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HomeMy WebLinkAbout11-02-12J 1505610140 REV-1500 EX ~°'_'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po Box 28oso1 INHERITANCE TAX RETURN County Code Year File Number __ Harrisbur , PA 17128-0(101 RESIDENT DECEDENT 2 1 1 2 0 0 9 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 7 0 5 8 7 8 2 8 0 1 D 7 2 0 1 2 0 5 0 7 1 9 3 8 Decedent's Last Name Suffix Decedent's First Name MI L A W R E N C E M A R I A R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required 0 s. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation 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 COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOUL Name D BE DIRECTED TO: Daytime Telephone Number D O U G L A S G M I L L E R 7 1 7 ~~+-~ 9 2 r:~:~ 5 -z~ REGISTE~T(~~_WfLL'S USE. ~ LY ;_ ~ ` ~~ <` First line of address ~`=, `~' ~~~ I R W I N & M c K N I G H T P C -, ~~ ~-~ , _- Second line of address _ ~~' ~:'=~ ~ - ~ ~-~ ~ 6 0 W E S T P O M F R E T S T R E E T ~' ~' City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 1 7 0 1 3 Correspondent's a-mail address: under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and compete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. DRES LE DS ROAD .NA RE OFiPREPARE REPRESENTATIVE NEWVILLE PA 17241 DATE i ~i ~ 60 WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J h c~ J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: MARIA R• LAWRENCE 1? 0 5 8 7 8 2 8 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 1 3 1 2 0 0. 0 0 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 1 0 . 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 2 1 9 8 8 . 9 9 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 2 8 7 9 8 . 9 9 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 1 7 9 4 8 . 9 1 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ....... .. 10. 9 1 5 9 0 • 0 1 11. Total Deductions (total Lines 9 and 10) ...................... ...... ... 11. 1 0 9 5 3 8. 9 2 12. Net Value of Estate (Line 8 minus Line 11) ................... ...... ... 12. 1 1 9 2 6 0 . 0 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............ ....... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............ .......... 14. 1 1 9 2 6 0 . 0 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 1 1 9 2 6 0. 0 7 16. 5 3 6 6. 7 0 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 1 g. . 19. TAX DUE ............................................ ....... ... 19. 5 3 6 6. 7 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 12 0095 DECEDENT'S NAME MARIA R. LAWRENCE STREET ADDRESS 450 ERFORD ROAD CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: ~ • 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. (1) 5,366.70 (3) 0.00 0.00 (5) 5, 366.70 Make check payable to: REGISTER OF WILLS, AGENT r.....-.... .-~.-~-1-•e..~ .,. ,.e...c w,Tis,. a.-.- _ ~ _.. _ .~ j~. ""TC"`~n"~"'^>'Tes?~'°`- -r°r_'~4. _ F"°fi'^ 3 _ _ _ - _ _ s--- _..~.~} _.~~__a`Asa:~i.K.iry.'~~"~.,_~~3..,,',~`,:.+~" ~ ~;° ~,.~.;:~ ~:^..it:~ ~3~_~.~1.~G~~.~ ~''~y~'~ ~~~ Y_~,_~~.~_ __ .._ _L. +.~_..~.~~ .-..a.. _ _ . ~.. ~ _Y..~~ ,.__ ~ T_, '~ 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 : ...................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. Q ^ 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 adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • 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. Total Credits (A + B) (2) (4) REV-1502 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: MARIA R. LAWRENCE 21 12 0095 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 exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 405 ERFORD ROAD, CAMP HILL, PENNSYLVANIA 131,200.00 TOTAL (Also enter on Line 1, Recapitulation.) I $ 131,200.00 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: MARIA R. LAWRENCE 21 12 0095 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PSECU -SAVINGS ACCOUNT 6,014.88 2. PSECU -CHECKING ACCOUNT 11,073.03 3. PSECU -MONEY MARKET 58,022.09 4. PERSONAL PROPERTY 500.00 TOTAL (Also enter on Line 5, Recapitulation) I $ 75,610.00 If more space is needed, insert additional sheets of paper of the same size REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MARIA R. LAWRENCE 21 12 0095 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. ALLIANZ LIFE INSURANCE COMPANY 21,988.99 100.00 21,988.99 BENEFICIARIES: ELIZABETH JANE LAWRENCE 2. JACQUELINE ANN LAU ROBERT EDWARD LAWRENCE EDWARD BRUNO LAWRENCE TOTAL (Also enter on Line 7, Recapitulation) I $ 21, 988.99 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARIA R. LAWRENCE 21 12 0095 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. BUSE FUNERAL HOME 4,098.00 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: IRWIN & McKNIGHT, P.C. 9,750.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) 3, 500.00 Claimant ELIZABETH JANE LAWRENCE Street Address 405 ERFORD ROAD City CAMP HILL State PA ZIP 17011 Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees: REGISTER OF WILLS 311.50 5 Accountant Fees: TAXACT ONLINE - 2011 TAX RETURN 176.41 6. Tax Retum Preparer Fees: 7. REGISTER OF WILLS -FILING FEE 30.00 8. RECORDER OF DEEDS -FILING FEE 63.00 9. REGISTER OF WILLS -RELEASE OF CLAIM (2) 20.00 TOTAL (Also enter on Line 9, Recapitulation) $ 17.948.91 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE -NHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER MARIA R. LAWRENCE 21 12 0095 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. DEBBIE LUPOLD, TREASURER -REAL ESTATE TAXES 1,617.96 2. PSECU -MORTGAGE LOAN 82,296.46 3. BANK OFAMERICA -CREDIT CARD #4313 0721 5513 4466 3,508.52 4. COMCAST -UTILITY 571.38 5. PP&L -ELECTRIC 243.96 6. PA AMERICAN WATER -WATER 146.51 7. EAST PENNSBORO TOWNSHIP - SEWER/TRASH 138.00 8. UGI -UTILITY 547.59 9. JC PENNEY -CREDIT CARD 2,519.63 TOTAL (Also enter on Line 10, Recapitulation) I $ 91, 590.01 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARIA R. LAWRENCE 21 12 0095 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. ELIZABETH JANE LAWRENCE Lineal 405 ERFORD ROAD REAL ESTATE CAMP HILL, PA 17011 2. ELIZABETH JANE LAWRENCE Lineal 405 ERFORD ROAD 1/4TH ANNUITY CAMP HILL, PA 17011 1/2 REMAINDER 3. JACQUELINE ANN LAU Lineal 4 LEEDS ROAD 1/4TH ANNUITY N EWVI LLE, PA 17241 1 /2 REMAINDER 4. ROBERT EDWARD LAWRENCE Lineal 1103 NUMBER 5 GREYS CORNERS RD. 1/4TH ANNUITY BERLIN, MD 21811 5. EDWARD BRUNO LAWRENCE Lineal 37080 HALIBUT POINT ROAD 1/4TH ANNUITY SITKA, AK 99835 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. jj, NON-TAXABLE DISTRIBUTIONS: 1, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size, k,. Will of Maria Rose Lawrence Part 1. Personal Information I, Maria Rose Lawrence, a resident of the State of Pennsylvania, County,East Pennsborough,Camp Hill, declare that -this is my wil ~~ cry ~~ ~r.~ Part 2. Revocation of Previous Wills I revoke all wills and codicils that I have previously made. ~.. Part 3. Children I have the following children now living: Elizabeth Jane Lawrence, Jacqueline Ann Lau, Edward Bruno Lawrence and Robert Edward Lawrence. _. ,. Part 4. Failure to Leave Property If I do not leave property in this will to any of my children named above, my failure to do so is intentional. Part 5. Disposition of Property A beneficiary must survive me for at least 45 days to receive property under this will. As used in this will, the phrase "survive me" means to be alive or in existence as an organization on the 45th day after my death. If I leave property to be shared by two or more beneficiaries, and any of them does not survive me, I leave his or her share to the others equally unless this will provides otherwise. My residuary estate is all property I own at my death that is subject to this will that does not pass under a general or specific bequest, including all failed or lapsed bequests. I leave My house at 405 Erford Road Camp Hill Pa 17011 to Elizabeth Jane Lawrence. I leave my residuary estate to Elizabeth Jane Lawrence and Jacqueline Ann Lau in equal shares. All personal and real property that I leave in this will shall pass subject to any encumbrances or liens placed on the property as security for the repayment of a loan or debt. Part 6. Executor I name Jacqueline Ann Lau to serve as my executor. If Jacqueline Ann Lau is unwilling or unable to serve as executor, I name Jeffrey Davis Lau to serve as executor. Page 1 of 4 Initials: '~ ~ ~ ~~ Date: ~.~ ~~ ;~?~c~ c;~ t" f Will of Maria Rose Lawrence Part 9. Payment of Taxes I direct that all estate taxes assessed against property in my estate or against my beneficiaries be paid using the following asset: with my .money market at PSECU. Part 10. No-Contest Provision If any beneficiary under this will contests this will or any of its provisions, any share or interest in my estate given to the contesting beneficiary under this will is revoked and shall be disposed of as if that contesting beneficiary had not survived me. Part 11. Severability If a court invalidates any provision of this will, that shall not affect other provisions that can be given effect without the invalid provision. Signature I, Maria Rose Lawrence, the testator, sign may name to this document this f . - .- day of ~ ~~,~~, at ~~~.~ (city or county, and state). I declare that I sign and execute this document as my last will, that I sign it willingly and that I execute it as my free and voluntary act. I declare that I am of the age of majority or otherwise legally empowered to make a will, and under no constraint or undue influence. Signature: Witnesses We, the witnesses, sign our names to this document, and declare that the testator willingly signed and executed this document as the testator's last will. In the presence of the testator, and in the presence of each other, we sign this will as witnesses to the testator's signing. //// //// //// //// //// //// //// //// //// //// //// Page 3 of 4 Initials: 11.,GFi Date: ~~ c =2c~iE~ Q d •o Will of Maria Rose Lawrence To the best of our knowledge, the testator is of the age of majority or otherwise legally empowered to make a will, is of sound mind and is under no constraint or undue influence. We declare under penalty of perjury that the foregoing is true and correct, this day of , at (city or county, and state). First Witness Sign your name: ~ ~`-' ~ - ~=.~ -'~'-~ Print our name: ~ ~ ~ a C'~ ~ ~~~~ Y Address: City, State: Second ~rness .~ ~ ,. ~ ~`~`''' Sign your name. Print your name. c ~ z. ~ ~ Address. `, ~ City, State: y of 4 Initials: ` " ~ ~ y~t Date' ` ~ ~ ~~1~ Page 4 ,~ Department of Revenue I am writing to ask for an extension for the estate of Maria RLawrence- File number 21-12-0095 -Cumberland County, PA, Death Date- January, 7 2012. SSN; 170-58-7828. Real Estate problems. Thank you for your help in this matter Jacqueline A Lau; Executor .~ 4 Leeds Road Newville -Pa 17241 ~ n /V `°`~ /J September 19, 2012 9~~~ o,a ~Je~' `~~ J v~ y,1S r~-°-s, -. n-- ~,~^:~~+r;i1 ~° i-itrt-'~J,9i~:.ccpa.net;F~ruG~crt+r~'r1.3FiFirf; ~'IVI;~'l}{I ~''i'.3~"~piJ Ir ~I File Edit View Favorites Tools Help ~ Favorites I ~ propertyMapper -Cumberland County, PA I I ~ ~~ O ~ ~ Page - SaFety - Tools - - ~~ i~i,z~-~ Tuesday, Sep 25, 2012 04:36 PM ' Internet ~ w` ~ ~ 100°f° Done ~ I ~ ~~ ~ ~ ~l ~ ~ ... PSEC 10/11/2012 €~ ~~ ~ z31~, ~ ' `' ~~~~a,ti ~ t~;~' Irwin & McKnight, P.C. Douglas Miller, Attorney W. Pomfret Professional Bldg. 60 W. Pomfret St. Carlisle, PA 17013-3222 Re: MARIA R LAWRENCE, Deceased. PSECU Reference # 6886903308625 Dear Attorney Miller: IRWIfV ~ I41cKiVIGli1~ I.A~V ~JFFlC~B The above referenced person has an account with PSECU which was opened on August 4. 2008. The Share accounts were individually held by MARIA R LAWRENCE. The mortgage loan was individually held. The following are the Date of Death Balances for MARIA R LAWRENCE'S account with PSECU: Account Shares: (S 1) Savings (S4) Checking (S7) Money Market Date of Death Balances Interest -January 7, 2012 $0.36 $0.29 $3.34 $6,014.88 $11,073.03 $58,022.09 Loans: #46446 Mortgage Loan $82,296.46 -loan was paid in full on 4/16/12 ~-_--- ~- The account has hPen closed. If yo~~ have any cauestions, please Contact me at (717) 234- 8484 or toll-free at (800) 237-7328, press 6, extension 3120. Sincerely, ,~ Sandy Fagley Member Service Representative PSECU Pennsylvania State Employees Credit Union 1 Credit Union Place, P.O. Box 67013, Harrisburg, PA 17106-7013 • 800.237.7328 • »pseCU.com THIS CREDIT UNION IS FEDERALLY INSURED BYTHE NATIONAL CREDIT UNION ADMINISTRATION. EQUAL OPPORTUNITY LENDER. \"\"\ '?ER':; na~rrs:. hrrrt:k Cdr{-~5, Cr.}~, slEde. EsnrS ZIP ~9 .L1,4N~ LIFE i~1SlJRAhICE C4hARAt~'Y = NClRTH AMERCCA [~~ GC?LaEI~i HILLS DFIIVE NNtmAPQLIS, MIV a~16 P/tYER:~ icd(:xal id?rtlifir,~lUon r~urnbar RtCfi'dENT'5 idelt"i1i~.fiCn liw-I~'i~r ~1-136675 f 74=58-726 ~iECIPIENT~ n[uma. 9lreef 8t9tlre~, [may. ~a1u, ar~ci ZIR rorir, MARIA R LAWRENCE CO JAC{r1~EI~INE ANN LAi.~ PC}A ~~ ~ 4 LEEDS R~QAD NEWVILLE. PA t7~4~1 ~l0 r'trnowlt aOC~le to If~R witl1in 5 yr5r 11 1st ti~var of d?si; Rr,Er cmt:ita. f'1CCOIlntrllnltY3r:;°_BB LIP.°rI1V 1~1`I9;1 Form 1©99-fi C~RFiEGTED (it checkad~ G~L1ESTiJNS CALL; I;B~a;l E~4-Q19? 1 un;:~ di.:lritulinr: c.}M86'+10, 154x-C~t1u+ S2t,9aE~.9~9 • i~lstribtltlans Frain Pensitins, 2a Taxa~:? wmpdnt - ~V' 1 1 i~Annuiti~s. R~#irElin~fltCr i; Pr4fit-$harin~ Plans,IRA~, S2~E,98$.~~ Farm 109-R !!Ins~ararNCe Gcrntracts, etc. 2b T8k8bW_ amulr~t tTIJI Tctil di .Irihrdi~r ltQl3y/ t,` d_~ta:mlined - i;or Fieci lenYs 9 CPJri181 gS~: ~;intluded it FJrSx 2;t1 4 FFdAnI in4::,rnE+ tar wiihna4] p frBC01"d3 ~r~, 1 rlp.ry~ 3U ,7 ~ S Inl[xm:rti4n IS h d 1 i f i h 6 EmplCryeE t~anlribulio:~~Desigl~li~rf 6 Nal vnr:alizrn appr4rriatian in gtttpS,z j?r 0 ng a om um s he Imemal R(Y..IAC4n911bU11Cf15~Jr:n9LLr8nCE prernlisns ~°p~n?ice iiQ+neflue service. 7 UiStrIGUGiDn tvde(e) ~~ ~ StF r ~ B dlher --- 9qr Y~glr pen~rlC]r,1s ~, tr~lEl r~151rWUtIM 9b ~ oral ?m~'o49e cc,~tnblsnne ,. ~o 12 Sh312 k1K wilhhelT 13 ~tete~ F~yur's sL•al~ n•. 14`:;:CC <::rnt:ulna: _ $~],c~~J PAr9403 P767 I ;21,98$.9 13 Ln i~l1~K tnthhs;?i 15 N7rts? of bGalft4 7 LOCaI d:51nDJt~4r (keep far your recaf~ds) D~~artment of >t~e Treasury-Ir~lternal R~ti~enue2 Service .~ ~I o~~- ~, ~~re-~ce_ -~ ~2~.~~ J . ~C~,UJ+~c~ ,~ Q C~ ~ ~ I , r1e.. ,~ ~ l~.t~., $us ~trN~~t~L ~o~~ 145 North Grant Street _9066~,Jonestown 'Road.; -` 2, East Main :Street Palmyra; PA 17078 - Grantville; PA 1.70?8 - _ Hummelstown, PA 1703.6 - :7;17-8.38-7034 ~ 717-469=23:4'1-; ~ ~ 717-566-2016- Jeffrey 1N. ~ Buse Nathan W ~ Buse; 'Supervisor ~ _ ~ Donna R:.G: Buse Funeral,Director ~ - :Branch Location - - Funeral Di'reator. Jacqueline A. Lau ~ _ January 20 20 ~12 4 Leeds Road ~ ~ Due.~Date: February.21; :2012 - Newville, PA 17241 - FUNERAL` :EXPENSES FOR l~ZARIA:R. I:AWRENCE: PROFESSIONAL SERVICES ~ _ ~ ~ - .Services of Funeral=~Director.and-:Staff (Direct cremation) $ 1,4.95.00; . $ 1,495..00 - :OTHER-STAFF AND RELATED FACILITIES - Services and~Facilities for Memorial Service ~ $ 795.00 . - - _ $ 795 :00 ~ _ TRANSPORTATION Transfer of Remains to Funeral -Home. $ 175.00 Limousine $~ 375..00 _ Lead .Gar /Flower. Car, - $ 100.00 $ 65.0.00 MERCHANDISE Classic Rose Urn $ 200.00 - 2Porcelain Angels - $ 8.0.00 Sea Salt Keepsake $ 30.00 Engraved Grecian Cobalt. Urn $ 250:00 $ 560.00 CASH ADVANCES Newspaper Notice=Harrisburg $ 184:56 ' Newspaper Notice-Carlisle $ 76.52 Clergy -Honorarium $ 100.00 Certified Copies of the Death Certificate $ 66.00 Coroner Authorization $ 25:00 Flowers $ 145.92 $ 598.00 TOTAL CHARGES $ 4,098.00 Payments. -$ 100.00 January 20, 2012 Cumberland County. Veterans $ 100.00 esanKOrwmenca Purchases and Adjustments 04/01 04/02:. TAXACT:.:ONLINE:1 ..:800573-4267IA.: _9938 .: 5281 .. _ 17:.9. 66831516: ---~ - 1 : ~Q~ 1~ a $176.41 ......_..- ........ ,;.. ....................... .. ~-.~. ~,,_ __ . _........ -- Interest Charged 04/05 04/05 Interest Charged.on Purchases 7.33 04/05 04/05 Interest Charged on Balance Transfers 0.00 04/05 04/05 Interest Charged on Dir Dep&Chk CashAdv 0.00 04/05 04/05 Interest Charged on Bank Cash Advances 0.00 TOTAL INTEREST FOR THIS. PERIOD $7.33 i ~ ~ ~ Total fees charged in 2012 $0.00 Total interest charged. in 2012 $29.54 Annual Promotional Promotional Promotional Balance Interest Percentage Transaction .Offer ID Rate End Subject to Charges by Rate Type Date Interest Transavtlon Rate Type Purchases 21.99~V $419.39 $7,33 Balance. Transfers 21.99~V $ 0.00 $0,00 Direct Deposit and Check Cash 21.99$V $ 0.00 $0.00 Advances Bank Cash Advances 21.99~V $ 0.00 $0.00 APR Type Definitions: Dally Interest Rate Type: V= Variable Rate (rate may vary) - F . -- Discover the convenience of paperlese statements: enjoy easy organization of your account statements, review your statement and traneactione sooner, and reduce your risk of mail fraud and identity theft -all while taking another step towards a greener lifestyle. Simply sign in to your online banking account at www.bankofamerica.com and click the green leaf "go paperlese" icon to get started. 1 ~rF ~r' . h•; ~~ I ~-+•~ 44-4 UI=13131E LUPOLD; TREASltFtER F?=S~?k~T_'G 9h 5. FND1.A ~~RIVE, ltt~C-ht l~] FIkS•I• ~_:..n::_ r+i;tilr h_Ntal.l~ 1~:1< I?'0~5-2T[.}=]• . n.~. P.^.~STA!'~ FnTi TeiY;fS-i~a^.uPll ~e?ruit:r, Rrtl~tµ:;(L~{ PERd1ST :~' ].~i. :.H_.~SSU4u r'A 15931 SCHaOL F2EAL ESTATE TAX STATEMENT ENCLaSED **,"~`~*",~**,~**kAUTC~y*5-DIGIT 1 ~o ~ ~ ~3~a ~ A~ a_~5o AR[~ A ~ MARK R E 4`fl~ RF~OR~ R~ CAMP 111LL PA '[7011-1118 III~IIIII~I~FIII~II~PIII~III1fI~~fII1~IIlolll1fl~l~lllll~l~~l~tll r,q;,+s~ T O' QEigBIE LUPOLf}, TREASIJR:Eft 9'8 S_ EN~LA DRIVE, RO~QM 101 ENOlLA PA 17025-27(A4 z:csr. A5SE5S.NQ -090(}4807 MAP N{l: 09-17-1042-101. 405 ERF[~RQ ROAED ACRES 340 DEEQ (}D26L1~ 03377 Rt~!_EY PAR3C LQT 27 BLK B P]_ 3 PB 11 PG 26 1~RSIpEAITtA1 1 FAMILY T.u: LAlA1,~F'JRp~N~yCE~,1EC~l1WAF~[] A ~ MARK R Pr,TU-1 KO~ ER~~FORL+ RV CAMP HILL FA 1 701 1-1 1 1$ orFi~-= MONDAY-Tf'4URSQAY 9.OUAM - 4:UUphd rr.i,:ur; C4,O~Ea FRIC3AYS 8, HOt.@QAYS PHQhE (717j901-g392 Illlllllllll III IIIIIIC~III 111 AEa~ase~~ Ln:i3 1~a__c~ ti , riCl~" EAST PEN1,15&OPoC) ARE,4 E.D. P.atr_a , pl p;; =,qn i'~'1j~J~~L E:r_ TAk F'AYI=R COPY 2012 Statement of Real Estato Taxes T_;.~Sd•:CmCT.~_ i+11r Cr1I ~ _. ___- g[1.r.][~ ii I ~~ ~~~ ~~~ ~.. ~~_ ~•~-~ ~.~ ~~~ 3 C}~ Bill ~fo: 38a5 Conifl}I No: OOg- 003713 ~i11 Late= 701;7012 T:~ t ?.1 Face Penal -K i.i~5 iij~i~,~5.1_ I --- _ ~- .. _i.1 ,_4.-- ___ TA-7~ A141~UIVT DtJE ---~> 51,231.98 1,257.12 51,382.53 ~€ Paid ~ or After ;'cl,~~~~1_ 9;'Ci.7.0i7 .. .- - _- Tf Paid Oxr ar Pefore e. r'; L7r_I,~UI - '~ -- RETURN ONE COPY WITH PAYMENT"'BF TAXES AR£ ESCFrOWEb FtrRwARD TO MQRTGAGI` CU."'- S1.OD FEE FQR EACH ADD'L COPY qR RECEIPT '6F NpT PD BY i2131l12 TH[5 (BILL YlILL BE RETURNEt} T© TAX CLM BUREAU FOR COLLECTION 8 FILING QF A LIEh1 AGttsT YQUR PROPERTY N~C'rT~~E OF PROPERTY TAX REL[EF Your enclosed tax bill includes a tax r€;ductierl for your hc5r3iastEasi and; ar farmstead prt~perly. As an eligible homesiead amd~cr aarm5tead property aymer, y~iu t~aue teoei~tcd t•~x relief thrau~h a ?lornestsad anlifor farmstead c+xe~u.~iora •~vhieh i7as been prn':ided urldEtr the Panns-y+lvania Taxpayer Relief Act, a lav; 3~assAd by the Pennsylvania General A;semhlY dpsic~nerJ to reduce y~~ur property 4axes. If paying In InstalBnnents us,r the eoupons below to sl,bmlt payments. tf paying in full u$e ONLY the iST coupon below to subinlt payment. TAX YF~1R ~2C11 ~~ 87ATE i i~4~J l+' ~©i ~tr B1LI.fi ~'S5 PAYAHLE Tp i]ERBIE WFY7L0. TFtE.>„SUF~E 9Q S. ENOLA [}RI'JE, R{YJM 10 ENCtLA PFD 17025-2;~tt4 CQNTROL# 009 003713 ,~~~ ~ ~ '~~~.~°;I MAPII o- sr f -I ~ 09-17-1442-101, scp~aoL aEQBp~ t~I.JP~LL] EAST PENNSBO~RO `~~~hJBBOFt~ T>f~~- 7A%PAYER T~~'4'~~~~~' @.AYVRENGE, EDiNARC- A ~ MARIS R E RETURh# DQ6.1430AI ~~'° ~fYITM FL ~~i FULL PA~'AAENT 5'1_9_L~4ON4 BEFORE B3I;`'2D=~ 17 T START AFT@R B~? 1? 2 ~~ . 2 ~~ FU4-L PAYM131JT AMQUNT ~ PAY'8Y . . OI$COUI~T ::,1,?31.9© I C5;'3112~~I2 -FACE.. - - ~ y-_ ~ ~ ~ -: ~ "_I 0 ; i I ~' dl ~:,1_ PENALTY ~1 , 3~>j2 . ~3 , 1.?;'31 'z~ai:. rAxYEA~ ?t11~ care ;;01203? 91LLS ?~g~5 PaYA9LE T4 I~EI3pIE LURDLG, TREkSURER 9S S. EN~LA f)RI'JE, rif5[]Pd 901 ENC3LA PA 1702-274 CDNZRS~L~ UaJ X03718 ~~ Q4-17-3 [t42-1 ~:l 1. sGHOiOL EAST PENt~SEdRU' AREA S.L. TAx PAYER LA'~~t'RENCE, E(JY~'ARU A ~ tJIAFilS [~ ~~ tAJIETH SEC~N[) PAYMENT $41a.n4 aN©ReEFi,]RE y;'+L~;' i2 r4n~' . 94 AFTER .i r', ~ r;'i TW(YEAR ?IPl? DATE ?~1J9r'3lll~ BILLX i?1S{. PA'dABLE Tfl DEBBIE L~JPOL`], 'rFt~uF<ER 9~J 5. ENQLA DRI`1E, RCG`h~1 101 ENDLAPA 67015-z~Ca coNT>~oL:a t~Q9 OO:i718 h4AR# 0~ a 7-1042.1 Q1. SCHQ~DL EAST PEh;N~80R0 AREA $,[?, TAX PAYER LAiNR)^tiCE, ED'NARQ A ~ fi.'iARIS R ~~~ RU~ITAH THIRD PAYMENTDN $~1°~~.0_ ON 4R BEFORE ~e;'~Ii~e,`. $}L-(i.95 AFTER 1=/si:_[~.2 Curnb~ri~n~d ~aunt~ P~nnsy-I~r~nia TA~t ~CQ~.I~ECTOR ~CC~P'Y -RETURN tfV'~T~ PAYMENT FCDR ~'t~~RER CREf}IT LAII~RENGE~ Ed1~+f~RC? Ak & M{~RIS R 40~ I~~F~RH~ I~C?A~ CAMP f°I I LL, PA 17'011-~ ~ ~ #3 Fayabt~ To: DEBBIE LUPQIyD, TREA~tJI~EFC 98 ~ ENC?LA Dt~IVE; R~ON9 '101 ENC~L~,, P~ 1702 PHc~NE (71 ~~ ~c91-~3~~ 405 ERFJI~D ROAD Aces 0 :~ RIDLEY PARi~ L4T ~~ BLK B PL 1 PB 11 PCa 2£ 8iil[ Nfl: 3632 Biii Date: 3?1?12 Control No: 0990046+G7 M,4P r~kC?: a~-'I?-1042=101 _ Amassed ~felue: Land: 41,600 Icnprvvernent: 69,$60 T©tal: i 3 i ,270 Dlacount f+aca Penally County fiE 1.802 $249.55 $249.54 - 5274.49 - - County Llb Tw~r?l~c~ra .143 0.957 $123.05 $16.76 _ $125.56 -- - .510.64 5133.12 'PA,% AMdUf~T t6lt~ If Qate C!f Payment is On 3,+1 i 9 5385.98 fi~ru 4J30112 5333.88 6~ 1 ~ 12 Chru BJ36112 5433.25 7f ~; t 2 ar Later a~i~uniun~~~rum ~~:~ IN RE: ESTATE OF MARIA R LAWRENCE STATE UF__ Pennsylvania IN THE REGISTER O(+ WILLS CUMBERLAND COUNTY CASE#: _ 2012-00095 STATEMENT OF CLAIM Bank of America 1 • hereby presents for filing against the above estate this statement of claim in the amount of $ $3,508.52 2. The basis for the claim is account number 4313072155134466 which was open on 9/22/1999 3. The name and address of the claimant is BANK OF AMERICA F1A CARD SERVICES NA PO BOX 982238 EI Paso TX 79998-2238 4. This claim IS NOT contingent 5. This claim IS NOT secured 6. The last payment made on. the account .was $ $5,00.0.00 on 12/24/2011 7. Please send payments to Bank of America PO BOX 982238 EI Paso TX 79998-2238 1-888-221-4299 Please write the above account number on your check. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Executed this 8 day of February 2012 BANK OF AMERICA FIA CARD SERVICES NA Claimant Name: Crai Smith Claimant Signature: .NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) COURT OF COMMON PLEAS OF C U M B E R LA N D COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF MARIA LAWRENCE ,DECEASED No. 21-2012-0095 To the Clerk of the Orphans' Court Division: Enter the claim of AscensionPoint Recovery Services LLC on behalf of GE Capital Retail Bank JC PENNEY CONSUMER ~:XXXX~~XX~:XXXX8136 (Claimant) in the amount of $ $2,519.63 ,against the above entitled Estate. The Decedent, who resided at 405 ERFORD RD, CAMP HILL PA (Street Address) 17011-1118,died on 01/07/2012. Written notice of said claim was given to (Date of Death) JACQUELINE LAU, (Personal Representative or his/her counsel) at 4 LEEDS RD, NEWVILLE PA 17241, (Address) on 3/16/2012. (Date) APRS Re resentative (CI imant) 2 Coon Rapids Blvd. Suite 200 (Street Address) Coon Rapids, MN 55433-5876 (City, State, Zip) Robin LeDonne - IL Bar # 6294763 (Claimant's Counsel) 200 Coon Rapids Blvd. Suite 200 (Address) Coon Rapids, MN 55433-5876 j7631235-4260 (Telephone)