HomeMy WebLinkAbout04-1034 PETITION FOR PROBATE and GRANT OF LETTERS
s a eoS 4
also known as To:
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
Social Security No. 203 - 10 - 905'5 Deceased.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of ag9 or older.aD the execut o r
in the last wll] of the above decedent, dated
and codicil(s) dated N / A '
in the
rJa, lned
, 19.°z
Decendent was domiciled at death in C u m b e r 1 a n d County, Pennsylvania, with
her last famllyorprincipalresidenceat 664 Bloserville Rd.~ Newville
(list street, number and muncipality)
Decendent, then 89 -- years of age, diefl0e t o b e r 30,2004 ,~
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopte~
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
WHEREFORE, petitioner(s) respectfull2L request(s) the probate of the llast"will and codicil(s)
presented herewith and the grant of letters ~t e s t a m e n t a r y
theron. (testamentary; administration c.t.a,; administrafi%h d.b.n.¢.t, ai~
147 N~orth Mountain~Rd. ,MeWville,
FA 1/241
tative(s) of the above decedent petitioner(s) will well and traly admiaister the estate
Sworn to or af,fir..n3~d and subscribed ,-'~' ~ ~)~-~
before~¢e thi~ ~ day of ] ' ~
~ ~mter L
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF Cumberland SS
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition arc
true and correct to thc best of the knowledge and belief of petitioner(s) and that as personal represen-
according to law.
No. AX-O ,- o$4
Estate Of Virgie E. Foster , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~Lr ~ ~., ~(StJr ~ , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated March 11, 1982
described therein be admitted to probate and filed of record as the last will of
Virgie E. Foster
;
and Letters Tmg~amentary
are hereby granted to Gary Lee Foster
~_ po.o~ FEES
Probate, Lett~s,° Etc .......... $
Short CeHiHcates( ) .......... S 9.00
R~nunciation ................ $ 5.00
TOTAL
Register of WilLs
Andrew H.Shaw 87371
A~VYORNEY (Sup. Ct. I.D. No.)
61 W.Louther ST~Carlisle
~ PA 17013
ADDRESS
717-249-1177
PHONE
RENUNCIATION
In Re Estate of
Virgie E. Foster
deceased,
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned of
the above decedent, hereby renounces) the fi~t to admi~ster the estate and resp~tfully ak(s) that Letters
~issu~to Gary Lee Foster
WITNESS hand this day of ,20 .
(Address)
(Signature)
(Address)
(Signature~/;7~
(Address)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be tbrwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p 10
TM
, 3 5 2 5
No.
NOV' 3 200~
Date
COMMONWEALTH OF PENNSYLVAfllA · O/PARTMEflT OF HEALTH * VITAL RECORDE
CERTIFICATE OF DEATH
E. Foster
88 i ! 9/2/1916
Cumberland
664 Bloserville Road
Newville, PA 17241
Samuel - Barrick
PA
Carlisle Boro. Carlisle Regional Medical Center
Foster~s General ~,[3 ~[] ~
Robert J. Foster, Jr.
F 203 -- 10 _9055 ,. 10/30/2004
PA
Cumberland
,,. Martha - Bloser
~ 214 Shuqhart Ave.; Boiling Springs, PA 17007
11/3/2004 ,~pper Frankford Brick Ch. . Upper Frankford Twp., Cu~
b
[] mC]
I, VIRGIE E. FOSTER, of Upper Frankford Township,
County, Pennsylvania, declare this instrument to be my
testament, hereby expressly revoking all wills and
made by me.
Cumberland
last will and
codicils heretofore
1. I direct my executors to pay all of my debts, funeral and
administrative expenses as soon as may be done conveniently after
my decease.
2. I authorize and empower my executors to sell any realty
owned by me at my death and not specifically devised or bequeathed
herein, at either public or private sale,
sufficient deeds therefor, in fee simple,
3. I give, devise and bequeath all
and to give good and
as I could do if living.
of my estate of every
nature and wherever situate to my four children, share and share
alike, the child or children of any deceased child taking the share
their parent would have taken if living.
4. I nominate and appoint Robert J. Foster, Jr. and Gary Lee
Foster, to be the executors of this my last will and testament; they
arc to serve as such without bond. ~.~ ~
5. I hereby suggest that my personal represent~±ve ~etain
the services of Irwin, Irwin & Irwin as attorneys in the se%~lemSnt
of my estate. ~
IN WITNESS WHEREOF, I have hereunto set my hand and s~al this
~ day of March, 1982. ~ ~
t~/~.~ ~-~ C- ~ ~ (SEAL)
VIR'GIE E. FOSTER
Signed, sealed, published and declared by Virgie E. Foster,
the testatrix above named, as and for her last will and testament,
in the presence of us, who at her request, in her presence and in
the presence of each other have subscribed our names as witnesses
hereto.
ACKNOWLEDGEMENT AND AFFIDAVIT
We, VIRGIE E. FOSTER
and SHARON L. SCHWALM
respectively, whose names are
, BETZI A. MORRISON ,
, the testatrix and the witnesses,
signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument
as her Last Will and that she had signed willingly, and that she
executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and
hearing of the testatrix , signed the Will as a witness and that
to the best of their knowledge the testatrix was at that time
of sound mind and under no
eighteen years of age or older,
constraint or undue influence.
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND
Subscribed, sworn to
VIRGIE E. FOSTER
and sworn to before me by
SHARON L. SCHWALM
March , 19 82 ·
SHARON L. SCHWALM
SS:
:
and acknowledged before me by
, the testatrix , and subscribed
BETZI A. MORRISON , and
, witnesses, this ~ ~ day of
CA!i : - ." ir'
CERTIFICATION OF NOTICE
UNDER RULE 5.6 (A)
Name of Decedent:
Date of Death:
Estate No.:
To the Register:
Virgie E. Foster
October ~0, 2004
2004-01034
I certify that notice of estate administration required by Rule 5.6 (a) of the Orphans'
Court Rules/~vas served on or mailed to the following beneficiaries of the above-captioned estate
on this,~_~day of November 2004.
Bob Foster
Linda Walker
Nancy Louise Snyder
214 Shughart Ave., Boiling springs, PA 17007
674 Bloserville Rd., Newville, PA 17241
90 Yorwick Rd., Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
None.
Date: November 22, 2004
Andrew H. Shaw, Esquire
61 West Louther Street
Carlisle, PA 17013
(717) 249-1177
Attorney for Personal Representative
REV-ISOOH(6-001
REV-1500
'* COMMONWEALTH OF
PENNSYLVANIA
'i1lii DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 04
01034
COUNTY CODE YEAR
_BER
I-
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W
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C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Foster, Virgie E.
DATE OF DEATH (MM~D-YEAR) I DATE OF BIRTH (MM:DD-YEAR)
10/30/2004 _ 109/02/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
N/A
SOCIAL SECURITY NUMBER
I 203-10-9055
I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
\ SOCIAL SECURITY NUMBER
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~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testa.te \Mam top)' uI Wi~)
o 9. Litiga~on Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death alter 12-12-62)
o 7. Decedent Maintained a Liv'lng Trust (Attach copy of Trusl)
o 10, Spousal Poverty Credit (date of death between 12-31-91 and H95]
o 3. Remainder Return (dale ofdeall1 prior to 12-13-621
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9i13(A) (At<.achSch0)
...
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THIS SECtJON',Mull1".' CO"PI..ETl1tl"AlL'COF!F!l!SPOIlDE~,ANtl'CtlllFlll"'llTlAl..tAJ('IIlFtmMAtlON'$!'l<:llllJ11l,l!,~ijl!Ct~'fli(lj"
NAME COMPLETE MAILING ADDRESS
Andrew H. Shaw, Esguire Andrew H. Shaw, Esquire
FIRM NAME Ilf","""I., 61 W. Louther Street
Carlisle, PA 17013
TELEPHONE NUMBER
(717) 249-1177
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1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-ProprietOfship
4. Mortgages & Notes Receivable (Schedule OJ
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate B1IHng Requested
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G orL)
(1)
(2)
(a)
(4)
(5)
75,000.00
94.35
0.00
0.00
205,764.46
(",.)
0.00
(6)
i>?
o
\"Q
(7)
0.00
280,858.81
(9)
(10)
(8)
11,778.38
978.05
(11)
(12)
(13)
12,756.43
268,102.38
0.00
B. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Casts (Schedu(e H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12 Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election \0 tax nas not been
made (ScheduleJ)
14. Net Value Subject to Tax (Une 12 minus Line 13)
(14)
268,102.38
SEE INSTRUCTIONS ON REVERSE SIDE FOR ~PPLlCABLE RATES
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15. Amount ofUne 14laxable at the spousal tax
rate, ortransiers under See, 9116 (a)(1.2)
0.00 x.O 0
(15) 0,00
(16) 12,064.61
(17) 0,00
(181 0.00
(19) 12,064.61
268,102.38
0.00
0.00
16. Amount of Line 14 taxable at lineal rate
x .045
17. Amount of Line 14 taxable at sibling rate
x .12
x .15
18. Amount of Line 14 taxable atcoltateral rale
19. Tax Due
20.0
CHECK HERE IF yOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TOANS1NERALL QUESnON$ ON llEVI;RIIE SlDE AND ll!CHllCK,t.lATH < <
':r-
Decedent's Complete Address:
STREET ADDRESS
.664 BIQ!;Elrvill~ Reali
CITY Newville
STATEpA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
ZIP 17241
12,064.61
0.00
0.00
603.23
Total Credits (A + B + C) (2)
603.23
3.
Interest/Penalty if applicable
D.lnterest
E. Penally
0.00
0.00
4.
TolallnteresUPenalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(3)
(4)
(5)
(SA)
(5B)
0.00
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
11,461.38
0.00
11,461.38
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:
a. retain the use or income of the property transferred;.. .........."...................
b. retain the right to designate who shall use the property transferred or its income;
c. retain a reversionary interest; or........
d. receive the promise for life of either payments, benefits or care?.. ....
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..... ,................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . ..........,......
Yes
o
....................0
..........0
o
.0
.........0
.0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
iii
iii
iii
iii
iii
iii
iii
Under penanies of pe~ury, I declare that I have examined this return. including acoompan,/ing schedules and statements. and to the best of my knowledge and belief. il is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
PERSONRE ~Rb:~
DATE. J.I ___
1/3,/ .oj
ADDRES
147.~M. eunlain Rd, Ne~~.l' -.Cll:t~TAT~
SIGNATU~w...R~r-
AODRESS
61W Leulher St., Carlisle, PA 17013
DATE
/- })- O$'_
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS 99116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 39116 (a) (1.1) (ii)].
The statute does not exemot a transfer 10 a surviving spouse from tax, and the statuto/}' requirements for disclosure of assets and filing a tax retum are still applicable even jf
the sUNlving spouse is tM 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 twenty-one years of age or younger al death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(I.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%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)J.
The tax rate imposed on the net value of transfers to or lor lhe use of the decedent's siblings is 12% [72 P.S. 9g116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX' 16-'.
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Virgie E. Fosler
FILE NUMBER
2004-01034
AU 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 which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
664 Bloserville Road, Newville, PA
75,000.00
TOTAL (Also enter on line 1, Recapitulation) $
75,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1S03 EX< 16-"*
COMMQNINEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Virgie E. Foster
FILE NUMBER
2004-01034
All property joilltly-oWned with right of sU1"'Iivorsl1lp must be disclosed on Schedule F.
ITEM
NUMBER
,.
DESCRIPTION
U.S. Savings Bond Series E, Serial Number Q62025345E
VALUE AT DATE
OF DEATH
94.35
TOTAL (Also enter on line 2, Recapitulation) $
94.35
(If more space is needed, insert additional sheets of the same size)
Savings Bond Calculator
Page 1 of I
Value As Of
11/2004
C TIpdai~]
i _~'!~~
CALCU
Savinc
Bond Info
Series
Denomination
Serial Number
Issue Date
E Bonds
$25
Results
# Bonds
I
Total Price
$18.75
Total Interest
$75.60
Total Value
$94.35
YTDIDl
$0.0
Serial N urn ber Issue Date Series Denom
Issue
Price
Interest
Interest Next Final
Value Rate Accrual Maturity
Q62025345E 04/1942
E
$25 $18.75
$75.60 $94.35
04/1982
le end
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-montb interest penalty
MA Matured and Not Earning Interest
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http://wwws.publicdebt.treas.gov/BC/SBCPrice 1/14/2005
.mmJ1nd.iJdlmJmfmJ
FOR VALUE RECEIVED PROM1SES TO PAY TO
38 s. BeQfo~Q St.,
UNITED STATES
SAVINGS BOND
SERIES E
IS SUE 0 F;'RSS~FD::~F
J~S. Virgie E.Foster,
Carlisle, Penna.
August
(MONTH)
1942
(YEAR)
DUE 10 YEARS
FROM SUCH DATE
~~~~~
~~1~~~
WITHOUT INTEREST, TEN YEARS FROM THE DATE AS OF WHICH THIS BOND IS ISSUED. THIS BOND IS REDEEMABLE AT
THE OPTION OF THE OWNER DURING ANY PERIOD AFTER SAID ISSUE DATE (BUT NOT WITHIN THE FIRST SIXTY DAYS) IN
AN AMOUNT EQUAL TO ITS REDEMPTION VALUE DURING THAT PERIOD AS SHOWN BY THE FOLLOWING
TAElL.E OF REDEMPTION VALUES
CURING SUCCESSIVE PERIODS AFTER ISSUE DATE
llSSUE PRICE-S18.751
..... 118.751212 TO 3 yEARS....... $19'2:515 TO 512 yEARS....... 120.50 17\2 TO B YEARS...
..... lB.75 3 TO 3\02 yEARS....... 19.50 SY.. TO 6 yEARS....... 20.75 6 TO 612 YEARS...
..... 16.67 312 TO 4 yEARS....... 19.75 6 TO 612 yEARS....... 21.00 612 TO 9 YEARS...
..... 19.00 4 TO 412 YEARS....... 20.00 612 TO 7 yEARS....... 21.S0 9 TO 912 YEARS...
..... 19.12 412 TO 5 yEARS....... 20.25 7 TO 712 yEARS....... 22.00 912 TO 10 YEARS.
MATURITY VALUE 10 YEARS FROM ISSUE DATE-S25.00
THIS IS A UN]TED STATES SAVINGS RIES E, J;.UTHORIZEO BY THE SECOND Ll.BERTY BONO ACT, AS
AMENDED, AND ISSUED PURSUANT TO TREA. NT ClJi.CULAR No. 653. REVISED. DATED JUNE 1, 1942, TO
WHICH REFERENCE ]S"MADE FOR A STATE OF HOL.DERS, AS FUllY AND WITH THE SAME EFFECT AS
THOUGH HEREIN SET FORTH.
THIS 60ND IS NOT TRANSFER PROVIDED UNDER SAID CIRCULAR, IT ]S PAYABLE. AT
MATURITY OR ON EARLIER REDEMPTION. 0 OWNER AND UPON THE PRESENTATION AND SURRENDER
OF THIS BOND WITH THE REQUEST FOR HEREOF DULY EXECUTED, ALLIN ACCORDANCE WITH THE
PROVISIONS OF SAID CIRCULAR AND THE 18EO FROM TIME TO TIME THEREUNDER.
THIS BONO SHALL BE VALID ONLY THE OWNER'S NAME AND ADDRESS. DATED THE FIRST DAY
OF THE MONTH IN WHICH THE ISSUE PRICE IS DULY DELIVERED BY AN AUTHORIZED ISSU]NG AGENT. THE
AMOUNT OF UNITED STATES SAVINGS BONDS OF ANY DESIGNATION, ORIGINALLY ISSUED IN ANY ONE CALEN.
OAR YEAR TO ANYONE PERSON,INCLUD]NG BONDS REGISTERED IN HIS NAME ALONE OR WITH ANOTHER AS COOWNER, THAT
MAY BE HELD BY THAT PERSON AT ANY ONE TIME SHALL NOT EXCEED $5.000 (MATURITY VALUE).
FIRST Y.l YEAR...
v.a TO 1 YEAR.. .
1 TO 112 YEARS.
1\2 TO 2 YEARS.
2 TO 212 YEARS
... '22.50
23.00
23.50
24.00
24.50
TREASURY DEPARTMENT, WASHINGTON
~ %""~}c,
Ser:n;taJy rlwlh:(lSwy
NOT TRANSFERABLE
''''Iirn ~r^T"~ I"'" "n'I~'"'' 0"1"'"
!ll~ t r.it rJ , ti ~ &:. 0:,). Jir h ~~ \Ht ~ . !U',- ,J l1 tJ \ U
E-2
REV-1'08 EX+ (6-98) ..
COMMON~ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Virgie E. Foster
FILE NUMBER
2004-01034
Indude 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
1. Orrstown Bank Account, # 5060066172 T
DESCRIPTION
VALUE AT DATE
OF DEATH
32,933.45
2. Commerca Bank, savings account, # 0616086931
23,891.97
3. Commerce Bank, checki9n account, # 0513038729
11,102.95
41,098.15
11,653.16
40,651.38
44,433.40
4. M&T Bank, Certificate of Deposit, # 031003910973378
5. Waypoint Bank, Certificate of Deposit, # 1900012452
6. Waypoint Bank, Certificate of Deposit, # 7100004917
7. Waypoint Bank, Certificate of Deposit, # 1754254931
TOTAL (Also enter on line 5, Recapitulation) $
205,764.46
(If more space is needed, insert additional sheets of the same size)
ORRSTOWN BANK
POBOX 250
SHIPPENSBURG PA 17257-0250
1-888-0RRSTOWN OR 717-532-6114
Payer's
Fed 1.D. No.
23-0934350
OMB No. 1545-0112
Interest Income
Form 1099-INT
Copy B
For Recipient
For year 2003
VIRGIE E FOSTER
664 BLOSERVILLE ROAD
NEWVILLE PA 17241
Recipient's
Tax LD. No.
203-10-9055
Account Information
* - - - - ~ - - - - - - - - - ~ - - ~ - - *
Interest
Income
*._-~--------*
Interest on U.S.
Bonds & Treas
* - - - - - - - - - - - - *
Federal Tax
Withheld
* - - - - - - - - - - - - *
5060066172 T
448.99
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
BOX 1 Interest income not included in box 3. . . . . . . . .
BOX 2 Early withdrawal penalty. .. ..........
BOX 3 Interest on U.S. Savings Bonds and Treas. obligations.
BOX 4 Federal income tax withheld.
BOX 5 Investment expenses. . . . . .
BOX 6 Foreign Tax paid . . . . . . .
BOX 7 Foreign country or U.S. Possession
448.99
This is important tax information and is being furnished to the
Internal Revenue Service. If you are required to file a return,
a negligence penalty or other sanction may be imposed on you if
this income is taxable and the IRS determines that it has not
been reported.
(KEEP FOR YOUR RECORDS.)
/,0/30/ 00 .~iZ.3;)1 t)3 3- YJ,-
Commerce
.Bank
Commerce BankJHarrisburg N.A.
100 Senate Avenue
Camp Hill. PA 17011
888-937-0004
STATEMENT DATE
VIRGIE E FOSTER
664 BLOSSERVILLE Em
NEWVILLE PA 17241
11/22/04
0616086931
ACCOUNT NO.
*** SAVINGS *** PREMcrER SAVINGS
ACCOUNT NUMBER 0616086931
PREVIOUS STATEMENT BALANCE AS OF 12/31/03 "" ....................
PLUS 11 DEPOSITS AND OTHER CREDITS ...................
LESS 1 WITHDRAWALS AND OTHER DEBITS ................
CURRENT STATEMENT BALANCE AS OF 11/22/04 .. .......................
NUMBER OF DAYS IN THIS STATEMENT PERIOD 327
BEGINNING RATE
CLOSED
0.99500
23,'714.74
207.12
23,921.86
.00
-----------------------------------------------------------------------------------
... SAVINGS ACCOUNT TRANSACTIONS ...
DATE DESCRIPTION
01/31 INTEREST PAYMENT
02/29 INTEREST PAYMENT
03/31 INTEREST PAYMENT
04/30 INTEREST PAYMENT
05/31 INTEREST. PAYMENT
06/30 INTEREST PAYMENT
07/31 INTEREST PAYMENT
08/31 INTEREST PAYMENT
09/30 INTEREST PAYMENT
10/31 INTEREST PAYMENT
11/16 DEBIT MEMO
11/17 PMT ON 00 ACCT
DEBITS
CREDITS
19.99
18. '71
20.02
19.39
20.05
19.42
20.08
20.10
19.47
20.14
23,921.86
9.75
-----------------------------------------------------------------------------------
*** BALANCE BY DATE ***
12/31 23,714.74 01/31
04/30 23;792.85 05/31
08/31 23,872.50 09/30
11/17 .00
23,734.73
23,812.90
23,891.97
02/29
06/30
10/31
23,753.44
23,832.32
23,912.11
03/31
07/31
11/16
23,773.46
23,852.40
9.75-
PAYER FEDERAL ID NUMBER
INTEREST PAID YEAR TO DATE
23-2324730
197.37
*** INTEREST EARNED THIS STATEMENT PERIOD
DAYS IN PERIOD .........................
INTEREST EARNED.............. ..........
ANNUAL PERCENTAGE YIELD EARNED (APY)....
***
323
197.37
0.95%
.~_......._~ ~nl'"
Commerce
.Bank
Commerce Bank/Harrisburg N.A
100 Senate Avenue
Camp Hill Pa 17011
888-937-0004
Page 1 of 3
STATEMENT DATE
VIRGIE E FOSTER
664 BLOSSERVILLE RD
NEWVILLE PA 17241
10513038729
ACCOUNT NO.
14
hw CHECKING wn 5U ~~~S CLUB
ACCOUNT NUMBER 0513038729
PREVIOUS STATEvmNT BALANCE AS OF 10/19/04 . ... ...... ... ...........
PLUS 4 DEPOSITS AND OTHER CREDITS.... ...............
LESS 14 CHECKS AND OTHER DEBITS .... ..... '" ..........
CURRENT STATEMENT BALANCE AS. OF 11/18/04 .. '" '" ...... ....... ....
NUMBER OF DAYS IN THIS STATEMENT PERIOD 30
CYCLE-015
11,533.72
1,778.35
13,312.07
.00
*** CHECK TRANSACTIONS ***
SERIAL DATE AMOUNT SERIAL DATE AMOUNT
1092 10/22 69.52 1098 10/29 164.64
1093 10/26 33.84 1100* 11/01 3,244.00
1094 10/25 28.74 1101 11/04 876.00
1095 10/25 19.06 1102 11/03 21. 06
1096 10/27 114. 97 1103 11/08 16.47
1097 11/04 69.89 1104 11/05 10.77
*** CHECKING ACCOUNT TRANSACTIONS ***
DATE DESCRIPTION
11/01 DEPOSIT
11/01 DEPOSIT
11/03 AC-US TREASURY 303 -SOC SEC
11/04 ACH RETURN ITEM 11/3
11/16 DEBIT MEMO
11/18 INTEREST PAYMENT
DEBITS
CREDITS
493.72
548.57
735.00
735.00
7,908.11
1.06
*** BALANCE BY DATE ***
10/19 11,533.72 10/22
10/27 11,267.59 10/29
11/04 7,934.29 11/05
11/18 .00
11,464.20
11,102.95
7,923.52
10/25
11/01
11/08
11,416.40
8,901.24
7,907.05
10/26
11/03
11/16
11,382.56
9,615.18
1. 06-
PAYER FEDERAL ID NUMBER
INTEREST PAID YEAR TO DATE
23-2324730
13.29
*** INTEREST EARNED THIS STATEMENT PERIOD
DAYS IN PERIOD... .......... ....... .....
INTEREST EARNED ........................
ANNUAL PERCENTAGE YIELD EARNED (APY)....
***
30
1. 06
0.15%
.........."Tr"'. ___ __.._........... .......... ...."'... ........................... ....~n....~..IITlnr.l
M""mhpr Fnlr.
F!1Mg,~
P.O. Box 767, Buffalo, NY 14240-0767
1099.tNT (OMB No. 1545-0112)
1099-DIV (OMB No. 1545-0110)
1099-010 (OMB No. 1545.0117)
1099 Mise (OMS No. 1545-0115)
QQ377781L
1099.A (OMB No i54S.0877)
1099-8 (OMS No 1545-0715)
1099-C (OMB No 1545-1424)
1099-S (OMB No 1545-0097)
1098 (OMS No, 1545-0901)
E.I.N. 16-0538020
1-800-724-2440
FOR TAX YEAR
VIRGIE E FOSTER
664 BLOSERVILLE RD
NEWVILLE PA 17241-871Q
377781
4319
2003
iAXPAYER 10 NUMBER
2Q3-1Q-9055
2003
1099-INT, INTEREST INCOME
CERT OF DEPOS IT
BOX 1
ACCOUNT NUMBER
031003910973378
INTEREST INCOME
419.32
TOTAL INTEREST
419.32
$ 4-\ OCJ8) 0- -, \ \~) oS-
)
"'Form 1099-010: This may not be the correct figure to report on your income tax return. See instructions on back.
LOOM (12/00)
1099-INT
1099.DlV
10.99-010
1D99.MISC
,0.99.B
1o.99-A
1Q99.C
1(l9IH~ORTGAGE
The irrformahcnI'lBxtto bOll8S1,2,lnd3 is imporlarrttllcinfor.
/'l'IItionlnd is bei1lg furnished to thB Internal RevenulService
If yo II a~ rell.uired to fil, a return, a negliglilnce pl!lnaltyor otMr
sanc1ion may be imposed on you If the IRS determines that an
undlrpaYrnIlIntoflaxresu1lsbeclIuseycuoverstatlda deductIon
for this rTlllrtglge u,terestor for these polmsor beclIuseyou dlo
I'IOt ,..pollthisl&ll.lmlof ime1as\onyour1Il'\urn.
This is importllrrttlxinforl!'llltionend is beingfurnillhedtothlil
Internal Revellue Service. If YOLlIHIiI reo,uiredto fill a return, a
nlilgligel1cep.enaltyor other sanction may be imposedonyouif
this il'lcome IS taxable and IRSdeterlTllf'l8sthat it has nOt been
reportld
This is impllrtanltilxinforlT\irlionllnd is being furnished to
thlt lntlrnllIRlvenueSlrvic;e.lfyau." "llulredtcfile a
rl'llrn,i1 Tl8gligencepenllltyclr otherSlll'll:tionlTllly be
imposedonyoulftlllllbllincomere$ultsfromthlstrans.
IIctionand the IRS deterlTlinesthat it has not been reportlo
90-.0050-0
Work with Customer Accounts
Subset by FOSTER VIRGIE E
Sequence by . . 1 Short name
Type options, then press
5=Display account
12=Customer summary
Opt Short Name
FOSTER VIRGIE E
FOSTER VIRGIE E
FOSTER VIRGIE E
FOSTER VIRGIE E
F3=Exit
F5=Refresh
Enter.
8=Display description
14=Work with alternate
Account number
9870010203109055 1
1754254931
1900012452
7100004917
Fll=Un/Fold
F12=Cancel
F4
10=Work with memo/tickler
15=Maintain relationships
Balance
44,433.40
11,653.16
40,651.38
F17=Subset
Rel Type prd Alt
1 Z
SOW TM 350
JOF TM 202
SOW TM 202
Bottom
REV-1511 EX+ (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Virgie E. Fosler
FILE NUMBER
2004-01034
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Ev.<ng Brothers Funeral Home, Inc.
Tombstone Engraving to John S. Wadel
Funeral Reception
9,762.50
110.00
389.59
2.
3.
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
0.00
Name of Personal Representative(s)
Social Security Number(s)fEIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commiss'lon Paid'
2.
Attorney Fees
1,000.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, aUach explanation)
0.00
Claimant
Street Address
City State .Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Legal Advertising
297.00
0.00
0.00
219.29
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
11,778.38
Ewing Bl"Others Funeral Home, Inc.
630 South Hanover Street
Carlisle, PA ] 7013-
(7] 7)243-242]
November 4.2004
Robel1 J. foster, Jr.
214 Shughal1 Avenue
Boiling Springs, PA 17007
The funeral Service for Virgie E. Foster
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.
TIlE rGLLOWIi\G IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE fUNERAL ARRANGEMENTS.
L PROFESSIONAL SERVICES
St'ni<,;c$ of hmeral Director/Staff
$3400.00
$3400.00
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Tapt'stry Rose Solid Copper, . . . . . . . .
#5 1\l1lcric<l11 Chief . . . . . . . . . . .
$4500.00
$1300.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
TIJA T YOU HAVE SELECTED . . . . . . . . . . . . .
$9200.00
Cash Advances
Opening (ir<we, . , . . . . . .
Certifit:cI Copies of the Death Certificate.
1100.\ers . . . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$50000
$30.00
$132.50
$662.50
Total
T utal Cost
. . . . . . . . . . . . . , . . . , . . . . .
$9862.50
SUB-TOTAL
IN!T1AL PAYMENT I DISCOUNT / CREDlTS
TOTAL AMOUNT DUE
$986250
]00.00
$9762.50
/i U'jL' au.;,""..?;; u/ chi/,.)
-L-U'-"?, . .
VeT ~eA)d;r..- rc ,1><2
/~ceiv~j
rill' 1Illp<iid b:1lilnce m'(T 45 days is subjected to a l_OO % service charge per month - 12.0000 % per annum
Member of National Funeral Directors Association
......2 ,.r-
,/' (p
.
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;;;; (g5--loPc~ E~/1A~)'/.!/-h/ /1./ ~'
TERRIE WISER
00ss~oods ctlestouMnf
and CBabe ghop
399 Carlisle Road . P.O. Box 133
Newville, PI'. 17241
Phone: 776-5901
~
Customer's
Rec'd by
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REV-1512 EX+(12-03}
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Virgie E. Foster 2004-01034
Report debts incurred by the decedent prior to death which remaIned unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Electric bills for maintenance of real estate 139.46
2. Final medical bills 326.98
3. Final Cable TV bill 19.06
4. Oil heat for real estate 402.42
5. Final trash bill 56.87
6. Final telephone bill 33.26
TOTAL (Also enter on line 10, Recapitulation) $
978.05
(If more space is needed, insert additional sheets of the same size)
Reading Dales: 11/19/2004 TO 12/14/2004
Rate: RHW32 RESIDENTIAL W/WTR HT
Service Loc: 664 BLOSERVlLLE RD NVL
_m___._____________.._____..___~_ BILLING DET AILS~-------------------._--.
BASIC CHARGES
Energy supply prices and charges are set
by your electric generation supplier.
Adams Electric Cooperative Inc.
1338 Biglerville Road
Gettysburg, PA 17325-1055
ENERGY SUPPLY:
(888) 232-6732
Energy charge
250kwh @ .04074
10kwh @ .02574
TOTAL ENERGY SUPPLY
DISTRIBUTION:
Service charge
Distribution charge
260 kwh @ .02926
TOTAL DISTRIBUTION
i FCR CHARGE
260 kwh @ .01805
TOTAL BASIC CHARGES: J .,/
PI~' 10)
1-~{1f
10.19
0.25
10.44
13.00
7.61
20.61
4.69
35.74
NON-BASIC CHARGES
@&
I ACCOUNT SUMMARY
f.....,-.-..-,~~,_._".-.,-,....,.~.-~.-.~.---..-.-;'r_~_,~._,~..~_____.__.~._,__~__~.~,___M__.._".~_;
I Rav Month I DEe 2004 I Previous Balance: 46.82 i
i-...-....._..j..--_..~ Payments Received: -46.82 !
:Total vaarlvl I Balance Forward: 0.00 i
i KWH for i 7070 I' Total Basic: 35.74 I
i past 12 :
1 months ! Total Non-Basic: 0.00 !
r-<A-~'~r~ie "\ Sales Tax: 0.00 t
i monthlv i 589 i ACCOUNT BALANCE 35.74 :
: KWH i I
I for past 12 :
f months r
-~~=::~~
------~
-...
PAYMENT DUE
01/15/2005
if~:
_..~4..]
Please detach the above portion and return with your payment
r-"'.'-,.__._-~_.._--,._-"~._---_.~- -..--.----~.,..---,.-'--------..-..,----"~---""--.-.------;
I Account #: 2051314100 Moter Type !Previcus Rd 1 Proseht Rd \ Multiplier I KWH Used I
i Name: V!RGIE E FOSTF-R KWH 32200 32740 j 540
Reading Dates: 09/24/2004 TO 10113/2004 I
Rate: RHW32 RESIDENTIAL W/WTR HT I
Service Loe: 664 BLOSERVILLE RD NVL I
i I
t-----------------..,------
-...R9adrngl'''.'--.~-..--. ....-[
Type ~ !
Act~.1 -----------.1
I
_,..___.'~ .~_~_.~.""___.._~__"'~,__.._____.....__o..,_"_.~
BILLING DETAILS
BASIC CHARGES NON.BASIC CHARGES
I ,
I Energy supply pnces and charges are set
, by your electnc generation supplier_
Adams Electric Cooperative Inc, (888) 232-6732
1338 Biglerville Road
Gettysburg, PA 17325-1055
: ENERGY SUPPLY:
I
I
I
1------- '---: -.-------------,-------- -----.-...------------ .------,--
I Rov Monl~ I OCT 2004 ! Previous Balance:
F ' I
1:;-----4---------------- Payments Received:
iTotal yoarly\ !. Late Penalty:
I KWH 10r 1 7500 !
I past 12 1 1 Balance Forward:
t,,~.~.~~~.~..~_.L.".~ "....; TotalSasic:
f Average I Total Non-Basic:
! mK(:J~ly I' 625 Sales Tax:
I tor posl12 ACCOUNT BALANCE
1_~~~lhSJ __
i
I
:
". __L
,
i /.~"-"",
i /-~/ . '-""
, i PAYMENT DUE 11/15/2004 i 56.90}
L____ ___________._______________________,______.------J_____________________----.. --.----,.--- ------1;--------------.--
- - " /-'
Energy charge
250 kwh @ ,04074
290 kwh @ ,02574
10_19
7.46
TOTAL ENERGY SUPPLY
17.65
DISTRIBUTION:
Service charge
Distribution charge
13_00
14_63
0.83
500 kwh @ ,02926
4UKWh @ .0;;::076
TOTAL DISTRIBUTION
28.46
FCR CHARGE
540 kwh @ _01805
9.75
TOTAL BASIC CHARGES:
55.86
~)c~ - /((!~I
" !Iq
If "--__
ACCOUNT SUMMARY
69_52
-69,52
1_04
1.04
55,86
0_00
0_00
56.90
Please detach the above portion and return wIth your payment
I Account ;: 2051314100""----- Meter Type Pre\ii';us Ad' pre.eni~"df"iiiiultiPlie;"TKWH U~"d! A~-r---"-I
Name: VIRGIE E FOSTER KWH 32740 33140 1 400 Actual I
I \
! Raading Dates: i\i(1312004 TO 11(19(2Q04 I I
Rate: AHW32 RESIDENTIAL W/WTR HT 1
! Service Loc: 664 BLOSEAVILLE AD NVL I
r -L-
[
,
!
._-"'~~----"--_._-,.,~-'--------_._~---_.__.!
BILLING DETAILS i
I
, BASIC CHARGES NON-BASIC CHARGES
Ii Energy supply prices and charges are set
i by your electric generation supplier.
i
Adams Electric Cooperative Inc, (888) 232-6732
1338 Biglerville Road
Gettysburg, PA 17325-1055
; ENERGY SUPPLY:
Energy charge
250kwh @ ,04074
150kwh @ ,02574
10,19
3,86
TOTAL ENERGY SUPPLY
14.05
I
I
I DISTRIBUTION:
Service charqe
Distribution charge
400 kwh @ .02926
13.00
11.70
TOTAL DISTRIBUTION
24.70
FCR CHARGE 400 kwh @ .01805
7.22
r-'-"'-'_._-"--"~"'---"~-"-
i ;~~;';:;;;~"i~~v{;~C?fO~~~O~SUB::~~-~----~9~1.'
1.__"__--+___._____ Payments Received: -56.90
ITotal yea~'YI Late Penalty: 0.85 !
I KWH lor . 7290 i
i past 12 f I Balance Forward: 0.85 ;
[ months i ) Total Basic: 45.97 \
i~_._.."u__".~.L. "'~"'~'"~ _. u', . '
1 Average i Total Non-BasIc: 0.00
I monthly ( 607 '.... Sales Ta)c 0.00 '
I KWH I .
I lor past 12 I ACCOUNT BALANCE 46.82
I months i
r------'-.,,,.
i
,
,
; TOTAL BASIC CHARGES:
45.97
(J0V \o~
\5 ~ \10
\11 .
i PAYMENT DUE 12/15/2004
".._,~_, ---1..----., ._,~_..".."_,____"..__.._..,..__.___.'"..,._._.__.__._~_.___,,__.;..__
DATE
TREATING PROVIDER
DESCRIPTION OF SERVICE
CHARGES/CREDITS
BALANCE
-,'~',
10/28/04 1108 RANKIN EMERGENCY DEPT VISIT
12/06/04 1108 RANKIN PENNSYLVANIA MEDICARE
12/06/04 1108 RANKIN INSURANCE WRITE-OFF
WE HAVE EITHER RECEIVED NO PAYMENT OR PARTIAL PAYMENT
FROM YOUR INSURANCE COMPANY. THE BALANCE REFLECTED IS
YOUR RESPONSIBILITY AND PAYABLE AT THIS TIME. HOWEVER,
IF YOU ARE UNABLE TO PAY THE FULL BALANCE IN ONE
PAYMENT, IT WILL BE NECESSARY FOR YOU TO CALL OUR
OFFICE TO SET UP A STRUCTURED PAYMENT PLAN. THANK YOU.
Referred by RANKIN DO, R. SCOTT
411.00
-116.81
-264.99
29.2,0
[, '. /
JO 'e(O /Y/
i, C\ '\' \, 0 ~
'j,! "I)I
J II
I'
\ \
Please Remit Payment tn, If you have questions regarding this bill please call
CENTRAL PENN MEDICAL GROUP EMERGENCY 1-866-247-3141 (toll free) or email
PO BOX 619
EAST PETERSBURG, PA \7520-0619 patientinquirv(aJ,mica.nel. THANK YOU.
FOR YOUR CONVENIENCE, YOU MAY PAYONLINEATwww.mjca.nel
DATE TREATING PROVIDER
DESCRIPTION OF SERVICE
CHARGES/CREDITS BALANCE
10/16/04 1108 RANKIN EMERGENCY DEPT VISIT 168.00
11/26/04 1108 RANKIN PENNSYLVANIA MEDICARE -48.00
11/26/04 1108 RANKIN INSURANCE WRITE-OFF -108.00
WE HAVE EITHER RECEIVED NO PAYMENT OR PARTIAL PAYMENT
FROM YOUR INSURANCE COMPANY. THE BALANCE REFLECTED IS
YOUR RESPONSIBILITY AND PAYABLE AT THIS TIME. HOWEVER,
IF YOU ARE UNABLE TO PAY THE FULL BALANCE IN ONE
PAYMENT, IT WILL BE NECESSARY FOR YOU TO CALL OUR
OFFICE TO SET UP A STRUCTURED PAYMENT PLAN. THANK YOU.
Referred by RANKIN DO, R. SCOTT
12.00
AA/1O ,,{if
;2- r;!/
'),1
}
PI.as. R.mH Paym.ntto, If you have questions regarding this bill please call
CENTRAL PENN MEDICAL GROUP EMERGENCY 1-866-247-3141 (toll free) oremail
PO BOX 619
EAST PETERSBURG, PA 17520-0619 patientinquiry@mica.net. THANK YOU.
FOR YOUR CONVENIENCE, YOU MAY PAY ONLINE ATwww.rnjca.nel
DATE DR PATIENT DESCRIPTION CHARGES CREDITS
10/29/04 jds Virgie . Initial Hospital ,Care Per Day Level 216.00
12/01/04 P ra". Pay",enf:106054843 .. ... -121.00
12/01/04 Adj:Medicare Adjustment -64.75
10/30/04 jds Virgie HospitaL Discharge Day 30 Min Or Les 100.00
12/01/04 Plan Payment:106054843 -54.40
12/01/04 Adj;Medicare Adjustment "32.00
$43.85 coinsLlrance
Appointments: Call 717/258-4700 Claim Questions: Call 717/249-2482
*Amounts pending with insurance are not included in the balance dUe. You will be billed once your insurance responds to our claim.
ACCT: 006014-00 CURRENT 30-60 DAYS 60-90 DAYS 90-120 DAYS OVER 120 DAYS
INS BALANCE 0.00 0.00 0.00 0.00 0.00
PATIENT BALANCE 43.85 0.00 0.00 0.00 0.00
() -0 /'
dlr! /(/>
dVJ
f
II
\I
II
II
SEDLACK SURGERY
220 WILSON STREET
SUITE 204
CARLISLE. PA 17013
717-258-4700
II
II
II
II
PATIENT DUE
$43.85
16466-VB03*1f40Y9GRSOOOO25
1IIIIIIIIMIIIIIIIIIIUlllllllmlMHlHlIll!lIIIIi
Ylease NOte: 11 a . J.' appears IR rots COlUmn, we nave l11eu WUII yuur pnuuuy ClIntt:.. .ll" '" .Vl't:l;U II, .
o Please cheol<ellw<.iIIlb<lll<da.Udt""8ri.~lOri<lsurance identified has cnanged, indicate change(s) on reverse side.
Date
~0/22/04 JJ
.1/19/04
"1/19/04
Account Balance
$10.10
Providers
Pro
ider
ICD9
R~ference
Descrh1tiodof S~rvices
~ount
. rharDed
414.00
99213 VIRGIE OF/OP VST EST LVL
MEDICARE WRITE OFF ADJUST
MEDICARE PAYMENT
68.00
. Da.....ent" Ins-;;rance
17.52
40.38
THERE WI L BE A
INSUFFIC ENT FUJi
25.00 CHARGE IF A CHECK IS ETURNED OR
S. WE ACCEPT VISA,M/C & MAC.
meferto
Due From
Patient" For
Amount to Pay)
flJ q I 0 ~
l ~) f{)
I $/10' t
ou~
a,~l
10.10 1
Current Over 30 Over 60 Over 90 Over 120 Du~ From
Balance Pattent
$10.10 SO.OO $0.00 <0.00 SO.OO .~10.10
Account Number
66514
Name
VIRGIE E FOSTER
JOHN CRAIG JURGENSEN MD
231869105
Statement Date
Make check Payable To
12/06/2004
I Telephone for Questions
1(717)243-3120
NEWVILLE COMM. AMBULANCE C/O PROMED SERVICES, INC.
4807 JONESTOWN ROAD SUITE 247
HARRISBURG, PA 17109
1-866-678-6855
Patient Bill
~ ~i
~\~~
~\
Page: 1
Printed: 11/19/04 08:52
VIRGIE FOSTER 10: Newv-509
664 BLOSERVILLE RD
NEWVILLE, PA 17241
DOB: 09/0211916
LIne Date Range prv Procedure DxRef POS Charge Unt Apprv'd Pt Pd Ins Pd Adjusted pt Due Balance
Patient: VIRGiE FOSTER
Claim Number: 47401057Diagnosis 1) 789.002) 560.9
Ins: 1) Me/Asgn 203109055A
01 10/28-10/28/04 010 A0427RH 12 A 725.00
Procedure: ALS LEVEL 1 EMERGENCY
02 10/28-10/28/04 010 A0425RH 12 A 88.00
Procedure: MILEAGE
0310/28-10/28/04 010 A0422RH 12 A 50.00
Procedure: OXYGEN
iD: 509 DOB: 0910211916
3) 4)
337.43 269.94 0.00 67.49 67.49
11 48.25 38.60 0.00 9.65 9.65
9.68 7.74 0.00 1.94 1.94
395.36 0.00 316.28 0.00 79.08 79.08
Patient Totals:
863.00
Total Amount Due By Guarantor: 79.081
q11~q H 7
I -~1~"
DATE TREATING PROVIDER
DESCRIPTION OF SERVICE
CHARGES/CREDITS BALANCE
09/05/04 1113 CORDLE EMERGENCY DEPT VISIT
10/14/04 1113 CORDLE PENNSYLVANIA MEDICARE
10/14/04 1113 CORDLE INSURANCE WRITE-OFF
WE HAVE FILED MEDICARE AND ACCEPT ASSIGNMENT. ANY
PORTION ABOVE THE MEDICARE ALLOWABLE IS WRITTEN OFF.
ANY BALANCE REMAINING IS A REFLECTION OF YOUR 20%
CO-PAY OR DEDUCTIBLE PORTION OWED TO THE PROVIDER.
PLEASE REMIT BALANCE TO THE ADDRESS INDICATED ON THIS
STATEMENT. THANK YOU FOR YOUR COOPERATION.
Referred by CORDLE MD, RANDALL
\' I'u:.J
-i oS I
411.00
-116.81
-264.99
29.20
V/120/Z ,?
(y~y 'D- \
GY~
1't/vW
irwJi.
~~
ocY I OJIO~ ,)..0
'f II II :/1 '
Please Remit Paymentto: If you have questions regarding this bill please call
CENTRAL PENN MEDICAL GROUP EMERGENCY 1 866 247 3141 ( II fi) '1
PO BOX 619 - - - to ree or ema1
EAST PETERSBURG, PA t7520-0619 patientinquirv@mica.net. THANK YOU.
FOR YOUR CONVENIENCE, YOU MAY PAY ONLINE ATwww.mjca.net
PATIENT NAME
FOSTER, VIRGIE E
rAUtN I ,I\(,buun I I'U. Ut\IC 'UI'" "LnVIVL.
'.1......:..., .............__
DATE
9294616
DESCRIPTION
10/16/200 EMERGENCY ROOM
897.85
PAYMENT/ADJUSTMENTS
11/04/04 MEDICARE PAYMENT
11/04/04 MEDICARE CONTRACTUAL ADJUSTMENT
110.08-
733.21-
g /, sJn
~~'\ I'1lo~
,I
MESSAGES
The amount shown on this statement is outstanding at
this time. Your prompt payment will be greatly
appreciated.
ACCOUNT BALANCE DUE
$54.56
PAYMENTS AND CHARGES RECEIVED AFTER THE STATEMENT DATE WILL BE REFLECTED ON THE NEXT STATEMENT.
FOR BILLING QUESTIONS, PLEASE CALL:
(717) 218-8852
--
~. ll/22/2QD~ I
p~'!tf@lf5U"'~~M(W~r.me~~ 1l!>~~~'!lMl\lfllt!i~~~fIM"'~l'\a;' ~~~!>d, indicate change(s) on reverse side. ~O~
we aye a so I e WI your seCOR ary carner.
ro ~ount
Oate ider ICD9 Reference DescTi";tlon .of Services C ar.....d Pa"Dlents Insurance Balance.. .: ......
9/05/04 JJ 427.31 93010 VIRGIE EKG INTERP & REPOR 40.00 1. 74 1
0/18/04 MEDICARE WRITE OFF ADJUST 31.28
0/18/04 MEDICARE PAYMENT 6.98
9/06/04 JJ 599.0 99232 VIRGIE HOSP,FOLLOW-UP-L 2 95.00 10.72 1
0/12/04 MEDICARE WRITE OFF ADJUST 41. 41
0/12/04 MEDICARE PAYMENT 42.87
9/07/04 JJ 599.0 99232 VIRGIE HOSP,FOLLOW-UP-L 2 95.00 10.72 1
0/12/04 MEDICARE WRITE OFF ADJUST 41.41
0/12/04 MEDICARE PAYMENT 42.87
9/08/04 JJ 599.0 99232 VIRGIE HOSP,FOLLOW-UP-L 2 95.00 10.72 1
0/12/04 MEDICARE WRITE OFF ADJUST 41. 41
0/12/04 MEDICARE PAYMENT 42.87
9/09/04 JJ 599.0 99232 VIRGIE HOSP,FOLLOW-UP-L 2 95.00 10.72 1
0/12/04 MEDICARE WRITE OFF ADJUST 41. 41
0/12/04 MEDICARE PAYMENT 42.87
9/10/04 JJ 599.0 99232 VIRGIE HOSP,FOLLOW-UP-L 2 95.00 10.72 1
0/12/04 MEDICARE WRITE OFF ADJUST 41. 41
0/12/04 MEDICARE PAYMENT 42.87
9/11/04 JJ 599.0 99238 VIRGIE HOSPITAL, DISCHG S 111.00 13.60 1
0/12/04 MEDICARE WRITE OFF ADJUST 43.00
0/12/04 MEDICARE PAYMENT 54.40
0/22/04 JJ 414.00 99213 VIRGIE OF/OP VST EST LVL 68.00 68.00 1
EFFECT IV 2/1/04 A $25 FEE WILL BE ASSESSED N ALL CH CKS
RETURNED FOR INS UFFICIENT FUNDS. WE ACCEPT V SA,M/C & MAC.
Account Balance m:efer to C::rrent Over 30 Over 60 Over 90 Over 120 Due Froro
Due From Ba ance Patient
Patient" For ~~:~~~
Amount to Pay) <68.9 SO.OO ~O.OO ~O.OO
5136.94 SO.OO
Providers Account Number Name I Telephone for Questions
66514 VIRGIE E FOSTER (717) 243 -3120
JOHN CRAIG JURGENSEN MD
231869105 Statement Date Make check Payable To
yc9. / J 11/03/2004 BELVEDERE MEDICAL CORPORATION
. I Jq to
JI <&,C1't
h
KUHN COMMUNICATIONS, INC.
P.O. BOX 277
WALNUT BOTTOM, PA 17266-0277
1-800-771-7072
AMOUNT IS DUE IN OUR OFFICE ON
OR BEFORE THE 15TH. IF THIS
AMOUNT IS NOT PAID A $2.00
SERVICE FEE WILL BE ADDED TO
YOUR ACCOUNT.
Billing Questions Please Call:
532-8857
OUrt OFFICE H:LL BE OPEN ON
SATL~AY, DECEMBER 4TH FROM
8AM - 12 NOON.
PLEASE SEE INSERT!
NOW ON BASIC 2 PACKAGE:
CHANNEL 55 - AMC
CHANNEL 56 - E!
COMING SOON ON CHANNEL 57
HALLMARK CHANNEL
1
/" Account Number T=~~-Du;-Dat;'~-----\:
t 006-001052 I 12/15/04 '
_.__________._______ __ ____1_ _______________._.___
,........-'--------'--_._,._---~._-_._.,--_._--"..,~---_._.,._-----------...--"
l Account Summary ___~
Billing Date 12/1/2004 Payments through:ll/22/04
VIRGIE FOSTER Previous balance
664 BLOSERVILLE RD (-) Payment (11/2/2004)
NEWVILLE PA 17241-8710 (=) After Payments
r
I
I.
Current Month Activity
Date
DescriptIon of Service
12/1./2004
12(1(2004
1.2/1/2004
12/1/2004
ADD'L OUTLET
BASIC
EX'!' El.r,.SIC _
FCC
12/01. .12/31
12/01. .12/31
12/01. .1.2/21
12/01. .12/31
Total Current Charges
Total Due
~JI)olof p.),ljo+
I~ [Jr'D
,II
( ct- u)
d 'r. [Vft
HOOK-UP TO CABLE MODEM SERVICE AND RECEIVE 1/2 OFF INSTALL (A $25
SAVINGS!) & 3 MONTHS' SERVICE FOR 1/2 PRICE. CALL FOR HOOK-UP!!
OFFER GOOD TILL 12/31/04.
$21.06
($21.06)
$0.00
Amount
$3.00
,910.00
S5.DO
$0.06
$19.06
$19.06
~_______..,_~__ __~" ____._~______~_~_~_ u__
KOUGH'S OIL SERVICE
P.O. BOX 116
NEWVillE, PA. 17241
PHONE: 776-3533 or 776-5685
r 58296
A
, \ DATE
SOLD TO . )'~7Jt.a. ;;;.;;~
6t:y ~ /~
/.r//~/;'/y
,
ADDRESS
TERMS: NET 15 DAYS. INTEREST OF 1 V4% PER MONTH ADDED TO ALL
ACCOUNTS OVER 30 DAYS, OR 15% ANNUALLY
I 0 AlC OLD BALANCE
o C.O.D. 0 CHARGE
~LL 0 NOT FULL
PAYMENT
RECEIVED
1$
o CHECK 0 CASH 0 THIS DELIVERY
THIS INVOICE HAS BEEN ACCURATELY COMPUTED
AND AUTOMATICALLY PRINTED.
o FUEL OIL
~EROSENE
REMARKS
(1/.
CUSTOMER
SIGN HERE
c> ~:i ..;- F:- -."L ;;~-: _,.-~' 1 L~ /" 0.'.1 Y ,~
'i' ~
Gals. Reading - Start
Gals. Reading - Finish
Sales Sequence Number
Price per Gallon - Cents
Product Cost
Tax /675"6
Total Price
'" .' - ... i'?1
".. -,.'
;::; ''?
~:)
'~~ f~!) ~ ~l!
..:;;
1...1
..;,-
'-:j;
-~,"-~-'"'----"--'--'----- ,~'" ~- -~._--- ._,--,--~-,
KOUGH'S OIL SERVICE
P.O. BOX 116
NEWVillE, PA. 17241
PHONE: 776.3533 or 776.5685
A 61111
DATE
/./' ,:::' ./:;/'c:/ 5'-
SOLD TO
rVl~f~_f ,~:;;~~
"
,',' ,/) ,d .. -'"
(( y /:);~&,,,~g;;;:/y
NET 15 DAYS. INTEREST OF 1'/,% PER MONTH ADDED TO All
ACCOUNTS OVER 30 DAYS, OR 15% ANNUALLY.
ADDRESS
TERMS:
PAYMENT
RECEIVED
1$
o CHECK 0 CASH 0 THIS DELIVERY
o C.O.D.
~LL
o CHARGE
I 0 NC OLD 8ALANCE
o NOT FUll
THIS INVOICE HAS BEEN ACCURATELY COMPUTED
AND AUTOMA TICALL Y PRINTED,
o FUEL OIL ~ROSENE
REMARKS
CUSTOMER
SIGN HERE
,-") > " T .,..' ,~:!. :.i /'J;;~1~5 "r I j'tflE;." :.L L) : ~~~ !/'!
" ill
~t ;~~! 2 ~ L1
-.. -." '1
Gals. Reading - Start
Gals. Reading - Finish
Saies Sequence Number
Price per Gallon - Cents
Product Cost
Tax /) ';7,-1 b''''' -, - -,_..-
. -I. J ..("S-'. -. ~ ~)"':::':j
Total Price .... ,..
:.i.. ,) Gj " f,;~
.~::' 3 ;:'~: " ~::; !::!
" (DE')
r::t=.
.."..'
L
I.oestinl'!:
FOSTER, VIRGIE
664 BLOSEHVILLE HD
NEWVILLE, PA 17241
For proper credit please return lop portion
. Mid Atlantic
10/15/04 1150
12/21/04 1
PREVIOU5 BALANCE
PAYMENT THANK YOU
JAN FE8 MAR SERVICE
1.00
1.00
.54.16
56.87
54.16
.54.16
56.B7
A monthly Interest Charge of 1.5% (18% per year)
will be assessed on balances over 30 days
Price may include a small increase to cover rising costs in labor,
Current Charges: 56.87
Taxes: 0.00
Invoice Total: 56.87
disposal and insurance.
I
,
,
,
,
l...
i
G(
LA"
(II
,/
, f t!>
I{/L!
/) ) I
56.87
0.00
0.00
Sprint~
Monthly statement: January 4, 2005
t of 6
Customer service
1-800-829-8009
Internet address
sprint.com/local
Customer number
717-776-3175-205
Summary of Current Charges
Local
Long Distance
Total
Monthly Service Charges
Other Charges and Usage
Taxes and Surcharges
17.02
.00
17.02
.07
8.59
8.66
6.29
1.09
7.38
Previous charges
Payment
Past due balance
.20
.00
.20
REV-1513 EX+ (9-0Q)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Virgie E. Foster
FILE NUMBER
2004-01034
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do' Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.211
1. Bob Foster, 214 Shughart Avenue, Boiling Springs, PA 17007 Son 64,160.25
2. Ginda Walker, 674 Bloserville Road, Newville, PA 17241 Daughter 64,160.25
3. Nancy Louise Snyder, 90 Yorwick Road, Carlisle, PA 17013 Daughter 64,160.25
4. Gary Foster, 147 N. Mountain Road, Newville, PA 17241 Son 64,160.25
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVlDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128~601
REV-1162 EX\11"96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHAW ANDREW H. ESQUIRE
61 W LOUTHER STREET
CARLISLE, PA 17013
^-------Iold
ESTATE INFORMATION: SSN: 203-10-9055
FILE NUMBER: 2104-1034
DECEDENT NAME: FOSTER VIRGIE E
DATE OF PAYMENT: 01/31/2005
POSTMARK DATE: 01/31/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/30/2004
NO. CD 004902
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $11 ,461 .38
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 117
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$11,461.38
GLENDA FARNER STRASBAUGH
REGISTER OF WilLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
c IN"'ITANCE TAX
RECORD ADJUSTMENT
BUREAU OF IIlDIVIDlllJC1I1"'''''''~ O'CFI"r n~
INtERITANCE TAX DIVISi...../~~iIj'[1) A LtC J
PO BOX 280601 ry~(,;r'\T'":'~!
HARRISlIJR& PA 11128-D6IJi)L''';;()' t,-;
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
. 2llll5MAY 16 PH 2: 44
CLERK OF
Me: COURT
ANDREW 1It I . l,,~ CO PA
61 W LO'U't' Sl' ,
CARLISLE PA 17013
04-29-2005
FOSTER
10-30-2004
21 04-1034
CUMBERLAND
101
_t _ltted
.,._--,-"_.._-~"---
*'
REY-159~ EX AFP (03-05)
V~RGIE
E
I:
ESTATE OF FOSTER
VIRGIE
E FILE NO. 21 04-1034
ACN 101
III
121
131
I'll
151
161
171
75.000.00
94.35
.00
.00
205.764.46
.00
.00
IBI
MAKE CHECK PAYABLE AND REMIT PAY~ENT TO:
REGISTER OF WILLS I
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To insure proper credit to your account, subIIlt the ~"r portion of this forti with your 'time: p~t.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1!V-~W"fr'la!rt'TGr-'1I!1......;;"~MMI!m~'"flY"I:1MIII".lIDffIIMf.W......."................. ...
DATE
04-29-2005
AO.lUSTIlEIIT BASED DH:
VALUE OF ESTATE:
ADMINISTRATIVE CORRECTION
1. ...1 Est.to ISchodul. Al
2. Stocks _ Bands ISchodul. BI
3. Clo..ly Held Stock/PBrtnershlp Interest (Sc~ul. Cl
'i. IIor~slNot.s R....l_l. ISehsdul. DI
S. Csshlll_ IIsposUsllllse. P.rso...l Pr_rty ISehsdul. EI
6. Jointly _ Prop.rty ISchodul. FI
7. Transfers (Schedule 6)
8. Tot.l As.t.
DEDUCTIONS AND EXEMPTIONS:
9. F~~l Expen..s1A~lnlstratlv. Costs/
"ls~ll~ Expense. (Schedule Hl
Dsbtslllortgsgs llsbll1tl.slllsns ISchodul. II
Tot.l DoMkootlons
...t Valu. of Tmc: Return
Chsrltsbla180vsrnssntol Bsqussts; Non-.lsct.d 9113 Trusts
list V.lus of Est.t. Subjsct to T_
10.
11.
12.
13.
1'1.
TAX:
IS. _t of llns 1'1 .t Spousal r.t.
16. _t of llns 1'1 t_sbl. .t llnssl/Cl.ss A r.t.
17. _t of llns 1'1 .t Sibling rat.
18. ~t of Line 14 tax8bl. .t Collateral/Class 8 rat.
19. Principal Tax Due
ITS:
_R
CD004902
INTEREST/PEN PAID 1- I
603.23
DATE
01-28-2005
191
1101
11.778.38
978.05
I1Il
1121
1131
11'11
280.858.81
1& 756.43
26~:lD2 .38
! .00
26~.102.38
.00
1~.064.61
i .00
.00
1~.064.61
12 064.61
.00
.00
.00
. IF PAID AFTER DATE IIlDICATED. SEE REVERSE I IF TDTAl DUE IS lESS THAN $1. NO PAYIlENT IS RElIUIIl/!D.
FOR CAlCULATIDH DF ADDITIOIlAl INTEREST. IF TDTAl DUE IS REFLECTED AS A '"CIlEllIT'" ICRI, YDU MY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTllUCTIDIIS.l cS ~
ISehsdul. JI
1151
1161
1171
I1BI
.OOX DO =
268.lD2.38X 045=
.OOX 12 =
.OOX 15 =
1191
ANDIINT PAID
11 ,461. 38
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
REV-1470 EX (O.6S)
.
. !
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEAlTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDMDUAl TAXES
DEPT. 280601
HARRISBURG PA 17125-0801
DECEDENT'S NAME
VIRGIE E FOSTER
FilE NUMBER
REVIEWED BY
Dianne McClain
. 2104-1034
ACN
101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions
and Assessment of Tax has been adjusted to reflect the early payment discqunt.
ROW
PaRe 1
BUREAU OF INIlIVIDUAL ):Al\ES
INHERITANCE TAX DIYISloN ,"
PO BOX 280601
HARRISBURG PA 171Z8-06Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
:INHER:ITANCE TAX
STATEMENT OF ACCOUNT
*
REY-1607 EX AFP (03-05)
I"
;, '7
~I l:..
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-02-2005
FOSTER
10-30-2004
21 04-1034
CUMBERLAND
101
Aorount R...itted
VIRGIE
E
('i~:.,-
~.i' .
ANDREW ~:~HAW ESQ
61 W LOUTHER ST
CARLISLE
PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this for. with your tax pay.ent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
................................................................................................................
REV-1607 EX AFP (03-05) ~~* INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF FOSTER VIRGIE E FILE NO.21 04-1034 AC" 101 DATE 05-02-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, ANIl, IF APPLICABLE,
A PRo.JECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT. 04-28-2005
PRINCIPAL TAX DUE. 12,064.61
PAYMENTS (TAX CREDITS).
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
.
01-2B-2005 CD004902 603.23 11,461. 38
TOTAL TAX CREDIT 12,064.61
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
"
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU HAY BE DUE A REFUNIl. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
~s~
Cumberland County - uRe~rlsEerur -W1LLS-
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
SHAW ANDREW H ESQUIRE
1202 PHEASANT DR S
CARLISLE, PA 17013
RE: Estate of FOSTER VIRGIE E
File Number: 2004-01034
D~ar Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing is due by: 10/30/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
.this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
~
Cumberland County ~-Register Ot WlllS
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
FOSTER GARY
147 MOUNTAIN RD
NEWVILLE I PA 17241
RE: Estate of FOSTER VIRGIE E
File Number: 2004-01034
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 11 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing is due by: 10/30/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~
Register of Wills of Cumberland County
STATIJS REPORT UNDER RULE 6.12
Name of Decedent: (j/IlGI< ~. ";;;;(T€~U
Date of Death: / 0 /-30 /0 'I
, ,
Estate No.: .;2.0iO c.f - () /03 f
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 0 No [2f
2. If the answer is No, state when the, personal;;ep~se~tjve reasonably believes that
the administration will be complete: / A L!..1 LO~
,
J. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account infonnally to the parties in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of fonnal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
Date:~a""Ched to this report. M~:"-"""
/Signature
<j-Pn~n(c/ E- 0 (i.-Ie,/--
Narlle
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Address
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.-
11 72-'-Iq. 111/
Telephone No.
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Capacity: 0 Personal Representative
~ounsel for personal representative
J
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
""""
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Decedent's Last Name Suffix
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C) 1. Original Retum
2. Supplemental Retum
C)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
-
C)
C)
C) 4a. Future Interest Compromise (date of
death after 12-12-82)
C) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
C) 10. Spousal Poverty Credit (date of death C) 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telep e Number ~
4. Limited Estate
C)
8. Total Number of Safe Deposit Boxes
C)
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
MI
1m
MI
REGISTER'~m-LS US~ ONLY', .
_ ~ :>3 ~f:~~ -.J '
)8~~
~
=~
Correspondent's e-mail address:
)::>0
::t::
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N
en
- I 7fJ.~/
TATIVE
;J-
17~/ 3
ADORES / . . Lr - /.
o I We;~ v/4&- S;;, .6 ~/~~. ~ /A
PLEASE USE RIGINAL FORrN6NLY
Side 1
L
15056051047
15056051047
--.J
-.J
15056052048
REV-1500 EX
Decedent's Name:
1/ II<. G" IE
E,
FOST 51(
Decedent's Social Security Number
RECAPITULATION
1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . " 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) C::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C::> Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 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.
TAX COMPUTATION - 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_
16. Amount of Line 14 ~x@le
at lineal rate X.O ~5
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . .
. . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c:::>
L
Side 2
15056052048
15056052048
-.J
HEV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
---___V'-g.Gl5- E~ _EC2EZE/C__
STREET ADDRESS
-- ---. ---?bfi=fl/C!~eLKJ/~___jCd';_
File Number
CITY
N
STATE f> A
----
ZIP
/7.-Z 1-:
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
/36r,5'7
Q; () 0
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3) t),Ol5
(4)
(5) /361- S7
(SA) If,2, 77
(5B) / ~()e2-.. 3~
Total Interest/Penalty ( D + E )
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.
A. Enter the interest on the tax due.
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;.......................................................................................... 0 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 0
c. retain a reversionary interest; or.......................................................................................................................... 0 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 0
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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. 99116 (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 twenty-one 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 zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
\.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
Foster, Virgie, E.
FILE NUMBER
21-04-1034
ESTATE OF
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 664 Bloserville Road, Newville, P A 17241. As a result of substantial
remodeling by Executor, this property sold for substantially more
than estimated FMV on original return. $70,000.00
2. Bloserville Road, Newville, PA 17241, approximately 0.62 acres of
unapproved realty- actual selling price. $1000.00
$71,000.00
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ESTATE OF
Foster, Virgie E.
FILE NUMBER
21-04-1034
ITEM
NUMBER DESCRIPTION
AMOUNT
A.
1.
Funeral Expenses:
B.
Administrative Costs:
1.
Personal Representative Commissions Gary Lee Foster
Social Security Number of Personal Representative: 162-36-8394
Year Commissions paid 2007
In addition to ordinary personal representative responsibilities,
Executor performed extensive work in conducting a private sale of
the realty at 664 Bloserville Rd., thereby saving the estate a realtor's
commission
$16,955.00
2. Attorney Fees:
3. Family Exemption
Claimant
Relationship
Address of Claimant at decedent's death
Street Address
City
State
Zip Code
4.
Probate Fees: Register of Wills - Filing of supplemental inheritance
tax return.
$15.00
C.
1.
Miscellaneous Expenses:
Settlement charges for sale of 664 Bloserville Rd.- see attached
settlement sheet ($1925.00 less tax prorations of $404.93)
$1520.62
2.
Sprint- service to realty.
$591.97
3.
WSI- trash removal from realty (due to remodeling).
$558.56
SCHEDULE H PART C
CONTINUATION
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Foster, Virgie E.
FILE NUMBER
21-04-1034
ITEM
NUMBER DESCRIPTION AMOUNT
C. Miscellaneous Expenses Continued:
4. Kough Oil- oil delivery to realty. $1262.24
5. Adams Electric- service to realty $544.28
6. Floyd Fahnestock Accounting- decedent's final income tax returns. $140.00
7. Erie Insurance- homeowners insurance on realty until sale date. $650.00
8. Evening Sentinel- advertising for private sale of realty. $1233.24
9. Kruger Rental- rental of nailers, etc. for remodeling. $183.21
10. Lowes- wood flooring, miscellaneous supplies. $3966.05
11. Signature Flooring- expert supervision and assistance in flooring
replacement. $500.00
12. Justin Foster-labor on remodeling. $500.00
13. Coby Foster-labor on remodeling. $500.00
14. Gary Lee Foster- substantial remodeling of realty. $8875.00
15. Dave Crum Carpet- installed some new carpet, repaired old carpet. $400.00
16. D.E.W. - septic pumping. $350.00
17. All American Termite- spraying for wood boring insects. $231. 00
18. Shirley Arnold, Tax Collector-local ($275.36) and school ($1313.52) $1588.88
property taxes.
TOTAL $40565.05
INVOICE
Services Rendered by Gary L. Foster in connection with remodeling/repair of
664 Bloserville Road, Newville, PAl 7241
1. First Floor: Removal of all floor coverings; New wood and ceramic coverings
installed over new underlayment; Refinishing/ replacement of trim work;
Repainting after patching/repairs of walls; Plumbing and electric work necessitated
by relocation of washer/dryer to basement
2. Second Floor: Painting of all walls following patching/repairs; Refinishing
and/or installation of new trim; Carpet cleaning; Installation of numerous new
panes on windows; Remodeling of bath with new vanity and floor
3. Exterior: Stripping of all spouting in front, with new prime and paint; Painting
of porch and vinyl siding
4. Miscellaneous: Substantial debris removal from garage and basement to landfill;
Electric and plumbing work in basement due to relocation of washer/dryer; Repair
of overhead garage doors; Extensive cleaning of entire house; Numerous other
projects
Grand Total 355 Hours @ $25.00
120 Hours
75 Hours
30 Hours
130 Hours
355 Hours
$8875.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
Foster, Virgie, E.
FILE NUMBER
21-04-1034
ESTATE OF
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 664 Bloserville Road, Newville, P A 17241. As a result of substantial
remodeling by Executor, this property sold for substantially more
than estimated FMV on original return. $70,000.00
2. Bloserville Road, Newville, PA 17241, approximately 0.62 acres of
unapproved realty- actual selling price. $1000.00
$71,000.00
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Foster, Virgie E.
FILE NUMBER
21-04-1034
ESTATE OF
ITEM
NUMBER DESCRIPTION
AMOUNT
A.
1.
Funeral Expenses:
B.
Administrative Costs:
1.
Personal Representative Commissions Gary Lee Foster
Social Security Number of Personal Representative: 162-36-8394
Year Commissions paid 2007
In addition to ordinary personal representative responsibilities,
Executor performed extensive work in conducting a private sale of
the realty at 664 Bloserville Rd., thereby saving the estate a realtor's
commISSIOn
$16,955.00
2. Attorney Fees:
3. Family Exemption
Claimant
Relationship
Address of Claimant at decedent's death
Street Address
City
State
Zip Code
4.
Probate Fees: Register of Wills - Filing of supplemental inheritance
tax return.
$15.00
1.
Miscellaneous Expenses:
Settlement charges for sale of 664 Bloserville Rd.- see attached
settlement sheet ($1925.00 less tax prorations of $404.93)
$1520.62
C.
2.
Sprint- service to realty.
$591.97
3.
WSI- trash removal from realty (due to remodeling).
$558.56
SCHEDULE H PART C
CONTINUATION
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Foster, Virgie E.
FILE NUMBER
21-04-1034
ITEM
NUMBER DESCRIPTION AMOUNT
C. Miscellaneous Expenses Continued:
4. Kough Oil- oil delivery to realty. $1262.24
5. Adams Electric- service to realty $544.28
6. Floyd Fahnestock Accounting- decedent's final income tax returns. $140.00
7. Erie Insurance- homeowners insurance on realty until sale date. $650.00
8. Evening Sentinel- advertising for private sale of realty. $1233.24
9. Kruger Rental- rental of nailers, etc. for remodeling. $183.21
10. Lowes- wood flooring, miscellaneous supplies. $3966.05
11. Signature Flooring- expert supervision and assistance in flooring
replacement. $500.00
12. Justin Foster-labor on remodeling. $500.00
13. Coby Foster-labor on remodeling. $500.00
14. Gary Lee Foster- substantial remodeling of realty. $8875.00
15. Dave Crum Carpet- installed some new carpet, repaired old carpet. $400.00
16. D.E.W. - septic pumping. $350.00
17. All American Termite- spraying for wood boring insects. $231.00
18. Shirley Arnold, Tax Collector-local ($275.36) and school ($1313.52) $1588.88
property taxes.
TOTAL $40565.05
INVOICE
Services Rendered by Gary L. Foster in connection with remodeling/repair of
664 Bloserville Road, Newville, PA 17241
1. First Floor: Removal of all floor coverings; New wood and ceramic coverings
installed over new underlayment; Refinishing/ replacement of trim work;
Repainting after patching/repairs of walls; Plumbing and electric work necessitated
by relocation of washer/dryer to basement
2. Second Floor: Painting of all walls following patching/repairs; Refinishing
and/or installation of new trim; Carpet cleaning; Installation of numerous new
panes on windows; Remodeling of bath with new vanity and floor
3. Exterior: Stripping of all spouting in front, with new prime and paint; Painting
of porch and vinyl siding
4. Miscellaneous: Substantial debris removal from garage and basement to landfill;
Electric and plumbing work in basement due to relocation of washer/dryer; Repair
of overhead garage doors; Extensive cleaning of entire house; Numerous other
projects
Grand Total 355 Hours @ $25.00
120 Hours
75 Hours
30 Hours
130 Hours
355 Hours
$8875.00
A, Settlement Statement
U.S. Department of HousinQ
and Urban Development ~
,r
OMB No. 2502-0265
B. Type of Loan
1. 0 FHA
4. OVA
2. 0 FmHA
5. 0 Conv. Ins.
3. I8J Conv. Unins File Number
D6-~8
Loan Number
Mortgage Insurance Case Number
C. NOTE:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "p.o.c" were paid outside of closing; they are shown here for informational purposes and are not included in the totals.
D NAME AND ADDRESS OF BORROWER: Christopher Ocker
. 495C Longs Gap Road, Carli/sle, PA 17013
E. NAME AND ADDRESS OF SELLER:
Estate of Virgie E. Foster
664 Bloserville Road, Newville, PA 17241
F. NAME AND ADDRESS OF LENDER:
Sovereign Bank
1130 Berkshire Blvd, Wyomissing, PA 19610
G. PROPERTY
LOCATION:
664 Bloserville Road
Newville, PA 17241
H. SETTLEMENT AGENT:
PLACE OF SETTLEMENT:
TIN:
I. SETTLEMENT DATE:
Law Office of Andrew H. Shaw
61 West Louther Street, Carlisle, PA 17013
33-1098509
04/28/2006 I RESCISSION DATE:
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price S145 000.00 401. Contract Sales Price $145,000.00
102. Personal Property 402. Personal property
103. Settlements charges to borrower: 403.
(from line 1400) $4,093.32
104. 404.
105. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
106. City/town taxes to 406. Cityltown Taxes to
107. County Taxes 04/28/2006 to 01/01/2007 $191. 73 407. County Taxes 04/28/2006 to 01/01/2007 $191.73
108. Assessments 04/28/2006 to 07/01/2006 $213.20 408. Assessments 04/28/2006 to 07/01/2006 $213..20
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER: $149,498.25 420. GROSS AMOUNT DUE TO SELLER: $145,404.93
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or eamest money 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) $145,000.00 502. Settlement charges to seller (line 1400) $1,925.55
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. Federa~ Home Loan Grant $3,958.25 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR $148,958.25 520. TOTAL REDUCTIONS $1,925.55
BORROWER: IN AMOUNT DUE TO SELLER:
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER
301. Gross amount due from borrower (line 120) $149,498.25 601. Gross amount due to seller (line 420) $145,404.93
302. Less amount paid by/for borrower (line 220) $148,958.25 602. Less reductions in amI. due seller (line 520) $1,925.55
303. CASH ( ~ FROM) ( OTO) BORROWER: $540.00 603. CASH ( 0 FROM) ( ~TO) SELLER: $143,479.38
HUD-1 (3-86) - RESPA, HB 4305.2
PAGE 1
Hutl-1 (Re~. 3/Bs)
.
OMB No. 2502-0265
L'
SETTLEMENT CHARGES
.
700~ TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FROM
BASED ON PRICE $145,000.00 @ %= BORROWER'S SELLER'S
FUNDS FUNDS
DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: AT AT
701. to SETTLEMENT SETTLEMENT
702. to
703. to
704. to
705. Commission paid at settlement
706.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN:
B01. Loan origination fee % to Sovereign Bank
802. Loan discount % to Sovereign Bank
803. Appraisal fee to: Central. .Penn Appraisal.s ( $350.00 p.o.cl
604. Credit report to: cac Companies ( $12.00 P.O.C.l
805. Lende(s inspection fee Sovereign Bank
606. Mortgege insurance applicetion fee to Sovereign Bank
807. Assumption fee Sovereign Bank
BOB. Automated Underwriting Fee to Fannie Mae/Freddie Mac ($20.00 .POCL)
BOB. Tax Service Fee to LSI Tax Services $69.00
611. Fl.ood Certification to Transamerica Fl.ood Hazard $25.00
612 Appl.ication Fee ($350.00.POCB)
900 ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE'
901. Interest from 04/28/2006 to 05/01/2006 @ $26. 18 / day $78.54
902. Mortgage insurance premium for mos. to
903. Hazard insurance premium for yrs. to
904. Flood insurance premium for yrs. to
905.
1000. RESERVES DEPOSITED WITH LENDER:
3. 00 months @
months @
months @
3 . 00 months @
11. 00 months @
months@
months@
months @
Escrow Adjustment
$35. 92 par month
per month
per month
$23.43 per month
$98.44 per month
per month
per month
par month
$107.76
1001. Hazard insurance
1002. Mortgage insurance
1003. City property taxes
1004. Counly properly laxes
1005. Annual assessments
1006. Flood Insurance
1007.
1006.
1009.
1100. TI
$70.29
$1,082.84
($237.36)
1101. Settlemenl or closing fee to
1102. Abstract or titie search to
1103. Tille examination to
1104. Titie insurance binder to
1105. Document preparation to Stephanie E. Chertok
1106. Notary fees 10 AndreW' H. ShaW'
1107. Attorney's fees to
(includes above items Numbers:
1108. Titieinsuranceto Security Titl.e Guarantee Cozporation
(includes above items Numbers: 1102, 1104, 1107, 1108
1109. Lende(s coverage
1110. Owne(s coverage
1111. Endorsements 100, 300, 8.1
1112. Cl.osing .Protection Letter
1113.
$200.00
$20.00
$145,000.00 )
, ~ ~ r ," "'l - , ,~ I f ~
~
~ ~ ~ -:oJ .1 ' ~ .,
. .
$150.00
$35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES:
1201. Recording fees: Deed $38. 50 ; Mortgage $64.50 ; Releases $103.00
1202. City/county taxlstamps: Deed $1,450. 00 ; Mortgage $1,450.00
1203. Slate tax/stamps: Deed $1,450.00 ; Mortgage ; Other $1,450.00
1204. Record Second Mortgage $40.50
1205.
1300. ADDITiONAL SETTLEMENT CHARGES:
1301. Survey to
1302. Pest inspection to
1303. OVernight Fee $15.00
1304. 2006 Cty/Twp Taxes $275.55
1305.
1306.
1307.
1400. TOTAL SETTLEMENT CHARGES $4,093.32 $1,925.55
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief. it is a true and accurate statement of all receipts and disbursements made
on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settleme~~~tatement.
Borrower:
( R-- U~
-
~ ;C,' Seller or
Date: l ~ Co Agent:
Date: tI f 8,1;,6'
Christopher Ocker
Borrower:
Date:
Seller or
Agent:
Date:
disbursed in accordance
Date:
SettleMent Agent:
Date: f ~A{ ~O ~~
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form, Penalties upon conviction can include a fine and imprison-
ment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REY-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHAW ANDREW H ESQUIRE
1 202 PH EASANT DR S
CARLISLE, PA 17013
_n_____ fold
ESTATE INFORMATION: SSN: 203-10-9055
FILE NUMBER: 2104-1034
DECEDENT NAME: FOSTER VIRGIE E
DA TE OF PAYMENT: 02/07/2007
POSTMARK DATE: 02/07/2007
COUNTY: CUMBERLAND
DA TE OF DEATH: 10/30/2004
NO. CD 007781
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,502.34
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$1,502.34
REMARKS:
CHECK#188
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-1607 EX AFP (03-05)
'7
~
II: 30
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-12-2007
FOSTER
10-30-2004
21 04-1034
CUMBERLAND
101
VIRGIE
E
,,-'-i,-
ANDREW H SHAW ES,tt::'"
61 W LOUTHER ST-'"
CARLISLE PA 17013
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
... INHERITANCE TAX STATEMENT OF ACCOUNT *.*
ESTATE OF FOSTER
VIRGIE
E FILE NO. 21 04-1034
ACN 101
DATE 03 -12-2007
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-28-2005
PRINCIPAL TAX DUE: 12,064.61
PAYMENTS (TAX CREDITS):
PAYMENT RECEI PT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-28-2005 CD004902 603.23 11,461.38
02-07-2007 CD007781 .00 1,502.34
TOTAL TAX CREDIT 13,566.95
BALANCE OF TAX DUE 1,502.34CR
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1,502.34CR
l!
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN tl.
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
vou M6.V 111" nul" 6. RI"FUND. SI"E REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
~.-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
*'
DATE 05-07-2007
ESTATE OF FOSTER VIRGIE E
DATE OF DEATH 10-30-2004
FILE NUMBER 21 04-1034
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 07-06-2007
( See reverse side under Objections)
A.ount Re.Ittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
~~!_~~~~~_!~!~-~!~~------~---~~!~!~-~~~~~-~~~!!~~-~~~-!~~~-~~~~~~!_-~--------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FOSTER VIRGIE E FILE NO. 21 04-1034 ACN 101 DATE 05-07-2007
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
Y - 7 Al'; II: I 6
CL.E ;.:~ ~<
ORPH.:~".:j'2::
jr)l j~ J r"",:- r-.
STEPHANIE E CHERTOK0~
61 W LOUTHER ST
CARLISLE PA 17013
REV-1547 EX AFP (06-05)
TAX RETURN WAS: (X) ACCEPTED AS F I LED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO . 0 1
71,000.00
.00
.00
.00
.00
.00
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
71,000.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
If an assess.ent was Issued prevIously, lInes 14, 15 and/or 16, 17, 18 and 19 wIll
reflect fIgures that Include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
12.
13.
14.
Net Value of Tax Return
NOTE:
T
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
R I S:
A N
DATE
01-28-2005
02-07-2007
04-30-2007
REC I T
NUMBER
CD004902
CD007781
SBADJUST
DISC U (+
INTEREST/PEN PAID (-)
603.23
132.77-
.00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(9)
(10)
40,565.05
.00
(11)
(12)
(13)
(14)
40.S;"1; OS;
30,434.95
.00
298,537.33
(15)
(16)
(17)
(18)
. 00 X
298,537.33 X
. 00 X
. 00 X
.00
13,434.18
.00
.00
13,434.18
00
045 =
12 =
15 =
(19) =
AMOUNT PAID
11,461.38
1,502.34
3.50
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
13,434.18
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE ~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) r~'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX OIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
. .NOTJ~EOF INHERITANCE TAX
-ApPRAISEMENT> . ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
l3 i+'t'i
ROBERT J FOSTER JR
214 SHUGHART AVE
BOILING SPGS
r,: i
PA 17007
REV-154B EX AFP (06-05)
~,_ DATE 04-16-2007
~=:.. ESTATE OF FOSTER VIRGIE E
DATE OF DEATH 10-30-2004
FILE NUMBER 21 04-1034
COUNTY CUMBERLAND
SSN/DC 203-10-9055
ACN 06122114
APPEAL DATE: 06-15-2007
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REY=is4i-EX-AFP-C03=Os5--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-16-2007
ESTATE OF FOSTER
VIRGIE
CUMBERLAND
E DATE OF DEATH 10-30-2004
FILE NO. 21 04-1034
TAX RETURN WAS:
COUNTY
S.S/D.C. NO. 203-10-9055
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK
TYPE OF ACCOUNT:
DATE ESTABLISHED
ACN
06122114
ACCOUNT NO.
1695213445
()SAVINGS () CHECKING (HRUST 0< HIME CERTIFICATE
04-07-1999
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
11 , 629.48
0.500
5,814.74
.00
5,814.74
.15
872.21
x
TAX CREDITS:
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 04-24-2007 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 872.21
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 101.30
TOTAL DUE 973.51
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
( IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
S!;!; R!;VI=RSI= S rnl= nl= TlH <: I=nl:l.. enl:l "'<:TDIII"TTn.." ,
~
Cumberland County - Register Of Wills
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
'l
':..-.:::;
C")
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--.;
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SHAW ANDREW H ESQUIRE
1202 PHEASANT DR S
'~J
Date: 9/26/2007
CARLISLEI PA 17013
()l
RE: Estate of FOSTER VIRGIE E
File Number: 2004-01034
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO. 103
SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July 11 19921 the personal representative or his counsell within two
(2) years of the decedent's deathl shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 10/30/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report I please disregard
this notice.
SincerelYI
I~~ l~~!Jd:a,f;~
,../ /
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/26/2007
FOSTER GARY
147 MOUNTAIN RD
NEWVILLE, PA 17241
a
(-~)
-J
I
i".J
_J
L:O
RE: Estate of FOSTER VIRGIE E
File Number: 2004-01034
ell
--J
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 10/30/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
Au_~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
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Pa. o.e. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUfi1B~A-j)}) COUNTY, PENNSYLVANIA
Date of Death:
JI~I<.G:IE
J~h%4L
,- ,
E, FO.5" TffIC.
File Number: c2.00 If- - 0/0 3 >L-
Name of Decedent:
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the e~tate is complete: . . . . . . . . . . . . . . . . . . . ~ D No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to No.1 is YES, state, the following:
a. Did the personal representative file a final account with the Court? . . . . . .. DYes ;riNO
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative st-ate an account ~
informally to the parties in interest? ............................... AYes DNo
,Date
en
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d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this report.
~~
Capacity: DPersonal Representative ~ounsel
Name;J[t~5F~fiL ~/ CA-l2r-TotL
6) jA;~J f- L~v~- S..;;
Address
C~ /;u-4= / rf7 A I/O L?
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Form RW-10 rev. 10.13.06
J
COMMONWEALTH OF PENNSYLVANIA
pEPARTMENT OF REVENUE
E'JREAU 0~ INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 009987
FOSTER GARY
147 MOUNTAIN RD
NEWVILLE, PA 17241
---°-- fold
ESTATE INFORMATION: ssrv: 2oa-io-so55
FILE NUMBER: 2104-1034
DECEDENT NAME: FOSTER VIRGIE E
DATE OF PAYMENT: 07/08/2008
POSTMARK DATE: 07/08/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 10/30/2004
REMARKS: GARY FOSTER
CHECK#193
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
06122114 ~ 5316.28
TOTAL AMOUNT PAID:
INITIALS: WZ
REV-1162 EX(11-961
5316.28
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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COMMDNWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
- ~--~ ,^~fy,.{`1~I:HERITANCE TAX
BUREAU OF INDIVIDUAL TAXES ,~ --~ t,~y
INHERITANCE TAX DIVISION - R'E`C~RD ADJUSTMENT
Po Box 2so6o1 {Jp~NTL'~1~= HELD OR TRUST ASSETS
HARRISBURG PA 17128-0601 -~ ~-{ ~ • `- ` "'
2~fl8 Jt~L _-~ A~ 11= 45
~~C~iytri v~
ROBERT J FOSTER JR QR~r'~a~~'S `~~,~ P
214 SHUGHART AVE C~~: !,'.,:. ,_r;, ~:_~ ~ ~ ~ . ~
BOILING SPGS PA 17007
REV-1604 EX AFP C03-D5)
DATE 06-27-2008
ESTATE OF FOSTER VIRGIE E
DATE OF DEATH 10-30-2004
FILE NUMBER 21 04-1034
COUNTY CUMBERLAND
SSN/DC 203-10-9055
ACN 06122114
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~---) RETAIN LOWER PORTION FOR YOUR RECORDS b-
REV-1604 EX AFP (03-05)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE 06-27-2008
ESTATE OF FOSTER VIRGIE E DATE OF DEATH 10-30-2004 COUNTY CUMBERLAND
FILE N0. 21 04-1034 S.S/D.C. N0. 203-10-9055 ACN 06122114
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK
ACCOUNT N0. 1695213445
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE
DATE ESTABLISHED 04-07-1999
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
11,629.48 NOTE:
X 0.500
5,814.74
.00
5,814.74
X .45
261.66
TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
T0: "REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
INTEREST IS CHARGED THROUGH 07-14-2008
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADD
C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF
..~~~ unv nr Hilt a RC FIINn_ SEE REVERSE SIDE OF THIS FORM FOR I
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 261.66
INTEREST AND PEN. 54.62
TOTAL DUE ~, ~ .,e ,
ITIONAL INTEREST.
TOTAL DUE IS REFLECTED AS A "CREDIT" CCR),
NSTRUCTIONS.)
REV-7470 EX (6-SS)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG. PA 17128-0601
INHERITANCE TAX
EXPLANATION
OF CHANGES
DECEDENT'S NAME FILE NUMBER
Virgie E. Foster 2104-1034
REVIEWED BY AGN
Joan Peters 06122114
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The above referenced Account Control Number has been adjusted to reflect a tax rate of
4.5 instead of 15%.
Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES -r,^ , ,~,.., fi'IVHERITANCE TAX
INHERITANCE TAX DIVISION -``' ~ 1 A 1, E:MENT OF ACCOUNT
PO BOX 280601
HARRISBURG PA 17128-0601 t~ ~~.
~~~u ~~,~.~G 1 ~ P E ~ 33
~~ i f ~,~ ~ ~, ~~~.~~
ROBERT J FOSTER JR v ~`~ !~~
214 SHUGHART AVE ~'vY, ;
BOILING SPGS PA 17007
REV-1607 EX AFP C03-05)
DATE 08-11-2008
ESTATE OF FOSTER VIRGIE E
DATE OF DEATH 10-30-2004
FILE NUMBER 21 04-1034
COUNTY CUMBERLAND
ACN 06122114
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this farm with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT **~
ESTATE OF FOSTER VIRGIE E FILE N0. 21 04-1034 ACN 06122114 DATE 08-11-2008
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-26-2008
PRINCIPAL TAX DUE:
PAYMENTS CTAX CREDITS):
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
07-08-2008 CD009987 54.32- 316.28
~ IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
261.66
TOTAL TAX CREDIT 261.96
BALANCE OF TAX DUE .30CR
INTEREST AND PEN. .00
TOTAL DUE .30CR
C IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )