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HomeMy WebLinkAbout12-30-11 (2)_J 1505.610140 REV-1500 ~` t°'-'°' OFFICUIL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number Po Box 2aosol 2 1 1 1 0 1 7 3 Harrisburg, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Sodal Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 2 0 6 1 0 8 2 9 1 0 1 3 0 2 D 1 1 0 8 0 9 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI F R E Y S I N G E R S Y L V A N K (H Appifcable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Sodal Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS © 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death pnorto 12-13-82) 4. Limited Estate [~ 4a. Future Interest Compromise (date of [~ 5. Federal Estate lax Retum Required death after 12-12-82) ® 8. Decedent Died Testate [~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Utigation 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 Sch. O) CORRESPONDENT -THIS SECTION MUST BE CpMPLETED. ALL CORRESPONDENCE AND CONFIDENTUU. TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephpge Number ?? ~~ R M A R K T H 0 M A S E S Q U I R E '~-- ? 1 7 6 2~ 0 ~! r~r ~-, ~:: ' REGISTE US LY ~' W , - First Iine of address --s c~ Q ~i w - 1 0 1 S O U T H M A R K E T S T R E E T ~ ~ ~ ~ `~' -r ~. , ~' Second Tine of address ~ 4"? City or Post Office State ZIP Code DATE FILED M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's e-mail address: rmarkthomasCc~gmail.com • Under penalties of perjury. I declare that I have examined this return, including accompanying schedules and statements, and to the bast of my knowledge and belief, It is true, cc-rect and complete. Declaration of preparor other than the personal representable is based on all information of which prepares has any knowledge. SIGNATURE OF PERSON R~PONStB1,~FOR jIIING RETUPtN DATE _ ~ , VE FAIRFIELD 101 SOUTH MARKET STREET MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1.505610240 REV-1500 EX Decedent's SoGal Security Number DecedenrsName: SYLVAN K• FREYSINGER 2 0 6 1 0 8 2 9 1 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2. Stocks and Bonds (Schedule B) ...................................... 2. $ 1 6 9 . 1 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. Cash, Bank De osits and Miscellaneous Personal Pro e P p rty (Schedule E)....... 5. 2 7 3 2 8 3. 8 0 8. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ S Billi t R t d epara e ng eques e ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 7 8 4 5 2. 9 6 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 1 4 0 4 0 . 8 6 10. Debts of Decedent, Mo a e Liabilities, and Liens Schedule I rt9 9 ( ) ............. 10. 3 2 3. 9 1 11. Total Deductions (total Lines 9 and 10) ............................... 11. 1 4 3 6 4 . 7 7 12. Net Valu® of Estate (Line 8 minus line 11) ............................ 12. 2 6 4 0 8 8. 1 9 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14. 2 6 4 0 8 8. 1 9 TAX CALCULATION - 8EE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (a)(1.2) x .045 2 6 4 0 8 8. 1 9 15. 1 1 8 8 3. 9 7 18. Amount of Line 14 taxable at lineal rate X .0 _ 1 g, 0 . 0 0 17. Amount of Line 14 taxable at sibling rate x .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 1 g. 0. 0 0 19. TAX DUE ...................................................... 19. 1 1 8 8 3• 9 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21 11 0173 DECEDENTS NAME SYLVAN K. FREYSINGER STREET ADDRESS 4905 EAST TRINDLE ROAD, APARTMENT 94 CITY MECHANICSBURG STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} 2. CreditslPayrrlents A. Prior Payments B. Discount 3. Interest 4. If tine 2 is greater than tine 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1} 11.883.97 Total Credits (A + B } (2} 0.00 (3) ,~5 (4) 0.00 (5) 11.883.97 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; ..............................: [^ ^ c. retain a reversionary interest; or ............................................................................................... d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death oax~rred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an 'intrust 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? .................................................................................................. ^ 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, tfie tax rate imposed on the net value of transfers to or for the use of the surviving spouse 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 (/2 P.S. §9116(a)(1.2)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent p2 P.S. §9116(a)(1.3)]. Asibling is defined, undl Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEbUL~ B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE ©F FILE NUMBER SYLVAN K. FREYSINGER 21 11 0173 All property jointly-owned with right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Black Rods Funds 5,169.16 P. O. Box 9819 Providence, Rf 02940 (Originally, this property belonged to decedent's spouse, Geraldine Freysinger, who predeceased decedent. his property was discovered while finalizing this estate and is being accounted for herein since Sylvan had had survived her and inherited this property pursuant fo the terms of her Last Will and Testament.) TOTAL (Also enter on line 2, Recapitulation) ~ i (If more space is needed, insert addfional sheets of the same size) REV-1508 EX + (8-98) SCHEDULE E COMMONWEALTH of PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY f.Cf1G\R ESTATE OF r~~~ nvmocw SYLVAN K. FREYSINGER 21 11 0173 Indude the proceeds of I'figation and the date the proceeds were received by the estate. AN property JoiMiy-ormed with rlpht of survivorship must bo dleclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. embers 1st FCU, savings account no. 13106-00 34,381.71 . O. Box 40 echanicsburg, PA 17055 2. embers 1st FCU, checking account no. 13106-11 24,944.77 . O. Box 40 echanicsburg, PA 17055 3. embers 1st FCU, money management account no. 13106-05 18,725.19 . O. Box 40 echanicsburg, PA 17055 4. embers 1st FCU, certificate of deposit no. 13106-41 31,686.45 . O. Box 40 echanicsburg, PA 17055 5. embers 1st FCU, certificate of deposit no. 13106-45 10,110.79 . O. Box 40 echanicsburg, PA 17055 6. embers 1st FCU, certificate of deposit no.13106-46 5,159.20 . O. Box 40 echanicsburg, PA 17055 7. embers 1st FCU, certiflcate of deposit no. 13106.49 5,316.83 . O. Box 40 echanicsburg, PA 17055 8. embers 1st FCU, certificate of deposit no. 13106-50 12,890.51 . O. Box 40 echanicsburg, PA 17055 9. embers 1st FCU, certificate of deposit no. 13106-51 15,759.99 . O. Box 40 echanicsburg, PA 17055 10. embers 1st FCU, certificate of deposit no. 13106-53 39,903.63 . O. Box 40 echanicsburg, PA 17055 11. embers 1st FCU, certiflcate of deposit no. 13106-54 54,101.71 . O. Box 40 echanicsburg, PA 17055 12. untry Meadows West Shore 3 (refund) 20,203.02 905 East Trindie Road echanicsburg, PA 17050 13. alpezzi Funeral Home (refund) 100.00 Market Plaza Way echanicsburc. PA 17055 TOTAL (Also enter on line 5, Recapitulation) I S ~~~ gas an (If more space is needed, insert additional sheets'of the same size) REV-1511 p(+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER SYLVAN K. FREYSINGER 21 11 0173 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home 353.77 2. Funeral dinner 327.60 3. Tombstone 4'260'00 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: R. Mark Thomas, Esquire 8,355.00 3, FamilyExemptxxl: (If decedenCs address is not the same as daimant's, attach explanation.) Claimant Street Address Cily State ZIP Relationship of Claimant to Decedent 4. probate Fees: 396.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Cumberland Law Journal (publication) 75.00 8, The Patriot News (publication) 272'99 TOTAL (Also enter on Line 9, Recapitulation) I ; If more space is needed, use additional sheets of paper of the sarr>e size. REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS QF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER SYLVAN K. FREYSINGER 21 11 0173 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medkal sxpen:ei. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. untry Meadovns West Shore 3 905 East Trindle Road echanicsburg, PA 17050 323.91 TOTAL (Also enter on Une 10, Recapitulation) ~ S If mae space is needed, ~sert additlonal sheets of Ule sarr>a size. REV-1513 EX+ (Ot-10) pennsyivania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: - - ~, „ ~„~ 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 Qndude ht s I distributions and transfers under Sec. 91'L6 (a (1.2).] 1. Joyce A. Klinefelter Lineal 0.40 6316 Shearwater Drive Faifield, OH 45014 2. Jeannette Rose Lineal 0.20 1500 Sherwood Drive, #1A Faifield, OH 45014 3. Lynn Krems Lineal 0.20 22 Hickory Drive Harrison, OH 45030 4. Amanda Uesse Blafs Lineal 0.10 700 Riddle Road, #201 Cincinnati, OH 45220 5. Megan H. Rose Lineal 0.05 1500 Sherwood Drive, #1A Fatfield, OH 45014 6. Isaiah T. Keeling Lineal 0.05 22 Hickory Drive Harrison, OH 45030 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, 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. ~ 0.00 Ii more space is needetl, use additionai sheets of paper of the same size. YOUR PORTFOLIO REVIEW Lead A/C #: 5002495363 BLACKRO~ April 01, 2011 -June 3C Account Activity High Yield Bond-Class A Fund Number 0123 Fund Symbol B Your Account NumheGis 50D24433d3 Estimated Cost Basis as of Your Personal Rate of Return The registered Account t)wner is 06/30/2011 - Geraldine W Freysinger Average Cost Current Year- Since One- Inc Per Share Total Cost Basis Quarter to-Date Ysar Inception Your Account Valueas of Od/3D/2011 N/A N/A 1.52% 5.33% N/A 7.22% 01N7 Shares Held O'OOD NefAssetValue X $7-74 Activity in This Fund Total ACCOUnt Value = 50.00 Trade Dollars This Shares This Estlmated Fund Operating'Expenses Date Transaction Transaction Share Price Transaction Shares Ob/01/11 Beginning Balance 65 Current C~uarter $O.DO 04/29/11 Dividend -Cash 525.73 65 0523111 Transfer Out 0123-0Obb5130fi3 -55,169.16 57.90 -656.326 Your Financial Professional - Krishingner David L -Rep. Phone #: (6101398-0100 ~I~II') Page 3 of 5 :~ ~,~ MEMBERS 1~ FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix 13106-00 Date Account Established 03/16/1972 Principal Balance at Date of Death $34,375.35 Axrued Interest to Date of Death $6.36 .Total Principal and Accrued Interest 81 71 Name of Joint Owner None CHECKING ACCOUNT: AccountNumber/Suffix 13106-11 Date Account Established "' _. _ 05/13/2010 _ -. - Prinapal Balance at Date of Death $24,942.80 Accrued Interest to Date of Death $1.97 Total Principal and Accrued Interest $24,944.77 Name of Joint Owner None MONEY MANAGEMENT ACCOUNT: Account Number/Suffa 13106-05 Date Account Established 07/2g/1997 Principal Balance at Date of Death $18,719.99 Accrued Interest to Date of Death $5.20 Total Principal and Accrued Interest 25.19 Name of Joint Owner None CERTIFICATES OF DEPOSIT: 1310611 13106-45 13106-46 Account Number/Suffix Date Account Established 11/03/2006 07/02/2009 05/14/2010` 51 155 $5 Principal Balance at Date of Death $31,642.71 $10,103.57 22 $7 . , $3.69 Acxrued Interest to Date of Death $43.74 45 686 $31 . $10,110.79 9 20 Total Principal and Accrued Interest . , None None None Name of Joint Owner *Rollover from certificate 9504-43, originally established 07/02/2009. CERTIFICATES OF DEPOSIT: 13106aL9 131106-50 13106-51 Account Number/Suffix 12/OS/2008* 05/14/2010'* 05/14/2010'*' Date Account Established Principal Balance at Date of Death $5,311.60 $12,863.22 $15,738.23 76 $21 Accrued Interest to Date of Death $5.23 83 316 $5 $27.29 $12,890.51 . $15,759.99 Total Principal and Accrued Interest . , None None None Name of Joint Owner *Opened by transfer of funds from 13106-05. '*Rollover from certificate 9504-44, originally established 10/17/2006. '""Rollover from certificate 9504-45, originally established 11/21/2006. 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283 2328 wwwmemberslstorg :~-' ~. CERTIFICATES OF DEPOSIT: 13106-53 13106-54 Account Number/Suffix Date Axount Established 05/14/2010' ~ 05/14/2010"" Principal Balance at Date of Death $39,871.95 $54,042.03 Accrued Interest to Date of Death $31.68 $59.68 Total Principal and Accrued Interest $39,903.63 $54,101.71 Name of Joint Owner None None 'Rollover from cert~cate 9504-53, originally established 08/08/2008. "'Rollover from certificate 9504-54, originally established 09/04/2008. VISA ACCOUNT: Account Number/Suffix 4672090000264028 Date Account Established 08/08/1996 Principal Balance at Date of Death $.00 Joint Cardholder None EMBERS 1sT FEDERAAL CREDIT UNION~\/\/''~/~J ~ D le A. Kline Lending Insurance Support Specialist September 1, 2011 Estate of SYLVAN K. FREYSINGER Date of Death: 01/30/2011 Social Security Number: 206-10-8291 ~.,..,.,--...,,.T.~_._-.- ~_~..__ .. _. __ Country Meadows West Shore 3 4905 East Trindle Road Mechanicsburg, PA 17050 . Telephone: (717) 975-3434 Joyce Klinefelter 6316 Shearwater Drive fairfreld, OH 45014 Ptease detach. and return top portion with payment. STATEMENT Statement Date: 02/01/2011 Amount Enclosed $ Amount Due: $ -19,879.1.1 Account #: 77489 RE: Sylvan Freysinger Date Descrt on ~~~~ Rate Cha Pa ants ~~ Baianoas . Balance B/F -23,191.91 -23,191.91 01/07/11 Laundry Btdg.3 1 2.00 2,00 -23,189.91 01/14/11 Laundry BIdg.3 1 2.00 2.00 -23,187.91 01/21/11 Laundry Bldgg.3 1 Z.00 2.00 -23,185.91. 01/21/ii Pharmacy Charges 1 159.37 _159.37 -23,026.54 01/27/11 ~omesdc Phone Service 1 26.00 26.00 -23,000.54 02/01/11 -02/28/11 Private Studio 28 3,237.00 -19,763.54 01/31/11 nterest on Prepay 115.57 -19,879.11 nterest Earned Year-to-Date: 115.57 Current 1-30 Days 31-60 Days 61-90 Days Over 90 Days Amount Due 3,237.00 75.80 3,158.90 3,237.00 -29,587.81 -19,879.11 ThanK you for choosing Country MeatlowS of West Shore 3! Please IrKlude the top portion of this b1A with your payment by the 15th using the enclosed envelope.. Make your check payable to Country Meadows Associates. Statement Date: 02/01/2011 Sylvan Freysinger -Account #: 77489 Country Meadows West Shore 3 .4905 East Trindle Road Mechanicsburg, PA 17050 Telephone:. (717) 975-3434 STATEMENT Coalitry Meadows West Shore 3 Statement Date: 03/01/2011 4905 East 7rindle Road Mechanicsburg, PA 17050 Telephone: (717) 975-3434 Amount Enclosed $ Amount Due: $ -323.91 Account #: 77489 RE: Sylvan Freysinger Joyce Klinefelter ....10404 Hwy 27 Lot 404 Frostproof, FL 33843 Please detach and return top portion with payment. Date Descrl on ~n Ram Cha ants Balances Balance B/F -19,879.11 -19,879.11 02/04/11. KLINEFELTER,] 326.21 -20,205.32 02/04/11 KLINEFELTER,J -247.32 -19,958.00 02/04/11 KLINEFELTER,J 245.02 -20,203.02 02/15/11 RTND CK -326.21 -19,876.81 02/15/11 RIND CK -245.02 -19,631.79 02/15/11 TND CK 247.33 -19,879.11 03/03/11 REFUND -360.21 -19,518.90 03/03/11 REFUND -22,594.22 .3,075.32 03/03/11.. REFUND 269.95 2,805.37 03/23/11 MEMBERS 1ST BK 323.91 2,481.46 01/30/11--01/31/11 Private Studio 2 134.07 2,615.53 01/O3/11- OI/29(11 Private Studio 29 3,086.24 5,701.77 01/O3/11- Ol/31/11 Private Studio . 31 -3,237.00 2,464.77 01/28/11. Laundry BIdg.3 i 2.00 2.00 2,466.77 02/01/11- p2/08/ii Private Studio 8 536.28 3,003.05 02/01/11- 02/28/11 L Private Studio 28 -3,237.00 -233.95 02/21/11 armacy Charges 1 22.93 22.93 -211.02 02/28/11 nterest on Prepay 112.89 -323.91 nterest Earned Year-to-Date: 22g.g6 Thank you for choosing Country Meadows of West Shore 3! Please indude the top portion of this bitl with your payment by the 15th using the endosed envelope. Make yourdtedc payable to Country Statement Date: 03/01/2011 Meadows Associates. Current i-30 Days 31-60 Days 61-90 Days Over 90 Days Amount bue -323.91 536.28 3,220.31 3,237.00 -6,993.59 -373.91 Sylvan Freysinger -Account #: 77489 Country Meadows West Shore 3 4905 East Trindle Road Mechanicsburg, PA 17050 Telephone: -(717) 975-3434 Thursday, ~ctob®r 13, 2011 4:07 PM .~ Malp®zzi Funeral Home 7176972414 Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 (717)697-4696 p.01 Michael J Malvezzi Owner FD Jeremy J. Shartzer. FD Kvle C. Knipe. FD October 13, ZO11 Mrs. Joyce A. Klinefelter 6316 Shearwater Drive Fairfield, OH 45014 The Funeral Selviee for Sylvan K. Freysinger We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to tllia statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES: 3erviceo of F'iuiernl Director/4tnff $4,G25.00 FUNERAL HOME SERVICE CHARGES 54+625.00 SELECTED MERCHA1~iDISE: Stainless Steel Casket 54,250.00 12 ~. Regular 51,485.W On Freedom's Wing Register Package $235.00 THE COPT OF OUR SERVICES, EQUIPMENI, AND MERCHANDISE. THAI YOU HAVE SELECTED $10,595.00 AT THE TIb1E PLRIERALARRANCtEME1dTS WERE MADE, WE ADVANCED CERTAIN PAYIv1ENT3 TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES: Opening 01~ave $G50.00 Cemetery Equipment $170.00 Certified Death. Certificates $G0.00 Nevc~spaperNotices -Patriot 5192'82 C1erRy/Masa OfFering $100.00 Flowers $240.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $1,412.SZ CONTRACT PRICE $12,007.8~Z HISTORY: 01/30/2011 Discrnurt Pre-Need Guarantee $1,622.65 02/01/2011 Paymelit Homa~teaden Life Company $10,031.40 02/26/2011 Paymerrt Paymeirt--CCVA $100.00 03/14/2011 Paymerrt Paym~rt $353.77 03/24/2011 Overpayment Refund Coiurty Veteran $100.00 TOTAL AMOUNT DUE $0'~ . F003~-BEER-~OUOR~ Box sE~V~rC~. 2_. o~lv ~ ~ ~. CASH ~ ) ~_ ~ B~ PROVIDED W/CASH BAR-FOR LIQUOit AND BO~T'I'LF.D BEER ( ) Hal-~ $'135.00 ~, ~~ Key: $85.00 :(Domestic j-$otties. (Domestic) $ `2.50..) $:; 2.75. p j~ beer based on marrke~ pric~_ L~ iquor. . (well)~~:2.75;{call) 3.25 _ ~ RFEE= $IU_UOI~L _ Roam _ _ ~ . . Food: ~o7Sld ($JPersan ~ No = $ ~ ) Bevera~e_ ~ ~ (alcoholic) Beverage ~ ~ ~ (naa-a3coholic ) 1Vlitscellaz~eous Bartender Fee: ~ ~d. cO ($~O.OOIhr_ ~ 3 = b~ _ $ o ."° ) Sub-Total: ~ a~ ~~ _"~ ~a~es pax (s4i°) ~ > 5! ~° {~ ~3 - - s~oral ~ ~~8~- ~o ~ _ rs ._ ..._ ..r B81 C~ (post Sub-Total ~~3~7. G ~ c~ ~7} sr~ct lulinus Deposit ~ ~ : -. _~~__..._,, _, ~,. `~_ - -_~.::.-~, ~_ -~°.. . .. _. ~_ .. ~~, eSM .L Jai ASV-v_a .~. Balance Dae - ~' a~ , G ~ l ~'~ " ~ Date.~-3 _~ Fost 1Vlgmt .'~ ,7 _3_ /~ Ren _-l Dec 20 i1 03t:36p Ginsricfi Memorials .R, ~'.. . .; ~ 1 ~: ~~. ~ ~~~ ~ngr~c ~- ~ MEM4RIAIS Since 1921 . 5243 Slnctpsa>:t Ferry Road, Mechanicsburg, PA 17050 . - (71?) 766,5622 • Fax 0717? 766-8007 • www.gingrlcttmemotials.cvm . «~:: ~~~ Kt;r~f~t~r~~ i~r'Fi ~ ~~ ~ Lt S 014 • 31st" • 5~a5_ can X17-766-8007 p.1 ,• ' ~~ ~=o~.so~ :. Drawing ~ Drawing Sent to Cust. Approved Found. By C~ trn ~t e r ~t Found. Ordered_.~_: Vendor Ack. # Grave Position Verified Cremation - ~ ~~ Date of Order ,Q Ct 31 a ~ 1 1 Cemetery Mt ~~t?a 54tti~ . Cemetery Location ~ «SbGCp Center Over ~_ Graves Sec. /Lot # Approx. Date of Completion ^' D t"t~ eZ~t ~. . ~i • Lettering., . ~. . ,• . -:>~- -~>:YYt- . SYLYAII EIKG t:E1>;ALDiHE 1rrJS>at ' ~ ai<casr ~.19i~ AQS:II3T !,1424 JUitiAlt 20. lOII JAlfitAYt 20.20tI Tyrpe ~ ~ / Material Tlcir\ob-vt ~ack `~aY~f yt 0~1 Ara4ult ~ SYr~ Additional Lettering: size "' _"X O ~ ~' X ~_ Fnish ~ ,t 'f'[~c~ t Si '~ e < o c k - ri t F C ^ Back ^ 8ase size 4-w X 1~ a X ~~.. Finish ~~ eat f ~~ ; r c.k • ~+t'c~ s ~ t~ r s ; Description ~ ~ ~ ~ ~ '` l ocatton on Cemetery _ - . . ,. "':`- . - . ~: . ~ Vase - O' Photo ^ Other - ' Agroernsnt:•A sox depoeR is nequired.to commencement of worts:. v• .. - .- . COSTS: ~ ~ 00 Agree ~-pay stated belattee upan eroctlon fegeidless Ct labor troubles or shipments or any other go3tt. reasoiis.'7his order or Memorial . •' $ T ~ a COrafadghnCRtJeCatlOAltOdbll otastpmertmleas agroed t~botlt parties. The•ertkte tiereln mentionedshatl remain the property df ' r ' Jmtq p. f~ingrlotrllMiobAeds until peiddn full and they rsssrve,Ihe rfgh! to remove the same to riot paid as~atated. "' • .Foundation ~$ ._..~~~ 1 eproe to'etaretuUy prtrotiead aR names errd dates tar accuraoy and acxept tun resportsibitlty~or erry errors or pmissbns.~7NE,RE Cemetery Fees $ . 1NILL QE All i4DD1'~lt741AL' f:HAAOt: F0A ANY LETTERING ADDED TO THiS MEMORIAL AFTiR.ERECTED DN THE i {ate gip, ~ paY ~ peianoe stated for the work performed under ails contract within thirty (~) days of r~Dt of the Mal ' ktrcke and tuA'ttet free ttnt interest shed accrue at the rate of one and one-half percent {1 >'4%) per month on the unpaid batarrce $ - owatf m ~~ A. Ciingrtch Memorider riot pad within tRFrty (30) days of the lrnolce, data. In addffion thereto, t agree it it becomes $ .. rteoeoeety tor,>amss R.'tihigridt to inetltu~ loped ptpceedl~r9lo collect artyturrds tittafromme fpr°rtiy.Acoouht tieing-pest due thirty ' (9~;day~;,mpay eoeb attorneysl~rin4va^eddl+,-ar;!4sF;~.tBir~iobctulerr!arial~soooueetthes~ine..' TOTAL .-»$ ,~.~.1~v`b` ~ np ~. ;l?e81er ~ ~e•C-xn,~. ~ , • _ DEPOSIT $ - . :. .. '. •. e Customer ~ ~ ~.~• ~ Balance t7ue $ = . (! iiuttrar agroe that the above names, spemng, and dates are correct) . ' ;. ~t° Upon Completkxt •~ RECEIPT. FOR PAYMENT GLENDA EARNER STRASBAUGH Receipt Date: 2/10/2011 Cumberland County - Register Of Wills Receipt Timer 09:35:49 One Courthouse Sqquuare Receipt No.: 1064369 Carlisle, PA 17J13 FREYSINGER SYLVAN K Estate File No.: 2011-00173 Paid By Remarks: R MARK THOMAS CJ ------------------------ Receip t Distribution ------ --------------- --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310.00 CUMBERLAND COUNTY GENERAL FUN. WILL 15.00 CUMBERLAND COUNTY GENERAL FUN. SHORT CERTIFICATE 16.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR` M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN -------- Check# 3118 $ -------- 369.50 Total Received..... .. $ 369.50 ~ ~ ~5.oa RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 8/1.8/2011 Cumberland County - Register Of Wills Receipt Time: 11:04:34 One Courthouse Sqquuare Receipt No.: 1066699 Carlisle, PA 17Q13 FREYSINGER SYLVAN K Estate File No.: 201.1-00173 Paid By Remarks: RDBMARK THOMAS ------------------------ Receipt Distribution ------------------------- Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN Check# 32.07 $12.00 Total Received......... $12.00. ~~ CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3168 Fax: (717) 249-2683 August 12, 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: R. Mark Thomas, Esquire Sylvan K. Freysinger Estate RE: 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: July 29, August 5, and August 12, 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 r PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW .JOURNAL (Under Act No. 587, .approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,. was established January 2, 1952, and designated by the Local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is ' exactly the same as was printed in the regular editions and issues of the said. Cumberland Law Journal on the following dates, V1Z: July 29, AUQL1St 5, and Aut?tlst 12, 2011 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ,.---- L sa Marie Coyne, E for SWORN TO AND SUBSCRIBED before me this 12 of August, 2011 r s Notary Freysix~er, Sylvan K., deed. Latc of Mechanicsburg, Hampden Township. Executrix: Joyce A. Klinefelter, 6316 Shearwater Drive, Fairfield, OH 45014. .Attorney: R.. Mark Thomas, Es- quire, .101 South Market Street, Mechanicsburg, PA 1.7055. NOTARfAL SEAL DEBORAH A COLLINS Notary Public CARLISLE 80ROUGH, CUMB£ALAND COUNTY My Commission Expires Apr28, 2014 The Patriot-News Co. 2020 Technology Pkwy ~'" quite 300 Mechanicsburg, PA 1.7050 Inquiries- 717-255-8213 R. MARK THOMAS 101 SOUTH MARKET STREET c't~e ~tta~triot News NOw you know MECHANICSBURG PA 17055 INVOICE ALL CHARGES ARE NET ACCT # ~A~ AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT 35242 R. MARK THOMAS 0002157501 07/16/11 REGULAR BASIC AD CHARGE.. $89.33 35242 R. MARK THOMAS 0002157501 07/23/11 REGULAR BASIC AD CHARGE $89.33 35242 R. MARK THOMAS 0002157501 07/30/11 REGULAR BASIC AD CHARGE $89.33 AFFIDAVIT CHARGE $5.00 TOTAL: REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL , Chicago, IL 60673-1237 Please include the Account # or Ad Order # (above) with your remittance--Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication $272.99 _ _ _ __ .The Patriot-News Co. " 2020,~T*echnology Pkwy ~ d to ~ ewx Swte 300 Mechanicsburg, PA 17050 NOW y0V k110W Inquiries - 717-255-8213 R. MARK THOMAS 101 SOUTH MARKET STREET MECHANICSBURG PA 17055 THE PATRIOT NEWS THE SUNDAY PATR[OT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Holly Blain, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and. place of business at 2020 Technology Pkwy, Suite 300, in the Township of Hampden, County of Cumberland., State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Driv2, in the City, County and State aforesaid;. that The Patriot-News and The Sunday Patriot-News were established March 4th; 1854, and September 18th, 1949, respectively,.,~nd alt have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Community Weekly editions which appeared on the date(s) indicated below. That neither. she nor said Company,is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION COPY This ad # 0002157501 ran on the dates shown below: -~ July 16, 2011 July 23, 2011 _ ; {_ ~ „~ ~~'~,_..~»sr~gTe r+Qrlce',. ~ ~~ ~= j on tM E ah o1'S f' t% I~~~ ~ _ July 30, 2011 ' to ~.~r~• .F~ io 1M d~Nd.;l!~'~ 6wn prarlt~Q , wl~rsiWnd.111{p~rwrnk+lOrYlrq-; ~ 1fl~rtuiNnli 10 D~'If+deblydio aald ~sfaf~ vWBmok~harirnntlmrtwtllah arW ( 2011 A Sworn to u scribed before me~this 04~y f ugust D mos.nwtnadatmswnrorem.m ~~**,~., Jeru-A. Klln~hlfik . , . . ~ .~ 8316 Sh~arvpl~r Drive i°! FolrftNd. OH 150U ,i "' ~ ~ ~~ f L ~ ~ -Aft \/" [ . +1~ Notary Public aw , or[KYa ` lor'soutn Mcrket str..t ~. ,,. '! ,~hlecharUcsburo. PA 175 `. ` COMMON1NPgL'r!i OF PEfVNSYLYANIA Noteritl 5q1 SheMe L Kfsrler, Notary Publk lower Paxkon 7 qvP., pauphM C~n~y My CommLS~on gcptres Nov. I6, Z011 Member, Pennsvhiania gssodadon of Notaries . .~ . ,,~ j; ' LAST WILL AND TESTAMENT ' BE IT REMEMBERED THAT I, SYLVAN K. FREYSINGER, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by.me. I I declare that I am married. to GERALDINE W. FREYSINGER, and that I have one-(1) daughter, namely 3OYCE A. KLIl~tEFELTER. I also have two (2) granddaughters and three (3) great-grandchildren who will tie referred to in this Will. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that maybe assessed in consequence of my death, of whatever nature acid bywhatever jurisdiction imposed, shall be paid from my residuary estate as .apart of the expense of the administration of my estate. IV I give, devise and bequeath all my property, whether real or personal,. wherever situate, including any property over which I may have a power of appointment to my wife, GERALDINE W. FREYSINGER, provided that she survives me by thirty (30) days. ,, V In the event that my wife, GERALDINE W. FREYSINGER, shall predecease me or fail to survive me by thirty (30) days, then I hereby direct that my estate be distributed accozriing to one of `the followingtwo (2} schedules, whichever schedule applies: A. In the event that the net value of my estate, following the payment of all debts, administration fees, and inheritance taxes, should be less than One Hundred Thousand Dollars ($100,000.00 then the entire amount is to pass to my daughter, JOYCE A. KLINEFELTER, per stirpes; . r , r (, ~ B• In the event that the net value of my estate, following the payment of all debts, + administration fees, and inheritance taxes, should exceed One Hundred Thousand Dollars ($100,000.00 then my daughter, JOYCE A. KLINEFELTER, is to receive the first One Hundred Thousand Dollars ($100,000.00 per stirpes, and any amount in excess thereof shall be distributed according to the following schedule: 1) To my daughter, JOYCE A. KLINEFELTER, Forty Percent (40%), per stirpes; 2) To my granddaughter, JEANETTE ROSE, Twenty Percent (20%), per stirpes; 3) Ta my granddaughter, LYNN KREMS, Twenty Percent (20%), per stirpes; 4) To my great-granddaughter, AMANDA LIESSE, Ten Percent (10%); 5) To my great-granddaughter, MEGAN ROSE, Five Percent (5%);.and ' 6) To my great-grandson, ISAIAH KEELING, Five Percent (5%). All of the above distributions are per stirpes, with the exception of distributions to my great- grandchildren. If any of my great-grandchildren should. predecease me, or fail to survive me by thirty (30) days, then the share of the deceased great-grandchild shall be equally distributed to the survivinggreat-grandchildren. VI GUARDIAN OF MINOR'S ESTATE ff any beneficiary who inherits money under the terms of this LAST WILL is under the age of eighteen (18) years, I hereby appoint that beneficiary's mother as the guardian of the assets inherited by said minor. If the mother is unable or unwilling to act as the guardian of these assets, then I hereby appoint the maternal aunt of said minor to act as guardian of the assets. When. the minor attains the age of eighteen (18) years, the assets held in guardianship shall be transferred to the named beneficiary. VII I nominate, constitute and appoint my wife, GERALDINE W. FREYSINGER, as Executrix of this LAST .WILL, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my daughter, JOYCE A. KLINEFELTER, as Executrix of this LAST WILL, to serve without bond. ~ ~, _ IlV WITNESS WHEREOF, I, SYLVAN K. FREYSINGER, have set my hand to this LAST WILL this l0a` dayof March, 2009. ~~~~' ~~' J ~~~ ~ SYLVAN K. FREYSINGER Signed, sealed, published and declared by the above-named SYLVAN, K. FREYSINGER, as and for; his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other have hereunto subscribed our names as witnesses. ~~ rL- ~ ' , ACKNOWLEDGEMENT , COMMONWEALTH OF PENNSYLVANIA . ss COUNTY OF CUMBERLAND I, SYLVAN K. FREYSINGER, Testator, whose name is signed to the attached or foregoing instnunent, having been duly qualified according to law, do hereby acknowled8e that i signed and executed the instnment as my LAST WILL; that I signed it as, my free and voluntary act for the purposes therein expressed. ~ ~ ~ ~~~~~~~~ SYLVAN K. FREYSINGER Sworn or affumed to and acknowledged before me by .SYLVAN K. FREYSINGER, Testator, this 10a' dayof March, 2009. Ct), MMd~ , d /%~~~ WEA_1.TH OF pFt~tieYL1 ANIA ~~'!" L ~ Notar~a- tieai N ary Public Jcatta L. •n, aotary Pubii~ M C~o~`' re~,C2oic AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND . We, R. Mark Thomas .and: ~~ /%~ ~~~/ `/(, J ,the .witnesses whose names. are signed to the attached or foregoing. instrument being duly qualified acconling to law, do depose and say that we were present and saw Testator sign and execute the instnrment as his.. LAST WILL; that SYLVAN K. ~FREYSINGER signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 years of age or more, of sound mind and underno constraint r undue influence. --~ ` Swom or affirmed to and acknowledged before me by R. Mark' Thomas and _lO~1V ~+ E~Q~E'/ilJ this 1Oa' dayof March, 2009. H t)F P'NN NI 1~taNal8eat Jaette L. MoOoiNen, Notary Public M~-~ eo%, anleert~a co~1y My Commlaslon t.xpicea July 8, 20101