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HomeMy WebLinkAbout11-07-11 (2) ~ 1505611185 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 0 11 0 017 5 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 175-48-4412 02012011 12121960 Decedent's Last Name Suffix Decedent's First Name MI SABELLA MICHAEL R (If Applicable) Enter Surviving Spous e'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 REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 4 Limit d E t t ^ 4 F ^ . e s a e a. uture Interest Compromise (date of 5. Federal Estate Tax Return Required ^ 6 Decedent Died Testate death after 12-12-82) ^ 7 Decedent Maintained a Li i T 8 t T t l N f S f b D it B . . v ng rus . _ o um er o a a e epos oxes (Attach Copy of Will) (Attach Copy of Trust.) ^ 9 Liti ti P d i ^ 10 ^ . ga on rocee s Rece ved . 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 CRAIG A• HATCH, ESQ• 717-731-9~0 --~ REC~ISTEROF~I USE ON~ - ,~~~ r ~~ `. ~-- f t'7 - First Line of Address _ -? _ r -~ ~~ --~~ '~' 1013 MUMMA RD, STE 100 .- __=<-~ - ~, ... Second Line of Address -~ ~ ,,~ ' ° '-' '=' -., ` ~l City Or POSt Office State ZIP Code DATE FILED ~'- ~' LEMOYNE PA 17043 correspondent'se-mailaddress: C • HATCHSIGATESLAWFIRM • COM Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules end statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than tha personal reprosentative is based on all information of which preparer has any knowedge. MARIAN SABELLA, ADMINISTRATRIX RUN ROAD BEL EFONTE, A 16823 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE --_.. CRAIG A• HATCH, ESQUIRE 1013 MUMMA ROAD, SUITE 100 1505611185 EMOYNE, PA 17043 side ~ OM4647 3.000 15 0 5 61118 5 J 03 • r 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 175-48-4412 Docedent'sName: SABELLA MIC HAEL R RECAPITULATION 1. Real Estate (Schedule A) 1 $ 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2. $ 0 , 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. $ 0 , 0 0 4. Mortgages and Notes Receivable (Schedule D) 4. $ 0 • 0 0 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. $ 0 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non- Probate Property (Schedule G) ~ Separate Billing Requested 7. $ 0 . 0 0 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 $ 0 • 0 0 11. Total Deductions (total Lines 9 and 10) , 11. $ 6 , 9 4 7.2 0 12. Net Value of Estate (Line 8 minus Line 11) 12 $ ], ], 2 , 0 0 6 • 0 5 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 1 g. $ 0 • 0 0 14. Net Value Subject to lax (Line 12 minus Line 13) , 14. $ ], ], 2 , 0 0 6 • 0 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 xable 4~ at lineal ratex.0 $0 • 00 16. $0 • 00 17. Amount of Line 14 taxable at sibling rate X .12 $ Q . Q Q 17. $ 0 • 0 0 18. Amount of Line 14 taxable at collateral rate X .15 $ 0 • 0 0 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 1505611285 Side 2 1505611285 OM4848 3.000 r REV-1500 EX (FI) Page 3 Decedent's ComlDlete Address: File Number DECEDENTS NAME A A M HA R STREET ADDRESS R AN CITY MECHAN G STATE PA ZIP 7 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments $ 0 • 0 0 B. Discount $ 0 • 0 0 3. Interest 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) $0.00 $0•DO (3) $0 • D0 $0.00 (s) $ 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 No a. retain the use or income of the property transferred ^ b. retain the right to designate who shall use the property transferred or its income ^ ^x 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? . ^ Q 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 properly, 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)]. 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)]. 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. Total Credits (A + B) (2) OM4671 2.000 i~EV-1506 EXt (11-10) pennsylvania SCHEDULE E DEPARTTAENTOF REVENUE CASH, BANK DEPOSITS, Hr MISC. RESIDENTDECEDENETURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Michael R. Sabella 20 11 00175 ow4sAD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) SCHEDULE H ' ` Pennsylvania DEPARTMENiDF REVENUE FUNERAL EXPENSES AN D INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT 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. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) 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 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 swaeAC z.ooo If more space is needed, use additional sheets of paper of the same size. IZEV'-1'f13FiX+(01-10) SCHEDULE J Pennsylvania DEPARTAAEN70F REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDEM ESTATE OF: FILE NUMBER: rLi.chael R, sabella 2011 00175 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (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 DISTRIBU110NS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. 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. S $0.00 swasAi 2.ooo It more space is needed, use additional sheets of paper of the same size. CERTIFICATE of GRANT of LETTERS of ADMINISTRATION REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS ADMINISTRATION No. 2091- 00175 PA No. 21- 11- 0175 Estate Of : M/CHAFE RONALD SABELLA (First, Middle, Lasil a/k/a : MICHAEL SABELLA Late Of: LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Secu_ri ty 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 Wi11s 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 law, alI of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIN'ONY WHEREOF, I have hereunto sF=t my hand and affixed the seal of my office on the 10th day of February X011. lC~/1~/~~D~r/1~h1 --- - "'R~egiJster o~fj(Wi~is~ j, L ) DepLty * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY a Settlement Statement U.S. Department of Housing OMB Approval No. 2502.0265 and Urban Development (expires 11/30/2009) 6. Rte Number. 7. loan Number B. Mortgage Insurant:e Case Number: 1. ^ FHA 2. ^ FmHA 3. ~ Conv. Unins. 4. ~ VA 5. ^ Conv. Ins. c. rvo1e: I rns roan Is tumisned to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent an: shown. Items marked "(p.o.c.)" were paid outside Uosing; they are shown here for inlormaUt3nal purposes and not induded in the totals. D. Noma end Atldreac of Borrower E. Nome end Address o1 SNler F. Name and Address of Lender John T. Norman Estate of Dominick C. SaDella Undo E. Zisman, Exeatdx G. Property Loofion. H. Settkmem Agent: Ronald D. Buller, Esquire 5219 Stuart Drive Plerw or Settlement: I. 5ealemeM Date: Mechanicsburg PA 17055 500 N. Third Street, 12th Floor 6/14/11 Hanisburg PA 17101 Disbursement Date: Lot: Bock: J. Summary of Bon'owar's Trenaaction K. Summary of Sellers Tnnsaetion 100. Gross Amount Dua From Borrswrer ._. .._ _ _ _- 101. Contract saga 120 OD0.00 401. Conuacl sales 120,000.00 t o2. Penanat 2 000.00 402. Personal e 2 000.00 103. Settlement oho es ro borrower irb 1400 1562.00 403. 104. 4a. 105, 4~ Adjustments for Items paid by seller In advant>o Ad)uatmants for hems paid by seller In advance 105. C gxas 6/14/11 b 12/31/11 382.03 405. C loxes 6/74/11 b 12/31/11 382.03 107, Coun fixes ro 407. Coun gzes to 105. Acussmentc to 405. Acsawmems to tog. School taxes 6/14/11 to 6/30111 53.44 400, Scholl taxes 6114/1 t ro 6/30111 53.44 110. Sewer 8 trash 6!14/11 to 6/30111 18.28 410. Sewer & trash 6/14!11 ro 6130!11 16.20 111. l0 411. ro 112. b 472. b 11 J. b 413. ro 114. b 414. 10 175. b 415. to 120. Gross Amount Due From Borrower 124,015.75 420. Gross Amount Due To Seller 122,453.75 200. Amounts Paid B Or In BaheK Of Borrower 500. Reductions In Amount Due To Seller 201. dl a esmesl mono 505. l.xcass da II eea Instrucaprq 202. Prind I amount of new bs s 602. SeegmaM dM to eelgr line 1400 1,210.00 203. ExisSn loans gken sub ad ro 509. ExiaN loans glean w ro 2A4. 504. P 6 of first a loan s 290.50 205. 505. Pa a of second mort a loan 205. Sae. Escrow 2,000.00 207. 507. 208. 6~ 20a. 508. Adjustments for items un aid b seller Ad uatmerrts for items un old b seller 210. Cif taxes b 510. lawn fixes b 211. Coun gxea b 577. Cou taxes ro 212. Aaaessmenls 10 572 Asssasmsnts ro 213. l0 513. t0 214, b 514. ro 215. b 575. to 21 B, to 515. to 217. b 577. to 218. b 515. to 219. b 5/9, to 220, Total Paid By/For Borrower 520. Total Reduction Amount Due Seller 3,500.50 t 303. Cash ®From ^ To Borrower I 124 015 75I ~3. Cash ®To ^ From Seller I 118 953 25 Section 5 of the Real Esgte Settlement Procedures Act (RESPA) requires Section 4(a) of RESPA mandates that HUO develop antl prescribe this the following: • HUD must develop a Spedal Informaton Booklet to help standard form to be used at the Ume of loan settlement to provide full persons borrowing money to finance the purchase of residentlal real estate disclosure of all charges imposed upon the borrower and seNer. These are to better understand the nature and costa W real esgte settlement seMcas; third party tlisclosures that are designed to provide the bonower with • Each lender must provide the booklet to all applicants from whom It pertinent Informatlon dudng the settlement process m order to be a better receives or for whom It prepares a wdtten applip8on to borcow money to shopper. finance the purchase of rosidenfial real estate; • Lenders must prepare and The Public Reportlng Burtlen for this collection of Inionna0on is estimated distribute with the Booklet a Gaod Faith EsOmate o1 the settlement costs to average one hour per response, Induding the Ume for reviewing instruc- that the borcower is likely to incur in connection with the settlement. Those Dons, searching existing daq sources, gaNering and maintaining the daq disclosures are mandatory. needed, and completing and reviewing the collection of information. This agency may not collect this intarmatian, and you are not required to complete this form, unless it displays a cunenUy valid OMB contrd number. The information requested does not lend itseD to confidendaliy. Previous edi8ons are obsolete page 1 of 2 form HUD-1 (3/86) ref Handbook 4305.2 701. 702. 703, Paid From Paid From Borrawefs Sellers FUntl6 AI Funtlb AI Sedlement Sedkmenl 800. Items Payable In Connection With Loan soon rse 5: 802. Login Discount 5: 803. nlaal Fae to 800. Credil Re b 805. Lmdera In ctbn Fee 808, Inwrence A katlon Fee to 807. Aewm lion Fee ege. 809. 810. 811. 812. 813, 900. Items Rnnuirad R., 1 ...aa. r., s_ v_..._ . _ __.. _ _. . _ _~ . ,,.,, .., .....ancv C%CMOD Iesl daY In ®ICS • ine 801 ingreei Tlall 10 t1 /da 902. Mort a InauTance Pramfum la months to 903. HavN Inaurenu Premium for are m 904. ere to 908. 1000_ Reennree n.r,n. uew un.~ r __.__ nazarc msurcnce 1 1002 Inaunnce 1 moot month S S r mbnM sr nlortri 1003. roses 1 moah S er monM 1004. Coon Gates 1 month S r month 100.5. Annual a6sesamanm 1 moot S r monM 1008. 1 month E per montll 1007, 1 monM S er monM 7008. mAxauntin Ad ctrnent 1100. Tilte rtiarnaa T. Jemement or aoa lee b - -- 1 t 02. Ababaet d title search M 1103. Title examination m Budar law Firtn 1104. Title irWlrerlG binder to 300 ~ 1105. Oooument ration b 1106. Naa tees w Cash 1107. A S lees m 1 D.OD Inqudes above Items numbers: 1108. Tide InsurencE to (Includes above dams numbers: 1108. Lender's mvere e S 1110. Owner's covers S 1111. 1112. 1113. 1200_ Gnvern....nr o...,..w1.._ __~ .~__.__ ,.~ _ _ ~sv,. nemmi revs: uses S 62.00 a S ' Releases S 62.00 t 202. G man mxlemm s: Deed S 1 200.OD ; M • S 1203. Smle tax/smm Deetl S 1 200 00 ; Mo a S 1 200.00 t 204. 1 200.00 1203. 130n AArlifinnal ewHe..._... n~_____ _ _ T. curve to 1302. Peal MS 'on to 1303. 1304. 1305. 1308. t 307. 1308. 1400. Total Settlement Charges (enter on Ilnes 103, SeW on J and 502, Seetlon K) 1 562.00 1 210.00 i nave careful reviewed the HU0.1 Settlement SmtemeM and to the peal o/ my knovdsd0e and belle(, II is a true and aocurete ammment of all receipts and disbursements on my accoun a by ma in riffs trensaglon. I lurther certify Mat I have rsceivad a copy a the HUp-`Sedl ant St me 1. Seller Borrower E teof mint beds J nff.NOrman Seller ~ Borower i da . Zisman, E t To Me N of my 1 wleo H 1 Seluement Smlament whkJ1 I have prepsred is a true erM Savrele eccounl of Me funds which were reeelved and have been or will Oe disburead by uMS e rt of menl Of Mis trensagion. Settlement Agent ~/~~/~~~ Dale Ronald D. u0er, EsQUire WARNING: II Is a time m knowingly make hlsa Slalemenli to the United Steles on rile or any other aimtlsr loan. Penallias upon mnviq'bn an include a fine entl i~apnmen6 For demBa sae: TNe 18 U S Code Section 1001 entl SeCtibn 1010 Previous edtdons are obsolete Page 2 of 2 form HUD•1 (3/66) ref Handbook 4305.2 PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS AVER CREMATION SERVICES CAF ~ENNSYL~'ANIA, INC. 4100 Jonestown Road, Harrisburg, PA 17109 1-800-720-8221 Fax 1-717-541-9943 Shawn E. Carper-Supervisor Charges aze 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 charged for embalming, we will explain why below. ~,W t,~ STATCEM7.,ENT OF GOODS AND Sy,ERVICES SELECTED 7,.~ ~~ `'~T t~' ~~q ~ "&~'~ed~~x Q~~a~A~ c7 ~.9.d~.~.~f~i ~~`&J .b. %~~~ ~~A~ .F~ Gld 's~ Deceased: " - ~at~ otD~~th - : ', . Date of Arrangements Chargeto• IdS?~'~, I~~~~=.n~~z°;. S~~~i l~ h~~~~a~~?~~~I.~ttl:~~tr ~'~~ ~ .~~`tk~ y .; a ~~ .~.~,r.~~~; Name Address City Staze Zip Code Phone Number A. SPECIAL SERVICES: ~ :~ ~ ~ ~ . ~ ~ D. AUTOMOTIVE EQUIPMENT: .r t~c_ a t.g~~I Direct Cremation ................................. t 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: Services of Funeral Director and Staff.........'~~~ I ud~d Grave Opening ..................... ................. Dressing and/or Cosmetizing ................... Cemetery Equipment............................. .. Facilities and Staff for Memorial Service........ Newspaper Crematory Charge............ ....1 "-' i'"'t ~'` .............. ,,,, 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....... ~'~ ' ~3~ ••••• -• TOTAL OF CASH ADVANCES ...................... C. MERCHANDISE: SUMMARY OF CHARGES: Register Book ..................................... Memorial Folders/Prayer Cards ........ A. Special Charges.............................. .. .~~ ~ r ~ r ~ , fd~ ......... Thank You Cards B. Professional Services................ . ~~ ................................ Rememberance Package . -.. . ........ C. Merchandise ....................... . ,,_, ,~ ~~ Urn(s)..:.:.. ~- .. ~ ~ a-c~~v ~ a' ~ • • t:f.~i~i ~ a'.t-rt~- Description) ..... D. Automotive Equipment.......... ~ ............... .~-~'. ~ ._ . --- Urn Burial Vault Container ............. E. Cash Advanced Items...........;.:........... . ......... (Description) V t Fl C r'v~ SUBTOTAL ................. . ~.... ............ .. !A y: 1 ® U ~ fit) . ~ Y6 _ e eran ag ase ......................... ........ . CREDITS ...... . °• ~:~ _ 'i:. Grave Marker/Monument ...................... .. ........... """"""""" -":'~ TOTAL DUE ................. ~'. . ...... .. .. ................... ~ ~ PAID ...................... "-.......... ,~ s ~ ~rt~~ ~, i ~~ ~~~~ra~.~. i z'I+tyr ....... ....,. BALANCE DUE. ................................... ~~ g11U n ~°tV TOTAL MERCHANDISE .............................. • '~. ~ • ' , ~ ; _ If any legal, cemetery, or crematory reqquirement t~as,)Regyir ~}}~e pllrghasC t~f apyxgfthe ittergtf. ~iste~~rav~~w,ewli~l explain the requirement below j' tti I y~ eidil a ~ ~ ~4r ' 1 } rr„ I.~ag ~: tt «aa SC :a i~e.i t.k .r ~2~c:~ c1 x,,v~ . 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 Servjiee~s Selected. I represent that I have sufficient funds available for payment of the cash price for the goods and services selected. i alsq,;ggree to make payment of $ ' within days. I agree to be jointly and severally Iiathe with anyone else who signs below. A late charge of '- -" '~ 'per month amounting to ~~ per year will be applied to the unpaid balance beginning days 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 vGrN be reflected on the final ill orlstatement. f it i t 9 (Seal) p' } I`~,e•.~ _7' a ~~~~^~'~..''' ~ ~~~ 'Yt , ~: ~ ~ .. ~ ~ (Purchaser) (Seal) ` , , - - (Licensed Funeral Director) (Date) (Date) RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S ware Carlisle, PA 1713 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