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HomeMy WebLinkAbout09-05-12 (2)1505610101 OFFICU\L USE ONLY REV-1500 °"°'-'°' PA Department of Revenue V ,",,aa^sylvanla Countp C°de Year Fle Number Bureau of Individual7axes INHERITANCE TAX RETURN ~p~ PO Box 28o6oi RESIDENT DECEDENT ai ~ ~ ~ I d -T ~ Harrislwrg PA 19128-o6oi ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Dale of Birth MIMODYYYY 10/08/2011 10/11/1918 Decedent's Last Name Suffix Decedent's First Name MI Adams Geraldine M (N Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Secudry Number THIS RETURN MUST BE FILED IN DUPLICATE WRH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW l~ 1. Original Retum O 2. Supplemental Retum O °'~. Remainder Realm (date of deaM pdor to i2-13.82) O 4. Limited Estate O 4a. FuWre Interest Compromise (date of O .ri. Federal Estate Tax Retum Required tleath after 12-122) m 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Tofal Number of Sale Deposit Boxes (Attach COPY of Will) (Attach COPY of Trust) O 9. Litiga9on Proceeds Receivetl O 70. Spousal Poverty Credit (date of death O 19. Election W tax under Sec. 9173(A) between 12-3t-9t and 1-t-95) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPDNDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Timothy M. Adams (717) 258-6318 First line of address 635 Anthony Road Second line of address Ciry or Post Office East Berlin REGISTER OF YYILLS USE ONLY IiIICURULa O199CI~: UI' RI(G IS'I'IiR OIL WII,].S 2012 SEP 5 CI,I ~:RK (71' UKYIi;AVS COGI2'I CUfvIBI~:R].AND c Y)Li R"f, YA State ZIP Coda ~ DATE FILED PA 17316 correspondent's e-mau addrns: tadamsDTSf woman com Under penalties of per)ury, I deUare t I have exemine0 this return, indWing exompenying sdtedules end statemema, antl to the best ar my knowledge ant belief, R is true, place. retbn of Preparer oMer Man the personal repreaentatNe IS based an all information of which preparer has any knoMetlge. SIG RE OF P PONSIBLE FOR FILING RETURN DATE 09/05!12 635 Anthony Road, East Berlin, PA 17316 Cl[;NATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE UEE ORIGINAL FORM ONLY Side 1 L 15D5610101 1505610101 J REV-1500 EX Decetlenrs Name: Geraldine M. Adams Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... t. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corpomtbn, Partnership or Sole~Propdetorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 5. Cash, Benk Deposits and Miscellaneous Personal Properly (Schedule E).... ... 5. 2,868.00 6. Jointty Owned Properly (Schedule F) O Separate Billing Requested .... ... 6. 58,950.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 61,818.00 9. Funeral Expenses and Administrative Cosis (Schedule H) ................. .. 9. 14,981.00 t0. Debts of Decedent Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 14,981.00 12. Net Value Of Estate (Line 6 minus line 11) ........................... ... 12. 46,837.00 13. Charttable and Governmental Bequests/Sec 9113 Trusts for which an eleIXion to tax has not been made (Schedule J) ...................... .. 13. 14. Nat Value Subject to Tax (Line 12 minus Line 13) ...................... .. 74. 46,837.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable al the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X .0_ 15. i6. Amount of Line 14 taxable at lineal rate X .0 45 16. 2,108.00 17. Amount of Line 14 taxable at sibling mte X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ....................................................... .. 19. 2,108.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 ]65J561~105 1505610105 REV-1500 EX Page 3 FIN Number Decedent's Complete Address: Geraldine M. Adams --- STREETADDRESS 442 Walnut Bottom Road STATE PA Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Cred'AsrPaymems A.PdorPaymems ___ B. Discount 3. Interest 4. If Line 2 is gloater than Line 1 + Line 3, enter the dAference. This is the OVERPAYMENT. FIII in oval on Pape 2, Line 20 to request a refund. 5. If line 1 + Line 3 is greater than Line 2, enter the dirfererxe. This is the TAX DUE. (1) Total Credits (A+ B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. ZIP 17013 2,108.00 0.00 10.00 2,118.00 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 transfened :.................................................................................... ...... ^ ^Q b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ^ (] c. retain a reversionary interest; or .................................................................................................................... ...... ^ ^x d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ ^x 2. If death ocxurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate censideretion? ........................................................................................................ ...... ^ ^x 3. Did decedem own an "in trust for' or payable-upon-0eath bank account or secudty at his or her death? ........ ...... ^ Q 4. Did decedent own an individual retirement axaunt, annuity a other non-probate property, which contains a beneficiary designafion7 .................................................................................................................. ...... ^ 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 ar 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 a fol• 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 sbaMay requirements for disdosure 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 ac 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)]. e The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beinefidades is 4.5 percent, except as noted in 72 P.S. §9116(1.z) [/2 P.S. §9116(a)(1)]. e The tax rate imposed on the net value of transfers to ar far the use of the decedent's siblings is 12 percent 172 P.S. §9116(a)(1.3)]. Asibling is defined, under Secfian 9102, as an individual who has at least one parent in common with the decedent, whether by bbod or adoption. REV-L5o8 EX+ (u-io) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS ~ MISC. INHE0.RANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: Geraldine M. Adams Include the proceeds of I'rtigation and tfie date the proceeds were received by the estate. All property jolntty owned with right of wrviwuship must be diedosed on Schedule F. If more space is needed, use additional sheets of paper of the same site. REV-CSOg EX+ (oi-io) i Pennsylvania ~iT DEPARTMENT OF flEVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT BCIIEpULE F ]OINTLY-OWNED PROPERTY ESTATE OF: Geraldine M. Adams If an asset became jointly owned wkhln one year of the daeedeM's date of death, k must be reported on Schedule G. SURVIVING ]DINT TENANT(S) NAME(S) ~ ADDRESS ~ RELATIONSHIP TO DECEDENT A• Thomas M. Adams PO Box 186 Plainfield, PA 17081 Son B. C. JOINTLY OWNED PROPERTY: REM NUMBER ll•TIER FDR JOIM TENANT DAIS MADE JOIM DESCRIPTION OF PROPERTY 1NCWDE NAME OF FINANCIAL INSfRMON AND BANK A[[OUNr NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FDR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENTS INIE0.EST DATE DF DEATH VALUE OF DECEDENT51Nn?RFSr I. A. 08/22/05 Parcel q 4Cr1&1394-057, 40 treason Rd. Plainfield, PA 17081 117,900.00 50 58,590.00 TOTAL (Also enter on Line 6, Recapitulation) I; 58,590.00 If more space is needed, use additlonal sheets of paper of the same size. REV-1511 EX+ (10-09) P pennsylvania ~ DEPARTMENT OF REVENNE [NHERRANCE TAX RENRN RE90ENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Geraldine M. Adams Decedent's debts mart be reported on Schedule I. A. FUNERAL ERPENSES: t' Ewing Brothers Funeral Home, Inc, 630 Soouth Hanover St., Carisle, PA 17013 Carlisle Memorial Service, Inc., 41 South Bedford St., Carlisle, PA 17013 VFW Post 4477, Cadilsle, PA 17013 (Funeral Reception -Wake) e. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Timothy M. Adams street address 635 Anthony Road - -- City _East Eterlm __ ___ state _ FA Z[P _17316 Year(s) Commission Paid: 2012 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address Gry __ ______ _ State _ ZIP Relationship of Claimant to Decedent 4. I Probate Fees: 5. I Accountant Fees: 6. ~ Tax Return Preparer Fees: 7 Thomwald Home, 442 Walnut Bottom Rd., Cadisle, PA 17013 Certified Mailings, postage stamps, envebpes, etc. Cumberland County Recorder of Deeds, Carlisle, PA 17013 Cumberland County Registrar of Wills, PA - PA Inheritance Tax filing Cumberland County Registrar, PA -Family Settlement Agreement filing 8,145.00 2,272.00 431.00 3,100.00 129.00 774.00 78.00 17.00 15.00 20.00 TOTAL (Also enter on Line SI, Recapitulation) # 14,981.00 If more space is needed, use additlonal sheets of DaDer of the same size.. REV-1513 EX+ (Ol-SO) _+ pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE INHERItANCE TAX 0.EIDAN BENEFICIARIES RESiDENi DECEDENT ESTATE OF: FILE NUMBER: NUMBEA I NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [Include outlight spousal distributions and transfers under Sec. 9116 (a) (1.2).] Rogene C. Jennngs, 3955 Folk Ream Rd., $pdngfield, OH 45502 Calvin J. Adams, 606 W. Lowther St., Carllisle, PA 17013 Joy L. Gray, 6938 McPherson Blvd., PiRtsburh, PA 15208 Thomas M. Adams, PO Box 186, 40 treason Rd. Plainfield, PA 17081 Timothy M. Adams, 635 Anthony Rd., East Berlin, PA 17316 DO 1'0 OF 1. 2 3 4 5 ', Daughter Son Daughter Son Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 10 Of REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECr10N TO TAX I$ NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISiRIBUT10N5: 1. TOTAL OF PART II -ENTER TOTAL NONdAXABLE DISTRIBl1TI0N5 ON LINE 13 OF REV-1500 COVER SHEET. 20% 20% 20% 20% 20% if more space is needed, use additlonal sheets of Daper of the same size. COMMONWEALTH OF PENNSYLVPN~o COUNTY OF CUMBERLAND estate of GERALDINEMADAMS SHORT CERTIFICATE I, GLENDA EARNER STRASB<9UGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 12th day of October, 1'wo Thousand and Eleven, Letters TESTAMENTARY in common form were granted by the Register of said County, on the late of CARL/;SLEBOROUGH in said county, deceased,. to TIMOTHYMADAMS (First, Mitldle, LasU and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 12th day of October Two Thousand and Eleven. File No. PA File No. Date of Death S.S. # 2011- O 1070 21- 11- 1070 10/08/2011 203-10-9098 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL Statement of Account of the Estate of Cmahtine M. Adams - SSAN:203-10.9098 Cash in Checking/Savings Account $ 2,868.00 509ii Of Jointly Owned Property with Tom $ 58,950.00 Total Gross Assets b D $ 61,818.00 e ts Final Nursing Home Payment $ (774.00) Funeral Expenses $ (8,145.00) Gravesite Marker $ (2,272.00) Funeral Reception (Wake) $ (431.00) Administrative Expenses $ (3,100.00) Register of Wills Fees $ (164.00) Certified Mailings, Postage, etc. $ (78.00) Cumberland Cnty. Recorder of Deeds Fees $ (17.00) Tate) Deductions $ (14,981.00) Net Value of Estate $ 46,837.00 Previous Distributions Inheritance Taxes $ (2,118.00) 50%Transfer of home to Tom $ (58,950.00) According to Deed Total $ (61,068.00) Remaining Estate Value 0 Net Value of Estate to be Dh:eributed to Heirs 0 i M'+..t :*..:,,.'- ~~ 2a STATEf1EN7 PERIOD PAGE.'. OCT.O4-NOV.03,2011 1 OF 2 00 GERALDINE M ADAMS C/0 TIMOTHY M ADAMS 635 ANTHONY RD EAST BERLIN PA 17316 0 04319M NN 017 15756 SELEGTE'R AGG:LIUNT SU'NNARY ACCOUNT ACCOIRIT INTEREST EARNED MATURITY ENDING TYPE ~KRlER YEAR-TO-DATE DATE BALANCE M6T CLASSIC CHECKING N/INTEREST 000000000400041 0.30 0.00 MBT PERSONAL SAVINGS 015004212519770 0.32 0.00 M MlIT CLASSIC CHECKING W/INTEREST TittE ACCOUNT N0. 400041 NIGN STREET-CARLISLE SNTEREST EARNED FOR STATEMENT PERIOD 0.00 AC Cf111MT CIIMMAGV R OTNE P R T N0. AlpUllT NO. AMOUNT N0. AMOUNT 2,393.37 0 0. 0 0.00 0.01 0.00 A Cf`fl11MT Of`TTVTTV ~s SWTRACTId13 30-04-11 BEGDWINC BALANCE 02,393.37 30-05-11 CNECK IRRlER 0055 250.00 2,143.E7 30-11-11 In Braneh Tr~nsf~r/Nithdraw~l 300.00 1,043.!7 10-12-11 INTEREST PAYMENT 0.01 10-12-11 CLOSEOUT 1,043.36 0.00 ENDING BALANCE 00.00 CHECKS PAm%SUMMIIRY 55 10-05-11 250.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 ~a1 tVI8cTB~.tl~+c GERALDINE M ADAMS ,~.x ST#TI]IENT PERIOD PAGE'.. OCT. 04-NOV.03,2011 2 OF 2 DID YOU KNON TINT YOU CAN ACCESS UP TO 24 IIONTILS OF ACCOUNT ACTIVITY, CLEARED CHECKS AND NOTICES FROM ANYNMERE YOU HAVE INTERNET ACCESS...AT THE OFFICE, ON VACATION...ANYNHERE? JUST LOC ON TO YOUR SECURE MfT NEB BANKI116 ACCOUNT AHD 60 TO TXE "CUSTOMER SERVICE^ TAB TO EDIT YOUR DELIVERY OPTIONS AND CHOOSE TXE DOCUMENT TYPE4 YOU MAN! TO RECEIVE ELECTRONICALLY. START ENJDY:ING THE CONVENIENCE OF ELECTRONIC DELIVERY TODAY! TO ENROLL IN NEB 6ANKINC, VISIT MTB.COM/NE66ANCING. MEMBER FDIC. L AMS M&T PERSONAL SAVINGS TITHE ACCOUNT N0. 15004212519770 CARLISLE NEST INTEREST EARNED FOR STATEMENT PERIOD 0.00 ACCOUNT SUMMARY 'LANCE NE : ° TRACt INTER T PAID ND. AMOUNT ND. AMOUNT 1,025.05 0 0.00 , 0.00 0.00 AGGUUNI AGI1V11Y ,. '. / N ~ Y -.-f~~rC - TOakaaM'ItlN tlE5[OYPTItlN f OTHER 1tlOITIONS SUBTRACTIONS BALANCE 10-04-11~BECINNIN6 BALANCE 10-12-11 CLOSEOUT f1,025.05 1,025.05 0.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 DID YOU KNON THAT FOR ONLY 12.99/MONTH, YOU CAN YIEN YOUR CREDIT SCORE ANYTIME YOU L06 ON TO YOUR SECURE PERSONAL MBT NEB BANKING ACCOUNT? SEE YOUR UPDATED SCORE, NOTE IF IT CHANGED AND READ TXE TOPTNO REASONS BENIIO 'YOUR SCORE. JUST L06 ON TO YOUR NEB BANKING ACCOUNT AND W TO TXE "CUSTOMER SERVICE^ T#6 TO ENROLL IN CREDIT SCORE TODAY! MEMBER FCIC. ~~c i , ~~ ~~~rz~~t,a ~:3i:1' n :!c~i.~7 6E%u'RDER dP iiEEOS CiI1d8ERLAtlD COUftTI'-Pq ~ RUG 24 P~'1 Y ~ ~ .. MADE THE Z2 day of August, 2005, ~~ NO. BETWEEN THOMAS M. ADAMS, single man, of West Pennsboro Township, Cumberland County, Pennsylvania, hereinafter called Grantor, AND THOMAS M. ADAMS, single man, of West Pennsboro Township, Cumberland County, Pennsylvania, and GERALDINE M. ADAMS, widow, of Carlisle, Cumberland County, Pennsylvania, hereinafter called Grantees: WITNESSETH, that in consideration of the sum of One and na'100 ($1.00) Dollar, in hand paid, the receipt whereof is hereby acknowledged, the said grantor hereby grants and conveys unto the grantees, their heirs and assigns, as joint. tenants with the right of SUNIVOrShlp: TRACT NO. 1: ALL that certain tract of land with the improvements thereon erected situate in the Village of Plainfield, West Pennsboro Township, Cumberland County, Pennsylvania, twunded and described as follows: BEGINNING at a point at a comer of the lend herein conveyed, and a public road leading to Greason; thence along the latter in a southerty direction, a distance of 80 feet to a point; thence abng land now or formerly of Frank W. Prosser, et ux, in a westerly direction, a distance of t34 feet to a point; thence along the same in a northerly direction and parallel to the aforementioned public road, a distance of 1 f3 feet to a point; thence along the same in a westerly direction and at right angles to the last mentioned line, a distance of 155 feet to a point; thence along land now or formerly of E. M. Kell in a northerly direction, a distance of 44 feet to a point; thence along land now or fortneriy of Minich in an easterly direction, a distance of 219 feet to a point, the Placs of BEGINNING. eoou 2'i~6 r~ce1553 ni n.ovv, nn~n nrn in~TV Ine1890lK'l00.O1 _ Pone 1 nl TRACT N0.2: ALL that certain tract of iandsituate in West, Pennsboro Township, Cumberland County, Pennsylvania, as follows: BEGINNING at a point in an existing fence line on the boundary line between land of the grantees and grantor herein, which point is North 83 degrees 55 minutes 31 seconds East, a distance of 140.94 feet from the northwest comer of land of the grantees herein; thence along said fence line along property of the grantees herein, North 83 degrees 55 minutes 31 seconds East, a distance of 14.00 feet to a point; thence continuing by land of the grantees herein, South 05 degrees 32 minutes 31 seconds East, a distance of 13.7i' feet to a point; thence by land of the grantor herein, of which this tract was formerly a part, South 84 degrees 27 minutes 29 seconds West, a distance of 14.00 feet to a point; thence continuing by land of the grantor herein, North 05 degrees 32 minutes 31 seconds West, a distance .of 13.64 feet to a point In an existing fence line, the Place of BEGINNING. CONTAINING 191.87 square feet according to a Final Subdivision Plan for Glenn L. Wetzel, dated November 13, 1985, recopied in Cumberland County Plan Book 49. page 76, and being designated thereon as Lot No. 2. BEING the same property which Geraldine M. Adams, widow, and Thomas M. Adams, single man, granted and conveyed to Thomas M. Adams, of West Pennsboro Township Cumberland County, Pennsylvania, grantor herein, by deed dated May 27, 2004 end recorded in the Cumberland County Recorder of Deeds Office in Deed Book 263, Page 3269. BEING AL80 the same property which THOMAS M. ADAMS, single man, granted and conveyed to THOMAS M. ADAMS, single man, and GERALDINE M. ADAMS, widow, by deed dated January 11, 2005, and recorded in the Office aforesaid in Deed Book 267, Page 574. For the purpose of clartfying the chain of tltle for the deeds rocordad In Dssd Book "K", Volume 32, Paps 142 (dated December 24, 1955),. Deed Book Z53, Pegs 3269 (dated May 27, 2004) and Dsed Book 267, Page 574 (dated January 11, 2008, the partks heroby certify that for the purposes of all of these deeds, GERALDINE M. ADAMS was and remains a widow and THOMA8 M. ADAM8 was and romaine a single man, though those desipnatfons were inadvertently omHbd from said deeds. ~ ~ ~i5b4 It Is the Interrtlon of this deed that the grantee shall each own an undivided one-half interost in the aforosaid property as Joint tenants with the right of sunrivorohip and confine that such ownerohip interosts wsro so Intended at the time of the transfer in Deed Book 267, Page 674 on January 11, 2006, though such designatlon was omitted in the deed. THIS DEED fS A NONTAXABLE CORRECTIVE DEED, CORRECTING THE DEED RECORDED IN DEED BOOK 267, PAGE 674, TRANSFERRING THE PROPERTY FROM A SON TO MOTHER AND SON, BUT WHICH NEGLECTED TO INCLUDE THE PHRASE "AS JOINT TENANTS WITH THE RIGHT OF SURVIVORSHIP". AND the grantor hereby covenants and agrees that he will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, the grantor has hereunto set his hand and seal the day, month and year first above written. Signed, Sealed and Delivered in the presence of COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :ss: n.( On this, the ~ day of August, 2006, before me the undersigned officer, personally appeared THOMAS M. ADAMS, single man, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hgn~J,,4nd seal. f~wTARULSF,u. v( HAROLD 3.IRYYdd, dl. NOTARY PUBLIC ARLIBLEBOROUGH.OOIIIrIYDfCliNBBiIAND Npyry MY COMMSSNk1 EJQ'Ifd:S OCTOBER 22.2006 eowc 2?6 ~15b5~, i.,.e x onnevnam _ o.,,.e ~ .. I do hereby certify that the predse residence and complete post office address of the within named grantees is: IO OREASON ROAD, PWNFlELD, PA 17051. August~,2005 for NAilOLf1 i NI AS>ww~Lsr~- tti4 Ss~11r1 ~ ti1~Mt cr~.~ rw ~ro~a fin ssaaMo Certify this to be recorded In Cumberland County PA ~.~-~~~ e~ V'~i. Recorder of Deeds ~ 276 Puu~i5b6 ._ Zr ~ooeo tp^+pm~ troy Oa$' m ~~OOyy9ppn ~ 1i.:~~le~,r0~11 •q ~1 p~ pytCmpy .1m 6611~QP~ee~i .'N V w\i0~' ~1++-1~ XI~~~+K~1~~ PA ~~M+.!~y•.p~~NmJ+~N+~p~bF~~Nli ~ W n ~agSym(~]p .aT . qK N ~•! N p •• W 'r~' n ~ f'{ M K D 'O ~ ~ W W~ ~ ~ ~ ~ O ~ 0 p IRy V 4d CWtl' 0 pW ty~ pyf typ ` S ~o M:1~+ . •• •' 01 R /7 Y K n ~ w I! .. .. .. ~ Q .. :-roe 'RI171E ~y1 •. .•~•+~••~t ]rN M C 4! R •~' •i' ~. ~ ~I ~y{ y~ ~ YI 07 ~f . Fr n U A+ A ~ . VNYI M ~_Oi ~ m p 6 M R7 ~pQp~ n ~+ . _ gfCy TJ M X :_~ pOo O. P,'O' y •• (N~ Mpg /~+- i IG'1 yp y n ~/ tLaa b ~ Q; O.O. 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I 1 1 1 I ! 1 N 1 1 1 I r 1 N Y I 1 a r 1 1 ' W O1 1 1 A OD . 1 A Froe:PENSKE LOGISTIf ~~~~ V X N 1a A t) Sa m ~ ~ 1m-' ~ ~ n y~ W N S ~~~~ ~~~~~~ 717 216 2087 0 0 N V N O W O1 W O O a m W M p ~ r x 9 b 4 n M C l I I N W \ n c W W C ~ O O L'~ O O ( ~ O N O A yP m n O o ~ ~ .~ 06/14!2012 20:28 ;r22a P.oo2ioo -~„ jqN '+~{ ~~~~ 0W0 Os .~ O ~_~ ~~a ~' W ~~ r W W ~ - I J ~~~~ ~ N H N N X M lot tpmpi o ~+ N M W 0 O . ~>,~ ~ rf+r~~ t ~ n ~~y~pr0 (q-~~ N N ~ ty 70 O tNJ1 O LMR N N N ~ N V N J 001 01-oAA 41 b '+o O N N i- 0 t• W ~- ~tlQ N O M ~\\ w~ ne~ N \\\ o ° o ~ ~ a i G ~~ ~ ~ \ '_1 08.. v ~~ ~ ° ~~ a ~~~ ~ ..~~~ P G W .._ $s w w ro~ r o a tf R N ~ a ro .. ~° ~n i ^ • i ^ 1: fF S H N $ O O w. a~o'i ~ n e 6C . 1 ~ tro ~pm+ ~ !!gyp Yfi N r a ~ ~ a r Ewing Brothers Funeral Home, Inc. '- 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 October 16, 2011 Timothy M. Adams 635 Anthony Rd. East Berlin, PA 17316 The Funeral Service for Geraldine M. Adams 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 this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACII.iT1ES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS,, 1. PROFESSIONAL SERVICES Services of FuneralDiroctor/Staff, 51863,00 Embalming, 5893.00 Dressing, Casketing, Cosmo etc. 5293.00 2. FACH.TfIES AND SERVICES One Day Event (Discounted, 5790.OD 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, 5273.00 Hearse (Casket Coach) 5273.W Safery/I.ead car/clergy 5123.00 Utility Vehicle for DC retrievaUfiling , 5123.00 FUNERAL HOME SERVICE CHARGES 54645.00 SELECTED MERCHANDISE: Sirius PoplarNenar Casket l/2 Cou , SI330.00 # 12 Guardian OBC S1295.00 Acknowledgementcards, 510.00 Register Book(s) . 540.00 Memorial folders , 583.00 THE COST OF OUR SERVICES, EQUII'MENT, AND MERCHANDISE THAT YOU HAVE SELECTED 57625.00 Cush Advances Certified Copies of the Death Certificate , 530.00 Flowers, S139.00 Hairdresser. ... 540.00 The Sentinel Obit w/Photo S 131.32 The Patriot Obit no photo 5239.22 TOTAL CASH ADVANCES AND SPECIAL CHARGES . 5619.74 Total Total Cost , 58244.7A \ C~6Ver PL~a~ > CARLISLE MEMORIAL SERVICE INC. 41 SOUTH BEDFORD 8T. CARLISLE, PA 17013 ro: ADAMS, TIMOTHY 635 ANTHONY RD. EAST BERLIN, PA 17316. Statement DATE 5/29/2012 TERMS DUE DATE AMOUNT DUE ~ AMOUNT ENC. Net 15 6/13/2012 $1,136.00 DATE TRANSACTION AMOUNT BALANCE 12/10/2011 Balance forward 0.00 12/22/2011 INV #31-140. Due 01/06/2012. 2,272.00 2,272.00 12/27/2011 PMT -1,136.00 1,136.00 ALL WORK IS NOW COMPLE THANK YOU FOR ALLOWING US TO S RVE YOU. LL ~~ Svc-rl~P~G ~ ~ ~~, AMOUNT DUE ~~r T~,~ ~ $1,136.00 ~~~ ~~~ ..r~.:_ . SUB-TOTAL INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE The unpaid bdenw over 30 days is subjected to a 1.50 °h amia charge per month - 18.0000 % per annum. Sg244.7a _ W~ V~ /~ 100.00 ~!Gt1.r~ 58144.74 ~'~~ L . ~~ ~~'jzo,R6 ~- S,S7G. zZ ~ ~ ~~ ~~~7 ~~_ U„ C' RECEIPT FOR PAYMENT GLENDA FARMER STRASBAUGH Cumberland County - Register Of Wille One Courthouse Square Carlisle, PA 17013 ADAMS GERALDINE M Estate File No.: 2011-01070 Paid By Remarks: TIMOTHY ADAMS DB Fee/Tax Description Receipt Distribution Payment Amount Pay PETITION LTRS TEST WILL SHORT CERTIFICATE JCS FEE AUTOMATION FEE RENUNCIATION Cash Total Received......... 60.00 C 15.00 20.00 23.50 B 5.00 5.00 $128.50 $128.50 Receipt Date: 10/12/2011 Receipt Time: 11:19:33 Receipt No.: 1067263 ee Name CUMBERLAND CUMBERLAND UREAU OF CUMBERLAND CUMBERLAND COUNTY COUNTY 2C0EUNTY~ COUNTY GENERAL FUN GENERAL FUN GENERAL FUN 3 & CNTR M.D GENERAL FUN GENERAL FUN STATEMENT Thonrwald home 442 Walnut Bottom Road Carlisle, PA 17013 Telephone: (717) 249-4118 Statement Date: 11/01/2031 Due Date: 11/25/2011 Amount Endosed $ Amount Due: $774.09 Account #: 1117 RE: Geraldine M Adams Timmy Adams 635 Anthony Road East Berlin, PA 17316 774. 774.09 ~ ~~e ~u~ ~ e C7ararN 1-30 Days 31-60 Days 61-90 Days Over 90 Days Amormt Dua .00 .00 774.09 .00 .00 'lli i I~ Remirger: Payrrlerlts are Cue 6Y the 25M of eaGl nanih. Please subrrlit your Dayment so k an be received tlmely. lharlk You. Geraldine MAdams -Account #: 1117 Thomwald Home 442 Walnut Bottom Road Carlisle, PA 17013 Telephone: (717) 249-4118 Statement Date: 11/01/2011 Due Date: 11/25/2011