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HomeMy WebLinkAbout01-06-12 (3) ~- 1505b10140 REV-15aQ EX (01-10i PA Department of Revenue OFFICIAI. Ut?tE ONLY Bureau of individual Taxes INHERITANCE TAX RETURN County Code Y~r FNe Numtter PO BOA 280gDt 2 1 1 1 1 1 1 7 Harrisburg, PA 17128.0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Sociei Security Number Date of Death kGADDYYYY Dave of Birth tYIMDDYYYY 1 8 4 2 6 4 1 9.7 1 0 1 7 2 0 1 1 0 5 0 7 1 9 3 4 Detxdarn's Last Name Suffix Detredent's First Name MI B I X L E R ANN A BELLE A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Natrte MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST Bf'e FILED IN DUPLICATE WITH THE REGISTER OF WILLS ® 1.Original Retum ~ 2. Supplemertttil Retum ~ 3. Remainder Rt3tium (date of death prior b 12.13.82) 4. Limited Estate ~ 4a. Futuna Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death afbr 12-12.82) ® 8. Decedent Died Tetrtate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposk Boxes (Attach Copy of Wlli) (Attach Copy of Trust) 9. Litigation Proc~ds Received ~ 10. Spousal Parerty Credit (dab of death ~ 1 t. Election to tax under Sac. 9113(A) between 121 91 and 1-1-fi3) (Attach Sch. O) CORRESPONDENT - THI8 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX SIFflRMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Numtler M A R C U S A- M c K N I G H T III 71 ? 2 4 9 2 3 53 M c K N I G H T P C- ~:> First line of address I R W I N f1 Second line of address 6 0 W E S T City or Past Office C A R L I S L E P O M F R E T S T R E E T State 2IP Code REGISTER OF 118E ONLY ~~~~ ~ ~_ T~ ~ ': E/ ? x t7l ~~© ~ ~ DAT~ W ILED c... P A 1 7 0 1 3 Conraspondent's a-mail adara~ss: Under psnaltise of I deGare Vet I have examined this return, including accompanying schatlules and sratemertts, and ~ the bast Ct' my WlCwkdge and pellet, it is true, cottMOt Comp preparer other than the personal representative ie baaetl on all infommtion of wh praparw has any Imowladpa. SIGNATURE O 0 (LING RETURN , ~ /Z DATE ADDRESS l 3616 TWE ST 3 MANHATTAN BEACH CA 9026.6 SIGNATURE t3F PREP H E DATE ADDRE ~ 60 WEST POM RET ST CARLISLE PA 17013 PLEASE USE ORIQINAL FORM ONLY L ],505610140 Side 1 1505610140 '' ~ : {~~ '~ u7 _L r^-i ~. .-- r r`I ~~ J~ a J 1505610240 REV-15oo Ex Decedent's Social Security Number t)eceaerH'sNarne: ANNABELLE A• BIXLER 1 8 4 2 6 4 1 9 7 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 9 2 5 0 0. 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. • 3. Closely Hek! Corporation, Partnerohip orSole-Proprietorship (Schedule C) ..... 3. • 4. Mor~ages and Notes Receivable (Schedule D) .......................... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 1 2 9 0 8. 0 9 6. Jointy owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 2 1 5 ? 9 . 7 1 7. Inter-Vivos Transfers 8 Miscellaneous N~Probate Property l 1 2 7 9 4 6 4 6 (sa,edu e G) o separate Bining Requested ....... 7. . 8. Total Gross Assets (total Lines 1 tl~rough 7) ........................... 8. 3 5 4 9 3 4. 2 6 9. Funeral Expenaea and Administrative Costs (Schedule H) .................. 9• 3 4 6 0 8. 1 7 10. Debts of Decedent, Mor~age Liabilities, and Liens (Schedule I) ............. 10. 1 4 ~ 3 . 6 0 11. Total Deductiorra (total Lines 9 and 10) ............................... 11. ~ 3 6 0 8 1. 7 7 12. Nst Value of Estate (Line 8 minus Line 11) ............................ 12. 3 1 8 8 5 2. 4 9 13. Charitabb and GovemmeMal Bequests/Sec 9113 Trusts for which an ebctlon to tax has not been made (Schedule J) ...................... 13. 14. Nst Vaiw Subjsct to Tax (Line 12 minus Line 13) ...................... 14. 3 1 8 8 5 2. 4 9 TAX CALCULATION - 8EE IN8TRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (aX1.2) X.0 _ O. O O 15. O. 0 O 16. Amount of Line 14 taxable at lineal rate x .04b 3 1 8 8 5 2. 4 9 1 s. 1 4 3 4 8. 3 6 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. D 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 . 18. 0. D D 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1 4 3 4 8. 3 6 Side 2 L 1505610240 1505610240 REV-150 EX Pape 3 Decedent's Complete Address: Fib t~hxnber 21 11 1117 DECEDENTS NAME ANNABELLE A BIXLER STREETADbRESS 245 GRAHAM STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments rind Credits: 1. Tax Dire (Page 2, Line 19) 2. Crer~lPaymerrts A. Prior Payments B. Discount 717.42 3. Interest 4. ff Line 2 is gr~r than Line 1 + Line 3, solar the . This is the OVERPAYMENT. FB M ovd on Pape 2, Line ZO b request a refund. 5. H Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 14,348.36 Total Credits (A + B) (2) 717.42 (3) (4) 0.00 (5) 13.630.94 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 d the property transferred : ....................................... ........................ ^ ....... b. retain the right lD designafa who sh~l use the property transferred or its income; ........................ ^ c. retain a reversionary infest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. ff death occurred after Decer~er 12,1962, d~ decedent transfer propeAy within one year of death without receiving adequate consideratiar? ....................................................................................... 3. Did decedent own an "in trust for" or payable-upon~eath bank account or security at hfs ar her de~h? ......... 4. Did decedent own an individual retirement account, annuity or other non~robate property, which contains a benetidary desk,Fr~iori? .................................................................................................. ^ IF THE ANSWER TO ANY ~ THE ABOVE QUESTIONS IS YES, YOU MU8T COMPLETE SCHEDULE G AND FILE R AS PART OF THE RfcTURN. _ _---- 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 xxviving spouse is 3 percent p2 P.S. 89116 (a) (1.1) (i)]. For dales 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. §911.6 (a) (1.1) (i§}. The stahrte does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdoetire of assets and filing a tax return are sfJ~ a~pNc;able even ff the surviving spouse is the Dory beneficiary. Fa dates of on or after July 1, 2000: • The tax rate imposed on iris net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a nature 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 decedents lineal beneficiaries is 4.5 percent, except as rested in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net v~ue of transfers to or for the use of the decedents siblings is 12 percent [72 P.S. §9116(a)(1.3)]. A sibNng is defined, under Section 9102, as an individual who has at lest one parent in common wish the decedent, whether by blood or adoption. REV-1 Cpl EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE H~IERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FS.E NUMBER: AN r~N ptnp~rty owned eokriy er ae a tenant M conurton want be reporbd at 1Gir market wlue. Fair madcet value is defined as the price at which property would be exchanged between a wfiling buyer and a wiNing seller, rreilher being corrrpelled to buy a sell, both having reasonable knaMedge of the relevant fads. Red property that is Jokglyowned wit rfplrt of sunrhronhk~ moat be dbcloted on Schedule F. Attach a Dopy of the settlement arrest ff the property has been sold. ITEM Indude a Dopy of the deed showing decedent's interest'rf owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 245 GRAHAM STREET,:CARLISLE, PENNSYLVANIA 92,500.00 SOLD -SETTLEMENT SHEET ATTACHED TOTAL (Also enter on Line 1, Recapitulation.) ~ i N more space ~ needed, uae additlonal sheets of paper of the same size. REV-12508 EX; (8-98) • OF PENNSYLVANIA iTAX RETURN SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ANNABELLE A. BIXLER 21 11 1117 Irldude nrep of Wigauon ~d the date the rrero reoeNed by the estate ~ tY k~ rMlh dpM of survivoRU be dkdoad on 8dledule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PERSONAL PROPERTY -APPRAISAL ATTACHED 10,342.00 2. )CORNERSTONE FEDERAL CREDIT UNION 2,566.09 TOTAL (Also enter on line 5, RecapitutaUon) ~ : (If more space is needed, insert additional sheets of the same sine) REV-1509 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY FE.E NUI~ER: ANNABELLE A BIXLER 21 11 1117 S an oast was made johdly owned wNhin one yar of the decedent's datie ~ death, it must be repo~bd on Schedule G. SURVIVMKi JOINT TENANT(S) NAME(S) A. B. C. JOINTLYAWNED PROPERTY: ADDRESS 6 THE STRAND APT C NHATTAN BEACH, CA 90266-3276 TO DECEDENT TTEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DE(~DENTS INTEREST 1. A. FIDELITY INVESTMENTS 243,159.42 50. 121,579.71 ACCOUNT #Z85-654175A TOTAL (Also enteral Line 6, Recapitulatic3n) I i 121,579.71 If more Speoe is needed, use additlonel sheNs ~ paper of the same sine. REY-1510 EX+ (06'09) Pennsylvania SCHEDULE G °~"~"~"~ of ~"~E INTER•VIVOS TRANSFERS AND 6~H~ruNC~ TAx REruRN MISC. NON-PROBATE PROPERTY ANNABELLE A. BIXLER 21 11 1117 This sdie~le must be oompteMd and filed H the answer to any of questions 1 thnxgh 4 on pegs three of the REV-1500 b yea. ITEM NUMBER DESCRIPTION OF PROPERTY WaAJDEiHEWIMEOFTIfTRANBFe~.711BRRBJITI0N8FiPTOD[i~ITAND 7FEOATEOFTRANBFBi.ATfACHACOP1fOFTFEDE~FORREALE,RTA7E DATE OF DEATH VALUEOFASSET %OFDECD'S INTEREST EXCLUSION ~~sq TAXABLE VALUE 1. FIDELITY INVESTMENTS -IRA 127,876.37 100.00 127,876.37 ACCOUNT ;•IF483-018827 BENEFICIARY: TIMOTHY E. BIXLER 2. SPRINT NEXTEL 401(k) 70.09 100.00 70.09 BENEFICIARY: TIMOTHY E. BIXLER TOTAL_(Also enter on Line 7, tZecapia,iation)~ t 127,946.48 N more space is needed, uge additlonei shells at paper of the same size. REV-1b11 EX+ (10-09) Pennsylvania ~ DEPARThM:Ni OF REVENUE INHERITANCE TAX RETURN ~slot~r DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ANNABELLE A. BIXLER 21 11 1117 DegdenCe debts must be reporbd on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 7,847,70 2. WE3TINSTER CEMETERY 2,337.00 3. FUNERAL LUNCHEON 1,157.71 4. PEALER'S FLOWERS 238,54 B. I ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representattre(s) Sheet Address Cily Stale ZIP Year(s) Commissbn Paid: 2, AtlomeyFees: IRWIN 8 McKNIGHT, P.C. 15,500.00 3. Family Exemption: (If deoedenYs address is not the same as clairrrarrCs, attach explanation.) Claimant Street Address City Stale ZIP Reletionsltip of Claimant to Decedent 4. probate Fees: REGISTER.OF WILLS 265.50 5. Accourrtarrt Fees: 6. .Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 375.00 7. REGISTER OF WILLS -FILING FEE 30.00 8. CLOSING COSTS FROM SALE OF REAL ESTATE 2,391.83 9. GOY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 45.00 10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE .75.00 11. THE SENTINEL -ESTATE NOTICE 188.54 12. TRAVEL EXPENSES -RECEIPTS ATTACHED 4,355.35 TOTAL (Also enter on Line 9, Recapitulation) I i 17 ff mae space is needed, use additional sheets of paper of the same sig. REV-1312 EX+ (12-06) Pennsylvania • oar+ARr~Nr of R INF#RITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF MILE 1W111BER ANNABELLE A. BIXLER 21 11 1117 debt hrcurnd by the da~datt priorb death Chet nmelned unpdd atthe date of dseth, Mdudinp unroNnburnd medical . NUMBER DESCRIPTION V ~ ~ATADHTE 1. CITIANK -CREDIT CARD 1,314.00 2. ICARLISLE REGIONAL MEDICAL CENTER -MEDICAL 3. (BOROUGH OF CARLISLE -TRASH 4. DAVID L. HARTZEL, M.D. -MEDICAL 50.00 26.60 83.00 TOTAL (Also enter on Line 10, Recapitulallan) I : ff more space is needed, ira~t additional sheets o(the same size. REV-15~ EX+ (01-10) Pennsylvania. SCHEDULE J DEPARr~ENT~ RE~NUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUII~ER: ~,, >' ~~ ANNABE LLE A. BIXLER 21 11 1117 RELATIONSHIP. TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Lid Trustees) OF ESTATE I TAXABLE DISTRIBUTIONS pndude oulriaM spousal dish~utlons and transfers under Sec. 91 6 a (1.2.] 1. TIMOTHY E. BIXLER Lineal 318,852.49 3616 THE STRAND #3 REMAINDER MANHATTAN BEACH CA 90266 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: L A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTALNON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. i ff more space is needed, use additional sheets of paper of the same size. K r ~ '~ - 1 i~ r ~ ~~~~ X11 ~rt~r C~~e~~ I, ~ABSLLS ALSRIaHT BIXLER, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I devise and bequeath all of my estate of every nature and wherever situate to my son, TT1rIOTSY 8. BIXLER. II. Should my son, TIMOTHY E. BIXLER, predecease me or die on or before the thirtieth day following my death, I devise and bequeath all of my estate of every nature and wherever situate to his issue per stirpes living on the thirty-first day following my death; and should my son, TIMOTHY E. BIXLER, leave no such issue living on the thirty-first day following my death, I devise and bequeath all of my estate of every nature and wherever situate to my sister, MARY JANE $WIGERT. III. I appoint my executor the guardian of any property which passes either under this will or otherwise to a minor and with ~.,~~ respect to whom I am authori$ed to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such ~~ guardian shall have the power to use principal as well as income. '~ ;~ from time to time for the minor's support and education ~~'®~ (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such fh I J support and education, or to make payment for these purposes, without further responsibility, to the minor ox to the minor's parent or to any person taking care of the minor. IV. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. V. I appoint my son, TIMOT'SY S. BI%LER, executor of this my last will. Should my said son fail to qualify or cease to act as executor, I appoint my sister, MARY JAAE SWIQBRT, executrix of this my last will. VI. I direct that my executor or guardian shall aot be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNE33 WHEREOF, I have hereunto set my hand this l8 ~ day of September, 1990. The preceding inatrumeat, consisting of this and one other typewritten page, identified by the signature of the testatrix, was on the day and date thereof signed, published and declared by ANNABELLE A. BIXLER, the testatrix therein named, 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 witnes ereto. ~- . . Q'Ci/G ~7~OrS'7~'c~ n. /G tL ~~~~' ,~'~r~~~y w -~wYrMrww~MwY /w~NO11wAMllnlr~t~t - ~F~$ IRWIN & McKNIGHT YEESJ' POM~RET PRCFF3SIalY1L AtJW.O~IG eo ~rPaMr4eeranmEr c Pewravw~uw ~ro»asn m~ i ~ ate: J~NWL~t St~ecnent u.& O+rrrAdMww~ ra tue~n ow.ap.w~ o~.w.:maars ECfLdW IN 2 ~'iMM 3. ~.WYs. A]~ IW w.ww ~.r. ~~~ rr.rr. `'~ its /l ~'+~~~Y~wiMiN rwxlin WY.r~MMaRr ,r :.~ ~+ ,~ . _. .. . _ , . G~~~ _ ~~ ___ , ~ A y / , / ~~ ~~/ j ~ ~r/~ r w , -.- '~ ~-_.L___._-~-.._ -__.__._ ._..._ ~~ , .. -~' ~/ r /~ ' 1 ., n '~~ ~t ~~~ ~ ~ ~` _- - .......... _ __ ._ . N a .~ ~ ~, -~ .~ _-- ---.- fl ~ (; . _. .. _.. ... _ w f _ ~ ..I l /~ .~ f _ _ ._ 4.. .__....._ ~._ y ~~' s _~' ~~ • ~,~, /~` --- - - ~~~/,~ ~~~ ~~ ~~~ CORNERSTONE FEDERAL CREDIT UNION RECEIVED BY ---------- Rec ------- T R A N S A C T I O N------- -- New -- --Avail-- Eff~c Date Code Description A~ount Fee Balance Balance ---------- ------ ------------------- ---------- ------ -- 10/21/2011 01-Reg CL08E ACCOUNT -2566.09 .00 .00 Msgs TELLER CK Payees IRWIN 3 MCKNIDHT -Paid In- -Raid Out Cashs .00 .Q Checka .00 2566.Q JVs .00 .Q a~s~..~: e~.a....:. Re~itter s ANNABELLE BIXLER Me~ber No.s 916 Check: 46316 Teller No. s 10 Tres 10s40 :U Use Only s <SWD, p30, bi, h7, d1249) Total: .00 2566.Q Don't pay high credit card rates any~ore! Take advantage of CFCU's low 2.9X APR pro~otion. Ask for details. JC ~ "ir rtr~~rrs November 30, 201 I TIMOTHY E BIXLER 3616 THE STRAND APT C MANHATTAN BCH, CA 90266-3276 Dear Timothy E Bixler: We ate responding to your request for information regarding Annabelle Bixler's Fdelity Investments account(s). All information in the enclosed valuation report(s) is (are) based on assets in the Fidelity account(s) as of the date indicated on the report(s). Valuation information is provided through a third party valuation service provider. Fidelity does not warranty the accuracy of this information for any particular purpose. nor does Fidelity provide legal or tax advice. Consult with an attorney or tax professional regarding any specific legal or tax situation. We hope this information is helpful. If you have any questions about account holdings or Hoed instructions on how to transfer the ownership of the accounts, please visit us at Fidelity.com and search under "Change Account Registration" or call us at 800-544-0003. Fidelity Inheritor Services Representatives are available Monday through Friday from 8:00 a.m. to 6:30 p.m. Eastero time. Sincerely, Carla Goias Carla Goias Fidelity Investments Account Re-Registration Services Representative Otu file: W398844-22NOV 11 IAL7R2/DDpDCNAM 531298.1.0 Btoken8e Services P~~ ~' y Bt'ekera~ sa'vkas LLC Member NYSE. SPtC Ckuing, custody sad setdemeat services by Nat~eBal Fts~aat3ai 4erviCa LLC Member NYSE. SPIC P.O. Boz 770001. ~ncianati. OH 4527?-0034 O .~ m 1! JJ w c4 S,1 ~ ~". 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J.1 ~ a c`~ rtA q~ Or Q 0 •~ Ovu~i 10i .-~i O >a r H O~ r O .-•I O O O O M ~O N 5~ O O N Iv1 N r-1 O O O O O O e-I O O O O O p ,O ~ O o •~ CO ~ ~c N ,1 r-1 x O N ~ ~ \ ~ dl ~ ~ '~ •-t .'t.' ~ z o Tf u1 0 ~ ~\ A O ~ P'10 [~ T v~ ~ rt a .°-~ H "' x a ~ ro ~H ~ Q a ~ ~ w ,~ ~ ~ .,.{ .'{ O U ~ W r-1 ~ O~ y --~ d N ~ d ~ w U . R7 i y y VI q U ~ - O ~ H ~ e 1 i L *. - N N O ~ ~O N N f A S,1 rl w ~ r ro ~ • ., . CA O ~ o- ~ ~ O .1 .~ ~ r w ,-i ~o •~ o O H .-. .-~ ~O ~ O~ N tp n N W O O n RI ~D r N a--I ~~ro ~~H ~ ~ H ~ 0 H W L'. O .,~ ++ m ~r .~ O ~_ W O H N .~ H O .~ N •N ~a a~ •'1 U U •r1 fA am ~~ ~~ O .~ JJ ~ N OO N 'J O ~ 1~ f+1 ~ e•i fA f+1 w w ao o .~ w~ 'd ~ a~ ~~ ~-i u~i' a~ JJ ~ ~ .4 R +~ O •~ U b ~ d a W 3 N w W .~ E . i`.J 219 alo1M1 F10~'ICMmf Stl~t CarA~le, RerrtiyWior~ 17013 717.243.4511 t//~~7 /^ ~.., C~,~/~~~ toM 1-ee 1.864,.451.4511 l ~(~/~- ( foot 717.243.3723 FUNERAL HOME ~r CREMA?ORY, INC. ~~~ October 21, 2011 Tim Bbder 3816 Tile Stfalgtd NlaMlattarl Beach, GA 90266 St~emsM of Funeral Expenses for. Mnat>aNe Bbcbr Dale of DeMh: Cklober 17, 2011 Aocoufrt Id: 18384-226 P Pedaps b set Individual of funeral expenses C s 1,995.00 Bub Toth: = 1,l0bA0 FA~dfIES A~ PROFESSIONAL SERVICES: lisp of FscMN~ea fior llfellrirlp 3 250.00 Otlsx Of Tghe Body i 260.00 ~ItCtlItNDISE: Bub Total: i !:10.00 cam caef~n s 2,090.00 outlet container: Monsrd- - concnsle vaue a 1,420.00 ~noriM Foa.~e s 26.00 acw~«l~~,t cam s 20.00 Bub Total: i 3,586.00 AUTOMOTNE C~PMENT': Hearse s 400.00 Sub Total: t 400.00 OPTIONAL SERVICES: Try of rornains b funeral home Z 320.00 Bub Total: i 350.00 TOTAL FUN~tAI. FIOME CHARGES: : 6,'7>f0A0 CASH AQVANCES: 10 GrtSled Death Csrdlice0es ~; 8.00 each 5 60.00 Ns1MSp~perNalioe - serltlnsi S ,43.46 Newspaper htotice -Patriot S 298.82 NsMrspa~per Ndioe -Public opin;on a 136.00 sr Notlce - Wayne Independent t 60.00 NsMrsp~er Wobice -Evening Sun S 85.00 Video Tribute 5 86.42 SERVING OUR COMMUNITY SINCE ~9Q~ s NYK, NOIE n ~~. M 17W tTi'~''~ .: wi T ~ Ssls ~~ V1SU .. ~ ~ .. Takii: 1 1,i~T,i9 1~ ~~~ ~ reit:~ ~ 1: ~~ ~ ca.r ~; "'e FUNERAL. HOME 6t CREMATORY, INC. 219 NofitlprgrePSbd Ccrlsle Pbn~6517013 717.243A511 idl fies 1.866;451.151 i fmt 717.243:37?3 "~"'~` y°°' ~ .the c~~nfidenoe you have placed in us and will continue to assist you in ...~.__ ~:~~w._~ -~. t ~1ae feel free to contact us if you have any questions. F,.rlcloeted-you will Snd an itemized bill for your records, showing that thin bill for the funeral service of ~,u~abelk Blb~aier is paid in full. 3' , Linda Kipp Office Manager SERVING OUR COMMUNITY SINCE 19,p7 suwnar D.ee: 1a11n 1-11na11 '~ AaaouK NuiaEw: 4147 2020 7982 27W Pao.2 as ovER DMs a Trrroectlon Merd~M Nero a Tgntodlon Dga4lbn = Mautt 10A8 ., ~ JEl'BI.l1E 2792188543728 SALT LAKE .. 387.00 101111 1 r ,IFic LAx 1a11 tat 1 lono 1a1o SWA NrPL1La117 Wlfl 888.7i~183e Tx swA B~IgHT We'I e5s79z-1839 Tx vo1Nr RESTAURANT PIZIJI s CARLSLE PA cvs PHARMACw t1e4s aos CAgUBLE PA 5.00 sao 9.97 e.oo 1a1o ALL rEL tow rAxl uwNDALE CA ZS.Op ta11 THE BACK DOOR CAFE CARLISLE PA 23.08 ta12 WA4MART A2574 CARLJSLE PA g.~ tall AMYt3 THN CUISME CARLISLE PA 41.42 tat t OFFICE MAX CARLISLE PA 18.22 ta12 SHOYYTMAE AUTO TRMISPORT 306.2328000 FL 30D,Op 1a12 WBrE 8 SPB'ii7'S 2110 CARLISLE PA 1r~~ 1x11 CARL131.E NITERNAL MEDIC81 CARLISLE PA 15.00 ta12 18SFJ NOODLE CARLISLE PA ~.~ 10n3 PANERA BREAD8791 CARLISLE PA 12.89 ta12 CVS PFIARALACY #1848 C03 CARLISLE PA 10.87 1x13 R11.0'S CARLRK.E PA 81.92 ta12 CVS P1VLlg1ACY 6848 003 CARLISLE PA 21.78 10n3 CVSPHAWIAOYA1818O03.CARLO3LEPA 13.50 1a14 ZONl161E)OCiV1A00888215 BALTNMORE MD 30.64 tOn4 EXXONMOSIL 4T8858Q9 SEVERN MD ~ 13.51 1a14 ALAMO aeNr-A'cAR -wNOVER I~ tOn4 THE BACK DOOR CAFE CARLISLE PA g,BB 1x14 34 PRZA HUT P300S.9013 PHOFJ~Sx AZ 18.37 1ai4 L~1LF OLLl2098131 CARLISLE PA 35.87 1x14 AUNI'~ ANNES M08001507 BALTOAORE MO g,~ 1017111 P LAX SLC 2 P $LC BWI ta1T DELTA AN1 0082193801814 ATLANTA OA 581,90 101711 1 P LAX SLC 2 P SLC BWI 1a1T DELTAANt 0080783B108WATLANTAGA ~r,00 1017111 X LAx SLC 1x17 DELTA AIR 0080783810805 ATLANTA OA ~,Op 1017111 X LAX SI.C ta18 OOQOAOi.COM 8T7~5D-0038 0. 9.95 1x17 0 WALL 8TREET DE3066M65 SALT LAKECITr tR 4.83 ta17 S8P CR0188A1118f08B5860 LAS ANGiELES CA 21.40 lane soull~IrYESrAIR52821aN48519 DALLAS Tx 2,50 1024/11 x BYIII LAx 1a15 souTHWESTA1R5Z821a8944481 DALLAS 7x X4.70 1024111 L S1A11 LAX ta19 asps CHANL3E oFeB100969 eoo-z3e315o TN 1.00 10n8 SOUTFNVESTAIR6280800881419 DALLAS TX 10.00 1018111 M DILL DAL ta18 Mi FUJI CARLISLE PA ~,~ ta19 THE BACK DOOR CAFE CARLISLE PA 23,81 ta18 OFFICE MAX CARIISI.E PA 9.95 1x19 SOUTMMIESTAIR6a80B00987038 DALLAS TX 10.00 X aflaaom c~wxi,sc~ aoo r a is »nv~o rao.td~ mesa w~-a ~1o1a au~oooooioowlosaz 10!'11 FAMiFE1.D IWNS&NiES CARL CARL03LE PA 545.41 late caooa~rl.coM sn,~B~oa1B LL s,~ 1x17 OEITA A8t 0082193801813 ATLANTA GA 581.90 ;, ow a Trs~an AAwidrrit Nams a T~aacYOn Dewiptlan i Amourk 10121 SOU111YYESTA0~5Zb2105915541 DAlLA3 TX 116.70 102911.1 L BYYI LAX 1082 COMFORT SUITES CA18.ISLE CARLISLE PA 356.M 10/22 PANERA BREAD fTpM1 CARLISLE PA 11.92 1022 OISEI NOODLE CARLISLE PA 21.00 102D CVS PHARMACY aW8r6 Opp CARLISLE PA 10.22 1020 CAFE BRUGES CARLISLE PA I5.µ 1029 AU{MO RENT-A<.IIR HANOMER IID 27t.S6 1021 DAVID LARRY MART2EL CARLISLE PA 63.00 t0/Z2 9MEETZ 00002329 MR HOLLY BPRO PA 11.38 101T,L 8p VEND8M31161 LOS ANOaELE$ CA ~Op 101091 SV1tA MIFII(~I1f Ylf~l ~-792-1835 TX 5.00 10f8t SCI VENDWO 1325 BALTIMIORE MD 5.00 1023 E7000NNOBIL 17856021 ELKRIDOE MD 20.01 10129 SIIMAIAY 00369272 HANOVER MD 10A6 X aoooom fls».vsa oao r o +o wnno vaad~ meeo w~~u ~aeo autaaooo~mo+ueapt 1205111 T OAK LAX hao~ ar3wolsn~ ~ ._- -- t ld loi n~n~ ~ nnwc• n~so• . ~ IIl Twr~~~v°MDtxePls Pssler s F1owr ~p -.drlisl• 8ALT1 RE MD Pi2~• ~• a; 1tN ul-~ 41 859-719° [ 1~ ff ,u i ler• ID: 74~R4.679 Ref N: 9193 t~dLO: 1O/20/ZOll Tsnllinst i~1~1 Tins: 12:31:29. PM SsNion: 5 t7~lI6AlII. ~ ~ salt aeridra fet=xxxxxxxxxx~C= rerrrrrrrrrr21i4 p N YtSA EAtrr Mtthod; Setoed :u iii Total: s Acc~tr!t'Wtlllber: o1r.~ts Account Nai9s: Kid Bixi.~ . • o e ' ~ lO~i4~11 16:23:24 Inv r: 991193 Roar Code: 99111D fisiancs ouo cia2or~ou>: ~ 1~ htch~: 991146 Pn ~ ~ ~~ 1to Codc: ~+ eai~ ~ cia~2o11>: -ea Cuetooer Coar ~ ~1101M'It Tsrtdorsd: THANK YOU! ~~ ~ O Smd fior-srs....Just 8°cewsl .~~ ~ '~1~ ALANO f '• SALE RECEIPT it 09c5~' u 423176900 I rw 0 p~ tanbi 10-OCT-20/1 05:32 PNr~~ ~ tk0 10/7~f 1 1 iALT rrwsNtwrar INTL APT Store ~,,C~,l~erk~l8~p Dwr I ~~i i9t~9-n 14-OCT- NTL N'T~ ~ R i t ~ ~ltiuw~+"'' ~~ ~N P~ 3ALT MA911Nfi101 -- - G1Y T ~.45 cINtIF.~r elta.~ - r Il9hlcl• M ~1394't3~(-2102 ~ i .0191 Oat C~r Dr i~ I~CAft Class 9~ -------- •; ~g 9.48 Liam 7t1210f SbtrlPr nc I~ + CHIPS TOTAL NllGn Oriwn 323 Sales Tx ~ 0.57 Nllfns Out 231132 ~ ---~ -' N1t49s In 2~ TAK -OUT #TOj~ ~~~~''''~ el I I i Ref 15965741010 Cr~it AMT Its ~~.i M Pr iw AMUUnt ~ r. ~ a t (T'ha6rg•s No Unit . 4p~ys qg,~ 193.40 ~~~ 0~ UifIIM NlI41 0 NlR~99 e.~w „cki ~' d we dot ~ a at ~~~~; :+.ei~Y ~ ar~Fff g FACIL{Tr tllN4it 15.00' ~~ ~i ~.~rYBY_ ~~'~~ . FAfrllt fr C4G 6.40+ ((~~j33~Z551111 ~ NO, 0632 Stott tlt ~ ~i :stow Re~erenc~ . vttt Llc 1~ AtxN r~ ***~*~**2704 SALES TAX 011.500 X , `'7.54 Total Charges ~ti~272.9e ~ CaT° 'fir =10A05 Atnourtt peposit ul« 2704 •~ Aeeaa,t Oue 2~' 888 88 • Ttiabl• Ib9as ~ ~ ~~ cri o~~ 00 &blact°'t~ Audit pt31 Cr•x{it to ~ ~ '''~ F, L F'Iy~r 000bQU06~•~~y m _ gq~i AI~M~ r 1-900-A45.5G64 r= ~ ~ i Custoaer• S.~~m~ ~ ...... .... ~. ~s+A~s srar- i ,. ~-. °O i ~ n~ ~ ~ ~~ ~ x ~m fir` --~ ~~ ~~ ~ ~. r ' g a c > >o ;.,~,,;_ ~fi a cc ~n ° .n t i Q ~ i r i AlAMO 4x -2011 08:23 ~ Bwlr +I~Ititit~i I-m APr eAlr RASHIi ~- ~ ~°t Ax KII~Jil.Y 81)O.Bi F~ IGR r sso ' :K?214 ~~ 15901938902 T 6 M t ttr~k 200.18 200. t$• Ili:.IM M/pt 0 M/Kss 4.Y FF Fff 0 - 1.50 ~txr Teel to, oax IRAiISp01tT FI~IUTY ~, 9,~ ~ess101i ' Fff 22. te• BI !!C Fff 2.40• ru.ES rAx otl.5oo x 27.E use z~1.5e • f portit Yla 2704 U50 271.58 er Ssrvip Niter 1-800-445-5664 .. t -± .,~.,.,.,,, cis.. ,.1~ C~iitI<<. , ~•., X7013 s. X7'1' ?' ,=ZiR1 '~' 'nGn~1 i4 Me•~tos 'tint U1149!~.;Z4~ $1.39 21Pkt ExP i•ar-,.; F<1r Bargu i13.9.o t Su~tota 1 ~ rax e.oorz x15.38 TOtAI. .. i(a • 64 + is11;.22 VISq Card. '!~`~ilrt~,~~. 16.22 8ai~rks :Nuisber .., ~::•,, .~ .. ': ` J 476 pp+~::•t a ; ; . , J~; 45~tTi •..~ .. 7...~yyy11,h . :, • { i ~ tar's fiowr Sho cartisle UINNY ~R>r'STAIr ~~ ...... , f .. ~ ~ ~~zzA ~ ~. re~1 ~~ c~.tsla 17013 r~ ~ , • ~ sl ,r3s ~ and ~t~- to• :.• 330• s. I-k.,r~; : ;~r; sT , r ~~~,, Oate: 10/13/2011 I .. CRRf.ISLE, PA 17CM3 tu~ T1~• 43:22:29 Py Terufn8l: 1 i x'17-;dg.6417 sar~•t a Session; 5764 j ~ ~ d1 iwta; ~ ~ _ ~ ~ta ~ Order Nunber: 230845 ; Oi . 2c~91 J:41.3, ' 2i it. Oty Oescr-tpt~on 1`ORREfi BY ~t10aE 1••977-1 1 MEOIUM VASE ~~NT sP'ric 49.95 ; ~ns~c. ~n p ~ ~. 7 ,' BY aE8 t~a,.Offi1 fal 1 colors +r .9 T y?` Uis ~ ` de i 1 verb Tota 1: ~ 49.95 ~'~+ • ~ •> to . ~ ,~~ , . Y ~'ges: 9. ~ n , ry~: 1 i total ~!~ Tax 3.59 ~~~: Anctmt Due: 63.49 ~ 4 ~1` '• Charge to liouw: 63.49 • Cha-iG-e Due: 0.00 .. _ . ~,~^ Rei r w+•.e ~,,,,, Semi f 1 ower's.... Just Because 1 ~ ' ~12Q3E tyyt,.. ; 7 Auth.Code: ~B?13L Print Date: 10/23/2011 Pon • ~iTKt Ci8723D Print Ttae; 03:27:01 PM Mierchant number +t+F~93'148 ~,,. CEJSTOMER COPY 5 + f i r r ~`.. it's t.-__. I y ~ Z c~2o o+ ~o ~~ ~er ~ X20 ,~ t; - e'' ~ ~ S ~~a~~{~n ~r~c .~~ 90~~ ~. ...~ C ~ ~ ~ a o ~ y o ~- ,,.., ~ ~~ V V **~ 1-+ M g r F+' c~ m x C 0 0 r 8~, a`~o~I___. ' ~ w~~~~~~~~~a~a~~y~~ ~~~ .... I = V! 0 ' I ~ T C ~ r g ~ ~' `Y iV ' QJ ~ v g" ~ « ! ~ a r., e ~. MMrtAi1~ M !fA 00~'1f l~011 Yi01N11iG011D~ _ Comfort 8ufbs (PAZkBB) _ Account 204325221. Date: 10/2?J11 10 3. Harrovsr Street Room: 310 u~urm CarMsk. PA 17013 A~~ Dom; 10/18/11 (717) 980.1000 Depertun Date: 10122/11 • r e r • ~ t t / frT E L f ~-PA28B~droke110tele.oom Check k1 Time: 1Q/18/11 1004 PM Check Out Time: BIXLER, KIM Rewards Program ID: 3816 THE STRAND APT C You wen diedad out try: Manhattan Beach. CA 90286 You were dredced in uy: trnauri.pa288 ToW BNanoe Due: 0.00 ,~ 10/18111 _~ Room Charge X310 BUQ.ER, KIM 78.00 10/18/11 City / Cotxrty Tax 2.37 10N8/11 Oogrper>cy Tax 4.74 10118/11 Parking 3.00 10119/11 Room Charge ~IKi10 BO(LER, KIM 79.00 1N19/11 City / Canty Tax 2.37 1x19111 Oocwpancy Tax 4.74 10/19/11 Parlrirq 3.00 10120/11 Room Charge 9310 BIXLER, KIM 79.00 10@OM 1 Clty /County Tsx 2.37 10/20111 Ooa~parwy Tax 4.74 101Za11 Parking 3.00 101121/11 Room Charge 8310 BIXLER, KIM 79.00 10/21/11 Cky /County Tax 2.37 10121/11 Occupancy Tax 4.74 10121/11 Parking 10122/11 Vlea Payment (356.44) 704