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Home My WebLink About05-02-111505611184 CLIENT COPY -' REV-1500 EX (o2-u) (FI) '~ !1 ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Coun Code Year File Number Bureau of Individual Taxes GE/ANTMENTO/ INuHERITANCE TAX RETURN ~ ~ PO BOX 280601 /~ Harrisbur , PA i 128-0601 RESIDENT DECEDENT ~, ~ ~ Q 4e ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 174-20-7118 09132010 06151927 Decedent's Last Name Suffix Decedent's First Name MI SEILER ANGELINE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Return Q 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate Q 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number RAYMOND SEILER ,... 717-766-~7 3 ~ .~ `~ ~.~ REGISTER ~ USE IDts1l.Y ~~ t '`'~ ,3 First line of address ~ ~;-~, ~ `- `i ~_-- 704 S BROAD ST ~~~ -r' ~r Second line of address --~ ~ C.,~ ~" ' ~.~ b ~ ~ d t;_ -`i`7 City or Post Office MECHANICSBURG State ZIP Code PA 17055 DATE FILED 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. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN URE OF PERS RE ONSI E F FILING RETURN DATE t . s..'~ ADDR 704 S BROAD ST, MECHANICSBURG, PA 17055 SIGN T RE F PREPA RER O HER THAN REPR~TATIVE D E ADDRESS G_..- 176 CUMBERLAND PARKWAY, MECHANICSBURG, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611184 1505611184 J 1505611284 REV 1500 EX (FI) Decedent's Name: ANGE L I NE S E I LER Decedent's Social Security Number 17 4- 2 0- 7118 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 12 3 , 610 • 0 0 2. Stocks and Bonds (Schedule 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. 15 , 7 9 5.0 0 6. Jointly Owned Property (Schedule F) Q Separate Billing Requested ....... 6. - 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ~ 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 13 9 , 4 0 5.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 16 , 4 0 3 .0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 10 , 19 8 • 0 0 11. Total Deductions (total Lines 9 and 10) ... . ............................. 11. 2 6 , 6 O 1 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 112 , 8 0 4 • 0 0 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. 112 , 8 04.0 0 TAX CALCULATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 4 5 112 , 8 0 4 • 16. 17. Amount of Line 14 taxable at sibling rate X .12 • 17 18. Amount of Line 14 taxable at collateral rate X .15 • 1 g. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 5,076.18 5,076.18 Q Side 2 1505611284 1505611284 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME ANGELINE SEILER STREET ADDRESS - 704 SOUTH BROAD ST CITY MECHANICSBURG STATE PA Zlp 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 5,076.18 5,700.00 623.82 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 the property transferred :.......................................................................................... X^ ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ 0 c. retain a reversionary interest .......................................................................................................................... ^ 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? .............................................................................................................. ^ 0 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 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(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(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)J. 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. 5, 700 REV-1502 EX+ (01-10) . ~ ~'° ~ ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER ANGELINE SEILER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Ir more space is needed, insert additional sheets of the same size. REV-1508 EX+ (11-10) ~~~ pennsylvania SCHEDI~ILE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ANGELINE SEILER 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. ~~ rnvre space is neeaea, use aaaitiona~ sheets of paper of the same size. REV-1511 EX+ (10-09) ~~~~~~~:` pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ANGELINE SEILER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ MYERS FUNERAL HOME 11,640 2. CUMBERLAND LAW JOURNAL 75 3. THE PATRIOT NEWS 89 4. REGISTER OF WILLS 320 5. AMERICAN LEGION 267 6. BOSCOVS/BONTON/SERVANT'S HEART 137 7. CATHOLIC DIOCESE 125 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant RAYMOND SEILER 4. 5. 6. ~. Street Address City State Relationship of Claimant to Decedent SON Probate Fees Accountant's Fees Tax Return Preparer's Fees ZIP TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 3,500 250 16,403.00 REV-1512 EX+ (12-08) ~` ~ a ~~`` pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER ANGELINE SEILER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. it more space is neeaea, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~~i ~.~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ANGELINE SEILER 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. RICHARD SEILER SON 99.86% 704 S BROAD ST MECHANICSBURG, PA 17055 2. BARBARA J COOKS DAUGHTER ,pg% 7624 TANSY PL MERRILLVILLE, IN 46410 3. SHAWN E COOKS GRANDSON .03% 3919 CEDAR RIDGE RD APT 2C INDIANAPOLIS, IN 46235 4. MATTHEW S COOKS GRANDSON .03% 1500 GAY RD #3-A WINTER PARK, FL 32789 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: 1. 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. A ~ ... ...... .. 7 ,a ~. _. ! . ,....... . ~. ~ ~~ k'.,. ~ 1 ~ is _„ WILL OF ANGELINE SEILER I, Angeline Seiler, of Cumberland County, Mechanicsburg, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: A. I leave to my son Raymond Seiler, rrly 2009 Ford Fusion, all my household furniture, household tools, lawn equipment, Grandfather Seller's railroad watch, his father's I.J.S. Marine Corp ring, wedding band and American flag, B. I leave to my daughter, Barbara J. Cooke, all ladies jewelry. C. I leave to my grandson's Shawn E. Cooke and Matthew S. Cooke, their grandfather's watches and items in his jewelry box to be divided equally. Should either of my grandson's predecease me, their share shall go to the surviving grandson. D. I reserve the right to attach a separate memorandum to this Will. E. Should my son, Raymond L. Seiler predecease me, I direct that his share shall go to Barbara J. Cooke. F. I leave the remainder of my estate to Raymond L. Seiler. EPHFN J. HOCTG SUITE 101 C':~~RLISI,I, F'A 1701 3 4. I appoint Raymond L. Seiler, as Executor of this my fast Will. Should Raymond L. Seiler predecease me or cease to act in such capacity, I appoint Barbara J. Cooke as alternate. ~ ~ ,. ~~~~~~~ 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN W TNESS WHE ~ eunto set m h ~- y and this day of ~ , 20 0. Angeline Seiie~ ~-~~ ~~ EPHEN J. HUCTG S. IIANC)VER STRI:;f.T SIJI"(~C; 101 C':~~RL,ISC,f:, Pn 1701.'> The preceding instrument consisting of this and two other pages was on the day and date hereof signed, published and declared by Angeline Seiler as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ~-,. rJ ITNES~_ ~ ITN SS t' ~ P~-iF.N J. ~-IOGG SIJI'I'I; I 0 C,~IZLISLF, Pn 17Ol_i .M. ,~.T ~ ~.~, -.Q, <.r~~ ., .,, av~~~..x~,.rr,~+-r+an!'M"97,w `j`'~`ryV~LEDGMENT' ~ ts.~,3~ ~~; aTEPHEN,j. ~-IOGG I ~~ ~. I-InNC>vrlt s"rIZ1:1'; I. S1)1"1'C; 101 C'~~RI,I~Lf, I'n 17U1 i State of Pennsylvania County of Cumberland ss I, Angeline Seiler, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; treat I signed it willingly and as my free and voluntary act for the purposes therein expr ssed. .~- Angelin eiler Sworn to or affirmed and acknowl ~t~~T~a~~ix.,~tk~~.s..~ day of w7 4...6Y ~, i .~>;I,j4yT .~,.~~:.~.~: , ~.Y Y~~:J~Y,,_ . ~ ~ ~ . ~ N ota ry State of Pennsylvania AFFIDAVIT Angeline ss County of Cumberland G We, ~ ~~~ S and a ~. ~ C C L ~ C the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound ~ ind and u erno onstraint or u d e influence. L .~ -~ I __.~. Sworn to or affir e this ~ day of ~/ d to before me by witnesses, ~~, 2,p 10 . ----.....,r~.,,_,.,, ~ i 8eep~n ~. H ~ -~ ~~~ ¢~"~~ r ~ .~ ~~~~~~ Coro ~~, `~ ~'~~~ota~ P u ~i c/Attorney gay ~,~,~~s, ~:~a~a~i,~~r.~ ~~, hags ~7;~;¢~,~ ~=~%~'~:~i13 '~ COMMONWEALTH OF PENNSYLVANIA REV-1161 EX~11-9(iI DEPARTMENT OF REVENUE E3UREiAU OF INDIVIDUAL TAXES UEPT.28U601 I-IARRISBURG, PA 17128-0601 PENNSYLVANIA IECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 013767 SEILER RAYMOND L 704 S BROAD ST MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: i 74-20-~~ ~ 8 FILE NUMBER: 2110-0969 DECEDENT NAME: SEILER ANGELiNE DATE OF PAYMENT: 1 2/ 1 0/201 0 POSTMARK DATE: 12/10/2010 couNTY: CUMBERLAND DATE OF DEATH: 09/ 1 3/201 0 101 ~ $5,700.00 TOTAL AMOUNT PAID: $5,700.00 REMARKS: CHECK# 568855 INITIALS: CJ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS 1"AXPAYER Payable To: BARRY L HECKARD SR TAX COLLECTOR Office Hours: MAR-APR TUES & THURS 10AM-4PM Bill No: 2656 605 SOMERSET DRIVE JUNE-DEC TUES 10AM-4PM Bill Date: 3/1110 MECHANIGSBURG, PA 17055 CLOSED MAR 11, AUG 5-20 & ALL HOLIDAYS Control No: 20000276 Phone: (717) 766-6205 PHONE (717) 766-6205 MAP N O: 20-240785-127 Desc: 704 S BROAD STREET Acres .380 Deed: 0022G-00420 GLENWOOD TERRAC~p ~~ ~~ LOT 36 l,,~r++~~~~ Residential Building IINII IIIII IIIII IIIII IIIii iilll 11111 11111 1111 1111 ~ ~ ~ ; ~ v ~ ~ ~ c r $1.00 FEE FOR ADDITION ~~'(~fi15. ~ ~ 1, f ~? ~ Assessed Value: Land: 30,000 Improvement: 93,610 Total: 123,610 Discount Face Penalty COUNTY R/E 2.39900 $290.61 $296.54 $326.19 COUNTY LIB .18000 $21,80 $22.25 $24.48 UNIC. R/E 3.25000 $393.70 $401.73 $441.90 TAX AMOUNT DUE ~~If Date Of Payment Is On $706,11 3/1 /10 thru 4/30/10 $720.52 5/1 /10 thru 6/30/10 $792.57 7/1 /10 or Later Tax Payer. SEILER, LESTER WAYNE & ANGELINE SEILER 704 S BROAD ST MECHANIGSBURG, PA 17055-4006 TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS ~ ~ • - ~ ~ . • . ~ • : PAYABLE TO BARRY L HECKARD SR 605 SOMERSET DRIVE 717-766-6205 MECHANIGSBURG, PA 17055 Assesse Values Homeste DESCRIPTION MECHANII ASSESS.NO - 20000276 ~j; Rates MAP NO: 20-24-0785-127 ~ ` ~ SCHOOL R 704 S BROAD STREET Hnnomesteac ACRES .380 DEED Q~~G/'Oiy420~U~~ GLENWOOD TERRACE LOT 36 Residential Building t) /1, ; j ;-; ~~~ ; { ~,~ L ; j ;`~ C{ [~ RESIDENTIAL ~, y ~•~ i , TAX PAYER ~f', .. -l ~-~ L_ L :~ ~,.rl~rt~--- SEILER, LESTER WAYN~ E ~ ~ ~ f ; ~ ~ • ~ f~ ~ • ~-~ ~ F.~ . & ANGELINE SEILER 704 SOUTH BROAD STREET MECHANIGSBURG PA 17055-4006 OFFICE HOURS 70LY~CTr; TOES & THUR 10-4PM SEPT-DEC TUES 10-4PM CLOSED ALL HOLIDAYS CLOSED AUG 6-20 & ELECTION DAY TAX PAYER COPY 2010 Statement of Real Estate Taxes Land Improvement Mineral ~" 30,000 93,610 p elusion G AREA 3.D. Discount 14.70000 14,70000 14.70000 2$' it TAX AMOUNT DUE -> ~ iy,65~,y1 If Paid Oa or ]1f ter 7 01 2 010 If Paid Oa or Before 8./31/2010 BIII No: 2659 Control No: 020 - 000276 Bill Date: 7/01/2010 Total 123,610 8,581- 817.07 51,690.93 57,860.02 9 O1 2010 11 O1 2010 0 31 2010 12 31/2010 ;1.00 FEE FOR EXTRA TAX BILL RETURN BILL WITH PAYMENT, ENCLOSE SELF ADDRESS STAMP ENV. IF TAXES ARE IN ESCROW, FORWARD BILL TO MORT. CO. 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 which has been provided under the Pennsylvania Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. St MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.members1st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 ANGELINE SEILER C/O RAYMOND SEILER 704 S BROAD ST MECHANICSBURG PA 17055-4006 Statement of Accounts Aug 25, 2010 thru Sep 24, 2010 Account Number: 24195 Balances at a Glance: Checking: 40.37 Savings: 1, 084.64 Certificates: o . 00 Loans: 10,197.90 Money Management: o . 00 Swipe 5 YTD Reward: o . 00 Page: 1 of 2 Your current Member Loyalty Revr~ards level is Gold. Your aggregate balance as of September 1st is $12,843.90. An aggregate balance of $35,000 and having 3 products will move you to the Platinum level. Visit any of our branch locations on Thursday, October 21, 2010 and join us in celebrating International Credit Union Day. CHECKING ACCOUNTS 0011 -CHECKING Date_~__ _._ Transaction Description__._._ _____ .__ _ _ ^_ _ Addlti_ons_ . _ Subtractions. _ Balance Aug 25 ._ Balance Forward __ _ ___ __ 472.11 Aug 26 Check 001943 Tracer 0001160310 247.42- 224.69 Aug 27 Withdrawal 20.00- 204.69 Aug 27 Check 001941 Tracer 0001158041 10.56- 194. 13 Aug 27 Check 001944 Tracer 0001177128 160. 00- 34.13 Aug 30 Deposit 100.00 134.13 Sep 01 Deposit Transfer From Share 0000 1,427.03 1,561.16 Sep 01 Check 001946 Tracer 0001758938 214. 60- 1,346.56 Sep 01 Check 001945 Tracer 0001758937 425. 00- 921.56 Sep 02 Check 001953 Tracer 0001627049 20.00- 901.56 Sep 02 Check 001948 Tracer 0001448632 91 .73- 809.83 Sep 03 Check 001949 Tracer 0001374909 38.34- 771.49 Sep 03 Check 001950 Tracer 0001395901 79.72- 691.77 Sep 03 Check 001951 Tracer 0001395902 100.00- 591.77 Sep 03 Check 001954 Tracer 0001366736 ~ 180.00- 411.77 Sep 07 Check 001958 Tracer 0093269123 81 .00- 330.77 Point of Purchase Check - SAMSCLUB- WALMART Terminal City & State - MECH PA TYPE: GE CARD ID: 9037111886 DATA: TELECHK 800- 697- 9263 Sep 07 Check 001947 Tracer 0005153995 22.89- 307.88 Sep 08 Check 001952 Tracer 0001405109 52.51- 255.37 Sep 09 Check 001955 Tracer 0001173311 2.74 252.63 Sep 09 Check 001957 Tracer 0001544436 56.76- 195.87 Sep 10 Check 001956 Tracer 0001533122 19.88- 175.99 Sep 13 Check 001961 Tracer 0002581055 5.77- 170.22 Sep 13 Check 001959 Tracer 0002443074 22.50- 147.72 Sep 15 Check 001960 Tracer 0001504868 26.16- 121.56 Sep 20 Check 001962 Tracer 0003112841 81.19- 40.37 Sep 24 Ending Balance 40.37 - - - Continued on following page - - - st Send Inquires to: Main Switchboard: (717} 697-1161 or (800) 283-2328 5000 Louise Drive PO Box 40 EZ Call: (717) 697-4372 or (800) 283-4372 Aug 25, 2010 thru Sep 24, 2010 Mechanicsburg, PA 17055 TDD: (717) 697-531?_ or (800) 283-2328 ext. 5312 Account Number: 24195 MEMBERS 111! TeleBranch: (717) 795-6049 or (800) 237-7288 ^[.M [.UNl IYNM wwlN.memberslst.org Page: 2 of 2 CHECK SUMMARY Check # 001941 _ _ _ Amount _ _ ____Date ___ __ __ _ _ _ 10.56 Aug 27 Check.# Amount _ _ .___Date ___ 001943* 247.42 Aug 26 001953 001954 20.00 180.00 Sep 02 Sep 03 001944 001945 160.00 Aug 27 425.00 Sep 01 001955 2.74 Sep 09 001946 214.60 Sep 01 001956 001957 19.88 56.76 Sep 10 Sep 09 001947 001948 22.89 Sep 07 91.73 Sep 02 001958 81.00 Sep 07 001949 38.34 Sep 03 001959 001960 22.50 26. 16 Sep 13 Sep 15 001950 001951 79.72 Sep 03 100.00 Sep 03 001961 5.77 Sep 13 001952 52.51 Sep 08 001962 81.19 Sep 20 * Asterisk next to number indicates skip in number sequence 21 Checks Cleared for 1, 938. 77 SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Date _ Aug 25 Transaction Description ______ _ _ _ _ _ Balance Forward ~A ^~ _ 4 ~~ ~~ ^ __ Additions Subtractions Balance Aug 31 Deposit Dividend 0.300% 0.30 924.34 924 64 Annual Percentage Yield Earned 0. 300% from 08/01/2010 through 08/31/2010 . Sep 01 Deposit ACH CIVIL SERV 1,427.03 2 351 67 ID: 3121736156 CO: CIVIL SERV , . Sep 01 Withdrawal Transfer To Share 0011 1 427 03- 924 64 Sep 07 Sep 24 Deposit by Check Ending Balance , . 160.00 . 1,084.64 1,084.64 LOAN ACCOUNTS 0010 - NEW VEHICLE Date__ ________Transaction Description _~ Amount Interest,Fees Principal Balance Aug 25 Balance Forward 10,358.10 Sep 01 Payments by Check 214. 60- 54.40 0.00 160. 20- 10,197.90 Sep 24 Ending Balance 10,197.90 Annual Percentage Rate 6.390% Daily Rate .017506°io YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 4.02 0011 CHECKING 0.00 TOTAL LOAN INTEREST PAID 0010 NEW VEHICLE 526.93 Total Year To Date Dividencls Paid NOTE: Total includes closed shares Total Year To Date Interest Paid NOTE: Total includes closed loans 4.02 526.93 Don't forget about our new VlAember Loyalty Rewards Program. The more products ~ou have with us, the more benefits you'll receive. Ask an associate for detai s or visit our website at www.members1st.org for details. BOB RUTH FORD, tNC. ~;• "'•vr.?''. psi h!. ''. cr. :::+ . PHONE D~~.L~~BURt' ~. x~,>."~ , ",.~~3'I~~ 717-4 32-9614 DATE BUYER ~~ .~ ~ { "~' .~ DRIVER L.IC. # CO-BUYER DRIVER LIC. # STREET CITY STATE 71P PHONE ~ PHONE RES. BUS. YR. MAKE _ MODEL TYPE r COLOR TRIM MILEAGE --- - , _,. VIN TITLE NO. PATE NO. EXP. DATE PLEASE ENTER MY ORDER FOR THE FOLLOWING N EW C~ ~R USED ^ DEMO D us oR YR. MAKE M,ODEI. TYPE COLOR TRIM MILEAGE VIN < : ' `,Ir. _ STOCK NO. SALESMAtJ TQ HE DEI.IVF,HFO ON OR AF30UT .... hlAtvtg C7R Alt:,;?31T ' f,~~ POtECY f~1F1MDErt : CQ1.l,tSl(7N p~ptisGTl~~r_ iNStJRANCE CO SPOKir Wiry TOTA FsF~cT3vr-I3ArE Fx, pnT~ vr;rt~~rEnar L CASH PRICE ;,:.... `: ::..: FACTORY REBATE ^ FACTORY WARRANTY -The factory warranty constitutes all of the warranties with respecK to the ALLOWANCE FOR TRAD E I N sale of this item/items. The seller hereby expressly disclaims all warranties either expressed or , implied including any implied warranty of merchantability or fitness for a particular purpose, and the ll BALANCE se er neither assumes nor authorizes any other person to assume for ft any liability in connection with the sale of this itemltem s. ^ USED CAR WARRANTY -Used Car i:; Covered by a limited warranty detailed in a separate document. SALES TAX ^ AS IS -This motor vehicle is sole "AS IS" without any warranty either expressed or implied The . purchaser will bear the entire expense of repairing or correcting any defect that presently exists or PTA TAX that may occur in the vehicle. PURCHASER'S SIGNATURE `' TEMP TAG TITLE TRANSFER If you cancel this purchase agreement or refuse to take delivery of the vehicle ENCUMBRANCE FEE REGISTRATION INCREASE FEE ordered, except as permitted by law you shall at our o tion forteit d DOCUMENTARY FEES , , p , as amages the amount of $ PURCHASER'S ENCUMBRANCE ON TRADE GOOD THROUGH SIGNATURE ! ': OWED7~~'j` ~;' ~~! ~; , i Purc~~~~ ' ~~k~~ tot~~~e~~~, : TOTAL BALANCE DUE USED CAR CONTRACTUAL DISCLOSURE STATEMENT The information you see on the window form for this vehicle is part of this contract. DEPOSIT Information on the window form overrides any contrary provisions in this contract of sale. Purchaser agrees that this order includes all of the terms and conditions on both DEPOSIT the face and reverse side hereof, that this order cancels and supersedes an ri r y p o agreement and as of the date hereof comprises the complete and exclusive state- BALANCE DUE AT DELIVERY ment of the terms of agreement relating to the subject matters covered hereb y. This order shall not be nm bindrnq ~ nta 11 any the ~+p~l~• ••~ ~~ ~ {~ -~ 111 GiU l1IVI IC ' ADDITIONS OR DELETIONS representahve. n `. 7 !'.' ? 1_ 'lrl/.~,, ~~ t;nr+ ,r ,nor, r~*~ci~,"c: a ftr'i ~ tt mac: ~~, ~ a' r ' ~ ~ u ; >r,, S- ~-~' ~ ^ _ _ ~ rte=~; ~, / ~~ w 1 nr I ~r _. ~.~_ _ - .~., ~.~ ~ i :1°~~ i4',•-,,., ,'pia rtr ..~'..i ~. ,, . . ;+, l;" ., .. ~} PURCHASER'S ° SIGNATURE ~ DATE NEW BALA PURCHASER'S NCE SIGNATURE ~~ DATE TAX ACCEPTED BY: DATE ncnl co nn urn .~ ~r~......«_-. _______- . -. TOTAL waG. ~~fx ~fi ~~ ,~`.~, is . `irs `~7~:" ~{ .. ; ~, o m I co r; C .~ .c 'i a Myers Funeral Home, .Inc. Boyd L. Myers Jr., Supervisor 37 East Main Street Mechanicsburg, Pennsylvania 17055 (717) 7ss-sa21 ,o, Fax (717) 795-7291 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED c'hargcs arc Only I~)r those items that yuu selected or that are required. if we are required by law or by a cen)etery or crematory to use any items, WC \'VlII Cxplalll In Wr1Ul1l; bel0\V, If you selected a funeral that may require embalming, such as a fimeral with viewinc;, you may have to pay for embalming. You do not have to pay li)r embalming you did not approve il'you selected arrangements such as direct cremation or immediate burial. !f we charge you for an embalming, we. will explain why below. I~Or Services ol• -` ! Angeline Seiler_ _ Uate Of Death September 13, 2010 Date of Contract ('barge to Raymond 1 Seil(,r --- --- 704 South Broad Street - ----- ---__---_.--__ _ . ~_-tNinic _ ._. - -------___ ----- _ . --- Mechanicsburg, PA 1705] - ----~-3c - resd s __` _ ply ---- ~tiilc -_ _. ---- --_ ....__.____ __ :~. C!-IARGE FOR SERVICES SEL,I6;CTED: ~'t' I. PROFF,SSIONAL SERVICES C. SPECIAL CHARGES Forwarding Remains to other I~trneral I tome $ Services ol~l~uneral Dil•ector and Staff 70yj __.___ __ _____._.____ ------- -----~ ___ Receiving Remains Form other I'klncral [tome $ I?n)haln)ing $ 995.00 __ ~- ___ _. --- --__-__-___-__._.____-_-__.___- Immediate Burial ~; Caskcting, dressing, cosmetolo r --- - c __._____ -__-_ gY $ 3.)5.00 __ __ - __^__ _-__._. _.____.~___.__.____ Direct Cremation $ (>ther Preparation ol• body__ $ --~-' _ _ .. __ __ ___... __ - _ -- -- _- _ _-___.____.. __ SUB-TOTAL UFSPECIAL CI-IARGF,S (-' $ _ `_ _.___ D. C;ASII AUVANCEU __- _-~- _--- ____...__._ Opening Grave/C'rypt Gate of f leaven C'emctcr ~; 1300.00 SUB-'TOT'AL PROFESSIONAL SERVICES AI _$ 3,485.00 -_ _ __. _. ______--__.Y 2. l1SE OF H'ACILI"PIES ANU SERVICES _ I~or visitation / wale service $ 575.00 ___ ___. 'ol• Itlnc;ral ceremony $ 600.00 - --- I'OI• n1CI11orIal Sel•VICe $ 1;(luipntcnt n services lo-- graveside service $ 395.00 -. - -..___ .__.---__-.____.-_______ _ _ w 5116-TO"I'AL FACILI"I'IF,S AND EQUIPMENT A2 $ 1,570.00 Al1TOM0"1'1VE EQUIPMENT VChICIC t0 tl•a11tiIC1. 1'Clllallls t0 I'UI1CraI I-lomc $ 350,OO ._ hearse (Casket Coach) _.__ $ 325.00 l~ lower Car /Floral Distribution $ Intl family Cal $ -_._- . _._._._. l ,cad Czar / Cler~~ _ ___ .,v C'ar --~--____, . - ------ $ .--_~.__._. 195.00 ______~. lJtility Car _ $ ^_ ~_,_ OUt of to\Vn tl•i1nSp01'tiltloll --_ ---_~ -- _^ St1B-"I'O"TAL AU'T'OMOTIVE I+,QUII'ME NT _ A3 $ 870.00 'I'O"1'AI, SERVICES, FACILI'I'II?S, AUTOMOBILE A $ 5,925.00 13. C;IIARGES FOR MERCHANDISE SELE CTED _ Casket S 1 I;RL,INCi 4505507 $ 2495.00 Uthcr R(,c.eptaclc -$ ~~_ (biter Burial Container 12 Gauge ---_ $ 1975.00 ._____.._--._-- ~~ i~CknUVVICdglllCnt (~ill'dti ___ ~__._ _,.._~_-, Register Book $ 95.00 Newspaper___- - _ $ 175.00 Newspaper $ Clergy /Mass Offering 1^aher C;hestcr 1' Snyder $ _ ~ j jq.~~~~ Ccrtif ed C'opies oI' Death Certi l kale !T"~ - ~ ---- $ __ - 90 00 Family Flowers flowers (.)rdered -.___-.__ __ $ 344.50 ...-_-- Set t1h _____.__ _ ... $ 195.00 .__ _..__- _____ Or ranist ____~_ -_ ---~___.__._____.---. ---- $ -___-_.____ 125.00 SUB-'TOTAL OF CASH ADVANCI':D St Du e Date Cale $ 2,379.x0 c charge you for our services in obtaining the fi)Ilowing: NONI; SUMMARY OF CHA.RGF,S 'TO"I'Al. ABOVE ITEMS (A,B.C.D) $ 12,869. 50 Sales "I'ax (if App) (cr? 0 ~%) $ "I'OTAI, OF ALL SECTIONS $ 12,869.50 LESS: }'aymcnt Made $ _ _. LESS: Credits Pending $ LESS: Other Credits/Payments Packa~ Price Discount $ 1,230.00 BALANCE DUE __..__ Jan 30, 0001 $ 11,639.50 A late charge of 1.5%~ per month on the outstanding balance (annual rate of 18°/~) will be added to the balance. • --- -~ RI?ASON FOR RE ; ~ , NlelllO1•laI I'Oldel's $ OUII2I';I) SF,RVI('I'~ OR NII~RCIIANDISI; Prayer Cards $ "I cmporary (;rave Markers $ Burial Clothin~_ _ _ _ _ _ __ _ $ ---_ .-_.--_-_ ----._------ -____ -_____.__-------^___._~_.__-_------- -_ ._.. - ___ . ___ Other Clothing-. ____ --- $ - - - - - -~~ ~ DISCLAIMER OF WARRANTIES C;rcnrltlon UPII Rosebud Urn SIlI;: 10" h x $ ~~ Our funeral home makes no representations or warranties regarding caskets _____.-..___.____.____.-. __._._____ or outer burial containers. The only warranties, expressed or implied, granted _-____ _ $ in connection with goods sold with the funeral service are the express written ~---- - warranties, if any, extended by the manufacturer thereof. No other warranties "- ~- `---------------- -- ----- $ including the implied warranties of merchantability or fitness for particular "I'O"I'A1, MERCHANDISE SELECTED B $ _ 4,565.00_ purpose are extended by the seller. agree a aye examine e i ems o goo s an services se ec e- a ove an oun em o e correc an accor Ing o e arrangemen s aye requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for payment of the cash price for the goods and services selected. f also agree to ma oe payment of $ 11639.50 within 30 days. I agree to be jointly and severally liable with anyone else who signs below. A LATE CHARGE of 1.5% per month (18 /o er annum wl e a g the date of this contract. I will also pay the Funeral Director all reasonable costs paid by the Funeral Directo1etotcollect amo nts I owe under this age mentr Those costs may include attorney fees and court costs. Any items requested after the date of this agreement will be considered dart of this agreement and will be reflected on the final bill. I acknowledge that a Casket Price List and a Outer Burial Container Price List were made available to me and that a copy of the General Price List was given to me prior to my making financial arrangements. (kcal) f urchascr _ _ _._ ___. - _-- (~eal ) _ ._..___.Purcha.SCr ~~ --- --- ontract '.TL's%~ _ __--._~.. Boyd yc,rs, Jr. .iccl c i' moral 1 roc or _ --~"~- COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I , GL ENDA FA RNER S TRA SBA UGH _ Register for the Probate of Wi 1.1. s and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 21st day of September, T.wo Thousand and Ten Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of~ ANGEL/NE SE/LER late of MECHANICSBURG BOROUGH (First, Middle, l.asll ~ in said county, deceased, to RA YMOND L SEILER !First, Middle, l.as1J and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office a t CARLISLE, PENNSYLVANIA, this 21st day of September Two Thousand and Ten . Fi 1 e No . 20 ~ 0- 00969 PA Fi 1 e 1Vo . 21- ~ 0- 0969 Date of Death 9/73/2070 S. S. # ~ 74-20- 71 7 8 r ~~ r 1. f,~fi~ ~ J ' Regis ter /~ ~ _ f l,,. , Deputy ~ /o /~~S.,. / ` ' ,. /~ ~ NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL