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HomeMy WebLinkAbout05-16-13 (3) J REV-1500 EX (01.10) 1505610140 PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual PO BOX 2 8460I Taxes INHERITANCE TAX RETURN County Code Year Fife Number Harrisburcl,PA 17128-0601 RESIDENT DECEDENT 2 1 1 3 0 2 2 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDOYYYY 0 2 1 7 2 0 1 3 0 5 0 1 1 9 2 5 Decedent's Last Name suffix Decedent's First Name S H A N K Mt J E A N E (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Mt Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS © 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(data of death 4.Limited Estate prior to 12-13-82) 4a.Future Interest Compromise(date of [,] 5.Federal Estate Tax Return Required ® death after 12-12-82) 6.Decedent Died Testate 7.Decedent Maintained a Livia Trust (Attach Copy of Will) (Attach Copy of Trust) 9 -- 8.Total Number of Safe Deposit Boxes 9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death ❑ 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.0), CORRESPONDENT-THIS SECTION MUST 8—E COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number R OG E R B I WIN , E S U I R E 71c7 245 2 _ jut c _ n; 7rMR F WILL: 'USE 6ALYa C!) –_0 First line of address I R W T N E M c K N I G H T P C Second line of address 6 0 W E S T P 0 M F R E T S T R E E T w rn- �-- r-s City or Post Office G� o State ZIP Code -° DATE AD& C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this return,including accompanying it is true,correct and complete,Declaration of preparer other than the personal representative is based on and ll information of which preparer has any k ow edge.�lief, SIGN AT RE OF PERSON RE ONSIBLE F K FILING RETURN /��.�.i ADDRESS 318 AVON DRIVE CARLISLE PA 17013 SIGNATUR F REPARER OTHER T N REPRESENTATIVE AT ADDRESS 6 31 u WEST R01 RET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 150561❑240 REV-1500 EX Decedent's Social Security Number oecedenxsName: JEAN E- SHANK RECAPITULATION 1. Real Estate(Schedule A) ......................................... .. 1. 2. Stocks and Bonds(Schedule B) . . .. . . . .. ... .. ..... ................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 1 4. Mortgages and Notes Receivable(Schedule D) .. .. . .. .. . . . . .. .. . . . .. ... . 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . .. . . 5. 2 6 9 3 3 . 6 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. ... .. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 2 8 2 6 9 1 . 1 9 (Schedule G) El Separate Bitting Requested .... ... 7. 8. Total Gross Assets(total Lines 1 through 7) ... . .. . .. . . .. .. . .. .. . . . . . .. 8. 3 0 9 6 2 4 . 8 6 9. Funeral Expenses and Administrative Costs(Schedule H) .. .. ...... . . .. . . .. 9. 1 5 4 5 8 . 5 1 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) ..... .... ... . 10. 7 2 3 G . 5 8 11, Total Deductions(total Lines 9 and 10) ............................... 11. 2 2 6 8 9 . 0 9 12. Net Value of Estate(Line 8 minus Line 11) ............................ 12. 2 8 6 9 3 5 . 7 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) .. .. .. .. .. ............ 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) . .. . . .. .. . . ...... .. . .. 14. 2 8 6 9 3 5. 7 7 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate,or transfers under Sec 9116 (a)(1.2)X.0 _ 0 . ❑ 0 15. 0 . ❑ 0 16. Amount of Line 14 taxable at lineal rate X.045 2 8 6 9 3 5 . 7 7 16. 1 2 9 1 2 . 1 1 17. Amount of tine 14 taxable at sibling rate X.12 0 . ❑ 0 17. ❑ . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 ❑ 18. 0 . ❑ 0 19, TAX DUE . . .. .. . . .. .. .. . .. .. . . . .. . . . . . .. .. . .. ... .. . . ..... . .... . 19. 1 2 9 1 2 . 1 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 13 0229 DECEDENT'S NAME JEAN E. SHANK _ STREET ADDRESS i-- ii-�i-- --i-- i— ---- --. 318 AVON DRIVE CITY i-- --' i---' --- STATE CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 12,912.11 2, Credits/Payments A.Prior Payments B.Discount 645.61 Total Credits(A+8) (2) 645,81 1 Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line t +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 12,26&50 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ...................................................................... 0 Q .. b. retain the right to designate who shall use the property transferred or its income; ... ............ c. retain a reversionary interest;or ................................................................................................ 11 1] d. receive the promise for life of either payments,benefits or care? ................................._...._.............. ❑ I] 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ........................................................._....._...._............... ❑ R 3. Did decedent own an'intrust 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?............................................................................._................... M ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(11)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)[72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAX RETURN CASH, BANK DEPOSITS & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: JEAN E. SHANK FILE NUMBER: 21 13 0229 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE i. WELLS FARGO-CHECKING ACCOUNT OF DEATH 656.98 2. WELLS FARGO- SAVINGS ACCOUNT 22,510.77 3. CITIZENS BANK-CHECKING ACCOUNT 3,643.56 4. CITIZENS BANK- CHECKING ACCOUNT 122.36 TOTAL(Also enter on Line 5,Recapitulation) $ 26 933.67 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX-(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF JEAN E. SHANK FILE NUMBER 21 13 0229 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION THE DATE OF TRANSFER,ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST TAXABLE i. WELLS FARGO ADVISORS —TOD ACCOUNT �'�"'"'°Aa�E� VALUE BENEFICIARIES: E. ALLEN SHANK 282,691.19 100.00 282,691.19 BETH ANN SHANK TOTAL (Also enter on Line 7,Recapitulation) $ 282 691.19 If more space is needed,use additional sheets of paper of the same size. REV-1591 EXt(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN E. SHANK 21 13 0229 Decedents debts must he reported on Schedule I. ITEM A. NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. EWING BROTHERS FUNERAL HOME 7,180.94 2. BACK DOOR CAFE -FUNERAL LUNCHEON 412.39 3. CARLISLE BAKERY- FUNERAL LUNCHEON 91.95 4. GIANT-FUNERAL LUNCHEON 35.99 5- ORGANIST 150.00 8. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representa ive(s) Stmt Address City Stale ZIP Year(s)Corrvnission Paid: Z AttomeyFees: IRWIN & MCKNIGHT, P.C. 4,500.00 3. Family Exemption:(if decedents address is not the same as claimanPs,attach explanation.) Claimant Street Address city State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 403.50 5 Accountant Fees: 6. Tax Return PreparerFees: PATRICIA A. ROSENDALE, CPA 375.00 FINAL FIDUCIARY TAX RETURN 7. CUMBERLAND LAW JOURNAL-ESTATE NOTICE 75 00 8. THE SENTINEL-ESTATE NOTICE 189.54 9. TRAVEL EXPENSES TO ATTEND FUNERAL 2,039.20 10. REGISTER OF WILLS-SHORT CERTIFICATE 5.00 TOTAL(Also enter on Line 9,Recapitulation) $ 15 458.51 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX-(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, RESIDENT DE ED RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN E. SHANK 21 13 0229 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I. THORNWALD HOME-NURSING 6,895.00 2. MILLENNIUM PHARMACY SYSTEMS-MEDICAL 113.89 3. PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM-REIMBURSEMENT 115.59 4. DIAMOND PHARMACY- MEDICAL 80.10 5. PA DEPARTMENT OF REVENUE -INCOME TAXES 26.00 TOTAL(Also enter on Line 10,Recapitulation) $ 7,230.58 If more space is needed, insert additional sheets of the same size. REV-1513 EX.(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: J FILE NUMBER: JEAN E. SHANK 21 13 0229 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustees) 1 TAXABLE DISTRIBUTIONS pndude outn'ght spousal distributions and transfers under OF ESTATE Sec.91p6(a)(1.2).) 1. E. ALLEN SHANK Lineal 143,467.89 318 AVON DRIVE 1/2 REMAINDER CARLISLE, PA 17013 2. BETH ANN SHANK Lineal 143,467.88 34538 TENNESSEE DRIVE 1/2 REMAINDER FRANKFORD, DE 19945 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. Il. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. LAST WILL AND TESTAMENT Of Jean E. Shank I, JEAN E. SHANK, of the Borough of Carlisle, Cumberland County, Pennsylvania, _ declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills - and Codicils heretofore made by me. I. I direct my Executors to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my Executors to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor,in fee simple, as I could do if living. 3. 1 give, devise and bequeath all of my estate of every nature and wherever situate to E. ALLEN SHANK and BETH ANN SHANK, share and share alike. 4. 1 nominate and appoint E. ALLEN SHANK and BETH ANN SHANK to be the Executors of this my Last Will and Testament; they are to serve as such without bond. 5. I hereby suggest that my personal representatives retain the services of Irwin & McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7 day of January, 2006. SEAL) AN E. SHANK Signed, sealed,published and declared by JEAN E. SHANK, the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. 444 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, JEAN E. SHANK, CHERYL L. CLELAND and KAREN S. NOEL, the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, that she had signed willingly, that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time,'eighteen years of age or older, of sound mind and under no constraint or undue influence. JEAN E.SHAN 1 C L L. CLELAND KAREN S.N L COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND Subscribed, swam to and acknowledged before me by JEAN E. SHANK, the Testatrix herein, and subscribed and sworn to before me by CHERYL L. CLELAND and KAREN S. NOEL,witnesses,this 7° day of January, 2006. 3 ck- o ary Public COM ONW ALTH OF PENNSYLVANIA Notarcat Seat Roger a.win,Notary Public Carlisle Eoro,Cumberland County MY Comntssion Expires Oct.3.2008 Member,Pennsylvania Association Of Notaries 3 CN oro z 3 O t� �c? no m F 1 p O (j Gr C N C Nj N '•� }� • E° Q m f° mD � � m � N 00 Cd N m C. O C7 C' w 00 00- I A ° o n m n m : (D m y $ T O O O. C m m a p, 121, CD (D 0 O SD fD m I a 1 d pFsF p S O y w iiig655 W � . 0 c (n N fn? N O � F 6�• C O pp y b C N � 8 e 6E�'+ A N O Y y .p O � � � ^ o o •p O Oo n p• 6 k a` ��p �y N O b N CAD H a Ag i Citizens Bank - One Citizens Drive ROP112 Riverside, RI 02915 March 26, 2013 Irwin & McKnight,P.C. West Pomfret Professional Building N 60 West Pomfret Street Carlisle PA 17013-3222 titWiN N}�ryci;IdlGtFi LHW OFFICES Estate of JEAN E SHANK Date of Death: Feb 17,2013 SSN: 209-12-8098 Dear Sir/Madam: In accordance with your request,the attached information sheets have been provided in the above decedent's name as of his/her date of death. There has been no change of ownership within one year prior to death to either account. Both accounts were closed as of March 14,2013. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries,please call 877-579-2667 option 2. Sincerely, b Kristen B. Correia Decedent Account Processing REF#: 585302 Citizens Bank. Account Number 6100731782 Account Title Jean E Shank Date Opened . 6/6/1966 Account Tye Checking Principal Balance as of DOD $3643.56 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $3643.56 YTD Interest to DOD $ .00 Citizens Bank" Account Number 6215431358 Account Title Jean E Shank Date Opened 2/9/2007 Account Type Checking Principal Balance as of DOD $122.36 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $122.36 YTD Interest to DOD $ .02 04/09/2013 12:41 717-975-8426 CENTRAL PA ADMIN CTR PAGE 02/02 Wells Fargo Advisors.LLC e . Three Lemoyne Drive Lemoyne,FA 17043 Tel:717761-7344 . Fas:717-975-8426 March 6, 2013 Irwin&McKnight, P.C. 60 West Pamphlet Street Carlisle, PA. 17013 RE: Estate of Jean Shank Dear Roger, Please find your request listed below: I. Jean E. Shank ' 1 Acct opened 12/27/2005 J. Changed to TOD 1/26/2009 4. None 5. None 6. Date of death was on a weekend I.have listed the total value for February 15, 2013 and February 19,2013 there was a holiday on February 18. Total value for 2/15/2013 $282,008.93 Total value for 2/19/2013 $282,697'.19 If I can be of further assistance, please give me a call. Since ly, s a . Neff Senii r Client AssoPte This report is not the official record of your account. However, it has been prepared to assist you with your investment planning and is for informational purposes only. Your Wells Fargo Advisors Client Statement is the official record of your account. Therefore, if there are any discrepancies between this report and.your Client Statement, you should rely on the Client Statement and call your local Branch Manager with any questions. Cost data and acquisition dates provided by you,are not verified by Wells Fargo Advisors. Transactions requiring tax consideration should be reviewed carefully with your accountant or tax advisor. Unless otherwise indicated, market prices/values are the most recent closing prices available at the time of this report, and are subject to change. Prices may not reflect the value at which securities could be sold. Past performance does not guarantee future results. Together well go fa: Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle,PA 17013- (717)243-2421 February 19, 2013 E. Allen Shank 318 Avon Dr. Carlisle, PA 17013 The Funeral Service for Jean E. Shank We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Basic Services of Funeral Director/Staff , , , , , , , , , , , , , , , , , $1300.00 Bathing&Embalming , , , , , , , , , , , , , , , , , , , , , , $895.00 Dressing,Casketing,Cosmetology etc. , , , , , , , , , , , , , , , , $295.00 2. FACILITIES/SERVICES/STAFF/EQUIPMENT Basic Use of Facility, , , , , , , , , , , , , , , , , , , , , , , $200.00 Document Prep/Permanent Recording, , , , , , , , , , , , , , , , , , $325.00 Facility Usage for Viewing/Visitation, , , , , , , , , , , , , , , , , , $375.00 Staff Usage for Viewing/Visitation. , , , , , , , , , , , , , , , , , $375.00 Staff for Graveside/Interment . . . . . . . . . . . . . . . . . . . . $125.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, , , , , , , , , , , , , , , , $295.00 Hearse(Casket Coach) , , , , , , , , , , , , , , , , , , , , , , $295.00 Safety Lead/Clergy Car , , , , , , , , , , , , , , , , , , , , , , $135.00 Utility Car , , , , , , , , , , , , , , , , , , , , , , , , , , $135.00 FUNERAL HOME SERVICE CHARGES . . . . . . . . . . . . $4750.00 SELECTED MERCHANDISE: Bethany Chiffon Rose 18G.Casket, , , , , , , , , , , , , , , , , , , $1650.00 Acknowledgement cards. . . . . . . . . . . . . . . . . . . . . . $10.00 Register Book(s) , , , , , , , , , , , , , , , , , , , , , , , , $40.00 Memorial folders . . . . . . . . . . . . . . . . . . . . . . . . $85.00 THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . . . $6535.00 Cash Advances Sentinel Obituary w.Photos, , , , , , , , , , , , , , , , , , , , , $550.94 Certified Copies of Death Certificate . . . . . . . . . . . . . . . . . . $36.00 Flowers. . . . . . . . . . . . . . . . . . . . . . . . . . . $159.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . . . . . . . . $745.94 Total Total Cost , $7280.94 r-- - SUB-TOTAL $7280.94 INITIAL PAYMENT/DISCOUNT/CREDITS 100.00 r— TOTAL AMOUNT DUE $7180.94 W � f Voe T The unpaid balance over 30 days is subjected to a 1.50%service charge per month-18.0000%per annum. To Your US Airways flight http://mail.aol.com/37488-111/aol-6/en-us/mail/Printmessage.aspx Flight#I Carrier Depart Arrive Travel time Meal Aircraft Cabin Seats 3399 = F; 06:09 PM PWM 07:55 PM PHL 1h 46m E170 Coach 16F 16D Stop:Change plane in Philadelphia.PA (PHL) ........................................................................................ 4275 =PIED 09:25 PM PHL 10:03 PM MDT Oh 38m Dash 8 Coach 5F 5D Return: Harrisburg, PA (MDT) Portland, ME (PWM) Date: Sunday, February 24,2013 Flight#1 Carrier Depart Arrive Travel time Meat Aircraft Cabin Seats 4243 =PIED 09:09 AM MDT 09:55 AM PHL Oh 46m Dash 8 Coach 3F 3A Stop:Change plane in Philadelphia,PA (PHL) ........................................................................................ 3684 =="' 11:24 AM PHL 12:44 PM PWM 1h 20m CRJ Coach 7C 10F wiF: Operated by Republic Airlines dba US Airways _PIED Operated by Piedmont Airlines dba US Airways Express Express Operated by Air Wisconsin dba LIS Airways Express Ir '..T' v;� ryr • �� x x+� IV r r• r • 1 1 I �, Total travel cost (2 passengers) Helpful links 2 Adults $1,793.48 USD Taxes and fees $215.72 USD Manage your reservation Join Dividend Miles Fare total $2,009.20 USD Airport information Baggage policies TSA requiations ChoiceSeats Inflight intern et JENNAELIZABETH SHANK $15.00 Seated in an edt row?Read about checking in. STEVENROGER WOODWARD $15.00 ChoiceSeats total $30.00 Total $2,039:20 USD 4 Charged to Jenne E.Shank '••**'*"»`7481 (Visa) Bags Pay for your checked bags when you check in online or at the airport!Read more about bags. 2 of4 2/22/2013 11:26 A OTI E ALLEN SHANK JR. 43ts G ELLEN SHANK 7042 318 AVON DRIVE CARLISLE,PA 17013 DATE Z;/ L Yj'7j ®Shield° ORDER THE C-"�'��Q�Gf ORDER OF cI EM"Bw* � d.� � —�— "'6 DOLL RS nnerio l:0 i302955j: 708842 Slim 7_ 0 THANK YOU ------ --- !t 35.9' FRUIT Tt,,sr 1 k rl f TA : 35 99 �. Y%M:TRIAL 3r, 99 _ Up CRE O1 ! t.ARG GIANT FOOD 255 SOUTH SPRING GARDEN ST. CARLISLE. PA_17013PAYMEI VISA Card XXXX XXXX XXn. ^415 �+ 'i Payment Amount $ *****35 99 .7h c rry'rDeiic�ht Trav- AUTH# 093378 Orde! Form 2/22/13 10:91 6112 17 oO17 119 CHANGE it tn4W fUtUM cani I°uPw 9tiPa41onmryew.pinrpW and TOTAL/NUMBER OF T f 5 001 2l2�t13 10:91 1"" 17 017119 I'm glad you d here today. I I �h`ilti� �4i Small $19.99 (Serves 10-16 people) Your Caer ,••,' - - WANDA uantity Mediurr $29.99 (Serves 16-20 people) Quantity Large $35.99 (Serves 20-28 people) Name � Ia U } Telephone Number Pickup Date FRUIT Y LARGE (� NET UT 13 LB a C21 4Z Z 1- rime V r� Myr� /21802) roES. a n+ip uara.uaE �roeu urr�a, � r + Order Taken By � �� •� r F...��. 0.2n m,n3 astir-a ra:�an� R .24. 3 PCs urrr r* nra �sav,,, t5.sst $-35.99 Fres teed or- �° a 0 ack! 156 West High Street Carlisle, as ilois BEST Of 7172494310 YvredFestY✓R.4P5Category 20W-2412 YAWW.t31EbdCd E:Ct?►TI r firedB�0051-2t1.Caeeg�rY 4CAy► *y'�$ 2404-.2032 !'►/r shop aocw.. shop downtown i Voted Hest SALAD CawgW rmmfl v 2012 NAl1�lE :c tiV+>t) DATE : J31�rq ADDRESS : PHONE : CONTACT: INVOICE* : // C. A U)1 `fIY9F 15/H� 7 a � 1 CCI (r�5 i L TTeN- 2£J1/ vlYfi�X511 i7 ✓�it'.�-� 111 l�� .� 1� // 774717. OfLIVERY1>:cruplitmRN 7C� L/ 2 TAX i Carlisle Baker 35 S Hanover S Carlisle, Pa 17013 (717) 462-4160 Dont forget we have Hersheys Ice Cream! Bring the family in for a shake or a cone! --------------------------------------- iicket # 21805 Date: 2/21'1 )13 9:30:18 AM Station: 1 Server: Holly Heldreth Order # 30499 ------------------------ ------------- Qty Item 1 Mini Cupcake $49.95 1 Any 10" Cake $42.00 Subtotal: $91 .95 Total : $91 .95 Credit Card: $91.95 Change: $0.00 'hank you! Dont forget to friend us on facebock at www.facebook.com\carlislebakery Days ate Description Quant Rate Charges Payments Balances Balance B/F 10,258.13 10,258.13 02/01/13 Incontinence Supplies 4 10.92 43.68 10,301.81 02/01/13 Personal Supplies 5 1.01 13.90 10,315.71 02/01/13 Medical Supplies 48 .20 45.29 10,361.00 02/05/13 Beauty&Barber 1 18.50 18.50 10,379.50 02/16/13 Personal Laundry Services 1 27.50 27.50 10,407.00 02/16/13 Cable Television 1 28.00 28.00 10,435.00 02/01/13 -02/28/13 Room&Board- Private 28 295.00 -8,260.00 2,175.00 02/01/13 - 02/16/13 Room&Board - Private 16 295.00 4,720.00 6,895.00 Current 31-60 Days 61-90 Days Over 90 Days Amount Due 6,895.00 .00 .00 .00 6,895.00 Payments MUST be received BY the 25th of each month. Attention: MA redpients Statement Date: 03/01/2013 Documentation MUST be received in order to receive credit on a monthly basis. _,, ..„Due.Date: 0312512013 Jean.Shank Account#:20058 Thomwald Home �. 442 Walnut Bottom Road Carbsle, PA 17013•w, Telephone:(71 . GC_AdwrynyResiUent rpt Page 36 of 52 @ m § § § § § § § a 6 Ott wo §/ m ! R,$ ! ' ! ag! :z OF a` _ 2 80 0. d #| �00 � ° ° \ \ ! ` 2 - - 7 ( E / 2 \ & § st m \ ° . \ \ � 2 § ■ - - - - - - - - - - � k k ( ) ( \ § \ \ � \ ` a § � ) \ � j ( 2 2 < f ] : ; ; / 2 / \ COMMONWEALTH OF PENNSYLVANIA PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM PSERS Toll-free: 1.888.773.7748(1.888.PSERS4U) Gt> 5 N 5th Street Local: 717.787.8540 Harrisburg PA 17101-1905 www.psers.state.pa.us March 4, 2013 E ALLEN SHANK 318 AVON DR CARLISLE, PA 17013 RE: Jean Shank SSN: XXX-XX-8098 Dear Mr. Shank: The Public School Employees' Retirement System is processing the benefit of Jean Shank. Please accept our condolences on your loss. PSERS issued the following monthly retirement benefit(s) prior to processing the death benefit: Check Date Check Amount February 2012 $644.08__,_. Jean Shank was entitled to a proRa 8.49 for the month of February. Therefore, p lease reimburse SFIrepresents;the total of the monthly benefit payments and debts (if apple abls the prorated amount. Please make your check or money order pa Employees Retirement System. Please retain this information for preparation of the member's final tax return. If you have any questions, please contact the PSERS Member Service Center by calling toil-free 1-888-773-7748 (1-888-PSERS4U). Harrisburg local callers, please use 717-787-8540. To contact PSERS by e-mail, use the following address: contactPSERS @pa.gov. For your convenience, the Member Service Center is staffed each business day from 8:00 a.m. to 5:00 p.m. For more general information, you may visit PSERS online at: www.psers.state.pa.us. 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