HomeMy WebLinkAbout07-19-13 ' 1 15056101�5
J REV-1500EX{oatq(Fp�
PA Department o(qevenue peMSylvania oFFICIAL USE ONLY
Bureau of Indivitlua�Taxes ""'"", ,•,�,"�� Coun(y Code Year File Number
PO BOX 28060� INHERITANCE TAX RETURN � / /� �j�i
Harrisburg,PA i7iz8-o6o� RESIDENT DECEDENT l G�S/
EN7ER pECEDENT INFORMATION BELOW
Social Sewrlly Number Dale ol Dea�h MMODYYYY Dale of Birth MMD�YYYY
12/21/2012 06/22/1920
Decedenl's La51 Name Suflix Decedenl's Firsl Name MI
SHIN�R ELIZABETH F
(If Applicable)Enter$urviving Spouse's InFormation Below
Spouse's Lasl Name Suffix Spouse's Firsl Name MI
Spouse's Social Securily Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.OriB�nal Refurn O Z.Supplemenlal Relurn O 3. Remainder ReWrn(�ale ol Dealh
Pdorlo 12-13-82)
p 4.Limiled Eslate O 4a. FuWre Interesl Compromise(date of O 5. Federal Estale Taz Return Required
tlea�h afler 12-12-82)
O 6.Decedenl Died Teslale O 7„Decedenl Maintainad a Living Tms! _ 8. Tolal Number ol Sale Deposil Boxes
(Allach CopY of Wil1) (Atlach Copy of Tms(.)
O 9.Llligalion Proceeds Received O 10.Spousal Povetly Credif(Date of Dealh O 7L Elaction to Tax under Sec.9113(A)
Befween 12-31-91 and 7-1-95) (Atlach Schedule O)
CORRESPONDENT- THIS SECTION MUS7 BE COMPLETEU.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHD BE DIRECTED 76: � �
Name Daytime TelephonrPl�ber � rn
RONALD L SHINER (717) 728-D47� - � �= � °
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. . _.� .�. r —.� c,
REC+ISTEftOF.WI-ZS�USEO�1Nf Y� ��
s v
t' c� ,y -r, r :�;
First Line of Adtlress :"a :_� ,7 � �' �
c� r_- 4
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1001 S MARKET STREET - �� rv ' i'
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SecondLineofAdtlress .. �� �
:V '�7
City or Posl ONice Slale ZIP Code DATE FILED
MECHANICSBURG PA 17055
CorrespondenYs e•mail address: �
Untler penalliesof perju7��dedare Ihal I haveexamined�his reNm,incWtling accomparrying schetlules antl slalemenls,antl lo Ihe Oesl ol my knowlstlge antl beliel, i �
il is Irue,cor and complale.DeGar - n of preparer oNer�han Ihe personal re0�esenlalive is basetl on all inlormalion ol which preparer has any knowletlge. �
SIGNA7 E/fPERS N51 L OR FIUNG RETURN DA7E �7 '�
Y/ /' ' �,�L � / ��7— �3 I I
ADDRES$ �
1001 S MARKET STREET MECHANICSBURG PA 17055 I �
SIGHRFtlfi6.C1EeREPHRER OTHEFj�1Ml�q REPR ENTATIVE DATE , '
�F j��T�f 07/01/2013 '
n�ORESS
430 N ENOLA DRIVE EN PA 17025
PLEASE USE ORlGINAL FORM OriLY �
Side 1 �
L 15�5610105 1505610105 � ! ;
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J 150561�205
REV-1500 EX(FI)
Decedenfs Social Security Number
DecaesnYs Name:
RECAPITULATION
7. Real Eslale(Scheduie Aj. ........ .. ...... ... ............. .... ... .... . 1.
2. S(ocks and Bonds(Schedule B) ... . ........ .... . .......... ............ 2. 11,035.44
. . ... .. .. ...... . .
3. Closely Held Corporafion,Parinership or Sole-Proprielorship(Scbedule C) .... . 3.
4. Morlgages and Noles Receivable(Schedule D). .. ......... .............. . 4.
5. Cash,Bank Deposits end Miscellaneous Parsonal Propetly(Schedule E)....... 5. 11,718.42
6. Jointly Owned Property(Schedule F) O Separate Billing Requesled ...... . 6. 29,910.15
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probale Propetly �- � -
(Schedule G) O Separale Billing Requesled........ 7.
6. Total Gross Assets(IO1al Lines 1 lhrough 7).. .... ........... ............ 8. 52,664.01
9. Funeral Expenses and Administretive Costs(Schedule H)................. .. 9. 7,203.50
10. Deb1s o�Decedent,Motlgage Liabilities and Liens(Schedule I)... ........ .... 10. 367,51
_.. .. ..... ... . . .. . . ... .. ...... _
11. Totai Deductions(total Lines 9 and 10). ........ ......... .............. . 11, 7,591.01
12. Net Value of Estate(Line e minus Line 11) .. ............. ............... 12. 45,073.00
13. Charilable and Governmental 8equests/Sec 9113 Tmsts tor which � � -
an eleclion lo taz has not been made(Schedule J) ............ ... ........ . 13.
.. .. _ ... . . ... . . ... ..
74. Net Value Subject to Tax(Line 12 minus Line 13) . .... ................. .. 14. 45,073.00
TA%CALCULATION-SEE iNSTRUCTIONS FOR APPLICABLE RATES
15. Amoun!of Line 14 taxable
al ihe spousal lax rale,or
transfers under Sec.9116 � � � � �
(a)(12)X A_ 15.
... ._...._..... .. .._ . ... ._........ .. ... ....._. ... .. . . . . ..
16. Amounl of Line 14 laxable , -
atlinealrate X.045 2,026.29 �g. ,
_. ... ..... .... . ... .. . . . . . ... . .... .. _ . . . .
17. Amounl of Line 14 laxable -
al slbling rate X.12 17.
_ . . ... . . . .. .. _. .
18. Amounl of Line 14 laxable
al collateral rate X.15 1 B. . i
19. TAX DUE ................. ........... .. ...... ....... .............. 19. . 2�028.29 �
i
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O !
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Slde 2 ;
� 150561�205 15056102�5 �
I
REV-7500 EX(FI) PeBe 3 � Flle Number
DecedenYs Complete Address:
DECEDENT'S NAA1E
ELIZABETH F SHINER
STREETADDRESS
1 D01 S MARKET STREET
CITY STATE Z�p
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. iax Due(Page 2,Line 19) (1J 2,028.29
2. Credils/Paymenls
A.Prior Paymenls
B.Discounl
Tolal Credils(A+B) (2)
3. Inleresl
4. If Line 2 is greater Ihan Line 1+Line 3,enler fhe diBerence. This is fhe OVERPAYMENL f3)
Ffll In oval on Pape 2,Line 20 to requesf a refund. (q�
5. If Line 1 +Line 3 is grea�er Ihan Line 2,enter lhe difference.This is Ihe TAX DUE. (5) 2,028.29
Make check payable to: REGISTER OF WIL�S, AGENT.
,:. , , � ,
,..,, » :>
. �:,�,�: , , s,__ . . s. , _ _ .� .., . ,. � _
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: � Yes No
a. refain Ihe use or income of Ihe properfy transferred.......................................................................................... ❑ �
b. relain Ihe right to designate who shall use fhe propedy Iransferred or its income ............................................ � �
c. retain a reversionary interesl.............................................................................................................................. ❑ �
d. receive lhe promise tor life of eifher paymenis,benefits or care?...................................................................... ❑ �
2. If death occurred afler Dec.12,1982,did decedenl iransfer propedy wilhin one year of death .
wilhout receiving adequale considera�ion?.............................................................................................................. ❑ �
3. Did decedenl own an"in trust fof'or payable-upon-dealh bank accounl or security af his or her death?.............. ❑ � i
4. Did decedenl own an individual retiremenl accounl,annuity or olher non-probafe propetly,which '
contains a beneficiary designalion? ...........__..........._................._..................................:...................................... ❑ � �
If THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND fILE IT AS PART OF 7HE RETURN,
;.-. , ,
.... _ . � ,..., � .. ... �. .t".' ,..,�::p., . , �. ._. . . .,.. . . . �r:? .. .. . _ I
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For dales of dealh on or afler Jufy 1,1994,and before Jan. 1, 1995,the tax rate imposed on the nef value of transfers lo or for lhe use of ihe survwing spouse !
is 3 percenl(72 P.S.§9116(a)(1.1)(i)J. �
For dates o( death on or afler Jan. 1, 1995, the tax rale imposetl on the ne( value ot (ransfers to or for the use o( �he surviving spouse is 0 percenl
[72 P.S.§9116(a!(1.1)(ii�j.7he sla��(e does not exempt a Uanster to a surviving spouse from fax,and 1he sfatutory requirements for disciosure oi assets and '
filing a tax return are slill applicable even if ihe surviving spouse is fbe only beneficiary. !
Foi dates of deafh on or afler July 1,20D0: �
. The tax rale imposed on lhe ne(value ot Iransfers fmm a deceased child 21 years of age or younger al dealh to or for the use of a natural pareM, an
adopfive parenl or a slepparenl of(he child is 0 percen(�72 P.S.§9116(a)(12)].
. The tax rate imposed on ihe nef value of transfers to or for the ose oi ihe decedenPs lineal beneficiaries is 4.5 percent,except as noled in(72 P.S.§9176(a)(1)). '
. The lax rate imposed on Ihe nel value of Iransfers �o or for fhe use of ihe decedenfs siblings is 12 percent��2 P.S.§8116(a)(1.3)].A sibling is defined, �
under Section 9102,as an individual who has al leasl one parenl in common with Ihe decedenf,whether by blood or adoption.
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RFV-�SO3 E%r(5-ix)
,�i ' pennsy(vania SCHEDULE B
'r�) DEGAqTMFNiDFPEVENUF
INHERITANCETAXR'xTl1AN STOCKS & BONDS
RESIOENiDECEOENT
ESiATE OF FILE NUMBER �
ELIZABETH F SHINER 2013-0526
A!I propertpjointly owned with right of survivorship must be diuAOSed on Scbedule F,
(TEM VALUE AT DATE .
NUMBER DESCRIPTION OF DEATH
1' 262 SHS BP S70CK 11,035.4A
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70TAL(Also enter on Line 2, Recapitulation) $ 11,035.44 , ,�
If more space is needed,insert additional shee[s of the same size . .
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BP p.l.c. np
American Depositary Receipls ��1 jri
♦
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Account Information Dividend Summary Current YTD Totals
Accu�m(Number .7001149851 Gross Divitlend $'141 48 $282.96
Record Date 05l10/13 Gross Dividentl Paid in Cash $141 48 $282.96
Payable Date . 06721/13 Gruss Dividend Reinvested $0.00 $0,00
Rate Per Sbare $�.540�00 Fed.7ax Withheld $0.00 $0.00
Record Dafe Shares 262.000 MRA Tax Withheld $0.0� $0.00
� Net Dividend $141.48 $282.g6
Retein Ior Tax Pufposes
View your stock account online at: www.adr.comishareholder
Some features available online are:
• View your account balance and dividend information
• Change your address
• Sign up or change your bank account information for direct deposit of dividends
How to sign-up to use this site:
You may activate your account for online access at www.adccom/shareholdec Under"I am a Curreni 5hareholder," select the Sign Up
Now link, and enter the tollowing:
1 Authentication IQ' 2 Account Number: 7001149851
3 Select the Authenticate button 4 Follow the prompts to create your sign on information
" If you do not have your Authentication Id, you may select the"I do not have my Authentication ID" box. Your Authentication ID will be
mailed to your address on record.
You will need your Username, Password, and tbe answer to the Secur�ty Question each time you sign onto your account in the future.
Questions? Please call 817�38-5672 or 851-306�383 !
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�Jlfuauce.yal�oo.comlqfhp?s=BP&a=11&b=2]&c-2012&d=] ]&e=21&f=2012&g=d 7/I(2013 �
ftEVa5o8 EX+(afl-1a)
�� pennsylvania SCHEDUdE E
DEPAPTMENiOFqEVENUE CASH, BANK DEPOSITS & MISC.
u+Meniraxcernxneruan PERSONAL PROPERTY
IIESIDENi pFCEDENl
ESTATE OF; FILE NUMBER:
ELIZABETH F SHINER 2013-0526
Include the proreeds of litigation and the date[he proceeds were received�by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
IiEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. HIGHMARK REFUND 546.70
2 CHURCH OF GOD HOME-REFUND 10,804.77
3 �IVIDENDS-BP Zg2.gg
q MISC REFUNDS 83.99
�
TOTAL(Also enter on Line 5, Recapitulation) $ 11,718.42 - ,
If more space is needed, use additional sheets o(paper of[he same size. i,
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REV-i5o9 EX.(oia0)
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V,;�i�;, pennsylvania SCHEDULE F
r�l �EPANTMENi OF qEVEHUE
iNHeairaNCeTaxaerunH JOINTLY-OWNED PROPERTY
RESIDENT DECEOENi
E57A7E OF: FILE NUMBER:
ELIZA6ETH F SHINER 2013-0526
if an asset became jointiy owned witB�in one year of the decedent's date of death, It must be reported on Schedule G.
SUftVIVING JOIN7 TENANi(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENi
A�RONALD L SHINER 1001 SOUTH MARKET STREET STEPSON
MECHANICSBURG, PA 17055
B.
C.
JOIN7LY OWNED PROPERTY:
LerrER DmE �ESCHIPiiON OF PROPERTY a;OF DaTE OF oEarH
REM FOR)OIN7 MpDE INCW�E NAME�F FfNANCIAI INSTITUf10N AND BhNK AQOVNi NUMBEft OR SIMIIAk DAiE OF DEAiH OECEDENT'S VAW E OF
NUMBEA iENANf JOIM IOEMIflING NUMBER.ATTACN OEED FO0.101NiLY HELD 0.EAL ESiATE VMUE OF ASSEf INTE0.EST DECE�EM'S INTERESf
i' A' 12l31l98 M8T BANK�CHECKING ACCOUNT#77926814 6,285.19 50 3,142.5D
2 A 12/31109 CITIZENSBANK-CHECKWGACCOUNT�l610058-62A-3 , 28,909.00 50 14,454.50
3 A 12/31/09 MBTBANK-SAVINGSACCOUNi#XXX2739 24,626.3� 50 12,313.15
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T07AL (Also enter on Line 6, Recapitulation) $ z9,9�0.15 � .
If more space is�eeded,use additional sheets of paper o(the same size.
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- ':ACROUN7 NO : ACCAUNT TYPE ���� ` STATEMEN7 �ERIOD�:: �:�ra6E
7792881p POMER CNELKING � �� APR.06 MAY.06�2013 ��1 OF 1
DD 0 04319M NM 017
�y 000003778 FID51548001705067305 02 000000 � 13046
�y� ELI2ABETH F SHINER
' . s OR RONpLD L SHINER
1001 SOUTH MARKET S7
SUITE C
MECHANICSBURG PA 17055
INTERfST EARNEO FOR STATEMENT PERIDD 0.05 HICH STREEi-CARLISLE
INiEREST PAI� YEAR T� DATE 0.25 .
ACCOUNT SUMMARY
��3;8EG NMING :�' i."DER05T 5;'8 AI�NER � &U RENT ::;�}J ING �
>iBALANCE �; -�>iDIHER ADbfTI0M5 ' CHECKS �PAEU �SUB7ftACTIDNS . IN7ERES7 PD 's$ALANC� �:
ND. AMOUNT N0. AMOUNT ��NO. AMOUNT
6�ON4�41 0 D.DD 0 0.00 0 0.00 0.05 6,044.46
ACCOUNT ACTIVITY
PpSiIMG EPASL7b,INTERFS.3 4HEE%5 & AT11Eft::: DATLY
DATE TRtd1SACTiUN 11ESCRTPTSUN� & DTNE{! ADD�T?SUNS SUBTBACfi20W5 �-: . BI:I:ANCE
04-Ob-13 BEGINNING BALANCE 6b�044.41
05-06-13 INTEREST PAYMENT 0.05 6�044.46
END2NG BALANCE 86,�44.46.
�Ios�, r.���,��s=1�` �l3
ANNUAL PERCENiAGE YIELD EARNE� = 0.00 '!.
�O y�( , <-1 �
MHETMER YOU ARE LODKING FOR A GREAT RATE� RENARDS� SUPERiOR BENEFITS DR A
CONBINATION OF ALL, NBT HAS THE CARD FDR YOU. -VISIT ANY H87 BRANCH� CALL OUR
7ELEPNONE BANK2NG CENTER AT 1-877-794-2373 OA VZSIT MTB.COM TDDAY FDR DETAILS. �
SUBJECI TO CREDIT APPROVAL. � � .
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' �� �������� ���� CircleGold
Account Statement
1-80D-773-7373 Q � 3
Gell Gltizens'speciel,detlicat¢tl 6oltl Cusmmm service line any[ime
Ior eccauni inlurmation,current retes,antl ernwers ro your quesbons. Beglnning DeCembel 71,2012
through January 09,2013
Checking
sumMaar ELIZABETH F SHINER
Balance Calcula[iun 8alance RONALD L SHINER
Circle Gold Cbeckiog w/Interest
PreviousBalance 29,122J5 AverageDallyBalance 79,541.55 610D58-624-3
Checks 28,00�.00 - �nterest
Withdrawals 713.75 -
Deposits&Additions 141.q8 + Current Interes[Rate .02%
InterestPaid .32 + AnnualPercentage YieldEarned .OZ%
Curren[Balance 550.89 = Numbe�ofDayslnterestEarrted 30
(nteres[Eemed .32 .
interest Paid this Yeer .32
You can waive the montbty maintenance fee of$20.00 by mainfaining a monthly combined balance
of$20,000.
Your monthly combined halance used to qualify this statement period is: $18,593
A Business Rela[ionship waiver is active on your account so monthlymaintenance fees
are not curreMfy 6eing assessed.
Previous 8alence
iRPN5AC110N DEiA1L5 Z9,�ZZ.75
Checks'tnere isabreak inUred:sequence
—�- CheckB pmount Dete Chmekp Amaunt Dace
sn 2s.oao,00 izrsi
� ^ tOtnlCheckS
28,OD0.00
Withdrewals
ATM(Purchases ,
Date pmount Demription
72/31 500.�0 0725 ATM Cash-MI6276 HamptlenlCamp HiII,Camp HiII PA �
Other Withdrawals -
Qe[e pmount Description
12/2l 213.75 HighmarkfdiPaymts121221 26962 7 2 � iotalWithdrawels
� 713.75
Deposits&Additions � ,
Dete Amouni Descrip[ion . �
1Z/28 141.-08 Deposit n To[alDeposlcsaAatlition: '
1
� iai.4s
Interest
Date pmount Description ,
�7/09 .32 Interest iotallnterestPaid � �
n
32 I
n Curtent Balence i
DailyBalanre 550.8� �
Uate 8olence Date BaWnce Oate Batance �
72/21 28,909.00 12/31 550.48 01/09 550.80 � �
12128 29,050.48 � ,
i
uernerue��l rq,dx��:�„t�a�,- , i
� ���5�, ��.
Lhulerscxnding what�s important°
Cariisle Pike Office
If you have any questions, piease
cal} our 7elephone Bankin9 Center
at 1-800-724-2440
Today's Date: Business Date:
12/31/2012 12/31/2012
Time: 01;33 PM
Savings Deposit $24,626,30
****2739
4342/42 55
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�
REV-]S11 E::+ (IV-09)
� SCHEDULE H
' im' �WfP
� � � pennsylvania
oevmm�eHtovnevewue FUNERAL EXPENSES ANp
inHenrtnNCernxnerun++ ADMINISTRA7IVE COSTS
IVESI�ENT OECFAEM
ESTATE OF F1LE NUMBER
ELIZABETH F SHINER 2013-0526
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
n. FUNERAL EXPENSES:
�' EWING BROTHERS FUNER4L HOME 6,150.00
B. ADMINISTRATNE LOSTS:
7, Personai Representative Commissions: �
Name(s)of Versonal RepreSenWGve(s)
Street Address
City .State_ZIP_ .
Year(s)Lommission Paid: _
2. Attomey Fees:
3. Famity Ezemption•.Qf deceden['s address is not the same as claimanPS,a@ach explanationJ
Ctaimant
Street Address
City 5[ate_ZIP �
Relationship of Claiman[to De�edent � �
�
4. Probate Pees: 213.5D '
5. Accountant fees: 650.D0 .
6. Tax Return Preparer Fees: 190.OQ �
7.
1
I I
I
�
TO7AL(Aiso enter on Gne 9, Recapitula[ion) $ 7,2D3.5D ,
If more space is needed,use additional sheets of paper of the same size.
, , RECEIPT FOR PAYMENT
---------------
------------------
GLENDA FARNER STRASBAUGH Receipt Date : 5/06/2013
Cumberland County - Register Of Wi11s Receipt Time : . 11 : 22 : 05
One Courthouse Square Receipt No. : 1074082
Carlisle, PA 17013
SHINER ELIZABETH F
Estate File No. : 2013-00526
Paid By Remarks : RONALD F SHINER
HEA
----- - ------------------ ReceipC Distribution ------ -------------- ----
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 135 . OD CUMBERLAND COUNTY GENERAL FUN
WILL 15 . OD CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M. D
AUTOMATION FEE 5 . �0 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . .00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUI3
------------- ---
Check# 618 , $213 . 50
Total Received. . . . . . . . . $213 . 50
�
❑wmy cruu�e�s rune�ei nunie, um. �yWw.Since1855.com
630 Sou�h Hanover SL;Carlisle, PA 17073 Seymour A. Ewing, Deceasetl
Phone: (717)243-2427 Fax: (717)243-7553 &Mail:atlmin@since1853.com William M. Ewing, Deceased
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
GborFcs mv unly lor Oiosc ncnn' Ilrai ymi evluncd ur Ihei u o�I�iireA II �a mc aqwrctl h�� hnr or M1y u ouneierv pr n cromorop�lu usu any ncros.
�. � . us wdl cxnlnin ihc rcnsons in wriiing M1clnu. II'Y���scicnW�a iimcrul iLm nmY mquuccmhnbnmg,such ns n fnncrnl willi mcwin6.Yo�������y b�rvc iu p:p'Ibi
embnlnnnN� ����dn nnl bavc�o m1�Ibr cnM1+nlnung ymi diA noi npPmvc il you ecNCU:�urrangc�rcn�s suG�as crunntian or imnwelie�e b�m�l N wc chnrgN lor
cnihnlmink��+'will cxpinm wip'Iwlox�.
For Ihe Servlce Ot. Elizabelh P.Shiner pa[e o/Death December 21,2012
Charge to: Roneld L Shiner 1�01 5.Ma�ket SL,SuNe C Mecf�anic5bvrg pq
Name Atltlress Cily Stale
A. CHARGE FOR SERVICES SELECTE�: Other Goth'na
i. PROFESSIONAL SERVICES $ _p_
GravesltleServiceOnly.......... ..... .g 2.]50.00 S .p.
Bal�ing 8 Embalming..................S -0- Cremahon Urn............._......8 .p.
Dressing,Caskeling,Cosmololopy elc.......8 -P (DescriotiaN
SUB-TOTAL OF PROFESSIONAL SERVICES..... ..... qi 5 2750,00
E -0-
2.FAGUTIES/SERVICES/STAFF/EOUIPMENT $ -0-
5 -0-
Basic Use oi Facilily..._...............5 -��
70TAL MERCHANDISE SELECTED ........... e b 2,245,00
�ocumenlPrep/Pe�manenlRecording. ....s____0� �. SPECIALCHARGES
Obituary Prep/Reviaw ._........._ ..E. -0� Porwartling ol remains lo
$ -0-
FaGlily Usage for ViewmBNisita(ion....,...5 -0. (FUnaral Home)
SIeH UsaBe(o�Viewi�gNkilation. ....§ -a Receiving ot remains trom
§ .0.
Fecih�y Usa9e lor Funeral/Memotial........? '0' (Funarel Home)
Immetliate Burial................_.E �0-
StaH Usage for Funeral/Memorial...._...a -�" Direcl Cremelion...................8 -0.
� SlaRfarGrevesitle�lmermanl ..........5 '�' E '�-
EquipmenUExlra SIeHB Time OH..........5 -0' S116�T0TAL OF SPECIAL CNARGES.....,.... C E •D-
Promise Evan1 � D. CASH AOVANCER�.
SUB-TO7ALFAQLITIES/SBRVICES/STAFF/EQUIP61ENT..A2 � 0.00 OpeningGrave....................§ 650.00
CemeteryEquipmenL.............$ -P
' Ceme�ery Lot entl Deed.............a -0-,
3. AUTOMOTIVEEO�IPMENT SenlinelOblWery(EStimete)..........$ 750.00
Vehicle to Vensier remains lo Funeral Petriot Oblluary(Estimate)...........d 250.00
Local...............................S -0. Cerlifiatl Copies ol Death Cetll6wte....5 3�.OD
Hesrse Ws%elCOach Cler Monorarium..... b 75.00
f ) BY ............
Local....... ......... ..... S .D- OrganisiMonora�ium......... S -0.
.. .. .......
Satety LeaelCleigy Cer CanloOSio e.Nonorarium.. S -D�
9 .......,.
Locel ..........................5 '4 Comner'sAUtho�izafionPee. .......a .0.
UlililYCar Fiowars.........................b "�"
Loeal......_........................b -0- AiRere...........................b "�"
FemflY Cai Allar Sarvers......................b A.
Local................................Y -D
OW o�TOwn Transvotlatian Rock Removal Charae § -0-
� -0-
Lotel............................... 5 -0-
a -o
_ a -o
Local................................ E 4
....................................5 -D� � '�'
$ .p. b '0'
5 -p. SU&TOTAL OF ADVANCES..................D� � 155 nb
We char e�ou for our gervipes in obtaining:
SUB-TOTALOFAUTOMOTNEEOUIPMENT...........A3 $ 0.00 (spec!/y�a5 ativance�fems/.
TOTAL OF PROFESSIONAL SERVICES,
FACIUTIES AND AUlOMOTNE SUMMARY OF CHARGES: '
E�UIPMENT........................._.........A 5 Z.�50.0� q prafessional Sarvices,Pacililies antl
B. CHARGES F�R MERCHAN�ISE Equipmenl antl Aulomotive
Ceskel............. ............5 850.00 E9uipmenL...................... g. 2]50.00
(�escriplion) 20G Charcoal NG Caskel B. Merohantlise......................$ 2,245.D0
0. Special Charges..................^ -0�
Ouler Receptacle ......................y 1.395.00
'�����;lashAtivances...................g 1.155D�
(Descrip�ion)a1ooFCCuare'anwnn�ain �� /��
TOTAL OF ALL SELECTIONS .................$ fi 150.00
Ouler burial conlainer................._`� -0- PA�D Ai TIME OF OR PRIOR TO .
(Descri0�ion�qllemale Container �'��— ARRANGEMENiS..... ....... ... $ 0.00
i
. _ . . . . _ . . . . . . . . �
Martin J. Flannery & Associates, LLP Client278
� 430North Enola Drive July 1, 2013
Enola, PA 17025
(717)732-2331
Estate of ELIZABETH F SHINER
C!0 Ronald Shiner
1001 S MARKET STREET SUITE C
MECHANICSBURG, PA 17055
Work: 717-766-1200 Ext. Ron
FEDERALFORMS
Form 1040 2012 U.S. Individual Income Tax Return
Schedule A Itemized Deductions
Form 8879 IRS e-file Signature Authorization
PENNSYLVANIA FORMS
Form PA-40 2012 Pennsylvania lncome Tax Return
Schedule SP Special Tax Forgiveness Credit
Form PA-8879 Pennsylvania e•file Signature Authorization
FEE SUMMARY
Preparation Fee $ 190.00
Amount Due 190.00
�
REW1512 E%+ (1b12) J
� • � pennsylvania SCHEDULE I
oEPnaTMeNTOFaevenue DEBTS OF DECEDENT,
mr+emrnncernxnerunn MORTGAGE LIABILITIES & LIENS
pE510ENT DELFpENT
ESTATE OF F7LE NUM6ER
EUZABETH F SHINER 2013-0526
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
fiEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
i ALERTPHARMACY 104.11
2 ALERT PHARMACY 88.26
3 M;SCEXPENSES i95.14
�
TOTAL(Alsa en[er on Line 10, Recapi[ulation) $ 387.51 ,
1f more space is neeJed,insert additional sheets of[he same size.