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HomeMy WebLinkAbout01-17-12 (2)r 1505610105 REV-1500 °` caa-il' ~'~ PA Department of Revenue ~ ~~I'ri1- USE ONLY ,Bureau of Individual Taxes County Code Year Fie Number PO Box 28o6oi INHERITANCE TAX RETURN ~ l;; ') ~~ ( , Harrisburg, PA i7i28-o6oi .RESIDENT DECEDENT c~ l J ' c~ `"1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 4.~~--_-.-._ __. ~' ~I r ~~~ r~~ ~ _..__. `_.__._._.----...__.. ~ ~~~~J /~~~0 Decedents Last. Name Suffix _ I''1 ~Kos~ ~--------- ---- --- ___- ~~. ( If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth __ ______ MMDDYYYY d3 a ~ /9 y~ Decedents First Name MI Sylr~, Q Spouse's First Name MI --------- THIS RETURN MUST BE FlLED IN DUPLICATE- WITH THE REGISTER OF WILLS FILL iN APPROPRIATE OPALS BELOW ~ 1. Caiginal Return O 2. Supplemental Return O 3. Remainder Return (Dabs of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82} O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Numbef ~ Safe Deposit Boxes (Attach Copy of tNiH) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O ti. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Comeaponderrt's e-mail address: ~ ~ ~ rj ~ S ~ ~/Q~,CpWt Under penaMiea ~ perjury, l declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowlerige and belief. it is true, correct and complete. Dedaretion of preparer other than the personal representative is based on aN infomiaflon of which preparer has arty luwwbdge. SIGNATURE~RESI~FOR FILIN~ ~at '®7lJl `~~ ADDRESS [j ~os~ ~~..~e,~ RAP. ~.~G~.h,b-~-l~,,~ R~ ~ ~oTo SIC~NATIIRE OF PREPARER OTHER THAN REPRESENTAT-VE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505b10105 ~, '; r s 1505610205 REV-1500 EX (FI) Decedent's Social Security Number .__..__._._.....___....-- -...- - - ~7 c Deca3dent's Name: ' / ~ ~ _ ~ ~ ~ I J RECAPRULATION 1. Real Estate (Schedule A) ............................................. 1. s ~ 3 ~ G~d(~ - ~ _,_..._...._.......t...__..._-.._..___.__,...~_..._.. _,..._..._...._..i t-' 2. .Stocks and Bonds (Schedule B) ....................................... 2. :. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ............................ 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ ~ ~ ~~ -/ . 5 ~ ` 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ~ _ ` 7. Inter-~vos Transfers & Miscellaneous Non-Probate Property i _ (Schedule G} O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~ ~ 3 !?~ So I , S~ 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ' ' _. a ~, _.i._ ~ ~. _~ 9.._.. _..__.__.__ 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. ' ~ [ / 3 $. / a __._..,...~..~~,...a._..~.......,,...~_-~_,r..~..._.._...._.__.. 11. Total Deductions (total Lines 9 and 10) ................................. 11. ' ~p( as ~ ~ , 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12 ; ~ S aZ 5 1 fl ~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which r_ ..-. ~."._.,,, ~~-~~"~ ' ~~• ~ ~•-~~-~-..-~ an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~ 5 SI a S~ s ~~C/ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or -.._._._.___._.__.__.... -- ~__ ____.___._._.. ....____.. __. _.. _.. _...____._._, _-- transfers under Sec. 9116 ;-_....___..._...___..._~____ (ax1.2) X .0_ , 15. t , _ .... .._._ 16. .......n_.., ____,. __ ,. _ Amount of Line 14 taxable y / at lineal rate X .0 ~ ; ~" ~ ~ ~ 16 , / 3 ~ ~ ~ ~ ~? 17. .. .._.... ..... . `.. .,. ;..... Amount of Line 14 taxable .. .... ...... _ .. . ... .. . at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 __ __ _ 18. '; 19. TAX DUE ............ ........... 19 _ _ _ ~ ( o.~.t.~ ~ ..... _ _....... ..._ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205. REV 1500 EX (FI) Page 3 Decedent's Comralete Address: File Number DECEDENTS NAME STREET ADDRESS ~~ STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 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 ............................................ ^ I$ c. retain a reversionary interest .............................................................................................................................. ^ ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ ~p I 2. I# death ocxurred after Dec. 12, 1982, did decedent transfer property within one year of death ^ ~~yyy without receiving adequate consideration? .......................:...................................................................................... d h? " ^ 1ct .............. eat or payable-upon-death bank account or security at his or her 3. Did decedent own an in trust for 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. 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 __~ a op e p or~a-s epparen o .. e- 1 .as.. ,per. _ -° ~ ~ • 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. §911 • 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. RE1/-1502 EX+, (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE A REAL ESTATE ESTATE OF FILE NUMBER 5ylv~~ rrleKuS~ All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be (If more space is needed, insert additional sheets of the same size) APPRAISAL OF REAL PROPERTY LOCATED AT: 1295 Letchworth Road Lower Allen Township, Cumberland County Camp Fiill, PA 17011-7518 FOR: Joann Decker 1053 Swartmore Road New Cumberland, PA 17070 AS OF: 12/05/2010 BY: DAK Appralsels Dean A. Kelly, PA Certified Residential Appraiser 317 Big Spring Road Ettere, PA 17319 ~ rnys *„ Porn GA3-'WInTOTAL' appraisal sol-ware by a la mode, Inc. -1-800-ALAMODE SUMMARY OF SALIENT FEATURES Subject Address 1295 Letchworth Road Legal Descdptlon Cumberland County Deed Book 20081 Page 468 ~~ Camp Hill Ocu~r Cumberland State PA Dp Code 17011-7518 Census Tract 42041-0109.00 Map Referonce 25420 Sak Price S N/A Date of Sak N/A BorrowegCGent lender Joann Decker Stze (Square Poet) 1,078 Price per Square Foot S Location Average AQe B2+/-Years Condition Fair Total Rwms 6 Bedroans 3 Baths 1.25 Appraiser Dean A Kelly, PA Certified Residential Appraiser Oats of Appraised Value 03/9/2011 Rnal Estimate of Value S 136,000 Form SSD -'WinTOTAL' appraisal software by a la mode, inc. -1.800-ALAMODE REV-1508IX+11.97) SCHEDULE E CAMMONWEALTHOFPENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RE (DENT DECEDENT ESTATE OF FILE NUMBER SyI ~ ~ ~. rn~.\~os~, Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be discbsed on SOhedule E. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEAtH 1. ` r(~ ~V'ne~~~t10~C.2 ti'polC'rc..~ CY'ecQ~f ui'L~orl a ~ ~ 5 ~~~.bl~ 3e.~ ~-bl lam ~U iYlechan; c S ~u •~, P ~ I~o.~S ~~Y, ~a ~ I ~ ~ 0 ~ ~ ~1~Y-~ce~ G~e c.LL~ n 3 `~ (c 1 , 10 (~ S ~ ~ n ~ I y7.9 1 ~ ~5 I'-~~,.S~.~old1 1 ~ern5 .- c~la-~-I~;n~} ~e~r ~. ~ ,3Sa©, o0 TOTAL (Also enter on line 5, Recapitulation) I S '~] S O q, ~ t (If more space is needed, insert additional sheets of the same size) 2175 Bumble Bee Hollow Road A~~t"'C~O'~~ Mechanicsburg, PA 17055 Phone: (717) 697-3474 FEDERAL CREDIT UNION Toll Free: (800) 240-4364 Building Relationships For Life Fax Number: (717)697-3713 www.americhoice.org SYLVIA MEKOSH 1295 LETCHWORTH RD CAMP HILL PA 17011-7518 Enclosed'tyi.~.v~ur s[ateiueIt; you ~ -~, - ~metiChoice~"til4c~trot~ Statement of Accounts Dec 01, 2010 thru Dec 31, 2010 Account Number: 43326 Account Balances at a Glance: Checking: 4,375.05 Savings: 147.87 Relationship Reward Level is: General PAGE 1 of 2 li'An~eri~bptica Pr~v~cy. Policy„ , ..~ 'eiF,Gc~ to wt~'+v;amencfii~ice org or visit i'opcp a-vai:auon`~1u1~ acctint~today!' ' ._ REGULAR SHARE - 0001 Joint Owner. SUSAN BRITT Date Transaction Descri tion Additions Subtractions Balance . i2-0i Balance Forward 147. 12-31 Deposit Dividend 0.250% 0.04 147.87 ~` Annual Percentage Yleld Eamed 0.320% from 12/01/10 through 12/31/10 12-31 Ending Balance 147.$7 Dividends Paid Year to Date 0.28 SHARE DRAFT - 0013 Joint Owner. SUSAN BRITT Date Transaction Description Additions Subtractions l3alan 12-01 Balance Forward 3,237.80 12-01 Draft 001099 -20.89 3,216.b1 12-03 Deposit ACH US TREASURY 303 X1;586:00:: 4,802.41 TYPE: SOC SEC AMT: 1,586.00 CO: US TREASURY 303 12-06 Withdrawal ACH AMTRUST BANK -502:09 4,300.32 TYPE: MTG PYMT CO: AMTRUST BANK 12-07 Withdrawal ACH LIBERTY MUTUAL =41:75= 4,258.57 TYPE: PAYMENT CO: LIBERTY MUTUAL k 12-07 Draft 001104 -60.00 4,198.x7 12-07 Draft 001105 -36.00 4,162;57 12-10 Draft 001100 -15.00 4,147:57 12-15 Withdrawal ACH National Debt Cr -29.00 4,118;57 TYPE: Pre & Dept CO: National Debt Cr 12-15 Withdrawal ACH Creditguard -2,6.9G30~~ 3,849,57 TYPE: Pre & Dept CO: Creditguard V - 12-17 Withdrawal ACH SETTLERS LIFE-VA -41.48 3,808;09 TYPE: SLI CO: SETTLERS LIFE-VA --^~'~ 12-17 Withdrawal Courtesy Pay tee -30.00 3,778.09 E i 2-30 Deposit ACH PA TREASURY DEPT 596..96' 4,375.05 TYPE: ANNUITANT CO: PA TREASURY DEPT ,, ••....xy?R.NSY"i'VwF:':t. .4YA:::WtiYCew.':..N y' X..:a,..E.?T.`W~:!'%]pRH:'Mi%X'u."~ii:Y~A.143!CR Er'4.T~bYR?~.SS 3ee~t?raF'YYwbY~E"ml.%`d14SYC~?:S Mi:ro o/A.~tAY4d..•. ;..= .:' '..YF. "i «X'., •:: ^. Si.::x4: zryRx... .. ..:',ta,:h .<.' :.. .. :: :. - . a~'. _.... .. :~ ~!~ AmeiriChoice ~EDiRAI Cii Dli YNION Building Relationships For Life Account Number: 43326 Dec 01, 2010 thru Dec 31, 207 0 PAGE 2 of 2 SHARE DRAFT - 0013 (Continued), Date Transaction Description Additions Subtractions _ Balance 12-31 Ending Balance 4,375.05 Dividends Paid Year to Date 0.00 Total for this eriod Total ear-to-date Total Overdraft Fees 30.00 30.00 Total Returned Item Fees 0.00 0.00 Nu~,ber Date Amount Number Date Amount 001099 12101 20.89 001100 12/10 15.00 001105 12/07 36.00 (* indicates skip in check number sequence.) 4 Drafts Cleared for 731.89 Cleared Check Summary ~~ Date Amount 001104' 12/07 60.00 Withdrawals and Other Charges Date unt Description ate Amount Description 12/06 502.09 Withdrawal ACH 12/15 269.00 Withdrawal ACH 12/07 41.75 Withdrawal ACH 12/17 41.48 Withdrawal ACH 12/15 29.00 Withdrawal ACH 12/17 30.00 Withdrawal Fee 6 Withdrawals and Other Charges for $913.32 Date Amount Description 12/03 1,586.00 Deposit ACH 2 Deposits and Other Credits for $2,182.96 YTD SUMMARIES TOTAL DIVIDENDS PAID REGULAR SHARE SHARE DRAFT Deposits and Other Credits Date m nt Description 12/30 596.96 Deposit ACH 0.28 0.00 Total Dividends Paid Year to Date 0.28 ? 175 Bumble Bee Hollow Road ~/ AmeriChoice Mechanicsburg, PA 17055 Phone: (717) 697-3474 FEDERAL CREDIT UNION ToII Free: (800) 240-4364 Building Relationships For Life Fax Number: (717)697-3713 www, am ericho~ce. org SYLVIA MEKOSH 1295 LETCHWORTH RD CAMP HILL PA 17011-7518 Statement of Accounts Jan 01, 2019 thru Jan 31, 2011 Account Number: 43326 Account Balances at a Glance: Checking: 3,861'..60 Savings: 147.91 Relationship Reward Levei is: General _ REGULAR SHARE - 0001 Joint Owner: SUSAN BRITT Date Transaction Descri s Subtractions 01-31 Deposit Dividend 0.250% 0.04 147.91 AnnualPercentage Yield Earned 0.320% from 01!01/11 through 01/31/11 01-31 .Ending Balance 1 147.91 Dividends Paid Year to Date 0.04 SHARE DRAFT - 0013 Joint Owner: SUSAN BRITT Date Transaction Description 01-01 Balance Forward 01-04 Withdrawal ACH AMTRUST BANK TYPE: MTG PYMT CO: AMTRUST BANK 01-18 Withdrawal RET 12130 PA TREASURY DEPT 01-31 Deposit ACH PA TREASURY DEPT TYPE: ANNUITANT CO: PA TREASURY DEPT 01.31 Ending Balance Dividends Paid Year to Date 585.60 0.00 Withdrawals and Other Charges to Amount bescription Date mount Description 01/04 502.09 Withdrawal ACH 01118 596.96 Wdhdravaal 2 Withdrawals and Other Charges for $1,099.05 Deposits and Other Credits Subtractions -502.09 -596.96 3,276;00 3, 861'.60 3,861.60 Date Amou t Description ate Amoun Description 01131 585.60 Deposit ACH AmeriChoice Jan 01, 2011 thru Jan 31, 2011 J i i D i i A t C R i 0 1 T Y N I O N Building Relationships For Life Account Number: 43326 PAGE 2 of 2 YTD SUMMARIES TOTAL DNIDENDS PAID REGULAR SHARE 0•~ SHARE DRAFT 0•~ Total Dividends Paid Year to Date 0•~ REV-1511 EX+ (10-06) SCHEpuLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT ESTATE OF Sv' V/C~ /~e.~ i O5~ FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~7 (' { ra~~'~13Y~ YUY~e~(7.~\ I-~~'+'~e.~ ~cQ ct t~~e.~$'~ne-~ ~3~ S ~~.`~ 7. B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. ~ Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attacnnh explanation) Claimant ~~x,r~ }~ec..~~r' ~f V £n4l~r,~t ~JC[cy'1 ~r•~~ 3 ~©Q Street Address ~~?Z ~c~XX f~ rnaXG.- City 1~ ~ ~ t,..vrnb f-' -r~ a h e~ State t ~' .Zip ! 70 7 r~ Relationship of Claimant to Decedent b.>~e, yd~'1~~''-' tTJ'~ 4. Probate Fees -~~n ~'S'~.-'~ ~~~ ~ S~o~" Cef~r~ca,'~S a(' a~ 5~ 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. lo~ ~x~s ~'~ ~ a~a ~~~er~.~ ~ ~7. 73 a~pq P~ s-t~t~ TOTAL (Also enter on line 9, Recapitulation) I $ a 3~ ~ ~ 4, ~ 9 (If more space is needed, insert additional sheets of the same size) State Zip f~EV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~i U~ U ~ ~ y~~ ~!~ ~ FILE NUMBER Re port debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ,. /1,~°uJ yor1~ CD~S')n~1c~h i ~ ~h ~ ' h'Iorf~c,~ Jc- ~ '7r`~ '~98_ S - J ~ 8'a l FaSf N; nth St' Gle~l~-~~?s-~~ u.~I/~ ..3. ~~.~nc~c~o~' {~nr-elk~rt~n ZnSvrc.t~Ce `'~re~~vv,-~ 51,oO }col y -Sp; r; ~' f,65P; ~ ( / O ®.:~ o 5, ~Qco 1 Solv~+ov~5 S'~_ d a G, '1e'~-r,~neX r75'oto0 '~, a o ~ ~ c~,~ be ~ 1G.~ cov n-~y ~~ c £5~-~ ~~x c~ ~o . ~o c~ , a o 11 C u nn b e r ~,1~ C t' c~ n~`~ Sehc7e f TIC Y 3 `f `~- '7 ~ 9: Cfzd~ ,'~- ~r~s g q at9 , 03 TOTAL (Also enter on line 10, Recapitulation) a ( 5 9, ~ 3 ~ /d (If more space is needed, insert additional sheets of the same size) ~~ r , /N'+~ YO~ D Loan Service OH98-0803 ___ ~___.~ COIVIlHUIVITY BANK 1801 East Ninth St Cleveland, OH 44114 4-717-46101-0004347-001-1-000-000-000-OOD SYLVIA MEKOSH 1295 LETCHWORTH RD CAMP HILL PA 17011-7518 RECIPIENTS!lENDER'S name, address, and telephone number New York Community Bank Loan Service OH98-0803 1801 East Ninth Street Cleveland, OH 44114 PAYER'SBORROWER'S name, street address (including apt. no.j, cdy, state and ZIP code SYLVIA . MEKOSH 1295 LETCHWORTH RD CAMP HILL PA 17011-7518 IMPORTANT TAX RETURN INFORMATION BELOW Visit our website at: www.amtrust.com Customer Service 1-888-696-4444 En Espanol 1-888-696-4443 Statement Date: 01/07/11 Loan Number: 1211738 Property Address: 1295 LETCHWORTH RD CAMP HILL PA 17011 CORRECTED (if checked) 'Caution: fie amount shown may not be fully deductible by you. LlmiGs based on the loan amount and the cost and value of the secured property mayappy. Also, you may only deduct interest to the extent it was incurred by you, actualty paid by you, and not reimbursed by another person. OMB No. 1545-0901 X010 Mortgage Interest Statement Form 1098 pave~(SYKS)' Copy B 2 706.30 For Payer/Borrower 2 Points paid on purchase of principal residence The ~ ~ 0.00 boxes 1, 2.3. and 4 is 1 Mortgage interest received f 3 Refund of overE $ o.oo 4 Mortgage insur< $ o.oo 5 RECIPIENTS federal IdentlM 11-1212640 Account number (see 1211738 Fonn 1098 c ~~~ N r' CVI VIA MFKCICH " I 1295 LETCHWORTH RD CAMP HILL PA 17011-7518 (Keep for your records) New York Community Bank Loan Service OH98-0803 1801 East Ninth Street Cleveland, OH 44114 TIN# : 11-1212640 YEAR: 2010 ACCT: 1211738 SSN: 181-32-7554 ESCROW RECONCILIATION ~ INTEREST RECONCILU4TiON PRINCIPAL RECONCILIATION 0.00 Beginning Balance 2,706.30 Gross Interest Paid 47,115.23 Beginning Balance 1,331,80 Deposits 0.00 Pre-paid Int Not Allowed Prior Years 2,316.42 Applied Prinapal 0.00 Property Tax Disbursements 0:00 Interest Subsidy (Buydown) 44,798.81 Ending Balance 1,878.00 Hazard insurance Disbursements 0.00 Interest Shortage 0.00 Mortgage Insurance Disbursements 0.00 Pre-paid Int Not AlknNed This Year 0.00 Escrow Refund 0.00 Interest Shortage Paid -546.10 Ending Balance 0.00 Prepayment Penalty 0.00 Late Charges Paid 418.56 Current P&I Payment 2,706.30 'Mortgage Interest Received 83.53 Current Escrow Payment From Payer(s)Borrower(s) 502.09 Current Total Payment !f the Tax ID Number shown above is incorrect or if the space is blank, please complete the Tax Identification Certification on the reverse side of this statement and return to us at our return address above. rest Important ta>a infartnatlon and k txirg umished to the Internal Revenue Imiums Service. N you pre required to iNe a return, a rla94gence penalty or other sanction mey be impo9ed on You 'rf the IRS detemdnes that an urdarpayrrlsnt of tax results Jo. PAYER'S social seaxiH rxrmber becetise Ya pverstated a dedu~on ~ ~~ use 181-32-7554 klterest ar for These points or acti ons) because Y~ ~ rwt report Cds refund of interest on your realm. Department of the Treasury -totems( Eteverure Service ©" AmeriChoice FEDERAL CREDIT UNION Building Relationships For Life January 18, 2011 Susan Britt 1295 Letchworth Road Camp Hill, PA 17011-7518 Ms. Britt: While AmeriChoice FCU extends its deepest condolences on the loss of your loved one, we regret to inform you that the Government has requested the return of funds received. The PA Treasury Dept is requesting the deposit made to Sylvia Mekosh on December 30, 2010 to be returned.. The checking account is currently frozen. -Please contact us as soon as possible to close this account. If you would like to set up an estate account, we are able to help you with this also. Please feel free to contact Bonnie at 717-591-1282. She is very knowledgeable and will be able to help in any way that she can. Please retain this information for your records. Our Sincerest Regards, ,~ " - Uit~eir~. Karen Vafias eServices Manager AmeriChoice FCU 2175 Bumble Bee Hollow Road Mechanicsburg, PA 17055 800-240-4364, Ext. 4529 Main Office: 2175 Bumble Bee Hollow Road • Mechanicsburg, PA 17055 • Phone: (717) 697-3474 • Fax: (717) 697-3713 Website: www.americhoice.org Egwl u~uc~•~ '= NCUA~ E R CREDIT UAIION: . KEEP FOR YOUR RECORDS CREDITGUARD OF AMERICA INC.ALAON-PROFIT COMPANY 5300 Broken Sound Blvd NW Suite 100 Boca Raton, FL 33487 Phone 877-HELP FREE Fax 866 - 460 - 4571 License number: 22761 CREDITOR LISTING TO MAKE ANY CORRECTIONS, OR ADDITIONS, PLEASE CALL CUSTOMER SERVICE AT 877-HELP-FREE 877-435-7373. CLIENT: Sylvia Mekosh DATE: December 4, 2009 ADDRESS: CGA ACCOUNT #: ME181327554RC 1295 Letchworth Rd MONTHLY PAYMENT: $256 Cam Hill PA 17011 CREDITOR ACCOUNT ACCOUNT MONTHLY CGA MONTHS NUMBER BALANCE PAYMENT PAYMENT BEHIND BON.TON 2116010106446897 0410.04 •841I- 30 17 0 ISCOVER CARD 6011002311100861 375a.7y 190 127 0 LITTMAN JEWELERS 6035264092263225 73a,3g -948 30 24 0 MONTGOMERY WARD 7934960461290 y~y~ q9 ~- 30 15 0 NEWPORT NEWS 5856373390167463 ~a,pg `2'09• 15 10 0 PEEBLE'S 5856373895377047 e~ ~'~• ~S 25 11 0 ROAMAN'S 175450431 19Y.$~ 25 13 0 EVENTH AVENUE 7934960461 Ste, los 30 15 0 WALMART 6032203583748321 aaa,g0 25 10 0 WOMAN WITHIN 175450431 ~e?;2, $ 7 25 14 0 ~:..~ v~.~.~-- s ~a. ~sr~ C~ .~. ; irk -13 0.3 9 r~ g~aa.s~ ~E C~,~f~( a,o ~.~9 ~ a9a9-o3 TOTAL DUE: $11257 TUTAL REGULAR PAYMENTS: $425 CGA PAYMENTS: $256 YOUR COUNSELOR: TOTAL SAVINGS: $169 * Estimated savin s ma va de endin on creditors 'defines SEE YA(iE 7 1'~Ult AUll111U1VH1. l;tcl;l.Jtlvx 1.,ta tuvv~ PAGE 6 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 MEKOSH SYLVIA Receipt Date: 2/23/2011 Receipt Time: 09:53:51 Receipt No.: 1064534 Estate File No.: 2011-00242 Paid By Remarks: JOANN DECKER CJ --------=--------------- Receip t Distribution ------------- ------- ---- Fee/Tax Description ~ Payment Amount Payee Name .r PETITION LTRS ADM ~~"",~" SHORT CERTIFICATE~ ''~ ~~ 2.10.00 CUMBERLAND COUNTY GENERAL FUN ~~,v1 JCS FEE 24.00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 23.50 5.00 BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN -------- Check# 1035 $ -------- 262.50 .Total Received......... $ 262.50 as ~a° _ - _ ApQraisals Plus (717) 932-5811. FROM: Dean A. Kelly DAK Appraisals 317 Big Spring Road Etters, PA 17319 Telephone Number: 717-932-5811 Fax Number: 717-932-5846 T0. Joann Decker 1053 Swarthmore Road New Cumberland, PA 17070 Telephone Number. 717-919-3697 Fez Number. Alternate Number: E-Dail: gyp: 17011-7518 Summary Appraisal 325.00 SUBTOTAL ~ 325.00 ~.i c ~Y li`VY~~ ~ ~~~. Check #: Date: Desalption: Check #: pate: Description: Chec)i~#~~ Date: Description: SUBTOTAL Due upon receipt,Thank You TOTAL DUE ~ 325.00 INVOICE .. , .w ., ~, 0001506 ;:.D~ 03/1412011 0171• III{ O I N ~1 V 1 1~ l!~/V1a~V~ 1 M J ~ / ~ ~ ~ LC~IYC~ ~/Oa0#~ Ciletd Flie #: Main Flle # on form: Britt (Mekosh) Other Flie # on form: 01103-1193 Federal Tax ID: Employer ID: y ~ 5 .FROM: Joann Decker 1053 Swarthmore Road New Cumberland, PA 17070 Telephone Number: 717-919-3697 Paz Number: Alternate Number: E-I~lail: AMOUNT DUE: $ 325.00 AMOUNT ENCLOSED: $ ,. ~ ;. . -. ~~ .. , :~..~. A 0001506 -.~ to . 03N4/2011 Internal Order #: 0001506 Lender Case #: gle~nt Flle #: iYlain File # on form: Britt (Mekosh) Other File # on ~~ 01103-1193 Federal TaxlD: Employer ID: T0: Dean A. Kelly DAK Appraisals .317 Big Spring Road Etters, PA 17319 Form NN1 . "vJinT~TAI ~ annraical software by a ~la mode. inc. - -1-800-ALAMODE BUREAU OF COLLECTIONS & TAXPAYER SERVICES PO BOX 281041 HARRISBURG PA 17128-1041 _. _._ __ pennsylvan~a ~ QEPARTMENT OF REVENUE NOTICE OF OVERDUE INHERITANCE TAXRETURN JOANN B DECKER 1053 SWARTHMORE RD NEW CUMBERLAND PA 17070 Date: 12/ 0 4/2 011 Estate of: SYLVIA MEKOSH SSN: 181-32-7554 Date of Death: 12 - 0 5 - 2 010 File Number: 2I 11- 0 24 2 REV-834 FO AFP (0611) Department records indicate you are responsible for the settlement of the estate identified above or that you represent the responsible party. The estate is in delinquent status as the inheritance tax return became delinquent within nine months of the decedent's death, but has yet to be filed. Please file the tax return and remit payment of any tax due within 15 days of the date of this notice with the Register of Wills identified below. If this estate was opened for the purpose of filing a lawsuit, please provide the court term and docket number of the proceeding in writing to this office. We encourage you to take this opportunity to address your tax delinquency. If you fail to do so, your account may be referred to a collection agency and additional fees up to 39 percent of the amount due will be added to the liability. If the requested return was filed recently, please disregard this notice. Direct any questions regarding this notice to: Harrisburg Call Center 717-783-3000 1-800-447-3020 (Services for taxpayers with special hearing and/or speaking needs) RETURNS SHOULD BE FILED AND PAYMENTS MADE AT THE REGISTER OF WILLS LISTED BELOW: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013