HomeMy WebLinkAbout07-25-13 J � 1505610101
REV-1500 Ex(oaao) �,�!1;� OFFICIALUSEONLY
iii
PA Department of Revenue pennsyLvania
BureauoflndividualTaxes E�•���F� `pINHERITANCETAXRETURN �OUnryCode Year fileNumber
PO BOX z8a6oi " `_ j �
Harrisburp,PA 1�iz&o6oi RESIDENT DECEDENT (�I ( �, I� I i' ��� . �
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
�- - - - -- - ------ - --- --� --- --' i - - --- `--------^,
'
� 01l14/2�13 � 07l20l1942 J
___ - - - - ---- - �---- —�- ---
DecedenYS Last Name Suffx Decedent's First Name ` MI
, - --- --- -- ------ —"-.__...__. ._----� i - -- - - ,.�..-----� -----. _.^� �
� Freeman I I � I Joanne i ��
�--- --- - --- ----- -- ------ —I :_ _� -... . L_ ___�-� - .-. ._____. �.J
(If Appliaable) Enter Surviving Spouse's Informatlon Below
Spouse's Last Name Suffix Spouse's First Name MI
-- �-- --' - --- _ .__--- —i [------- � �� --' --.._...,_ .�_. ___ —.f ._—.
iN1A .__.__.. __� __ _�_,. � L_. ..� � -- ----��. _`_.��� ��J
Spouse's Social Security Number
r ----- -- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
�_ ___� ____ �� REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Relurn O 2.Supplemental Retum O 3. Remainder Return(date of death
priorto 12-13-82)
p 4. Limited Estate O 4a.Future Interest Compromise(date o( O 5. Federal Estate Tax Return Required
death aker 12-12-82)
� 6. Decetlent Died Testate O 7. Decedent Maintained a Living Trust 0 8, Total Number of Safe�eposif Boxes
(Atlach Copy of Will) (Attach Copy of TrusQ
O 9. Litigation Proceeds Received O 10. Spousal Poverty Gredit(date of death O 11. Election to tax under Sec.9113(A)
beiween 1231-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL 7AX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
' --°--°-- ----- -.. . .__.. _ .. .._r_. �
_ _.. . - - ----- � ---`- �` ---n '- '--�...�—. ..
I �
;Andrew Shaw ; � (717) 243-7135-, �
�-- - - -- .� _.__.^_. ._.J-- _.___—._.__�._..._ . , . __.� . _ ..__r-� .-=� rn
��
- E,f`�STER OF /ILIS USE�N'Y
s,
G7 " � i� 'O
�r, -%-: C; ' .� C�
First line of address _ � __� �_ __ �` � :� �.: � N? '`�
�S
j 200 S. Spring Garden St � �- vt ;: o =?
'- - __ ----- ----- --- - -�- -. -a -.: -.�
--- ..________.. _- � -
Second line of address � � � �
�7 =
� Swte 11 - -. - .-.� --- -- -- � -- - --_. l J ry; - : �, �y ;s
L- - -----_ ..�� _ __--- -- --- --- ---..
City or Post Office State ZIP Code "� � oATe¢�EO u% o
�--- -- _.- --- - -- . . . ._.�_--- --- - - � '- --�- "'�-- -,u�
' -�� r--'---- I
Carlisle � i PA , j 17013
� ___.. �. __� �. - -' � .._. --- -.. __ .___._'
Correspondent�s e-ma�i address: andrew(a�ashawlaw.com
Under p alties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best ot my knowledge and belief,
it is im ,correct and wmplete.Declaretion of preparer other than ihe personal representative is based on all information of which preparer has any knowletlge.
SIG E OF PERSON RESPON IBLE R FILING RETURN DAT/E/
� � / l0 ��
A DRESS
405 ast Street Carlisle, Pennsylvania 17013
SIGN U E P E ERTHANREPRESENTATIVE DATE
� - /�- 1 .�
AD RESS
200 S. Spring Garden St., Suite 11 Carlisle, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610101 1505610101 J
�
_ _ _
J 1505610105
REV-1500 EX
. DecedenCs Social Security Number
oe�eae�rs Name: Joanne A. Freeman � �
RECAPITUTATION
- -- --� - -- -- -- -----I
1. Real Estate(Schedule A). .. ... .. .. ... .. . .. ... .. .. ... ... ... ... . ... .. .. 1. ! 0.00 1
- --� - -.. ..� .- . ..- -----_ .__ J
2. Stocks and Bonds(Schedule B) .. .. .. ... .. ... .. . .. .. ... ...... .. .. .. ... 2. �_ 0.00 i
3. Closely Held Corporation,Partnership or Sole-Propnetorship(Schedule C) . ... . 3. ( 'T �� � � � y 0.00 �
f"_- _ _.._-_.,.__�r..�..,-z.�..�...�
4. Mort a es and Notes Receivable Schedule D .. .. . . . .. 4. ' 0.00 i
9 9 ( ) .. ... .. . .. ... .. .. . .
�,.�_ _�._--._
..-.._.. - --.._ . . �.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .. . . 5. 58,285.60
6. Jointly Owned Property(Scbedule F) O Separate Billing Requested . .. . .. . 6. � _^�_ _� � �`'�0.00 1
7. Inter-�vos Transfers&Miscellaneous Non-Probate Property -- �i
(Schedule G) O Separate Billing Requested.. ,.. .. . 7. � 365,928.95 �
._-��- -�._.--r-w.-.-..a
8. Total Gross Assets(total Lines 1 through 7).. .. ... ... .. ... . . ... .. ... .. .. 8. ��� � 424,274.55 I
�
9. Funeral Expenses and Administrative Costs(Schedule H).. .. . .. ... .. .. ... .. 9. 5,'�86.67�
- .� i
10. DebGS of Decedent,Mortgage Liabilities,and Liens(Schedule I) .. .. ... .. . . .. . 10. 3,572.52�
-.._ _.____._ ._-_.-�__�.-..-�-_.._
11. ToWI Deductions(total Lines 9 and 10). . ... .. ... ... .. .. ... .. ... ... .. ... 11. i 8,759.791
� . .- - - -.....��- ----°___'�-i
12. Net Value of Estate(Line 8 minus Line 11) . ...... .. ... ... . ... ... .. ... .. . 12. I 415,455.36 i
1 -.._.__ . �. _.-�....---.--. ..----
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - � i
an election to tax has not been made(Schedule J) ...... .. ... .. .. ... .. ... . 13. 0.�00 j
_ __ _ _� � ...- _ �,
14. Net Value Subject to 7ax(Line 12 minus Line 13) ... ... .. . .. ..... .. .. ... . 14. � 415,455.36 i
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
l5. Amount of Line 14 taxable
at the spousal tax rete,or
transters uoder Sec.911fi - `�-'�'----- "- - -" � �"-
(a)(12)X.0 0 { 0.001 15. O.00j
_ . �---'-° -•------°----_ _- _, .. ..__. _,_ _...-�_ - -- -
16. Amount of Line 14 taxable k�� � --
at lineal rate X.0 45 415,455.36 � �s. � 18,695.49!
- - . . --- _ _ . __.._____.-°-.�. --_ _, ___ _ �.-- 1
17. Amount of Line 14 taxable fi "� ��mm- ~ � '
at sibling rate X.12 ' 0.00 I ��. 0.00 �
. _ __ .._--_..�------.-.._.. _�,---' ---- --�--- -.__. T_-.._. .__-.--�. ,i
'I8. Amount of Line 14 taxable � �
at collateral rete X.15 � _ OAO i �g 0.00
-- - ---- - -._ "-- -- .-. __ .__ _. _,
19. TAX DUE ... .. .. .. ... .. ... .. .. . . ..... ..... ... .. .. ... .. . .. ... .. . . .. 19.� _�_ __- 'I8,69rJ.49 �
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND Of AN OVERPAYMENT O
Side 2
� 1505610105 15�5610105 J
_ _ _ - _
REV•1500 EX Page 3 Flle Number
DecedenYs Complete Address:
DECEDENT'S NAME
Joanne A. Freeman
STREEfADDRESS
250 Richland Road
cin STATE zia
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 18,695.49
2. CreditslPaymeMs
A.Prior Payments 0.00
e.Discount 0.00
Total Credits(A+g) (p) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter fhe diBerence. This is ihe OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +line 3 is greater than Line 2,enter lhe difierence.This is the TAX DUE. (5) 18,695.49
Make check payable to: REGISTER OF WILLS, AGENT.
C�—"- — — �.�_--- - - — �: _---�- --��
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a lransfer and: Yes No
a. reWin lhe use or i�rame ot the property iransferted:.......................................................................................... ❑ 0
b. retain Ihe right to designate who shall use the property transferred or its income:............................................ ❑ �
c. retain a reversionary interesl;or.......................................................................................................................... ❑ �
d. receive the promise for life of either payments,benefits or pre4...................................................................... ❑ �
2. If death occurted after Dec. 12,1982,did decedent trsnsfer property within one year of death
without receiving adequate wnsideration?.............................................................................................................. ❑ �
3. Did decedent own an"in Irust fo�'or payable-upon-0eafh bank account or searity at his or her death?.............. ❑ 0
d. Did decedent own an individual retirement account,annuity ar other non-probate property,which
contains a benefidary designation7 ........................................................................................................................ � ❑
IF THE ANSWER TO ANY OF 7HE ABOVE QUESTIONS lS YES,Y�U 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)J.
For dates of deaN 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
p2 P.S,§9116(a)(t.t){ii)].The statute does not exempt a transfer to a surviv�ng spouse from tax, and the statutory requirements for disclosure ot assets and
filing a tax retum are still applicable even'rf the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on fhe net value ot 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 stepparenl of the child is 0 percent(72 P.S.§9116(a)(1.2)].
. The tax rate imposed on the net value of Vansfers to or for the use of the decedenfs lineal benefidaries 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 decedenPs 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 o�e parent in common with ihe decedent,whether by blood or adoption.
� I
00809
L.A�7' WTLL AND T`ESTA.tVd'E.1dtT
I, JOANNE FR�EMAN, of West Pennsboro Township, Cumberland County,
Pennsylvania, being of sound mind, disposing mamory and full legal age, do hereby make,
pubtish and declaze this to be my Last Will and Testament, hereby revoking ali Wills and
Codicils heretofore made by me.
ONE. I direct my Executor or Executtix, as the case may be, to pay all of my
debts, funerai and administrative expenses as soon as convenient af�er my decease. Furthermore,
I direct that all state, inheritance, succession and other death taxes imposed or payable by reason
of my death and interest and penalties theteon with respect to all property composing of my gross
estate for death tax purposes, whether or not such property passes under this Will, shall be paid
by the Executor or Executrix of my estate. Purther, to ttie extent that sufficient assets exist in my�
� ,
estate, any and all inheritance or other estate ta�ces, whether to non-charitable or charitable
beneficiaries, shall be paid by my Executor or Executrix from the residuary o�my estate.
TWO. My Executor or Executrix may, ac his or her discrerion, compromise
claims, borrow money, retain property for such length of time as he or she may deem proper;
lease and sell properfy for such prices, on such terms, at public or private sales, as he or she may
deem proper; and invest estate property and income without restriction to legal investments
unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell
any realty and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or privatc sale or sales and to give good and sufficient deeds and/or bills of sale
therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and
empowered to engage in any busi�iess in which I may be engaged at my death, for such period of
time after my death as seems expedient to said Executor or Executrix.
Original retained by:
SALZMANN �-NGRES,PC
_ _ _ _
THI2�E. I give, devise and bequeath all of my estate of whatever nature and
wherever situate, in equal shares, to my children, SHARI M. KYLE and NANCY J. XENTZER,
per stirpes, which provides thatthe child or children of any deceased beneficiary shall take d�e
share theit parent would have taken if living, provided, however, if any said heir or beneficiary is
under the age of thirty (30) years, then his or her share shall be held IN TRUST, in accordance
with the following terms and conditions of Paragraph Four herein.
FOUR. If any heir or beneficiary is under the age of thirty(30)years at the date of
my death, then his or her share of my estata I give, devise and bequeath to be held IN TRUST by
the hereinafter mentioned Trustee according to the following terms and conditions:
Upon the creation of tlus Trust, the Trustees shall divide this trust principal into�
individual shares in the name of eacb heir or beneficiary in the amount equal to the
amount that said heir or beneficiary inherited hereunder. The Trustee, as well as my
Executor or Executrix, as the case may be, is hereby authorixed to retain, unconverted,
any propertq, real or personal, that I may own at my death and shall be under no duty to
convert it into legal investments. The Trustee shall have the power and authority to sell,
transfer, convey, invest and reinvest and to pay over the net income of the trust property,
to or for the use of my children, or to accumulate it in the sole discretion oFthe Trustee.
The 'frustee is also authorized and empowared to pay over to, or for the use and benefit of
my children such portion of or all of the principal of the trust estate as in the Trustee's
sole discretion seems proper for kheir continued support, maintenance, education, medical
care or general welfare. My primary objective is to ensure the continued support,
maintenance, education and medical care of my heir or beneficiary until they reach tbe
age of thirty (30) years. Notwithstflnding the above purpose of this trust, the Trustee, in
the Trustee's sole discretion, may distribute any portion of the income or principal of the
2
trust estate over to any heir or beneficiary who has attained the age of thirty (30) years
prior to the uItimate distribution hereof as the Trustee deems proper for the health,
maintenance, education or setting up of a child in business or in a profession, or the
purchase of real property or for similar purposes or for any other purpose which would in
the Trustee's sole discretion advance the best interest of said child. The Trustee shall be
under no duty to distribute or use the principal equelly, but may distribute or use principal
unequally in his or her discretion. When said heir or beneficiary reaches the age of
twenty-five (25) years, then one-half(1/2) of whatever rernains of income or principal of
the heir or beneficiary's trust estate shall be distributed to said heir or beneficiary, per�
stir�es. When said heir or beneficiary reaches the age of thirty (30) years, then whatever
remains of income or principal of his or her trust estate shall be distributed to said heir or
beneficiary, per stirpes. In the event that any heir or beneficiary of this Paragraph Five
predeceases me or becomes deceased prior. to the disMbution of this Trust without
leaving surviving issue, then in that event, the deceased individual's share shall be
divided equally, per stirpes, between my surviving heirs and beneficiaries of Paragraph
Four. If, for whatever reason, all of my children of Yhis Paragraph Four predecease me or
become deceased prior to the distribution of this Trust without leaving surviving issue,
then said heir or bene6ciary's share shall be distributed in accordance Paragraph Six
hereof.
FIVE. I hereby nominate and appoint SHARI M. ICYLE and NANCY J.
YENTZER, or the survivor of the two of them, to be the Co-Executors of this my Last Will and
Testament.
,5IX. I hereby nominate and appoint SHAIti M. ICYL� and Nt1NCY J. YENTZER, or
the survivor of the two of them, to serve as Trustees of the irust created in Paragraph Four hereof.
3
SEV�N. No person(s) shall benefit hereunder unless such beneficiary shall survive
me by sixty(60)days.
EIGtIT. No Executor or Trustee acting hereunder shall be required to post bond or
enter sectuity in this or any otherjurisdiction.
NINE . No heneficiary may assign, anticipate or pledge his or her interest in any
income or principal hetd or distributable hereunder, and no beneficiary's creditors may levy,
attach or otherwise reach any such interest.
NINE. If any person or institution entitled to shaze in any distribution under the
terms of this my Last Will and Testament Uecomes an adverse party in any proceeding to contest
the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its
entire interest inherited hereunder and all provisions in favor of such person or institution shall
be declared void and of no effect. The share of such person or insUtution so.forfeited shall be
distributed as part of the residue pursuant to Paragraph Four hereof except fhat if such person or
instifution is entitled to shaze in the said residue, that interest shall be disUibuted proportionately
to ihe other residuary distributees.
IN WIINESS WHEREOF, I have herew�to set my hand and seal this '/ day of
March,2007. .
�t'.rr'�t�r �.'�„r,4...t��_a(Sr�j-)
JD E FRLEMAN
4
Signed, sealed, published and declared by the above-named person as and for.a Last Will
and Testameut, in our presence, who at said person's requast, in said person's presence and in the
presence of each other have hereunto set our narnes as subscribing witnesses.
��..��� �
��
�
//
�
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5
ACKNOWLEDGMENT AND AFFIDAVIT
WE,JOANt�TE FREEIVIAN, JAN1�S D. HiJGI3ES and JENNIFER M. NEGLEY,the
testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly swom, do hereby declare to the undersigned authority that the tastatrix signed and
executed the instrument as her Last Will, and that she had signed willingly, �nd thaf 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 yeazs oP age or older, of sound mind and
under no constraint or undue influence.
��.rarvti+.� � ri9�*.�--�'wv�+.._�a.M.�
JO NE � ��1VIAN
S D.HUGTIES
�
� J NNIF � M.NEGLE
COMMONWEALTfI OF P�NNSYLVANIA .
. SS:
COUNTY OF CUMBERLAND ,
Subscribed, sworn to and acknowledged bcfore me by JOANNE FR�EMAN, the
testatrix herein and subscribed and swor before me by JAMES D. HUGHES and
JENNIFER M. NEGLEY,witnesses,this�day o arch, 200Z.
COMMONWEqL7H OF PENNSYLVAf��p �
nbra--' ,��� tury Pubiic
� �°��wn•r�r�a��
MY Canmi�a�E�q�.C'o4'unzo�o7
MenUe�.Penr�vnr�a Asad�edon
�rldarles
REV-1508 EX+(&98)
SCNEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� St MISC.
INHERITANCE TNC RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTqTE OF FILE NUMBER
Joanne A. Freeman 21-13-0120
Indude the Draceeds af litigatbn and the date Ne proceeds were received by the esUte.
All properry Jointly-wrned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T Bank Account No.709581 4,016.66
2. Orrstown Bank Account No. 106005352 21,243.87
3. Orrstown Bank Investment Account No. 50 00 0836 010 33,025.07
TOTAL(Atso enter on line 5,Recapitulation) S 58,285.60
(If rtrore space is needed,insert additlorql sheets of the same Size)
C . a
��QUNT NQ. AECOUNT TYPE-' STATEM€N7 PERIOp ppgE �!; _;
709581 CLASSIC CHECKING �� NOV.17-DEC.14�2012 I 1 OF 1 ��
I
i
� 00 0 04319H NM 017
r. .�,
000007579 FIOS1549D�t7121a1212 OS 050000 42455
^},� NERBERT E FREEMAN
JOANNE A FREEMAN
C/0 JAMES D HUGHES POA
354 ALEXANDER SPRIN6 RD STE 1
CARLISLE PA 17013-7451
INTEREST EARNED FOR STA7EhiENT PERIOD 0.00 HIGH STREET-CARLISLE �
ACCOUNT SUMMARY
:iB�GZNN2NG-:> I::. QEPOSET5 & ;;�pTNER "LURRENT ENPING.
<-�&ALANCE. ii .�-;�ATNER ,ADDEiZDNS CMESKS P0.ZD �.SUBTRAC7IONS��. INTEREST PD ����: BAt�ANCE
N0. AMOUNT �NO. AMOUNT N0. AMOUNT
2,886.13 1 1,604.40 0 O.OU 1 473.87 0.�6 4�016.66
ACCOUNT ACTIVITY
::PQSTtNG ::�R�EQSxT9;:INT�RRS7 ::>CHECKS �&��07HER �' DAI4Y :;�:
(DATE .TBAYiSACTION DESCRIP7ION &"�OTHER ADDITIONS ::�SUBTRAC7SUNS ���� BALANCE ;i
11-17-12 BEGINNING BALANCE � , 52,886.33
11-21-12 SSA TREAS 310 XXSOC SEC 1�604.40 4,490.53
22-04-12 CARDMEC!EER S.RV CR CD PNT OOOOCOOC60�:64E 473.E7 'c,Clo.66
ENDING BALANCE 54,016.66
SAVE MONEY ON GIFTS AND MORE Ai MAJOR RETAILERS THIS HOLZDAY SEASON WHEN YOU
USE YOUR MBT CHECK CARU AT MTB.COM/SHOPPING.
PLUS, CAPTURE YOUR FAVORITE HOIIDAY I4DMENS AND NEEP IT MITN YOU ON AN M&T CUSTOM
.CARD. VISIT MTB.COM/CUSTOMCARD TO ENHANCE YOUR p8T CHECK CARD NITH THE PILTURE
OR UESIGN OF YOUR CHOICE.
FOR CUSTOMER SERVICE QUESTIONS, PLEASE CALL L-800-724-2440.
LPoB(e(.21
. _. _. _ . _ .. _ _ . . _. . . . _. .
� C)RRS'I'OWNI�ANK
A Tradition ofExcellence
ORRS P O. BOx 25U
c Shippensbure;PA 17257
� Temp�Retum Service Requested Date 12/31/12 paqe 1
Primary Account 106005352
Enclosttres
hlu�uPpi��qli��h�li��ii����i�ii��ql�ih���lu�llhl��u�i
— 001356 0.6500 AV 0.350 TR00005
v Soanne Freeman �
— James D Hughes, POA
� 359 Alexander Sprir.g Road, Suite 1
— Carlisle PA 17015-7951 �
C H E C K 2 N G A C C O U N T S
Account Title Joanne Freeman
James D Hughes, POA
50+ Interest Checking � � Check Safekeeping
Account Number 106005352 Statement Dates 12/03/12 thru 12/31/12
Previous Balance 22, 035. 99 Days In The Statement Period 29
. 2� Deposits/Cxedits 5,706. 40 Avesage Ledger 22, 098 . 68
12 Checks/Debits 6, 499.39 Average Collected 22, 037 . 67
Service Fee .00 Interest Earned � .87
Interest Paid .87 Annual Percentage Yield Eaxned � 0.05�
Cuzrent Balance 21, 293.87 2012 Interest Paid 12. 95
Deposits and Additions
�+ Date Description Amossnt �
0
'�' 12/1'7 DEPOSIT O B TRUST DEPT 5, 500.00
� PPD
� 12/28 Deposit , 206.90
0 12/31 Intezest Deposit .87
..
0
0
r�
r+
o -- CHECK SUMMARY --
• Date Check No Amount Date Check No Amount
0 12/19 1991 35.15 12/31 1953 . 92.18
� 12/19 1996* 92 . 18 12/19 1959 360.00
,"', 12/18 1999* 2, 985. 00 12/13 1955 783.00
°o 0 12/19 1950 636.00 12/26 1956 350.00
o v 12/29 1451 - . 10.00 12/26 1957 250.00
�°ti 12/19 1452 179 . 88 12/27 1960* 831.00
a� * Denotes missing check numbers
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REV-151�EX+(08-69)
�� ; pennsylvania SCHEDULE G
' DEPAPTMENTOFFEVENUE INTER-VIVOS TRANSFERS AND
INHERITqNCETq%REiUpN MISC. NON-PROBATE PROPERTY
RESIDENT DECEUENT
ESTATE OF FILE NUMBER
Joanne A. Freeman 21-13-0120
This schedule must be completed and filed if the answer tu aay of questlons 1 fhrough 4 on page three of the REV-1500 is yes.
�M DESCRIPTION OF PROPER7Y
NUMBER ��OEMEN0.t1E�il1ETqA115iE0.EE,iNflRPE1A110N5Xi4TpDE��EM44D DA'fEOFDEATH 9bOFDECD'S EXCLUSION TAXABLE
TIEORlE0F7NPMFE0..ATTAOIACMYOFiNEDEEOPoRNFAlF5TA7E. VALUEOFASSET INTEREST �ruvun�e VALUE
�• Orrstown Bank Investrnent Account No. 14 00 0834 010 365,928.95 100 0.00 365,926.95
TOTAL(Also enter on Line 7, Recapitulation) ¢ 365,928.95
If more space is needed,use additlonal sheets of paper of the same slze.
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REV-1511 E%+ (]0-69)
�pennsylvania SCHEDULE H
�EGAqTMENTpFREVENUE FUNERAL EXPENSES AND
INHERITANCETA%RETURN ADMINISTRATIVE COSTS
RES�DENTDECFUENT
ESTATE OF FILE NUMBER
Joanne A. Freeman 21-13-0120
Decedent's dehts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUiYT
A• FUNERAL EXPENSES:
1' Ewing Brothers Funeral Home,Inc.
3,408.17
B. ADMINISTRATIVE CO5T5:
1. Personal RepresenWfive Commissions: -
Name(s)of Personal Representative(s)
Street Address
��ty State Z[P
Year(s)Commisslon Pald:
Z• Attomey Fees: 1,200.00
3• Famify Ezemption: (If decedent's address Is not the same as claimant's,attach ezplanatian.)
Claimant
S[reet Addrest
��n' State ZIP
Relationship of Claimant[o Decedent
4• Probate Fees: 453.50
5• Acmuntant Fees: 125.00
6� Tax ketum Preparer Fees:
I.
TOTAL(Also enter on Line 9, Recapituiation) $ 5,186.67
If more space Is needed,use additianal sheets of paper of the same size.
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Cadisle,PA ]7013-
(717)243-2421
January 19, 2013
Nancy J. Yeotzer
2S0 Richand Rd.
Carlisle, PA 17015
The Funeral Service for JoAnne A. Freeman
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we ca��. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SGRVICES,FACILITIES,AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Basic Services of Funeral Directorf$[aff , , , , , $1300.00
2. FACILITIES/SERVICES/STAFF/EQUIPMENT
Basic Use of Facility, , , , , $200.00
Document Prep/Permanent Recording, . , , . , . . $325.00
FacilityUsageforViewing/Visi[ation, , , , . . . $375.00
3. AUTOMOTIVE EQUIPMENT � � �
Vehicle to transfer remains[o Funeral Home, . , , , $295.00
Utility Car . . . . . . . . . . . . . . . . . . . . . . . . . . $135.00
G SPECIAL CHARGES � � � �
Direct Cremation , . , , , $345.00
FUNERAL HOME SERVICE CHARGES . . . . . . . . . . . . $2975.00
SELECTED MERCHANDISE:
Memorial f'olders . , $50.00
THE COST OF OUR SERVICES, EQUIPMENT,AND MERCHANDISE
THAT YOU HAVE SELECTED , , , . . $3025.OQ -
Cash Advances
Sentinel Obituary wlPhoto , , , , $265.17
Certified Copies of Death Certificate , , , , . , $I'8.00
ClergyHonorarium , , , , . . . . . . . $100.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES . . . . . . . . $353.17
Total
Total Cos[ . . . . . . . . . . . . . . . . . . . . . . . . . . $3408.17
SUB-TOTAL $3qpg.�7
INITIAL PAYMBNT/DISCOUNT/CREDITS 0.00
� TOTAL AMOUNT DUE $3408.17 '
The unpaid balance over 30 days is subjected[o a I.50%service charge per mon[h- 18.0000%per annum.
Pat�icict A. Rosendale CPA, LLC
Certified Public Accountant
255 Hickory Rd. • Carlisle PA 17015
Telephone or fax: (7�7) 243-3184
e-mail: rosendale@comcast.net
January 22, 2013
Jennifer Negley
Salzmann, Hughes, P.C.
354 Alexander Spr'ing Rd.
Carlisle PA 17015
Re: Joanne Freeman
For professional services rendered, as follows:
Preparation of unemployment compensation reports for the
Fourth quarter of2013................................................$50.
Terms: Invoices are due upon presentation. A finance charge of]%per month will be assessed on any amount not
paid by[he I S'^day of the month following the billing date,unless prior arrangement have been made. Checks re[urned
for non-sufficient funds or any other reason will be charged a$30 NSF and rebilling fee. � -
. _ . . . . _ . . . _ . . . . _ .. . .. _
Pat�icia A. Rosendale CPA, �LC
Certified Pubiic Accountant
255 Hickory Rd. • Carlisle PA 17075
Telephone or fax. (717) 243-3184
e-mail: rosendale@comcast.net
January 24, 2013
Salzmann Hughes P. C.
354 Alexander Spring Rd.
Suite 1
Cazlisle PA 17015
Re: Joanne Freeman
For professional services rendered, as follows:
Preparation of 2012 Form 1099-MI5C for personal caze workers. . . . . . . . . . . . . . . $75.
REVd512 EX+(12-08)
' ��'pennsylvania SCHEDULE I
�EP^ATME�r�FpE�E��E DEBTS OF DECEDENT,
�NneR�rnNCernxReruaN MORTGAGE IIABILITIES & LIENS
0.ESIDENT DECEDEM
ESTATE OF FILE NUMBER
Joanne A Freeman 21-13-0120
Report debts incurred by the decedent prlor to deatb that remained unpaid at the date of death,including unrelmbursed medical expenses.
ITEM VAWE AT DATE
NUMBER DESCRIPTION �F DEATN
1 Anna Smith 174.Q0
2. Cheryl Shultz 397.00
3. Severance for Cheryl Shultz 1,440.00
4. PA UC Fund 142.54
5. Messiah Lifeways 795.00
6. Orrstown Bank Cardmember Service 415.98
7. Highmark Blue Shield 208.00
TOTAL(Also enter on Line 10, Recapitulation) $ 3,572.52
If more space is needed,insert additional sheets of the same size.
. wE : JJ((��� d f ��'stnv�'� 14,5h.>r °I2 �
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WEEKLY SCHEDULE �Amx+.�ri$3s=3`
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PENNSYLVANIA UNEMPLOYMENT COMPENSATION (PA UC) QUARTERIY TAX FORPAS �
• Form UC-2, Employer's Report for Unemployment Compensation (below)
• Form UC-2A, Employer's Quarterly Report of Wages Paid to Each Employee pennsylVania
iNSrRUCTIONS: ' Form UC-2B, Employer's Report of Employment and Business Changes DEPARTMENTOFlA90R8IN�USTf
This is an Adobe Acrobat fill-in form. To use this form you must have
Adobe Acrobat Reader 6.0. To download Acrobat Reader 6.0, go to
www.adobe.com.
Start by keying in the your Employer's Contribution Rate(the first red box
at the far left of this form).Tab through the form to go to the next required
fieid. The round yellaw question mark symbols are help instructions. To
view these instructions, hold the mouse over the question mark symbol.
For more detailed information, refer fo the UC-2 INS(UC-2/2A/2B
Instructions).
For assistance, contact the nearest
PRINTING INSTRUCTIONS: When the Print dialog box appears, set Field Accounting Service (FAS)office.
Page Scaling as NONE, uncheck AUTO-ROTATE AND CENTER and AIIenWwn 610-821-6559 Mercer �za-ssz-aoo�
uncheck CHOOSE PAPER SOURCE BY PDF PAGE SIZE. .vtoona &ta-sas-ss9i Wilkes-Barre 570301-1527
&istW 216781-3217 Norristown 610.270-7376 OR 3450
PhiladelpMa 215560.�8280R3136
Sign and date your report and mail it with payment to: aittsb�rgn a�2-ses-2aoo
Office of Unemployment Compensation Tax Services Chambersburg �n-zsa-»sz Reading 610-378-4395 OR d511
Labor& Indust Buildin cneste� 610-447-3290 screnton e�o-ssa-asas
n' 9 Geart�eld 8�4-765-0572 Shamokin 570-644-3415
P.O. Box 68568 erie aiaar�-assi
Harrisburg PA 17106-8568 Greensburg 724-858-3944 Uniontown 724-039-7230
Hamsburg 717•214-2991 WashingWn 724-223-4530
JOhnstown 814-533-2377 Williamsport 570-327-3525
Lancaster 717-29376D6 York 717-767-7620
Mafvem 610-647-3799 All Out of State
_ Empbyers Call 866�A03-6�63
PA Form UC-2 Emolo�r's Report for Unemeloyment Compensation. This form is machine-readable. Information MUST be
typewritten or printed in BLACK ink, Do not use dashes or slashes in place of zeros or blanks.
If typed, disregard the vertical bars in the shaded areas,type a consecutive �Zg45678.90
string of characters, left justified, with decimal only. Do not use commas (,)or
dollar signs ($), Font size MUST be a minimum of 10 pt.
tf hand printed, print legible numbers within the data entry boxes provided. DO ( �,�, 3 4 S b Z $ Ql O
NOT close the 4 or cross the �D and�. DO NOT fill in commas or decimal points.
Do not staple anything to this form. Photocopy this report for your records. Do not photocopy this form for use.
C+efa�n belaw and rpturn with yoG�r p�y�enk. To report any changes to your account, complete the reverse side.
. PA Form UG2 REV1-12, Employer's Report for Unemployment Compensation OTR.lYEAR 4 /2� 12 �
Read Instructions—Answer Each Item oUE DATE °
W iSTMONTH 2NDMONTH 3R�MONTH j
INV.� EXAMINED BV: � 3 3 3 =
1.TOYALCOYEREOEMPLOYE£5
IN PAYPERIO�INCL.12YH OF
MO H =
Signature certifies that the information contained �
herein is true and correc[to the best of the signer's POR OEPi.USE m
knowledge. z.cROSS wnces g],a 4 • 9 7 �
3.EMPLOVEECONTftI- 1 • C�
10. SiC-iV HERc..DG (`109�PRI�dT 00oe Sa.oB%) o �
m TITLE OAiE PHONE# I.TnXAaLEWa�Es
; N, FlLED ❑PMERUC-1A ❑INTERNETUG2A ❑MAGNETICMEDIAUG2A CONiR�BOiIaNb 3645 • 97
? 12 FEDERALIOENTIFIGATIONNUM6ER e.EMCLOYERCaNTai-
E EMPLOYEIC9 CONTRIBUTON MTE cHECK ��jE X ITEM d) 13 5 • 9 9
EMPI.OVER'SACCiNO. oicrt
� EMPLOYER'S h'7�' , 7 3 _ 91�2 8_�0 6.io*u corfra�-
� GONTRIBUTION ftATE✓;^___ � �;,E's";ps�E 14 2 • 5 4
_' FREEMAN JOANNE A. ,.��ERESro�E
354 ALEXANDER SPRING RD. sEE��sTRUCnous
CARLISLE PA 17015 e.PeNa�roue
SEEINSTRUCTIONS
l s�°��` 142 • 54
' REMIITANCE �
! (REM58�"/+B) w
73917280000124ppp8�373� MAKECHECKSPAVABLETO: PAUCFUND �
SUBJECiIVITYDATE REGORTDELIN�UENTDATE
PA Form UC-2A, �mployers Quarterly Report of Wages paid to Each Employee I II�II'(�II I�������I�I�I�I II'I
I 11!
See insWCtions on separete sheet.InformaUon MUST ba typewritlen or printe0 in BLACK ink.Do NOT use commas(,)or dollar signs($).
If yped,tlisregard vertical bars and rype a con5ewtive string of charecte�s.It hand pflntetl,print in CAPS and within the boxes as belaw;
SAMPLE r�—''2 4 6. �0� "�`i SAMPLE �� F�3�4 5 6'y � 0 SANlPLE
Typed: L._�__ _._.a__.�..�.._..__..�. Handwritten: L.._�.,__._._�___��_}___� ^—�. d
Filled-in:
Empioyer name Employer Check Quarter and year Quarter ending date
make corredions on Form UC-28 PA UC account no.
t ) digit C! Y1'1'Y N4C,AiD� lY1'\'Y
�FFEEMAN,�JOANNE A.y_�_~�^�� 79_- 91728�� ^u� �0 j L4/2012 ��� 12/31/2012 W _ _ ���
. a a d te hone number of oreoalgr 2.Total number of 3.Total number of employees listed 4.Plant number
PATRICIA A. ROSENOALE CPA �� pages in this report in ttem 8 on all pages of Forrr�UC-2A (if approved)
f (717) 243-3184 � � �
5.Gross wages,MUST agree with dem 2 on UC-2
and the sum of item 11 on afl pages of Form UG2A 6.Fi1V in this circle if you would fike the
� Department to preprint your employee's � �
8 �84 97 names&SSNs on Form UC-2A�wct
quarter
7. Employee's 8.Employee's name 9.Gross wages paid this qtr 10.Credit
Social Security Number FI MI I.AST Exampie: 123456.00 Weeks
� T� ❑ CLELAN 456,97� �0
�� � L..1 � I . . . _ _ _ _ _ I �
� � � � � �� �
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❑ ❑ �
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�?_,�_____� ❑ ❑ �_�� � �-z_:��► �
Lis?any atlditional employees on contiruation sheets in the required format(se�instructions).
11. Totat gross wages 4or this page: --�r � a�84.9� �
� 12. Tota! number of emptoyees for this gage 2 �
UC-ZA RE1/9-05 13. Page �of 1
�� � M E S S I A H FOrtn PB-01
��•� u
L ewa s��
� � .
A�ULT DAY
QUESTIONS? CALL: 717) 697-4666
100 MT.ALLEN DRIVE, MECHANICSBURf>, PA 17055 RESIDENT# UNIT STMT. DATE
571229 l2l31/2012
RESIDENT S
JIM HUGHES, ATTORNEY-AT-LAW Ms. JOANNE FREEMAN
354 ALEXANDER SPRING ROAD
SUITE 1 TOTAL AMOUNT DUE $795.00
CARLISLE, PA 17015 DATE DUE Ol/30/2013
$
DA7E OESCRIPTION RATE ��y� CHARGES CREDITS BALANCE
. Balance Forward 636.00
]2/18/2012 PAYMENT RECEIVED - TAANK YOU! 636.00 OAO
`,12/31/2012 PVT- LEVEL 1 - CARLISLE . $3.00]5.00 795,00 _ ��5.00
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE
571229 795.00 0.00 0.00 0.00 0.00 $795.00
SIDEN7 NAME Ms.JOANNE FREEMAN F�P��
ise make check payabie to Messiah Lifeways Community Support Services.
% finance charge may be assessed if balance is not paid by the due date. Thank You!
ou have qucstions or concerns about your statement,please address them directiy to Fiscal Services at(717)790-8220. Thank You!
O�sTOw�vBaNx
,�. :,:.
January 2013 Statement Page 1 of 3
�a� Open Date: 12/2112012 Closing Date; 01!18/2013 Account:4037 6600 1151 4205
: n�
Setect Rewards Visa(�Piatinum Card Cardmerrnber Service t' 1-8o0-558-3424
JOANNE A FREEMAN aNK ea ia �
New Bala.nce $415.98� Activity Summary
Minimum:Payment Oue $30.00 arevious saiance + $517.g�
Payment,Due Date 02/17{20'I3 Payments - $517.91ca
Other Credits $�.00
Late Payment Warningi If wedo notrecewe your PurchaSes + $415.98
minimum payment by the date listed above,you may have Balance TYansfers $0.00
to pay up to a$35 q0 tate Fee. Advances $0,00
Other Debits $O.OQ
Reward Pofnts Fees Charged $o.00
Interest Charged $0.00
Earned This Statement 4�6 New Baiance
For details, see your rewards summary. _ $415.98
Past Due $0.00
Minimum Payment Due $30.00
Credit Line $1,500.00
Available Credit $1,084.02
Days in Billing Period 29
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Account Number 4037 6600 7 151 4205 I
Payment Due Oate 2/17/2013 (
24-Hour Cardmember Service: 1-800-5583424 New Balance $475.98
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Amount Enclosed $
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JOANNE A FREEMAN Cardmem6er Service
STE t P.O. Box 790408
354 ALEXANDER SPRING RD St. LOUIS, MO 63179-0408
CARLiSLE PA 17015J451
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P.O.Box 382054 Pittsburgh PA 15251-8054
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izosmn�e PittsburghPA 15222-3�99 Date GroUp
01(O8l13 01998215
Company Code Biliing ID
09 600048367
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� 359 ALEXANDER SPRING ROAD
o SUITE 1
CARLISLE PA 17015
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Coverage Period Account Status
Member ID Beginnin Endin previous Balance 208 . o0
1138906U90010 02/01/13 02l28/13 Payments Received CR (208.00)
Adjustments 0. 00
Product: Freedom Biue PPO prior Balance Due o. o0
Coverage Period Premium 2os ,o0
Total Salance Due 208, o0
Look for important information in this space on future bills. We will provide updates on your benefits,
health tips and other information. If you have any yuestions about your coverage, please contact our
Member Services department. The address and telephone number appear on the reverse side of this
statement.
To ensure proper credit to your account, always include your Biliing ID on your payment.
See reverse side for important information.
--------------------- Detach Here and Retwn Botto[n Portion With Your Payment --------------------
��IGHM�RK.� � Freedom Blue PPO Company Code Date Billing ID
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P.O. Box 382054 payableto:
Pittsburgh PA 15251-8D54 Freedom Blue PPO
Covera e Period Due Before Amount Due Amount Paid
Member ID Beginnin Ending 02t01/13
1138906090010 OZl01113 02l28l13 S 2oe.o0
JOANNE A FREEMAN
� CHECK HERE FOR ADDRESS CHAIVGE - PRINT CORRECTIONS ON REVERSE SIDE
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REV-1513 EX+(01-10J
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OEPAqTMENT OFqEVENUE
�NHeatraNCe rax aETUaN BENEFICIARIES
RESIDENTDECE9ENT
ESTATE�F;
fILE NUMBER:
Joanne A. Freeman
21-13-0120
NUMBER NAME AND ADORESS OF PERSON(5)AECEIVIN6 PRORERTY RELA7IONSHIP TO DECEDEN7 AMOUN7 QR SHARE
Do Not List Trustee(s) OF ESTATE
I TAXABIE D757RIBUTIONS[Indude outright spousal distributions and transfers under
sec,4116(a)(1.2}.j
�• Shari M.Kyle Daughter 50%
2. Nancy J.Yentzer Daughter 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROU6H 18 OF REV-1500 COVER SHEET,.AS APPROPRIATE.
II NON-TAXABLE D[ST0.18UTIONS -
A. SGOUSAL DISTRIBUIIONS UN�ER SECf[ON 9113 FO0.WHICH AN ELECTION TO TAA IS NOT TAKEN:
1.
8. CHARITABLE AND GOVERNMENTAL DISTR18UT10N5:
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1.
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TOTAL OF PART II -ENTER TOTAL NON-TAXpBLE DISTRIBUTIONS ON IINE 13 OF REV-1500 COVEk SHEET. S . .
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