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HomeMy WebLinkAbout06-05-12J 1505610105 REV-15001x,°=-""~'~ PA Department of Revenue per~troylvaMa OFFICLLL USE ONLY Can Code Year File Number Bureau of Individual Tazes "~°"° h PO BOxz8G6oi INHERITANCE TAX RETURN ~ ~~ Harrisburg, PA 17123-06oi RESIDENT DECEDENT ~--~, _ ___ I V~^„V , ~cw Social Security Number Date of Death MMDDYYYY Date of Birth MAIDDYYYY 02/22/2012 05/08/1961 Decedent's Last Name Suffix Decedent's First Name MI Russ Mueller Ann M (N Applicable) Enter Surviving Spouse's IMOrmaUon Below Spouse's Last Name Suffix Spouse's First Name MI Mueller Markus R Spouse's Social Secudty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 173-7s-asa3 REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW m 1. Original Retum O 2. Supplemental Retum O 3. Igemainder Return (Dale of Death Pdor [0 12-1332) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. 1=ederal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Oecetlent Maintained a Living Trust 8. "rota) Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 70. Spousal Poverty Credit (Dale of Death O 11. Election to Taz under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCEAND CONFIDENTIAL TAX INFORMATION SHWLD BE DIRECTED T0: Name Daytime Telephone Number Markus Mueller (7171737-2719 _ _ REGISTER c First Line of Address t' j-~ 1 ". 31 Cherish Drive ~ ~ %'~ ~ Second Line of Address AA~ ~' ~ O y rV DATE FrLEO C Ci or Post Office ty State ZIP Code .ry Camp Hill PA 17011 CorresponMnt's a-man address: mamue33C42bluewin.ch Under pe lea of part I declare that I have examined this relum, including accompanying schedules antl statemems, antl to the bast of my Imovdedge and belie(, is true, and plate. reaon W preperer other than Me pereonal represenlatlve re basetl on all infomiatlon M whkh preparer hae arty knovAedge. SIGNA E OF E SIBL FOR FILING RETURN DATE 06/02/2012 ADD 55 31 ChpFish DriyA, Camp Hill, PA 17011 SIGNA~E OF P~PA~SE(Z ER T}~gM.RGPRESENTATNE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 151]5610105 J ~~ ~~ ~~ ~~ J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number oecedanPS Name: Ann Marie Russ Mueller RECAPRULATION 1. Real Estate (Schedule A) .......................................... ... i. 2. Stocks antl Bonds (Schedule B) .................................... ... 2. 160,113.62 3. Closely Held Corporation. Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule O) ........................ ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 79,986.01 6. Jointly Ownetl Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vrvos Transfers & Miscellaneous Non-Probate Properly (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 240,099.63 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 10,585.11 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 229,514.52 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to taz has not been made (Schedule J) ..................... ... 13. 14. Net Value SubJact to Tax (Line 12 minus Line 13) ..................... ... 14. 229,514.52 TAX CALCULATION -SEE INSTRUCTIONB FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9176 229,514.52 (a)(1.2) X .OQ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ - 16. ' 17. Amount of Line 14 taxable at sibling rate X .12 17, 16. Amount of Line 14 taxable at collateral rate X .15 19. 19. TAX DUE ... .................................................... 1g, .. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1500 EX (FI) Page 3 FII• Number Decedent's Complete Address: DECEDENTS NAME Ann Marie Russ Mueller STRELTAODRESS _-- _... _ __ 31 Cherish Drive __ _ _ - _.. CITY - STATE - ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments 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. (1) 0.00 Total Cred'As (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 aM: Yes No a. retain the use ar income of the property transferred .................................................................................... ...... ^ b. retain the right to designate who shall use the properly transferred or its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death oaumed after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate considerefion7 ........................................................................................................ ...... ^ 3. Did decedent own an "intrust for" or payable-upon-death bank account or secudty at his or her d&Ith? ........ ...... ^ 4. Did decedent awn an individual retirement account, annuity or other rwn•probate property, which centains 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 lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [/2 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 survivirg 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 s011 applicable even it the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The lax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the rret value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 penx;nt, except as noted in [y2 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least orre parent in common with the decedent, whether by blood or adoption. REV-a5D3 EX+ (y-ss) Pennsylvania I SCREp11LE B DEVANIMENT OF NEVEHUE MHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT e~~wm ur FILE NUMBER Ann Marie Russ Mueller If more space is needed, Insert additional sheets of the same slze REV-~5o8 E%+ (uno) ~ Pennsylvania SCIIEpULE E DEPARTMENT OF REVENUE CASHr BANK DEPOSITS & MISC. INHERRANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDEM ESTATE OF: FILE NUMBER: Ann Marie Russ Mueller Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly owned wide right of survivorship must be discbsed on Schedule F. 1. Cash: See attached Morgan Stanley Smith Bamey statement 2,127,85 2, Roth IRA: See attached Morgan Stanley Smith Bamey statement 27,053.92 3. Standard IRA: See attached Morgan Stanley Smith Barney statement 43,804.24 q. Misc. used apparel (estimated value) 1,000.00 5, Misc. pieces of jewelry (estimated value) 6,000.00 TOTAL (Also enter on Line 5, Recapitulation) ~ I 79.966.01 If more space is needed, use additlonal sheets of paper of the same size. REV-1511 EX+ (10-09) ~ Pennsylvania DEPARTMENT Of REVENUE INNERRAN~ TAX RETURN RESIDENT UECEUENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF Ann Marie Russ Mueller Decedent's debts moat be reported on Schedule I. A. FUNERAL EXPENSES: I' Parthemore Funeral Home (see attached invoice) 2. Gingrich Memorials (see attached invoice) s. Reception at West Shore Country Club (see attached invoice) B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address CRY _____ ________ _____.__- _- - _-_- _ State_ __- Z1P Year(s) Commission Pald: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City __ State - _ ZIP Relationship of Claimant to OecedeM 4. Probate Fees: 5. Accountant Fees: 6. Tax Retum Preparer Fees: 7. 5,105.66 2,065.00 3,414.45 TOTAL (Also enter on Line 9, Recapitulation) I # 10,585.11 If more space Is needed, use additional sheets of paper of the same size. a 0 0 N Q7 O 0 W 0 3 y m^ a t 3 a m m t n 3 Q A H a n f ~ g „m~'„o o ~o t7 ~ rDm xa a~ ~. ! € f y „moo p tt O d a _ v' ~ ~ O O y 2 a3 ~ nm+' ~m m mo y gym N .. C 9 ~ elf n T'~ x -~ ~ ~ G72 ~ . , pp i v ~ T O m O p~0 V :~ O S ~ ~ p ~ V U D O r ~rn<n Z ~ 7 ~ -i y f f f O O f ~ m ° ~ b z < a o i ~ O ^~'~ m3 mom =°$ ~m~ '~ o S ame '~S ~ c ~ ° N O n~ 3 Op C~ ~ G~ O pWpm ~ ~O 'E G~ ?m AS. ~ p 1 A OJ 3~ ~ ti o ~ ~ 3 ® M a N ~ ~ ® ~° 3 n ° ~ fi } 5. ' °i ~ ~~ ~ ~ N > j w o y ~ ° 3 ~ 3 ~ ~ c ~ a c m o• m ~ ~ 3 m ~ ~ ° :~ o ~ 3 3 3 n w a z ~z xm; -70 ~ rr-tnm x r D O m _ 70 77 V G o m O J a w 1 ~~~ a~~ N o T 0 T a O m 9 ~ D ,.. O C 2 1 n z ^, -I -' ~ a z n ~., r m Z J D Z '~ ~ r 31 ... 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Z i m ~ y a 1 m m Z 0 0 a c Z m 'c N O N A qA i O O] w N b C W .~i 2 a; ~ G~r (nom ~ 9 mT ~ /V ~ -~ _ ~ 0 o r c Z ~ ~ fl- 1 < ~ ~ ~- ~ y n C m n Ri < Z ~ r 1 ~' C y rn ~ o n n ~ ' c W rn ~ d = 0 a m ~ m CD c fp d ~i 1 T m Q C d N o O ~ N N J a~ W~ N O R b w~ J _ '" i Z O S o 7_'^0 ~ ~ a a ~m ~ <9 ~ ~ m ~F rr W .~ ~ W m ~ ~~ N IA O O O J a av n m n a oN C z N r m H m 3 m ~o o~ ~> ~~ W Z ~c O N C "~ H DO m O C O 2 ~m zyy N N A 2 H 0 ]D m a 0 v a) N N N O y SS Z 9 m < a<; a ~` ~ m;' ~ m k% 1 ~': T C Z O 3 a Z v ~ ;`gi a `a Z ° ~ ~: c ~~ m ;c ~ cn~ O iM N ;,N H a A "'~ C ~±. eo: O' C o c H ~ r N • ~ _ ^ m _ < S T -.1 O `< y ~ 1 n m 1 3 m ~ z W ~ o m ~ m m O a d c T Q c' m z N O_ N 9 A 1 0 0 ~3 my og ots m.. ~; ~c ~ r ~ ~ <~ m rF :y% p1 ~ ~ ~~ ~ ~ 7 t 3 S b m 3 3 m° y f f f e w -~, m ~ o m ~ n ~ o ~ m m ^3W ~ o y ~ O C T W CJ OD A C a ',' n3 m m 3 y~~ -m-I i D ~ 2 A j ~ D cr o m y O .4j ~~ ~ V r O O y 2 V ~ ~ C S ~ N cWn W ~G)S ? 0 ~ o ~ a °'aNyo ~ V in 2 ~ W W ~ ti OO~~y rn m , ~ v m c ~ °' z v C7 S7J Dom. 2C02CA < m i z w 2 N ~ 3 ~ <v~c°O m" O D r w 7orm V 1 ~ W N -y ~ V D 1 N ~ O r p D 1 z m 0 0 0 rn V 10 m i W f GJ n r m 1 N 1 a m m a 1 m 0 n w Z 3 O N A_ O O A W W W 0 w ~<~ ~ ~ d l T ~. x O y p ~^ 3 m N N 3 m 0 3 ~_ ~ g O ~G ~ T N pp ~ ~ d ~ N ri m w ¢ Wm` Ol ~ W y 5 V~ O T m ,~ m p d j ~ ~ ~~ N ti p z q 0 5 N 1 GJ a 0 3 s^o d . 1 «+p d ~:, r N m r 0 3 C cpi n O C 2 -d M N V O (if W O C7 z ~ -1 2 m '~ O p ~ ~D z n ~~r m = !~ D Z ~ :.. r z ._ c n m m r ~ ~ ~ a m O ~ z j m 2 70 ~ o x v 0 9 p r W 00 N A V t0 tG Oo ^lG v' ~~ ~~ ~ ~ g a ~ ~, 9 j n y oga~ ~n~~ o' o m ~ ~ i m o 0 0'^ C a f b ~ ~ i ~ ° ~ n '' ~o~o i, > m 3 ~v ~,5; m m i N ~ y d am ' .aa L m y W N yj m' ~ 0 W N_ i ~ F y N ~ d ~O ~. 0_ _d 0 C_ ~ y ~ _ ~ o m ~ c a_ ~ n n' N y n G y 0 d ~. O ~3`= :? o T m O O N f~i1 0 j O N m a ,y, '^ t „ ' yI' nay ~ ~ y O ~ y. y N'~ m y y d 0 0 y n N ode y ~. G ~~ ~ R ~ N > R ~ 3 m nt m n _C ~ y ~ W ~ 1 N d na'~ ~a C ~ N y M ~ ? ~ O 3 m n C `mG n o'a3 3 < O ~~~ gmd y + N m O_ m y w C ~' 6 N ~ ~ 3 v>~ y ~ ~ Q m . O o ~ m 3 T 6 N r O a 1 0 Z T 0 r v_ Z G1 N 3 s H ~s~ N 0 ~ t v w o ~ ,m°Q~ i W O N ~ n `~'c c y ~ 0 m ~ m rya E o d o .~. arc y ~ 0 n O O t~~ d y aim ~ n a O W ~ N ~ j ~.~ n O y y R O W 0 y ; m 3 o' e 0 Q i W T ~ ~ H m ~ j y (l y d f m C m ~ ? d ~f m m o v `mac m m °j O N ~ ~a ~ N 0 S~ ~' O~ O ~ C q W yo3 ~m~ j ~G ==N ,~ _' O O j ~ 0 ~ m y ~ N q z ~ a ^_ -'i ` J W ~ a-~ ~m a y N y 9, w ~y aim y C N Q y W C O~ j ~ N m _a m m n m a N N a 0 c n O_ n m m gg~ ~n E ~~ m n ~. w ~ ~. d o ~. N y C n a Z m Z r C m O T 0 C n n C z V 0 41 fD 8 ~ ~O ~~ O °c ~ ~ r~ n ~ d ~' d v N c w 0 Chi (J O m N N V N d.. w ~~.+ l ~ ~ ~ m~s o N m~~ N ~ (i ) Thausanda ~ ~ _ sm a m w ~ .~ ~ N tr a ° _m ~0 0 0 ^9 Z N y N ~ y a o ~ CJ a ~ C m a d..o m 3 m ~ N ~ c m `'3 ~ ~ ~ o m n ~ ~ 3 ~ m A N o N ~ O o ~a am m 3 ~ f7 o w N ~ 3 0 f ~ a- f_ ~ 9 6 O_ N n r m 1 m 3 m O w N r 0 N ^O W L11 N !°f ~~ ^,~ W ~/~_ ao ~m n a ci N r a ca ~~ am n o ~+ c o~ ca 2 ~ y O Z a -~ Cl 9 Cl C ON C ti N D m n C n O 2 C Z N y a n r 0 H LZ'1 D H S O m N a N N f0 N a m 3 c T 6 N N A A O N W W V tD a ~ ° n= (/! o ~ ti m 2 3 W ~y ~'`°°~~ m ~ ,~ m y T < O y S s N ~ ti C y O W D 5 r ~ C9 c ~^ m y x m m w 1 q~ 3. 8 S ~' 9 3. g n a H T 0 j /N~ A A G VI W &y tT ~n O~ f0 '~ 3 fT A ~ 00 N XS' ~((..~~~ as O acS p• cnA O q~~ Ne G A r m 2 1 a m 3 m Z 1 m .Q R D n m c m Z N S W N O N 0 w~ W N''~AA VF ~: w ~~ W~ ~~ vm m m ~ o~ o m a„ p~ ~ 1 ~~ o o p c ~~ Q? e w y ~ ~~ t° ~~ 3 °m o ~ - R+ ' Q ' ~, ~ ; s m °°^~ o'" a m ~ o 3 N a ~ 1 3 m m c~ y m ~^ a" '; ~s ~. ~~ _, - m Q~ n c~ ~. s°a ~ H ~. a w ~. O J A H~ H m o °+ G C n O y m ~_ ~ O w p. m O ~ ~ n Q C N' n n G n !1 ~ n m C N q m R n y 2 ~ .nu 0 N o a a c m c N _< A m d V Ut C Q 10 0 3 is ,m ~m m `^ ~ _. . m N' ~ ~ I O I Aa m~ ~ m O o O O W aut ~ W ~ ~ I N C O c m O a T 0 n " N Q _ J m Q ; ~ H oIN IolAa o p O O in N ~ O N ~ A VI N N 0 ~ y i g j~ n m Cji + y (iJ Z~ m o w ~ IiJ Z~ (i m 0 ~ Q 6T G m o ~. ~ m ? ~ _ t~ ~ 9 K o w o a_ ~ = 8 ~ ~ ~ ° ^m ~ a C ~... 0 0 0 o n e ~ n j m C ~ m 2 y ° 0 ° y 6 m am. go' ~ y m 3 H ~ ~ . , ~~ 5 m 0 N m~ N O .i o n ~ E ~ ~ N C p mmm3 41 ~ `~' H ~ 5 ;•aam a y ~ N C C~ o pr m 3 G N N m_ m y m a m R° ^~ `~ a ~ in V) c m m c m o Z '• o a 3 ~o c n m ~ m ~a G a m C O O 3 3 m m to ~ ~ '~ Q `2 ~ m 0 o r m O G $ N IV O y I I I ~ ~ A ~ m qa g ° y ~ m ~ ~ ~ N T ~4 3 ° 0 `c as o m ~ z y S a r' rn 0 ~ I L 2 O m H C a i gXR9 6 F~a C ~' a H C .3 n r m 1 1 m 3 m 2 1 m .'t 6 m w n s N O O N~ ~~ Al W^ ~~ av om ~a O O cz z a N r a ca ~~ (a)O O C C D 2 ~ y0 2 C9Y 9 O C O N 2 ~ N n~ O i c z N y A i W ~, n V N N N N I'J N 1" ~ Z 31 Q C m V m b O -' N y T y ~ ~ w 3 i C'1 m c° o. m d a o n 3 a O ^~ ~`> 4 N n v O Q ~ " w - ~ ° O e a o ~ ~. " Qe n ~ Q i _ y O W ~ ^ P n e ~ O I n p ~ ~ -. n w >, y N N = W ` C n O } a ~ C C O c y ~ A +o ~ ~ o V V 3 ~ O O n o ~ O O Q O O O O CJ O O ~ °ca ooooc~oo ' '>' 0 00 oc>oo a o' 0 ~ ~ F m m ~ 'l^ o o ~ c c o m o ° « S ~ +~ w 000 oc~oo ~ 0 ooooc~oo ' am o oooc~oo a A N N V O O O O G O _ O Q D O 0 7 v w W s a v H o ~ M 3. O C O ~ N O N v ,~ o c ~j a F m m m n r m 2 1 1 1 m T 2 1 O N N O d C! W 0 3 .^Q ~~ " ~~ ~ .N. ^« W ~ 7 ^W W 7 A X33 "~ m m ~ d m o ~ ~ n- 4amp 3d~ ap d '~ N n = j `~ w d C O m m non "= " 3 x 3 ~. `° a o m a 3 d n ~ a = n 0 0` ~ " d o m o ° ~ m mG iwt O m0 lA a °i C 'mc m R R i? x Smmn m w° ~ V o ~ w C d N b ~ y > d d tlp b m m t m ~ m G = d o m m ~ d p on m a n` n n. ~ ~..g a a ~ 3 N O a m = _ d ti ~ d m " ~ p O ;; ~, m n w c t ~ ~ o a w ? > d ? O nAm 3 = n d m G _ ~ tr = n m n- q d > n d m N mi a 9 ~ 4 m ~ O T y m p 3 o ~ ~ 3 _ ~ d N j N o~ n ~ i a n 0 R j o = m y > b m' ~ e m m 3 o v g 5 t o u l m a N `mC w o o d m e °o m C n 3 O z ra T t s z x a my D °' is m o i~o m=Q~b r ~ ~ y m^3e iy~~n~mm , ~ 3 '~n•_ ~d 3 m m T m ~b ^bo m ~'i.Ajn nm ~ m o Z ~ ' N ~ " ~ m ~ '^ ~ _ ' m 4 ~ o ~ i td ~C nOd y ~ =y`~ a m e : ~~ = ~ 1 E </1 o ~o m a da'^3n ~ g'.'i m $o ~ a =o°iwcanmo = 33 S. ' ? ~ oyrom~ m3~~a o a _ _ m Z m m ~ m ~ '~ o o m o ~ y m O > O a d ~ .G Ct 'Y m 10 O h ~ W 1 m m 0~ 0 W> yp y Q '~ ^ wm d 31 eo> -~p w n~~ o ~~ o m` ~2 n n m 1 o. ~ ~ m> p c m $, $ ~ n o h b T ~ 'D cwi • ml' d ~ O W 'Z C ) N ~~j n O ~ n `C m Z f b H N Q e ° ~ ~ m > O > > y j G a N 'p' a~ tD O N = y a Rl ~ 2'w' 3 0~ m n n ~ m ~ N C > m ~ ~ R ~' W ~ Gn ~ N G > 3d ~£ nnO1 otri v n y a m '0 3 m O d :i y ~ m N o pl 0' O m :~ 0 m? °, ~ d N m n ` > n b a O ya ~ ` '^ m ya N u O_O•w+b j Qi `~ n F d O a y Q mm c3'~ "nc'r3 m c _p ~ ? ~ ~ ` ~ ~ T o y 's ° °m R' m b $c~ td - ~ e n .o@n n~ ~ WN y ?~ O hN O C .nN ~ N n Q O n 7' ~ W O i{ ~ Om y ~i C n m t> `` N ~' T •' m'n ~~ ? L~ q C d N ~ i 0 j N O tpp ~^ • ti ~. = N vi CR = ci m m n b s m ?m m rn~ c d n w y ~ a~ a w n c G a d d N `} tr ~ 0 A = O ~ ~w o.c m p~co~3 a om $ ~ ` o` a ' ~ ^ er m 0 CI y m 3 1 ~ O ^ m tr W 0 ~ ~I m d OQ d d See' = . \Ld n, O eti> 5,>>.~3 0 y Q o o C:..mQn D N~ ~ owN ~n3bm _ ° m ~ ~ a ~ ~ m e ° R N 0 C ' >, m _ W m ~.1, ~ «~am Ra 3 / ~' ~ i m tr ® C" ~ R n'C O ~ iiI d A^ a ~ ~ ° ~ m O Ri 0 ~ V _• F a n= m_ o n m n m m _?+ ~m c d3oa m T °° _ ~. ~ ~ ~ ~. m? m ' N ' m m 3 °~ 4;a . m°m 3 n . 3 m ~ ~ m d O m m 3 b ~+ n m m m d m o D O ~~° d. g m `T m ~ ~e > `~ a ~ m: ~ > F m ~ a F m tr e 3 0 a _. m ~ ~ e m.m o3, 'n n ~n and m m~~ $ O1 n ~ o . m " " m ;° ~ m m " ' ~ a m ~c 4 4 m O H m 1 - .. ~ ~ m e _? O m ~ O d m c y m 1 H n av ~m O A 00 cz z~ N m r ff O ~-. c o~ cn 2 ti N ~ 2 A C O y c y n~ O m C 2 y N In 3, A i 3~'+ o ^~ = N D _ ~ ~ ,3 a= o e -~. ~ n m°~a a if ~ j N O ~ °-n 3n ~ m f n 3 m ?; m C T .l j N n O O m °1 N `C ~d m m ~ n n N C C W w n N `~ w R= ~ O_ ~ ~ ~ o " m m' Q m m ~ ~ ~ _ n 0 m c 3 W O m g m N ~ N C C .Hi ~ a n O1 m 'n m N A ; mmi m ~ m m a V t0 o > a c r j :. _ V W N O O f` O WIW C O W W C N V1 r W N N Na N N W W N A C] V ~ o_ ~ m n m C ~ C ~^ n 3 'n ~ m w N m H N 03 ~ ~ m ,m'c, m ~ m N m m A mIN s V Cl O ~ t0 N N fL f0 N W fL O -~I~ C O N N C N V in w V V V Of m ~ V V W r O W N N W O O O 0 0 0 ~ V Ol W ~ o ~ w d N C C o = 3 w w m m m n N H ~ ;°. ?~ N W O V O ~ i O (4 W G o u O a ~ C O ~ ~a mm (T T m ~ m't o ~ ~ r ¢m " m~3 ~= C n y ~ a w e 9 C Z a m c '.^ 'N .° C T C ...~ a m m n a ~ y i eo ~:a ;c cn ' O m O ~ d ~ ~ N N 1 y e` ;~ ~~: m c a : .. m ~ i9 d ~ ` d p~ ~ T O N n C ~ j 1 T p y ~ .~ ~ !? $ ~ ~ N on y- m^ :3 n v ~ ~ m Y n n .3 o n ~ ~ n ;- S I Z C~ C4 I r O y m C ~ i; ~ i y O m~, N ~> ~ > ~ on ~ s o u a ~„ ~ ? _ 3'n N N x m 3 y 0 0 p ~ C ;~ O p ~ N y ~ 7 ~ Op ~ O ~ C y N b ~l ~ :~ y ~ o n ~ T :~ N C D n Si On iY Q b ~j O ~ C a N i~ ~ :~ 0 R n:, 3 N ~ ~ u ~ F a `c n ~ Q ~ N n y ~~ ~ G m 1 f) C y = N m 3 !a '- m `3 _ ° ~ ~ .: 3 ~ S m .~ m e '~ '3 ; ~ n ~ R ~/~ > 3~ ~ i ' > ~F YY Y ~ IV ~ m N ~S 3 T W 1y C ^, ~/ ~n m 1 frZ q C N i~ e ~ n c :a a >+ ° .°, ~ 3 A ie a ~1 ~ iS '~ a :s ,y 3 i£ ~ ~ _ ~ ; i o i V~ a e ;~ c i`e m }°, '3 ~ .~ r O O D D m - Z r r 1 A r- ~ i C- m m m --1 7a _~ m ~, < Z c ~ 1 ~ C ~ m Gl T O O C) j C" fD A ~ C1 fO 0 .7 d ~ ~ L9 c G7 m Z m n 9 W ~ O N O N N N V V O ~ ~ O O /^ ~ V ~ ^~,F rf W S N ~ ~ ~ /^ • V a Q1 ~ a a ~ .7 0 0 0 3 A D L O m ~z zg N >m ~o o~ C y 2 H O 2 Y -~ na Nc O N C ~ 2 ti am cOSC O Z C 2 y y N m H 9 m m N ~ ~ r = m O N ~ a a m c i 1 Z j O v m 1 m ~ N O 6 L N _ C N N Cl W N O_ N O ^~ Ww, W N _~ rw,~ r~ W ^`~ W 1 9. A 0 0 a 0 0 N N V O 0 0 0 a d 0 to m' t 3 m w t r 3 3 0 m H n F ~i £ g 3 w m b Si 3 o ~_ ~ m N n ~~ 3 i4~ .v a ' y i m m y o 'O~ ~ V ~ > > H = a ~ ~ m C 9 N ~ --I S N w ~ O 2 Oi O V 9 ~ ~ ~ D O .~~~, V a o ~ ~ O rn rn .. ~ V O O N W O Z O O L m ~ t ~ € ~ ~~ <~ ~ m~*71 v$ ~ ~~ N ~ qq S 3 N a~ ~ 3 m z 3 ~ ~ = ~ 3 c~ r ~ C ~ r us m x r m D O _ s ~o V o_ m j 0 m " ~ ~O o` A = m d Z ~ ,;,r m ~r ~iOG Z 'D v ~ ° C 2 ~ r C c m D ~ m m ~ ~ < m 2 -yi m 3 C ~ ~ 9 2 ~ -~ O ~ x O ° c a ~ a r y N 00 i i N A N CT1 N t0 O N A V o rn -~ N O OD Ja ao O orn V N O CSC r m a 1 H a T Z 1 m v O 6 c w Z N b O ~/O~ W ~~ ~ ~ fD a _ ~ N >c' = nm~ p' p , m n ~ 2a °$e ~~y y C N "a= C N p p ~ O _ Q _ ~ m 3 '$ .l d d 3 ~ '~ :~ y ,w` .n t. ~ y o m ~ w ~ ~ ~ ._ 0 Q m N R ~ N N N ~ N ~O 4 N y'b O 0_ j n o _y ~* O p y m =y N "Z 1 ~ m 0 om~ t~y.y y D m ~. o ~ 3 y ;? p 'n w ~ ~ o e p y N R d _ 4 W n O ~ ~^ d p m n~ 2 4 N o ~ y y y ~ ~• y W N N y ~~ m p ~ N y y y~.C A ,~ N = y m 3 m at m >p y S y T°m m p aa',~ tyD O ^ C ~ }fin ^' ~ c o ~ c N p f o= y 3 m o~m ~y N W ~T O ~ p ~ °pic T ~.Q C = n y N ^f d ~ O y y y a -m. 'a = o, O 3 c c N N O N V A rn r O a 1 O Z 0 T 0_ 2 H S3~ m y ~ G k a t o a eo3 e'Oc m = ad, '^ ° a ~~_ y = RQ m ~ 0 m y 1 y `° c W' F p e mm '^ ~ o, o t~m y >o'Si3 nom _ `., y+ O 3°~'= n M m ~ ~ ~ . m ~ O y y typ O N d y 3 ; m ao o~ m T= p ~ H ~y _ y p p d `C n 3 m o . ~ ~.y C 'C W y q O "=c m C C [E N O O ~ M ~ ~~ m `^ m 3 ?~ m = v m p ^ 'y i; p c `° = N 0 y ~ d ~ ~ 0 O O~ ~ ~ c c = m m ~ y ~^ 1 n m^ ~o^ "S m ate` ~m8 y °i a ^. ~N „_Tm O [O 7 n O N 0 y N 5 niO ~ N C)2 [n~C> '°. ~ -' > > ~ c ~.. _n a. o.Q ~ fD ~ w S ='3. d~ 0 w ~ ± ~' m 4~~~ n ~ ~ 3 ; 2 Z c~ m Z a r c m Q T 0 C 9 C9 l= Z a= ~ g8 ~ 25 a ~~ n ~ N N N ~ a o w a 9 O n o_ ~' N N A N N ~ro°o I to J N O O N A o~ 8. 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W + V V O Z~ ^` W O N O r- ' W aco V ~ V Ole N~ icw in w o ~~~.Vi ~ 6mR &C w r w t- r t- r w 1~ W t-' r -1 -1 -1 -I -i -1 -~ ti ti ti ti ti V m b m -Oa a o .] N O 6 O O $ ~ O O 6 in m O ~~ m m ~~ ~~ cZ ~ r s H 0 ~9 a " ~ m cm 9 z ~ y T 0 ~o ~+ c a~ C y 2 _ y O 2 ~n CJ C Ofn C ~ ti N am ~c of c z N y N 'O O 9 O Of t0 O Z a S m 1 T C Z 0 3 T a Z W a Z v m _N "'~ y a n 1 C 'A T v_ 0 m N O O N r = m O N f a ~ m „ ~ 1 ~ 2 W v a ~ ~ m ~, O 6 T C a w Q N N O_ N O ^~{ W N ~_ ^r`f rf W ^,~ W V~ \~~% A Family Tradition Of Caring® ~., ,,,, PARTHEMORE Funeral Home & Cremation Services, Inc. Maekus R Mueller 31 Cherish Drive Cam Hill, PA 17011 For the Services of Ann Marie Moeller 1303 Bridge Street P.O. Box 431 New Cumberland, PA 17070 (717) 774-7721 (Fax) 774-5546 www.parthemore.com Gilbert W. Parthemote, Founder Gilbert J. Parthemore, Supervisor Stephen K. Parthemore, CFSP Bruce R.Parthemore, Pre-Need Coordinator, CPC Professional Memberships: NFDA•PFDA DCFDA•CCFDA G r..ti.+orr+. ~~,~~i The Rnle~ou~K~ma The People Ymr Tiurr 2/232012 We sincerely appreciate the confidence you have placed in us and will coatione to assist yoo is every way we can. Please feel free to contest us if yon have say questioffi in regard to this statement. The following is ao itemized statement of the services, facilities, automotive equipment and machmdiae that you selected when making the fineral arrengements. Terms Due Date Atxount# 2242012 2012011.3 Description Amount SERVICES.& MERCHANDISE Cremation with Memorial Service 4,460.00 165 00 ~ Stationery Set Angelicas Urn with Angel Top ~~..--~~~/~N '7 _ V. _. Total ServicesaadMerchandise - < ~.I ~(~, . 710.00 5,335.00 ~ ~. 3 CASH ADVANCE ITEMS / 2 ,t ( t Death Notlce,:HarrisburgPatriot ~ 20 Certified Copies of Death Certificate _ 23s.66 120.00 Clergy Honorarium - Couvty Coroner Fee, Cremation Authorization 200.00 30.00 Altar Servets Organist Honorarium 30.00 125.00 Soloist Honorarium 75'00 00 64s Grave Opening . Total Cash Advances 1.460.66 p~ C L~. ~'J.2. I~0 t~ ~~- 0. ~' 41A.L_ CGY1 ~i"61 ~ ~ eted c. ~ 6~e%J ~'n a1v~ r,V~ qM,c- ~ / !/ ~ ~ M ~ Total $6,79s.66 . ~~(l~y Payments/Cred(ts s-i,69o:00 l ~~ ~ Balance Due $5,1°5.66 V `! West Shore Country Club 100 Brentwater Road Camp Hill, PA 17011 Phone: 717-761-4530 Fax: 717-7ti1-7234 j ClientlOrganization ~PO~ # Category ~ Booking Contact ~ Mueller, Markus i 334553 I Reception Markus Mueller, M2455 Markus Mueller, M2455 Mueller, Markus 31 Cherish Drive Camp Hill, PA 17011 Banquet Invoice Mueller Memorial Reception Thursday, March 01, 2012 1 Preimum Brands Open Bar -Billed on Consumption @ ti01.00 75 1:15pm - 3:30pm -Reception @ 28.50 $601.00 $2,137.50 _- ~ -~ Subtotal 2,738.50 Gratuity 0.00 Service Charge 547.70 0% Taxes 128.25 Total --- 3,414.45 ---- ------- Paid 0.00 Balance 3,414.45 Please remit the "Total Balance Due" within 10 days ajreceiving this invoice. Send Check with jull amount to West Shore Country Club, 100 Brentwater Road, Camp HlU, PA, 17011. For any questions concerning this invoice, please reference the PO iR Thank you for this opportunity to serve you. Wi appreciate your business. 3!8/2012 01:26 pm West Shore Country Club Page 1 of t ~r.~rieh ~ ~ 2-o~.fi~~ ~`'~ MEMORIALS Since 1921 5243 Simpson Ferry Road, Mechanicsburg, PA 17050 (717) 766-5622 • Fax (717) 766-8007 unuw. gingrichmemorials.com SOLD~TO: CI d Phone ~' ° ? ~,., Cell ~ ~ q ' ~ k ~'~ Center Over Graves Sec. /Lot # Email Approx. Date of Completion r``~ 1U taee~S Lettering ""^T Drawing /~~ Drawing Sent to Co';t. Approved Found. By f 15 Found. Ordered Vendor Ack.# Grave Position Verifi9eyd~~ __ Cremation Date of Order ~~ (~ r ~ O ( 4 Cemetery AT ~~.~~VF~ Cemetery Location_~~."'d"^'•"•'~ c~n ~,y M nA~ur~ #544,1 ~~ N M~ R 1 E M u ~. ~.~. ~. R ~~. ~hr~e ~uz.> p1P~' Kl IR 6l FEES 7,,2, 2©( 2 Type ~{+a1~2s.' S+~~~. Materialy"^'° pSeR~ ~1~'~~l~{ Yi 't'dtM1KA Size~.X~f~ X '-° Finish r'~nrk tOKt(~'t, k 'f(a`~ '~aGe 44~C~S - Size .~ X ~_ X ~ Finish MOtShi ~ 'Y~x~ QYfIL~r~*e. - C ^ Vase ^ Photo ^ Other - Agreerttent: A 50% deposb is required to oommencemem of work. Agree to pay stated balance upon erection regardless of labor troubles or shipmeras or arty other good reasons. This order or wnkact ceratot be cancelled by customer unless agreed M' bodt parties. The amide herein memlonetl shell remain the property of Jump 0.. Girgrien Mamorlale urull paid in fuu and they reserve the rigor to remove the same is not P~ es stated. t agree to cerefulfy praotread ell names antl dates for accuracy and accept full responsibillry for any errors or omresions. THERE WILL BE AN ADDTONAL CHARGE FOR ANV LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE I fuller agree to peY thebalance stated for the work pertormetl under Mis contred within thirty (3D) days of receipt of Me'linal invoice and further agree that imerest sfrell aarue at fha rate of one and orre-haN percent (154%) per month on the unpaid belarrce owed to James R. GMgdch Memorials not paid witlrin thirty (30) days of the invoice date. In eddldon merek,, l agree a n became necessary for Jarttes R. Gingdch to instltute legal proceeding ro tolled erry funtls due from me for my account being pest duo thirty (30) days, to pay all cou~ ats and^etlomeys fees irwvned by James R. Gingnch Memodals to collect the same. Dealer Customer (I fuller agree that the above names, spelling, and dates ere correct) ^ Back ^ Base chteC(~~caS' COSTS: ^7 ~ Memorial $ ~L~~-. Foundation $ ~.,c~.. Cemetery Fees $ aas• $ $ TOTAL $ ~L~..-'"" DEPOSIT $ ~=~ Balance Due $ f'} ~~ "" Upon Completion Location on Cemetery - ~. ~` w w ~ a N ~~P m oo~-vim Lno vn ~¢S~oo ~}o .d - ~ M a z¢ s ~ ~ Q ~ U ~_~~ M_ ~N ~= O N w`. ~U; o i~~ ~: c~ s; i.U ; ~__ c, ::, cr `~-' ~_ ~ S -- O O m N T O ~~~ ,• L t ~~ ~ `r M fl cal s ~ ~ ~ ~ ~i ,f ~ ~ ~,-~ r ~~ 8007 Nenuef'tlGOI le9e'1 woo•sdsn le sn a!s!~ 3;11AM357V150d 531V154311Nn '~ ~-- C