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HomeMy WebLinkAbout11-07-11 (3)J 1505611185 REV-1500 Ex (°2-"' (FI, OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po Box 2aosol INHERITANCE TAX RETURN 2 0 11 0 017 5 Harrisburg, PA 1 7 1 28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDrnrY 175-48-4412 02012D11 12121960 Decedent's Last Name Suffix Decedent's First Name M I SABELLA MICHAEL R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I SABELLA MARIAN Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 208-52-08D9 REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-Et2) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate 'fax Return Required ^ 6 Decedent Died Testate ^ death after 12-12-82) 7 t M i i D d t d Li i T t 8 T l . . en ece a n a ne a v ng rus _ . ota Number of Safe Deposit Boxes (Attach Copy of Will) (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 Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CRAI G A• HATCH, ESQ• 717-731-9~D First Line of Address 1013 MUMMA RD, STE 100 Second Line of Address City or Post Office LEMOYNE REGISTER O~YijIC USE ONLY= - ;- -, : , - ~ - r-~ I t~ __... _ ._ _ ~ .. ~ ,, t-• J f State ZIP Code DATE FILED ~-' - `i ~ PA 17043 correspondent'se-mail address: C • HATCHaGATESLAWFIRM • COM 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. MARIAN SABELLA, ADMINISTRATRIX 696 BUFFALO RUN ROAD BEL EFONTE, A 16823 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE - ~ , ' - ' .__..__. DATE. CRAIG A • HATCH, ESQUIRE ~/ ,/~ ; f,~C"f ~ 1013 MUMMA ROAD, SUITE 100 1505611185 EMOYNE, PA 17D43 Side 1 OM4647 3.000 1505611185 J n 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 175-48-4412 Decedent's Name: S A B E L L A M I C H A I R RECAPITULATION 1. Real Estate (Schedule A) 1 $ 0 • Q 0 2. Stocks and Bonds (Schedule B) . 2 $ 0 • Q 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. $ 0 , Q Q 4. Mortgages and Notes Receivable (Schedule D) 4 $ 0 • Q Q 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. $ ], ], 8 , 9 5 3.2 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested g. $ Q . Q Q 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested 7. $ Q . Q Q 8. Total Gross Assets (total Lines 1 through 7) 8 $ ], ], 8 , 9 5 3.2 5 9. Funeral Expenses and Administrative Costs (Schedule H). g. $ 6 , 9 4 7.2 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 $ Q , Q 0 1 1 . Total Deductions (total Lines 9 and 10) , _ 1 1 $ 6 , 9 4 7.2 0 12. Net Value of Estate (Line 8 minus Line 11) _ 12 $112 , Q Q 6 • 0 5 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) , _ , 13 $ Q • Q Q 14. Net Value Subject to Tax (Line 12 minus Line 13) _ 14 $112 , Q Q 6 • Q 5 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.z>x.o_ $112,006.05 15. $0.00 16. Amount of Line 14 t xable 4~ at linealratex o . $0.00 1s. $0.00 17. Amount of Line 14 taxable at sibling rate X .12 $ Q • Q Q 17. $ 0 • Q 0 18. Amount of Line 14 taxable at collateral rate X .15 $ Q . Q Q 18. $ 0 • 0 0 19. TAX DUE 19. $ 0 • 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505611285 1505611285 OM4646 3.000 REV-1500 EX (Fp Page 3 Decedent's Complete Address: File Number DECEDENTS NAME SABE LA MICHAEL R STREET ADDRESS MB R AND CITY MECHANICSBURG STATE PA ?IP 17055- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) $ 0 • 0 0 2. Credits/Payments A. Prior Payments $ 0 • ~ 0 B. Discount $ [] . 0 ~ Total Credits (A + B > (z> $ 0 •0 0 3. Interest (3) $ 0.0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in boz on Page 2, Line 20 to request a refund. (4) $ 0 • 0 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the 7AX DUE. (5) $ 0 • 0 0 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 N o a. retain the use or income of the property transferred ^ ~ l ^~ b. retain the right to designate who shall use the property transferred or its income ^ ^X c. retain a reversionary interest ~ r 1 L3J d. receive the promise for life of either payments, benefits or care? L~a~l 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . ^ f v ~~ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ^ ^~ 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which contains a beneficiary designation? ^ rr Ld~ 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)]. 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. §91 16(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)j. • 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. OM4671 2.000 REV-1508 EX' (11-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Michael R. Sabella 2011 00175 Include the proceeds of litigation and the date the proceeds were received by the estate. ow4sAD 2.000 If more space is needed, use additional sheets oT paper of the same size. REV-1511 Ex+ (10.09) ' ' Pennsylvania DEPPRTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Michael R. Sabella 20 11 00175 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Auer Cremation Services of Pennsylvania, Inc. funeral goods ~ services $1,525.00 B. 1 2. 3. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal publication fee 2 Patriot-News publication fee $5,000.00 $60.50 $75.00 $286.70 TOTAL (Also enter on Line 9 Recapitulation) ~ $ $ 6 , 947.2 0 swasnc 2.00o If more space is needed, use additional sheets of paper of the same size. 72EV'-1`t13cX+(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Michael R. Sabella 20 11 00175 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 91 t6 (a) (1.2).] 1. Marian Sabella 696 Buffalo Run Road Bellefonte, PA 16823 All of Residue to Marian Sabella 696 Buffalo Run Road Bellefonte, PA 16823: $112,006.05 Surviving Spouse $112,006.05 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. [[ NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1, TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ $0.00 If more space is needed, use additional sheets of paper of the same size. 9W46AI 2.000 CERTIFICATE of GRANT of LETTERS of ADMINISTRATION REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS ADMINISTRATION No . 2011- 00175 PA No . 21- 1 1- 0175 Estate Of : MICHAEL RONALD SABELLA /First, Middle, Last) a/k/a : MICHAEL SABELLA Late Of : LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 175-48-4412 WHEREAS, MICHAEL RONALD SABELLA /First, Middle, Last) a/k/a MICHAEL SABELLA late of LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY died on the 1st day of February 2011 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: MARIAN SABELLA who has duly qualified as ADMINISTRATOR (RIX) of the estate of the above named decedent and has agreed to administer the estate according to Iaw, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto sF^t my hand and affixed the seal of my office on the 10th day of February ~'0 ~ 1. 4 Register of Wils ~~~ Deputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST,) PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY ~ 0. Settlement Statement U.S. Department of Housing and Urban Development OMB Approval No. 2502-0265 (expires 11/30!2009) 6. File Number 7. loan Number 6. Mortgage Insurance Case Number: 1. ^ FHA 2. ^ FmHA 3. ^Conv. Unins. 4. ^ VA 5. ^Conv. Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside Uosing; they are shown here for informational purposes and not included in the totals. D. Name and Adtlress of Borrower E. Name end Address of Seller. F. Name and Address of Lender. John T. Norman Fsmm ..r nr..n~..~w r c., r,e~~. G. Property Location: N. Senlemem Agent: Ronald D. Butler, Esquire 5219 Stuart Drive Place of 6ettlemenr I. 8enlement Date: Mechanicsburg PA 17055 500 N. Third Street, 12th Floor 6/14/11 Harrisburg PA 17701 Disbursemem Date-. Lot: Block: J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due From Borrower enn r_.,..~ •.,....._. r..._ r_ c_,r_- 101. Contract sales rice 120 OOOAO 401. Contract sales Ace 120,000.00 102. Penonet 2 000.00 s02. Personal e 2 OOD.00 703. Sehlement ohs es to borrower line 7400 1 562.00 a03. 104. 4~. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106. CI !lawn taxes 6114/11 to 12/31!11 382.03 406. C down (axes 6!14111 l0 12/31111 382.03 107. Court taxes l0 407. Court lazes to 706. Assesamanls l0 406. Aiaea6mems to 709. School taxes 6174/11 to 6/30111 53.44 400. School taxes 6/74/11 to 6/3D/11 53.44 t 10. Sewer & trash 6/14/11 b 6/30/11 18.28 a10. Sewer 8 trash 6114111 to 6/30!11 18.26 111 I° 411. to t 7 2. to 612, to 113, b 413. to tta. b sta. to 175. b 415. to 120. Gross Amount Due From Bonower 124,015.75 420. Gross Amount Due To Seller 722,453.75 mow. w.rounas raw ov yr m nenatr ur eorrewer znn DaA....H..,." 1.. .......~ .._ _ _ __ 207. sit or earnest mone 501. Exceaa da sit see inatruAioru 202. PAnci I amount of new loans 502. Bealement char to seller (Ina 7400 1,210.00 203. Existin loan a taken aub'ec1 to 503, Exialin loan a taken sub act to 204. 504. Pa fl of first mort a e ban L 290.50 205. 505. Pa a o! seratd mort a a loan 206. 506. Escrow 2.000.00 zo7 soz zoe 5oe 209. 509. Adjustments for items un aid b seller Ad ustments for items un aid b seller 270. Cil town taxes 1O 510. C town tezes to 271. Court fazes b 517. Court taxes to 212. Assessments 10 512. Asseaamanfs to 213. tO 513. to 27 a. b 514. to Z15. t° 515. to 216, l0 576 to 217. t0 517. to 216. to to 516. 27 4 I° to 519. 220. Total Pald By/FOr Bonower 520. Total Reduction Amount Due Seller 3,500.50 300. Cash At Settlement FromfTo Borrower 600. Cash At Settlement TolFrom Seller Sot. Gross Amount due from banower line 120 124,015.75 601, Gross amount due to seller line 420 722,453.75 302. Less amounts Deb b dor bonwer Ilne 220 602. Less reductions in amt. due setter line 520 3,500.50; 303. Cash ^X From ^ To Borrower 124,015.75 603. Cash 0 To ^ From Seller 718.953.25 Section 5 of the Real Estate Settlement Procedures Act (RESPA) requires Section 4(a) of RESPA mandates that HUD develop and prescribe Nis the following: • HUD must develop a Spedal Information Booklet to help standard form to be used at the time of loan settlement to provide full persons borrowing money to finance the purchase of residenttal real estate disclosure of ail charges imposed upon the Bonower and seller. These are to better understand the nature and costs of real estate settlement services; third party disclosures Nat are designed to provitle the borrower with • Each lender must provide the booklet to all aDPlicants from whom II pertinent informatlon during the settlement process in order to be a better receives or for whom it prepares a written application to borrow money to shopper. finance the purchase of residential real estate; . Lenders muss prepare and The Public Reporting Burden for this cgllecUon of infonnaGon is estimated distribute with the Booklet a Good Faith Estimate of the settlement costs that the borrower is likely to incur in connection with the settlement These to average one Hour per response, including the time for reviewing instruc- . disclosures are mandatory. lions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. The information requested does not lend itself to confidentiality. Previous editions are obsolete Page 1 of 2 form HUD-1 (3/86) ref Handbook 4305.2 L. Settlement Charges ~-- •~•-• ~=~=~~r.rv.a. s ~ommismon based an rice S 120 OOD.00 %= 0.00 Division of Commission (line 700 as tolbws: Paid From B r Paid From 701 S to onowe s Funds AI Sellers Funds AI 702.E to Settlement Setllemenl 703. Commission paitl al Senlemem 70a. BDO. Items Pa able In Connection With Loan 801. Loan Ori inatlon Fee ,A Bog. Loan Discount 803. Appraisal Fge to 80a. Credit Ra rt 10 805. Lenders Ins Ilion Fee BOB. Mon a Insurance A licalion Fee Io 807. Assum lion Fee BOB. 809. e1D. att. 872. 813. 900. Itemz Rem nred R..I e..,r,.. r_ e_ n_.. ~_ . . excwde last day in talcs • line 901 marem rrom ip _ E rda 902. Mort a Insurance Premium /or months to 903. HaZartl Insurance Premium for ars to 904. ars to 905. 1 o0n Ro=nrvn= n=n..=I...A un.~ i __.__ nauro Insurance 1 1002. Mona insurance 1 month S month S per month er monM ttp3. C ro taxes 1 monM E er month 10tH, Count a saxes 1 month E er monde 1005. Annual asse55ment5 1 monm E r month 1~' 1 monm E per month 1007. 1 month E per monal 1 DOB. A re to ACCpuntin Ad'ustment 1100. Title Char es 11D7. Selllement or dosin lee ip 1102. Abstract or tihe search tp 1103. Title examination to Butler Law Firm 300.00 / 704. Title insrrance biller 1p 7105. Document re aration 10 1106. Nola tees 1107 An f to Cash 1 D.00 . ome s ees to Includes above Items numbers' 1108. Tllle VfaU2nCe to (Indutles above hems numbers: 1108. Lenders covers e E 1110. Owner's covers e E 1111. 1112. 1113. 72nD- fnvsrnms.n. R......ar_,. __~ r~__ .__ ..._ ~au~. nemrom reel' Deed S 62.00 ;Mon E ;Releases S 7202. Ci mutt taz/atam S: Deed E 1 200.00 ;Mort e S 62.00 1 200.00 1203. State taz/sWm :Deed E 1,200.00 ; Mort a e E 1204. 1 200.00 1205. 13nn ew.lut.....r c...a_.___. ..~----- _ . curve to -- 1302. Pest ins c8on ip 1303. 1304. 1305. 1306. 1307. 1306. 1400. Total Settlement Charges (enter on Ilnes 103, Seetlon J and 502, Seetion K) 1 562.00 1 210.00 I nave carelully reviev.W the HUD-1 Settlement Statement and to the Dent of my knowledge and belief, it is a true and acwrele statement o! all receipts and disbursements on my account or by me in His trencadion. I further parti(y that 1 have received a copy of the HUD-~Settl am Sla me 1. Seller - Borrower E to of ominic bells J n)f. Norman Seller / Borrower i da . Zisman, Ez t c To the esl of my k ovAed a th HUD)1 Settlement Statement which I have prepared is a true end ecwrete account of the funds which ware received and have been or will be disbureed by Me n a d o/ easement of Isis transaction. Senlemcnl Agent ~/~~/~~~ Date Ronald D. utler, Esquire WARNING: It Is a vime to knowingly make false statements to the United Steles On Ihis or any other similar form. Penalties upon mnvid'ron wn include a fine and imprisonment For tletails see: Title 18 U S Code Sedbn 1001 end Section 1010 Previous editions are obsolete Page 2 of 2 form HUD-1 (3/86) ref Handbook 4305.2 PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS AVER CREMATION SERVICES 'CAF PENNSYLVANIA, INC, 4100 Jonestown Road, Harrisburg, PA 17109 1-800-720-8221 Fax 1-717-541-9943 Shawn E. Carper-Supervisor Charges are only for items that you selected or that aze required. If we are required by law or by a cemetery or crematory to use any items you have not selected, we will explain the reasons in writing below. If you have selected services that may require embalming, you may have to pay for embalming. You do not have to pay for embalming that you did not approve. Embalming is nol required for direct cremation or immediate burial. Embalming is not required by law, except in certain special cases. If you are chazged for embalming, we will explain why below. STATEMENT OF GOODS AND SERVICES SELECTED °' ~~ Deceased. " ~ ` ° Date of Death Date of Arrangements Charge t0 ^ . ~~ ~~ `_ __ ~ ~_a1~ ' .. ~_ !it~{~ e~:`a..- °"'ti. tr: ~'.j'~ ,. _. ~ ., ~ _ .~. ~.. .-y Name Address City State Zip Code Phone Number A. SPECIAL SERVICES: , ,., D. AUTOMOTIVE EQUIPMENT: - ~ _. ~~ 9 ~; , +~t ,~ ~_ k ~,_ . Direct Cremation ............................. `~ Removal Venicle..................................... Nationwide Guarantee Program ................ Lead Car and/or/Clergy Car........................ Worldwide Travel Protection ............... ,, ,, Family Car (Sedan or Limo)...................... ---,-., TOTAL SPECIAL CHARGES ................... ` ' ' Service Vehicle................. :: , , . TOTAL OF AUTOMOTIVE EQUIPMENT........ B. PROFESSIONAL SERVICES: E. CASH ADVANCE ITEMS: nd Staff. . t °~ ~~` ~ ~" ~~ ~ Grave O enin P g ...................................... .::::: : Dressing and/or Cosm etizing. Cemetery Equipment ............................... Facilities and Staff for Memorial Service...... a„ Newspaper .,....• ~- Crematory Charge ........................... . __ ~m'a.o fir-,; Newspaper Staff and Equipment for Memorial Service.. _ Newspaper ••• Private ID Viewing ............................... _ Clergy.............................. ................... Witnessing the Cremation ....................... Church/Sexton/Organist/Soloist.................. Packaging and Forwarding Cremated Flowers ............. ............ ................ Remains by Registered Mail ................... County Coroner Fee....:.:.................: - ~'` Personal Delivery of Cremated Remains..... `~ -'-'~ Certified Copies of the Death Certificate ` '~'`~' Scattering of Remains over Land or Sea...... .. ... - ........ TOTAL OF PROFESSIONAL SERVICES....... 4;i ~ tr~+ ^;a •••••• - -- •_ v . ~ _., _ - TOTAL OF CASH ADVANCES ....................... M ,. :,, C. MERCHANDISE: SUMMARY OF CHARGES: egtster Book ............. ,~.~ _ ° ~ ;~ r~, A. Special Charges , ,. ~ ,~ Memorial Folders/Prayer Cards ................. ............................ ;, , Thank You Cards ................................ T B. Professional Services........................... , .~ Rememberance Package... C. Merchandise ...................... Urn(s)..:... .. ~3 ~ ~. ~,. a ~ ~ ~, (Description) ~ .t `_ ............... D. Automotive E ui ment.......... ~- .... ~ ~ q P ........ T _.. ,~ f- ~~ om,, ~3 Urn Burial Vault Container ...................... .......... w . E. Cash Advanced Items.. ... Descri tion ( P ) V l ''~' ` ' ~ ~ ~" SUBTOTAL ................. ....... ................. ~ 4~ ... , ~ ° t, rid r,~;. .. eteran F ag Case............ ..................... .. ti - ' CREDITS............. ~- rave Marker/Monument ........................ ....... .............................. ;, Y. ~~ _ TOTAL DUE ............... ... .... ....................... .. ~» -.,, PAID ................ .. ............... .... •••••• ................... $ ~~ BALANCE DUE.. ..................., .... TOTAL MERCHANDISE ...... ~ ~~ ~ ~=~'~~ -- , If an le al, cemete Y g y g ry, or cremator re mrement has xe t qµ ~e p>Irghase pf any r,*pp'd t of the items listed ~bev~,-we wi)1 explain the requirement below y ~ i d m ~. ~ . ,. . y ~_.J 1'. L t'.,~ e. iJn to L 4,"i't~l , . t .. ~ Y .s +n ..c r ... _. _. - .. - .e. I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of this Statement of Goods and Serv,ees Selected. I represent that 1 have sufficient funds available for payment of the cash price for the goods and services selected. I also agree to make payment of $ ` ` within ~ days. I agree to be jointly and severally liable with anyone else who signs below. A late char e of =~ " ~ °° '' g p y pp p g• g y g tier month amountin to er ear will be a lied to the un aid balance be tnnin da s from the date of this agreement. I will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorneys' fees, court costs and other costs. Any additional services or merchandise ordered or requested after the date of this agreement will be considered part of this agreement and the cost thereof w~i41 be reflected on the final bill ortstatement. (Seal) ~-~ ,~ -1 ~ ~,,/mar -~,~ <. ~~ ~' ..- (Prvchaser) --- ~;, (Date) (Seal) (Licensed Funeral Director) (Date) RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 SABELLA MICHAEL RONALD Estate File No.: 2011-00175 Paid By Remarks: MARIAN SABELLA HMW ------------------- Fee/Tax Description PETITION LTRS ADM SHORT CERTIFICATE JCS FEE AUTOMATION FEE Cash Total Received......... Receipt Date: 2/10/2011 Receipt Time: 11:16:05 Receipt No.: 1064371 Receipt Distribution -------------- ------- ---- Payment Amount Payee Name 20.00 CUMBERLAND COUNTY GENERAL FUN 12.00 CUMBERLAND COUNTY GENERAL FUN 23.50 BUREAU OF RECEIPTS & CNTR M.D 5.00 ---------------- CUMBERLAND COUNTY GENERAL FUN 60.50 60.50 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 June 10, 2011 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Craig A. Hatch, Esquire RE: Ronald M. Sabella Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: May 27, June 3, and June 10, 2011 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director