouse's First Name MI
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
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise
(date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
a g Decedent Died Testate
(Attach Copy of Will)
^ ~ Decedent Maintained a Living Trust
(Attach Copy of Trust) ~ 8. Total Number of Safe De osit Boxes
P
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit jdate of death
between 12-31 91 and 1-1-95)
^ 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDE_ NCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JOHN M SMITH ESQ (717) 3 6'~-~ 13 7 0
,_. ...: ,
. ~ r
__ _.~
First line of address
222 S MARKET STREET SUI
Second line of address
PO BOX 267
City or Post Office State ZIP Code
ELIZABETHTOWN pA
Correspondent's a-mail address: Jsmith@gskdlaw.COm
REGISTER OF 111%IL-LSrt~SE OAILY
_ }
^_`
DATE FILED
,..~~ - .
_-= 7
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.
SIGN RE OF PERSON RESP NSIBLE FOR FILING RETURN DATE
1
. ~,.. / Irene Heisev `~1i.~`~~
ADDRESS ,/ _ ,/
~.
28 Timber Villa Elizabeth wn PA 17022
SIGNATURE OF REPA ER OTHER THAN PRE TIVE DATE
John M. Smith Esq. ? 1~ ~~
ADDRESS
222 S. arket Street, Suite 201, Elizabethtown, PA
Side 1
1505610143 1505610143
J
REV-1500 EX
Decedents name: HENRY, E M MA B.
Decedent's Social Security Number
19 8 14 5 0 4 0
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) ........................................................ 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 8 , 134.68
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous ~.on; Probate Property
Se
arate Billin
Re
uested
h
l
S
d
G
p
g
q
............
) ^
(
c
e
u
e 7•
8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 8 ,13 4. 6 8
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 1 , 4 8 9.3 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 4 , 357.14
11. Total Deductions (total Lines 9 8~ 10) ................................................................... 11. 5 , 8 4 6. 5 0
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 2 , 2 8 8.18
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. 2 , 2 8 8.18
TAX COMPUTATION -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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 0 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 2 , 2 8 8.18 18.
19. Tax Due ..................................................... ............................................................ . 19.
1505610243
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
L
1505610243
Side 2
1505610243
0.00
0.00
0.00
343.23
343.23
J
REV-1500 EX Page 3
r1e,.e.as.,~~~ [~mm~1A•n ArIrIrOCC'
File Number 21-10-00769
DECEDENT'S NAME
HENRY, EMMA B. _
STREET ADDRESS
442 Messiah Circle
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box 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.
(1)
Total Credits (A + B) (2)
(3)
(4)
(5}
343.23
0.00
343.23
Make Check Pa able to: REGISTER OF WILLS, AGENT.
. .
s
`~
u„
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 :............................................................................... x
x
i na a who shall use the ro ert transferred or its income :..................
b. retain the nght to des g t p p Y ••••••••••••••••
c. retain a reversionary interest; or ............................................................................................................... x
h r mise for life of either a ments benefits or care? ............................................................ ^
d. receive t e p o p Y ,
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^
receiving adequate consideration? .................................................................................................................... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
,,,
^~.~~-x, v''Y't7. F4'Y :•~ Fa~r4 r .~;.~ tt ~'gE ,~ "Y+ .. -,. ...a ~; h'~i
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 January 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 [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1508 EX+ t6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HENRY, EMMA B. 21-10-00769
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.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (10-06)
p E, .
COM INHfTAN~ TAXE~EN~RN ANIA
R IDEN DEC
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
HENRY. EMMA B. 21-10-00769
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N R
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(sl Commission paid
2, Attorney's Fees John M. Smith Esq.
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
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
892.86
475.00
121.50
TOTAL (Also enter on line 9, Recapitulation) I 1,489.36
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF F1LE NUMBER
HENRY, EMMA B. 21-10-00769
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Miller/Sekely Funeral Home 222.86
2 Weaver Memorials, Inc. -headstone 670.00
H-A 892.86
Probate Fees
3 Escrow -final closing costs 25.00
4 Register of Wills -Letters Testamentary 96.50
H-B4 121.50
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HENRY, EMMA B. 21-10-00769
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, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+(11-OS)
COM INHEWFj,ITAN~ T~~~T~RN ANIA
RE IDEN D ED N
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
HENRY, EMMA B. 121-10-00 769
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions, and transfers
under Sec. 9116 a 1.2
Joseph Charette
DECEASED
Irene Heisey Niece One-half (1/2) of
28 Timber Villa the Estate
Elizabethtown, PA 17022
Geraldine Shuman Niece One-half (1/2) of
547 Donnerville Road the Estate
Lancaster, PA 17603
Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARTABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS oN LINt 13 or Kty-~ 5uu c;uvtrc Jr1ct i I __
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
t L:TWILLS\J.-1CK`Hc\'RY-E.WIL
=~~~~t mill ~n~ LP~trzmPnt
I, EMiVIA B. HENRY, of the Borough of Elizabethtown, County of Lancaster and
Commonwealth of Pennsylvania, being of sound mind, memory and understanding do make, publish
and declare this to be my Last Will and Testament, hereby revoking and making void any former
Will or Writing in the nature thereof by me at any time heretofore made.
EIRS';i': I order and direct my Executrix hereinafter named to pay all my just debts
and funeral expenses, including the cost of a grave lot, a grave marker and the final lettering thereon,
if necessary, as soon as can be conveniently done after my decease.
~EC€7ND: I hereby order and direct that all inheritance, estate, transfer succession
and death taxes, of any kind whatsoever, other than income taxes and death taxes on the special
"use" va.';ue of real estate, and special "use" value of qualifying businesses, (including any interest
and peralti~a thereon), which may be payable by reason of my death, whether or not with respect
to :~~~; p~rsio~.. prc:~it sharing or retirement plan, or nf.'_n_er employee benefit plan, shall be paid out
of the principal of my residuary estate passing under Paragraph THIRD herein. Taxes on future
interests shall be prepaid. Such payment shall be made as an expense of administration without
apportionment and reimbursement.
I also empower my Executrix: (i) to allocate any of my unused federal generation
skipping transfer tax exemption to any property of which I am the transferor for the purposes of such
tax (whether or not passing under this Will), (ii) to exclude any such property from any such
allocation, and (iii) to make any related election, all as she in her sole and conclusive discretion
deems mess advantageous and equitable. I direct that no party in interest to the transfer of any such
pro~~eity sha'l ~ a~~e ar•~y ciair.: against ~~~y Executrix or my estate or any claim for equitable
rei:~nbursement or any other cause.
`hI~D: All the rest, residue and remainder of my estate of whatsoever kind and
wheresoever the same may be situate at the time of my decease, I give, devise and bequeath in equal
EMMA B. HENR
shares unto my nieces, IRENE HEISEY, GERALDINE SHUMAN and my friend, JOSEPH
CHARETTE. if Joseph Charette should fail to survive me I give, devise and bequeath his share of
the residue of my Estate in equal shares among my nieces, IRENE HEISEY and GERALDINE
t
i SHUMAN. If either of my nieces fail to survive me I give, devise and bequeath their share of the
,J residue of my Estate unto ST. PAUL'S UNITED METHODIST CHURCH, Elizabethtown,
Pennsylvania.
EGU~'I'H: I nominate, constitute and appoint FARMERS FIRST BANK to act as
Guardian of the estate of any minor beneficiaries under this my Last Will and Testament, and any
other beneficiary physically or mentally unable to manage his or her affairs: Such Guardian shall
have the power to use principal as well as income from time to time, for the minor's or physically
or mentally disabled beneficiary's support, welfare and education, and shall have the authority to
invest the principal and any accumulated income in income producing real estate and in any
securities, stocks, common trust funds, whether of the corporate guardian or any other financial
institution, money market funds and life insurance proceeds, or other personal property, which the
Guardian may deem for the best interests of the minor or physically or mentally disabled beneficiary
according to the standards of prudent investments without being confined to so-called legal
investments.
ELET`H: I authorize and empower my Executrix hereinafter named to sell any real
estate which I may own at the time of my decease at either public or private sale at her discretion and
to sign any and all other documents pursuant thereto, to include but not necessarily be limited to the
power to execute any Agreements of Sale, Conditions of Sale and Deeds of conveyance.
SIXTH: I nominate, constitute and appoint my niece, IRENE HEISEY, to be the
Executrix of this my Last Will and Testament. In the event that she should predecease me or
otherwise be unable to serve, then I nominate, constitute and appoint my niece, GERALDINE
SHUMAN, to be the Executrix of this my Last Will and Testament. In the event that she should
predecease me or otherwise be unable serve, then I nominate, constitute and appoint FARMERS
r~ a
2 EMMA B. HENR~'~~
FIRST BANI{ to be the Executor of this my Last ~rG'ill and Testament. Said Executrix or Executor
shall serve in such capacity in any jurisdiction without the necessity of giving any Bond.
IN iVi'I'NESS W)~IEIZEOF, I have hereunto set my hand and seal this ~_ day
of ___._Apri_l__ ____, in the year of our Lord, Nineteen Hundred Ninety-Eight (1998).
~-~~~~~% ~ ,~~.;~ (SEAL)
EMMA B. HENRY
:-~
STONED, sealed, published and declared by the above named Testatrix, EMMA B.
HENRY, as and for her Last Will and Testament, in the presence of us, who, at her request, in her
presence, and in the presence of each other, have hereunto subscribed our names as witnesses
thereto.
_- ~. i"~ . ~l_~1 _ C.~ ~i ~ ~~ " ~-', of __ Mount Joy __-_ ,Pennsylvania
-- ~'.~ ~r--:.~
' ~ 4,-' ~.,~ ~ f:.i.4~ ~~_ Elizabethtown Penns lvania
r\~ Y
COi~i~ONWEAI,Ti3 OF PENNSYLVANIA )
SS:
~OIJNTY OF LAi~i~ASrI'ER )
y!tie, EMMA B. HENRY, .Angela M.- Lockard and Tina M. Renda
the Testatrix and witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix.
signed and executed the instrument as her Last Will and Testament; that she signed willingly; that
she executed it as her free and voluntary act for the purposes therein expressed; and that each of the
witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and 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.
,J;
_,
TESTATRIX
`~~,~ y
~ WITNESS
. ,}
~._
WITNES S
3
~~JB5ORiBEI), sworn to and acknowledged before me by EMMA B. HENRY, the
Testatri,~, and subscribed and sworn to before me by ___ An~,ela r1. Lockard and
Tina M. Renda witnesses, on _Apri1 9 _._.___,_ 1998.
NOTARY PUBLIC ~,
^0~ ~• 'A~~ a.!
Notarial Seal '~ O
Stephanie L. Shank, Notary Public ~ ~ '~~{~~r'~'~,,-r • ~
Elizabethtown Boro, Lancaster County ;
My Commission Expires May 3, 2C01 j x ~0 ^ ~ j
r ~~ c~
~ ~ ~`
~~y ~r3k-,c"~~b,
s ~? 3 ~ h`~
Frank S. MILLER/David T. SEKEL~
--- - - -- Funeral Services, Inc. Statement
David T. Sekely, President/Supervisor
130 North Market Street DATE
Elizabethtown, PA 17022-2040
8/6/2010
Phone: 717-367-1543
AMOUNT DUE
TO:
Irene Heisey $222.86
28 Timber Villa -
Elizabethtown, PA 17022
INVOICE NUMBER AMOUNT ENCLOSED
...........................................................................................................................................................................................................................................................................
Please return top portion with your payment. Thank you.
DATE TRANSACTION AMOUNT BALANCE
07J0612010 Balance forward 0.00
07/14/2010 INV #3273. 3,422.68 3,422.68
08/02/2010 PMT -3,199.82 222.86
CURRENT 1-30 DAYS 31-60 DAYS 61-90 DAYS OVER 90 DAYS AMOUNT DUE
PAST DUE PAST DUE PAST DUE
0.00 222.86 0.00 0.00 0.04 $222.86
WEB SITE
www.millerfuneralhome. com
Form PB-01
~~ `N~~
100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055
IRENE HEISEY
28 TIMBER VILLA
ELIZABETHTOWN, PA 17022-9487
RESIDENT # UNIT STMT. DATE
89802 442 06/30/2010
RESIDENT S
Mrs. EMMA B. HENRY
TOTAL AMOUNT DUE $4 145.14
DATE DUE 0713112010
QAT~ ^vEaC~i~'Tl.^..iti RATE D3VSI
Units C~~:,i~GES CF:~^iT l Sr^,L.^-.":~~ ~
Balance Forward 1,101.75
06/17/2010 PAYMENT RECEIVED -THANK YOU!!! 1,101.75 0.00
*** Assisted Living ***
06/01/2010 WATCH MATE MONITORING 06/01-06/29 17.33 1.00 17.33 17.33
#110
06/17/2010 BED ALARM PAD 57.00 1.00 57.00 74.33
06!29/2010 SRC - JUNIATA 06/01-06/29 29.00 1,101.75 1,176.08
*** Nursing Care ***
06/01/2010 WATCH MATE MONITORING 06/16-06/21 1.33 1.00 1.33 1,177.41
#110
06/21/2010 RM/ BRD -NURSING -SEMI-PVT 286.00 6.00 1,716.00 2,893.41
06/16-06/21
06/23/2010 PRESCRIPTION DRUGS 11.13 1.00 11.13 2,904.54
PHENOBARBITAL 20M
06/23/2010 OXYGEN 17.50 1.00 17.50 2,922.04
06/24/2010 OXYGEN 17.50 1.00 17.50 2,939.54
06/2512010 OXYGEN 17.50 1.00 17.50 2,957.04
06/26/2010 RM/ BRD -NURSING -SEMI-PVT 286.00 4.00 1,144.00 4,101.04
06/23-06/26
06!26/2010 OXYGEN 17.50 1.00 17.50 4,118.54
06/26/2010 PREVAIL PROTECTIVE UNDERWEAR 1.30 7.00 9.10 4,127.64
06/27/2010 OXYGEN 17.50 1.00 17.50 4,145.14
RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTA!_ AMOUNT DUE
89802 4,145.14 0.00 0.00 0.00 0.00 $4,145.14
U ' _ Form PB•01
RESIDENT NAME Mrs. EMMA B. HENRY GENE
A 1% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you!
If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You!
Weaver Memorials, Inc.
213 W. Main Street
P.O. Box 245
New Holland, PA 17557
(717) 354-4329 fax: 354-3087
Toll free (800) 269-3042
www.weavermemorials.com
Weaver-Carlson Memorials
4355 Pottsville Pike
(Route 61 North)
Reading, PA 19605
(610) 929-4900 fax: 929-4978
Weaver-Hiestand Memorials
1854 W. Main Street
Mount Joy, PA 17552
(717) 653-0380
fax: (717) 653-0410
00 NOT WRITE IN THIS AREA. FOR OFFICE USE ONLY
Weaver Memorials
1 Long Lane
Willow Street, PA 17584
(717) 464-6923
fax: (717) 464-6933
~~
-=- J .
THE ROCK OF AGES WARRANTY HAS BEEN EXPLAINED AND HAS BEEN ACCEPTED REFUSED
The Price for delivery of the described work under this contract is as follows:
NOTE: FUTURE DEATH DATES not included in memorial cost Memorial Cost $
INSCRIPTION: Estimated
Foundation Cost $
,, , .,
;; , . .:
_ r ~ ~ ^ NOB $
_ Vases $
Cem Code
Seller agrees to install the above described work in ~' CEMETERY (on or about
subject to labor and shipment delays and any other causes beyond the control of seller.) '
Title and ownership of the memorial or other work shall remain in seller until payment of balance in full. Seller reserves the right to remove any memorial or other
work already erected at any time until entire balance is paid in full. Title and ownership shall pass to buyer only upon full and final payment to seller.
Buyer shal{ be deemed to have accepted the memorial or other work as delivered if written notice of rejection of the work is not given to seller within twenty (20) days after delivery to the cemetery.
Buyer acknowledges that seller is not responsible for correcting any foundations not installed by seller.
This order cannot be canceled after acceptance. This contract shalt be binding on the parties, their heirs and assigns.
Neither seller or buyer may assign any part of this contract without the prior written consent of the other, which consent will not be reasonably withheld.
After installation buyer agrees to the use of this memorial for promotional and advertising purposes by Weaver Memorials, Inc.
There are no agreements or representations concerning the sale herein provided for other than as stated or provided for in this contract.
TERMS NET 30 DAYS, 1 1/2% PER MONTH INTERESTADDED AFTER 30 DAYS, WHICH AMOUNTS TO 18°1° PER YEAR.
Buyer
Buyer
Seller Weaver Memorials,~lnc
By