HomeMy WebLinkAbout05-06-13 (2) . ,
� 15056101q5
REV-1500 fX��'�,"<F"�
PA Department of Revenue PmnSY���� �FFIqAL USE ONLY
BureauofIndivfdualTexes �"`� CounryCode Year FileNumber
ao aoxzeoeos INHERITANCE TI►X RE7URN �i ` r� ��C f
Harnsbu+zt,PA i7128-O6oi RESIDENT DECEDENT ( QS b
ENTER DECEDENT INFORMATION BELOW
Sociai Securiry Number Data of Death MM6pYYYY Date of Birth MMDDYYYV
4$/0312412 11t4911944
DecedenPs Laffit Name Suffix DecedenCS First Name M1
' BAITSELL . . . . . KENNETH L_
_ _ . . _ _
(If Applicabie)Enler SurviNng Spouse's Informatfon Below
Spouse's Last Name Saffix Spouse's First Name MI
. . . .. . . . .... . ...... ._ .... .. .
Sppuse's Social Secunty Number
THIS RESURN MUST BE f11.ED IN QUPUGATE WITH THE
REGISTER OF WILLS
F0.t tN APPROPRIATE OVALS BEIOW
(,'�1 1.Original Return p 2.Supplementel Retum O 3. Remaindet Raturn{bate of 6eath .
Prinrto 12�13-82j
CT 4.Limited Estate O 4a.Future Intsrest Compromise(d8te of p 5. Federal Esiate Taz Return Required
death atter 12-12-82}
�1 6, pecadent Died Tesiete Ct 7.Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes
(Attach Copy of Wiii} (AftaCh Copy ofTrust.}
O 9. Litigation Proceed5 Received O 10. Spousal Poverty Credit(Date of Death GG� 11. EleCtion to Tax under Sec.9113(A)
Bariveen 12-31-91 end t-7-95) (Att2ch SChedule O}
CORRE5PONDENT- THIS SECTION MUST BE CaNPlETEO.A!L CORRESPONDENCE AN�CONFlDEN'I'NLTAX INFpRMATION SHOULO BE DIREGTE�70:
Name Daytime Teiephpne Num¢e,r,
SHER!BAITSEI� {717}3�-747$ U� '° �T�
a m
__. � � ca
REpffiT� OF WIIL�SE O�Y�
� ,�. n �� t:�
:.=J :> � !^rS f�1
__ -,. _ G)
...
Pirsl Line of Address ....... . . .. . _.. . . r:,s vy 1 "�� �,�
�� �
108 GREASC}N ROAD � z-, ,_ ,.� "'� ��
Second Line ot Atldress � ���
� �._.., r- =�'
" r""
"""
y f._,� {�3 .
City or Post Offioe � � � � $tate ZIP Code ' ��� DA7E FILE
. . ._. .._ . .
CARUSLE PA ' 17d15
_ . _ ..
CorrespondenCs e�roail addresa:Sb8R5@II�CCpe.119t
Under penallies of perjury,1 declare that i have axaminatl this reNrn,including accompanying schedules and stalamenls,and to ihe best of my knowledge snd balinf,
it is true,corcect and Complete.DeGaretion of preparer other Uan lhe personal represenlative is based an all information of which preparer has any knowletlga.
51GNATURE O RSON RESPQNSIBLE FQ�F �"�ryRN �_�A���
!X f � f
ADp SS
108 GftEASON ROAD, CARLISLE, PA 17015
SIGNATURE OF PftEPARER OTHER THAN REPRESENTATIVE DATE
ADDRES5
28 BROAD ST., SHIPPEN98URG, PA 17257
PIGASE USE ORIQINAL FORM ONLY
Side 1
� 1505610105 LSOS6101n5 �
�
_ _
J 15�561�205
REV-1500 EX(FI)
RECAPITti ViTi6N
1. Reat Esiate{Schedale A}. ........... .................. .. ... .......... t. . .
„_... .... . . . _. ._....... ........
2. Slocks and Bonds(Schadule 8) .................. ................... . . 2.
3. Ciosely Heid Corporation,Part�ership or Sole-Proprietorship(Schedule C} ..... 3.
4. Mortgages and Notes Receiva6ie{SCheduie 6}....... ...... ..... ......... 4.
. ...... . _ _..... . . ......... . . .
5. Cash,Bank Depasits a�d Miscelianeous Persanal Property{Schedu3e E}..... .. 5. '123,790.27 �'
6. Jointly 4wned Property(Schedule F) O Separate Billing Requesied ....... 6.
. . . .... ... ..<;.
7. Inter-Vivos Transfers&Miscellaneous Non•Probate Pmperty �
(Schedule G) O Separafe Biiling ftequested...,.... 7. �-
8. Totai Gross 14ssets(totai Lines t throu9h 7)............................. & 123,790.27
9. Funeral Expenses and Adminishative Costs(5chetluie H}.................. . 9. �$0.�$
. . . . . . ... .. ._....
10. Debts of Decedent,Mortgage liabitities and�iens{Schedule i)............... 10. 3,T71.S$
._ . _.. .... . ....
1t. Totai Deduct}ons(totai lines 8 and 10}.........._.........._......... ti. 4,7{1.T') -.
.. _..... .. . . . ..........._..__......�
t2. Net Yalue af Estate{L'€ne 8 minus Line 11).............................. 12. 1'3$,0$$-�
13. CharitableandGovernmentalBequesis/Sec91137rustsforwhich � --��� ---��������� ��� � �������� .
an eleciion to tax tras not been made{ScheduVe J) ........ ................ 13. �..
_... . .. ..... .... .
i4. Nat Yalue Subject to Taz{�ine 12 minus Line 13) ....._........._....., tA. 'C1$,a�S.S$
TAX CALCULATItlN•SEE INSTRUCTIONS FOR APPUCABLE RATES
15. Amoont of lino 14 taxabie
at the spousal tex rate,or
transfers under Sec.9116 . .. . .. . . ..____ .
(a)(L2)X.0 1� �. 15.
.._ _.., ._ _. _ . ___ . . . . . . .. . .. ... . . ._ . .
16. Amount af�ina�4 tazabte �
e�Iinea�rate X.0 4�` 79,358.D4 �6. 3,571.15
_ _.,_. . �_
17. Amount of Line'IA taxabie
et sibling rate x.�2 39,679.52 �� 4,761.54
18. Amount af lkne 14 ta�61e . .-.... ._ .. .... . . . . ._ . . . . .. . . . . . .;....
at collateral rate X.15 1 B.
19. TAX DUE . .... ... ... . ...... ...... .......... . _ . . 19. .. . .. .._ . .._. _ .. .8�$$2.6� ',.
.._. _ ... _....... ...
20. PtLt tN THE OVAL tF YdU AR@ REQUESTING A REFUND OF AN OVERPAYMENT G7
Side 2
� 15�5610205 150561�205 �
REV�15p0 EX(FI) Page 3 fiiB Num6er
Decedent's Complete Address:
DECEDENT'S NAME
KENNETH BAITSELL
---.._ __ _.._ -- ---- --- __ _ -- ------ --- — _------
STREETADDRESS
108 GREAS(3N RD
C+T(�___ ._..____—____—__.._._ --_____._.._..___—...._ "_._— S7ATE .._—_.____ .,.__. ...ZIP _'—_—_....__
CARLISLE PA 17015
Tax Payments and Gredits:
1. Tax Due(Page 2,Line 19) (1) 8,332.69
2. Credits/Payments
A.Pdor Payments __ 7,540.00
_... -----_,___...
8.6iscount _ __ 394.72
Total Credits(A+g) (2� 7,894.72
3. Interest � �—
{3}
4. I#Line 2 is greater than Line i +Line 3,enter the difference. This is the OYERPAYMENT.
FIII in oval pn Page 2,Line 2010 requeat a refund. (q)
5. If�(ne 4*�ine 3 is greater than�ine 2,enler the difference.This is the TA7(DUE {5} 437.97
Make check payable to: REGISTER OF WI�I�S,AGENT.
.'���^��� ''''�ws,"�, . ... . .�m��' , �;.ii� ..� .. ���'��s«� . ....�i:�...�. �, .�:x �'r'xi�:��n±9���"` .. �'i , .,��v
PLEASE ANSWER THE FOLL4WING QUESTtQNS BY PLAGING AN "X"IN THE APPROPRIATE BL4CKS
1. Did decedent make a transfer and: Yes Nn
a. retain the use or income of the property transferred..._..................................................................................... ❑ �
b. retairt the nght to designate wha sha8 use the properiy trans(erred or fls income.........._..._........__......_....... ❑ �
c. retain a reversionary interest._.._....................................................................................................................... � �
d. receive the promise for life of either payments,benefts or care?.._.................................................................. ❑ �
2. It death oacurred after Dec.52,1982,did decedant transfer property wilhin orie year of death
without receiving adequate carsideratiar?.........................._.................................._................._...._............_....... ❑ �
3. Did decedent own an"in trust for"or payable•upon-death bank account or security at his or her death7.............. ❑ �
4. Did decedent own an individual retirement account,annuiry or other non-probate propedy,which
cflntatnsa beneficiary designation? ............._...............,...................................._....,............_..._......,.................... ❑ �
1F THE ANSWER TO ANY OF THE ABOVE QUE5TIQNS 15 YES,YOU MUST COMPLETE SCHry�E�D,��U� LE G ANp FILE IT AS PART OF THE RETURN.
�Ka`,�? ar,,� .�. , w,'e'� :K,.ep�.rra�.,,"t�?y'�., r v eq,'P,'; . .�a��lo.. � f.�`�r.%%�'%�a%„ i i "y,{� �a� ..,
V,._ , {�.. . 3 , ..P . M d�+��'-4fi. i... ..��x R.rt.
For dates of death 4n or a8e�July 1,f 994,and before Jan.1,1995,the tax rat�impased on the net value of Va�sfers 10 or for the use of the surriving spouse
is 3 psrcent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the ta�c rete impased on the net value of transfers to or for the use of the surviving spr�use is 0 percent
j72 PS.§9116{a)(1.1}(ii}].The statute dces rwt exempf a transfer to a survivir�spouse from tax,and the statutory requirements fix disdosure of assets and
filing a tax retum are still appi�able even if the survrving spoose is the only beneficiary.
For dates of death pn or aRer July 1,20p0:
. The taac rate imposed on t�e net value of transfers from a deceased chiid 21 years of age or your�ger af deakh to ar far the use of a naturai parent,an
adoptive parenf or a stepparent of the chiid is D percem(72 P.S.§911fi{a}(f.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal benefcianes is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
s 7he tax rate impased on the net valua of transferS to w for the use o#ihe decedenYS siblings is 12 percent(72 P.S.§9116{a)(1.3}].A sibiing is deflned,
under SecGan 9162,as an indn+idual vfio has at ieast ane paren!in common with the decedent,whether by biood or adoption.
LAST WILL AND TESTAMENT
I, KENNETH L. BAITSELL, of Middlesex Township, Cumberland County,
Pennsylvania, declaze this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my executcix to pay all of my debts, funeral and administrative expenses
as soon as may be done conveniently after my decease.
2. I authorize and empower my executrix to sell any realty owned by me at my
death, at either public or private sale, and to give good and sufficient deeds therefor, in fee
simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate
to Larry A. Baitsell, Sheri L. Baitsell and Kristen M. Baitsell, share and share alike.
4. I nominate and appoint Sheri L. Baitsell to be the executrix of this my Last Will
and Testament, she is to serve as such without bond. Should she die before my death, renounce
or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and
appoint Kristen M. Baitsell, as substitute executrix, also to serve as such without bond, with the
same powers as are given herein to my executrix. C �-�
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5. I hereby suggest that my personal representative retain the services af Irwin,
McKnight &Hughes as attorneys in the settlement af my estate.
IN WITNESS WHEREOF,I hava hereunto sat my hand and seal this 11T'�day of April,
zooi.
�iti.�vt-i���1�� - �c��cGt��QSEAL}
KENNETH L. BAITSELL
Signed, sealed, published and declazed by KENNETH L. BAITSELL, the Testator
above named, as and for his Last Will and Testament, in the ptesence of us, who, at his request,
in his presance and in iha presence of each other have subscri6ed our narnas as witnesses hereto.
� �
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2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, KENNETH L. BAITSELL, CHERYL L. CLELAND and MARTHA L.
NOEL, the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as his Last Will, and that he had signed willingly,
and that he executed it as his free and voluntary act for the purpose herein expressed, and that
each of the witnesses, in the presence and heazing of the testator,signed the Will as a witness and
that to the best of their knowledge the testator was, at that time,eighteen yeazs of age or older, of
sound mind and under no constraint or undue influence.
`i��./F�✓�ivv��Mi/ ���,1��
KENNETH L�BAI ELL„ �
;
� i` , ;i ,
CHER . CLELAND
:. . �!!%G'-C=�
N/ RTHA L. OEL
COMMONWEALTH OF PENNSYLVANIA .
. SS:
COUNTY OF CUMBERLAND .
Subscribed, sworn to and acknowledged before me by, KENNETH L. BAITSELL, the
testator herein and subscribed and sworn to before me by CHERYL L. CLELAND and
MARTHA L. NOEL,witnesses, this I1"` day of April, 2001.
i
�� 3 - c�a`�
Notary Pu c
�f,
�Noteriel Seel
Roger B.Invin,Notery Publk
CaAisle Boro,Curr�eAend Counly
My Commission Ezpires Oct.3,2004
�er,�nsyiveoiane�creno�,a riomr�as
_ . _
R�v�na7-0�x.'�s.oeJ
� pennsylvania ��HEDUI.E E, PART 7
DEPAP7MENT OF REVENUE MISCELLAN�OtI�r
cNHenRaNCeTn�ca�ruAn PERSONAL PROP6RTY
NONRESIDENTQECEDENT
ESTATE 4F FILE NUMBER
KENNETH BAITSELL 21-12-0988
Part 1 must include a!I tengibie personei property having its sftus in Pennsylvania. Examples of tangibke personal praperty are
jeweiry,fumiture, paintings,etc.Atl property jointiy-owned with the rigM of survivorshlp must be disciosed on Scheduie F.
Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected.
ITEM
NUMBER DESCRIFTION VAEUE AT DATE OF DEA'FH
� Looal 520 U.A.Federal Credit Union,7187 Jonestown Rd, Harrisburg,Pa 17112 Savings Acct#"'OQ635 51,56274
2 United AssociaGon of Jovmeyman 8 Appren6ce-Refund of Prepeid Union Dues 4$.00
3 BeneCard PBF, 1200 Route 46 West,Clifton,NJ 07013 Retund oT Pharrnecy Expenses(Sept) 270.30
4 BeneGard PBF,1200 Route AB West,Glifton,NJ 07013 Refund of Phatmacy Er�enses{May-Aug} 3,245.34
5 M&T BANK,Cadisle Plaza Offce,Carlisle,PA Ckg 98-33890412 67,383.89
6 lntemal Revenue Service, 2412 Feder�Taa�Refund 1,280.00
PART '! TOTAL i23,790.27
$
PART S TO*AL
(From reverse side.) S
T07'A#. {Alsa entar on line 5, Recapitutation.} S �23'7g0'27
Qf mpre space is needed, use additional sheeta pf paper pf the same size)
' Se�'fl Inquiriee �0��� ��� ��A� potleW� eee rawree sida [or importwt inlorn�tSOV ragarding
FEDERAL GREUIT UNIQN yonr ziqnt to diepssta anera m yaui atatan�at.
Pe Q]c Hefpira,q PeapJe.lri a lil,iy ofL��.
7187 Jonestown ftoad = Flarrisburg, PA 171t2 ACCOONT NSIMBBRs x�acoo53s
Phane (717) 545-9829 + www.loca1520fcu.org
��g�i,.'x=� YTA DIV RECEZYLD: 62.62
^W PACB NOMBSR: 1 af 1
1525
Holidsy laens are no« sveilable
nt a gzeet znte.
10
TCPsNNETH L SAIT3�LL
7338 WSRTZVILI,E RD.
CARLISLE PA 17d15
The Supervzsory Committee is performing a verification of accaunts. Flcase review yaur statement for any discrepanciea.
If any di9crepancies are found, please report them Ca [he Supervieozy Co�nmittee, P.O. Box 530, Campbell[awn, HA 1��SO,
sv�cx oF xoofe accavxTs
_
jsvrexx ooi �tscnua�x sFwnas �� ,I �
� STATSMEkTf PERZOD Q7f01J12 - 09J34/12 ( i ���� �
� BEGINNING HALANCE 48,889.50 � � ' �
� DSPOSTTS 3 2,632.22 � � �
� WITHDRAWALS 0 .00 � I I
� enrnxxc snvar�cs si,ssi.zz � 1 (
� � i I
� DIVT➢END YEAR-Tp-DATE 62.62 � � �
i DZVSDEND THIS PERIOb 18.98 � j I
� AVERAGE DAILY BALANCE 50,342.35 � ! �
� DAYS DIVIDEND EARNEP 92 � i i
� ANN[)AL PERCENTAGE I I I
f YIfiLD EARN£D 0.15t
�.� — —
SVFFI% ObI RECiULAR SSSARB9 ,_,..,� ._,_
RZST4RY
DA1'E DESCRIPTTON TRANSAC'T'ION AMOUNT ACCOIINT HALANC&
7j2?J12 Aug 2672 Penaion 1,336.62 50,226.12 /
e/28/12 Sep 2012 Penalon 1,336.62 51,562.79✓
9(SOj12 DSVZD6N4 1&.48 51,'S61.T2��
. _
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� Ai Cbt�pi � NO T . �. ACCOUNT TYPE . . STATEMENT PERIOD _A PAGE__ _ -I -.
'ri�,� p�`0 Cl?1._ M8T CLASSIC CHECKING M/INTEREST AUG.04-SEP.05�2012 1 Of 1__ _ I
00 0 04342N NM 017
[� 7DUJ'U! F [)51549D01709051209 02 001000 12496
� = KENNETH L BAITSELL
� � 7338 WERTZVILLE RD
CARLISLE PA 17015
Ii iERE:if ERiNEO FOR STATEMENT PERIOU 0.65 CARLISLE PIKE
II iERE:if PA.[0 VF�AR TO DATE 3.11
ACCOUNT SUMMARY
9E4INF. MG P � g " � TN ��:��� ��CURRENT � ENp2N� ��� �
BALidi_I . OTNER ADDIIIONS CHELNS PAID�.'� 'SUBtRAfTIONS :INiERES7;PD BAI:ANCE'���
N0. AMOUNT N0. Alq1MT . N0. AMOUNT
___!7 , S2� 64 _ 1 1� 0.00 ll�i3 . 5 0 0 00 0 66 I 67 384 �S5 �
ACCOUNT ACTIVITY
�� '�� � � .�NT ;EH GKS '�O7N OA LY� --
'.� i ATE_�_ ________ ': 1RAN5ACTIdN hESCR2pTTfNi ��.f OTNER AhqI7IpN5 E SU91`RAf'fIQNS .BALANCE
Ot �04-1:! I EICIlN]�,IIG� BALANCE
t77�329.64
OE �08-li! I5� TF!EiI:iUF'Y 30i H%SOC SEC 1�390.00 78�719.64
0! �16�4L' I HIECM IM1IMBER 059E 9E.00 �E�621.64
0l �17°12 IMIECN ldIMBER 0597 1,114.10 77,507.54
OE �20-1Y IHECM lINIBER 0596 10,123.65 67,383.E9���
09 O5�•1:�, INTEAE<_7' PAYMENT 0.66 6)�384.55
i ND[N6 BIALANCE
, --' "'--"—' i67�304.55_ i
C _""___"_' fNECKS PAID.SUIIMARY � � . . . � _.�
59Er 00-'<0-].2 30�123.65 597 00-17-12 1�114.10 59E OB-16-12 98.�U0
ANNUAL PERCENiAGE YIELD EARNED = 0.00 %
�, i �� . .� . ,.� .. ,�.`,.
D:[U YW KNOM THAT YOU CAN MANA6E VIRTUALLY � I �
I)I:iI;OVER MAYS TO SAVE MONEY BY USIN6 FINANCE .:hi'`4r
.E1' STARTED TODAY FOR ONLY f0.99 PER MONiH. "A"
' �;,!;:
"iF7:IdNCEflORKS" INqER THE ACCOUpTS ^TAE^. LEA
I'IlU1NCENORKS IS A RE6IS7ERED TRADEMARK OF IN '" �'
IIIEltlIER FDIC. ' �"�"��
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REV-17�7�6 EX+(6-08)
REVER5E
��r entls tvania '�CHEp11LE N
� y FUNERAt EXPENSE�i & Use Schedute H ONLY for proportionste
DEPARTMENT OP REVENUE ppMlNlf*!tA?IVi COSTS methad of tax computation.
INNERIfANCE7AXfiETUflN
NtlNRESIDENr�ECEDENT
ESTATE OF FILE NUMBER
KENNETH BAITSEL� 21-12-0988
Debts of decedent must ba reported on Schedule l.
ITEM NUMBER nESCRIPTION AMOUNT
A. FUNERAIEXPENSES:
1 Hollinger Funeral Home&Crematory, Inc Remaining from Prepafd Funeral 178.44
2 Kristin Mitchell, Reimbursement for Funeral Reception Food 64.09
B. ADMINISTHATIVE Cp5T5:
i. Personal Represenlalive's Commission(s)
Name(s)of Pereonal Repreeenlalive(S)
{Submit reqveateC information for additionai persot�ai re{xase�tadve's an aCditionai�eets}
Social 5eanty Number(s)or EIN Number{s�ot Personal RepresenWtive(s)
StreetAddress(es)
Giry(ies) 81aie(s} ZIP{s)
Year{s}Cammission PaM
2. Attomey Fees
3. Prabete Fees 31$.50
<. Accountanl's Fees
5. T�Retum Preparer'e Fess 224.44
6. Miscellaneous Ezpenses
Advertising-Cumberia�d Law Joumai
75.Q0
Advertising-The Sentinel
83.34
U S Post Office-Certified Maii
15.80
Cumberland County- Filing Fee
i 5.d0
M&T Bank-Service Fee
4.95
TOTAL (Also enter on Line 9, Recapitulatioa} $
9$0.08
(If more space is needed, use additional sheets of paper of the same size)
aEV�+�a�a ex'.�sae1
scHEe�u�.E �
pennsytvania aESTS oF Q�tEaEN!'r �ge s`h�a°ie i,P�"Z,°"`'``o`
oeanaTMer+r oF eevENUe MORT6A�6 LIABINTIES� & LIENS Proportionate method o(tax computation.
INHEFiTANCETAX FETUpN
NONRE5(DENT DECEOENT
ESTATE OF FILE NUMBER
KENNETH L BAITSELL 21-12-0988
Part 1 must inciude mortgage itabilities, liens and taxes against the Pennsylvania realty that were due and
owed as af the dste of decedenfs death.
Complete Part 2 ONLY wben the proportlonate methpd of tax camputatian is elected.
ITEM
NUMBER DESCRIPTION AMOUNT
1.
70t/t� MRT � S 4.4U
ifEM
NUt�ER DESGRiP'f10N AMOUNT
� Millennium Phcy Systems Inc, 5020 Ritter Rd, Suite 110, Mechanicsburg Pa- Drugs 941.p5
2 Sarah A Todd Memoriai Home, 1 d00 W South St. Cerlisie, PA 17�13,Skiiied Nursing Home 2,487.96
3 5arah A Todd Memonal Home, 1000 W South St. Carlisle, PA 17013, 5killed Nursing Home 62.21
4 Miilennium Phcy Systems Inc, 5020 Ritter Rd, Suite 110, Meohanicsburg Pa-Drugs 300.41
TOfAL PART S $ 3,771.63
TOTAL (Atso enter on Llne 10, RecapitWation.} § 3,771,63
(If mpre space is needed, use additional sheets of paper of the same size)
'nvo�ce Date:08/28/2012,Acct#:STMH1862, BAITSELL,KENNETH,Sarah Todd NC,A.BFL4NSCUn�,c�tvhtt;❑ ��
_ 5 : �( � , . . . . .rc
07/29/2012 6525356 90.00 Albutarol-Ipratropium Inhalation SolWion 2.5-0.5 MG/3ML $ 7124 $ 0.00 $ 71.24 RX
00487-0201-01
/30/2012 2029385 30.00 Oavcodona-Acetaminonhan Orel 7eblet 5325 MG $ 11.51 $ 0.00 $ 11.51 RX
00406-ost2-05
OB/OS/2012 6525356 90.00 Albutaml-Ipratrooium Inhelation Solution 2.5-0.5 MG/3ML $ 7124 $ 0.00 $ 71.24 RX
00487-a201-ot
08/07/2012 2029683 30.00 Oavcodorre-ACatamino0hen Orel Teblet 5325 MG $ 11.51 $ 0.00 $ 11.51 RX
00406-0512-05
08/10/2012 6550309 90.00 Albuterol-IDratrooium Inhalation Solulion 2.5-0.5 MG/3ML $ 7124 $ 0.00 $ 7124 RX
00487-0201-0�
08/17/2012 6550309 90.00 Albuterol-IOratro0ium Inhalation Solulion 2.5-0.5 MG/3ML $ 71.24 $ 0.00 $ 7124 RX
00987-0201-01
08/21/2012 2030190 28.00 O�'codone-Aceteminophen Oral Tablet 5-325 MG $ 11.08 $ 0.00 $ 11.08 RX
00408-0512-05
OB/22/2012 6550309 90.00 Albuterol-IpretroDium Inhelation SolNion 2.5-0.5 MG/3ML $ 71.24 $ 0.00 $ 7124 RX
00481-0201-0'I
OB/28/2012 6534203 31.00 Omeprazole Oral Capsula Delaved Release 40 MG $ 55.38 $ 0.00 $ 55.38 RX
82175-013843
OB/28/2012 6476009 31.00 Folic Acid Orel Tablat 1 MG $ 15.28 $ 0.00 $ 1528 RX
65162-0361-10
08/28l2012 6476010 31.00 Furosemide Orel Tablet 20 MG $ 9.34 $ 0.00 $ 9.34 RX
. 63369-0624-10
OB128/2012 6476013 31.00 7ab-A-Vite Orel Tablat . $ 0.51 $ 0.00 $ 0.51 OTC
00904-0530-BO -�
08/28/2012 6476014 31.00 Amlodipine Besvlate Oral Teblet 10 MG $ 78.67 $ 0.00 $ 78.67 RX
88382-0123-18
OB/28/2012 6476020 82.00 PeMasa Orel Capsule E#ended Release 500 MG $ 229.58 $ 0.00 $ 229.58 - RX
54082-0191-12 .
OB/28I2012 6476131 31.00 Citalovram HWrobromide Oral7ablet 10 MG $ 43.66 $ 0.00 $ 43.66 RX
55117-0342-01
08/28/2012 6484638 31.00 PredniSONE Orel Teblet 10 MG $ 6.95 $ 0.00 $ 8.95 RX
00143-1473-10
08/28/2012 8560657 118.00 Ramedv Skin Repeir Extemal Creem 1.5% ����~ $ 5.84 $ 0.00 $ 5.64 OTC
53329-0161-04 ^
08/28/2012 6560658 15.00 Nvstop Eaternal Powder 100000 UNIT/GM v�� $ 31.85 $ 0.00 $ 31.85 RX
oos�a-zooe-�s �i
08/28/2012 6476011 62.00 Mucinex Orel Teblet EMended Releaae 12 Hour 800 MG $ 21,69 $ 0.00 $ 21.69 OTC
83824-0008-50
08/28/2012 8476016 62.00 Metoprolol Tartrete Orel Teblet 100 MG $ 52.20 $ 0.00 $ 52.20 RX
63304-0581-10
$ 0.00 $ t,114.10 08116/2012 $ 0.00 $ 0.00 $ 0.00 $ 913.21 S 27.84 $ 0.00 E 0.00 941.05
.
� STATEM ENT
Sarah A Tadd Memoriai Home Statement Date: 04J23J2fl i2
lODO West Sputh Street
Carlisle, PA i7413-2798 Due Date: 44(25(2012
Telephane: (717) 245-2187
Amaunt Endoseci $
Amount Due: $ 2,467.96
Account #: 102247
RE: Kenneth Baitseii
E.arry Baitseli
7342 Werizvilie Road
Carlisle, PA 17015
Balance B/F 10,123.65 10,123.65
� �1�31�2 �AITSELI,I.ARkY 10,Y23.65 .DO
OSJZO/12 MedicalEqulpmentRentai 78 25.88 1,624.56 1,624.56
08l23l12 Personal Supplies 66 2.1 137.10 1,761.86
08j28j12 Beauty&Barber i 13.d 13.00 1,774.5b
OS/28/12 Medical5upplies 139 JO 124.65 1,899.31;
08131J12 hie Television 1 34.fi5 34.55 1,933.46
09/Ol/12-09/02/1 Room&BoaM-Semi-Pdvate 2 257.00 534.00 2,467,46�
�
Current 31-60 pays 61-90 pays Over 90 paya Amount due
z,a��.ae .ao .00 .00
NOTE: ***'�*PAYMENT IS DUE UPON RECEIFi*****BUT NO LATER .
7HE 2STtf OF THE MONTH'*'** Please rertilt the LAST AMOUNT
your statement.Include the ACCT# fram the statement on the MEMO Statament Date: 09Ji3/2d12
of your check.Payments after 9/11(12 do not reflect on 5tatement. Due Date: 09j25j2012
NqTE: **IATE PAYMENTS ARE SUB7ECi TO A 1.25°lo tATE CHARGE hER
MONTN **A$10.00 FEE WILL BE CNARGED for RETURNED CHECKS
Kenneth Baitseii- Account#: 102247
Sarah A Todd Memarial liome
1000 West South Street
Carlisle, PA 17013-2798
Telepho�re: (717}245-2187
� � STATEMENT
Sarah A Todd Memorial Nome Statement Date: 10/10/2012
1000 West South Street
Cariisle, PA 17013-2798 Due Date: 10/25/2012
Telephone: (717) 245-2187
Amount Enciosed $
Amount Due: $ 62.21
Account #: 102247
RE: Kenneth Baitsell
Larry eaitsell
7342 Wertzville Road
Carlisle, PA 17015
Balance B/F 2,467.96 2,467.96
09/18/12 BAITSELL, LARRY 2,467.96 .00
09/Ol/12 Medical Equlpment Rental 2 21.88 43.76 43.76
09/01/12 Personal SuppIies 6 2.12 11.45 55.21
09/03/12 Medical Supplies 5 2.03 7.00 62.21
Current 31-60 Days 61-90 Days Over 90 Days Amoun!Due
62.21 .00 .00 .00
NOTE: ****•PAYMENT IS DUE UPON RECEIP!*"*"BUT NO LATER
THE 25TH OF THE MONTH•***• Please remit the LAST AMOUNT
your statement.Include the ACCT# from the statement on the MEMO Statement Date: 30/10/2012
of your check. Payments aRer 10/5/12 do not reflect on statement.
NOTE: **LATE PAYMENTS ARE SUBJECT TO A 1.25%LATE CHARGE PER DUE DatE: 10/25/2012
MONTH **A$10.00 FEE WILL BE CHARGED for RETURNED CHECKS
Kenneth Baitsell - Account#: 102247
Sarah A Todd MemoMal Home
1000 West South Street
Cariisle, PA 17013-2798
Telephone: (717) 245-2187
Mit[enniam Phcy.Systems Mechanicst
, ,502p ftitter Rped, Suite 1 i0
� Mechanicsburg PA, 17055 . - -:�
�
. s: � �; .� :f! } t^'.'�t'<.�J��S���`�`,.'..`!.
INVOICE
09128/2012 Account Number: s`r�aH�as2
KENNETH BAITSELL
Cto tRRRY BA{TSELL ��'j�'e�-t
7342 WERTZVILGE ROAD PV�
CARLISLE PA, 17015 {� tN!����a� g v�o-
��2yF t F d,`tI�tlrf�l�{. . . �� � fii (�qn��s'ttl���4���`���'�
`�, y��'8 t+ �s€�t2�i�`� � j�'#�d��.� S'�`.,'
Piease Detach Here and Retum Top Portion With Your Payment
°� - - _.. - ---- -- -°-°-- - --- --- ---° - --° - - --- ---.... -------... ---°-- -
Imoice pate:Q9t28l2042,Acct#:STMHt882,BAITSEII,KENNETH,Sarah Todd NQ A,BRANSCUM,GEORGE
��i ';" �i't!
Q8l29l2012 6550309 90.00 Amutero4tnratropium inhalation Salutian 2.5-0.5 MG/3ML $ 71.24 $ 0.00 $ 7124 RX
W481-QZOi-91
09/01/2012 2030668 30.Op Mwphine Sulfete $ 30.20 $ 0.00 $ 302p RX
00054•OA04-0a
69102t2412 6565249 7.06 CdeiaN'am Hverobromida Or�Tabiet 1�tdG $ 18.73 $ O.OQ $ 13.73 ftX
seia�-o3a2-m �
09/02/2012 6565255 7.Otl Folic Acid orai Tablet 1 MG $ 7.32 $ 0.00 $ 7.32 RX
65182-0361 4 0 .
09t4272012 856525Q 14.64 Mucirrez Oral Tabbt E�ctended Retease i2 tbur F�tdG $ 4.90 $ 0.W $ A.90 � OTC
6382A-0608-50
09/02/2012 6565251 7.Op Furosemlde orel Tablet 2o MG $ 5.88 $ 0.00 $ 5.98 RX
83304-W24-10
09J62J2012 fi565252 14.60 Metoprotoi Tertwte OreI Tebiet ip0 MG $ 15.66 $ 0.00 $ 15.86 RX
63304-0691-10
09(OZ/2012 6565253 7.00 Tab�A-VOeOralFablet $ 0.12 $ O.QO $ 0.12 OTC
- 0090a-053o�0
p9/02/2012 .6585248 7.00 Amlodipine Besylatu pral Tablet 10 MG $ 27.63 $ 0.00 $ 21.63 RX
� 68382•0123-16
09t02tZ012 656525d 14.00t Pentasa Orat Capsuk Fztendetl Release 5�AaG $ 55.71 $ 4.00 $ 55.7i RX
54092-0191-t2
p9/02/2012 6484638 7.Op PredniS4NE Orel Tehlet 10 MG $ 5.44 $ 0.00 $ 5.44 RX
00143-1473-10
09/0212Qt2 8534203 7.00 Omeprazale Or�Capsule Qelaved Reiesse AO MG $ T6.38 $ 4.06 $ 16.38 RX
82i75-0136�3
09l02/2012 6564825 15.00 Atropine SNfale Ophthalmic Solutbn 1% $ 52.10 $ 0.00 $ 52.10 RX
2A208-p75Q-O6 .
r. _ . . ,� � dd��, +�1.1 �� �' 9,� � �,� �,
� � �:�
$ 0.00 $ 941.05 09118/2012 $ p.00 $ 0.00 $ 0.00 $ 295.39 $ 5 02 $ 0.40 $ 0 00 L__30p 41
aEV-irsra ex'.�s ae)
REVER9E
s pennsylvania SCHEDIlLE �
�EPARTMfeNT OF FEVENUE Bi1�1iFIC1AR1E5
lNHER1TANCE TAX flENNN
NONRESIDEFR DECE�NT
E57ATE OF FILE NUMBER
KENNETH L BAITSELL 27-12-0988
When flat rete method is elscted, Iist the be�efioiaries of the Pennsyivania praparty.
When proportionata method is eiected, list all beneficiaries.
RELATIONSHIP T4
ITEM DECEDENT AMOUNTORSHARE
NUMBER NAME AND AWRE55 OF PERSONjS}RECENING PROPER7Y Do Not Uet ttueh�(s OF ESTATE
I. TAXABLE DISTRI9U710NS�Inclutle outright spousel distnbufions and transters und9r Sea 2116(e)(L2)J
1.
Sheri L. Baitsefi, 1Q8 Gresson Rd, Carlisie, PA 17415 Daughter 39,679.52
Z Kristen M. Mitchell, 2530 Carriage Lane, Dover, PA. 17315 Daughter 39,679.52
3 Larry A Baitseii,7342 Wsrtzviile Road,Carlisle, PA 17015 Brother 39,679.52
ENiER DOLLAR AMOUNTS FOR PISTRIBUTIONS$HOWN ABOVE ON REV-1737 GOVER SHEE7 OR THE PROPORTIONATE MHTHOD WORKSHEET ON THE REVERSE SIDE
OF REV-1737 COVER SHEET,AS APPROPRIATE,
II. NON�TA%ABLE OtS1RI6UilONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 2fl3 POR WHICH AN EtECTiON TO 7AX IS NOT BEING MA�E
1.
B. CHARITABLEANDGOVERNMENTALDIS7RIBUTIONS
i.
TOiAt O! PARi II $�18,038.86
Enter Ntal non-taxable dlstributions on line /3 of REV-'1737 cover sheet.}
(If mare space is needed, use additional sheete of paper of the same size)
C9MMONW EAL:iH OF PENNSYLVANfA RE V�1 7 82 EX�7 7-96)
dEPAFTMENT OFftEVENUE
� OUR�AUOFINpIViDVALTAXES
OEPT.260601
HAAF159U8G.PA ili2$�b6G1
PENNSYLVANIA
RECEIVED FROM: INNERITANCE AND ESTATE TAX
OFFIClAL RECEIPT
NO. CD 016854
BAITSELL SHERI
908 GREASdN RD
CAftLISLE, PA 17015
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
_"""__ tn!d
101 j 57,500.04
ESTATE (NF(JRMATEOfV: SsN: t99-34-8i63 �
FILE NUMBER: 2112-G988 �
oECe�ErvT rvannE: BAITSELL KENNETH LEROY �
DATEOFPAYMENT: 11/30/2072 �
PQS7MARK DATE: 1 1(3{?1209 2 �
C4UNTY: CUMBERLAf�iD �
DATE OF DEATN: (}9J�3J2012 �
�
TCtTA� AMOUNT PAIL}: 57,500.00
REMARKS:
CHECK# 10$
INITIALS: NEA
seA� RECEIVED 6Y: GIENDA FARNER STRASBAUGH
REGISTER C7F WIL�S
TAXPAYER
I