HomeMy WebLinkAbout06-05-13 J 1505610101
REV-1500 EX`°'-'°> �
OFFICIAL USE ONLY
PA Department of Revenue P�!!ESY��ania County Code Year File Num6er
Bureau of Individual Taxes ��_� �+� �� -
INHERITANCE TAX RETURN
Po sox a8o6os RESIDENT DECEDENT � 1* � � � y� 9 �
Hamsburg PA iy128 0601 � a�
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MM�DWYY
,..- n r .�.. .,.-_ . ,.. . ,-
�
�� � �U G 2�� o`/ .� � �� L �
Decedent s Last Name Suffix Decedent s First Name
��� , .��.�..�F, ,. �a ._ . .. . , �. � .�.��. . ,...:k.,,..�. ....W. ... ...
MI
„ � �
, .=w� � .� ,���,���� ��� �� µ .� � �� � ��� ` � =
(If Applicable) Enter Surviving Spouse's Information Below
Spouse s Last Name Suffx Spouse's First Name M�
r , . . �.$� ��� ,,��„�.�- fl€ �.„� r x.� � �>.��� � �� �� .,� �,. �
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Spouse s Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
. � v�.�..��� ..��
; �� � , � �w ; . , REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return O 2. Supplemental Return O 3. Remainder Retum(date of death
priorto 12-13-82)
p 4. Limited Estate O 4a. Future Interest Compmmise(date of O 5. Federal Estate Tax Return Required
death aRer12-12-82) .
p 6. Decedent Died Teslate O 7. Decedent Mainlained a Living Trust _ 8. Total Number of Safe Deposit Bozes
(Attach Copy of Will) (Attach Copy of Tmst)
p 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(date of death O 11. Election to[ax under Sec.9173(A)
between 1231-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETEO.ALL CORRESPONDENCE AND CONFIOENTIAL TA7(INFORMATION SMW LD BE DIRECTED T0:
Name Daytime Telephone Number
Y�'� 5,�� ��..u�8�`x�� �+�t` � ,.� � , y � .�,�.,� � � '�.�,�� ��,4� 9 4 ���Y`
�.. �_.
REGISTER OF_QIlLLS USE�yNLV
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"'�^ � C__ G> p
First line of address c-� �`._ � -�s
�°��,3��?` �„��L L:�S 'T�o���0':R��V �f�' � ,�,�.. � r _ " � ; . ry
A. .� , c.n
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Second line of addrese �� �� �,� r,5
y �:,, x, L„�».. .�,� ,; .,�� �<,K�,. �, r _, -n _�E
. ° ? $ � � ' , ":5t -`�
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,,. -. �...., . . . ' . , _u . ,, . " DATE FILED..I.: !,'3
Cdy or Post Office Slate 21P Code y � ' . _ ,
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CorcespondenYs e-mail address: S A I � T � '�d �,'O L , W ��
Under penalties of perjury,I declare tha[I have examined this retum,inclutling accompanying schedules and statements,and to ihe best of my knowledge and belief,
it is tme,wrrect antl complete.Declarelion of preparer other than the personal representative is 6asad on all informa[ion of which preparer has any knowledge.
SIGNATU F�RSOp�$ES NrSIBLE�OF�,FILING RETURN � ' 7�AT��
•�� % rl a
ADDRE I � -1 G� j'�a J���`Q-.�- N��ah �a�ir� / � � �� �./ �
O(
SIGNATUR OF PREPARER OT ER THAN REPRESENTATIVE ATE
��_r, � ��� �3
ADDR SS
� 3 �0 �����5'�(�, �<i�e �Vew �i�m�2r�� nr�. � 1 �07� _
PLEASE USE ORIGINAL FORM ONLY
$ide 1
� 15056101�1 1505610101 J
�
J 1505610105
REV-1500 EX
Decedent's Sxial Security Number
Decedant's Name: � �.:,.
RECAPITULATION
1. Real Estate(Schedule A). . . . . . . . . . . . . � �
: ���� ,ti
ia6 -g}o o ��
2. Stocks and Bonds(Schedule B) .. . . . .. . .. . . . . . . . . . . . . 2 � � ,d<iU � ;
,� r -� .S*.�FY7k.a�} . .. fi
3. Closely Held Corporation, PaAnership or Sole-Proprietorship(Schedule C) . . . . 3 �• ' ` Q -0 �
�'c..? t,: . ,�+� . -:
4. Mortgages and Notes Receivable(Schedule D) . . . . . . .. . .. . . . . . . . . . . . . . . . 4. �� � : �.,.
: #� ,,.;�,.
; - �
5. Cash, Bank Deposits and Miscellaneous Personal Pmperty(Schedule E). . . . . . 5 � {qx � �;� � �;
,�,,;.. .. 4.
6. Jointly Owned Property(Schedule F) p Separate Billing Requested . .. . _ . . 6. � z Q��yQ Q�Q��;
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property "����� � %` � �" �'
(Schedule G) p Separate Bilhng Requested . . . . 7 � :Q a#0`
. .. � .. ... t, o-�Xx" +.`�f �s ,3e.����
B. Total Gross Assets(total Lines 1 through 7). . . . . . . . . . . . . . . . . . . . . . 8 � y:q�4�7 'fi:g.� i r ,`�,;.
.. � ��-, .�� . q .
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . 9 5 � � I '6 �'
. ,����.: . � � �.
10. Debts ot Decedent, Mortgage Liabilities,and Liens(SChedule I) . . . . . . . . . . . . . 10 � .
�.ttyv.. ..: : �`�,.
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . .. 11 ' � ,Q�6;'��
�.x.:,�..r� a '���.
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . _ .. . 12 � $' i
13. Chantable and Governmental Bequests/Sec 9113 Tmsts for which �'tt�`�'*�� . .+s„�T ��
an election to tax has not been made(SChedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. � � �� �
��6
14. Net Value Subject to Taz(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 74 �f� p 6 ,��Oj �a�a�
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
trensfers under Sec. 9116 w ;. �� � . .,._. . , . : .�
(a)(12)X.0— y� � 15 �5�V.3�d �8,�
76. Amount of Line 14 taxable � �� ,` -fi x; < " �a-�tr: h"_� ' � 0
at lineal rate X .0_ � � ig � , ' . k
17. Amount of Line t4 taxable `^:�`�`�'?� . � �"��, �
at sibling rate X.12 ' �� � �7, �
18. Amount of Line 14 taxable ""'�""`���� � ' �
at collateral rate X.15 � � ; . � -,: 18 't � � � a
� "�j��L:�3V�.'�a����" .
19. TAX DUE . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . .. . . . 19 . � , ,s � : � '' " K
yy.t.�n::-nw .aX are.,� ` ,. .. � . -"_
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 1505610105 150561U105 �
REV-1500 EX Page 3 Fiie Number
Decedent's Complete Address:
DECEDENT'S NAME �
— ---- - C'`� � L h��� _Sh c�n _F-_r e_�
_ _ - —
STREETADDRESS -��� � � � � �
- ------- _—_—._—._-- —_ _ ..
_ _ _ _ 9 � v I e +� s f {-��f
_ __ __ ______ _ _ _ _ _
cin __ _ _ _ sTnTe T ziP
(�1 e lti` C�UM ��.r' ICtin� � �� I�O�b
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (�)
2. Credits/Payments
A.Prior Payments
_ __ - —------_
B.Discounl
---_ - _ --- --
Total CrediGs(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the differe�ce. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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 incrome of the property transferred:.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income:............................................ ❑ �
c. retain a reversionary interest;or.......................................................................................................................... ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death �
without receiving adequale considerafion?.............................................................................................................. ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ ❑
IF THE ANSWER TO ANY OF THE A604E QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILf 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)(Ltj(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
. The tax rate Imposed on the net value of transfers irom 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)(12)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal benefciaries is 4.5 percent, except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)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-1502 EX+ (01-10)
� pennsylvania SCHEDULE A
oEPAarMENr oF RE�EN�E REAL ESTATE
INHERITANCE TA%REfORN
RES[DENT OECEDENT
ESTATE OF: F LE NUMBER:
� 1G� Q2 � � -�r2� � l � � - C�(� � �j
All real propertµowned solely or as a tenant in common must be reported at fair market value. Fair market value is definetl as the price at which property
woultl be exchanged between a willing buyer antl a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Atlach a mpy of the settlement sheet if the property has been sold.
ITEM Indutle a copy of the tleetl showing decedent's interest if owned as tenant in mmmon. VALUE A7 DATE
NUMBER OF DEATH
DESCRIPTION
�. ����d ��o p-��"y Ci.f' �1 �O I(�+�' rce�-
N�����mbe��G�� �� � a �`� va . v a
► ��-� �
se ��e.nn e n-h She e� a�'c�cti-ec�
TOTAL (Also enter on Line 1, Recapitulation.) �
If more space is needed, use adtlitional sheets of paper of the same size.
Tp�v.cxrqaN
CGq ��cok; OMB Approval No.2502-0285
y ` * � A. Settlement Statement (HUD-1)
BRA'o eJE�'�
a. Type or Loan
6. File Number: 7. Loan Number: 8. Mortgage Insurence Case Number
1.�FHA 2.0 RHS 3. �Conv. Unins. RESETAR.920 104305t 14 446-1372725-703
d.�VA 5.Q Com. Ins.
C. Note: 7his form is fumished to give}rou e statement of actual settlement tosts. Amounts peid fo and by the settlement agent are shown.
Ifems marked"(p.o.c.)"were paid outsida tha closing;theyare shown here larin/ormetional purposes and are rrot included in the totals.
D. Name and Address of Borrower E. Name and Address of Seller. F. Name and Address ot Lender.
Tyler G. Resetar PRIMARY RESIDENTIAL
761 Old Siiver Spring Rtl Richard H. Frey,Executor MORTGAGE,INC.
Mechanicsburg, PA 17050 0�the Estate of Michael J.Frey a750 WEST WIIEY POST WAY,SUITE 200
920 16fh Street , SA�T LAKE CITV, UTAH 84116
New Cumberland, PA 17070
G. Property Location: H. Settlement Agent: 23-2402316 I. Setllement Date:
920 161h Street PURITY ABSTRACT COMPANY
New Cumberland,PA 17070 3329 MARKET STREET August 24,2072
Cumberland County, Pennsylvania CAMP HILL PA 17011 Ph. (717)737-8359
Place of Settlement:
3329 MARKET STREET
CAMP HILL PA 17011
J. Summary of Bortower's trarnactlon K Summary of Sa1Nr's tranwctlon
100. Gross Amount Due lrom Borrower: 400. Grosa Amount Due to Seller
101. Contrect sales pnce 126 800.00 401. Contract sales dce 126,800.00
102. Personal ro e 402. PeBOnal ro e
103. Settlement Char es to Borrower Line 1400 8,133.63 403.
104. 404.
105. 405.
Ad'ustments for items Id Sellsr In advanu Ad ustrnenb for Items aid Seller In adwnea
106. COUNTY/BORO TAX OS124l12 to 01/Ot/13 364.68 406. COUNTY/BORO TAX 08@4/12 to Ot/Ot/13 364.68
107. CITYTAX to 407. CITYTAX to
106. SCHOOLTAX 08/24/12 to 07101/13 1,274.45 408. SCHOOLTAX . 08f24/12 [0 07/01/13 1,274,45
109. 409.
110. 410.
111. 4t1.
112 4t2.
720. Gross Amount Due from 6orrower 136,572,76 420. Gross Amount Due to Seller 128,439.13
200. Amounb Pald or In BehaN of Borrower 500, Raductions In Amount�ue Seller:
201. De osit or eamest mone 501, Excess de osit see instrudions
202. Princi al amount of new loan s 124 503.00 502. Settlement cha es to Seller Line 1400 2,940.92
203. Existin loan s taken sub�ect to 503. Existin loan s taken sub'ect to
z�4, 504. PayoB First Mortgage to WELIS FARGO HOME MORT 95,933.71
205. 505. Pa off Second Mort a e
206. 506.
207. 507.
208. 508.
209. Seller's Assistance 6,800.00 509, Seller's Assistance 6,800.00
Ad uatments for Items un id b Seller Ad us6nenb for Items un id b Seller
210. COUNTYBOROTAX to 510. COUNTYIBORO7AX to
211, CITY TAX to 51 t. CITY TAX to
212. SCHOOL TAX to 512. SCHOOL TAX to
213. 3rd�tr SEWER e 07f01/12 to 08/24/12 51.89 513. 3rd Qtr SEWER e 07/01/12 to 0824l12 51.89
Z�4. 514.
215 515.
216. 516.
Z��� 517. INHERITANCE TAX ESCROW to PURIiYABSTRACT 3,0OO.00
218 518.
219. 519.
220. Totel Pald b Itor Borrower 131,354.89 520. Total Reductlon Amount Dus Seller 108,726.5�
300. Caah at Sattlement fromtto Bovower B00. Cash at s�@lement tolfrom Selier
301. Gross amount due from Borrower line 120 136,572.76 601. Groas amount due to Seller line 420 128,439.1:
302. Less amount paid b /for 8orrower(line 220) ( 131,354.891 602. Less reductions due Sel�er(line 520) ( 108,726.5:
303.. Cash X❑ From � To Bonower 5,217.B7 803. Cash XO 70 � From Seller 79,712.6'
Ty'e�G. Rese'a� � . . i�R?M.W'Y R=$P�EN??A,L . .. . . _ _
761 Old Silver Spring Rd �' Richard H.Frey,Ezecufor !MORTGAGE. INC.
Mechanir,sbur�. PA 17050 of the Estate o(Michael J.Frey 4750 WEST WILEY POST WAV,SUITE 200
920 16ih Street SALT IAKE CIN, UTAH 84116
NewCum6erland, PA 17070
G. Property Location� H. Settlement Agent: 23-2402316 I. Settlement Date:
920 16ih Sireet PURITY ABSTRACT COMPANY
New Cumberland,PA 77070 3329 MARKET STREET August 24,2012
Cumberland County,Pennsylvania CAMP HILL PA 77011 Ph. pi7)737-8359
Place of Settlement:
3329 MARKET STREET
CAMP HILL PA 17011
J. Summary of BortowaYs M�uction K Summ�ry of Sellers trenwctlon
100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller:
101. Contrect sales price 126,800.00 401, Conlracl seles nce 126,800.00
702. Personal property 402. Personal ro e
103. Settlement Char es to Borcower Line 1400 8,133.63 403.
104. 404.
105. 405.
Ad'uatments for IUms Id b Ssller In advance uWneMs tor Itsms id Seller In advanee
106. COUNTY/BOROTAX 08l24/12 to Ot/01/13 364.88 408. COUNTYIBOROTAX OBR4/12 to 0�/Otl13 364.68
107. CITY TAX to 407. CIIY TAX to
108. SCHOOL TAX 08/24/12 to 07/Ot/13 1,274.45 408. SCHOOL TAX � 08/24/12 to 07/Ot/13 1,274.45
109. 409.
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Bortower 136,572.76 42D. Gross Amount Dua to Seller 128,439.13
200. Amounb Pald b or in BehaM of Borrower 500. Reduetlons In Amount Due Seller:
201. De osit or eamest mone 501. Excess de osit see instructions
202. Princi al amount of new loan s 124,503.00 502. Settlement char es to Seller Line 1400 2,g40.92
203. Existin loan s taken sub'ect to 503. Existin loan s taken sub'ect to
z�4. 504. PayoH Firet Mortgage to WELLS FARGO HOME MORT 95,933.71
205. 505. Pa oH Second Mort a e
206 506.
207. 507.
208. 508.
209. Seilers Assistance 6,800.00 509. Seller's Assistance 6,800.00
Ad ustments for Items un id Seller Ad uatmeMs for Items un Id b Seller
210. COUNN/BOROTAX to 510. COUNTY/BOROTAX to
211. CITYTAX to 511. CIIYTAX �o
212. SCHOOL TAX to 512. SCHOOL TAX to
273. 3rd Qtr SEWER e 07/O7/12 to 08/24112 5�.89 5�3. 3rd�tr SEWER e 07101/12 to OB/24112 51.gg
214, 514.
215. 515,
216. 516.
Z��� 517. INHERITANCE TAX ESCROW to PURITY ABSTRACT 3,000.00
218 518.
219. 519.
220. Total Paid ifor Bortower 131,354.89 520. Total ReductlortAmount Due Seller �08,726.52
300. Cash at Settlement fromtto Borrower B00. Caah at seriiemeot toHrom Sellar
307. Gross amount due from Borrowei line 120 136,572.76 601. Gross amount due to Seller line 420 128,439.13
302. Less amount paid b /for Borrower(Iine 220) ( 131,354.89) 602. Less reductions due Seller(line 520) ( 108.726.52
303. Cash X� From � To Borrower 5,217.87 803. Cash X❑To � Prom Seller � 19,712.61
The undersigned hereby acknowl dge receipt ot a completed copy o(this statement&any attachments referred to herein
Borrower . Seller The E te of i ael Frey
Tyler . eseta
BY� � Kc�h� �av>>�
ichard .Fr ,Executor
The PubOC ftepoNng BuMen Ior Vila Colletllon ot iniortnaYOn is esUmaleO aI3S minules per rasponse br cdlectlip,reviewing,entl repoNng Ihe tlata.TNS agency«may not cUlec!t�ia informauon,antl you are nol maWrea lo
.. .. . . . ... •. ... '' . �: ' ' ' ^��^^^..:a. e narliec In a qFGPA fnvqM(11la1158C�i0f1 W1��I'11110R118�1O11
REV-1503 EX+(6-98) �
SCNEDIlLE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
� � c�h��� � ��.�Y �11 I - Dg I �
All property jointly-owned with right ot survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
non -�
TOTAL(Also enter on line 2, Recapitulation� $
(fl more space is needed,insert additional sheets of ihe same size)
RE�-,SO4 EX'�,-9�, : SCMEDULE C
CLOSELY-HELD CORPORATION,
COMMONWEA�TH OF PENNSYLVANIA PARTNERSHIP OR
INHERITANCE TAX RETURN
ResioervT oeeeoeNr SOLE-PROPRIETORSHIP
ESTATE OF �/ C+ �e � T �� FILE NUMBER
� J y � �11 - 0�1�
Schedule C-1 or G2(including all supporting information)must be attached for each closely-held corporationlpartnership interest of the decedent,other than a
sole-proprietorship.See insimctions for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1,
TOTAL(Also enter on line 3, Recapitulation) $
(It more space is needed,insert additional sheets of the same size)
REV-1 W7 EX+(1-97)
SCNEDULE D
COMMONWEALTH OF PENNSVLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIYABLE
pESIDENT DECEDENT
ESTATE OF � ;� / � �re� FILE NUMBER O // / � / �
! �
All prope�ty jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VA W E AT DATE
NUMBER DESCRIPTION OF DEATH
1
h O�'1 -�
TOTAL(Also enter on line 4, Recapitulation) $
(If more space is needed,insen additional sheets of the same size)
4EV-!508 EX+(i:-1o)
�' pennsylvania SCMEpULE E
°E"`R'"E"T oF RE°E"�E CASH, BANK DEPOSITS & MISC.
`""ER`T""`E'"X"ET�"" PERSONAL PROPERTY
FE9�ENT DECEDENT
ESTATE OF: 1_ T FILE NUMBER: p
� � �-I'CA2� U . �(2.� e� l � � `DOl
Include tha proceeds oi litigation and the date the proceeds were received by the estate. �
All property jolntly owned with Nght of wrv�vorship must be disclosed on Schedule f.
ITEM
NUMBER VALUE AT pATE
DESCRIPTION OF DEATH
C(�
�a n� 4. c co� n�- �- `7 (� �a.
S`�"�e me,� afI`ac�.�� `� �
�Sc� v"1 nc�.s c�LC.D�n� � 3 8 g q . � 3
+ � oo • o �
�oc� I b' �f � . O b
��cp1o� � �- 3 �b , a �
T�t�uc.. l� � ( 5� _
I 3� I 8 . � �2
TOTAL(Also enter on Line 5, Recapitulation) �
If more space is needed, use addi[ional sheets of paper of the same size.
SL Send Inquires to: � �
L s000 Louise orive Statement of Accounts
PO Box 40
Mec�anicaburg,Pqr197p55 May 25, 2011 th�u Jun 24, 2011
www.memberstst.o
Main SwitchboaM: (800)283-2328
EZ Call: p77)697-4372 or(800)283-4372 32928
TDD: (717)697-5312 or(800)2834328 ext.5312
� TeleBranch: (800)237�7288 �
MEMBERS ls� Balances at a Glance: —
FEDERALCREDITUNION Checking: 7 �2 �
8673 1 AV 0.340 30742-86J3 Savings: 3,889. 13
� I„�III�„III���I���III„����II�I�I����III��1���1�111���1��1�1 Certificates: p. _
—��— MICHAE�J FREY
920 16TH ST Mone g ��
� NEW CUMBERLAND PA 17070 y Mana ement: p.pp
� Swipe 5 YTD Reward: 4.05
� Page: 1 of 3
�
Your current Member Loyatty Rewards level is Gold.
Your aggregate balance as of June 1st is $10,649.62.
An aggregate balance of$35,000 and having 3 products
will move you to the Platinum level.
You can now personalize your debit card with your favorite picturet
See the enclosed insert for more details.
CHECKING ACCOUNTS
0017 -CHECKING
Date Transaction Descripdon Addifqns SubtracLons Balance
May 25 Bala� FawaM
May 25 Withdrawal Debit Card CHECK CARD 552.63
05/24 4445077001630 CVS PHARMACY #1630 Qp3 CAMP 5�61 ��'�Z
May 26 Withdrawal Debit Card CHECK CARD 42.79- 504.23
OS/25 159992000pgp54p SUNOCO 07360779pp IEMOYNE
May 27 Withdrawal Debit Card CHECK CARD �� �_ � �
TRANSACTION DATE - 05/26/2011
�5�25 06176380125WE11 WEIS MARKETS #125 S CAMP H
May 27 Deposit Members 1st Online Transfer From Share 000 6,000.00 6,486.90 '
May 27 Deposit Transfer From Share 0000 678 81 � �� ��
May 28 Withdrawal Debit Card CHECK CARD 3.76- 7,161.95
05/27 172269ppp167955 GIANT 6269 CAMP HILL PA
May 28 Wfti�drawel Dntit Card CHECK CARD � 67 � �� �
OS/28 Oqg2pqqpqggg WM SUPERCENTER ETTERS PA
May 31 Check 004931 7racer 000109961g � � � ��� �
May 31 Check 004925 Tracer 0001107752 234.15- 6,867.29
May 31 Deposit Swipe 5 Rebate 0.90 6,868.19
Jun 04 Withdrawal Debit Card CHECK CARD 30.00- 6,836.19
06/02 0617638p125WE11 WEIS MARKETS #125 S CAMP H
Jun 07 Withdrawal ACH LTCP FLTCIP 35.48- 6,802.73
TYPE: INS Prem ID: 7273728941 CO: LTCP FLTCIP
Jun 10 Withdrewal Debit Card CHECK CARD 53.77- 6,748.96
TRANSACTION DATE - O6/O9/2p11
06�08 1599920000805�W SUNOCO 0736077900 LEMOYNE
Jun 10 Deposit Transfer From Share 0000 806.24 7,555.20
Jun 13 Check 004932 Tracer 00p115254$ � � � � �
Jun 15 Withdrawal ACH Harrisburg YMCA � � � 2� �
TYPE: GYMACCOUNT ID: 1231665437
DA7A: ACCOUNT PAYMENT CO: Harrisburg YMCA
Jun 16 Withdrawal Debit Card CHECK CARD 3� 94_ � Z�� �
06�15 �59992000080540 SUNOCO 07360T79pp LEMOYNE
Jun 16 Check 004g33 Trecer ODpt23642g 25 � � 792 �
Jun 17 Withdrawal Debit Card CHECK CARD � �_ 7 �� ��
--- Continued on following page ___
REV-i509 EX+(oi-to)
�pennsylvania SCNEpYLE F
DEFAPTMENT OGPFVENUE
,N„ER„AN�ETAxR�r�RN 70INTLY-OWNED PROPERTY
RES[OENT OECEDENT
ESTATEOF. `�,I �����I �r� fILENUMBER:
� �.
y a ► � � -os , y
If an assM became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING]OINT TENANT(5)NAME(S) ADDRESS RELAIIONSHIP 70 DECEDEN7
A.
B.
�.
�o ��
]OINTLY OWNED PROPERTY:
LEfTER �ATE DESCRIVTION OF PROPERTV %OF �qTE OF DEnTH
ITEM FOR]OiNT MADE INCLUDE NAME Oi fINANCIAL INSTRUTION ANO BANK ACCOUNT NUMBER OR SIMIIAR DHTE OF�EATH �ECEDEMS VALUE OF
NUMBER TENAM )OINT IDENTlFY7NG NUMBER.PRACH 9EE�FOR]O7NTY HEID AFAL E5fA7E VAW E OF FSSEf INTE0.EST DKEDENT'S INTE0.EST
1. A.
TOTAL (Also enter on Line 6, Recapitulation) ;
I(more space is needed,use additional sbeets of paper of the same size.
. _ . . . . _. . . . . _ .. . . _ . . - -
REV-1510 E%+ (08-09)
�pennsylvania SCHEDULE G
oePaarMENroFAevENUE INTER-VIVOS TRANSFERS AND
rNnearrANCernxaeTUaN MISC. NON-PROBATE PROPERTY
RESIDEN7�KEDENT
ESTATE OF � � �' ��� FILE NUMBER
� , �-1�0.� y � l l l •U g/ �
This schedule must be mmpleted and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PR07ERTY
mcwoE rhe xamE aFtHe TanxsFEaEE,TME�a nEUnoNSH�p ro oecEOeNrnrvo DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUM8E0. rHeonreoFmoxsFEa. anncHacovrorrHeo�oraaa�aiesrnre. VALUEOFASSET INTEREST ��Facauue�� VALUE
1.
� � ��
TOTAL(Also enter on Line 7, Recapitulation) $
If more space is neetled, use additional sheets of paper of the same size.
_ .
REV4511 EX+ (10-09)
�pennsylvania SCHEDULE H
oeaaarmer+roFaevervuE FUNERAL EXPENSES AND
r""E"'T""cET"xRE"'R" ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTpTEOf �„^ i ���� � ���� FILENU�ER� oar�
� r � C� ! ' �
DecedenPS debts must be reported on Schedule I.
ISEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. �--�6A,�� �
433a . � �
l�'1'� s c e�p so o � d c�
e. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)_ _ _
Street Address
City__ ._._..__ _._.. _ ._. _ ._ State_ --ZIP- --
Year�s)Commission Paid: .
z. pttorney Fees: � O � O • U U
3. Family Exemption: (If decedent's address is not the same as daimanYS,attach explanation.)
Claimant
Street Address
City _—. _ _ —_ .—._—. .--..._—. — —State—_ __ZIP __
Relationship of Claimant to Decetlent . _
4. Probate Fees: � � 3 . O �
5. Acmuntant Fees: I � � � � 3
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $5/ �� . O O
If more space is needed, use additional sheets of paper of the same size.
_
The Pat.riot-News Co. �
202Q Tec;hnology Pkwy �he atriot~��w,s
' Suite 300 �
Mechanicsburg, PA 17050 � Now you know
Inquiries - 717-255-8213
aRiTr
236 HILLSIDE DRIVE
NEW CUMBERLAND PA 17070
I N VO I C E ALL CHARGES ARE NET
A_�T# NAME AD ORDER# DATE DIT ON ADDT INFO TYPE OF CHAR E A
--�? MOUNT
104628 BRITT 0002170038 09/27/11 REGULAR BASIC AD CHARGE
704628 BRITT $6�.91
0002170038 09/28/11 REGULAR BASIC AD CHARGE $61.91
704628 BRITT 0002770038 70/05/11 REGULAR BASICADCHARGE
$61.91
AFFIDAVIT CHARGE $5.00
TOTAL: $190.73
REMITTANCE ADDRESS
The Patriot-News Co.
23794 Nelwork PL
Chicago, IL 60673-1237
Please include the Account# or Ad Order # (above) with your remittance--Thank You
NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 7/25/2011
Cumberland County - Register Of Wills Receipt Time : 10 :39 :40
One Courthouse Square Receipt No . : 1066421
Carlisle, PA 17613
FREY MICHAEL JOHN
Eetate File No. : 2011-00819 �--
Paid By Remarks : RICHARD FREY
DB
----- -' --- - - -—--------- Receipt Distribution -- — ---- -----—______ _ __
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 90 . 00 CUMBERLAND CpUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 40 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Cash 173 . 50
Tptal Received. . . . . . . . . �173 . 50
��, , I ,,//
���� A Family Tradition Of Caring�'
_ �.�'"''�,
PARTHEMORE Funeral Home & Cremation Services, Inc.
Mr.Balry L.Frey
509 State Street 9/5/2011
West Fairview,PA 17025
For the Service of Michael J.Frey
l 303 Brid�e Sh-ect We sineerely appruiate the confidenee you have plaeed in us and will continue to assist you in every way
�'���� �"� '�s 1 we can. Please frel free to contact us ifyou have any questions in regard to this statement. The following �
i�eu� Cwnberland. PA 17070 is mi itemized statemant oFthe services,facilities,sutomotive equipmrnt and merchaedise khat you selected
�7��� 7�d_77Z� when maldng the funesal arrangements.
(Fax)7�45546 Tertns DueDate Account#
�r�cw�.parthcmorc.corn Net30 8/4/2�11 20ll0433
Description Amount
SERVICES&MERCHANDISE
Visibtion/Viewing 435.00 ��
Memorial Service 575.00 j
(iifbert N'. P¢�nhemore. DirectCremation 2,250.00 j
Poimdca' On Freedom's Wings Stationecy Set 165.00 �
Marble Um,Wetching Over Us 389.00 �
6ilbert J. Partl�cinore, Total Services and Merchandise
Supervisur 3,814.00
I
�
Stephen K. Panhemore_ CASH ADVANCfi ITEMS
CFSP
� Deeth Notice,Harristnug Patriot 2�5 5� I
Brucz R. Paithemore. 18 Cetti&ed Copies ofDeath CeRificate ]OS.00
Pre-Need Coordin�tor, CPC Clecgy Honoiarium(Refuaed) �pQ j
Cumbedand County Coroner Fee,Cremation Authorizapon 25.00 '
FSowe[s
169.60 I
�Total Cash Advances �
. . .. _.. . . . . .. .... _. . . ..... 518.17 j
i
�
Professional Memberships: �
NFDA • PF�lln
DCFDA • CCPDA
G l',n,,..nl.�
in��e�,i,� s,�,n��,,,.:
ii,<i•,,,�,o-- r„��z,�,,,,
I
Total $4,332.]7
Payments/Credits s-a9a.s�
;
Balance Due , s3,833.60
�-, �,, � `
Y�� +�r ?� `� \�'�� �31�\�� � �,y,Q�
w ���
� r�i �IA.1- l.�"" U
REV-1512 E%+ (12-OS)
'�i�pennsylvania SCHEDULE I
� oeanarnervroFaeveNUe DEBTS OF DECEDENT�
,NHeairnNCe rnx aerunN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF , FIqE i�M�ER �G I
/�`��c�a�1 �J. F-r�� ,,� 0 9
Report debts incuned by the decedent prior to death that remained unpaid at the date of death,including unr¢imbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OFDEA7H
�. I���-I-9�y�. s+�-��,�n� `�� ;4 4 3 . �I S
�-f+��hev,
med��U,. I 4 a S. 4 5
TOTAL(Also enter on Line 10, Recapitulation) ; ��p�� $ � �
[f more space is needed, insert additional sheets of the same size.
Retum Mail Operetions
�' �� e`< , aosox�ae�i Quarterly Mortgage Statement
� Des Manes.IA 50306-3411 StatameM Date 07/O7/11
Loan Numbe� 0258977396
Property Address
920 W'16TH ST
NEW CUMBERLAND PA 17070
� Customer Service e on��ne
yourwellsfargomortgage.co
� �I�i�lllnl'll�'1��'��I���°��h6�uhJuI�L1�l'�P�IIP�n��� � Fax g Telephone
(866)278-1179 (800)222-0238
7AT 1 094/257094/00 7 094 850 01 ACNZ52 936 Correspondenca Hours of OperaHon
MICHAELFREY P08ox10335 Mon-Fn,6AM-tOPM
920 W 16TH ST
Des Moines IA 50306 ��•8 AAA-2 PM C7
NEW CUMBERLAND PA 17070-1518 � PaymeMs
PO 9ox 6423 TTY DeaflHard of Hearins
Carol Stream,IL 60197 (800)g36.gggg
Purchase or Refinan¢e (800)443-3429
Important Messages
Summary This is rrot a Dill,our records indicate your
Payment(Principal and/or Interest, Escrow PaYn���e scheduled to withdraw
� $879'� Unpald Principal Balanca ggg,qq3_45 �����Cally.All tunds efe applied when
Optlonal Product(s) $0.00 sufficient tunds have xcumulated to make a
Current Monthly Payment (��ecfCusfwnerSpmcelorya.�pa Mamountl fuil montltl
._. _
5879.64 innre.t Rero Y PeYment as outlined in your
__--_. .._-___..------------
Overdue Payments �����pam rearto-0ate g3,p�.p6 "�9a9e�� Ii ynu are paying off your loan,
$0.00 racu Pala Yaarto-0at. $83s.s3 P�e con�ect us ffi least five(5)deys priof to
Unpaid Late Charge(s) $0.00 Escrow eaiance 3t,s2oss �'01r neut wimdrawal date.
Other Charges $0.00
TOTAL PAYMENT 5879.64 M/EL�S F,nRGO Now Has B�wK s7oRES
IN YIX1R AREA
Take care of yvur rtaney and your mortgage at
Activity Since Your Last Statement one n�r6y Wells Fargo loca6on.Enjoy
special benefiLS and discounts when yai have
Date Descrlptbn Total Principal Interast Es a mortgege end banking reiationship.Stop by
07f01 Pa menl a beflk stOfe t0 S witli a W CIIS Far
Y $87964 5794.31 E432.8 $25247 �� �
--�--- ---� banker or go to wellsfargo.com fa mae
.__._ --- -----
O6l10 Hazardmsurancepmt - -----��----------
.---. .___ $478.00- DONEGAL MUTUAL INS CO �nformation,
. ._._ _ .__-_�-_.__-.
O6107 Pa ment __.. ._____. ___ _.- .-_.-
Y $879.64 5193.45 $433.72 $252.47
_.. . - .__-_ .____�
_ _ .— ___- .__ _' _
05/02 Payment 587964 � -__..__ _-_.__.__-_-
..__ -..___.
81925e Sa3a5e 825247 ��� � REFINANCENOW-MORTGAGERATES
-- ---
..... _-. . - --- -.. .----"-----�----"-� REMAIN HISTORICALLY LOW
� TAe Home Affordable Refinanca Program
(HARP)has been eztended,so now may be a
good time b see if youYe eligiWe fa a r�nance,
even it you're cmcerne.d about your credit a
property value.The sooner�rou ca11,fhe sooner •
you could t�egin to enjoy program benefits.Call
866-810-2596 a Hsit your local branch.
25]O9qI0�1091hCNA21pP1ETM1CW3 0n6
. . _. . . _. __ __
REVd513 EX+ (O1-10)
,�i 'pennsylvania SCHEDULE 7
T"� BENEFICIARIES
INHERITANCE TqX RETURN
RESIDENT OECEDENT
ESTATE OF: FILE NUMBER:
d� ; c tiG e. 1 �. ���e. � 1 I l -vd' 1 �j
RElATI0N5HIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVWG PROPERTY Du Nat Ust Trustee(s) OP ESTATE
I TAXABLE DISTRIBUTIONS[Inclutle ou[right spousal distributions antl transfers under
Sec 9116(aj (11).j
1.
�' d��
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE�N LINES 15 THROUGH 18 OF REV-1500 COVER SHEEf,p5 APPROPR[ATE.
tI 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 R - ENTER TOTAL NON-TAXABLE DISTR[BUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
[f more space is needed, use additional sheets of paper of the same size.
COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
I, GLENDA FARNER STRASBAUGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 25th day of July, Two Thousand and Eleven,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of M/CHAEL JOHN FREY late of NEW CUMBERLAND BOROUGH
,
lFnst Midtlle,Lastl
in said county, deceased, to RICHARDHFREY
lFirsC Mitltlle,Lasq
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 25th day of July
Two Thousand and Eleven.
File No. 2011- 00819
PA File No. 21- 11- 0819
Da te of Dea th 6/29/201 1
S. S. #
��]dL� c �f7�a-��-
egister t u's
�`.�.np.Caa�f__IIepufy�D �
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSEP. SEAL