HomeMy WebLinkAbout04-1044PETITION FOR PROBATE and GRANT OF LETTERS
Estate of r~/I//V~-/'lq, d~y~//~
also known as
Social Security No. ~ / - ! ~f - ~ '( ~ceased.
To:
Register of ~/ills for the
County of ~tc~c$~""/Ec4 ~
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execot
in the last will of the above decedent, dated ."f~/:i-~J, [ 7; £q ~c~c~
and codicil(s) dated
in the
named
· 19
(state relevanl cirounstances, e.$. renunciation, death of executor, et¢,)
Decendent was domiciled at death in CZ-tD~/'{°~'~ ~t~o~ County, Pennsylvania, with
last family or principal residence at '7[3 /4ctr~r'~n~J ~L~_~-treo . 7~o~'~t ~.
(list strut, number and muncipality)
Decendcnt, then~'~7__.__years of~ge, died tirOLt, ((
EXc~p~ ~s follow[, decedent did not murry, was not divorced and did not have a child bom or adol~ed
after ~xecution of the will offered for probatc; was uo~ the victim of a killins and was never adjudicated
incomp~ent:
D~:emlent at d~ath owned prol~'rty with ~timat~d valuta as follows:
(If domiciled in Pa.) All personal prol~'ty
(If not domiciled in Pa.) Personal prop~ty in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of r~il e~tate in Pennsylvania
situated aa follows:
WHEREFORE, petitioner(s) respectfully request(s) thc probate of the last will and codicil(s)
presented herewith and the grant of letters
~m~ admtaistration c.t.~.~ ~ministmtion d.b.n.c.t.a.)
theron. ~ ~,' ~ :::
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } sa
COUNTY OF
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
before me this ~ ~-t~- -- day of [ t/~ ~-~~~.
Estate Of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~J~.v~-~r- ~_ ~ c~(~l~ ~ in co.ideation of ~e petition on
· e rever~ side her~f, ~sfa~o~ proof ha~ng b~n pre.ted before me,
IT IS DE~D ~ the ~ment(s) ~t~ ~ - [~ ' {~ ~
~fib~ ~ereM~e ~mitt~ tRgro~at~ ~d nl~ of r~ord ~ the last ~ of
FEES
Probate, Letters, Etc .......... $_~.
Short Certificates( ) ..........
TO?AL S ~ ~-$ -OD
~iled . .~.k-..~..-..o..~.,..=~',,, ..' ........
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PROI,~
OATH OF NON-SUBSCRIBING WITNESS
Also known as
Deceased
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
-~ ~Zr~familiar with the signature of ,~,~-/~/, gO~rA//~/ .,testat__of
(one of the subscribing witnesses to) the codicil/Mil prestmted herewith and that believes
the signature on the codicil/will is in the handwriting of
to the best of knowledge and belief.
Sworn to or affirmed and subscribed ~a~)~
Before me this I
(Address)
his is to certify that the information here given is correctly cnpied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded 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 10687673
Local Registrar ~/' '
NOV 1 ZOO4
No. Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH .... = ......
emale =.201 --18.. -6181
Anne M. Wynn
SEx
AGE (Las[ Bd~hday )
77 y~
Cumberland
,,.Home Maker
713 Hummel Ave. Lemoyne,
PA
DATE OF ~IRTH
Pennsboro
KINO OF BUSINESS I IN~JSTRY
FATHER'S NAME {FirSt, M~ddle, LeSl)
T.ouis $chaffhauser
~[9v. 15,2004
LICENSE NUMBER
1248 L
It--tl-Oq
Mary M~yon
I~plling Green Mem. Park,~.amp Hill, PA
I~usselman F.H.&C.S.Inb 324 Hummel Ave.
.0 ~
TIME OF INJURY
WAS AN AUTOPSY V~ERE AUTOPSY FiN[~NGS I MANNER OF D~ATH DATE OF INJURY
--i~. . /
NEW CUMBERLANDl PENNSYLVANIA 17070
LAST WILL AND TESTAMENT
OF
ANNE M. WYNN
I, ANNE M. WYNN, of Lemoyne Borough, Cumberland County, Pennsylvania,
!!being of sound mind, memory and understanding, do hereby make, publish and
~declare this as and for my Last Will and Testament hereby revoking and making
void any and all other wills by me at any time heretofore made.
I direct that my Executor hereinafter named shall pay all my just
debts and funeral expenses as soon as conveniently may be done after my decease.
II.
Ail the rest, residue and remainder of my estate, whether real,
ipersonal or mixed, and wheresoever situate, I hereby give, devise and bequeath
lunto my husband, CLAYTON R. ~/NN, if he survives me by a period of thirty days.
i
i!If my said husband does not survive me by a period of thirty days, then this
ilgift to him shall be divested and I then give, devise and bequeath my entire
iestate unto such of the following people as shall survive me, in equal shares:
1
!my son, GARY gERBE, my son, CLAYTON R. WYNN, JR., my daughter, GAIL MURDOCK,
llmy daughter, DARLENE WILLOW, and my daughter, LINDA LAUFFER.
III.
WYNN,
I hereby nominate, constitute and appoint my h~band, ~AYT0~Ai
Executor of this, my Last Will and Testament. If the Said Cl~ton
I as
R.
Wynn
should predecease me, fail to qualify or cease to act as such, tbYe~n I nominate,
~constitute and appoint my son, CLAYTON R. WYNN, JR., as Executor.~J
Page one of two Pages
IV.
No fiduciary acting under this Will shall be required to post bond
in this jurisdiction or in any jurisdiction in which he may act.
IN WITNESS ~-'IEREOF, I, /~dqNE M. !~NN, the Testatrix, have unto this,
my Last Will and Testament, set my hand and seal this /~ day of January,
A. D., 1989.
(SEAL]
JON F, LAFAVEE
SIGNED, SEALED, PUBLISHED and DECLARED by ANNE M. WYNN, the above-
;named Testatrix, as and for her Last Will and Testament, in the presence of
:us who have hereunto subscribed our names as witnesses at her request, in the
presence of the said Testatrix and in the presence of each other.
Page two of two Pages
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 02/01/2005
WYNN CLAYTON R JR
851 STRAWS CHURCH RD
HALIFAX, PA 17032
RE: Estate of WYNN ANNE M
File Number: 2004-01044
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
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 ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 02/26/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sir/~~MJ~
GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
cc: File
Counsel
Judge
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
ANN&' f\Il (,l JYrJ N
11- I ( -04
Date of Death:
Will No.
200 cf - 0 ( 0 t.f<f
Admin. No f k No, 2( -0 '!-fO<f-<f
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orpllans' Sf:.rl Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ((- , 7 - 0 :
Name
Address
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Notice has now been given to all persons entitled thereto un~le 5.6(a) except
Date:
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Name C(./J. Y'fO~ R.. WY/lJN (S-.e)
Address ~S [ ~~ s C fA I, rd~ (Cd
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H-A<-l FA-X I A (7632.
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Telephone my .3t~l-22.t.f-t,
Capacity: ~ Personal Representative
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_Counsel for personal representative
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*' CDMMDNWEALTIi OF
, PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
, HARRISBURG, PA 17128-0601
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REV -1 5 0 O~,I'.;\\))
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (lAST, FIRST, AND MIOOLE INITIAL)
W I\j N All fle ,IY1.
DATE OF DEATH (MM,DO-YEAR) DATE OF BIRTH (MM.OD.YEA"
/(-rr-e 05-2.':;-- (L(27
(IF APPLICABLE) SURVIVING SOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Oliginal Return
o 4, Limi!ed Eslale
~6. Decedent Died Testale /AIlitdlcopyolWill}
o 9. Utigation Proceeds Received
o 2. Supplemental Return
o 48. Future Interest Compromise (date ofdeatnalter 12-12.-82)
o 7. Decedent Maintained a Living Trust (Al1adlcopyafTrost)
o 10. Spousal Povel1y Credit (date Of dealh beIWeen 12-31-41 and 1-1-95,
FILE NUMBER \
:;)..1- _~l_
COUHTY COOE YEAR
-Lot{~_
NUMBER
SOCIAL SECURITY NUMBER
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THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. RemaIDder Return {date III death ptior 10 12-13-82/
o 5. Federal Estate Tax Return Required
B, Total Number 01 Safe Deposit Boxes
o 11, Election to tax under See, 9113(A) f""'" 5<.0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME Q(QA. f2. . W n n J 0 COMPLETEMAfLING ADDRESS fJ _ f t) 1
FIRM NAME ,. g;)( JTt2A-c.0's CNifO\. I-C!
HaQ{~ fA /7032..
TELEPHONE NUMBER
7( -362-22/+6
(1)
(2)
(3)
(4)
(5)
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1. Real ESlate (Schedule A)
2, Slooks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4, Mortgages & Noles Reoeivable (Schedule D)
5. Cash, Bank Deposits & Miscel4aneous Personal Property
(Schedule EI
6, JoinIly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter.Viv05 Transfers & Mfsceltaneous Non-Probate Property
(Schedule G Of L)
8, Total Gross A$sets (_ Lines 1.71
9, Funeral Expenses & _live CasIS (Schedule H)
10, Debls of Decedent, MofIgage Liabifflies, & Liens (Schedule I)
11, Totallleductions (lolal L_9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
eX, 5'5".02...
(6)
(7)
I 01 r3?,9~
(9)
g t.f 23, 2.(
( '3 0 c+9. '1~
(10)
14. Net Value Subject to Tax (Una 12 minus line 13)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 laxable al the spousal tax
raie, or transfers under Sec. 9116 (a){1.2)
x,O_ (15)
x ,0 45 (16)
16. Amount of Une 141axab1e at lineal rate
'8<1,/2-'2. 73
17. Amount of line 14 taxable at sibling rate
x ,12 (11)
x ,15 (18)
1B. Amount of Une 14 taxable at coIfaterm rale
19. Tax Due
2()O
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH'" '"
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(8)
1/ 2., :; '1 s-; 97
(11)
(12)
(13)
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9 1/ f 2. 2, 73
eX! caJ I 00
'E9, 122,73
(14)
LfOfO.52
(19)
'-to 10, $2.
DeceJ:lent:s Complete Address:
STREET ADDRESS 7/ S U/lJ ~
CITY
ZIP / 70 '1'3
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
'1-0 II, $.;L
Total Credits(A+ B + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE.
Lf 0 It}, S;;L
B. Enter the total of Une 5 + SA. This is the BALANCE DUE.
(5)
(SA)
(5B)
,
A. Enter the interest on the tax due.
~o I{J/ T;;-
Make Check Payable to: REGISTER OF WILLS, AGENT
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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 ~
b. retain the right to designate who shall use the property transferred or its income; ................. .......................... 0 I2'S-
c. retain a reversionary interest; or............................. .... ............................................................................ .. 0 ~
d. receive the promise for life of either payments, benefits or care? ....................... ................................... .......... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
wrthout receiving adequate consideration? .............................................................................................................. 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneficiary designation? ..................................................................................................,~.:....~..."..,........ ~ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHE~~E G ~D FILE IT AS PART OF THE RETURN.
Under penalties of pefjury, I declare that I have examirled this return, irlcluding accomparlyirlg schedules arid slatemerlts, and to the best of my knowledge and belief, it is true,
correct arld complete.
Declaration 01 prepa other tharlthe personal representative is based on all information of which preparer has any krlowledge.
SIGNATUR
reA ;eel 1/-4 L-i h4X jJ A-
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
/10 =3 2-
DATE
ADDRESS
For dates of death on or after July 1, 1 994 and before January 1, 1 995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
(72 P.S. ~9116 (a) (1.1) (iH.
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. ~9116 (a) (1.1) (ii)
The statute does not exemot 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
the surviving spouse is the only beneficiary.
For dates ot death on or after July I, 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 paren
or a stepparent of the child is 0% (72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net vaiue of transfers to or for the use of the decedenfs siblings is 12% (72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as,
individual who has at least one Darent in common with the decedent. whether bv blood or adoption.
REV-1502 EX.,!. (6-~8) ,
. ;...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
IJ-nl?e.
FILE NUMBER
/11. tU:'fn/7
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
~'~ de6d.ed res/d~ee..-
@ 7(3 II-t.,un m e/ A-u-e./l L{ ~
~el ;JA- /70~3
!IorJ1e. Sold 0/1 4-/o-t.C5
:;k-lllern VI -t:- ~ e. e-C C2~he.d
(EXIu' 6<'t .6 )
VALUE AT DATE
OF DEATH
99, 900, ()l
TOTAL (Also enter on line 1, Recapitulation) $
(11 more space is needed, insert additional sheets of the same size)
<EV:'~""I"7}'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF /1
/-r /} /) e.
/n.
t.U y A./ AJ
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
/II/A-
TOTAL (Also enter on line 2, Recapitulation) $
(It more space is needed, insert additional sheets of the same size)
'REV'1504D:'(1-!l7J'I~.
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESlDEN1 DECEDENT
ESTATE OF 4
/V/I.,Le-
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP or SOLE.PROPRIETORSHIP
/It.
u..J Y /VA!
FILE NUMBER
Sche<!ule C-1 or C-2 (Including all supporting information) must be attached for each closely-held oorporatlonlpartnership interest of the decedent other than a sOIe-propnetorship.
See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
#/4
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets ot the same size)
'REV"05E)('(('71.~
.~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
/J /} rJ~
SCHEDULE C.1
CLOSEL Y.HELD CORPORATE
STOCK INFORMATION REPORT
/11- iLl /lJ-N
FILE NUMBER
1. Name of Corporation
Address
City
2. Federal Employer I.D. Number
3. Type of Business
State
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
Product/Service
4.
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting I Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? 0 Yes 0 No
If yes, Position Annual Salary $
Time Devoted to Business
6. Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
7. Was there life insurance payabie to the corporation upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
DYes
o No
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholders agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
Consideration $
Date
o Yes 0 No
10. Was the decedent's stock sold?
DYes
o No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerShips? 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-l or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address!es and estimated fair market value!s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those deeared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
REV-150p EX+ (9-00)
. '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
1. Name of Partnership
,4 A.,I/VE /h c.J Y /V-/J
(IJ/A-
FILE NUMBER
ESTATE OF
Date Business Commenced
Address
Business Reporting Year
State
Zip Code
City
2. Federal Employer I.D. Number
3. Type 01 Business
Product/Service
4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $
5.
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent?
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? .... 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner 01 the policy
DYes ONo
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
DYes 0 No
II yes, 0 Transfer 0 Sale
Percentage transferred/sold
Consideration $
Transferee or Purchaser
Attach a separate sheet 10r additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time 01 the decedent's death?
If yes, provide a copy of the agreement
Date
DYes 0 No
11. Was the decedent's partnership interest sold? ....
If yes, provide a copy 01 the agreement 01 sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? .. 0 Yes 0 No
If yes, provide a breakdown 01 distributions received by the estate, including dates and amounts received.
DYes ONo
13. Was the decedent related to any 01 the partners?
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? 0 Yes 0 No
If yes, report the necessary in10rmation on a separate sheet, including a Schedule C-1 or C-2 10r each interest.
.... DYes ONo
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/as and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
ROV''''07. EX+ (1.97) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
41\1~ /J1.
FILE NUMBER
w-yrtl-/'lJ
AU property jointly-owned with right at survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
,.
IV /,4
TOTAL (Also enter on line 4, Recapitulation) $
(It more space is needed, insert additional sheets of the same size)
~'~~'I'~ ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
ESTATE OF /1
nN/\/g /7'1.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
tv y",.; AI
FILE NUMBER
4,t
.;(.
"
",
c< 3. (J 'f
-:E2, y'g
3,
4.
!Jf SoO, 00
i?" I oeJo, DO
"
#" /,. CCCJ, Ot.:'
s:
-Jrr /J/-.J-'""T DANK
III G# LA /II LJ fJAtVr!- t);Ch c g'
Lr2/J7c.J;j/1e" PA- /70<,/3
TOTAL (Also enleron line 5, Recapitulation) $ ;;?, 5 5', c2
REV.1509EX+(1.97)
'*'
SCHEDULE F
JOINTL Y.OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IJ--NN~ /h
W YAJ-A./
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S( NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
/
IV A--
8.
c.
JOINTLY -OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifyir,g number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
_REV""EX''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
.471 f1 e. Ik. W YNAJ
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV~ 1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUllETHENAMEOFTHETRANSFEREE,THEIRRaATIONSHIPTOOECEDENTANDTHE QATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUI
ATTACH A COP'!'OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPPlICABLE\
NUMBER
1. John ~co~ 4n~;ry (0,/39. if5 ro:/1o - 10,13 ?,
r<UO~7/G \(53
'^- S2e l?~hLt- "0 If
TOTAL (Also enter on line 7, Recapitulation) $
rp
(If morP. ~n::r.A i~ nAP.rlP.f1 im;'Rrt ~rtrlitinn::tl ~hAAt~ of thA ~::ImA ~i7R\
REV-1511 EX+ (12-99) .
. ..
.'''''..
"!o(.,~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ANNe m. tOY/VA.!
Debts of decedent must be reported on Schedule I.
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: h.. (~er ) Is"
1. SI c-,o/-fmvSo'lf..s. Lou3~ .s;4.4Ay' :2/.:<. ,0P
c2 /hu-SSe/ /hf:U1 (S ~~ 4O.m.e. (AtLS-er-vICes- ~ '7070.
CA-Ske7; 1h<K<<
3- ,.e,LUiVC- ~ ~e.~f-~e- .
tf 8' 9'5", ~
1 Qf~'-:3
1 e-,~ r;vb-S~ ~ ~de...o'7P/'Olh~IO/l S' 109,1
B. ADMINISTRATIVE COSTS: 1\Io~
1. Personal Representative's Commissions
Name of Personal Aepresentative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State _ Zip
Year(s) Commission Paid:
2. Attorney Fees ;V"'~
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees ;f!E-GfSrr;?72. ~ F 4..h CL.S f1' /~3, a;?
~~Em...~ ~L<-AJ-ry
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 53 t(,;[ a ..;L'
Ie
'f
7'
(If more space is needed, insert additional sheets of the same size)
"":""""{"".~
~ SCHEDULE I
COMMONWEALTH OF PENNSYLVAN<A DEBTS OF DECEDENT,
INH~:~~~~~i6E'tE~:~~RN MORTGAGE LIABILITIES & LIENS
ESTATE OF /I.
t-rl1l1e 111. W y IV ,.J FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. (!1ark.-f>. G. etT'(~ 4-f}y. vA frer
2...B AAI /L.Ct>t-R-j) _Y-f'V1 ce 'S
---
;) \ fY\ c....L
1. tuer(s ~tO ? ILQ"C-( QQ ;; E: ~ /leer J
5. /h~f ~ 2: Co~+ of cks.. r "3
~, lit -AmenCaJ1 tVa er
II p"'f--L 0
T ra.-ueJ er~ <::::::/,,-Si: Uj-a.Ac€"
8.
q. 'f)oro eiF ~D~(\e
/0. GmAC IYJOf'fcj <=<8 ~
I{. ufFler- Z./l~~
/'Z, 6~"Jl1~rf(y\d t1~n~ ---r;ahS+er-7A-k
r~, .5hQ. + Z<er PooFNj
/1 MS (fome cua rrQ'n~
( 5 ~ (Y\.ax f6- t>1J~ .
/6. (Je.n/l f~ST tef'f1/l.-<-k
/7- NoTT+l2-Y - (JcJL,1'/ Ab sfrcLcT
t<g, 1ft 0. f1 0 r C' o..re.-
f9, f-f02J2-+1, Souftc
dO t?IlSr pefll1'5borO ~fCi^~ _
A' c." tf)osk~.J- {:df'T-s -f?r r:zfQr,5
do /. ~rh~rS~fner\ T . "fo Cfa:Jfm (pA I~ f~f
;<.;< ~(.L'f--herll P roUrl1ces .- (~ hO<;J (,/"IS{
, hefOre S2t-(./ e. fY1 ~ f:
AMOUNT
f S; c::v
'f7, tU
d \? , of
lfCf),oo
f{, b L
;,L/ ;;t, 30
/ sc; ,:35
I :2..9, If?
32{J ,53
t(ro 7,32
9cf3,m
999, .,0
500,0;)
+os-: 00
02-93.00
"52L/, 70
6,CD
I 0 "2-{. So
'eJ,9,02
c:; 0 ,0<:>
372, L/2
50,00
TOTAL (Also enter on line 10, Recapitulation) $ 13 0 9' 0::;-
III -.- ---__:_ ___~_..l ;___... _..1"':'1...__1 _10,__1_ ",:'L.... _.......... ...1......\
REV-1513 EX+ 19-1lO*,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 la) (1.2))
GA-/<.- V 1> Ze/'b r:-
;<5 IC1/C!.CI-IAa../J At./en"-e
YoR-l( I-fA lieN, PA /7370
CLAYTON tf 4JYN'NJ1'<-
g515~i-<J.s CAur-cA 12e1
!/4u,C'A-X flA- /7032-
J. (;.-A 1 L .5. /h uj?' tl 0 C/<
02.17 /.{)e.s Tv' lif",cV hte-
/JIEU/4NICSt3.u/2G- ,PA /7055
bAr<.. L ~/II E /h , 4.J /c..L-L)L~
/19 tV. m~HV sr:} jJo &x [2
7/fo/h~S O/'./Toc-vN / 'pA /70 '1'-/
LIN{)A 8! L, t:..ALtF'Fe/C...- ~G-,'"
I I III N. W. (;;,0774 7e/rCL-C e...
A LAc.Hu..A FL-oAI(j/'r- 32."(5
ENTIofl DOLLAR AMOUNTS FOR DIsTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16. AS APPROPRIATE, ON REV-1500 COVER SHEET
NUMBER
I
s
1.
:1,
r.
RELATIONSHIP TO DECEDENT
Do Not List Trustoe(s)
AMOUNT OR SHARE
OF ESTATE
.x,/\/
Ys
..YON
Ys
~~
Is
~1'T'7
Y5
Ys
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
0ALJ44770rV AR-/h Y - doy-Ii~Nj ."'-'
ft /' J{ / -It. Lr"€...
1.
'2ao.CC
tv
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ ,;(, C;W,
'''-------__,____-'.-' ,---...-....'''___1_'-.... _.,,__
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-1500 Cover Sheet
ESTATE OF A-/f/N-<:? ""'C<.J y~ FILE NUMBER
REV:1~"EX;;"".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
This schedule is to be used for all single life, joint or. successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
o Will 0 Intervivos Deed of Trust 0 Other
UFE ESTATE INTEREST CAL.CUI.ATlON
NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS
LIFE TENANT(S\ DATE OF BIRTH DATE OF DEATH PAYABLE
I D Life or D Term of Years _
N/fr D LifeorD Term of Years _
. DLifeorDTermofYears _
D Life or D Term of Years _
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - 0 3 1/2% 06% 0 10% 0 Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2)
.ANtIOl'I'YlNTEREsfCAL~lJL.ATlON
$
%
$
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUIT ANTIS) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
D LifeorD Term of Years _
D Life or D Term of Years _
DLifeorDTermofYears _
D LifeorD Term of Years _
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1)
3. Amount of payout per period
4. Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate 0 3 1/2% 0 6% 0 10% 0 Variable Rate
6. Adjustment Factor (see instructions)
7. Value of annuity -If using 3 1/2%,6%, 10%, or if variable rate and period payout is at end of period,
calculation is : Line 4 x Line 5 x Line 6
If using variable rate and periOd payout is at beginning of period, calculation is :
(Line 4 x Line 5 x Line 6) + Line 3 $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13, 15, 16 and 17.
$
o Monthly (12)
o other ( )
$
%
$
(If more space is needed, insert additional sheets of the same size)
rJ(
RE'i-~'044 EX-+- {3.84) INHERITANCE TAX
~~
SCHEDULE "L"
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION
INHERITANCE TAX RETURN
RESIDENT DECEDENT OF TRUST PRINCIPAL FilE NUMBER
I. Estate of #rJ/Ve /J1. W V/VN
(La!.t Nome) (First Name) (Middle Initial)
This schedule is appropriate only for estates of decedents dying on or before December 12, 1982.
This schedule is to be used For all remainder returns when on election to prepay has been filed under the provisions
of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
II. Remainder Prepayment:
k' A. Election to prepay Filed with the Register of Wills on IDate)
(attach copy of election)
B. Name(s} of Life Tenant(s) Dote of Birth Age on date Term of years income
or Annuitant(s) of election or annuity is payable
e. Assets: Complete Schedule L-l
1. Real Estate S
2. Stocks and Bonds S
3. Closely Held Stock/Partnership S
4. Mortgages and Notes S
5. Cash/Misc. Personal Property S
6. Total from Schedule L-l S
D. Credits: Complete Schedule l-2
1. Unpaid Liabilities S
2. Unpaid Bequests S
3. Value of Unincludable Assets S
4. Total from Schedule l-2 S
E. Total value of trust assets (line C-6 minus Line 0-4) S
--',.t.'
F. Remainder factor (see Table J or Table II in Instruction Booklet)
G. Taxable Remainder value (Line E x line F) S
(Also enter on Line 7, Recapitulation)
III. Invasion of Corpus:
A. Invasion of corpus
(Month, Day, rear)
B. Name(s) of Life Tenant(s) Dote of Birth Age on date Term of years income
or Annuitant(s) corpus consumed or annuity is payable
e. Corpus consumed S
D. Remainder factor (see Table I or Tobie II in Instruction Booklet) S
E. Taxable value of corpus consumed (Line C x Line D) S
(Also enter on Line 7. Recapitulation)
rJ
REV-16.46 ~X+ (3-841 INHERITANCE TAX
* SCHEDULE L-2
COMMONWEALTH OF PENNSYlVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN
RESIDENT DECEDENT -CREDITS- filE NUMBER
I. Estate of IJ.-/V~ /h. U; Y/VN
(last Name) If\rs1 Name) {Middle Initial)
II. Item No. Description Amount
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule l- 1 (pleose list)
(it
Total unpaid liabilities $
(include on Section II, line 0-1 on Schedule l)
B. Unpoid Bequests poyoble from ossets reported on Schedule l-1 (please list)
Total unpaid bequests $
(include on Section II, line 0-2 on Schedule l)
C. Value of ossets reported on Schedule l-l (other than unpaid bequests listed under
"B" above) that are not included for tax purposes or that do not form a part
of tne trust.
Computation as follows:
T oto\ uninc\udoble assets $
(include on Section II, line 0-3 on Schedule l)
III. TOTAL (Also enter on Section II, line 0-4 on Schedule l) $
(If more space is needed, attach additional 8% x 11 sheets,)
"V:'~7EX''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
ESTATE OF /J
frNtVE 171- uY )/AJcN
This schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession
and enjoyment cannot be established with certainly.
indicate below the type of instrument which created the future interest and attach a copy to the tax retum.
o Will 0 Trust 0 Other
Check Box 4a on Rev.1500 Cover Sheet
FILE NUMBER
~(
I. Beneficiaries
A NAME OF AGE TO
BENEFiCIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1. 1994, if a surviving spouse exercised or intends to exercise a right of witl1drawal within 9 months
of tI1e decedenfs death, check the appropnate block and attach a copy of the document in which the surviving spouse exercises such
withdrawal nght.
o Unlimited right of withdrawal o Limited right of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amounl of Fulure Interest $
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 00%
(also include as part of total shown on Line 15 of Cover Sheet) $
4. Value of Line 1 Taxable at 6% Rate
(also inciude as part of lolal shown on Line 16 of Cover Sheet) $
5. Vaiue of Line 1 Taxable at 15% Rate
(also include as part of total shown on Line 17 of Cover Sheet) $
6. Total value of Future Interest (sum of Lines 2 thru 5 must equal Linel) $
(If more space is needed, insert additional sheets of the same size)
R.EY.l~A8 EX,I1.92} ..
COMMONWEALTH OF PENNSYlANIA
INHERITANCE TAX DIVISION
ESTATE OF
SCHEDULE N
SPOUSAL POVERTY CREDIT
AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91
PART I - CALCULATION OF GROSS ESTATE
L
Taxable Assets total from line B (cover sheet) ____.__________.__/__________.__.____________.____.____.____.__
Insurance Proceeds on life of Decedent --.----..--.-/V-/.4--.------.------------------.-------- 2.
Retirement BeneFits......................................... .......................................... ..................... 3.
L
2.
3.
4.
Joint Assets with Spouse................................................................ ................................. 4.
5.
P A Lottery Winnings...................................................................................................... 5.
6b.
60. Other Nontaxable Assets: List (Attach schedule if necessary).. 60.
6"
6d.
6.
SUBTOTAL (lines 60, b, c, d) .
__.__.________. 6.
7. Total Gross Assets (Add lines 1 thru 61________.____.__________.__________.__________.______.__.__.________________. 7.
8. Total Actual Liabilities.................................................................................................... 8.
9. Net Value of Estate {Subtract line 8 from line 7)................................................................ 9.
If line 9 is greater than $200,000. STOP The estate is not eligible to claim the credit If not, continue to Part II
PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income
Tax Returns for decedent and spouse.)
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
o. Spouse........ . ............ 10. 20. 30.
b. Decedent ............. ..... lb. 2b. 3b.
c. Joint .......................... lc. 2c. 3c.
d. Tax Exempt Income..... ld. 2d. 3d.
e. Other Income not
listed above _.......... Ie. 2e. 3e.
f. Totol...........__..........__. If. 2f. 31.
4. Averoge Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(If)
+ (2f)
+ (3fl
=
(+ 31
4b. Average Joint Exemption Income ..................................................................................... =
If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part 111.
PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT
ESTATES
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less.......................... 1.
2. Multiply by credit percentage (see instructions) ............................................................. 2.
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet. ............................................ 3.
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate.................................................................................................. 4.
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of t<:,tal credits on line 18 of the cover sheet. 5.
."""~~'''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
SPOUSAL DISTRIBUTIONS
NNB /h, to YNN
FILE NUMBER
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, B, By-pass, Unified Creeit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Scheeule 0,
then the transferors personal representative may specifically identify the trust (all or a fractional portion or percentage) to be includee in the election to have such trust or
similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the
personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to
the amount of the trust or similar arranQement includee as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
survivin souse under a Section 9113 A trust or similar arran ement.
DESCRIPTION VALUE
fJ (ft
Part A Total $
PART B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A election to tax is bein made.
DESCRIPTION VALUE
Part B Total
(If more space is needed, insert additional sheets of the same size)
EXHIBIT A
Death certificate
Probated Will
Short Letters of Testimony
-hj'. 1:-' '0 certify that the information here given is correctly copied from an original certificate of death duly filed with me as
1.1< Ii "egislrar. The original eerlificale will be forwarded to the Stale Vilal Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
If"II"I"'H~';"""
,"""!,.\>-\.," .OF PEl----,
,i'~'y ~4'~\
t~.- - \(.<,
~~i ~", 'i?~
~ Qi:~ : i~~
~t-:l'_'i-n- "I.:z:..~
"*~... ,...... ."*1
l~ ' "-" -" /~l
\.;() /~\\\
,1'4> - /,Il<.r...
--'" 'MENl ~\" .".,
"'~~"H'H''''IIIIIII,1
thn-7? ~f1"-'~
Local Rcgistrar I,
P 10687579
NOV 1 22004
Date
I ,,~, 14j Rev, 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATE flLENUM6ER
"
,,,
'"
female
SOCIAL SECURITY NUMBER
'"
,
NAME Of DECEDENT (fnl. Middle, Lnl)
1. Anne M. Wynn
AGE (la$l Bilthday)
,.201 -18
";181
r II 2"c./
77
BIRTHPLACE (Cilyend
SlataorForelgoColX1lry)
teelton,PA
1.
,
.
COUNTY OF DEATH
Cumberland
HO T..-L
Inp.b....O
...
RoOKlOlloo 0 :~~tyl 0
RACE-Amancanlndian, Black, V\Illile,et
(Specify) Whi te
".
50.
E.
k.
Pennsboro
DECEDENT'S USUAL OCCUPATION
(~:.,.kin,,:,:~~~,::l
H.I.Home Maker 11b,
DECEDENT'S MAILING ADDRESS {Slree!, Cit1fTown, Slale, Zip Coda)
713 Hummel Ave. Lemoyne,
PA
KINO OF BUSINESS I INDUSTRY
AS DECEDENT EVER IN
US ARMED fORCES?
YeiD NOG.
12.
17.1.Slale PA
DECEDENT'S EDUCATION
onl, .lo"'oom.l.d
Elo"""'WyIS,o""dory CoMooge
11 la-12) IH.,~.)
n.
MARITALSTATUS-MllfliEld.
Ne\lf!l MlIITled. Wdowed,
Divorcad(Specily)
widowed
SURVIVINGSPOU$E
(Ir""',IlI,",n.IOeIlnom<1
".
".
fATHER'S NAME (Firsl, MidciloEt, Last)
11 Louis Schaffhauser
INFORMANT'S NAME (T1peJPrint)
,...
METIiOD Of DIS SITleN
Ooollborl 0 Burial IX! Cremation ~em
. 21., Olher(Specit)')
. SIGNATUR Oi ERAL SER
DECEDENT'S
ACTUAL
RESIDENCE
(SeeinilruclJOJU
onOltlElrside)
17b. Counlv
cllylt>oro
LICENSE NUM8ER
",.011248 L
Od
decadent
lI\1f!ina de
Cumberland lown5Np? 17dfi ~~hin=I~ri:~oILemovne
MOTHER'S NAME (Fil$l, Middle. Maidan Surnama)
1', Mar
INFORMANT'S MAILING ADDRESS (Stleel. Clt1/Town, Slate, Zip Code)
....
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REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2004- 01044
Esta te Of: WYNN ANNE M
PA No. 21-04- 1044
(Last, First. Middle)
Late Of:
LEMOYNE BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No: 201-18-6181
WHEREAS, on the 16th day of November 2004 an instrument dated
January 17th 1989 was admitted to probate as the last will of
WYNN ANNE M
(Last. First. Middle)
late of LEMOYNE BOROUGH, CUMBERLAND County,
who died on the 11th day of November 2004 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH
for CUMBERLAND County, in the Commonwealth of
certify that I have this day granted Letters TESTAMENTARY to:
WYNN CLA YTON R JR
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
Register of Wills
Pennsylvania, hereby
in and
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 16th day of November 2004.
flu nA. \in * "' ""~'~
eglster 0 11 ^- I . \
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J4.W OFFICES
.. F. LAFAVER
, THIRD STREET
CUMBERLAND, PA
LAW OFFICES
JON F. LAFAVER
o
o
317 THIRD STREET
NEW CUMBERLAND, PENNSYLVANIA 17070
LAST WILL AND TESTAMENT
OF
ANNE M. WYNN
I, ANNE M. WYNN, of Lemoyne Borough, Cumberland County, Pennsylvania,
,being of sound mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament hereby revoking and making
'void any and all other wills by me at any time heretofore made.
1.
I direct that my Executor hereinafter named shall pay all my just
debts and funeral expenses as soon as conveniently may be done after my decease
II.
All the rest, residue and remainder of my estate, whether real,
personal or mixed, and wheresoever situate, I hereby give, devise and bequeath
,unto my husband, CLAYTON R. WYNN, if he survives me by a period of thirty days.
'If my said husband does not survive me by a period of thirty days, then this
"gift to him shall be divested and I then give, devise and bequeath my entire
estate unto such of the following people as shall survive me, in equal shares:
my son, GARY ZERBE, my son, CLAYTON R. WYNN, JR., my daughter, GAIL MURDOCK,
my daughter, DARLENE WILLOW, and my daughter, LINDA LAUFFER.
III.
I hereby nominate, constitute and appoint my h~;band, eLAYTONR; WYNN,
as Executor of this, my Last Will and Testament. If the said CI~~ton R. Wynn
should predecease me, fail to qualify or cease to act as such, then I nominate,
._;-,
constitute and appoint my son, CLAYTON R. WYNN, JR., as Executor.'.'
Page one of two Pages
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717-382-8488
p.2
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I,
GLENDA FARNER STRASBAUGH
Register for the Probate of wills and Granting
Letters of Administration in and for
CUMBBRLAND County, do bereby certify tbat on
the 16th day of November, Two Thousand and Four
Letters TESTAA4ENTARY
in common form were granted by the Register of
said County, on the
, 1a te of LEMO YNE BOROUGH
estate of WYNNANNEA4
(l.ast, Fin!. MJddIflJ
in said county, deceased, to WYNNCLAYTONRJR
(Ltr&I, Fhr.MfddIo1
and tbat same has not since been revoked.
IN TESTIMONY WHEREOF, I bave hereunto set my hand and affixed tbe
seal of said office at CARLISLE, PENNSYLVANIA, tbis 16th day of November
Two Thousand and Four.
File No.
PA File No.
Date of Death
S.S. #
2004.01044
21.04.1044
11/11/2004
201-18.6181
,1:~Lt''\l\ ~Ov~.~~~"fU~
,~""'~
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NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Recetpt Date:
Rece:)-pt Time:
Recelpt No. :
11/16/2004
15:23:56
1038487
WYNN ANNE M
Estate File No.:
Paid By Remarks:
2004-01044
CLAYTON R WYNN
JA
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION FOR PROBA
EXTRA PAGES
SHORT CERTIFICATE
JCP FEE
Check# 0924
Total Received... ......
115.00
3.00
15.00
10.00
---~------------
$143.00
$143.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
EXHIBIT B
,/ Settlement sheet for sold
residence
,/ Statements reflecting value of
assets
,/ Receipts of expenses directly
related to Anne's liabilities and
maintenance of home until date of
settlement (NOTE: SOME EXPENSES SHOW ONLY ON
SETTLEMENT SHEET/MAJORITY ARE SUPPORTED BY
RECEIPTS)
OMB NO. 2502-02 ,r
- .
A B. TYPE OF LOAN:
U.S. DEPARTMENT OF !lOUSING & URBAN DEVELOPMENT 1.~FHA 2.oFmHA 3.0CONV. UNINS. 4.DVA 5. DCONV. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT ZEIGLER.MJ 0051256317
8. MORTGAGE INS CASE NUMBER:
441.7638191
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Am~unts paid to and by the settlemBnt ~gent are .shown.
Items marked "(POC)" were paid outside the closing; they are shown here for Informational purposes and are not Included In the totals.
1.0 3/98 (ZE1GlERMJ.PFD/ZEJGLERMJJ41)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
MICHAEL L. ZEIGLER and WELLS FARGO BANK, N.A
JILLIAN M. ZEIGLER CLAYTON R. WYNN. JR. EXECUTOR OF THE 111 CONTINENTAL DRIVE. SU ITE 114
1908 LOUSIA LANE ESTATE OF ANNE M. WYNN NEWARK. DE 19713
MECHANICSBURG. PA 17050
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-2402316 I. SETTLEMENT DATE:
713 HUMMEL AVENUE PURITY ABSTRACT COMPANY
LEMOYNE. PA 17043 March 10. 2005
CUMBERLAND County. Pennsylvania PLACE OF SETTLEMENT
, 3329 Markel Street
Camp Hill. PA 17011
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 99,900.00 401. Contract Sales Price 99,900.00
102. Personal Pro ertv 402. Personal ProoeriV
103. SetUement Charaes to Borrower (Line 14001 7,765.00 403.
104. 404.
105. 405.
Adluslments For lIems Paid Bv Seller In advance Adiustments For Items Paid Bv Seller In advance
106. CounlVlTwc Taxes 03/10/05 to 01/01/06 356.45 406. CounlVlTwc Taxes 03/10/05 to 01101106 356.45
107. CitvTax to 407. City Tax to
108. School Tax 03/10/05 to 07101/05 325.25 408. School Tax 03/10/05 to 07101/05 325.25
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 108,346.70 420. GROSS AMOUNT DUE TO SELLER 100,581.70
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deooslt or earnest money 2000.00 501. Excess DeDOsit (See Instructions
202. Principal Amount of New Loan(s) 99116.00 502. SelUement Charaes to Seller (Une 1400l - 16,009.84
203. ExIstina loan(s\ taken sub'ectto 503. ExlstinQ loan(s) taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Pa of second Mort age
206. 508.
207. 507. lOeooslt dlsb. a5 nroceeds
208. 508.
209. 509.
Adiustments For Items Unaald Bv Seller Adlustmenfs For /fems Unoald Bv Seller
210. CountvlTwc Taxes to 510. CountvlTwc Taxes to
211. CitvTax to 511. CitvTax to
212. School Tax to 512. SchoolTax to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 101,116.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 16.009.84
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From BorrowerlUne 120l 108346.70 601. Gmss Amount Due To Seller Une420 100,581.70
302. Less Amount Paid BylFor Borrower (Une 220l ( 101,116.00) 602. Less Reductions Due Seller (Une 520) ( 16,009.84
303. CASH ( X FROM) ( TO) BORROWER 7,230.70 603. CASH ( X TO)( FROM) SELLER 84,571.86
65 ...
The undersigned hereby acknOlMedge receipt of a completed copy of pages 1 &2 of this statement & any a!!i'chments referred to herein.
. ,if' I
0..... .y'J . / /('.' ,
" '..' ,/
Sellero'. ' i' f /, ., i'-. ~- './. '0'":.:--'0. .
".' ,..,..././ It>.''-~
L.' Yr . IIV,YN'N,JR., EXECUTOR OFTHE ESTATE
OF ANNE M. WYNN"
Borrower
j
,~,'
-
- L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ 99,900.00 I8J 6.0000 % 5,994.00 PAID FROM PAlO FROM
.DMsion of Commission (f[ne 7001 as Foi/ows: BORROWER'S SElLER'S
701. $ 3,022.00 to RcMAX REALTY ASSOCIATES, INC. FUNDS AT FUNDS AT
702. $ 2,972.00 to CENTURY 21 PISCIONERI REAL TY,INC. SETTlEMENT SEmEMEm
703. Commission Paid at Settlement 5,994.00
704. to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. !.oan Oriolnation Fee % to
802. Loan Discount 3.0000 % to WELLS FARGO BANK, N.A. 2,973.48
803. Appraisal Fee $375.00 to RES DIRECT $375.00 POC
804. COMMITMENT FEE to WELLS FARGO BANK, N.A. 27.56
805. FINAL INSPECTION to ROLAND JOHNSON 75.00
806. FLOOD LIFE OF LOAN FEE to WF FLOOD SERVICES 16.00
807. Assumption Fee to
808. COMMITMENT FEE to WELLS FARGO BANK, NA 100.00
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 03110i05 to 04/01/05 @ $ 13.580000/day ( 22 da", 5.0000 %) 298.76
902. Mortaaoe insurance Premium for months to DEFT OF HUD 1 454.78
903. Hazard Insurance Premium for 1.0 vears to FARMERS MUTUAL $351.00 POC
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 2.000 months $ 29.25 oer month 58.50
1002. Insurance 0.000 months $ 40.69" nAr month
1003. CounlvfTwp Taxes 2.000 months $ 36.51 "er month 73.02
1004. Cllv Tax months $ Der month
1005. School Tax 9.000 months $ 87.55 per month 787.95
1006. months $ Der month
1007. months $ "ef month
1008. AGGREGATE ESCROW ADJ. months $ 08r month -328.77
1100, TITLE CHARGES
1101. Settlement Fee to PURITY ABSTRACT COMPANY 50.50
1102. Abstract or Tltie Search to
1103. Tltie Examination to
1104. Insured Closlno Letter to Lawver's Title Insurance Corooration 35.00 )
1105. Document Preoaration to REMAX REALTY ASSOCIATES,INC DEED \100.00
1106. Notarv Fees to SHERI L MELL-MOTTER 12.00 'lC6.00
1107. Attomey's Fees to ~
includes above item numbers:
1108. TiUe Insurance to PURITY ABSTRACT COMPANY PL T.05-11 858.75
(includes above item numbers: )
1109. Lenders Coverage $ 99,116.00 G47-2718588
1110. OWI1ers Coverage $ 99,900.00 A75-0803277
1111. PA ENDORSEMENTS:100,300,900 to PURITY ABSTRACT COMPANY 150.00
1112.
1113.
1114. TAX CERT. FEE to REMAX REALTY ASSOCIATES, INC. I.. 4.00
1115.2005COUNTYTAX to FAITH A. NICOLA, TC 438.06
\116. INHERITANCE TAX ESCROW to PURITY ABSTRACT COMPANY 6,743.25
1117.
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordlna Fees: Deed $ 39.50; Mortgage $ 50.50; Releases $ 90.00
1202. CltvlCounlV Tax/Stamps: Deed 999.00' Mortoeae 999.00 ~- )
1203. Slate Tax/Slama.: Revenue Stamns 999.00; Mortllaae ( 999.00
1204. RECnRDi'R OF DEEDS
1205. RECORDER OF DEEDS
'300. ADDITIONAL SETTLEMENT CHARGES
301. Survev to
302. Pest Insnaction to PENN PEST & TREATMENTIH.1. POC --"~ --..
303. 1ST OTR. SEWER $60/REFUSE$36 to LEMOYNE BOROUGH 23.47 / 72.53 ~.
304. 4TH OTR. SEWER BILL to LEMOYNE BOROUGH 1... ___4Sll:OO
305. See addlrl dlsb. exhibit to \.I,o"".ull /
400. TOTAL SETTLEMENT CHARGES IEnter on Line. 103, Section J and 502 Section Kl 7,765.00 16,009.84
By.........' ",,,..10'''''''"', "..1..''''''.' "'.""""..""';"01' ,om,...., copy of ,... 2oflhls....~ V\. , ~ 2 jj(J}rJ""\
PURITY AB~ rrPAfY) ,
Certlfled to be a true copy. Settlement Agen /-..'
_2
{ZE1GLER.MJ 1 ZEIGLER.MJ 142)
ADDITIONAL DISBURSEMENTS EXHIBIT ,
Borrower: MICHAEL L. ZEIGLER and JILLlAN M. ZEIGLER
Seller: CLAYTON R. WYNN, JR., EXECUTOR
lender: WELLS FARGO BANK, NA
Settlement Agent: PURITY ABSTRACT COMPANY
(717)737-8359
Place of Settlement: 3329 Market Street
Camp Hill, PA 17011
Settlement Date: March 10, 2005
Property Location: 713 HUMMEL AVENUE
LEMOYNE, PA 17043
CUMBERLAND County, Pennsylvania
PAYEE/DESCRIPTION
NOTE/REF NO
BORROWER
SELLER
SHATZER ROOFING
ROOF REPAIR
LEFFLER ENERGY
HOT WATER COIL
REMAX REALTY ASSOCIATES, INC.
TRANSACTION FEE
AHS
HOME WARRANTY
G~
-
493.00
195.00-)
~--",
~,-"
\(lnFi ~
Total Additional Disbursements shown on Line 1305 $
0.00
$
1,593.00
-r ~ /Md '7; r~Tf
/?,/rtL.--- ff~T-
-I 1f.4V
- / o77K-- ~ 6\
70 IC1- rY7,4x'
r Q S- c)'O
/ I .
/oC, fJ'O
5'C; 9 9: 01J
Lfcv
., / 2- r 3 0<0 (ZEIGLER.MJ.PFDIZEIGLER.MJ/28)
Checking
Page ] of]
Classic Checking
IAccount #1 Totlll AV!lil!ll:ll~ Peneling
~!l.I.!lnce l:!alllnG!! T[llnsllGli9ns
I 0127 II $32.9811 $32.9811 $0.001
Pending Transactiomj
.ti~
History: ILast 10 Transactions .ti View by: IDate
'-'--'._-'~'-""'-'
- '"
"
E1IDaJe IITransaction DesG.nptic)D II VIIIthdI!lw51ls II Deposits I Total Balance
0111/1912004 IICHECK NUMBER 4210 II $27.9611 I "'\ :IE
E1111/1812004 IIDEPOSIT II II $60.001 ~~-
8111/1812004 II~~ERSE INSUFFICIENT FUNDS II II $32.0011 $0.941
8111/1612004 I INSl.Jf.EICIENTfJJNDS FEE-CtlECK I $32.0011 II -$31.061
NUMBER 4210
E111111612004 IIREVERSE CHECK PAID II II $27.96 $0.941
E111111512004 I!cHECK NUMBER 4210 II $27.96 -$27.021
E111111512004 I CHECK NUMBER 4215 $895.00 $0.941
E1111/1512004 I CHECK NUMBER 4180 $931.66 $895.941
8111/1212004 I GMAC MTG CORP CHECKPAYMT $200.00 $1,627.621
000000000004
E111111012004 I CHECK NUMBER 4214 $150.00 $2,027.621
EXPORT I
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are ava_from 61-90 days.
02004 Manufacturers and Traders Trust Company. Users of this web site agree to be bound by the provisions of the M&T Web Banking Terms and Conditions. VIeW the \Neb
BankingT.~fTIl-'!~ CO!1qitign~ and theerjy~t;;yp.9nQ~ of M&T. 9~~Wrty_ JnfQIm~jiQJ1.
PI
..CK TO rO,.
Note: John Hancock Annuity
RV 02716853
Value on date of death: $ 10139.95
The children of Anne M. Wynn instructed John Hancock to assign $ 7,070.10 of the
claim directly to the funeral home since none of us had the means to pay it until Anne's
house sold.
Below is the stub from Clayton's portion where they list his share (one offive children)
as $2,027.99, less his 'share' ofthe funeral bill (1I5th) as $1414.02. His net amount
before tax withholding was $ 613.97. The only other statement on the value that we
could find was the June statement (see attached) but Anne had withdrawn funds from
the annuity between that date and her death. No other statement was provided by John
Hancock on the value of the annuity.
~
John Hancock Life Insurance Company
CLAYTON R WYNN JR
851 STRAWS CHURCH RD
HALIFAX PA 17032
Reference Number
Cheque Number
Cheque Dato
Cheque Amount
Policy Number
Certificate Number
Agent Number
Enclosure Code
DECEASED ANNE WYNN RV02716853
DEATH BEN DUE: $2,027.99 7
FUNERALASSIGN:-$1,414.02 G
FED TAX: -$22.98
CKAMT:$590.99 ~ less:-
P.O. BOX 111
BOSTON. MA 02117
(800) 732-5543
4357J021620
0100009742
12/22/2004
$590.99
DM
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Y 5 -f4 :5Act/--€' ~eraP.
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'202-1, err X 5' = /c; /32 f~--
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W - d-: ,q 301989 '
THE SALVATION A1Q4Y-. - I
ADULT lIerlMllLITATION CENTER !
3850~n Way. Hanisbu.Ill. PA 17110 II
Phone: (717) 541-l1203 ___
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.
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Apt or Floor ~.r Tel No.,..
. AppI+Q-CIothlng~I'u~.i..~D
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. Zip
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I
I THANK YOU
;';'
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... ...,. - "
CONTRIf/tnlONS OF GOODS ARE DEDUCTIBLE FDR INCOME TAX pURPDSES
TO THE EXTENT ALLOWED BY LAW. THE SALVAnON ARMY DOES NOT FIX
AN EVALUA110N QIlo' YOUR GIFT. !l;/.AT IS 7llE' PRIYIl.EGE AND
RESPONSIBILITY OF l'IIE DONOR. THIS IS V'UR TAX RSElP'!'. '
..
i:l{.2..
OF' /J,.W€ . J
W YAlIV
CHARLES E. PETRIE
ATTORNEY-AT-LAW
3528 BRISBAN STREET
HARRISBURG PA 17111
(7171 561-1939
FAX (7171 561-4121
CHARLES E. PETRIE. ESQUIRE
KELLY P. ROBERTS. PARALEGAL
October 13, 2004
<-
CLIENT:
BILL
Anne Marie Wynn
713 Hummel Avenue
Lemoyne, PA 17043
SERVICE:
FEE:
Preparation of Power of Attorney
$50.00
SERVICE: Hospital/Nursing Home Visit
FEE: $25.00
i
TOTAL AMOUNT DUE: ~
IJj, (]<;!V d# fOZ
r' . 1/ / z3~Of
CHARLES E. PETRIE
-.
o.
CuhorCllldltAtlalMb/e
txxxI'" Number
$6,800.00
$6,654.69
Transactions... .
4 STATEMENT
IYMENT S ANI:J <:'REDI'
1/08 303t
JRCHASES AND ADdU!
>/12 10/11 668~
Q4fl!~
~CGS
<{ 2-0 .()O
r ~1( '1(,
~
~ L/7. %
~zo,CP;
-
11/09/04
ToIaI MltWtxim Pa
Due Pa
Due Dale
$15.00
12/04/04
Ch
Credtts (eA)
Y0t
3/
281.35 CR
'/05 11/05 0368
./06 11/05 0612
800-230-4077 GA MAIL/PHONE
IE 11/04
800-4327951 VA
39.00
15.36
S-7 f? . r[_J;....
- 3'1. ro 4-~ e-r- ~
/~'j"6
-- ....... (-)P~ (+)Cuh (+l Purc:haea and \.1lo::'c"t" c:::.... l;lli.....""'" Foe (_)=Balance
...C<edIIa _..... ...-.... CE CHARGE. Paet Due Amount ................. $0.00
CUrrent PlI)'ment .................. $15.00
$281.35 $281.35 $0.00 $141.11 $3.60 $0.00 $145.31 TctIlI MInimum Pavment
Due...................................... $15.00
TDTAL
THRDUGH 11
./
(/1-;
/D 9
('~c ^,V II
[U &tV
(/ 11--
,
\IGE IT THIS
y
IMPORTANT
NEWS
LITY THE
BSC
/s
i
'-'-
5:,
UMMARY OF TRANSACTIONS
PerlodIcfWe
eorr::1lng
p.......,.-
.......
_to
Finance Charge
'NANCE CHARGE SCHEDULE
"-
ash Advances
A. BALANCE TRANSFERS. CHECKS.O.OOOCKXYhDLY.
B. ATM, BANK.................0.059561%DLY.
;. PURCHASES.................. '0.034904% DLY.
0.00%
21.74%
12.74%
$0.00
$355.59
* Periodic Rate May Vary
FOR THIS SlWNG PERIOD:
ANNUAL PERCENTAGE RATE...................
12.74%
7.35
$141.71
$281.35 CR
DUE
"
---
OFFER--
TOTAL MINIMUM PJltMENT DUE
FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY
. Fer CU.lomllf SlIiIfaction IIJd up 10 Ihe Rimlle aulomated infCl'maIiaR iK:IudiAg
balMce, available a'ediI, paymenls received, paymenls due, due ~~fAllIIt'
8IkHss infOl'malion. Ol' torequesl dupIcate llalemenls, C111.AO().J ~
For TOO lTeIecornnunicaion OeYIcefor Ute Deal) aslistalce,
"'1-800-346-3178.
Mail fM'/menla to: BANKCARD SERVICES, P.O. BOX 15287, WILMINGTON, DE
1989&-5287 .
Bllng rights are preserved only by wrilIen inquWy. Mal bling inquiriee:, Ulilg
fOl'm on Ihe back, ..d other ~iries to:
~ SFRVIC PO ROX 150?6 WII MINGTON OF
(IncltIdN IWIodIo Ral8end T~ Fee FIMnoe ~)
'LEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION.
USE010
7728
431304050011 5282
036 Y 8KL 0402 0000 00
PAGE 1 OF 1
--.-------
CUhorCredIIAva/J1IbIe
-
12/09/04
TotaJ MinJrwm Pa
Duo Pa
Duo_
01/05/05
=..
PAYMENTS AND CREDITS
11/.6 11/16 2720 VS
11/26 8448 VS
12/09 5953 VS
TOTAL FOR
$6.800.00
T......."I). . DE~MBER 2004 STATEMENT
$15.00
Ch&Jg89
CredItS (OA)
LATE CHARGE ADJUSTMENT
PAYMENT - THANK YOU
FDOTSMART PRODUCTS 800-230-4077 GA MAIL/PHONE
P11491140001
BILLING CYCLE FROM 11/10/2004 THROUGH 12/09/2004
39.00 (
20.00 (
59.95 (
$0.00
$11B.95 (
~I /j----
/ /J ~/"
1 J--11~
j IMPORTANT
I NEWS
IUIfIfARY OF TIlANSACTIONS
TotAL MINIMUM PAYMENT DUE
- .....00 (-)~&:Its (+) Caah (+) Purchases Md \.'i='~. ~m-&~ (_) New Balance $0.00
_...... -- T.... Pest Due Amount ........."......
Current payment ...."............ $15.00
$145.31 $118.95 $0.00 $0.00 $1.10 $0.00 $27.46 Total MInimum Payment
Due...............,..,..,..,.......,..... $15.00
0.00%
21.99%
12.99%
$0.00
$103.38
FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY
For CutIomw SaWaction md up \0 !he ..ute automated information iookll_g.
b_ce. 8V8WJIe a'edt, payment. received, paymenls due, <lie dale, pavment
Bdlteu inlorrnslon, or to r...t duplicate .1aIemen1s, call ~~:.A?QQ
For 100 (JeIecomRl.loiCalion DeW:e for Ibe 0eaI) assislMce,
"" 1-800-346-3178.
Mal paj'mertls to: 8ANI<CARD SERVICES, P.O. BOX 15281. WIUItNG10M. DI
15JBl16.5287 .
BIIng fights are pl'eserved ooly by written inquiry. M. bIitg itquiies., usl\g
tormoolhebd,lIMtoflerin~to:
~~~ SFRVICFs, ".0 BOX 15O?6 WII MINGTON Of
1711 000 lXl 0200 0000 00
4313 0405 0011 5282 PAGE 1 OF 1
~NANCE CHARGE SCHEDULE
"-"
:ash Advances
A. BALANCE TRANSFERS. CHECKS.O.OOOO(XYh OLY'
B. ATM, BANK............... "0.060246%OLY'
C. PURCHASES.................. '0.035589% DLY'
Pddacllc Ra
""""-....
......
Percentage FWe
""'on..
llubioctlo
Anance ctwge
FOR THIS BILLING PERJOD:
ANNUAL PERCENTAGE RATE-...............
12.99%
. P.riod~ Rat. May Very
{IncIudetI PwIodIc RUrJ and TIIIfIMCIIon PM FIfrenoe c/lMpN.)
'LEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION.
USE010
MGI Aecount: 2X195208
Telephone Number: 717763-4335
Customer Service: g www.mci.com/service
Statement Date: 11/21104
Page 1 of4
. 1 888 624-5622
Summary of Charges
Previous Charges .......................................
Payments through 11/20104 ......................
Balance Forward .........................................
$27.96
$27.96 Gr
$.00
Current Charges .........................................
$28.08
k'.
,.,p ,q.
.. /-.' ..~ .., ,-.
-'/
'N"'_ .
Total Amount Due .....................................
C"'-;;;';~'d
.-
^,-.
Payment Due Date ....................................
12/15104
REMINDER: A 1.20% late payment charge will apply to any
unpaid balance as of December 20, 2004 .
*"
Met
IMPORTANT ACCOUNT
INFORMA nON
Our records Indicate that you
have requested that we cancel
the long distance portion of your
account. If you want to continue
to use our service, please
promptly call the 800 number on
yourtnvoice. Otherwise, please
call your local phone company to
switch )lour service to a new
long distance carrier In order to
avoid being charged higher
casual calling rates and
surcharges on future calls.
0,"'
pd. 12/2-1 joy..
ctJ1r / /0
r Z-f ~~
.
::m~iiI'_i'_ii::~illt.i~i~~l~~'1_~~_ID
.
"".
Revolving Charge
Statement of Account
208 N THIRD ST SUITE 110
HARRISBURG. PA 17101
B
37
-
ANNE M WYNN
713 HUMMEL AVE
LEMOYNE.PA 17043-1832
1...111...111....1..1..11....111..1...11.,.1.1".11..11.1..,11
1
Your local store;
Pim:haS9S made from:
HELLS FARGO FINANCIAL
208 N THIRD ST SUITE 110
HARRISBURG, PA 17101
PHONE. 717-236-8091
0286
LEMOYNE SLEEPER COMPANY
Account Number
This information is a summary of your account Incll/cfirrg<;ub-account(s).
Credit Limit Available Credit Billing l?dl~_ __ Duo Date
Past Due Amount
64819478
$5,000
Payments!
Cnldits
$4,800
11/18/04
12/18/04
$0.00
Previous
Balance
+
FlmtnC#!
Charges
+
Purchases/
DebitS
New
Balance
Minimum Payment
(indudes past tJue amount)
$408.1t1t
$200.00
$0.00
$B.OO
$200.00
$20.00
Dates
TransactJon Posting
Transaction Description
Amount
11/08
11/08 PAYMENT - THANK YOU $200.00-
ANNE M WYNN. your credit line at ~ /'L?/.11Ll ~/
LEMOYNE SLEEPER COMPANY is sti 11 open~ ~-n~-:~u </- /
have $4,800.00 aveilable credit on you~ account. Your .~~.~ -~__
current available credit is equal to your line of credit ~~~~,'-
amount less any transactions made afte~ the date of this ~A~/." .
statement. t/177~~~
FY/zL./e- (
amount, htt. cI ~
lei/h~
~A-NCe A'T
pem?f
( 'f 00 00
On behalf of LEMOYNE SLEEPER COMPANY. we thank you
for you~ business.
You cen use this credit to your advantage. Additional
transactions at LEMOYNE SLEEPER COMPANY will be
financed for you, and any amount up to $4.800.1t0 is
available at this time. If you'd like more than this
just ask. Ha'll do our best to honor your raquest.
THOMAS H. MARTINDALE
Your Wells Fargo Financial Manager
THIS INFORMATION IS FOR YOUR REGULAR ACCOUNT.
THERE IS NO DATE BY WHICH OR TIME PERIOD WITHIN WHICH THE NEH
BALANCE ON YOUR REGULAR ACCOUNT CAN 8E PAID TO AVOID ADDITIONAL
FINANCE CHARGES. CAll US FOR THE PAYOFF BALANCE ON YOUR ACCOUNT
WHICH WILL INCLUDE FINANCE CHARGES ACCRUED SINCE THE BIllING DATE.
MONTHLY ~ANNUAL~ RANGE FINANCE CHARGE SEE EXPLANATION
PERIODIC ~PERCENTAGE~ OF COMPUTED ON ON REVERSE SIDE
RATE ~RATE~ BALANCES THIS BALANCE OF THIS FORM
~ nnn.,. 24. OOY. ALL $0.00 AD
'. _..~ _.,~
!~
f3t,8!
:SCf, Cf g
31",03
35,52-
I~ 9 ( 06
......h;>'L"'''J''' ru,,"'UU,H II11U,,,'dUVII
For Service To: C Wynn
713 Hummel Ave
Account Number: 24-0628033-5
Premise Numb~r: 24-0371121
Billing Period & Meter Information
Billing Date: Nov 09. 2004
Billing Period: Oct 07 to Nov 04 (28 days)
Next reading on/about: Dee 07, 2004
Rate Type: Residential
Meter readings in current billing period:
Meter Number N041828263 is a 5/8-inch meter.
Present-actual 208700
Last-aclual 207800
Gallons used 900
Water Usage Comparison
Monthly usage in hundred gallons.
35
<2
',-
21 %
~~
14 ,"
fl." ,~,
,-' ,?f " z
7 "
" "
,~ ;b: ':
0 ,;.'
2 N D J F M A M J J A S
0 0 . a . a p a u r u .
g v c n b r r y n 9 p
Dilling :.ummary
-----,----Prior Balance----------------
Balance from last bill
Payments prior to Nov 09, 2004, Thanks!
Total prior balance, Nov 09, 2004
---------Current Water Charges-------
Service Charge
Water Volume ($.005735 x 900)
STAS PAWC Water 0.04%
DS/- PAWC Charge 0.82%
Total water charges, Nov 09, 2004
--------Other Current Charges--------
Mthly Sewer Line Protection
Mthly Water Line Protection
Total other charges, Nov 09, 2004
------AMOUNT DUE --------
fc
/l IP}/o1
(/r(fJ '
#JO~
f 'f(J- vi
$36.01
-36.01
.00
11.50
5.16
.01
,14
16.81
9.00
5.00
14.00
I $30.811
:~>
,
:~,
o N 2
COO
t v 0
4
Messages to you from Pennsylvania American
Any portion of the water charges wnlch is not paid as of 12/06/04 will be subject to a 1.50% penalty.
. Customers may use their credit card. debit card or pay by electronic check only by calling loll free: 1-866-271-5522
Customers may also pay on-line at www.water.paymybill.com. A service fee will apply.
. Approximately 4.72 percent or $.79, of Stale taxes are included in your current bill.
. Effective April 1,2004. the State Tax Adjuslmenl Surcharge (STAS) is now ,04%,
. Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Tum-Off Program link
. Effective October 1. 2004. the Distribution System Improvement Charge (DSIC) increases from .37%
to ,82%, This charge funds the replacement of water distribution facilities.
Customer Service & Emergencies 1-800-565-7292 (24 Hours)
For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
"'$~
"M
32375
,""U:HU",t1, ,HC;C;aUnllnrormallOn
For Service To: C Wynn
713 Hummel Ave
Account Number: 24-0628033-5
, Premise Number: 24-0371121
Billing Period & Meter Information
Billing Date: Dee 10. 2004
Billing Period: Nov 04 to Dee 07 (33 days)
Next reading onlabout: Jan 07. 2005
Rate Type: Residential
Meter readings in current billing period:
Meter Number N041828263 is a 518-inch meter.
Present-actual 211100
last-actual 208700
Gallons used 2400
/-iP 11,/ 1/
15 ;i r- if ]'1, 11
Water Usage Comparison
Monthly usage in hundred gallons.
35
2
8
1 '" .,..
4 ~<
k. Fl ::t PI ,/ F~ '","
" rJ !? IiI )', -,., r]
;,'~: ;;;, .~~ ",-
fjlllmg summary
__....~~~wprior Balance~~w-~~-~"~-"~"~~-~~~"
Balance from last bill
Payments prior to Dee 10, 2004. Thanks!
Tolal prior balance, Dee 10, 2004
.....--Current Water Charges..---m
Service Charge
Water Volume ($.005735 x 2,400)
STAS PAWC Water 0.04%
OS/- PAWC Charge 0.82%
Total water charges, Dee 10,2004
-----m--Other Current Chargesm-------
Mthly Sewer Line Protection
Mthly Water Line Protection
Total other charges, Dee 10, 2004
pO.81
-30.81
.00
11.50
13.76
.01
.n
25.48
9.00
5.00
14.00
.-------.AMOUNT DUE ..--..-----.--.
p9.48!
8
2DJFMAMJJASOND2
o eaeapauuuecoeo
gcnbr~YIl19plVc~
Messages to you from Pennsylvania American
Any portion of the water charges which is not paid as of 1/04/05 will be subjecf to a 1.50% penally.
. Customers may use their credit card. debit card or pay by electronic check only by calling tal/ free: t-866-271-552~
Customers may also pay on-line at www.water.paymybifl.com. A service fee wifl appro
. Approximately 4.72 percent or $1.20. of State taxes are included in your current bi!.
. Effective April 1, 2004, the State Tax Adjuslment Surcharge (STAS) is now .04%.
. Arrangements to disconnect your service just got easier. Log on to pawc.com and fol/ow the Turn-Off Program link
. Effective Dclober 1. 2004. the Distribulion System Improvement Charge (DSfC) increases from .37%
to .82%. This charge funds the reptacement of waler distribution facilities.
Customer Service & Emergencies 1-800-565.7292 (24 Hours)
For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
.,'* GiiI
A1M
34616
Customer Account Information
Billing Summary
_.-----Prior 8alance------------
Balance from last bill
Payments prior to Jan 12,2005. Thanks!
Total prior balance, Jan 12, 2005
---Current Water Charges--.-
Service Charge
Water Volume ($.005735 x 2,200)
STAS PAWC Water-0.14%
DS/ - PAWC Charge 1.42%
Total water charges, Jan 12, 2005
------Other Current Charges-----
Mth/y Sewer Line Protection
Mthly Water Line Protection
Total other charges, Jan 12, 2005
For Service To: C Wynn
713 Hummel Ave
Account Number: 24-0628033-5
Premise Number: 24-0371121
Billing Period & Meter Information
Billing Date: Jan 12,2005
Billing Period: Dec 07 to Jan 08 (32 days)
Next reading on/about: Feb 04, 2005
Rate Type: Residential
Meter readings in current billing period:
MeIer Number N041828263 is a 5/8-inch meter.
Present-actual 213300
Last-actual 211100
Gallons used 2200
---AMOUNT DUE -----.-----
tliP /A"}
1(, If }
~lltlJ-
Water Usage Comparison
Monlhly usage in hundred gallons.
1
7
71
''??
;,~
.,c,~
,.';'
8
2JFMAMJ
8~g~fy~
4
JASQNDJ2
uuecoeao
!gptvcno
5
$39.48
-39.48
.00
11.50
12.62
-.03
.34
24.43
9.00
5.00
14.00
I $38.431
Messages to you from Pennsylvania American
Any portion of the water charges wnich is not paid as or 2/07/05 will be subject to a 1.50% penalty.
. Customers may use their credit card, debit card or par by electronic check only by calling toll free: 1-866-271-552;
Customers may aiso pay on-line at www.water.paymybill.com. A service tee will apply.
. Approximately 4.72 percent or $1.15, of State taxes are included in your current bill.
. Effective January I, 2005, the Distribution System Improvement Charge (DSIC) increases from .82%
to 1.42%. This charge funds the replacement of water distribution facilities.
. Effective January I, 2005, the State Tax Adjustment Surcharge (STAS) decreases from .04% to -.14%.
. Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Turn-Off Program lin
Customer Service & Emergencies 1-800-565-7292 (24 Hours)
For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
;:j R.;
',M
26004
Customer Account Information
For Service To: C WYNN
713 Hummel Ave
Account Number: 24-0628033-5
Premise Number: 24-0371121
Billing Period & Meter Information
Billing Date: Feb 08, 2005
Billing Period: Jan 08 to Feb 04 (27 days)
Next reading on/about: Mar 07. 2005
Rate Type: Residential
Meter readings in current billing period:
Meter Number N041828263 is a 5/8-inch meter.
Present-actual 215000
Last-actual 213300
Gallons used 1700
, Billing Summary
.
-.-......Prior Balance.-..-....----..-..
Balance from lasl bill
Paymenls prior 10 Feb 08, 2005. Thanks!
Total prior balance, Feb 08, 2005
-_.--.Current Water Charges-._.
Service Charge
Waler Volume ($.005735 x 1,700)
STAS PAWC Waler-0.14%
DSI- PAWC Charge 1.42%
Total water charges, Feb 08, 2005
-.--..-Other Current Charges....._.
Mlhly Sewer Une Pro/ecuon
Mlhly Waler Une Protection
Total other charges, Feb 08, 2005
$38.43
-38.43
.00
11.50
9.75
-.03
.30
21.52
9.00
5.00
14.00
(~
.-._...-AMOUNT DUE .-..--.--. I
jJd f 35 5"2 2/11/(}:)
I a7b / zC;
Water Usage Comparison
Monthly usage in hundred gallons.
J
28
*:;
2
o
o
4
2
g
Messages to you from PennsYlvania American
Any pomon at the water charges wnich is not paid as or 3/07/05 will be subject 10 a 1.50% penalty.
. Customers may use their credit card. debit card or pay by electronic check only by calling toll free; 1-866-271-552~
Customers may also pay on-line at www.water.paymybill.com. A service fee will apply.
. Approximate!y 4.72 percent or $1.07. of Slate taxes are included in your current bill.
. Effective January 1. 2005, the Distribution Syslem Improvement Charge (DSIC) increases from .82%
to 1.42%. This charge funds the replacement of water distribution facilities.
. Effective January 1, 2005. the State Tax Adjustment Surcharge (STAS) decreases from .04% to -.14%.
. Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Turn-Off Program link
Customer Service & Emergencies 1.800.565-7292 (24 Hours)
For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
""~
AIM
20949
_____u__. '" .___...... ,'UV""Q&'UI,
For Service To: C WYNN
713 Hummel Ave
Aecount Number: 24-0628033-5
Pre,!,ise Number: 24-0371121
Billing Period & Meter Information
Billing Date: Mar 14, 2005
Billing Period: Mar 04 to Mar 10 (6 days)
Next reading on/about: Apr 07, 2005
Rate Type: Residential
Meter readings in current billing period:
Meter Number N041828263 is a 5/8-inch meter.
Present-actual 221900
Last-actual 220900
Gallons used 10 0 0
Water Usage Comparison
Monthly usage in hundred gallons.
2
2
8
4
M A M J J
~ r ; ~ r
ASONDJF
U9C09ae
gptvcnb
Dilling :,ummary
------Prior Balance----------------
Balance /rom lasl bill
Payments prior to Mar 14,2005. Thanks!
T olal prior balance, Mar 14, 2005
-------Current Water Charges-------
Service Charge
Water Volume ($.005735 x 1,000)
STASPAWC Water-0_14%
DSI- PAWC Charge 1.42%
T atal water charges, Mar 14, 2005
---Other Current Charges----
Mthly Sewer Line Protection
Mthly Waler Line Protection
Totel other charges, Mar 14, 2005
----AMOUNT DUE ----------
rhD <f fo ~
~-f(;,/()S
CJ2- -fk-- ( 33
M 2
. 0
r g
2,30
5.74
- .01
8.14
14.00
$82.061
6
Messages to you from Pennsylvania American Water
rt!is is your Fina! Bill for service. 7t has been a pleasure serving you and we hope we may again have the
.pportunity in the future.
'he due date pertains /0 current charges only. Any past due balance should be paid immediately.
o Cus/omers may use their credit card, debit card or par by electronic check only by calling /011 free: 1-866-271-552
:ustomers may also pay on-line at www.water.paymybill.rom. A service fee will apply.
Approximately 4. 72 percent or $.38, of State taxes are included in your current bill.
Effective January 1, 2005, the Distribution System Improvement Charge (DSIC) increases trom .82%
) 1.42%. This charge funds the replacement of water distribution facilities.
Effective January 1, 2005, the State Tax Adjustment Surcharge (STASI decreases /rom .04% /0 -.14%.
Arrangements /0 disronnect your service just got easier. Log on to pawc.rom and follow the Turn-Off Program lin
Attentions cus/omers: as Pennsylvania American Water transitions /0 new rompany vehicles,
ou may notice a ro/or change from white to pewter vehicles. For security purposes. all officiai
ompeny vehicles are clearly marked with the Pennsylvania American Water/RWE logos, despite
'e ro/or of the vehicle.
ustomer Service & Emergencies 1-800-565-7292 (24 Hours)
Jr Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours)
isit us on the INTERNET: www.pawc.com
" AlEi;L
"M
30426
PPL Ilectric
Utilities
Electric
Service
For:
eLA YTON WYNN
713 HUMMEL AV
LEMOYNEPA t:
Questious ab
tliis bill? Pie'
contact us by
at 1-300-341
4844\34-49f
or write 10'
CuslolUer
827 Hallsit'
Allenlo"lI
18104-93\
www.ppl\\
Electric
Use
This gmphshows
your electnc use
over the last 13
months.
Types of
Meter Readings:
Actual -
Estimated I!ll:m
Customer D
Page I
:9.<<t..l:~nt
!jJ-J- C
I 2~, Vo
3(1)-
Sl It:
3e,70
~52, V'f
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16450-82007
.>>0
so.oo
fLlTIES Charges $ 29.40
$ 29.40
,-
S 29.40
/fJ: joy
1~1~1
'}..'1. r6'
36 "'Wn - .......:,e PerO"y Meter Reading Information
30 Actual /2101
Aclual 11831
24 I e
18 Average - Nov 2003 2004
T emllerature 54P 53F
KW Per Day 19 9
12
Yearly Use: Tolal Avera~e
6 Use Monlh b
Dec 2002 - Nov 2003 9236 77
0 Dec 2003 - Nov 2004 9025 752
NOJFMAMJ JASON
2003 Months 2004
Other important information 011 back -+
PPL Electric
Utilities
Electric
Service
For:
CLAYTON WYNN
713 HUMMEL AVE
LEMOYNE PA \7043
Questions about
t6is bill? Please
contact us by Dec 28
at 1-800-342-5775 or
484-634-4900
or write to:
Cnstomer Service
827 Hausman Rd.
Allentown, P A
18104-9392
www.pplweb.com
, ~ " ~ ~ ,
pp':"f\i
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Page I
....:...:.:::ii:X~::l\j\l'A~lI>itNijm\\i!if....:. ...
16450-82007
.:;::;::::::::;::;::::j1~:W""
Summary Page
Balance as ofDec 6,2004
$ 0.00
Char~s:
TotarpPL ELECTRIC UTILITIES Charges $ 31.95
Total Charges $ 31. 95
-
Accoon;1ti /.3 $31.95
:5 l f)~ I/; )J---
Electric
Use
This graph shows
your electric use
over the last 13
months.
Types of
Meter Readings:
Actual _
Estimated _
Customer D
KWH - Average Per Day Meter Reading Information
36
\Ieter >lU
30 Dec 6 Actual 12404
Nov 4 Actual 12101
24 32 Da;'s ~
18 Average - Dec 2003 2004
Te~rature 44F 46F
KW Per Day 23 9
12
Yearly Use: Total A vera~e
6 Use Month 1
Jan 2003 - Dec 2003 9135 76
0 Jan 2004 - Dee 2004 8651 721
DJFMAMJ JASOND
2003 Months 2004
_9th~r_ important illfllr:mation on back_..
" ,
. lit'
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PPL Electric
Utilities
16450-82007
Eiectric
Service
Summary Page
Balance as of Jan 6, 2005
$0.00
Char~s:
TotarPPL ELECTRIC UTILITIES Charges $ 31.86
Total Charges $ 31.86
-
Account Balance $ 31.86
M ft,fS-
I'~ (A()
For:
CLAYTON WYNN
713 HUMMEL AVE
LEMOYNE PA 17043
Questions abont
this bill? Please
conlact us by Jan 27
at 1-800-342-5775 or
484-634-4900
~;. rf b
or write to:
Customer Service
827 Hausman Rd.
Allentown, PA
18104-9392
www.pplweb.com
Electric
Use
36 KWH -AveragePerDay Meter Reading Information
Meter
30 Jan 6 Actual 12698
Dec 6 Actual 12404
24 31 Daus I ~l11ed -m
18 Average - Jan 2004 2005
Temnerature 36F 36F
KW Per Day 26 9
12
Yearly Use: Total Avera~e
6 Use Month!
Feb 2003 - Jan 2004 9152 76
0 Peb 2004 - Jan 2005 8092 674
JFMAMJ JASONDJ
2004 Months 2005
This graph shows
your electric use
over the last 13
months.
Types of
MeIer Readings:
Actual _
Estimated liW?\:~
Customer D
Other iRlP(jrtantjnformation onbaek ..
PPL Electric
Utilities
Electric
Service
Por:
eLA YTON WYNN.ESTATE
713 HUMMEL A VB
LEMOYNE P A 17043
Ouestlons about
this bill'? Please
contact us by F eb 28
at 1-800-342-5775 or
484-634-4900
or wrile to:
Cuslomer Service
827 Hausman Rd.
Allentown, P A
18104-9392
www.pplweb.com
, ~ I 6 '
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Page 1
:OUr;~tW[
16450-82007
36
30
24
18
12
6
o
KWH - Average Per Day
Meter Reading Informallon
Summary Page
Balance as of Feb 4, 2005
CharMS:
TotarPPL ELECTRIC UTILITIES Charges
Tolal Charges
'e.....T"IC!iii.....?jy~.~.f.. .'Il..... ...t:i<%
.ilt~;""'.t~iP!.l!P.ll.~.~.!i1\~;~~...~l0it.'.; \!..I..,
Accounl Balance
so.oo
$ 30.70
$ 30.70
. . .
. .
.
e er
Feb 4 AClual
Jan 6 Actual
29 Da I e
Average - Feb
T emperalure
KWH Per Day
Vearly Use:
Mar 2003 - poo 2004
Mar 2004 . P..b 2005
2004
20P
33
1'olal
Use
9230
7431
7)=:/,' P 3{J 7!!-
! CL.~ /28
2-/19 Ie) fJ/
Electric
Use
This graph shows
your electric use
ov..rth.. last 13
months.
Types of
Meier Readings:
Actual
EstimatM
-
"""""
~
CJ
Customer
FMAMJ J ASOND J F
2004 Months 2005
Other Important Information on back ..
12948
12698
))
2005
29F
9
Average
Monlhly
769
619
. PPL Electric
Utilities
Electric
Service
For;
CLAYTON WYNN-EST ATE
713 HUMMEL AVE
LEMOYNE PA 17043
Final Bill
Questions about
this bill? Please
contact us by Mar 31
at 1-S00-342-5775 or
484-634-4900
or write to:
Customer Service
827 Hausman Rd.
Allentown, PA
18104-9392
www.pplweb.com
, ',:.'1,
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16450-82007
.. ............,."..
Summary Page
Balance as of Mar 10,2005 $ 30.70
Char~s:
TotarpPL ELECTRIC UTILITIES Charges $ 1.74
Total Charges $ 32.44
~
bNA-L
- A-lid> f 32 Ii /,
f ~:-O5 d~ /32-
Electric
Use
This graph shows
your electric use
over the last 13
months.
Types of
Miter Readiags:
Actual _
Estimated IlI!!!iI
Customer D
36 KWH -Average Per Day Meter ReadiDg Information
e er
30 Mar 10 Actual 13211
Mar 8 Actual 13198
24 2 a s KWH B lied --rr
18 Average - Mar 2004 21105
TemlIerature 43F 33F
KW Per Day 22 7
12
Vearly Use: Total A vera~e
6 Use Month y
Apr 2003 - Mar 2004 9171 76'1
0 Apr 2004 - Mar 2005 6259 522
AMJ JASONDJFMA
2004 Months 2005
. Other import3ntinformatlon on back ..
, "
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It'TRAVELERS
Automobile
670
Account Bill
Billing Account No. 975252620
Please refer to this billing account number
when calling or making payments.
Billing Date: 11/29/04
Due Date: DECEMBER 15, 2004
For Policy Questions or Change of Address
call 1-800-842-5075
For Claims call: 1-800-CLAIM-33
Sign up for fast and easy bill payments
at www.eft.travelers.com todayl
Visit us on the web at www.Travelers.com
AAA INSURANCE AGENCY
2301 PAXTON CHURCH ROAD
HARRISBURG, PA 17110
0H07
ANNE M WYNN
713 HUMMEL AVENUE
LEMOYNE PA 17043
lit 11')-$11.(3
>>>: .. ......... ........ .. ... .. ........~aYmel'ifQP.t'Ofi~.>>.>. ...... ...
1) Pay the minimum installment amount due of $39.83 by DECEMBER 15, 2004.
Mmimum Minimum
Due Date Amount Due Due Date Amount Due
12/15/04 $39.83 06/15/05 $39.84
01/15/05 $39.83
02/15/05 $39.83
03/15/05 $39.84
04/15/05 $39.84
05/15/05 $39.84
Each payment includes a service charge of $5.00.
Payment schedule may change if there is policy activity on the account.
2) Pay the entire unpaid balance of $248.85.
No further service charge applies.
37. f3
Yp- //2-
;;f;l.8-h I
3) Pay more than $39.83 but less than $248.85.
Each time you choose this option, a $5.00 service charge will be assessed.
You will not receive a bill for any installment(s) you prepay in full.
A new payment schedule will appear on your next bill.
Questions on your bill? See reverse for policy activity.
Please detach and mail the lower portion of this bill with your payment in the enclosed envelope
.,............ il'. J:M:.i5~.EiB?, Sml'i .Tg)(l{~13. ~9!-!~I3.~,.t!~.I3IE 9.13.9" ~T. ftlJ J.~;>;).qP.1,. J:t'i!'~!\ X 9,~.............,
. TRAVELERS
Automobile
670
Account Bill
Billing Account No. 975252620
Please refer to this billing account number
when calling or making payments.
Billing Date: 12/27/04
Due Date: JANUARY 15, 2005
For Policy Questions or Change of Address
call 1-800-842-5075
For Claims call: 1-800-CLAIM-33
Sign up for fast and easy bill payments
at www.eft.travelers.com today!
Visit us on the web at www.Travelers.com
AAA INSURANCE AGENCY
2301 PAXTON CHURCH ROAD
HARRISBURG, PA 17110
--
ANNE M WYNN
713 HUMMEL AVENUE
LEMOVNE PA 17043
::<::::::<:::::>:::::<J>.:~y.m~(Qm~~:::::::::::::>:::::>:
1) Pay the minimum installment amount due of $89.66 by JANUARY 15, 2005.
Minimum
Due Date Amount Due
01/15/05 $89.66,-
02/15/05 $39.83
03/15/05 $39.84
04/15/05 $39.84 /j/~L 0 . 57 .3
05/15/05 $39.84 (f 1/2,
06/15/05 $39.84 __ 5. <:>'D ~e
Each payment includes a service charge of $5.00. . ./'.-.------- "
Payment schedule may change if there is POliCYC!cliV' :On ~ account. 0 I ~S-
2) Pay the entire unpaid balance of $263.85. f ~ ~ g 3 p ____
No further service charge applies. _--" -:J)c.c.c:;;
------
3) Pay more than $89.66 but less than $263.85. " - /d:--- /10
Each time you choose this option, a $5.00 service charge will be asses Y'" 7
You will not receive a bill for any installment(s) you prepay in full. 1./'-1 0- 1/
A new payment schedule will appear on your next bill. 7 I, 1$:> /(()
7>
g ~ 0~
3c;. ~ 3
-
Questions on your bill? See reverse for policy
Please detach and mail the lower portion of this bill with your payment in the enclosed envelope
............. JP. J:~Y~~.J;B~,. 9N~.T9~,\[5=.13. R9Ht\~.~". t~J~:tf.Q~J?... ~T. P.q 3.Ci~: J.QP.1.. :nj~iJh. X 9.t!:............ .,,,
. . TRAVELERS
Automobile
670
Account Bill
Billing Account No. 975252620
Please refer to this billing account number
when calling or making payments.
Billing Date: 01126/05
Due Date: FEBRUARY 15,2005
For Policy Questions or Change of Address
call 1-800-842-5075
For Claims call: 1-800-CLAIM-33
Sign up for fast and easy bill payments
at www.eft.travelers.com today!
Visit us on the web at www.Travelers.com
AAA INSURANCE AGENCY
2301 PAXTON CHURCH ROAD
HARRISBURG, PA 17110
'. /4J-f, c:.
fr.'f- jf _~/J" 7'/- 3ilL-
L1, fh/;r,q , i1u?l1-
,
...,.
ANNE M WYNN
713 HUMMEL AVENUE
lEMOYNE PA 17043
;z./r /0 J
.. >>>> ...... ..... : <<<>>: . ::'P.~Yfue-n(Qpt,ii>:n~:::>:><::<<:::.. . .<: .. ..
1) Pay the minimum installment amount due of $44.83 by FEBRUARY 15, 2005.
Minimum
Due Date Amount Due
02/15/05 $44.83
03/15/05 $39.84
04/15/05 $39.84
05/15/05 $39.84
06/15/05 $39.84
Each payment includes a service charge of $5.00.
Payment schedule may change if there is policy activity on the account.
I If})../:?
'Iy, t3
2) Pay the entire unpaid balance of $184.19.
No further service charge applies.
3) Pay more than $44.83 but less than $184.19.
Each time you choose this option, a $5.00 service charge will be assessed.
You will not receive a bill for any installment(s) you prepay in full.
A new payment schedule will appear on your next bill.
Questions on your bill? See reverse for policy activity.
Please detach and mail the lower portion of this bill with your payment in the enclosed envelope
. __....A\'.....r-'''''H'"' ......".......,..........,.II....n,........I.,.roo.... 'l~r'OoTr-......,..~ ........06183-1001. Thank You.
- - - - - - ~--- ""................. ... ........'
/ uN--- f;ro rfJ. )
~ 1#,1-
.. 611:
q f ;3 .~
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~
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/JeI. cr~ /p/
LEMOYNE BOROUGH r 11-2-3,-P'/
665 MARKET STREET SEWER AND REFUSE BILL
LEMOYNE PA 17043
713 HUMMEL AVE
SERVICE LOCATION:
SewER SERVICE
REFUSE SERVICE
UTILITY
SewER
REFUSE
PREV BALANCE,
. IF PAID BY
IF PAID AFTER
07/01/04
07/01/04
ACCOUNT NO.
.- :1
316675 ,.
TO 09/30/04
TO 09/30/04 "
CURRENT PREVIOUS
READING READING USAGE
i
,
iCHARGES i
i
I $60.00
$34.00 i
$0.00
o
o
o
12/10/04
12/10/04
PAY'~
PAY $96.70 ;
'".----.- - ---- ._---._---~..
,;.,,,,.. if&
LEMOYNE BOROUGH
866 MARKET STREET
LEMOYNE PA 17043
if l'(Oj
l' '/'1.,
SewER AND REFUSE BILL
.._--.~-
--.---.----- .-.-------- -- I
SERVICE LOCATION ACCOUNT NO.. .~
I .------- - --- --- i
~ HUMMEL AVE 316675'
SEWERSERVicE'--1-oio1iii4-' TO'-12i:i1/04__~~=J
REFUSE SERVICE '10/01/04_ TO .="'12/31/04_ __ ~
1'"---- --..----- ____.:..___.\
i CURRENT PREVIOUS ' i
! UTILITY READING READING USAGE !CHARGES!
!u_ _.__.....___...___. - + ---;
I SEWER 0 0 O! $60.00 i
! REFUSE i $34.00 I
I PREV BALANCE i i $0.00 I
I, I I
I, _
~IFP';DSY--" ;;;~;._..-I.'-. PAY' C:S94.0i-B
!-'~~~D!,~.R._ n' 2/2/~OO~_____._. p'AY ,$66'~ll..ill
""'-'~,-~'_..i:.1t
CUSTOMER INFORMATION
PROPERTY ADDRESS
N:4ne:
ANNE M M WYNN
713 HUMMEL AVE
LEMOYNE PA 17043
GMAC Mortgage
-
Account Number:
Home Phone #:
8097217128
(717)763-4335
",,-
HBWNHJPY
HKW81106A14492H
1",111.,,111..,.1..1..11,...111,.1,..11...1,1...11.,11,1.,.11
ANNE M M WYNN
713 HUMMEL AVE
LEMOYNE PA 17043-1632
[i,~
~
86'l4HE <l6/111I04 10;DO 000'256 2004111$ D~1711DI G"'ACHE I OZ DO'" 0"'1110000- 146316 eM
Customer Care Inquiries: 1-800-766-4622
Please verify your mailing address, borrower and co.borrower information Make necessary correctIons on this portion of the statement, detach and mail to address listed lor Inqulfles
on the rever.se side
Account Information
Details of Amount DueJPaia
Interest Paid Year-to-oate
13.99000
$517 .16
$0.00
$120.58
$0.00
Principal and Interest
Subsidy/Buydown
Escrow
Amount Past Oue
Outstanding late Charges
Other
Total Amount Due
Account Due Date
$60.14
$0.00
$0.00
$0.00
$0.00
$60.14-
$0.00
December 21, 2004
Account Nulllber
8097217128
Current Statement Date
Nove1llber 12, 2004
Maturity Date
November 21, 2005
Interest Rate
Current Principal Balance*
Current Escrow Balance
;(/-.;10/
,/"'" /& t
'l'iPO, JY
Taxes Paid Year-to-oate
For questions on the servicing of your account,
call 1-800-766-4622.
Account Activity Since Last Statement
Description Due Date Tran. Date Tran. Tolal Principal Interest Escrow Add'l Products Late Charge Other
Principal Curtailment 11/21/04 11/11/04 1139,86 1139.86
Pa}1lent 11/21/04 11/11/04 160.14 150,41 19.73
*This is your Pri~n ?::: Balan ~rOnIY. no the amount r :J.~ired to #'?: ~r~ loan in full. For ~ayoff f!4; ures and maili g instruction . call the
Customer Care nu r above r you ma obtam neces ry payo Ig res through 0 r au amated ystem (24 hou s a day. 7 da s a week).
See back fu< a_ payment sign-up infunnatlon and other payment options.
SAVE TIME! GMAC Mortgage offers a free and convenient way to make your mortgage payments
through our automatic payment system. Enjoy the flexibility of paying through either your
checking or savings account You can also make automatic additional principal payments
monthly. Simpty follow the instructions as detailed on the back of this statement or call
us at 1-800-766-4622 for more information.
CUSTOMER INFORMATION
PROPERTY ADDRESS
Name:
ANNE M M WYNN
713 HUMMEL AVE
LEMOYNE PA 17043
GMAC Mortgage
Account Number:
Home Phone #:
8097217128
(717)763-4335
""
#BWNHJPY
#KW81l06A14492#
1",111",111.,.,1"1,.11,,,.111,,1,..11.,,1,1,.,11,.11,1."II
~NNE M M W~NN
713 HUMMEL AVE
LEMO~NE PA 17043-1B32
&.1i;if,1
~
B"94"E 06130104 lOlXl 0000911100412220.240101 ""ACHE , 0>: DOM 01140'0000. 141,;31. GM
Customer Care Inquiries: 1-800-766-4622
Please verily YOUI mailing address, borrower and co.borrower information Make necessary corrections on this portion of the statement, detach and mail to addres!'.listed forlnquifles
on the reverse side
Account Information
Details of Amount Due/Paid
$60.14
$0.00
$0.00
$0.00
$0.00
$60.14-
$0.00
January 21, 2005
Interest Paid Year-to-Oate
$460.58
$0.00
$124.14
$0.00
Principal and Interest
Subsidy/8uydown
Escrow
Amount Past Oue
Outstanding late Charges
Other
Total Amount Due
Account Due Date
Account Number
8097217128
Current Statement Date
December 21, 2004
Maturity Date
November 21, 2005
Interest Rate
13.99000
Current Principal Balance*
Current Escrow 8alance
p~/cj
Il:I-i/7
f rf ojl
Taxes Paid Year-to-Date
For questions on the servicing of your account,
call 1-800-766-4622.
Account Activity Since Last Statement
Oescri tion
Due Oate Tran. Date Tran. Tolal
Prinei al
Interesl
Escrow
Add'l Products lale Charge
Olher
Payment
12/21/04 11/29/04
$60.14
$56.58
$3.56
.III
rCY;> -
Jf
""This is your Prine pal Balanc only, not he amount r uired to pay t e loan in full. or payoff fig res and mailin instructions call the
Customer Care nurn r above r you may obtain neces ry payoff fig es through 0 r automated 5 stem (24 hour a day, 7 day a week).
See back for automatic payment sign-up information and other payment options.
!".~\f'\lOl~h>J;l....)~rl"~"'~I~l"'lI'lli. .
'-. +~'~, -,:",;,~;t~,,~~&f.~~-,,~lJ
SAVE TIME! GMAC Mortgage offers a free and convenient way to make your mortgage payments
through our automatic payment system. Enjoy Ihe flexibility of paying through either your
checking or savings account. You can also make automatic additional principal payments
monthly. Simply follow the instructions as detailed on the back of this statement or call
us at 1-aOO-766-4622 for more informalion.
CUSTOMER INFORMATION
PROPERTY ADDRESS
Name:
ANNE M M WYNN
713 HUMMEL AVE
LEMOYNE PI'. 17043
GMAC Mortgage
Account Number:
Home Phone #:
8097217128
(717}7634335
HALIFAX PA 17032-9262
~
~
a6A4I<E 11/21/04 OS,2D llOOOBD1 10(l!;OTU OA2!l4101 OMACHEXI 1 OZ DOM OA29410COO. 146316 (lM
HBWNHJPY
HKW8II06AI4492H
1".111".111."..11..,1,11,1.",1,1.11,.,,1,1,1.1,.,.11.,1.11
ANNE M M WYNN
851 STRAWS CHURCH RO
Customer Care Inquiries: 1-800-7664622
Please verity your mailing address, borrower and co-barlOwer information Make necessary corrections on this portion of the statement, detach and mail to address listed for Inquiries
on the reverse side
Account Information
Details of Amount Due/Paid
Current Principal Balance""
13.99000
$347.04
Principal and Interest
SubsidylBuydown
Escrow
Amount Past Due
outstanding Late Charges
Other
Total Amount Due
Account Due Date
$60.14
SO.oo
SO.OO
$0.00
$0.00
$0.00
$60.14
February 21, 2005
Account Number
8097217128
Current Statement Date
January 21, 2005
Maturity Date
November 21, 2005
Interest Rate
Taxes Paid Year-to-Date
$0.00
1/;1 jJ.,L
),~ t /' 397 OJ
l;elJ
/v____/
/till
Interest Paid Year-to-Date
$0.00
$6.74
Current Escrow Balance
For questions on the servicing of your account,
call 1-800-766-4622.
Account Activity Since Last Statement
Description Due Oate T,ao. Date Trao. Total Priocipal 'nterest Escrow Add.' Products late C.arge Ot.er
-This is your Pri:; ~: Balanc only, n~: he amount re uired to 1i"J: t e Joan in full. or cayOff fig r:.:s and mailin instructions call the
Customer Care nu r above r you ma obtain neces ary payo Ig res through 0 r au omated1 stem (24 hou a day, 7 day a week).
See bad< fu< automatic payment slgn-up information and other payment options.
'.i;'.':t"~'ll~"~"~'l;'~~'
'f,"~'~~"~i>",~J~Mt\.hM, ", ',i '~
SAVE TIMEI GMAC Mortgage offers a free and convenient way to make your mortgage payments
through our automatic payment system. Enjoy the flexibility of paying through either your
checking or savings account You can also make automatic additional principal payments
monthly. Simply follow the instructions as detailed on the back of this statement or call
us at 1-800-766-4622 for more information.
lfFFLE?lC-- ..
Gv e12-G-Y
..-'----
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15'0 co
/5'0 ~
193 Co ->I-
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Payment No. 11 of 11
June Payment
Amount Due:
Amount Paid:
Check No.:
Date Paid:
Account No.:
Payment No.10 of J 1
May Payment
Amount Due:
Amount Paid:
Check No.:
Date Paid:
Account No.:
$150.00
$
450750
$150.00
$
450750
>>>>>>>>>>
BE READY FOR THE HOT
SUMMER MONTHS AHEAD WITH
THIS 16-POINT AIR CONDITION-
ING TUNE-UP OFFER!
>>>>>>>>>>
'ayment No.9 of 11
"pril Payment
"mount Due:
"mount Paid:
:heck No.:
)ate Paid:
\ccount No.:
'ayment No.8 of 11
~arch Payment
\.mount Due:
\IlIount Paid:
:heck No.:
late Paid:
lccount No.:
$150.00
$
450750
$150.00
$
450750
ayment No. 7 of 11
ebruary Payment
.mount Due: $150.00
mount Paid: $ (fcJ, ,,~
~~... r
F
s.
Payment No.6 of 11
January Payment
Amount Due: $150.00
Amount Paid: $ /[0 ""
Check No.: I(g
Date Paid: 1/ (o/,:};'.
Account No.: ~~_.)
P;
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C
A
F
s.
Payment No. 5 of 11
December Payment
Amount Due: $150.00
Amount Paid: $ I (6 &0
Check No.: ID15
Date Paid: /f- ~3 .ell
Account No.: ~1l75~~
P;
A
C
A
2
C
p
(
N
C
Payment No.4 of I 1
November Payment
Amount Due: $150.00
Amount Paid: $ /50,1<7
Check No.: If 2/'1
Date Paid: /1- '1-c'l
Account No.: 450750
F
s
Payment No.3 of 11
October Payment
Amount Due: $150.00
Amount Paid: $ 1s:>'::D
Check No.: 4i8'r
Date Paid: t:>- I
Account No.: 450750
P
A
C
A
I
s
Payment No.2 of 11
September Payment
Amount Due: $150.00
Amount Paid: $ 1 <\<).I:D
Check No.: ''-t\~'\
Date Paid: ct. Ii
Account No.: 450750
P
A
C
A
Payment No. I of 11
August Payment
Amount Due:
Amount Paid:
Check No.:
Date Paid:
Account No.:
$150.00
$ ISO.(\:>
~'l
. '!I I
450750
...
Lefflerenergy
Amount Enclosed: $
Check No.:
Note: Your monthly service contract
payment is included in the amount due.
Lefflerenergy
Amount Enclosed: $
Check No.:
Note: Your monthly service contract
payment is included in the amount due.
Lefflerenergy
Don't have cool central air installed yet?
Ask us about low-rate financing options
on new high-efficiency cooling systems.
We are the year-round comfort pros!
Lefflerenergy
Amount Enclosed: $
Check No.:
Note: Your monthly service contract
payment is included in the amount due.
Lefflerenergy
Amount Enclosed: $
Check No.:
Note: Your monthly service contract
payment is included in the amount due.
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WEST SHORE SPOUTING Co.
EAMLESS ALUM.
2030 POTTS HILL ROAD
ETTERS. PA 11319
717-938-8394
DATE -.Jj:1.J.a5- -
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SHATZER ROOFING
OR.
WESTSHORE SPOUTING Co.
EAMLESS ALUM.
2030 POTTS Hill ROAD
ETTERS. PA 17319
717-938-6394
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AH6~~I~~~e ~.;( /C-h, f: !/Jee-f-) CONFIRMATION
Have you visited www.ahssales.com to order an AHS home warranty on-line ?
.Real Estate Professional -Thank you for choosing an American Home Shield warranty for this home. Please keep
this document for your records. Review the information below and phone us at 1-BOO-SEL-HOME ( 1-BOO-735-4663 )
with any corrections. You may also fax corrections to us at : 1-BOO-FAX-AHSB ( 1-800-329-247B) .
Again, thank you for selecting American Home Shield.
GARY MUCCIO Because the AHS Contract you referred to when ordering may
RE MAX REALTY ASSOCIATES not have been our most current version, this Contract may
3425 MARKET ST contain enhancements. Please review this most current version
CAMP HILL. PA 17011 carefully.
(,4-LSD L, S TFtJ
./
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THE AMERICAN HOME SHIELD GROUP OF COMPANIES
AMERICAN HOME SHIELD CORPORATION
CONTRACT NUMBER: 11817142
AHS Select Home Warranty - Buyer Only
IMPORTANT: For Service CaN American Home Shield ONLY:
1..800-n6-4663 or visit www.ahsservice.com. American Home Shield
'Nill not reimburse for services performed without its prior approval.
I SECTION 1
Address of Covered Property :
713 HUMMEL AVE
LEMOYNE, PA 17043
Home Seller:
ESTATE OF ANNE M. WYNN
Listing Date:
Listing Expiration Date:
Real Estate Company:
RE MAX REALTY ASSOCIATES
3425 MARKET ST
CAMP HILL, PA 17011
01/31/2005
03107/2005
Real Estate Professional Submitting Application:
GARY MUCCIO
I SECTION 2
Basic Coverage for Home Buyer and, if Selected.
Home Seller :
Seller's Listing Coverage has not been selected.
See contract for fun terms and conditions.
$ 405.00 Single Family Residence under 5,000 sq.ft.
$ 50.00 SeNice foe per repair vISit.
Optional Coverages - See contract for availability
O@$ 80 CLOTHES WASHER AND DRYER
O@$ 40 REFRIGERATOR
O@ $ 85 WELL PUMP
o@ $ 160 POOCONl Y
O@$ 160 SPA ONLY
oe $ 160 POOL/SPA COMMON EQUIP
O@$ 160 ADDITIONAl SPA (Only avail8ble wlpurchase of Pool or spa)
The above named real estate company. in addition to representing the
seller and/or buyer. acts as agent for AHS in connection with the sale of
this home warranty plan. The plan fee to be paid at closing includes the
full amount of fees due and payable to AHS for plan administration and
provision of service. as well as a reimbursement to the above-named real
estate company based on a good faith estimate of its expenses incurred in
promoting. selling, processing, and _sing the plan.
$ 0.00 Total of Optional Coverage(s) Selected
$ 405.00 Basic Coverage
$ 405.00 Subtotal
~'OT"'~0
Proposed ClosIng Date (if available) :
03Kl712005
I SECTION 3
Closing Company (if available) :
PURITY ABSTRACT
3315 MARKET ST
CAMP HILL, PA 17011
Closing Agent or Attorney's Name:
UZ MOTTER
::Iosing File Number:
Home Buyer:
MICHAEL L. & JILLlAN ZEIGLER
9 2000 AHS Corp.
70.lNAA59D - 2
'. (A-L.50lS7C:'?>
. o/J :;e-rlk/Y7<VJr
(PENNPEST.INC'~ . $~e.r-)
The T ennite (; Pest Control Specialic:t
I for whateuer Bugs YOUJ
$
j:\'U{:.
~",qj g
1. o RATS
2. 0 ANTS
3. 0 MICE
4. 0 ROACHES
5. 0 SILVER FISH
7. 0 SPIDERS
8. 0 WASPS I BEES
9. 0 FLEAS
10. OGPC
11. 0
6.
TERMITES
o NO INFESTATION FOUND
o INFESTATION FOUND
"filr(i!!I:!.:Q";!m!\' .,'~~
PREVENTATIVE
TREATMENT RENDERED
TREATMENT
RENDERED
Harrisburg . . . . . . . (717) 540-5554
Mechanicsburg. . . . (717) 795-7333
New Cumberland . . (717) 770-0688
Carlisle. . . . . . . . . . (717) 249-5290
1. BEDROOMS
2. BATHS
@)OUTSIDE
4. KITCHEN
5. LIVING ROOM
6. D1NINGROOM
<VBASEMENT
8.
TALSTAR (Blfenthrin) .08%
M B l60dium Octllborate Tetrahydrale) 10%
TERMIDO (Aprunil)
SUSPEND SC (Deltamelhdn) .03%
CATALYST (Propelamphos) .5%
PRECOR (Melhop<ene) .008%
PRE.EMPT (ImkWlloptid)
ROACH BAIT GEL (Hydramethylnon) 2.15%
MAXFORCE GRANULES (Hydramethylnon) 1%
MAXFORCE Fe ANT BAIT (Flpronll) .01%
DELTA DUST (Dellamelhrln) .05%
U. .Bonlx
162.4-39
",-
Ag-
013;2.763
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272......50
.
27'24.$2.5Ol!O9
31~~
\
642411-5
-.
84248-6
...",,,,,
&428-10
t392~;~
ROACHES
ANTS
RATS I MICE
TERMITES
OTHER (SPECIFY)
Sol
12455-91
GLUE BOARDS
Special Service Instructions._
C00e<,e{e.
bea.r""" ,('\ bo.",eme,,+
\) ':i\\.:c,\ 1'-i,";-e4eA
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1. THE CUSTOMER AGREES TO MAKE PREMISES AVAILABLE FOR INSPECTiON AND TREATMENT AS OFTEN AS NECESSARY TO CONTROL
THESE PESTS DURING THE DURATION OF CUSTOMER'S SERVICE AGREEMENT WITH PENN PEST, INC. THERE IS A 3D.DAY WARRANTY.
CUSTOMER MUST WAIT A MINIMUM OF 2 WEEKS AFTER THE INITIAL PEST CONTROL TREATMENT. IF THE PROBLEM STILL EXISTS, WE
WILL RETURN TO TREAT THE INSIDE ONLY AT CHARGE. ANY ADOITIONAL EXTERIOR SERVICES WILL BE CHARGED
ACCORDINGLY.
2. A $15.00 CHARGE WILL BE APPLIED FOR ANY CHECKS THAT DO NOT CLEAR THE BANK.
Customer's SIgnature ,
'Penn Pest, Inc. (WS)
460] Locust Lane
Harrisburg, P A ] 7I 09
717-540-5554
Bill TO
Holly Wynn
851 Straws Church Road
Halilax, Pa 17032
P.O. NO.
TERMS
Due on receipt
Invoice
DATE INVOICE NO.
2/10/2005 8055
SERVICE lOCATION
Holly Wynn
713 Hummel Avenue
Lemoyne, Pa 17043
DUE DATE
2/10/2005
REP
DB
TARGET PEST
Termites
QUANTITY
DESCRIPTION
1
Termite Treatment
Payment - Check #127
Thank you!
Sales Tax
Thanks for your business!
RATE
495.00
-524.70
Total
AMOUNT
495.0
-524.7
6.00%
29.7
$0.00
!-f c/2- .
11l1/-NO ;2..-
Cff/2--e-
--:j C; ~). ~~
30 tP
Jl~
<< / 0.2 J .50
ffCR-ManorCare
MANORCARE CAMP HILL 583
1700 MARKET STREET
CAMP HILL, PA 17011
(717)-737-8551
GAIL MURDOCK
POR ANNE WYNN
217 WESTVIEW DRIVE
MECHANICSBURG, PA 17055
WYNN, ANNE M
1636
,":,;-1-
12/01/04
BALANCE -FORWARD
~~s'\ ~~t
PAYMENT DUE UPON RECEIPT
,-
MEDICARE A
PRIVATE:
ROOM 224 -A
10/13/04 11/11/04 12/31/04
---------j ,
985.50 /
_/
--------
d yI61).{
P df (JI
985
lCll-ManorCare
MANORCARE CAMP HILL 583
1700 MARKET STREET
CAMP HILL. PA 17011
(717)-737-8551
GAIL MURDOCK
FOR ANNE WYNN
217'WESTVIEW DRIVE,
MECHANICSBURG, PA 17055
WYNN, ANNE M
1636
:;E:;-j'~::
:CCE
SERViCE ~E:NC::::::,~C
11/01/04
11/29/04
11 /02-11 /10/04
BALANCE FORWARD
PAYMENT CHECK # 105
CO-INSURANCE 9 DAYS AT
PAYMENT DUE UPON RECEIPT
.>.tatement
Plea5~ Return This Portion
'Nt,h '{;Li~ ~3.'/~em
MEDICARE A
PRIVATE
ROOM 224 -A
10/13/04 11/11/04 11/30/04
':i-A.~GE3
36.0
109.50
.1~)C;_'NT DUE
36.00
985.50
985.5
10/25/04 11100 BEAUTY AND BARBER
18/31/04 1160. CABLE RENTAL
....
(QTY 1)
(QTY 1)
~IJ 10-01
J 6 ~ucJ
/ ~ /()~
PAYMENT DUE UPON RECEIPT
24.0\'
12.00
36
HEAL THSOUTH Rehabilitation Hospital
Of Mechanicsburg
BILLING DATE: December 6, 2004
PATIENT NAME: ANNE WYNN
PATIENT NUMBER: 213939
BILL TO: ANNE WYNN
713 HUMMEL AVE.
LEMOYNE, PA 17043
n/HD
r I'zJu lolf
I' j:/ /1/ f 2r6f!
SECOND NOTICE
rJl-- ~ -
DESCRIPTION AMOUNT
TELEVISION: ($1.00 PER DAY) $
DATE:
TAX ON TELEVISION: (PA SALES TAX 6%) $
PAST DUE AMOUNT: $29.68 $
DATE: ORIGINAL BILL SENT 10/14/04 FOR TV CHARGES
DATE: 29.68
PREVIOUS PAYMENTS RECEIVED: $
TOTAL: (PLEASE PAY THIS AMOUNT) $ 29.68
(Please return the bottom portion with your remittance)
--------------------------------------------------------
East Pennsboro Ambulance Service, Inc.
Post Office Box 47
Enola, PA 17025
(717) 732-5552 FAX (717) 728-9501
Federal Tax Number 23-2464545
./
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-
/
Invoice
DATE INVOICE #
10/25/2004 04-2349
BILL TO PATIEN f NAME Ann Wino
Winn,Ann ADDRESS 1700 Market St.
CIO Gail Murdock
217 Westview Dr. ADDRESS Camp Hill, PA 17011
Mechanicsburg, PA 17055 PICK UP Holy Spirit Hospital
TAKEN .[0: MCW
DESCRIPTION Stretcher
TRIP NUMBER
04-521-6
DATE OF SERV...
10/24/2004
DESCRIPTION
UNIT
Stretcher Transport - One Way
I
----"-
For your convenience, we now accept Mastercard, Visa and Oiscover.
Card Type:
Name on ca rd:
Credit Card Number____
Expiration:_ _'_ _ Amount to be charged: $
I agree to pay the above total amount according to card issuer. agn'crHcnt.
Signature:
RATE
60.00
AMOUNT
60.00
TOTAL DUE
Comments: Please remit payment upon receipt. Medicare and nw.<;;t insunllJce,<;; do not covel- this s<.'rvice. Uopai!
accounts will be seQt to a collection agency after 90 days.
Discounts available to members of ambulance services. Please call 712-5552 for more information.
$60.00
1-0
){bd
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reCfoj1~" 10 ~srv
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THANf: YOU FOR SHOPPING #~I3o-o
HEPfER'S_ T~lIE76VAIL7U7Eoo "
(; I/) - ._.
553 SALE
11/17 ~~~____~~~~__~~____________ ____
EA 5.38 EA
'14 j 232 1 5 _ 38
BRi"w~ lG Outlet B1" EA 8.55 EA c
24440~ C "^f' 8.5J
BRZ Hori GFl Snap Ovr I~ 99 EA
~"OOI'l 1 EA J. c 99
.'J' 1- 1 1,...10 .
20A WHT HD GfC! Out et
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yrl/~-=-~CJaL.{::'"
Hal mrp8mSm~nift 1
170329998
4134870032-0097
01/10/2005 (800)275-8777 03:22:54 PM
Salas Raceipt Final
Product Sale Unit Price
Description Qty Pr, ce
1 $0.13 $0.13
PVI $0.15
PV! 1 $0.15 $0.15
PV! 1 $0.15 $1.00
lOc Amer i can 10 $0.10
Clock PSA 10 $0.05 $0.50
5c Amer
Toleware PSA
TAX:
SUB-TOTAL: 29.92 TOTAL:
BC AMT:
BK CARD#: XXXXXXXXXXXX4184
1.80
31. 72
31.72
Total:
~y: $2.00
Ca -$0.07
. ange Due:
Order stamps at USPS. com/shop or call
Gs~~~~~'~f~kns~fpt~o ~j~~h:::iPPjng
labels with posltla~~800~ASK_USPS.
informatIon ca
Bll1#: 1000301274170
Clerk: 01
1 stamps and postage. --
-- A~~f~~~:sf~~ngua~~nteed services only_
Thank you for your bus,ness.
Customer Copy
$1. 93
;::;;::;::;=} >
JRNUt A25288
CUST # *5
~ YOU CLAYTON R WYNN
THA~dR YOUR PATRONAGE
< (==;::;=
mM!r~~
DEPOSIT/PAYMENT RECEIPT
Bank By Phone... CalI
M&T Telephone Banking Center
1-800-724-2440
"JSi(OEPOSIT 0 PAYMENT
b 'CHECKING
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2/19/05 11:54 PS
HECHAHlCS6URll. PA
(711)155-8552
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SALES I: S0405&Rl 804179 02-21-05
554 SALE
----------------
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250407 ? EA 11 99 EA
15A IVY PRM GFCIfuttl<?t, . 23.98
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7001 2X4X95" TOP CHOIC 1.15
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3410 8' STAIN 240/120 31.52
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100393 TOlLET FILL UALUE 9.97
11365 2 112"P6 1 L6 DEC 6.04
63691 AMT 8R ECOHO HRMO 9.18
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43661 114" FLAT VASHER 1.60
53351 HEX LAG SCREWS 1.15
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SUBTOTAL: 56.02
TAX 36550 : 4.06
INUOICE 59399 TOTAL: 72.10
SUB-TOTAL: 23.98 TAX: 1.44
TOTAL: 25.42
DEBIT/ATM: 25.42
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Bill#: 1000301257696
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Label Serial #: 70041160000251365418
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Halifax. Pennsylvania
170329998
4134870032-0097
1V15/2004 (800)275-8777 12;20:34 PM
Sales Receipt
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WYNN CLAYTON R JR
851 STRAWS CHURCH RD
HALIFAX, PA 17032
_nun_ fold
ESTATE INFORMATION: SSN: 201-18-6181
FILE NUMBER: 2104-1044
DECEDENT NAME: WYNN ANNE M
DATE OF PAYMENT: 04/11/2005
POSTMARK DATE: 04/11/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/11/2004
NO, CD 005180
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,010.52
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TOTAL AMOUNT PAID:
$4,010.52
REMARKS:
CHECK#140
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
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June 24, 2005
Register of Wills
Cumberland County Court House
Carlisle, PA 17013
Re: Estate of Anne M. Wynn
File: 21 04-1044
Amendment to CD005180 with additional I final payment of: $90.00 (enclosed)
The enclosed represents the change and additional tax due on the above Inheritance
Tax filing.
Kindly process this and send notification of acceptance in a timely manner. Escrowed
funds are being held by the real estate settlement company and will not be released to
the heirs until the Commonwealth acknowledges that taxes due have been paid.
Since the charitable donations are not being accepted, we ask that you return the
oriQinal receipts for this so that the individual heirs may claim their applicable portion
with their federal tax returns. Thank you for your prompt processing of these requests.
Please contact me promptly if there are any questions.
Sincerely,
ENC: Estate check #146
Commonwealth of PA Dept of Revenue form REV-1547 EX AFP (06-05)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005493
WYNN CLAYTON R JR
851 STRAWS CHURCH RD
HALIFAX, PA 17032
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
______n fold
101
$90.00
ESTATE INFORMATION: SSN: 201-18-6181
FILE NUMBER: 2104-1044
DECEDENT NAME: WYNN ANNE M
DATE OF PAYMENT: 06/28/2005
POSTMARK DATE: 06/27/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/11/2004
TOTAL AMOUNT PAID:
$90.00
REMARKS:
CHECK#146
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF IM)IVIJlUAL T..ftJ(\ORDED O~FICE OJ: INHERITANCE TAX
JIlIIERITAIlCE TAll DIVISIOII --rn:.v ~_~ ~",,' STATEMENT OF ACCOUNT
PO lOll 2lIlI601 h'Cr::l i d:) f\. ",".,1' "
_1_ PA 171211-0601 '.LU') ..." '.." ',',"L)
*'
REV-1607 EX AFP (03-05)
2005 JUL 22 PH 2: 12
DATE
ESTATE OF
DATE OF DEATH
FILE NUMER
COUNTY
ACN
07-18-2005
WYNN
11-11-2004
21 04-1044
CUMBERLAND
101
~t R.."Uecl
ANNE
M
CLERK OF
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lli'n/"\!\ '... I_'''')U I
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HALIFAX PA 17032
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
IlDTE:To in....... proper crecllt to your IlCCCIUI'lt, subIIlt the _r portion of this fo... with your tu p~t.
CUT ALONG THIS LINE
---------------------------------------------------------------------------
... RETAIN LOWER PORTION FOR YOUR RECORDS ...
REV-1607 EX AFP (03-05)
... INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF WYNN ANNE M FILE NO.21 04-1044 ACN 101 DATI 07-18-2005
THIS STATEItENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF TIlE STATED ACN IN TIlE IWIED ESTATE. SIlllIIN IELOlI
IS A SUllltARY OF THE PRINCIPAL TAX DUE, APPLICATIllIl Of ALL PAvttENTS, THE CURRENT IALANeE, AlII, IF APPLICAlLE,
A PIlO..IECTED INTEtlEST FIClUIE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-27-2005
PRINCIPAL TAX DUE: 4,100.52
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISC*,NT (+) AMOUNT PAID
DATE NUMBER INTERESTI EN PAID (-)
04-11-2005 CD005180 .00 4,010.52
06-27-2005 CD005493 .00 90.00
TOTAL TAX CREDIT 4,100.52
BALANCE OF TAX DUE .00
INTEREST AND PIN. .00
. IF PAID AFTER THIS DATE, SEE-'REVERSE TOTAL DUE .00
SIDE FOR CALCULATIllIl OF ADDITIlIItAL INTEREST.
( IF TOTAL DUE IS LESS THAN .1,
NO PAYIENI' IS REllUIRED.
IF TOTAL DUE IS REFLECTED AS A "'CREDIT" (CR),
YOU ItA Y 8E DUE A REFUND. SEE REVERSE SIDE OF THIS FOIllt FOR INSTRUCTIllIlS. )
:J(
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
06-27-2005
WYNN
11-11-2004
21 04-1044
CUMBERLAND
101
APPEAL DATE: 08-26-2005
( 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:is4;-Ex-AFP-C03:osj-NoTlcE-OF-INHERITANCE-TAX-APPRAIsEMENT:-ALLowANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ANNE M FILE NO. 21 04-1044 ACN 101 DATE 06-27-2005
TAX RETURN liAS: ) ACCEPTED AS FILED I X) CHANGED SEE ATTACHED NOTICE
_r-."_. .,-"--'---
BUREAU OF INDIVIOUAL'T~E$
INtERITANCE TAX DIVISIlJfi:.
PD BOX 280601
HARRISBURG PA 17128-0601
"", e,l
33
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
I. ,I
I.:',
CLAYTO~'R WYNN JR
851 STRAWS CHURCH RD
HALIFAX PA 17032
ESTATE OF
WYNN
'*
REV-1547 EX AFP (06-05)
ANNE
M
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..1 Est.t. (Schedule A)
2. stocks and Bonds (Schedule BJ
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule OJ
S. Cash/Bank Deposits/Hisc. P.rso~l Property (Schedule E)
6. ~ointly Owned Property (Schedule f)
7. Tr8nsfers (Schedule 8)
8. Total As.-ts
III
(2)
(3)
(4)
IS)
(6)
171
99,900.00
.00
.00
.00
2.556.02
.00
10,139.95
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule Il
11. Totel Deductions
12. Net Value of Tax Return
13. Charit8b1e/Governmental Baquestsi Non-elected 9113 Trusts (Schedule J)
14. N.t Value of Estate Subiect to Tax
I~ an assessment was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will
re~lect ~igures that include the total af abb returns assessed to date.
ASSESSMENT OF TAX:
15. A.ount of Line 14 at Spousal rate (lS)
16. ~ount of Line 14 taxable at Lineal/Class A rat. (16)
17. A.aunt of Line 14 at Sibling rat. (17)
18. A.ount of Line 14 taxable at Co11.tera1/C1ass Brat. (18)
19. Principal Tax Due
(9)
(10)
NOTE:
8,423.29
13.049.95
Ill)
(12)
(13)
(14)
.00 X
91,122.73 X
.00 X
.00 X
NOTE: To insure proper
credit to your account,
subMit the upper portion
of this fOrM with your
tax payeent.
112,595.97
?l .473 ?4
91, 122.73
.00
91,122.73
00 =
045 =
12 =
15 =
.00
4,100.52
.00
.00
4,100.52
(19)=
rAX CREDIT!!'
nnn:". '+J AMOUNT PAID
DATE NUHBER INTEREST/PEN PAID 1-)
04-11-2005 CD005180 .00 4,010.52
PAYMENT MUST BE MADE BY 08-11-2005~. TOTAL TAX CREDIT 4,010.52
BALANCE OF TAX DUE 90.00
INTEREST AND PEN. .00
TOTAL DUE 90.00
~
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS.)
RE\I.1470EX(e-88)
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
IlUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRlSBURG PA 17128-0601
DECEDENT'S NAME
FILE NUMBER
Anne M. Wynn
REVIEWED BY
ACN
2104-1044
101
Sheila Megonnell
ITEM
SCHEDULE NO.
J 11-8
EXPLANATION OF CHANGES.
The value of the charitable bequest has been disallowed. The decedent's Will did not
contain a specific bequest to the charity.
i'f.
ROW
Page 1
Cumberland County - Register Ot WlIJ.S
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 10/30/2006
WYNN CLAYTON R JR
851 STRAWS CHURCH RD
HALIFAX, PA 17032
RE: Estate of WYNN ANNE M
File Number: 2004-01044
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 lS due by: 11/11/2006
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,
g~~'1P/J~.~~/2
,/ ,
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~
Register of Wills of Cumberland County
~ .---
STATUS REPORT UNDER RULE 6.12
Name of Decedent: IINNe' /171 t(}Y/lIN
-'1/-//-0'1
c200tf ~ fJ/ncrf
Date of Death:
Estate No.:
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 ~ No 0
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?
Yes ~ 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 informally to the parties in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Cler :-pf the Orphans \ Court and may be
attached to this report. .-
Date: /1- 7-~
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Itln08 S,N\fHdl:10
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19n
Nf!4ffon I? WYNN (Jr.)
&5/ SmAuJ~CiuJrdt!Cd
Address Jia.k~( tit /7032-
7/7 -302-- Z 2-tffo
Telephone No.
Capacity: I:2rP"ersonal Representative
o Counsel for personal representative
o I : I lJ.d S I AON 900Z
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